Orchard Hospital Chargemaster

Transcription

1 Item # Description Charge TRANSFUSION BLOOD OR COMPONENT $ PICC INSERTION FOR PATIENT >5 $ 3, TRANSFUSION BLOOD OR COMPONENT $ OBSERVATION SERVICES - 1ST HR $ OBSERVATION SERVICES - 2ND HR $ OBSERVATION SERVICES - 3RD HR $ OBSERVATION SERVICES - ADDL HR $ TRANSFUSION BLOOD OR COMPONENT $ SIGMOIDOSCOPE $ SURGERY RM SETUP-PK $ 1, RECOVERY RM 1HR $ RECOVERY RM 2HR $ MINOR RM SUPPLY S/UP $ 2, MAJOR RM SUPPLY S/UP $ 3, ORTHOPEDIC RM SET-UP $ 1, OPERATING RM 3 HR $ 6, PROCEDURE ROOM $ EXC CA TRUNK $ OPERATING RM 1 HR $ 2, OR 1ST ADDTL 1/2 HR $ 1, OR 2ND ADDTL 1/2 HR $ 1, BIER BLOCK $ SPINAL $ NURSE ANES 1/2 HR $ NURSE ANES 1 HR $ ER EXAM ROOM I $ ER EXAM ROOM III $ ER EXAM ROOM IV $ 1, ER EXAM ROOM V $ 1, ER EXAM ROOM II $ ER CRITICAL CARE ADD'L 30 MIN $ CHARGE VOIDED $ EAR WAX REMOVAL $ ER IV BUNDLE $ SNELLEN EYE TEST 7> $ IV INFUSION INITIAL UP 1 HR $ IV INFUSION EA ADD'L HR. $ IV INFUSION HYDRAT EA ADD'L HR $ INJECTION EA ADD'L PUSH $ INJECTION SUBCUTAN OR IM $ INJECTION IV PUSH SINGL OR INI $ SUBCUT OR IM INJECT 1 VACCINE $ INSERT TEMP BLADDER CATH SIMPL $

2 STRAPPING SHOULDER - RIGHT $ STRAPPING SHOULDER LEFT $ INJECTION EA ADD SEQUENT PUSH $ IV INFUSION HYDRATION 31M-1HR $ CONTROL NASAL HEMORRHAGE SIMPL $ CPR $ STRAPPING HAND OR FINGER $ SHORT ARM SPLIT - LEFT $ SIMPLE REPAIR 2.6 CM TO 5 CM $ SIMPLE REPAIR 2.6CM TO 7.5 CM $ SHORT ARM SPLINT - RIGHT $ SIMPLE REPAIR 2.5 CM OR LESS $ REPAIR COMPLETE 1.1CM TO 2.5CM $ CONTROL NASAL HEMORRHAGE INITI $ SIMPLE REPAIR 2.5 OR LESS $ SHORT LEG SPLINT LT CALF/FOOT $ SHORT LEG SPLIT RT CALF/FOOT $ DISLOCATED SHOULD REDUCTION RT $ DISLOCATED SHOULD REDUCTION LT $ FOLEY CATHETER - COMPLICATED $ FOREIGN BODY REMOVAL EAR - RT $ FOREIGN BODY REMOVAL EAR - LT $ DIGIT NERVE BLCK LT HAND 2ND D $ 1, DIGITAL NERVE BLOCK TOE - T5 $ 1, NAIL REMOVAL - TOE - T5 $ FINGER SPLINT - LEFT THUMB $ STRAPPING KNEE - LT $ STRAPPING KNEE - RT $ LONG ARM SPLINT - RT $ LONG ARM SPLIT - LT $ FB REMOVAL NOSE - LEFT $ FB REMOVAL OF NOSE - RIGHT $ BURN DRESSING/DEBRIDE SMALL $ STRAPPING TOES $ SOFT TISSUE FB REMOVAL $ FINGER SPLINT LT HAND 5TH DIGI $ WOUND REPAIR INTERM 2.5 CM < $ FINGER SPLIT-LT HAND 3RD DIGIT $ FINGER SPLIT-LF HAND 2ND DIGIT $ FINGER SPLIT-RT HAND 2ND DIGIT $ WOUND REPAIR-FACE 2.6CM-5.0CM $ IV INFUSION ADDL SEQ - UP 1 HR $ FINGER SPLIT-LT HAND/4TH DIGIT $ FINGER SPLINT - RT HAND THUMB $

3 IV INFUSION/RX CONCURRENT INF $ THORACENTESIS W/O IMAGING GUID $ 1, DIGIT NERVE BLCK RT HAND 5TH D $ 1, FINGER SPLIT - RT HAND 3RD DIG $ FINGER SPLIT RT HAND 5TH DIGIT $ CONTROL NASAL HEMORRHAGE $ WOUND REPAIR - INTERM. $ LONG LEG SPLINT - RIGHT $ LONG LEG SPLINT - LEFT $ CERUMEN REMOVAL UNILATERAL $ FOREIGN BODY REMOVAL $ WOUND REPAIR EYE NOSE LIPS $ 1, INCISION&DRAINAGE ABSCESS $ INSERTION NON TUNNELED CATHETE $ 2, BURN DRESSING/DEBRIDEMENT MED $ INITIAL TMNT 1ST DEGREE BURNS $ INSERTION NONINDWELLING CATHET $ INSERTION TEMP CATHETER COMPLI $ WOUND REPAIR 7.6 CM TO 12.5 CM $ ER CRITICAL CARE FIRST MIN $ 1, CHEST TUBE $ 1, FB REMOVAL - NOSE RIGHT $ SOFT TISSUE FB REMOVAL - RT $ 2, SOFT TISSUE FB REMOVAL - LT $ 2, REMOVAL OF FB RT $ REMOVAL OF FB LT $ FRACTURE AND/OR DISLOCATION RT $ FRACTURE AND/OR DISLOCATION LT $ FOREIGN BODY REMOVAL - EYE/LT $ FOREIGN BODY REMOVAL - EYE/RT $ ARTHROCENTESIS $ WOUND REPAIR 7.6CM TO 12.5CM $ TRANSFUSION BLOOD OR COMPONENT $ STRAPPING ACE BANDAGE-F-ARM $ STRAPPING - ANKLE AND/OR FOOT $ ET INTUBATION $ BLADDER IRRIGATION $ INCISION & DRAINAGE $ MODERATE SEDATION - E.R. $ INTERMEDIATE REPAIR 2.5 CM OR LESS $ INTERMEDIATE REPAIR 2.6 TO 7.5 CM $ INTERMEDIATE REPAIR 7.6 TO 12.5 CM $ INTERMEDIATE REPAIR 12.6 TO 20.0 CM $ IV BUNDLE - SPECIFIC TO ER $

