Shoppable Service,CPT,Gross Charge,De-Identified minimum negotiated charge,De-identified maximum negotiated charge,Discounted Cash Price
X-RAY EYE FOR FOREIGN BODY,70030,"$2,190.00 ",#N/A,#N/A, N/A 
MANDIBLE 1-3V,70100,"$1,824.00 ",#N/A,#N/A, N/A 
MANDIBLE MIN 4V,70110,"$2,538.00 ",#N/A,#N/A, N/A 
MASTOIDS 1-2V,70120,$464.38 ,#N/A,#N/A, N/A 
MASTOIDS MIN 3V EA SIDE,70130,"$1,824.00 ",#N/A,#N/A, N/A 
FACIAL BONES 1-2 VIEWS,70140,"$2,394.00 ",#N/A,#N/A, N/A 
ZYGOMA > 2 FILMS,70150,"$2,394.00 ",#N/A,#N/A, N/A 
NASAL BONES MIN 3V,70160,"$3,024.00 ",#N/A,#N/A, N/A 
ORBITS MIN 4V,70200,"$3,024.00 ",#N/A,#N/A, N/A 
SINUSES 1-2V,70210,"$3,024.00 ",#N/A,#N/A, N/A 
SINUSES MIN 3V,70220,"$3,024.00 ",#N/A,#N/A, N/A 
SKULL 1-3 VIEWS,70250,"$2,724.00 ",#N/A,#N/A, N/A 
SKULL MIN 4V,70260,"$2,724.00 ",#N/A,#N/A, N/A 
TMJ BI,70330,"$3,024.00 ",#N/A,#N/A, N/A 
"TUBING, Y BLOOD",70355,$268.38 ,#N/A,#N/A, N/A 
NECK SOFT TISSUE,70360,"$3,024.00 ",#N/A,#N/A, N/A 
MODIFIED BA SWALLOW W/ VIDEO,70371,"$1,173.00 ",#N/A,#N/A, N/A 
CT HEAD/BRAIN W/O DYE,70450,"$7,429.00 ",#N/A,#N/A, N/A 
CT HEAD/BRAIN W/CONTRAST,70460,"$6,804.00 ",#N/A,#N/A, N/A 
CT HEAD/BRAIN W/W/O CONTRAST,70470,"$6,804.00 ",#N/A,#N/A, N/A 
CT EAR IN/OUT/MID W/O CON,70480,"$6,804.00 ",#N/A,#N/A, N/A 
CT POST FOSSA W/CONTRAST,70481,"$6,804.00 ",#N/A,#N/A, N/A 
CT EAR IN/OUT/MID W/W/O CONT   70482,70482,"$6,804.00 ",#N/A,#N/A, N/A 
CT MAX-FAC MINI W/O CONTRAST   70486,70486,"$6,804.00 ",#N/A,#N/A, N/A 
CT MAXILLOFACIAL W/CONT,70487,"$6,804.00 ",#N/A,#N/A, N/A 
CT MAXILLOFACIAL W/W/O CO,70488,"$6,048.00 ",#N/A,#N/A, N/A 
CT NECK W/CONTRAST,70491,"$6,804.00 ",#N/A,#N/A, N/A 
CT NECK W/W/O CONTRAST,70492,"$6,048.00 ",#N/A,#N/A, N/A 
CTA HEAD W/&W/O CONTRAST,70496,"$6,048.00 ",#N/A,#N/A, N/A 
MRI ORB/FACE/NECK W/CONT,70542,"$5,843.50 ",#N/A,#N/A, N/A 
MRI ORB/FACE/NECK W&WO CONT,70543,"$7,173.88 ",#N/A,#N/A, N/A 
MRA HEAD W&WO CONT,70546,"$7,974.38 ",#N/A,#N/A, N/A 
MRA NECK WO CONT,70547,"$6,366.88 ",#N/A,#N/A, N/A 
MRA NECK W/CONT,70548,"$6,188.38 ",#N/A,#N/A, N/A 
MRA NECK W&WO CONT,70549,"$7,970.50 ",#N/A,#N/A, N/A 
MRI IAC W&WO CONT              70553,70553,"$10,265.45 ",#N/A,#N/A, N/A 
Chest Xray 2 View,71046,"$3,024.00 ",#N/A,#N/A, N/A 
Chest Xray 2 View,71046,"$3,024.00 ",#N/A,#N/A, N/A 
Chest Xray 3 View,71047,"$3,024.00 ",#N/A,#N/A, N/A 
RIBS UNILATERAL WITHOUT CHEST,71100,"$2,274.00 ",#N/A,#N/A, N/A 
RIBS UNI W/ CHEST 3V,71101,"$2,634.00 ",#N/A,#N/A, N/A 
RIBS BILATERAL 3V,71110,"$3,024.00 ",#N/A,#N/A, N/A 
RIBS BILATERAL W/CHEST 4V,71111,"$3,024.00 ",#N/A,#N/A, N/A 
STERNUM MIN 2 VWS,71120,"$3,024.00 ",#N/A,#N/A, N/A 
CT CHEST W/O CONTRAST,71250,"$6,804.00 ",#N/A,#N/A, N/A 
CT CHEST W/CONTRAST,71260,"$6,804.00 ",#N/A,#N/A, N/A 
CT CHEST W&W/O CONTRAST,71270,"$6,804.00 ",#N/A,#N/A, N/A 
CT ANGIOGRAPHY CHEST,71275,"$10,046.00 ",#N/A,#N/A, N/A 
SPINE COMP AP&LAT-ENTIRE,72010,"$1,022.75 ",#N/A,#N/A, N/A 
SPINE SINGLE VIEW-ANY LEV,72020,"$3,024.00 ",#N/A,#N/A, N/A 
SPINE CERVICAL 2-3V,72040,"$3,024.00 ",#N/A,#N/A, N/A 
SPINE CERVICAL MIN 4V,72050,"$3,025.00 ",#N/A,#N/A, N/A 
CERVICAL SPINE FLEX&EXT&COMPLE,72052,"$3,025.00 ",#N/A,#N/A, N/A 
SPINE THORACOLUMBAR STAND,72069,$555.27 ,#N/A,#N/A, N/A 
SPINE THORACIC 2V,72070,"$3,024.00 ",#N/A,#N/A, N/A 
