|
I&d/bursa/foot 28001
|
$699.20 |
$699.20 |
$699.20 |
$1,917.33
|
|
Identify sperm tissue
|
$157.60 |
$157.60 |
$157.60 |
$157.60
|
|
I&d frarm&/wrst deep absc/hematoma
|
$2,910.40 |
$2,910.40 |
$2,910.40 |
$3,839.54
|
|
Idh1 common variants
|
$387.20 |
$387.20 |
$387.20 |
$415.35
|
|
Idh2 common variants
|
$592.00 |
$592.00 |
$592.00 |
$486.00
|
|
I&d intramural/intramuscular/submuc abscess transanal anes
|
$1,077.60 |
$1,077.60 |
$1,077.60 |
$3,245.23
|
|
I&d lacrimal gland
|
$1,435.20 |
$1,435.20 |
$1,435.20 |
$1,435.20
|
|
I&d lacrimal sac
|
$1,619.20 |
$1,619.20 |
$1,619.20 |
$2,760.73
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$1,745.60 |
$1,745.60 |
$1,745.60 |
$3,371.02
|
|
I & d vag hematoma non-ob 57023
|
$789.60 |
$789.60 |
$789.60 |
$3,435.60
|
|
I&d vag hemtma obst/postpart
|
$439.20 |
$439.20 |
$439.20 |
$3,370.52
|
|
Ifnl3 gene
|
$147.20 |
$147.20 |
$147.20 |
$147.20
|
|
Ifosfamide 1 gram intravenous solution
|
$494.70 |
$494.70 |
$494.70 |
$246.95
|
|
Igh gene rearrang dir probe
|
$137.60 |
$137.60 |
$137.60 |
$111.50
|
|
Igh gene rearrange amp meth
|
$444.80 |
$444.80 |
$444.80 |
$464.25
|
|
Igh@ var region somatic mutation analy
|
$660.80 |
$660.80 |
$906.75 |
$660.80
|
|
Igk rearrangeabn clonal pop
|
$345.60 |
$345.60 |
$345.60 |
$399.36
|
|
Ihc/icc per specimen each additional single antibody stain
|
$292.13 |
$292.13 |
$19,153.29 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$236.60 |
$236.60 |
$328.79 |
$331.86
|
|
Ihc/icc per specimen initial single antibody stain
|
$292.13 |
$292.13 |
$18,283.34 |
$278.40
|
|
Iiv3 vacc no prsv 0.25 ml im
|
$23.20 |
$23.20 |
$23.20 |
$29.70
|
|
Ikbkap gene
|
$127.86 |
$127.86 |
$127.86 |
$172.70
|
|
Ileostomy/jejunostomy non-tube 44310
|
$2,568.80 |
$2,568.80 |
$2,568.80 |
$1,976.40
|
|
Iliac bone graft microvasc
|
$6,512.80 |
$6,512.80 |
$6,512.80 |
$6,512.80
|
|
Iliac/fem angio cath insert
|
$1,434.55 |
$1,434.55 |
$2,197.84 |
$1,856.01
|
|
Iliac revasc add-on 37222
|
$9,058.70 |
$9,058.70 |
$9,058.70 |
$6,082.65
|
|
Imbrication/diaphragm/transthor/transabd 39545
|
$2,181.60 |
$2,181.60 |
$2,181.60 |
$1,728.00
|
|
Imetelstat 188 mg intravenous solution
|
$31,931.40 |
$31,931.40 |
$31,931.40 |
$20,373.55
|
|
Img rta detcj/mntr ds staff
|
$32.00 |
$32.00 |
$32.00 |
$70.29
|
|
Img rta detc/mntr ds phy/qhp
|
$71.20 |
$71.20 |
$71.20 |
$51.36
|
|
Img rta detc/mntr ds poc aly
|
$120.00 |
$120.00 |
$120.00 |
$71.25
|
|
Immob elbow child sm
|
$29.02 |
$29.02 |
$29.02 |
$85.39
|
|
Immobilizer lwr extrem nylon 20in reinforc 21-35in
|
$525.01 |
$525.01 |
$525.01 |
$259.20
|
|
Immobilizer shldr cntor adlt
|
$332.80 |
$332.80 |
$43,475.64 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$136.42 |
