Charge Code|Description| Amount 
10|SEMI-PRIV MED/SUR/GYN (OPO) Room & Bed| $714 
20|NURSERY (REGULAR) Room & Bed| $759 
30|NURSERY SPECIAL CARE Room & Bed| $820 
40|NURSERY (ACUTE CARE) Room & Bed| $842 
80|INTENSIVE CARE  (ICU) Room & Bed| $1,471 
120|ISOLATION Room & Bed| $826 
125|INTERMEDIATE CARE (IMC) Room & Bed| $1,284 
145|PRIVATE OB (L&D) Room & Bed| $893 
147|PRIVATE Room & Bed| $790 
60114042|NITROGEN WASHOUT| $149 
60200117|TX PROPH/DX INJECTION-IV PUSH ADD| $176 
60200118|TX/PRO/DX INJ SAME DRUG ADDON| $176 
60200121|ADMIN FLU VIRUS VACCINE| $94 
60200122|ADMIN PNEUMONIA VACCINE| $94 
60209000|R&B SPECIALTY PRIVATE MED| $875 
60211001|CARDIAC REHAB W/CONT ECG| $208 
60211003|CARDIAC REHAB W/O CONT ECG| $212 
60500115|THER/PROPH/DIAG INJ, SC/IM| $100 
60600116|TX PROPH/DX INJECTION-IV PUSH| $176 
60824003|FETAL NON STRESS TEST| $407 
60824006|LABOR RECOVERY FEE| $482 
60824009|EPIDURAL| $581 
60824012|POST DELIVERY HIGH RISK CARE| $484 
60824013|HIGH RISK ANTENATAL CARE| $617 
60825001|DELIVERY UP TO 5 HOURS| $1,288 
60825002|DELIVERY 6 - 15 HOURS| $1,931 
60825003|DELIVERY > 15 HOURS| $2,897 
60829001|OB E&M LEVEL 1| $260 
60829002|OB E&M LEVEL 2| $312 
60829003|OB E&M LEVEL 3| $364 
60829004|OB E&M LEVEL 4| $416 
60829005|OB E&M LEVEL 5| $468 
61201000|TELEMETRY| $272 
61209000|SPECIALTY ICU| $1,626 
61209351|MINOR PROCEDURE| $231 
61209352|PICC/MIDLINE INSERTION / REPLACEMENT| $1,870 
61231000|CIRCUMCISION NEONATE| $292 
61231003|HEARING SCREEN| $254 
61239021|BILIRUBIN TOTAL, TRANSCUTANEOUS| $89 
61603001|HEMODIALYSIS/INPATIENT ACUTE| $1,479 
61603002|HEMODIALYSIS/OUTPATIENT ACUTE| $821 
61700054|BREATH ALCOHOL TEST (AFTER HOURS)| $20 
61702000|TRACHEOTOMY TUBE CHANGE| $486 
61704002|INHALER MED ADMIN| $281 
61704004|NON-INVASIVE OXIMETRY FOR O2 SAT| $79 
61704005|NON-INVASIVE OXIMETRY CONTINOUS| $179 
61704007|ABG ANALYSIS /PH/PCO2/PO2| $323 
61704018|PRE PULMONARY FUNCTN W MVV| $397 
61704019|PRE & POST PULMONARY FUNCTN W MVV| $515 
61704020|VENTILATION FIRST DAY| $701 
61704021|CPAP/BIPAP INIT & MCMT| $691 
61704022|SPUTUM INDUCTION/DIAG PURPOSE| $281 
61704040|JET NEB| $365 
61704046|CO-OXIMETER| $187 
61704058|HUMIDIFIER/AEROSOL INITIATION| $281 
61704070|PULMONARY FUNCTION SSI| $314 
61704078|VENTILATION MANAGEMENT| $863 
61704083|RESPIRATORY TIME EA 30MIN| $244 
61704096|INTUBATION ENDOTRACHEAL| $717 
61704097|INHALER MED ADMIN SUB| $281 
61704101|DLCO| $160 
61704102|MAXIMAL VOLUNTARY VENTILATION| $207 
61704110|CONT INHALATION TREATMENT 1ST HR| $543 
61704119|INITIAL CHEST PERCUSSIVE THERAPY| $122 
61704120|SUBSEQUENT CHEST PERCUSSIVE THER| $77 
61704414|OXYGEN SET UP 0-4 HOURS| $120 
61705815|SUCTIONING| $158 
61705816|CPT OSCILLATION| $243 
62116000|OPERATING ROOM LEVEL I| $3,297 
62116001|OPERATING ROOM LEVEL II| $4,193 
62116002|OPERATING ROOM LEVEL III| $5,029 
62116003|OPERATING ROOM LEVEL IV| $8,380 
62116004|OPERATING ROOM LEVEL V| $8,866 
62116005|OPERATING ROOM LEVEL I, SUBSQT| $330 
62116006|OPERATING ROOM LEVEL II, SUBSQT| $335 
62116007|OPERATING ROOM LEVEL III, SUBSQT| $503 
62116008|OPERATING ROOM LEVEL IV, SUBSQT| $841 
62116009|OPERATING ROOM LEVEL V, SUBSQT| $739 
62185000|RECOVERY ROOM| $695 
62210107|DECLOT VASCULAR DEVICE| $375 
62212000|SSU PROCEDURE I| $1,401 
62212001|SSU PROCEDURE II| $6,208 
62212248|SSU-TILT TABLE CARDIOVASC EVAL| $844 
62214678|CARDIOVERSION| $1,087 
62218377|ENDO-PAIN MANAGEMENT LEVEL II| $2,416 
62218428|ENDO-LEVEL I| $1,528 
62218429|ENDO-LEVEL II| $3,245 
62218430|ENDO-LEVEL III| $4,556 
62310114|THER/DIAG CONCURRENT INF| $130 
62310124|ER CHARGE LEVEL VI, EA ADDTL 30| $676 
62310800|THER/PROPH/DIAG IV INF,1ST HR| $526 
62310801|THER/PROPH/DG IV INT,EA ADDTL HR| $151 
62311006|HYDRATION IV INFUSION, INIT.| $536 
62311007|HYDRATION IV INFUSION,EA ADDTL HR| $142 
62311200|CPR| $1,132 
62318141|TEMP EXTERNAL PACING| $1,280 
62318163|CONSCIOUS SEDATION 5+ OLDER INITIAL15| $474 
62318167|CONSCIOUS SEDATION UNDER 5 YRS INITIAL15| $439 
62318266|ER CHARGE LEVEL V| $827 
62318268|ER CHARGE LEVEL IV| $694 
62318269|ER CHARGE LEVEL III| $395 
62318270|ER CHARGE LEVEL II| $306 
62318271|ER CHARGE LEVEL I| $192 
62318275|ER CHARGE LEVEL VI| $1,401 
62318280|FOLY INSERTION| $150 
62318281|STRAIGHT CATHETERIZATION| $155 
62318282|INJECTION IM IMMUNIZATION| $94 
62318283|PROCEDURE LEVEL 1| $399 
62318284|PROCEDURE LEVEL 2| $629 
62318285|PROCEDURE LEVEL 3| $942 
62318286|PROCEDURE LEVEL 4| $1,622 
62318291|CONSCIOUS SEDATION EA ADDTL 15| $158 
62319000|OCCULT BLOOD-FECES| $48 
62360001|PROC WND CARE SIMPLE| $433 
62360002|PROC WND CARE MINOR| $826 
62360003|PROC WND CARE INTERM| $1,401 
62360004|PROC WND CARE MAJOR| $3,762 
62360277|HYPERBARIC OXYGEN THERAPY, 30M| $580 
62369203|LEVEL 3 INITIAL VISIT| $270 
62369204|LEVEL 4 INITIAL VISIT| $354 
62369205|LEVEL 5 INITIAL VISIT| $434 
62369212|LEVEL 2 FOLLOW-UP VISIT| $133 
62369213|LEVEL 3 FOLLOW-UP VISIT| $211 
62369214|LEVEL 4 FOLLOW-UP VISIT| $276 
62369215|LEVEL 5 FOLLOW-UP VISIT| $338 
62378007|PAIN MANAGEMENT LEVEL I| $1,512 
62378008|PAIN MANAGEMENT LEVEL II| $2,416 
62378009|PAIN MANAGEMENT LEVEL III| $4,681 
62378010|PAIN MANAGEMENT LEVEL IV| $7,089 
63101003|ACETONE| $74 
63101006|ALBUMIN| $87 
63101008|ASO TITER| $151 
63101009|AMYLASE| $98 
63101011|ALCOHOL| $165 
63101012|ALKALINE PHOSPHATASE| $94 
63101013|AMMONIA| $295 
63101017|BILIRUBIN (TOTAL)| $92 
63101018|BILIRUBIN (DIRECT/CONJUG)| $95 
63101021|BLEEDING TIME| $59 
63101022|BUN| $72 
63101023|CALCIUM| $107 
63101025|FIBRINOGEN| $165 
63101026|SPINAL FLUID, CELL COUNT| $75 