4 PT MCAL 1ST 30 MIN/RPT $ PT ELECTRICAL STIMUL UNATTENDED $ PT BALANCED TX SET UP $ PT THERAPY INITIAL 30 MINS MCAL $ PT TESTS/MEASUR -EA ADD'L 15M $ PT THER ACTIVITY $ PT GAIT TRAINING $ PT SELF CARE ADL $ PT PARAFFIN BATH $ PT THERAPY EA ADD'L 15 MINS MCAL $ PT CONTRAST BATH $ PT THER EX $ PT HOT OR COLD PACKS $ PT WHIRLPOOL $ PT MECHANICAL TRACTION $ PT RE-EVAL $ PT TENS $ PT MANUAL THERAPY - EA 15 MINS. $ PT ULTRA SOUND $ PT WHEEL CHAIR TRAINING $ PT WOUND CARE MAJOR $ PT DRESSING/DEBRIDEMENT $ PT DRESSING/DEBRIDEMENT ADD'L $ PT NEUROMUSC. RE-ED $ PT MASSAGE $ PT CANALITH REPOSITION PRO/PERDAY $ PT PHYSICAL PERF TESET&MEASURE $ PT ELEC. STIM. (MANUAL) $ PT EVALUATION LOW COMPLEXITY $ PT EVALUATION MODERATE COMPLEX $ PT EVALUATION HIGH COMPLEXITY $ PT ORTHOTIC MANAGEMENT $ ST SWALLOW EVAL $ ST SWALLOW FUNCTION TX $ ST SWALLOW DYSFUCNTION TX $ ST SPEECH TREATMENT GROUP $ ST SPEECH FLUENCY EVAL $ ST EVAL OF SPEECH SOUND PRODUCTIO $ ST EVAL OF SPEECH W/LANG COMPREH $ ST EVAL SPEECH GEN DEVICE 1ST HR $ ST EVAL SPCH GEN DEVICE EA SUB30M $ ST FLOUROSCOPIC SWALLOW EVAL $ ST APHASIA EVAL PER HR INTERP/RPT $ ST DEVELOP TESTING W/INTER/RPT $

5 ST COGNITIVE TRAINING $ ST SENSORY INTEGRATIVE TECHNIQUES $ ST BEHAV/QUALITAT ANALYSIS VOICE $ ST EVAL USE/FITTING VOICE PROSTH $ ST THERAP SVCS USE SPCH GEN DEVIC $ OT SELF CARE ADL $ OT ELEC.STIM.(MANUAL) $ OT THER EX $ OT NEUROMUSCULAR RE-EDUCATION $ OT THERAPY EXERCISE $ OT RE EVALUATION $ OT MASSAGE $ OT PHYSICAL PERF TEST&MEASURE $ OT TENS $ OT HOT OR COLD PACKS $ OT ELECTRICAL STIMUL UNATTENDED $ OT EVALUATION LOW COMPLEXITY $ OT EVALUATION MODERATE COMPLEX $ OT EVALUATION HIGH COMPLEXITY $ OT PARAFFINE BATH $ OT CONTRAST BATH $ OT ULTRA SOUND $ OT MANUAL THERAPY $ OT ADL RETRAINING $ OT THERAPEUTIC ACTIVITY $ OT COGNITIVE THERAPY $ OT COMMUNITY WORK REINTEGRATION $ OT ORTHOTIC MANAGEMENT $ OT MCAL-EVAL 30 MINS PLUS REPORT $ OT MCAL - EVAL ADD'L 15 MINS/RPT $ OT MCAL -TREATMENT INITIAL 30 MIN $ OT MCAL - EA ADD'L 15 MINS $ RN INFUSION THERAPY - 1ST HR $ RN IV INFUSION EA ADD'L HR $ MINS INDIV. PSYCHOTHERAPY $ MIN INDIV. PSYCHOTHERAPY $ MIN INDIVD PSYCHOTHERAPY $ FAMILY PSYCHOT W/O PT PRESENT $ FAMILY PSYCHOTHER W/PT PRESENT $ GROUP PSYCHOTHERAPY $ TELEHEALTH FACILITY FEE $ ALBUMIN $ ALCOHOL/ETHYL $ ALK. PHOSPHATASE $

6 ALT $ AMMONIA $ AMYLASE $ AST $ BASIC METABOLIC $ BILIRUBIN DIRECT $ BILIRUBIN TOTAL $ BNP $ BUN $ CALCIUM $ CHLORIDE $ CHOLESTEROL $ CK $ COMP METABOLIC $ CREATININE $ CREATININE 24 HR URINE $ CREATININE CLEARANCE $ CREATINE RANDOM URINE $ D-DIMER $ DIGOXIN LEVEL $ DILANTIN/PHENYTOIN $ CBC W/ AUTO DIFF $ GLUCOSE BLOOD $ FECAL OCCULT BLOOD $ FERRITIN $ FOLATE $ FREE T4 $ GGT $ GLUCOSE BLOOD $ GLUCOSE ADDITIONAL $ GLUCOSE POST DOSE $ GLUCOSE TOL 3 SPEC $ HEMOGRAM $ HEPATIC FUNC PANEL $ HGB A1C $ HIV RAPID $ INFLUENZA A/B $ IRON $ LACTATE (LACTIC ACID) $ LDL CHOLESTEROL DIR $ LIPASE $ LIPID PANEL $ LYTES $ MAGNESIUM $

7 MANUAL DIFF $ MICROALBUMIN 24 HR URINE $ MICROALBUMIN URINE RANDOM $ MONO TEST $ PHOSPHORUS $ POTASSIUM $ POTASSIUM 24 HR URINE $ FINGERSTICK GLUCOSE IN-HOUSE $ PROTEIN TOTAL 24 HR URINE $ PROTHROMBIN TIME $ PSA TOTAL $ PTT $ HCG QUANT BETA $ RA TITER $ RENAL FUNCTION PANEL $ RETIC COUNT-AUTOMATED $ RSV $ SEDIMENTATION RATE $ STOOL WBC $ PROTEIN TOTAL $ TOTAL VOLUME 24 HR URINE $ TSH $ UREA NITROGEN URINE $ URINALYSIS DIP $ URINALYSIS MICROSCOPIC ONLY $ MICRO (UA) $ URINE DRUGS OF ABUSE $ VANCOMYCIN $ VENIPUNCTURE $ VIT B-12 $ WET MOUNT KOH PREP $ URINE DIPSTICK $ KETONES $ RA FACTOR $ TRIGLYCERIDE $ TROPONIN I $ TSH $ QUALITATIVE BETA HCG $ URIC ACID BLOOD $ VALPROIC ACID $ URINE SODIUM $ POTASSIUM RAND URINE $ PROTEIN TOTAL RAN UR $ STREP A RAPID $

8 DIP STICK URINE $ URINE PREGNANCY $ BUN - UREA NITROGEN - ISTAT $ CHLORIDE - ISTAT $ C02 CONTENT - ISTAT $ CREATININE - ISTAT $ GLUCOSE BLOOD - ISTAT $ POTASSIUM SERUM - ISTAT $ SODIUM - ISTAT $ HEMOGLOBIN - ISTAT $ HEMATOCRIT - ISTAT $ TROPONIN I - ISTAT $ BNP - ISTAT $ CLOSTR DIFF/CDA - INHOUSE $ SALICYLATES SERUM $ SODIUM $ GASTROCULT SLIDE $ HDL $ VITAMIN D 25 HYDROXY $ ECO2 $ ACETAMINOPHEN $ DIRECT IBC $ TRANSFERRIN $ THYROGLOBULIN A&B SEND OUT $ PROTEIN CREATINE SEND OUT $ RAPID PLASMIN REAGIN RPR SEND OUT $ RUBELLA IGG SEND OUT $ CARBOXY HEROGLOBIN SEND OUT $ PATHOLOGY DURING SUGGERY SEND OUT $ SODIUM 24 HR URINE SEND OUT $ STAIN MICO ORGANISMS SEND OUT $ GROSS MICRO LEVEL V SEND OUT $ QUINIDINE SEND OUT $ IGF-BP3 SEND OUT $ UREA NITRO 24HR URINE SEND OUT $ ADH SEND OUT $ URINE I.D. SEND OUT $ HUMAN T CELL LYMPHO SEND OUT $ POTASSIUM 24HR URINE SEND OUT $ THYROGLOBULIN PANEL SEND OUT $ RUBELLA AB SEND OUT $ GROSS MICRO EXAM LEVEL III SEND OUT $ CYTOPATHOLOGY FINE NEEDLE SEND OUT $ CYTOPATHOLOGY SEND OUT $ 54.89

