dameron hospital association chargemaster on june 1, 2019...2000180 eye for fb 20 320 70030 1,781.00...

Dameron Hospital Association Chargemaster on June 1, 2019

NUMBER DESCRIPTION DEPTRev

Code CPT CODE UNIT PRICEROOM PRICE

14241 R&B 4FE - ICU 0 201 0.00 18,077.0024059 R&B 4FW - CCU 0 210 0.00 18,077.0032003 R&B 2FM - CCU INTERM CARE 0 214 0.00 9,096.0032425 R&B 2HTU - PRE-OP HOLDING 0 206 0.00 9,096.0034009 R&B 4FM - ICU INTERM CARE 0 206 0.00 9,096.0034058 R&B 4FW-CCU AT TELE LOC 0 214 0.00 9,096.0034249 R&B 4FE-ICU AT TELE LOC 0 206 0.00 9,096.0042465 R&B 2FN - PEDIATRICS PVT 0 113 0.00 6,984.0043000 R&B 3FM - MED/SURG PVT 0 111 0.00 6,984.0043216 R&B 3FE - OBSTETRICS PVT 0 112 0.00 6,984.0043471 R&B 3FE - L & D PVT 0 112 0.00 6,984.0052001 R&B 2FM-TELE AT M/S S-PVT 0 121 0.00 6,984.0052464 R&B 2FN - PEDIATRCS S-PVT 0 123 0.00 6,984.0053009 R&B 3FM - MED/SURG S-PVT 0 121 0.00 6,984.0053215 R&B 3FE - OBSTETRCS S-PVT 0 122 0.00 6,984.0054007 R&B 4FM-TELE AT M/S S-PVT 0 121 0.00 6,984.0054056 R&B 4FW-CCU AT M/S S-PVT 0 121 0.00 6,984.0054247 R&B 4FE-ICU AT M/S S-PVT 0 121 0.00 6,984.0062463 R&B 2FN - PEDIATRICS WARD 0 153 0.00 6,984.0073411 R&B 3FM - NWBRN LVL 4 ICN 0 174 0.00 16,771.0073429 R&B 3FM - NWBRN LVL 4 ICN 0 174 0.00 16,771.0073437 R&B 3FM - NWBRN LVL 4 ICN 0 174 0.00 16,771.0083402 R&B 3FM - NWBRN LVL2 NURS 0 172 0.00 6,984.0083410 R&B 3FM - NWBRN LVL 3 SCN 0 173 0.00 9,096.0083428 R&B 3FM - NWBRN LVL 3 SCN 0 173 0.00 9,096.0083436 R&B 3FM - NWBRN LVL 3 SCN 0 173 0.00 9,096.0092460 R&B 2FN - NWBRN LVL 2 CCN 0 172 0.00 6,984.0093401 R&B 3FM - NWBRN LVL 1 NSY 0 171 0.00 3,353.0093419 R&B 3FM - NWBRN LVL 2 CCN 0 172 0.00 6,984.0093427 R&B 3FM - NWBRN LVL 2 CCN 0 172 0.00 6,984.0093435 R&B 3FM - NWBRN LVL 2 CCN 0 172 0.00 6,984.00

500108 LATE DISCHARGE ORDER ICU 5 224 0.00 18,077.00500801 CARDIOVERSION (ICU) 5 480 92960 1,270.00 0.00600106 LATE DISCHARGE ORDER CCU 6 224 0.00 18,077.00600809 CARDIOVERSION (CCU) 6 480 92960 1,270.00 0.00

1600477 CONSULT NEW PAT PER 15MIN 16 099 0.00 0.001600485 FOLLOW-UP CNSLT PER 15MIN 16 099 0.00 0.001600493 WOUND TREATMENT PER 15MIN 16 099 0.00 0.001600501 EDUCATION PER 15 MIN 16 099 0.00 0.001600519 ATYPICAL CNSLT PER 15 MIN 16 099 0.00 0.001800010 MNT INITIAL ASSESS EA 15M 18 942 97802 159.00 0.001800028 MNT RE-ASSESSMENT EA 15M 18 942 97803 193.00 0.001800036 MNT GROUP EA 30MIN 18 942 97804 176.00 0.001800044 MNT EA 15M AFTER 2ND RFRL 18 942 G0270 159.00 0.001800051 MNT GP EA 30M AFT 2ND REF 18 942 G0271 176.00 0.001800069 DSMT INDIV EA 30MIN 18 942 G0108 389.00 0.001800077 DSMT GROUP EA 30MIN 18 942 G0109 389.00 0.00




2000065 SKULL LIMTED 20 320 70250 1,150.00 0.002000073 SKULL COMPLETE 20 320 70260 2,155.00 0.002000099 FACIAL BONES LIMITED 20 320 70140 1,206.00 0.002000107 FACIAL BONES COMPLETE 20 320 70150 2,212.00 0.002000123 NASAL BONES 20 320 70160 1,417.00 0.002000164 MANDIBLE LIMIT 20 320 70100 1,008.00 0.002000172 MANDIBLE COMP 20 320 70110 2,401.00 0.002000180 EYE FOR FB 20 320 70030 1,781.00 0.002000198 ORBITS 20 320 70200 1,763.00 0.002000214 TEMPOROMANDIBULAR JOINTS 20 320 70330 2,387.00 0.002000222 SINUSES LIMITED 20 320 70210 1,102.00 0.002000230 SINUSES COMPLETE 20 320 70220 1,985.00 0.002000263 SOFT TISS NECK 20 320 70360 1,213.00 0.002000297 SPINE SINGLE VIEW 20 320 72020 917.00 0.002000305 CERVICAL SPINE LIMIT 20 320 72040 1,477.00 0.002000313 CERVICAL SPINE COMPLETE 20 320 72050 1,865.00 0.002000321 CERVICAL SPINE FLEX & E 20 320 72052 3,191.00 0.002000339 THORACIC SPINE 20 320 72070 1,510.00 0.002000362 LUMBOSACRAL LIMITED 20 320 72100 1,603.00 0.002000370 LUMBOSACRAL COMPLETE 20 320 72110 2,810.00 0.002000388 LUMBOSACRAL BENDING VIEW 20 320 72120 1,542.00 0.002000396 PELVIS 1 VIEW 20 320 72170 1,039.00 0.002000404 PELVIS 3 VIEWS 20 320 72190 1,234.00 0.002000412 SACROILIAC JOINTS 20 320 72202 1,446.00 0.002000420 SACRUM 20 320 72220 1,561.00 0.002000438 COCCYX 20 320 72220 1,561.00 0.002000446 SACRUM & COCCYX 20 320 72220 1,561.00 0.002000453 STERNUM 20 320 71120 1,009.00 0.002000461 STERNO/CLAVICULAR JOINTS 20 320 71130 987.00 0.002000487 RIBS BILATERAL 20 320 71110 1,647.00 0.002000537 ACROMIOCLAVICULAR JOINTS 20 320 73050 951.00 0.002000883 CHILD FB 20 320 76010 563.00 0.002001063 CHOLANGIOGRAPHY OPERATIVE 20 320 74300 5,107.00 0.002001097 UROGRAM IVP 20 320 74410 2,901.00 0.002001105 INF IVP-TOMOS 20 320 74415 3,323.00 0.002001113 IVP W TOMO OR INF 20 320 74400 2,717.00 0.002001121 URO RETROGRADE 20 320 74420 4,136.00 0.002001147 CYSTOGRAM 20 320 74430 2,456.00 0.002001162 URETHRO CYST RETRO VOIDNG 20 320 74455 2,960.00 0.002001170 URETHRO CYST RETROGRADE 20 320 74450 2,040.00 0.002001188 TOMOGRAM INDEP 20 320 76100 1,940.00 0.002001196 TOMOGRAM W/ROUTINE 20 320 76100 1,940.00 0.002001279 ESOPHAGUS 20 320 74220 2,550.00 0.002001287 UPPER GI 20 320 74247 2,665.00 0.002001295 UPPER GI LIMIT 20 320 74246 3,077.00 0.002001303 UPPER GI/SMALL BOWEL 20 320 74249 3,432.00 0.002001311 SMALL BOWEL XRAY 20 320 74250 2,570.00 0.00




2001329 BARIUM ENEMA 20 320 74270 2,973.00 0.002001337 BARIUM ENEMA AIR CONTRAST 20 320 74280 3,843.00 0.002001378 FLUORO, UP TO 1 HOUR 20 320 76000 2,867.00 0.002001394 ENTEROCLYSIS 20 320 74251 6,686.00 0.002001410 BARIUM SWALLOW W/THERAPIS 20 320 74230 2,686.00 0.002001527 INSERT PICC AGE 5 /> 20 361 36569 6,031.00 0.002001543 INJ W/FLUOR, EVAL CVAD 20 361 36598 1,176.00 0.002001550 EXTREMITY ANGIO - UNIL 20 323 75710 7,884.00 0.002001576 BONE AGE STUDIES 20 320 77072 1,136.00 0.002001584 BONE SURVEY COMPLETE 20 320 77075 2,623.00 0.002001592 INFANT BONE SURVEY 20 320 77076 3,057.00 0.002001600 BONE LENGTH STUDIES 20 320 77073 2,348.00 0.002001683 PERC PEG TUBE PLACEMENT 20 361 43246 6,687.00 0.002001691 INS N-TNLD CV CTH AGE 5/> 20 361 36556 7,637.00 0.002001709 ENDO CATH - PANCR DUCT 20 320 74329 2,721.00 0.002001741 CHANGE G-TUBE TO G-J PERC 20 361 49446 6,756.00 0.002001758 REPLACE G/C TUBE PERC 20 361 49450 3,880.00 0.002001766 FLUORO PER HOUR 20 361 294.00 0.002001774 MAMMO NEEDLE LOCAL LEFT 20 361 2,185.00 0.002001782 MAMMO NEEDLE LOCAL RIGHT 20 361 2,185.00 0.002001790 SCOLIOSIS SER SPI 2-3 VWS 20 320 72082 1,175.00 0.002001808 HIP BILATERAL COMP 2 VWS 20 320 73521 2,035.00 0.002001816 HIP BILATERAL CPL 3-4 VWS 20 320 73522 2,110.00 0.002001824 HIP LIMITED LEFT 1 VIEW 20 320 73501 1,053.00 0.002001832 HIP LIMITED RIGHT 1 VIEW 20 320 73501 1,053.00 0.002001840 HIP COMPLETE LEFT 2-3 VWS 20 320 73502 1,594.00 0.002001857 HIP CMPLT RIGHT 2-3 VIEWS 20 320 73502 1,594.00 0.002001865 HIP OPER LEFT 1 VIEW 20 320 73501 4,588.00 0.002001873 HIP OPER LFT 2-3 VIEWS 20 320 73502 4,661.00 0.002001881 HIP OPER RIGHT 1 VIEW 20 320 73501 4,588.00 0.002001899 HIP OPER RIGHT 2-3 VIEWS 20 320 73502 4,661.00 0.002001907 HIPS & PLVS INFANT 1 VIEW 20 320 73501 801.00 0.002001915 HIPS & PLVS INFNT 2-3 VWS 20 320 73502 850.00 0.002001923 FEMUR LEFT 1 VIEW 20 320 73551 1,228.00 0.002001931 FEMUR LEFT 2 OR MORE VWS 20 320 73552 1,254.00 0.002001949 FEMUR RIGHT 1 VIEW 20 320 73551 1,228.00 0.002001956 FEMUR RIGHT 2 OR MORE VWS 20 320 73552 1,254.00 0.002001964 IMAGING SERVICES PROVIDED 20 099 0.00 0.002001972 CHOLANGIOGRAM INJ EXIST 20 361 47531 5,000.00 0.002001980 CHEST 1 VIEW 20 324 71045 1,152.00 0.002001998 CHEST PORT 1 VIEW 20 324 71045 1,152.00 0.002002202 CHEST 2 VIEW 20 324 71046 1,310.00 0.002002210 CHEST PORT 2 VIEW 20 324 71046 1,310.00 0.002002228 FOOT LIMITED LEFT 20 320 73620 981.00 0.002002236 FOOT COMPLETE LEFT 20 320 73630 1,236.00 0.002002251 ELBOW LEFT LIMITED 20 320 73070 1,008.00 0.002002269 CLAVICLE LEFT 20 320 73000 1,329.00 0.00




2002277 ANKLE COMPLETE LEFT 20 320 73610 1,225.00 0.002002285 ANKLE LIMITED LEFT 20 320 73600 1,070.00 0.002002293 FOREARM LEFT 20 320 73090 1,070.00 0.002002301 HAND LIMITED LEFT 20 320 73120 1,070.00 0.002002319 HAND COMPLETE LEFT 20 320 73130 1,241.00 0.002002327 HEEL LEFT 20 320 73650 878.00 0.002002368 FINGERS LEFT 20 320 73140 775.00 0.002002376 HUMERUS LEFT 20 320 73060 856.00 0.002002384 KNEE & PATELLA LEFT 20 320 73564 1,763.00 0.002002392 KNEE COMPLETE RIGHT 20 320 73562RT 1,088.00 0.002002400 KNEE COMPLETE LEFT 20 320 73562LT 1,088.00 0.002002418 KNEE LIMITED LEFT 20 320 73560 975.00 0.002002426 NAVICULAR SERIES LEFT 20 320 73110 1,247.00 0.002002434 NEPHROSTOGRAM LEFT 20 320 74425 4,136.00 0.002002459 RIBS LEFT 20 320 71100 1,322.00 0.002002467 SCAPULA LEFT 20 320 73010 1,481.00 0.002002475 SHOULDER COMPLETE LEFT 20 320 73030 1,375.00 0.002002483 SHOULDER LIMITED LEFT 20 320 73020 975.00 0.002002491 TIBIA & FIBULA LEFT 20 320 73590 1,105.00 0.002002509 TOES LEFT 20 320 73660 728.00 0.002002517 WRIST COMPLETE LEFT 20 320 73110 1,247.00 0.002002525 WRIST LIMITED LEFT 20 320 73100 1,059.00 0.002002533 CHEST 3 VIEW 20 324 71047 903.00 0.002002541 ELBOW RIGHT COMPLETE 20 320 73080 1,247.00 0.002002558 ELBOW LEFT COMPLETE 20 320 73080 1,247.00 0.002002608 RIBS RIGHT 20 320 71100 1,322.00 0.002002616 SCAPULA RIGHT 20 320 73010 1,481.00 0.002002624 SHOULDER LIMITED RIGHT 20 320 73020 975.00 0.002002632 SHOULDER COMPLETE RIGHT 20 320 73030 1,375.00 0.002002640 HUMERUS RIGHT 20 320 73060 856.00 0.002002657 ELBOW RIGHT LIMITED 20 320 73070 1,008.00 0.002002665 FOREARM RIGHT 20 320 73090 1,070.00 0.002002673 WRIST LIMITED RIGHT 20 320 73100 1,059.00 0.002002681 WRIST COMPLETE RIGHT 20 320 73110 1,247.00 0.002002699 NAVICULAR SERIES RIGHT 20 320 73110 1,247.00 0.002002707 HAND COMPLETE RIGHT 20 320 73130 1,241.00 0.002002715 HAND LIMITED RIGHT 20 320 73120 1,070.00 0.002002723 FINGERS RIGHT 20 320 73140 775.00 0.002002764 KNEE LIMITED RIGHT 20 320 73560 975.00 0.002002772 KNEE & PATELLA RIGHT 20 320 73564 1,763.00 0.002002780 TIBIA & FIBULA RIGHT 20 320 73590 1,105.00 0.002002798 ANKLE LIMITED RIGHT 20 320 73600 1,070.00 0.002002806 ANKLE COMPLETE RIGHT 20 320 73610 1,225.00 0.002002814 FOOT LIMITED RIGHT 20 320 73620 981.00 0.002002822 FOOT COMPLETE RIGHT 20 320 73630 1,236.00 0.002002830 HEEL RIGHT 20 320 73650 878.00 0.002002855 NEPHROSTOGRAM RIGHT 20 320 74425 4,136.00 0.00