SPINE THORACIC W/SWIMMERS,72072,"$3,024.00 ",#N/A,#N/A, N/A 
SPINE THORACIC COMP W/OBL,72074,"$3,024.00 ",#N/A,#N/A, N/A 
"THORACOLUMBAR, AP & LAT",72080,"$3,024.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF LOWER SPINE,72100,"$3,258.00 ",#N/A,#N/A, N/A 
SPINE LUMBAR MIN 4V,72110,"$3,571.00 ",#N/A,#N/A, N/A 
X-RAY BEND ONLY L-S SPINE,72120,"$3,024.00 ",#N/A,#N/A, N/A 
CT NECK SPINE W/O DYE,72125,"$6,804.00 ",#N/A,#N/A, N/A 
CT CERVICAL W/CONTRAST,72126,"$6,048.00 ",#N/A,#N/A, N/A 
CT CERV W/W/O CONTRAST,72127,"$6,930.00 ",#N/A,#N/A, N/A 
CT THORACIC W/W/O CONT,72130,"$6,804.00 ",#N/A,#N/A, N/A 
CT LUMBAR W/O CONTRAST,72131,"$6,804.00 ",#N/A,#N/A, N/A 
CT LUMBAR W/CONTRAST,72132,"$6,804.00 ",#N/A,#N/A, N/A 
CT LUMBAR W/W/O CONTRAST,72133,"$6,804.00 ",#N/A,#N/A, N/A 
MRI C-SPINE W/CONT,72142,"$6,240.38 ",#N/A,#N/A, N/A 
MRI T-SPINE WO CONT,72146,"$4,859.00 ",#N/A,#N/A, N/A 
MRI T-SPINE W/CONT,72147,"$5,511.63 ",#N/A,#N/A, N/A 
MRI L-SPINE WO CONT,72148,"$8,385.37 ",#N/A,#N/A, N/A 
MRI C-SPINE W&WO CONT,72156,"$10,265.45 ",#N/A,#N/A, N/A 
MRI T-SPINE W&WO CONT,72157,"$10,265.45 ",#N/A,#N/A, N/A 
PELVIS 1V,72170,"$2,111.00 ",#N/A,#N/A, N/A 
PELVIS MIN 3V,72190,"$2,214.00 ",#N/A,#N/A, N/A 
CTA PELVIS W&W/O CONTRAST,72191,"$5,097.63 ",#N/A,#N/A, N/A 
CT PELVIS W/O CONTRAST,72192,"$6,804.00 ",#N/A,#N/A, N/A 
CT PELVIS W/CONTRAST,72193,"$6,827.00 ",#N/A,#N/A, N/A 
CT PELVIS W/W/O CONTRAST,72194,"$3,904.38 ",#N/A,#N/A, N/A 
MRI PELVIS WO CONT,72195,"$8,079.63 ",#N/A,#N/A, N/A 
MRI PELVIS W/CONT,72196,"$9,074.60 ",#N/A,#N/A, N/A 
MRI PELVIS W&WO CONT,72197,"$7,340.50 ",#N/A,#N/A, N/A 
SACROILIAC JOINTS 1-2V,72200,"$2,940.00 ",#N/A,#N/A, N/A 
SACROILIAC JOINTS MIN 3V,72202,$447.38 ,#N/A,#N/A, N/A 
SACRUM/COCCYX MIN 2V,72220,"$3,024.00 ",#N/A,#N/A, N/A 
MYELOGRAM THORACIC S&I,72255,"$3,903.42 ",#N/A,#N/A, N/A 
MYELOGRAM COMPLETE SPINE S&I,72270,"$3,024.00 ",#N/A,#N/A, N/A 
DISKOGRAPHYLUMBAR S&I,72295,"$1,309.00 ",#N/A,#N/A, N/A 
CLAVICLE RT,73000,"$3,024.00 ",#N/A,#N/A, N/A 
SCAPULA RT,73010,"$3,024.00 ",#N/A,#N/A, N/A 
SHOULDER 1V,73020,"$2,279.00 ",#N/A,#N/A, N/A 
ARTHROGRAPHY SHOULDER S&I,73040,"$4,221.69 ",#N/A,#N/A, N/A 
"XR AC JTS,BILAT W/WT BEAR",73050,"$3,024.00 ",#N/A,#N/A, N/A 
HUMERUS MIN 2V RT,73060,"$3,024.00 ",#N/A,#N/A, N/A 
ELBOW 2V RT,73070,"$3,024.00 ",#N/A,#N/A, N/A 
ELBOW MIN 3V RT,73080,"$3,024.00 ",#N/A,#N/A, N/A 
FOREARM 2V RT,73090,"$3,024.00 ",#N/A,#N/A, N/A 
UPPER EXTREMITY INFANT,73092,$622.11 ,#N/A,#N/A, N/A 
WRIST 2V LT,73100,"$3,024.00 ",#N/A,#N/A, N/A 
WRIST MIN 3V RT,73110,"$3,164.00 ",#N/A,#N/A, N/A 
ARTHROGRAPHY WRIST S&I,73115,"$1,440.25 ",#N/A,#N/A, N/A 
HAND 2V RT,73120,"$2,584.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF HAND,73130,"$3,024.00 ",#N/A,#N/A, N/A 
FINGER(S) MIN 2V,73140,"$2,274.00 ",#N/A,#N/A, N/A 
CT UPPER EXTREM W/CONT,73201,"$6,804.00 ",#N/A,#N/A, N/A 
CT UPPER EXT W/W/O CONT,73202,"$6,804.00 ",#N/A,#N/A, N/A 
CTA UPPER EXTRM W&W/O CONTRAST,73206,"$4,655.75 ",#N/A,#N/A, N/A 
MRI UP EXTREM W/CONT,73219,"$5,907.38 ",#N/A,#N/A, N/A 
MRI UP EXTREM JT W&WO CONT,73223,"$10,265.45 ",#N/A,#N/A, N/A 
"Radiologic examination, hip, unilateral, with pelv",73501,"$2,100.00 ",#N/A,#N/A, N/A 
"X-RAY HIP, UNILATERAL, W PEL IF PERF 2-3 VIEW",73502,"$3,024.00 ",#N/A,#N/A, N/A 