63101030|CHOLESTEROL| $80 
63101035|CK (TOTAL)| $119 
63101036|CREATININE| $80 
63101037|CREATININE CLEARANCE| $188 
63101038|CRP (C-REACTIVE PROTEIN)| $264 
63101044|DIGOXIN| $225 
63101045|ELECTROLYTES| $147 
63101053|GLUCOSE TOLERANCE TEST 3 HOUR| $323 
63101056|GLUCOSE| $94 
63101063|B12 UNSAT BINDING CAPACITY| $157 
63101067|POTASSIUM (K)| $79 
63101070|LIPASE| $123 
63101073|LACTIC ACID| $115 
63101074|LDH| $124 
63101077|MONO TEST| $62 
63101079|MAGNESIUM| $93 
63101082|OSMOLARITY SERUM| $257 
63101088|PLATELET COUNT| $51 
63101090|PREGNANCY TEST (URINE)| $140 
63101093|PROTIME (PT)| $92 
63101094|PTT| $81 
63101095|PROTEIN-TOTAL| $108 
63101098|PHENOBARBITAL LEVEL| $178 
63101100|RA FACTOR (RHEUMATOID FACTOR)| $126 
63101102|RETICYLOCYTE COUNT (RETIC)| $56 
63101103|RUBELLA VIRUS AB IGG| $96 
63101104|SALICYLATE| $114 
63101105|SEDIMENTATION RATE-ESR| $62 
63101107|AST/SGOT| $108 
63101108|ALT/SGPT| $108 
63101109|SICKLE CELL SCREEN| $63 
63101110|SODIUM| $72 
63101113|CHLORIDE, SPINAL FLUID| $66 
63101114|PROTEIN, SPINAL FLUID| $87 
63101115|GLUCOSE, SPINAL FLUID| $97 
63101121|T3| $121 
63101129|URIC ACID| $93 
63101132|URINE PH| $37 
63101135|RPR| $72 
63101139|PHOSPHORUS| $104 
63101141|DILANTIN LEVEL| $188 
63101154|RA TITER| $140 
63101157|TSH ULTRASENSITIVE| $147 
63101162|PROTEIN URINE (QUANT)| $95 
63101171|TEGRETOL (CARBAMAZAPINE)| $196 
63101176|KETONES| $74 
63101178|HCG TITER (PREG, QUANT)| $159 
63101184|THEOPHYLLINE| $124 
63101209|SPECIMEN COLLECTION (UA)| $28 
63101210|ACETOMINOPHEN| $237 
63101211|VALPROIC ACID (DEPAKENE)| $177 
63101220|SGGT/GGT| $99 
63101228|GLYCO-HEMOGLOBIN| $95 
63101232|GENTAMYCIN| $161 
63101233|ROTOZYME| $124 
63101234|TOBRAMYCIN| $136 
63101238|PREGNANCY TEST SERUM| $175 
63101245|FERRITIN| $114 
63101268|VANCOMYCIN| $274 
63101317|PSA (PROSTATIC SP ANTIGEN)| $210 
63101352|RSV ANTIGEN| $166 
63101353|RPR TITER| $120 
63101372|D DIMERS| $147 
63101386|HEMOGLOBIN| $34 
63101387|HEMATOCRIT| $34 
63101409|URINE AMPHETAMINES| $121 
63101410|URINE BARBITURATES| $121 
63101411|URINE BENZODIAZEPINES| $121 
63101412|URINE COCAINE| $121 
63101413|URINE OPIATES| $121 
63101414|URINE MARIJUANA| $121 
63101415|URINE ALCOHOL| $165 
63101421|GROUP A QUICK STREP| $166 
63101426|HELICOBACTOR ANTIBODY| $320 
63101450|GLUCOSE TOLERANCE TEST 2 HOUR| $233 
63101454|T4-FREE| $142 
63101464|SCAN SMEAR| $42 
63101465|MANUAL WBC DIFFERENTIAL| $63 
63101482|CELL COUNT, MISC FLUID| $78 
63101483|AMYLASE, FLUID| $98 
63101484|GLUCOSE, FLUID| $80 
63101485|LDH FLUID| $124 
63101486|PROTEIN, FLUID| $111 
63101491|OSMOLALITY, URINE| $235 
63101493|GENTAMYCIN, PEAK| $161 
63101494|GENTAMYCIN, TROUGH| $161 
63101495|TOBRAMYCIN, PEAK| $144 
63101496|TOBRAMYCIN, TROUGH| $144 
63101497|VANCOMYCIN, PEAK| $263 
63101498|VANCOMYCIN, TROUGH| $274 
63101507|AMYLASE, URINE| $82 
63101508|CALCIUM, URINE| $106 
63101509|CHLORIDE, URINE| $73 
63101510|CREATININE, URINE| $120 
63101511|GLUCOSE, URINE| $93 
63101512|POTASSIUM, URINE| $80 
63101514|SODIUM, URINE| $80 
63101516|URIC ACID, URINE| $98 
63101517|URIC ACID, FLUID| $98 
63101530|MCKMB| $210 
63101531|VOLUME MEASUREMENT| $34 
63101553|WET PREP| $78 
63101560|CBC/AUTOMATED DIFF| $165 
63101582|GLUCOSE TOLERANCE ADD SUGAR| $78 
63101588|IRON| $82 
63101589|URINALYSIS/MACRO ONLY| $45 
63101590|URINALYSIS WITH MICRO| $86 
63101594|VENIPUNCTURE I| $28 
63101681|CHOLESTEROL-TOTAL| $42 
63101682|TRIGLYCERIDES| $129 
63101685|T3 FREE| $192 
63101686|CHOLESTEROL, TOTAL| $33 
63101696|TIBC| $104 
63101698|PH FLUID| $10 
63101707|SPECIFIC GRAVITY, FLUID| $35 
63101734|ALBUMIN, FLUID| $90 
63101768|URINE ECSTASY| $121 
63101769|URINE METHADONE| $121 
63101787|BETA-HYDROXYBUTYRATE| $78 
63101799|CBC| $140 
63101800|PROTEIN, 24 HOUR URINE| $95 
63101801|URIC ACID, 24 HOUR URINE| $98 
63101802|PHOSPHORUS, 24 HOUR URINE| $115 
63101803|SODIUM, 24 HOUR URINE| $72 
63101804|MAGNESIUM, 24 HOUR URINE| $93 
63101805|POTASSIUM, 24 HOUR URINE| $79 
63101809|CREATININE, 24 HOUR URINE| $120 
63101810|CHLORIDE, 24 HOUR URINE| $70 
63101811|CALCIUM, 24 HOUR URINE| $123 
63101977|METANEPHRINES, RANDOM UA| $177 
63101978|SENSITIVITY,KIRBY BAUER| $107 
63101988|MYCOBACTERIUM AVIUM INTRACELLULAR| $131 
63102007|EPINEPHRINE| $129 
63102008|NOREPINEPHRINE| $129 
63102009|ANTI TPO(ANTITHYRD PERIOX ANTIBOD| $87 
63102018|TRICYCLIC ANTIDEPRESSANT (TCA)| $121 
63102020|TROPONIN I| $179 
63102027|SPECIMEN COLLECTION (VP)| $24 
63102084|COMPREHENSIVE METABOLIC PANEL 14| $345 
63102085|HEPATIC FUNCTION PANEL| $220 
63102086|BASIC METABOLIC PANEL| $204 
63102087|RENAL FUNCTION PANEL| $253 
63102138|BNP B-TYPE NATRIURETIC PEPTIDE| $203 
63104150|MIXING STUDIES| $356 
63104175|LIPID ANALYSIS (II)| $167 
63104262|PSA, SCREEN| $210 
63104263|OCCULT BLOOD| $52 
63104269|BUN, RANDOM URINE| $35 
63104292|INFLUENZA A ANTIGEN| $135 
63104293|INFLUENZA B ANTIGEN| $135 
63104294|PLACENTAL ALPHA MICROGLOBULIN-1 (ROM)| $336 
63104332|HIV-1/HIV-2 SINGLE RESULT| $224 
63104333|AGENT NOS ASSAY W/OPTIC| $208 
63104349|B12| $129 
63104350|FOLATE| $129 
63109020|GLUCOSE, POINT OF CARE| $45 
63111032|COOMBS TEST (DIRECT)| $94 
63111040|COLD AGGLUTINATION STUDIES| $106 
63111075|PLASMA, FRESH FROZEN| $68 
63111138|ANTIBODY SCREEN| $145 
63111416|FETAL SCREEN| $77 
63111558|ABO GROUP| $53 
63111559|RH TYPING| $62 
63111578|RHOGAM IMMUNE GLOBULIN| $379 
63111587|CRYO-PRECIPITATE| $60 
63111591|XM PACKED RBC'S| $193 
63111615|ANTIGEN SCREENS| $134 
63111629|ANTIBODY IDENTIFICATION| $305 
63112104|PLATELET APHERESIS PACK LR ISSUED| $624 
63112105|PACKED RBC'S, UNIT ISSUED| $209 
