Shoppable Service,CPT,Gross Charge,De-Identified minimum negotiated charge,De-identified maximum negotiated charge,Discounted Cash Price 3D ULTSND PRCSS IND WRKSTN,76377," $1,036.13 ", N/A , N/A , N/A 3D ULTSND PRCSS NO IND WRKSTN,76376," $1,855.01 ", N/A , N/A , N/A 3N-HYSTROSONOGRAM,76831," $1,615.88 ", N/A , N/A , N/A "A1C HEMOGLOBIN, GLYCOSYLATED",83036, $330.00 , 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 "ACETONE ASSAY, Quanitative",82010, $382.00 , N/A , N/A , N/A ACETYLCHOLINE RECEPTOR BINDING,84238, $628.38 , 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 ACUTE VENOUS THROMB IMAG PEPTI,78456," $4,577.63 ", N/A , N/A , N/A ALBUMIN FLUID,82042, $88.88 , N/A , N/A , N/A ALBUMIN SERUM,82040, $204.00 , 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 ALKALINE PHOS TOTAL,84075, $306.00 , N/A , N/A , N/A ALPHA-FETOPROTEIN SERUM,82105, $288.25 , N/A , N/A , N/A AMIKACIN LEVEL,80150, $259.00 , N/A , N/A , N/A AMMONIA BLOOD,82140," $1,020.00 ", N/A , N/A , N/A "Analgesics, Non-opioid 1 Or 2",80329, $684.00 , 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 ANGIO VIA EXIST CATH S&I,75898," $1,600.13 ", N/A , N/A , N/A ANGIOPLASTY ADD PERIP ART S&I,75964," $1,239.50 ", 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 ANGIOPLSTY RENAL/VISC ART S&I,75966," $2,251.25 ", N/A , N/A , N/A ANGIOTENSIN CONV ENZYME,82164, $250.88 , N/A , N/A , N/A ANGIOTENSION II,82163, $150.25 , N/A , N/A , N/A ANKLE 2V RT,73600," $3,024.00 ", N/A , N/A , N/A AORTA ABD W/BI ILIOFEM S&I,75630," $2,336.88 ", N/A , N/A , N/A ARTHROGRAPHY HIP S&I,73525," $1,363.63 ", N/A , N/A , N/A ARTHROGRAPHY KNEE S&I,73580," $1,691.38 ", N/A , N/A , N/A ARTHROGRAPHY SHOULDER S&I,73040," $4,221.69 ", N/A , N/A , N/A ARTHROGRAPHY WRIST S&I,73115," $1,440.25 ", N/A , N/A , N/A ASSAY OF AMYLASE,82150, $572.00 , N/A , N/A , N/A ASSAY OF BREATH ETHANOL,82075, $600.00 , N/A , N/A , N/A ASSAY OF PROTEIN OTHER,84157, $524.10 , N/A , N/A , N/A ASSAY TEST FOR BLOOD FECAL,82274, $273.25 , N/A , N/A , N/A BARIUM ENEMA W/GAST,74270," $1,956.38 ", N/A , N/A , N/A BARIUM SWALLOW,74230," $1,167.88 ", N/A , N/A , N/A BETA 2 MICROGLOBULIN,82232, $278.00 , N/A , N/A , N/A BETA HCG QUANT SERUM,84702," $1,176.00 ", N/A , N/A , N/A BILIRUBIN DIRECT,82248, $450.00 , N/A , N/A , N/A BILIRUBIN TOTAL,82247, $366.00 , N/A , N/A , N/A BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,85025," $1,512.00 ", N/A , N/A , N/A BLOOD COUNT COMPLETE AUTOMATED,85027, $408.00 , N/A , N/A , N/A Blood Creatinine,82565, $468.00 , 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 BLOOD OCCULT GUIAC SINGL SPEC,82272," $1,512.00 ", N/A , N/A , N/A B-NATRIURETIC PEPTIDE,83880," $1,056.00 ", N/A , N/A , N/A BONE AGE STUDIES,77072, $298.25 , N/A , N/A , N/A BONE DENSITY DEXA,77080, $630.63 , N/A , N/A , N/A BONE SURVEY LIMITED,77074, $894.88 , 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 C PEPTIDE,84681, $357.63 , N/A , N/A , N/A CADMIUM,82300, $397.63 , 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 "Cannabinoids, Natural",80349, $480.00 , N/A , N/A , N/A CARBON DIOXIDE,82374, $360.00 , N/A , N/A , N/A CARBON MONOXIDE TEST,82376, $103.00 , N/A , N/A , N/A CARBOXYHEMOGLOBIN,82375, $211.75 , N/A , N/A , N/A C-ARM OVER 1 HOUR,76001," $1,839.38 ", N/A , N/A , N/A CATECHOLAMINES BLOOD,82383, $430.63 , N/A , N/A , N/A CATECHOLAMINES TOTAL URIN,82382, $295.50 , N/A , N/A , N/A