Room and Board CHARGEBEHAVIORAL HEALTH ROOM 2410.63ICU SEMI PRIVATE 7934.71ICU LEVEL 1 9611.11ICU LEVEL 2 8541.03ISOLATION ROOM AND BOARD 5498.74NURSERY ROOM 1186.03NURSERY LVL 2 2390.86NURSERY LVL 1 1789.24NURSERY LVL 3 2995.62ROOM AND BOARD 3 TO 4 BEDS 3360.23TELEMETRY ROOM/BOARD 4398.99SEMI PRIVATE ROOM GENERAL MEDICAL SURGICAL 3360.23SEMI PRIVATE ROOM CPCU 5011.59

Emergency CHARGECRITICAL CARE 30-74 MIN 1992.41CRITICAL CARE EACH ADD'L 30 MI 826.37LEVEL 1 FACILITY CHG 246.13LEVEL 2 FACILITY CHG 403.92LEVEL 3 FACILITY CHG 787.58LEVEL 4 FACILITY CHG 1284.14LEVEL 5 FACILITY CHG 1588.17

OPERATING ROOM CHARGEOR LEVEL 1 EACH 15 MINS 3215.70OR LEVEL 2 EACH 15 MINS 3381.80OR LEVEL 3 EACH 15 MINS 3547.92OR LEVEL 4 EACH 15 MINS 4710.70OR LEVEL 5 EACH 15 MINS 5541.27OR LEVEL 6 EACH 15 MINS 8863.52OR LEVEL 7 EACH 15 MINS 36544.77

LABORATORY CHARGES CHARGECDC COVID-19 125.72REF COVID-19 236.00SPECIMEN COLLECTION 122.50BLOOD DRAW 17.00SMN1 GENE DOS/DELETION ALYS 745.39ARC phenotyping 112.42NK CELLS TOTAL COUNT 179.87B CELLS TOTAL COUNT 179.87IMMUNOASSAY NONANTIBODY 54.99RIA NONANTIBODY 64.40CYTP URNE 3-5 PROBES EA SPEC 732.97FTL CGEN ABNOR FOUR ANAL 199.15CULTURE BLOOD ADD'L 49.25MICRODISSECTION MANUAL 201.00

BRAF GENE 626.43MOPATH PROCEDURE LEVEL 5 735.00MOPATH PROCEDURE LEVEL 5 735.00NUDT15 GENE COMMON VARIANTS 1019.76DIR NA PROBE MULTI ORGANISMS 180.00NON-DRUG LEVEL BY CC/MS 86.10TRICHOMONAS VAGINALIS AMPLIF 80.00TRB gene rearrangement 459.00TRG gene rearrangement 459.00HLA-ABC Sequencing 1360.00TB AG RESPONSE T-CELL SUSP 357.25SERPINA1 GENE 208.11PYTEST CARBON 1 -UREA BREATH 321.13PMP22 GENE DUP/DELET 1029.00BLOOD DRAWING FEE 10.50URINE DRUG COLLECTION 17.00RENAL FUNCTION PANEL 41.41SUBOXONE 279.79BENZODIAZEPINES BLOOD 279.79FELBAMATE 279.79ITRACONAZOLE 50.47KEPPRA 63.21ZONISAMIDE 63.21GABAPENTIN NON-BLOOD 89.00PDGFRA GENE 495.00URINALYSIS (WITH MICRO) 15.12MICROSCOPIC URINE 19.00ELECTROLYTES 21.56BCR-ABL 1(9:22) 782.26HALOPERIDOL/HALDOL 69.44ADAMTS13 Activity ?? 214.00MOPATH PROCEDURE LEVEL 7 990.08ACYLCARNITINES QUANT 80.40ALBUMIN - SERUM 23.59ASCORBIC ACID LEVEL (VIT C) 47.11BILE ACIDS 81.66BILIRUBIN 19.25CALCIUM QUANT 24.61CALCIUM IONIZED 65.21STONE ANALYSIS 61.46CARINITINE FREE AND TOTAL 80.40CHLORIDE SERUM 21.91CHLORIDE OTHER SOURCE 23.31Sugar single qual 26.40C-TELOPEPTIDE 89.11CREATININE 24.43HTT GENE DEC ALLELES 479.50CYSTATIN C 64.82

IMIPRAMINE 62.00ALPHA GALACTOSIDASE A 384.00FIBRINOGEN 40.50CARBON DIOXIDE 23.31GLUCOGON 68.11HISTAMINE 77.00CORTISOL URINE 79.66A INFECTIOUS AGENT AB QUAN 71.47SJOGRENS AB 85.51TSH 80.12CELIAC DISEASE 54.99TTG 54.99ANTI-MULLERIAN HORMONE 61.71CENTROMERE AB 54.99PANCREATIC POLYPEPTIDE 64.40VGCC ANTIBODY 468.00CALPROTECTIN 93.60INTERLEUKIN 6 235.00LACTOFERRIN FECAL 93.60KIT GENE ANALYS D816 VARIANT 437.04HLA II TYPING 1 LOC HR 480.97LIPASE 32.83TPMT 86.10OPIATES ASSAY URINE 279.79PHOSPHATASE ALKALINE 24.68PHOSPHOROUS 22.61POTASSIUM SERUM 21.91PROCALCITONIN 127.72PROTEIN TOTAL 17.50SODIUM SERUM 22.96SODIUM OTHER SOURCE 23.21SPECIFIC GRAVITY 14.00GLUCOSE 18.73SGOT 24.68SGPT 25.27ALPHA-1 ANTITRYSIN 64.06TARGETED GENOMIC SEQ ANALYS 2139.00UREA NITROGEN (BUN) 18.83VITAMIN NOS 225.00TEGRETOL 69.44CYTOGENETIC ANALYSIS 642.00POTASSIUM OTHER SOURCE 78.75HEMOGRAM PLAT CNT COMP AUT DIF 37.07WBC FLUID 26.25ATP7B sequencing 2317.30EOSINPHIL NASAL OR URINE SMEAR 15.96PLATELET AGGREGATION EA AGENT 47.50PROTHROMBIN TIME (LUPUS) 18.76

