| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $84 | $257 | $493 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $295 | $475 | $748 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $195 | $380 | $780 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $238 | $345 | $660 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $207 | $383 | $552 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $26 | $55 | $80 |
| Tympanostomy tube insertion CPT 69436 • ENT | $144 | $204 | $410 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $687 | $1,244 | $2,256 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $840 | $1,689 | $2,670 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $35 | $58 | $92 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $87 | $212 | $336 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $159 | $281 | $547 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $36 | $86 | $135 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $48 | $130 | $349 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $69 | $153 | $286 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $91 | $267 | $670 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $120 | $333 | $721 |
| Initial treatment first degree burn CPT 16000 • Emergency | $55 | $123 | $205 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $17 | $32 | $46 |
| Emergency department visit low severity CPT 99282 • Emergency | $34 | $56 | $104 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $60 | $121 | $210 |
| Emergency department visit high severity CPT 99284 • Emergency | $96 | $193 | $298 |
| Emergency department visit highest severity CPT 99285 • Emergency | $142 | $269 | $432 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $223 | $401 | $691 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $111 | $164 | $299 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $143 | $211 | $393 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $188 | $370 | $732 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $110 | $433 | $948 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $201 | $628 | $969 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $174 | $666 | $1,479 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $219 | $418 | $687 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $224 | $474 | $778 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $194 | $358 | $559 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $351 | $566 | $795 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $276 | $566 | $879 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $331 | $603 | $897 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $522 | $799 | $1,137 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $150 | $432 | $805 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $253 | $602 | $1,500 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $295 | $575 | $960 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $246 | $429 | $627 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $250 | $415 | $630 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $370 | $465 | $563 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $238 | $490 | $708 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $171 | $525 | $1,425 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $502 | $2,938 | $7,128 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $308 | $526 | $819 |
| Esophageal motility study CPT 91010 • Gastroenterology | $99 | $272 | $558 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $82 | $619 | $1,050 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $123 | $696 | $1,193 |