CEA,82378, $326.00 , N/A , N/A , N/A CELIAC DISEASE ANTIBOD,83520, $225.50 , N/A , N/A , N/A CERULOPLASMIN,82390, $184.50 , N/A , N/A , N/A CERVICAL SPINE FLEX&EXT&COMPLE,72052," $3,025.00 ", 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 CHG PERC TUBE/CATH CONT S&I,75984," $1,423.75 ", N/A , N/A , N/A CHLORIDE RANDOM URINE,82436, $86.38 , N/A , N/A , N/A CHOLECYSTO ORAL CONTRAST,74290, $899.38 , N/A , N/A , N/A "CHOLINESTERASE,RBC",82482, $132.00 , N/A , N/A , N/A "CHOLINESTERASE,SERUM",82480, $135.38 , N/A , N/A , N/A CHROMIUM,82495, $348.50 , N/A , N/A , N/A CISTERNOGRAPHY,78630," $4,457.38 ", N/A , N/A , N/A CITRATE,82507, $477.75 , N/A , N/A , N/A CLAVICLE RT,73000," $3,024.00 ", N/A , N/A , N/A Clinitest Body Fluid Non-Blood,82945, $474.00 , N/A , N/A , N/A COLLECTION VENOUS BLOOD VENIPUNCTURE,36415, $456.00 , N/A , N/A , N/A COMPREHEN METABOLIC PANEL,80053," $1,794.00 ", N/A , N/A , N/A CONTRAST X-RAY BLADDER,74430, $520.13 , N/A , N/A , N/A CONTRAST X-RAY OF ANKLE,73615," $1,363.63 ", 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 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 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 CREATININE CLEARANCE,82575, $162.38 , N/A , N/A , N/A CREATININE URINE RANDOM,82570, $136.11 , N/A , N/A , N/A CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,99292," $3,427.08 ", N/A , N/A , N/A CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,99291," $9,026.00 ", N/A , N/A , N/A CRYOGLOBULIN,82595, $111.13 , N/A , N/A , N/A CSF IGG,82784, $810.00 , N/A , N/A , N/A CSF LEAKAGE DETECT/LOCALIZE,78650," $4,307.75 ", N/A , N/A , N/A CSF SHUNT EVALUATION,78645," $3,643.13 ", N/A , N/A , N/A CT ABD & PELV W/CONTRAST,74177," $14,400.80 ", N/A , N/A , N/A CT ABD & PELVIS,74176," $12,476.00 ", N/A , N/A , N/A CT ABDOMEN & PELVIS W/ W/O CONTRAST,74178," $12,554.73 ", N/A , N/A , N/A CT ABDOMEN W/CONTRAST,74160," $7,177.00 ", N/A , N/A , N/A CT ABDOMEN W/O CONTRAST,74150," $7,177.00 ", N/A , N/A , N/A CT ABDOMEN W/W/O CONT,74170," $7,261.96 ", N/A , N/A , N/A CT ANGIO ABD&PELV W/O&W/DYE,74174," $10,368.99 ", N/A , N/A , N/A CT ANGIOGRAPHY CHEST,71275," $10,046.00 ", N/A , N/A , N/A CT CERV W/W/O CONTRAST,72127," $6,930.00 ", N/A , N/A , N/A CT CERVICAL W/CONTRAST,72126," $6,048.00 ", N/A , N/A , N/A CT CHEST W&W/O CONTRAST,71270," $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/O CONTRAST,71250," $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 EAR IN/OUT/MID W/W/O CONT 70482,70482," $6,804.00 ", N/A , N/A , N/A CT GUIDED NEEDLE BIOPSY,77012," $1,612.63 ", 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/O DYE,70450," $7,429.00 ", N/A , N/A , N/A CT HEAD/BRAIN W/W/O CONTRAST,70470," $7,507.13 ", 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/O CONTRAST,73700," $8,004.00 ", N/A , N/A , N/A CT LOWER EXT W/W/O CONT,73702," $6,407.70 ", N/A , N/A , N/A CT LTD/FOLLOW UP STUDY,76380," $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/O CONTRAST,72131," $6,804.00 ", N/A , N/A , N/A CT LUMBAR W/W/O CONTRAST,72133," $7,366.48 ", 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," $6,249.52 ", N/A , N/A , N/A CT NECK SPINE W/O DYE,72125," $8,000.07 ", 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," $6,650.40 ", N/A , N/A , N/A CT PELVIS W/CONTRAST,72193," $6,827.00 ", N/A , N/A , N/A CT PELVIS W/O CONTRAST,72192," $6,804.00 ", N/A , N/A , N/A CT PELVIS