HGB FRACT. BY CHROMOTOGRAPHY 86.10ACT. PARTIAL THROMBOPLASTIN 28.64ANTIBODY TITER 103.88TYPE RH BLOOD BANK 28.38ARC-AUTOLOGUS BLOOD PROCESSING 144.73TRANSFUSION REACTION 28.38ARC-ELUTION 360.57EXTRACTABLE NUCLEAR Ag Ab EA 85.51ANTI JO 85.51COOMBS 28.38AQUAPORIN-4 (NMO) AB 54.99HEPATITIS Be ANTIGEN 54.95CA 15-3 68.15IMMUNOGLOBUILIN D 44.35IGG 44.35IGM 44.35IGA 44.35ANTI-NUCLEAR ANTIBODIES 57.65MONONUCLEAR CELL ANTIGEN EACH 127.65ABSOLUTE CD4 AND CD8 224.04ANAPLASMA AB 48.55HTLV I AND II WB 226.00CULTURE ROUTINE 41.10CULTURE BLOOD 49.25CULTURE ORGANISM IDENTIFICATIO 38.50MIC SENT TO REF LAB 36.86HISTOPLASMA ANTIGEN URINE 57.16CANDIDA DNA PROBE 95.62EB ANTIBODY (VCA-IGG) 65.59VIRUS ISOLATION 124.29INFLUENZA FIRST 2 TYPES 405.37GARDNERELLA DNA PROBE 95.62TRICHOMONAS DNA PROBE 95.62ADENOVIRUS BY PCR 65.00INF AGENT QUANT NOS 204.23CHROM TIS CULT SKIN OR SOLID 670.95Men?s Health Panel 105.00Woman?s Health Panel 110.00BONE MARROW 170.00T CELL F 459.00OXYCODONE 279.79T CELLS TOTAL COUNT 179.87T CELLS ABSOLUTE CD4 127.65FACTOR XI (PTA) 21.74FACTOR XII (HAGEMAN) 21.74MOL GEN.INTERPRET AND REPORT 130.17MOLECULAR CYTOGENETICS DNA PRO 152.00IMMUNHISTOCHEMISTRY EACH Ab 361.00

INFECTIOUS AGENT AG-MULTIPLE 125.00INF AGENT-AMP NUCLEIC ACID PRO 44.09IA-2 ANTIBODY 85.19MYCOPLASMA PNEUMONIAE BY PCR 44.09CMV VIRAL LOAD 204.23IEP OTHER FLUIDS 139.90FECES FREE FAT 7.49SIROLIMUS 65.49OCCULT BLOOD SINGLE SPECIMEN 26.00PNEUMOCOCCAL AB 71.47ASPERGILLUS GALACTOMANNAN 57.16FECAL OCCULT BLD HGB BY IA 75.85PML/RARALPHA COM BREAKPOINTS 710.00ANNA BY IMMUNOBLOT 54.99GIARDIA 57.16INF AG DETECT ENTEROVIRUS AMP 167.30PANCREATIC ELASTASE FECAL 61.71VORCONAZOLE 50.47CHROMOGRANIN A 68.15CORTISOL SALIVA 77.74TRYPTASE 61.71OCC HEALTH USEC PANEL 21.00SEMEN POST VAS 57.44INSITU HYBRIDIZATION (FISH) 250.00INSITU HYBRIDIZATION (FISH) 300.00DRUG SCREEN PRSMPTV 1 CLASS 164.78HERPES S AMPLIF NA PROBE 167.30PSA FREE 130.00SEMEN ANALYSIS 57.44SPECIAL STAIN II 113.00DECALCIFICATION 115.00STAIN I 167.13TUMOR IHC MANUAL QUANT 732.97IMMUNOCYTOCHEMISTRY 361.00pregabalin 279.79tramadol 279.79CULTURE CSF 41.09alcohol biomarkers 279.79SYPHILIS TEST NON-TREP QUANT 20.97ARC-IRRADIATED COMPONENT OTHER 106.79ZINC PROTOPORPHYRIN 68.39ALLERGEN SPECIFIC IGE 36.02M/PHMTRC ALYS ISHQUANT/SEMIQ 257.00EBV ANTIBODY ( VCA-IGM ) 65.59DIPROPYLACETIC ACID FREE 45.71HLA I TYPING 1 ALLELE HR 450.94KRAS mutations 690.17IMMUNOHISTO ANTB 1ST STAIN 361.00

BRAF GENE 178.98KRAS GENE ADDL VARIANTS 690.17NRAS GENE VARIANTS EXON 2&3 1035.27AMYLASE BODY FLUID 30.91KIT GENE TARGET SEQ ANALYS 495.00LDH BODY FLUID 28.77M/PHMTRIC ALYS ISHQUANT/SEMIQ 523.55Rufinamide, Serum or Plasma ?? 279.79ABG MIXED GASES 135.28ABG CORD ARTERIAL 92.26Statin Sensitivity SLCO1B1, 1 198.50ABG CORD VENOUS 92.26Somatostatin Quantitative, Pla 87.15LEAD ODOT 57.72CLOTEST 38.50SCLERODERMA ANTIBODY IgG 85.51MOPATH PROCEDURE LEVEL 3 574.00CLOTTING; FACTOR XIII - FS 235.00ST2, Soluble ?? 190.00Cytogenomic SNP Microarray 1645.00HLA I TYPING 1 ANTIGEN LR 245.00CLOZAPINE 88.17ANTIEPILEPTIC TESTING 279.79NEURON SPECIFIC ENDOLASE 315.00COMPTBLTY TST ELETC CROSMTCH 144.73ANTI-MIOCHONDRIAL ANTIBODY 54.99ANTIPARIETAL CELL ABS 54.99CALCIUM IONIZED 65.21CALCIUM IONIZED 65.21RBC ANTIGEN TYPING 18.24IMMUNOFLUOR ANTB ADDL STAIN 525.00CHROMOSOME TISSUE CULTURE 555.42calr exon 9 mutation by pcr 579.88LEUKOCYTE ANTIBODIES 57.44ANTITHYROGLOBULIN AB 75.85ASPERGILLUS Ab 65.59ASPERGILLIS 65.59ASPERGILLUS FLAVUS 65.59KRAS, ADDITIONAL VARIANTS 493.00BLASTOMYCES 61.53COCCIDIOIDES ANTIBODY 54.71HISTOPLASMA ANTIBODY 59.57MICROSCOPIC CRYSTAL EXAM 34.13MYELIN BASIC PROTEIN 65.00SERUM ALBUMIN 23.59OLIGOCLONAL BANDING 95.87MS IgG 44.35ALBUMIN URINE OR OTHER SOURCE 24.68