2002863 CLAVICLE RIGHT 20 320 73000 1,329.00 0.002002871 TOES RIGHT 20 320 73660 728.00 0.002002889 INSERTION OF CHEST TUBE 20 361 32551 2,995.00 0.002002897 NEPHROSTOMY TUBE CHANGE 20 320 75984 6,501.00 0.002002905 ASPIRATION OF MAJOR JOINT 20 361 20610 4,220.00 0.002002921 ABDOMEN 1 VIEW 20 320 74018 1,003.00 0.002002939 ABD PORT 1 VIEW 20 320 74018 1,003.00 0.002002947 NEPHRO GRAM IN OR 20 320 74018 1,003.00 0.002002954 ABDOMEN 2 VIEW 20 320 74019 1,281.00 0.002002962 ABD PORT 2 VIEW 20 320 74019 1,281.00 0.002002970 ABDOMEN 3 VIEW 20 320 74021 1,355.00 0.002079903 OTHER RADIOLOGY SERVICES 20 320 0.00 0.002080026 KNEE ARTHROGRAM 20 322 73580 2,629.00 0.002080067 SINUS FISTULA 20 323 76080 1,838.00 0.002080075 HYSTEROSALPINGOGRAPHY 20 320 74740 1,861.00 0.002080091 ERCP 20 320 74330 3,338.00 0.002080133 SURGICAL SPECIMEN MAMM 20 320 76098 836.00 0.002080158 MYELOGRAM CERVICAL 20 320 72240 5,038.00 0.002080166 MYELOGRAM THORACIC 20 320 72255 6,850.00 0.002080299 VENOGRAM EXTREMITY RT 20 320 75820 7,927.00 0.002080307 VENOGRAM EXTREMITY BILAT 20 320 75822 9,508.00 0.002080471 INFERIOR VENA CAVA 20 323 75825 14,288.00 0.002080497 MYELOGRAM LUMBAR 20 320 72265 3,996.00 0.002080505 MYELOGRAM 2 OR > REGIONS 20 320 72270 6,504.00 0.002080562 ABSCESS DRAINAGE 20 320 75989 7,412.00 0.002080570 ANGIO EXISTING CATH 20 323 75898 2,613.00 0.002080588 INS TUNLD CV CATH AGE 5/> 20 361 36558 18,147.00 0.002080687 ARTHRO SHOULDER 20 322 73040 1,833.00 0.002080737 ARTHRO HIP 20 322 73525 2,172.00 0.002080802 VENOGRAM EXTREMITY LEFT 20 320 75820 7,927.00 0.002081222 INS TNLD CVAD W PORT 20 361 36561 16,873.00 0.002081248 REMOVE TNLD CV CATH 20 361 36589 4,692.00 0.002081263 SPINAL PUNCTURE 20 361 62270 1,756.00 0.002081305 REM TNLD CVAD W PORT/PUMP 20 361 36590 9,044.00 0.002085009 RADIOLOGY SURG/COMPONENT 20 361 MULTI 2,256.00 0.002100014 MRA BRAIN W/O 21 615 70544 4,666.00 0.002100022 MRA BRAIN W 21 615 70545 4,899.00 0.002100030 MRA BRAIN W/O & W 21 615 70546 5,074.00 0.002100048 MRA CAROTIDS W/O 21 615 70547 4,666.00 0.002100055 MRV BRAIN W/O 21 615 70544 4,666.00 0.002100063 MRA CAROTIDS W/O & W 21 615 70549 5,074.00 0.002100071 MRV PELVIS W/O & W 21 618 72198 5,074.00 0.002100089 MRI FACE W/O 21 610 70540 4,666.00 0.002100097 MRA THORACIC AORT W/O & W 21 618 71555 5,074.00 0.002100105 MRI FACE W 21 610 70542 4,899.00 0.002100113 MRI FACE W/O & W 21 610 70543 5,074.00 0.002100121 MRI SOFT TISSUE NECK W/O 21 610 70540 4,666.00 0.00




2100139 MRA PELVIS ILLIAC VES W/O 21 618 72198 4,666.00 0.002100147 MRA PELVIS ILLIAC VESS W 21 618 72198 4,899.00 0.002100154 MRA PELVIS ILLIAC W/O & W 21 618 72198 5,074.00 0.002100162 MRA UPPER EXTREMITY W/O 21 618 73225 4,666.00 0.002100170 MRA UPPER EXTREMITY W 21 618 73225 4,899.00 0.002100188 MRA UPPER EXT W/O & W 21 618 73225 5,074.00 0.002100196 MRA LOWER EXTREMITY W/O 21 616 73725 4,666.00 0.002100204 MRA LOWER EXTREMITY W 21 616 73725 4,899.00 0.002100212 MRA LOW EXTREMITY W/O & W 21 616 73725 5,074.00 0.002100220 MRA ABDOMEN W/O 21 618 74185 4,666.00 0.002100238 MRA ABDOMEN W 21 618 74185 4,899.00 0.002100246 MRA ABDOMEN W/O & W 21 618 74185 5,074.00 0.002100253 MRI OF TMJ(S) 21 610 70336 4,666.00 0.002100261 MRI ORBITS W/O 21 610 70540 4,666.00 0.002100279 MRI ORBITS W 21 610 70542 4,899.00 0.002100287 MRI ORBITS W/O & W 21 610 70543 5,074.00 0.002100295 MRI BRAIN W/O 21 611 70551 4,666.00 0.002100303 MRI BRAIN W 21 611 70552 4,899.00 0.002100311 MRI BRAIN W/O & W 21 611 70553 5,074.00 0.002100329 MRI CHEST W/O 21 610 71550 4,666.00 0.002100337 MRI CHEST W 21 610 71551 4,899.00 0.002100345 MRI CHEST W/O & W 21 610 71552 5,074.00 0.002100352 MRI CERVICAL SP W/O 21 612 72141 4,666.00 0.002100360 MRI CERVICAL SP W 21 612 72142 4,899.00 0.002100378 MRI CERVICAL SP W/O & W 21 612 72156 5,074.00 0.002100386 MRI THORACIC SP W/O 21 612 72146 4,666.00 0.002100394 MRI THORACIC SP W 21 612 72147 4,899.00 0.002100402 MRI THORACIC SP W/O & W 21 612 72157 5,074.00 0.002100410 MRI LUMBAR SP W/O 21 612 72148 4,666.00 0.002100428 MRI LUMBAR SP W 21 612 72149 4,899.00 0.002100436 MRI LUMBAR SP W/O & W 21 612 72158 5,074.00 0.002100444 MRI PELVIS W/O 21 610 72195 4,666.00 0.002100451 MRI PELVIS W 21 610 72196 4,899.00 0.002100469 MRI PELVIS W/O & W 21 610 72197 5,074.00 0.002100477 MRI SOFT TISSUE NECK W 21 610 70542 4,899.00 0.002100485 MRI SFT TISS NECK W/O & W 21 610 70543 5,074.00 0.002100493 MRI BR SEIZURE PRTCL W/O 21 611 70551 4,666.00 0.002100501 MRI HUMERUS L W/O 21 610 73218LT 4,666.00 0.002100519 MRI HUMERUS L W 21 610 73219LT 4,899.00 0.002100527 MRI HUMERUS L W/O & W 21 610 73220LT 5,074.00 0.002100535 MRI BR SEIZURE PRTCL W 21 611 70552 4,899.00 0.002100543 MRI BR SEIZ PRTCL W/O & W 21 611 70553 5,074.00 0.002100550 MRI BRAIN POST FOSSA W/O 21 611 70551 4,666.00 0.002100568 MRI HUMERUS R W/O 21 610 73218RT 4,666.00 0.002100576 MRI HUMERUS R W 21 610 73219RT 4,899.00 0.002100584 MRI HUMERUS R W/O & W 21 610 73220RT 5,074.00 0.002100592 MRI ABDOMEN W/O 21 610 74181 4,666.00 0.00




2100600 MRI ABDOMEN W 21 610 74182 4,899.00 0.002100618 MRI ABDOMEN W/O & W 21 610 74183 5,074.00 0.002100626 MRI FETAL 21 610 74712 4,666.00 0.002100634 MRI CARDIAC MORPH W/O 21 610 75557 4,666.00 0.002100642 MRI CARD W/STRESS IMG W/O 21 610 75559 4,666.00 0.002100659 MRI CARDIAC MORPH W/O & W 21 610 75561 5,074.00 0.002100667 MRI CARD MPH W/O&W STRESS 21 610 75563 6,299.00 0.002100675 MRI BONE MARROW 21 610 77084 4,666.00 0.002100683 FMRI BRAIN BY TECH 21 611 70554 4,666.00 0.002100691 FMRI BRAIN BY PHYS/PSYCH 21 611 70555 4,666.00 0.002100709 MRI BREAST UNIL L W/O 21 614 77058 4,666.00 0.002100717 MRI BREAST UNILATERAL L W 21 614 77058 4,899.00 0.002100725 MRI BREAST UNIL L W/O & W 21 614 77058 5,074.00 0.002100733 MRI BREASTS BILATERAL W/O 21 614 77059 4,666.00 0.002100741 MRI BREASTS BILATERAL W 21 614 77059 4,899.00 0.002100758 MRI BREASTS BILAT W/O & W 21 614 77059 5,074.00 0.002100766 MRI BRAIN POST FOSSA W 21 611 70552 4,899.00 0.002100774 MRI BR POST FOSSA W/O & W 21 611 70553 5,074.00 0.002100782 MRI BRAIN IAC'S W/O 21 611 70551 4,666.00 0.002100790 MRI BRAIN IAC'S W 21 611 70552 4,899.00 0.002100808 MRI BRAIN IAC'S W/O & W 21 611 70553 5,074.00 0.002100816 MRI BRAIN PITUATARY W/O 21 611 70551 4,666.00 0.002100824 MRI BRAIN PITUATARY W 21 611 70552 4,899.00 0.002100832 MRI BR PITUATARY W/O & W 21 611 70553 5,074.00 0.002100840 MRI BRACHIAL PLEXUS W/O 21 610 73218 4,666.00 0.002100857 MRI PELVIS FEMALE W/O 21 610 72195 4,666.00 0.002100865 MRI PELVIS FEMALE W 21 610 72196 4,899.00 0.002100873 MRI PELVS FEMALE W/O & W 21 610 72197 5,074.00 0.002100881 MRI PELVIS BONY W/O 21 610 72195 4,666.00 0.002100899 MRI PELVIS BONY W 21 610 72196 4,899.00 0.002100907 MRI PELVIS BONY W/O & W 21 610 72197 5,074.00 0.002100915 MRI SACRUM/COCCYX W/O 21 610 72195 4,666.00 0.002100923 MRI SACRUM/COCCYX W 21 610 72196 4,899.00 0.002100931 MRI SACRUM/COCCYX W/O & W 21 610 72197 5,074.00 0.002100949 MRI PROSTATE GLND W/O & W 21 610 72197 5,074.00 0.002100956 MRI HUMERUS BIL W/O 21 610 7321850 4,666.00 0.002100964 MRI HUMERUS BIL W 21 610 7321950 4,899.00 0.002100972 MRI HUMERUS BIL W/O & W 21 610 7322050 5,074.00 0.002100980 MRI FOREARM L W/O 21 610 73218LT 4,666.00 0.002100998 MRI FOREARM L W 21 610 73219LT 4,899.00 0.002101004 MRI FOREARM L W/O & W 21 610 73220LT 5,074.00 0.002101012 MRI FOREARM R W/O 21 610 73218RT 4,666.00 0.002101020 MRI FOREARM R W 21 610 73219RT 4,899.00 0.002101038 MRI FOREARM R W/O & W 21 610 73220RT 5,074.00 0.002101046 MRI FOREARM BIL W/O 21 610 7321850 4,666.00 0.002101053 MRI FOREARM BIL W 21 610 7321950 4,899.00 0.002101061 MRI FOREARM BIL W/O & W 21 610 7322050 5,074.00 0.00




2101079 MRI HAND L W/O 21 610 73218LT 4,666.00 0.002101087 MRI HAND L W 21 610 73219LT 4,899.00 0.002101095 MRI HAND L W/O & W 21 610 73220LT 5,074.00 0.002101103 MRI HAND R W/O 21 610 73218RT 4,666.00 0.002101111 MRI HAND R W 21 610 73219RT 4,899.00 0.002101129 MRI HAND R W/O & W 21 610 73220RT 5,074.00 0.002101137 MRI HAND BIL W/O 21 610 7321850 4,666.00 0.002101145 MRI HAND BIL W 21 610 7321950 4,899.00 0.002101152 MRI HAND BIL W/O & W 21 610 7322050 5,074.00 0.002101160 MRI SHOULDER L W/O 21 610 73221LT 4,666.00 0.002101178 MRI SHOULDER L W 21 610 73222LT 4,899.00 0.002101186 MRI SHOULDER L W/O & W 21 610 73223LT 5,074.00 0.002101194 MRI SHOULDER R W/O 21 610 73221RT 4,666.00 0.002101202 MRI SHOULDER R W 21 610 73222RT 4,899.00 0.002101210 MRI SHOULDER R W/O & W 21 610 73223RT 5,074.00 0.002101228 MRI SHOULDER BIL W/O 21 610 7322150 4,666.00 0.002101236 MRI SHOULDER BIL W 21 610 7322250 4,899.00 0.002101244 MRI SHOULDER BIL W/O & W 21 610 7322350 5,074.00 0.002101251 MRI SHLDER ARTHROGRAM L W 21 610 73222LT 4,899.00 0.002101269 INJ ARTHROGRAM SHOULDER 21 361 23350 700.00 0.002101277 MRI SHLDER ARTHROGRAM R W 21 610 73222RT 4,899.00 0.002101285 MRI SHOULDER ARTHRO BIL W 21 610 7322250 4,899.00 0.002101293 MRI ELBOW L W/O 21 610 73221LT 4,666.00 0.002101301 MRI ELBOW L W 21 610 73222LT 4,899.00 0.002101319 MRI ELBOW L W/O & W 21 610 73223LT 5,074.00 0.002101327 MRI ELBOW R W/O 21 610 73221RT 4,666.00 0.002101335 MRI ELBOW R W 21 610 73222RT 4,899.00 0.002101343 MRI ELBOW R W/O & W 21 610 73223RT 5,074.00 0.002101350 MRI ELBOW BIL W/O 21 610 7322150 4,666.00 0.002101368 MRI ELBOW BIL W 21 610 7322250 4,899.00 0.002101376 MRI ELBOW BIL W/O & W 21 610 7322350 5,074.00 0.002101384 MRI WRIST L W/O 21 610 73221LT 4,666.00 0.002101392 MRI WRIST L W 21 610 73222LT 4,899.00 0.002101400 MRI WRIST L W/O & W 21 610 73223LT 5,074.00 0.002101418 MRI WRIST R W/O 21 610 73221RT 4,666.00 0.002101426 MRI WRIST R W 21 610 73222RT 4,899.00 0.002101434 MRI WRIST R W/O & W 21 610 73223RT 5,074.00 0.002101442 MRI WRIST BIL W/O 21 610 7322150 4,666.00 0.002101459 MRI WRIST BIL W 21 610 7322250 4,899.00 0.002101467 MRI WRIST BIL W/O & W 21 610 7322350 5,074.00 0.002101475 MRI THUMB L W/O 21 610 73218LT 4,666.00 0.002101483 MRI THUMB L W 21 610 73219LT 4,899.00 0.002101491 MRI THUMB L W/O & W 21 610 73220LT 5,074.00 0.002101509 MRI THUMB R W/O 21 610 73218RT 4,666.00 0.002101517 MRI THUMB R W 21 610 73219RT 4,899.00 0.002101525 MRI THUMB R W/O & W 21 610 73220RT 5,074.00 0.002101533 MRI THUMB BIL W/O 21 610 7321850 4,666.00 0.00




