Mt. Ascutney Hospital and Health Center

Price List for Shoppable Services. Effective 11-04-2021.

Hospital Website Machine-Readable Chargemaster

Filter by Availability

Search by Keyword or Code

Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.

Service Description	Service Code	Department	Charge Code	Cash Price	Rates
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	70035070450	$1,710
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	-	$1,950
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	70035070450	$1,710
CT THORAX DX C-	CPT 71250	Outpatient	70035071250	$2,173
CT THORAX DX C-	CPT 71250	Outpatient	70035071250	$2,173
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	70032071275	$3,661
CT NECK SPINE W/O DYE	CPT 72125	Outpatient	70035072125	$2,011
CT PELVIS W/DYE	CPT 72193	Outpatient	70035072193	$2,986
CT PELVIS W/DYE	CPT 72193	Outpatient	-	$2,986
CT PELVIS W/DYE	CPT 72193	Outpatient	70035072193	$2,334
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	70035074176	$3,500
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	70035074176	$3,500
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	70035074176	$3,500
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	-	$3,160
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	70035074177	$3,661
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	70035074177	$3,661
Cancer Services
CHEMO IV INFUSION 1 HR	CPT 96413	Outpatient	90033596413	$173
CHEMO IV INFUSION ADDL HR	CPT 96415	Outpatient	90033596415	$112
IRRIG DRUG DELIVERY DEVICE	CPT 96523	Outpatient	90033596523	$22
Cardiology
TTE W/DOPPLER COMPLETE	CPT 93306	Outpatient	70048093306	$1,547
Clinic
DRAINAGE OF SKIN ABSCESS	CPT 10060	Outpatient	50036010060	$285
DRAINAGE OF SKIN ABSCESS	CPT 10061	Outpatient	50036010061	$486
DEB SUBQ TISSUE 20 SQ CM/<	CPT 11042	Outpatient	50036011042	$612
TRIM SKIN LESION	CPT 11055	Outpatient	20051011055	$95
TRIM SKIN LESIONS 2 TO 4	CPT 11056	Outpatient	20096011056	$175
EXC TR-EXT B9+MARG 0.6-1 CM	CPT 11401	Outpatient	50036011401	$327
EXC TR-EXT B9+MARG 1.1-2 CM	CPT 11402	Outpatient	50036011402	$392
EXC TR-EXT B9+MARG 2.1-3CM	CPT 11403	Outpatient	50036011403	$502
EXC TR-EXT B9+MARG >4.0 CM	CPT 11406	Outpatient	50036011406	$1,094
EXC H-F-NK-SP B9+MARG 2.1-3	CPT 11423	Outpatient	50036011423	$610
EXC FACE-MM B9+MARG 1.1-2 CM	CPT 11442	Outpatient	50036011442	$437
EXC TR-EXT MAL+MARG 3.1-4 CM	CPT 11604	Outpatient	50036011604	$648
EXC TR-EXT MAL+MARG >4 CM	CPT 11606	Outpatient	50036011606	$953
EXC S/N/H/F/G MAL+MRG 3.1-4	CPT 11624	Outpatient	50036011624	$727
EXC F/E/E/N/L MAL+MRG 1.1-2	CPT 11642	Outpatient	50036011642	$566
TRIM NAIL(S) ANY NUMBER	CPT 11719	Outpatient	20096011719	$53
DEBRIDE NAIL 1-5	CPT 11720	Outpatient	20096011720	$198
DEBRIDE NAIL 6 OR MORE	CPT 11721	Outpatient	20096011721	$143
REMOVAL OF NAIL BED	CPT 11750	Outpatient	20051011750	$509
REMOVE PILONIDAL CYST EXTEN	CPT 11771	Outpatient	50036011771	$1,283
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	Outpatient	30098112001	$327
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	Outpatient	30098112002	$353
INTMD RPR S/A/T/EXT 2.6-7.5	CPT 12032	Outpatient	50036012032	$538
DESTRUCT B9 LESION 1-14	CPT 17110	Outpatient	20096017110	$199
PARTIAL MASTECTOMY	CPT 19301	Outpatient	50036019301	$2,861
MAST SIMPLE COMPLETE	CPT 19303	Outpatient	50036019303	$4,422
INJECT TRIGGER POINTS 3/>	CPT 20553	Outpatient	20096020553	$683
DRAIN/INJ JOINT/BURSA W/O US	CPT 20610	Outpatient	20096020610	$285
EXC SHOULDER TUM DEEP 5 CM/>	CPT 23073	Outpatient	50036023073	$682
INCISION OF FOOT FASCIA	CPT 28008	Outpatient	50036028008	$1,759
PARTIAL REMOVAL FOOT FASCIA	CPT 28060	Outpatient	50036028060	$3,174
PARTIAL REMOVAL OF FOOT BONE	CPT 28122	Outpatient	50036028122	$3,122
REPAIR OF HAMMERTOE	CPT 28285	Outpatient	50036028285	$1,502
CORRJ HALUX RIGDUS W/O IMPLT	CPT 28289	Outpatient	50036028289	$2,525
CORRECTION HALLUX VALGUS	CPT 28296	Outpatient	50036028296	$2,464
FUSION OF BIG TOE JOINT	CPT 28750	Outpatient	50036028750	$4,309
AMPUTATION OF TOE	CPT 28820	Outpatient	50036028820	$1,586
PARTIAL AMPUTATION OF TOE	CPT 28825	Outpatient	50036028825	$1,851
APPLICATION OF PASTE BOOT	CPT 29580	Outpatient	20096029580	$290
INSERT TUNNELED CV CATH	CPT 36561	Outpatient	50036036561	$1,659
REMOVAL TUNNELED CV CATH	CPT 36590	Outpatient	50036036590	$950
BIOPSY/REMOVAL LYMPH NODES	CPT 38500	Outpatient	50036038500	$1,141
LAPAROSCOPY FUNDOPLASTY	CPT 43280	Outpatient	50036043280	$4,238
LAPAROSCOPY APPENDECTOMY	CPT 44970	Outpatient	50036044970	$2,669
COLONOSCOPY W/LESION REMOVAL	CPT 45384	Outpatient	20051045384	$1,155
REMOVE INT/EXT HEM 1 GROUP	CPT 46255	Outpatient	50036046255	$1,564
LAPARO CHOLECYSTECTOMY/GRAPH	CPT 47563	Outpatient	50036047563	$2,808
RPR UMBIL HERN REDUC > 5 YR	CPT 49585	Outpatient	50036049585	$1,970
RPR UMBIL HERN BLOCK > 5 YR	CPT 49587	Outpatient	50036049587	$1,497
LAP ING HERNIA REPAIR INIT	CPT 49650	Outpatient	50036049650	$1,898
LAP ING HERNIA REPAIR RECUR	CPT 49651	Outpatient	50036049651	$2,186
XCAPSL CTRC RMVL CPLX WO ECP	CPT 66982	Outpatient	50036066982	$4,142
REMOVE IMPACTED EAR WAX UNI	CPT 69209	Outpatient	20051069209	$181
ECHO EXAM OF EYE THICKNESS	CPT 76514	Outpatient	20096076514	$28
ECHO EXAM OF EYE	CPT 76519	Outpatient	20051076519	$323
PSYCH DIAGNOSTIC EVALUATION	CPT 90791	Outpatient	20096090791	$337
EYE EXAM NEW PATIENT	CPT 92004	Outpatient	20096092004	$261
EYE EXAM ESTABLISH PATIENT	CPT 92012	Outpatient	20096092012	$146
EYE EXAM&TX ESTAB PT 1/>VST	CPT 92014	Outpatient	20096092014	$234
DETERMINE REFRACTIVE STATE	CPT 92015	Outpatient	20096092015	$62
SPECIAL EYE EVALUATION	CPT 92020	Outpatient	20096092020	$78
VISUAL FIELD EXAMINATION(S)	CPT 92083	Outpatient	20096092083	$170
CMPTR OPHTH IMG OPTIC NERVE	CPT 92133	Outpatient	20096092133	$86
PURE TONE HEARING TEST AIR	CPT 92551	Outpatient	20096092551	$66
DEVELOPMENTAL SCREEN W/SCORE	CPT 96110	Outpatient	20096096110	$27
RMVL DEVITAL TIS 20 CM/<	CPT 97597	Outpatient	20051097597	$437
RMVL DEVITAL TIS 20 CM/<	CPT 97597	Outpatient	20051097597	$437
MEDICAL SERVICES AFTER HRS	CPT 99050	Outpatient	20096099050	$64
VISUAL ACUITY SCREEN	CPT 99173	Outpatient	20096099173	$42
OFFICE O/P NEW SF 15-29 MIN	CPT 99202	Outpatient	20096099202	$156
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	Outpatient	20096099203	$215
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	Outpatient	20096099204	$330
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	Outpatient	20096099205	$407
OFFICE O/P EST MINIMAL PROB	CPT 99211	Outpatient	20051099211	$64
OFFICE O/P EST SF 10-19 MIN	CPT 99212	Outpatient	20096099212	$95
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	Outpatient	20096099213	$127
OFFICE O/P EST MOD 30-39 MIN	CPT 99214	Outpatient	20096099214	$200
OFFICE O/P EST HI 40-54 MIN	CPT 99215	Outpatient	20096099215	$305
OBSERVATION CARE DISCHARGE	CPT 99217	Outpatient	25051099217	$216
INITIAL OBSERVATION CARE	CPT 99219	Outpatient	20096099219	$392
INITIAL HOSPITAL CARE	CPT 99221	Outpatient	20096099221	$282
INITIAL HOSPITAL CARE	CPT 99222	Outpatient	20096099222	$388
INITIAL HOSPITAL CARE	CPT 99223	Outpatient	20096099223	$468
SUBSEQUENT HOSPITAL CARE	CPT 99231	Outpatient	20096099231	$142
SUBSEQUENT HOSPITAL CARE	CPT 99232	Outpatient	20096099232	$212
SUBSEQUENT HOSPITAL CARE	CPT 99233	Outpatient	20051099233	$318