BLOOD TYPE ABO 54.55CHEMILUMINESCENT ASSAY 105.00PROTEIN ELECTROPHORESIS-OSU 51.21METHYL MALONIC ACID 78.44URINE CULT W ISOLATION AND ID 38.61CULTURE FUNGUS IDENTIFICATION 49.25CULTURE FUNGUS-OTHER SOURCE 40.08MIC ANAEROBE SENT TO REF LAB 36.86RISTOCETIN COFACTOR 109.38VON WILLEBRANDS FACTOR 109.38FECES CULTURE 45.02CMV TITER IGM 80.33CITRATE 24 HOUR URINE 132.55HOMOCYSTEINE 80.43von WILLEBRAND FACTOR AG NUME 109.38URINALYSIS W/O MICRO 10.71URINARY AMYLASE 30.91PRENATAL ABO TYPE 54.55EHRLICHIA Ab 48.55IMMUNOFIXATION ELECTROPHORESIS 106.54HEPARIN INDUCED ANTIBODY 87.57TSH RECEPTOR ANTIBODY 61.71CULTURE; IF EA ANTISERUM 60.00S.PNEUMONIAE Ag 57.16APOLIPOPROTEIN A1 OR B 73.89QUANT.BENZODIAZEPINES 279.79CHLAMYDIA DNA PROBE 167.30GC DNA PROBE 167.3025-HYDROXY VIT D 141.161/25-DIHYDROXY VIT D 183.54PLATELET NEUTRALIZATION PROCED 85.72DILUTED RUSSELL VIPER VENOM TI 27.51MAG-MYELIN ASSOC.GLYCOPROTEIN 232.00GM1 OR ASIALO GM1 ANTIBODY 54.99PROTEIN C ANTIGEN 57.30PREALBUMIN 69.55I.A. for Non-infectious Ag/Ab 54.99PROTEIN S FREE 73.08APC RESISTANCE PANEL 84.00WESTERN EQUINE ENCEPHALITIS 62.90ST. LOUIS ENCEPHALITIS 62.90EASTERN EQUINE ENCEPHALITIS AB 62.90CALIFORNIA ENCEPHALITIS AB 62.90SULFONYLUREA HYPOGLYCEMICS 279.79ORGANIC ACIDS 78.44TROPONIN QUANTITATIVE 46.90FETAL FIBRONECTIN ASSAY 307.09LDL DIRECT MEASUREMENT 45.50

NICOTINE/COTININE 279.79LIPOPROTEIN A 61.71TOPIRAMATE 56.84DEOXYCORTICOSTERONE 147.70QUANTATIVE CHROMATOGRAPHY 155.00MISC FLUOR AB SCREEN 57.44CMV BY PCR 167.30HEP C PCR QUANT 204.23HSV BY PCR 167.30INFECTIOUS AGENT DETECT.BY PCR 405.72PORPHOBILINOGEN URINE 40.25AMINOLEVULINIC ACID URINE 114.00FLOURIDE URINE 88.38PSA FREE 87.71HPV PROBE A OR B 75.00MIC SENSITIVITY 36.86BREATH ALCOHOL TEST 48.00A1A PHENOTYPE 68.95COLLAGEN CROSSLINKS ANY METHOD 89.11GLIADIN Ab IgG or IgA 54.99PROPHYRINS QUALITATIVE 33.32SCREENING PSA 87.71HEPATITIS PANEL ACUTE 217.00BILIRUBIN DIRECT 19.25FACTOR X 21.74FACTOR II 21.74HEPARIN ASSAY 62.41HEMOGRAM + PLATLET COUNT AUTO 30.84IMMUNOASSYA,ANALYTE QUANT 94.00NEPHELOMETRY EA ANALYTE NOS 64.82FLOURESCENT NONINFECT AGENT AB 57.44IMMUNOASSAY ANALYTE QUANT 61.71ALPHA-1-ANTITRYPSIN FECES 179.00H PYLORI ANTIGEN 68.57VITAMIN B1 (THIAMINE) 101.22ACETYLHOLINE RECEPTOR MODUL Ab 64.40CK ISOEMZYMES 63.88ISLET CELL Ab 85.19GLUTAMIC ACID DECARBOXYLASE Ab 54.99IGF BINDING PROTEIN - 3 67.34INFECTIOUS AGENT Ag BY DFA 239.00PROTOZOA AB 59.05DIBUCAINE NUMBER 102.00HEP B VIRAL DNA QUANT 204.23GLUCOSE NOT BLOOD 18.73SEX HORMONE BINDING GLOBULIN 91.36INHIBIN A 68.15PHENYTOIN FREE 65.63

VERY LONG CHAIN FATTY ACIDS 86.10LEUKOCYTE LYSOSOMAL ENZYME 973.00b-HEXOSAMINIDASE EACH ASSAY 318.00CULTURE TYPING IMMUN EA ANTISE 21.74SUSCEPTIBILITY ENZYME DETECT 8.40HOMOGENATION TISSUE FOR CULT 28.04QUANT.DRUG LEVEL NOS 50.47MACROSCOPIC PARASITE EXAM 20.37VIRUS Ab NOT ELSEWHERE SPEC 251.00CHROMOSOME ANAL ADDL KARYOTYPE 146.00CULTURE FUNGUS-BLOOD 42.98PSA (SEND OUT TO REF LAB) 87.71CULTURE FOR GROUP B STREP 31.61MOLD IDENTIFICATION 49.25INHIBIN B 61.71HELMINTH Ab NOS 62.02RIBOFLAVIN LEVEL 96.50BRUCELLA ANTIBODY 42.60CHLAMYDIA Ab 56.39CHLAMYDIA AB IGM 60.48PROINSULIN 84.91HEAVY METAL QUANT 104.72CADMIUM 110.32WESTERN BLOT W/PROBE BAND ID 85.82BASIC METABOLIC W TOTAL CA 34.97COMPREHENSIVE METABOLIC 50.37HEPATIC FUNCTION PANEL 30.14LYME DISEASE CONFIRMATORY 73.85HIV I/II AB 65.35DEOXYRIBONUCLEASE ANTIBODY 63.18D-DIMER QUANTITATIVE 48.55INF AGENT-AMP NUCLEIC ACID PRO 65.00ARC-ANTIBODY ID 732.97ARC-RBC ANTIGEN TYPING 184.01ARC-SERUM ANTIBODY ABSORPTION 69.00NICKEL URINE 63.00NICKEL BLOOD 63.00LYMPH TRANSFORM MIT OR ag IND 233.77DIPTHERIA ANTIBODY 71.47OPIATES ASSAY 279.79REVERSE TRIIODOTHYRONINE T3 75.15HISTOPLASMA ANTIGEN 57.16HEPATITIS C GENOTYPING 1227.42HEPATITIS A Ab TOTAL 59.05INSULIN FREE 61.74FACTOR VII 21.74VITAMIN E 67.59GENOTYPE 1227.42