63112106|PACKED RBC'S, L/R, UNIT ISSUED| $221 
63112107|PACKED RBC'S,L/R,IRR.,UNIT ISSUED| $275 
63112108|PLATELET APHERESIS,L/R,IRR,ISSUED| $678 
63112113|TRANSFUSION BLOOD OR BLOOD COMP| $1,114 
63114184|ELUTION| $114 
63114185|FRESH FROZEN PLASMA, THAWING| $168 
63114272|BLOOD THAWING CHARGE| $154 
63114348|KLEIHAUER-BETKE| $116 
63114360|POOLED PLATELETS, LEUKOREDUCED| $520 
63114375|PLATELETS, LEUKO REDUCED (EA UNIT)| $520 
63141052|GRAM STAIN SMEARS| $76 
63141080|OCCULT BLOOD, SCREEN| $49 
63141292|CLOSTRIDIUM DIFFICILE TITER| $163 
63141390|GIARDIA ANTIGEN| $268 
63141500|CULTURE, BLOOD| $180 
63141501|CULTURE, STOOL| $171 
63141502|CULTURE, THROAT/NOSE| $177 
63141503|CULTURE, WOUND| $180 
63141504|CULTURE, OTHER| $177 
63141505|CULTURE, URINE| $164 
63141506|CULTURE, FUNGUS| $167 
63141699|SENSITIVITY, MIC| $90 
63141979|IDENTIFICATION, AEROBIC CULTURE| $76 
63142126|IDENTIFICATION, ANEROBIC CULTURE| $89 
63142158|CULTURE, GROUP B STREP| $180 
63144156|GASTROCCULT| $52 
63144186|CRYPTOSPORIDIUM ANTIGEN| $96 
63144196|MRSA SCREEN| $114 
63144211|CULTURE, INTRA-OP| $177 
63144300|FECAL LACTOFERRIN| $147 
63144321|CLOSTRIDIUM DIFFICILE AMPLIFIED| $364 
63151049|FROZEN SECTION| $374 
63151166|KOH PREP| $81 
63151397|CRYSTAL EXAM| $78 
63151436|PATH CYTO CONCENTRATION| $124 
63151437|DECALCIFICATION #1| $35 
63151598|PATH CYTO FLUIDS WASH BRUSH| $120 
63151606|PATH FNA IMED STUDY ADEQUACY| $192 
63151607|PATH FNA INTERPRETATION REP| $115 
63151608|PATH LEVEL 1 GROSS| $35 
63151609|PATH LEVEL II| $124 
63151611|PATH LEVEL III| $146 
63151612|PATH LEVEL IV| $165 
63151613|PATH LEVEL V| $284 
63151614|PATH LEVEL VI| $829 
63151616|PATH SP STAINS GPI ORGANISMS| $146 
63151617|PATH SP STAINS CPII ALL OTH| $148 
63151624|PATH CONSULT FS ADDITIONAL| $138 
63151625|IMMUNOCYTOCHEMISTRY| $394 
63151963|CARDIOLIPIN ANTIBODY| $188 
63154267|TOUCH PREP| $829 
63154268|TOUCH PREP ADDTL| $48 
63154275|ESTROGEN RECEPTOR| $394 
63154276|PROGESTERONE RECEPTOR| $394 
63154277|HER2-NEU| $394 
63154280|DNA IN SITU HYBRIDIZATION| $243 
63154334|IMMUNOCYTOCHEMISTRY, EACH| $90 
63154336|MULTIPLEX PROBE STAIN PROCEDURE EA| $564 
63154347|PATHOLOGY CONSULTATION| $76 
63154364|TRIPLE IMMUNOSTAIN| $346 
63161005|CYSTINE (URINE)| $168 
63161014|ANA| $174 
63161016|ANTIMITOCHONDRIAL ANTIBODY| $162 
63161024|ANGIOTENSION CONVERTING ENZYME| $179 
63161027|CAROTENE| $163 
63161046|PROTEIN ELECTROPHORESIS| $126 
63161058|HDL CHOLESTEROL| $92 
63161059|IGA| $119 
63161060|VDRL, SPINAL FLUID| $78 
63161061|IGM| $119 
63161062|IGG| $119 
63161064|IGE| $202 
63161066|ACETYLCHOLINE REC BINDING AB| $569 
63161072|LITHIUM| $96 
63161084|TESTOSTERONE TOTAL| $262 
63161087|NEWBORN METABOLIC SCREENING| $106 
63161096|STOOL LACTOSE & SUCROSE| $106 
63161111|VON WILLEBRAND FACTOR ACTIVITY| $370 
63161116|AFB STAIN| $131 
63161117|CULTURE, AFB| $187 
63161122|T4, TOTAL| $120 
63161123|IGG SUB-CLASSES| $456 
63161127|IMMUNOFIXATION, SERUM| $264 
63161144|INSULIN LEVEL (1ST SAMPLE)| $136 
63161145|FSH| $257 
63161146|PROLACTIN| $218 
63161147|RENIN| $200 
63161148|ALDOSTERONE| $371 
63161149|ESTRADIOL| $261 
63161153|CRYPTOCOCCAL ANTIGEN| $180 
63161158|PTH, INTACT| $500 
63161159|LH| $223 
63161160|CORTISOL| $151 
63161161|ACTH| $337 
63161164|CEA| $164 
63161168|KIDNEY STONE ANALYSIS| $166 
63161172|CH50| $211 
63161177|ALKALINE PHOS (FRACTION)| $106 
63161179|LDH ISOENZYMES| $110 
63161180|VMA| $217 
63161181|PROGESTERONE-SERUM| $181 
63161182|ESTROGEN TOTAL| $284 
63161186|TESTOSTERONE FREE| $431 
63161191|CATECHOLS FRACTION| $415 
63161193|FUNGAL SEROLOGY| $309 
63161194|HEPATITIS SCREENING PROFILE| $322 
63161195|ZINC| $120 
63161196|CK ISOENZYMES (FRACT)| $142 
63161197|CHROMOSOME ANALYSIS ROUT| $2,324 
63161198|ARSENIC SCREEN| $184 
63161201|CERULOPLASMIN| $120 
63161202|COPPER| $131 
63161204|SEROTONIN| $466 
63161205|HLA B27| $452 
63161206|FTA ABS| $106 
63161208|HYDROXYCORTICOSTEROIDS| $122 
63161214|SMOOTH MUSCLE ANTIBODY| $179 
63161216|ANTI-STRIATED MUSCLE ANTIBODY| $166 
63161219|HEAVY METAL SCREEN| $279 
63161223|CRYOGLOBULIN| $98 
63161224|ADH| $457 
63161227|LEGIONAIRES (DISEASE)| $348 
63161229|STREPTOCOCCUS M.G.| $147 
63161230|ALDOLASE| $114 
63161236|LEAD| $109 
63161246|DHEA-SULFATE| $414 
63161247|HYDROXYPROGESTERONE, 17| $264 
63161249|HERPES CULTURE| $211 
63161250|ALPHA ANTI-TRYPSIN| $172 
63161252|GASTRIN LEVEL| $150 
63161254|MYCOPLASMA PNEUMONIAE, IGG| $172 
63161256|ALPHA FETO PROTEIN (TM)| $220 
63161259|STOOL FOR FAT| $76 
63161262|COMPLEMENT C4| $130 
63161263|G6PD| $151 
63161269|C1 Q| $270 
63161270|INSULIN ANTIBODY DETRM| $262 
63161271|HAPTOGLOBIN| $105 
63161272|MYOGLOBIN| $142 
63161274|WARFARIN (COUMADIN)| $182 
63161276|TRANSFERRIN| $153 
63161279|HEPARIN ASSAY| $173 
63161280|ANTI-THYROID| $149 
63161284|5-H1AA| $230 
63161285|ANTI-DNA, DOUBLE STRAND| $239 
63161287|GROWTH HORMONE| $149 
63161289|METANEPHRINES (FRACTIONAT)| $192 
63161290|CHROMOSOME STUDY H. RES.| $3,000 
63161295|ANDROSTEMEDIONE| $457 
63161300|CALCIUM IONIZED| $250 
63161303|PROTEIN C, ACTIVITY| $304 
63161304|ANTI THROMBIN III FUNCTIONAL| $205 
63161305|OLIGOCLONONAL BANDING| $267 
63161308|HEPATITIS B SURF ANTIGEN| $140 
63161309|CALCITONIN ASSAY| $320 
63161314|TETANUS TITER| $230 
63161320|LYME SEROLOGY| $356 
63161324|LUPUS ANTICOAGULANT| $234 
63161327|ORGANIC ACID (URINE)| $347 
63161329|MUMPS VIRUS AB IGG| $140 
63161330|B2 MICROGLOBULIN| $106 
63161335|BORDETELLA PERTUSIS (FAS)| $284 
63161342|DIHYDROTESTOSTERONE-DHT| $329 
63161343|PNEUMOCOCCAL TITERS| $482 
