|
Idet 1 or more levels
|
$2,039.05 |
$2,039.05 |
$2,039.05 |
$4,649.60
|
|
Idet single level
|
$3,622.45 |
$3,622.45 |
$3,622.45 |
$3,347.50
|
|
I&d frarm&/wrst deep absc/hematoma
|
$1,401.40 |
$1,401.40 |
$1,401.40 |
$3,839.54
|
|
Idh1 common variants
|
$866.45 |
$866.45 |
$866.45 |
$415.35
|
|
Idh2 common variants
|
$1,326.65 |
$1,326.65 |
$1,326.65 |
$486.00
|
|
I&d intramural/intramuscular/submuc abscess transanal anes
|
$1,526.20 |
$1,526.20 |
$1,526.20 |
$3,245.23
|
|
I&d lacrimal gland
|
$452.40 |
$452.40 |
$452.40 |
$1,435.20
|
|
I&d lacrimal sac
|
$6,975.80 |
$6,975.80 |
$6,975.80 |
$2,760.73
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$777.40 |
$8,557.25 |
$8,557.25 |
$3,371.02
|
|
Idursulfase injection
|
$2,519.32 |
$2,519.32 |
$2,519.32 |
$5,646.08
|
|
I & d vag hematoma non-ob 57023
|
$1,346.80 |
$1,346.80 |
$1,346.80 |
$3,435.60
|
|
I&d vag hemtma obst/postpart
|
$2,512.90 |
$2,512.90 |
$2,512.90 |
$3,370.52
|
|
Ifnl3 gene
|
$328.90 |
$328.90 |
$328.90 |
$147.20
|
|
Ifosfamide 1 gram intravenous solution
|
$190.87 |
$335.53 |
$335.53 |
$246.95
|
|
Igh gene rearrang dir probe
|
$307.45 |
$307.45 |
$307.45 |
$111.50
|
|
Igh gene rearrange amp meth
|
$887.90 |
$887.90 |
$887.90 |
$464.25
|
|
Igh@ var region somatic mutation analy
|
$1,320.80 |
$1,320.80 |
$1,320.80 |
$660.80
|
|
Igk rearrangeabn clonal pop
|
$774.80 |
$774.80 |
$774.80 |
$399.36
|
|
Ihc/icc per specimen each additional single antibody stain
|
$160.55 |
$160.55 |
$160.55 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$1,613.30 |
$1,613.30 |
$1,613.30 |
$331.86
|
|
Ihc/icc per specimen initial single antibody stain
|
$768.30 |
$768.30 |
$768.30 |
$278.40
|
|
Iiv3 vacc no prsv 0.25 ml im
|
$14.30 |
$14.30 |
$14.30 |
$29.70
|
|
Ikbkap gene
|
$176.15 |
$176.15 |
$176.15 |
$172.70
|
|
Ileostomy/jejunostomy non-tube 44310
|
$5,031.00 |
$5,031.00 |
$5,031.00 |
$1,976.40
|
|
Iliac/fem angio cath insert
|
$4,478.50 |
$4,478.50 |
$4,478.50 |
$1,856.01
|
|
Imbrication/diaphragm/transthor/transabd 39545
|
$3,814.20 |
$3,814.20 |
$3,814.20 |
$1,728.00
|
|
Imetelstat 188 mg intravenous solution
|
$32,477.90 |
$32,477.90 |
$32,477.90 |
$20,373.55
|
|
Img rta detcj/mntr ds staff
|
$85.80 |
$85.80 |
$85.80 |
$70.29
|
|
Img rta detc/mntr ds poc aly
|
$177.45 |
$177.45 |
$177.45 |
$71.25
|
|
Immob elbow child sm
|
$50.31 |
$50.31 |
$55.90 |
$85.39
|
|
Immobilizer lwr extrem nylon 20in reinforc 21-35in
|
$122.85 |
$122.85 |
$122.85 |
$259.20
|
|
Immobilizer shldr cntor adlt
|
$331.50 |
$331.50 |
$331.50 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$40.30 |
$40.30 |
$100.75 |
$115.75
|
|
Immobilizer shldr sling med
|
$99.45 |
$99.45 |