9 GROSS MICRO EXAM LEVEL IV SEND OUT $ GROSS EXAM LEVEL I SEND OUT $ GROSS MICRO EXAM LEVEL IV SEND OUT $ PIN WORM EXAM SEND OUT $ PROTEIN 24 HR URINE SEND OUT $ FOOD ALLERGY SEND OUT $ IGE SEND OUT $ ALLERGEN PROFILE SEND OUT $ CYCLIC CITRULLINATED SEND OUT $ PORPHYRINS URO COPRO URINE SEND OUT $ KEPPRA LEVEL SEND OUT $ REERSE T3 - QUEST SEND OUT $ CYCLOSPORINE BLOOD SEND OUT $ FORTICAL CALCITONIN NASAL SPR SEND OUT $ CALCIUM - ISTAT $ AEROBIC CULTURE SEND OUT $ AFP TUMOR SEND OUT $ ANA SEND OUT $ ANAEROBIC CULTURE SEND OUT $ BETA-2 MICROGLOBULIN SEND OUT $ BLOOD CULTURE SEND OUT $ CA 125 SEND OUT $ CA 19-9 SEND OUT $ CA SEND OUT $ CEA SEND OUT $ CHLAMYDIA GC URINE OR SWAB SEND OUT $ COMPLEMENT C3 SEND OUT $ COMPLEMENT C4 SEND OUT $ CORTISOL SEND OUT $ CORTISOL URINE 24 HR SEND OUT $ C-REACTIVE PROTEN CARDIAC SEND OUT $ C-REACTIVE PROTEIN SEND OUT $ CULTURE URINE SEND OUT $ ESTRADIOL SEND OUT $ ESTROGEN SEND OUT $ DHEA SULFATE IMMUNOASSAY SEND OUT $ TESTOSTERONE FREE SEND OUT $ GENTAMICIN SEND OUT $ GRAM STAIN SEND OUT $ HELICOBACTER-ANTI PY SEND OUT $ HCV RNA PCR QI RFLX SEND OUT $ HEP C RNA PCR QUAL SEND OUT $ NGI HCV QUANTASURE SEND OUT $ HEP. B SURFACE A-B SEND OUT $ 9.63

10 MYOGLOBIN SERUM SEND OUT $ HEP A B C PANEL SEND OUT $ HEP C VIRAL AB SEND OUT $ HERPES CULTURE SEND OUT $ HIV 2 AB SEND OUT $ HIV-1 AB SEND OUT $ H-PYLORI STOOL SEND OUT $ B12 UNSATURATED BINDING CAP SEND OUT $ HSV 1&2 HERPES SIMPLE TYP 1 SEND OUT $ IGF-1 SEND OUT $ CULTURE OTH SOURCE NOT BLOOD SEND OUT $ ISLET CELL DYSFU SEND OUT $ CALCIUM IONIZED SEND OUT $ LYME DISEASE IGG WBA SEND OUT $ LEAD SEND OUT $ LEAD BLOOD PEDIATRIC SEND OUT $ THEOPHYLLINE SEND OUT $ LUTEINIZING HORMONE SEND OUT $ LYME DISEASE AB SEND OUT $ METHYLMALONIC ACID SERUM SEND OUT $ CULTURE MRSA SCREEN SEND OUT $ MUMPS AB IGG TITER SEND OUT $ PROTEIN S FUNCTIONAL SEND OUT $ OSMOLALITY URINE SEND OUT $ OVA & PARASITE SEND OUT $ PHENOBARBITAL SERUM SEND OUT $ PRE ALBUMIN SEND OUT $ PROGESTERONE SEND OUT $ PROLACTIN SEND OUT $ PTH-C-TERMINAL SEND OUT $ UPPER RESPIRATORY CULTURE SEND OUT $ RUBEOLA ANTIBODIES IGG SEND OUT $ CULTURE STOOL SEND OUT $ ANTIBODY IDENT LEUKOCYTE ATIB SEND OUT $ ANTI MULLERIAN HORMONE SEND OUT $ T3 TOTAL RIA SEND OUT $ T3 FREE SEND OUT $ T3 UPTAKE SEND OUT $ T4 TOTAL SEND OUT $ TACROLIMUS FK506 BLOOD SEND OUT $ CARBAMAZEPINE TEGRETOL SEND OUT $ HEMOGLOBIN (HAB)SOLU SEND OUT $ TESTOSTERONE TOTAL SEND OUT $ CULTURE THROAT/NOSE SEND OUT $ 38.63

11 THYROID PEROXIDASE SEND OUT $ UNSTATURATED IRON INDING TIBC SEND OUT $ LIPOPROTEIN SEND OUT $ VARICELLA ZOSTER A-B SEND OUT $ VITAMIN D 1 25 HYDRO SEND OUT $ LACOSAMIDE LC/MC/MS SEND OUT $ FOLATE RBC PROFILE SEND OUT $ SUSCEPTIBILITY SEND OUT $ INSULIN FREE SEND OUT $ ANGIOTENSIN CONV ENZ SEND OUT $ CELL CNT BODY FLUID SEND OUT $ URIC ACID 24 HR URINE SEND OUT $ CMV I/B IGG & IGM SEND OUT $ FACTOR VIII ACTIVITY CLOTTING SEND OUT $ FACTOR IX ACTIVITY COAG SEND OUT $ ANTI SMOOTH MUSCLEAB SEND OUT $ MITOCHONDRIAL M2 AB SEND OUT $ HEPATITIS A IGM SEND OUT $ ASO-SCREEN SEND OUT $ CSF PROTEIN SEND OUT $ ANCA X2 SEND OUT $ COLD AGGLUTINATION SEND OUT $ FEBRILE AGGLUTININX6 SEND OUT $ EOSINOPHILL URINE RA SEND OUT $ CALCULI URINE SEND OUT $ PREGNANCY SERUM $ HT LVI / HTLV II SEND OUT $ DHEA SEND OUT $ ASSAY OF PROGESTERONE SEND OUT $ BETA 2-GLYCOPROTEIN I SEND OUT $ PROTHROMBIN GENE ANALYSIS SEND OUT $ THROMBIN TIME SEND OUT $ STONE ANALYSIS SEND OUT $ SPECIAL STAINS-MISCELLANEOUS SEND OUT $ ZONISAMIDE SEND OUT $ IGFBP-3 SEND OUT $ LACTIC ACID DEHYDROGENASE SEND OUT $ THYROXINE SEND OUT $ COPPER SEND OUT $ ALDOLASE SEND OUT $ OSMOLALITY SERUM SEND OUT $ TESTOSTERONE SEND OUT $ FSH SERUM SEND OUT $ ACTH PLASMA SEND OUT $ 25.25

