|
Esrd srv 2-3 vsts p mo 2-11
|
$2,683.20 |
$2,683.20 |
$2,683.20 |
$1,023.20
|
|
Esrd srv 4 visits p mo 20+
|
$1,760.20 |
$1,760.20 |
$1,760.20 |
$652.00
|
|
Esrd srv 4 vsts p mo 12-19
|
$4,019.60 |
$4,019.60 |
$4,019.60 |
$1,440.00
|
|
Esrd svc pr day pt 12-19
|
$85.80 |
$85.80 |
$85.80 |
$34.40
|
|
Esrd svc pr day pt <2
|
$91.00 |
$91.00 |
$91.00 |
$40.80
|
|
Esrd svc pr day pt 20+
|
$46.80 |
$46.80 |
$46.80 |
$53.76
|
|
Esrd svc pr day pt 2-11
|
$88.40 |
$88.40 |
$88.40 |
$36.00
|
|
Establish access to artery
|
$785.20 |
$785.20 |
$785.20 |
$1,145.65
|
|
Establish brain cavity shunt
|
$4,018.30 |
$4,018.30 |
$4,018.30 |
$2,464.00
|
|
Establish brain cavity shunt
|
$5,870.80 |
$5,870.80 |
$5,870.80 |
$2,870.05
|
|
Establish brain cavity shunt
|
$3,164.20 |
$3,164.20 |
$3,164.20 |
$1,446.87
|
|
Establish brain cavity shunt
|
$3,471.00 |
$3,471.00 |
$3,471.00 |
$2,316.00
|
|
Establish brain cavity shunt
|
$5,015.40 |
$5,015.40 |
$5,015.40 |
$5,015.40
|
|
Establish brain cavity shunt
|
$3,666.00 |
$3,666.00 |
$3,666.00 |
$2,338.40
|
|
Established Patient Office Visit (level 1)
|
$122.20 |
$122.20 |
$122.20 |
$122.20
|
|
Established Patient Office Visit (level 2)
|
$182.00 |
$182.00 |
$182.00 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$338.00 |
$338.00 |
$338.00 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$499.20 |
$499.20 |
$499.20 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$728.00 |
$728.00 |
$728.00 |
$290.68
|
|
Estim aid bone healg invasiv
|
$676.00 |
$676.00 |
$676.00 |
$2,620.80
|
|
Estradiol total
|
$18.00 |
$18.00 |
$133.90 |
$152.10
|
|
Estradiol valerate 10 mg inj
|
$87.56 |
$87.56 |
$87.56 |
$57.35
|
|
Estrogens total-sendout
|
$43.55 |
$43.55 |
$67.00 |
$97.50
|
|
Etanercept injection
|
$4,772.20 |
$4,772.20 |
$4,772.20 |
$3,172.86
|
|
Ethanolamine oleate 100 mg
|
$618.46 |
$618.46 |
$618.46 |
$824.88
|
|
Ethylene glycol -sendout
|
$15.00 |
$15.00 |
$45.50 |
$86.04
|
|
Etonogestrel implant system
|
$1,989.56 |
$1,989.56 |
$1,989.56 |
$2,081.30
|
|
Etoposide 20 mg/ml intravenous solution
|
$89.37 |
$89.37 |
$531.49 |
$235.20
|
|
Etoposide 50 mg cap
|
$135.02 |
$135.02 |
$135.02 |
$135.02
|
|
Euflexxa inj per dose
|
$421.94 |
$421.94 |
$421.94 |
$510.68
|
|
Euglobulin lysis
|
$70.20 |
$70.20 |
$75.00 |
$63.84
|
|
Evacuate mole of uterus
|
$1,708.20 |
$1,708.20 |
$1,708.20 |
$3,762.53
|
|
Eval aud funcj ea addl 15
|
$85.80 |
$85.80 |
$85.80 |
$69.60
|
|
Eval aud rehab status/first hr 92626
|
$364.00 |
$364.00 |
$364.00 |
$329.59
|
|
Eval/fit voice prosthesis iii, st
|
$1,153.75 |
$1,153.75 |
$1,490.00 |
$359.50
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$412.10 |
