| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $106 | $206 | $272 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $186 | $290 | $401 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $282 | $541 | $895 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $236 | $397 | $749 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $130 | $286 | $529 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $21 | $52 | $81 |
| Tympanostomy tube insertion CPT 69436 • ENT | $104 | $235 | $477 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $685 | $1,249 | $2,250 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $644 | $1,043 | $1,488 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $32 | $39 | $53 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $107 | $138 | $172 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $159 | $309 | $598 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $81 | $153 | $264 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $98 | $126 | $159 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $44 | $109 | $159 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $117 | $237 | $371 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $246 | $399 | $642 |
| Initial treatment first degree burn CPT 16000 • Emergency | $65 | $96 | $112 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $17 | $32 | $59 |
| Emergency department visit low severity CPT 99282 • Emergency | $59 | $73 | $98 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $58 | $72 | $99 |
| Emergency department visit high severity CPT 99284 • Emergency | $111 | $157 | $225 |
| Emergency department visit highest severity CPT 99285 • Emergency | $180 | $303 | $479 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $219 | $372 | $661 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $96 | $168 | $294 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $143 | $172 | $214 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $220 | $431 | $799 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $335 | $402 | $547 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $129 | $566 | $1,220 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $1,046 | $1,776 | $3,224 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $436 | $606 | $795 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $216 | $426 | $697 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $194 | $327 | $595 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $298 | $488 | $873 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $293 | $359 | $494 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $336 | $621 | $1,118 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $428 | $781 | $1,400 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $107 | $194 | $298 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $283 | $425 | $596 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $243 | $351 | $530 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $246 | $419 | $630 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $250 | $620 | $1,176 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $208 | $416 | $707 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $198 | $435 | $652 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $412 | $975 | $2,001 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $502 | $2,411 | $4,047 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $307 | $480 | $846 |
| Esophageal motility study CPT 91010 • Gastroenterology | $69 | $156 | $221 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $453 | $742 | $1,467 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $383 | $434 | $554 |