12 VITAMIN B6 SEND OUT $ CYTOMEGALOVIRUS CMV AB SEND OUT $ HSV CULTURE AND TYPING SEND OUT $ GENITAL CULTURE ROUTINE SEND OUT $ C-PEPTIDE SEND OUT $ H PLYLORI IGM IGG IGA AB SEND OUT $ CCP IGG/IGA SEND OUT $ LOWER RESPIRATORY CULTURE SEND OUT $ H PYLORI BREATH TEST SEND OUT $ HSV CULTURE WITHOUT TYPING SEND OUT $ HCV QUANT REAL TIME PCR SEND OUT $ HOMOCYSTEINE PLASMA SEND OUT $ FREE K+L LT CHAINS QN S SEND OUT $ VITAMIN B1 THIAMINE BLOOD SEND OUT $ CYTOMEGALOVIRUS CMV QUAT SEND OUT $ TOTAL PROTEIN SEND OUT $ PROTEIN ELECTROPHORECTIC SEND OUT $ STOOL AEROBIC PATHOGENS ISO SEND OUT $ STOOL SHIGA LIKE TOXIN SEND OUT $ OVA AND PARASITE COMPLEX SEND OUT $ WEST NILE VIRUS IGM SEND OUT $ WEST NILE VIRUS SEND OUT $ GL CELIAC DISEASE GAM/IMMUN SEND OUT $ HSV 1&2 HERPES SIMPLEX SEND OUT $ NEISSERIA GONORRHOEAE AMP SEND OUT $ EBV ACUT EB NUCLEAR ANTIGEN SEND OUT $ EBV ACUTE EB EARLY ANTIGEN SEND OUT $ EBV ACUTE EB VIRAL CAPSID SEND OUT $ IGA QUANT SERUM SEND OUT $ DEAMIDATED GLIADIN IGA SEND OUT $ DEAMIDATED GLIADIN IGG SEND OUT $ HSV 1&2 HERPES SIMPLEX 2 SEND OUT $ TISSUE TRANGULATIMASE IGA SEND OUT $ TISSUE TRANGLUTAMINASE IGG SEND OUT $ HEPATITIS C ANTIBODY SEND OUT $ HEPATITIS A AB IGM SEND OUT $ HEPATITIS B CORE AB IGM SEND OUT $ ANTI-DSDNA ANTIBODIES SEND OUT $ HIV 1 & 2 SEND OUT $ CA 15-3 SEND OUT $ ZINC SEND OUT $ TRANSFERRIN SEND OUT $ SCLERODERMA ANTIBODY SEND OUT $ PROTEIN ELECTROPHORESIS PANEL SEND OUT $ 19.95

13 DONOR SYPHILLS IGG ANTIBODY SEND OUT $ VITAMIN A (RETINOL) SEND OUT $ CALPROTECTIN STOOL SEND OUT $ DRVVT CONFIRM SEND OUT $ HEXAGONAL PHASE CONFIRM SEND OUT $ THROMBIN CLOTTING TIME SEND OUT $ DRVVT 1:1 MIX SEND OUT $ BK VIRUS DNA TIME PCR URINE SEND OUT $ ALPHA-1-ANTITRYPSIN QUANTITIVE SEND OUT $ CATECHOLAMINES FRAC 24HR URINE SEND OUT $ HEPATITIS C VIRAL RNA SEND OUT $ VISCOSITY SEND OUT $ CHROMOGRANIN SEND OUT $ GAMMA-HYDROXYBUTYRIC ACID(GHB) SEND OUT $ METANEPHRINES SEND OUT $ LAMOTRIGINE SEND OUT $ BETA CAROTENE SEND OUT $ RBC ANTIBODY ID - BLOOD SOURCE SEND OUT $ COOMBS TST DIRECT BLOOD SOURCE SEND OUT $ SELENIUM 2.5% SUSP TOPICAL SEND OUT $ ALDOSTERONE SEND OUT $ RUBELLA SEND OUT $ ACUTE HEPATITIS PANEL SEND OUT $ PRENATAL/OB PANEL SEND OUT $ HEPATITIS B CORE IGM SEND OUT $ HEPATITIS B SURFACE AG SEND OUT $ HEPATITIS C AB SEND OUT $ RPR SEND OUT $ HEPATITIS B SURFACE AB SEND OUT $ AGINITIS PLUS VG SEND OUT $ PARASITE INDETIFIY SEND OUT $ TUBERCULOSIS SUSCEPT SEND OUT $ PROTEIN ELECTROPHORESIS SEND OUT $ HEREDITARY HEMO DNA ANALYSIS SEND OUT $ DIHYDROTESTERONE DHT SEND OUT $ CERULOPLASMIN SEND OUT $ IMMUNO ER PR HER-2 SEND OUT $ TSH SEND OUT $ FECAL IMMUNOCHEM SEND OUT $ DRUG CONFIRMATION EA PROCEDUR SEND OUT $ ANDROSTENEDIONE SEND OUT $ CYCLIC AMP URINE SEND OUT $ FREE ANDROGEN SEND OUT $ ORO-SPUTUM CULTURE SEND OUT $ 2.13

14 CRYPTOSPORIDIUM ANTIGEN SEND OUT $ URINE PROTEIN TOTAL W/O CREAT SEND OUT $ ALLERGY EVAL 5 NORTH CENTRAL SEND OUT $ TSI-THYROID STIMULATING IMMUN SEND OUT $ OVA & PARASITES W/GIARDIA ANTI SEND OUT $ LEUK/LYMPHOMA 1ST MARKER SEND OUT $ SEX HORMONE BINDING GLOBULIN SEND OUT $ HLA-B27 ANTIGEN SEND OUT $ VITAMIN C LC/MS/MS SEND OUT $ LEUK/LYMPHOMA 2ND ADDTL MARKER SEND OUT $ LEUK/LYMPHOMA 16+ MARKERS SEND OUT $ MERCURY QUANTITATIVE SEND OUT $ COXIELLA BURNETII (Q FEVER) SEND OUT $ ACETYLCHOLINE RECEPTOR BINDING SEND OUT $ GLUTAMIC ACID DECARB-65 ANTIBY SEND OUT $ FUNGAL STAIN SEND OUT $ FUNGAL TISSUE/SKIN SEND OUT $ RED CELL ANTIBODY SCREEN SEND OUT $ MYSOLINE SEND OUT $ AMYLASE ISOENZYMES SEND OUT $ ARSENIC URINE SEND OUT $ SPECTROPHOTOMETRY SEND OUT $ COCCIDIOIDES ANTIBODIES SEND OUT $ ORO-GLUCOSE BODY FLUID NOT BL SEND OUT $ ORO-WET MOUNT FOR INFECTIONS SEND OUT $ CYTOPATH/CELL ENHANCER SEND OUT $ FECES ANALYTE SEND OUT $ HIV-1 QUANTIFICATION INCL REV SEND OUT $ GABAPENTIN SEND OUT $ TETANUS SEND OUT $ DIPHTHERIA SEND OUT $ TRICHOMONAS VAGINALIS AMPLIFY SEND OUT $ HAPTOGLOBIN SEND OUT $ PORPHOBILINOGEN QUANTITATIVE SEND OUT $ POPHYRINS TOTAL PLASMA SEND OUT $ ANTITHROMBIN III ACTIVITY SEND OUT $ PROTEIN C FUNCTIONAL SEND OUT $ FOLATE RBC SEND OUT $ NOROVIRUS RNA PCT RT SEND OUT $ CORTICOSITERIOS BDING GLOB SEND OUT $ ORO-GRAM STAIN DX SEND OUT $ ALUMINUM SEND OUT $ ESTRADIOL FREE LC/MS/MS SEND OUT $ INSULIN ATIBODIES SEND OUT $ 10.50