2101541 MRI THUMB BIL W 21 610 7321950 4,899.00 0.002101558 MRI THUMB BIL W/O & W 21 610 7322050 5,074.00 0.002101566 MRI FEMUR L W/O 21 610 73718LT 4,666.00 0.002101574 MRI FEMUR L W 21 610 73719LT 4,899.00 0.002101582 MRI FEMUR L W/O & W 21 610 73720LT 5,074.00 0.002101590 MRI FEMUR R W/O 21 610 73718RT 4,666.00 0.002101608 MRI FEMUR R W 21 610 73719RT 4,899.00 0.002101616 MRI FEMUR R W/O & W 21 610 73720RT 5,074.00 0.002101624 MRI FEMUR BIL W/O 21 610 7371850 4,666.00 0.002101632 MRI FEMUR BIL W 21 610 7371950 4,899.00 0.002101640 MRI FEMUR BIL W/O & W 21 610 7372050 5,074.00 0.002101657 MRI TIBIA/FIBULA L W/O 21 610 73718LT 4,666.00 0.002101665 MRI TIBIA/FIBULA L W 21 610 73719LT 4,899.00 0.002101673 MRI TIBIA/FBULA L W/O & W 21 610 73720LT 5,074.00 0.002101681 MRI TIBIA/FIBULA R W/O 21 610 73718RT 4,666.00 0.002101699 MRI TIBIA/FIBULA R W 21 610 73719RT 4,899.00 0.002101707 MRI TIBIA/FBULA R W/O & W 21 610 73720RT 5,074.00 0.002101715 MRI TIBIA/FIBULA BIL W/O 21 610 7371850 4,666.00 0.002101723 MRI TIBIA/FIBULA BIL W 21 610 7371950 4,899.00 0.002101731 MRI TIB/FBULA BIL W/O & W 21 610 7372050 5,074.00 0.002101749 MRI FOOT L W/O 21 610 73718LT 4,666.00 0.002101756 MRI FOOT L W 21 610 73719LT 4,899.00 0.002101764 MRI FOOT L W/O & W 21 610 73720LT 5,074.00 0.002101772 MRI FOOT R W/O 21 610 73718RT 4,666.00 0.002101780 MRI FOOT R W 21 610 73719RT 4,899.00 0.002101798 MRI FOOT R W/O & W 21 610 73720RT 5,074.00 0.002101806 MRI FOOT BIL W/O 21 610 7371850 4,666.00 0.002101814 MRI FOOT BIL W 21 610 7371950 4,899.00 0.002101822 MRI FOOT BIL W/O & W 21 610 7372050 5,074.00 0.002101830 MRI HIP L W/O 21 610 73721LT 4,666.00 0.002101848 MRI HIP L W 21 610 73722LT 4,899.00 0.002101855 MRI HIP L W/O & W 21 610 73723LT 5,074.00 0.002101863 MRI HIP R W/O 21 610 73721RT 4,666.00 0.002101871 MRI HIP R W 21 610 73722RT 4,899.00 0.002101889 MRI HIP R W/O & W 21 610 73723RT 5,074.00 0.002101897 MRI HIP BIL W/O 21 610 7372150 4,666.00 0.002101905 MRI HIP BIL W 21 610 7372250 4,899.00 0.002101913 MRI HIP BIL W/O & W 21 610 7372350 5,074.00 0.002101921 MRI HIP ARTHROGRAM L W 21 610 73722LT 4,899.00 0.002101939 INJECTION ARTHROGRAM HIP 21 361 27093 700.00 0.002101947 MRI HIP ARTHROGRAM R W 21 610 73722RT 4,899.00 0.002101954 MRI HIP ARTHROGRAM BIL W 21 610 7372250 4,899.00 0.002101962 MRI KNEE L W/O 21 610 73721LT 4,666.00 0.002101970 MRI KNEE L W 21 610 73722LT 4,899.00 0.002101988 MRI KNEE L W/O & W 21 610 73723LT 5,074.00 0.002101996 MRI KNEE R W/O 21 610 73721RT 4,666.00 0.002102002 MRI KNEE R W 21 610 73722RT 4,899.00 0.00




2102010 MRI KNEE R W/O & W 21 610 73723RT 5,074.00 0.002102028 MRI KNEE BIL W/O 21 610 7372150 4,666.00 0.002102036 MRI KNEE BIL W 21 610 7372250 4,899.00 0.002102044 MRI KNEE BIL W/O & W 21 610 7372350 5,074.00 0.002102051 MRI KNEE ARTHROGRAM L W 21 610 73722LT 4,899.00 0.002102069 INJECTION ARTHROGRAM KNEE 21 361 27370 700.00 0.002102077 MRI KNEE ARTHROGRAM R W 21 610 73722RT 4,899.00 0.002102085 MRI KNEE ARTHROGRAM BIL W 21 610 7372250 4,899.00 0.002102093 MRI ANKLE L W/O 21 610 73721LT 4,666.00 0.002102101 MRI ANKLE L W 21 610 73722LT 4,899.00 0.002102119 MRI ANKLE L W/O & W 21 610 73723LT 5,074.00 0.002102127 MRI ANKLE R W/O 21 610 73721RT 4,666.00 0.002102135 MRI ANKLE R W 21 610 73722RT 4,899.00 0.002102143 MRI ANKLE R W/O & W 21 610 73723RT 5,074.00 0.002102150 MRI ANKLE BIL W/O 21 610 7372150 4,666.00 0.002102168 MRI ANKLE BIL W 21 610 7372250 4,899.00 0.002102176 MRI ANKLE BIL W/O & W 21 610 7372350 5,074.00 0.002102184 MRI LIVER W/O & W 21 610 74183 5,074.00 0.002102192 MRI ADRENAL W/O 21 610 74181 4,666.00 0.002102200 MRI PANC W/O MRCP W/O & W 21 610 74183 5,074.00 0.002102218 MRI KIDNEY W/O & W 21 610 74183 5,074.00 0.002102226 MRI MRCP W/O 21 610 74181 4,666.00 0.002102234 MRI MRCP RECONSTRUCTION 21 610 76377 1,516.00 0.002102242 MRI BREAST UNIL R W/O 21 614 77058 4,666.00 0.002102259 MRI BREAST UNILATERAL R W 21 614 77058 4,899.00 0.002102267 MRI BREAST UNIL R W/O & W 21 614 77058 5,074.00 0.002102275 INJ ARTHRO SHOULDER BIL 21 361 2335050 991.00 0.002102283 INJ ARTHROGRAM HIP BIL 21 361 2709350 991.00 0.002102291 INJ ARTHROGRAM KNEE BIL 21 361 2737050 991.00 0.002102309 MRI CERVI SP W/O LIMITED 21 612 7214152 1,555.00 0.002102317 MRI THORAC SP W/O LIMITED 21 612 7214652 1,555.00 0.002102325 MRI LUMBAR SP W/O LIMITED 21 612 7214852 1,555.00 0.002102333 INJECTION ARTHROGRAM KNEE 21 361 27369 700.00 0.002102341 MRI BREAST UNIL L W/O 21 614 77046 4,666.00 0.002102358 MRI BREAST UNIL L W/O & W 21 614 77048 5,074.00 0.002102366 MRI BREAST UNIL R W/O 21 614 77046 4,666.00 0.002102374 MRI BREAST UNIL R W/O & W 21 614 77048 5,074.00 0.002102382 MRI BREASTS BILATERAL W/O 21 614 77047 4,666.00 0.002102390 MRI BREASTS BILAT W/O & W 21 614 77049 5,074.00 0.002190007 MRA RUN-OFF W/O & W ORDER 21 099 0.00 0.002190015 MRI BR/ORB W/O & W ORDER 21 099 0.00 0.002190023 MRI SPNL SURVEY W/O ORDER 21 099 0.00 0.002190031 MRI SHLDR ARTHR L W ORDER 21 099 0.00 0.002190049 MRI SHLDR ARTHR R W ORDER 21 099 0.00 0.002190056 MRI SHLD ARTH BIL W ORDER 21 099 0.00 0.002190064 MRI HIP ARTHRO L W ORDER 21 099 0.00 0.002190072 MRI HIP ARTHRO R W ORDER 21 099 0.00 0.00




2190080 MRI HIP ARTHR BIL W ORDER 21 099 0.00 0.002190098 MRI KNEE ARTHRO L W ORDER 21 099 0.00 0.002190106 MRI KNEE ARTHRO R W ORDER 21 099 0.00 0.002190114 MRI KNEE ARTH BIL W ORDER 21 099 0.00 0.002190122 MRI ENTGRPHY W/O &W ORDER 21 099 0.00 0.002190130 MRI ABD & PLVS W/O ORDER 21 099 0.00 0.002190148 MRI/MRA BR STRK W/O ORDER 21 099 0.00 0.002200020 ABDOMEN COMPLETE 22 402 76700 3,133.00 0.002200038 ABDOMEN LIMITED 22 402 76705 2,341.00 0.002200046 LIVER SONOGRAM 22 402 76705 2,341.00 0.002200053 GALL BLADDER SONOGRAM 22 402 76705 2,341.00 0.002200061 KIDNEY SONOGRAM 22 402 76770 2,694.00 0.002200087 SPLEEN SONOGRAM 22 402 76705 2,341.00 0.002200095 AORTA SONOGRAM 22 402 76770 2,694.00 0.002200111 CHEST 22 402 76604 2,432.00 0.002200129 URINARY BLADDER 22 402 76856 2,708.00 0.002200137 PREGNANCY - LIMITED 22 402 76815 2,187.00 0.002200145 OB US => 14 WKS SGL FETUS 22 402 76805 2,998.00 0.002200160 OB US F-UP SIZE & GROWTH 22 402 76816 1,099.00 0.002200178 OB US => 14 WKS ADL FETUS 22 402 76810 2,444.00 0.002200202 PELVIC 22 402 76856 2,708.00 0.002200228 CAROTID, LIMITED 22 921 93882 1,286.00 0.002200251 SCROTUM (TESTICLES) 22 402 76870 2,564.00 0.002200269 THYROID/NECK MASS 22 402 76536 2,468.00 0.002200277 INTRALUMINAL PROSTATE 22 402 76872 2,605.00 0.002200285 NEONATAL HEAD 22 402 76506 2,309.00 0.002200327 ARTERIAL VASC-DUP BILAT 22 921 93925 3,672.00 0.002200335 NON-OB TRANSVAG US 22 402 76830 1,770.00 0.002200350 FETAL BIOPHYSICAL PROFILE 22 402 76819 2,332.00 0.002200384 GUIDANCE FOR THORACENTESI 22 402 76942 1,070.00 0.002200392 GUIDANCE FOR PARACENTESIS 22 402 76942 1,070.00 0.002200400 GUIDANCE BIOPSY/INJECTION 22 402 76942 1,070.00 0.002200426 GUIDANCE FOR CYST/ASPIR 22 402 76942 1,070.00 0.002200434 GUIDANCE FOR AMNIOCENTESI 22 402 76946 806.00 0.002200483 CAROTID IMAGING BILATERAL 22 921 93880 3,581.00 0.002200491 DPLX AORTA ILEO FEM 22 921 93978 1,633.00 0.002200517 PVL SEGMENTAL PRESSURES 22 921 93923 4,982.00 0.002200525 ANKLE-BRACHIAL INDEX (ABI 22 921 93922 2,526.00 0.002200533 PSEUDOANEURYSM COMPRESSIO 22 402 76936 5,028.00 0.002200541 PVL PENILE BRACHIAL INDIC 22 921 93980 3,796.00 0.002200558 SAPHENOUS VEIN MAPPING UN 22 921 93971 2,684.00 0.002200566 SAPHENOUS VEIN MAPPING BI 22 921 93970 3,943.00 0.002200574 PVL THORACIC OUTLET 22 921 93923 4,982.00 0.002200582 PVL RAYNAUDS SYNDROME 22 921 93923 4,982.00 0.002200590 PVL PPG PHOTOPLETHYSMOGR 22 921 93923 4,982.00 0.002200608 ARTERIAL VASC-DUPLEX UNIT 22 921 93926 3,065.00 0.002200616 PVL VISCERAL VASCULAR 22 921 93975 2,857.00 0.00




2200640 VENOUS DUPLEX BILAT 22 921 93970 3,943.00 0.002200657 VENOUS DUPLEX UNILAT 22 921 93971 2,684.00 0.002200673 HEMODIALYSIS ACCESS 22 921 93990 1,415.00 0.002200681 SPINAL CANAL 22 402 76800 2,256.00 0.002200715 VEIN MAPPING UPPER EXT BI 22 921 93970 3,943.00 0.002200731 OB US < 14 WKS SNGL FETUS 22 402 76801 3,075.00 0.002200756 VEIN MAPPING UPPER EX UNI 22 921 93971 2,684.00 0.002200772 US GUIDE VASCULAR ACCESS 22 402 76937 334.00 0.002200798 TRANSVAGINAL OB US 22 402 76817 1,934.00 0.002200814 US GUIDE INTRAOPERATIVE 22 402 76998 3,322.00 0.002200830 OB US < 14 WKS ADDL FETUS 22 402 76802 1,722.00 0.002200848 NEONATAL HIP 22 402 76885 2,256.00 0.002200855 US XTR NON-VASC COMPLETE 22 402 76881 1,543.00 0.002200863 APPENDIX 22 402 76705 2,341.00 0.002200871 US XTR NON-VASC LMTD 22 402 76882 996.00 0.002200897 INSERTION OF CHEST TUBE 22 361 32551 2,995.00 0.002200939 US BREAST LMTD LEFT 22 402 76642LT 1,163.00 0.002200947 US BREAST LMTD RIGHT 22 402 76642RT 1,163.00 0.002200954 US BREAST LMTD BILAT 22 402 7664250 1,163.00 0.002200962 US BREAST CMPLT LEFT 22 402 76641LT 1,163.00 0.002200970 US BREAST CMPLT RIGHT 22 402 76641RT 1,163.00 0.002200988 US BREAST CMPLT BILAT 22 402 7664150 1,163.00 0.002201002 ULTRASOUND SURG/COMPONENT 22 361 MULTI 2,256.00 0.002300028 CT LMTD OR LOCALIZED EXAM 23 351 76380 4,725.00 0.002300051 HEAD W/O CONTRAST 23 351 70450 8,192.00 0.002300069 HEAD W/CONTRAST 23 351 70460 8,867.00 0.002300077 HEAD DBL STUDY 23 351 70470 10,190.00 0.002300234 MAXILLO FACIAL W/O CONTRS 23 351 70486 6,710.00 0.002300242 MAXILLO FACIAL W/CONTRAST 23 351 70487 9,113.00 0.002300259 MAXILLO FACIAL DBL 23 351 70488 10,190.00 0.002300267 INTERNAL AUDITORY CANAL 23 351 70480 7,674.00 0.002300291 MASTOID 23 351 70480 7,674.00 0.002300309 TEMPORAL MANDIBULAR JTS 23 351 70486 6,710.00 0.002300317 NASOPHARYNX W/O CONTRAST 23 351 70486 6,710.00 0.002300325 NASOPHARYNX W/CONTRAST 23 351 70487 9,113.00 0.002300366 EXTREM UP W/O CONTRAST 23 352 73200 6,167.00 0.002300374 EXTREM UP W/CO 23 352 73201 6,564.00 0.002300390 EXTREM LOW W/O CONTRAST 23 352 73700 6,457.00 0.002300408 EXTREM LOW W/CONTRAST 23 352 73701 8,412.00 0.002300465 GUIDANCE ABSCESS DRAINAGE 23 352 75989 7,412.00 0.002300549 CHEST W/O CONTRAST 23 352 71250 8,572.00 0.002300556 CHEST W/CONTRAST 23 352 71260 9,113.00 0.002300564 CHEST DOUBLE STUDY 23 352 71270 9,831.00 0.002300598 ABDOMEN W/O CONTRAST 23 352 74150 8,656.00 0.002300606 ABD W/CONTRAST 23 352 74160 9,113.00 0.002300622 PELVIS W/O CONTRAST 23 352 72192 8,656.00 0.002300630 PELVIS W/CONTRAST 23 352 72193 9,113.00 0.00