MANGANESE 117.29SELENIUM 121.73CHROMIUM 96.71TRICHINELLA Ab 148.00BORRELIA BURGDORFERI BY PCR 167.30CREUTZFELDT JACOB DETECTION 71.47B-TYPE NATRIURETIC PEPTIDE 161.84ANA TITER 53.20EBV BY PCR 65.00INTRINSIC FACTOR ANTIBODY 71.89TISSUE IN SITU HYBRIDIZATION 909.00SPECTROPHOTOMETRY NES 33.32INFLUENZA BY DIRECT OBSERVATIO 57.16OSMOTIC FRAGILITY 162.00COLLECTION CAPILLARY BLOOD SPE 17.00ANTI-PHOSPHATIDYLSERINE EA Ab 64.00ARC-DIRECT ANTIGLOBULIN TEST 32.12ARC-RBC PRETREATMENT-DRG CHEM 106.79

PULMONARY THERAPY CHARGES CHARGEPULSE OXIMETRY 0.00PULSE OXIMETRY, MULTIPLE CHKS 0.00PULMONARY FUNCTION SCREEN 468.46PULMONARY FUNCTION B/A 468.46VITAL CAPACITY/ VT MEASUREMENT 225.61METHACHOLINE CHALLENGE 1372.476 MIN WALK TEST 468.46PULMONARY STRESS TEST - SIMPLE 418.33B/A EXERCISE * 439.56PULM FUNCT TST PLETHYSMOGRAP 1115.53PULM FUNCTION TEST BY GAS 523.31C0/MEMBANE DIFFUSE CAPACITY 1115.536 MIN WALK TEST 468.46ETC02 MONITORING INITIAL DAY 275.59ETC02 MONITORING SUBSEQ DAY 275.59OXIMETRY PER DAY 371.33HELIOXY 225.61SURFACTANT ADMINISTRATION 177.33WEANING PARAMETERS - COMPLETE 225.61PEAK FLOW MEASUREMENT 225.61CAR SEAT STUDY 225.61PULSE OXIMETRY, SPOT CHECK 87.10PULMONARY REHAB W/EXER1HR SES 254.19PULM REHAB W/EXCER 1 HOUR KX 254.19

OCCUPATIONAL THERAPY CHARGES CHARGETHERAPEUTIC EXERCISE OT 169.22

ELEC STIMULATION OT 148.84OT EVAL MOD COMPLEX 45 MIN 385.13HOME INSTRUCTION OT 177.05IONTOPHORESIS (EA 15) OT 145.71GROUP THERAPY OT 109.68WHIRLPOOL SMALL OT 103.41OT RE-EVAL EST PLAN CARE 229.80MANUAL TECHNIQUES (EA 15) OT 158.25REHAB PLAN PHYSICAL RECOND OT 130.64THER IVNTJ EA ADDL 15 OT 145.95Vasopneumatic 92.45THERAPEUTIC ACTIVITIES OT 180.18ULTRASOUND (EA 15) OT 65.81OT CONGTIVE SKILLS PER 15 MINS 158.25OT EVAL HIGH COMPLEX 60 MIN 385.13PARAFFIN BATH OT 47.02FCE (EA 15) OT 159.82E-STIM MANUAL OT 100.28OT G-CODE 0.00EQUIP FABRIC/MEASUREMENT OT 178.61INFRARED THERAPY (UNTIMED)-OT 39.18NEUROMUSCULAR COORDINATION OT 178.61CONTRAST BATHS (EA 15) OT 77.57THERAPEUTIC MASSAGE (EA 15) OT 136.32W/C ASSESSMENT 15 MIN 117.51COGNITIVE SKILLS DVLPMENT-OT 158.25WORK TASK ANALYSIS (15 MIN) OT 158.25SENSORY INTEGRATION OT 150.42OT EVAL LOW COMPLEX 30 MIN 385.13

PHYSICAL THERAPY CHARGES CHARGEWORK CONDITIONING AT 451.22AT WRK CNDITIONING (ECH ADL HR 197.32AMBULATION & GAIT TRNG 150.42CONTRAST BATHS (EA 15) PT 77.57ELEC STIMULATION PT 148.84THERAPEUTIC EXERCISE PT 164.52MASSAGE PT 136.32TRACTION - MECHANICAL 92.45THER IVNTJ EA ADDL 15 PT 145.95ULTRASOUND/REGION PT 65.81FLUIDOTHERAPY PT 103.41EQUIP FABRIC./ADJ PT 178.61VASOPNEUMATIC 92.45THER IVNTJ 1ST 15 MIN 145.95IONTOPHORESIS (EA 15) PT 145.71GROUP THERAPY PT 95.26NEUROMUSCULAR COORDINATION PT 178.61

PARAFIN BATH PT 40.82WORK CONDITIONING PT 451.22FCE (EA. 15 MINUTES) PT 159.82WORK CONDITIONING (EACH ADD HR 197.32MANUAL TECHNIQUES (EA 15) PT 158.25MANUAL TECHNIQUES PT 137.45HOME MANAGEMENT TRAINING PT 177.05THERAPUTIC ACTIVITIES PT 180.18E STIM MANUAL PT 100.28REHAB PLAN PHYSICAL RECOND PT 150.42SENSORY INTEGRATION PT 150.42PROSTHETIC TRAINING-PT 175.48INFRARED THERAPY (UNTIMED)-PT 39.18THERAPEUTIC ACTIVITIES - RT 198.99HOME INSTRUCTION - RT 189.58NEUROMUSCULAR COORDINATION AT 140.16Wheelchair Management Training 108.11W/C ASSESSMENT 15 MIN 102.05

X-RAY AND RADIOLOGICAL SERVICES CHARGEINJ PROC FOR KNEE ARTHROGRAPHY 359.67FLUOROSCOPY FOR NEEDLE PLCMT 348.74STERNUM 307.40CERVICAL SPINE W/ODONTOID 307.40LUMBAR SPINE 2 OR 3 VIEWS 307.40PELVIS 307.40SHOULDER LEFT 307.40DEXA BONE DENSITY APPENDICULAR 237.44ARTHROGRAPHY KNEE-LEFT 1057.88CHOLANGIOGRAM OR 540.60METASTATIC BONE SURVEY COMPLET 528.94BONE SURVEY INFANT 307.40CR Clavicle RT 307.40CR Clavicle RT 307.40SHOULDER LEFT ND 307.40SHOULDER LEFT ND 307.40ARTHOGRAPHY HIP BILAT 1586.82KNEE 1-2 VIEWS LIMITED 306.34RIGHT KNEE 4 OR MORE VIEWS 325.42MYELOGRAPHY LUMBAR INJECTION 1711.90MYELOGRAPHY CERVICAL INJECTION 1666.32JOINT INJ / ASPIRATION HIP 860.73XOFIO 173.53SODIUM PERTECHNETATE PER mCi 165.99IODINE I0123 CAP 300uCi 565.87HEART MUSCLE IMAGE SPECT-MULTI 5227.38ZEVALIN,IN111,LIMITED 2195.57LUNG VENTILAT&PERFUS IMAGING 3468.15