63161345|PROTEIN S, ACTIVITY| $603 
63161349|BETA HCG SUBUNIT TUMOR MARKER| $144 
63161354|VITAMIN A| $151 
63161355|HVA| $145 
63161358|CA 125| $210 
63161362|PLATELET ANTIBODY| $443 
63161363|MEASLES VIRUS AB IGM| $121 
63161364|THYROGLOBULIN AB| $217 
63161366|CA-19-9| $214 
63161369|ANTI ENA| $288 
63161373|HEPATITIS C ANTIBODY| $182 
63161380|VISCOSITY, SERUM| $106 
63161389|COMPLEMENT C5| $165 
63161405|VARICELLA ZOSTER 1GG| $172 
63161406|CYCLOSPORINE| $323 
63161417|SJOGRENS PROFILE| $231 
63161418|CA 15-3| $204 
63161420|ANCA| $446 
63161425|B1 THIAMINE| $208 
63161428|T-LYMPH HELPER (CD4)| $291 
63161429|HEPATITIS DELTA ANTIBODY| $72 
63161430|B2 RIBOFLAVIN| $182 
63161440|IGD| $160 
63161441|ERYTHROPOIETIN| $345 
63161445|VLDL CHOLESTEROL| $322 
63161448|PNEUMONITIS HYPERSENSITIVITY| $200 
63161451|HEPATITIS B SURF ANTIBODY| $133 
63161452|CAT SCRATCH FEVER| $171 
63161455|PARVO B-19 IGG ANTIBODY| $92 
63161456|PARVO B-19 IGM ANTIBODY| $88 
63161457|AMIODARONE| $153 
63161458|HEPATITIS A IGM ANTIBODY| $121 
63161463|ANTIMICROSOMAL (TPO)| $108 
63161466|MICROALBUMIN, URINE| $98 
63161467|DIPTHERIA AB| $267 
63161472|PARIETAL CELL AB| $150 
63161473|INTRINSIC FACTOR AB| $193 
63161477|B6| $415 
63161481|CHROMIUM, SERUM| $239 
63161487|MYOGLOBIN, URINE| $142 
63161490|PROTEIN ELECT, URINE| $120 
63161499|COMPLEMENT C3| $130 
63161518|HEMOGLOBIN ELECTROPHORESIS| $181 
63161533|RAST TEST| $41 
63161540|GALACTOSEMIA| $1,017 
63161542|HEPATITIS C-RNA BY PCR| $797 
63161545|PRE-ALBUMIN| $116 
63161547|C PEPTIDE| $252 
63161549|HEPATITIS B CORE ANTIBODY| $95 
63161556|VITAMIN E| $130 
63161583|RICKETTSIA AB IGG| $209 
63161584|RICKETTSIA AB IGM| $209 
63161704|HEPATITIS E ANTIBODY (IGM)| $150 
63161718|EHRLICHIA CHAFFEENIS AB, IGM| $109 
63161750|CORTISOL FREE, URINE| $126 
63161754|JAK 2 MUTATION| $887 
63161757|MYSOLINE| $171 
63161760|HEPATITIS BE ANTIGEN| $82 
63161763|HEPATITIS BE ANTIBODY| $82 
63161771|NOROVIRUS| $479 
63161772|ANTI-DNA, SINGLE STRAND| $218 
63161773|ANTI MULLERIAN HORMONE| $236 
63161775|FISH DNA PROBE| $626 
63161783|CU INDEX| $401 
63161786|HEPARIN INDUCED THROMBOCYTOP. ABS| $382 
63161815|OXALATES (24 HOUR URINE)| $135 
63161842|GLUCOSE TOLERANCE TEST 1 HOUR| $116 
63161857|C1 ESTERASE INHIBITOR| $236 
63161859|FUNGAL STAIN| $41 
63161860|LAMOTRIGINE| $173 
63161861|MYELOPEROXIDASE AB| $829 
63161867|SCLERODERMA ANTIBODY (SCL-70)| $246 
63161869|CITRATE, 24 HR. URINE| $69 
63161878|HIV-1 BY PCR| $484 
63161881|CA 27-29| $109 
63161965|PSA, TOTAL & FREE| $261 
63161972|ANTIGLIADIN ANTIBODY PANEL| $370 
63161993|EPSTEIN BARR VIRUS AB.VCA IGM| $106 
63161994|EPSTEIN BARR VIRUS AB-VCA IGG| $106 
63161995|EPSTEIN BARR VIRUS EARLY AG D| $67 
63161996|EPSTEIN BAR VIRS AB-NUCLER AG IGG| $67 
63162004|HERPO SIMPLEX TYPE 1,2,IQG| $174 
63162005|LEUKEMIA DIAG PANEL CLL/HCL/SLL| $492 
63162012|VITAMIN D 1,25 DIHYDROXY| $187 
63162013|CORTISOL A.M.| $147 
63162014|RBC FOLATE| $202 
63162019|DIRECT LDL| $87 
63162023|HEPATITIS A TOTAL AB| $55 
63162035|HOMOCYSTEINE, PLASMA| $243 
63162038|CRYOFIBRINOGEN| $61 
63162039|ANTIENDOMYSIAL ANTIBODY| $202 
63162042|CMV CULTURE| $300 
63162043|VARICELLA ZOSTER VIRUS ANTBDY IGM| $120 
63162048|HTLV/AB| $150 
63162049|CMV AB IGG| $119 
63162050|HERPES SIMPLEX AB IGG TITER| $97 
63162051|CYSTIC FIBROSIS PANEL| $577 
63162052|IMMUNOFIXATION URINE| $176 
63162053|CHROMOSOME BCR/ABL, PCR| $574 
63162054|24HR URINE, BUN| $35 
63162057|HIV-1 RNA QUANT PCR| $449 
63162059|FRUCTOSAMINE| $58 
63162061|ACETYCHOLINE REC BLOCKING ANTIBOD| $151 
63162062|ACETYLCHOLINE REC MODULATING ANTI| $287 
63162064|FACTOR V (LEIDEN)| $267 
63162066|THYROID STIMULATING IMMUNOGLOBULIN (TSI)| $328 
63162068|LYMPHOMA PHENOTYPE (FIRST MARKER)| $394 
63162072|PROTEIN C ANTIGENIC| $109 
63162073|METHYLMALONIC ACID| $206 
63162074|TOPAMAX| $112 
63162075|T3 REVERSE| $106 
63162078|MEASLES VIRUS AB IGG| $108 
63162081|IGA SUBCLASS PANEL| $88 
63162093|PROTHROMBIN MUTATION ANALYSIS| $473 
63162094|ANTI THROMBIN III ANTIGENIC| $205 
63162101|HEPATITIS B VIRAL DNA| $237 
63162103|DENGUE FEVER ANTIBODIES| $279 
63162110|CMV AB IGM| $123 
63162111|ENTEROVIRUS RNA QUAL BY PCR| $258 
63162112|GLUTAMIC ACID DECARB 65 ANTBODIES| $157 
63162117|HEREDITARY HEMACHROMOTOSIS DNA| $810 
63162118|PLATELET ASSOC AB DIRECT ASY| $201 
63162121|PROGRAF| $164 
63162122|VON WILLEBRAND FACTOR ANTIGEN| $202 
63162125|HERPES SIMPLEX AB,IGM| $69 
63162139|ISLET CELL ANTI BODIES| $87 
63162141|KEPPRA/LEVETIVACETAM| $283 
63162143|JO-1 ANTIBODY IGG| $89 
63162146|TRILEPTAL| $160 
63162147|LEGIONELLA ANTIGEN, URINE| $235 
63162150|NEISSERIA GONORRHOEAE AB| $139 
63162156|COBALT WHOLE BLOOD| $171 
63162162|CCP-IGM| $131 
63162165|ACYLCARNITINE PLASMA| $321 
63162167|NICOTINE LEVEL SERUM| $171 
63162168|NICOTINE LEVEL URINE| $163 
63162170|HERPESVIRUS 6 ANTIBODY| $150 
63164136|INHIBIN B| $263 
63164137|WEST NILE VIRUS AB IGM| $289 
63164142|ADENOSINE DEAMINOSE, FLUID| $262 
63164143|CHOLESTEROL FLUID| $70 
63164145|GALACTOSE 1 PHOSPHATE| $186 
63164147|CARNITINE TOTAL & FREE| $115 
63164153|HEPATITIS B BY PCR| $214 
63164154|CATECHOLAMINES FRACT PLASMA| $395 
63164157|SACCHAROMYCES CEREVISIAE AB IGG| $136 
63164158|TISSUE TRANSGLUTANINASE AB, IGA| $144 
63164160|FLOW CYTOMETRY EACH ADD MARKER| $97 
63164163|INSULIN-LIKE GROWTH FACTOR 1| $166 
63164165|PTH, RP| $102 
63164167|CHROMOGRANIN A| $86 
63164168|HCV, VIRAL LOAD| $329 
63164169|HCV GENOTYPING BY PCR| $799 
63164174|T3 UPTAKE| $59 
63164187|COMPREHENSIVE OVA/PARASITE EXAM| $97 
63164192|ANTI SRP| $192 