$412.10 |
$531.00 |
$213.15
|
|
Evaluation heart device
|
$2,883.40 |
$2,883.40 |
$2,883.40 |
$2,199.00
|
|
Evaluation of speech fluency 92521
|
$582.40 |
$582.40 |
$2,307.00 |
$302.50
|
|
Evaluation psychiatric diagnostic
|
$998.40 |
$998.40 |
$998.40 |
$318.24
|
|
Evasc prlng admn rx agnt 1st
|
$5,525.65 |
$5,525.65 |
$5,525.65 |
$4,031.48
|
|
Evasc prlng admn rx agnt add
|
$5,070.65 |
$5,070.65 |
$5,070.65 |
$2,803.24
|
|
Evasc repair of iliac artery; endograft 34718
|
$25,595.05 |
$25,595.05 |
$25,595.05 |
$6,311.00
|
|
Evasc rpr a-ao ndgft 34701
|
$24,190.40 |
$24,190.40 |
$24,190.40 |
$5,403.50
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$9,360.00 |
$9,360.00 |
$9,360.00 |
$4,577.00
|
|
Evasc rpr a-biiliac ndgft rptr
|
$12,867.40 |
$12,867.40 |
$12,867.40 |
$8,565.60
|
|
Evasc rpr a-iliac ndgft 34717
|
$28,133.30 |
$28,133.30 |
$28,133.30 |
$4,919.00
|
|
Evasc rpr a-unilac ndgft 34703
|
$12,867.40 |
$12,867.40 |
$12,867.40 |
$5,741.00
|
|
Evasc rpr a-unilac ndgft rpt
|
$12,867.40 |
$12,867.40 |
$12,867.40 |
$5,902.40
|
|
Evasc rpr ilio-iliac ndgft
|
$12,868.05 |
$12,868.05 |
$12,868.05 |
$7,060.51
|
|
Evasc rpr ilio-iliac rpt
|
$12,867.40 |
$12,867.40 |
$12,867.40 |
$7,922.00
|
|
Evasc st rpr thrc/aa acrs br
|
$5,225.35 |
$5,225.35 |
$5,225.35 |
$5,225.35
|
|
Evasc st rpr thrc/aa x crsg
|
$18,508.10 |
$18,508.10 |
$18,508.10 |
$11,524.11
|
|
Event monitor
|
$349.05 |
$349.05 |
$349.05 |
$231.00
|
|
Evoked auditory tst complete
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$357.41
|
|
Evoked oa emissions ltd
|
$886.00 |
$886.00 |
$1,012.70 |
$244.00
|
|
Evoked potentials auditory screening automated analysis
|
$512.85 |
$512.85 |
$512.85 |
$261.30
|
|
Evoked potentials upper limbs
|
$1,886.30 |
$1,886.30 |
$1,886.30 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$1,836.90 |
$1,836.90 |
$1,836.90 |
$814.61
|
|
Evok oa screening qual
|
$48.75 |
$48.75 |
$48.75 |
$109.13
|
|
Exam of vagina w/scope 57420
|
$1,136.85 |
$1,136.85 |
$1,136.85 |
$486.03
|
|
Exam pelvic add-on
|
$34.45 |
$34.45 |
$34.45 |
$46.85
|
|
Exam plvc w/anes othr thn lcl
|
$455.00 |
$455.00 |
$455.00 |
$3,816.40
|
|
Ex arm/elbow tum deep < 5 cm
|
$2,119.00 |
$2,119.00 |
$2,119.00 |
$3,386.84
|
|
Ex arm/elbow tum deep 5 cm/>
|
$2,633.80 |
$2,633.80 |
$2,633.80 |
$3,412.80
|
|
Exc abd les sc 3 cm/>
|
$10,696.40 |
$10,696.40 |
$10,696.40 |
$3,994.09
|
|
Exc abdl tum deep < 5 cm
|
$2,163.20 |
$2,163.20 |
$2,163.20 |
$3,786.00
|
|
Exc abdl tum deep 5 cm/>
|
$2,628.60 |
$2,628.60 |
$2,628.60 |
$3,386.84
|
|
Exc arm/elbo les sc >=3cm 24071
|
$10,696.40 |
$10,696.40 |
$10,696.40 |
$4,529.20
|
|
Exc arm/elbo les sc <3cm 24075