"X-RAY, HIP, UNILATERAL W PEL WHEN PERF 4 VIEW",73503,"$3,024.00 ",#N/A,#N/A, N/A 
HIP BI W/PELVIS,73520,$532.13 ,#N/A,#N/A, N/A 
X-Ray Hip BI W/Pelvis 2 View,73521,"$3,024.00 ",#N/A,#N/A, N/A 
X-ray Hips 3-4 View,73522,"$3,024.00 ",#N/A,#N/A, N/A 
Xray Hips Min 5 View,73523,$582.13 ,#N/A,#N/A, N/A 
ARTHROGRAPHY HIP S&I,73525,"$1,363.63 ",#N/A,#N/A, N/A 
"X-RAY, FEMUR 1 VIEW",73551,"$1,320.00 ",#N/A,#N/A, N/A 
"X-RAY, FEMUR, MIN 2 VIEW",73552,"$2,382.00 ",#N/A,#N/A, N/A 
KNEE 3V RT,73562,"$3,300.00 ",#N/A,#N/A, N/A 
KNEE MIN 4V RT,73564,"$3,024.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF KNEES,73565,"$3,024.00 ",#N/A,#N/A, N/A 
ARTHROGRAPHY KNEE S&I,73580,"$1,691.38 ",#N/A,#N/A, N/A 
TIBIA & FIBULA MIN 2V PORT,73590,"$3,024.00 ",#N/A,#N/A, N/A 
LOWER EXTREMITY INFANT RT,73592,"$3,024.00 ",#N/A,#N/A, N/A 
ANKLE 2V RT,73600,"$3,024.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF ANKLE,73610,"$3,024.00 ",#N/A,#N/A, N/A 
CONTRAST X-RAY OF ANKLE,73615,"$1,363.63 ",#N/A,#N/A, N/A 
FOOT 2V RT,73620,"$2,538.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF FOOT,73630,"$2,700.00 ",#N/A,#N/A, N/A 
HEEL OSCALCIS MIN 2V RT,73650,"$3,024.00 ",#N/A,#N/A, N/A 
TOE(S) MIN 2V LT,73660,"$1,760.00 ",#N/A,#N/A, N/A 
CT LOWER EXT W/O CONTRAST,73700,"$8,004.00 ",#N/A,#N/A, N/A 
CT LOWER EXT W/CONTRAST,73701,"$7,770.00 ",#N/A,#N/A, N/A 
CT LOWER EXT W/W/O CONT,73702,"$4,143.00 ",#N/A,#N/A, N/A 
CTA LOWER EXTRM W&W/O CONTRAST,73706,"$5,991.93 ",#N/A,#N/A, N/A 
MRI LOW EXTREM WO CONT,73718,"$7,814.00 ",#N/A,#N/A, N/A 
MRI LOW EXTREM W/CONT,73719,"$6,005.38 ",#N/A,#N/A, N/A 
MRI LOW EXTREM W&WO CONT,73720,"$10,265.45 ",#N/A,#N/A, N/A 
MRI LOW EXTREM JT WO CONT,73721,"$6,086.21 ",#N/A,#N/A, N/A 
MRI LOW EXTREM JT W/CONT,73722,"$9,074.60 ",#N/A,#N/A, N/A 
MRI LOW EXTREM JT W&WO CONT,73723,"$10,265.45 ",#N/A,#N/A, N/A 
Abd Xray 1 View,74018,"$2,142.00 ",#N/A,#N/A, N/A 
Abd Xray 2 View,74019,"$2,058.00 ",#N/A,#N/A, N/A 
"Abd Xray, 3 Or More Views",74021,"$2,389.00 ",#N/A,#N/A, N/A 
ABDOMEN ACUTE W/PA CHEST,74022,"$2,275.00 ",#N/A,#N/A, N/A 
CT ABDOMEN W/O CONTRAST,74150,"$7,177.00 ",#N/A,#N/A, N/A 
CT ABDOMEN W/CONTRAST,74160,"$7,177.00 ",#N/A,#N/A, N/A 
CT ABDOMEN W/W/O CONT,74170,"$4,079.25 ",#N/A,#N/A, N/A 
CT ANGIO ABD&PELV W/O&W/DYE,74174,"$6,804.00 ",#N/A,#N/A, N/A 
CTA ABDOMEN W&W/O CONTRAST,74175,"$7,170.00 ",#N/A,#N/A, N/A 
CT ABD & PELVIS,74176,"$12,476.00 ",#N/A,#N/A, N/A 
CT ABD & PELV W/CONTRAST,74177,"$14,400.80 ",#N/A,#N/A, N/A 
CT ABDOMEN & PELVIS W/ W/O CONTRAST,74178,"$6,810.00 ",#N/A,#N/A, N/A 
MRI ABD W&WO CONT,74183,"$10,265.45 ",#N/A,#N/A, N/A 
ESOPHAGUS W/GASTROGRAFFIN,74220,"$1,176.13 ",#N/A,#N/A, N/A 
BARIUM SWALLOW,74230,"$1,167.88 ",#N/A,#N/A, N/A 
REMOVE ESOPHAGUS OBSTRUCTION,74235,"$1,960.00 ",#N/A,#N/A, N/A 
UPPER GI SERIES,74240,"$3,024.00 ",#N/A,#N/A, N/A 
UPPER GI W/KUB,74241,"$3,024.00 ",#N/A,#N/A, N/A 
CONTRST X-RAY UPPR GI TRACT,74246,"$1,653.75 ",#N/A,#N/A, N/A 
CONTRST X-RAY UPPR GI TRACT,74247,"$7,068.81 ",#N/A,#N/A, N/A 
CONTRST X-RAY UPPR GI TRACT,74249,"$2,088.75 ",#N/A,#N/A, N/A 
SMALL BOWEL SERIES W/GAST,74250,"$3,024.00 ",#N/A,#N/A, N/A 
SMALL BOWEL/ENTEROCOLYSIS,74251,"$3,024.00 ",#N/A,#N/A, N/A 
BARIUM ENEMA W/GAST,74270,"$1,956.38 ",#N/A,#N/A, N/A 
CHOLECYSTO ORAL CONTRAST,74290,$899.38 ,#N/A,#N/A, N/A 