63164197|SEX BINDING HORMONE TEST (SBHG)| $139 
63164198|MUMPS VIRUS AB, IGM| $140 
63164199|LYMPHOCYTE SUBSET PANEL 5| $393 
63164204|PARVOVIRUS ANTIGEN BY PCR| $136 
63164208|PORPHYRIN, TOTAL AND FRACTIONATED| $263 
63164210|CALPROTECTIN| $236 
63164212|MYCOPHENOLIC ACID| $131 
63164214|MICROALBUMIN RAND. URINE WITH CREATININE| $120 
63164215|NEISSERIA, AMPLIF NA PROBE| $116 
63164216|PROTEIN URINE| $88 
63164217|CHLAMYDIA T, APLIF NA PROBE| $123 
63164222|CORTISOL FREE, 24 HR URINE| $149 
63164223|MICROALBUMIN WO CREATININE (RAND URINE)| $104 
63164233|ANA TITER/PATTERN| $174 
63164235|HEPATITIS B CORE AB IGM| $93 
63164236|VITAMIN D, 25-HYDROXY| $225 
63164245|HEPATITIS C ANTIBODY| $134 
63164251|SJOGRENS AB (SS-A)| $135 
63164252|SJOGRENS AB (SS-B)| $135 
63164253|RNP ANTIBODY| $135 
63164254|SM ANTIBODY| $135 
63164255|TESTOSTERONE, TOTAL (WOMEN, CHILD)| $196 
63164271|PANCREATIC ELASTASE - 1| $246 
63164287|KAPPA LAMBDA LIGHT CHAINS| $237 
63164295|QUANTIFERON TB GOLD| $393 
63164303|PROTEINASE-3 ANTIBODY| $256 
63164304|ALPHA 1 ANTITRYPSIN MUTATION ANALYSIS| $292 
63164306|MYELIN BASIC PROTEIN| $108 
63164310|SHIGA TOXINS, EIA| $80 
63164318|HEPATITIS B SURFACE ANTIBODY| $76 
63164341|CYTOMEGALOVIRUS DNA, QUAL, REAL-TIME PCR| $140 
63164342|PHENYTOIN, FREE| $96 
63164353|RUFINAMIDE| $122 
63164361|JCV ANTIBODY| $227 
63164362|HEPATITIS B SURFACE AB IMMUNITY| $76 
63164365|BETA-2 TRANSFERRIN| $320 
63164366|HEPATITIS C VIRAL RNA GENO NS5A| $800 
63164368|GLUCOSE; QUAN BLOOD| $93 
63164369|AST OR SGOT| $108 
63164370|TRANSFERASE; ALANINE AMINO| $108 
63164371|AUTOMATED PLATELET COUNT| $51 
63164372|ASSAY OF SERUM ALBUMIN| $87 
63164373|HELICOBACTER PYLORI ANTIGEN, EIA| $144 
63164376|APOLIPOPROTEIN A-1| $74 
63164378|ADAMTS13 ACTIVITY| $322 
63164379|PD-L1 22C3 (KEYTRUDA)| $567 
63172135|FACTOR II| $129 
63172136|FACTOR VII| $268 
63302900|EKG| $208 
63302901|EKG PROFESSIONAL COMPONENT| $105 
63302924|EKG PRO FEE SUBSEQUENT SAME MD| $105 
63302932|EKG PRO FEE SUBSEQUENT DIFF. MD| $105 
63305818|HOLTER MONITOR UP TO 48 HOURS| $288 
63342904|EEG RECORDING| $782 
63342922|EEG W/SLEEP DEPRIVATION| $1,154 
63342934|EEG AWAKE & DROWSY PROFEE| $167 
63342935|EEG AWAKE & ASLEEP PROFEE| $165 
63342936|HOME EEG [PER DAY]| $1,408 
63387865|US ECHOCARDIOGRAM| $1,968 
63387942|US ECHOCARDIOGRAM W| $2,919 
63401025|DILATATION| $277 
63401999|STERNO CLAVICULAR JTS| $192 
63402000|ABD FLAT KUB| $234 
63402001|ABD 3 VIEW ERECT OR DECUB| $431 
63402003|CHEST PA AND LATERAL| $279 
63402004|CHEST PA AND LATERAL AND OBLIQUE| $249 
63402005|CHEST 1 VIEW| $268 
63402006|RIBS 4-VIEW| $515 
63402007|STERNUM| $223 
63402008|CHEST LORDOTIC| $319 
63402009|CHEST PORTABLE| $268 
63402013|KNEE AP STANDING| $188 
63402025|PELVIS W FROG POSITION| $244 
63402032|BARIUM ENEMA| $596 
63402033|BARIUM ENEMA WITH AIR CONTRAST| $960 
63402036|INJECTION FOR CHOLANGIOGRAM| $555 
63402038|OPERATIVE CHOLANGIOGRAM| $539 
63402039|BARIUM SWALLOW| $385 
63402040|SMALL BOWEL STUDY| $713 
63402041|UGI| $524 
63402042|VOIDING CYSTOURETHROGRAM| $661 
63402045|FISTULOGRAM| $391 
63402046|HYSTEROSALPINGOGRAM| $631 
63402051|IVP W NEPHROTOMOGRAM| $800 
63402052|RETROGRADE PYELOGRAM| $617 
63402053|MANDIBLE| $321 
63402056|MASTOIDS| $262 
63402057|NASAL BONE| $190 
63402059|TMJS| $399 
63402060|SINUSES| $311 
63402061|SKULL SERIES| $369 
63402062|NECK SOFT TISSUE| $162 
63402063|SKULL AP LAT| $187 
63402069|COCCYX SACRUM| $264 
63402072|SACRO ILIAC JOINTS| $264 
63402073|SPINE THORACIC DORSAL| $343 
63402074|PORT FLUORO LESS THAN 1 HR| $566 
63402076|LONG BONES ADULT| $388 
63402077|LONG BONES CHILD| $347 
63402078|PORT FLUORO GREATER THAN 1 HR| $1,056 
63402081|FLUORO W RAD HELP| $314 
63402098|UROGRAPHY,ANTEGRADE| $528 
63402105|CROSSTABLE ABD| $234 
63402107|TOE (FOOT) | $159 
63402108|BARIUM SWALLOW MODIFIED| $542 
63402114|IVP LIMITED| $549 
63402116|SKELETAL SURVEY CHILD| $502 
63402119|SPINE CERVICAL 3 VIEWS| $331 
63402120|SPINE CERVICAL 5 VIEWS| $393 
63402121|CHEST DECUB UNILATERAL| $164 
63402122|CHEST DECUB BILATERAL| $189 
63402124|ABD COMPLETE| $340 
63402125|DIGIT (HAND) | $162 
63402126|PELVIS 1 FILM| $276 
63402130|TOMOGRAM 10| $425 
63402132|SPINE LUMBAR 3 VIEWS| $316 
63402133|SPINE LUMBAR 5 VIEWS| $441 
63402135|FACIAL BONES ZYGOMATIC| $240 
63402140|SKELETAL SURVEY ADULT| $598 
63402145|AC JOINTS W WO WEIGHTS| $219 
63402146|G-TUBE W/CONTRAST| $234 
63402147|MAMMO NEEDLE LOC| $557 
63402151|CYSTOGRAM 3 VIEWS| $522 
63402192|MAMMO STEREO BIOPSY| $3,644 
63402234|CT SINUS LIMITED| $601 
63402266|US ABD COMPLETE| $954 
63402593|SPINE SCOLIOSIS AP LAT STAND| $270 
63402594|ABD FOREIGN BODY CHILD| $361 
63402595|WRIST BONE AGE STUDIES| $147 
63402606|US VENOUS PATENCY (BILAT)| $666 
63402636|ANKLE| $256 
63402638|CALCANEUS HEEL| $192 
63402640|CLAVICLE| $236 
63402642|ELBOW| $281 
63402644|FEMUR| $225 
63402645|FOOT| $279 
63402647|HAND 2 VIEWS| $214 
63402649|HAND 3 VIEWS| $265 
63402652|HIP| $257 
63402654|HUMERUS| $229 
63402656|KNEE| $354 
63402659|RADIUS ULNA| $233 
63402661|SCAPULA| $176 
63402663|SHOULDER| $269 
63402666|TIBIA FIBULA| $244 
63402667|WRIST| $251 
63402764|MAMMO DIAGNOSTIC DIGITAL| $469 
63402779|ARTHROGRAM ELBOW| $729 
63402786|ARTHROGRAM SHOULDER| $761 
63402881|MAMMO SCREENING DIGITAL| $366 
63407747|US ECHO DOPPLER| $681 
63407774|UGI W SBFT| $920 
63407779|BONE DENSITY DEXA W/FRAX| $431 
63407814|HIP BILATERAL| $433 
63407842|MAMMO SCREENING DIGITAL BIL| $474 
63407844|MAMMO DIAGNOSTIC BIL| $550 
63407857|GASTROVIEW ENEMA| $596 
63407909|RIBS 3-VIEW| $478 