HOSPITAL DISCHARGE DAY	CPT 99238	Outpatient	20096099238	$216
HOSPITAL DISCHARGE DAY	CPT 99239	Outpatient	20096099239	$298
OFFICE CONSULTATION	CPT 99242	Outpatient	20096099242	$285
OFFICE CONSULTATION	CPT 99243	Outpatient	20096099243	$358
OFFICE CONSULTATION	CPT 99244	Outpatient	20096099244	$440
NURSING FACILITY CARE INIT	CPT 99304	Outpatient	20096099304	$122
NURSING FACILITY CARE INIT	CPT 99305	Outpatient	20096099305	$162
NURSING FACILITY CARE INIT	CPT 99306	Outpatient	20096099306	$201
NURSING FAC CARE SUBSEQ	CPT 99307	Outpatient	20096099307	$64
NURSING FAC CARE SUBSEQ	CPT 99308	Outpatient	20096099308	$107
NURSING FAC CARE SUBSEQ	CPT 99309	Outpatient	20096099309	$150
NURSING FAC CARE SUBSEQ	CPT 99310	Outpatient	20096099310	$187
NURSING FAC DISCHARGE DAY	CPT 99316	Outpatient	20096099316	$258
INIT PM E/M NEW PAT INFANT	CPT 99381	Outpatient	20096099381	$224
PREV VISIT NEW AGE 18-39	CPT 99385	Outpatient	20096099385	$277
PREV VISIT NEW AGE 40-64	CPT 99386	Outpatient	20096099386	$315
PER PM REEVAL EST PAT INFANT	CPT 99391	Outpatient	20096099391	$170
PREV VISIT EST AGE 1-4	CPT 99392	Outpatient	20096099392	$191
PREV VISIT EST AGE 5-11	CPT 99393	Outpatient	20096099393	$188
PREV VISIT EST AGE 12-17	CPT 99394	Outpatient	20096099394	$207
PREV VISIT EST AGE 18-39	CPT 99395	Outpatient	20096099395	$234
PREV VISIT EST AGE 40-64	CPT 99396	Outpatient	20096099396	$293
PER PM REEVAL EST PAT 65+ YR	CPT 99397	Outpatient	20096099397	$291
WORK RELATED DISABILITY EXAM	CPT 99455	Outpatient	20096099455	$383
COLORECTAL SCRN; HI RISK IND	HCPCS G0105	Outpatient	500361G0105	$983
DIAB MANAGE TRN PER INDIV	HCPCS G0108	Outpatient	200983G0108	$86
COLON CA SCRN NOT HI RSK IND	HCPCS G0121	Outpatient	500361G0121	$983
PPPS, SUBSEQ VISIT	HCPCS G0439	Outpatient	200510G0439	$582
COMP MULTIDISIPLN EVALUATION	HCPCS H2000	Outpatient	200510H2000	$146
EEG
(N/O) SLEEP STUDY	CPT 95810	-	-	-	-
EKG
ELECTROCARDIOGRAM COMPLETE	CPT 93000	Outpatient	-	$289
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	45073093005	$290
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	45073093005	$290
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	45073093005	$290
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	45073093005	$290
ECG RECORD/REVIEW	CPT 93268	Outpatient	30073293268	$379
ECG RECORD/REVIEW	CPT 93268	Outpatient	30073293268	$379
Emergency Room
HYDRATION IV INFUSION INIT	CPT 96360	Outpatient	30045096360	$145
HYDRATE IV INFUSION ADD-ON	CPT 96361	Outpatient	30045096361	$126
HYDRATE IV INFUSION ADD-ON	CPT 96361	Outpatient	30045096361	$126
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	30045096365	$118
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	30045096365	$124
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	30045096365	$118
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	30045096366	$124
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	30045096366	$124
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	30045096367	$56
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	30045096367	$56
THER/PROPH/DIAG INJ SC/IM	CPT 96372	Outpatient	20051096372	$38
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	30045096374	$111
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	30045096374	$111
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	30045096375	$56
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	30045096375	$56
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	30045096376	$54
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	30045096376	$54
EMERGENCY DEPT VISIT	CPT 99281	Outpatient	30098199281	$258
EMERGENCY DEPT VISIT	CPT 99282	Outpatient	30098199282	$287
EMERGENCY DEPT VISIT	CPT 99283	Outpatient	30045099283	$426
EMERGENCY DEPT VISIT	CPT 99284	Outpatient	30045099284	$680
EMERGENCY DEPT VISIT	CPT 99285	Outpatient	30045099285	$1,091
Imaging
US EXAM OF HEAD AND NECK	CPT 76536	Outpatient	70040276536	$862
ULTRASOUND BREAST LIMITED	CPT 76642	Outpatient	70040276642	$358
ULTRASOUND BREAST LIMITED	CPT 76642	Outpatient	70040276642	$358
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	-	$957
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	70040276700	$957
ECHO EXAM OF ABDOMEN	CPT 76705	Outpatient	70040276705	$740
ECHO EXAM OF ABDOMEN	CPT 76705	Outpatient	70040276705	$740
OB US >= 14 WKS SNGL FETUS	CPT 76805	Outpatient	-	$1,060
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	70040276830	$866
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	-	$866
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	70040276830	$866
BREAST TOMOSYNTHESIS UNI	CPT 77061	Outpatient	70040177061	$126
BREAST TOMOSYNTHESIS BI	CPT 77063	Outpatient	70040377063	$126
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	-	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	70040177065	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	-	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	70040177065	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	-	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	70040177065	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	-	$537
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	70040177065	$537
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	-	$537
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	70040177066	$537
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	-	$537
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	70040177066	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	-	$537
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	70040377067	$537
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	-	-	-	-
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-
Laboratory
CONTROLLED SUBSTANCE MONITORING PANEL, URINE MAYO	CPT 18100 (5280307380347480364)	Outpatient	40030080307	$346
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	40030036415	$30
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	40030036415	$30
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	40030036415	$30
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	40030080048	$126
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	40030080048	$126
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	40030080053	$147
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	40030080053	$147
(N/O) OBSTETRIC BLOOD TEST PANEL	CPT 80055	-	-	-	-
LIPID PANEL	CPT 80061	Outpatient	40030080061	$139
RENAL FUNCTION PANEL	CPT 80069	Outpatient	-	$106
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	40030070076	$118
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	Outpatient	20030080305	$34
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	40030080307	$331
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	40030080307	$331
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	40030080307	$331
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	40030080307	$331
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	40030081001	$46
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	40030081001	$46
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	40030081001	$46
URINALYSIS NONAUTO W/O SCOPE	CPT 81002	Outpatient	-	$18
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	40030081003	$37
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	40030081003	$37
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	40030081003	$37