BRAIN VASCULAR FLOW 715.51THYROID UPTAKE MEASUREMENT 395.13GASTRIC REFLUX 2008.21BRAIN SCAN, 4 VIEWS MIN 2550.18PARATHYRD PLANAR W/WO SUBTRJ 2058.51CT ANGIO HRT W/CON 3D IMAGE 3424.86CT INTERNAL AUDITORY CANALS 1329.24CT NECK W/WO CONTRAST 2078.66CT RT LOWER EXT W/O CONTRAS 1329.24CTA LOWER EXTREMITY W/CONTRAST 2085.02CT ABD & PELVIS W/O CONTRAST 2655.30DX BRS MAMMO TOMOSYNTHESIS BIL 145.27US PELVIS 753.67US PANCREAS 753.67US BREAST LT 480.19US PREG UTERUS<14WK EA AD GEST 480.19PET IM W/CT SKULL-THIGH SUBS 6950.42LYMPHOMA,RESTAGING 6950.42ULTRASOUND GUIDE THORACENTESIS 536.37US RETROPERITONEAL LIMITED 753.67OB US, DETAILED, SNGL FETUS 0.00OB US >/= 14 WKS, ADDL FETUS 0.00US AORTA (ABDOMINAL) 753.67ESOPHAGEAL,INITIAL STAGING 6950.42COLORECTAL CANCER,DIAGNOSIS 6950.42ULTRASOUND BREAST LIMITED-RIGH 293.63ANGIOGRAPHY EXT BILAT S&I 3972.88VENOGRAPHY,CAVAL INFERIOR S 2360.60INDIUM-111 PER 0.5 mCi 0.00NON-HEU TC-99M ADD-ON/DOSE 12.58ANGIOGRAPHY,BRACHIAL RETRO S&I 1813.66MASTOIDS 307.40ORBIT - LEFT 307.40TMJ BILATERAL 307.40CERVICAL W/OBL& FLEX/EXT 528.94LUMBAR W/OBLIQUES 528.94CLAVICLE LEFT 307.40LOWER EXTREMITY INFANT 307.40ARTHROGRAPHY ANKLE LEFT 1057.88HEEL LEFT 307.40TIBIA & FIBULA BILAT 461.10C-ARM < 60 MIN 248.04SKULL MIN 4 VIEWS 528.94HAND RIGHT 307.40KNEE RIGHT 3 VIEWS 307.40FLOURO NEEDLE ASPIRATION LOC 348.74RIBS RIGHT 307.40HEEL RIGHT 307.40

HIP RIGHT 307.40KNEE RIGHT 1 OR 2 VIEWS 307.40SCAPULA RIGHT 307.40ARTHROGRAPHY WRIST RIGHT 1057.88X-RAY XM ESOPHAGUS 2CNTRST 637.70X-RAY EXAM OF ELBOW 2 VIEWS LT 231.08BONE-THREE PHASE 2152.81CHOLETEC (MEBROFENIN TO 15 mCi 165.99PERFUSION LUNG SCAN ONLY 1864.86ZEVALIN IN111,WHOLE BODY 2195.57GASTRIC BLEED 2008.21BONE - WHOLE BODY 2152.81CT GUIDANCE - TISSUE ABLATION 2254.62CTA HEAD W/WO CONTRAST 2085.02CT UPPER EXTREMITY W/ CONTRAST 1753.24BREAST TOMOSYNTHESIS RT 132.39MAMMOGRAM, DX UNILAT DIGITAL 534.25US GALL BLADDER 753.67US NEO NEWBORN 480.19US EXTENDED PELVIS 753.67US BIOPSY NEEDLE GUIDANCE 536.37US OB FOLLOW UP 480.19US BREAST RT 480.19US EXAM,ABDO BACK WALL,COMPL 685.82LYMPHOMA,DIAGNOSIS 6950.42VENOGRAPHY,EXTREMITY UNI S& 1191.44VENOGRAPHY,CAVL SUPERIOR S& 1813.66MR-TEMPOROMANDIBULAR JOINT 1840.17MR-BRAIN W/WO CONTRAST 2600.30MR-THORACIC W/CONTRAST 2074.00MRA UPPER EXTREM W/WO CONTR 2293.85MRA PELVIS W W/O CONTRAST 3281.77MR-ANKLE W/ CONTRAST, LEFT 1836.33MR-KNEE,LEFT 2003.93MR-FOREARM,LEFT 1837.73MR-ANKLE W/WO CONTRAST,RIGHT 2714.59MR-KNEE W/CONTRAST,RIGHT 1836.33MR-WRIST W/CONTRAST,RIGHT 2165.47MR-TIB/FIB W/WO CONTRAST,LEFT 2559.41MR-CHEST 1476.00MR-THORACIC 2009.80MR-BRAIN W/CONTRAST 2188.73MRA ABDOMEN W/WO CONTRAST 2420.00MR-ANKLE W/WO CONTRAST,LEFT 2714.59MR-SHOULDER W/WO CONTRAST,LEFT 2627.88MR-HUMERUS, LEFT 1837.73MR-FOREARM W/WO CONTRAST,LEFT 2493.71MR-KNEE,RIGHT 2003.93