15 HANDLING FEE SEND OUT $ PROTEIN CSF FLUID SEND OUT $ FUNGUS NOT ELSEWHERE SPECIFY SEND OUT $ CALCIUM 24-HR URINE W/O CREAT SEND OUT $ ORO-ANTIBODY RBC PANELS SEND OUT $ ORO-ANTIHUMAN GLOBIN(COOMBS) SEND OUT $ ORO-STAT HANDLING FEE SEND OUT $ FLUOXETINE SEND OUT $ PSA TOTAL W/REFLEX TO PAS FREE SEND OUT $ DRUG ABUSE 9 ITH CONFIRM SEND OUT $ LUPUS ANTICOAG EVAL W/REFLEX SEND OUT $ POLIOVIRUS (TYPES 1 3) AB NEUT SEND OUT $ BACTERIUM PNEUNOMITIS SEND OUT $ ASPERGILLIS SEND OUT $ ALLERGEN SPEC IGC QUANTATIVE SEND OUT $ RETICULOCYTE COUNT AUTOMATED SEND OUT $ ASPERGILLUS ANTGN EIA SEND OUT $ IHC INTIAL SINGLE AB STAIN SEND OUT $ EGFR SEND OUT $ LACTOFERRIN FECAL QUALITATIVE SEND OUT $ PANCREATIC ELASTASE-1 SEND OUT $ FACTOR X ACTIVITY CLOTTING SEND OUT $ FACTOR XII ACTIVITY CLOTTING SEND OUT $ VON WILLEBRAND FACTOR ANTIGEN SEND OUT $ GLYCOMARK SEND OUT $ CALCITONIN SEND OUT $ HEMOGLOBINOPATHY SEND OUT $ HEMOGLOBINOPATHY EVAL SEND OUT $ PROTEIN C ANTIGEN SEND OUT $ VITAMIN K SEND OUT $ REPTILASE TEST SEND OUT $ FIBRINOGEN ANTIGEN SEND OUT $ FIBRINOGEN ACTIVITY SEND OUT $ CARDIOLIPIN AB IGA IGG IGM SEND OUT $ ANA TITER/PATTERN SEND OUT $ ALDOSTERONE/PRAR LC/MS/MS SEND OUT $ ROTAVIRUS ANTIGEN DETECTION SEND OUT $ ST.LOUIS ENCEPHALITIS VIRUS SEND OUT $ MTHFR DNA MUTATION SEND OUT $ LITHIUM SEND OUT $ CLOSTR DIFF/CDA - QUEST SEND OUT $ CLOSTR DIFF/CDA - OROVILLE SEND OUT $ BB RBC UNIT 1 IGG GEL COMPATIBILI $ BB RBC UNIT 1 IS TUBE COMPATIBILI $

16 BB RBC UNIT 2 IGG GEL COMPATIBILI $ BB RBC UNIT 2 IS TUBE COMPATIBILI $ BB RBC UNIT 3 IGG GEL COMPATIBITI $ BB RBC UNIT 3 IS TUBE COMPATIBILI $ BB RBC UNIT 4 IGG GEL COMPATIBILI $ BB RBC UNIT 4 IS TUBE COMPATIBILI $ BB R H FACTOR $ BB ABO GROUP $ BB ANTIBODY SCREEN $ BB CYROPRECIPITATE EA. UNIT $ BB DIRECT COOMBS - REF LAB $ BB PLATELET PHERESIS $ BB PRBC #1 CHARGE $ BB PRBC #2 CHARGE $ BB PRBC #3 CHARGE $ BB PRBC #4 CHARGE $ BB RHOGAM $ XR FACIAL BONES $ XR MANDIBLE RT $ XR MASTOIDS RT $ XR NASAL BONES RT $ XR ORBITS RT $ XR SINUSES $ XR SKULL COMPLETE $ XR SKULL LTD LESS THAN 4V $ XR NECK SOFT TISSUE $ XR TEMPOROMANDIBULAR RT $ XR ENTIRE SPINE SURVEY $ XR CHEST 1V $ XR CHEST 2V $ XR CHEST 3V $ XR CHEST SP VIEWS $ XR RIB BIL W/CHEST 4 VIEWS RT $ XR STERNUM $ XR CERVICAL SPINE 1V $ XR CERVICAL SPINE COMPLETE 5V $ XR CERVICAL SPINE COMPLETE + FLEX/EXT $ XR CERVICAL SPINE LTD 2V OR 3V $ XR LUMBAR SPINE COMPLETE $ XR LUMBAR SPINE FLEX/EXT $ 2, XR LUMBAR SPINE LTD 2V OR 3V $ XR PELVIS 1 or 2V $ XR PELVIS COMPLETE $ XR HIP UNILAT W/ PELVIS 1V RT $

17 XR SACRUM & COCCYX $ XR SCOLIOSIS STUDY 1V $ XR SI JOINTS $ XR THORACIC SPINE LTD 2V $ XR THORACIC SPINE 4V COMPLETE $ XR THORACO-LUMBAR JNCT 2V $ XR CERVICAL SPINE 1V $ XR AC JOINT BILAT $ XR ANKLE COMPLETE RT $ XR ANKLE LTD 2V RT $ XR CLAVICLE RT $ XR ELBOW COMPLETE 3V RT $ XR ELBOW LTD 2V RT $ XR FEMUR LTD VIEW RT $ XR FINGER(S) 2V RT $ XR FOOT COMPLETE RT $ XR FOREARM RT $ XR HAND COMPLETE RT $ XR HAND LTD 2V RT $ XR CALCANEUS RT $ XR HIP BILAT 2V W/ PELVIS $ XR HUMERUS RT $ XR KNEE COMPLETE RT $ XR KNEE COMPLETE RT $ XR KNEE LTD 2V RT $ XR KNEE STANDING BILAT $ XR SCAPULA $ XR SHOULDER 1V RT $ XR SHOULDER COMPLETE RT $ XR TIBIA & FIBULA 2V RT $ XR TOES RT $ XR WRIST COMPLETE RT $ XR WRIST LTD 2V RT $ XR ABDOMEN 2V $ XR ACUTE ABDOMEN SERIES COMPLETE $ XR ABDOMEN (KUB) SINGLE VIEW $ XR ACUTE ABD SERIES COMP (INCL CHEST) $ XR SINGLE FILM CHILD FOREIGN BODY $ XR RIBS UNILAT W/ 1V CHEST RT $ XR BONE AGE $ XR BONE LENGTH $ XR BONE SURVEY INFANT $ XR BONE SURVEY METASTATIC $ XR HIP BILAT 3-4V $

18 XR HIP BILAT 3-4V $ XR HIP BILAT 5V OR MORE $ XR HIP BILAT 5V OR MORE $ XR ABDOMEN (GB) $ XR MANDIBLE LT $ XR MASTOIDS LT $ XR NASAL BONES LT $ XR ORBITS LT $ XR TEMPOROMANDIBULAR LT $ XR HIP UNILAT 2V LT $ XR HIP UNILAT W/PELVIS MIN 4V LT $ XR SHOULDER ARTHRO LT $ XR RIBS UNILAT W/ 1V CHEST LT $ XR RIB BIL W/CHEST 4 VIEWS LT $ XR HIP UNILAT W/ PELVIS 1V LT $ XR ANKLE COMPLETE LT $ XR ANKLE LTD 2V LT $ XR CLAVICLE LT $ XR ELBOW COMPLETE 3V LT $ XR ELBOW LTD 2V LT $ XR FEMUR LTD VIEW LT $ XR FINGER(S) 2V LT $ XR FOOT COMPLETE LT $ XR FOREARM LT $ XR HAND COMPLETE LT $ XR HAND LTD 2V LT $ XR CALCANEUS LT $ XR HUMERUS LT $ XR KNEE COMPLETE LT $ XR KNEE COMPLETE LT $ XR KNEE LTD 2V LT $ XR SHOULDER 1V LT $ XR SHOULDER COMPLETE LT $ XR TIBIA FIBULA 2V LT $ XR TOES LT $ XR WRIST COMPLETE LT $ XR WRIST LTD 2V LT $ XR MANDIBLE BILAT $ XR MASTOIDS BILAT $ XR NASAL BONES BILAT $ XR ORBITS BILAT $ XR AC JOINT BILAT $ XR ANKLE COMPLETE $ XR ANKLE LTD 2V $ 30.75