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	40030081003	$37
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	40030081015	$43
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	40030081015	$43
URINE PREGNANCY TEST	CPT 81025	Outpatient	40030081025	$92
HLA II TYPING 1 LOCUS LR	CPT 81376	Outpatient	40030081376	$415
HLA II TYPING 1 LOCUS LR	CPT 81376	Outpatient	40030081376	$415
ACETONE ASSAY	CPT 82010	Outpatient	40030082010	$121
ACETONE ASSAY	CPT 82010	Outpatient	40030082010	$96
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	40030082043	$70
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	40030082043	$70
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	40030082043	$70
ALPHA-FETOPROTEIN SERUM	CPT 82105	Outpatient	40030082105	$211
ALPHA-FETOPROTEIN SERUM	CPT 82105	Outpatient	40030082105	$211
ASSAY TEST FOR BLOOD FECAL	CPT 82274	Outpatient	40030082274	$157
ASSAY TEST FOR BLOOD FECAL	CPT 82274	Outpatient	40030082274	$157
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	40030082306	$243
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	40030082306	$243
ASSAY OF CK (CPK)	CPT 82550	Outpatient	40030082550	$94
ASSAY OF CK (CPK)	CPT 82550	Outpatient	40030082550	$98
ASSAY OF CK (CPK)	CPT 82550	Outpatient	40030082550	$98
ASSAY OF CREATININE	CPT 82565	Outpatient	40030082565	$67
ASSAY OF CREATININE	CPT 82565	Outpatient	40030082565	$67
VITAMIN B-12	CPT 82607	Outpatient	40030082607	$155
VITAMIN B-12	CPT 82607	Outpatient	40030082607	$155
ASSAY OF FERRITIN	CPT 82728	Outpatient	40030082728	$189
ASSAY OF FERRITIN	CPT 82728	Outpatient	40030082728	$189
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	40030082746	$202
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	40030082746	$202
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	40030082784	$111
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	40030082803	$266
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	40030082803	$266
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$53
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$46
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	40030082947	$46
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	40030083001	$278
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	40030083001	$278
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	40030083001	$278
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	40030083036	$140
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	40030083036	$145
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	40030083036	$140
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	40030083516	$170
ASSAY OF IRON	CPT 83540	Outpatient	40030083540	$98
ASSAY OF IRON	CPT 83540	Outpatient	40030083540	$98
ASSAY OF IRON	CPT 83540	Outpatient	40030083540	$98
ASSAY OF IRON	CPT 83540	Outpatient	40030083540	$98
ASSAY OF IRON	CPT 83540	Outpatient	40030083540	$98
IRON BINDING TEST	CPT 83550	Outpatient	40030083550	$127
IRON BINDING TEST	CPT 83550	Outpatient	40030083550	$127
IRON BINDING TEST	CPT 83550	Outpatient	40030083550	$127
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	40030083605	$159
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	40030083605	$154
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	40030083615	$87
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	40030083615	$89
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	40030083615	$89
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	40030083615	$89
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	40030083615	$70
ASSAY OF LEAD	CPT 83655	Outpatient	40030083655	$180
ASSAY OF LEAD	CPT 83655	Outpatient	40030083655	$180
ASSAY OF LEAD	CPT 83655	Outpatient	40030083655	$180
ASSAY OF LIPASE	CPT 83690	Outpatient	40030083690	$69
ASSAY OF LIPASE	CPT 83690	Outpatient	40030083690	$67
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	Outpatient	40030083721	$118
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	Outpatient	40030083721	$118
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	40030083735	$98
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	40030083735	$101
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	40030083880	$505
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	40030083880	$489
ORGANIC ACID SINGLE QUANT	CPT 83921	Outpatient	40030083921	$269
ASSAY OF PARATHORMONE	CPT 83970	Outpatient	40030083970	$502
ASSAY OF PARATHORMONE	CPT 83970	Outpatient	40030083970	$502
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	40030084100	$70
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	40030084100	$68
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	40030084132	$68
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	40030084132	$66
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	40030084153	$226
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	40030084153	$226
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	40030084153	$226
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	40030084153	$226
ASSAY OF PSA FREE	CPT 84154	Outpatient	40030084154	$273
ASSAY OF PSA FREE	CPT 84154	Outpatient	40030084154	$273
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	40030084165	$137
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	40030084165	$137
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	40030084165	$137
ASSAY OF TOTAL THYROXINE	CPT 84436	Outpatient	40030084436	$80
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	40030084439	$130
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	40030084439	$136
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	40030084443	$205
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	40030084443	$205
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	40030084443	$205
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	40030084443	$205
FREE ASSAY (FT-3)	CPT 84481	Outpatient	40030084481	$206
FREE ASSAY (FT-3)	CPT 84481	Outpatient	40030084481	$206
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	40030084520	$51
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	40030084520	$52
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	40030084550	$67
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	40030084550	$66
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	40030084702	$176
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	40030084702	$176
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	40030084702	$206
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	40030084703	$100
HEMATOCRIT	CPT 85014	Outpatient	40030085014	$36
HEMATOCRIT	CPT 85014	Outpatient	40030085014	$36
HEMATOCRIT	CPT 85014	Outpatient	40030085014	$35
HEMATOCRIT	CPT 85014	Outpatient	40030085014	$35
HEMOGLOBIN	CPT 85018	Outpatient	40030085018	$35
HEMOGLOBIN	CPT 85018	Outpatient	40030085018	$36
HEMOGLOBIN	CPT 85018	Outpatient	40030085018	$36
HEMOGLOBIN	CPT 85018	Outpatient	40030085018	$35
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	40030085025	$102
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	40030085025	$102
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	40030085027	$84
RETICYTE/HGB CONCENTRATE	CPT 85046	Outpatient	40030085046	$66
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	40030085379	$140
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	40030085379	$151
