|
Img rta detc/mntr ds phy/qhp
|
$129.36 |
$129.36 |
$129.36 |
$51.36
|
|
Img rta detc/mntr ds poc aly
|
$146.72 |
$146.72 |
$146.72 |
$71.25
|
|
Immob elbow child sm
|
$109.20 |
$109.20 |
$109.20 |
$85.39
|
|
Immobilizer lwr extrem nylon 20in reinforc 21-35in
|
$110.03 |
$110.03 |
$110.03 |
$259.20
|
|
Immobilizer shldr cntor adlt
|
$302.58 |
$302.58 |
$302.58 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$20.66 |
$20.66 |
$266.56 |
$114.60
|
|
Immobilizer shldr sling med
|
$20.25 |
$20.25 |
$126.00 |
$126.00
|
|
Immt breast prosthesis 19340
|
$662.10 |
$662.10 |
$12,857.60 |
$4,883.20
|
|
Immune complex assay
|
$72.80 |
$72.80 |
$72.80 |
$100.80
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$9,155.07 |
$9,155.07 |
$9,155.07 |
$6,106.32
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$3,979.77 |
$3,979.77 |
$3,979.77 |
$2,900.11
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$3,396.74 |
$3,396.74 |
$3,396.74 |
$3,846.15
|
|
Immune globulin ig human im use 90281
|
$17.36 |
$17.36 |
$17.36 |
$92.00
|
|
Immunoassay tumor antigen quantitative ca 125
|
$41.55 |
$41.55 |
$172.48 |
$131.95
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$35.85 |
$35.85 |
$173.60 |
$116.40
|
|
Immunoassay tumor qual
|
$199.36 |
$199.36 |
$199.36 |
$66.50
|
|
Immunodiff gel qual ea antigen/ab
|
$1.21 |
$1.21 |
$21.84 |
$48.38
|
|
Immunodiffusion nes
|
$1.87 |
$1.87 |
$38.08 |
$48.57
|
|
Immunofixation electrophoresis serum
|
$33.15 |
$33.15 |
$117.60 |
$142.50
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$221.76 |
$221.76 |
$222.24 |
$154.05
|
|
Immunofluorescence per specimen initial single antibody stain
|
$81.00 |
$81.00 |
$492.80 |
$231.40
|
|
Immunoglobulin assay
|
$13.34 |
$13.34 |
$33.60 |
$75.88
|
|
Immunology procedure
|
$47.60 |
$47.60 |
$47.60 |
$142.56
|
|
Impact tooth remov part bony
|
$4,099.20 |
$4,099.20 |
$4,099.20 |
$1,840.30
|
|
Impedence cardiogram
|
$244.16 |
$244.16 |
$244.16 |
$152.54
|
|
Imp extar knee shck absrb
|
$32,748.80 |
$32,748.80 |
$32,748.80 |
$24,109.66
|
|
Impl absrb msh/prsth dly cls
|
$750.40 |
$750.40 |
$750.40 |
$750.40
|
|
Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster
|
$2,228.80 |
$2,228.80 |
$2,228.80 |
$3,036.25
|
|
Implant 11 volt lithium-ion backup battery for controller pocket
|
$1,016.40 |
$1,016.40 |
$1,016.40 |
$1,754.00
|
|
Implantation iris prosthesis
|
$29,232.00 |
$29,232.00 |
$29,232.00 |
$19,426.56
|
|
Implant cartilage 10mm synthetic
|
$375.30 |
$375.30 |
$12,313.56 |
$8,184.00
|
|
Implant cochlear device
|
$39,558.40 |
$39,558.40 |
$39,558.40 |
$34,229.98
|
|
Implant cochlear osia osi300
|
$15,645.80 |
$15,645.80 |
$15,645.80 |
$16,200.89
|
|
Implant eye drug system
|
$13,647.20 |
$13,647.20 |
$13,647.20 |
$13,647.20
|
|
Implant hormone pellet(s) 11980
|
$716.80 |
$716.80 |
$716.80 |
$315.75
|
|
Implant nerve end
|
$4,760.00 |
$4,760.00 |
$4,760.00 |
$2,152.40
|
|
Implant neuroelectrodes
|
$18,334.40 |
$18,334.40 |
$18,334.40 |
$18,334.40
|
|
Implant neuroelectrodes
|
$18,855.20 |
$18,855.20 |
$18,855.20 |
$13,628.55
|
|
Implant neuroelectrodes
|
$10,830.40 |
$10,830.40 |
$10,830.40 |
$8,763.11
|
|
Implant neuroelectrodes
|
$10,617.60 |
$10,617.60 |
$10,617.60 |
$7,766.27
|
|
Implant neurostim arrays
|
$23,262.40 |
$23,262.40 |
$23,262.40 |
$23,262.40
|
|
Implant power module patient cable cable 14 volt
|
$0.56 |
$0.56 |
$0.56 |
$3,380.00
|
|
Implant pulse generator remede el
|
$44.80 |
$44.80 |
$44.80 |
$46,034.74
|
|
Implant/replace hearing aid
|
$520.80 |
$520.80 |
$520.80 |
$520.80
|
|
Implant spinal canal cath
|
$14,481.60 |
$14,481.60 |
$14,481.60 |
$8,184.80
|
|
Implant spine infusion pump
|
$18,020.80 |
$18,020.80 |
$18,020.80 |
$17,262.84
|
|
Implant spine infusion pump
|
$17,270.40 |
$17,270.40 |
$17,270.40 |
$17,270.40
|
|
Implant tcat pulm vlv perq
|
$3,404.80 |
$3,404.80 |
$3,404.80 |
$9,812.40
|
|
Implant ureth bulk agent
|
$201.94 |
$201.94 |
$2,548.00 |
$2,168.00
|
|
Impl ear abutment ba300 9mm
|
$3,974.88 |
$3,974.88 |
$3,974.88 |
$3,974.88
|
|
Impl eye bio-eye 16mm
|
$3,917.20 |
$3,917.20 |
$3,917.20 |
$3,917.20
|
|