W/W/O CONTRAST,72194," $7,507.13 ", N/A , N/A , N/A CT POST FOSSA W/CONTRAST,70481," $6,804.00 ", N/A , N/A , N/A CT THORACIC W/W/O CONT,72130," $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 CT UPPER EXTREM W/CONT,73201," $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 CTA AORTA W/RUNOFFS W&W/O CONT,75635," $7,068.81 ", N/A , N/A , N/A CTA HEAD W/&W/O CONTRAST,70496," $7,000.13 ", N/A , N/A , N/A CTA LOWER EXTRM W&W/O CONTRAST,73706," $5,991.93 ", N/A , N/A , N/A CTA PELVIS W&W/O CONTRAST,72191," $5,991.23 ", N/A , N/A , N/A CTA UPPER EXTRM W&W/O CONTRAST,73206," $7,114.54 ", N/A , N/A , N/A CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,87086, $465.00 , N/A , N/A , N/A CYCLOSPORINE LEVEL,80158, $310.13 , N/A , N/A , N/A CYSTATIN C,82610, $233.63 , N/A , N/A , N/A "Cytopathology, cervical/vaginal, automated thin layer",88174, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, automated thin layer, manual rescreen",88175, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, automated, manual rescreen",88143, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, interpretation only",88141, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, screening, automated",88147, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, screening, automated, manual rescreen",88148, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, smears, automated, manual rescreen",88167, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, smears, manual screening",88166, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, smears, physician interpretation",88165, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, thin layer, automated",88153, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, thin layer, automated, manual rescreen",88154, N/A , N/A , N/A , N/A "Cytopathology, cervical/vaginal, thin layer, manual screening, physician",88152, N/A , N/A , N/A , N/A Definitive Drug Test,80358, $756.00 , N/A , N/A , N/A DIGOXIN,80162, $780.00 , N/A , N/A , N/A DISKOGRAPHYLUMBAR S&I,72295," $1,309.00 ", N/A , N/A , N/A DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,76827," $1,948.41 ", N/A , N/A , N/A DRAIN PERC TRANS HEP S&I,75980," $3,771.50 ", N/A , N/A , N/A Drug Screen Class,80305, $493.00 , N/A , N/A , N/A ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,93010, $240.00 , N/A , N/A , N/A ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,93005, $960.00 , N/A , N/A , N/A ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,93000, $756.00 , N/A , N/A , N/A ECHO EXAM OF ABDOMEN,76705," $4,003.00 ", N/A , N/A , N/A ECHO GUIDE FOR BIOPSY,76942," $2,612.50 ", 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 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 ELECTROLYTE PANEL,80051, $540.00 , N/A , N/A , N/A EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,99284," $5,400.00 ", N/A , N/A , N/A EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,99281," $1,199.00 ", N/A , N/A , N/A EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,99282," $2,400.00 ", N/A , N/A , N/A EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,99283," $5,040.00 ", N/A , N/A , N/A EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,99285," $7,553.32 ", 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 ERYTHROPOIETIN,82668, $780.00 , N/A , N/A , N/A ESOPHAGUS W/GASTROGRAFFIN,74220," $2,160.91 ", 