|
ER Visit (level 1, minor)
|
$252.35 |
$252.35 |
$252.35 |
$276.70
|
|
ER Visit (level 2)
|
$505.40 |
$505.40 |
$505.40 |
$487.50
|
|
ER Visit (level 3)
|
$962.15 |
$962.15 |
$962.15 |
$850.50
|
|
ER Visit (level 4)
|
$1,372.00 |
$1,372.00 |
$1,372.00 |
$1,359.15
|
|
ER Visit (level 5, high severity)
|
$1,760.15 |
$1,760.15 |
$1,760.15 |
$2,007.00
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$97.70 |
$97.70 |
$519.00 |
$260.24
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln
|
$155.05 |
$155.05 |
$155.05 |
$671.00
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$156.53 |
$156.53 |
$156.53 |
$540.00
|
|
Esophageal dilat s&i
|
$272.30 |
$272.30 |
$4,944.28 |
$525.00
|
|
Esophageal recording
|
$10,799.87 |
$10,799.87 |
$10,799.87 |
$1,963.00
|
|
Esophageal recording
|
$10,615.86 |
$10,615.86 |
$10,615.86 |
$1,963.00
|
|
Esophagus motility study
|
$2,230.86 |
$2,230.86 |
$2,230.86 |
$1,289.20
|
|
Esoph imped function test
|
$1,209.46 |
$1,209.46 |
$1,209.46 |
$597.03
|
|
Establish access to aorta
|
$244.30 |
$244.30 |
$244.30 |
$1,280.06
|
|
Established Patient Office Visit (level 1)
|
$340.55 |
$340.55 |
$2,394.84 |
$121.00
|
|
Established Patient Office Visit (level 2)
|
$118.65 |
$118.65 |
$2,394.84 |
$138.60
|
|
Established Patient Office Visit (level 3)
|
$148.40 |
$148.40 |
$148.40 |
$187.00
|
|
Established Patient Office Visit (level 4)
|
$168.70 |
$168.70 |
$3,698.35 |
$233.60
|
|
Established Patient Office Visit (level 5)
|
$174.65 |
$174.65 |
$3,698.35 |
$287.10
|
|
Estradiol total
|
$155.40 |
$155.40 |
$155.40 |
$153.00
|
|
Estradiol valerate 10 mg inj
|
$6.04 |
$6.04 |
$6.04 |
$63.50
|
|
Estrogens total-sendout
|
$155.75 |
$155.75 |
$1,947.85 |
$89.25
|
|
Etanercept injection
|
$1,341.52 |
$1,341.52 |
$1,341.52 |
$1,801.20
|
|
Ethanolamine oleate 100 mg
|
$504.89 |
$504.89 |
$2,416.31 |
$1,046.87
|
|
Ethylene glycol -sendout
|
$103.00 |
$445.25 |
$658.08 |
$75.00
|
|
Etoposide 20 mg/ml intravenous solution
|
$533.84 |
$533.84 |
$533.84 |
$213.17
|
|
Etoposide 50 mg cap
|
$24.18 |
$24.18 |
$600.81 |
$196.27
|
|
Eval/fit voice prosthesis iii, st
|
$309.75 |
$309.75 |
$676.37 |
$370.41
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$166.25 |
$166.25 |
$464.00 |
$219.60
|
|
Evaluation heart device
|
$1,897.35 |
$4,825.00 |
$11,246.06 |
$2,368.17
|
|
Evaluation of speech fluency 92521
|
$83.65 |
$83.65 |
$1,164.59 |
$347.75
|
|
Evaluation psychiatric diagnostic
|
$620.00 |
$620.00 |
$620.00 |
$320.00
|
|
Evasc prlng admn rx agnt 1st
|
$3,822.00 |
$3,822.00 |
$40,684.00 |
$4,462.80
|
|
Evasc prlng admn rx agnt add
|
$1,606.50 |
$1,606.50 |
$25,383.00 |
$3,484.88
|
|
