| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $82 | $192 | $304 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $180 | $399 | $881 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $234 | $431 | $915 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $120 | $344 | $765 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $130 | $290 | $633 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $31 | $58 | $88 |
| Tympanostomy tube insertion CPT 69436 • ENT | $104 | $218 | $518 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $839 | $1,253 | $2,860 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $723 | $1,424 | $2,491 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $32 | $47 | $66 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $88 | $141 | $236 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $97 | $270 | $403 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $26 | $81 | $131 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $33 | $89 | $159 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $44 | $119 | $170 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $126 | $274 | $490 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $126 | $307 | $526 |
| Initial treatment first degree burn CPT 16000 • Emergency | $29 | $81 | $143 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $7 | $25 | $111 |
| Emergency department visit low severity CPT 99282 • Emergency | $23 | $55 | $111 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $58 | $84 | $137 |
| Emergency department visit high severity CPT 99284 • Emergency | $77 | $138 | $260 |
| Emergency department visit highest severity CPT 99285 • Emergency | $160 | $232 | $383 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $217 | $326 | $489 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $79 | $132 | $189 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $145 | $211 | $381 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $81 | $283 | $481 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $91 | $307 | $616 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $169 | $464 | $707 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $99 | $878 | $1,817 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $140 | $536 | $909 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $221 | $286 | $403 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $212 | $283 | $392 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $88 | $359 | $556 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $276 | $448 | $615 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $332 | $453 | $628 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $328 | $554 | $796 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $107 | $292 | $585 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $164 | $442 | $761 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $177 | $361 | $626 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $192 | $520 | $799 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $158 | $446 | $815 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $214 | $497 | $897 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $194 | $481 | $830 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $203 | $598 | $1,001 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $257 | $1,865 | $4,136 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $231 | $367 | $573 |
| Esophageal motility study CPT 91010 • Gastroenterology | $69 | $212 | $412 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $65 | $480 | $843 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $45 | $368 | $750 |