PROTHROMBIN TIME	CPT 85610	Outpatient	40030085610	$59
PROTHROMBIN TIME	CPT 85610	Outpatient	40030085610	$53
PROTHROMBIN TIME	CPT 85610	Outpatient	40030085610	$62
RBC SED RATE NONAUTOMATED	CPT 85651	Outpatient	40030085651	$51
RBC SED RATE NONAUTOMATED	CPT 85651	Outpatient	40030085651	$52
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	40030085730	$86
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	40030085730	$88
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	40030085730	$70
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	40030086038	$167
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	40030086038	$180
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	40030086038	$167
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	40030086038	$161
C-REACTIVE PROTEIN	CPT 86140	Outpatient	40030086140	$51
C-REACTIVE PROTEIN	CPT 86140	Outpatient	40030086140	$51
C-REACTIVE PROTEIN HS	CPT 86141	Outpatient	40030086141	$154
C-REACTIVE PROTEIN HS	CPT 86141	Outpatient	40030086141	$154
CCP ANTIBODY	CPT 86200	Outpatient	40030086200	$178
CCP ANTIBODY	CPT 86200	Outpatient	40030086200	$178
HETEROPHILE ANTIBODY SCREEN	CPT 86308	Outpatient	40030086308	$151
HETEROPHILE ANTIBODY SCREEN	CPT 86308	Outpatient	40030086308	$78
HETEROPHILE ANTIBODY SCREEN	CPT 86308	Outpatient	40030086308	$78
IMMUNOFIX E-PHORESIS SERUM	CPT 86334	Outpatient	40030086334	$322
IMMUNOFIX E-PHORESIS SERUM	CPT 86334	Outpatient	40030086334	$331
PARTICLE AGGLUT ANTBDY SCRN	CPT 86403	Outpatient	40030089055	$118
RHEUMATOID FACTOR QUANT	CPT 86431	Outpatient	40030086431	$85
RHEUMATOID FACTOR QUANT	CPT 86431	Outpatient	40030086431	$85
TB TEST CELL IMMUN MEASURE	CPT 86480	Outpatient	40030086480	$673
TB TEST CELL IMMUN MEASURE	CPT 86480	Outpatient	40030086480	$673
LYME DISEASE ANTIBODY	CPT 86617	Outpatient	40030086617	$222
LYME DISEASE ANTIBODY	CPT 86617	Outpatient	40030086617	$214
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$185
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$167
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$185
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$185
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$232
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	40030086618	$232
EPSTEIN-BARR NUCLEAR ANTIGEN	CPT 86664	Outpatient	40030086664	$206
EPSTEIN-BARR NUCLEAR ANTIGEN	CPT 86664	Outpatient	40030086664	$206
HIV-1/HIV-2 1 RESULT ANTBDY	CPT 86703	Outpatient	40030086703	$158
HEP B CORE ANTIBODY TOTAL	CPT 86704	Outpatient	40030086704	$180
HEP B CORE ANTIBODY TOTAL	CPT 86704	Outpatient	40030086704	$180
HEP B CORE ANTIBODY TOTAL	CPT 86704	Outpatient	40030086704	$180
HEP B SURFACE ANTIBODY	CPT 86706	Outpatient	40030086706	$154
HEP B SURFACE ANTIBODY	CPT 86706	Outpatient	40030086706	$154
HEPATITIS A ANTIBODY	CPT 86708	Outpatient	40030086708	$183
HEPATITIS A ANTIBODY	CPT 86708	Outpatient	40030086708	$183
MUMPS ANTIBODY	CPT 86735	Outpatient	40060086735	$189
RUBELLA ANTIBODY	CPT 86762	Outpatient	40030086762	$191
RUBELLA ANTIBODY	CPT 86762	Outpatient	40030086762	$191
RUBELLA ANTIBODY	CPT 86762	Outpatient	40030086762	$215
RUBEOLA ANTIBODY	CPT 86765	Outpatient	40030086765	$184
RUBEOLA ANTIBODY	CPT 86765	Outpatient	40030086765	$191
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	40030086787	$191
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	40030086787	$191
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	40030086787	$184
HEPATITIS C AB TEST	CPT 86803	Outpatient	400300868	$158
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	40030086850	$157
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	40030086850	$130
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	40030086850	$130
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	40030086850	$103
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	40030087040	$114
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	40030087040	$114
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	40030087040	$114
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	40030087040	$114
FECES CULTURE AEROBIC BACT	CPT 87045	Outpatient	40030087045	$111
STOOL CULTR AEROBIC BACT EA	CPT 87046	Outpatient	40030087046	$118
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	Outpatient	40030087101	$129
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	Outpatient	40030087045	$134
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	Outpatient	40030087075	$137
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	Outpatient	40030087075	$141
CULTURE AEROBIC IDENTIFY	CPT 87077	Outpatient	40030087077	$121
CULTURE AEROBIC IDENTIFY	CPT 87077	Outpatient	40030087077	$118
URINE CULTURE/COLONY COUNT	CPT 87086	Outpatient	40030087086	$68
SKIN FUNGI CULTURE	CPT 87101	Outpatient	40030087101	$102
SKIN FUNGI CULTURE	CPT 87101	Outpatient	40030087101	$104
CULTURE TYPE IMMUNOLOGIC	CPT 87147	Outpatient	40030087147	$78
DNA/RNA AMPLIFIED PROBE	CPT 87150	Outpatient	40030087150	$304
MICROBE SUSCEPTIBLE MIC	CPT 87186	Outpatient	40030087186	$155
SMEAR GRAM STAIN	CPT 87205	Outpatient	40030087205	$65
SMEAR GRAM STAIN	CPT 87205	Outpatient	40030087205	$62
CRYPTOSPORIDIUM AG IA	CPT 87328	Outpatient	40030087328	$165
CRYPTOSPORIDIUM AG IA	CPT 87328	Outpatient	40030087328	$134
CRYPTOSPORIDIUM AG IA	CPT 87328	Outpatient	40030087328	$170
GIARDIA AG IA	CPT 87329	Outpatient	40030087329	$169
GIARDIA AG IA	CPT 87329	Outpatient	40030087329	$134
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	40030087340	$154
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	40030087340	$150
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	40030087340	$154
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	40030087491	$304
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	40030087491	$304
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	40030087491	$304
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	40030087491	$304
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	40030087491	$304
INFLUENZA DNA AMP PROBE	CPT 87502	Outpatient	40030087502	$657
INFLUENZA DNA AMP PROBE	CPT 87502	Outpatient	40030087502	$657
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	Outpatient	40030087522	$635
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	Outpatient	40030087522	$635
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	40030087591	$381
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	40030087591	$381
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	40030087591	$381
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	40030087591	$304
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	40030087591	$381
HPV HIGH-RISK TYPES	CPT 87624	Outpatient	40030087624	$237
RESP VIRUS 3-5 TARGETS	CPT 87631	Outpatient	40030087631	$314
STREP A DNA AMP PROBE	CPT 87651	Outpatient	40030087651	$304
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$304
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$304
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$304
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$304
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$311
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	40030087798	$388
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$288
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$288