X-RAY BILE DUCTS/PANCREAS,74300,$570.38 ,#N/A,#N/A, N/A 
X-RAYS AT SURGERY ADD-ON,74301,$336.00 ,#N/A,#N/A, N/A 
X-RAY BILE STONE REMOVAL,74327,"$1,800.25 ",#N/A,#N/A, N/A 
ERCP BILIARY DUCT,74328,"$4,282.00 ",#N/A,#N/A, N/A 
ERCP PANCREATIC DUCT S&I,74329,"$3,024.00 ",#N/A,#N/A, N/A 
X-RAY GUIDE FOR GI TUBE,74340,"$1,500.00 ",#N/A,#N/A, N/A 
X-RAY GUIDE INTESTINAL TUBE,74355,"$1,874.00 ",#N/A,#N/A, N/A 
X-RAY GUIDE GI DILATION,74360,"$2,038.63 ",#N/A,#N/A, N/A 
X-RAY BILE DUCT DILATION,74363,"$1,376.75 ",#N/A,#N/A, N/A 
CONTRST X-RAY URINARY TRACT,74400,"$7,068.81 ",#N/A,#N/A, N/A 
CONTRST X-RAY URINARY TRACT,74415,"$1,781.38 ",#N/A,#N/A, N/A 
CONTRST X-RAY URINARY TRACT,74420,"$1,622.75 ",#N/A,#N/A, N/A 
CONTRST X-RAY URINARY TRACT,74425,$915.38 ,#N/A,#N/A, N/A 
CONTRAST X-RAY BLADDER,74430,$520.13 ,#N/A,#N/A, N/A 
VASOGRAM S&I,74440,"$3,024.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF PENIS,74445,"$1,300.75 ",#N/A,#N/A, N/A 
X-RAY URETHRA/BLADDER,74450,$983.75 ,#N/A,#N/A, N/A 
URETHROCYSTOGRAM VOIDING S&I,74455,"$1,087.00 ",#N/A,#N/A, N/A 
X-RAY EXAM OF KIDNEY LESION,74470,$996.63 ,#N/A,#N/A, N/A 
X-RAY CONTROL CATH INSERT,74480,"$1,244.63 ",#N/A,#N/A, N/A 
X-RAY GUIDE GU DILATION,74485,"$1,248.88 ",#N/A,#N/A, N/A 
HYSTEROSALPINGOGRAPHY S&I,74740,$993.38 ,#N/A,#N/A, N/A 
X-RAY FALLOPIAN TUBE,74742,$962.25 ,#N/A,#N/A, N/A 
X-RAY EXAM OF PERINEUM,74775,"$1,163.00 ",#N/A,#N/A, N/A 
AORTA ABD W/BI ILIOFEM S&I,75630,"$2,336.88 ",#N/A,#N/A, N/A 
CTA AORTA W/RUNOFFS W&W/O CONT,75635,"$7,068.81 ",#N/A,#N/A, N/A 
ANGIO EXTREME UNI W/CONT S&I,75710,"$2,285.50 ",#N/A,#N/A, N/A 
ANGIO PELVIC SEL/SUP SEL S&I,75736,"$2,217.25 ",#N/A,#N/A, N/A 
ANGIO PUL UN SELECT S&I,75741,"$2,063.38 ",#N/A,#N/A, N/A 
ANGIO SELEC ADD VESSEL S&I,75774,"$1,286.63 ",#N/A,#N/A, N/A 
VENO EXTREMITY UNI S&I,75820,"$1,611.25 ",#N/A,#N/A, N/A 
VENO EXTREMITY BI S&I,75822,"$2,003.38 ",#N/A,#N/A, N/A 
VENO CAVAL INF W/SERIAL S&I,75825,"$1,896.63 ",#N/A,#N/A, N/A 
ANGIO VIA EXIST CATH S&I,75898,"$1,600.13 ",#N/A,#N/A, N/A 
TRANSCATH INT IV STENT S&I,75960,"$1,589.88 ",#N/A,#N/A, N/A 
ANGIOPLASTY ADD PERIP ART S&I,75964,"$1,239.50 ",#N/A,#N/A, N/A 
ANGIOPLSTY RENAL/VISC ART S&I,75966,"$2,251.25 ",#N/A,#N/A, N/A 
ANGIOPLASTY ADD VISC ART S&I,75968,"$1,125.38 ",#N/A,#N/A, N/A 
ANGIOPLASTY VENOUS S&I,75978,"$1,900.88 ",#N/A,#N/A, N/A 
DRAIN PERC TRANS HEP S&I,75980,"$3,771.50 ",#N/A,#N/A, N/A 
CHG PERC TUBE/CATH CONT S&I,75984,"$1,423.75 ",#N/A,#N/A, N/A 
S&I RAD GUID PERC DRN/CATH PLT,75989,"$1,586.75 ",#N/A,#N/A, N/A 
C-ARM OVER 1 HOUR,76001,"$1,839.38 ",#N/A,#N/A, N/A 
INFANT NOSE TO RECTUM,76010,"$2,520.00 ",#N/A,#N/A, N/A 
SURGICAL SPECIMEN X-RAY,76098,$238.50 ,#N/A,#N/A, N/A 
TOMOGRAPHY,76100,"$1,273.88 ",#N/A,#N/A, N/A 
XRAY READING OUTSIDE,76140,$0.00 ,#N/A,#N/A, N/A 
3D  ULTSND PRCSS NO IND WRKSTN,76376,$754.25 ,#N/A,#N/A, N/A 
3D  ULTSND PRCSS IND WRKSTN,76377,"$1,036.13 ",#N/A,#N/A, N/A 
CT LTD/FOLLOW UP STUDY,76380,"$6,804.00 ",#N/A,#N/A, N/A 
UNLISTED FLUOROSCOPIC PROC,76496,"$1,428.25 ",#N/A,#N/A, N/A 
UNLISTED CT PROC,76497,"$1,235.88 ",#N/A,#N/A, N/A 
Ophthalmic Ultrasound;Diagnostic of Eye,76512,"$1,202.88 ",#N/A,#N/A, N/A 
US SOFT TISS HEAD/NECK,76536,"$3,024.00 ",#N/A,#N/A, N/A 
US CHST W/MEDIASTINUM,76604,"$2,865.56 ",#N/A,#N/A, N/A 