Evasc repair of iliac artery; endograft 34718
|
$9,855.30 |
$9,855.30 |
$43,358.00 |
$10,843.20
|
|
Evasc rpr a-ao ndgft 34701
|
$7,939.40 |
$7,939.40 |
$63,658.88 |
$6,020.00
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$10,010.70 |
$10,010.70 |
$10,010.70 |
$4,537.60
|
|
Evasc rpr a-biiliac ndgft rptr
|
$10,138.80 |
$10,138.80 |
$10,138.80 |
$10,294.05
|
|
Evasc rpr a-iliac ndgft 34717
|
$4,631.90 |
$4,631.90 |
$4,631.90 |
$6,925.05
|
|
Evasc rpr a-unilac ndgft 34703
|
$8,446.20 |
$8,446.20 |
$8,446.20 |
$7,465.20
|
|
Evasc rpr a-unilac ndgft rpt
|
$10,010.70 |
$10,010.70 |
$10,010.70 |
$9,282.60
|
|
Evasc rpr ilio-iliac ndgft
|
$5,412.05 |
$5,412.05 |
$57,169.00 |
$8,412.85
|
|
Evasc rpr ilio-iliac rpt
|
$6,331.15 |
$6,331.15 |
$68,604.00 |
$9,122.40
|
|
Evasc st rpr thrc/aa acrs br
|
$7,991.20 |
$7,991.20 |
$7,991.20 |
$5,510.00
|
|
Evasc st rpr thrc/aa x crsg
|
$7,692.30 |
$7,692.30 |
$7,692.30 |
$11,524.11
|
|
Event monitor
|
$74.55 |
$74.55 |
$575.25 |
$242.12
|
|
Evoked oa emissions ltd
|
$416.85 |
$416.85 |
$416.85 |
$273.00
|
|
Evoked potentials auditory screening automated analysis
|
$222.95 |
$222.95 |
$222.95 |
$283.62
|
|
Evoked potentials upper limbs
|
$565.95 |
$565.95 |
$565.95 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$654.50 |
$654.50 |
$654.50 |
$829.44
|
|
Exam of vagina w/scope 57420
|
$224.35 |
$224.35 |
$224.35 |
$535.00
|
|
Exam pelvic add-on
|
$18.00 |
$75.60 |
$75.60 |
$41.60
|
|
Exc benign tal 0.5 < cm 11400
|
$411.25 |
$411.25 |
$411.25 |
$837.48
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$348.25 |
$348.25 |
$348.25 |
$914.34
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$1,967.35 |
$1,967.35 |
$1,967.35 |
$2,112.60
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$337.75 |
$337.75 |
$337.75 |
$818.53
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$588.00 |
$588.00 |
$588.00 |
$1,301.30
|
|
Exchange biliary drg cath
|
$3,525.90 |
$3,525.90 |
$14,560.00 |
$4,176.15
|
|
Exchange drainage catheter
|
$1,974.00 |
$1,974.00 |
$20,434.05 |
$2,256.80
|
|
Exchange nephrostomy cath
|
$4,159.05 |
$4,159.05 |
$4,159.05 |
$3,097.16
|
|
Excise anal ext tag/papilla
|
$981.05 |
$981.05 |
$981.05 |
$1,395.28
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$1,704.15 |
$1,704.15 |
$1,704.15 |
$1,981.25
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$490.70 |
$490.70 |
$490.70 |
$1,064.30
|
|
Excision of anal lesion(s)
|
$2,327.85 |
$2,327.85 |
$2,327.85 |
$3,245.23
|
|
Excl laa open any method 33267
|
$5,957.00 |
$5,957.00 |
$5,957.00 |
$3,391.00
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$324.80 |
$324.80 |
$324.80 |
$932.35
|
|
Exc thrombosed hemorrhoid 46320