19 US EXT BILAT VENOUS DOP UPP/LOW $ XR TEMPOROMANDIBULAR BILAT $ XR BONE AGE $ XR BONE LENGTH $ XR CERVICAL SPINE COMPLETE 5V $ XR CERVICAL SPINE LTD 2V OR 3V $ XR CHEST SP VIEWS $ XR CHEST 1V $ XR CHEST 2V $ XR CHEST 3V $ XR CLAVICLE $ XR COLON B.E. $ XR CYSTOGRAM $ XR DEXA VFA (PERIPH/RADIUS,WRIST,HEEL) $ XR B.E. STUDY W/ OR W/O KUB $ XR ELBOW COMPLETE $ XR ELBOW LTD 2V $ XR UPP GI VIDEO SWALLOW STUDY $ XR FACIAL BONES $ XR FEMUR LTD $ XR FINGER(S) 2V $ XR FISTULA TRACT $ XR FLUOROSCOPY UP TO 1HR $ XR FOOT COMPLETE $ XR FOOT LTD $ XR FOREARM $ XR HAND LTD 2V $ XR HAND COMPLETE $ XR CALCANEUS $ XR HIP ARTHRO $ XR HIP UNILAT $ XR HIP BILAT 2V W/ PELVIS $ XR HUMERUS $ XR KNEE COMP $ XR KNEE LTD 2V $ XR KNEE COMPLETE $ XR KNEE ARTHRO $ XR KNEE STANDING BILAT $ XR LAMINOGRAPHY $ US EXT BILAT ARTERIAL DOP UPP/LOW $ US EXT UNILAT ARTERIAL DOP UPP/LOW $ XR LUMBAR SPINE FLEX/EXT $ XR LUMBAR SPINE LTD 2V OR 3V $ XR LUMBAR SPINE COMPLETE $ 90.10

20 XR MANDIBLE $ XR NASAL BONES $ XR NECK SOFT TISSUE $ XR PELVIS 1 or 2V $ XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V $ XR RIBS UNILAT W/ 1V CHEST $ XR RIBS BILAT W/ CHEST 4V $ XR RIBS BILAT 3V $ XR SACRUM & COCCYX $ XR SHOULDER COMPLETE $ XR SHOULDER ARTHRO $ XR SHOULDER 1V $ XR SI JOINTS $ XR SINGLE FILM CHILD FOREIGN BODY $ XR SKULL COMPLETE $ XR SKULL LTD LESS THAN 4V $ XR SPECIMEN RADIOG $ XR UPP GI VIDEO SWALLOW STUDY $ XR THERAPEUTIC ENEMA $ XR THORACIC SPINE 4V COMPLETE $ XR THORACIC SPINE LTD 2V $ XR THORACO-LUMBAR JNCT 2V $ XR TIBIA & FIBULA 2V $ XR TEMPOROMANDIBULAR $ XR TOES $ XR WRIST COMPLETE $ XR WRIST LTD 2V $ XR ENTIRE SPINE SURVEY $ XR ABDOMEN (KUB) SINGLE VIEW $ XR SHOULDER ARTHRO RT $ XR ABDOMEN 2V $ XR ACUTE ABDOMEN SERIES COMPLETE $ XR RIBS BILAT W/ CHEST 4V $ XR SCOLIOSIS STUDY 1V $ XR ACUTE ABD SERIES COMP (INCL CHEST) $ XR B.E. STUDY W/ OR W/O KUB $ XR ANKLE COMPLETE BILAT $ XR SHOULDER ARTHRO BILAT $ XR CLAVICLE BILAT $ XR ELBOW COMPLETE 3V BILAT $ XR ELBOW LTD 2V BILAT $ XR FOOT COMPLETE BILAT $ XR FOREARM BILAT $ XR HAND COMPLETE BILAT $

21 XR HAND LTD 2V BILAT $ XR HUMERUS BILAT $ XR KNEE COMPLETE BILAT $ XR KNEE COMPLETE BILAT $ XR KNEE LTD 2V BILAT $ XR SHOULDER 1V BILAT $ XR SHOULDER COMPLETE BILAT $ XR TIBIA FIBULA 2V BILAT $ XR WRIST COMPLETE BILAT $ XR WRIST LTD 2V BILAT $ XR ANKLE LTD 2V BILAT $ XR MASTOIDS $ XR DEXA BASIC (HIPS,PELVIS,SPINE) $ XR DEXA VFA (PERIPH,RADIUS,WRIST,HEEL) $ XR FLUORO GUIDE SPINE OR PARASPINE $ XR FLUORO GUIDE SPINE OR PARASPINE $ XR FLURO GUIDE CENTRAL VENOUS $ XR FLUORO GUIDE CENTRAL VENOUS $ XR FLUOROSCOPY UP TO 1HR $ XR FLURO (SEP PROC)UP 1 HR $ XR HIP UNILAT 2V RT $ XR HIP UNILAT 2V $ XR HIP UNILAT W/PELVIS MIN 4V RT $ XR HIP UNILAT W/PELVIS MIN 4 $ XR RIBS BILAT 3V $ XR FINGER(S) 2V BILAT $ XR FOOT LTD LT $ XR FOOT LTD RT $ XR HIP ARTHRO $ XR KNEE ARTHRO $ 1, XR LUMBAR SPINE COMPLETE W/ FLEX/EXT 7V $ XR SC JOINT BILAT $ XR SC JOINT LT $ XR SC JOINT RT $ XR SCOLIOSIS COMPLETE $ XR THORACIC SPINE 3V COMPLETE $ XR UPP GI W/ SMALL BOWEL F/T (BARIUM) $ XR WRIST ARTHRO $ XR BONE SURVEY INFANT $ XR BONE SURVEY METASTATIC $ XR DEXA BASIC (HIPS,PELVIS,SPINE) $ XR HIP UNILAT W/ PELVIS 1V $ XR SC JOINT $ XR SCOLIOSIS COMPLETE $ 75.00