63407912|INDUSTRIAL MED CHEST PA AND LATERAL| $50 
63407914|FLUORO GUIDE FOR VEIN DEVICE| $196 
63407928|INJ FOR ARTHROGRAPHY| $176 
63407973|SNIFF TEST - 2 VIEWS| $438 
63407975|BREAST SPECIMEN| $730 
63407978|VCUG/CYSTOGRAM INJECTION| $309 
63407994|KNEE 2 VIEW| $266 
63407997|WRIST 2 VIEW| $182 
63407998|ELBOW 2 VIEW| $212 
63408001|FOOT 2 VIEW| $174 
63408002|ANKLE 2 VIEW| $174 
63408022|SPINAL TAP| $2,328 
63408040|KNEE BILATERAL| $707 
63408041|CHEST PA/LAT AND BIL DECUBS| $476 
63408042|CHEST 1 VIEW AND BIL DECUBS| $372 
63412202|CT SINUS FULL| $1,383 
63412203|CAT.RECONSTRUCTION| $166 
63412206|CT ABD WO| $1,557 
63412207|CT ABD W| $2,232 
63412208|CT HEAD WO| $1,427 
63412210|CT NECK WO| $1,462 
63412211|CT NECK W| $1,814 
63412212|CT ORBIT WO| $1,463 
63412213|CT ORBIT W| $1,981 
63412216|CT PELVIS WO| $1,593 
63412217|CT PELVIS W| $2,072 
63412220|CT IAC TEMP BONE WO| $1,463 
63412222|CT SPINE LUMBAR WO| $1,771 
63412223|CT SPINE LUMBAR W| $2,303 
63412224|CT CHEST WO| $1,655 
63412225|CT CHEST W| $1,969 
63412229|CT SPINE THORACIC WO| $1,848 
63412230|CT SPINE CERVICAL WO| $1,828 
63412235|CT FACIAL BONES WO| $1,257 
63412236|CT FACIAL BONES W| $1,353 
63412240|CT SPINE THORACIC W| $2,289 
63412442|CT CHEST HIGH RES W| $1,924 
63412577|CT CHEST HIGH RES WO| $1,655 
63412579|CT CHEST HIGH RES W WO| $2,185 
63412613|CT HEAD W WO| $2,068 
63412614|CT ORBIT W WO| $2,185 
63412615|CT FACIAL BONES W WO| $1,933 
63412616|CT NECK W WO| $2,140 
63412617|CT CHEST W WO| $2,272 
63412618|CT SPINE CERVICAL W WO| $2,528 
63412620|CT SPINE LUMBAR W WO| $2,541 
63412621|CT PELVIS W WO| $2,224 
63412624|CT ABD W WO| $2,377 
63412679|CT EXTREMITY HIP W| $1,276 
63412682|CT EXTREMITY TIB FIB W| $1,276 
63412685|CT EXTREMITY HIP WO| $1,239 
63412686|CT EXTREMITY FEMUR WO| $1,239 
63412687|CT EXTREMITY KNEE WO| $1,239 
63412690|CT EXTREMITY FOOT WO| $1,239 
63412694|CT EXTREMITY TIB FIB WO| $1,239 
63412695|CT EXTREMITY ANKLE WO| $1,239 
63412703|CT EXTREMITY HIP W WO| $1,408 
63412707|CT EXTREMITY ANKLE W WO| $1,408 
63412708|CT EXTREMITY FOOT W WO| $1,408 
63412717|CT EXTREMITY ELBOW W| $2,433 
63412722|CT EXTREMITY HUMERUS WO| $1,192 
63412725|CT EXTREMITY WRIST WO| $1,239 
63412726|CT EXTREMITY HAND WO| $1,192 
63412727|CT EXTREMITY SHOULDER WO| $1,192 
63412729|CT EXTREMITY ELBOW WO| $1,192 
63412730|CT EXTREMITY RAD ULNA WO| $1,192 
63412746|CTA EXTREMITY W WO| $2,903 
63412864|CT NEEDLE CORE BIOPSY| $1,207 
63417745|CT GUIDANCE| $1,474 
63417746|CT CYST ASPIRATION| $1,473 
63417835|CTA ABD W WO| $3,209 
63417836|CTA AORTA RUN OFF| $3,955 
63417839|CTA HEAD W WO| $3,754 
63417840|CTA CHEST| $3,533 
63417841|CTA NECK W WO| $3,325 
63417850|CT HEART SCORING| $420 
63417858|CT ABD/PELVIS WO| $3,041 
63417859|CT ABD/PELVIS W| $4,041 
63417860|CT ABD/PELVIS W WO| $4,290 
63417868|CTA ABD/PELVIS W WO| $4,329 
63417898|CT BIOPSY SOFT TISSUE/MUSCLE| $1,656 
63422502|MRI ORBIT FACE NECK WO| $2,796 
63422503|MRI BRAIN WO| $3,022 
63422508|MRI CERVICAL WO| $2,749 
63422511|MRI DORSAL WO| $2,716 
63422512|MRI DORSAL W| $2,894 
63422513|MRI LUMBAR WO| $2,702 
63422515|MRI PELVIS W| $2,279 
63422520|MRI ABD WO| $3,024 
63422524|MRA HEAD WO| $2,797 
63422807|MRI EXT KNEE W| $2,509 
63422812|MRI EXT HIP W WO| $3,000 
63422813|MRI EXT KNEE W WO| $3,000 
63422814|MRI EXT ANKLE W WO| $3,000 
63422818|MRI EXT HIP WO| $2,749 
63422819|MRI EXT KNEE WO| $2,749 
63422820|MRI EXT ANKLE WO| $2,749 
63422824|MRI EXT TIB FIB W WO| $2,500 
63422826|MRI EXT TIB FIB WO| $2,749 
63422827|MRI EXT FEMUR WO| $2,749 
63422842|MRI EXT SHOULDER W WO| $2,750 
63422845|MRI EXT SHOULDER WO| $2,749 
63422846|MRI EXT ELBOW WO| $2,749 
63422850|MRI EXT WRIST WO| $2,749 
63422851|MRI EXT HUMERUS W WO| $2,501 
63422857|MRI EXT HUMERUS WO| $2,562 
63422858|MRI EXT RAD ULNA WO| $2,562 
63422871|MRI EXT HAND WO| $2,562 
63422876|MRI EXT FOOT W WO| $2,500 
63422878|MRI EXT FOOT WO| $2,749 
63427760|MRA ABD W| $2,972 
63427781|MRA ABD WO| $2,202 
63427788|MRA HEAD W WO| $2,500 
63427789|MRA NECK WO| $2,910 
63427790|MRA NECK W| $2,910 
63427791|MRA NECK W WO| $3,305 
63427792|MRI ORBIT FACE NECK W| $2,632 
63427793|MRI ORBIT FACE NECK W WO| $3,495 
63427794|MRI PELVIS WO| $2,749 
63427795|MRI PELVIS W WO| $3,240 
63427796|MRI BRAIN W WO| $3,460 
63427799|MRI DORSAL W WO| $3,300 
63427823|MRI ABD W WO| $3,240 
63427824|MRI LUMBAR W WO| $3,259 
63427825|MRI CERVICAL W WO| $3,300 
63427925|MRV SUPERIOR SAGITTAL SINUS VENOGRAM| $2,738 
63427939|MRI BRAIN W| $3,011 
63432054|US ECHO TE AND PLACEMENT| $1,893 
63432068|US ECHO CF| $308 
63432075|US ECHO STRESS DOBUTAMINE| $1,979 
63432196|US OB ADDTL GESTATION| $516 
63432197|US HIP INFANT| $284 
63432267|US CHEST| $698 
63432302|US ENDOVAGINAL| $634 
63432303|US SPLEEN| $746 
63432304|US OB GREATER THAN 14 WEEKS| $635 
63432305|US OB FOLLOW UP| $415 
63432307|US PELVIS| $695 
63432308|US GALLBLADDER COMMON BILE DUCT| $746 
63432309|US PANCREAS COMMON BILE DUCT| $746 
63432310|US LIVER| $746 
63432312|US KIDNEY BILATERAL| $639 
63432313|US AORTA| $578 
63432317|US THYROID BILATERAL| $765 
63432318|US NEONATAL HEAD| $842 
63432320|US GUIDANCE| $797 
63432321|US TESTICULAR| $699 
63432322|US CAROTID DOPPLER BILATERAL| $1,086 
63432324|US FETAL BIOPHYSICAL PROFILE| $596 
63432326|US SOFT TISSUE HEAD AND NECK| $736 
63432328|US DOPPLER EXT BIL| $1,243 
63432331|US APPENDIX ING AREA| $746 
63432332|US BLADDER| $546 
63432334|US BREAST BILATERAL| $615 
63432336|US PROSTATE| $570 
63432337|US GASTROINTESTINAL| $746 
63432339|US ARTERIAL PRESSURES| $842 
63432572|US OB LESS THAN 14 WKS| $718 