US Breast,76642,"$1,194.00 ",#N/A,#N/A, N/A 
US ECHO BREAST UNI/BI,76645,"$1,142.00 ",#N/A,#N/A, N/A 
Ultrasound - Abdominal Complete,76700,"$3,224.00 ",#N/A,#N/A, N/A 
ECHO EXAM OF ABDOMEN,76705,"$4,003.00 ",#N/A,#N/A, N/A 
US RENAL BI & AORTA W/NODES,76770,"$2,153.00 ",#N/A,#N/A, N/A 
US EXAM ABDO BACK WALL LIM,76775,"$3,024.00 ",#N/A,#N/A, N/A 
Ultrasound - OB Abd < 14 weeks,76801,"$2,724.00 ",#N/A,#N/A, N/A 
OB US < 14 WKS ADDL FETUS,76802,"$1,170.00 ",#N/A,#N/A, N/A 
Ultrasound - OB Abd > 14 weeks,76805,"$3,024.00 ",#N/A,#N/A, N/A 
ULS OBSTET POST 1RST EA ADL,76810,"$3,024.00 ",#N/A,#N/A, N/A 
ULS OBSTETRIC DETAIL FIRST TRI,76811,"$2,377.25 ",#N/A,#N/A, N/A 
ULS OBSTETRIC DETAILED EA ADDL,76812,"$1,916.63 ",#N/A,#N/A, N/A 
ULTRSND PREGNANCY LMTD,76815,"$1,151.88 ",#N/A,#N/A, N/A 
US FETAL FOLLOW UP,76816,"$1,854.00 ",#N/A,#N/A, N/A 
Ultrasound - OB Transvaginal,76817,"$3,024.00 ",#N/A,#N/A, N/A 
U/S FETAL BIOPHYS PROF W/NST,76818,"$1,578.50 ",#N/A,#N/A, N/A 
DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,76827,$759.63 ,#N/A,#N/A, N/A 
Ultrasound - Transvaginal - non OB,76830,"$3,208.00 ",#N/A,#N/A, N/A 
3N-HYSTROSONOGRAM,76831,"$1,615.88 ",#N/A,#N/A, N/A 
Ultrasound - Pelvis,76856,"$3,024.00 ",#N/A,#N/A, N/A 
Pelvic US limited,76857,"$2,724.00 ",#N/A,#N/A, N/A 
US EXAM SCROTUM,76870,"$3,654.00 ",#N/A,#N/A, N/A 
ECHOGRAHY TRANSRECTAL,76872,$920.88 ,#N/A,#N/A, N/A 
ECHOGRAP TRANS R PROS STUDY,76873,"$2,170.63 ",#N/A,#N/A, N/A 
US XTR NON-VASC COMPLETE,76881,"$3,024.00 ",#N/A,#N/A, N/A 
LIMITED EXTREMITY ULS,76882,"$1,520.97 ",#N/A,#N/A, N/A 
USG PERICARDIOCENTESIS,76930,"$1,075.25 ",#N/A,#N/A, N/A 
U/S GUIDED REPAIR PSEUDO-ANEUR,76936,"$2,571.75 ",#N/A,#N/A, N/A 
US GUIDE FOR VASCULAR ACCESS,76937,$455.50 ,#N/A,#N/A, N/A 
ECHO GUIDE FOR BIOPSY,76942,"$2,612.50 ",#N/A,#N/A, N/A 
U/S AMNIOCENTESIS GUIDE,76946,$409.50 ,#N/A,#N/A, N/A 
FLUORO CENT VEN ACCESS DEV,77001,"$1,516.88 ",#N/A,#N/A, N/A 
FLUORO GUIDE SPINE,77003,"$1,202.13 ",#N/A,#N/A, N/A 
CT GUIDED NEEDLE BIOPSY,77012,"$1,612.63 ",#N/A,#N/A, N/A 
MAMMO GUIDE NEEDLE LOC BREAST,77032,$656.63 ,#N/A,#N/A, N/A 
MAMMO EXTRA VIEW,77055,"$1,116.88 ",#N/A,#N/A, N/A 
BONE AGE STUDIES,77072,$298.25 ,#N/A,#N/A, N/A 
BONE SURVEY LIMITED,77074,$894.88 ,#N/A,#N/A, N/A 
BONE DENSITY DEXA,77080,$630.63 ,#N/A,#N/A, N/A 
THYROID METASTASES W/BODY,78018,"$4,035.75 ",#N/A,#N/A, N/A 
PLASMA VOLUMNE SINGLE SAMPLE,78110,"$1,188.13 ",#N/A,#N/A, N/A 
LIVER/SPLEEN SCAN STATIC ONLY,78215,"$2,517.88 ",#N/A,#N/A, N/A 
GASTRIC EMPTYING SCAN,78264,"$3,690.38 ",#N/A,#N/A, N/A 
UREA BREATH TEST C-14ACQ ANALY,78267,$135.13 ,#N/A,#N/A, N/A 
UREA BREATH TEST C-14 ANALYSIS,78268,"$1,157.38 ",#N/A,#N/A, N/A 
SCHILLING TEST W/O INTR FACTOR,78270,"$1,099.38 ",#N/A,#N/A, N/A 
SCHILLING TEST W/FACTOR,78271,"$1,201.63 ",#N/A,#N/A, N/A 
SCHILLING TEST W&W/O FACTOR,78272,"$1,209.75 ",#N/A,#N/A, N/A 
GI BLEEDING SCAN ACUTE,78278,"$3,801.75 ",#N/A,#N/A, N/A 
MECKELS DIVERTICULUM SCAN,78290,"$3,617.88 ",#N/A,#N/A, N/A 
PERITONEAL SHUNT PATENCY TEST,78291,"$3,298.25 ",#N/A,#N/A, N/A 
ACUTE VENOUS THROMB IMAG PEPTI,78456,"$4,577.63 ",#N/A,#N/A, N/A 
LUNG PERFUSION,78580,"$3,064.13 ",#N/A,#N/A, N/A 
BRAIN IMAGING COMPLETE STATIC  78605,78605,"$2,547.88 ",#N/A,#N/A, N/A 