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$288
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$288
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$288
AGENT NOS ASSAY W/OPTIC	CPT 87899	Outpatient	40030087899	$120
CYTOPATH C/V THIN LAYER	CPT 88142	Outpatient	40030088142	$301
TISSUE EXAM BY PATHOLOGIST	CPT 88304	Outpatient	40030088304	$567
TISSUE EXAM BY PATHOLOGIST	CPT 88305	Outpatient	40030088305	$766
IMMUNOHISTO ANTB 1ST STAIN	CPT 88342	Outpatient	40030088342	$690
LEUKOCYTE ASSESSMENT FECAL	CPT 89055	Outpatient	40030089055	$65
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	400300P9016	$555
MRI
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	70061070551	$3,595
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	70061070551	$3,595
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	-	$6,767
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	70061070553	$5,103
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	-	$6,767
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	70061070553	$5,103
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	-	$6,767
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	70061070553	$5,103
MRI LUMBAR SPINE W/O DYE	CPT 72148	Outpatient	-	$4,378
MRI LUMBAR SPINE W/O DYE	CPT 72148	Outpatient	70061072148	$3,298
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	-	$4,775
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	70061073721	$3,474
Other Diagnostic
EXTRACRANIAL BILAT STUDY	CPT 93880	Outpatient	70040293880	$731
EXTREMITY STUDY	CPT 93971	Outpatient	70092193971	$588
EXTREMITY STUDY	CPT 93971	Outpatient	70092193971	$588
EXTREMITY STUDY	CPT 93971	Outpatient	70092193971	$588
EXTREMITY STUDY	CPT 93971	Outpatient	70092193971	$588
VASCULAR STUDY	CPT 93976	Outpatient	70092193976	$747
SLP STDY UNATTENDED	CPT 95800	Outpatient	80096095800	$199
MUSC TST DONE W/NERV TST LIM	CPT 95885	Outpatient	20096095885	$522
MUSC TEST DONE W/N TEST COMP	CPT 95886	Outpatient	20096095886	$736
NRV CNDJ TST 5-6 STUDIES	CPT 95909	Outpatient	20096095909	$742
NRV CNDJ TEST 7-8 STUDIES	CPT 95910	Outpatient	20096095910	$885
NRV CNDJ TEST 9-10 STUDIES	CPT 95911	Outpatient	20096095911	$1,194
HOME SLEEP TEST/TYPE 3 PORTA	HCPCS G0399	Outpatient	800960G0399	$520
HOME SLEEP TEST/TYPE 3 PORTA	HCPCS G0399	Outpatient	800960G0399	$520
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	Outpatient	90038036430	$564
CARDIAC REHAB/MONITOR	CPT 93798	Outpatient	90094393798	$286
PHLEBOTOMY	CPT 99195	Outpatient	90094099195	$146
PULMONARY REHAB W EXER	HCPCS G0424	Outpatient	800960G0424	$175
PULMONARY REHAB W EXER	HCPCS G0424	Outpatient	800960G0424	$185
PULMONARY REHAB W EXER	HCPCS G0424	Outpatient	800960G0424	$185
PULMONARY REHAB W EXER	HCPCS G0424	Outpatient	800960G0424	$185
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	400300P9016	$555
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	400300P9016	$555
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	400300P9016	$555
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	400300P9016	$555
Psychiatric
PSYTX W PT 30 MINUTES	CPT 90832	Outpatient	20096090832	$168
PSYTX W PT 45 MINUTES	CPT 90834	Outpatient	20096090834	$222
PSYTX W PT 60 MINUTES	CPT 90837	Outpatient	20096090837	$335
FAMILY PSYTX W/O PT 50 MIN	CPT 90846	Outpatient	20096090846	$270
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MIN	CPT 90847	-	-	-	-
(N/O) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-
Pulmonary Function
EVALUATION OF WHEEZING	CPT 94060	Outpatient	80046094060	$618
EVALUATION OF WHEEZING	CPT 94060	Outpatient	80046094060	$618
EVALUATION OF WHEEZING	CPT 94060	Outpatient	80046094060	$318
PULM FUNCT TST PLETHYSMOGRAP	CPT 94726	Outpatient	80046094726	$334
CO/MEMBANE DIFFUSE CAPACITY	CPT 94729	Outpatient	80046094729	$259
CO/MEMBANE DIFFUSE CAPACITY	CPT 94729	Outpatient	80046094729	$504
CO/MEMBANE DIFFUSE CAPACITY	CPT 94729	Outpatient	80046094729	$259
Radiology
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	70032071045	$306
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	70032071045	$306
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	70032071046	$393
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	70032071046	$393
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	70032071046	$393
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	70032072050	$768
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	70032072050	$768
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	Outpatient	70032072070	$414
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	Outpatient	70032072100	$600
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	Outpatient	-	$822
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	Outpatient	70032072110	$822
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	70032073030	$430
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	70032073030	$430
X-RAY EXAM OF HAND	CPT 73130	Outpatient	70032073130	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	70032073130	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	70032073130	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	70032073130	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	70032073130	$489
X-RAY EXAM OF FINGER(S)	CPT 73140	Outpatient	70032073140	$507
X-RAY EXAM OF FINGER(S)	CPT 73140	Outpatient	70032073140	$507
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$935
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$935
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$620
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	70032073502	$882
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	70032073560	$439
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	70032073560	$439
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	70032073560	$439
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	70032073560	$439
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	70032073562	$550
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	70032073562	$550
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	70032073562	$550
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	70032073562	$550
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	70032073610	$496
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	70032073610	$496
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	70032073630	$482
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	70032073630	$482
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	Outpatient	70032074018	$334
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	Outpatient	70032074022	$679
X-RAYS AT SURGERY ADD-ON	CPT 74301	Outpatient	70032074301	$479
X-RAYS AT SURGERY ADD-ON	CPT 74301	Outpatient	70032074301	$479
DXA BONE DENSITY AXIAL	CPT 77080	Outpatient	70032077080	$687
Respiratory
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	80096094640	$155
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	80096094640	$155
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	80096094640	$155
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	80096094640	$155
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	80096094640	$155
Surgical Procedures
REMOVAL OF BREAST LESION	CPT 19120	Outpatient	-	$1,042
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE	CPT 29881	-	-	-	-
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...	CPT 42820	-	-	-	-