$99.45 |
$126.00
|
|
Immt breast prosthesis 19340
|
$2,724.80 |
$2,724.80 |
$2,724.80 |
$4,883.20
|
|
Immune complex assay
|
$109.20 |
$109.20 |
$109.20 |
$101.60
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$40.85 |
$40.85 |
$136.57 |
$6,106.32
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$5,326.31 |
$5,326.31 |
$5,326.31 |
$2,900.11
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$45.45 |
$45.45 |
$45.45 |
$3,846.15
|
|
Immune globulin ig human im use 90281
|
$143.00 |
$143.00 |
$143.00 |
$92.00
|
|
Immunoassay tumor antigen quantitative ca 125
|
$93.60 |
$93.60 |
$93.60 |
$132.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$93.60 |
$93.60 |
$93.60 |
$116.50
|
|
Immunodiff gel qual ea antigen/ab
|
$53.95 |
$53.95 |
$53.95 |
$48.57
|
|
Immunodiffusion nes
|
$63.05 |
$63.05 |
$63.05 |
$53.76
|
|
Immunofixation electrophoresis serum
|
$100.10 |
$100.10 |
$105.95 |
$142.50
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$161.85 |
$161.85 |
$169.00 |
$154.05
|
|
Immunofluorescence per specimen initial single antibody stain
|
$768.30 |
$768.30 |
$768.30 |
$234.27
|
|
Immunoglobulin assay
|
$55.90 |
$55.90 |
$55.90 |
$78.00
|
|
Immunology procedure
|
$211.90 |
$211.90 |
$211.90 |
$154.95
|
|
Impact tooth remov part bony
|
$1,300.00 |
$1,300.00 |
$1,300.00 |
$1,300.00
|
|
Impedence cardiogram
|
$481.65 |
$481.65 |
$481.65 |
$152.54
|
|
Impl absrb msh/prsth dly cls
|
$1,833.00 |
$1,833.00 |
$1,833.00 |
$750.40
|
|
Implant 11 volt lithium-ion backup battery for controller pocket
|
$1,755.00 |
$1,755.00 |
$1,755.00 |
$1,754.00
|
|
Implantation iris prosthesis
|
$3,051.75 |
$3,051.75 |
$3,051.75 |
$19,332.98
|
|
Implant biventricular device 33976
|
$7,995.00 |
$7,995.00 |
$7,995.00 |
$5,053.23
|
|
Implant brain electrodes
|
$4,266.60 |
$4,266.60 |
$4,266.60 |
$1,896.89
|
|
Implant brain electrodes
|
$5,579.60 |
$5,579.60 |
$5,579.60 |
$2,331.47
|
|
Implant brain electrodes
|
$5,821.40 |
$5,821.40 |
$5,821.40 |
$2,410.94
|
|
Implant cartilage 10mm synthetic
|
$54.60 |
$54.60 |
$1,235.00 |
$8,332.51
|
|
Implant cochlear device
|
$4,609.80 |
$4,609.80 |
$4,609.80 |
$34,229.98
|
|
Implant eye drug system
|
$45,940.70 |
$45,940.70 |
$45,940.70 |
$10,009.03
|
|
Implant hormone pellet(s) 11980
|
$778.05 |
$778.05 |
$778.05 |
$315.75
|
|
Implant nerve end
|
$1,115.40 |
$1,115.40 |
$1,115.40 |
$4,760.00
|
|
Implant neuroelectrde addl
|
$1,167.40 |
$1,167.40 |
$1,167.40 |
$1,158.00
|
|
Implant neuroelectrde addl
|
$2,262.00 |
$2,262.00 |
$2,262.00 |
$727.26
|
|
Implant neuroelectrode
|
$5,384.60 |
$5,384.60 |
$5,384.60 |
$5,925.00
|
|
Implant neuroelectrode
|
$9,446.45 |
$9,446.45 |
$9,446.45 |
$3,442.27
|
|
