|
Esphg dstl 2/3 w/laps moblj 43287
|
$16,380.00 |
$16,380.00 |
$16,380.00 |
$7,128.80
|
|
Esphg thrsc moblj
|
$17,269.20 |
$17,269.20 |
$17,269.20 |
$7,526.40
|
|
Esphg tot w/laps moblj
|
$14,300.00 |
$14,300.00 |
$14,300.00 |
$6,423.20
|
|
Esphg tot w/thrcm
|
$16,120.00 |
$16,120.00 |
$16,120.00 |
$4,863.84
|
|
Esrd home pt serv p mo 12-19
|
$2,548.00 |
$2,548.00 |
$2,548.00 |
$1,016.00
|
|
Esrd home pt serv p mo 20+
|
$1,435.20 |
$1,435.20 |
$1,435.20 |
$540.80
|
|
Esrd home pt serv p mo 2-11
|
$2,665.00 |
$2,665.00 |
$2,665.00 |
$1,064.00
|
|
Esrd home pt serv p mo <2yrs
|
$3,143.40 |
$3,143.40 |
$3,143.40 |
$1,216.80
|
|
Esrd serv 1 visit p mo 20+
|
$928.20 |
$928.20 |
$928.20 |
$409.60
|
|
Esrd serv 1 visit p mo <2yrs
|
$1,540.50 |
$1,540.50 |
$1,540.50 |
$928.80
|
|
Esrd serv 1 vst p mo 12-19
|
$1,609.40 |
$1,609.40 |
$1,609.40 |
$660.80
|
|
Esrd serv 2-3 vsts p mo <2yr
|
$2,463.50 |
$2,463.50 |
$2,463.50 |
$1,284.00
|
|
Esrd serv 4 visits p mo <2yr
|
$6,219.20 |
$6,219.20 |
$6,219.20 |
$2,130.40
|
|
Esrd serv 4 vsts p mo 2-11
|
$5,423.60 |
$5,423.60 |
$5,423.60 |
$1,838.40
|
|
Esrd srv 1 visit p mo 2-11
|
$1,726.40 |
$1,726.40 |
$1,726.40 |
$711.20
|
|
Esrd srv 2-3 vsts p mo 12-19
|
$2,566.20 |
$2,566.20 |
$2,566.20 |
$977.60
|
|
Esrd srv 2-3 vsts p mo 20+
|
$1,435.20 |
$1,435.20 |
$1,435.20 |
$540.80
|
|
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
|
|
Essure 58565
|
$14,760.20 |
$14,760.20 |
$14,760.20 |
$5,841.60
|
|
Establish access to aorta
|
$655.20 |
$655.20 |
$655.20 |
$1,273.00
|
|
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 |
$2,674.30
|
|
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 |
$2,104.22
|
|
Establish brain cavity shunt
|
$3,666.00 |
$3,666.00 |
$3,666.00 |
$2,338.40
|
|
Established Patient Office Visit (level 1)
|
$97.50 |
$97.50 |
$115.05 |
$122.40
|
|
Established Patient Office Visit (level 2)
|
$97.50 |
$97.50 |
$182.00 |
$141.60
|
|
Established Patient Office Visit (level 3)
|
$97.50 |
$97.50 |
$338.00 |
$187.00
|
|
Established Patient Office Visit (level 4)
|
$121.55 |
$121.55 |
$499.20 |
$239.94
|
|
Established Patient Office Visit (level 5)
|
$156.00 |
$156.00 |
$728.00 |
$291.00
|
|
Estim aid bone healg invasiv
|
$676.00 |
$676.00 |
$676.00 |
$2,620.80
|
|
Estradiol total
|
$125.45 |
$125.45 |
$125.45 |
$152.64
|
|
Estradiol valerate 10 mg inj
|
$87.56 |
$87.56 |
$87.56 |
$57.35
|
|
Estrogens total-sendout
|
$97.50 |
$97.50 |
$97.50 |
$97.60
|
|
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
|
|
Ethmoidectomy extranasal total 31205
|
$2,750.80 |
$2,750.80 |
$2,750.80 |
$4,593.60
|
|
Ethylene glycol -sendout
|
$66.95 |
$66.95 |
$66.95 |
$86.00
|
|
Etonogestrel implant system
|
$1,203.57 |
$1,989.56 |
$1,989.56 |
$2,081.30
|
|
Etoposide 20 mg/ml intravenous solution
|
$1.45 |
$531.49 |
$531.49 |
$235.20
|
|
Etoposide 50 mg cap
|
$135.02 |
$135.02 |
$135.02 |
$135.02
|
|
Euflexxa inj per dose
|
$152.43 |
$421.94 |
$421.94 |
$510.68
|
|
Euglobulin lysis
|
$37.70 |
$37.70 |
$37.70 |
$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
|
$406.90 |
$406.90 |
$406.90 |
$316.00
|
|
Eval/fit voice prosthesis iii, st
|
$923.00 |
$923.00 |
$923.00 |
$360.00
|
|
Evaluation cervical mucus
|
$46.80 |
$46.80 |
$46.80 |
$14.32
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$440.05 |
$440.05 |
$440.05 |
$212.46
|
|
Evaluation heart device
|
$2,670.20 |
$2,670.20 |
$2,670.20 |
$2,147.00
|
|
Evaluation of speech fluency 92521
|
$385.45 |
$385.45 |
$582.40 |
$305.50
|
|
Evaluation psychiatric diagnostic
|
$313.30 |
$313.30 |
$998.40 |
$318.24
|
|
Evasc prlng admn rx agnt 1st
|
$4,420.65 |
$4,420.65 |
$4,420.65 |
$4,031.48
|
|
Evasc prlng admn rx agnt add
|
$4,056.65 |
$4,056.65 |
$4,056.65 |
$2,803.24
|
|
Evasc repair of iliac artery; endograft 34718
|
$20,476.30 |
$20,476.30 |
$20,476.30 |
$6,311.00
|
|
Evasc rpr a-ao ndgft 34701
|
$19,352.45 |
$19,352.45 |
$19,352.45 |
$5,403.50
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$4,210.70 |
$4,210.70 |
$9,360.00 |
$4,577.00
|
|
Evasc rpr a-biiliac ndgft rptr
|
$10,294.05 |
$10,294.05 |
$11,700.00 |
$8,535.75
|
|
Evasc rpr a-iliac ndgft 34717
|
$22,506.25 |
$22,506.25 |
$22,506.25 |
$4,919.00
|
|
Evasc rpr a-unilac ndgft 34703
|
$10,294.05 |
$10,294.05 |
$10,294.05 |
$5,689.05
|
|
Evasc rpr a-unilac ndgft rpt
|
$10,294.05 |
$10,294.05 |
$11,700.00 |
$5,902.40
|
|
Evasc rpr ilio-iliac ndgft
|
$10,294.05 |
$10,294.05 |
$10,294.05 |
$6,931.00
|
|
Evasc rpr ilio-iliac rpt
|
$10,294.05 |
$10,294.05 |
$10,294.05 |
$7,480.00
|
|
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
|
$14,806.35 |
$14,806.35 |
$14,806.35 |
$11,524.11
|
|
Event monitor
|
$139.10 |
$139.10 |
$349.05 |
$231.00
|
|
Evoked auditory tst complete
|
$809.90 |
$809.90 |
$967.20 |
$354.40
|
|
Evoked oa emissions ltd
|
$809.90 |
$809.90 |
$910.00 |
$244.00
|
|
Evoked potentials auditory screening automated analysis
|
$410.15 |
$410.15 |
$410.15 |
$261.30
|
|
Evoked potentials upper limbs
|
$1,396.85 |
$1,396.85 |
$1,537.25 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$1,487.85 |
$1,487.85 |
$1,487.85 |
$819.00
|
|
Evok oa screening qual
|
$120.90 |
$120.90 |
$120.90 |
$109.13
|
|
Exam of vagina w/scope 57420
|
$909.35 |
$909.35 |
$909.35 |
$470.00
|
|
Exam pelvic add-on
|
$34.45 |
$34.45 |
$34.45 |
$46.85
|
|
Exam plvc w/anes othr thn lcl
|
$9,506.90 |
$9,506.90 |
$9,506.90 |
$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 1st&/crv rib w/sympth
|
$3,299.40 |
$3,299.40 |
$3,299.40 |
$7,413.38
|
|
Exc abd les sc 3 cm/>
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,986.00
|
|
Exc abdl tum deep < 5 cm
|
$2,163.20 |
$2,163.20 |
$2,163.20 |
$3,696.00
|
|
Exc abdl tum deep 5 cm/>
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,386.84
|
|
Exc arm/elbo les sc >=3cm 24071
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$4,350.00
|
|
Exc arm/elbo les sc <3cm 24075
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$2,532.80
|
|
Exc aurl glomus tum extended
|
$9,352.20 |
$9,352.20 |
$9,352.20 |
$3,202.99
|
|
Exc aurl glomus tum trnscanl
|
$2,899.00 |
$2,899.00 |
$2,899.00 |
$7,000.36
|
|
Exc aurl glomus tum trnsmstd
|
$5,150.60 |
$5,150.60 |
$5,150.60 |
$7,000.36
|
|
Exc back les sbq <3 cm 21930
|
$4,844.45 |
$4,844.45 |
$4,844.45 |
$2,676.58
|
|
Exc back tum deep 5 cm/>
|
$8,557.25 |
$8,557.25 |
$8,557.25 |
$3,994.09
|
|
Exc bartholins gland/cyst
|
$1,268.80 |
$1,268.80 |
$1,268.80 |
$3,790.00
|
|
Exc benign feenlm 3.1-4.0cm 11444
|
$3,159.65 |
$3,159.65 |
$3,159.65 |
$2,315.50
|
|
Exc benign feenlm >4.0cm 11446
|
$5,580.90 |
$5,580.90 |
$5,580.90 |
$3,386.84
|
|
Exc benign snhfg 3.1-4.0cm 11424
|
$3,159.65 |
$3,159.65 |
$3,159.65 |
$2,306.25
|