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	Outpatient	20096043235	$3,989
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	Outpatient	20096043239	$6,934
DIAGNOSTIC COLONOSCOPY	CPT 45378	Outpatient	20051045378	$983
COLONOSCOPY AND BIOPSY	CPT 45380	Outpatient	20096045380	$7,471
COLONOSCOPY W/LESION REMOVAL	CPT 45385	Outpatient	20096045385	$7,100
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...	CPT 45391	-	-	-	-
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	Outpatient	50036047562	$25,916
PRP I/HERN INIT REDUC >5 YR	CPT 49505	Outpatient	50036049505	$21,296
BIOPSY OF PROSTATE	CPT 55700	Outpatient	-	$3,877
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...	CPT 55866	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...	CPT 59610	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62322	-	-	-	-
NJX INTERLAMINAR LMBR/SAC	CPT 62323	Outpatient	50036162323	$2,770
NJX AA&/STRD TFRM EPI L/S 1	CPT 64483	Outpatient	50036164483	$1,561
AFTER CATARACT LASER SURGERY	CPT 66821	Outpatient	20096066821	$4,766
XCAPSL CTRC RMVL W/O ECP	CPT 66984	Outpatient	50036066984	$14,112
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSIS	CPT 93452	-	-	-	-
Therapy
ULTRASOUND THERAPY	CPT 97035	Outpatient	90042097035	$64
ULTRASOUND THERAPY	CPT 97035	Outpatient	90042097035	$64
THERAPEUTIC EXERCISES	CPT 97110	Outpatient	90042097110	$160
THERAPEUTIC EXERCISES	CPT 97110	Outpatient	90042097110	$160
NEUROMUSCULAR REEDUCATION	CPT 97112	Outpatient	90042097112	$167
NEUROMUSCULAR REEDUCATION	CPT 97112	Outpatient	90042097112	$167
AQUATIC THERAPY/EXERCISES	CPT 97113	Outpatient	90042097113	$218
AQUATIC THERAPY/EXERCISES	CPT 97113	Outpatient	90042097113	$218
AQUATIC THERAPY/EXERCISES	CPT 97113	Outpatient	90042097113	$204
GAIT TRAINING THERAPY	CPT 97116	Outpatient	90042097116	$142
MANUAL THERAPY 1/> REGIONS	CPT 97140	Outpatient	90042097140	$149
MANUAL THERAPY 1/> REGIONS	CPT 97140	Outpatient	90042097140	$149
PT EVAL LOW COMPLEX 20 MIN	CPT 97161	Outpatient	90042097161	$300
PT EVAL MOD COMPLEX 30 MIN	CPT 97162	Outpatient	90042097162	$364
OT EVAL LOW COMPLEX 30 MIN	CPT 97165	Outpatient	90043097165	$300
OT EVAL MOD COMPLEX 45 MIN	CPT 97166	Outpatient	90043097166	$364
THERAPEUTIC ACTIVITIES	CPT 97530	Outpatient	90042097530	$174
THERAPEUTIC ACTIVITIES	CPT 97530	Outpatient	90042097530	$174
SELF CARE MNGMENT TRAINING	CPT 97535	Outpatient	90043097535	$174
SELF CARE MNGMENT TRAINING	CPT 97535	Outpatient	90043097535	$174
WHEELCHAIR MNGMENT TRAINING	CPT 97542	Outpatient	90042097542	$152
WHEELCHAIR MNGMENT TRAINING	CPT 97542	Outpatient	90042097542	$152
Uncategorized
AMPUTATION TOE & METATARSAL	CPT 28810	Outpatient	-	$1,035
X-RAY EYE FOR FOREIGN BODY	CPT 70030	Outpatient	-	$417
X-RAY EXAM OF JAW 4/> VIEWS	CPT 70110	Outpatient	-	$566
X-RAY EXAM OF MASTOIDS	CPT 70120	Outpatient	-	$538
X-RAY EXAM OF FACIAL BONES	CPT 70140	Outpatient	-	$426
X-RAY EXAM OF FACIAL BONES	CPT 70150	Outpatient	-	$620
X-RAY EXAM OF NASAL BONES	CPT 70160	Outpatient	-	$507
X-RAY EXAM OF EYE SOCKETS	CPT 70200	Outpatient	-	$629
X-RAY EXAM OF SINUSES	CPT 70210	Outpatient	-	$461
X-RAY EXAM OF SINUSES	CPT 70220	Outpatient	-	$550
X-RAY EXAM OF SKULL	CPT 70250	Outpatient	-	$634
X-RAY EXAM OF SKULL	CPT 70260	Outpatient	-	$518
X-RAY EXAM OF JAW JOINTS	CPT 70330	Outpatient	-	$749
MAGNETIC IMAGE JAW JOINT	CPT 70336	Outpatient	-	$4,206
X-RAY EXAM OF NECK	CPT 70360	Outpatient	-	$398
SPEECH EVALUATION COMPLEX	CPT 70371	Outpatient	-	$1,106
CT HEAD/BRAIN W/DYE	CPT 70460	Outpatient	-	$2,527
CT HEAD/BRAIN W/O & W/DYE	CPT 70470	Outpatient	-	$3,116
CT ORBIT/EAR/FOSSA W/O DYE	CPT 70480	Outpatient	-	$3,172
CT ORBIT/EAR/FOSSA W/O DYE	CPT 70480	Outpatient	-	$3,172
CT ORBIT/EAR/FOSSA W/DYE	CPT 70481	Outpatient	-	$3,747
CT ORBIT/EAR/FOSSA W/DYE	CPT 70481	Outpatient	-	$3,747
CT ORBIT/EAR/FOSSA W/O&W/DYE	CPT 70482	Outpatient	-	$4,302
CT ORBIT/EAR/FOSSA W/O&W/DYE	CPT 70482	Outpatient	-	$4,302
CT MAXILLOFACIAL W/O DYE	CPT 70486	Outpatient	-	$2,597
CT MAXILLOFACIAL W/O DYE	CPT 70486	Outpatient	-	$2,597
CT MAXILLOFACIAL W/DYE	CPT 70487	Outpatient	-	$3,174
CT MAXILLOFACIAL W/DYE	CPT 70487	Outpatient	-	$3,174
CT MAXILLOFACIAL W/O & W/DYE	CPT 70488	Outpatient	-	$3,961
CT MAXILLOFACIAL W/O & W/DYE	CPT 70488	Outpatient	-	$3,961
CT SOFT TISSUE NECK W/O DYE	CPT 70490	Outpatient	-	$2,444
CT SOFT TISSUE NECK W/DYE	CPT 70491	Outpatient	-	$3,048
CT SFT TSUE NCK W/O & W/DYE	CPT 70492	Outpatient	-	$3,816
CT ANGIOGRAPHY HEAD	CPT 70496	Outpatient	-	$10,497
MRI ORBIT/FACE/NECK W/O DYE	CPT 70540	Outpatient	-	$4,823
MRI ORBIT/FACE/NECK W/DYE	CPT 70542	Outpatient	-	$5,327
MRI ORBT/FAC/NCK W/O &W/DYE	CPT 70543	Outpatient	-	$6,949
MR ANGIOGRAPHY HEAD W/O DYE	CPT 70544	Outpatient	-	$5,425
MR ANGIOGRAPH HEAD W/O&W/DYE	CPT 70546	Outpatient	-	$8,534
MR ANGIOGRAPHY NECK W/O DYE	CPT 70547	Outpatient	-	$5,413
MR ANGIOGRAPHY NECK W/DYE	CPT 70548	Outpatient	-	$3,938
MR ANGIOGRAPH NECK W/O&W/DYE	CPT 70549	Outpatient	-	$8,540
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	-	$4,944
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	-	$4,944
MRI BRAIN STEM W/DYE	CPT 70552	Outpatient	-	$5,437
CT ANGIO NECK W/ CONTRAST	CPT 70998	Outpatient	-	$10,705
XR CHEST 2 VIEWS W/ FLUOROSCOPY	CPT 71023	Outpatient	-	$1,040
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	-	$306
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	-	$417
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	-	$393
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	-	$393
X-RAY EXAM CHEST 3 VIEWS	CPT 71047	Outpatient	-	$518
X-RAY EXAM CHEST 3 VIEWS	CPT 71047	Outpatient	-	$518
X-RAY EXAM CHEST 4+ VIEWS	CPT 71048	Outpatient	-	$643
X-RAY EXAM CHEST 4+ VIEWS	CPT 71048	Outpatient	-	$643
X-RAY EXAM CHEST 4+ VIEWS	CPT 71048	Outpatient	-	$643
X-RAY EXAM CHEST 4+ VIEWS	CPT 71048	Outpatient	-	$643
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100	Outpatient	-	$447
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100	Outpatient	-	$447
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101	Outpatient	-	$545
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101	Outpatient	-	$545
X-RAY EXAM RIBS BIL 3 VIEWS	CPT 71110	Outpatient	-	$573
X-RAY EXAM RIBS/CHEST4/> VWS	CPT 71111	Outpatient	-	$768
X-RAY EXAM BREASTBONE 2/>VWS	CPT 71120	Outpatient	-	$461
X-RAY STRENOCLAVIC JT 3/>VWS	CPT 71130	Outpatient	-	$550
CT THORAX DX C-	CPT 71250	Outpatient	-	$2,524
CT THORAX DX C-	CPT 71250	Outpatient	-	$2,524
CT THORAX DX C+	CPT 71260	Outpatient	-	$3,146
CT THORAX DX C+	CPT 71260	Outpatient	-	$3,146
CT THORAX DX C-/C+	CPT 71270	Outpatient	-	$3,958
CT THORAX DX C-/C+	CPT 71270	Outpatient	-	$3,958
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	-	$7,860
MRI CHEST W/O DYE	CPT 71550	Outpatient	-	$5,490
MRI CHEST W/O & W/DYE	CPT 71552	Outpatient	-	$8,090
X-RAY EXAM OF SPINE 1 VIEW	CPT 72020	Outpatient	-	$334
X-RAY EXAM OF SPINE 1 VIEW	CPT 72020	Outpatient	-	$334
X-RAY EXAM OF SPINE 1 VIEW	CPT 72020	Outpatient	-	$334
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	Outpatient	-	$566
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	-	$768
X-RAY EXAM NECK SPINE 6/>VWS	CPT 72052	Outpatient	-	$1,013
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	Outpatient	-	$474
X-RAY EXAM THORACOLMB 2/> VW	CPT 72080	Outpatient	-	$518
X-RAY EXAM ENTIRE SPI 2/3 VW	CPT 72082	Outpatient	-	$1,072