$136.42 |
$201.96 |
$115.75
|
|
Immobilizer shldr sling med
|
$34.03 |
$34.03 |
$34.03 |
$126.00
|
|
Immt breast prosthesis 19340
|
$4,883.20 |
$4,883.20 |
$4,883.20 |
$4,883.20
|
|
Immune complex assay
|
$61.60 |
$61.60 |
$61.60 |
$101.60
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$141.44 |
$141.44 |
$10,106.10 |
$6,106.32
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$4,576.15 |
$4,576.15 |
$4,576.15 |
$2,900.11
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$157.16 |
$157.16 |
$6,381.00 |
$3,846.15
|
|
Immune globulin ig human im use 90281
|
$92.00 |
$92.00 |
$92.00 |
$92.00
|
|
Immunoassay tumor antigen quantitative ca 125
|
$52.80 |
$52.80 |
$54,110.19 |
$132.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$52.80 |
$52.80 |
$74.10 |
$116.50
|
|
Immunoassay tumor qual
|
$56.80 |
$56.80 |
$56.80 |
$66.50
|
|
Immunodiff gel qual ea antigen/ab
|
$26.00 |
$26.00 |
$48.57 |
$48.57
|
|
Immunodiffusion nes
|
$48.57 |
$48.57 |
$48.57 |
$53.76
|
|
Immunofixation electrophoresis serum
|
$48.57 |
$48.57 |
$176.80 |
$142.50
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$231.40 |
$231.40 |
$292.13 |
$154.05
|
|
Immunofluorescence per specimen initial single antibody stain
|
$231.40 |
$231.40 |
$292.13 |
$234.27
|
|
Immunoglobulin assay
|
$48.57 |
$48.57 |
$48.57 |
$78.00
|
|
Immunotherapy 2/> injections
|
$40.00 |
$40.00 |
$40.00 |
$40.00
|
|
Impedence cardiogram
|
$55.20 |
$55.20 |
$55.20 |
$152.54
|
|
Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster
|
$5,473.00 |
$5,473.00 |
$5,473.00 |
$2,946.00
|
|
Implant 11 volt lithium-ion backup battery for controller pocket
|
$913.25 |
$913.25 |
$913.25 |
$1,754.00
|
|
Implantation iris prosthesis
|
$2,808.00 |
$2,808.00 |
$2,808.00 |
$19,332.98
|
|
Implant cartilage 10mm synthetic
|
$2,636.01 |
$2,636.01 |
$4,241.57 |
$8,332.51
|
|
Implant cochlear device
|
$6,016.00 |
$6,016.00 |
$6,016.00 |
$34,229.98
|
|
Implant cochlear osia osi300
|
$6,237.66 |
$6,237.66 |
$6,237.66 |
$16,195.55
|
|
Implant eye drug system
|
$4,228.80 |
$4,228.80 |
$4,228.80 |
$10,009.03
|
|
Implant hormone pellet(s) 11980
|
$233.60 |
$233.60 |
$233.60 |
$315.75
|
|
Implant nerve end
|
$600.80 |
$600.80 |
$600.80 |
$4,760.00
|
|
Implant neuroelectrodes
|
$1,985.60 |
$1,985.60 |
$57,499.48 |
$18,334.40
|
|
Implant neuroelectrodes
|
$6,842.40 |
$6,842.40 |
$6,842.40 |
$13,628.55
|
|
Implant neuroelectrodes
|
$4,554.40 |
$4,554.40 |
$4,554.40 |
$8,836.80
|
|
Implant neuroelectrodes
|
$3,678.40 |
$3,678.40 |
$3,678.40 |
$7,728.86
|
|
Implant neurostim arrays
|
$2,026.40 |
$2,026.40 |
$2,026.40 |
$23,262.40
|
|
Implant power module patient cable cable 14 volt