MR-KNEE W/WO CONTRAST,RIGHT 2714.59MR-BRAIN W/O CONTRAST 2017.09MR-PELVIS 1988.41MRI BREAST W/WO CONTRAST BILAT 2902.65MDP UP TO 30 MCI 116.26SINUSES 307.40UPPER EXTREM.INFANT >1 YR 307.40FOOT LEFT 307.40BABY GRAM 227.90ESOPHAGRAM/BA SWALLOW 455.80ANTE PYELOGRAM NEPHROST 769.56ACUTE ABDOMINAL SERIES 390.08CERVICAL SPINE W/ OBL 528.94CERVICAL SPINE 1 VIEW 307.40TOE(S) RIGHT 307.40ANKLE RIGHT 307.40FOOT LEFT ND 307.40FOOT LEFT ND 307.40SHOULDER RIGHT ND 307.40SHOULDER RIGHT ND 307.40TIBIA & FIBULA RIGHT 307.40RIBS LEFT W PA CHEST 307.40ABDOMEN SUPINE & UPRIGHT ND 227.90FOOT RIGHT ND 307.40FOOT RIGHT ND 307.40RP LOCLZJ TUM SPECT W/CT 1 4452.18ARTHORGRAPHY ELBOW RIGHT 1057.88X-RAY EXAM OF SHOULDER 1 VIEW 183.38X-RAY EXAM OF WRIST 2 VIEWS RT 250.16X-RAY EXM OF THRCIC SPINE 3 VW 454.74CT LS W CONTRAST 2050.04CT localization 5530.00THYROID TX - INITIAL 1990.60TC SESTAMIBI PER DOSE (1) 475.33TC SESTAMIBI PER DOSE (2) 475.33THYROID CA METASTASES UPTAKE 828.68RENAL SCAN W/FLOW & FUNCTION 1879.95CT - MF W&WO CONTR 2018.24CT - MAXILLOFACIAL 1329.24CTA NECK W/CONTRAST 2085.02CT THORAX W/W0 CONTRAST 2078.66CT CERVICAL SPINE 1329.24CT UPPER EXTREM W/O CONTRAST 1329.24CTA CHEST W/CONTRAST NONCORONA 2085.02CT ABD & PELVIS 1+ SECTION/REG 4157.33TRANSRECTAL ULTRASOUND 604.21US SPINAL CANAL 753.67OB US, LIMITED, FETUS(S) 0.00

HEAD & NECK CANCER,RESTAGING 6950.42PET IM W/CT WHOLE BDY SUBS 6950.42COLORECTAL CANCER,RESTAGING 6950.42COLORECTAL CANCER,INIT.STAGING 6950.42ULTRASOUND BREAST LIMITED LEFT 293.63ULTRASOUND BREAST COMPLETE 588.30ANGIO, SELECT EA ADD'L VES 1813.66MAMMOGRAPHY SPECIMEN P-OP 497.49X-RAY Wrist Bilat 614.80X-RAY Foot BILAT 614.80THORACIC SPINE 307.40SACRUM OR COCCYX 307.40ACROMIOCLAVICULAR JOINTS 307.40FOREARM LEFT 307.40HAND LEFT 307.40FEMUR LEFT 2 or more views 307.40TIBIA & FIBULA LEFT 307.40ANKLE LEFT 307.40ABDOMEN KUB 227.90SMALL BOWEL FT 455.80HYSTEROSALPINGOGRAM 942.34THORACIC SPINE 4V 379.00LUMBAR SPINE W/FLEX/EXT 528.94MYELOGRAPHY ENTIRE SPINAL CANA 732.46CHEST DECUBITUS 287.26LUMBAR FLEX EXT&OBLIQUE 528.94ELBOW RIGHT MIN 3 VIEWS 307.40NASAL BONE 307.40KNEE RIGHT 1 OR 2 VIEWS ND 307.40KNEE RIGHT 1 OR 2 VIEWS ND 307.40CERVICAL SPINE 2 OR 3 VIEWS 307.40UGI WITH AIR 455.80X-RAY SM INT F-THRU STD 637.70DEXA BONE DENSITY APPENDICULAR 237.44ARTHORGRAPHY ANKLE RIGHT 1057.88RP LOCLZJ TUM SPECT W/CT 2 5050.50MR-CERVICAL W/CONTRAST 2010.50MR-LUMBAR W/WO CONTRAST 2592.44MRI-ORBIT,FACE,NECK W W/O CONT 2473.54MR-KNEE W/WO CONTRAST,LEFT 2714.59MR-HIP W/WO CONTRAST,LEFT 2714.59MR-WRIST, LEFT 1902.82MR-HUMERUS W/CONTRAST,LEFT 2637.29MR-HAND,RIGHT 1837.73MR-FOOT W/WO CONTRAST,LEFT 2559.41MR-ANKLE W/CONTRAST,RIGHT 2624.56MR-HIP,RIGHT 2003.93MR-HIP W/CONTRAST,RIGHT 1836.33

MR-TIB/FIB,RIGHT 1969.24MR-ELBOW W/CONTRAST RIGHT 2165.47MR-LUMBAR 1991.86MR-ANKLE,BILAT 4007.86MAA UNIT DOSE UP TO 45 mCi 0.00PLACEMENT DRAINAGE CATH W GUID 555.44ARTHROGRAPHY HIP LEFT 1057.88KNEE LEFT 1 OR 2 VIEWS 307.40CYSTO URETHOGRAM 769.56LUMBAR SPINE 1 VIEW 307.40SACROILIAC JOINTS 795.00SHOULDER RIGHT 307.40WRIST RIGHT 307.40SKULL AP LAT 307.40X-RAY EXAM OF WRIST 2 VIEWS LT 250.16X-RAY EXAM OF FOOT 2 VIEWS LT 254.40X-RAY EXAM OF ELBOW 2 VIEWS RT 231.08CT THORACIC SPINE W & WO CONTR 2625.19CHEST FLUOROSCOPY W/FILMS 348.74DTPA UNIT DOSE UP TO 25 mCi 0.00CERETEC PER DOSE 3165.10PARATHYROID SCAN 2220.72LUNG PERF&VENTILAT DIFERENTL 2802.94CTA AORTA RUNOFF W/CONTRAST 2085.02CT-LIMITED 662.51CT HEAD W/O CONTRAST 1329.24CT HEAD W/ CONTRAST 1753.24CT HEAD W/WO CONTRAST 2078.66CT ORBITS W/O CONTRAST 1329.24CT THORAX W/ CONTRAST 1753.24CT - 3-D RECONSTRUCT 175.97ENDO CATH - BIL & PANCR D S&I 984.74KNEE BILATERAL 3 VIEWS 612.68BIL X-RAY EXAM OF KNEE 1 OR 2 536.36X-RAY EXAM OF HAND 2 VIEWS LT 265.00X-RAY EXAM OF HAND 2 VIEWS RT 265.00X-RAY EXAM HIPS BI 3-4 VIEWS 528.94X-RAY EXAM ENTIRE SPI 1 VW 307.40RP LOCLZJ TUM SPECT 2 AREAS 4452.18HDP UP TO 30 mCi 165.99RENAL SCAN (LASIX) 2220.72BONE MARROW IMAGING,WHOLE BODY 2242.10PROVISION OF ISOTOPE,FDG DOSE 1681.26HEPATOBIL SYST IMAGE W/DRUG 2405.58ABD PARACENTESIS W/IMAGING 1239.59CT ABDOMEN W/WO CONTRAST 2078.66CT PELVIS W/ CONTRAST 1753.24CT ASPIRATION 1643.00