BRAIN SCAN TOMOGRAP SPECT,78607,"$4,535.13 ",#N/A,#N/A, N/A 
CISTERNOGRAPHY,78630,"$4,457.38 ",#N/A,#N/A, N/A 
CSF SHUNT EVALUATION,78645,"$3,643.13 ",#N/A,#N/A, N/A 
CSF LEAKAGE DETECT/LOCALIZE,78650,"$4,307.75 ",#N/A,#N/A, N/A 
KIDNEY W/FLOW&FUNCT W/O PHARM,78707,"$2,970.75 ",#N/A,#N/A, N/A 
KIDNEY W/FLOW&FUNCT W/ PHARM,78708,"$2,195.50 ",#N/A,#N/A, N/A 
KIDNEY SPECT,78710,"$2,634.13 ",#N/A,#N/A, N/A 
TUMOR LOCAL LTD AREA,78800,"$2,445.63 ",#N/A,#N/A, N/A 
TUMOR LOCAL MULT AREAS,78801,"$3,140.63 ",#N/A,#N/A, N/A 
LOCAL INFLAMM PROCESS WB,78806,"$4,274.38 ",#N/A,#N/A, N/A 
UNLISTED NUC MED PROC,78999,"$1,425.38 ",#N/A,#N/A, N/A 
METABOLIC PANEL BASIC CA TOTAL,80048,"$1,430.00 ",#N/A,#N/A, N/A 
ELECTROLYTE PANEL,80051,$540.00 ,#N/A,#N/A, N/A 
COMPREHEN METABOLIC PANEL,80053,"$1,794.00 ",#N/A,#N/A, N/A 
LIPID PANEL,80061,"$1,512.00 ",#N/A,#N/A, N/A 
RENAL FUNCTION PANEL,80069,$149.25 ,#N/A,#N/A, N/A 
AMIKACIN LEVEL,80150,$259.00 ,#N/A,#N/A, N/A 
CYCLOSPORINE LEVEL,80158,$310.13 ,#N/A,#N/A, N/A 
DIGOXIN,80162,$780.00 ,#N/A,#N/A, N/A 
VALPROIC ACID,80164,$960.00 ,#N/A,#N/A, N/A 
GENTAMICIN LEVEL TROUGH,80170,$494.88 ,#N/A,#N/A, N/A 
LIDOCAINE,80176,$252.38 ,#N/A,#N/A, N/A 
LITHIUM,80178,$113.63 ,#N/A,#N/A, N/A 
PHENOBARBITAL (LUMINAL),80184,$196.75 ,#N/A,#N/A, N/A 
PHENYTOIN (DILANTIN),80185,$243.10 ,#N/A,#N/A, N/A 
PRIMIDONE (MYSOLINE),80188,$285.13 ,#N/A,#N/A, N/A 
N-ACETYL PROCAINAMIDE,80192,$287.88 ,#N/A,#N/A, N/A 
SALICYLATE,80196,$166.59 ,#N/A,#N/A, N/A 
PROGRAF (TACROLIMUS) LEVEL,80197,$235.88 ,#N/A,#N/A, N/A 
THEOPHYLLINE (AMNIOPHYLLIN,80198,$459.20 ,#N/A,#N/A, N/A 
TOBRAMYCIN PEAK,80200,$277.00 ,#N/A,#N/A, N/A 
VANCOMYCIN PEAK,80202,$232.88 ,#N/A,#N/A, N/A 
OXCARBAZEPINE,80299,"$1,020.00 ",#N/A,#N/A, N/A 
Drug Screen Class,80305,$493.00 ,#N/A,#N/A, N/A 
Presumptive Drug Testing,80307,$756.00 ,#N/A,#N/A, N/A 
"Analgesics, Non-opioid 1 Or 2",80329,$684.00 ,#N/A,#N/A, N/A 
"Cannabinoids, Natural",80349,$480.00 ,#N/A,#N/A, N/A 
Definitive Drug Test,80358,$756.00 ,#N/A,#N/A, N/A 
URINE DIPSTICK,81000,$510.00 ,#N/A,#N/A, N/A 
URINALYSIS AUTO W/SCOPE,81001,$690.00 ,#N/A,#N/A, N/A 
URINALYSIS AUTO W/O SCOPE,81003,$545.00 ,#N/A,#N/A, N/A 
URINE SCREEN FOR BACTERIA,81007,$44.13 ,#N/A,#N/A, N/A 
MICROSCOPIC EXAM OF URINE,81015,$124.12 ,#N/A,#N/A, N/A 
URINALYSIS GLASS TEST,81020,$63.38 ,#N/A,#N/A, N/A 
URINE PREGNANCY TEST,81025,$684.00 ,#N/A,#N/A, N/A 
KETONE SERUM,82009,$74.88 ,#N/A,#N/A, N/A 
"ACETONE ASSAY, Quanitative",82010,$382.00 ,#N/A,#N/A, N/A 
ACETYLCHOLINESTERASE,82013,$121.38 ,#N/A,#N/A, N/A 
ACTH,82024,$663.75 ,#N/A,#N/A, N/A 
ALBUMIN SERUM,82040,$204.00 ,#N/A,#N/A, N/A 
ALBUMIN FLUID,82042,$88.88 ,#N/A,#N/A, N/A 
MICROALBUMIN URINE,82043,$95.75 ,#N/A,#N/A, N/A 
ASSAY OF BREATH ETHANOL,82075,$600.00 ,#N/A,#N/A, N/A 
ALDOLASE,82085,$166.75 ,#N/A,#N/A, N/A 
ALDOSTERONE,82088,$700.25 ,#N/A,#N/A, N/A 
ALPHA-FETOPROTEIN SERUM,82105,$288.25 ,#N/A,#N/A, N/A 
AMMONIA BLOOD,82140,"$1,020.00 ",#N/A,#N/A, N/A 
ANGIOTENSION II,82163,$150.25 ,#N/A,#N/A, N/A 
ANGIOTENSIN CONV ENZYME,82164,$250.88 ,#N/A,#N/A, N/A 
BETA 2 MICROGLOBULIN,82232,$278.00 ,#N/A,#N/A, N/A 
BILIRUBIN TOTAL,82247,$366.00 ,#N/A,#N/A, N/A 
BILIRUBIN DIRECT,82248,$450.00 ,#N/A,#N/A, N/A 
HEMOCULT/GASTROCULT,82270,"$1,512.00 ",#N/A,#N/A, N/A 