63432628|US TETHERED CORD| $420 
63432629|US PARACENTESIS| $825 
63432631|US FNA| $881 
63432632|US NEEDLE CORE BIOPSY BREAST| $1,593 
63432749|US BREAST| $453 
63432752|US DOPPLER EXT| $666 
63432756|US EXTREMITY| $556 
63432760|US KIDNEY| $519 
63432761|US VENOUS PATENCY RIGHT| $373 
63432865|US ASPIRATION BIOPSY MAJ JOINT| $342 
63432883|US LIMITED OB| $476 
63436350|US OB ENDOVAGINAL| $473 
63436351|US OB ENDOVAGINAL CL| $316 
63437744|US NEEDLE PLACEMENT J-WIRE| $537 
63437833|US GUIDANCE VAS ACCESS| $283 
63437854|US PROSTATE NEEDLE BIOPSY| $1,368 
63437861|4D ULTRASOUND - PKG A| $150 
63437862|4D ULTRASOUND - PKG B| $175 
63437872|US QUADRANT| $746 
63437899|US BIOPSY SOFT TISSUE/MUSCLE| $1,653 
63437900|US BIOPSY LYMPH NODE| $1,194 
63437902|US THORACENTESIS| $840 
63437911|US RUQ| $765 
63437932|US ARTERIAL DOPPLER DUPLEX LE BILAT| $925 
63437933|US ARTERIAL DOPPLER DUPL LE| $660 
63437934|US ARTERIAL DOPPLER  DUPL UE| $544 
63437940|US SCREENING AAA| $306 
63437945|US RENAL ARTERY| $647 
63437946|US ABD DUPLEX VAS FLOW LTD| $970 
63437948|US SPLENIC VESSEL DUPLEX| $647 
63437950|US CELIAC AXIS DUPLEX| $647 
63437952|US STRESS ECHO TREADMILL| $1,979 
63437953|US ECHO LIMITED W OR W WO| $818 
63437954|US ECHO LIMITED| $612 
63437957|US DUPLEX LEV REFLUX| $691 
63437959|US DUPLEX LEV REFLUX BIL| $999 
63437964|US EXT MAPPING LOWER BIL| $983 
63437965|US EXT MAPPING LOWER RT| $590 
63437967|US EXT MAPPING UPPER BIL| $393 
63437969|US-ABI| $702 
63437970|US SOFT TISSUE ABD| $746 
63437971|US ECHO STRESS DOBUTA W OR W WO| $2,102 
63437977|US-ABLATION FOLLOW-UP| $691 
63437981|US BREAST LIMITED| $283 
63437991|US BUTTOCKS| $542 
63437992|US UPPER BACK| $698 
63437993|US LOWER BACK| $746 
63438032|US PENIS| $546 
63438033|US AXILLA| $556 
63438036|US GROIN DOPPLER UNILATERAL| $660 
63438037|US GROIN DOPPLER BILATERAL| $925 
63447979|MAMMO SCREENING TOMOSYNTHESIS BIL| $88 
63447980|MAMMO DIAGNOSTIC TOMOSYNTHESIS BIL| $88 
63447983|MAMMO DIAGNOSTIC TOMOSYNTHESIS UNI| $66 
63447984|MAMMO SCREENING TOMOSYNTHESIS UNI| $66 
63447986|MAMMO DIAGNOSTIC ADTL VIEWS| $373 
63459000|PET BRAIN| $5,400 
63459001|PET SKULL BASE TO MID THIGH| $5,400 
63459002|PET WB MELANOMA SCAN| $5,400 
63459003|ZZ PET FDG-18 ISOTOPE| $400 
63500006|CATH-PULSE GEN DEVICE CHANGE| $8,532 
63500238|VASC-ATHERECTOMY ILIAC ARTERY| $37,986 
63503208|CATH-INSERT/REPL PERM PACEMAKER| $10,189 
63503210|CATH-INSERT ELECTRD/PM CATH SNGL| $10,429 
63503222|CATH-RELOC POCKET PM| $3,603 
63503224|CATH-INSERT PACING LEAD & CONNECT| $24,285 
63503225|CATH-INSERT PACING LEAD ADD-ON| $1,123 
63503233|CATH-REMOVAL OF PM GENERATOR| $5,944 
63503249|CATH-INSJ/RPLCMT DEFIB W/LEAD(S)| $78,862 
63503282|CATH-IMPL PT-ACTIVATED CARD EVENT RECORD| $16,105 
63503284|CATH-REMOVAL IMPLANTABLE LOOP REC| $1,452 
63503451|CATH-RIGHT HEART| $9,598 
63503454|CATH-CORONARY ARTERY ANGIO S&I| $9,654 
63503455|CATH-CORONARY ART/GRFT ANGIO S&I| $11,935 
63503458|CATH-L HRT ARTERY/VENTRICLE ANGIO| $12,919 
63503459|CATH-L HRT ART/GRFT ANGIO| $13,378 
63503460|CATH-R&L HRT ART/VENTRICLE ANGIO| $13,766 
63503461|CATH-R&L HRT ART/GRAFT/VENTRICLE ANGIO| $14,087 
63503567|CATH-INJECT SUPRVLV AORTOGRAPHY| $173 
63503568|CATH-INJECT PULM ART HRT CATH| $173 
63503658|VASC-REMOVE TNL CV CATH| $1,092 
63504701|VASC-EVASC RPR A-AO ENDOGRAFT| $36,891 
63504704|VASC-EVASC RPR A-UNILAC NDGFT RPT| $36,891 
63504707|VASC-EVASC RPR ILIO-ILIAC ENDOGRAFT| $36,891 
63504709|VASC-PLACE XTN PROSTH EVASC RPR| $8,925 
63505605|AORTOGRAM THORACIC W SERIALOGR| $5,519 
63505625|ANGIO ABDOMINAL AORTAGRAM| $5,519 
63505630|ANGIO ABD AORTOGRAM W BILATERAL RUNOFF| $6,552 
63505710|ANGIO EXTREMITY UNIL| $4,252 
63505716|ANGIO EXTREMITY BILATERAL| $6,552 
63505756|ANGIO INTERNAL MAMMARY| $5,117 
63505820|VENOGRAM, EXTREMITY UNIL| $1,062 
63505822|VENOGRAM EXTREMITY; BILATERAL| $1,610 
63505825|VENOGRAM IVC W SERIALOGRAPHY| $6,552 
63505827|VENOGRAM SVC W SERIALOGRAPHY| $2,071 
63506005|VASC-INJECTION VENOGRAM EXTREMITY| $494 
63506010|VASC-NONSELECTIVE CATH SUP/INF VENA CAVA| $1,188 
63506140|VASC-INTRO NEEDLE/CATH EXT ARTERY| $669 
63506200|VASC-PLACE CATH AORTA| $695 
63506222|PLACE CATH CAROTID/INOM ART| $5,740 
63506224|PLACE CATH CAROTD ART| $7,221 
63506225|PLACE CATH SUBCLAVIAN ART| $5,518 
63506245|VASC-INS CATH ABD/L-EXT ART 1ST| $1,216 
63506246|VASC-INS CATH ABD/L-EXT ART 2ND| $1,216 
63506247|VASC-INS CATH ABD/L-EXT ART 3RD| $1,216 
63506251|VASC-INS CATH REN ART 1ST UNILAT| $6,553 
63506252|VASC-INS CATH REN ART 1ST BILAT| $6,553 
63506253|VASC-INS CATH REN ART 2ND+ UNILAT| $12,030 
63506556|VASC-INS NON-TUNNEL CV CATH 5 YRS/>| $2,539 
63506558|VASC-INS TUNNELED CV CATH AGE 5/>| $3,886 
63506561|VASC-INS TUNNELED CVAD W PORT| $5,722 
63506581|VASC-REPLACE TUNNELED CV CATH| $5,722 
63506589|VASC-REMOVE TNL CV CATH| $1,363 
63506901|VASC-DIAGNOSTIC FISTULOGRAM| $1,610 
63506902|VASC-PTA OF AV FISTULA| $11,353 
63506903|VASC-AV FISTULA STENT PLACEMENT| $22,947 
63506905|VASC-AV FISTULA THROMB AND PTA| $22,947 
63506906|VASC-AV FISTULA THROMB AND STENT| $27,824 
63506907|VASC-FISTULA/CENTRAL VENOUS PTA| $1,610 
63506908|VASC-FISTULA/CENTR VENOUS STENT| $1,610 
63506937|VASC-US GUIDE VASCULAR ACCESS| $437 
63507184|VASC-PRIM ART MECH THROMBECTOMY| $7,707 
63507191|VASC-INS ENDOVAS VENA CAVA FILTR| $8,094 
63507220|VASC-ILIAC REVASC| $11,616 
63507221|VASC-ILIAC REVASC W/STENT| $24,637 
63507222|VASC-ILIAC REVASC ADD-ON| $2,905 
63507223|VASC-ILIAC REVASC W/STENT ADD-ON| $2,905 
63507224|VASC-FEMORAL/POPLITEAL REVASC W/TLA| $11,616 