2300663 GUIDANCE BIOPSY 23 352 77012 9,286.00 0.002300689 GUIDANCE FOR CYST ASP 23 352 77012 9,286.00 0.002300697 GUIDANCE FOR TUBE PLACEMT 23 352 77012 9,286.00 0.002300705 GUIDANCE CHEST TUBE PLACE 23 352 77012 9,286.00 0.002300713 CTA ABD W & WO CONTRAST 23 352 74175 13,297.00 0.002300721 CT ABD W AND WO CONTRAST 23 352 74170 11,619.00 0.002300739 CTA CAROTID 23 350 70498 13,875.00 0.002300747 CTA THORACIC AORTA 23 352 71275 13,875.00 0.002300754 CTA ABDOMEN WITH RUNNOFF 23 352 75635 13,875.00 0.002300762 CERVICAL W/O CONTRAST 23 352 72125 9,419.00 0.002300770 CERVICAL W/CONTRAST 23 352 72126 9,697.00 0.002300788 THORACIC W/O CONTRAST 23 352 72128 9,667.00 0.002300796 THORACIC W/CONTRAST 23 352 72129 9,844.00 0.002300804 LUMBAR W/O CONTRAST 23 352 72131 9,549.00 0.002300812 LUMBAR W/CONTRAST 23 352 72132 9,844.00 0.002300820 NECK W/O CONTRAST 23 352 70490 8,656.00 0.002300838 NECK W/CONTRAST 23 351 70491 9,113.00 0.002300861 KIDNEY STONE STUDY 23 352 74150 8,656.00 0.002300879 CTA BRAIN 23 351 70496 13,875.00 0.002301034 PELVIS LIMITED 23 350 76380 4,725.00 0.002301042 ABDOMEN LIMITED 23 350 76380 4,725.00 0.002301059 CHEST LIMITED 23 350 76380 4,725.00 0.002301091 CTA HEART W/3D IMAGE 23 350 75574 13,875.00 0.002301117 CT CARDIAC CALCIUM SCORE 23 352 75571 3,849.00 0.002301133 CT ABD & PELV W/O CONTR 23 352 74176 13,881.00 0.002301141 CT ABD & PELVIS W/ CONTR 23 352 74177 15,269.00 0.002301158 CT ABD & PEL W & W/O CONT 23 352 74178 18,508.00 0.002301166 CHEST ANGIO R/O PE 23 352 71275 13,875.00 0.002301174 CT NECK W AND WO CONTRAST 23 350 70492 10,546.00 0.002301182 CTA PELVIS W/O & W CONTRA 23 352 72191 4,428.00 0.002301190 CTA PELVIS W/CONTRAST 23 352 72191 4,428.00 0.002301208 INSERTION OF CHEST TUBE 23 361 32551 2,995.00 0.002301505 CT SURGICAL COMPONENT 23 361 MULTI 2,256.00 0.002400059 THYROID METS; WHOLE BODY 24 341 78018 6,609.00 0.002400067 PARATHYROID IMAGING 24 341 78070 4,116.00 0.002400075 BONE MARROW MULTIPLE 24 341 78103 5,754.00 0.002400083 LIV/SPL VASC FLOW 24 341 78216 3,931.00 0.002400109 GASTRIC EMPTYING 24 341 78264 5,131.00 0.002400133 BONE IMAGING MUL. 24 341 78305 3,927.00 0.002400141 BONE IM WHOLE BOD 24 341 78306 6,178.00 0.002400158 BONE 3-PHASE 24 341 78315 7,515.00 0.002400166 BONE SPECT 24 341 78320 3,624.00 0.002400174 GATED W/EF, REF, VV 24 341 78472 4,875.00 0.002400182 PUL PERF IMA PART 24 341 78580 4,414.00 0.002400208 BRAIN SPECT 24 341 78607 4,292.00 0.002400216 RENOGRAM W/FLOW 24 341 78707 6,550.00 0.002400224 RENAL W/DRUG INTERVENTION 24 341 78708 8,193.00 0.00




2400232 TUMOR LOC ISO MUL 24 341 78801 4,781.00 0.002400240 TUMOR LOC ISO WHO 24 341 78802 5,104.00 0.002400307 HYP THYR - INIT RX 24 342 79005 1,012.00 0.002400315 INDIUM WBC 24 341 78806 10,174.00 0.002400323 GI BLEED 24 341 78278 7,026.00 0.002400331 TESTICULAR 24 341 78761 3,384.00 0.002400349 NM ISOT RX IV THERAPY 24 342 79101 2,057.00 0.002400364 SPINAL PUNCTURE LUMB DIAG 24 361 62270 1,756.00 0.002400372 SENTINEL NODE INJECTION 24 361 38792 720.00 0.002400380 RAD SOURCE HANDLING 24 342 77790 1,649.00 0.002400398 MULTIPLE MYO/PERF W/GATED 24 341 78452 13,389.00 0.002400406 CISTERNOGRAM 24 341 78630 7,218.00 0.002400448 CYSTOGRAM 24 341 78740 3,965.00 0.002400455 TUMOR LOCALIZATION-SPECT 24 341 78803 5,325.00 0.002400463 THROMBOSIS IMAG/BILATERAL 24 341 78456 2,523.00 0.002400471 MECKELS 24 341 78290 3,384.00 0.002400489 SINGLE MYO/PERF W/GATED 24 341 78451 6,083.00 0.002400505 ISOT I-123 MIBG TO 15MCI 24 343 A9582 7,765.00 0.002400513 HEPATOBILIARY SYSTEM IMAG 24 341 78226 6,048.00 0.002400521 HEPATOBIL SYS IMAG W/DRUG 24 341 78227 6,048.00 0.002400539 LUNG VENTILATION IMAGING 24 341 78579 4,171.00 0.002400547 LUNG VENTIL & PERFUS IMAG 24 341 78582 6,522.00 0.002400554 LUNG PERFUS DIFFERENTIAL 24 341 78597 4,171.00 0.002400562 THYD IMAG SNGL OR MULTI 24 341 78014 2,079.00 0.002400570 THYROID IMAGING W/BLD FLW 24 341 78013 1,637.00 0.002400588 PROC DELAY PER 30 MIN/TR 24 099 0.00 0.002400596 THYRD IMG W/BLD FLW&UPTK 24 341 78014 2,079.00 0.002400604 LYMPH GLAND IMAGING 24 341 78195 5,765.00 0.002400612 THYROID IMG W/BLOOD FLOW 24 341 78013 1,637.00 0.002400638 THER/PROPH/DIAG INJ SC/IM 24 940 96372 498.00 0.002400661 I-131 RX / THYROID CANCER 24 342 79005 1,012.00 0.002490027 ISOT TC 99M MDP 24 343 A9503 734.00 0.002490035 ISOT TC 99M LYMPHOSEEK 24 343 A9520 1,320.00 0.002490076 ISOT TC99M PERTEC PER MCI 24 343 A9512 50.00 0.002490175 ISOT TC 99M MYOVIEW 24 343 A9502 1,769.00 0.002490209 ISOT TL 201 1 MCI 24 343 A9505 885.00 0.002490225 ISOT TC 99M CERETEC 24 343 A9521 4,027.00 0.002490274 ISOT IN-111 DTPA 0.5 MCI 24 343 A9548 5,217.00 0.002490290 ISOT OCTREOTIDE PER DOSE 24 343 A9572 9,138.00 0.002490308 ISOT I-123 DX ISOTP 1 MCI 24 343 A9509 1,120.00 0.002490316 ISOT IN-111 WBC PER DOSE 24 343 A9570 4,276.00 0.002490324 ISOT CERETEC WBC PER DOSE 24 343 A9569 4,276.00 0.002490340 ISOT RX P-32 PER MCI 24 344 A9563 3,299.00 0.002490357 ISOT TC99M MYOVW DBL DOSE 24 343 A9502 3,541.00 0.002490449 ISOT TC 99M ACUTECT 24 343 A9504 5,406.00 0.002490456 ISOT TC 99M NEOTECT 24 343 A9536 5,768.00 0.002490498 ISOT TC 99M CARDIOLITE 24 343 A9500 2,657.00 0.00




2490514 ISOT I-131 RX PER MCI 24 344 A9517 119.00 0.002490548 ISOT I 123 THYR PER 100UC 24 343 A9516 600.00 0.002490555 ISOT TC 99M DISOFENIN 24 343 A9510 895.00 0.002490621 ISOT I-131 DX PER MCI 24 343 A9528 2,108.00 0.002490696 ISOT I-131 MIBG PER 500 U 24 343 A9508 7,839.00 0.002490712 ISOT SR-89 RX PER MCI 24 344 A9600 2,380.00 0.002490720 ISOT TC99M SC PER DOSE 24 343 A9541 1,001.00 0.002490746 ISOT TC99M DTPA PER DOSE 24 343 A9567 712.00 0.002490761 ISOT TC99M CHOLETEC DOSE 24 343 A9537 1,652.00 0.002490803 ISOT TC99M DMSA PER DOSE 24 343 A9551 9,772.00 0.002490829 ISOT GA67 PER MCI 24 343 A9556 310.00 0.002490845 ISOT TC99M MAA PER DOSE 24 343 A9540 2,333.00 0.002490860 ISOT TC99M MAG3 PER DOSE 24 343 A9562 7,578.00 0.002490886 ISOT TC99M RBC PER DOSE 24 343 A9560 3,498.00 0.002500031 POC-ACT CARTRIDGE 25 305 85347 164.00 0.002500205 POC-URINE MLTISTX 10 SPGR 25 301 81002 57.00 0.002500239 POC-OCCULT BLOOD 25 301 82272 91.00 0.002500254 POC-GLUCOSE QUAN BLD DVCE 25 301 82947 179.00 0.002500270 POC-NITRAZINE PH 25 301 83986 96.00 0.002500296 POC-URINE PREGNANCY 25 301 81025 224.00 0.002500304 POC-GEM THB 25 305 85018 68.00 0.002500312 POC-GEM O2HB 25 301 82820 190.00 0.002500320 POC-GEM COHB 25 301 82375 350.00 0.002500338 POC-GEM MET HB 25 301 83050 134.00 0.002500346 POC-GEM BLD GAS W/O2 SAT 25 301 82805 1,508.00 0.002500353 POC-GEM SODIUM 25 301 84295 136.00 0.002500361 POC-GEM POTASSIUM 25 301 84132 405.00 0.002500379 POC-GEM CHLORIDE 25 301 82435 90.00 0.002500387 POC-GEM ICA++ 25 301 82330 388.00 0.002500395 POC-GEM GLUCOSE 25 301 82947 179.00 0.002500403 POC-GEM LACTATE 25 301 83605 117.00 0.002590032 POC URINE PREGNANCY ORDER 25 099 0.00 0.002590040 POC-BLOOD GAS PANEL ORDER 25 099 IN OC-GUI 0.00 0.002600104 LATE DISCH/ORDER INTER 2M 26 224 0.00 9,096.002690014 OBSRV PER HOUR PEDS 26 762 G0378 291.00 0.002690022 OBSRV DIRECT ADMIT PEDS 26 762 G0379 798.00 0.002690030 PRE OBSV SVCS PER HR PEDS 26 762 291.00 0.002690071 OBSRV PER HOUR 2M 26 762 G0378 291.00 0.002690089 OBSRV DIRECT ADMIT 2M 26 762 G0379 798.00 0.002690097 PRE OBSV SVCS PER HR 2M 26 762 291.00 0.002690105 OBSRV PER HOUR 3M 26 762 G0378 291.00 0.002690113 OBSRV DIRECT ADMIT 3M 26 762 G0379 798.00 0.002690121 PRE OBSV SVCS PER HR 3M 26 762 291.00 0.002690139 OBSRV PER HOUR 4M 26 762 G0378 291.00 0.002690147 OBSRV DIRECT ADMIT 4M 26 762 G0379 798.00 0.002690154 PRE OBSV SVCS PER HR 4M 26 762 291.00 0.002690162 OBSRV PER HOUR ICU 26 762 G0378 291.00 0.00




2690170 OBSRV DIRECT ADMIT ICU 26 762 G0379 798.00 0.002690188 PRE OBSV SVCS PER HR ICU 26 762 291.00 0.002690196 OBSRV PER HOUR CCU 26 762 G0378 291.00 0.002690204 OBSRV DIRECT ADMIT CCU 26 762 G0379 798.00 0.002690212 PRE OBSV SVCS PER HR CCU 26 762 291.00 0.002690220 OBSRV PER HOUR ED 26 762 G0378 269.00 0.002800100 LATE DISCH/ORDER MED/SUR 28 224 0.00 6,984.002900207 LATE DISCH/ORDER INTER 4M 29 224 0.00 9,096.003100088 CBC & AUTO DIFFERENTIAL 31 305 85025 380.00 0.003100096 BLOOD COUNT INC PLATELET 31 305 85027 352.00 0.003100104 RETICULOCYTE COUNT 31 305 85045 376.00 0.003100138 FDP 31 305 85362 420.00 0.003100146 FIBRINOGEN 31 305 85385 380.00 0.003100153 FETAL ROSETTE TEST 31 305 85461 353.00 0.003100187 RPR CORD BLOOD 31 302 86592 225.00 0.003100211 PROTHROMBIN TIME 31 305 85610 389.00 0.003100237 ESR WESTERGREN 31 305 85652 388.00 0.003100245 SICKLE CELL SCREEN 31 305 85660 253.00 0.003100260 PTT 31 305 85730 473.00 0.003100328 ANTIBODY ID STD RBC 31 305 86870 1,102.00 0.003100336 ANTIBODY ID SEL RBC 31 305 86870 1,102.00 0.003100344 COOMBS DIRECT POLY 31 305 86880 435.00 0.003100351 ANTIBODY SCREEN RBC 31 300 86850 645.00 0.003100369 CROSSMATCH IS/UNIT 31 305 86920 539.00 0.003100393 TRANS RXN WORKUP 31 305 86078 409.00 0.003100401 SYRINGE ALIQUOT 31 305 86985 410.00 0.003100419 BLOOD TYPING ABO 31 300 86900 318.00 0.003100427 ANTIGEN RBC 31 305 86905 373.00 0.003100435 FFP THAW/UNIT-TR 31 099 86927 0.00 0.003100443 CRYO THAW/UNIT-TR 31 099 86927 0.00 0.003100450 NON-CROSSMATCH SETUP 31 305 86999 341.00 0.003100468 DRAW CLOT & HOLD 31 300 36415 99.00 0.003100476 PREWARMED TECHNIQUE 31 305 86850 645.00 0.003100484 BLOOD TYPING RH 31 300 86901 201.00 0.003100500 SPLITTING COMPONENT 31 305 86985 410.00 0.003100518 ANTIGEN RBC COOMBS 31 305 86905 373.00 0.003100526 CROSSMATCH CBS/UNIT 31 305 86922 427.00 0.003100534 CRYOFIBRINOGEN 31 305 82585 166.00 0.003100542 CRYOGLOBULIN 31 305 82595 166.00 0.003100559 PERINATAL RAPID HIV 31 302 86701 151.00 0.003100567 KLEIHAUER TEST 31 305 85460 540.00 0.003100583 RUBELLA ANTIBODY IGG 31 305 86762 240.00 0.003100641 TZANCK SMEAR 31 311 88160 177.00 0.003100666 PREWARM XM 31 300 86850 645.00 0.003100674 PREWARM ANTIBODY SCREEN 31 300 86850 645.00 0.003100690 SMEAR, EOSINOPHILS 31 300 89190 135.00 0.003100716 RHEUMATOID FACTOR QUALITA 31 302 86430 23.00 0.00




3100732 HETEROPHILE ANTIBODY 31 305 86308 361.00 0.003100740 RPR 31 305 86592 225.00 0.003100799 CRYSTALS EXAM FLUID 31 300 89060 360.00 0.003100807 HEMATOCRIT FLUID 31 305 85013 191.00 0.003100815 CRYSTALS EXAM SYNOV 31 300 89060 360.00 0.003100823 CELL COUNT CSF 31 300 89051 472.00 0.003100849 CELL COUNT FLUID 31 300 89051 472.00 0.003100856 COOMBS DIRECT IGG 31 305 86880 435.00 0.003100864 COOMBS DIRECT CORD 31 305 86880 435.00 0.003100872 COOMBS DIRECT C3BD 31 305 86880 435.00 0.003100880 COOMBS INDIRECT 31 305 86885 477.00 0.003100898 SICKLE CELL SCREEN UNIT 31 305 85660 253.00 0.003100906 SMEAR WBC DIFF 31 305 85007 203.00 0.003100922 SMEAR WBC DIFF BUFFY 31 305 85009 129.00 0.003100948 MANUAL DIFFERENTIAL 31 305 85027 352.00 0.003101185 D-DIMER - QUAN 31 305 85379 647.00 0.003101227 RUBEOLA IGG 31 302 86765 42.00 0.003101235 MUMPS IGG 31 302 86735 39.00 0.003101243 VARICELLA ZOSTER IGG 31 302 86787 38.00 0.003101292 PTT WITH HEPARIN THERAPY 31 305 85730 473.00 0.003101300 PROTIME WITH COUMADIN 31 305 85610 389.00 0.003101326 SYPHILIS BY ELISA 31 302 86780 108.00 0.003101334 VARICELLA ZOSTER IGG ELIS 31 302 86787 38.00 0.003101342 MUMPS IGG ELISA 31 302 86735 39.00 0.003101359 RUBEOLA IGG ELISA 31 302 86765 42.00 0.003101367 RH(D) IMM GLOB (300 MCG) 31 636 J2790 814.00 0.003101409 HEMATOCRIT 31 305 85014 159.00 0.003101417 HEMOGLOBIN 31 305 85018 68.00 0.003101425 PLATELET COUNT 31 305 85049 181.00 0.003190014 ABO/RH TYPE ORDER 31 099 0.00 0.003190022 TYPE & AB SCREEN ORDER 31 099 0.00 0.003190030 ABO/RH TYPE CORD ORDER 31 099 0.00 0.003190048 RHOGAM WORKUP ORDER 31 099 0.00 0.003200045 CUL MISC 32 306 87070 482.00 0.003200060 CUL STOOL 32 306 87045 741.00 0.003200078 CUL THROAT 32 306 87070 482.00 0.003200086 CUL PEDS BLOOD 32 306 87040 606.00 0.003200094 CUL BLOOD 32 306 87040 606.00 0.003200110 CUL ANAEROBIC 32 306 87075 687.00 0.003200144 CUL URINE 32 306 87088 384.00 0.003200151 SMR WET MOUNT CX-VAG 32 306 87210 279.00 0.003200169 STREP SCREEN 32 306 87880 442.00 0.003200284 SENS MIC PANEL 32 306 87186 606.00 0.003200326 SMR MALARIAL 32 306 87207 311.00 0.003200342 SMR PINWORM PREP 32 306 87172 216.00 0.003200359 SMR KOH 32 306 87220 187.00 0.003200375 ROTAVIRUS AG 32 306 87425 592.00 0.00