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	Outpatient	-	$600
X-RAY EXAM L-S SPINE BENDING	CPT 72114	Outpatient	-	$1,154
CT NECK SPINE W/O DYE	CPT 72125	Outpatient	-	$2,544
CT NECK SPINE W/DYE	CPT 72126	Outpatient	-	$3,154
CT CHEST SPINE W/O DYE	CPT 72128	Outpatient	-	$2,538
CT CHEST SPINE W/DYE	CPT 72129	Outpatient	-	$3,158
CT CHEST SPINE W/O & W/DYE	CPT 72130	Outpatient	-	$3,958
CT LUMBAR SPINE W/O DYE	CPT 72131	Outpatient	-	$2,527
CT LUMBAR SPINE W/DYE	CPT 72132	Outpatient	-	$3,151
CT LUMBAR SPINE W/O & W/DYE	CPT 72133	Outpatient	-	$3,954
MRI NECK SPINE W/O DYE	CPT 72141	Outpatient	-	$4,309
MRI NECK SPINE W/DYE	CPT 72142	Outpatient	-	$5,441
MRI CHEST SPINE W/O DYE	CPT 72146	Outpatient	-	$4,386
MRI CHEST SPINE W/DYE	CPT 72147	Outpatient	-	$4,799
MRI NECK SPINE W/O & W/DYE	CPT 72156	Outpatient	-	$6,650
MRI CHEST SPINE W/O & W/DYE	CPT 72157	Outpatient	-	$6,172
MRI LUMBAR SPINE W/O & W/DYE	CPT 72158	Outpatient	-	$6,635
X-RAY EXAM OF PELVIS	CPT 72170	Outpatient	-	$346
X-RAY EXAM OF PELVIS	CPT 72190	Outpatient	-	$634
CT PELVIS W/O DYE	CPT 72192	Outpatient	-	$2,390
CT PELVIS W/O & W/DYE	CPT 72194	Outpatient	-	$3,996
MRI PELVIS W/O DYE	CPT 72195	Outpatient	-	$4,917
MRI PELVIS W/O & W/DYE	CPT 72197	Outpatient	-	$7,018
X-RAY EXAM SI JOINTS 3/> VWS	CPT 72202	Outpatient	-	$524
X-RAY EXAM SACRUM TAILBONE	CPT 72220	Outpatient	-	$430
MYELOGRAPHY THORACIC SPINE	CPT 72255	Outpatient	-	$1,892
MYELOGRAPHY L-S SPINE	CPT 72265	Outpatient	-	$2,002
MYELOGPHY 2/> SPINE REGIONS	CPT 72270	Outpatient	-	$3,085
X-RAY EXAM OF COLLAR BONE	CPT 73000	Outpatient	-	$426
X-RAY EXAM OF COLLAR BONE	CPT 73000	Outpatient	-	$426
X-RAY EXAM OF SHOULDER BLADE	CPT 73010	Outpatient	-	$439
X-RAY EXAM OF SHOULDER BLADE	CPT 73010	Outpatient	-	$439
X-RAY EXAM OF SHOULDER	CPT 73020	Outpatient	-	$334
X-RAY EXAM OF SHOULDER	CPT 73020	Outpatient	-	$334
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	-	$430
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	-	$430
CONTRAST X-RAY OF SHOULDER	CPT 73040	Outpatient	-	$1,666
CONTRAST X-RAY OF SHOULDER	CPT 73040	Outpatient	-	$1,666
X-RAY EXAM OF SHOULDERS	CPT 73050	Outpatient	-	$566
X-RAY EXAM OF HUMERUS	CPT 73060	Outpatient	-	$426
X-RAY EXAM OF HUMERUS	CPT 73060	Outpatient	-	$426
X-RAY EXAM OF ELBOW	CPT 73070	Outpatient	-	$426
X-RAY EXAM OF ELBOW	CPT 73070	Outpatient	-	$426
X-RAY EXAM OF ELBOW	CPT 73080	Outpatient	-	$530
X-RAY EXAM OF ELBOW	CPT 73080	Outpatient	-	$530
CONTRAST X-RAY OF ELBOW	CPT 73085	Outpatient	-	$1,456
CONTRAST X-RAY OF ELBOW	CPT 73085	Outpatient	-	$1,456
X-RAY EXAM OF FOREARM	CPT 73090	Outpatient	-	$411
X-RAY EXAM OF FOREARM	CPT 73090	Outpatient	-	$411
X-RAY EXAM OF ARM INFANT	CPT 73092	Outpatient	-	$466
X-RAY EXAM OF ARM INFANT	CPT 73092	Outpatient	-	$466
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	-	$454
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	-	$454
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	-	$454
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	-	$454
X-RAY EXAM OF WRIST	CPT 73110	Outpatient	-	$573
X-RAY EXAM OF WRIST	CPT 73110	Outpatient	-	$573
CONTRAST X-RAY OF WRIST	CPT 73115	Outpatient	-	$1,679
CONTRAST X-RAY OF WRIST	CPT 73115	Outpatient	-	$1,679
X-RAY EXAM OF HAND	CPT 73120	Outpatient	-	$404
X-RAY EXAM OF HAND	CPT 73120	Outpatient	-	$404
X-RAY EXAM OF HAND	CPT 73120	Outpatient	-	$404
X-RAY EXAM OF HAND	CPT 73130	Outpatient	-	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	-	$489
X-RAY EXAM OF HAND	CPT 73130	Outpatient	-	$977
X-RAY EXAM OF HAND	CPT 73130	Outpatient	-	$489
X-RAY EXAM OF FINGER(S)	CPT 73140	Outpatient	-	$507
X-RAY EXAM OF FINGER(S)	CPT 73140	Outpatient	-	$507
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	-	$2,458
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	-	$3,051
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
CT UPPR EXTREMITY W/O&W/DYE	CPT 73202	Outpatient	-	$4,074
MRI UPPER EXTREMITY W/O DYE	CPT 73218	Outpatient	-	$5,018
MRI UPPER EXTREMITY W/O DYE	CPT 73218	Outpatient	-	$5,018
MRI UPPER EXTREMITY W/O DYE	CPT 73218	Outpatient	-	$5,018
MRI UPPER EXTREMITY W/O DYE	CPT 73218	Outpatient	-	$5,018
MRI UPPER EXTREMITY W/DYE	CPT 73219	Outpatient	-	$5,338
MRI UPPER EXTREMITY W/DYE	CPT 73219	Outpatient	-	$5,338
MRI UPPER EXTREMITY W/DYE	CPT 73219	Outpatient	-	$5,338
MRI UPPER EXTREMITY W/DYE	CPT 73219	Outpatient	-	$5,338
MRI UPPR EXTREMITY W/O&W/DYE	CPT 73220	Outpatient	-	$7,050
MRI UPPR EXTREMITY W/O&W/DYE	CPT 73220	Outpatient	-	$7,050
MRI UPPR EXTREMITY W/O&W/DYE	CPT 73220	Outpatient	-	$7,050
MRI UPPR EXTREMITY W/O&W/DYE	CPT 73220	Outpatient	-	$7,050
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/O DYE	CPT 73221	Outpatient	-	$4,671
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,338
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,338
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTREM W/DYE	CPT 73222	Outpatient	-	$5,018
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$7,050
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$7,050
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	-	$6,635
X-RAY EXAM HIP UNI 1 VIEW	CPT 73501	Outpatient	-	$339
X-RAY EXAM HIP UNI 1 VIEW	CPT 73501	Outpatient	-	$339
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	-	$620
X-RAY EXAM HIPS BI 5/> VIEWS	CPT 73523	Outpatient	-	$566
CONTRAST X-RAY OF HIP	CPT 73525	Outpatient	-	$1,498
CONTRAST X-RAY OF HIP	CPT 73525	Outpatient	-	$1,498
X-RAY EXAM OF FEMUR 2/>	CPT 73552	Outpatient	-	$404
X-RAY EXAM OF FEMUR 2/>	CPT 73552	Outpatient	-	$404
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	-	$878
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	-	$439
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	-	$439
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	-	$1,102
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	-	$550
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	-	$550
X-RAY EXAM KNEE 4 OR MORE	CPT 73564	Outpatient	-	$629
X-RAY EXAM KNEE 4 OR MORE	CPT 73564	Outpatient	-	$629
X-RAY EXAM OF KNEES	CPT 73565	Outpatient	-	$502
CONTRAST X-RAY OF KNEE JOINT	CPT 73580	Outpatient	-	$2,131
CONTRAST X-RAY OF KNEE JOINT	CPT 73580	Outpatient	-	$2,131
X-RAY EXAM OF LOWER LEG	CPT 73590	Outpatient	-	$398
X-RAY EXAM OF LOWER LEG	CPT 73590	Outpatient	-	$398
X-RAY EXAM OF LEG INFANT	CPT 73592	Outpatient	-	$474
X-RAY EXAM OF LEG INFANT	CPT 73592	Outpatient	-	$474
X-RAY EXAM OF ANKLE	CPT 73600	Outpatient	-	$417
X-RAY EXAM OF ANKLE	CPT 73600	Outpatient	-	$417
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	-	$496
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	-	$496
X-RAY EXAM OF FOOT	CPT 73620	Outpatient	-	$404
X-RAY EXAM OF FOOT	CPT 73620	Outpatient	-	$404
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	-	$482
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	-	$482
X-RAY EXAM OF HEEL	CPT 73650	Outpatient	-	$411
X-RAY EXAM OF HEEL	CPT 73650	Outpatient	-	$411
X-RAY EXAM OF TOE(S)	CPT 73660	Outpatient	-	$474
X-RAY EXAM OF TOE(S)	CPT 73660	Outpatient	-	$474
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	-	$2,390
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	-	$3,087
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	-	$4,094
CT ANGIO LWR EXTR W/O&W/DYE	CPT 73706	Outpatient	-	$7,929
CT ANGIO LWR EXTR W/O&W/DYE	CPT 73706	Outpatient	-	$7,929