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 FACIAL BONES 1-2 VIEWS,70140," $2,394.00 ", N/A , N/A , N/A FECAL FAT SCREEN,82705, $87.38 , N/A , N/A , N/A FENTANYL AND METABOLITE,83925, $334.25 , N/A , N/A , N/A FERRITIN,82728, $660.00 , N/A , N/A , N/A FINGER(S) MIN 2V,73140," $2,274.00 ", 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 FOLIC ACID RBC,82747, $358.00 , N/A , N/A , N/A FOOT 2V RT,73620," $2,538.00 ", N/A , N/A , N/A FOREARM 2V RT,73090," $3,024.00 ", N/A , N/A , N/A FSH,83001, $319.25 , N/A , N/A , N/A "Gases, blood, pH only",82800, $193.47 , N/A , N/A , N/A GASTRIC EMPTYING SCAN,78264," $3,690.38 ", N/A , N/A , N/A GASTRIN,82941, $303.00 , N/A , N/A , N/A General health panel,80050, N/A , N/A , N/A , N/A GENTAMICIN LEVEL TROUGH,80170, $494.88 , N/A , N/A , N/A GGT,82977, $600.00 , N/A , N/A , N/A GI BLEEDING SCAN ACUTE,78278," $3,801.75 ", N/A , N/A , N/A GLUCOSE 1HR PC/50G,82950, $81.63 , N/A , N/A , N/A GLUCOSE BLOOD,82947, $276.00 , N/A , N/A , N/A GLUCOSE BLOOD TEST,82962, $283.05 , 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 GLUTAMIC ACID DECARBOXYLASE,83519, $232.13 , N/A , N/A , N/A GROWTH HORMONE (HGH),83003, $286.63 , N/A , N/A , N/A H PYLORI (C-13) BLOOD,83009," $1,157.38 ", N/A , N/A , N/A HAND 2V RT,73120," $2,584.00 ", N/A , N/A , N/A HAPTOGLOBIN QUANT,83010, $216.13 , N/A , N/A , N/A "HCG, GONADOTROPIN, CHORIONIC, QUAL",84703," $1,020.00 ", N/A , N/A , N/A "HDL CHOLESTEROL, LIPOPROTEIN ASSAY",83718, $420.00 , N/A , N/A , N/A HEAVY METAL SCREEN,83015, $323.63 , N/A , N/A , N/A HEEL OSCALCIS MIN 2V RT,73650," $3,024.00 ", N/A , N/A , N/A HEMOCULT/GASTROCULT,82270," $1,512.00 ", N/A , N/A , N/A HEMOGLOBIN CHROMOTOGRAPHY,83021, $310.25 , 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 HETEROPHILE ANTIBODIES SCREEN,86308, $524.00 , N/A , N/A , N/A HGB ELECT,83020, $251.50 , N/A , N/A , N/A HIP BI W/PELVIS,73520, $532.13 , N/A , N/A , N/A "HPV, high-risk types, detection",87624, N/A , N/A , N/A , N/A HUMERUS MIN 2V RT,73060," $3,024.00 ", 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 HYSTEROSALPINGOGRAPHY S&I,74740, $993.38 , N/A , N/A , N/A IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,87491, $756.00 , N/A , N/A , N/A IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,87591, $408.00 , N/A , N/A , N/A IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,90471, $324.00 , N/A , N/A , N/A IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,90472, $420.00 , N/A , N/A , N/A "IMMUNOASSAY ANALYSIS, QUAL/SEMI-QUANT, SINGLE-STEP",83518, $145.63 , N/A , N/A , N/A IMMUNOGLOBULIN E,82785, $283.00 , N/A , N/A , N/A INFANT NOSE TO RECTUM,76010," $2,520.00 ", N/A , N/A , N/A Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2,87635, $600.00 , N/A , N/A , N/A INSULIN,83525, $342.00 , N/A , N/A , N/A INSULIN LK GRWTH FAC 1 (IGF-1),84305, $365.25 , N/A , N/A , N/A IRON,83540," $1,020.00 ", N/A , N/A , N/A ISTAT CHLORIDE,82435, $335.46 , N/A , N/A , N/A ISTAT ION CALCIUM,82330, $504.00 , N/A , N/A , N/A ISTAT SODIUM,84295, $240.00 , N/A , N/A , N/A KETONE SERUM,82009, $195.50 , N/A , N/A , N/A KIDNEY SPECT,78710," $2,634.13 ", N/A , N/A , N/A KIDNEY W/FLOW&FUNCT W/ PHARM,78708," $2,195.50 ", N/A , N/A , N/A KIDNEY W/FLOW&FUNCT W/O PHARM,78707," $2,970.75 ", 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 LACTIC ACID,83605, $570.00 , N/A , N/A , N/A LDH ISOENZYMES,83625, $220.00 , N/A , N/A , N/A LDH SERUM,83615, $600.00 , N/A , N/A , N/A LEAD ASSAY,83655, $208.00 , N/A , N/A , N/A LIDOCAINE,80176, $252.38 , N/A , N/A , N/A LIMITED EXTREMITY ULS,76882," $1,520.97 ", N/A , N/A , N/A LIPASE,83690, $556.00 , N/A , N/A , N/A LIPID PANEL,80061," $1,512.00 ", N/A , N/A , N/A LITHIUM,80178, $113.63 , N/A , N/A , N/A LIVER/SPLEEN SCAN STATIC ONLY,78215," $2,517.88 ", N/A , N/A , N/A LOCAL INFLAMM PROCESS WB,78806," $4,274.38 ", N/A , N/A , N/A LOWER EXTREMITY INFANT RT,73592," $3,024.00 ", N/A , N/A , N/A LUNG PERFUSION,78580," $3,064.13 ", N/A , N/A , N/A LUTEINIZING HORMONE,83002, $318.52 , N/A , N/A , N/A MAGNESIUM,83735, $600.00 , N/A , N/A , N/A MAMMO EXTRA VIEW,77055," $1,116.88 ", N/A , N/A , N/A MAMMO GUIDE NEEDLE LOC BREAST,77032, $656.63 , N/A , N/A , N/A MANDIBLE 1-3V,70100, $153.75 , 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 MECKELS DIVERTICULUM SCAN,78290," $3,617.88 ", N/A , N/A , N/A METABOLIC PANEL BASIC CA TOTAL,80048," $1,430.00 ", N/A , N/A , N/A METANEPHRINES 24 HR URINE,83835, $780.00 , N/A , N/A , N/A METHEMOGLOBIN,83050, $50.63 , N/A , N/A , N/A MICROALBUMIN URINE,82043, $95.75 , N/A , N/A , N/A "MICROALBUMIN, URINE, SEMIQUANTITATIVE ASSAY",82044, $79.00 , N/A , N/A , N/A "MICROFLUID ANALYSIS, TEARS",83861, $283.88 , N/A , N/A , N/A MICROSCOPIC EXAM OF URINE,81015, $124.12 , N/A , N/A , N/A MISC CHEMISTRY,84999, N/A , N/A , N/A , N/A MODIFIED BA SWALLOW W/ VIDEO,70371," $1,173.00 ", N/A , N/A , N/A MRA HEAD W&WO CONT,70546," $7,974.38 ", N/A , N/A , N/A MRA NECK W&WO CONT,70549," $7,970.50 ", N/A , N/A , N/A MRA NECK W/CONT,70548," $6,188.38 ", N/A , N/A , N/A MRA NECK WO CONT,70547," $6,366.88 ", N/A , N/A , N/A MRI ABD W&WO CONT,74183," $10,265.45 ", N/A , N/A , N/A MRI C-SPINE W&WO CONT,72156," $10,265.45 ", N/A , N/A , N/A MRI C-SPINE W/CONT,72142," $6,240.38 ", N/A , N/A , N/A MRI IAC W&WO CONT 70553,70553," $10,265.45 ", N/A , N/A , N/A MRI LOW EXTREM JT W&WO CONT,73723," $10,265.45 ", 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 WO CONT,73721," $6,086.21 ", 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 W/CONT,73719," $6,005.38 ", N/A , N/A , N/A MRI LOW EXTREM WO CONT,73718," $7,814.00 ", N/A , N/A , N/A MRI L-SPINE WO CONT,72148," $8,385.37 ", N/A , N/A , N/A MRI ORB/FACE/NECK W&WO CONT,70543," $7,173.88 ", N/A , N/A , N/A MRI ORB/FACE/NECK W/CONT,70542," $5,843.50 ", N/A , N/A , N/A MRI PELVIS W&WO CONT,72197," $7,340.50 ", N/A , N/A , N/A MRI PELVIS W/CONT,72196," $9,074.60 ", N/A , N/A , N/A MRI PELVIS WO CONT,72195," $8,079.63 ", N/A , N/A , N/A MRI T-SPINE W&WO CONT,72157," $10,265.45 ", N/A , N/A , N/A MRI T-SPINE W/CONT,72147," $5,511.63 ", N/A , N/A , N/A MRI T-SPINE WO CONT,72146," $4,859.00 ", N/A , N/A , N/A MRI UP EXTREM JT W&WO CONT,73223," $10,265.45 ", N/A , N/A , N/A MRI UP EXTREM W/CONT,73219," $5,907.38 ", 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 MYELOGRAM COMPLETE SPINE S&I,72270," $3,024.00 ", N/A , N/A , N/A MYELOGRAM THORACIC S&I,72255," $3,903.42 ", N/A , N/A , N/A MYELOPEROXIDASE (MPO) ANTIBODS,83516, $198.25 , N/A , N/A , N/A MYOGLOBIN,83874, $780.00 , N/A , N/A , N/A N-ACETYL PROCAINAMIDE,80192, $287.88 , N/A , N/A , N/A NASAL BONES MIN 3V,70160," $3,024.00 ", N/A , N/A , N/A NECK SOFT TISSUE,70360," $3,024.00 ", N/A , N/A , N/A OB US < 14 WKS ADDL FETUS,76802," $1,170.00 ", N/A , N/A , N/A "Office/outpatient visit, established, 10-19 