3200391 OCCULT BLOOD FECAL 32 306 82270 166.00 0.003200409 RSV ANTIGEN 32 306 87420 352.00 0.003200425 SMR GRAM STAIN 32 306 87205 242.00 0.003200458 TISSUE GRINDING 32 306 87176 151.00 0.003200466 STREP LATEX A CUL TYP STA 32 306 87147 204.00 0.003200474 STREP LATEX B CUL TYP STA 32 306 87147 204.00 0.003200482 STREP LATEX C CUL TYP STA 32 306 87147 204.00 0.003200490 STREP LATEX F CUL TYP STA 32 306 87147 204.00 0.003200516 CL DIFFICILE TOXINS 32 306 87324 480.00 0.003200524 STREP LANCEFIELD A 32 306 87430 442.00 0.003200573 STREP LATEX G CUL TYP STA 32 306 87147 204.00 0.003200581 SPUTUM SCREEN SPSCR 32 306 87205 242.00 0.003200599 ID AEROBIC IDACR 32 306 87077 294.00 0.003200631 CUL CATHETER TIP 32 306 87070 482.00 0.003200649 CUL CSF 32 306 87070 482.00 0.003200672 CUL EAR - EYE 32 306 87070 482.00 0.003200680 CUL STERILE FLUID 32 306 87070 482.00 0.003200698 CUL GONORRHEAE 32 306 87081 360.00 0.003200706 CUL UROGENITAL 32 306 87070 482.00 0.003200730 CUL MRSA 32 306 87070 482.00 0.003200748 CUL NEWBORN EYE 32 306 87070 482.00 0.003200755 CUL RESPIRATORY 32 306 87070 482.00 0.003200763 CUL TISSUE 32 306 87070 482.00 0.003200771 CUL TXN RXN 32 306 87070 482.00 0.003200789 CUL VRE 32 306 87070 482.00 0.003200821 SMR WBC 32 306 87205 242.00 0.003200847 NEISSERIA TYPE 32 306 87147 204.00 0.003201506 CUL ID GRP B STREP 32 306 87081 360.00 0.003201514 ID ANAEROBIC IDAN 32 306 87076 265.00 0.003201530 WOUND CULT SUPERF CUWDS 32 306 87070 482.00 0.003201548 WOUND CULT DEEP CUWDD 32 306 87070 482.00 0.003201555 LEGIONELLA UA AG 32 306 87449 272.00 0.003201563 STREP PNEUMO AG 32 306 87449 272.00 0.003201571 INFLUENZA A 32 306 87804 211.00 0.003201589 INFLUENZA B 32 306 87804 211.00 0.003201597 OCCULT BLD FHG, QUAL, 1-3 32 300 82274 114.00 0.003201613 ENTEROVIRUS QUAL BY PCR 32 306 87498 432.00 0.003201621 MRSA BY PCR-TR 32 099 87641 0.00 0.003201654 WOUND (SSTI) SA BY PCR 32 306 87640 432.00 0.003201696 WOUND MRSA SA BY PCR 32 306 87641 1,010.00 0.003201753 AST-GN24 32 306 87186 606.00 0.003201761 AST-GP67 32 306 87186 606.00 0.003201779 AST-GP68 32 306 87186 606.00 0.003201787 AST-YS02 32 306 87181 125.00 0.003201795 ID-YST 32 306 87106 151.00 0.003201803 PROCALCITONIN 32 301 84145 295.00 0.003201811 C. DIFFICILE TOXIN B -PCR 32 306 87798 490.00 0.00




3201845 XPRT FLU A 2009 H1N1-PCR 32 306 87798 490.00 0.003201852 XPERT FLU A BY PCR 32 306 87798 490.00 0.003201928 ENV CULT DIALY/PHORESIS 32 306 87070 482.00 0.003201969 XPERT FLU B BY PCR 32 306 87798 490.00 0.003201977 XPERT FLU A AND B BY PCR 32 306 87502 400.00 0.003201985 XPRT FLU A 2009 H1N1-PCR 32 306 87503 400.00 0.003202009 C. DIFFICILE 027-NAP1 PCR 32 306 87493 490.00 0.003202017 C. DIFFICILE TOXIN B PCR 32 306 87493 490.00 0.003202041 QUANTIFERON TB 32 302 86480 186.00 0.003202058 C. TRACHOMATIS AMPL PROBE 32 306 87491 378.00 0.003202066 N. GONORRHOEAE AMPL PROBE 32 306 87591 378.00 0.003202074 SHIGA TOXIN 1 & 2 32 306 87427 164.00 0.003202108 MTB AMPLIFIED PROBE 32 306 87556 282.00 0.003202116 RIF RESISTANCE AMP PROBE 32 306 87798 490.00 0.003202124 GRAM POSITIVE PANEL 74 32 306 87186 606.00 0.003202132 GRAM POSITIVE PANEL 75 32 306 87186 606.00 0.003202140 AST-GN69 32 306 87186 606.00 0.003202157 AST-XN06 32 306 87186 606.00 0.003202165 AST-ST01 32 306 87186 606.00 0.003202173 MRSA PCR NARES 32 306 87641 1,010.00 0.003202181 CLO TEST 32 306 87077 294.00 0.003202199 C. DIFF GDH ANTIGEN DET 32 306 87449 272.00 0.003290012 CUL STOOL ORDER 32 099 0.00 0.003290020 CUL CSF ORDER 32 099 0.00 0.003290038 CUL EAR/EYE ORDER 32 099 0.00 0.003290046 CUL STERILE FLUID ORDER 32 099 0.00 0.003290053 CUL GONORRHEAE ORDER 32 099 0.00 0.003290061 CUL UROGENITAL ORDER 32 099 0.00 0.003290079 CUL RESPIRATORY ORDER 32 099 0.00 0.003290087 CUL TISSUE ORDER 32 099 0.00 0.003290095 CUL TRANSFUSION RXN ORDER 32 099 0.00 0.003290103 WOUND CULT SUPERF ORDER 32 099 0.00 0.003290111 WOUND CULT DEEP ORDER 32 099 0.00 0.003290129 M. TUBERCUL BY PCR ORDER 32 099 0.00 0.003290137 INFLUE RESP VIR PCR ORDER 32 099 0.00 0.003290145 C.TRACH & N.GON AMP ORDER 32 099 0.00 0.003290152 C. DIFF GDH/TOX RFX ORDER 32 099 0.00 0.003300019 ELECTROLYTE PANEL 33 301 80051 606.00 0.003300027 METABOLIC BASE PANEL 33 301 80048 730.00 0.003300035 METABOLIC COMP PANEL 33 301 80053 904.00 0.003300043 HEP FUNC PANEL 33 301 80076 698.00 0.003300050 RENAL FUNC PANEL 33 301 80069 800.00 0.003300068 CREATININE W/GFR 33 301 82565 388.00 0.003300084 2 HR GLUC TOLERANCE TEST 33 301 82951 610.00 0.003300092 VANCOMYCIN TROUGH 33 301 80202 703.00 0.003300142 GLUCOSE GEST SCREEN 50GMS 33 301 82950 325.00 0.003300159 VOLUME URINE COLLECT 33 301 81050 75.00 0.00




3300167 LIPID PANEL 33 301 80061 822.00 0.003300183 UBG URINE QUAL 33 301 84578 116.00 0.003300209 VALPROIC ACID 33 301 80164 643.00 0.003300225 UA AUTO & MICRO 33 301 81001 279.00 0.003300233 UA REFLEX MICRO 33 301 81001 279.00 0.003300241 UA REAGENT STRIP AUTO 33 301 81003 224.00 0.003300258 UA MICROSCOPIC 33 301 81015 35.00 0.003300266 HCG URINE QUAL 33 301 81025 224.00 0.003300274 VOLUME TIMED URINE 33 301 81050 75.00 0.003300290 ACETAMINOPHEN 33 301 82003 664.00 0.003300308 KETONES SERUM 33 301 82009 164.00 0.003300316 KETONES URINE 33 301 81002 57.00 0.003300332 ALBUMIN, SERUM 33 301 82040 294.00 0.003300340 ETHANOL 33 301 82055 669.00 0.003300357 THEOPHYLLINE 33 301 80198 647.00 0.003300365 AMMONIA 33 301 82140 566.00 0.003300373 AMYLASE SERUM 33 301 82150 567.00 0.003300381 AMYLASE 24HR URINE 33 301 82150 567.00 0.003300399 PHENOBARBITAL 33 301 80184 643.00 0.003300407 CHLORIDE CSF 33 301 82438 312.00 0.003300431 CALCIUM TOTAL 33 301 82310 345.00 0.003300456 CALCIUM 24HR URINE 33 301 82340 429.00 0.003300464 CO2 TOTAL 33 301 82374 207.00 0.003300472 CHLORIDE 33 301 82435 97.00 0.003300480 CHLORIDE 24HR URINE 33 301 82436 419.00 0.003300498 CHLORIDE FLUID 33 301 82438 312.00 0.003300506 CHOLESTEROL TOTAL 33 301 82465 411.00 0.003300514 CK TOTAL 33 301 82550 516.00 0.003300522 CK-MB FRACTION 33 301 82553 616.00 0.003300548 CREATININE URINE 33 301 82570 300.00 0.003300555 CREATININE CLEAR 33 301 82575 719.00 0.003300563 DIGOXIN 33 301 80162 800.00 0.003300571 PHENYTOIN TOTAL 33 301 80185 568.00 0.003300613 GENTAMICIN TROUGH 33 301 80170 676.00 0.003300639 ARTERIAL GASES 33 301 82805 1,508.00 0.003300647 REDUCING SUBS FECES 33 301 81002 57.00 0.003300654 GLUCOSE 33 301 82947 179.00 0.003300662 GTT 2-HR ADD 3 33 301 82952 139.00 0.003300670 GTT 2-HR ADD 6 33 301 82952 139.00 0.003300688 GTT 2-HR ADD 4 33 301 82952 139.00 0.003300696 GTT 2-HR 3-SPEC 33 301 82951 610.00 0.003300704 GTT 2-HR ADD 5 33 301 82952 139.00 0.003300712 GLUCOSE 1HR PPD 33 301 82950 325.00 0.003300720 GGT 33 301 82977 296.00 0.003300738 HCG SERUM QUAL 33 301 84703 409.00 0.003300753 FERRITIN 33 301 82728 686.00 0.003300761 BLOOD URINE 33 301 81001 279.00 0.00




3300779 HORMONE TSH 33 301 84443 714.00 0.003300787 IRON TOTAL 33 301 83540 475.00 0.003300803 LACTIC ACID 33 301 83605 441.00 0.003300811 LD TOTAL 33 301 83615 443.00 0.003300837 LD FLUID 33 301 83615 443.00 0.003300845 FLUID TRIGLYCERIDE 33 301 84478 438.00 0.003300860 HDL CHOLESTEROL 33 301 83718 363.00 0.003300878 MAGNESIUM TOTAL 33 301 83735 539.00 0.003300894 MYOGLOBIN 33 301 83874 490.00 0.003300928 PH FLUID 33 301 83986 104.00 0.003300936 ALKALINE PHOSPHATASE 33 301 84075 408.00 0.003300944 PHOSPHORUS 33 301 84100 428.00 0.003300951 PHOSPHORUS 24HR URINE 33 301 84105 378.00 0.003300977 POTASSIUM 33 301 84132 405.00 0.003300985 POTASSIUM 24HR URINE 33 301 84133 374.00 0.003300993 PREALBUMIN 33 300 84134 443.00 0.003301009 PROTEIN TOTAL, SERUM 33 301 84155 274.00 0.003301017 PROTEIN URINE QUAL 33 301 81002 57.00 0.003301025 PROTEIN TOTAL FLUID 33 301 84157 274.00 0.003301033 PROTEIN TOTAL CSF 33 301 84157 274.00 0.003301041 QUINIDINE 33 301 80194 523.00 0.003301058 SODIUM 33 301 84295 136.00 0.003301066 SODIUM 24HR URINE 33 301 84300 378.00 0.003301074 SP GR FLUID 33 301 84315 135.00 0.003301082 THYROXINE FREE 33 301 84439 426.00 0.003301090 TOBRAMYCIN TROUGH 33 301 80200 676.00 0.003301108 AST 33 301 84450 438.00 0.003301116 ALT 33 301 84460 442.00 0.003301124 TRIGLYCERIDES 33 301 84478 438.00 0.003301132 TROPONIN, QUAN 33 301 84484 616.00 0.003301140 UREA NITROGEN 33 301 84520 343.00 0.003301157 UREA NIT 24HR URINE 33 301 84540 252.00 0.003301165 UREA CLEARANCE 33 301 84545 480.00 0.003301173 URIC ACID 33 301 84550 360.00 0.003301181 URIC ACID 24HR URINE 33 301 84560 361.00 0.003301215 URIC ACID FLUID 33 301 84560 361.00 0.003301223 PSA TOTAL 33 301 84153 647.00 0.003301231 CEA 33 301 82378 647.00 0.003301249 VITAMIN B-12 33 301 82607 582.00 0.003301256 FOLIC ACID 33 301 82746 531.00 0.003301272 HCG B-SUBUNIT QUANT 33 301 84702 647.00 0.003301280 FLUID LIPASE 33 301 83690 567.00 0.003301306 CARBAMAZEPINE(TEGRETOL) 33 301 80156 643.00 0.003301314 ASSAY LIPOPROTEIN PLA2 33 301 83698 141.00 0.003301322 HEP A AB. IGM 33 302 86709 60.00 0.003301330 HEP B CORE AB IGM 33 302 86705 48.00 0.003301348 HEP C AB 33 302 86803 75.00 0.00