|
$6,055.40 |
$6,055.40 |
$6,055.40 |
$2,532.80
|
|
Exc back les sbq <3 cm 21930
|
$6,055.40 |
$6,055.40 |
$6,055.40 |
$2,711.00
|
|
Exc back tum deep 5 cm/>
|
$10,696.40 |
$10,696.40 |
$10,696.40 |
$3,994.09
|
|
Exc bartholins gland/cyst
|
$1,268.80 |
$1,268.80 |
$1,268.80 |
$3,902.88
|
|
Exc benign feenlm 3.1-4.0cm 11444
|
$3,949.40 |
$3,949.40 |
$3,949.40 |
$2,443.20
|
|
Exc benign feenlm >4.0cm 11446
|
$6,976.45 |
$6,976.45 |
$6,976.45 |
$3,386.84
|
|
Exc benign snhfg 3.1-4.0cm 11424
|
$3,949.40 |
$3,949.40 |
$3,949.40 |
$2,306.25
|
|
Exc benign tal 0.5 < cm 11400
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$832.60
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$969.60
|
|
Exc ben+marg excep skin tag feenlm 1.1-2cm 11442
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$1,152.96
|
|
Exc ben+marg excep skin tag feenlm 2.1-3cm 11443
|
$3,949.40 |
$3,949.40 |
$3,949.40 |
$2,069.20
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$1,501.50
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$3,949.40 |
$3,949.40 |
$3,949.40 |
$2,271.01
|
|
Exc ben+marg excep skin tag snhfg >4cm 11426
|
$6,976.45 |
$6,976.45 |
$6,976.45 |
$3,483.00
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$974.35 |
$974.35 |
$974.35 |
$779.35
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$1,314.67
|
|
Exc breast duct fistula 19112
|
$990.60 |
$990.60 |
$990.60 |
$4,238.48
|
|
Exc carotid body tumor without exc art 60600
|
$6,523.40 |
$6,523.40 |
$6,523.40 |
$3,356.80
|
|
Exc chest wall tumor w/ribs 21601
|
$4,622.80 |
$4,622.80 |
$4,622.80 |
$3,386.84
|
|
Exc coccygl pr ulc prim sutr
|
$2,155.40 |
$2,155.40 |
$2,155.40 |
$2,682.40
|
|
Exc/crtg b1 cst/b9 tum rds
|
$1,773.20 |
$1,773.20 |
$1,773.20 |
$2,617.60
|
|
Exc/curtg b1 cst/b9 tum hum
|
$1,970.80 |
$1,970.80 |
$1,970.80 |
$3,839.54
|
|
Exc excessive skin buttock
|
$3,377.40 |
$3,377.40 |
$3,377.40 |
$3,386.84
|
|
Exc excessive skin leg
|
$3,403.40 |
$3,403.40 |
$3,403.40 |
$4,321.60
|
|
Exc excsv skin forearm/hand
|
$2,483.00 |
$2,483.00 |
$2,483.00 |
$3,386.84
|
|
Exc ext ear/partial/simple repair 69110
|
$9,301.50 |
$9,301.50 |
$9,301.50 |
$3,339.00
|
|
Exc face tum deep < 2 cm
|
$1,409.20 |
$1,409.20 |
$1,409.20 |
$2,206.43
|
|
Exc face tum deep 2cm/> 21014
|
$10,696.40 |
$10,696.40 |
$10,696.40 |
$3,421.60
|
|
Exc feenl mal+mrg 0.6-1 11641
|
$1,715.35 |
$1,715.35 |
$1,715.35 |
$999.50
|
|
Exc feenl mal+mrg 2.1-3 11643
|
$3,949.40 |
$3,949.40 |
$3,949.40 |
$2,101.45
|
|
Exc foot/toe tum subq < 1.5 cm 28043
|
$6,055.40 |
$6,055.40 |
$6,055.40 |
$3,484.00
|
|
Exc forearm les sc 3 cm/>
|
$6,055.40 |
$6,055.40 |
$6,055.40 |
$3,628.50
|