Impl neurostim electr perc
|
$8,254.40 |
$8,254.40 |
$8,254.40 |
$7,672.50
|
|
Implnt bio implnt for soft tiss reinforcement 15777
|
$117.90 |
$117.90 |
$4,351.20 |
$1,072.00
|
|
Implnt spinl canal catheter 62350
|
$12,045.60 |
$12,045.60 |
$12,045.60 |
$5,095.20
|
|
Impl oi implt sk tc esp<100
|
$27,798.40 |
$27,798.40 |
$27,798.40 |
$22,958.00
|
|
Impl oi implt sk tc esp>=100
|
$27,557.60 |
$27,557.60 |
$27,557.60 |
$15,226.08
|
|
Impl oi implt skull perq esp
|
$18,928.00 |
$18,928.00 |
$18,928.00 |
$13,525.50
|
|
Impltj ntrstrml crnl rng seg
|
$10,264.80 |
$10,264.80 |
$10,264.80 |
$5,683.61
|
|
Impltj tot rplcmt hrt sys
|
$4,580.80 |
$4,580.80 |
$4,580.80 |
$4,580.80
|
|
Implt neurostim elctr each
|
$4,579.99 |
$4,579.99 |
$4,579.99 |
$4,579.99
|
|
Imp neurosti pls gn any type
|
$2,214.80 |
$2,214.80 |
$2,214.80 |
$8,789.19
|
|
Impres&prep auricular prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$6,557.24
|
|
Impres&prep def obt prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$4,881.00
|
|
Impres&prep facial prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$5,028.40
|
|
Impres&prep intrm obt prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$3,986.00
|
|
Impres&prep mndbl res prosth
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$7,000.36
|
|
Impres&prep nasal prosth
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$7,000.36
|
|
Impres&prep oral surg splint
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$1,751.20
|
|
Impres&prep orbital prosth
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$7,000.36
|
|
Impres&prep paltl aug prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$3,837.72
|
|
Impres&prep paltl lft prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$3,837.72
|
|
Impres&prep sp aid prosth
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$4,054.40
|
|
Impres&prep surg obt prosth
|
$4,692.80 |
$4,692.80 |
$4,692.80 |
$2,945.12
|
|
Imuglucerase injection
|
$3,032.67 |
$3,032.67 |
$3,032.67 |
$3,399.59
|
|
In-111 autologous plt stdy dx
|
$7,731.36 |
$7,731.36 |
$7,731.36 |
$6,139.64
|
|
In-111 autol wbc diag per dose
|
$589.95 |
$589.95 |
$8,554.56 |
$3,523.65
|
|
In-111 capromab pendet
|
$1,929.90 |
$1,929.90 |
$2,182.32 |
$3,141.45
|
|
In-111 ibritumomab tiux dx
|
$1,555.20 |
$1,555.20 |
$7,633.36 |
$4,748.02
|
|
In-111 oxyquinolin per 0.5 mci
|
$688.95 |
$688.95 |
$7,380.84 |
$2,581.82
|
|
In-111 pentetate dtpa / 0.5 mci
|
$1,378.80 |
$1,378.80 |
$4,666.65 |
$2,598.17
|
|
In-111 pentetreotide
|
$2,951.40 |
$2,951.40 |
$11,753.28 |
$5,201.00
|
|
In-111 satumomab pend
|
$3,113.04 |
$3,113.04 |
$3,113.04 |
$3,113.04
|
|
Inactivated je vacc im
|
$518.36 |
$518.36 |
$518.36 |
$481.34
|
|
Inc dp bone crtx f/arm&/wrst
|
$7,588.00 |
$7,588.00 |
$7,588.00 |
$6,650.80
|
|
Inc dp opn b1 crtx hum/elbw
|
$308.70 |
$308.70 |
$7,285.60 |
$3,821.05
|
|
Incise diaphragm nerve
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$2,421.48
|
|
Incise/drain eyelid lining
|
$2,671.20 |
$2,671.20 |
$2,671.20 |
$1,271.00
|
|
Incise flexor carpi radialis
|
$5,112.80 |
$5,112.80 |
$5,112.80 |
$3,839.54
|
|
Incise hand/finger tendon
|
$6,137.60 |
$6,137.60 |
$6,137.60 |
$2,007.15
|
|
Incise hip/thigh nerve
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$2,500.80
|
|
Incise hip/thigh nerve
|
$11,922.40 |
$11,922.40 |
$11,922.40 |
$3,086.40
|
|
Incise inner ear
|
$4,457.60 |
$4,457.60 |
$4,457.60 |
$2,186.08
|
|
Incise inner ear nerve
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$5,339.00
|
|
Incise inner eye adhesions
|
$2,951.20 |
$2,951.20 |
$2,951.20 |
$1,202.90
|
|
Incise inner eye adhesions
|
$7,117.60 |
$7,117.60 |
$7,117.60 |
$2,698.92
|
|
Incise inner eye adhesions
|
$9,161.60 |
$9,161.60 |
$9,161.60 |
$2,940.80
|
|
Incise inner eye adhesions
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$2,524.45
|
|
Incise inner eye adhesions
|
$7,229.60 |
$7,229.60 |
$7,229.60 |
$4,760.49
|
|
Incise inner eye strands
|
$7,184.80 |
$7,184.80 |
$7,184.80 |
$3,905.20
|
|
Incise nerve back of head
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$2,685.07
|