BLOOD OCCULT GUIAC SINGL SPEC,82272,"$1,512.00 ",#N/A,#N/A, N/A 
ASSAY TEST FOR BLOOD FECAL,82274,$273.25 ,#N/A,#N/A, N/A 
CADMIUM,82300,$397.63 ,#N/A,#N/A, N/A 
VITAMIN D 25-OH,82306,"$1,020.00 ",#N/A,#N/A, N/A 
CALCITONIN,82308,$460.25 ,#N/A,#N/A, N/A 
CALCIUM BLOOD,82310,$504.00 ,#N/A,#N/A, N/A 
ISTAT ION CALCIUM,82330,$504.00 ,#N/A,#N/A, N/A 
STONE ANALYSIS QUAN,82360,$221.13 ,#N/A,#N/A, N/A 
CARBON DIOXIDE,82374,$360.00 ,#N/A,#N/A, N/A 
CARBOXYHEMOGLOBIN,82375,$211.75 ,#N/A,#N/A, N/A 
CARBON MONOXIDE TEST,82376,$103.00 ,#N/A,#N/A, N/A 
CEA,82378,$326.00 ,#N/A,#N/A, N/A 
CATECHOLAMINES TOTAL URIN,82382,$295.50 ,#N/A,#N/A, N/A 
CATECHOLAMINES BLOOD,82383,$430.63 ,#N/A,#N/A, N/A 
CERULOPLASMIN,82390,$184.50 ,#N/A,#N/A, N/A 
ISTAT CHLORIDE,82435,$300.00 ,#N/A,#N/A, N/A 
CHLORIDE RANDOM URINE,82436,$86.38 ,#N/A,#N/A, N/A 
"CHOLINESTERASE,SERUM",82480,$135.38 ,#N/A,#N/A, N/A 
"CHOLINESTERASE,RBC",82482,$132.00 ,#N/A,#N/A, N/A 
CHROMIUM,82495,$348.50 ,#N/A,#N/A, N/A 
CITRATE,82507,$477.75 ,#N/A,#N/A, N/A 
CORTISOL 24HR URINE,82530,$287.13 ,#N/A,#N/A, N/A 
CORTISOL AM,82533,$408.00 ,#N/A,#N/A, N/A 
CREATINE MB FRACTION,82553,$780.00 ,#N/A,#N/A, N/A 
Blood Creatinine,82565,$468.00 ,#N/A,#N/A, N/A 
CREATININE URINE RANDOM,82570,$136.11 ,#N/A,#N/A, N/A 
CREATININE CLEARANCE,82575,$162.38 ,#N/A,#N/A, N/A 
CRYOGLOBULIN,82595,$111.13 ,#N/A,#N/A, N/A 
CYSTATIN C,82610,$233.63 ,#N/A,#N/A, N/A 
ERYTHROPOIETIN,82668,$780.00 ,#N/A,#N/A, N/A 
ESTRADIOL,82670,$480.13 ,#N/A,#N/A, N/A 
ESTRIOL,82677,$415.63 ,#N/A,#N/A, N/A 
FECAL FAT SCREEN,82705,$87.38 ,#N/A,#N/A, N/A 
FERRITIN,82728,$660.00 ,#N/A,#N/A, N/A 
FOLIC ACID RBC,82747,$358.00 ,#N/A,#N/A, N/A 
CSF IGG,82784,$810.00 ,#N/A,#N/A, N/A 
IMMUNOGLOBULIN E,82785,$283.00 ,#N/A,#N/A, N/A 
"Gases, blood, pH only",82800,$145.38 ,#N/A,#N/A, N/A 
Blood Gases,82803,$649.00 ,#N/A,#N/A, N/A 
BLOOD GASES W/O2 SATURATION,82805,$426.32 ,#N/A,#N/A, N/A 
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen),82820,$171.63 ,#N/A,#N/A, N/A 
GASTRIN,82941,$303.00 ,#N/A,#N/A, N/A 
Clinitest Body Fluid Non-Blood,82945,$474.00 ,#N/A,#N/A, N/A 
GLUCOSE BLOOD,82947,$276.00 ,#N/A,#N/A, N/A 
REAGENT STRIP/BLOOD GLUCOSE (TO LAB),82948,$684.00 ,#N/A,#N/A, N/A 
GLUCOSE 1HR PC/50G,82950,$81.63 ,#N/A,#N/A, N/A 
GLUCOSE TOL 2HR,82951,$221.13 ,#N/A,#N/A, N/A 
GLUCOSE TOL 4TH HR ONLY,82952,$67.38 ,#N/A,#N/A, N/A 
GLUCOSE BLOOD TEST,82962,$276.00 ,#N/A,#N/A, N/A 
GGT,82977,$600.00 ,#N/A,#N/A, N/A 
FSH,83001,$319.25 ,#N/A,#N/A, N/A 
LUTEINIZING HORMONE,83002,$318.25 ,#N/A,#N/A, N/A 
GROWTH HORMONE (HGH),83003,$286.63 ,#N/A,#N/A, N/A 
H PYLORI (C-13) BLOOD,83009,$606.00 ,#N/A,#N/A, N/A 
HAPTOGLOBIN QUANT,83010,$216.13 ,#N/A,#N/A, N/A 
HEAVY METAL SCREEN,83015,$323.63 ,#N/A,#N/A, N/A 
HGB ELECT,83020,$251.50 ,#N/A,#N/A, N/A 
HEMOGLOBIN CHROMOTOGRAPHY,83021,$310.25 ,#N/A,#N/A, N/A 
"A1C HEMOGLOBIN, GLYCOSYLATED",83036,$330.00 ,#N/A,#N/A, N/A 
METHEMOGLOBIN,83050,$50.63 ,#N/A,#N/A, N/A 
HYDROXYINDOLACETIC 5-HIAA,83497,$79.88 ,#N/A,#N/A, N/A 
HYDROXYPROGESTERONE 17-D,83498,$466.88 ,#N/A,#N/A, N/A 
MYELOPEROXIDASE (MPO) ANTIBODS,83516,$198.25 ,#N/A,#N/A, N/A 
"IMMUNOASSAY ANALYSIS, QUAL/SEMI-QUANT, SINGLE-STEP",83518,$145.63 ,#N/A,#N/A, N/A 
GLUTAMIC ACID DECARBOXYLASE,83519,$232.13 ,#N/A,#N/A, N/A 
CELIAC DISEASE ANTIBOD,83520,$225.50 ,#N/A,#N/A, N/A 