Implant neuroelectrodes
|
$3,123.25 |
$3,123.25 |
$3,123.25 |
$18,334.40
|
|
Implant neuroelectrodes
|
$1,593.80 |
$1,593.80 |
$1,593.80 |
$13,628.55
|
|
Implant neuroelectrodes
|
$8,897.85 |
$8,897.85 |
$10,395.45 |
$8,836.80
|
|
Implant neuroelectrodes
|
$15,876.90 |
$15,876.90 |
$15,876.90 |
$7,728.86
|
|
Implant neuroelectrodes
|
$5,787.60 |
$5,787.60 |
$5,787.60 |
$2,378.72
|
|
Implant neurostim arrays
|
$2,839.85 |
$2,839.85 |
$2,839.85 |
$23,262.40
|
|
Implant single ventricular device 33975
|
$6,500.00 |
$6,500.00 |
$6,500.00 |
$5,053.23
|
|
Implant spinal canal cath
|
$3,031.60 |
$3,031.60 |
$3,031.60 |
$7,913.97
|
|
Implant spine infusion pump
|
$22,948.25 |
$22,948.25 |
$22,948.25 |
$17,262.84
|
|
Implant spine infusion pump
|
$22,940.45 |
$22,940.45 |
$22,940.45 |
$17,270.40
|
|
Implant tcat pulm vlv perq
|
$11,839.75 |
$11,839.75 |
$11,839.75 |
$10,895.04
|
|
Implant ureter in bowel
|
$4,693.00 |
$4,693.00 |
$4,693.00 |
$1,632.00
|
|
Implant ureth bulk agent
|
$343.85 |
$343.85 |
$462.15 |
$2,168.00
|
|
Impl ear abutment ba300 9mm
|
$2,184.00 |
$2,184.00 |
$2,184.00 |
$3,974.88
|
|
Impl neurostim electr perc
|
$16,515.85 |
$16,515.85 |
$16,515.85 |
$7,672.50
|
|
Implnt bio implnt for soft tiss reinforcement 15777
|
$949.00 |
$949.00 |
$949.00 |
$1,072.00
|
|
Implnt spinl canal catheter 62350
|
$16,998.15 |
$16,998.15 |
$16,998.15 |
$5,095.20
|
|
Impl oi implt sk tc esp<100
|
$33,453.55 |
$33,453.55 |
$33,453.55 |
$22,958.00
|
|
Impl oi implt sk tc esp>=100
|
$2,592.20 |
$2,592.20 |
$2,592.20 |
$15,226.08
|
|
Impl oi implt skull perq esp
|
$1,910.35 |
$1,910.35 |
$1,910.35 |
$13,525.50
|
|
Impl/rplcmt gstr nstim eltrd
|
$3,471.00 |
$3,471.00 |
$3,471.00 |
$3,471.00
|
|
Implt brain chemotx add-on 61517
|
$358.80 |
$358.80 |
$358.80 |
$153.00
|
|
Impltj ntrstrml crnl rng seg
|
$12,028.25 |
$12,028.25 |
$12,028.25 |
$5,683.61
|
|
Impltj tot rplcmt hrt sys
|
$12,740.00 |
$12,740.00 |
$12,740.00 |
$4,580.80
|
|
Implt neurostim elctr each
|
$9,727.25 |
$9,727.25 |
$9,727.25 |
$4,320.00
|
|
Imp neurosti pls gn any type
|
$6,142.50 |
$6,142.50 |
$6,142.50 |
$8,789.19
|
|
Imported lipodox inj
|
$1,647.75 |
$1,647.75 |
$1,647.75 |
$528.86
|
|
Impres&prep auricular prosth
|
$9,696.70 |
$9,696.70 |
$9,696.70 |
$6,557.24
|
|
Impres&prep def obt prosth
|
$9,696.70 |
$9,696.70 |
$9,696.70 |
$4,558.89
|
|
Impres&prep facial prosth
|
$5,028.40 |
$5,028.40 |
$5,028.40 |
$5,028.40
|
|
Impres&prep intrm obt prosth
|
$9,696.70 |
$9,696.70 |
$9,696.70 |
$3,837.72
|
|
Impres&prep mndbl res prosth
|
$17,687.80 |
$17,687.80 |
$17,687.80 |
$6,966.64
|
|
Impres&prep nasal prosth
|
$17,687.80 |
$17,687.80 |
$17,687.80 |
$6,966.64
|
