| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $340 | $424 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $282 | $354 | $442 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $236 | $296 | $374 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $196 | $243 | $313 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $34 | $52 | $69 |
| Tympanostomy tube insertion CPT 69436 • ENT | $127 | $163 | $232 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $687 | $999 | $1,427 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $840 | $1,187 | $1,689 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $36 | $45 | $52 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $87 | $125 | $186 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $166 | $212 | $310 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $36 | $93 | $150 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $71 | $111 | $160 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $69 | $106 | $159 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $91 | $225 | $379 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $120 | $271 | $408 |
| Initial treatment first degree burn CPT 16000 • Emergency | $49 | $70 | $136 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $16 | $27 | $59 |
| Emergency department visit low severity CPT 99282 • Emergency | $37 | $50 | $59 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $67 | $77 | $99 |
| Emergency department visit high severity CPT 99284 • Emergency | $120 | $137 | $169 |
| Emergency department visit highest severity CPT 99285 • Emergency | $180 | $202 | $245 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $219 | $304 | $442 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $96 | $138 | $193 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $142 | $157 | $223 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $155 | $302 | $467 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $184 | $352 | $537 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $201 | $298 | $549 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $174 | $566 | $1,585 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $219 | $390 | $703 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $216 | $319 | $371 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $208 | $304 | $360 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $298 | $358 | $450 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $331 | $459 | $567 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $336 | $496 | $554 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $428 | $574 | $735 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $97 | $305 | $501 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $198 | $352 | $589 |
| Flexible sigmoidoscopy diagnostic CPT 45330 • Gastroenterology | $66 | $66 | $66 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $295 | $397 | $489 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $290 | $437 | $621 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $279 | $432 | $633 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $308 | $466 | $698 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $331 | $463 | $649 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $287 | $563 | $863 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $359 | $1,179 | $3,000 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $307 | $398 | $464 |
| Esophageal motility study CPT 91010 • Gastroenterology | $90 | $166 | $231 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $82 | $414 | $816 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $78 | $263 | $748 |