|
$1,082.20 |
$1,082.20 |
$1,082.20 |
$2,491.20
|
|
Exercise w/hemodynamic meas
|
$705.25 |
$705.25 |
$8,783.87 |
$971.00
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$7,515.38 |
$7,515.38 |
$7,515.38 |
$3,473.04
|
|
Exploration of chest 39010
|
$5,702.20 |
$5,702.20 |
$5,702.20 |
$1,920.00
|
|
Explore limb vessels 35860
|
$16,962.17 |
$16,962.17 |
$16,962.17 |
$3,965.00
|
|
Explore penetrating wnd/extremity 20103
|
$624.75 |
$624.75 |
$624.75 |
$1,917.33
|
|
Explore wound abdomen 20102
|
$1,014.30 |
$1,014.30 |
$1,014.30 |
$2,837.09
|
|
Explore woundchest 20101
|
$1,014.30 |
$1,014.30 |
$1,014.30 |
$2,179.44
|
|
Explor not followed by surg repair artery; low extrem 35703
|
$7,783.65 |
$7,783.65 |
$7,783.65 |
$2,559.50
|
|
Explor not followed by surg repair artery; up extrem 35702
|
$7,783.65 |
$7,783.65 |
$7,783.65 |
$1,851.20
|
|
Expose art endoprosth iliac 34820
|
$238.35 |
$238.35 |
$238.35 |
$1,820.00
|
|
Expose endoprosth brachial 34834
|
$306.25 |
$306.25 |
$306.25 |
$1,807.40
|
|
External chromosome analysis 20-25 cells
|
$321.30 |
$321.30 |
$1,192.19 |
$389.35
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$37.45 |
$37.45 |
$1,218.00 |
$61.32
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$647.15 |
$647.15 |
$647.15 |
$458.73
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$159.60 |
$159.60 |
$159.60 |
$102.78
|
|
Eye implant band 40
|
$9,738.75 |
$9,738.75 |
$9,738.75 |
$125.00
|
|
F-18 fdg pet diag
|
$479.15 |
$479.15 |
$3,482.00 |
$602.25
|
|
F-18 florbetapir less than or equal to 10 mci
|
$4,073.83 |
$4,073.83 |
$4,073.83 |
$4,960.80
|
|
F-18 fluciclovine per mci
|
$1,042.30 |
$1,042.30 |
$1,042.30 |
$1,307.52
|
|
F-18 sodium fluoride
|
$254.10 |
$254.10 |
$254.10 |
$564.20
|
|
Facial bones <3
|
$112.35 |
$112.35 |
$112.35 |
$248.60
|
|
Factor ix
|
$71.75 |
$71.75 |
$1,815.97 |
$131.30
|
|
Factor ix alprolix recomb
|
$131.30 |
$131.30 |
$131.30 |
$3.59
|
|
Factor ix complex
|
$126.36 |
$126.36 |
$126.36 |
$3.23
|
|
Factor ix non-recombinant
|
$3,690.00 |
$3,690.00 |
$3,690.00 |
$1.41
|
|
Factor ix recombinant nos
|
$2,644.25 |
$2,644.25 |
$2,644.25 |
$3.04
|
|
Factor viii
|
$226.10 |
$226.10 |
$226.10 |
$144.30
|
|
Factor viii recombinant nos
|
$5,557.21 |
$5,557.21 |
$10,989.52 |
$4.68
|
|
Factor viii recomb novoeight
|
$3,643.48 |
$3,643.48 |
$3,643.48 |
$1.38
|
|
Factor xiii anti-hem factor
|
$146.89 |
$146.89 |
$146.89 |
$10.78
|
|
Fallopian tube recnl
|
$2,814.70 |
$2,814.70 |
$2,814.70 |
$3,624.75
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$7,077.64 |
$7,077.64 |
$7,077.64 |
$7,077.64
|
|
Fat/lipids feces qualitative
|
$417.00 |
$417.00 |
$417.00 |
$34.56
|