3301355 HEP B SURF AB 33 302 86706 50.00 0.003301363 HIV AB 1 & 2 33 300 86703 56.00 0.003301371 HEP B SURF AG 33 306 87340 56.00 0.003301389 HEP B SURF AG SOURCE 33 099 87340 0.00 0.003301397 HEP C AB SOURCE 33 099 86803 0.00 0.003301405 BILIRUBIN TOTAL 33 301 82247 291.00 0.003301413 BILIRUBIN DIRECT 33 301 82248 261.00 0.003301421 GLUCOSE 2HR PPD 33 301 82950 325.00 0.003301439 AMYLASE 2HR URINE 33 301 82150 567.00 0.003301447 SODIUM URINE 33 301 84300 378.00 0.003301454 CHLORIDE URINE 33 301 82436 419.00 0.003301462 POTASSIUM URINE 33 301 84133 374.00 0.003301470 UREA NITROGEN URINE 33 301 84540 252.00 0.003301488 ALBUMIN FLUID 33 301 82042 239.00 0.003301496 AMYLASE FLUID 33 301 82150 567.00 0.003301504 CALCIUM FLUID 33 301 82310 345.00 0.003301512 CHOLESTEROL FLUID 33 301 82465 411.00 0.003301520 CREATININ 24HR URINE 33 301 82570 300.00 0.003301538 CREATININE FLUID 33 301 82570 300.00 0.003301546 POTASSIUM FLUID 33 301 84132 405.00 0.003301553 SODIUM FLUID 33 301 84302 266.00 0.003301561 UREA NITROGEN FLUID 33 301 84520 343.00 0.003301579 VANCOMYCIN PEAK 33 301 80202 703.00 0.003301587 VANCOMYCIN RANDOM 33 301 80202 703.00 0.003301595 TOBRAMYCIN PEAK 33 301 80200 676.00 0.003301603 TOBRAMYCIN RANDOM 33 301 80200 676.00 0.003301611 GENTAMICIN RANDOM 33 301 80170 676.00 0.003301629 GENTAMICIN PEAK 33 301 80170 676.00 0.003301637 REDUCING SUBS URINE 33 301 81002 57.00 0.003301645 PROTEIN TOTAL URINE 33 301 84156 274.00 0.003301652 PROTEIN 24HR URINE 33 301 84156 274.00 0.003301660 GLUCOSE CSF 33 301 82945 364.00 0.003301678 GLUCOSE FLUID 33 301 82945 364.00 0.003301686 GLUCOSE URINE 33 301 82945 364.00 0.003301694 GLUCOSE 24HR URINE 33 301 82945 364.00 0.003301702 HORMONE TSH REFLEX 33 301 84443 714.00 0.003301710 OCMED CHEM PANEL 8 33 301 27.00 0.003301728 OCMED CHEM PANEL A 33 301 133.00 0.003301736 OCMED CHEM PANEL 16 33 301 72.00 0.003301744 OCMED EXEC PANEL B 33 301 123.00 0.003301751 OCMED EXEC PANEL C 33 301 123.00 0.003301769 SP GR URINE 33 301 81002 57.00 0.003301777 LIPASE 33 301 83690 567.00 0.003301876 MAGNESIUM 24HR URINE 33 301 83735 539.00 0.003301884 LD CSF 33 301 83615 443.00 0.003301892 MICROALBUMIN RANDOM URINE 33 301 82043 266.00 0.003301900 LDL CHOLESTEROL 33 301 83721 363.00 0.00




3301926 CRP HIGH SENSITIVITY 33 302 86141 437.00 0.003301934 SALICYLATE 33 301 80196 568.00 0.003301942 TRANSFERRIN 33 301 84466 548.00 0.003301959 HEMOGLOBIN GLYCO 33 301 83036 557.00 0.003301967 NATRIURETIC PEPTIDE 33 301 83880 850.00 0.003301975 CHLAMYDIA URINE 33 301 87491 378.00 0.003302031 OCC HEALTH HIV SOURCE 33 099 86703 0.00 0.003302056 URINE TP,CR W RATIO PANEL 33 301 84156 274.00 0.003302064 ALPHA-FETOPROTEIN 33 301 82105 203.00 0.003302072 APOLIPOPROTEIN A1 33 301 82172 139.00 0.003302080 APOLIPOPROTEIN B 33 301 82172 139.00 0.003302098 BETA HYDROY BUTYRATE 33 301 82010 99.00 0.003302114 COMPLIMENT 4 OR C4 33 302 86160 146.00 0.003302122 CHOLINESTERASE 33 301 82482 44.00 0.003302130 CORTISOL 33 301 82533 199.00 0.003302148 COMPLEMENT 3 OR C3 33 302 86160 146.00 0.003302155 CYSTAIN-C 33 301 82610 133.00 0.003302163 ENZYMATIC CREATININE 33 301 82565 388.00 0.003302171 ESTRADIOL 33 301 82670 224.00 0.003302189 FREE PSA 33 302 84154 148.00 0.003302197 HUMAN LUTEINIZING HORMONE 33 301 83002 221.00 0.003302205 HAPTOGLOBIN 33 301 83010 152.00 0.003302213 LITHIUM 33 301 80178 79.00 0.003302221 LIPOPROTEIN A 33 301 83695 105.00 0.003302239 PROGESTERONE 33 301 84144 166.00 0.003302247 PROLACTIN 33 301 84146 234.00 0.003302254 PARATHYROID HORMONE 33 301 83970 498.00 0.003302262 RHEUMATOID FACTOR QUANT 33 302 86431 69.00 0.003302270 TESTOSTERONE 33 301 84403 311.00 0.003302288 THYROGLOBULIN AB 33 302 86800 191.00 0.003302296 THROGLOBULIN 33 301 84432 129.00 0.003302304 TOTAL T3 33 301 84480 171.00 0.003302312 IMMUNOGLOBULIN G 33 301 82784 79.00 0.003302320 IMMUNOGLOBULIN A 33 301 82784 79.00 0.003302338 IMMUNOGLOBULIN M 33 301 82784 79.00 0.003302346 IMMUNOGLOBULIN E 33 301 82785 200.00 0.003302353 FOLLICLE STIMULATING HORM 33 301 83001 251.00 0.003302361 FT3 33 301 84481 136.00 0.003302387 HOMOCYSTEINE 33 301 83090 204.00 0.003302395 TOBRAMYCIN PEAK 33 301 80200 676.00 0.003302403 TOBRAMYCIN RANDOM 33 301 80200 676.00 0.003302411 TOBRAMYCIN TROUGH 33 301 80200 676.00 0.003302445 CALCIUM,URINE 33 301 82340 429.00 0.003302452 MAGNESIUM,URINE 33 301 83735 539.00 0.003302460 CSF LACTIC ACID 33 301 83605 441.00 0.003302486 DRUG OF ABUSE SCREEN 33 301 G0434 542.00 0.003302494 KETONES B-HYDROXYBUTYRATE 33 301 82009 164.00 0.00




3302510 CALCIUM IONIZED 33 301 82330 388.00 0.003302528 FSH, GONADOTROPIN 33 301 83001 251.00 0.003302544 TOTAL T4 THYROXINE 33 301 84436 259.00 0.003302551 HGB A1C CHROMATOGRAPHY 33 301 83021 131.00 0.003302569 VITAMIN D, 25 ASSAY 33 301 82306 125.00 0.003302577 URINALYSIS, CUL IF INDICA 33 301 81001 279.00 0.003390010 HEP ABC ACUTE PANEL ORDER 33 099 0.00 0.003390028 GLUCOSE 3 HOUR ORDER 33 099 0.00 0.003390036 GLUCOSE 4 HOUR ORDER 33 099 0.00 0.003390044 GLUCOSE 5 HOUR ORDER 33 099 0.00 0.003390051 FRACTIONAL EX OF NA ORDER 33 099 0.00 0.003390069 CK/CKMB WITH INDEX ORDER 33 099 0.00 0.003390077 ANEMIA PANEL ORDER 33 099 0.00 0.003410982 F: SMEAR AFB PH 34 306 87206 22.65 0.003410990 F: CULTURE AFB PH 34 306 87116 42.94 0.003411998 B: AFB CULTURE 34 306 87116 27.00 0.003412509 B: CYCLOSPORINE 34 300 80158 30.00 0.003412541 B: LIDOCAINE 34 300 80176 23.00 0.003412566 B: LITHIUM 34 300 80178 12.00 0.003412574 B: CALCIUM,IONIZED 34 301 82330 15.00 0.003412582 B: PRIMIDONE 34 300 80188 33.00 0.003412590 B: AFB SMEAR 34 306 87206 13.00 0.003412608 B: NAPA/PROCAINAMIDE 34 300 80192 33.00 0.003412624 B: PSEUDO CHE 34 300 82480 15.00 0.003412699 B: CRYPTOCOCCUS ANTIGEN 34 302 86403 17.50 0.003412707 F: CUL AFB BLOOD 34 300 87116 21.97 0.003412715 F: SENS AFB PANEL (6) 34 300 87190 119.28 0.003412731 F: RPR QUAL 34 300 86592 7.17 0.003412749 F: RPR QUANT 34 300 86593 7.17 0.003412806 MISC BATTERY 34 300 0.00 0.003412855 F: SENS AFB EACH 34 306 87190 18.24 0.003412889 B: TOBRAMYCIN PEAK 34 300 80200 23.00 0.003412897 B: TOBRAMYCIN RANDOM 34 300 80200 23.00 0.003412905 B: TOBRAMYCIN TROUGH 34 300 80200 23.00 0.003412913 B: QUINIDINE 34 300 80194 23.00 0.003412939 B: CARBAMAZEPINE 34 300 80156 23.00 0.003413689 U: COCCI AB, CF 34 302 86171 47.50 0.003413697 U: COCCI AB, ID 34 302 86331 39.50 0.003413705 B: AMYLASE 34 301 82150 10.50 0.003413713 B: LIPASE 34 301 83690 12.00 0.003413721 B: RETIC 34 305 85044 7.00 0.003413739 B: TACROLIMUS 34 301 80197 39.00 0.003413747 B: AFB PROBE MTB 34 306 87797 25.00 0.003413754 B: AFB PROBE MKANS 34 306 87797 25.00 0.003413762 B: AFB PROBE MAC 34 306 87797 25.00 0.003413770 B: AFB SMEAR FLUID 34 306 87206 7.50 0.003413788 B: AFB CONCENTRATION IA 34 306 87015 4.00 0.00




3413796 B: AFB CULTURE FLUID 34 306 87116 8.00 0.003413838 G: 17-OH PROGESTERONE RPD 34 301 83498 24.30 0.003413846 G: ACE, SERUM 34 301 82164 15.10 0.003413853 G: ACTH, PLASMA 34 301 82024 28.20 0.003413861 G: AFP, TUMOR MARKER 34 301 82105 14.30 0.003413879 G: ALDOSTERONE 34 301 82088 24.00 0.003413887 G: ALPHA-1-ANTITRYPSIN 34 301 82013 13.30 0.003413895 G: AMIKACIN, SERUM 34 301 80150 12.80 0.003413911 G: ANCA VASCULITIDES 34 301 83516 27.40 0.003413929 G: B2 MICROGLOB SER/PLASM 34 301 82232 14.50 0.003413960 G: CARNITINE FREE & TOTAL 34 301 82379 31.50 0.003413978 G: CEA 34 301 82378 12.30 0.003413986 G: CERULOPLASMIN 34 301 82390 8.80 0.003414000 G: COPPER 34 301 82525 13.20 0.003414018 G: CORTISOL SERUM/PLASMA 34 301 82533 9.70 0.003414026 G: C-PEPTIDE 34 301 84681 12.50 0.003414034 G: CRYOGLBLN (% CRYOCRIT) 34 301 82595 7.90 0.003414042 G: DRUG SCREEN MECONIUM 34 301 80101 61.65 0.003414059 G: ERYTHROPOIETIN 34 301 82668 27.80 0.003414067 G: ESTRADIOL, LC/MS/MS 34 301 82670 33.50 0.003414075 G: F-ACTIN-SMOOTH MSCL AB 34 301 83516 13.55 0.003414083 G: FOLATE, RBC 34 301 82747 20.70 0.003414091 G: FSH, SERUM 34 301 83001 9.00 0.003414109 G: G-6-PD, RBC 34 301 82955 21.20 0.003414117 G: GASTRIN, SERUM 34 301 82941 16.30 0.003414125 G: GBM AB, IGG 34 301 83516 29.00 0.003414133 G: HAPTOGLOBIN 34 301 83010 11.60 0.003414141 G: HEMOGLOBINOPATHY EVAL 34 301 83021 29.40 0.003414158 G: HOMOCYSTEINE, SERUM 34 301 83090 21.30 0.003414166 G: IGA, SERUM 34 301 82784 8.70 0.003414174 G: IGG, SERUM 34 301 82784 8.70 0.003414182 G: IGM, SERUM 34 301 82784 8.70 0.003414190 G: LEAD, BLOOD 34 301 83655 7.70 0.003414216 G: LH, SERUM 34 301 83002 10.15 0.003414224 G: LIPOPROTEIN (A) 34 301 83695 21.00 0.003414232 G: METANEPHRIN 24HR URINE 34 301 83835 29.00 0.003414265 G: MYOGLOBIN, URINE 34 301 83874 13.50 0.003414299 G: PROGESTERONE, LC/MS/MS 34 301 84144 22.50 0.003414307 G: PROINSULIN 34 301 84206 33.90 0.003414315 G: PROLACTIN, SERUM 34 301 84146 18.90 0.003414331 G: PTH, INTACT 34 301 83970 11.60 0.003414349 G: T3 UPTAKE 34 301 84479 7.80 0.003414356 G: T3, FREE 34 301 84481 9.75 0.003414364 G: T3, TOTAL 34 301 84480 6.80 0.003414372 G: TACROLIMUS (FK506) 34 301 80197 28.80 0.003414380 G: TESTOSTRNE(MALES) ICMA 34 301 84403 11.40 0.003414398 G: TOTAL IGE 34 301 82785 8.70 0.00




3414406 G: TSI 34 301 84445 43.20 0.003414414 G: VITAMIN D, 25-HYDROXY 34 301 82306 11.75 0.003414422 G: ANA W/ REFLEX TO TITER 34 302 86038 7.70 0.003414430 G: ASO AB 34 302 86060 11.70 0.003414448 G: C3, SERUM 34 302 86160 11.65 0.003414455 G: C4, SERUM 34 302 86160 11.55 0.003414463 G: CA 125 34 302 86304 16.10 0.003414471 G: CA 15-3 34 302 86300 14.30 0.003414489 G: CA 19-9 34 302 86301 16.10 0.003414497 G: CARDIOLIPIN AB IGG 34 302 86147 12.40 0.003414505 G: CMV AB (IGG) 34 302 86644 11.95 0.003414513 G: CMV AB (IGM) 34 302 86645 11.95 0.003414521 G: COCCDIODES AB,CF,SERUM 34 302 86635 11.70 0.003414539 G: COCCIDIOIDES AB,ID 34 302 86635 11.60 0.003414547 G: COLD AGGLUTININS 34 302 86157 14.70 0.003414554 G: COMPLEMENT TTL (CH50) 34 302 86162 14.50 0.003414562 G: DNA (DS) ANTIBODY 34 302 86625 12.50 0.003414570 G: EPSTEIN-BARR 2 TST PNL 34 302 86665 23.20 0.003414596 G: HA AB IGM 34 302 86709 11.60 0.003414604 G: HB CORE AB, IGM 34 302 86705 17.20 0.003414612 G: HB S AB, QUANT 34 302 86317 8.75 0.003414620 G: HCV AB 34 302 86803 15.40 0.003414646 G: HEPARIN-INDUCED PLATLT 34 302 86022 66.00 0.003414661 G: LEGIONELA PNEUM AB IGM 34 302 86713 12.70 0.003414679 G: LYME DISEASE AB, W/RFL 34 302 86618 10.40 0.003414687 G: M. PNEUMO AB IGM, EIA 34 302 86738 11.50 0.003414695 G: MITOCHONDRIAL AB 34 301 83516 14.30 0.003414703 G: RHEUMATOID FACTOR QUAN 34 302 86431 11.50 0.003414711 G: RNP ANTIBODIES 34 302 86235 14.70 0.003414729 G: RUBELLA AB IGM 34 302 86762 11.50 0.003414737 G: SCL-70 ANTIBODY 34 302 86235 14.70 0.003414745 G: SJOGREN'S AB (SSA) 34 302 86235 14.70 0.003414752 G: SJOGREN'S AB (SSB) 34 302 86235 14.70 0.003414760 G: SMITH ABS 34 302 86235 14.70 0.003414778 G: THYROGLOBULIN AB 34 302 86800 12.40 0.003414786 G: THYRD PEROXIDAS AB TPO 34 302 86376 9.80 0.003414794 G: TOXOPLASMA IGG AB 34 302 86317 11.80 0.003414802 G: TOXOPLASMA IGM AB 34 302 86778 11.80 0.003414810 G: VDRL, CSF 34 302 86592 7.80 0.003414828 G: WEST NILE AB (IGM) CSF 34 302 86788 24.10 0.003414836 G: WEST NILE AB (IGM) SRM 34 302 86788 18.30 0.003414844 G: ANTI-THRMBN III ANTGN 34 305 85301 22.90 0.003414851 G: FACTR V ACTVTY CLOTTI 34 305 85220 25.40 0.003414869 G: FACTR VIII ACTVTY CLOT 34 305 85240 24.45 0.003414877 G: PROTEIN C ACTIVITY 34 305 85303 29.00 0.003414885 G: PROTEIN S ACTIVITY 34 305 85306 40.80 0.003414901 G: CMV CULTURE 34 306 87254 73.00 0.00