22 XR THORACIC SPINE 3V COMPLETE $ XR SCAPULA $ XR RIBS UNILATERAL 2 VIEW $ XR RIBS UNILATERAL 2 VIEW RT $ XR RIBS UNILATERAL 2 VIEW LT $ MM DIAGNOSTIC MAMMOGRAM BILAT $ MM MAMMOGRAPHY ROUTINE SCREENING $ MM DIAGNOSTIC MAMMOGRAM UNILAT $ MM DIAGNOSTIC MAMMOGRAM UNILAT RT $ MM DIAGNOSTIC MAMMOGRAM BILAT $ MM MAMMOGRAPHY ROUTINE SCREENING $ MM DIAGNOSTIC MAMMOGRAM UNILAT LT $ MRI CHEST W/ & W/O CONT $ 3, MRI CHEST W/O CONT $ 3, MRI CERVICAL SPINE W/O CONT $ 3, MRI BRAIN W/O CONT $ 3, MRI LOWER EXT JOINT W/O RT $ 2, MRI LOW EXTREM JOINT W & W/O RT $ 2, MRI KNEE W/O CONT RT $ 2, MRI LOW EXT W/ & W/O CONT RT $ 3, MRI LOW EXT W/ CONT RT $ 3, MRI LUMBAR SPINE W/ & W/O CONT $ 2, MRI LUMBAR SPINE W/O CONT $ 3, MRI ORBIT/FACE/NECK W/ & W/O CONT $ 3, MRI ABDOMEN W/O CONT $ 3, MRI ABDOMEN W/ CONT $ 3, MRI BRAIN W/ & W/O CONT $ 3, MRI PELVIS W/ & W/O CONT $ 3, MRI PELVIS W/O CONT $ 3, MRI THORACIC SPINE W/ & W/O CONT $ 4, MRI THORACIC SPINE W/O CONT $ 4, MRI UPP EXTRE JOINT W/O CONT RT $ 3, MRI UPP EXT JOINT W/ & W/O CONT RT $ 2, MRI UPP EXT W/ & W/O CONT RT $ 2, MRI UPP EXT NOT JOINT W/O CONT RT $ 3, MRI ABDOMEN W/ & W/O CONT $ 1, MRA HEAD W/ & W/O CONT $ 3, MRA HEAD W/O CONT $ 3, MRA HEAD W/ CONT $ 1, MRA NECK (CAROTIDS) W/ & W/O CONT $ 1, MRA NECK (CAROTIDS) W/ CONT $ 2, MRI LOW EXT W/O CONT RT $ 3, PROHANCE 10ML SYRINGE CONT $ MRI PITUITARY W&W/O READING $

23 MRA NECK (CAROTIDS) W/O CONT $ 1, MRA NECK (CAROTIDS) W/O CONT $ MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CONT $ 1, MRI ORBIT/FACE/NCK SFT TIS W/ & W/O CON $ MRI CERVICAL SPINE W/ & W/O CONT $ 1, MRI CSPINE W & W/O $ MRI HIP W/O CONT RT $ 2, MRI HIP W/O CONT $ MRI LOW EXT JOINT W/ & W/O CONT RT $ 3, MRI LOW EXT JOINT W/O CONT RT $ 2, MRI LOW EXT JOINT W/O CONT $ MRI FOOT W/O CONT RT $ 2, MRI FOOT CONT W/O $ MRI SHOULDER W/O CONT RT $ 1, MRI SHOULDER W/O CONT $ MRI UPP EXT JOINT W/O CONT RT $ 1, MRI UPP EXT JOINT W/O CONT $ MRI WRIST W/O CONT RT $ 1, MRI WRIST W/O CONT $ MRI UPP EXT W/O CONT RT $ 1, MRI UPP EXT NOT JOINT W/O CONT $ MRI ABDOMEN W/ & W/O CONT $ MRI LOW EXT W/O CONT $ MRI BREAST UNILAT W/ & W/O CONT RT $ 3, MRI BREAST UNILAT W/ & WO CONT $ MRA HEAD W/ & W/O CONT $ MRI CERVICAL SPINE W/ CONT $ 3, MRI CERVICAL SPINE W/ CONT $ MRI LOWER EXT JOINT W/O LT $ 2, MRI LOW EXT JOINT W/ & W/O CONT $ 2, MRI KNEE W/O CONT LT $ 2, MRI LOW EXT W/ & W/O CONT LT $ 3, MRI LOW EXT W/ CONT LT $ 3, MRI UPP EXTRE JOINT W/O CONT LT $ 3, MRI UPP EXT JOINT W/ & W/O CONT LT $ 2, MRI UPP EXT W/ & W/O CONT LT $ 2, MRI UPP EXT NOT JOINT W/O CONT LT $ 3, MRI LOW EXT W/O CONT LT $ 3, MRI HIP W/O CONT LT $ 2, MRI LOW EXT JOINT W/ & W/O CONT LT $ 3, MRI LOW EXT JOINT W/O CONT LT $ 2, MRI FOOT W/O CONT LT $ 2, MRI SHOULDER W/O CONT LT $ 1, MRI UPP EXT JOINT W/O CONT LT $ 1,910.65

24 MRI WRIST W/O CONT LT $ 1, MRI UPP EXT W/O CONT LT $ 1, MRI UPP EXT W/ & W/O CONT LT $ 2, MRI ORBIT/FACE/NECK W/ CONT $ 1, MRI ABDOMEN W/ CONT $ MRI ABDOMEN W/O CONT $ MRI ABD W/O CONT $ MRI BRAIN W/O CONT $ MRI BRAIN (PITUITARY) W/ & W/O CONT $ MRI CERVICAL SPINE W/O CONT $ MRI CERVICAL SPINE W/ & W/O CONT $ MRI CHEST W/O CONT $ MRI CHEST W/ & W/O CONT $ MRI ORBIT/FACE/NECK W/ & W/O $ MRI UPP EXT W/ & W/O CONT $ MRI UPP EXT W/O CONT $ MRI LOWER EXT W/O $ MRI LUMBAR SPINE W/ & W/O CONT $ MRI LUMBAR SPINE W/O CONT $ MRI PELVIS W/ CONT $ MRI PELVIS W/O CONT $ MRI PELVIS W/ & W/O CONT $ MRI KNEE W/O CONT $ MRI LOW EXT W/ CONT $ MRI LOW EXT W/ & W/O CONT $ MRI THORACIC SPINE W/ & W/O CONT $ MRI THORACIC SPINE W/O CONT $ MRI TMJ W/O CONT $ MRI UPP EXT W/ & W/O CONT RT $ 2, MRI UPP EXT JOINT W/ & W/O CONT $ MRA HEAD W/ CONT $ MRA NECK (CAROTIDS) W/ CONT $ MRA NECK (CAROTIDS) W/ & W/O CONT $ MRA PELVIS W/ & W/O CONT $ MRA ABDOMEN W/ & W/O CONT $ 1, MRA PELVIS W/ & W/O CONT $ 1, MRI BREAST BILAT W/ & W/O CONT $ 3, MRI ORBIT/FACE/NECK W/O CONT $ 1, MRI PELVIS W/ CONT $ 3, MRI THORACIC SPINE W/ CONT $ 2, MRA ABDOMEN W/ & W/O CONT $ MRA HEAD W/O CONT $ MRI BREAST BILAT W/ & WO CONT $ MRI ORBIT/FACE/NECK W/ CONT $

25 MRI ORBIT/FACE/NECK W/O CONT $ MRI THORACIC SPINE W/ CONT $ MRI UPP EXT W/ & W/O CONT $ 1, MRI BREAST UNILAT W/ & W/O CONT LT $ 3, MRI UPP EXT W/ & W/O CONT $ US ABDOMEN COMPLETE $ 1, US NON OB PELVIC LTD $ US ABDOMEN LTD (GB) $ US KIDNEYS $ US AORTA $ US OB AFTER 1ST TRIMESTER $ 1, US NON OB TRANSVAGINAL $ US NON OB PELVIC COMPLETE $ US SCROTUM & CONTENTS $ US BREAST UNILAT COMPLETE (W/ AXILLA) RT $ US EXT BILAT ARTERIAL DOP UPP/LOW $ US LOW EXT/ART/UNILAT KIT RT $ US EXT BILAT VENOUS DOP UPP/LOW $ US ANY EXT/VEN/UNIL RT $ US UPP EXT/ART/UNILAT RT $ US CAROTID $ US GUID NEEDLE BX/ASP/INJ/LOCALIZATION $ US PERCUTANEOUS DRAIN $ US CHORIONIC $ US UNSPECIFIED EXAM $ US SOFT TISSUE CHEST (MEDIASTINUM) $ US NON OB TRANSVAGINAL $ US EXT UPP/LOW NON VASCULAR STUDY RT $ US EXT UPP/LOW NON VASCULAR LTD STUDY $ US ANKLE BRACHIAL INDEX RT $ US ABD PARACENTESIS W/ IMG GUIDE $ 1, US ABD PARACENTESIS W/ IMG GUIDE $ US THORACENTESIS W/O IMG GUIDE $ 1, US THORACENTESIS W/O IMG GUIDE $ US THORACENTESIS W/ IMG GUIDE $ 1, US THORACENTESIS W/ IMG GUIDE $ US GUIDE FOR VASCULAR ACCESS $ US GUIDE FOR VASCULAR ACCESS $ US NON OB PELVIC COMPLETE $ US OB < 14 WEEKS PREG 1ST TRIMESTER $ 1, US OB < 14 WEEKS PREG 1ST TRIMESTER $ US OB TRANSVAGINAL $ 1, US OB TRANSVAGINAL $ US GUIDED BREAST BIO W/PLACEMENT $ 2,868.40