minutes",99212, N/A , N/A , N/A , N/A "Office/outpatient visit, established, 20-29 minutes",99213, N/A , N/A , N/A , N/A "Office/outpatient visit, established, 30-39 minutes",99214, N/A , N/A , N/A , N/A "Office/outpatient visit, established, 40-54 minutes",99215, N/A , N/A , N/A , N/A "Office/outpatient visit, new, 15-29 minutes",99202, N/A , N/A , N/A , N/A "Office/outpatient visit, new, 30-44 minutes",99203, N/A , N/A , N/A , N/A "Office/outpatient visit, new, 45-59 minutes",99204, N/A , N/A , N/A , N/A "Office/outpatient visit, new, 60-74 minutes",99205, N/A , N/A , N/A , N/A OLIGOCLONAL BANDS,83916, $345.50 , N/A , N/A , N/A Ophthalmic Ultrasound;Diagnostic of Eye,76512," $3,140.55 ", N/A , N/A , N/A ORBITS MIN 4V,70200," $3,024.00 ", N/A , N/A , N/A OSMOLALITY URINE,83935, $169.53 , N/A , N/A , N/A OXCARBAZEPINE,80299," $1,020.00 ", N/A , N/A , N/A PAP SMEAR DIAGNOSTIC,88150, $181.63 , N/A , N/A , N/A PAP SMEAR DIAGNOSTIC-BETHESDA,88164, $181.63 , N/A , N/A , N/A PAP SMEAR THIN PREP DIAGNOSTIC,88142, $348.13 , N/A , N/A , N/A PARATHYROID HORMONE,83970, $709.25 , N/A , N/A , N/A Pelvic US limited,76857," $2,724.00 ", 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 PERITONEAL SHUNT PATENCY TEST,78291," $3,298.25 ", N/A , N/A , N/A "PH ASSAY, BODY FLUID, NOS",83986, $61.50 , 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 PHOSPHORUS,84100, $292.00 , N/A , N/A , N/A PHOSPHORUS 24HR URINE,84105, $88.88 , N/A , N/A , N/A PKU BLOOD,84030, $94.50 , N/A , N/A , N/A PLASMA VOLUMNE SINGLE SAMPLE,78110," $1,188.13 ", 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 POTASSIUM SERUM PLASMA/WHOLE BLOOD,84132, $300.00 , N/A , N/A , N/A PREALBUMIN,84134, $170.74 , N/A , N/A , N/A Presumptive Drug Testing,80307, $756.00 , N/A , N/A , N/A PRIMIDONE (MYSOLINE),80188, $285.13 , N/A , N/A , N/A PROGESTERONE,84144, $358.50 , N/A , N/A , N/A PROGRAF (TACROLIMUS) LEVEL,80197, $520.57 , N/A , N/A , N/A PROINSULIN,84206, $306.13 , N/A , N/A , N/A PROLACTIN,84146, $754.31 , N/A , N/A , N/A PROSTATIC ACID PHOSPHATAS,84066, $166.00 , N/A , N/A , N/A PROTEIN PHORESIS URINE,84166, $251.50 , N/A , N/A , N/A "PROTEIN SERUM ASSAY, BLOOD, TOTAL",84155, $347.00 , N/A , N/A , N/A PROTHROMBIN TIME,85610, $934.00 , N/A , N/A , N/A PSA FREE,84154, $316.13 , N/A , N/A , N/A PSA TOTAL,84153, $650.00 , N/A , N/A , N/A "Psychotherapy, 30 minutes with patient",90832, N/A , N/A , N/A , N/A "Psychotherapy, 45 minutes with patient",90834, N/A , N/A , N/A , N/A "Psychotherapy, 60 minutes with patient",90837, N/A , N/A , N/A , N/A "Radiologic examination, hip, unilateral, with pelv",73501," $2,571.81 ", N/A , N/A , N/A REAGENT STRIP/BLOOD GLUCOSE (TO LAB),82948, $684.00 , N/A , N/A , N/A REMOVE ESOPHAGUS OBSTRUCTION,74235," $1,960.00 ", N/A , N/A , N/A RENAL FUNCTION PANEL,80069, $149.25 , N/A , N/A , N/A RENIN,84244, $378.00 , 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 RIBS UNI W/ CHEST 3V,71101," $2,634.00 ", N/A , N/A , N/A RIBS UNILATERAL WITHOUT CHEST,71100," $2,274.00 ", N/A , N/A , N/A S&I RAD GUID PERC DRN/CATH PLT,75989," $1,586.75 ", 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 SALICYLATE,80196, $166.59 , N/A , N/A , N/A SCAPULA RT,73010," $3,024.00 ", N/A , N/A , N/A SCHILLING TEST W&W/O FACTOR,78272," $1,209.75 ", N/A , N/A , N/A SCHILLING TEST W/FACTOR,78271," $1,201.63 ", N/A , N/A , N/A SCHILLING TEST W/O INTR FACTOR,78270," $1,099.38 ", N/A , N/A , N/A SELENIUM,84255, $438.75 , N/A , N/A , N/A SENSITIVITY MIC,87186, $148.50 , N/A , N/A , N/A SEROTONIN,84260, $298.88 , N/A , N/A , N/A SGPT OR ALT,84460, $300.00 , N/A , N/A , N/A SHOULDER 1V,73020," $2,279.00 ", 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 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 SMR PRIM SRC WET MOUNT NFCT AGT,87210," $1,020.00 ", N/A , N/A , N/A SODIUM RANDOM URINE,84300, $345.75 , N/A , N/A , N/A SPECIFIC GRAVITY-OTHER,84315, $43.13 , 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 SPINE COMP AP&LAT-ENTIRE,72010," $1,022.75 ", N/A , N/A , N/A SPINE LUMBAR MIN 4V,72110," $3,571.00 ", N/A , N/A , N/A SPINE SINGLE VIEW-ANY LEV,72020," $3,024.00 ", N/A , N/A , N/A SPINE THORACIC 2V,72070," $3,024.00 ", N/A , N/A , N/A SPINE THORACIC COMP W/OBL,72074," $3,024.00 ", N/A , N/A , N/A SPINE THORACIC W/SWIMMERS,72072," $3,024.00 ", N/A , N/A , N/A SPINE THORACOLUMBAR STAND,72069, $555.27 , N/A , N/A , N/A STERNUM MIN 2 VWS,71120," $3,024.00 ", N/A , N/A , N/A STONE ANALYSIS QUAN,82360, $221.13 , N/A , N/A , N/A SURGICAL SPECIMEN X-RAY,76098, $238.50 , N/A , N/A , N/A T-3 FREE,84481, $570.00 , N/A , N/A , N/A T-3 REVERSE,84482, $275.41 , N/A , N/A , N/A T-3 TOTAL,84480, $684.00 , 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 THEOPHYLLINE (AMNIOPHYLLIN,80198, $459.20 , N/A , N/A , N/A "THORACOLUMBAR, AP & LAT",72080," $3,024.00 ", N/A , N/A , N/A THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,85730, $359.00 , N/A , N/A , N/A THYROID METASTASES W/BODY,78018," $4,035.75 ", N/A , N/A , N/A THYROXINE FREE T4,84439, $538.00 , N/A , N/A , N/A THYROXINE TOTAL T4,84436, $438.00 , N/A , N/A , N/A TIBIA & FIBULA MIN 2V PORT,73590," $3,024.00 ", N/A , N/A , N/A TMJ BI,70330," $3,024.00 ", N/A , N/A , N/A TOBRAMYCIN PEAK,80200, $277.00 , N/A , N/A , N/A TOE(S) MIN 2V LT,73660," $1,760.00 ", N/A , N/A , N/A TOMOGRAPHY,76100," $1,273.88 ", N/A , N/A , N/A TRANSCATH INT IV STENT S&I,75960," $1,589.88 ", N/A , N/A , N/A TRANSFERASE ASPARTATE AMINO AST SGOT,84450, $356.00 , 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 TROPONIN QUANTITATIVE,84484," $1,055.00 ", N/A , N/A , N/A TSH (THYROID STIM HORMONE) ASSAY,84443, $774.00 , N/A , N/A , N/A "TUBING, Y BLOOD",70355, $268.38 , 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 U/S AMNIOCENTESIS GUIDE,76946, $409.50 , N/A , N/A , N/A U/S FETAL BIOPHYS PROF W/NST,76818," $1,578.50 ", N/A , N/A , N/A U/S GUIDED REPAIR PSEUDO-ANEUR,76936," $2,571.75 ", 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 Ultrasound - Abdominal Complete,76700," $3,224.00 ", N/A , N/A , N/A Ultrasound - OB Abd < 14 weeks,76801," $2,865.56 ", N/A , N/A , N/A Ultrasound - OB Abd > 14 weeks,76805," $3,024.00 ", N/A , N/A , N/A Ultrasound - OB Transvaginal,76817," $3,024.00 ", N/A , N/A , N/A Ultrasound - Pelvis,76856," $3,024.00 ", N/A , N/A , N/A Ultrasound - Transvaginal - non OB,76830," $3,208.00 ", N/A , N/A , N/A ULTRSND PREGNANCY LMTD,76815," $2,300.00 ", N/A , N/A , N/A UNLISTED CT PROC,76497," $1,235.88 ", N/A , N/A , N/A UNLISTED FLUOROSCOPIC PROC,76496," $1,428.25 ", N/A , N/A , N/A UNLISTED NUC MED PROC,78999," $1,425.38 ", N/A , N/A , N/A UPPER EXTREMITY INFANT,73092," $2,019.18 ", 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 UREA BREATH TEST C-14 ANALYSIS,78268," $1,157.38 ", N/A , N/A , N/A UREA BREATH TEST C-14ACQ ANALY,78267, $135.13 , 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 URETHROCYSTOGRAM VOIDING S&I,74455," $1,087.00 ", 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 URINALYSIS AUTO W/O SCOPE,81003, $545.00 , N/A , N/A , N/A URINALYSIS AUTO W/SCOPE,81001, $690.00 , N/A , N/A , N/A URINALYSIS GLASS TEST,81020, $63.38 , N/A , N/A , N/A URINE DIPSTICK,81000, $510.00 , N/A , N/A , N/A URINE PREGNANCY TEST,81025, $684.00 , N/A , N/A , N/A URINE SCREEN FOR BACTERIA,81007, $350.00 , N/A , N/A , N/A URINE VANILYMANDELIC ACID,84585, $266.25 , N/A , N/A , N/A US Breast,76642," $1,941.41 ", N/A , N/A , N/A US CHST W/MEDIASTINUM,76604," $2,865.56 ", N/A , N/A , N/A US ECHO BREAST UNI/BI,76645," $1,142.00 ", N/A , N/A , N/A US EXAM ABDO BACK WALL LIM,76775," $3,024.00 ", N/A , N/A , N/A US EXAM SCROTUM,76870," $3,654.00 ", N/A , N/A , N/A US FETAL FOLLOW UP,76816," $1,854.00 ", N/A , N/A , N/A US GUIDE FOR VASCULAR ACCESS,76937," $2,671.18 ", N/A , N/A , N/A US RENAL BI & AORTA W/NODES,76770," $2,865.56 ", N/A , N/A , N/A US SOFT TISS HEAD/NECK,76536," $3,024.00 ", N/A , N/A , N/A US XTR NON-VASC COMPLETE,76881," $3,024.00 ", N/A , N/A , N/A USG PERICARDIOCENTESIS,76930," $1,075.25 ", N/A , N/A , N/A VALPROIC ACID,80164, $960.00 , N/A , N/A , N/A VANCOMYCIN PEAK,80202," $1,764.75 ", N/A , N/A , N/A VASOACT INTES PEPTIDE-VIP,84586, $239.75 , N/A , N/A , N/A VASOGRAM S&I,74440," $3,024.00 ", N/A , N/A , N/A VENO CAVAL INF W/SERIAL S&I,75825," $1,896.63 ", N/A , N/A , N/A VENO EXTREMITY BI S&I,75822," $2,003.38 ", N/A , N/A , N/A VENO EXTREMITY UNI S&I,75820," $1,611.25 ", N/A , N/A , N/A VITAMIN D 25-OH,82306," $1,020.00 ", 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 "XR AC JTS,BILAT W/WT BEAR",73050," $3,024.00 ", N/A , N/A , N/A X-RAY BEND ONLY L-S SPINE,72120," $13,053.45 ", N/A , N/A , N/A X-RAY BILE DUCT DILATION,74363," $1,376.75 ", N/A , N/A , N/A X-RAY BILE DUCTS/PANCREAS,74300, $570.38 , N/A , N/A , N/A X-RAY BILE STONE REMOVAL,74327," $1,800.25 ", N/A , N/A , N/A X-RAY CONTROL CATH INSERT,74480," $1,244.63 ", N/A , N/A , N/A X-RAY EXAM OF ANKLE,73610," $3,024.00 ", N/A , N/A , N/A X-RAY EXAM OF FOOT,73630," $2,700.00 ", N/A , N/A , N/A X-RAY EXAM OF HAND,73130," $3,024.00 ", N/A , N/A , N/A X-RAY EXAM OF KIDNEY LESION,74470, $996.63 , N/A , N/A , N/A X-RAY EXAM OF KNEES,73565," $7,196.31 ", N/A , N/A , N/A X-RAY EXAM OF LOWER SPINE,72100," $3,258.00 ", N/A , N/A , N/A X-RAY EXAM OF PENIS,74445," $1,300.75 ", N/A , N/A , N/A X-RAY EXAM OF PERINEUM,74775," $1,163.00 ", N/A , N/A , N/A X-RAY EYE FOR FOREIGN BODY,70030," $2,190.00 ", N/A , N/A , N/A X-RAY FALLOPIAN TUBE,74742, $962.25 , N/A , N/A , N/A X-RAY GUIDE FOR GI TUBE,74340," $1,733.75 ", N/A , N/A , N/A X-RAY GUIDE GI DILATION,74360," $2,038.63 ", N/A , N/A , N/A X-RAY GUIDE GU DILATION,74485," $1,248.88 ", N/A , N/A , N/A X-RAY GUIDE INTESTINAL TUBE,74355," $1,874.00 ", 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 HIP, UNILATERAL, W PEL IF PERF 2-3 VIEW",73502," $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 XRAY READING OUTSIDE,76140," $3,024.00 ", N/A , N/A , N/A X-RAY URETHRA/BLADDER,74450," $5,636.56 ", 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 "X-RAY, HIP, UNILATERAL W PEL WHEN PERF 4 VIEW",73503," $3,024.00 ", N/A , N/A , N/A X-RAYS AT SURGERY ADD-ON,74301, $336.00 , N/A , N/A , N/A ZYGOMA > 2 FILMS,70150," $2,394.00 ", N/A , N/A , N/A