3414919 G: CT/NG RNA, TMA 34 306 87801 42.90 0.003414927 G: FUNGUS CULTURE, MISC. 34 306 87102 35.00 0.003414935 G: GIARDIA AG, STOOL, EIA 34 306 87329 16.50 0.003414943 G: HB S AG, EIA 34 306 87340 7.70 0.003414950 G: HCV RNA, PCR, QUANT 34 306 87522 90.00 0.003414968 G: HIV-1 RNA QN REAL-TIME 34 306 87536 98.00 0.003414976 G: HERPES SIMP VIRUS PCR 34 306 87529 60.00 0.003415023 G: ALDOLASE 34 301 82085 8.25 0.003415031 G: ZINC 34 301 84630 11.40 0.003415049 G: CATECHOLAMINES, PLS 34 301 82384 31.70 0.003415056 G: FECAL FAT, QUAL 34 301 82705 19.40 0.003415064 G: TTRANSGLUTAMINASE, IGA 34 301 83516 9.60 0.003415098 G: TRYPTASE 34 301 83520 60.50 0.003415106 G: INSULIN 34 301 83525 9.70 0.003415114 G: METANEPHRINES, PLASMA 34 301 83835 74.50 0.003415122 G: MYELIN BASIC PROTEIN 34 301 83873 31.15 0.003415130 G: METHYMALONIC ACID 34 301 83921 24.10 0.003415148 G: RENIN ACTIVITY 34 301 84244 21.00 0.003415155 G: VITAMIN B1, PLASMA 34 301 84425 29.00 0.003415171 G: CATECHOLAMINES, URINE 34 301 82382 33.30 0.003415189 G: VMA, URINE 34 301 84585 17.70 0.003415197 G: CCP IGG 34 302 86200 17.30 0.003415205 G: INSULIN ANTIBODY 34 302 86337 43.40 0.003415213 G: LKM-1 AB, IGG 34 302 86376 16.60 0.003415239 G: BRUCELLA ABS 34 302 86622 13.50 0.003415247 G: Q FEVER AB, IGG 34 302 86638 33.00 0.003415254 G: COXSACKIE A SERO 9 34 302 86658 23.60 0.003415262 G: COXSACKIE B VIRUS ABS 34 302 86658 117.60 0.003415270 G: HSV IGM ABS 34 302 86694 14.40 0.003415288 G: LEPTOSPIRA AB 34 302 86720 28.50 0.003415296 G: MUMPS VIRUS AB, IGG 34 302 86735 9.60 0.003415304 G: MUMPS VIRUS AB, IGM 34 302 86735 13.40 0.003415312 G: PARVOVIR AB B19 IGG 34 302 86747 14.75 0.003415320 G: PARVOVIR AB B19 IGM 34 302 86747 14.75 0.003415338 G: E. HISTOLYTICA IGG 34 302 86753 11.80 0.003415346 G: MEASLES AB, IGG 34 302 86765 10.80 0.003415353 G: VZV AB, IGG 34 302 86787 11.95 0.003415361 G: VWF AG 34 305 85246 29.20 0.003415379 G: LAP STAIN 34 305 85540 62.60 0.003415387 G: H. PYLORI AG, STOOL 34 306 87338 49.00 0.003415403 G: HB E AG 34 306 87350 16.60 0.003415411 G: CMV DNA, QN PCR 34 306 87496 97.50 0.003415429 G: ENTEROVIRUS PCR 34 306 87498 146.00 0.003415460 G: TTL PRTN SERUM ELP-PNL 34 301 84160 7.85 0.003415478 G: ALBUMIN ELP-PANEL 34 301 84165 7.85 0.003415486 G: PSA, FREE-PANEL 34 301 84154 12.75 0.003415494 G: PSA TOTAL-PANEL 34 301 84153 12.75 0.00




3415502 G: TTL PRTN URINE ELP-PNL 34 301 84156 12.00 0.003415510 G: URINE IFE INTERP-PANEL 34 302 86335 12.00 0.003415528 G: LUPUS PT-PANEL 34 305 85610 12.30 0.003415536 G: LUPUS PTT-PANEL 34 305 85730 12.30 0.003415544 G: DRVVT SCREEN-PANEL 34 305 85613 12.30 0.003415577 G: IGG, CSF-PANEL 34 301 82784 19.84 0.003415585 G: ALBUMIN, SRM/PLSMA-PNL 34 301 82040 19.84 0.003415593 G: ALBUMIN, CSF-PANEL 34 301 82042 19.84 0.003415601 G: OLIGOCLONAL BANDS-PNL 34 301 83916 19.84 0.003415619 G: SEX HORM BIND GLOB-PNL 34 301 84270 12.85 0.003415684 G: RUBELLA AB IGG-PANEL 34 302 86317 12.66 0.003415692 G: HSV IGG ABS-PANEL 34 302 86694 12.66 0.003415700 G: IMMUNOFIXATION-PANEL 34 302 86334 10.23 0.003415718 G: ALBUMIN, CSF-PANEL 34 301 84166 11.75 0.003415726 G: TTL PROTEN CSF ELP-PNL 34 301 84157 11.75 0.003415734 G: PRIMIDONE-MYSOLINE-PNL 34 301 80188 8.80 0.003415742 G: PHENOBARBITAL-PANEL 34 301 80184 8.80 0.003415759 G: IGG, SERUM-PANEL 34 301 82784 19.84 0.003415767 G: OVA & PARASITES 1-PNL 34 306 87177 16.00 0.003415775 G: OVA & PARASITES 2-PNL 34 306 87209 16.00 0.003415783 G: CHROMO ANALYSIS 1-PNL 34 311 88262 114.17 0.003415791 G: CHROMO ANALYSIS 2-PNL 34 311 88230 114.17 0.003415809 G: CHROMO ANALYSIS 3-PNL 34 311 88291 114.17 0.003415940 G: TTL PROTEIN SRM IF-PNL 34 301 84160 10.24 0.003415957 G: ALBUMIN IF-PANEL 34 301 84165 10.24 0.003415965 G: CHLAMYDIA CULTURE-PNL 34 306 87110 27.00 0.003415973 G: CULT IF-EA ANTISRM-PNL 34 306 87140 27.00 0.003415981 G: VIR ISLT TIS CULT-PNL 34 306 87252 14.75 0.003415999 G: VIRUS ISOLT ADD/ID-PNL 34 306 87253 14.75 0.003416005 G: (HSV 1, DFA)-PANEL 34 306 87274 29.25 0.003416013 G: (HSV 2, DFA)-PANEL 34 306 87273 29.25 0.003416047 G: VIT D, 1,25-DIHYDROXY 34 301 82652 25.60 0.003416054 G: ANTIBODY NUCLEAR TITER 34 300 86039 15.40 0.003416088 F: MHA-TP 34 302 86780 8.22 0.003416096 F: TP-PA 34 302 86780 21.93 0.003416104 G: HEP B SURF AG CONFIRM 34 302 87341 38.20 0.003416138 G: HIV BY WESTERN BLOT 34 302 86689 64.40 0.003416146 G: HIV WESTRN BLOT SOURCE 34 099 86689 0.00 0.003416161 G: AMYLASE ISOENZYMES 34 301 82150 19.40 0.003416179 F: RESPIRATORY VIRAL CULT 34 306 87252 59.63 0.003416187 F: RESP VIRAL PANEL PCR 34 306 87798 110.00 0.003416203 G: PERTUSSIS CULTURE 34 306 87081 43.50 0.003416211 G: PERTUSSIS BY PCR 34 306 87081 89.00 0.003416237 G: TESTOSTERONE FREE/TOT 34 301 84403 41.30 0.003416245 G: CELIAC DISEASE RFLX PN 34 301 82784 8.70 0.003416286 G: ZINC PROTOPORPHYRIN 34 301 84202 21.10 0.003416302 B: GENTAMYCIN 34 301 80170 23.00 0.00




3416310 B: PHENOBARBITAL 34 301 80184 24.00 0.003416328 B: PHENYTOIN 34 301 80185 23.00 0.003416336 G: CADMIUM B 34 301 82300 15.60 0.003416344 G: CADMIUM URINE 34 301 82300 15.60 0.003416351 G: BETA 2 MICROGLOB URINE 34 301 82232 15.50 0.003416377 F: SPECIMN HNDL NO CHG-TR 34 099 0.00 0.003416385 G: VITA E PLASMA OR SERUM 34 301 84446 17.20 0.003416393 G: T3 REVERSE 34 301 84482 25.10 0.003416401 G: SEROTONIN 34 301 84260 38.00 0.003416419 G: HERPES AB IGG 34 302 86694 15.40 0.003416427 F: MALARIA SMEAR 34 306 87207 80.44 0.003416435 B: CALCIUM IONIZED 34 301 82330 15.00 0.003416443 G: CHLAMYDIA TRACH AMP DE 34 306 87491 42.50 0.003416450 G: VIRUS CULT NON RESP 34 306 87252 49.00 0.003416468 G: VIRUS CULT RESP 34 306 87252 73.00 0.003416500 G: CYSTIC FIB 165 PATH V 34 301 81220 240.00 0.003416518 G: PROTHROMBIN MUT F2 34 301 81240 67.00 0.003416526 G: LEIDEN MUT FACTOR V 34 301 81241 62.50 0.003416534 G: PROCALCITONIN 34 301 84145 155.50 0.003416542 G: DHEAS 34 301 82627 14.30 0.003416559 G: ALLERGENS PROFILE 19 34 302 86003 117.23 0.003416567 G: ALLERG RESP PNL REG 14 34 302 86003 175.29 0.003416575 G: INFLUENZA BY PCR 34 306 87276 21.20 0.003416583 G: VIRUS RESP CULT 34 306 87252 73.00 0.003416591 G: VIRUS NON RESP CULT 34 306 87252 73.00 0.003416609 G: BETA 2 UA MICROGLOBULI 34 306 82232 15.50 0.003416633 G: VITAMIN A (RETINOL) 34 301 84590 14.50 0.003416641 G: VITAMIN B1 (THIAMINE) 34 301 84425 24.10 0.003416658 G: CYCLOSPORINE MASS SPEC 34 301 80158 29.00 0.003416666 G: ACID FAST BACILLUS 34 306 87116 39.00 0.003416674 G: CRYPTOCOCCUS AG, CSF 34 306 87327 29.50 0.003416682 G: CRYPTOCOCCUS AG, BLD 34 306 87327 24.70 0.003416690 G: HEPB VIR DNA QT RT PCR 34 306 87517 103.00 0.003416708 G: PLATELET AB, INDIRECT 34 302 86022 106.50 0.003416716 G: HRPS SIMP 1&2 IGG IGM 34 302 86694 29.80 0.003416724 G: HRPS SIMP VRS 1&2 IGG 34 302 86694 15.40 0.003416732 G: ANA BY IFA 34 302 86039 15.40 0.003416740 G: CD4 % & ABSOLUTE 34 302 86361 37.00 0.003416757 G: PTH RELATED PROTEIN 34 301 82542 72.50 0.003416765 G: LAMOTRIGINE 34 301 80175 19.40 0.003416773 G: LEVETIRACETAM 34 301 80177 33.30 0.003416781 G: HEMOGLOBIN A1C 34 301 83036 11.70 0.003416799 B: H. PYLORI AB IGG 34 302 86677 35.00 0.003416807 B: MTB/RIF PCR 34 306 87556 125.00 0.003416815 G: TSTRONE-MALE-ICMA PNL 34 301 84403 12.85 0.003416823 G: ANA W/ RFLX-TITER-PNL 34 302 86038 10.60 0.003416831 G: C3, SERUM-PANEL 34 302 86160 10.60 0.00




3416849 G: C4, SERUM-PANEL 34 302 86160 10.60 0.003416856 G: RHEUMTD FACTR QUAN-PNL 34 302 86431 10.60 0.003416864 G: CMV AB (IGG)-PANEL 34 302 86644 12.66 0.003416872 G: TOXOPLASMA IGG AB-PNL 34 302 86317 12.66 0.003416880 G: CMV AB (IGM)-PANEL 34 302 86645 12.41 0.003416898 G: RUBELLA AB IGM-PANEL 34 302 86762 12.41 0.003416906 G: TOXOPLASMA IGM AB-PNL 34 302 86778 12.41 0.003416914 G: HSV IGM ABS-PANEL 34 302 86694 12.42 0.003416922 G: IGA, SERUM-PANEL 34 301 82784 10.23 0.003416930 G: IGG, SERUM-PANEL 34 301 82784 10.23 0.003416948 G: IGM, SERUM-PANEL 34 301 82784 10.23 0.003416955 G: HCV QUANTITATIVE NAAT 34 306 87522 90.00 0.003416963 B: OSMOLALITY, SERUM 34 301 83930 10.50 0.003416971 B: OSMOLALITY, URINE 34 301 83935 10.50 0.003490018 NBS DATE OF REPORT ORDER 34 099 0.00 0.003490026 G: CELIAC PANEL ORDER 34 099 0.00 0.003490034 G: PROTEIN ELP SERU ORDER 34 099 0.00 0.003490042 G: PSA FREE & TOTAL ORDER 34 099 0.00 0.003490059 G: PROTEIN ELP, UA ORDER 34 099 0.00 0.003490067 G: LUPUS ANTICOAG ORDER 34 099 0.00 0.003490075 G: CD4 ORDER 34 099 0.00 0.003490083 G: OLIGOCLON BAND P ORDER 34 099 0.00 0.003490091 G: TESTOSTERONE F&T ORDER 34 099 0.00 0.003490109 G: LUPUS PANEL ORDER 34 099 0.00 0.003490117 G: TORCH PROFIL IGG ORDER 34 099 0.00 0.003490125 G: TORCH PROFIL IGM ORDER 34 099 0.00 0.003490133 G: IMMUNOFIX SERUM ORDER 34 099 0.00 0.003490141 G: PROTEIN ELP CSF ORDER 34 099 0.00 0.003490158 G: PRIMIDONE ORDER 34 099 0.00 0.003490166 G: OVA & PARASITES ORDER 34 099 0.00 0.003490174 G: CHROMOSOME ANALY ORDER 34 099 0.00 0.003490182 G: VAP TM CHOLESTER ORDER 34 099 0.00 0.003490190 G: C TRACHOMATI CUL ORDER 34 099 0.00 0.003490208 G: CUL HSV W/RFL TY ORDER 34 099 0.00 0.003490216 G: HRPS AG DFA RFLX ORDER 34 099 0.00 0.003500071 WHOLE BLOOD DBB 35 390 P9010 236.00 0.003500089 PRBC DBB 35 390 P9021 224.00 0.003500113 CRYOPRECIPITATE AHF DBB 35 390 P9012 55.00 0.003500204 FFP WITHIN 8 HOURS DBB 35 390 P9017 45.00 0.003500238 PRBC LR DBB 35 390 P9016 224.00 0.003500303 FFP PEDI (CMV NEG) DBB 35 390 P9017 47.00 0.003500345 E: DESIGNATION FEE 35 399 ?BUND 50.00 0.003500360 E: AUTO PC NOT TXD 35 390 86890 226.00 0.003500436 E: HLA MATCH/UNIT 35 300 86813 185.00 0.003500451 FFP CRYO REDU DBB 35 390 P9044 83.00 0.003500477 PLT ESIS LR DBB 35 390 P9035 507.00 0.003500659 FFP 8-24 HOURS DBB 35 390 P9059 45.00 0.00