63507225|VASC-FEM/POPL REVAS W/ATHER| $24,637 
63507226|VASC-FEM/POPL REVASC W/STENT| $24,637 
63507227|VASC-FEM/POPL REVASC W/STENT & ATHER| $37,991 
63507228|VASC-TIBIAL/PERONEAL UNILAT REVASC W/TLA| $24,637 
63507229|VASC-TIB/PER REVASC W/ATHER| $37,991 
63507232|VASC-TIB/PER REVASC ADD-ON| $10,402 
63507233|VASC-TIBPER REVASC W/ATHER ADD-ON| $21,522 
63507236|VASC-OPEN/PERQ PLACE STENT INTIAL| $24,637 
63507237|VASC-OPEN/PERQ STENT EA ADD ARTERY| $9,787 
63507238|VASC-OPEN/PERQ STENT SAME INITIAL VEIN| $24,637 
63507239|VASC-OPEN/PERQ STENT EA ADD VEIN| $9,411 
63507248|VASC-TRLUML BALO ANGIOP 1ST VEIN| $11,353 
63507252|VASC-IVUS NONCORONARY INITIAL VESSEL| $1,188 
63507253|VASC-IVUS NONCORONARY ADD-ON VESSEL| $1,188 
63602263|ZZ NM MD SUPERVISION| $216 
63602264|NM RECORDING| $829 
63602265|ZZ NM PROFESSIONAL COMPONENTS| $216 
63602531|NM MUGA STUDY| $1,443 
63602534|NM PARATHYROID| $883 
63602543|NM THYROID UPTAKE AND SCAN| $1,226 
63602545|NM GASTRIC EMPTYING STUDY| $1,796 
63602546|NM TECHNETIUM| $21 
63602547|NM GALLIUM| $218 
63602551|NM LIVER SPLEEN SCAN| $1,046 
63602552|NM LUNG SCAN| $1,056 
63602553|NM RENAL SCAN| $1,043 
63602557|NM BONE SCAN SINGLE| $1,026 
63602559|NM BONE SCAN WHOLE BODY| $1,949 
63602561|NM SODIUM IODINE CAPSULES| $225 
63602568|NM TESTICULAR SCAN| $992 
63602576|NM ZZ MYOVIEW| $444 
63602596|NM ZZ IMAGING AGENT MAA/PULMOLITE| $321 
63602597|ZZ NM DTPA PENETATE IMAGING AGENT| $222 
63602600|NM ZZ TC 99M SESTAMIBI/CARDIOLITE| $210 
63602601|NM ZZ THALLOUS CHLORIDE/THALLIUM| $106 
63602603|NM ZZ IMAGING AGENT CHOLETEC/MEBR| $258 
63607765|NM BONE 3 PHASE| $2,786 
63607766|NM RENAL W LASIX AND OR CAPTOPRIL| $1,890 
63607773|NM SULFUR COLLOID| $304 
63607830|NM GATED STRESS| $4,726 
63607851|NM LYMPHOSCINTIGRAPHY| $1,247 
63607852|SENTINEL NODE INJECTION NO IMAGES| $450 
63607869|NM HEPATOBILIARY SYSTEM IMAGING| $1,511 
63607870|NM HEPATOBIL SYST IMAGE W/DRUG| $1,779 
63607919|NM TECHNETIUM HDP| $122 
63608012|NM GA 67 INFLAMMATORY PROCESS WB| $3,123 
63608023|STRESS TEST-PROFESSIONAL COMP| $229 
63608024|STRESS TEST-DR SUPERVISION| $229 
63608025|STRESS TEST-CARDIO, TRACING| $809 
63802311|NERVE BLOCK-SPINE LUMBAR/SACRAL| $1,171 
63804415|NERVE BLOCK-BRACHIAL PLEXUS SGL| $1,579 
63804418|NERVE BLOCK-SUPRASCAPULAR NERVE| $669 
63804441|NERVE BLOCK-FEMORAL BILATERAL| $1,528 
63804447|NERVE BLOCK-FEMORAL SGL| $764 
63804450|NERVE BLOCK-OTHR PERIPH NRV/BRANCH| $669 
63924000|WS-POST-OFFER COMP EVAL| $146 
63924005|WS-NO SHOW FEE (W/O 24 HR NOTICE)| $116 
63924009|WS-NO SHOW FEE (W/O 24 HR NOTICE)| $78 
63924010|WS-POST-OFFER COMP EVAL-OTHER| $137 
63924014|WS-POST-OFFER COMP EVAL| $182 
63924017|WS-POST-OFFER COMP EVAL| $156 
63924018|WS-NO SHOW FEE (W/O 24 HR NOTICE)| $146 
63925001|GAIT TRAINING 15 MIN| $100 
63925003|THERAPEUTIC EXERCISE 15 MIN| $85 
63925006|WHIRLPOOL WITHOUT WOUND| $78 
63925011|ADL 15 MIN| $78 
63925015|ORTHOTIC TRAINING 15 MIN| $59 
63925022|MECH TRACTION| $70 
63925023|MANUAL TRACTION 15 MIN| $76 
63925024|E-STIM UNATTENDED| $125 
63925026|VASOPNEUMATIC DEVICE| $56 
63925029|IONTOPHORESIS 15 MIN| $84 
63925032|ULTRASOUND 15 MIN| $77 
63925053|PHYSICAL PERFORMANCE TEST 15 MIN| $77 
63925068|FLUIDO THERAPY/15 MIN| $76 
63925077|NEUROMUSCULAR RE-EDUCATION 15MN| $83 
63925117|SHORT ARM SPLINT| $129 
63925123|SPLINT APPL SHORT LEG| $154 
63925128|THERAPEUTIC ACTIVITY| $76 
63925500|IMPAIRMENT RATING(W/PPT SAME DAY)| $77 
63925501|WHEELCHAIR MANAGEMENT| $66 
63925512|WHIRLPOOL WITH WOUND| $112 
63925514|CANALITH REPOSITIONING PROC| $90 
63926001|EVALUATION - INITIAL LEVEL I| $227 
63926002|EVALUATION - INITIAL LEVEL II| $289 
63926003|EVALUATION - INITIAL LEVEL III| $352 
63926004|REEVALUATION| $208 
63927000|OT-EVAL LOW COMPLEX 30 MIN| $289 
63927001|OT-EVAL MOD COMPLEX 45 MIN| $320 
63927002|OT-EVAL HIGH COMPLEX 60 MIN| $352 
63927003|OT-RE-EVAL EST PLAN CARE| $289 
63927004|OT-WHIRLPOOL WITH WOUND| $112 
63927005|OT-NON WND ELECT STIM| $125 
63927007|OT-SLCTV WND DEBRIDEM 20 CM OR <| $145 
63927009|OT-THERAPEUTIC EXERCISES EA 15 MINS| $85 
63927010|OT-NEUROMUSCULAR REEDUCATION EA 15 MINS| $83 
63927011|OT-MANUAL THERAPY EA 15 MINS| $76 
63927012|OT-ELECTRIC CURRENT THERAPY EA 15 MINS| $84 
63927013|OT-ULTRASOUND THERAPY EA 15 MINS| $77 
63927014|OT-THERAPEUTIC ACTIVITIES| $76 
63927015|OT-SELF CARE MNGMENT TRAINING| $78 
63927016|OT-ORTHOTIC MGMT AND TRAINING EA 15 MINS| $59 
63927017|OT-COGNITIVE SKILLS DEVELOPMENT| $98 
63927025|OT-E-STIM ATTENDED 15 MINUTES| $68 
63927053|OT-PHYSICAL PERFORMANCE TEST 15 MIN| $77 
63927068|OT-FLUIDO THERAPY/15 MIN| $76 
63927114|OT-SPLINT FINGER DYN| $97 
63927115|OT-SPLINT FINGER STATIC| $97 
63927117|OT-SHORT ARM SPLINT| $129 
63927501|OT-WHEELCHAIR MANAGEMENT| $66 
63949001|SPEECH/HEARING THERAPY| $270 
63949004|SWALLOWING FUNCTION EVAL| $317 
63949010|SWALLOWING DYSFUNCTION TX| $291 
63949011|SPEECH SOUND LANG COMPREHEN| $380 
63949012|MBS SWALLOWING FUNCTION EVAL| $317 
64320003|CHEMO ADMIN IV-INFUSION UP TO 1HR| $635 
64320100|CHEMO ADMIN IV-PUSH SNGL DRUG| $400 
64320105|REFILL/MAINT PUMP/RESUR SYST| $376 
64320110|EVAL AND MGMNT LEVEL I| $191 
64320112|CHEMO ADMIN-IV INFUSION SEQ HR| $223 
64320113|TX/PROPH/DG ADD SEQ IV INF| $154 
64322001|CHEMO ADMIN IV-PUSH ADDL DRUG| $229 
64322002|CHEMO ADMN IV-INFUSION EA ADD HR| $188 
64322003|CHEMO ADMIN ANTI-NEOPL SQ/IM| $218 
64322004|CHEMO ADMIN HORMON ANTINEOPL SQ/IM| $218 
64329352|CHEMO BLADDER INSTILLATION| $487 
78111007|VISION SCREENING| $15 
78111008|DOT EXAM| $50 
78111010|WORK PHYSICAL (NO OTHER TESTS)| $52 
78111013|PPD TEST| $9