BREAST TOMOSYNTHESIS LT 132.39US ABDOMEN LIMITED 753.67US SCROTUM 753.67US LIMITED GESTATIONAL AGE 480.19MRA-HEAD WITH/WITHOUT CONTRAST 2070.92MR-SHOULDER W/CONTRAST,LEFT 2165.47MR-HAND W/WO CONTRAST,LEFT 2493.71MR-HAND W/WO CONTRAST,RIGHT 2493.71MR-FEMUR W/WO CONTRAST,LEFT 2559.41MR-TIB/FIB W/CONTRAST,LEFT 2083.85MR-FOOT, RIGHT 1969.24MR-FOOT W/CONTRAST,RIGHT 2624.56MR-ELBOW,RIGHT 1902.82MR-ELBOW W/WO CONTRAST,RIGHT 2627.88MR-FOREARM,RIGHT 1837.73MR-HIP W/WO CONTRAST,RIGHT 2714.59MR-KNEE,BILAT 3005.89MAG-3 UP TO 15 mCi 1179.52ULTRTAG KIT PYP 99mTc TO 30mCi 201.67US EXTREMITY LT 753.67US PREG UTERUS < 14WK SGL GEST 753.67OB US >/= 14 WKS, SNGL FETUS 0.00OB US, DETAILED, ADDL FETUS 0.00OB US NUCHAL MEAS, 1 GEST 0.00US ABD AORTA SCREEN AAA 113.00PET BRAIN METABOLIC INIT TX 5518.36PET IM W/CT SKULL-THIGH INT TX 6950.43NON SMALL CELL LUNG CA,INITIAL 6950.42AORTOGRPHY W/RUNOFF BILT S& 3972.88MR-CERVICAL W/WO CONTRAST 2587.38MR-LUMBAR W CONTRAST 1971.50MRI-CHEST W W/O CONTRAST 2422.33MR-HIP,LEFT 2003.93MR-HIP W/CONTRAST,LEFT 1836.33MR-ELBOW W/CONTRAST,LEFT 2165.47MR-ELBOW W/WO CONTRAST,LEFT 2627.88MR-HAND,LEFT 1837.73MR-FOOT,LEFT 1969.24MR-FOOT W/WO CONTRAST,RIGHT 2559.41MR-ANKLE,RIGHT 2003.93MR-SHOULDER,RIGHT 1902.82MR-SHOULDER W/CONTRAST,RIGHT 2165.47MR-FOREARM W/WO CONTRAST,RIGHT 2493.71MRA ABD WO CONTRAST 2420.00IN-111 PENTETREOTIDE 6mCi 6886.53FLUOROSCOPY UP TO 1 HOUR 248.04FLUORO CARDIAC > 1 HR 347.68FLUORO CENTRAL VENOUS ACCESS 348.74

US SPECIMEN POST-OP 287.26ZYGOMATIC ARCHES 307.40X-RAY EXAM CHEST 1 VIEW 287.26RIBS BILATERAL W/PA CHEST 528.94SCOLIOSIS SURVEY SPINE 307.40ELBOW LEFT MIN 3 VIEWS 307.40WRIST-LEFT 307.40ARTHROGRAPHY WRIST LEFT 1057.88RETROGRADE PYELOGRAM 769.56VOIDING CYSTO URETHOGRAM 769.56X-RAY SM INT F-THRU STD 705.96BONE LENGTH 307.40VIDEOTAPED ESOPHAGUS (SWALLOW) 455.80FACIAL BONES MIN 3 VIEWS 307.40ORBIT RIGHT 307.40FOREARM RIGHT 307.40MANDIBLE MIN 4 VIEWS W/ORTHO 307.40RIBS LEFT 307.40FINGERS LEFT 307.40FINGERS RIGHT 307.40CLAVICLE RIGHT 307.40SHOULDER BILAT 461.10FOOT RIGHT 307.40SHUNTOGRAM 540.60ARTHOGRAPHY HIP RIGHT 1057.88ARTHROGRAPHY KNEE RIGHT 1057.88ARTHROGRAPHY SHOULDER RIGHT 1057.88LEFT KNEE 4 OR MORE VIEWS 325.42X-RAY EXAM OF SHOULDER 1 VIEW 183.38MYELOGRAPHY THORACIC INJECTION 1711.90CT THORACIC SPINE W CONTR 2081.02CT CERV SPINE W CONTR 2106.90CHEST WITH APICAL LORDOTIC 287.26Administration of Xofigo 836.23THYROID CA - WHOLE BODY 2195.57SULFUR COLLOID UNIT DOSE 0.00ZEVALIN IN111,MULTIPLE AREAS 2195.57HEART MUSCLE IMAGE SPECT,SINGL 2268.51LUNG VENTILATION IMAGING 2298.69CT - MF W CONTR 2220.70CT - ORBIT SELLA MID/INNER EAR 1753.24CT THORAX W/O CONTRAST 1329.24CT LOWER EXT. WITH CONTRAST-LT 2078.66CT PELVIS W/O CONTRAST 1329.24CT LOWER EXT. WITH CONTRAST 1753.24CT LOWER EXT. W/WO CONTRAST 2078.66CTA UPPER EXTREMITY W/CONTRAST 2085.02CT ANGIO ABD&PELV W/O&W/DYE 3506.49

CT NEEDLE BIOPSY 1643.00DX MAMMO INCL CAD BI 652.00US THYROID 753.67US ASPIRATION BREAST 536.37US UTERUS > 14 WKS SGL GEST 753.67US EXTREMITY RT 753.67OB US NUCHAL MEAS, ADD-ON 0.00PET IM W/CT SKU-THIG SUBS ADD 6950.42PET IM W/CT SKU-THIG SUBS ADD 6950.42NON SMALL CELL LUNG CA,DIAGNOS 6950.42MRA CHEST W/WO CONTRAST 3281.77MRA-NECK W W/O CONTRAST 2246.49MRI-PELVIS W W/O CONTRAST 2633.80MR-KNEE W/CONTRAST,LEFT 2624.57MR-SHOULDER,LEFT 1902.82MR-ELBOW,LEFT 1902.82MR-HUMERUS W/WO CONTRAST,LEFT 3305.09MR-FEMUR W/WO CONTRAST,RIGHT 2559.41MR-FOOT W/CONTRAST,LEFT 2083.85MR-SHOULDER W/WO CONTRST,RIGHT 2627.88MR-WRIST,RIGHT 1902.82MR-TIB/FIB,LEFT 1969.24MR-HIP W/CONTRAST,BILAT 2754.49MR-CERVICAL 2001.67MRI-ABDOMEN W W/O CONTRAST 2659.79MR-WRIST W/CONTRAST,LEFT 2165.47MR-FEMUR,RIGHT 1969.24MR-WRIST W/WO CONTRAST,RIGHT 2627.88MR-TIB/FIB W/WO CONTRAST,RIGHT 2559.41MR-ABDOMEN W/OUT CONTRAST 2015.43MRI BREAST W/WO CON UNILAT 3281.76MRI BREAST C- BILATERAL 951.06ANGIOGRAPHY,PULMON VEN INJ S&I 1813.66ANGIOGRAPHY,PULMONARY UNI S&I 1813.66EYE FOREIGN BODY 227.90RIBS RIGHT W/PA CHEST 307.40CORPORA CAVERNOSOGRAM 392.25HUMERUS LEFT 307.40HIP LEFT 307.40ABDOMEN SUPINE & UPRIGHT 227.90BARIUM ENEMA 455.80CDSM NDSC 0.01BONE AGE 307.40C-ARM > 60 MIN 348.74HAND BILAT 461.00KNEE LEFT 3 VIEWS 307.40RIBS BILAT W/O PA CXR 307.40TOE(S) LEFT 307.40