3500675 E: ANTIBDY PNLS-RARE CELL 35 305 86870 130.00 0.003500683 E: RARE PHENOTYPE CHARGE 35 305 86906 75.00 0.003500691 E: EGA TRTMT CELL SAMPLE 35 305 86970 40.00 0.003500709 E: RBC TRTMT (DTT,EGA) 35 305 86970 40.00 0.003500733 E: SCREENED UNIT/AG 35 300 86902 50.00 0.003500741 E: HIGH FREQ RBC AG NEG 35 300 86902 130.00 0.003500758 CRYPRCPTE AHF POOLED DBB 35 390 P9012 350.00 0.003500766 E: SCRN UNIT HIST NEG 35 300 86902 15.00 0.003500774 E: EXT PHENOTYPE/AG 35 305 86905 18.00 0.003500782 E: DTT TREATMENT OF SERUM 35 305 86975 50.00 0.003500790 E: RBC TRTMT (ENZY) 35 305 86971 30.00 0.003500808 E: AFTER HOURS FEE 35 399 ?BUND 150.00 0.003500816 E: DBB DILUT SERUM TITRAT 35 300 86976 50.00 0.003500824 E: ANTIBODY SCRN LISS/PEG 35 300 86850 42.00 0.003500832 E: AUTOLOGOUS BLD COLL/PR 35 390 ?BUND 100.00 0.003500840 E: AUTOLOGOUS WB NOT TX 35 390 86890 236.00 0.003500857 E: STERILE DOCK PLATE 35 305 86985 30.00 0.003500865 E: STERILE DOCK BLOOD 35 305 86985 30.00 0.003500873 E: IMPORT FEE - OOA UNITS 35 399 ?BUND 100.00 0.003500881 RBC WASHED DBB 35 390 P9022 325.00 0.003500899 RBC DEGLYCEROLIZED DBB 35 390 P9039 226.00 0.003500907 RBC FROZEN DBB 35 390 P9057 226.00 0.003500923 E: WARM PRTMNT PER ABSORB 35 399 ?BUND 40.00 0.003500931 E: RBC TRTMT (ENZY) SAMPL 35 305 86971 30.00 0.003500949 E: ABO DISCRPNCY RESOLUTN 35 399 ?BUND 100.00 0.003500956 E: TRAUMA PLATLETPHERESIS 35 399 ?BUND 50.00 0.003510021 E: CMV UNIT TESTING 35 300 86644 37.00 0.003510039 E: IRRADIATION/UNIT 35 300 86945 50.00 0.003510054 E: ANTIBODY ID PANEL 35 300 86870 70.00 0.003510062 E: ANTIBODY ID AUTO 35 300 86978 58.00 0.003510070 E: RARE BLOOD SEARCH FEE 35 399 ?BUND 75.00 0.003510088 E: CROSS AHG/UNIT 35 300 86922 40.00 0.003510138 E: DLVRY CODE 4STAT-TRKNG 35 099 0.00 0.003510146 E: ANTIBODY ID ALLO 35 300 86978 58.00 0.003510153 E: ANTIBODY ID EXTRA 35 300 86870 50.00 0.003510161 E: ABO TYPE 35 300 86900 20.00 0.003510179 E: TX RXN EVALUATION 35 305 86078 300.00 0.003510187 E: ANTIBODY TITER 35 300 86886 75.00 0.003510195 E: ANTIBODY ELUTION 35 300 86860 75.00 0.003510211 E: HTLA NEUTRALIZE 35 300 86977 60.00 0.003510252 E: RH PHENOTYPING 35 305 86906 38.00 0.003510278 E: RH-D TYPE 35 305 86901 18.00 0.003510286 E: DAT 35 305 86880 22.00 0.003600038 K: MARROW: ASP ST+INT 36 310 85097 217.30 0.003600079 K: MARROW: IRON ST 36 310 88313 45.85 0.003600426 K: CONS: DURING SURG 36 310 88329 125.00 0.003600632 K: UNLISTED SURG PATH 36 310 88399 65.90 0.00




3600681 K: CYT FLUID WSH/SMR W/IN 36 311 88104 100.85 0.003600699 K: CYT SMR LIQ BASED SLID 36 311 88112 217.30 0.003600715 K: CYTO SMR OTH SCRN W/IN 36 311 88160 100.85 0.003600723 K: CYT SMR TCH PREP/SCR W 36 311 88161 100.85 0.003600731 K: CYT EVAL NDL ASP 1ST 36 311 88172 100.85 0.003600749 K: CYT FINE NDL ASP W/I&R 36 311 88173 217.30 0.003600756 K: SPEC STAINS: GRP 1 36 310 88312 100.85 0.003600764 K: SPEC STAINS: GRP 2 36 310 88313 100.85 0.003600772 K: CONS: INTEROP CYT SPEC 36 310 88333 100.85 0.003600780 K: CONS: INTEROP CYT ADDL 36 310 88334 100.85 0.003600798 K: MORPH ANALY EA ANTIBDY 36 310 88360 217.30 0.003600806 K: IMMUNOHISTOCHEM/H PYLO 36 310 88342 217.30 0.003600814 N: BRAF GENE ANALYSIS 36 301 81210 180.00 0.003600822 N: KRAS MUTATION ANALY 36 301 81275 320.00 0.003600830 N: MICROSATELLITE INSTABI 36 301 81301 480.00 0.003600871 N: FLOW CYTO TC 1ST MARKR 36 311 88184 95.00 0.003600889 N: FLOW CYTO TC EA ADDL 36 311 88185 60.00 0.003600897 N: TC SKIN OR SOLID BX 36 311 88233 195.00 0.003600905 N: TC AMNIOTIC FLUID 36 311 88235 205.00 0.003600913 N: TISS CUL BM BLD CELLS 36 311 88237 185.00 0.003600921 N: TISS CUL OTHER TISSUE 36 311 88239 205.00 0.003600939 N: CHROM ANALY 15-20 CELL 36 311 88262 185.00 0.003600947 N: CHROM ANALY 20-25 CELL 36 311 88264 185.00 0.003600954 N: CHROM ANALY ADD KAR EA 36 099 88280 0.00 0.003600962 N: FISH 36 310 88368 183.00 0.003600970 N: MICRODISSECTION MANUAL 36 310 88381 140.00 0.003600988 N: CHROM ANALY 5 CELLS 36 311 88261 200.00 0.003600996 N: CHROM ANA AD CELL CNTS 36 099 88285 0.00 0.003601002 N: CG MCG INT & REP 36 311 88291 35.00 0.003601010 N: FSH TECH PER PROB AUTO 36 310 88367 210.00 0.003601028 K: SRG PTH GRS PRST 10-20 36 310 G0416 600.00 0.003601036 N: IMMHSTOCYTCHM-EA AD AB 36 310 88341 81.00 0.003601044 N: IMMHSTOCYTCHM-EA MU AB 36 310 88344 130.00 0.003601051 N: EFGR GENE COM VARIANTS 36 301 81235 341.00 0.003601069 N: FISH (HEME) TC PROB AU 36 310 88367 210.00 0.003601077 N: FISH (HEME) TC PROB MA 36 310 88368 183.00 0.003601085 N: FISH BREAST (HER2) AUT 36 310 88367 210.00 0.003601093 N: FISH BREAST (HER2) MAN 36 310 88368 183.00 0.003601101 N: FISH LUNG (ALK) TC AUT 36 310 88367 210.00 0.003601119 N: FISH LUNG (ALK) TC MAN 36 310 88368 183.00 0.003601127 K: HISTO STAIN MID SURGRY 36 310 88314 120.00 0.003601135 N: M/PHMTRC ALYS,EA MPX,A 36 310 88374 280.00 0.003601143 N: M/PHMTRC ALYS,EA MPX,M 36 310 88377 280.00 0.003650009 K: LEVEL I:GRS 36 310 88300 65.90 0.003650025 K: LEVEL II: GRS+MIC 36 310 88302 100.85 0.003650041 K: LEVEL III: GRS+MIC 36 310 88304 217.30 0.003650066 K: LEVEL IV: GRS+MIC 36 310 88305 217.30 0.00




3650082 K: MARROW: BX INT 36 310 88305 217.30 0.003650108 K: MARROW: BX ST+INT 36 310 88305 217.30 0.003650124 K: LEVEL V: GRS+MIC 36 310 88307 340.40 0.003650140 K: LEVEL VI: GRS+MIC 36 310 88309 340.40 0.003650165 K: DECALCIFICATION 36 310 88311 65.90 0.003650181 K: ACID FAST/AFB 36 310 88312 74.85 0.003650207 K: GIEMSA 36 310 88312 74.85 0.003650223 K: GMS/FUNGUS 36 310 88312 74.85 0.003650249 K: GMS/PCP 36 310 88312 74.85 0.003650264 K: GRAM/MICROORGANISMS 36 310 88312 74.85 0.003650280 K: PAS/FUNGUS 36 310 88312 74.85 0.003650306 K: SPEC STAINS: GRP 1 36 310 88312 90.15 0.003650322 K: ALB-MPS 36 310 88313 79.10 0.003650348 K: ALB-PAS/MPS 36 310 88313 79.10 0.003650363 K: CONGO RED/AMYLOID 36 310 88313 79.10 0.003650389 K: G&S/RETICULUM 36 310 88313 79.10 0.003650405 K: MUCICARMINE/MUCIN 36 310 88313 79.10 0.003650421 K: PAS/GLYCOGEN 36 310 88313 79.10 0.003650447 K: PRUSSIAN BLUE/IRON 36 310 88313 79.10 0.003650462 K: SPEC STAINS: GRP 2 36 310 88313 90.15 0.003650488 K: TRICHROME/COLLAGEN 36 310 88313 79.10 0.003650504 K: VERHOEFF/ELASTIN 36 310 88313 79.10 0.003650520 K: CONS: FS FIRST SPEC 36 310 88331 217.30 0.003650546 K: CONS: FS ADD SPECS 36 310 88332 65.90 0.003800018 ECG 12LD NEWBORN 38 730 93005 862.00 0.003800026 ECG 12LD ADULT 38 730 93005 862.00 0.003800034 ECG 12LD PEDIATRIC 38 730 93005 862.00 0.003800042 ECG RHYTHM TRACE 38 730 93041 642.00 0.003800059 ECG 12LD WITH MAGNET 38 730 93005 862.00 0.003900040 CARDIAC STRESS TEST 39 482 93017 3,670.00 0.004100087 POC-URINE PREGNANCY 41 300 81025 224.00 0.004100277 NEWBORN RESUSCITATION 41 410 99465 3,780.00 0.004100285 TH/PR/DX IV PUSH EA ADD 41 450 96376 421.00 0.004100293 HYDRATION IV INFUSION INI 41 450 96360 719.00 0.004100301 THER/PRO/DIAG IV INF INIT 41 450 96365 719.00 0.004100319 HYDRATE IV INFUSON ADD-ON 41 450 96361 669.00 0.004100327 THER/PRO/DX IV INF ADD-ON 41 450 96366 674.00 0.004100335 THER/PROPH/DIAG INJ SC/IM 41 450 96372 498.00 0.004100350 T/P/D INJ IV PUSH INIT 41 450 96374 498.00 0.004100384 TPDX IV PUSH NEW SUB INIT 41 450 96375 421.00 0.004100392 TX/PROPH/DG AD SEQ IV INF 41 450 96367 341.00 0.004100400 THER/DIAG CONCURRENT INF 41 450 96368 249.00 0.004100426 INTRO NEEDLE OR CATH VEIN 41 450 36000 1,916.00 0.004100434 DRUG SCREEN ONLY DIR-LAB 41 099 0.00 0.004100442 INC LABIAL FRENUM 41 450 40806 2,256.00 0.004100459 INSERT PICC AGE 5 & OLDER 41 450 36569 6,031.00 0.004100475 UNL PROC DENTOALVR STRUCT 41 360 41899 931.00 0.00




4100509 RPR PRO DVC LABOR EA 15MI 41 274 L7520 0.00 0.004100525 SLCTV WND DEBR 20CM OR < 41 450 97597 1,197.00 0.004100533 SLCTV WND DEBR EA AD 20CM 41 450 97598 847.00 0.004100541 TX GASTRO INTUB W/ASP 41 450 43753 760.00 0.004100566 ABD PARACENTESIS W/O IMG 41 450 49082 3,575.00 0.004100574 ABD PARACENTESIS W/ IMAG 41 450 49083 3,575.00 0.004100582 PERITONEAL LAVAGE 41 450 49084 3,575.00 0.004100632 ASPIRATE PLEURA W/O IMAGE 41 450 32554 3,169.00 0.004100640 ASPIRATE PLEURA W/ IMAGE 41 450 32555 3,169.00 0.004100657 CATH SPECIMEN COLL SGL PT 41 300 P9612 172.00 0.004100665 REMOVE SHOULDER FB DEEP 41 450 23333 6,110.00 0.004100673 SUTURE EYELID FULL THICKN 41 361 67935 10,141.00 0.004100681 IV PUSH INITIAL MANUAL 41 450 96374 498.00 0.004100699 IV PUSH NEW SUBSTN MANUAL 41 450 96375 421.00 0.004100707 IV PUSH ADDITIONAL MANUAL 41 450 96376 421.00 0.004100715 RMVL IMPCT CERU LAVAG UNI 41 450 69209 343.00 0.004100723 PM DEVICE EVAL IN PERSON 41 480 93288 191.00 0.004100731 MEAS PV RS UR/BLAD CAP US 41 361 51798 302.00 0.004100749 CL TX SHLD DIS W/MAN W/AN 41 361 23655 4,199.00 0.004100905 ER VISIT - LEVEL 1 41 450 99281 1,190.00 0.004100921 ER VISIT - LEVEL 2 41 450 99282 1,643.00 0.004100947 ER VISIT - LEVEL 3 41 450 99283 2,391.00 0.004100962 ER VISIT - LEVEL 4 41 450 99284 3,534.00 0.004100988 ER VISIT - LEVEL 5 41 450 99285 4,887.00 0.004101010 GT REPLACEMENT W REVISION 41 450 43762 1,175.00 0.004101036 INS CATH PLEURA W/O IMAGE 41 450 32556 3,169.00 0.004101051 INS CATH PLEURA W/ IMAGE 41 450 32557 3,169.00 0.004101119 IMMUNIZATION ADM 1 VACCI 41 771 90471 239.00 0.004101135 GT REPLCMNT W/O REVISION 41 450 43763 1,175.00 0.004101143 BLOOD ADMINISTRATION 41 391 36430 2,971.00 0.004101168 INTRAOSSEUS PLACEMENT 41 450 36680 1,036.00 0.004101200 CUTDOWN 41 450 36625 1,089.00 0.004101325 TRACHEOSTOMY INSERTION 41 450 31603 6,358.00 0.004101341 CRICOTHYROTOMY 41 450 31605 7,772.00 0.004101408 THROMBOLYTIC THERAPY 41 450 92977 1,273.00 0.004101424 PACEMAKER EXTERNAL PROC 41 450 92953 2,375.00 0.004101440 CARDIOVERSION 41 450 92960 1,270.00 0.004101465 CPR 41 410 92950 9,715.00 0.004101622 FEMCATH INSERTION 41 450 51701 650.00 0.004101648 FOLEY INSERTION 41 450 51702 667.00 0.004101705 EAR IRRIGATION 1OR2 EARS 41 450 69210 534.00 0.004101820 EPISTAXSIS SIMPLE 41 450 30901 1,126.00 0.004101846 EPISTAXSIS COMPLEX 41 450 30903 1,568.00 0.004102109 SPINAL PUNCT LUMBAR DIAG 41 450 62270 1,756.00 0.004102240 GT REPLACEMENT 41 450 43760 1,812.00 0.004102349 FB REMOVAL EAR 41 450 69200 906.00 0.004102364 ET INSERT/MAINT 41 410 31500 980.00 0.00




4102463 FOLEY IRRIGATION 41 450 51700 2,200.00 0.004102521 D&C 41 450 59812 8,113.00 0.004102562 CRITICAL CARE 41 450 99291 9,624.00 0.004102604 FB REMOVAL NOSE 41 450 30300 1,049.00 0.004102760 I&D 41 450 10060 1,508.00 0.004102786 I&D WITH PACKING 41 450 10061 1,832.00 0.004102851 BREATH ALCOHOL ASSAY 41 301 82075 77.00 0.004102927 ED DELIVERY/STABILIZATION 41 450 59409 6,992.00 0.004103206 PACEMAKER PERCUT PROC 41 450 33210 19,116.00 0.004103461 I&D PILONID CYS; SMPL 41 450 10080 810.00 0.004103479 I&D PILONID CYST; CPLX 41 450 10081 8,135.00 0.004103487 INC & REM FB, SQ; SMPL 41 450 10120 1,213.00 0.004103495 INC & REM FB, SQ; COMPL 41 450 10121 7,347.00 0.004103503 I&D HEMATOMA 41 450 10140 8,497.00 0.004103511 PUNCT ASP-ABSC,HEMAT,CYST 41 450 10160 1,213.00 0.004103529 I&D, CPLX, POSTOP WND INF 41 450 10180 12,893.00 0.004103537 DEBR EXZ/INF SKIN; 10% BS 41 450 11000 686.00 0.004103545 DEBR EXZ/INF SKIN ADD 10% 41 450 11001 559.00 0.004103552 DEBR W OPEN FX; SKIN & SQ 41 450 11010 3,027.0

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