|
$2,283.12 |
$2,283.12 |
$2,283.12 |
$3,695.42
|
|
Implant pulse generator remede el
|
$12,314.25 |
$12,314.25 |
$12,314.25 |
$43,752.80
|
|
Implant single ventricular device 33975
|
$3,195.20 |
$3,195.20 |
$3,195.20 |
$5,053.23
|
|
Implant spinal canal cath
|
$2,089.60 |
$2,089.60 |
$2,089.60 |
$7,913.97
|
|
Implant spine infusion pump
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$17,262.84
|
|
Implant spine infusion pump
|
$936.80 |
$936.80 |
$936.80 |
$17,270.40
|
|
Implant ureth bulk agent
|
$1,297.80 |
$1,297.80 |
$2,100.47 |
$2,168.00
|
|
Impl ear abutment ba300 9mm
|
$3,704.37 |
$3,704.37 |
$3,704.37 |
$3,974.88
|
|
Impl eye bio-eye 16mm
|
$1,657.55 |
$1,657.55 |
$1,657.55 |
$3,917.20
|
|
Impl neurostim electr perc
|
$11,955.81 |
$11,955.81 |
$54,798.65 |
$7,672.50
|
|
Implnt bio implnt for soft tiss reinforcement 15777
|
$1,072.00 |
$1,072.00 |
$1,072.00 |
$1,072.00
|
|
Implnt spinl canal catheter 62350
|
$978.40 |
$978.40 |
$978.40 |
$5,095.20
|
|
Impl oi implt skull perq esp
|
$5,209.60 |
$5,209.60 |
$5,209.60 |
$13,525.50
|
|
Impltj ntrstrml crnl rng seg
|
$11,556.80 |
$11,556.80 |
$11,556.80 |
$5,683.61
|
|
Impltj tot rplcmt hrt sys
|
$6,232.00 |
$6,232.00 |
$6,232.00 |
$4,580.80
|
|
Impreg gauze no h20/sal/yard
|
$5.60 |
$5.60 |
$5.60 |
$11.90
|
|
Impres&prep auricular prosth
|
$8,366.40 |
$8,366.40 |
$8,366.40 |
$6,557.24
|
|
Impres&prep def obt prosth
|
$4,369.60 |
$4,369.60 |
$4,369.60 |
$4,558.89
|
|
Impres&prep intrm obt prosth
|
$3,824.80 |
$3,824.80 |
$3,824.80 |
$3,837.72
|
|
Impres&prep mndbl res prosth
|
$4,013.60 |
$4,013.60 |
$4,013.60 |
$6,966.64
|
|
Impres&prep nasal prosth
|
$4,183.20 |
$4,183.20 |
$4,183.20 |
$6,966.64
|
|
Impres&prep oral surg splint
|
$1,751.20 |
$1,751.20 |
$1,751.20 |
$1,751.20
|
|
Impres&prep orbital prosth
|
$11,244.80 |
$11,244.80 |
$11,244.80 |
$7,000.36
|
|
Impres&prep paltl aug prosth
|
$3,716.80 |
$3,716.80 |
$3,716.80 |
$3,837.72
|
|
Impres&prep paltl lft prosth
|
$3,540.00 |
$3,540.00 |
$3,540.00 |
$3,837.72
|
|
Impres&prep sp aid prosth
|
$4,054.40 |
$4,054.40 |
$4,054.40 |
$4,054.40
|
|
Impres&prep surg obt prosth
|
$2,271.20 |
$2,271.20 |
$2,271.20 |
$2,945.12
|
|
In-111 autologous plt stdy dx
|
$1,494.95 |
$1,494.95 |
$1,494.95 |
$6,139.64
|
|
In-111 autol wbc diag per dose
|
$5,805.76 |
$5,805.76 |
$10,776.60 |
$3,493.75
|
|
In-111 capromab pendet
|
$7,024.00 |
$7,024.00 |
$7,024.00 |
$3,141.45
|
|
In-111 ibritumomab tiux dx
|
$7,246.75 |
$7,246.75 |
$7,246.75 |
$4,748.02
|
|
In-111 oxyquinolin per 0.5 mci
|
$10,776.60 |
$10,776.60 |
$10,776.60 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$11,163.95 |
$11,163.95 |
$11,163.95 |
$2,598.17
|
