| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $130 | $265 | $737 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $180 | $379 | $846 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $241 | $414 | $747 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $202 | $395 | $973 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $167 | $338 | $814 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $22 | $51 | $81 |
| Tympanostomy tube insertion CPT 69436 • ENT | $141 | $265 | $607 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $524 | $1,432 | $3,381 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $626 | $1,649 | $3,989 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $30 | $49 | $90 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $92 | $196 | $485 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $163 | $345 | $814 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $41 | $103 | $244 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $47 | $121 | $205 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $41 | $94 | $159 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $93 | $294 | $569 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $146 | $299 | $636 |
| Initial treatment first degree burn CPT 16000 • Emergency | $41 | $87 | $197 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $11 | $32 | $64 |
| Emergency department visit low severity CPT 99282 • Emergency | $31 | $51 | $68 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $57 | $93 | $196 |
| Emergency department visit high severity CPT 99284 • Emergency | $124 | $173 | $334 |
| Emergency department visit highest severity CPT 99285 • Emergency | $179 | $249 | $484 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $215 | $362 | $774 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $96 | $162 | $336 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $124 | $242 | $578 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $118 | $304 | $491 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $132 | $382 | $643 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $169 | $459 | $1,019 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $167 | $934 | $1,931 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $140 | $468 | $842 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $216 | $403 | $854 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $208 | $384 | $825 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $262 | $431 | $700 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $308 | $519 | $1,077 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $336 | $522 | $790 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $399 | $621 | $1,376 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $107 | $304 | $600 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $164 | $421 | $701 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $207 | $438 | $1,069 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $225 | $559 | $1,272 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $158 | $523 | $1,155 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $214 | $479 | $832 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $217 | $529 | $928 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $237 | $740 | $1,965 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $257 | $1,752 | $4,047 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $270 | $442 | $978 |
| Esophageal motility study CPT 91010 • Gastroenterology | $44 | $271 | $848 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $315 | $603 | $1,338 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $49 | $404 | $1,193 |