26 US GUIDED BREAST BIO W/PLACEMENT $ US GUIDED BREAST BIO ADD LESION $ 2, US GUIDED BREAST BIO ADD LESION $ US GUIDED PLACEMENT OF BREAST $ 1, US GUIDED PLACEMENT OF BREAST $ US GUID PLACE OF BREAST ADD $ 1, US GUID PLACE OF BREAST ADD $ US FINE NDL ASP $ US FINE NDL ASP $ US RENAL DOPPLER $ 1, US LUMBAR RT OR LT FLANK $ US SOFT TISSUE UPP BACK R/L QUADRANT $ US DIALYSIS GRAFT DOPPLER $ 1, US DIALYSIS GRAFT DOPPLER $ US ECHO COMPLETE $ 2, US ECHOCARD WAVE/DOP $ US ECHOCARD COLOR FL $ US EXT UNILAT ARTERIAL DOP UPP/LOW RT $ US EXT UNILAT VENOUS DOP UPP/LOW RT $ US UPP EXT/ART/UNILAT LT $ US EXT UPP/LOW NON VASCULAR STUDY LT $ US ANKLE BRACHIAL INDEX LT $ US BILAT ART UPP OR LOW EXT 1-2 LVL $ US LUMBAR RT OR LT FLANK $ US EXT UNILAT VENOUS DOP UPP/LOW $ US AORTA $ US BREAST UNILAT COMPLETE (W/ AXILLA) $ XR CERVICAL SPINE COMPLETE + FLEX/EXT $ US CAROTID $ US CARDIOGRAPHY $ US CHOLANGIOGRAPHY $ US KIDNEYS $ US EXT UPP/LOW NON VASCULAR STUDY $ CT LOW EXT W/O CONT $ US OB AFTER 1ST TRIMESTER $ XR ORBITS $ US PELVIS & HIPS/CHILD $ XR PELVIS COMPLETE $ US CHORIONIC $ US PERCUTANEOUS DRAIN $ US SCAPULA $ US SCROTUM & CONTENTS $ XR SINUSES $ US SMALL BOWEL $ 67.05

27 XR STERNUM $ US SOFT TISSUE THYROID/PARATHYROID $ XR UPP GI W/ SMALL BOWEL F/T (BARIUM) $ XR SMALL BOWEL F/T $ XR SMALL BOWEL F/T $ US UPPER EXT/BILAT $ US UPP EXT/ART/UNILAT $ US UROGRAPHY BOLUS $ US RENAL DOPPLER $ US VENOGRAM UNIL $ US VOIDING CYSTOGRAM $ XR WRIST ARTHRO $ US FETAL US MULTI $ US SOFT TISSUE UPP BACK R/L QUADRANT $ US EXTREMITY N/V $ US NON OB PELVIC LTD $ US GUID CYST ASP $ US GUID FOR PARA $ US GUID NEEDLE BX/ASP/INJ/LOCALIZATION $ US SOFT TISSUE THYROID/PARATHYROID $ US C-SPINE W/CONT $ US CT GUID CYST ASP $ US ABDOMEN COMPLETE $ CT ORBITS/IAC W/ & W/O CONT $ US HIP CT UNILAT $ US ANKLE BRACHIAL INDEX BILAT COMPLETE $ US NONINVASIVE UPPER/LOWER $ US ANKLE BRACHIAL INDEX COMPLETE $ US ABDOMEN LTD $ US AORTA/ILIAC DOPPLER COMPLETE $ 1, US AORTA/ILIAC DOPPLER LTD $ US BLADDER COMPLETE $ US BLADDER LTD $ US BREAST BILAT COMPLETE (W/ AXILLA) $ US BREAST LTD BILAT $ US BREAST LTD UNILAT LT $ US BREAST LTD UNILAT RT $ US DIALYSIS GRAFT DOPPLER $ 1, US GROIN DOPPLER BILAT $ US GROIN DOPPLER UNILAT LT $ US GROIN DOPPLER UNILAT RT $ US GROIN NON VASCULAR ONLY $ US LIVER DOPPLER $ 1, US LIVER DOPPLER LTD $

28 US MESENTERIC DOPPLER COMPLETE $ 1, US MESENTERIC DOPPLER LTD $ US RENAL DOPPLER LTD $ US RETROPERI COMPLETE (RENAL & BLADDER) $ US RETROPERI LTD (AORTA OR RENAL) $ 1, US SCROTAL W/ DOPPLER COMPLETE $ 1, US SCROTAL W/ DOPPLER LTD $ US SOFT TISSUE HEAD/NECK $ US SOFT TISSUE LUMP OR MASS $ US UPP EXT/ART/BILAT COMPLETE $ 1, US ABDOMEN LTD $ US ABDOMEN LTD (GB) $ US AORTA/ILIAC DOPPLER COMPLETE $ US AORTA/ILIAC DOPPLER LTD $ US BILAT ART UPP OR LOW EXT 1-2 LVL $ US BLADDER COMPLETE $ US BLADDER LTD $ US BREAST BILAT COMPLETE (W/ AXILLA) $ US BREAST LTD BILAT $ US BREAST LTD UNILAT $ US DIALYSIS GRAFT DOPPLER $ US ECHO COMPLETE $ US EXT UPP/LOW NON VASCULAR LTD STUDY $ US GROIN DOPPLER BILAT $ US GROIN DOPPLER UNILAT $ US GROIN NON VASCULAR ONLY $ US KIDNEYS $ US LIVER DOPPLER $ US LIVER DOPPLER LTD $ US MESENTERIC DOPPLER COMPLETE $ US MESENTERIC DOPPLER LTD $ US RENAL DOPPLER LTD $ US RETROPERI COMPLETE(RENAL & BLADDER) $ US RETROPERI LTD (AORTA OR RENAL) $ US SCROTAL W/ DOPPLER COMPLETE $ US SCROTAL W/ DOPPLER LTD $ US SOFT TISSUE CHEST (MEDIASTINUM) $ US SOFT TISSUE HEAD/NECK $ US SOFT TISSUE LUMP OR MASS $ US UPP EXT/ART/BILAT COMPLETE $ US BREAST UNILAT COMPLETE (W/ AXILLA) LT $ US EXT UNILAT ARTERIAL DOP UPP/LOW LT $ US EXT UNILAT VENOUS DOP UPP/LOW LT $ CT ABDOMEN W/ & W/O CONT $ 2,762.15