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/O DYE	CPT 73718	Outpatient	-	$4,900
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LOWER EXTREMITY W/DYE	CPT 73719	Outpatient	-	$5,322
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720	Outpatient	-	$7,061
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT OF LWR EXTR W/DYE	CPT 73722	Outpatient	-	$5,107
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723	Outpatient	-	$6,620
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	Outpatient	-	$334
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	Outpatient	-	$559
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	Outpatient	-	$559
X-RAY EXAM ABDOMEN 3+ VIEWS	CPT 74021	Outpatient	-	$559
X-RAY EXAM ABDOMEN 3+ VIEWS	CPT 74021	Outpatient	-	$559
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	Outpatient	-	$679
CT ABDOMEN W/O DYE	CPT 74150	Outpatient	-	$2,370
CT ABDOMEN W/DYE	CPT 74160	Outpatient	-	$3,418
CT ABDOMEN W/O & W/DYE	CPT 74170	Outpatient	-	$4,691
CT ABDOMEN W/O & W/DYE	CPT 74170	Outpatient	-	$4,691
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	-	$1,657
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	-	$1,657
CT ABD & PELV 1/> REGNS	CPT 74178	Outpatient	-	$4,179
CT ABD & PELV 1/> REGNS	CPT 74178	Outpatient	-	$4,179
CT ABD & PELV 1/> REGNS	CPT 74178	Outpatient	-	$446
MRI ABDOMEN W/O DYE	CPT 74181	Outpatient	-	$4,319
MRI ABDOMEN W/O & W/DYE	CPT 74183	Outpatient	-	$7,036
MRI ANGIO ABDOM W ORW/O DYE	CPT 74185	Outpatient	-	$5,147
X-RAY XM ESOPHAGUS 1CNTRST	CPT 74220	Outpatient	-	$1,393
X-RAY XM UPR GI TRC 1CNTRST	CPT 74240	Outpatient	-	$1,603
XR UPPER GI + KUB	CPT 74241	Outpatient	-	$1,757
X-RAY XM UPR GI TRC 2CNTRST	CPT 74246	Outpatient	-	$1,920
XR UPPER GI W/ AIR CONTRAST + KUB	CPT 74247	Outpatient	-	$2,213
XR UPPER GI W/ AIR W/ SMALL BOWEL	CPT 74249	Outpatient	-	$3,020
X-RAY XM SM INT 1CNTRST STD	CPT 74250	Outpatient	-	$1,722
XR DUODENOGRAPHY HYPOTONIC	CPT 74260	Outpatient	-	$1,221
X-RAY XM COLON 1CNTRST STD	CPT 74270	Outpatient	-	$2,460
X-RAY XM COLON 1CNTRST STD	CPT 74270	Outpatient	-	$2,460
X-RAY XM COLON 2CNTRST STD	CPT 74280	Outpatient	-	$3,385
X-RAY BILE DUCTS/PANCREAS	CPT 74300	Outpatient	-	$956
X-RAY BILE/PANC ENDOSCOPY	CPT 74330	Outpatient	-	$656
UROGRAPHY IV +-KUB TOMOG	CPT 74400	Outpatient	-	$1,814
UROGRAPHY RTRGR +-KUB	CPT 74420	Outpatient	-	$1,370
CONTRAST X-RAY BLADDER	CPT 74430	Outpatient	-	$938
X-RAY URETHRA/BLADDER	CPT 74455	Outpatient	-	$1,520
X-RAY FEMALE GENITAL TRACT	CPT 74740	Outpatient	-	$1,251
CT ANGIO ABDOMINAL ARTERIES	CPT 75635	Outpatient	-	$8,729
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$974
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$974
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$734
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$1,698
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$1,651
ABSCESS DRAINAGE UNDER X-RAY	CPT 75989	Outpatient	-	$734
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	-	$1,429
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	-	$1,429
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	-	$1,429
XR C-ARM > 1 HR	CPT 76001	Outpatient	-	$882
X-RAY NOSE TO RECTUM	CPT 76010	Outpatient	-	$361
X-RAY EXAM OF FISTULA	CPT 76080	Outpatient	-	$734
X-RAY EXAM SURGICAL SPECIMEN	CPT 76098	Outpatient	-	$214
X-RAY EXAM SURGICAL SPECIMEN	CPT 76098	Outpatient	-	$214
3D RENDER W/INTRP POSTPROCES	CPT 76376	Outpatient	-	$778
3D RENDER W/INTRP POSTPROCES	CPT 76377	Outpatient	-	$682
US EXAM OF HEAD AND NECK	CPT 76536	Outpatient	-	$862
US EXAM CHEST	CPT 76604	Outpatient	-	$1,261
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	-	$1,429
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	-	$1,429
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	-	$1,429
ECHO EXAM OF ABDOMEN	CPT 76705	Outpatient	-	$740
US EXAM ABDO BACK WALL COMP	CPT 76770	Outpatient	-	$922
US EXAM ABDO BACK WALL COMP	CPT 76770	Outpatient	-	$922
US EXAM ABDO BACK WALL LIM	CPT 76775	Outpatient	-	$785
US EXAM ABDO BACK WALL LIM	CPT 76775	Outpatient	-	$785
OB US < 14 WKS SINGLE FETUS	CPT 76801	Outpatient	-	$1,686
OB US < 14 WKS SINGLE FETUS	CPT 76801	Outpatient	-	$1,686
OB US < 14 WKS ADDL FETUS	CPT 76802	Outpatient	-	$600
OB US >= 14 WKS ADDL FETUS	CPT 76810	Outpatient	-	$1,026
OB US LIMITED FETUS(S)	CPT 76815	Outpatient	-	$821
TRANSVAGINAL US OBSTETRIC	CPT 76817	Outpatient	-	$1,378
TRANSVAGINAL US OBSTETRIC	CPT 76817	Outpatient	-	$1,378
ECHO EXAM UTERUS	CPT 76831	Outpatient	-	$1,863
US EXAM PELVIC COMPLETE	CPT 76856	Outpatient	-	$862
US EXAM PELVIC COMPLETE	CPT 76856	Outpatient	-	$862
US EXAM PELVIC LIMITED	CPT 76857	Outpatient	-	$1,694
US EXAM SCROTUM	CPT 76870	Outpatient	-	$873
US COMPL JOINT R-T W/IMG	CPT 76881	Outpatient	-	$817
US COMPL JOINT R-T W/IMG	CPT 76881	Outpatient	-	$817
US LMTD JT/NONVASC XTR STRUX	CPT 76882	Outpatient	-	$426
US LMTD JT/NONVASC XTR STRUX	CPT 76882	Outpatient	-	$426
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	-	$1,136
FLUOROGUIDE FOR VEIN DEVICE	CPT 77001	Outpatient	-	$1,969
NEEDLE LOCALIZATION BY XRAY	CPT 77002	Outpatient	-	$993
NEEDLE LOCALIZATION BY XRAY	CPT 77002	Outpatient	-	$993
NEEDLE LOCALIZATION BY XRAY	CPT 77002	Outpatient	-	$993
FLUOROGUIDE FOR SPINE INJECT	CPT 77003	Outpatient	-	$679
FLUOROGUIDE FOR SPINE INJECT	CPT 77003	Outpatient	-	$679
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	-	$1,341
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	-	$1,341
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	-	$1,341
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	-	$1,341
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	-	$1,341
X-RAY STRESS VIEW	CPT 77071	Outpatient	-	$446
X-RAY STRESS VIEW	CPT 77071	Outpatient	-	$446
X-RAYS FOR BONE AGE	CPT 77072	Outpatient	-	$292
X-RAYS BONE LENGTH STUDIES	CPT 77073	Outpatient	-	$502
X-RAYS BONE SURVEY COMPLETE	CPT 77075	Outpatient	-	$1,575
X-RAYS BONE SURVEY INFANT	CPT 77076	Outpatient	-	$1,371
DXA BONE DENSITY AXIAL	CPT 77080	Outpatient	-	$687
DXA BONE DENSITY/PERIPHERAL	CPT 77081	Outpatient	-	$388
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	-	$56
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	-	$290
RHYTHM ECG TRACING	CPT 93041	Outpatient	-	$18
ECG MONIT/REPRT UP TO 48 HRS	CPT 93226	Outpatient	-	$118
TTE W/DOPPLER COMPLETE	CPT 93306	Outpatient	-	$1,547
EXTRACRANIAL BILAT STUDY	CPT 93880	Outpatient	-	$731
LOWER EXTREMITY STUDY	CPT 93926	Outpatient	-	$884
EXTREMITY STUDY	CPT 93970	Outpatient	-	$607
EXTREMITY STUDY	CPT 93970	Outpatient	-	$607
EXTREMITY STUDY	CPT 93971	Outpatient	-	$588
EXTREMITY STUDY	CPT 93971	Outpatient	-	$588
EXTREMITY STUDY	CPT 93971	Outpatient	-	$588
EXTREMITY STUDY	CPT 93971	Outpatient	-	$588
IMMUNOTHERAPY INJECTIONS	CPT 95117	Outpatient	20096095117	$133
ADMIN INFLUENZA VIRUS VAC	HCPCS G0008	Outpatient	200771G0008	$74
ADMIN PNEUMOCOCCAL VACCINE	HCPCS G0009	Outpatient	200771G0009	$37
MA MAMMOGRAM LEFT	HCPCS G0202	Outpatient	-	$477
MA MAMMOGRAM RIGHT	HCPCS G0202	Outpatient	-	$477
MA MAMMOGRAM DIGITAL DIAGNOSTIC BILAT.	HCPCS G0204	Outpatient	-	$477
IR INTRAPERITONEAL CATH INSERT	HCPCS G0206	Outpatient	-	$477
IR INTRAVASC STENT PLACE W/ EMBOLIC PROTECT	HCPCS G0206	Outpatient	-	$477
MA MAMMOGRAM DIGITAL DIAGNOSTIC LEFT.	HCPCS G0206	Outpatient	-	$331
ZZ MA MAMMOGRAM DIGITAL DIAGNOSTIC RIGHT.	HCPCS G0206	Outpatient	-	$331