INSULIN,83525,$342.00 ,#N/A,#N/A, N/A 
IRON,83540,"$1,020.00 ",#N/A,#N/A, N/A 
LACTIC ACID,83605,$570.00 ,#N/A,#N/A, N/A 
LDH SERUM,83615,$600.00 ,#N/A,#N/A, N/A 
LDH ISOENZYMES,83625,$220.00 ,#N/A,#N/A, N/A 
LIPASE,83690,$556.00 ,#N/A,#N/A, N/A 
"HDL CHOLESTEROL, LIPOPROTEIN ASSAY",83718,$420.00 ,#N/A,#N/A, N/A 
MAGNESIUM,83735,$600.00 ,#N/A,#N/A, N/A 
METANEPHRINES 24 HR URINE,83835,$780.00 ,#N/A,#N/A, N/A 
"MICROFLUID ANALYSIS, TEARS",83861,$283.88 ,#N/A,#N/A, N/A 
MUCIN SYNOVIAL FLUID,83872,$100.75 ,#N/A,#N/A, N/A 
MYELIN BASIC PROTEIN CSF,83873,$295.63 ,#N/A,#N/A, N/A 
MYOGLOBIN,83874,$780.00 ,#N/A,#N/A, N/A 
B-NATRIURETIC PEPTIDE,83880,"$1,056.00 ",#N/A,#N/A, N/A 
OLIGOCLONAL BANDS,83916,$345.50 ,#N/A,#N/A, N/A 
FENTANYL AND METABOLITE,83925,$334.25 ,#N/A,#N/A, N/A 
OSMOLALITY URINE,83935,$169.53 ,#N/A,#N/A, N/A 
PARATHYROID HORMONE,83970,$709.25 ,#N/A,#N/A, N/A 
"PH ASSAY, BODY FLUID, NOS",83986,$61.50 ,#N/A,#N/A, N/A 
PKU BLOOD,84030,$94.50 ,#N/A,#N/A, N/A 
PROSTATIC ACID PHOSPHATAS,84066,$166.00 ,#N/A,#N/A, N/A 
ALKALINE PHOS TOTAL,84075,$306.00 ,#N/A,#N/A, N/A 
PHOSPHORUS,84100,$292.00 ,#N/A,#N/A, N/A 
PHOSPHORUS 24HR URINE,84105,$88.88 ,#N/A,#N/A, N/A 
PORPHOB. URINE(QUANT),84110,$145.00 ,#N/A,#N/A, N/A 
PORPHYRIN URINE QUANT,84120,$252.75 ,#N/A,#N/A, N/A 
PREALBUMIN,84134,$145.13 ,#N/A,#N/A, N/A 
PROGESTERONE,84144,$358.50 ,#N/A,#N/A, N/A 
PROLACTIN,84146,$333.00 ,#N/A,#N/A, N/A 
PSA TOTAL,84153,$650.00 ,#N/A,#N/A, N/A 
PSA FREE,84154,$316.13 ,#N/A,#N/A, N/A 
"PROTEIN SERUM ASSAY, BLOOD, TOTAL",84155,$347.00 ,#N/A,#N/A, N/A 
ASSAY OF PROTEIN OTHER,84157,$425.00 ,#N/A,#N/A, N/A 
PROTEIN PHORESIS URINE,84166,$251.50 ,#N/A,#N/A, N/A 
PROINSULIN,84206,$306.13 ,#N/A,#N/A, N/A 
ACETYLCHOLINE RECEPTOR BINDING,84238,$628.38 ,#N/A,#N/A, N/A 
RENIN,84244,$378.00 ,#N/A,#N/A, N/A 
SELENIUM,84255,$438.75 ,#N/A,#N/A, N/A 
SEROTONIN,84260,$298.88 ,#N/A,#N/A, N/A 
ISTAT SODIUM,84295,$240.00 ,#N/A,#N/A, N/A 
SODIUM RANDOM URINE,84300,$345.75 ,#N/A,#N/A, N/A 
INSULIN LK GRWTH FAC 1 (IGF-1),84305,$365.25 ,#N/A,#N/A, N/A 
SPECIFIC GRAVITY-OTHER,84315,$43.13 ,#N/A,#N/A, N/A 
TESTOSTERONE FREE,84402,$437.50 ,#N/A,#N/A, N/A 
TESTOSTERONE TOTAL,84403,$443.63 ,#N/A,#N/A, N/A 
THYROXINE TOTAL T4,84436,$438.00 ,#N/A,#N/A, N/A 
THYROXINE FREE T4,84439,$538.00 ,#N/A,#N/A, N/A 
TSH (THYROID STIM HORMONE) ASSAY,84443,$774.00 ,#N/A,#N/A, N/A 
SGPT OR ALT,84460,$300.00 ,#N/A,#N/A, N/A 
TRANSFERRIN,84466,$360.00 ,#N/A,#N/A, N/A 
TRIGLYCERIDES,84478,$858.00 ,#N/A,#N/A, N/A 
T-3 TOTAL,84480,$684.00 ,#N/A,#N/A, N/A 
T-3 FREE,84481,$570.00 ,#N/A,#N/A, N/A 
T-3 REVERSE,84482,$132.25 ,#N/A,#N/A, N/A 
TROPONIN QUANTITATIVE,84484,"$1,055.00 ",#N/A,#N/A, N/A 
Urea Nitrogen,84520,$431.00 ,#N/A,#N/A, N/A 
UREA NITROGEN 24HR URINE,84540,$81.63 ,#N/A,#N/A, N/A 
"URIC ACID ASSAY, BLOOD",84550,$684.00 ,#N/A,#N/A, N/A 
URIC ACID FLUID,84560,$540.00 ,#N/A,#N/A, N/A 
URINE VANILYMANDELIC ACID,84585,$266.25 ,#N/A,#N/A, N/A 
VASOACT INTES PEPTIDE-VIP,84586,$239.75 ,#N/A,#N/A, N/A 
C PEPTIDE,84681,$357.63 ,#N/A,#N/A, N/A 
BETA HCG QUANT SERUM,84702,"$1,176.00 ",#N/A,#N/A, N/A 
"HCG, GONADOTROPIN, CHORIONIC, QUAL",84703,"$1,020.00 ",#N/A,#N/A, N/A 
MISC CHEMISTRY,84999,$0.00 ,#N/A,#N/A, N/A 
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