FEMUR RT 2 OR MORE VIEWS 307.40NECK SOFT TISSUE 227.90IODINE I-131 IOBENGUANE 1MCI 1088.71RP LOCLZJ TUM SPECT 2 AREAS 4452.18LOOPOGRAM 769.56ENDO CATH - BILE DUCTS S&I 736.70ABDOMEN KUB ND 227.90X-RAY EXAM OF FOOT 2 VIEWS RT 254.40CT LOWER EXT W/O CON BILAT 1993.86GASTRIC EMPTYING SCAN 2174.20BONE - SPECT 2152.81LIVER/SPLEEN SPECT 2405.58Tumor imaging whole body 4302.83LIVER SPLEEN SCAN 2571.56BONE - LIMITED 2152.81CT - ORBIT SELLA MID/INNER EA 2078.66CT NECK W/ CONTRAST 1753.24CT LUMBAR SPINE 1329.24CT ABDOMEN W/ CONTRAST 1753.24CT ABDOMEN & PELVIS W/CONTRAST 3506.48CT GUIDANCE 530.00MAMMOGRAM,DX BILAT DIGITAL 624.35US ABDOMEN 753.67US ASPIRATION 536.37US CHEST 480.19US SOFT TISSUE HEAD/NECK 753.67OB US, FOLLOW-UP, PER FETUS 0.00ESOPHAGEAL, DIAGNOSIS 6950.42ULTRASOUND BREAST LIMITED 293.63ULTRASOUND BREAST LIMITED BIL 587.26ANGIOGRAPHY,EXT UNILAT S&I 3972.88ANGIOGRAPHY,VISCERAL S&I 3972.88VENOGRAPHY,SINUS/JUG CATH S 1191.44I-131 CAPSULE PER mCi 440.12MRI BREAST C-+ W/CAD BI 1254.94ANGIOGRAM, FOLLOW-UP 325.42DEXA BONE DENSITY AXIAL CEDC 507.74CHEST PA & LATERAL 287.26STERNOCLAVICULAR JOINT 307.40SACRUM & COCCYX 307.40SCAPULA-LEFT 307.40ARTHROGRAPHY SHOULDER-LEFT 1057.88DEXA BONE DENSITY AXIAL CEDC 507.74UPPER GI 455.80BARIUM ENEMA AIR CONTRAST 705.96IVP (UROGRAPHY) 769.56CYSTOGRAM 769.56TOE(S) BILAT 461.10

CERVICAL SPINE W/ FLEX/EXT 528.94THORACIC SPINE 1 VIEW 307.40HUMERUS RIGHT 307.40CHEST PA ND 287.26KNEE LEFT 1 OR 2 VIEWS ND 307.40KNEE LEFT 1 OR 2 VIEWS ND 307.40FLUOROGUIDE VEIN DEVICE 348.74CR Clavicle LT 307.40CR Clavicle LT 307.40RP QUAN MEAS SINGLE AREA 4452.18X-RAY EXAM OF ANKLE 2 VIEWS RT 237.44X-RAY EXAM OF ANKLE 2 VIEWS LT 237.44FLUOROGUIDE FOR SPINE INJECT 488.66CT LS W & WO CONTRAST 2525.98FEMUR RT 1 VIEW 307.40CT LT LOWER EXT W/O CONTRAS 1329.24ZEVALIN Y-90,THERAPY 431.32TUMOR LOC MULTI WHOLE BODY 3256.89SULFUR COLLOID UNIT DOSE 0.00THYROID IMAGING W/BLOOD FLOW 1495.15MECKLES SCAN 2008.21MUGA REST - SINGLE 2268.51HEPATOBILIARY SYSTEM IMAGING 1575.63CT HRT W/O DYE W/CA TEST 309.52CT NECK W/O CONTRAST 1329.24CT SINUS 1329.24CTA HEAD W/CONTRAST 2085.02CT THORACIC SPINE 1329.24CT ABDOMEN W/O CONTRAST 1329.24CT PELVIS W/WO CONTRAST 2078.66CTA PELVIS W/CONTRAST 2085.02CTA ABDOMEN W/CONTRAST 2085.02CTA ABDOMEN W/WO CONTRAST 2085.02DX MAMMO INCL CAD UNI RT 567.00DX MAMMO INCL CAD UNI LT 567.00US TRANSVAGINAL 753.67US LIVER/BILE DUCT 753.67US- PREG TRANSVAGINAL 480.19US EXAM,BLADDER,PELVIC,LTD 460.05OB US < 14 WKS, SINGLE FETUS 0.00LYMPHOMA,INITIAL STAGING 6950.42PET IM W/CT WHOLE BDY INITIAL 6950.43NON SMALL CELL LUNG CA,RESTAG 6950.42AORTAGRAPHY, ABDOMINAL S&I 3972.88AORTOGRAPHY, THORACIC S&I 4376.52VENOGRAPHY,RENAL UNILAT S&I 1813.66MR-THORACIC W/WO CONTRAST 2578.19MRA-HEAD WITHOUT CONTRAST 1846.70

MRA-NECK WITHOUT CONTRAST 1780.38MR-ANKLE, LEFT 2003.93MR-FEMUR,LEFT 1969.24MR-FEMUR W/CONTRAST,RIGHT 2083.85MR-HUMERUS,RIGHT 1837.73MR-HUMERUS W/WO CONTRAST,RIGHT 3305.09MR-ORBIT, FACE AND NECK 2027.45