"Last Updated on December 4, 2023" hospital_id cpt cpt_modifier hcpcs hcpcs_modifier DRG APR-DRG Severity APC APG rev_code item_description item_setting gross_charge cash_price medicare medicaid 1199 SEIU National Benefits & Pension Plan Aetna ASA Products Aetna Commercial Aetna Medicare Advantage Affinity Child Health Plus Affinity Exchange Product Affinity Medicaid and Family Health Plus Affinity Medicare Care Connect Commercial Center's Plan For Healthy Living Commercial Centivo Commercial Cigna Commercial Emblem Health Essential Plan 1 & 2 Emblem Health Essential Plan 3 & 4 Emblem Health GHI Access Network Emblem Health GHI Commercial Emblem Health HIP HMO Emblem Health HIP PPO Emblem Health Medicaid Emblem Health Medicare Advantage Emblem Health Select Care "Empire BCBS CHP, Essential Plan 1 & 2" Empire BCBS Commercial "Empire BCBS Medicaid, FHP, Essential Plan 3 & 4" Fidelis Child Health Plus Fidelis Essential Plan Program Fidelis Exchange Fidelis Care Fidelis Medicare Healthfirst Medicare Longevity Medicare Advantage Magnacare Multiplan MVP Child Health Plus MVP Commercial "MVP Essential Plans 1, 2, 5, 6" "MVP Essential Plans 3,4" MVP Medicaid Northwell Direct Oscar Individual Oscar SG Broad Oscar SG Narrow (1000-5000 employees) Oscar SG Narrow (<1000 employees) Oxford Health Plan All Payer Partners Health Plan Medicare Advantage Triwest Veterans Plan Medicare United Healthcare Commercial United Healthcare Community VNS Medicaid Wellcare Child Health Plus "Wellcare Medicaid, Family Health Plus" Wellcare Medicare de_identified_min de_identified_max 330104 100 HC TRANSITIONAL CARE UNIT I "$2,621.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,572.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,097.20 " "$2,228.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,572.90 " "$2,228.28 " 330104 111 HC PRIVATE I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 112 HC PRIVATE MATERNITY/OB I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 114 HC PRIVATE; I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 116 HC PRIVATE ROOM DETOX I "$4,439.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,551.54 " "$3,773.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " "$3,773.52 " 330104 118 HC PRIVATE REHAB I "$4,439.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,551.54 " "$3,773.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " "$3,773.52 " 330104 121 HC SEMI-PRIVATE I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 122 HC ANTIPARTUM SEMI-PRIVATE I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 123 HC PEDIATRICS SEMI PVT I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 124 HC SEMI PRIVATE. I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 126 HC SEMI PVT STABILIZATION I "$4,365.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,492.48 " "$3,710.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " "$3,710.76 " 330104 128 HC REHAB SEMI-PVT I "$4,365.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,492.48 " "$3,710.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " "$3,710.76 " 330104 171 HC SEMI PRIVATE BASSINET I "$2,841.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,705.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,273.54 " "$2,415.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,780.00 " N/A N/A "$4,752.00 " N/A N/A N/A N/A N/A "$1,705.15 " "$4,752.00 " 330104 174 HC NICU-INTENSIVE I "$10,708.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,425.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,566.85 " "$9,102.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,560.00 " N/A N/A "$8,856.00 " N/A N/A N/A N/A N/A "$6,425.14 " "$9,102.28 " 330104 179 HC BOARDER BABY I "$2,841.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,705.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,273.54 " "$2,415.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,780.00 " N/A N/A "$4,752.00 " N/A N/A N/A N/A N/A "$1,705.15 " "$4,752.00 " 330104 180 HC LOA DUMMY CHARGE I N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 330104 201 HC CS INTENSIVE CARE UNIT I "$12,752.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,651.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,201.81 " "$10,839.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,651.36 " "$10,839.42 " 330104 201 HC MS / ICU I "$10,111.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,089.20 " "$8,594.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " "$8,594.77 " 330104 202 HC ICU - MEDICAL I "$10,111.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,089.20 " "$8,594.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " "$8,594.77 " 330104 214 HC INTERMEDIATE CARDIAC CARE UNIT I "$8,947.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,368.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,157.87 " "$7,605.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,368.40 " "$7,605.24 " 330104 T2101 999 220 HC BREAST MILK PROC/STORE/DIST O $1.07 N/A N/A $0.17 $0.54 $0.66 $0.66 N/A $0.17 N/A $0.17 N/A $0.80 N/A $0.70 $0.78 $0.20 $0.17 $0.64 $0.86 N/A $0.54 $0.17 N/A $0.70 $0.24 $0.86 $0.17 $0.17 $0.20 N/A $0.17 N/A N/A N/A $0.86 $0.91 $0.23 $0.80 $0.35 $0.23 $0.54 $0.70 $0.72 $0.72 $0.72 $0.72 N/A N/A N/A $0.71 $0.17 $0.17 N/A N/A N/A $0.17 $0.91 330104 250 HC PHARMACY W/O HCPCS O $15.00 N/A N/A N/A $7.50 $9.30 $9.30 $9.81 N/A N/A N/A N/A $11.25 $10.50 $9.75 $10.96 $5.25 $5.25 $9.00 $12.00 N/A $7.50 $5.25 N/A N/A N/A $12.00 N/A $12.00 N/A N/A $12.00 N/A N/A N/A $12.00 $12.75 $7.50 $11.25 $7.50 $7.50 N/A $9.75 $10.12 $10.12 $10.12 $10.12 N/A N/A N/A $10.01 $7.50 N/A N/A N/A N/A $5.25 $12.75 330104 250 HC NYACK CODE CART O "$1,134.00 " N/A N/A N/A $567.00 $703.08 $703.08 $741.64 N/A N/A N/A N/A $850.50 $793.80 $737.10 $828.95 $396.90 $396.90 $680.40 $907.20 N/A $567.00 $396.90 N/A N/A N/A $907.20 N/A $907.20 N/A N/A $907.20 N/A N/A N/A $907.20 $963.90 $567.00 $850.50 $567.00 $567.00 N/A $737.10 $765.45 $765.45 $765.45 $765.45 N/A N/A N/A $756.38 $567.00 N/A N/A N/A N/A $396.90 $963.90 330104 250 HC NITRIC OXIDE PER HOUR O $200.00 N/A N/A N/A $100.00 $124.00 $124.00 $130.80 N/A N/A N/A N/A $150.00 $140.00 $130.00 $146.20 $70.00 $70.00 $120.00 $160.00 N/A $100.00 $70.00 N/A N/A N/A $160.00 N/A $160.00 N/A N/A $160.00 N/A N/A N/A $160.00 $170.00 $100.00 $150.00 $100.00 $100.00 N/A $130.00 $135.00 $135.00 $135.00 $135.00 N/A N/A N/A $133.40 $100.00 N/A N/A N/A N/A $70.00 $170.00 330104 96360 5693 111 260 HC HYDRATION IV INFUSION INIT O $847.44 $247.83 $247.83 $35.00 $423.72 $525.41 $525.41 $245.35 $35.00 $470.88 $35.00 $247.83 $635.58 $272.61 $550.84 $619.48 $42.00 $35.00 $508.46 $677.95 $842.62 $423.72 $35.00 $247.83 $297.40 $49.00 $677.95 $35.00 $35.00 $42.00 $346.96 $35.00 $247.83 $247.83 $270.14 $677.95 $720.32 $35.00 $635.58 $71.75 $35.00 $423.72 $408.92 $572.02 $572.02 $572.02 $572.02 N/A $260.22 $247.83 $565.24 $35.00 $35.00 $210.66 $210.66 $247.83 $35.00 $842.62 330104 96361 5691 110 260 HC HYDRATE IV INFUSION ADD-ON O $245.03 $50.83 $50.83 $5.00 $122.52 $151.92 $151.92 $50.32 $5.00 $96.58 $5.00 $50.83 $183.77 $55.92 $159.27 $179.12 $6.00 $5.00 $147.02 $196.02 $172.83 $122.52 $5.00 $50.83 $61.00 $7.00 $196.02 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $196.02 $208.28 $5.00 $183.77 $10.25 $5.00 $122.52 $83.87 $165.40 $165.40 $165.40 $165.40 N/A $53.37 $50.83 $163.44 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 $208.28 330104 96365 5693 111 260 HC THER/PROPH/DIAG IV INF INIT O "$1,356.76 " $247.83 $247.83 $35.00 $678.38 $841.19 $841.19 $245.35 $35.00 $470.88 $35.00 $247.83 "$1,017.57 " $272.61 $881.89 $991.79 $42.00 $35.00 $814.06 "$1,085.41 " $842.62 $678.38 $35.00 $247.83 $297.40 $49.00 "$1,085.41 " $35.00 $35.00 $42.00 $346.96 $35.00 $247.83 $247.83 $270.14 "$1,085.41 " "$1,153.25 " $35.00 "$1,017.57 " $71.75 $35.00 $678.38 $408.92 $915.81 $915.81 $915.81 $915.81 N/A $260.22 $247.83 $904.96 $35.00 $35.00 $210.66 $210.66 $247.83 $35.00 "$1,153.25 " 330104 96366 5691 110 260 HC THER/PROPH/DIAG IV INF ADDON O $471.87 $50.83 $50.83 $5.00 $235.94 $292.56 $292.56 $50.32 $5.00 $96.58 $5.00 $50.83 $353.90 $55.92 $306.72 $344.94 $6.00 $5.00 $283.12 $377.50 $172.83 $235.94 $5.00 $50.83 $61.00 $7.00 $377.50 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $377.50 $401.09 $5.00 $353.90 $10.25 $5.00 $235.94 $83.87 $318.51 $318.51 $318.51 $318.51 N/A $53.37 $50.83 $314.74 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 $401.09 330104 96367 5692 111 260 HC TX/PROPH/DG ADDL SEQ IV INF O $511.46 $80.95 $80.95 $5.00 $255.73 $317.11 $317.11 $80.14 $5.00 $153.80 $5.00 $80.95 $383.59 $89.04 $332.45 $373.88 $6.00 $5.00 $306.88 $409.17 $275.22 $255.73 $5.00 $80.95 $97.14 $7.00 $409.17 $5.00 $5.00 $6.00 $113.33 $5.00 $80.95 $80.95 $88.23 $409.17 $434.74 $5.00 $383.59 $10.25 $5.00 $255.73 $133.56 $345.24 $345.24 $345.24 $345.24 N/A $84.99 $80.95 $341.14 $5.00 $5.00 $68.80 $68.80 $80.95 $5.00 $434.74 330104 96368 111 260 HC THER/DIAG CONCURRENT INF O $511.46 N/A N/A $5.00 $255.73 $317.11 $317.11 $23.47 $5.00 N/A $5.00 N/A $383.59 N/A $332.45 $373.88 $6.00 $5.00 $306.88 $409.17 N/A $255.73 $5.00 N/A $332.45 $7.00 $409.17 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $409.17 $434.74 $6.75 $383.59 $10.25 $6.75 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 N/A N/A N/A $341.14 $5.00 $5.00 N/A N/A N/A $5.00 $434.74 330104 96371 5692 111 260 HC SC THER INFUSION RESET PUMP O "$1,218.73 " $80.95 $80.95 $19.00 $609.37 $755.61 $755.61 $80.14 $19.00 $153.80 $19.00 $80.95 $914.05 $89.04 $792.17 $890.89 $22.80 $19.00 $731.24 $974.98 $275.22 $609.37 $19.00 $80.95 $97.14 $26.60 $974.98 $19.00 $19.00 $22.80 $113.33 $19.00 $80.95 $80.95 $88.23 $974.98 "$1,035.92 " $19.00 $914.05 $38.95 $19.00 $609.37 $133.56 $822.64 $822.64 $822.64 $822.64 N/A $84.99 $80.95 $812.89 $19.00 $19.00 $68.80 $68.80 $80.95 $19.00 "$1,035.92 " 330104 96374 5693 109 260 HC THER/PROPH/DIAG INJ IV PUSH O $847.44 $247.83 $247.83 N/A $423.72 $525.41 $525.41 $245.35 N/A $470.88 N/A $247.83 $635.58 $272.61 $550.84 $619.48 N/A N/A $508.46 $677.95 $842.62 $423.72 N/A $247.83 $297.40 N/A $677.95 N/A N/A N/A $346.96 N/A $247.83 $247.83 $270.14 $677.95 $720.32 N/A $635.58 N/A N/A $423.72 $408.92 $572.02 $572.02 $572.02 $572.02 N/A $260.22 $247.83 $565.24 N/A N/A $210.66 $210.66 $247.83 $210.66 $842.62 330104 96375 5691 109 260 HC TX/PRO/DX INJ NEW DRUG ADDON O $471.87 $50.83 $50.83 N/A $235.94 $292.56 $292.56 $50.32 N/A $96.58 N/A $50.83 $353.90 $55.92 $306.72 $344.94 N/A N/A $283.12 $377.50 $172.83 $235.94 N/A $50.83 $61.00 N/A $377.50 N/A N/A N/A $71.17 N/A $50.83 $50.83 $55.41 $377.50 $401.09 N/A $353.90 N/A N/A $235.94 $83.87 $318.51 $318.51 $318.51 $318.51 N/A $53.37 $50.83 $314.74 N/A N/A $43.21 $43.21 $50.83 $43.21 $401.09 330104 96376 109 260 HC TX/PRO/DX INJ SAME DRUG ADON O $432.28 N/A N/A N/A $216.14 $268.01 $268.01 N/A N/A N/A N/A N/A $324.21 N/A $280.98 $316.00 N/A N/A $259.37 $345.82 N/A $216.14 N/A N/A $280.98 N/A $345.82 N/A N/A N/A N/A N/A N/A N/A N/A $345.82 $367.44 N/A $324.21 N/A N/A $216.14 $280.98 $291.79 $291.79 $291.79 $291.79 N/A N/A N/A $288.33 N/A N/A N/A N/A N/A $216.14 $367.44 330104 96370 5691 110 260 HC SC THER INFUSION ADDL HR O "$1,218.73 " $50.83 $50.83 $5.00 $609.37 $755.61 $755.61 $50.32 $5.00 $96.58 $5.00 $50.83 $914.05 $55.92 $792.17 $890.89 $6.00 $5.00 $731.24 $974.98 $172.83 $609.37 $5.00 $50.83 $61.00 $7.00 $974.98 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $974.98 "$1,035.92 " $5.00 $914.05 $10.25 $5.00 $609.37 $83.87 $822.64 $822.64 $822.64 $822.64 N/A $53.37 $50.83 $812.89 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 "$1,035.92 " 330104 270 HC POLYSKIN 4X4 OPSITE KC6641 **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 $1.96 N/A N/A N/A N/A $2.25 $2.10 $1.95 $2.19 $1.05 $1.05 $1.80 $2.40 N/A $1.50 $1.05 N/A N/A N/A $2.40 N/A $2.40 N/A N/A $2.40 N/A N/A N/A $1.50 $1.50 $1.50 $2.25 $1.50 $1.50 N/A $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 $1.50 N/A N/A N/A N/A $1.05 $2.40 330104 270 HC VAC SIMPLACE O $131.00 N/A N/A N/A $65.50 $81.22 $81.22 $85.67 N/A N/A N/A N/A $98.25 $91.70 $85.15 $95.76 $45.85 $45.85 $78.60 $104.80 N/A $65.50 $45.85 N/A N/A N/A $104.80 N/A $104.80 N/A N/A $104.80 N/A N/A N/A $65.50 $65.50 $65.50 $98.25 $65.50 $65.50 N/A $85.15 $88.43 $88.43 $88.43 $88.43 N/A N/A N/A $87.38 $65.50 N/A N/A N/A N/A $45.85 $104.80 330104 270 HC VAC GRANULOFOAM SILVER O $43.00 N/A N/A N/A $21.50 $26.66 $26.66 $28.12 N/A N/A N/A N/A $32.25 $30.10 $27.95 $31.43 $15.05 $15.05 $25.80 $34.40 N/A $21.50 $15.05 N/A N/A N/A $34.40 N/A $34.40 N/A N/A $34.40 N/A N/A N/A $21.50 $21.50 $21.50 $32.25 $21.50 $21.50 N/A $27.95 $29.03 $29.03 $29.03 $29.03 N/A N/A N/A $28.68 $21.50 N/A N/A N/A N/A $15.05 $34.40 330104 270 HC VAC GRANULOFOAM DRESSING SMALL O $111.00 N/A N/A N/A $55.50 $68.82 $68.82 $72.59 N/A N/A N/A N/A $83.25 $77.70 $72.15 $81.14 $38.85 $38.85 $66.60 $88.80 N/A $55.50 $38.85 N/A N/A N/A $88.80 N/A $88.80 N/A N/A $88.80 N/A N/A N/A $55.50 $55.50 $55.50 $83.25 $55.50 $55.50 N/A $72.15 $74.93 $74.93 $74.93 $74.93 N/A N/A N/A $74.04 $55.50 N/A N/A N/A N/A $38.85 $88.80 330104 270 HC VAC GRANULOFOAM DRESSING MEDIUM O $124.00 N/A N/A N/A $62.00 $76.88 $76.88 $81.10 N/A N/A N/A N/A $93.00 $86.80 $80.60 $90.64 $43.40 $43.40 $74.40 $99.20 N/A $62.00 $43.40 N/A N/A N/A $99.20 N/A $99.20 N/A N/A $99.20 N/A N/A N/A $62.00 $62.00 $62.00 $93.00 $62.00 $62.00 N/A $80.60 $83.70 $83.70 $83.70 $83.70 N/A N/A N/A $82.71 $62.00 N/A N/A N/A N/A $43.40 $99.20 330104 270 HC VAC CANNISTERS O $106.00 N/A N/A N/A $53.00 $65.72 $65.72 $69.32 N/A N/A N/A N/A $79.50 $74.20 $68.90 $77.49 $37.10 $37.10 $63.60 $84.80 N/A $53.00 $37.10 N/A N/A N/A $84.80 N/A $84.80 N/A N/A $84.80 N/A N/A N/A $53.00 $53.00 $53.00 $79.50 $53.00 $53.00 N/A $68.90 $71.55 $71.55 $71.55 $71.55 N/A N/A N/A $70.70 $53.00 N/A N/A N/A N/A $37.10 $84.80 330104 270 HC OFF LOADING BOOTS O $86.00 N/A N/A N/A $43.00 $53.32 $53.32 $56.24 N/A N/A N/A N/A $64.50 $60.20 $55.90 $62.87 $30.10 $30.10 $51.60 $68.80 N/A $43.00 $30.10 N/A N/A N/A $68.80 N/A $68.80 N/A N/A $68.80 N/A N/A N/A $43.00 $43.00 $43.00 $64.50 $43.00 $43.00 N/A $55.90 $58.05 $58.05 $58.05 $58.05 N/A N/A N/A $57.36 $43.00 N/A N/A N/A N/A $30.10 $68.80 330104 270 HC INCENTIVE SPIROMETER O $178.00 N/A N/A N/A $89.00 $110.36 $110.36 $116.41 N/A N/A N/A N/A $133.50 $124.60 $115.70 $130.12 $62.30 $62.30 $106.80 $142.40 N/A $89.00 $62.30 N/A N/A N/A $142.40 N/A $142.40 N/A N/A $142.40 N/A N/A N/A $89.00 $89.00 $89.00 $133.50 $89.00 $89.00 N/A $115.70 $120.15 $120.15 $120.15 $120.15 N/A N/A N/A $118.73 $89.00 N/A N/A N/A N/A $62.30 $142.40 330104 270 HC THUMB ABDUCTION SPLINT O $117.00 N/A N/A N/A $58.50 $72.54 $72.54 $76.52 N/A N/A N/A N/A $87.75 $81.90 $76.05 $85.53 $40.95 $40.95 $70.20 $93.60 N/A $58.50 $40.95 N/A N/A N/A $93.60 N/A $93.60 N/A N/A $93.60 N/A N/A N/A $58.50 $58.50 $58.50 $87.75 $58.50 $58.50 N/A $76.05 $78.98 $78.98 $78.98 $78.98 N/A N/A N/A $78.04 $58.50 N/A N/A N/A N/A $40.95 $93.60 330104 270 HC SPLINT-FELT O $140.00 N/A N/A N/A $70.00 $86.80 $86.80 $91.56 N/A N/A N/A N/A $105.00 $98.00 $91.00 $102.34 $49.00 $49.00 $84.00 $112.00 N/A $70.00 $49.00 N/A N/A N/A $112.00 N/A $112.00 N/A N/A $112.00 N/A N/A N/A $70.00 $70.00 $70.00 $105.00 $70.00 $70.00 N/A $91.00 $94.50 $94.50 $94.50 $94.50 N/A N/A N/A $93.38 $70.00 N/A N/A N/A N/A $49.00 $112.00 330104 270 HC CAST:LONG LEG O $890.00 N/A N/A N/A $445.00 $551.80 $551.80 $582.06 N/A N/A N/A N/A $667.50 $623.00 $578.50 $650.59 $311.50 $311.50 $534.00 $712.00 N/A $445.00 $311.50 N/A N/A N/A $712.00 N/A $712.00 N/A N/A $712.00 N/A N/A N/A $445.00 $445.00 $445.00 $667.50 $445.00 $445.00 N/A $578.50 $600.75 $600.75 $600.75 $600.75 N/A N/A N/A $593.63 $445.00 N/A N/A N/A N/A $311.50 $712.00 330104 270 HC CAST:LONG ARM O $631.00 N/A N/A N/A $315.50 $391.22 $391.22 $412.67 N/A N/A N/A N/A $473.25 $441.70 $410.15 $461.26 $220.85 $220.85 $378.60 $504.80 N/A $315.50 $220.85 N/A N/A N/A $504.80 N/A $504.80 N/A N/A $504.80 N/A N/A N/A $315.50 $315.50 $315.50 $473.25 $315.50 $315.50 N/A $410.15 $425.93 $425.93 $425.93 $425.93 N/A N/A N/A $420.88 $315.50 N/A N/A N/A N/A $220.85 $504.80 330104 270 HC PLASTER LONG ARM CAST O $149.00 N/A N/A N/A $74.50 $92.38 $92.38 $97.45 N/A N/A N/A N/A $111.75 $104.30 $96.85 $108.92 $52.15 $52.15 $89.40 $119.20 N/A $74.50 $52.15 N/A N/A N/A $119.20 N/A $119.20 N/A N/A $119.20 N/A N/A N/A $74.50 $74.50 $74.50 $111.75 $74.50 $74.50 N/A $96.85 $100.58 $100.58 $100.58 $100.58 N/A N/A N/A $99.38 $74.50 N/A N/A N/A N/A $52.15 $119.20 330104 270 HC POLYSKIN 2X2 OPSITE KC6640 **NYACK ONLY O $1.00 N/A N/A N/A $0.50 $0.62 $0.62 $0.65 N/A N/A N/A N/A $0.75 $0.70 $0.65 $0.73 $0.35 $0.35 $0.60 $0.80 N/A $0.50 $0.35 N/A N/A N/A $0.80 N/A $0.80 N/A N/A $0.80 N/A N/A N/A $0.50 $0.50 $0.50 $0.75 $0.50 $0.50 N/A $0.65 $0.68 $0.68 $0.68 $0.68 N/A N/A N/A $0.67 $0.50 N/A N/A N/A N/A $0.35 $0.80 330104 270 HC SPLINT:THUMB SPIKA O $113.00 N/A N/A N/A $56.50 $70.06 $70.06 $73.90 N/A N/A N/A N/A $84.75 $79.10 $73.45 $82.60 $39.55 $39.55 $67.80 $90.40 N/A $56.50 $39.55 N/A N/A N/A $90.40 N/A $90.40 N/A N/A $90.40 N/A N/A N/A $56.50 $56.50 $56.50 $84.75 $56.50 $56.50 N/A $73.45 $76.28 $76.28 $76.28 $76.28 N/A N/A N/A $75.37 $56.50 N/A N/A N/A N/A $39.55 $90.40 330104 270 HC SOFT CAST O $225.00 N/A N/A N/A $112.50 $139.50 $139.50 $147.15 N/A N/A N/A N/A $168.75 $157.50 $146.25 $164.47 $78.75 $78.75 $135.00 $180.00 N/A $112.50 $78.75 N/A N/A N/A $180.00 N/A $180.00 N/A N/A $180.00 N/A N/A N/A $112.50 $112.50 $112.50 $168.75 $112.50 $112.50 N/A $146.25 $151.88 $151.88 $151.88 $151.88 N/A N/A N/A $150.08 $112.50 N/A N/A N/A N/A $78.75 $180.00 330104 270 HC AIR CAST O $274.00 N/A N/A N/A $137.00 $169.88 $169.88 $179.20 N/A N/A N/A N/A $205.50 $191.80 $178.10 $200.29 $95.90 $95.90 $164.40 $219.20 N/A $137.00 $95.90 N/A N/A N/A $219.20 N/A $219.20 N/A N/A $219.20 N/A N/A N/A $137.00 $137.00 $137.00 $205.50 $137.00 $137.00 N/A $178.10 $184.95 $184.95 $184.95 $184.95 N/A N/A N/A $182.76 $137.00 N/A N/A N/A N/A $95.90 $219.20 330104 270 HC PLASTER BELOW KNEE CAST O $174.00 N/A N/A N/A $87.00 $107.88 $107.88 $113.80 N/A N/A N/A N/A $130.50 $121.80 $113.10 $127.19 $60.90 $60.90 $104.40 $139.20 N/A $87.00 $60.90 N/A N/A N/A $139.20 N/A $139.20 N/A N/A $139.20 N/A N/A N/A $87.00 $87.00 $87.00 $130.50 $87.00 $87.00 N/A $113.10 $117.45 $117.45 $117.45 $117.45 N/A N/A N/A $116.06 $87.00 N/A N/A N/A N/A $60.90 $139.20 330104 270 HC SPLINT:MASON ALLEN O $100.00 N/A N/A N/A $50.00 $62.00 $62.00 $65.40 N/A N/A N/A N/A $75.00 $70.00 $65.00 $73.10 $35.00 $35.00 $60.00 $80.00 N/A $50.00 $35.00 N/A N/A N/A $80.00 N/A $80.00 N/A N/A $80.00 N/A N/A N/A $50.00 $50.00 $50.00 $75.00 $50.00 $50.00 N/A $65.00 $67.50 $67.50 $67.50 $67.50 N/A N/A N/A $66.70 $50.00 N/A N/A N/A N/A $35.00 $80.00 330104 270 HC JORDAN SPLINT SHORT O $210.00 N/A N/A N/A $105.00 $130.20 $130.20 $137.34 N/A N/A N/A N/A $157.50 $147.00 $136.50 $153.51 $73.50 $73.50 $126.00 $168.00 N/A $105.00 $73.50 N/A N/A N/A $168.00 N/A $168.00 N/A N/A $168.00 N/A N/A N/A $105.00 $105.00 $105.00 $157.50 $105.00 $105.00 N/A $136.50 $141.75 $141.75 $141.75 $141.75 N/A N/A N/A $140.07 $105.00 N/A N/A N/A N/A $73.50 $168.00 330104 270 HC SPLINT:FOREARM O $145.00 N/A N/A N/A $72.50 $89.90 $89.90 $94.83 N/A N/A N/A N/A $108.75 $101.50 $94.25 $106.00 $50.75 $50.75 $87.00 $116.00 N/A $72.50 $50.75 N/A N/A N/A $116.00 N/A $116.00 N/A N/A $116.00 N/A N/A N/A $72.50 $72.50 $72.50 $108.75 $72.50 $72.50 N/A $94.25 $97.88 $97.88 $97.88 $97.88 N/A N/A N/A $96.72 $72.50 N/A N/A N/A N/A $50.75 $116.00 330104 270 HC SPLINT:FINGER O $32.00 N/A N/A N/A $16.00 $19.84 $19.84 $20.93 N/A N/A N/A N/A $24.00 $22.40 $20.80 $23.39 $11.20 $11.20 $19.20 $25.60 N/A $16.00 $11.20 N/A N/A N/A $25.60 N/A $25.60 N/A N/A $25.60 N/A N/A N/A $16.00 $16.00 $16.00 $24.00 $16.00 $16.00 N/A $20.80 $21.60 $21.60 $21.60 $21.60 N/A N/A N/A $21.34 $16.00 N/A N/A N/A N/A $11.20 $25.60 330104 270 HC SPLINT:ELBOW O $168.00 N/A N/A N/A $84.00 $104.16 $104.16 $109.87 N/A N/A N/A N/A $126.00 $117.60 $109.20 $122.81 $58.80 $58.80 $100.80 $134.40 N/A $84.00 $58.80 N/A N/A N/A $134.40 N/A $134.40 N/A N/A $134.40 N/A N/A N/A $84.00 $84.00 $84.00 $126.00 $84.00 $84.00 N/A $109.20 $113.40 $113.40 $113.40 $113.40 N/A N/A N/A $112.06 $84.00 N/A N/A N/A N/A $58.80 $134.40 330104 270 HC DAILY OXYGEN ADM O $406.00 N/A N/A N/A $203.00 $251.72 $251.72 $265.52 N/A N/A N/A N/A $304.50 $284.20 $263.90 $296.79 $142.10 $142.10 $243.60 $324.80 N/A $203.00 $142.10 N/A N/A N/A $324.80 N/A $324.80 N/A N/A $324.80 N/A N/A N/A $203.00 $203.00 $203.00 $304.50 $203.00 $203.00 N/A $263.90 $274.05 $274.05 $274.05 $274.05 N/A N/A N/A $270.80 $203.00 N/A N/A N/A N/A $142.10 $324.80 330104 270 HC CART CHEST TUBE INSERTION O "$1,598.00 " N/A N/A N/A $799.00 $990.76 $990.76 "$1,045.09 " N/A N/A N/A N/A "$1,198.50 " "$1,118.60 " "$1,038.70 " "$1,168.14 " $559.30 $559.30 $958.80 "$1,278.40 " N/A $799.00 $559.30 N/A N/A N/A "$1,278.40 " N/A "$1,278.40 " N/A N/A "$1,278.40 " N/A N/A N/A $799.00 $799.00 $799.00 "$1,198.50 " $799.00 $799.00 N/A "$1,038.70 " "$1,078.65 " "$1,078.65 " "$1,078.65 " "$1,078.65 " N/A N/A N/A "$1,065.87 " $799.00 N/A N/A N/A N/A $559.30 "$1,278.40 " 330104 270 HC CART G-U O $727.00 N/A N/A N/A $363.50 $450.74 $450.74 $475.46 N/A N/A N/A N/A $545.25 $508.90 $472.55 $531.44 $254.45 $254.45 $436.20 $581.60 N/A $363.50 $254.45 N/A N/A N/A $581.60 N/A $581.60 N/A N/A $581.60 N/A N/A N/A $363.50 $363.50 $363.50 $545.25 $363.50 $363.50 N/A $472.55 $490.73 $490.73 $490.73 $490.73 N/A N/A N/A $484.91 $363.50 N/A N/A N/A N/A $254.45 $581.60 330104 270 HC SPLINT:LONG LEG O $82.00 N/A N/A N/A $41.00 $50.84 $50.84 $53.63 N/A N/A N/A N/A $61.50 $57.40 $53.30 $59.94 $28.70 $28.70 $49.20 $65.60 N/A $41.00 $28.70 N/A N/A N/A $65.60 N/A $65.60 N/A N/A $65.60 N/A N/A N/A $41.00 $41.00 $41.00 $61.50 $41.00 $41.00 N/A $53.30 $55.35 $55.35 $55.35 $55.35 N/A N/A N/A $54.69 $41.00 N/A N/A N/A N/A $28.70 $65.60 330104 270 HC PUMP FEEDING O $50.00 N/A N/A N/A $25.00 $31.00 $31.00 $32.70 N/A N/A N/A N/A $37.50 $35.00 $32.50 $36.55 $17.50 $17.50 $30.00 $40.00 N/A $25.00 $17.50 N/A N/A N/A $40.00 N/A $40.00 N/A N/A $40.00 N/A N/A N/A $25.00 $25.00 $25.00 $37.50 $25.00 $25.00 N/A $32.50 $33.75 $33.75 $33.75 $33.75 N/A N/A N/A $33.35 $25.00 N/A N/A N/A N/A $17.50 $40.00 330104 270 HC K THERMIA (MATTRESS ONLY) O $104.00 N/A N/A N/A $52.00 $64.48 $64.48 $68.02 N/A N/A N/A N/A $78.00 $72.80 $67.60 $76.02 $36.40 $36.40 $62.40 $83.20 N/A $52.00 $36.40 N/A N/A N/A $83.20 N/A $83.20 N/A N/A $83.20 N/A N/A N/A $52.00 $52.00 $52.00 $78.00 $52.00 $52.00 N/A $67.60 $70.20 $70.20 $70.20 $70.20 N/A N/A N/A $69.37 $52.00 N/A N/A N/A N/A $36.40 $83.20 330104 270 HC CAST PADDING 4 IN X 4 YD MCMW04 **NYACK ONLY O $2.00 N/A N/A N/A $1.00 $1.24 $1.24 $1.31 N/A N/A N/A N/A $1.50 $1.40 $1.30 $1.46 $0.70 $0.70 $1.20 $1.60 N/A $1.00 $0.70 N/A N/A N/A $1.60 N/A $1.60 N/A N/A $1.60 N/A N/A N/A $1.00 $1.00 $1.00 $1.50 $1.00 $1.00 N/A $1.30 $1.35 $1.35 $1.35 $1.35 N/A N/A N/A $1.33 $1.00 N/A N/A N/A N/A $0.70 $1.60 330104 270 HC CURITY ADAPTIC 3X16 DRESSING JJ6114 **NYACK ONLY O $8.00 N/A N/A N/A $4.00 $4.96 $4.96 $5.23 N/A N/A N/A N/A $6.00 $5.60 $5.20 $5.85 $2.80 $2.80 $4.80 $6.40 N/A $4.00 $2.80 N/A N/A N/A $6.40 N/A $6.40 N/A N/A $6.40 N/A N/A N/A $4.00 $4.00 $4.00 $6.00 $4.00 $4.00 N/A $5.20 $5.40 $5.40 $5.40 $5.40 N/A N/A N/A $5.34 $4.00 N/A N/A N/A N/A $2.80 $6.40 330104 270 HC DRESSING REPLICARE ULTRA 4X4 59484600 **NYACK ONLY O $10.00 N/A N/A N/A $5.00 $6.20 $6.20 $6.54 N/A N/A N/A N/A $7.50 $7.00 $6.50 $7.31 $3.50 $3.50 $6.00 $8.00 N/A $5.00 $3.50 N/A N/A N/A $8.00 N/A $8.00 N/A N/A $8.00 N/A N/A N/A $5.00 $5.00 $5.00 $7.50 $5.00 $5.00 N/A $6.50 $6.75 $6.75 $6.75 $6.75 N/A N/A N/A $6.67 $5.00 N/A N/A N/A N/A $3.50 $8.00 330104 270 HC SPLINT 5X30 OG-5PC (76530) **NYACK ONLY O $45.00 N/A N/A N/A $22.50 $27.90 $27.90 $29.43 N/A N/A N/A N/A $33.75 $31.50 $29.25 $32.89 $15.75 $15.75 $27.00 $36.00 N/A $22.50 $15.75 N/A N/A N/A $36.00 N/A $36.00 N/A N/A $36.00 N/A N/A N/A $22.50 $22.50 $22.50 $33.75 $22.50 $22.50 N/A $29.25 $30.38 $30.38 $30.38 $30.38 N/A N/A N/A $30.02 $22.50 N/A N/A N/A N/A $15.75 $36.00 330104 270 HC SPLINTS 3 X 12 OG-3PC (76312) **NYACK ONLY O $13.00 N/A N/A N/A $6.50 $8.06 $8.06 $8.50 N/A N/A N/A N/A $9.75 $9.10 $8.45 $9.50 $4.55 $4.55 $7.80 $10.40 N/A $6.50 $4.55 N/A N/A N/A $10.40 N/A $10.40 N/A N/A $10.40 N/A N/A N/A $6.50 $6.50 $6.50 $9.75 $6.50 $6.50 N/A $8.45 $8.78 $8.78 $8.78 $8.78 N/A N/A N/A $8.67 $6.50 N/A N/A N/A N/A $4.55 $10.40 330104 270 HC NITROUS OXIDE PER HOUR O $200.00 N/A N/A N/A $100.00 $124.00 $124.00 $130.80 N/A N/A N/A N/A $150.00 $140.00 $130.00 $146.20 $70.00 $70.00 $120.00 $160.00 N/A $100.00 $70.00 N/A N/A N/A $160.00 N/A $160.00 N/A N/A $160.00 N/A N/A N/A $100.00 $100.00 $100.00 $150.00 $100.00 $100.00 N/A $130.00 $135.00 $135.00 $135.00 $135.00 N/A N/A N/A $133.40 $100.00 N/A N/A N/A N/A $70.00 $160.00 330104 270 HC EPIDURAL TRAY CONT WITH DRUGS O $390.00 N/A N/A N/A $195.00 $241.80 $241.80 $255.06 N/A N/A N/A N/A $292.50 $273.00 $253.50 $285.09 $136.50 $136.50 $234.00 $312.00 N/A $195.00 $136.50 N/A N/A N/A $312.00 N/A $312.00 N/A N/A $312.00 N/A N/A N/A $195.00 $195.00 $195.00 $292.50 $195.00 $195.00 N/A $253.50 $263.25 $263.25 $263.25 $263.25 N/A N/A N/A $260.13 $195.00 N/A N/A N/A N/A $136.50 $312.00 330104 A6257 1001 270 HC TRANSPARENT FILM <= 16 SQ IN O $171.00 N/A N/A N/A $85.50 $106.02 $106.02 N/A N/A N/A N/A N/A $128.25 N/A $111.15 $125.00 N/A N/A $102.60 $136.80 N/A $85.50 N/A N/A $111.15 N/A $136.80 N/A N/A N/A N/A N/A N/A N/A N/A $85.50 $85.50 N/A $128.25 N/A N/A $85.50 $111.15 $115.43 $115.43 $115.43 $115.43 N/A N/A N/A $114.06 N/A N/A N/A N/A N/A $85.50 $136.80 330104 A6258 1001 270 HC TRANSPARENT FILM >16<=48 IN O $23.00 N/A N/A N/A $11.50 $14.26 $14.26 N/A N/A N/A N/A N/A $17.25 N/A $14.95 $16.81 N/A N/A $13.80 $18.40 N/A $11.50 N/A N/A $14.95 N/A $18.40 N/A N/A N/A N/A N/A N/A N/A N/A $11.50 $11.50 N/A $17.25 N/A N/A $11.50 $14.95 $15.53 $15.53 $15.53 $15.53 N/A N/A N/A $15.34 N/A N/A N/A N/A N/A $11.50 $18.40 330104 270 HC VAC WHITE FOAM DRESSING SMALL O $30.00 N/A N/A N/A $15.00 $18.60 $18.60 $19.62 N/A N/A N/A N/A $22.50 $21.00 $19.50 $21.93 $10.50 $10.50 $18.00 $24.00 N/A $15.00 $10.50 N/A N/A N/A $24.00 N/A $24.00 N/A N/A $24.00 N/A N/A N/A $15.00 $15.00 $15.00 $22.50 $15.00 $15.00 N/A $19.50 $20.25 $20.25 $20.25 $20.25 N/A N/A N/A $20.01 $15.00 N/A N/A N/A N/A $10.50 $24.00 330104 270 HC SPLINTS 4 X 30 OG-430PC (76430) **NYACK ONLY O $71.00 N/A N/A N/A $35.50 $44.02 $44.02 $46.43 N/A N/A N/A N/A $53.25 $49.70 $46.15 $51.90 $24.85 $24.85 $42.60 $56.80 N/A $35.50 $24.85 N/A N/A N/A $56.80 N/A $56.80 N/A N/A $56.80 N/A N/A N/A $35.50 $35.50 $35.50 $53.25 $35.50 $35.50 N/A $46.15 $47.93 $47.93 $47.93 $47.93 N/A N/A N/A $47.36 $35.50 N/A N/A N/A N/A $24.85 $56.80 330104 270 HC SLEEVES CALF ALP1 **NYACK ONLY O $33.00 N/A N/A N/A $16.50 $20.46 $20.46 $21.58 N/A N/A N/A N/A $24.75 $23.10 $21.45 $24.12 $11.55 $11.55 $19.80 $26.40 N/A $16.50 $11.55 N/A N/A N/A $26.40 N/A $26.40 N/A N/A $26.40 N/A N/A N/A $16.50 $16.50 $16.50 $24.75 $16.50 $16.50 N/A $21.45 $22.28 $22.28 $22.28 $22.28 N/A N/A N/A $22.01 $16.50 N/A N/A N/A N/A $11.55 $26.40 330104 270 HC BINDER ABDOMINAL SMALL **NYACK ONLY O $20.00 N/A N/A N/A $10.00 $12.40 $12.40 $13.08 N/A N/A N/A N/A $15.00 $14.00 $13.00 $14.62 $7.00 $7.00 $12.00 $16.00 N/A $10.00 $7.00 N/A N/A N/A $16.00 N/A $16.00 N/A N/A $16.00 N/A N/A N/A $10.00 $10.00 $10.00 $15.00 $10.00 $10.00 N/A $13.00 $13.50 $13.50 $13.50 $13.50 N/A N/A N/A $13.34 $10.00 N/A N/A N/A N/A $7.00 $16.00 330104 270 HC SPECIMEN TRAP **NYACK ONLY O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 $3.27 N/A N/A N/A N/A $3.75 $3.50 $3.25 $3.65 $1.75 $1.75 $3.00 $4.00 N/A $2.50 $1.75 N/A N/A N/A $4.00 N/A $4.00 N/A N/A $4.00 N/A N/A N/A $2.50 $2.50 $2.50 $3.75 $2.50 $2.50 N/A $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 $2.50 N/A N/A N/A N/A $1.75 $4.00 330104 270 HC THORA-DRAIN **NYACK ONLY O $175.00 N/A N/A N/A $87.50 $108.50 $108.50 $114.45 N/A N/A N/A N/A $131.25 $122.50 $113.75 $127.92 $61.25 $61.25 $105.00 $140.00 N/A $87.50 $61.25 N/A N/A N/A $140.00 N/A $140.00 N/A N/A $140.00 N/A N/A N/A $87.50 $87.50 $87.50 $131.25 $87.50 $87.50 N/A $113.75 $118.13 $118.13 $118.13 $118.13 N/A N/A N/A $116.73 $87.50 N/A N/A N/A N/A $61.25 $140.00 330104 271 HC ADMIN AQUAMATIC (PAD) O $243.00 N/A N/A N/A $121.50 $150.66 $150.66 $158.92 N/A N/A N/A N/A $182.25 $170.10 $157.95 $177.63 $85.05 $85.05 $145.80 $194.40 N/A $121.50 $85.05 N/A N/A N/A $194.40 N/A $194.40 N/A N/A $194.40 N/A N/A N/A $194.40 $206.55 $121.50 $182.25 $121.50 $121.50 N/A $157.95 $164.03 $164.03 $164.03 $164.03 N/A N/A N/A $162.08 $121.50 N/A N/A N/A N/A $85.05 $206.55 330104 271 HC SCROTAL SUPPORT X-LARGE **NYACK ONLY O $38.00 N/A N/A N/A $19.00 $23.56 $23.56 $24.85 N/A N/A N/A N/A $28.50 $26.60 $24.70 $27.78 $13.30 $13.30 $22.80 $30.40 N/A $19.00 $13.30 N/A N/A N/A $30.40 N/A $30.40 N/A N/A $30.40 N/A N/A N/A $30.40 $32.30 $19.00 $28.50 $19.00 $19.00 N/A $24.70 $25.65 $25.65 $25.65 $25.65 N/A N/A N/A $25.35 $19.00 N/A N/A N/A N/A $13.30 $32.30 330104 271 HC BAG BILE **NYACK ONLY O $44.00 N/A N/A N/A $22.00 $27.28 $27.28 $28.78 N/A N/A N/A N/A $33.00 $30.80 $28.60 $32.16 $15.40 $15.40 $26.40 $35.20 N/A $22.00 $15.40 N/A N/A N/A $35.20 N/A $35.20 N/A N/A $35.20 N/A N/A N/A $35.20 $37.40 $22.00 $33.00 $22.00 $22.00 N/A $28.60 $29.70 $29.70 $29.70 $29.70 N/A N/A N/A $29.35 $22.00 N/A N/A N/A N/A $15.40 $37.40 330104 271 HC SCROTAL SUPPORT LARGE **NYACK ONLY O $41.00 N/A N/A N/A $20.50 $25.42 $25.42 $26.81 N/A N/A N/A N/A $30.75 $28.70 $26.65 $29.97 $14.35 $14.35 $24.60 $32.80 N/A $20.50 $14.35 N/A N/A N/A $32.80 N/A $32.80 N/A N/A $32.80 N/A N/A N/A $32.80 $34.85 $20.50 $30.75 $20.50 $20.50 N/A $26.65 $27.68 $27.68 $27.68 $27.68 N/A N/A N/A $27.35 $20.50 N/A N/A N/A N/A $14.35 $34.85 330104 271 HC SCROTAL SUPPORT MEDIUM **NYACK ONLY O $42.00 N/A N/A N/A $21.00 $26.04 $26.04 $27.47 N/A N/A N/A N/A $31.50 $29.40 $27.30 $30.70 $14.70 $14.70 $25.20 $33.60 N/A $21.00 $14.70 N/A N/A N/A $33.60 N/A $33.60 N/A N/A $33.60 N/A N/A N/A $33.60 $35.70 $21.00 $31.50 $21.00 $21.00 N/A $27.30 $28.35 $28.35 $28.35 $28.35 N/A N/A N/A $28.01 $21.00 N/A N/A N/A N/A $14.70 $35.70 330104 271 HC AE HOSE KNEE HI X LRG-LNG **NYACK ONLY O $17.00 N/A N/A N/A $8.50 $10.54 $10.54 $11.12 N/A N/A N/A N/A $12.75 $11.90 $11.05 $12.43 $5.95 $5.95 $10.20 $13.60 N/A $8.50 $5.95 N/A N/A N/A $13.60 N/A $13.60 N/A N/A $13.60 N/A N/A N/A $13.60 $14.45 $8.50 $12.75 $8.50 $8.50 N/A $11.05 $11.48 $11.48 $11.48 $11.48 N/A N/A N/A $11.34 $8.50 N/A N/A N/A N/A $5.95 $14.45 330104 271 HC AE HOSE THIGH HI LRG-LNG **NYACK ONLY O $21.00 N/A N/A N/A $10.50 $13.02 $13.02 $13.73 N/A N/A N/A N/A $15.75 $14.70 $13.65 $15.35 $7.35 $7.35 $12.60 $16.80 N/A $10.50 $7.35 N/A N/A N/A $16.80 N/A $16.80 N/A N/A $16.80 N/A N/A N/A $16.80 $17.85 $10.50 $15.75 $10.50 $10.50 N/A $13.65 $14.18 $14.18 $14.18 $14.18 N/A N/A N/A $14.01 $10.50 N/A N/A N/A N/A $7.35 $17.85 330104 271 HC SUCTION CATH KIT **NYACK ONLY O $11.00 N/A N/A N/A $5.50 $6.82 $6.82 $7.19 N/A N/A N/A N/A $8.25 $7.70 $7.15 $8.04 $3.85 $3.85 $6.60 $8.80 N/A $5.50 $3.85 N/A N/A N/A $8.80 N/A $8.80 N/A N/A $8.80 N/A N/A N/A $8.80 $9.35 $5.50 $8.25 $5.50 $5.50 N/A $7.15 $7.43 $7.43 $7.43 $7.43 N/A N/A N/A $7.34 $5.50 N/A N/A N/A N/A $3.85 $9.35 330104 A6212 1001 272 HC FOAM DRG <=16 SQ IN W/BORDER EACH O $40.00 N/A N/A N/A $20.00 $24.80 $24.80 N/A N/A N/A N/A N/A $30.00 N/A $26.00 $29.24 N/A N/A $24.00 $32.00 N/A $20.00 N/A N/A $26.00 N/A $32.00 N/A N/A N/A N/A N/A N/A N/A N/A $20.00 $20.00 N/A $30.00 N/A N/A $20.00 $26.00 $27.00 $27.00 $27.00 $27.00 N/A N/A N/A $26.68 N/A N/A N/A N/A N/A $20.00 $32.00 330104 A6234 1001 272 HC HYDROCOLLD DRG <=16 W/O BDR EACH O $137.00 N/A N/A N/A $68.50 $84.94 $84.94 N/A N/A N/A N/A N/A $102.75 N/A $89.05 $100.15 N/A N/A $82.20 $109.60 N/A $68.50 N/A N/A $89.05 N/A $109.60 N/A N/A N/A N/A N/A N/A N/A N/A $68.50 $68.50 N/A $102.75 N/A N/A $68.50 $89.05 $92.48 $92.48 $92.48 $92.48 N/A N/A N/A $91.38 N/A N/A N/A N/A N/A $68.50 $109.60 330104 A6223 1001 272 HC GAUZE >16<=48 NO W/SAL W/O BRDR EACH O $19.00 N/A N/A N/A $9.50 $11.78 $11.78 N/A N/A N/A N/A N/A $14.25 N/A $12.35 $13.89 N/A N/A $11.40 $15.20 N/A $9.50 N/A N/A $12.35 N/A $15.20 N/A N/A N/A N/A N/A N/A N/A N/A $9.50 $9.50 N/A $14.25 N/A N/A $9.50 $12.35 $12.83 $12.83 $12.83 $12.83 N/A N/A N/A $12.67 N/A N/A N/A N/A N/A $9.50 $15.20 330104 A6213 1001 272 HC FOAM DRG >16 <=48 SQ IN W/BDR EACH O $580.00 N/A N/A N/A $290.00 $359.60 $359.60 N/A N/A N/A N/A N/A $435.00 N/A $377.00 $423.98 N/A N/A $348.00 $464.00 N/A $290.00 N/A N/A $377.00 N/A $464.00 N/A N/A N/A N/A N/A N/A N/A N/A $290.00 $290.00 N/A $435.00 N/A N/A $290.00 $377.00 $391.50 $391.50 $391.50 $391.50 N/A N/A N/A $386.86 N/A N/A N/A N/A N/A $290.00 $464.00 330104 A6252 1001 272 HC ABSORPT DRG >16 <=48 W/O BDR O $386.00 N/A N/A N/A $193.00 $239.32 $239.32 N/A N/A N/A N/A N/A $289.50 N/A $250.90 $282.17 N/A N/A $231.60 $308.80 N/A $193.00 N/A N/A $250.90 N/A $308.80 N/A N/A N/A N/A N/A N/A N/A N/A $193.00 $193.00 N/A $289.50 N/A N/A $193.00 $250.90 $260.55 $260.55 $260.55 $260.55 N/A N/A N/A $257.46 N/A N/A N/A N/A N/A $193.00 $308.80 330104 A6209 1001 272 HC FOAM DRSG <=16 SQ IN W/O BDR EACH O $310.00 N/A N/A N/A $155.00 $192.20 $192.20 N/A N/A N/A N/A N/A $232.50 N/A $201.50 $226.61 N/A N/A $186.00 $248.00 N/A $155.00 N/A N/A $201.50 N/A $248.00 N/A N/A N/A N/A N/A N/A N/A N/A $155.00 $155.00 N/A $232.50 N/A N/A $155.00 $201.50 $209.25 $209.25 $209.25 $209.25 N/A N/A N/A $206.77 N/A N/A N/A N/A N/A $155.00 $248.00 330104 272 HC CUSTOM OPEN HEART PACK **NYACK ONLY O $637.00 N/A N/A N/A $318.50 $394.94 $394.94 $416.60 N/A N/A N/A N/A $477.75 $445.90 $414.05 $465.65 $222.95 $222.95 $382.20 $509.60 N/A $318.50 $222.95 N/A N/A N/A $509.60 N/A $509.60 N/A N/A $509.60 N/A N/A N/A $318.50 $318.50 $318.50 $477.75 $318.50 $318.50 N/A $414.05 $429.98 $429.98 $429.98 $429.98 N/A N/A N/A $424.88 $318.50 N/A N/A N/A N/A $222.95 $509.60 330104 A6021 1002 272 HC COLLAGEN DRESSING <=16 SQ IN EACH O $416.00 N/A N/A N/A $208.00 $257.92 $257.92 N/A N/A N/A N/A N/A $312.00 N/A $270.40 $304.10 N/A N/A $249.60 $332.80 N/A $208.00 N/A N/A $270.40 N/A $332.80 N/A N/A N/A N/A N/A N/A N/A N/A $208.00 $208.00 N/A $312.00 N/A N/A $208.00 $270.40 $280.80 $280.80 $280.80 $280.80 N/A N/A N/A $277.47 N/A N/A N/A N/A N/A $208.00 $332.80 330104 272 HC CUSTOM MINOR PACK **NYACK ONLY O $160.00 N/A N/A N/A $80.00 $99.20 $99.20 $104.64 N/A N/A N/A N/A $120.00 $112.00 $104.00 $116.96 $56.00 $56.00 $96.00 $128.00 N/A $80.00 $56.00 N/A N/A N/A $128.00 N/A $128.00 N/A N/A $128.00 N/A N/A N/A $80.00 $80.00 $80.00 $120.00 $80.00 $80.00 N/A $104.00 $108.00 $108.00 $108.00 $108.00 N/A N/A N/A $106.72 $80.00 N/A N/A N/A N/A $56.00 $128.00 330104 272 HC CATH FOLEY 30CC-24FR(2WAY) **NYACK ONLY O $4.00 N/A N/A N/A $2.00 $2.48 $2.48 $2.62 N/A N/A N/A N/A $3.00 $2.80 $2.60 $2.92 $1.40 $1.40 $2.40 $3.20 N/A $2.00 $1.40 N/A N/A N/A $3.20 N/A $3.20 N/A N/A $3.20 N/A N/A N/A $2.00 $2.00 $2.00 $3.00 $2.00 $2.00 N/A $2.60 $2.70 $2.70 $2.70 $2.70 N/A N/A N/A $2.67 $2.00 N/A N/A N/A N/A $1.40 $3.20 330104 272 HC CUSTOM HIP PACK **NYACK ONLY O $427.00 N/A N/A N/A $213.50 $264.74 $264.74 $279.26 N/A N/A N/A N/A $320.25 $298.90 $277.55 $312.14 $149.45 $149.45 $256.20 $341.60 N/A $213.50 $149.45 N/A N/A N/A $341.60 N/A $341.60 N/A N/A $341.60 N/A N/A N/A $213.50 $213.50 $213.50 $320.25 $213.50 $213.50 N/A $277.55 $288.23 $288.23 $288.23 $288.23 N/A N/A N/A $284.81 $213.50 N/A N/A N/A N/A $149.45 $341.60 330104 272 HC CATH COUDE 5CC 20FR **NYACK ONLY O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 $3.27 N/A N/A N/A N/A $3.75 $3.50 $3.25 $3.65 $1.75 $1.75 $3.00 $4.00 N/A $2.50 $1.75 N/A N/A N/A $4.00 N/A $4.00 N/A N/A $4.00 N/A N/A N/A $2.50 $2.50 $2.50 $3.75 $2.50 $2.50 N/A $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 $2.50 N/A N/A N/A N/A $1.75 $4.00 330104 A6449 1001 272 "HC LT COMPRES BAND >=3"" <5""/YD" O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 N/A N/A N/A N/A N/A $3.75 N/A $3.25 $3.65 N/A N/A $3.00 $4.00 N/A $2.50 N/A N/A $3.25 N/A $4.00 N/A N/A N/A N/A N/A N/A N/A N/A $2.50 $2.50 N/A $3.75 N/A N/A $2.50 $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 N/A N/A N/A N/A N/A $2.50 $4.00 330104 A6196 1001 272 HC ALGINATE DRESSING <=16 SQ IN EACH O $22.00 N/A N/A N/A $11.00 $13.64 $13.64 N/A N/A N/A N/A N/A $16.50 N/A $14.30 $16.08 N/A N/A $13.20 $17.60 N/A $11.00 N/A N/A $14.30 N/A $17.60 N/A N/A N/A N/A N/A N/A N/A N/A $11.00 $11.00 N/A $16.50 N/A N/A $11.00 $14.30 $14.85 $14.85 $14.85 $14.85 N/A N/A N/A $14.67 N/A N/A N/A N/A N/A $11.00 $17.60 330104 C1769 2006 272 HC COAXIAL MICROINDUCER KIT O $96.00 N/A N/A N/A $48.00 $59.52 $59.52 $62.78 N/A N/A N/A N/A $72.00 N/A $62.40 $70.18 N/A N/A $57.60 $76.80 N/A $48.00 N/A N/A N/A N/A $76.80 N/A N/A N/A N/A N/A N/A N/A N/A $48.00 $48.00 N/A $72.00 N/A N/A $48.00 $62.40 $64.80 $64.80 $64.80 $64.80 N/A N/A N/A $64.03 N/A N/A N/A N/A N/A $48.00 $76.80 330104 A4346 1001 272 HC CATH FOLEY 5CC-24FR(2WAY) **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 N/A N/A N/A N/A N/A $2.25 N/A $1.95 $2.19 N/A N/A $1.80 $2.40 N/A $1.50 N/A N/A $1.95 N/A $2.40 N/A N/A N/A N/A N/A N/A N/A N/A $1.50 $1.50 N/A $2.25 N/A N/A $1.50 $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 N/A N/A N/A N/A N/A $1.50 $2.40 330104 272 HC CUSTOM HIP PINNING PACK **NYACK ONLY O $279.00 N/A N/A N/A $139.50 $172.98 $172.98 $182.47 N/A N/A N/A N/A $209.25 $195.30 $181.35 $203.95 $97.65 $97.65 $167.40 $223.20 N/A $139.50 $97.65 N/A N/A N/A $223.20 N/A $223.20 N/A N/A $223.20 N/A N/A N/A $139.50 $139.50 $139.50 $209.25 $139.50 $139.50 N/A $181.35 $188.33 $188.33 $188.33 $188.33 N/A N/A N/A $186.09 $139.50 N/A N/A N/A N/A $97.65 $223.20 330104 272 HC CUSTOM ARTHROSCOPY PACK **NYACK ONLY O $199.00 N/A N/A N/A $99.50 $123.38 $123.38 $130.15 N/A N/A N/A N/A $149.25 $139.30 $129.35 $145.47 $69.65 $69.65 $119.40 $159.20 N/A $99.50 $69.65 N/A N/A N/A $159.20 N/A $159.20 N/A N/A $159.20 N/A N/A N/A $99.50 $99.50 $99.50 $149.25 $99.50 $99.50 N/A $129.35 $134.33 $134.33 $134.33 $134.33 N/A N/A N/A $132.73 $99.50 N/A N/A N/A N/A $69.65 $159.20 330104 272 HC CUSTOM NEURO PACK **NYACK ONLY O $251.00 N/A N/A N/A $125.50 $155.62 $155.62 $164.15 N/A N/A N/A N/A $188.25 $175.70 $163.15 $183.48 $87.85 $87.85 $150.60 $200.80 N/A $125.50 $87.85 N/A N/A N/A $200.80 N/A $200.80 N/A N/A $200.80 N/A N/A N/A $125.50 $125.50 $125.50 $188.25 $125.50 $125.50 N/A $163.15 $169.43 $169.43 $169.43 $169.43 N/A N/A N/A $167.42 $125.50 N/A N/A N/A N/A $87.85 $200.80 330104 272 HC CATH TRAY ADD A FOLEY **NYACK ONLY O $13.00 N/A N/A N/A $6.50 $8.06 $8.06 $8.50 N/A N/A N/A N/A $9.75 $9.10 $8.45 $9.50 $4.55 $4.55 $7.80 $10.40 N/A $6.50 $4.55 N/A N/A N/A $10.40 N/A $10.40 N/A N/A $10.40 N/A N/A N/A $6.50 $6.50 $6.50 $9.75 $6.50 $6.50 N/A $8.45 $8.78 $8.78 $8.78 $8.78 N/A N/A N/A $8.67 $6.50 N/A N/A N/A N/A $4.55 $10.40 330104 272 HC CANNULA TRACH INNER SZ 4 **NYACK ONLY O $105.00 N/A N/A N/A $52.50 $65.10 $65.10 $68.67 N/A N/A N/A N/A $78.75 $73.50 $68.25 $76.75 $36.75 $36.75 $63.00 $84.00 N/A $52.50 $36.75 N/A N/A N/A $84.00 N/A $84.00 N/A N/A $84.00 N/A N/A N/A $52.50 $52.50 $52.50 $78.75 $52.50 $52.50 N/A $68.25 $70.88 $70.88 $70.88 $70.88 N/A N/A N/A $70.04 $52.50 N/A N/A N/A N/A $36.75 $84.00 330104 272 HC SKIN STAPLES **NYACK ONLY O $35.00 N/A N/A N/A $17.50 $21.70 $21.70 $22.89 N/A N/A N/A N/A $26.25 $24.50 $22.75 $25.59 $12.25 $12.25 $21.00 $28.00 N/A $17.50 $12.25 N/A N/A N/A $28.00 N/A $28.00 N/A N/A $28.00 N/A N/A N/A $17.50 $17.50 $17.50 $26.25 $17.50 $17.50 N/A $22.75 $23.62 $23.62 $23.62 $23.62 N/A N/A N/A $23.35 $17.50 N/A N/A N/A N/A $12.25 $28.00 330104 272 HC TRACH TUBE CUFFED SIZE 8 505080 **NYACK ONLY O $109.00 N/A N/A N/A $54.50 $67.58 $67.58 $71.29 N/A N/A N/A N/A $81.75 $76.30 $70.85 $79.68 $38.15 $38.15 $65.40 $87.20 N/A $54.50 $38.15 N/A N/A N/A $87.20 N/A $87.20 N/A N/A $87.20 N/A N/A N/A $54.50 $54.50 $54.50 $81.75 $54.50 $54.50 N/A $70.85 $73.58 $73.58 $73.58 $73.58 N/A N/A N/A $72.70 $54.50 N/A N/A N/A N/A $38.15 $87.20 330104 272 HC URINE METER FOLEY TRAY 16FR KC7006LL **NYACK ONLY O $39.00 N/A N/A N/A $19.50 $24.18 $24.18 $25.51 N/A N/A N/A N/A $29.25 $27.30 $25.35 $28.51 $13.65 $13.65 $23.40 $31.20 N/A $19.50 $13.65 N/A N/A N/A $31.20 N/A $31.20 N/A N/A $31.20 N/A N/A N/A $19.50 $19.50 $19.50 $29.25 $19.50 $19.50 N/A $25.35 $26.33 $26.33 $26.33 $26.33 N/A N/A N/A $26.01 $19.50 N/A N/A N/A N/A $13.65 $31.20 330104 272 HC URINE METER FOLEY TRAY 18 **NYACK ONLY O $34.00 N/A N/A N/A $17.00 $21.08 $21.08 $22.24 N/A N/A N/A N/A $25.50 $23.80 $22.10 $24.85 $11.90 $11.90 $20.40 $27.20 N/A $17.00 $11.90 N/A N/A N/A $27.20 N/A $27.20 N/A N/A $27.20 N/A N/A N/A $17.00 $17.00 $17.00 $25.50 $17.00 $17.00 N/A $22.10 $22.95 $22.95 $22.95 $22.95 N/A N/A N/A $22.68 $17.00 N/A N/A N/A N/A $11.90 $27.20 330104 272 HC SPLINTS 4 X 15 OG-4PC (76415) **NYACK ONLY O $18.00 N/A N/A N/A $9.00 $11.16 $11.16 $11.77 N/A N/A N/A N/A $13.50 $12.60 $11.70 $13.16 $6.30 $6.30 $10.80 $14.40 N/A $9.00 $6.30 N/A N/A N/A $14.40 N/A $14.40 N/A N/A $14.40 N/A N/A N/A $9.00 $9.00 $9.00 $13.50 $9.00 $9.00 N/A $11.70 $12.15 $12.15 $12.15 $12.15 N/A N/A N/A $12.01 $9.00 N/A N/A N/A N/A $6.30 $14.40 330104 272 HB KIT MULTI-LUMEN CATH ARROW GUARD O $353.00 N/A N/A N/A $176.50 $218.86 $218.86 $230.86 N/A N/A N/A N/A $264.75 $247.10 $229.45 $258.04 $123.55 $123.55 $211.80 $282.40 N/A $176.50 $123.55 N/A N/A N/A $282.40 N/A $282.40 N/A N/A $282.40 N/A N/A N/A $176.50 $176.50 $176.50 $264.75 $176.50 $176.50 N/A $229.45 $238.28 $238.28 $238.28 $238.28 N/A N/A N/A $235.45 $176.50 N/A N/A N/A N/A $123.55 $282.40 330104 272 HC GASTRIC TUBING O $51.90 N/A N/A N/A $25.95 $32.18 $32.18 $33.94 N/A N/A N/A N/A $38.92 $36.33 $33.73 $37.94 $18.16 $18.16 $31.14 $41.52 N/A $25.95 $18.16 N/A N/A N/A $41.52 N/A $41.52 N/A N/A $41.52 N/A N/A N/A $25.95 $25.95 $25.95 $38.92 $25.95 $25.95 N/A $33.73 $35.03 $35.03 $35.03 $35.03 N/A N/A N/A $34.62 $25.95 N/A N/A N/A N/A $18.16 $41.52 330104 272 HC ADHESIVE SKIN DERMABOND O $55.00 N/A N/A N/A $27.50 $34.10 $34.10 $35.97 N/A N/A N/A N/A $41.25 $38.50 $35.75 $40.20 $19.25 $19.25 $33.00 $44.00 N/A $27.50 $19.25 N/A N/A N/A $44.00 N/A $44.00 N/A N/A $44.00 N/A N/A N/A $27.50 $27.50 $27.50 $41.25 $27.50 $27.50 N/A $35.75 $37.12 $37.12 $37.12 $37.12 N/A N/A N/A $36.69 $27.50 N/A N/A N/A N/A $19.25 $44.00 330104 272 HC CATH FOLEY 5CC-22FR(2WAY) **NYACK ONLY O $25.00 N/A N/A N/A $12.50 $15.50 $15.50 $16.35 N/A N/A N/A N/A $18.75 $17.50 $16.25 $18.27 $8.75 $8.75 $15.00 $20.00 N/A $12.50 $8.75 N/A N/A N/A $20.00 N/A $20.00 N/A N/A $20.00 N/A N/A N/A $12.50 $12.50 $12.50 $18.75 $12.50 $12.50 N/A $16.25 $16.88 $16.88 $16.88 $16.88 N/A N/A N/A $16.68 $12.50 N/A N/A N/A N/A $8.75 $20.00 330104 272 HC CUSTOM MAJOR PACK **NYACK ONLY O $325.00 N/A N/A N/A $162.50 $201.50 $201.50 $212.55 N/A N/A N/A N/A $243.75 $227.50 $211.25 $237.57 $113.75 $113.75 $195.00 $260.00 N/A $162.50 $113.75 N/A N/A N/A $260.00 N/A $260.00 N/A N/A $260.00 N/A N/A N/A $162.50 $162.50 $162.50 $243.75 $162.50 $162.50 N/A $211.25 $219.38 $219.38 $219.38 $219.38 N/A N/A N/A $216.78 $162.50 N/A N/A N/A N/A $113.75 $260.00 330104 272 HC CATH FOLEY 5CC-14FR(2WAY) **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 $1.96 N/A N/A N/A N/A $2.25 $2.10 $1.95 $2.19 $1.05 $1.05 $1.80 $2.40 N/A $1.50 $1.05 N/A N/A N/A $2.40 N/A $2.40 N/A N/A $2.40 N/A N/A N/A $1.50 $1.50 $1.50 $2.25 $1.50 $1.50 N/A $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 $1.50 N/A N/A N/A N/A $1.05 $2.40 330104 272 HC MULTI LUMEN CATHETER AK-45703-ASK **NYACK ONLY O $413.00 N/A N/A N/A $206.50 $256.06 $256.06 $270.10 N/A N/A N/A N/A $309.75 $289.10 $268.45 $301.90 $144.55 $144.55 $247.80 $330.40 N/A $206.50 $144.55 N/A N/A N/A $330.40 N/A $330.40 N/A N/A $330.40 N/A N/A N/A $206.50 $206.50 $206.50 $309.75 $206.50 $206.50 N/A $268.45 $278.78 $278.78 $278.78 $278.78 N/A N/A N/A $275.47 $206.50 N/A N/A N/A N/A $144.55 $330.40 330104 272 HC FULLER SHIELD **NYACK ONLY O $57.00 N/A N/A N/A $28.50 $35.34 $35.34 $37.28 N/A N/A N/A N/A $42.75 $39.90 $37.05 $41.67 $19.95 $19.95 $34.20 $45.60 N/A $28.50 $19.95 N/A N/A N/A $45.60 N/A $45.60 N/A N/A $45.60 N/A N/A N/A $28.50 $28.50 $28.50 $42.75 $28.50 $28.50 N/A $37.05 $38.48 $38.48 $38.48 $38.48 N/A N/A N/A $38.02 $28.50 N/A N/A N/A N/A $19.95 $45.60 330104 272 HC MOLDED CERVICAL COLLAR O $70.00 N/A N/A N/A $35.00 $43.40 $43.40 $45.78 N/A N/A N/A N/A $52.50 $49.00 $45.50 $51.17 $24.50 $24.50 $42.00 $56.00 N/A $35.00 $24.50 N/A N/A N/A $56.00 N/A $56.00 N/A N/A $56.00 N/A N/A N/A $35.00 $35.00 $35.00 $52.50 $35.00 $35.00 N/A $45.50 $47.25 $47.25 $47.25 $47.25 N/A N/A N/A $46.69 $35.00 N/A N/A N/A N/A $24.50 $56.00 330104 272 HC CELERO-INTRO-12 O $64.00 N/A N/A N/A $32.00 $39.68 $39.68 $41.86 N/A N/A N/A N/A $48.00 $44.80 $41.60 $46.78 $22.40 $22.40 $38.40 $51.20 N/A $32.00 $22.40 N/A N/A N/A $51.20 N/A $51.20 N/A N/A $51.20 N/A N/A N/A $32.00 $32.00 $32.00 $48.00 $32.00 $32.00 N/A $41.60 $43.20 $43.20 $43.20 $43.20 N/A N/A N/A $42.69 $32.00 N/A N/A N/A N/A $22.40 $51.20 330104 272 HC CELERO-12 O $755.00 N/A N/A N/A $377.50 $468.10 $468.10 $493.77 N/A N/A N/A N/A $566.25 $528.50 $490.75 $551.90 $264.25 $264.25 $453.00 $604.00 N/A $377.50 $264.25 N/A N/A N/A $604.00 N/A $604.00 N/A N/A $604.00 N/A N/A N/A $377.50 $377.50 $377.50 $566.25 $377.50 $377.50 N/A $490.75 $509.63 $509.63 $509.63 $509.63 N/A N/A N/A $503.59 $377.50 N/A N/A N/A N/A $264.25 $604.00 330104 272 HC EVIVA NGO9L - NEEDLE GUIDE O $32.00 N/A N/A N/A $16.00 $19.84 $19.84 $20.93 N/A N/A N/A N/A $24.00 $22.40 $20.80 $23.39 $11.20 $11.20 $19.20 $25.60 N/A $16.00 $11.20 N/A N/A N/A $25.60 N/A $25.60 N/A N/A $25.60 N/A N/A N/A $16.00 $16.00 $16.00 $24.00 $16.00 $16.00 N/A $20.80 $21.60 $21.60 $21.60 $21.60 N/A N/A N/A $21.34 $16.00 N/A N/A N/A N/A $11.20 $25.60 330104 272 HC EVIVA HANDPIECE 913-12/20 O $808.00 N/A N/A N/A $404.00 $500.96 $500.96 $528.43 N/A N/A N/A N/A $606.00 $565.60 $525.20 $590.65 $282.80 $282.80 $484.80 $646.40 N/A $404.00 $282.80 N/A N/A N/A $646.40 N/A $646.40 N/A N/A $646.40 N/A N/A N/A $404.00 $404.00 $404.00 $606.00 $404.00 $404.00 N/A $525.20 $545.40 $545.40 $545.40 $545.40 N/A N/A N/A $538.94 $404.00 N/A N/A N/A N/A $282.80 $646.40 330104 272 HC PYNSINC VIAL ADAPTER 13MM O $11.00 N/A N/A N/A $5.50 $6.82 $6.82 $7.19 N/A N/A N/A N/A $8.25 $7.70 $7.15 $8.04 $3.85 $3.85 $6.60 $8.80 N/A $5.50 $3.85 N/A N/A N/A $8.80 N/A $8.80 N/A N/A $8.80 N/A N/A N/A $5.50 $5.50 $5.50 $8.25 $5.50 $5.50 N/A $7.15 $7.43 $7.43 $7.43 $7.43 N/A N/A N/A $7.34 $5.50 N/A N/A N/A N/A $3.85 $8.80 330104 272 HC BAG LEG URIN DRAIN(DISP) **NYACK ONLY O $9.00 N/A N/A N/A $4.50 $5.58 $5.58 $5.89 N/A N/A N/A N/A $6.75 $6.30 $5.85 $6.58 $3.15 $3.15 $5.40 $7.20 N/A $4.50 $3.15 N/A N/A N/A $7.20 N/A $7.20 N/A N/A $7.20 N/A N/A N/A $4.50 $4.50 $4.50 $6.75 $4.50 $4.50 N/A $5.85 $6.08 $6.08 $6.08 $6.08 N/A N/A N/A $6.00 $4.50 N/A N/A N/A N/A $3.15 $7.20 330104 272 HC M MARK STOPLIGHT O $450.00 N/A N/A N/A $225.00 $279.00 $279.00 $294.30 N/A N/A N/A N/A $337.50 $315.00 $292.50 $328.95 $157.50 $157.50 $270.00 $360.00 N/A $225.00 $157.50 N/A N/A N/A $360.00 N/A $360.00 N/A N/A $360.00 N/A N/A N/A $225.00 $225.00 $225.00 $337.50 $225.00 $225.00 N/A $292.50 $303.75 $303.75 $303.75 $303.75 N/A N/A N/A $300.15 $225.00 N/A N/A N/A N/A $157.50 $360.00 330104 272 HC MRI NEEDLS LOC 18G-100G O $204.00 N/A N/A N/A $102.00 $126.48 $126.48 $133.42 N/A N/A N/A N/A $153.00 $142.80 $132.60 $149.12 $71.40 $71.40 $122.40 $163.20 N/A $102.00 $71.40 N/A N/A N/A $163.20 N/A $163.20 N/A N/A $163.20 N/A N/A N/A $102.00 $102.00 $102.00 $153.00 $102.00 $102.00 N/A $132.60 $137.70 $137.70 $137.70 $137.70 N/A N/A N/A $136.07 $102.00 N/A N/A N/A N/A $71.40 $163.20 330104 272 HC MRI - COLD SPOT -70MM X 70MM O $6.00 N/A N/A N/A $3.00 $3.72 $3.72 $3.92 N/A N/A N/A N/A $4.50 $4.20 $3.90 $4.39 $2.10 $2.10 $3.60 $4.80 N/A $3.00 $2.10 N/A N/A N/A $4.80 N/A $4.80 N/A N/A $4.80 N/A N/A N/A $3.00 $3.00 $3.00 $4.50 $3.00 $3.00 N/A $3.90 $4.05 $4.05 $4.05 $4.05 N/A N/A N/A $4.00 $3.00 N/A N/A N/A N/A $2.10 $4.80 330104 272 HC MRI NEEDLE BIOPSY PETITE -9GX14X12 ATEC O $990.00 N/A N/A N/A $495.00 $613.80 $613.80 $647.46 N/A N/A N/A N/A $742.50 $693.00 $643.50 $723.69 $346.50 $346.50 $594.00 $792.00 N/A $495.00 $346.50 N/A N/A N/A $792.00 N/A $792.00 N/A N/A $792.00 N/A N/A N/A $495.00 $495.00 $495.00 $742.50 $495.00 $495.00 N/A $643.50 $668.25 $668.25 $668.25 $668.25 N/A N/A N/A $660.33 $495.00 N/A N/A N/A N/A $346.50 $792.00 330104 272 HC MRI INTRODUCER PETITE 9G ILS 0914-12 O $570.00 N/A N/A N/A $285.00 $353.40 $353.40 $372.78 N/A N/A N/A N/A $427.50 $399.00 $370.50 $416.67 $199.50 $199.50 $342.00 $456.00 N/A $285.00 $199.50 N/A N/A N/A $456.00 N/A $456.00 N/A N/A $456.00 N/A N/A N/A $285.00 $285.00 $285.00 $427.50 $285.00 $285.00 N/A $370.50 $384.75 $384.75 $384.75 $384.75 N/A N/A N/A $380.19 $285.00 N/A N/A N/A N/A $199.50 $456.00 330104 272 HC VERAFLO VERALINK O $172.00 N/A N/A N/A $86.00 $106.64 $106.64 $112.49 N/A N/A N/A N/A $129.00 $120.40 $111.80 $125.73 $60.20 $60.20 $103.20 $137.60 N/A $86.00 $60.20 N/A N/A N/A $137.60 N/A $137.60 N/A N/A $137.60 N/A N/A N/A $86.00 $86.00 $86.00 $129.00 $86.00 $86.00 N/A $111.80 $116.10 $116.10 $116.10 $116.10 N/A N/A N/A $114.72 $86.00 N/A N/A N/A N/A $60.20 $137.60 330104 272 HC VERAFLO GRANUFOAM O $431.00 N/A N/A N/A $215.50 $267.22 $267.22 $281.87 N/A N/A N/A N/A $323.25 $301.70 $280.15 $315.06 $150.85 $150.85 $258.60 $344.80 N/A $215.50 $150.85 N/A N/A N/A $344.80 N/A $344.80 N/A N/A $344.80 N/A N/A N/A $215.50 $215.50 $215.50 $323.25 $215.50 $215.50 N/A $280.15 $290.93 $290.93 $290.93 $290.93 N/A N/A N/A $287.48 $215.50 N/A N/A N/A N/A $150.85 $344.80 330104 272 HC VERAFLO CLEANSE FOAM O $359.00 N/A N/A N/A $179.50 $222.58 $222.58 $234.79 N/A N/A N/A N/A $269.25 $251.30 $233.35 $262.43 $125.65 $125.65 $215.40 $287.20 N/A $179.50 $125.65 N/A N/A N/A $287.20 N/A $287.20 N/A N/A $287.20 N/A N/A N/A $179.50 $179.50 $179.50 $269.25 $179.50 $179.50 N/A $233.35 $242.33 $242.33 $242.33 $242.33 N/A N/A N/A $239.45 $179.50 N/A N/A N/A N/A $125.65 $287.20 330104 272 HC FOLEY TRAY CATH 14 FR O $28.00 N/A N/A N/A $14.00 $17.36 $17.36 $18.31 N/A N/A N/A N/A $21.00 $19.60 $18.20 $20.47 $9.80 $9.80 $16.80 $22.40 N/A $14.00 $9.80 N/A N/A N/A $22.40 N/A $22.40 N/A N/A $22.40 N/A N/A N/A $14.00 $14.00 $14.00 $21.00 $14.00 $14.00 N/A $18.20 $18.90 $18.90 $18.90 $18.90 N/A N/A N/A $18.68 $14.00 N/A N/A N/A N/A $9.80 $22.40 330104 272 HC INTRAUTERINE CATHOTIP TRN O $178.00 N/A N/A N/A $89.00 $110.36 $110.36 $116.41 N/A N/A N/A N/A $133.50 $124.60 $115.70 $130.12 $62.30 $62.30 $106.80 $142.40 N/A $89.00 $62.30 N/A N/A N/A $142.40 N/A $142.40 N/A N/A $142.40 N/A N/A N/A $89.00 $89.00 $89.00 $133.50 $89.00 $89.00 N/A $115.70 $120.15 $120.15 $120.15 $120.15 N/A N/A N/A $118.73 $89.00 N/A N/A N/A N/A $62.30 $142.40 330104 272 HC VACUUM EXTRACTOR SILICUP O $90.00 N/A N/A N/A $45.00 $55.80 $55.80 $58.86 N/A N/A N/A N/A $67.50 $63.00 $58.50 $65.79 $31.50 $31.50 $54.00 $72.00 N/A $45.00 $31.50 N/A N/A N/A $72.00 N/A $72.00 N/A N/A $72.00 N/A N/A N/A $45.00 $45.00 $45.00 $67.50 $45.00 $45.00 N/A $58.50 $60.75 $60.75 $60.75 $60.75 N/A N/A N/A $60.03 $45.00 N/A N/A N/A N/A $31.50 $72.00 330104 272 HC BAIR HUGGER O $14.00 N/A N/A N/A $7.00 $8.68 $8.68 $9.16 N/A N/A N/A N/A $10.50 $9.80 $9.10 $10.23 $4.90 $4.90 $8.40 $11.20 N/A $7.00 $4.90 N/A N/A N/A $11.20 N/A $11.20 N/A N/A $11.20 N/A N/A N/A $7.00 $7.00 $7.00 $10.50 $7.00 $7.00 N/A $9.10 $9.45 $9.45 $9.45 $9.45 N/A N/A N/A $9.34 $7.00 N/A N/A N/A N/A $4.90 $11.20 330104 272 HC SPINAL ANES TRY WHITACRE O $66.00 N/A N/A N/A $33.00 $40.92 $40.92 $43.16 N/A N/A N/A N/A $49.50 $46.20 $42.90 $48.25 $23.10 $23.10 $39.60 $52.80 N/A $33.00 $23.10 N/A N/A N/A $52.80 N/A $52.80 N/A N/A $52.80 N/A N/A N/A $33.00 $33.00 $33.00 $49.50 $33.00 $33.00 N/A $42.90 $44.55 $44.55 $44.55 $44.55 N/A N/A N/A $44.02 $33.00 N/A N/A N/A N/A $23.10 $52.80 330104 272 HC CVP KIT O $326.00 N/A N/A N/A $163.00 $202.12 $202.12 $213.20 N/A N/A N/A N/A $244.50 $228.20 $211.90 $238.31 $114.10 $114.10 $195.60 $260.80 N/A $163.00 $114.10 N/A N/A N/A $260.80 N/A $260.80 N/A N/A $260.80 N/A N/A N/A $163.00 $163.00 $163.00 $244.50 $163.00 $163.00 N/A $211.90 $220.05 $220.05 $220.05 $220.05 N/A N/A N/A $217.44 $163.00 N/A N/A N/A N/A $114.10 $260.80 330104 C1756 2006 272 HC CATH THERACATH EPIDUR ARROW 20GEC-5000 O $57.00 N/A N/A N/A $28.50 $35.34 $35.34 $37.28 N/A N/A N/A N/A $42.75 N/A $37.05 $41.67 N/A N/A $34.20 $45.60 N/A $28.50 N/A N/A N/A N/A $45.60 N/A N/A N/A N/A N/A N/A N/A N/A $28.50 $28.50 N/A $42.75 N/A N/A $28.50 $37.05 $38.48 $38.48 $38.48 $38.48 N/A N/A N/A $38.02 N/A N/A N/A N/A N/A $28.50 $45.60 330104 272 HC BRONCH CATH WITH CPAP O $252.00 N/A N/A N/A $126.00 $156.24 $156.24 $164.81 N/A N/A N/A N/A $189.00 $176.40 $163.80 $184.21 $88.20 $88.20 $151.20 $201.60 N/A $126.00 $88.20 N/A N/A N/A $201.60 N/A $201.60 N/A N/A $201.60 N/A N/A N/A $126.00 $126.00 $126.00 $189.00 $126.00 $126.00 N/A $163.80 $170.10 $170.10 $170.10 $170.10 N/A N/A N/A $168.08 $126.00 N/A N/A N/A N/A $88.20 $201.60 330104 272 HC SPINAL ANESTHESIA TRAY O $194.00 N/A N/A N/A $97.00 $120.28 $120.28 $126.88 N/A N/A N/A N/A $145.50 $135.80 $126.10 $141.81 $67.90 $67.90 $116.40 $155.20 N/A $97.00 $67.90 N/A N/A N/A $155.20 N/A $155.20 N/A N/A $155.20 N/A N/A N/A $97.00 $97.00 $97.00 $145.50 $97.00 $97.00 N/A $126.10 $130.95 $130.95 $130.95 $130.95 N/A N/A N/A $129.40 $97.00 N/A N/A N/A N/A $67.90 $155.20 330104 272 HC BLOOD COLLECTION SET O $134.00 N/A N/A N/A $67.00 $83.08 $83.08 $87.64 N/A N/A N/A N/A $100.50 $93.80 $87.10 $97.95 $46.90 $46.90 $80.40 $107.20 N/A $67.00 $46.90 N/A N/A N/A $107.20 N/A $107.20 N/A N/A $107.20 N/A N/A N/A $67.00 $67.00 $67.00 $100.50 $67.00 $67.00 N/A $87.10 $90.45 $90.45 $90.45 $90.45 N/A N/A N/A $89.38 $67.00 N/A N/A N/A N/A $46.90 $107.20 330104 272 HC MEDICAL/SURGICAL SUPPLIES - STERILE O $390.00 N/A N/A N/A $195.00 $241.80 $241.80 $255.06 N/A N/A N/A N/A $292.50 $273.00 $253.50 $285.09 $136.50 $136.50 $234.00 $312.00 N/A $195.00 $136.50 N/A N/A N/A $312.00 N/A $312.00 N/A N/A $312.00 N/A N/A N/A $195.00 $195.00 $195.00 $292.50 $195.00 $195.00 N/A $253.50 $263.25 $263.25 $263.25 $263.25 N/A N/A N/A $260.13 $195.00 N/A N/A N/A N/A $136.50 $312.00 330104 C1751 2006 272 HC BARD ACCESS PICC 5.0FR O $750.00 N/A N/A N/A $375.00 $465.00 $465.00 $490.50 N/A N/A N/A N/A $562.50 N/A $487.50 $548.25 N/A N/A $450.00 $600.00 N/A $375.00 N/A N/A N/A N/A $600.00 N/A N/A N/A N/A N/A N/A N/A N/A $375.00 $375.00 N/A $562.50 N/A N/A $375.00 $487.50 $506.25 $506.25 $506.25 $506.25 N/A N/A N/A $500.25 N/A N/A N/A N/A N/A $375.00 $600.00 330104 272 HC TRIPLE LUMEN CATHETER #16 O $327.00 N/A N/A N/A $163.50 $202.74 $202.74 $213.86 N/A N/A N/A N/A $245.25 $228.90 $212.55 $239.04 $114.45 $114.45 $196.20 $261.60 N/A $163.50 $114.45 N/A N/A N/A $261.60 N/A $261.60 N/A N/A $261.60 N/A N/A N/A $163.50 $163.50 $163.50 $245.25 $163.50 $163.50 N/A $212.55 $220.73 $220.73 $220.73 $220.73 N/A N/A N/A $218.11 $163.50 N/A N/A N/A N/A $114.45 $261.60 330104 272 HC ESOPHAGEAL STETHOSCOPE O $7.00 N/A N/A N/A $3.50 $4.34 $4.34 $4.58 N/A N/A N/A N/A $5.25 $4.90 $4.55 $5.12 $2.45 $2.45 $4.20 $5.60 N/A $3.50 $2.45 N/A N/A N/A $5.60 N/A $5.60 N/A N/A $5.60 N/A N/A N/A $3.50 $3.50 $3.50 $5.25 $3.50 $3.50 N/A $4.55 $4.73 $4.73 $4.73 $4.73 N/A N/A N/A $4.67 $3.50 N/A N/A N/A N/A $2.45 $5.60 330104 272 HC TEMNO 14G - 16G O $165.00 N/A N/A N/A $82.50 $102.30 $102.30 $107.91 N/A N/A N/A N/A $123.75 $115.50 $107.25 $120.61 $57.75 $57.75 $99.00 $132.00 N/A $82.50 $57.75 N/A N/A N/A $132.00 N/A $132.00 N/A N/A $132.00 N/A N/A N/A $82.50 $82.50 $82.50 $123.75 $82.50 $82.50 N/A $107.25 $111.38 $111.38 $111.38 $111.38 N/A N/A N/A $110.06 $82.50 N/A N/A N/A N/A $57.75 $132.00 330104 272 HC SPINAL ANESTHESIA TRAY O $73.00 N/A N/A N/A $36.50 $45.26 $45.26 $47.74 N/A N/A N/A N/A $54.75 $51.10 $47.45 $53.36 $25.55 $25.55 $43.80 $58.40 N/A $36.50 $25.55 N/A N/A N/A $58.40 N/A $58.40 N/A N/A $58.40 N/A N/A N/A $36.50 $36.50 $36.50 $54.75 $36.50 $36.50 N/A $47.45 $49.28 $49.28 $49.28 $49.28 N/A N/A N/A $48.69 $36.50 N/A N/A N/A N/A $25.55 $58.40 330104 272 HC MARKER SKIN MRI 1.5CM #122 O $8.00 N/A N/A N/A $4.00 $4.96 $4.96 $5.23 N/A N/A N/A N/A $6.00 $5.60 $5.20 $5.85 $2.80 $2.80 $4.80 $6.40 N/A $4.00 $2.80 N/A N/A N/A $6.40 N/A $6.40 N/A N/A $6.40 N/A N/A N/A $4.00 $4.00 $4.00 $6.00 $4.00 $4.00 N/A $5.20 $5.40 $5.40 $5.40 $5.40 N/A N/A N/A $5.34 $4.00 N/A N/A N/A N/A $2.80 $6.40 330104 272 HC CART BRONCHOSCOPY O "$1,050.00 " N/A N/A N/A $525.00 $651.00 $651.00 $686.70 N/A N/A N/A N/A $787.50 $735.00 $682.50 $767.55 $367.50 $367.50 $630.00 $840.00 N/A $525.00 $367.50 N/A N/A N/A $840.00 N/A $840.00 N/A N/A $840.00 N/A N/A N/A $525.00 $525.00 $525.00 $787.50 $525.00 $525.00 N/A $682.50 $708.75 $708.75 $708.75 $708.75 N/A N/A N/A $700.35 $525.00 N/A N/A N/A N/A $367.50 $840.00 330104 272 HC BIOPSY TRAY BASIC **NYACK ONLY O $29.00 N/A N/A N/A $14.50 $17.98 $17.98 $18.97 N/A N/A N/A N/A $21.75 $20.30 $18.85 $21.20 $10.15 $10.15 $17.40 $23.20 N/A $14.50 $10.15 N/A N/A N/A $23.20 N/A $23.20 N/A N/A $23.20 N/A N/A N/A $14.50 $14.50 $14.50 $21.75 $14.50 $14.50 N/A $18.85 $19.58 $19.58 $19.58 $19.58 N/A N/A N/A $19.34 $14.50 N/A N/A N/A N/A $10.15 $23.20 330104 272 HC LUMBAR PUNCTURE TRAY AD **NYACK ONLY O $33.00 N/A N/A N/A $16.50 $20.46 $20.46 $21.58 N/A N/A N/A N/A $24.75 $23.10 $21.45 $24.12 $11.55 $11.55 $19.80 $26.40 N/A $16.50 $11.55 N/A N/A N/A $26.40 N/A $26.40 N/A N/A $26.40 N/A N/A N/A $16.50 $16.50 $16.50 $24.75 $16.50 $16.50 N/A $21.45 $22.28 $22.28 $22.28 $22.28 N/A N/A N/A $22.01 $16.50 N/A N/A N/A N/A $11.55 $26.40 330104 272 HC TROCAR CATH 24 FR **NYACK ONLY O $46.00 N/A N/A N/A $23.00 $28.52 $28.52 $30.08 N/A N/A N/A N/A $34.50 $32.20 $29.90 $33.63 $16.10 $16.10 $27.60 $36.80 N/A $23.00 $16.10 N/A N/A N/A $36.80 N/A $36.80 N/A N/A $36.80 N/A N/A N/A $23.00 $23.00 $23.00 $34.50 $23.00 $23.00 N/A $29.90 $31.05 $31.05 $31.05 $31.05 N/A N/A N/A $30.68 $23.00 N/A N/A N/A N/A $16.10 $36.80 330104 272 HC TRACH TUBE 7.0MM 513070 FENEST **NYACK ONLY O $95.00 N/A N/A N/A $47.50 $58.90 $58.90 $62.13 N/A N/A N/A N/A $71.25 $66.50 $61.75 $69.44 $33.25 $33.25 $57.00 $76.00 N/A $47.50 $33.25 N/A N/A N/A $76.00 N/A $76.00 N/A N/A $76.00 N/A N/A N/A $47.50 $47.50 $47.50 $71.25 $47.50 $47.50 N/A $61.75 $64.12 $64.12 $64.12 $64.12 N/A N/A N/A $63.37 $47.50 N/A N/A N/A N/A $33.25 $76.00 330104 272 HC PERI GYN PACK **NYACK ONLY O $22.00 N/A N/A N/A $11.00 $13.64 $13.64 $14.39 N/A N/A N/A N/A $16.50 $15.40 $14.30 $16.08 $7.70 $7.70 $13.20 $17.60 N/A $11.00 $7.70 N/A N/A N/A $17.60 N/A $17.60 N/A N/A $17.60 N/A N/A N/A $11.00 $11.00 $11.00 $16.50 $11.00 $11.00 N/A $14.30 $14.85 $14.85 $14.85 $14.85 N/A N/A N/A $14.67 $11.00 N/A N/A N/A N/A $7.70 $17.60 330104 272 HC CYSTO PACK **NYACK ONLY O $82.00 N/A N/A N/A $41.00 $50.84 $50.84 $53.63 N/A N/A N/A N/A $61.50 $57.40 $53.30 $59.94 $28.70 $28.70 $49.20 $65.60 N/A $41.00 $28.70 N/A N/A N/A $65.60 N/A $65.60 N/A N/A $65.60 N/A N/A N/A $41.00 $41.00 $41.00 $61.50 $41.00 $41.00 N/A $53.30 $55.35 $55.35 $55.35 $55.35 N/A N/A N/A $54.69 $41.00 N/A N/A N/A N/A $28.70 $65.60 330104 272 HC BASIC PACK **NYACK ONLY O $23.00 N/A N/A N/A $11.50 $14.26 $14.26 $15.04 N/A N/A N/A N/A $17.25 $16.10 $14.95 $16.81 $8.05 $8.05 $13.80 $18.40 N/A $11.50 $8.05 N/A N/A N/A $18.40 N/A $18.40 N/A N/A $18.40 N/A N/A N/A $11.50 $11.50 $11.50 $17.25 $11.50 $11.50 N/A $14.95 $15.53 $15.53 $15.53 $15.53 N/A N/A N/A $15.34 $11.50 N/A N/A N/A N/A $8.05 $18.40 330104 272 HC HEAD AND NECK PACK **NYACK ONLY O $93.00 N/A N/A N/A $46.50 $57.66 $57.66 $60.82 N/A N/A N/A N/A $69.75 $65.10 $60.45 $67.98 $32.55 $32.55 $55.80 $74.40 N/A $46.50 $32.55 N/A N/A N/A $74.40 N/A $74.40 N/A N/A $74.40 N/A N/A N/A $46.50 $46.50 $46.50 $69.75 $46.50 $46.50 N/A $60.45 $62.78 $62.78 $62.78 $62.78 N/A N/A N/A $62.03 $46.50 N/A N/A N/A N/A $32.55 $74.40 330104 272 HC CHLORAPREP APPLICATOR 10 ML O $10.00 N/A N/A N/A $5.00 $6.20 $6.20 $6.54 N/A N/A N/A N/A $7.50 $7.00 $6.50 $7.31 $3.50 $3.50 $6.00 $8.00 N/A $5.00 $3.50 N/A N/A N/A $8.00 N/A $8.00 N/A N/A $8.00 N/A N/A N/A $5.00 $5.00 $5.00 $7.50 $5.00 $5.00 N/A $6.50 $6.75 $6.75 $6.75 $6.75 N/A N/A N/A $6.67 $5.00 N/A N/A N/A N/A $3.50 $8.00 330104 272 HC SANDEL SKIN MARKER O $42.00 N/A N/A N/A $21.00 $26.04 $26.04 $27.47 N/A N/A N/A N/A $31.50 $29.40 $27.30 $30.70 $14.70 $14.70 $25.20 $33.60 N/A $21.00 $14.70 N/A N/A N/A $33.60 N/A $33.60 N/A N/A $33.60 N/A N/A N/A $21.00 $21.00 $21.00 $31.50 $21.00 $21.00 N/A $27.30 $28.35 $28.35 $28.35 $28.35 N/A N/A N/A $28.01 $21.00 N/A N/A N/A N/A $14.70 $33.60 330104 272 HC SITE RITE PROBE COVER KIT W/ GEL O $21.00 N/A N/A N/A $10.50 $13.02 $13.02 $13.73 N/A N/A N/A N/A $15.75 $14.70 $13.65 $15.35 $7.35 $7.35 $12.60 $16.80 N/A $10.50 $7.35 N/A N/A N/A $16.80 N/A $16.80 N/A N/A $16.80 N/A N/A N/A $10.50 $10.50 $10.50 $15.75 $10.50 $10.50 N/A $13.65 $14.18 $14.18 $14.18 $14.18 N/A N/A N/A $14.01 $10.50 N/A N/A N/A N/A $7.35 $16.80 330104 272 HC TRAY THOROCENTESIS O $468.00 N/A N/A N/A $234.00 $290.16 $290.16 $306.07 N/A N/A N/A N/A $351.00 $327.60 $304.20 $342.11 $163.80 $163.80 $280.80 $374.40 N/A $234.00 $163.80 N/A N/A N/A $374.40 N/A $374.40 N/A N/A $374.40 N/A N/A N/A $234.00 $234.00 $234.00 $351.00 $234.00 $234.00 N/A $304.20 $315.90 $315.90 $315.90 $315.90 N/A N/A N/A $312.16 $234.00 N/A N/A N/A N/A $163.80 $374.40 330104 272 HC TRAY INTUBATION O $112.00 N/A N/A N/A $56.00 $69.44 $69.44 $73.25 N/A N/A N/A N/A $84.00 $78.40 $72.80 $81.87 $39.20 $39.20 $67.20 $89.60 N/A $56.00 $39.20 N/A N/A N/A $89.60 N/A $89.60 N/A N/A $89.60 N/A N/A N/A $56.00 $56.00 $56.00 $84.00 $56.00 $56.00 N/A $72.80 $75.60 $75.60 $75.60 $75.60 N/A N/A N/A $74.70 $56.00 N/A N/A N/A N/A $39.20 $89.60 330104 272 HC TRAY CUT DOWN O $308.00 N/A N/A N/A $154.00 $190.96 $190.96 $201.43 N/A N/A N/A N/A $231.00 $215.60 $200.20 $225.15 $107.80 $107.80 $184.80 $246.40 N/A $154.00 $107.80 N/A N/A N/A $246.40 N/A $246.40 N/A N/A $246.40 N/A N/A N/A $154.00 $154.00 $154.00 $231.00 $154.00 $154.00 N/A $200.20 $207.90 $207.90 $207.90 $207.90 N/A N/A N/A $205.44 $154.00 N/A N/A N/A N/A $107.80 $246.40 330104 272 HC ELECTRODE QUADTRODE ECG STAND 9303N O $19.00 N/A N/A N/A $9.50 $11.78 $11.78 $12.43 N/A N/A N/A N/A $14.25 $13.30 $12.35 $13.89 $6.65 $6.65 $11.40 $15.20 N/A $9.50 $6.65 N/A N/A N/A $15.20 N/A $15.20 N/A N/A $15.20 N/A N/A N/A $9.50 $9.50 $9.50 $14.25 $9.50 $9.50 N/A $12.35 $12.83 $12.83 $12.83 $12.83 N/A N/A N/A $12.67 $9.50 N/A N/A N/A N/A $6.65 $15.20 330104 272 HC CONTINUOUS BLOCK KIT O $319.00 N/A N/A N/A $159.50 $197.78 $197.78 $208.63 N/A N/A N/A N/A $239.25 $223.30 $207.35 $233.19 $111.65 $111.65 $191.40 $255.20 N/A $159.50 $111.65 N/A N/A N/A $255.20 N/A $255.20 N/A N/A $255.20 N/A N/A N/A $159.50 $159.50 $159.50 $239.25 $159.50 $159.50 N/A $207.35 $215.33 $215.33 $215.33 $215.33 N/A N/A N/A $212.77 $159.50 N/A N/A N/A N/A $111.65 $255.20 330104 272 HC MEDELA BREAST PUMP HARMONY MAN 67186S O $43.00 N/A N/A N/A $21.50 $26.66 $26.66 $28.12 N/A N/A N/A N/A $32.25 $30.10 $27.95 $31.43 $15.05 $15.05 $25.80 $34.40 N/A $21.50 $15.05 N/A N/A N/A $34.40 N/A $34.40 N/A N/A $34.40 N/A N/A N/A $21.50 $21.50 $21.50 $32.25 $21.50 $21.50 N/A $27.95 $29.03 $29.03 $29.03 $29.03 N/A N/A N/A $28.68 $21.50 N/A N/A N/A N/A $15.05 $34.40 330104 272 HC MEDELA NIPPLE SHIELD 20MM 89907S O $12.00 N/A N/A N/A $6.00 $7.44 $7.44 $7.85 N/A N/A N/A N/A $9.00 $8.40 $7.80 $8.77 $4.20 $4.20 $7.20 $9.60 N/A $6.00 $4.20 N/A N/A N/A $9.60 N/A $9.60 N/A N/A $9.60 N/A N/A N/A $6.00 $6.00 $6.00 $9.00 $6.00 $6.00 N/A $7.80 $8.10 $8.10 $8.10 $8.10 N/A N/A N/A $8.00 $6.00 N/A N/A N/A N/A $4.20 $9.60 330104 272 HC CERVICAL RIPENING BALLOON W/STYLET O $131.00 N/A N/A N/A $65.50 $81.22 $81.22 $85.67 N/A N/A N/A N/A $98.25 $91.70 $85.15 $95.76 $45.85 $45.85 $78.60 $104.80 N/A $65.50 $45.85 N/A N/A N/A $104.80 N/A $104.80 N/A N/A $104.80 N/A N/A N/A $65.50 $65.50 $65.50 $98.25 $65.50 $65.50 N/A $85.15 $88.43 $88.43 $88.43 $88.43 N/A N/A N/A $87.38 $65.50 N/A N/A N/A N/A $45.85 $104.80 330104 272 HC NOVII PATCH FETAL MONITOR 107-PT-004-50 O $111.00 N/A N/A N/A $55.50 $68.82 $68.82 $72.59 N/A N/A N/A N/A $83.25 $77.70 $72.15 $81.14 $38.85 $38.85 $66.60 $88.80 N/A $55.50 $38.85 N/A N/A N/A $88.80 N/A $88.80 N/A N/A $88.80 N/A N/A N/A $55.50 $55.50 $55.50 $83.25 $55.50 $55.50 N/A $72.15 $74.93 $74.93 $74.93 $74.93 N/A N/A N/A $74.04 $55.50 N/A N/A N/A N/A $38.85 $88.80 330104 272 HC PUMP FLANGES O $17.00 N/A N/A N/A $8.50 $10.54 $10.54 $11.12 N/A N/A N/A N/A $12.75 $11.90 $11.05 $12.43 $5.95 $5.95 $10.20 $13.60 N/A $8.50 $5.95 N/A N/A N/A $13.60 N/A $13.60 N/A N/A $13.60 N/A N/A N/A $8.50 $8.50 $8.50 $12.75 $8.50 $8.50 N/A $11.05 $11.48 $11.48 $11.48 $11.48 N/A N/A N/A $11.34 $8.50 N/A N/A N/A N/A $5.95 $13.60 330104 272 HC SINGLE KIT WITH MANUAL PUMP O $58.00 N/A N/A N/A $29.00 $35.96 $35.96 $37.93 N/A N/A N/A N/A $43.50 $40.60 $37.70 $42.40 $20.30 $20.30 $34.80 $46.40 N/A $29.00 $20.30 N/A N/A N/A $46.40 N/A $46.40 N/A N/A $46.40 N/A N/A N/A $29.00 $29.00 $29.00 $43.50 $29.00 $29.00 N/A $37.70 $39.15 $39.15 $39.15 $39.15 N/A N/A N/A $38.69 $29.00 N/A N/A N/A N/A $20.30 $46.40 330104 272 HC DOUBLE PUMP KIT O $26.00 N/A N/A N/A $13.00 $16.12 $16.12 $17.00 N/A N/A N/A N/A $19.50 $18.20 $16.90 $19.01 $9.10 $9.10 $15.60 $20.80 N/A $13.00 $9.10 N/A N/A N/A $20.80 N/A $20.80 N/A N/A $20.80 N/A N/A N/A $13.00 $13.00 $13.00 $19.50 $13.00 $13.00 N/A $16.90 $17.55 $17.55 $17.55 $17.55 N/A N/A N/A $17.34 $13.00 N/A N/A N/A N/A $9.10 $20.80 330104 272 HC CIVCO NEEDLE GUIDE COVERS O $65.00 N/A N/A N/A $32.50 $40.30 $40.30 $42.51 N/A N/A N/A N/A $48.75 $45.50 $42.25 $47.52 $22.75 $22.75 $39.00 $52.00 N/A $32.50 $22.75 N/A N/A N/A $52.00 N/A $52.00 N/A N/A $52.00 N/A N/A N/A $32.50 $32.50 $32.50 $48.75 $32.50 $32.50 N/A $42.25 $43.88 $43.88 $43.88 $43.88 N/A N/A N/A $43.36 $32.50 N/A N/A N/A N/A $22.75 $52.00 330104 272 HC SINGLE PUMP KIT O $15.00 N/A N/A N/A $7.50 $9.30 $9.30 $9.81 N/A N/A N/A N/A $11.25 $10.50 $9.75 $10.96 $5.25 $5.25 $9.00 $12.00 N/A $7.50 $5.25 N/A N/A N/A $12.00 N/A $12.00 N/A N/A $12.00 N/A N/A N/A $7.50 $7.50 $7.50 $11.25 $7.50 $7.50 N/A $9.75 $10.12 $10.12 $10.12 $10.12 N/A N/A N/A $10.01 $7.50 N/A N/A N/A N/A $5.25 $12.00 330104 272 HC BASIC DIALYSIS CATH. #20 O $383.00 N/A N/A N/A $191.50 $237.46 $237.46 $250.48 N/A N/A N/A N/A $287.25 $268.10 $248.95 $279.97 $134.05 $134.05 $229.80 $306.40 N/A $191.50 $134.05 N/A N/A N/A $306.40 N/A $306.40 N/A N/A $306.40 N/A N/A N/A $191.50 $191.50 $191.50 $287.25 $191.50 $191.50 N/A $248.95 $258.53 $258.53 $258.53 $258.53 N/A N/A N/A $255.46 $191.50 N/A N/A N/A N/A $134.05 $306.40 330104 272 HC BARD ACCESS PICC 4.0FR O $627.00 N/A N/A N/A $313.50 $388.74 $388.74 $410.06 N/A N/A N/A N/A $470.25 $438.90 $407.55 $458.34 $219.45 $219.45 $376.20 $501.60 N/A $313.50 $219.45 N/A N/A N/A $501.60 N/A $501.60 N/A N/A $501.60 N/A N/A N/A $313.50 $313.50 $313.50 $470.25 $313.50 $313.50 N/A $407.55 $423.23 $423.23 $423.23 $423.23 N/A N/A N/A $418.21 $313.50 N/A N/A N/A N/A $219.45 $501.60 330104 272 HC MRI CLIP V SHAPE STMK14GSS O $301.00 N/A N/A N/A $150.50 $186.62 $186.62 $196.85 N/A N/A N/A N/A $225.75 $210.70 $195.65 $220.03 $105.35 $105.35 $180.60 $240.80 N/A $150.50 $105.35 N/A N/A N/A $240.80 N/A $240.80 N/A N/A $240.80 N/A N/A N/A $150.50 $150.50 $150.50 $225.75 $150.50 $150.50 N/A $195.65 $203.18 $203.18 $203.18 $203.18 N/A N/A N/A $200.77 $150.50 N/A N/A N/A N/A $105.35 $240.80 330104 272 HC MRI SITE MARKER WING BARD O $189.00 N/A N/A N/A $94.50 $117.18 $117.18 $123.61 N/A N/A N/A N/A $141.75 $132.30 $122.85 $138.16 $66.15 $66.15 $113.40 $151.20 N/A $94.50 $66.15 N/A N/A N/A $151.20 N/A $151.20 N/A N/A $151.20 N/A N/A N/A $94.50 $94.50 $94.50 $141.75 $94.50 $94.50 N/A $122.85 $127.58 $127.58 $127.58 $127.58 N/A N/A N/A $126.06 $94.50 N/A N/A N/A N/A $66.15 $151.20 330104 272 HC NEEDLE BRST BLOCK MRI 9896-032-03481 O $20.00 N/A N/A N/A $10.00 $12.40 $12.40 $13.08 N/A N/A N/A N/A $15.00 $14.00 $13.00 $14.62 $7.00 $7.00 $12.00 $16.00 N/A $10.00 $7.00 N/A N/A N/A $16.00 N/A $16.00 N/A N/A $16.00 N/A N/A N/A $10.00 $10.00 $10.00 $15.00 $10.00 $10.00 N/A $13.00 $13.50 $13.50 $13.50 $13.50 N/A N/A N/A $13.34 $10.00 N/A N/A N/A N/A $7.00 $16.00 330104 272 HC ENT CART O $162.00 N/A N/A N/A $81.00 $100.44 $100.44 $105.95 N/A N/A N/A N/A $121.50 $113.40 $105.30 $118.42 $56.70 $56.70 $97.20 $129.60 N/A $81.00 $56.70 N/A N/A N/A $129.60 N/A $129.60 N/A N/A $129.60 N/A N/A N/A $81.00 $81.00 $81.00 $121.50 $81.00 $81.00 N/A $105.30 $109.35 $109.35 $109.35 $109.35 N/A N/A N/A $108.05 $81.00 N/A N/A N/A N/A $56.70 $129.60 330104 L3260 1001 274 HC AMBULATORY SURGICAL BOOT EAC O $24.00 N/A N/A N/A $4.44 $19.20 $19.20 $15.70 N/A N/A N/A N/A N/A $12.00 $15.60 $17.54 N/A N/A $14.40 $19.20 N/A $12.00 N/A N/A N/A $12.00 $7.92 $12.00 N/A N/A N/A N/A N/A N/A N/A $19.20 $20.40 N/A $9.12 N/A N/A $12.00 $15.60 $16.20 $16.20 $16.20 $16.20 $9.60 $12.00 N/A $9.60 N/A $12.00 $12.00 $12.00 N/A $4.44 $20.40 330104 Q4195 455 278 HC PURAPLY (5X5) 25 SQ CM O $155.00 N/A N/A N/A $28.68 $124.00 $124.00 N/A N/A N/A N/A N/A N/A $77.50 $100.75 $113.30 N/A N/A $93.00 $124.00 N/A $77.50 N/A N/A $100.75 $77.50 $51.15 $77.50 N/A N/A N/A N/A N/A N/A N/A $124.00 $131.75 N/A $58.90 N/A N/A $77.50 $100.75 $104.62 $104.62 $104.62 $104.62 $62.00 $77.50 N/A $62.00 N/A $77.50 $77.50 $77.50 N/A $28.68 $131.75 330104 C1751 2006 278 HC BARD MIDLINE KIT 4F O $400.00 N/A N/A N/A $74.00 $320.00 $320.00 $261.60 N/A N/A N/A N/A N/A $200.00 $260.00 $292.40 N/A N/A $240.00 $320.00 N/A $200.00 N/A N/A N/A $200.00 $132.00 $200.00 N/A N/A N/A N/A N/A N/A N/A $320.00 $340.00 N/A $152.00 N/A N/A $200.00 $260.00 $270.00 $270.00 $270.00 $270.00 $160.00 $200.00 N/A $160.00 N/A $200.00 $200.00 $200.00 N/A $74.00 $340.00 330104 Q4158 455 278 HC MARIGEN O $703.00 N/A N/A N/A $130.06 $562.40 $562.40 N/A N/A N/A N/A N/A N/A $351.50 $456.95 $513.89 N/A N/A $421.80 $562.40 N/A $351.50 N/A N/A $456.95 $351.50 $231.99 $351.50 N/A N/A N/A N/A N/A N/A N/A $562.40 $597.55 N/A $267.14 N/A N/A $351.50 $456.95 $474.53 $474.53 $474.53 $474.53 $281.20 $351.50 N/A $281.20 N/A $351.50 $351.50 $351.50 N/A $130.06 $597.55 330104 A4648 2006 278 HC IMPLANTABLE TISSUE MARKER O $252.00 N/A N/A N/A $46.62 $201.60 $201.60 N/A N/A N/A N/A N/A N/A $126.00 $163.80 $184.21 N/A N/A $151.20 $201.60 N/A $126.00 N/A N/A $163.80 $126.00 $83.16 $126.00 N/A N/A N/A N/A N/A N/A N/A $201.60 $214.20 N/A $95.76 N/A N/A $126.00 $163.80 $170.10 $170.10 $170.10 $170.10 $100.80 $126.00 N/A $100.80 N/A $126.00 $126.00 $126.00 N/A $46.62 $214.20 330104 C2639 2639 335 278 HC BRACHYTX NON-STRANDEDI-125 RADONC O $300.00 $42.36 $42.36 $997.14 $55.50 $240.00 $240.00 $41.94 $997.14 $80.49 $997.14 $42.36 N/A $150.00 $195.00 $219.30 "$1,196.57 " $997.14 $180.00 $240.00 $144.03 $150.00 $997.14 $42.36 $50.84 $150.00 $99.00 $150.00 $997.14 "$1,196.57 " $59.31 $997.14 $42.36 $42.36 $46.18 $240.00 $255.00 $997.14 $114.00 "$2,044.14 " $997.14 $150.00 $69.90 $202.50 $202.50 $202.50 $202.50 $120.00 $150.00 $42.36 $120.00 $997.14 $150.00 $150.00 $150.00 $42.36 $41.94 "$2,044.14 " 330104 Q4195 455 278 HC PURAPLY (2X4) 8 SQ CM O $356.00 N/A N/A N/A $65.86 $284.80 $284.80 N/A N/A N/A N/A N/A N/A $178.00 $231.40 $260.24 N/A N/A $213.60 $284.80 N/A $178.00 N/A N/A $231.40 $178.00 $117.48 $178.00 N/A N/A N/A N/A N/A N/A N/A $284.80 $302.60 N/A $135.28 N/A N/A $178.00 $231.40 $240.30 $240.30 $240.30 $240.30 $142.40 $178.00 N/A $142.40 N/A $178.00 $178.00 $178.00 N/A $65.86 $302.60 330104 Q4196 455 278 HC PURAPLY AM (5X5) 25 SQ CM O $155.00 N/A N/A N/A $28.68 $124.00 $124.00 N/A N/A N/A N/A N/A N/A $77.50 $100.75 $113.30 N/A N/A $93.00 $124.00 N/A $77.50 N/A N/A $100.75 $77.50 $51.15 $77.50 N/A N/A N/A N/A N/A N/A N/A $124.00 $131.75 N/A $58.90 N/A N/A $77.50 $100.75 $104.62 $104.62 $104.62 $104.62 $62.00 $77.50 N/A $62.00 N/A $77.50 $77.50 $77.50 N/A $28.68 $131.75 330104 A4648 2006 278 HC IMPLANTABLE TISSUE MARKER EACH O $189.00 N/A N/A N/A $34.96 $151.20 $151.20 N/A N/A N/A N/A N/A N/A $94.50 $122.85 $138.16 N/A N/A $113.40 $151.20 N/A $94.50 N/A N/A $122.85 $94.50 $62.37 $94.50 N/A N/A N/A N/A N/A N/A N/A $151.20 $160.65 N/A $71.82 N/A N/A $94.50 $122.85 $127.58 $127.58 $127.58 $127.58 $75.60 $94.50 N/A $75.60 N/A $94.50 $94.50 $94.50 N/A $34.96 $160.65 330104 Q4101 455 278 HC APLIGRAF O $185.00 N/A N/A N/A $34.23 $148.00 $148.00 N/A N/A N/A N/A N/A N/A $92.50 $120.25 $135.23 N/A N/A $111.00 $148.00 N/A $92.50 N/A N/A $120.25 $92.50 $61.05 $92.50 N/A N/A N/A N/A N/A N/A N/A $148.00 $157.25 N/A $70.30 N/A N/A $92.50 $120.25 $124.88 $124.88 $124.88 $124.88 $74.00 $92.50 N/A $74.00 N/A $92.50 $92.50 $92.50 N/A $34.23 $157.25 330104 Q4150 455 278 HC ALLOWRAP DS OR DRY O "$3,150.00 " N/A N/A N/A $582.75 "$2,520.00 " "$2,520.00 " N/A N/A N/A N/A N/A N/A "$1,575.00 " "$2,047.50 " "$2,302.65 " N/A N/A "$1,890.00 " "$2,520.00 " N/A "$1,575.00 " N/A N/A "$2,047.50 " "$1,575.00 " "$1,039.50 " "$1,575.00 " N/A N/A N/A N/A N/A N/A N/A "$2,520.00 " "$2,677.50 " N/A "$1,197.00 " N/A N/A "$1,575.00 " "$2,047.50 " "$2,126.25 " "$2,126.25 " "$2,126.25 " "$2,126.25 " "$1,260.00 " "$1,575.00 " N/A "$1,260.00 " N/A "$1,575.00 " "$1,575.00 " "$1,575.00 " N/A $582.75 "$2,677.50 " 330104 Q4196 455 278 HC PURAPLY AM 1.6 CM DISC O $675.00 N/A N/A N/A $124.88 $540.00 $540.00 N/A N/A N/A N/A N/A N/A $337.50 $438.75 $493.43 N/A N/A $405.00 $540.00 N/A $337.50 N/A N/A $438.75 $337.50 $222.75 $337.50 N/A N/A N/A N/A N/A N/A N/A $540.00 $573.75 N/A $256.50 N/A N/A $337.50 $438.75 $455.63 $455.63 $455.63 $455.63 $270.00 $337.50 N/A $270.00 N/A $337.50 $337.50 $337.50 N/A $124.88 $573.75 330104 Q4196 455 278 HC PURAPLY AM (2X4) 8 SQ CM O $356.00 N/A N/A N/A $65.86 $284.80 $284.80 N/A N/A N/A N/A N/A N/A $178.00 $231.40 $260.24 N/A N/A $213.60 $284.80 N/A $178.00 N/A N/A $231.40 $178.00 $117.48 $178.00 N/A N/A N/A N/A N/A N/A N/A $284.80 $302.60 N/A $135.28 N/A N/A $178.00 $231.40 $240.30 $240.30 $240.30 $240.30 $142.40 $178.00 N/A $142.40 N/A $178.00 $178.00 $178.00 N/A $65.86 $302.60 330104 Q4196 455 278 HC PURAPLY AM (3X4) 12 SQ CM O $110.00 N/A N/A N/A $20.35 $88.00 $88.00 N/A N/A N/A N/A N/A N/A $55.00 $71.50 $80.41 N/A N/A $66.00 $88.00 N/A $55.00 N/A N/A $71.50 $55.00 $36.30 $55.00 N/A N/A N/A N/A N/A N/A N/A $88.00 $93.50 N/A $41.80 N/A N/A $55.00 $71.50 $74.25 $74.25 $74.25 $74.25 $44.00 $55.00 N/A $44.00 N/A $55.00 $55.00 $55.00 N/A $20.35 $93.50 330104 Q4196 455 278 HC PURAPLY AM (4X4) 16 SQ CM O $108.00 N/A N/A N/A $19.98 $86.40 $86.40 N/A N/A N/A N/A N/A N/A $54.00 $70.20 $78.95 N/A N/A $64.80 $86.40 N/A $54.00 N/A N/A $70.20 $54.00 $35.64 $54.00 N/A N/A N/A N/A N/A N/A N/A $86.40 $91.80 N/A $41.04 N/A N/A $54.00 $70.20 $72.90 $72.90 $72.90 $72.90 $43.20 $54.00 N/A $43.20 N/A $54.00 $54.00 $54.00 N/A $19.98 $91.80 330104 C1713 2006 278 HC LINER LONGEVITY 36X62 O "$5,160.00 " N/A N/A N/A $954.60 "$4,128.00 " "$4,128.00 " "$3,374.64 " N/A N/A N/A N/A N/A "$2,580.00 " "$3,354.00 " "$3,771.96 " N/A N/A "$3,096.00 " "$4,128.00 " N/A "$2,580.00 " N/A N/A N/A "$2,580.00 " "$1,702.80 " "$2,580.00 " N/A N/A N/A N/A N/A N/A N/A "$4,128.00 " "$4,386.00 " N/A "$1,960.80 " N/A N/A "$2,580.00 " "$3,354.00 " "$3,483.00 " "$3,483.00 " "$3,483.00 " "$3,483.00 " "$2,064.00 " "$2,580.00 " N/A "$2,064.00 " N/A "$2,580.00 " "$2,580.00 " "$2,580.00 " N/A $954.60 "$4,386.00 " 330104 C2639 2639 335 278 HC BRACHYTX NON-STRANDEDI-125 O $225.00 $42.36 $42.36 $997.14 $41.62 $180.00 $180.00 $41.94 $997.14 $80.49 $997.14 $42.36 N/A $112.50 $146.25 $164.47 "$1,196.57 " $997.14 $135.00 $180.00 $144.03 $112.50 $997.14 $42.36 $50.84 $112.50 $74.25 $112.50 $997.14 "$1,196.57 " $59.31 $997.14 $42.36 $42.36 $46.18 $180.00 $191.25 $997.14 $85.50 "$2,044.14 " $997.14 $112.50 $69.90 $151.88 $151.88 $151.88 $151.88 $90.00 $112.50 $42.36 $90.00 $997.14 $112.50 $112.50 $112.50 $42.36 $41.62 "$2,044.14 " 330104 C2638 2638 335 278 HC BRACHYTX STRANDED I-125 O $115.00 $45.77 $45.77 $997.14 $21.27 $92.00 $92.00 $45.31 $997.14 $86.96 $997.14 $45.77 N/A $57.50 $74.75 $84.06 "$1,196.57 " $997.14 $69.00 $92.00 $155.62 $57.50 $997.14 $45.77 $54.92 $57.50 $37.95 $57.50 $997.14 "$1,196.57 " $64.08 $997.14 $45.77 $45.77 $49.89 $92.00 $97.75 $997.14 $43.70 "$2,044.14 " $997.14 $57.50 $75.52 $77.62 $77.62 $77.62 $77.62 $46.00 $57.50 $45.77 $46.00 $997.14 $57.50 $57.50 $57.50 $45.77 $21.27 "$2,044.14 " 330104 C2628 2006 278 HC CATHETER OCCLUSION O $780.00 N/A N/A N/A $144.30 $624.00 $624.00 $510.12 N/A N/A N/A N/A N/A $390.00 $507.00 $570.18 N/A N/A $468.00 $624.00 N/A $390.00 N/A N/A N/A $390.00 $257.40 $390.00 N/A N/A N/A N/A N/A N/A N/A $624.00 $663.00 N/A $296.40 N/A N/A $390.00 $507.00 $526.50 $526.50 $526.50 $526.50 $312.00 $390.00 N/A $312.00 N/A $390.00 $390.00 $390.00 N/A $144.30 $663.00 330104 Q4196 455 278 HC PURAPLY AM (2X2) 4 SQ CM O $563.00 N/A N/A N/A $104.16 $450.40 $450.40 N/A N/A N/A N/A N/A N/A $281.50 $365.95 $411.55 N/A N/A $337.80 $450.40 N/A $281.50 N/A N/A $365.95 $281.50 $185.79 $281.50 N/A N/A N/A N/A N/A N/A N/A $450.40 $478.55 N/A $213.94 N/A N/A $281.50 $365.95 $380.03 $380.03 $380.03 $380.03 $225.20 $281.50 N/A $225.20 N/A $281.50 $281.50 $281.50 N/A $104.16 $478.55 330104 Q4106 455 278 HC DERMAGRAFT O $99.00 N/A N/A N/A $18.32 $79.20 $79.20 N/A N/A N/A N/A N/A N/A $49.50 $64.35 $72.37 N/A N/A $59.40 $79.20 N/A $49.50 N/A N/A $64.35 $49.50 $32.67 $49.50 N/A N/A N/A N/A N/A N/A N/A $79.20 $84.15 N/A $37.62 N/A N/A $49.50 $64.35 $66.83 $66.83 $66.83 $66.83 $39.60 $49.50 N/A $39.60 N/A $49.50 $49.50 $49.50 N/A $18.32 $84.15 330104 0708T 111 280 HC INTRADERMAL CANCER IMMNTX PREP & 1ST INJECTION O $107.00 N/A N/A $271.09 $53.50 $66.34 $66.34 N/A $271.09 N/A $271.09 N/A $80.25 N/A $69.55 $78.22 $325.31 $271.09 $64.20 $85.60 N/A $53.50 $271.09 N/A $69.55 $379.53 $85.60 $271.09 $271.09 $325.31 N/A $271.09 N/A N/A N/A $85.60 $90.95 $365.97 $80.25 $555.74 $365.97 $53.50 $69.55 $72.23 $72.23 $72.23 $72.23 N/A N/A N/A $71.37 $271.09 $271.09 N/A N/A N/A $53.50 $555.74 330104 E0779 1002 291 HC INFUSE PUMP O $29.96 N/A N/A N/A $14.98 $18.58 $18.58 $19.59 N/A N/A N/A N/A $22.47 N/A $19.47 $21.90 N/A N/A $17.98 $23.97 N/A $14.98 N/A N/A N/A N/A $23.97 N/A N/A N/A N/A N/A N/A N/A N/A $23.97 $25.47 N/A $22.47 N/A N/A $14.98 $19.47 $20.22 $20.22 $20.22 $20.22 N/A N/A N/A $19.98 N/A N/A N/A N/A N/A $14.98 $25.47 330104 81003 410 300 HC URINALYSIS AUTO W/O SCOPE O $112.35 $2.25 $2.25 $2.00 $56.17 N/A N/A N/A $2.00 $4.27 $2.00 $2.25 $84.26 $2.48 $70.78 $82.13 $2.40 $2.00 $67.41 $89.88 $7.65 $12.83 $2.00 $2.25 $73.03 $2.80 $89.88 $2.00 $2.00 $2.40 $3.15 $2.00 $2.25 $2.25 $2.45 $89.88 $95.50 $2.70 $84.26 $4.10 $2.70 $56.17 $73.03 $3.16 $3.16 $3.16 $3.16 $3.79 $2.36 $2.25 $3.79 $2.00 $2.00 $1.69 $1.69 $1.69 $1.69 $95.50 330104 81002 410 300 HC URINALYSIS NONAUTO W/O SCOPE O $192.60 $3.48 $3.48 $2.00 $96.30 N/A N/A N/A $2.00 $6.61 $2.00 $3.48 $144.45 $3.83 $121.34 $140.79 $2.40 $2.00 $115.56 $154.08 $11.83 $19.84 $2.00 $3.48 $125.19 $2.80 $154.08 $2.00 $2.00 $2.40 $4.87 $2.00 $3.48 $3.48 $3.79 $154.08 $163.71 $2.70 $144.45 $4.10 $2.70 $96.30 $125.19 $4.89 $4.89 $4.89 $4.89 $4.32 $3.65 $3.48 $4.32 $2.00 $2.00 $2.61 $2.61 $2.61 $2.00 $163.71 330104 81001 410 300 HC URINALYSIS AUTO W/SCOPE O $42.80 $3.17 $3.17 $3.17 $21.40 N/A N/A N/A $3.17 $6.02 $3.17 $3.17 $32.10 $3.49 $26.96 $31.29 $3.80 $3.17 $25.68 $34.24 $10.78 $18.07 $3.17 $3.17 $27.82 $4.44 $34.24 $3.17 $3.17 $3.80 $4.44 $3.17 $3.17 $3.17 $3.46 $34.24 $36.38 $4.28 $32.10 $6.50 $4.28 $21.40 $27.82 $4.45 $4.45 $4.45 $4.45 $5.34 $3.33 $3.17 $5.34 $3.17 $3.17 $2.38 $2.38 $2.38 $2.38 $36.38 330104 80365 2040 300 HC OXYCODONE O $151.94 $114.43 $114.43 $5.00 $75.97 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $113.95 $125.87 $95.72 $111.07 $6.00 $5.00 $91.16 $121.55 $389.06 $652.25 $5.00 $114.43 $98.76 $7.00 $121.55 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $121.55 $129.15 $6.75 $113.95 $10.25 $6.75 $75.97 $98.76 $160.77 $160.77 $160.77 $160.77 $31.91 $120.15 $114.43 $31.91 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 81025 410 300 HC URINE PREGNANCY TEST O $54.57 $8.61 $8.61 $2.00 $27.29 N/A N/A N/A $2.00 $16.36 $2.00 $8.61 $40.93 $9.47 $34.38 $39.89 $2.40 $2.00 $32.74 $43.66 $29.27 $49.08 $2.00 $8.61 $35.47 $2.80 $43.66 $2.00 $2.00 $2.40 $12.05 $2.00 $8.61 $8.61 $9.38 $43.66 $46.38 $2.70 $40.93 $4.10 $2.70 $27.29 $35.47 $12.10 $12.10 $12.10 $12.10 $10.68 $9.04 $8.61 $10.68 $2.00 $2.00 $6.46 $6.46 $6.46 $2.00 $49.08 330104 80361 2040 300 HC OPIATES 1 OR MORE O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $41.98 $120.15 $114.43 $41.98 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80358 2040 300 HC METHADONE SERUM O $205.44 $114.43 $114.43 $5.00 $102.72 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $154.08 $125.87 $129.43 $150.18 $6.00 $5.00 $123.26 $164.35 $389.06 $652.25 $5.00 $114.43 $133.54 $7.00 $164.35 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $164.35 $174.62 $6.75 $154.08 $10.25 $6.75 $102.72 $133.54 $160.77 $160.77 $160.77 $160.77 $26.66 $120.15 $114.43 $26.66 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80353 2040 300 HC COCAINE O $219.35 $114.43 $114.43 $5.00 $109.67 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $164.51 $125.87 $138.19 $160.34 $6.00 $5.00 $131.61 $175.48 $389.06 $652.25 $5.00 $114.43 $142.58 $7.00 $175.48 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $175.48 $186.45 $6.75 $164.51 $10.25 $6.75 $109.67 $142.58 $160.77 $160.77 $160.77 $160.77 $24.74 $120.15 $114.43 $24.74 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80349 2040 300 HC CANNABINOIDS NATURAL O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $29.32 $120.15 $114.43 $29.32 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80347 2040 300 HC BENZODIAZEPINES; 13 OR MORE O $121.98 $114.43 $114.43 $5.00 $60.99 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $91.48 $125.87 $76.85 $89.17 $6.00 $5.00 $73.19 $97.58 $389.06 $652.25 $5.00 $114.43 $79.29 $7.00 $97.58 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $97.58 $103.68 $6.75 $91.48 $10.25 $6.75 $60.99 $79.29 $160.77 $160.77 $160.77 $160.77 $32.33 $120.15 $114.43 $32.33 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 36415 304 300 HC ROUTINE VENIPUNCTURE O $21.40 $8.57 $8.57 N/A $10.70 N/A N/A N/A N/A $16.28 N/A $8.57 $16.05 $9.43 $13.48 $15.64 N/A N/A $12.84 $17.12 $29.14 $48.85 N/A $8.57 $13.91 N/A $17.12 N/A N/A N/A $12.00 N/A $8.57 $8.57 $9.34 $17.12 $18.19 N/A $16.05 N/A N/A $10.70 $13.91 $12.04 $12.04 $12.04 $12.04 $3.60 $9.00 $8.57 $3.60 N/A N/A $6.43 $6.43 $6.43 $3.60 $48.85 330104 80345 2040 300 HC BARBITURATES O $466.52 $114.43 $114.43 $5.00 $233.26 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $349.89 $125.87 $293.91 $341.03 $6.00 $5.00 $279.91 $373.22 $389.06 $652.25 $5.00 $114.43 $303.24 $7.00 $373.22 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $373.22 $396.54 $6.75 $349.89 $10.25 $6.75 $233.26 $303.24 $160.77 $160.77 $160.77 $160.77 $18.70 $120.15 $114.43 $18.70 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80332 2041 300 HC IMIPRAMINE- O $202.23 $114.43 $114.43 N/A $101.11 N/A N/A N/A N/A $217.42 N/A $114.43 $151.67 $125.87 $127.40 $147.83 N/A N/A $121.34 $161.78 $389.06 $652.25 N/A $114.43 $131.45 N/A $161.78 N/A N/A N/A $160.20 N/A $114.43 $114.43 $124.73 $161.78 $171.90 N/A $151.67 N/A N/A $101.11 $131.45 $160.77 $160.77 $160.77 $160.77 $29.32 $120.15 $114.43 $29.32 N/A N/A $85.82 $85.82 $85.82 $29.32 $652.25 330104 80329 2040 300 HC ACETAMINOPHEN- O $182.97 $114.43 $114.43 N/A $91.48 N/A N/A N/A N/A $217.42 N/A $114.43 $137.23 $125.87 $115.27 $133.75 N/A N/A $109.78 $146.38 $389.06 $652.25 N/A $114.43 $118.93 N/A $146.38 N/A N/A N/A $160.20 N/A $114.43 $114.43 $124.73 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $160.77 $160.77 $160.77 $160.77 $33.05 $120.15 $114.43 $33.05 N/A N/A $85.82 $85.82 $85.82 $33.05 $652.25 330104 80326 2040 300 HC AMPHETAMINES; 5 OR MORE O $364.87 N/A N/A $5.00 $182.44 N/A N/A N/A $5.00 N/A $5.00 N/A $273.65 N/A $229.87 $266.72 $6.00 $5.00 $218.92 $291.90 N/A N/A $5.00 N/A $237.17 $7.00 $291.90 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $291.90 $310.14 $6.75 $273.65 $10.25 $6.75 $182.44 $237.17 N/A N/A N/A N/A $25.38 N/A N/A $25.38 $5.00 $5.00 N/A N/A N/A $5.00 $310.14 330104 0097U 388 300 "HC GI PROFILE, STOOL, PCR" O $303.88 N/A N/A N/A $151.94 N/A N/A $198.74 N/A N/A N/A N/A $227.91 N/A $191.44 $222.14 N/A N/A $182.33 $243.10 N/A N/A N/A N/A N/A N/A $243.10 N/A N/A N/A N/A N/A N/A N/A N/A $243.10 $258.30 N/A $227.91 N/A N/A $151.94 $197.52 N/A N/A N/A N/A N/A N/A N/A $202.69 N/A N/A N/A N/A N/A $151.94 $258.30 330104 G2023 304 300 HC SPECIMEN COLLECT COVID-19 O $84.53 $23.46 $23.46 $23.46 $42.27 $3.59 $3.25 $2.85 $23.46 $44.57 $23.46 $23.46 $63.40 $25.81 $53.25 $61.79 $28.15 $23.46 $50.72 $67.62 $79.76 $133.72 $23.46 $23.46 $54.94 $32.84 $67.62 $23.46 $23.46 $28.15 $32.84 $23.46 $23.46 $23.46 $25.57 $67.62 $71.85 $31.67 $63.40 $48.09 $31.67 $42.27 $54.94 $32.96 $32.96 $32.96 $32.96 N/A $24.63 $23.46 $56.38 $23.46 $23.46 $17.59 $17.59 $17.59 $2.85 $133.72 330104 0241U 388 300 HC NFCT DS RNA 4 TARGETS UPPER RESPIRATORY SPECIMEN O $449.40 $142.63 $142.63 N/A $224.70 N/A N/A $293.91 N/A $271.00 N/A $142.63 $337.05 $156.89 $283.12 $328.51 N/A N/A $269.64 $359.52 $484.94 $812.99 N/A $142.63 N/A N/A $359.52 N/A N/A N/A $199.68 N/A $142.63 $142.63 $155.47 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $200.40 $200.40 $200.40 $200.40 N/A $149.76 $142.63 $299.75 N/A N/A $106.97 $106.97 $106.97 $106.97 $812.99 330104 81311 386 300 HC NRAS GENE VARIANTS EXON 2&3 O "$1,274.37 " $295.79 $295.79 $177.47 $637.18 N/A N/A N/A $177.47 $562.00 $177.47 $295.79 $955.78 $325.37 $802.85 $931.56 $212.96 $177.47 $764.62 "$1,019.50 " "$1,005.69 " "$1,686.00 " $177.47 $295.79 $828.34 $248.46 "$1,019.50 " $177.47 $177.47 $212.96 $414.11 $177.47 $295.79 $295.79 $322.41 "$1,019.50 " "$1,083.21 " $239.58 $955.78 $363.81 $239.58 $637.18 $828.34 $415.58 $415.58 $415.58 $415.58 $354.95 $310.58 $295.79 $354.95 $177.47 $177.47 $221.84 $221.84 $221.84 $177.47 "$1,686.00 " 330104 80201 405 300 HC ASSAY OF TOPIRAMATE O $151.94 $11.92 $11.92 N/A $75.97 N/A N/A N/A N/A $22.65 N/A $11.92 $113.95 $13.11 $95.72 $111.07 N/A N/A $91.16 $121.55 $40.53 $67.94 N/A $11.92 $98.76 N/A $121.55 N/A N/A N/A $16.69 N/A $11.92 $11.92 $12.99 $121.55 $129.15 N/A $113.95 N/A N/A $75.97 $98.76 $16.75 $16.75 $16.75 $16.75 $20.14 $12.52 $11.92 $20.14 N/A N/A $8.94 $8.94 $8.94 $8.94 $129.15 330104 80346 2040 300 HC BENZODIAZEPINES- O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $32.33 $120.15 $114.43 $32.33 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 81364 386 300 HC HBB FULL GENE SEQUENCE O "$1,213.38 " $324.58 $324.58 N/A $606.69 N/A N/A N/A N/A $616.70 N/A $324.58 $910.04 $357.04 $764.43 $886.98 N/A N/A $728.03 $970.70 "$1,103.57 " "$1,850.11 " N/A $324.58 $788.70 N/A $970.70 N/A N/A N/A $454.41 N/A $324.58 $324.58 $353.79 $970.70 "$1,031.37 " N/A $910.04 N/A N/A $606.69 $788.70 $456.03 $456.03 $456.03 $456.03 $389.50 $340.81 $324.58 $389.50 N/A N/A $243.44 $243.44 $243.44 $243.44 "$1,850.11 " 330104 86870 5673 2043 300 HC RBC ANTIBODY IDENTIFICATION O "$1,308.61 " $388.85 $388.85 $14.10 $654.30 N/A N/A $384.96 $14.10 $738.81 $14.10 $388.85 $981.46 $427.73 $824.42 $956.59 $16.92 $14.10 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $14.10 $388.85 $466.62 $19.74 "$1,046.89 " $14.10 $14.10 $16.92 $544.39 $14.10 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $14.10 $981.46 $28.90 $14.10 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $30.10 $408.29 $388.85 $30.10 $14.10 $14.10 $291.64 $291.64 $291.64 $14.10 "$2,216.43 " 330104 81511 386 300 HC FETAL CONGENITAL ABNOR ASSAY FOUR ANAL O $606.69 $153.50 $153.50 $42.87 $303.35 N/A N/A N/A $42.87 $291.65 $42.87 $153.50 $455.02 $168.85 $382.21 $443.49 $51.44 $42.87 $364.01 $485.35 $521.90 $874.95 $42.87 $153.50 $394.35 $60.02 $485.35 $42.87 $42.87 $51.44 $214.90 $42.87 $153.50 $153.50 $167.32 $485.35 $515.69 $57.87 $455.02 $87.88 $57.87 $303.35 $394.35 $215.67 $215.67 $215.67 $215.67 $184.20 $161.18 $153.50 $184.20 $42.87 $42.87 $115.12 $115.12 $115.12 $42.87 $874.95 330104 81455 2045 300 HC TARGETED GENOMIC SEQ ANALYS O "$10,630.45 " "$2,919.60 " "$2,919.60 " N/A "$5,315.23 " N/A N/A N/A N/A "$5,547.24 " N/A "$2,919.60 " "$7,972.84 " "$3,211.56 " "$6,697.18 " "$7,770.86 " N/A N/A "$6,378.27 " "$8,504.36 " "$9,926.64 " "$16,641.72 " N/A "$2,919.60 " "$6,909.79 " N/A "$8,504.36 " N/A N/A N/A "$4,087.44 " N/A "$2,919.60 " "$2,919.60 " "$3,182.36 " "$8,504.36 " "$9,035.88 " N/A "$7,972.84 " N/A N/A "$5,315.23 " "$6,909.79 " "$4,102.04 " "$4,102.04 " "$4,102.04 " "$4,102.04 " "$3,503.52 " "$3,065.58 " "$2,919.60 " "$3,503.52 " N/A N/A "$2,189.70 " "$2,189.70 " "$2,189.70 " "$2,189.70 " "$16,641.72 " 330104 87209 396 300 HC SMEAR COMPLEX STAIN O $283.55 $17.98 $17.98 $5.85 $141.78 N/A N/A N/A $5.85 $34.16 $5.85 $17.98 $212.66 $19.78 $178.64 $207.28 $7.02 $5.85 $170.13 $226.84 $61.13 $102.49 $5.85 $17.98 $184.31 $8.19 $226.84 $5.85 $5.85 $7.02 $25.17 $5.85 $17.98 $17.98 $19.60 $226.84 $241.02 $7.90 $212.66 $11.99 $7.90 $141.78 $184.31 $25.26 $25.26 $25.26 $25.26 $30.35 $18.88 $17.98 $30.35 $5.85 $5.85 $13.48 $13.48 $13.48 $5.85 $241.02 330104 87210 396 300 HC SMEAR WET MOUNT SALINE/INK O $151.94 $5.82 $5.82 $3.40 $75.97 N/A N/A N/A $3.40 $11.06 $3.40 $5.82 $113.95 $6.40 $95.72 $111.07 $4.08 $3.40 $91.16 $121.55 $19.79 $33.17 $3.40 $5.82 $98.76 $4.76 $121.55 $3.40 $3.40 $4.08 $8.15 $3.40 $5.82 $5.82 $6.34 $121.55 $129.15 $4.59 $113.95 $6.97 $4.59 $75.97 $98.76 $8.18 $8.18 $8.18 $8.18 $7.21 $6.11 $5.82 $7.21 $3.40 $3.40 $4.37 $4.37 $4.37 $3.40 $129.15 330104 87301 396 300 HC IAAD IA ADENOVIRUS ENTERIC TYP 40/41 O $185.11 $11.98 $11.98 $8.03 $92.56 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $138.83 $13.18 $116.62 $135.32 $9.64 $8.03 $111.07 $148.09 $40.73 $68.29 $8.03 $11.98 $120.32 $11.24 $148.09 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $148.09 $157.34 $10.84 $138.83 $16.46 $10.84 $92.56 $120.32 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $157.34 330104 87498 397 300 HC ENTEROVIRUS PROBE&REVRS TRNS O $359.52 $35.09 $35.09 $21.43 $179.76 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $269.64 $38.60 $226.50 $262.81 $25.72 $21.43 $215.71 $287.62 $119.31 $200.01 $21.43 $35.09 $233.69 $30.00 $287.62 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $287.62 $305.59 $28.93 $269.64 $43.93 $28.93 $179.76 $233.69 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $305.59 330104 87502 388 300 HC INFLUENZA DNA AMP PROBE O $909.50 $95.80 $95.80 $53.45 $454.75 N/A N/A N/A $53.45 $182.02 $53.45 $95.80 $682.12 $105.38 $572.99 $664.84 $64.14 $53.45 $545.70 $727.60 $325.72 $546.06 $53.45 $95.80 $591.18 $74.83 $727.60 $53.45 $53.45 $64.14 $134.12 $53.45 $95.80 $95.80 $104.42 $727.60 $773.07 $72.16 $682.12 $109.57 $72.16 $454.75 $591.18 $134.60 $134.60 $134.60 $134.60 $143.70 $100.59 $95.80 $143.70 $53.45 $53.45 $71.85 $71.85 $71.85 $53.45 $773.07 330104 87503 397 300 HC INFLUENZA DNA AMP PROB ADDL O $218.28 $29.22 $29.22 $21.43 $109.14 N/A N/A N/A $21.43 $55.52 $21.43 $29.22 $163.71 $32.14 $137.52 $159.56 $25.72 $21.43 $130.97 $174.62 $99.35 $166.55 $21.43 $29.22 $141.88 $30.00 $174.62 $21.43 $21.43 $25.72 $40.91 $21.43 $29.22 $29.22 $31.85 $174.62 $185.54 $28.93 $163.71 $43.93 $28.93 $109.14 $141.88 $41.05 $41.05 $41.05 $41.05 $35.06 $30.68 $29.22 $35.06 $21.43 $21.43 $21.91 $21.91 $21.91 $21.43 $185.54 330104 87532 397 300 HC HHV-6 DNA AMP PROBE O $704.06 $35.09 $35.09 N/A $352.03 N/A N/A N/A N/A $66.67 N/A $35.09 $528.04 $38.60 $443.56 $514.67 N/A N/A $422.44 $563.25 $119.31 $200.01 N/A $35.09 $457.64 N/A $563.25 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $563.25 $598.45 N/A $528.04 N/A N/A $352.03 $457.64 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $598.45 330104 87593 397 300 HC IADNA ORTHOPOXVIRUS AMPLIFIED PROBE TECHNIQUE EA O $95.23 N/A N/A $51.31 $47.62 N/A N/A N/A $51.31 N/A $51.31 N/A $71.42 N/A $59.99 $69.61 $61.57 $51.31 $57.14 $76.18 N/A N/A $51.31 N/A $61.90 $71.83 $76.18 $51.31 $51.31 $61.57 N/A $51.31 N/A N/A N/A $76.18 $80.95 $69.27 $71.42 $105.19 $69.27 $47.62 $61.90 N/A N/A N/A N/A N/A N/A N/A $63.52 $51.31 $51.31 N/A N/A N/A $47.62 $105.19 330104 87633 388 300 HC RESP VIRUS 12-25 TARGETS O "$1,820.07 " $416.78 $416.78 $61.77 $910.03 N/A N/A N/A $61.77 $791.88 $61.77 $416.78 "$1,365.05 " $458.46 "$1,146.64 " "$1,330.47 " $74.12 $61.77 "$1,092.04 " "$1,456.06 " "$1,417.05 " "$2,375.65 " $61.77 $416.78 "$1,183.05 " $86.47 "$1,456.06 " $61.77 $61.77 $74.12 $583.49 $61.77 $416.78 $416.78 $454.29 "$1,456.06 " "$1,547.06 " $83.38 "$1,365.05 " $126.62 $83.38 $910.03 "$1,183.05 " $585.58 $585.58 $585.58 $585.58 $687.49 $437.62 $416.78 $687.49 $61.77 $61.77 $312.58 $312.58 $312.58 $61.77 "$2,375.65 " 330104 86901 5732 486 300 HC BLOOD TYPING RH (D) O $155.15 $40.74 $40.74 $2.99 $77.58 N/A N/A $40.34 $2.99 $77.41 $2.99 $40.74 $116.36 $44.82 $97.74 $113.41 $3.59 $2.99 $93.09 $124.12 $138.53 $232.24 $2.99 $40.74 $48.89 $4.19 $124.12 $2.99 $2.99 $3.59 $57.04 $2.99 $40.74 $40.74 $44.41 $124.12 $131.88 $2.99 $116.36 $6.13 $2.99 $77.58 $109.60 $57.24 $57.24 $57.24 $57.24 $5.04 $42.78 $40.74 $5.04 $2.99 $2.99 $30.56 $30.56 $30.56 $2.99 $232.24 330104 89051 390 300 HC BODY FLUID CELL COUNT O $54.57 $5.60 $5.60 $2.80 $27.29 N/A N/A N/A $2.80 $10.64 $2.80 $5.60 $40.93 $6.16 $34.38 $39.89 $3.36 $2.80 $32.74 $43.66 $19.04 $31.92 $2.80 $5.60 $35.47 $3.92 $43.66 $2.80 $2.80 $3.36 $7.84 $2.80 $5.60 $5.60 $6.10 $43.66 $46.38 $3.78 $40.93 $5.74 $3.78 $27.29 $35.47 $7.87 $7.87 $7.87 $7.87 $9.30 $5.88 $5.60 $9.30 $2.80 $2.80 $4.20 $4.20 $4.20 $2.80 $46.38 330104 89310 390 300 HC SPERM PRESENCE/MOTILITY O $142.31 $8.61 $8.61 N/A $71.16 N/A N/A N/A N/A $16.36 N/A $8.61 $106.73 $9.47 $89.66 $104.03 N/A N/A $85.39 $113.85 $29.27 $49.08 N/A $8.61 $92.50 N/A $113.85 N/A N/A N/A $12.05 N/A $8.61 $8.61 $9.38 $113.85 $120.96 N/A $106.73 N/A N/A $71.16 $92.50 $12.10 $12.10 $12.10 $12.10 $14.53 $9.04 $8.61 $14.53 N/A N/A $6.46 $6.46 $6.46 $6.46 $120.96 330104 89320 390 300 HC SEMEN ANAL VOL/COUNT/MOT O $306.02 $12.31 $12.31 N/A $153.01 N/A N/A N/A N/A $23.39 N/A $12.31 $229.51 $13.54 $192.79 $223.70 N/A N/A $183.61 $244.82 $41.85 $70.17 N/A $12.31 $198.91 N/A $244.82 N/A N/A N/A $17.23 N/A $12.31 $12.31 $13.42 $244.82 $260.12 N/A $229.51 N/A N/A $153.01 $198.91 $17.30 $17.30 $17.30 $17.30 $20.35 $12.93 $12.31 $20.35 N/A N/A $9.23 $9.23 $9.23 $9.23 $260.12 330104 99437 260 300 HC CHRONIC CARE MGMT SVC PHYS EA ADDL 30 MIN CAL MNTH O $258.94 N/A N/A N/A $129.47 $73.13 $66.11 $57.92 N/A N/A N/A N/A $194.20 N/A $163.13 $189.29 N/A N/A $155.36 $207.15 N/A N/A N/A N/A $168.31 N/A $207.15 N/A N/A N/A N/A N/A N/A N/A N/A $207.15 $220.10 N/A $194.20 N/A N/A $129.47 $168.31 N/A N/A N/A N/A N/A N/A N/A $172.71 N/A N/A N/A N/A N/A $57.92 $220.10 330104 86200 394 300 HC CCP ANTIBODY O $207.58 $12.95 $12.95 N/A $103.79 N/A N/A N/A N/A $24.60 N/A $12.95 $155.69 $14.25 $130.78 $151.74 N/A N/A $124.55 $166.06 $44.03 $73.81 N/A $12.95 $134.93 N/A $166.06 N/A N/A N/A $18.13 N/A $12.95 $12.95 $14.12 $166.06 $176.44 N/A $155.69 N/A N/A $103.79 $134.93 $18.19 $18.19 $18.19 $18.19 $21.86 $13.60 $12.95 $21.86 N/A N/A $9.71 $9.71 $9.71 $9.71 $176.44 330104 86580 5731 394 300 HC TB INTRADERMAL TEST O $20.33 $29.95 $29.95 $5.00 $10.16 $15.87 $14.34 $29.65 $5.00 $56.90 $5.00 $29.95 $15.25 $32.94 $12.81 $14.86 $6.00 $5.00 $12.20 $16.26 $101.81 $170.69 $5.00 $29.95 $35.93 $7.00 $16.26 $5.00 $5.00 $6.00 $41.92 $5.00 $29.95 $29.95 $32.64 $16.26 $17.28 $5.00 $15.25 $10.25 $5.00 $10.16 $80.55 $42.07 $42.07 $42.07 $42.07 $6.68 $31.44 $29.95 $6.68 $5.00 $5.00 $22.46 $22.46 $22.46 $5.00 $170.69 330104 87207 396 300 HC SMEAR SPECIAL STAIN O $276.06 $5.99 $5.99 $5.99 $138.03 N/A N/A N/A $5.99 $11.38 $5.99 $5.99 $207.05 $6.59 $173.92 $201.80 $7.19 $5.99 $165.64 $220.85 $20.37 $34.14 $5.99 $5.99 $179.44 $8.39 $220.85 $5.99 $5.99 $7.19 $8.39 $5.99 $5.99 $5.99 $6.53 $220.85 $234.65 $8.09 $207.05 $12.28 $8.09 $138.03 $179.44 $8.42 $8.42 $8.42 $8.42 $10.13 $6.29 $5.99 $10.13 $5.99 $5.99 $4.49 $4.49 $4.49 $4.49 $234.65 330104 86355 395 300 HC B CELLS TOTAL COUNT O $590.64 $37.73 $37.73 $23.17 $295.32 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $442.98 $41.50 $372.10 $431.76 $27.80 $23.17 $354.38 $472.51 $128.28 $215.06 $23.17 $37.73 $383.92 $32.44 $472.51 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $472.51 $502.04 $31.28 $442.98 $47.50 $31.28 $295.32 $383.92 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $502.04 330104 86357 395 300 HC NK CELLS TOTAL COUNT O $400.18 $37.73 $37.73 $23.17 $200.09 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $300.13 $41.50 $252.11 $292.53 $27.80 $23.17 $240.11 $320.14 $128.28 $215.06 $23.17 $37.73 $260.12 $32.44 $320.14 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $320.14 $340.15 $31.28 $300.13 $47.50 $31.28 $200.09 $260.12 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $340.15 330104 80335 2040 300 HC NORTRIPYLINE- O $311.37 $114.43 $114.43 $5.00 $155.69 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $233.53 $125.87 $196.16 $227.61 $6.00 $5.00 $186.82 $249.10 $389.06 $652.25 $5.00 $114.43 $202.39 $7.00 $249.10 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $249.10 $264.66 $6.75 $233.53 $10.25 $6.75 $155.69 $202.39 $160.77 $160.77 $160.77 $160.77 $29.23 $120.15 $114.43 $29.23 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80320 2041 300 HC ALCOHOL ETHYL- O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $28.22 $120.15 $114.43 $28.22 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 89060 390 300 HC EXAM SYNOVIAL FLUID CRYSTALS O $208.65 $7.33 $7.33 $6.00 $104.33 N/A N/A N/A $6.00 $13.93 $6.00 $7.33 $156.49 $8.06 $131.45 $152.52 $7.20 $6.00 $125.19 $166.92 $24.92 $41.78 $6.00 $7.33 $135.62 $8.40 $166.92 $6.00 $6.00 $7.20 $10.26 $6.00 $7.33 $7.33 $7.99 $166.92 $177.35 $8.10 $156.49 $12.30 $8.10 $104.33 $135.62 $10.30 $10.30 $10.30 $10.30 $12.07 $7.70 $7.33 $12.07 $6.00 $6.00 $5.50 $5.50 $5.50 $5.50 $177.35 330104 86900 5734 486 300 HC BLOOD TYPING ABO O "$1,395.28 " $139.30 $139.30 $2.99 $697.64 N/A N/A $137.91 $2.99 $264.67 $2.99 $139.30 "$1,046.46 " $153.23 $879.03 "$1,019.95 " $3.59 $2.99 $837.17 "$1,116.22 " $473.63 $794.02 $2.99 $139.30 $167.16 $4.19 "$1,116.22 " $2.99 $2.99 $3.59 $195.02 $2.99 $139.30 $139.30 $151.84 "$1,116.22 " "$1,185.99 " $2.99 "$1,046.46 " $6.13 $2.99 $697.64 $374.72 $195.72 $195.72 $195.72 $195.72 $5.04 $146.27 $139.30 $5.04 $2.99 $2.99 $104.48 $104.48 $104.48 $2.99 "$1,185.99 " 330104 86921 5672 2043 300 HC COMPATIBILITY TESTINCUB TECH O $800.36 $188.66 $188.66 N/A $400.18 N/A N/A $186.77 N/A $358.45 N/A $188.66 $600.27 $207.53 $504.23 $585.06 N/A N/A $480.22 $640.29 $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A $640.29 N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 $640.29 $680.31 N/A $600.27 N/A N/A $400.18 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 N/A N/A $141.49 $141.49 $141.49 $17.92 "$1,075.36 " 330104 86860 5672 2043 300 HC RBC ANTIBODY ELUTION O "$1,357.83 " $188.66 $188.66 $11.70 $678.91 N/A N/A $186.77 $11.70 $358.45 $11.70 $188.66 "$1,018.37 " $207.53 $855.43 $992.57 $14.04 $11.70 $814.70 "$1,086.26 " $641.44 "$1,075.36 " $11.70 $188.66 $226.39 $16.38 "$1,086.26 " $11.70 $11.70 $14.04 $264.12 $11.70 $188.66 $188.66 $205.64 "$1,086.26 " "$1,154.16 " $11.70 "$1,018.37 " $23.98 $11.70 $678.91 $507.49 $265.07 $265.07 $265.07 $265.07 $30.10 $198.09 $188.66 $30.10 $11.70 $11.70 $141.49 $141.49 $141.49 $11.70 "$1,154.16 " 330104 82017 400 300 HC ACYLCARNITINES QUANT O $227.91 $16.87 $16.87 $16.87 $113.95 N/A N/A N/A $16.87 $32.05 $16.87 $16.87 $170.93 $18.56 $143.58 $166.60 $20.24 $16.87 $136.75 $182.33 $57.36 $96.16 $16.87 $16.87 $148.14 $23.62 $182.33 $16.87 $16.87 $20.24 $23.62 $16.87 $16.87 $16.87 $18.39 $182.33 $193.72 $22.77 $170.93 $34.58 $22.77 $113.95 $148.14 $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $16.87 $16.87 $12.65 $12.65 $12.65 $12.65 $193.72 330104 82270 402 300 HC OCCULT BLOOD FECES O $121.98 $4.38 $4.38 $3.40 $60.99 N/A N/A N/A $3.40 $8.32 $3.40 $4.38 $91.48 $4.82 $76.85 $89.17 $4.08 $3.40 $73.19 $97.58 $14.89 $24.97 $3.40 $4.38 $79.29 $4.76 $97.58 $3.40 $3.40 $4.08 $6.13 $3.40 $4.38 $4.38 $4.77 $97.58 $103.68 $4.59 $91.48 $6.97 $4.59 $60.99 $79.29 $6.15 $6.15 $6.15 $6.15 $5.50 $4.60 $4.38 $5.50 $3.40 $3.40 $3.29 $3.29 $3.29 $3.29 $103.68 330104 82803 401 300 HC BLOOD GASES ANY COMBINATION O $836.74 $26.07 $26.07 $16.20 $418.37 N/A N/A N/A $16.20 $49.53 $16.20 $26.07 $627.56 $28.68 $527.15 $611.66 $19.44 $16.20 $502.04 $669.39 $88.64 $148.60 $16.20 $26.07 $543.88 $22.68 $669.39 $16.20 $16.20 $19.44 $36.50 $16.20 $26.07 $26.07 $28.42 $669.39 $711.23 $21.87 $627.56 $33.21 $21.87 $418.37 $543.88 $36.63 $36.63 $36.63 $36.63 $32.66 $27.37 $26.07 $32.66 $16.20 $16.20 $19.55 $19.55 $19.55 $16.20 $711.23 330104 82950 402 300 HC GLUCOSE TEST O $162.64 $4.75 $4.75 $4.75 $81.32 N/A N/A N/A $4.75 $9.03 $4.75 $4.75 $121.98 $5.23 $102.46 $118.89 $5.70 $4.75 $97.58 $130.11 $16.15 $27.07 $4.75 $4.75 $105.72 $6.65 $130.11 $4.75 $4.75 $5.70 $6.65 $4.75 $4.75 $4.75 $5.18 $130.11 $138.24 $6.41 $121.98 $9.74 $6.41 $81.32 $105.72 $6.67 $6.67 $6.67 $6.67 $8.02 $4.99 $4.75 $8.02 $4.75 $4.75 $3.56 $3.56 $3.56 $3.56 $138.24 330104 84081 400 300 HC PHOSPHATI DYLGLYCEROL AMN O $262.15 $16.52 $16.52 $7.97 $131.07 N/A N/A N/A $7.97 $31.39 $7.97 $16.52 $196.61 $18.17 $165.15 $191.63 $9.56 $7.97 $157.29 $209.72 $56.17 $94.16 $7.97 $16.52 $170.40 $11.16 $209.72 $7.97 $7.97 $9.56 $23.13 $7.97 $16.52 $16.52 $18.01 $209.72 $222.83 $10.76 $196.61 $16.34 $10.76 $131.07 $170.40 $23.21 $23.21 $23.21 $23.21 $27.90 $17.35 $16.52 $27.90 $7.97 $7.97 $12.39 $12.39 $12.39 $7.97 $222.83 330104 85046 408 300 HC RETICULOCYTE COUNT AUTO W CELL PARAM O $58.15 $5.57 $5.57 $1.43 $29.08 N/A N/A N/A $1.43 $10.58 $1.43 $5.57 $43.62 $6.13 $36.64 $42.51 $1.72 $1.43 $34.89 $46.52 $18.94 $31.75 $1.43 $5.57 $37.80 $2.00 $46.52 $1.43 $1.43 $1.72 $7.80 $1.43 $5.57 $5.57 $6.07 $46.52 $49.43 $1.93 $43.62 $2.93 $1.93 $29.08 $37.80 $7.83 $7.83 $7.83 $7.83 $9.42 $5.85 $5.57 $9.42 $1.43 $1.43 $4.18 $4.18 $4.18 $1.43 $49.43 330104 85347 406 300 HC COAGULATION TIME ACTIVATED O $129.47 $4.28 $4.28 $4.28 $64.73 N/A N/A N/A $4.28 $8.13 $4.28 $4.28 $97.10 $4.71 $81.57 $94.64 $5.14 $4.28 $77.68 $103.58 $14.55 $24.40 $4.28 $4.28 $84.16 $5.99 $103.58 $4.28 $4.28 $5.14 $5.99 $4.28 $4.28 $4.28 $4.67 $103.58 $110.05 $5.78 $97.10 $8.77 $5.78 $64.73 $84.16 $6.01 $6.01 $6.01 $6.01 $7.19 $4.49 $4.28 $7.19 $4.28 $4.28 $3.21 $3.21 $3.21 $3.21 $110.05 330104 85420 406 300 HC FIBRINOLYTIC PLASMINOGEN O $103.79 $6.53 $6.53 N/A $51.90 N/A N/A N/A N/A $12.41 N/A $6.53 $77.84 $7.18 $65.39 $75.87 N/A N/A $62.27 $83.03 $22.20 $37.22 N/A $6.53 $67.46 N/A $83.03 N/A N/A N/A $9.14 N/A $6.53 $6.53 $7.12 $83.03 $88.22 N/A $77.84 N/A N/A $51.90 $67.46 $9.17 $9.17 $9.17 $9.17 $11.04 $6.86 $6.53 $11.04 N/A N/A $4.90 $4.90 $4.90 $4.90 $88.22 330104 86880 5733 486 300 HC COOMBS TEST DIRECT O $358.45 $68.96 $68.96 $4.69 $179.22 N/A N/A $68.27 $4.69 $131.03 $4.69 $68.96 $268.84 $75.86 $225.82 $262.03 $5.63 $4.69 $215.07 $286.76 $234.47 $393.08 $4.69 $68.96 $82.75 $6.57 $286.76 $4.69 $4.69 $5.63 $96.55 $4.69 $68.96 $68.96 $75.17 $286.76 $304.68 $4.69 $268.84 $9.61 $4.69 $179.22 $185.51 $96.89 $96.89 $96.89 $96.89 $9.07 $72.41 $68.96 $9.07 $4.69 $4.69 $51.72 $51.72 $51.72 $4.69 $393.08 330104 86359 395 300 HC T CELLS TOTAL COUNT O $590.64 $37.73 $37.73 $23.17 $295.32 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $442.98 $41.50 $372.10 $431.76 $27.80 $23.17 $354.38 $472.51 $128.28 $215.06 $23.17 $37.73 $383.92 $32.44 $472.51 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $472.51 $502.04 $31.28 $442.98 $47.50 $31.28 $295.32 $383.92 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $502.04 330104 86361 395 300 HC T CELL ABSOLUTE COUNT O $739.37 $26.78 $26.78 $23.17 $369.69 N/A N/A N/A $23.17 $50.88 $23.17 $26.78 $554.53 $29.46 $465.80 $540.48 $27.80 $23.17 $443.62 $591.50 $91.05 $152.65 $23.17 $26.78 $480.59 $32.44 $591.50 $23.17 $23.17 $27.80 $37.49 $23.17 $26.78 $26.78 $29.19 $591.50 $628.46 $31.28 $554.53 $47.50 $31.28 $369.69 $480.59 $37.63 $37.63 $37.63 $37.63 $45.20 $28.12 $26.78 $45.20 $23.17 $23.17 $20.09 $20.09 $20.09 $20.09 $628.46 330104 86341 394 300 HC ISLET CELL ANTIBODY O $311.37 $23.57 $23.57 $12.50 $155.69 N/A N/A N/A $12.50 $44.78 $12.50 $23.57 $233.53 $25.93 $196.16 $227.61 $15.00 $12.50 $186.82 $249.10 $80.14 $134.35 $12.50 $23.57 $202.39 $17.50 $249.10 $12.50 $12.50 $15.00 $33.00 $12.50 $23.57 $23.57 $25.69 $249.10 $264.66 $16.88 $233.53 $25.62 $16.88 $155.69 $202.39 $33.12 $33.12 $33.12 $33.12 $33.42 $24.75 $23.57 $33.42 $12.50 $12.50 $17.68 $17.68 $17.68 $12.50 $264.66 330104 86480 395 300 HC TB TEST CELL IMMUN MEASURE O $817.48 $61.98 $61.98 $50.00 $408.74 N/A N/A N/A $50.00 $117.76 $50.00 $61.98 $613.11 $68.18 $515.01 $597.58 $60.00 $50.00 $490.49 $653.98 $210.73 $353.29 $50.00 $61.98 $531.36 $70.00 $653.98 $50.00 $50.00 $60.00 $86.77 $50.00 $61.98 $61.98 $67.56 $653.98 $694.86 $67.50 $613.11 $102.50 $67.50 $408.74 $531.36 $87.08 $87.08 $87.08 $87.08 $104.66 $65.08 $61.98 $104.66 $50.00 $50.00 $46.48 $46.48 $46.48 $46.48 $694.86 330104 86850 5671 486 300 HC RBC ANTIBODY SCREEN O $348.82 $60.15 $60.15 $5.55 $174.41 N/A N/A $59.55 $5.55 $114.29 $5.55 $60.15 $261.62 $66.17 $219.76 $254.99 $6.66 $5.55 $209.29 $279.06 $204.53 $342.88 $5.55 $60.15 $72.19 $7.77 $279.06 $5.55 $5.55 $6.66 $84.22 $5.55 $60.15 $60.15 $65.57 $279.06 $296.50 $5.55 $261.62 $11.38 $5.55 $174.41 $161.82 $84.52 $84.52 $84.52 $84.52 $17.92 $63.16 $60.15 $17.92 $5.55 $5.55 $45.12 $45.12 $45.12 $5.55 $342.88 330104 86403 394 300 HC PARTICLE AGGLUT ANTBDY SCRN O $121.98 $11.54 $11.54 $3.75 $60.99 N/A N/A N/A $3.75 $21.93 $3.75 $11.54 $91.48 $12.69 $76.85 $89.17 $4.50 $3.75 $73.19 $97.58 $39.24 $65.78 $3.75 $11.54 $79.29 $5.25 $97.58 $3.75 $3.75 $4.50 $16.16 $3.75 $11.54 $11.54 $12.58 $97.58 $103.68 $5.06 $91.48 $7.69 $5.06 $60.99 $79.29 $16.21 $16.21 $16.21 $16.21 $17.21 $12.12 $11.54 $17.21 $3.75 $3.75 $8.65 $8.65 $8.65 $3.75 $103.68 330104 86702 394 300 HC HIV-2 ANTIBODY O $218.28 $13.52 $13.52 $13.52 $109.14 N/A N/A N/A $13.52 $25.69 $13.52 $13.52 $163.71 $14.87 $137.52 $159.56 $16.22 $13.52 $130.97 $174.62 $45.97 $77.06 $13.52 $13.52 $141.88 $18.93 $174.62 $13.52 $13.52 $16.22 $18.93 $13.52 $13.52 $13.52 $14.74 $174.62 $185.54 $18.25 $163.71 $27.72 $18.25 $109.14 $141.88 $19.00 $19.00 $19.00 $19.00 $22.84 $14.20 $13.52 $22.84 $13.52 $13.52 $10.14 $10.14 $10.14 $10.14 $185.54 330104 86701 394 300 HC HIV-1ANTIBODY O $372.36 $8.89 $8.89 $8.89 $186.18 N/A N/A N/A $8.89 $16.89 $8.89 $8.89 $279.27 $9.78 $234.59 $272.20 $10.67 $8.89 $223.42 $297.89 $30.23 $50.67 $8.89 $8.89 $242.03 $12.45 $297.89 $8.89 $8.89 $10.67 $12.45 $8.89 $8.89 $8.89 $9.69 $297.89 $316.51 $12.00 $279.27 $18.22 $12.00 $186.18 $242.03 $12.49 $12.49 $12.49 $12.49 $15.00 $9.33 $8.89 $15.00 $8.89 $8.89 $6.67 $6.67 $6.67 $6.67 $316.51 330104 86696 394 300 HC HERPES SIMPLEX TYPE 2 TEST O $613.11 $19.35 $19.35 $14.50 $306.56 N/A N/A N/A $14.50 $36.77 $14.50 $19.35 $459.83 $21.29 $386.26 $448.18 $17.40 $14.50 $367.87 $490.49 $65.79 $110.30 $14.50 $19.35 $398.52 $20.30 $490.49 $14.50 $14.50 $17.40 $27.09 $14.50 $19.35 $19.35 $21.09 $490.49 $521.14 $19.58 $459.83 $29.72 $19.58 $306.56 $398.52 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $14.50 $14.50 $14.51 $14.51 $14.51 $14.50 $521.14 330104 86769 394 300 HC ANTIBODY; SEVERE ACUTE RESP SYND CORONA 2 (SARS-COV-2) ( COVID-19) O $174.41 $42.13 $42.13 $42.13 $87.20 N/A N/A N/A $42.13 $80.05 $42.13 $42.13 $130.81 $46.34 $109.88 $127.49 $50.56 $42.13 $104.65 $139.53 $143.24 $240.14 $42.13 $42.13 $113.37 $58.98 $139.53 $42.13 $42.13 $50.56 $58.98 $42.13 $42.13 $42.13 $45.92 $139.53 $148.25 $56.88 $130.81 $86.37 $56.88 $87.20 $113.37 $59.19 $59.19 $59.19 $59.19 N/A $44.24 $42.13 $116.33 $42.13 $42.13 $31.60 $31.60 $31.60 $31.60 $240.14 330104 86658 394 300 HC ENTEROVIRUS ANTIBODY O $716.90 $13.03 $13.03 $8.03 $358.45 N/A N/A N/A $8.03 $24.76 $8.03 $13.03 $537.67 $14.33 $451.65 $524.05 $9.64 $8.03 $430.14 $573.52 $44.30 $74.27 $8.03 $13.03 $465.99 $11.24 $573.52 $8.03 $8.03 $9.64 $18.24 $8.03 $13.03 $13.03 $14.20 $573.52 $609.37 $10.84 $537.67 $16.46 $10.84 $358.45 $465.99 $18.31 $18.31 $18.31 $18.31 $22.01 $13.68 $13.03 $22.01 $8.03 $8.03 $9.77 $9.77 $9.77 $8.03 $609.37 330104 86602 394 300 HC ANTINOMYCES ANTIBODY O $277.13 $10.18 $10.18 $8.03 $138.56 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $207.85 $11.20 $174.59 $202.58 $9.64 $8.03 $166.28 $221.70 $34.61 $58.03 $8.03 $10.18 $180.13 $11.24 $221.70 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $221.70 $235.56 $10.84 $207.85 $16.46 $10.84 $138.56 $180.13 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $235.56 330104 86593 394 300 HC SYPHILIS TEST NON-TREP QUANT O $237.54 $4.40 $4.40 $3.70 $118.77 N/A N/A N/A $3.70 $8.36 $3.70 $4.40 $178.16 $4.84 $149.65 $173.64 $4.44 $3.70 $142.52 $190.03 $14.96 $25.08 $3.70 $4.40 $154.40 $5.18 $190.03 $3.70 $3.70 $4.44 $6.16 $3.70 $4.40 $4.40 $4.80 $190.03 $201.91 $5.00 $178.16 $7.58 $5.00 $118.77 $154.40 $6.18 $6.18 $6.18 $6.18 $7.43 $4.62 $4.40 $7.43 $3.70 $3.70 $3.30 $3.30 $3.30 $3.30 $201.91 330104 86592 394 300 HC SYPHILIS TEST NON-TREP QUAL O $151.94 $4.27 $4.27 $3.27 $75.97 N/A N/A N/A $3.27 $8.11 $3.27 $4.27 $113.95 $4.70 $95.72 $111.07 $3.92 $3.27 $91.16 $121.55 $14.52 $24.34 $3.27 $4.27 $98.76 $4.58 $121.55 $3.27 $3.27 $3.92 $5.98 $3.27 $4.27 $4.27 $4.65 $121.55 $129.15 $4.41 $113.95 $6.70 $4.41 $75.97 $98.76 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.27 $3.27 $3.20 $3.20 $3.20 $3.20 $129.15 330104 86682 394 300 HC HELMINTH NOT ELSEWHERE SPECIFIED O $121.98 $13.01 $13.01 N/A $60.99 N/A N/A N/A N/A $24.72 N/A $13.01 $91.48 $14.31 $76.85 $89.17 N/A N/A $73.19 $97.58 $44.23 $74.16 N/A $13.01 $79.29 N/A $97.58 N/A N/A N/A $18.21 N/A $13.01 $13.01 $14.18 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $18.28 $18.28 $18.28 $18.28 $21.97 $13.66 $13.01 $21.97 N/A N/A $9.76 $9.76 $9.76 $9.76 $103.68 330104 80324 2040 300 HC AMPHETAMINES; 1 OR 2 O $245.03 $114.43 $114.43 $5.00 $122.52 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $183.77 $125.87 $154.37 $179.12 $6.00 $5.00 $147.02 $196.02 $389.06 $652.25 $5.00 $114.43 $159.27 $7.00 $196.02 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $196.02 $208.28 $6.75 $183.77 $10.25 $6.75 $122.52 $159.27 $160.77 $160.77 $160.77 $160.77 $25.38 $120.15 $114.43 $25.38 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 83704 401 301 HC LIPOPROTEIN BLOOD QUAN NUMBERS AND SUBCLASSES O $112.35 $34.19 $34.19 N/A $56.17 N/A N/A N/A N/A $64.96 N/A $34.19 $84.26 $37.61 $70.78 $82.13 N/A N/A $67.41 $89.88 $116.25 $194.88 N/A $34.19 $73.03 N/A $89.88 N/A N/A N/A $47.87 N/A $34.19 $34.19 $37.27 $89.88 $95.50 N/A $84.26 N/A N/A $56.17 $73.03 $48.04 $48.04 $48.04 $48.04 $53.28 $35.90 $34.19 $53.28 N/A N/A $25.64 $25.64 $25.64 $25.64 $194.88 330104 83718 402 301 HC ASSAY OF LIPOPROTEIN O $182.97 $8.19 $8.19 $5.03 $91.48 N/A N/A N/A $5.03 $15.56 $5.03 $8.19 $137.23 $9.01 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $27.85 $46.68 $5.03 $8.19 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $11.47 $5.03 $8.19 $8.19 $8.93 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $11.51 $11.51 $11.51 $11.51 $13.82 $8.60 $8.19 $13.82 $5.03 $5.03 $6.14 $6.14 $6.14 $5.03 $155.52 330104 83721 402 301 HC ASSAY OF BLOOD LIPOPROTEIN O $176.55 $10.50 $10.50 N/A $88.28 N/A N/A N/A N/A $19.95 N/A $10.50 $132.41 $11.55 $111.23 $129.06 N/A N/A $105.93 $141.24 $35.70 $59.85 N/A $10.50 $114.76 N/A $141.24 N/A N/A N/A $14.70 N/A $10.50 $10.50 $11.45 $141.24 $150.07 N/A $132.41 N/A N/A $88.28 $114.76 $14.75 $14.75 $14.75 $14.75 $16.10 $11.03 $10.50 $16.10 N/A N/A $7.88 $7.88 $7.88 $7.88 $150.07 330104 83735 402 301 HC ASSAY OF MAGNESIUM O $182.97 $6.70 $6.70 $5.03 $91.48 N/A N/A N/A $5.03 $12.73 $5.03 $6.70 $137.23 $7.37 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $22.78 $38.19 $5.03 $6.70 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $9.38 $5.03 $6.70 $6.70 $7.30 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $9.41 $9.41 $9.41 $9.41 $11.32 $7.04 $6.70 $11.32 $5.03 $5.03 $5.03 $5.03 $5.03 $5.03 $155.52 330104 83825 404 301 HC ASSAY OF MERCURY O $527.51 $16.26 $16.26 $16.26 $263.75 N/A N/A N/A $16.26 $30.89 $16.26 $16.26 $395.63 $17.89 $332.33 $385.61 $19.51 $16.26 $316.51 $422.01 $55.28 $92.68 $16.26 $16.26 $342.88 $22.76 $422.01 $16.26 $16.26 $19.51 $22.76 $16.26 $16.26 $16.26 $17.72 $422.01 $448.38 $21.95 $395.63 $33.33 $21.95 $263.75 $342.88 $22.85 $22.85 $22.85 $22.85 $27.46 $17.07 $16.26 $27.46 $16.26 $16.26 $12.20 $12.20 $12.20 $12.20 $448.38 330104 83835 398 301 HC ASSAY OF METANEPHRINES O $548.91 $16.94 $16.94 $16.94 $274.45 N/A N/A N/A $16.94 $32.19 $16.94 $16.94 $411.68 $18.63 $345.81 $401.25 $20.33 $16.94 $329.35 $439.13 $57.60 $96.56 $16.94 $16.94 $356.79 $23.72 $439.13 $16.94 $16.94 $20.33 $23.72 $16.94 $16.94 $16.94 $18.46 $439.13 $466.57 $22.87 $411.68 $34.73 $22.87 $274.45 $356.79 $23.80 $23.80 $23.80 $23.80 $28.61 $17.79 $16.94 $28.61 $16.94 $16.94 $12.71 $12.71 $12.71 $12.71 $466.57 330104 82565 402 301 HC ASSAY OF CREATININE O $42.80 $5.12 $5.12 $5.03 $21.40 N/A N/A N/A $5.03 $9.73 $5.03 $5.12 $32.10 $5.63 $26.96 $31.29 $6.04 $5.03 $25.68 $34.24 $17.41 $29.18 $5.03 $5.12 $27.82 $7.04 $34.24 $5.03 $5.03 $6.04 $7.17 $5.03 $5.12 $5.12 $5.58 $34.24 $36.38 $6.79 $32.10 $10.31 $6.79 $21.40 $27.82 $7.19 $7.19 $7.19 $7.19 $8.66 $5.38 $5.12 $8.66 $5.03 $5.03 $3.84 $3.84 $3.84 $3.84 $36.38 330104 83690 402 301 HC ASSAY OF LIPASE O $182.97 $6.89 $6.89 $5.75 $91.48 N/A N/A N/A $5.75 $13.09 $5.75 $6.89 $137.23 $7.58 $115.27 $133.75 $6.90 $5.75 $109.78 $146.38 $23.43 $39.27 $5.75 $6.89 $118.93 $8.05 $146.38 $5.75 $5.75 $6.90 $9.65 $5.75 $6.89 $6.89 $7.51 $146.38 $155.52 $7.76 $137.23 $11.79 $7.76 $91.48 $118.93 $9.68 $9.68 $9.68 $9.68 $11.63 $7.23 $6.89 $11.63 $5.75 $5.75 $5.17 $5.17 $5.17 $5.17 $155.52 330104 82638 400 301 HC ASSAY OF DIBUCAINE NUMBER O $404.46 $12.25 $12.25 N/A $202.23 N/A N/A N/A N/A $23.27 N/A $12.25 $303.34 $13.48 $254.81 $295.66 N/A N/A $242.68 $323.57 $41.65 $69.83 N/A $12.25 $262.90 N/A $323.57 N/A N/A N/A $17.15 N/A $12.25 $12.25 $13.35 $323.57 $343.79 N/A $303.34 N/A N/A $202.23 $262.90 $17.21 $17.21 $17.21 $17.21 $20.68 $12.86 $12.25 $20.68 N/A N/A $9.19 $9.19 $9.19 $9.19 $343.79 330104 82652 401 301 HC VIT D 1 25-DIHYDROXY O $610.97 $38.50 $38.50 N/A $305.49 N/A N/A N/A N/A $73.15 N/A $38.50 $458.23 $42.35 $384.91 $446.62 N/A N/A $366.58 $488.78 $130.90 $219.45 N/A $38.50 $397.13 N/A $488.78 N/A N/A N/A $53.90 N/A $38.50 $38.50 $41.97 $488.78 $519.32 N/A $458.23 N/A N/A $305.49 $397.13 $54.09 $54.09 $54.09 $54.09 $65.02 $40.43 $38.50 $65.02 N/A N/A $28.88 $28.88 $28.88 $28.88 $519.32 330104 82656 400 301 HC PANCREATIC ELASTASE FECAL O $73.83 $11.53 $11.53 $5.20 $36.91 N/A N/A N/A $5.20 $21.91 $5.20 $11.53 $55.37 $12.68 $46.51 $53.97 $6.24 $5.20 $44.30 $59.06 $39.20 $65.72 $5.20 $11.53 $47.99 $7.28 $59.06 $5.20 $5.20 $6.24 $16.14 $5.20 $11.53 $11.53 $12.57 $59.06 $62.76 $7.02 $55.37 $10.66 $7.02 $36.91 $47.99 $16.20 $16.20 $16.20 $16.20 $19.49 $12.11 $11.53 $19.49 $5.20 $5.20 $8.65 $8.65 $8.65 $5.20 $65.72 330104 82668 400 301 HC ASSAY OF ERYTHROPOIETIN O $527.51 $18.79 $18.79 $17.06 $263.75 N/A N/A N/A $17.06 $35.70 $17.06 $18.79 $395.63 $20.67 $332.33 $385.61 $20.47 $17.06 $316.51 $422.01 $63.89 $107.10 $17.06 $18.79 $342.88 $23.88 $422.01 $17.06 $17.06 $20.47 $26.31 $17.06 $18.79 $18.79 $20.48 $422.01 $448.38 $23.03 $395.63 $34.97 $23.03 $263.75 $342.88 $26.40 $26.40 $26.40 $26.40 $31.75 $19.73 $18.79 $31.75 $17.06 $17.06 $14.09 $14.09 $14.09 $14.09 $448.38 330104 82670 398 301 HC ASSAY OF ESTRADIOL O $588.50 $27.94 $27.94 $27.94 $294.25 N/A N/A N/A $27.94 $53.09 $27.94 $27.94 $441.38 $30.73 $370.75 $430.19 $33.53 $27.94 $353.10 $470.80 $95.00 $159.26 $27.94 $27.94 $382.53 $39.12 $470.80 $27.94 $27.94 $33.53 $39.12 $27.94 $27.94 $27.94 $30.45 $470.80 $500.22 $37.72 $441.38 $57.28 $37.72 $294.25 $382.53 $39.26 $39.26 $39.26 $39.26 $47.18 $29.34 $27.94 $47.18 $27.94 $27.94 $20.96 $20.96 $20.96 $20.96 $500.22 330104 82672 398 301 HC ASSAY OF ESTROGEN TOTAL O $572.45 $21.70 $21.70 $21.70 $286.23 N/A N/A N/A $21.70 $41.23 $21.70 $21.70 $429.34 $23.87 $360.64 $418.46 $26.04 $21.70 $343.47 $457.96 $73.78 $123.69 $21.70 $21.70 $372.09 $30.38 $457.96 $21.70 $21.70 $26.04 $30.38 $21.70 $21.70 $21.70 $23.65 $457.96 $486.58 $29.30 $429.34 $44.48 $29.30 $286.23 $372.09 $30.49 $30.49 $30.49 $30.49 $36.64 $22.79 $21.70 $36.64 $21.70 $21.70 $16.27 $16.27 $16.27 $16.27 $486.58 330104 82677 398 301 HC ASSAY OF ESTRIOL O $387.34 $24.18 $24.18 $17.50 $193.67 N/A N/A N/A $17.50 $45.94 $17.50 $24.18 $290.50 $26.60 $244.02 $283.15 $21.00 $17.50 $232.40 $309.87 $82.21 $137.83 $17.50 $24.18 $251.77 $24.50 $309.87 $17.50 $17.50 $21.00 $33.85 $17.50 $24.18 $24.18 $26.36 $309.87 $329.24 $23.62 $290.50 $35.88 $23.62 $193.67 $251.77 $33.97 $33.97 $33.97 $33.97 $40.84 $25.39 $24.18 $40.84 $17.50 $17.50 $18.13 $18.13 $18.13 $17.50 $329.24 330104 82679 398 301 HC ASSAY OF ESTRONE O $535.00 $24.95 $24.95 $24.95 $267.50 N/A N/A N/A $24.95 $47.40 $24.95 $24.95 $401.25 $27.45 $337.05 $391.08 $29.94 $24.95 $321.00 $428.00 $84.83 $142.22 $24.95 $24.95 $347.75 $34.93 $428.00 $24.95 $24.95 $29.94 $34.93 $24.95 $24.95 $24.95 $27.20 $428.00 $454.75 $33.68 $401.25 $51.15 $33.68 $267.50 $347.75 $35.05 $35.05 $35.05 $35.05 $42.14 $26.20 $24.95 $42.14 $24.95 $24.95 $18.71 $18.71 $18.71 $18.71 $454.75 330104 82681 398 301 HC ASSAY DIR MEAS FR ESTRADIOL O $169.06 $27.94 $27.94 $27.94 $84.53 N/A N/A N/A $27.94 $53.09 $27.94 $27.94 $126.80 $30.73 $106.51 $123.58 $33.53 $27.94 $101.44 $135.25 $95.00 $159.26 $27.94 $27.94 $109.89 $39.12 $135.25 $27.94 $27.94 $33.53 $39.12 $27.94 $27.94 $27.94 $30.45 $135.25 $143.70 $37.72 $126.80 $57.28 $37.72 $84.53 $109.89 $39.26 $39.26 $39.26 $39.26 N/A $29.34 $27.94 $112.76 $27.94 $27.94 $20.96 $20.96 $20.96 $20.96 $159.26 330104 82693 404 301 HC ASSAY OF ETHYLENE GLYCOL O $186.18 $14.90 $14.90 N/A $93.09 N/A N/A N/A N/A $28.31 N/A $14.90 $139.63 $16.39 $117.29 $136.10 N/A N/A $111.71 $148.94 $50.66 $84.93 N/A $14.90 $121.02 N/A $148.94 N/A N/A N/A $20.86 N/A $14.90 $14.90 $16.24 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $20.93 $20.93 $20.93 $20.93 $25.15 $15.65 $14.90 $25.15 N/A N/A $11.18 $11.18 $11.18 $11.18 $158.25 330104 82705 402 301 HC FATS/LIPIDS FECES QUAL O $71.69 $5.10 $5.10 $5.10 $35.84 N/A N/A N/A $5.10 $9.69 $5.10 $5.10 $53.77 $5.61 $45.16 $52.41 $6.12 $5.10 $43.01 $57.35 $17.34 $29.07 $5.10 $5.10 $46.60 $7.14 $57.35 $5.10 $5.10 $6.12 $7.14 $5.10 $5.10 $5.10 $5.56 $57.35 $60.94 $6.88 $53.77 $10.45 $6.88 $35.84 $46.60 $7.17 $7.17 $7.17 $7.17 $8.59 $5.35 $5.10 $8.59 $5.10 $5.10 $3.82 $3.82 $3.82 $3.82 $60.94 330104 82726 400 301 HC LONG CHAIN FATTY ACIDS O $227.91 $19.75 $19.75 $19.75 $113.95 N/A N/A N/A $19.75 $37.52 $19.75 $19.75 $170.93 $21.73 $143.58 $166.60 $23.70 $19.75 $136.75 $182.33 $67.15 $112.58 $19.75 $19.75 $148.14 $27.65 $182.33 $19.75 $19.75 $23.70 $27.65 $19.75 $19.75 $19.75 $21.53 $182.33 $193.72 $26.66 $170.93 $40.49 $26.66 $113.95 $148.14 $27.75 $27.75 $27.75 $27.75 $30.49 $20.74 $19.75 $30.49 $19.75 $19.75 $14.81 $14.81 $14.81 $14.81 $193.72 330104 82728 400 301 HC ASSAY OF FERRITIN O $340.26 $13.63 $13.63 $13.63 $170.13 N/A N/A N/A $13.63 $25.90 $13.63 $13.63 $255.19 $14.99 $214.36 $248.73 $16.36 $13.63 $204.16 $272.21 $46.34 $77.69 $13.63 $13.63 $221.17 $19.08 $272.21 $13.63 $13.63 $16.36 $19.08 $13.63 $13.63 $13.63 $14.86 $272.21 $289.22 $18.40 $255.19 $27.94 $18.40 $170.13 $221.17 $19.15 $19.15 $19.15 $19.15 $23.00 $14.31 $13.63 $23.00 $13.63 $13.63 $10.22 $10.22 $10.22 $10.22 $289.22 330104 82731 384 301 HC ASSAY OF FETAL FIBRONECTIN O $830.32 $64.41 $64.41 $64.41 $415.16 N/A N/A N/A $64.41 $122.38 $64.41 $64.41 $622.74 $70.85 $523.10 $606.96 $77.29 $64.41 $498.19 $664.26 $218.99 $367.14 $64.41 $64.41 $539.71 $90.17 $664.26 $64.41 $64.41 $77.29 $90.17 $64.41 $64.41 $64.41 $70.21 $664.26 $705.77 $86.95 $622.74 $132.04 $86.95 $415.16 $539.71 $90.50 $90.50 $90.50 $90.50 $108.77 $67.63 $64.41 $108.77 $64.41 $64.41 $48.31 $48.31 $48.31 $48.31 $705.77 330104 82746 400 301 HC ASSAY OF FOLIC ACID SERUM O $306.02 $14.70 $14.70 $12.50 $153.01 N/A N/A N/A $12.50 $27.93 $12.50 $14.70 $229.51 $16.17 $192.79 $223.70 $15.00 $12.50 $183.61 $244.82 $49.98 $83.79 $12.50 $14.70 $198.91 $17.50 $244.82 $12.50 $12.50 $15.00 $20.58 $12.50 $14.70 $14.70 $16.02 $244.82 $260.12 $16.88 $229.51 $25.62 $16.88 $153.01 $198.91 $20.65 $20.65 $20.65 $20.65 $24.83 $15.44 $14.70 $24.83 $12.50 $12.50 $11.02 $11.02 $11.02 $11.02 $260.12 330104 82634 398 301 HC DEOXYCORTISOL O $233.26 $29.28 $29.28 $15.00 $116.63 N/A N/A N/A $15.00 $55.63 $15.00 $29.28 $174.94 $32.21 $146.95 $170.51 $18.00 $15.00 $139.96 $186.61 $99.55 $166.90 $15.00 $29.28 $151.62 $21.00 $186.61 $15.00 $15.00 $18.00 $40.99 $15.00 $29.28 $29.28 $31.92 $186.61 $198.27 $20.25 $174.94 $30.75 $20.25 $116.63 $151.62 $41.14 $41.14 $41.14 $41.14 $49.44 $30.74 $29.28 $49.44 $15.00 $15.00 $21.96 $21.96 $21.96 $15.00 $198.27 330104 82747 400 301 HC ASSAY OF FOLIC ACID RBC O $186.18 $17.65 $17.65 $12.50 $93.09 N/A N/A N/A $12.50 $33.53 $12.50 $17.65 $139.63 $19.41 $117.29 $136.10 $15.00 $12.50 $111.71 $148.94 $60.01 $100.60 $12.50 $17.65 $121.02 $17.50 $148.94 $12.50 $12.50 $15.00 $24.71 $12.50 $17.65 $17.65 $19.24 $148.94 $158.25 $16.88 $139.63 $25.62 $16.88 $93.09 $121.02 $24.80 $24.80 $24.80 $24.80 $29.26 $18.53 $17.65 $29.26 $12.50 $12.50 $13.24 $13.24 $13.24 $12.50 $158.25 330104 82633 399 301 HC DESOXYCORTICOSTERONE O $416.23 $30.98 $30.98 N/A $208.12 N/A N/A N/A N/A $58.86 N/A $30.98 $312.17 $34.08 $262.22 $304.26 N/A N/A $249.74 $332.98 $105.33 $176.59 N/A $30.98 $270.55 N/A $332.98 N/A N/A N/A $43.37 N/A $30.98 $30.98 $33.77 $332.98 $353.80 N/A $312.17 N/A N/A $208.12 $270.55 $43.53 $43.53 $43.53 $43.53 $52.31 $32.53 $30.98 $52.31 N/A N/A $23.23 $23.23 $23.23 $23.23 $353.80 330104 82626 400 301 HC DEHYDROEPIANDROSTERONE (DHEA) O "$1,800.81 " $25.27 $25.27 $23.82 $900.40 N/A N/A N/A $23.82 $48.01 $23.82 $25.27 "$1,350.61 " $27.80 "$1,134.51 " "$1,316.39 " $28.58 $23.82 "$1,080.49 " "$1,440.65 " $85.92 $144.04 $23.82 $25.27 "$1,170.53 " $33.35 "$1,440.65 " $23.82 $23.82 $28.58 $35.38 $23.82 $25.27 $25.27 $27.54 "$1,440.65 " "$1,530.69 " $32.16 "$1,350.61 " $48.83 $32.16 $900.40 "$1,170.53 " $35.50 $35.50 $35.50 $35.50 $42.67 $26.53 $25.27 $42.67 $23.82 $23.82 $18.95 $18.95 $18.95 $18.95 "$1,530.69 " 330104 82495 404 301 HC ASSAY OF CHROMIUM O $321.00 $20.28 $20.28 $20.28 $160.50 N/A N/A N/A $20.28 $38.53 $20.28 $20.28 $240.75 $22.31 $202.23 $234.65 $24.34 $20.28 $192.60 $256.80 $68.95 $115.60 $20.28 $20.28 $208.65 $28.39 $256.80 $20.28 $20.28 $24.34 $28.39 $20.28 $20.28 $20.28 $22.11 $256.80 $272.85 $27.38 $240.75 $41.57 $27.38 $160.50 $208.65 $28.49 $28.49 $28.49 $28.49 $34.25 $21.29 $20.28 $34.25 $20.28 $20.28 $15.21 $15.21 $15.21 $15.21 $272.85 330104 82523 400 301 HC COLLAGEN CROSSLINKS O $298.53 $18.68 $18.68 $18.68 $149.26 N/A N/A N/A $18.68 $35.49 $18.68 $18.68 $223.90 $20.55 $188.07 $218.23 $22.42 $18.68 $179.12 $238.82 $63.51 $106.48 $18.68 $18.68 $194.04 $26.15 $238.82 $18.68 $18.68 $22.42 $26.15 $18.68 $18.68 $18.68 $20.36 $238.82 $253.75 $25.22 $223.90 $38.29 $25.22 $149.26 $194.04 $26.25 $26.25 $26.25 $26.25 $31.57 $19.61 $18.68 $31.57 $18.68 $18.68 $14.01 $14.01 $14.01 $14.01 $253.75 330104 82525 404 301 HC ASSAY OF COPPER O $388.41 $12.41 $12.41 $12.41 $194.21 N/A N/A N/A $12.41 $23.58 $12.41 $12.41 $291.31 $13.65 $244.70 $283.93 $14.89 $12.41 $233.05 $310.73 $42.19 $70.74 $12.41 $12.41 $252.47 $17.37 $310.73 $12.41 $12.41 $14.89 $17.37 $12.41 $12.41 $12.41 $13.53 $310.73 $330.15 $16.75 $291.31 $25.44 $16.75 $194.21 $252.47 $17.44 $17.44 $17.44 $17.44 $20.95 $13.03 $12.41 $20.95 $12.41 $12.41 $9.31 $9.31 $9.31 $9.31 $330.15 330104 82530 400 301 HC CORTISOL FREE O $522.16 $16.71 $16.71 $16.71 $261.08 N/A N/A N/A $16.71 $31.75 $16.71 $16.71 $391.62 $18.38 $328.96 $381.70 $20.05 $16.71 $313.30 $417.73 $56.81 $95.25 $16.71 $16.71 $339.40 $23.39 $417.73 $16.71 $16.71 $20.05 $23.39 $16.71 $16.71 $16.71 $18.21 $417.73 $443.84 $22.56 $391.62 $34.26 $22.56 $261.08 $339.40 $23.48 $23.48 $23.48 $23.48 $28.22 $17.55 $16.71 $28.22 $16.71 $16.71 $12.53 $12.53 $12.53 $12.53 $443.84 330104 82533 398 301 HC TOTAL CORTISOL O $300.67 $16.30 $16.30 $16.30 $150.34 N/A N/A N/A $16.30 $30.97 $16.30 $16.30 $225.50 $17.93 $189.42 $219.79 $19.56 $16.30 $180.40 $240.54 $55.42 $92.91 $16.30 $16.30 $195.44 $22.82 $240.54 $16.30 $16.30 $19.56 $22.82 $16.30 $16.30 $16.30 $17.77 $240.54 $255.57 $22.01 $225.50 $33.41 $22.01 $150.34 $195.44 $22.90 $22.90 $22.90 $22.90 $27.54 $17.12 $16.30 $27.54 $16.30 $16.30 $12.23 $12.23 $12.23 $12.23 $255.57 330104 82542 400 301 HC COL CHROMOTOGRAPHY NON DRUG QUAL/QUAN O $283.55 $24.09 $24.09 N/A $141.78 N/A N/A N/A N/A $45.77 N/A $24.09 $212.66 $26.50 $178.64 $207.28 N/A N/A $170.13 $226.84 $81.91 $137.31 N/A $24.09 $184.31 N/A $226.84 N/A N/A N/A $33.73 N/A $24.09 $24.09 $26.26 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $33.85 $33.85 $33.85 $33.85 $30.49 $25.29 $24.09 $30.49 N/A N/A $18.07 $18.07 $18.07 $18.07 $241.02 330104 82550 402 301 HC ASSAY OF CK (CPK) O $142.31 $6.51 $6.51 $5.03 $71.16 N/A N/A N/A $5.03 $12.37 $5.03 $6.51 $106.73 $7.16 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $22.13 $37.11 $5.03 $6.51 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $9.11 $5.03 $6.51 $6.51 $7.10 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $9.15 $9.15 $9.15 $9.15 $11.00 $6.84 $6.51 $11.00 $5.03 $5.03 $4.88 $4.88 $4.88 $4.88 $120.96 330104 82553 400 301 HC CREATINE MB FRACTION O $311.37 $11.55 $11.55 $8.05 $155.69 N/A N/A N/A $8.05 $21.95 $8.05 $11.55 $233.53 $12.71 $196.16 $227.61 $9.66 $8.05 $186.82 $249.10 $39.27 $65.84 $8.05 $11.55 $202.39 $11.27 $249.10 $8.05 $8.05 $9.66 $16.17 $8.05 $11.55 $11.55 $12.59 $249.10 $264.66 $10.87 $233.53 $16.50 $10.87 $155.69 $202.39 $16.23 $16.23 $16.23 $16.23 $19.50 $12.13 $11.55 $19.50 $8.05 $8.05 $8.66 $8.66 $8.66 $8.05 $264.66 330104 83873 400 301 HC ASSAY OF CSF PROTEIN O $490.06 $17.20 $17.20 N/A $245.03 N/A N/A N/A N/A $32.68 N/A $17.20 $367.55 $18.92 $308.74 $358.23 N/A N/A $294.04 $392.05 $58.48 $98.04 N/A $17.20 $318.54 N/A $392.05 N/A N/A N/A $24.08 N/A $17.20 $17.20 $18.75 $392.05 $416.55 N/A $367.55 N/A N/A $245.03 $318.54 $24.17 $24.17 $24.17 $24.17 $29.05 $18.06 $17.20 $29.05 N/A N/A $12.90 $12.90 $12.90 $12.90 $416.55 330104 82570 402 301 HC ASSAY OF URINE CREATININE O $182.97 $5.18 $5.18 $5.03 $91.48 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $137.23 $5.70 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.61 $29.53 $5.03 $5.18 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $155.52 330104 82575 402 301 HC CREATININE CLEARANCE TEST O $311.37 $9.46 $9.46 $5.83 $155.69 N/A N/A N/A $5.83 $17.97 $5.83 $9.46 $233.53 $10.41 $196.16 $227.61 $7.00 $5.83 $186.82 $249.10 $32.16 $53.92 $5.83 $9.46 $202.39 $8.16 $249.10 $5.83 $5.83 $7.00 $13.24 $5.83 $9.46 $9.46 $10.31 $249.10 $264.66 $7.87 $233.53 $11.95 $7.87 $155.69 $202.39 $13.29 $13.29 $13.29 $13.29 $15.96 $9.93 $9.46 $15.96 $5.83 $5.83 $7.10 $7.10 $7.10 $5.83 $264.66 330104 82585 400 301 HC ASSAY OF CRYOFIBRINOGEN O $254.66 $14.14 $14.14 N/A $127.33 N/A N/A N/A N/A $26.87 N/A $14.14 $191.00 $15.55 $160.44 $186.16 N/A N/A $152.80 $203.73 $48.08 $80.60 N/A $14.14 $165.53 N/A $203.73 N/A N/A N/A $19.80 N/A $14.14 $14.14 $15.41 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $19.87 $19.87 $19.87 $19.87 $14.48 $14.85 $14.14 $14.48 N/A N/A $10.61 $10.61 $10.61 $10.61 $216.46 330104 82595 402 301 HC ASSAY OF CRYOGLOBULIN O $108.07 $6.47 $6.47 $5.48 $54.03 N/A N/A N/A $5.48 $12.29 $5.48 $6.47 $81.05 $7.12 $68.08 $79.00 $6.58 $5.48 $64.84 $86.46 $22.00 $36.88 $5.48 $6.47 $70.25 $7.67 $86.46 $5.48 $5.48 $6.58 $9.06 $5.48 $6.47 $6.47 $7.05 $86.46 $91.86 $7.40 $81.05 $11.23 $7.40 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $5.48 $5.48 $4.85 $4.85 $4.85 $4.85 $91.86 330104 82607 398 301 HC VITAMIN B-12 O $276.06 $15.08 $15.08 $12.50 $138.03 N/A N/A N/A $12.50 $28.65 $12.50 $15.08 $207.05 $16.59 $173.92 $201.80 $15.00 $12.50 $165.64 $220.85 $51.27 $85.96 $12.50 $15.08 $179.44 $17.50 $220.85 $12.50 $12.50 $15.00 $21.11 $12.50 $15.08 $15.08 $16.44 $220.85 $234.65 $16.88 $207.05 $25.62 $16.88 $138.03 $179.44 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $12.50 $12.50 $11.31 $11.31 $11.31 $11.31 $234.65 330104 82608 400 301 HC B-12 BINDING CAPACITY O $326.35 $14.32 $14.32 $14.32 $163.18 N/A N/A N/A $14.32 $27.21 $14.32 $14.32 $244.76 $15.75 $205.60 $238.56 $17.18 $14.32 $195.81 $261.08 $48.69 $81.62 $14.32 $14.32 $212.13 $20.05 $261.08 $14.32 $14.32 $17.18 $20.05 $14.32 $14.32 $14.32 $15.61 $261.08 $277.40 $19.33 $244.76 $29.36 $19.33 $163.18 $212.13 $20.12 $20.12 $20.12 $20.12 $24.18 $15.04 $14.32 $24.18 $14.32 $14.32 $10.74 $10.74 $10.74 $10.74 $277.40 330104 82627 398 301 HC DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) O $352.03 $22.23 $22.23 $22.23 $176.01 N/A N/A N/A $22.23 $42.24 $22.23 $22.23 $264.02 $24.45 $221.78 $257.33 $26.68 $22.23 $211.22 $281.62 $75.58 $126.71 $22.23 $22.23 $228.82 $31.12 $281.62 $22.23 $22.23 $26.68 $31.12 $22.23 $22.23 $22.23 $24.23 $281.62 $299.23 $30.01 $264.02 $45.57 $30.01 $176.01 $228.82 $31.23 $31.23 $31.23 $31.23 $37.55 $23.34 $22.23 $37.55 $22.23 $22.23 $16.67 $16.67 $16.67 $16.67 $299.23 330104 83695 400 301 HC ASSAY OF LIPOPROTEIN(A) O $207.58 $14.32 $14.32 N/A $103.79 N/A N/A N/A N/A $27.21 N/A $14.32 $155.69 $15.75 $130.78 $151.74 N/A N/A $124.55 $166.06 $48.69 $81.62 N/A $14.32 $134.93 N/A $166.06 N/A N/A N/A $20.05 N/A $14.32 $14.32 $15.61 $166.06 $176.44 N/A $155.69 N/A N/A $103.79 $134.93 $20.12 $20.12 $20.12 $20.12 $21.86 $15.04 $14.32 $21.86 N/A N/A $10.74 $10.74 $10.74 $10.74 $176.44 330104 82784 402 301 HC ASSAY IGA/IGD/IGG/IGM EACH O $439.77 $9.30 $9.30 $9.30 $219.88 N/A N/A N/A $9.30 $17.67 $9.30 $9.30 $329.83 $10.23 $277.06 $321.47 $11.16 $9.30 $263.86 $351.82 $31.62 $53.01 $9.30 $9.30 $285.85 $13.02 $351.82 $9.30 $9.30 $11.16 $13.02 $9.30 $9.30 $9.30 $10.14 $351.82 $373.80 $12.56 $329.83 $19.07 $12.56 $219.88 $285.85 $13.07 $13.07 $13.07 $13.07 $15.71 $9.77 $9.30 $15.71 $9.30 $9.30 $6.98 $6.98 $6.98 $6.98 $373.80 330104 82787 402 301 HC IGG 1 2 3 OR 4 EACH O $263.22 $8.02 $8.02 $5.90 $131.61 N/A N/A N/A $5.90 $15.24 $5.90 $8.02 $197.42 $8.82 $165.83 $192.41 $7.08 $5.90 $157.93 $210.58 $27.27 $45.71 $5.90 $8.02 $171.09 $8.26 $210.58 $5.90 $5.90 $7.08 $11.23 $5.90 $8.02 $8.02 $8.74 $210.58 $223.74 $7.97 $197.42 $12.09 $7.97 $131.61 $171.09 $11.27 $11.27 $11.27 $11.27 $13.55 $8.42 $8.02 $13.55 $5.90 $5.90 $6.01 $6.01 $6.01 $5.90 $223.74 330104 83070 402 301 HC ASSAY OF HEMOSIDERIN QUAL O $26.75 $4.75 $4.75 N/A $13.38 N/A N/A N/A N/A $9.03 N/A $4.75 $20.06 $5.23 $16.85 $19.55 N/A N/A $16.05 $21.40 $16.15 $27.07 N/A $4.75 $17.39 N/A $21.40 N/A N/A N/A $6.65 N/A $4.75 $4.75 $5.18 $21.40 $22.74 N/A $20.06 N/A N/A $13.38 $17.39 $6.67 $6.67 $6.67 $6.67 $8.02 $4.99 $4.75 $8.02 N/A N/A $3.56 $3.56 $3.56 $3.56 $27.07 330104 83088 401 301 HC ASSAY OF HISTAMINE O $572.45 $29.53 $29.53 N/A $286.23 N/A N/A N/A N/A $56.11 N/A $29.53 $429.34 $32.48 $360.64 $418.46 N/A N/A $343.47 $457.96 $100.40 $168.32 N/A $29.53 $372.09 N/A $457.96 N/A N/A N/A $41.34 N/A $29.53 $29.53 $32.19 $457.96 $486.58 N/A $429.34 N/A N/A $286.23 $372.09 $41.49 $41.49 $41.49 $41.49 $49.87 $31.01 $29.53 $49.87 N/A N/A $22.15 $22.15 $22.15 $22.15 $486.58 330104 83090 398 301 HC ASSAY OF HOMOCYSTINE O $265.36 $17.92 $17.92 $17.92 $132.68 N/A N/A N/A $17.92 $34.05 $17.92 $17.92 $199.02 $19.71 $167.18 $193.98 $21.50 $17.92 $159.22 $212.29 $60.93 $102.14 $17.92 $17.92 $172.48 $25.09 $212.29 $17.92 $17.92 $21.50 $25.09 $17.92 $17.92 $17.92 $19.53 $212.29 $225.56 $24.19 $199.02 $36.74 $24.19 $132.68 $172.48 $25.18 $25.18 $25.18 $25.18 $28.49 $18.82 $17.92 $28.49 $17.92 $17.92 $13.44 $13.44 $13.44 $13.44 $225.56 330104 83497 398 301 HC ASSAY OF 5-HIAA O $332.77 $12.90 $12.90 $12.90 $166.38 N/A N/A N/A $12.90 $24.51 $12.90 $12.90 $249.58 $14.19 $209.65 $243.25 $15.48 $12.90 $199.66 $266.22 $43.86 $73.53 $12.90 $12.90 $216.30 $18.06 $266.22 $12.90 $12.90 $15.48 $18.06 $12.90 $12.90 $12.90 $14.06 $266.22 $282.85 $17.42 $249.58 $26.44 $17.42 $166.38 $216.30 $18.12 $18.12 $18.12 $18.12 $21.77 $13.55 $12.90 $21.77 $12.90 $12.90 $9.68 $9.68 $9.68 $9.68 $282.85 330104 83498 398 301 HC ASSAY OF PROGESTERONE 17-D O $421.58 $27.17 $27.17 $27.17 $210.79 N/A N/A N/A $27.17 $51.62 $27.17 $27.17 $316.19 $29.89 $265.60 $308.17 $32.60 $27.17 $252.95 $337.26 $92.38 $154.87 $27.17 $27.17 $274.03 $38.04 $337.26 $27.17 $27.17 $32.60 $38.04 $27.17 $27.17 $27.17 $29.62 $337.26 $358.34 $36.68 $316.19 $55.70 $36.68 $210.79 $274.03 $38.17 $38.17 $38.17 $38.17 $45.88 $28.53 $27.17 $45.88 $27.17 $27.17 $20.38 $20.38 $20.38 $20.38 $358.34 330104 83516 400 301 HC IMMUNOASSAY NONANTIBODY O $548.91 $11.53 $11.53 N/A $274.45 N/A N/A N/A N/A $21.91 N/A $11.53 $411.68 $12.68 $345.81 $401.25 N/A N/A $329.35 $439.13 $39.20 $65.72 N/A $11.53 $356.79 N/A $439.13 N/A N/A N/A $16.14 N/A $11.53 $11.53 $12.57 $439.13 $466.57 N/A $411.68 N/A N/A $274.45 $356.79 $16.20 $16.20 $16.20 $16.20 $19.49 $12.11 $11.53 $19.49 N/A N/A $8.65 $8.65 $8.65 $8.65 $466.57 330104 83519 400 301 HC RIA NONANTIBODY O $218.28 $18.40 $18.40 N/A $109.14 N/A N/A N/A N/A $34.96 N/A $18.40 $163.71 $20.24 $137.52 $159.56 N/A N/A $130.97 $174.62 $62.56 $104.88 N/A $18.40 $141.88 N/A $174.62 N/A N/A N/A $25.76 N/A $18.40 $18.40 $20.06 $174.62 $185.54 N/A $163.71 N/A N/A $109.14 $141.88 $25.85 $25.85 $25.85 $25.85 $22.81 $19.32 $18.40 $22.81 N/A N/A $13.80 $13.80 $13.80 $13.80 $185.54 330104 83520 400 301 HC IMMUNOASSAY QUANT NOS NONAB O $143.38 $17.27 $17.27 N/A $71.69 N/A N/A N/A N/A $32.81 N/A $17.27 $107.53 $19.00 $90.33 $104.81 N/A N/A $86.03 $114.70 $58.72 $98.44 N/A $17.27 $93.20 N/A $114.70 N/A N/A N/A $24.18 N/A $17.27 $17.27 $18.82 $114.70 $121.87 N/A $107.53 N/A N/A $71.69 $93.20 $24.26 $24.26 $24.26 $24.26 $21.86 $18.13 $17.27 $21.86 N/A N/A $12.95 $12.95 $12.95 $12.95 $121.87 330104 83525 398 301 HC ASSAY OF INSULIN TOTAL O $439.77 $11.43 $11.43 $11.43 $219.88 N/A N/A N/A $11.43 $21.72 $11.43 $11.43 $329.83 $12.57 $277.06 $321.47 $13.72 $11.43 $263.86 $351.82 $38.86 $65.15 $11.43 $11.43 $285.85 $16.00 $351.82 $11.43 $11.43 $13.72 $16.00 $11.43 $11.43 $11.43 $12.46 $351.82 $373.80 $15.43 $329.83 $23.43 $15.43 $219.88 $285.85 $16.06 $16.06 $16.06 $16.06 $19.31 $12.00 $11.43 $19.31 $11.43 $11.43 $8.57 $8.57 $8.57 $8.57 $373.80 330104 83540 402 301 HC ASSAY OF IRON O $108.07 $6.47 $6.47 $5.03 $54.03 N/A N/A N/A $5.03 $12.29 $5.03 $6.47 $81.05 $7.12 $68.08 $79.00 $6.04 $5.03 $64.84 $86.46 $22.00 $36.88 $5.03 $6.47 $70.25 $7.04 $86.46 $5.03 $5.03 $6.04 $9.06 $5.03 $6.47 $6.47 $7.05 $86.46 $91.86 $6.79 $81.05 $10.31 $6.79 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.94 $6.79 $6.47 $10.94 $5.03 $5.03 $4.85 $4.85 $4.85 $4.85 $91.86 330104 83550 402 301 HC IRON BINDING TEST O $142.31 $8.74 $8.74 $5.03 $71.16 N/A N/A N/A $5.03 $16.61 $5.03 $8.74 $106.73 $9.61 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $29.72 $49.82 $5.03 $8.74 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $12.24 $5.03 $8.74 $8.74 $9.53 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $12.28 $12.28 $12.28 $12.28 $14.76 $9.18 $8.74 $14.76 $5.03 $5.03 $6.55 $6.55 $6.55 $5.03 $120.96 330104 83586 398 301 HC ASSAY 17- KETOSTEROIDS O $311.37 $12.80 $12.80 $9.40 $155.69 N/A N/A N/A $9.40 $24.32 $9.40 $12.80 $233.53 $14.08 $196.16 $227.61 $11.28 $9.40 $186.82 $249.10 $43.52 $72.96 $9.40 $12.80 $202.39 $13.16 $249.10 $9.40 $9.40 $11.28 $17.92 $9.40 $12.80 $12.80 $13.95 $249.10 $264.66 $12.69 $233.53 $19.27 $12.69 $155.69 $202.39 $17.98 $17.98 $17.98 $17.98 $21.62 $13.44 $12.80 $21.62 $9.40 $9.40 $9.60 $9.60 $9.60 $9.40 $264.66 330104 83605 400 301 HC ASSAY OF LACTIC ACID O $263.22 $11.57 $11.57 $9.30 $131.61 N/A N/A N/A $9.30 $21.98 $9.30 $11.57 $197.42 $12.73 $165.83 $192.41 $11.16 $9.30 $157.93 $210.58 $39.34 $65.95 $9.30 $11.57 $171.09 $13.02 $210.58 $9.30 $9.30 $11.16 $16.20 $9.30 $11.57 $11.57 $12.61 $210.58 $223.74 $12.56 $197.42 $19.07 $12.56 $131.61 $171.09 $16.26 $16.26 $16.26 $16.26 $18.04 $12.15 $11.57 $18.04 $9.30 $9.30 $8.68 $8.68 $8.68 $8.68 $223.74 330104 83615 402 301 HC LACTATE (LD) (LDH) ENZYME O $182.97 $6.04 $6.04 $5.03 $91.48 N/A N/A N/A $5.03 $11.48 $5.03 $6.04 $137.23 $6.64 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $20.54 $34.43 $5.03 $6.04 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $8.46 $5.03 $6.04 $6.04 $6.58 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $8.49 $8.49 $8.49 $8.49 $10.20 $6.34 $6.04 $10.20 $5.03 $5.03 $4.53 $4.53 $4.53 $4.53 $155.52 330104 83655 404 301 HC ASSAY OF LEAD O $191.53 $12.11 $12.11 $12.11 $95.77 N/A N/A N/A $12.11 $23.01 $12.11 $12.11 $143.65 $13.32 $120.66 $140.01 $14.53 $12.11 $114.92 $153.22 $41.17 $69.03 $12.11 $12.11 $124.49 $16.95 $153.22 $12.11 $12.11 $14.53 $16.95 $12.11 $12.11 $12.11 $13.20 $153.22 $162.80 $16.35 $143.65 $24.83 $16.35 $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.44 $12.72 $12.11 $20.44 $12.11 $12.11 $9.08 $9.08 $9.08 $9.08 $162.80 330104 83051 402 301 HC ASSAY OF PLASMA HEMOGLOBIN O $296.39 $7.31 $7.31 $3.75 $148.19 N/A N/A N/A $3.75 $13.89 $3.75 $7.31 $222.29 $8.04 $186.73 $216.66 $4.50 $3.75 $177.83 $237.11 $24.85 $41.67 $3.75 $7.31 $192.65 $5.25 $237.11 $3.75 $3.75 $4.50 $10.23 $3.75 $7.31 $7.31 $7.97 $237.11 $251.93 $5.06 $222.29 $7.69 $5.06 $148.19 $192.65 $10.27 $10.27 $10.27 $10.27 $12.35 $7.68 $7.31 $12.35 $3.75 $3.75 $5.48 $5.48 $5.48 $3.75 $251.93 330104 82785 400 301 HC ASSAY OF IGE O $439.77 $16.46 $16.46 $12.50 $219.88 N/A N/A N/A $12.50 $31.27 $12.50 $16.46 $329.83 $18.11 $277.06 $321.47 $15.00 $12.50 $263.86 $351.82 $55.96 $93.82 $12.50 $16.46 $285.85 $17.50 $351.82 $12.50 $12.50 $15.00 $23.04 $12.50 $16.46 $16.46 $17.94 $351.82 $373.80 $16.88 $329.83 $25.62 $16.88 $219.88 $285.85 $23.13 $23.13 $23.13 $23.13 $27.82 $17.28 $16.46 $27.82 $12.50 $12.50 $12.35 $12.35 $12.35 $12.35 $373.80 330104 83050 402 301 HC BLOOD METHEMOGLOBIN ASSAY O $466.52 $8.20 $8.20 $3.75 $233.26 N/A N/A N/A $3.75 $15.58 $3.75 $8.20 $349.89 $9.02 $293.91 $341.03 $4.50 $3.75 $279.91 $373.22 $27.88 $46.74 $3.75 $8.20 $303.24 $5.25 $373.22 $3.75 $3.75 $4.50 $11.48 $3.75 $8.20 $8.20 $8.94 $373.22 $396.54 $5.06 $349.89 $7.69 $5.06 $233.26 $303.24 $11.52 $11.52 $11.52 $11.52 $12.37 $8.61 $8.20 $12.37 $3.75 $3.75 $6.15 $6.15 $6.15 $3.75 $396.54 330104 83018 404 301 HC QUANTITATIVE SCREEN METALS O $346.68 $21.96 $21.96 N/A $173.34 N/A N/A N/A N/A $41.72 N/A $21.96 $260.01 $24.16 $218.41 $253.42 N/A N/A $208.01 $277.34 $74.66 $125.17 N/A $21.96 $225.34 N/A $277.34 N/A N/A N/A $30.74 N/A $21.96 $21.96 $23.94 $277.34 $294.68 N/A $260.01 N/A N/A $173.34 $225.34 $30.85 $30.85 $30.85 $30.85 $37.09 $23.06 $21.96 $37.09 N/A N/A $16.47 $16.47 $16.47 $16.47 $294.68 330104 82805 384 301 HC BLOOD GASES W/O2 SATURATION O $836.74 $78.77 $78.77 $23.89 $418.37 N/A N/A N/A $23.89 $149.66 $23.89 $78.77 $627.56 $86.65 $527.15 $611.66 $28.67 $23.89 $502.04 $669.39 $267.82 $448.99 $23.89 $78.77 $543.88 $33.45 $669.39 $23.89 $23.89 $28.67 $110.28 $23.89 $78.77 $78.77 $85.86 $669.39 $711.23 $32.25 $627.56 $48.97 $32.25 $418.37 $543.88 $110.67 $110.67 $110.67 $110.67 $47.93 $82.71 $78.77 $47.93 $23.89 $23.89 $59.08 $59.08 $59.08 $23.89 $711.23 330104 82941 398 301 HC ASSAY OF GASTRIN O $527.51 $17.63 $17.63 $17.63 $263.75 N/A N/A N/A $17.63 $33.50 $17.63 $17.63 $395.63 $19.39 $332.33 $385.61 $21.16 $17.63 $316.51 $422.01 $59.94 $100.49 $17.63 $17.63 $342.88 $24.68 $422.01 $17.63 $17.63 $21.16 $24.68 $17.63 $17.63 $17.63 $19.22 $422.01 $448.38 $23.80 $395.63 $36.14 $23.80 $263.75 $342.88 $24.77 $24.77 $24.77 $24.77 $29.78 $18.51 $17.63 $29.78 $17.63 $17.63 $13.22 $13.22 $13.22 $13.22 $448.38 330104 82943 398 301 HC ASSAY OF GLUCAGON O $80.25 $14.29 $14.29 $14.29 $40.12 N/A N/A N/A $14.29 $27.15 $14.29 $14.29 $60.19 $15.72 $50.56 $58.66 $17.15 $14.29 $48.15 $64.20 $48.59 $81.45 $14.29 $14.29 $52.16 $20.01 $64.20 $14.29 $14.29 $17.15 $20.01 $14.29 $14.29 $14.29 $15.58 $64.20 $68.21 $19.29 $60.19 $29.29 $19.29 $40.12 $52.16 $20.08 $20.08 $20.08 $20.08 $24.13 $15.00 $14.29 $24.13 $14.29 $14.29 $10.72 $10.72 $10.72 $10.72 $81.45 330104 82947 402 301 HC ASSAY GLUCOSE BLOOD QUANT O $108.07 $3.93 $3.93 $3.93 $54.03 N/A N/A N/A $3.93 $7.47 $3.93 $3.93 $81.05 $4.32 $68.08 $79.00 $4.72 $3.93 $64.84 $86.46 $13.36 $22.40 $3.93 $3.93 $70.25 $5.50 $86.46 $3.93 $3.93 $4.72 $5.50 $3.93 $3.93 $3.93 $4.28 $86.46 $91.86 $5.31 $81.05 $8.06 $5.31 $54.03 $70.25 $5.52 $5.52 $5.52 $5.52 $6.62 $4.13 $3.93 $6.62 $3.93 $3.93 $2.95 $2.95 $2.95 $2.95 $91.86 330104 82951 400 301 HC GLUCOSE TOLERANCE TEST (GTT) O $206.51 $12.87 $12.87 $6.84 $103.25 N/A N/A N/A $6.84 $24.45 $6.84 $12.87 $154.88 $14.16 $130.10 $150.96 $8.21 $6.84 $123.91 $165.21 $43.76 $73.36 $6.84 $12.87 $134.23 $9.58 $165.21 $6.84 $6.84 $8.21 $18.02 $6.84 $12.87 $12.87 $14.03 $165.21 $175.53 $9.23 $154.88 $14.02 $9.23 $103.25 $134.23 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $6.84 $6.84 $9.65 $9.65 $9.65 $6.84 $175.53 330104 82952 402 301 HC GTT-ADDED SAMPLES O $185.11 $3.92 $3.92 $1.40 $92.56 N/A N/A N/A $1.40 $7.45 $1.40 $3.92 $138.83 $4.31 $116.62 $135.32 $1.68 $1.40 $111.07 $148.09 $13.33 $22.34 $1.40 $3.92 $120.32 $1.96 $148.09 $1.40 $1.40 $1.68 $5.49 $1.40 $3.92 $3.92 $4.27 $148.09 $157.34 $1.89 $138.83 $2.87 $1.89 $92.56 $120.32 $5.51 $5.51 $5.51 $5.51 $6.61 $4.12 $3.92 $6.61 $1.40 $1.40 $2.94 $2.94 $2.94 $1.40 $157.34 330104 82955 402 301 HC ASSAY OF G6PD ENZYME O $155.15 $9.70 $9.70 $9.70 $77.58 N/A N/A N/A $9.70 $18.43 $9.70 $9.70 $116.36 $10.67 $97.74 $113.41 $11.64 $9.70 $93.09 $124.12 $32.98 $55.29 $9.70 $9.70 $100.85 $13.58 $124.12 $9.70 $9.70 $11.64 $13.58 $9.70 $9.70 $9.70 $10.57 $124.12 $131.88 $13.10 $116.36 $19.88 $13.10 $77.58 $100.85 $13.63 $13.63 $13.63 $13.63 $16.38 $10.19 $9.70 $16.38 $9.70 $9.70 $7.27 $7.27 $7.27 $7.27 $131.88 330104 82963 400 301 HC ASSAY OF GLUCOSIDASE O $155.15 $21.48 $21.48 $21.48 $77.58 N/A N/A N/A $21.48 $40.81 $21.48 $21.48 $116.36 $23.63 $97.74 $113.41 $25.78 $21.48 $93.09 $124.12 $73.03 $122.44 $21.48 $21.48 $100.85 $30.07 $124.12 $21.48 $21.48 $25.78 $30.07 $21.48 $21.48 $21.48 $23.41 $124.12 $131.88 $29.00 $116.36 $44.03 $29.00 $77.58 $100.85 $30.18 $30.18 $30.18 $30.18 $36.28 $22.55 $21.48 $36.28 $21.48 $21.48 $16.11 $16.11 $16.11 $16.11 $131.88 330104 82977 402 301 HC ASSAY OF GGT O $121.98 $7.20 $7.20 $5.03 $60.99 N/A N/A N/A $5.03 $13.68 $5.03 $7.20 $91.48 $7.92 $76.85 $89.17 $6.04 $5.03 $73.19 $97.58 $24.48 $41.04 $5.03 $7.20 $79.29 $7.04 $97.58 $5.03 $5.03 $6.04 $10.08 $5.03 $7.20 $7.20 $7.85 $97.58 $103.68 $6.79 $91.48 $10.31 $6.79 $60.99 $79.29 $10.12 $10.12 $10.12 $10.12 $12.16 $7.56 $7.20 $12.16 $5.03 $5.03 $5.40 $5.40 $5.40 $5.03 $103.68 330104 82985 400 301 HC ASSAY OF GLYCATED PROTEIN O $84.53 $16.76 $16.76 $10.64 $42.27 N/A N/A N/A $10.64 $31.84 $10.64 $16.76 $63.40 $18.44 $53.25 $61.79 $12.77 $10.64 $50.72 $67.62 $56.98 $95.53 $10.64 $16.76 $54.94 $14.90 $67.62 $10.64 $10.64 $12.77 $23.46 $10.64 $16.76 $16.76 $18.27 $67.62 $71.85 $14.36 $63.40 $21.81 $14.36 $42.27 $54.94 $23.55 $23.55 $23.55 $23.55 $25.45 $17.60 $16.76 $25.45 $10.64 $10.64 $12.57 $12.57 $12.57 $10.64 $95.53 330104 83001 398 301 HC ASSAY OF GONADOTROPIN (FSH) O $454.75 $18.58 $18.58 $18.58 $227.38 N/A N/A N/A $18.58 $35.30 $18.58 $18.58 $341.06 $20.44 $286.49 $332.42 $22.30 $18.58 $272.85 $363.80 $63.17 $105.91 $18.58 $18.58 $295.59 $26.01 $363.80 $18.58 $18.58 $22.30 $26.01 $18.58 $18.58 $18.58 $20.25 $363.80 $386.54 $25.08 $341.06 $38.09 $25.08 $227.38 $295.59 $26.10 $26.10 $26.10 $26.10 $31.38 $19.51 $18.58 $31.38 $18.58 $18.58 $13.93 $13.93 $13.93 $13.93 $386.54 330104 83002 398 301 HC ASSAY OF GONADOTROPIN (LH) O $522.16 $18.52 $18.52 $18.52 $261.08 N/A N/A N/A $18.52 $35.19 $18.52 $18.52 $391.62 $20.37 $328.96 $381.70 $22.22 $18.52 $313.30 $417.73 $62.97 $105.56 $18.52 $18.52 $339.40 $25.93 $417.73 $18.52 $18.52 $22.22 $25.93 $18.52 $18.52 $18.52 $20.19 $417.73 $443.84 $25.00 $391.62 $37.97 $25.00 $261.08 $339.40 $26.02 $26.02 $26.02 $26.02 $31.27 $19.45 $18.52 $31.27 $18.52 $18.52 $13.89 $13.89 $13.89 $13.89 $443.84 330104 83003 398 301 HC ASSAY GROWTH HORMONE (HGH) O $535.00 $16.67 $16.67 $16.67 $267.50 N/A N/A N/A $16.67 $31.67 $16.67 $16.67 $401.25 $18.34 $337.05 $391.08 $20.00 $16.67 $321.00 $428.00 $56.68 $95.02 $16.67 $16.67 $347.75 $23.34 $428.00 $16.67 $16.67 $20.00 $23.34 $16.67 $16.67 $16.67 $18.17 $428.00 $454.75 $22.50 $401.25 $34.17 $22.50 $267.50 $347.75 $23.42 $23.42 $23.42 $23.42 $28.16 $17.50 $16.67 $28.16 $16.67 $16.67 $12.50 $12.50 $12.50 $12.50 $454.75 330104 83010 400 301 HC ASSAY OF HAPTOGLOBIN QUANT O $368.08 $12.58 $12.58 $12.58 $184.04 N/A N/A N/A $12.58 $23.90 $12.58 $12.58 $276.06 $13.84 $231.89 $269.07 $15.10 $12.58 $220.85 $294.46 $42.77 $71.71 $12.58 $12.58 $239.25 $17.61 $294.46 $12.58 $12.58 $15.10 $17.61 $12.58 $12.58 $12.58 $13.71 $294.46 $312.87 $16.98 $276.06 $25.79 $16.98 $184.04 $239.25 $17.67 $17.67 $17.67 $17.67 $21.24 $13.21 $12.58 $21.24 $12.58 $12.58 $9.44 $9.44 $9.44 $9.44 $312.87 330104 83013 384 301 HC H PYLORI (C-13) BREATH O $267.50 $67.36 $67.36 $67.36 $133.75 N/A N/A N/A $67.36 $127.98 $67.36 $67.36 $200.62 $74.10 $168.53 $195.54 $80.83 $67.36 $160.50 $214.00 $229.02 $383.95 $67.36 $67.36 $173.88 $94.30 $214.00 $67.36 $67.36 $80.83 $94.30 $67.36 $67.36 $67.36 $73.42 $214.00 $227.38 $90.94 $200.62 $138.09 $90.94 $133.75 $173.88 $94.64 $94.64 $94.64 $94.64 $113.75 $70.73 $67.36 $113.75 $67.36 $67.36 $50.52 $50.52 $50.52 $50.52 $383.95 330104 83036 402 301 HC GLYCOSYLATED HEMOGLOBIN TEST O $131.61 $9.71 $9.71 $9.71 $65.81 N/A N/A N/A $9.71 $18.45 $9.71 $9.71 $98.71 $10.68 $82.91 $96.21 $11.65 $9.71 $78.97 $105.29 $33.01 $55.35 $9.71 $9.71 $85.55 $13.59 $105.29 $9.71 $9.71 $11.65 $13.59 $9.71 $9.71 $9.71 $10.58 $105.29 $111.87 $13.11 $98.71 $19.91 $13.11 $65.81 $85.55 $13.64 $13.64 $13.64 $13.64 $16.39 $10.20 $9.71 $16.39 $9.71 $9.71 $7.28 $7.28 $7.28 $7.28 $111.87 330104 83874 400 301 HC ASSAY OF MYOGLOBIN O $584.22 $12.92 $12.92 N/A $292.11 N/A N/A N/A N/A $24.55 N/A $12.92 $438.17 $14.21 $368.06 $427.06 N/A N/A $350.53 $467.38 $43.93 $73.64 N/A $12.92 $379.74 N/A $467.38 N/A N/A N/A $18.09 N/A $12.92 $12.92 $14.08 $467.38 $496.59 N/A $438.17 N/A N/A $292.11 $379.74 $18.15 $18.15 $18.15 $18.15 $21.80 $13.57 $12.92 $21.80 N/A N/A $9.69 $9.69 $9.69 $9.69 $496.59 330104 84166 400 301 HC PROTEIN E-PHORESIS/URINE/CSF O $281.41 $17.83 $17.83 $11.25 $140.71 N/A N/A N/A $11.25 $33.88 $11.25 $17.83 $211.06 $19.61 $177.29 $205.71 $13.50 $11.25 $168.85 $225.13 $60.62 $101.63 $11.25 $17.83 $182.92 $15.75 $225.13 $11.25 $11.25 $13.50 $24.96 $11.25 $17.83 $17.83 $19.43 $225.13 $239.20 $15.19 $211.06 $23.06 $15.19 $140.71 $182.92 $25.05 $25.05 $25.05 $25.05 $30.11 $18.72 $17.83 $30.11 $11.25 $11.25 $13.37 $13.37 $13.37 $11.25 $239.20 330104 83883 394 301 HC ASSAY NEPHELOMETRY NOT SPEC O $185.11 $13.60 $13.60 N/A $92.56 N/A N/A N/A N/A $25.84 N/A $13.60 $138.83 $14.96 $116.62 $135.32 N/A N/A $111.07 $148.09 $46.24 $77.52 N/A $13.60 $120.32 N/A $148.09 N/A N/A N/A $19.04 N/A $13.60 $13.60 $14.82 $148.09 $157.34 N/A $138.83 N/A N/A $92.56 $120.32 $19.11 $19.11 $19.11 $19.11 $22.96 $14.28 $13.60 $22.96 N/A N/A $10.20 $10.20 $10.20 $10.20 $157.34 330104 84480 398 301 HC ASSAY TRIIODOTHYRONINE (T3) O $420.51 $14.18 $14.18 $5.70 $210.25 N/A N/A N/A $5.70 $26.94 $5.70 $14.18 $315.38 $15.60 $264.92 $307.39 $6.84 $5.70 $252.31 $336.41 $48.21 $80.83 $5.70 $14.18 $273.33 $7.98 $336.41 $5.70 $5.70 $6.84 $19.85 $5.70 $14.18 $14.18 $15.46 $336.41 $357.43 $7.70 $315.38 $11.68 $7.70 $210.25 $273.33 $19.92 $19.92 $19.92 $19.92 $23.94 $14.89 $14.18 $23.94 $5.70 $5.70 $10.63 $10.63 $10.63 $5.70 $357.43 330104 84479 398 301 HC ASSAY OF THYROID (T3 OR T4) O $108.07 $6.47 $6.47 $3.30 $54.03 N/A N/A N/A $3.30 $12.29 $3.30 $6.47 $81.05 $7.12 $68.08 $79.00 $3.96 $3.30 $64.84 $86.46 $22.00 $36.88 $3.30 $6.47 $70.25 $4.62 $86.46 $3.30 $3.30 $3.96 $9.06 $3.30 $6.47 $6.47 $7.05 $86.46 $91.86 $4.46 $81.05 $6.76 $4.46 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $3.30 $3.30 $4.85 $4.85 $4.85 $3.30 $91.86 330104 84478 402 301 HC ASSAY OF TRIGLYCERIDES O $96.30 $5.74 $5.74 $5.03 $48.15 N/A N/A N/A $5.03 $10.91 $5.03 $5.74 $72.22 $6.31 $60.67 $70.40 $6.04 $5.03 $57.78 $77.04 $19.52 $32.72 $5.03 $5.74 $62.59 $7.04 $77.04 $5.03 $5.03 $6.04 $8.04 $5.03 $5.74 $5.74 $6.26 $77.04 $81.85 $6.79 $72.22 $10.31 $6.79 $48.15 $62.59 $8.06 $8.06 $8.06 $8.06 $9.72 $6.03 $5.74 $9.72 $5.03 $5.03 $4.30 $4.30 $4.30 $4.30 $81.85 330104 84466 400 301 HC ASSAY OF TRANSFERRIN O $378.78 $12.76 $12.76 $12.50 $189.39 N/A N/A N/A $12.50 $24.24 $12.50 $12.76 $284.08 $14.04 $238.63 $276.89 $15.00 $12.50 $227.27 $303.02 $43.38 $72.73 $12.50 $12.76 $246.21 $17.50 $303.02 $12.50 $12.50 $15.00 $17.86 $12.50 $12.76 $12.76 $13.91 $303.02 $321.96 $16.88 $284.08 $25.62 $16.88 $189.39 $246.21 $17.93 $17.93 $17.93 $17.93 $21.56 $13.40 $12.76 $21.56 $12.50 $12.50 $9.57 $9.57 $9.57 $9.57 $321.96 330104 84460 402 301 HC ALANINE AMINO (ALT) (SGPT) O $121.98 $5.30 $5.30 $5.03 $60.99 N/A N/A N/A $5.03 $10.07 $5.03 $5.30 $91.48 $5.83 $76.85 $89.17 $6.04 $5.03 $73.19 $97.58 $18.02 $30.21 $5.03 $5.30 $79.29 $7.04 $97.58 $5.03 $5.03 $6.04 $7.42 $5.03 $5.30 $5.30 $5.78 $97.58 $103.68 $6.79 $91.48 $10.31 $6.79 $60.99 $79.29 $7.45 $7.45 $7.45 $7.45 $8.93 $5.57 $5.30 $8.93 $5.03 $5.03 $3.97 $3.97 $3.97 $3.97 $103.68 330104 84450 402 301 HC TRANSFERASE (AST) (SGOT) O $142.31 $5.18 $5.18 $5.03 $71.16 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $106.73 $5.70 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $17.61 $29.53 $5.03 $5.18 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $120.96 330104 84446 400 301 HC ASSAY OF VITAMIN E O $58.85 $14.18 $14.18 $14.18 $29.43 N/A N/A N/A $14.18 $26.94 $14.18 $14.18 $44.14 $15.60 $37.08 $43.02 $17.02 $14.18 $35.31 $47.08 $48.21 $80.83 $14.18 $14.18 $38.25 $19.85 $47.08 $14.18 $14.18 $17.02 $19.85 $14.18 $14.18 $14.18 $15.46 $47.08 $50.02 $19.14 $44.14 $29.07 $19.14 $29.43 $38.25 $19.92 $19.92 $19.92 $19.92 $23.94 $14.89 $14.18 $23.94 $14.18 $14.18 $10.63 $10.63 $10.63 $10.63 $80.83 330104 84445 399 301 HC ASSAY OF TSI GLOBULIN O $795.01 $50.86 $50.86 N/A $397.50 N/A N/A N/A N/A $96.63 N/A $50.86 $596.26 $55.95 $500.86 $581.15 N/A N/A $477.01 $636.01 $172.92 $289.90 N/A $50.86 $516.76 N/A $636.01 N/A N/A N/A $71.20 N/A $50.86 $50.86 $55.44 $636.01 $675.76 N/A $596.26 N/A N/A $397.50 $516.76 $71.46 $71.46 $71.46 $71.46 $85.87 $53.40 $50.86 $85.87 N/A N/A $38.14 $38.14 $38.14 $38.14 $675.76 330104 84443 398 301 HC ASSAY THYROID STIM HORMONE O $340.26 $16.80 $16.80 $9.00 $170.13 N/A N/A N/A $9.00 $31.92 $9.00 $16.80 $255.19 $18.48 $214.36 $248.73 $10.80 $9.00 $204.16 $272.21 $57.12 $95.76 $9.00 $16.80 $221.17 $12.60 $272.21 $9.00 $9.00 $10.80 $23.52 $9.00 $16.80 $16.80 $18.31 $272.21 $289.22 $12.15 $255.19 $18.45 $12.15 $170.13 $221.17 $23.60 $23.60 $23.60 $23.60 $28.37 $17.64 $16.80 $28.37 $9.00 $9.00 $12.60 $12.60 $12.60 $9.00 $289.22 330104 84442 398 301 HC ASSAY OF THYROID ACTIVITY O $522.16 $14.78 $14.78 $9.00 $261.08 N/A N/A N/A $9.00 $28.08 $9.00 $14.78 $391.62 $16.26 $328.96 $381.70 $10.80 $9.00 $313.30 $417.73 $50.25 $84.25 $9.00 $14.78 $339.40 $12.60 $417.73 $9.00 $9.00 $10.80 $20.69 $9.00 $14.78 $14.78 $16.11 $417.73 $443.84 $12.15 $391.62 $18.45 $12.15 $261.08 $339.40 $20.77 $20.77 $20.77 $20.77 $24.98 $15.52 $14.78 $24.98 $9.00 $9.00 $11.08 $11.08 $11.08 $9.00 $443.84 330104 84439 398 301 HC ASSAY OF FREE THYROXINE O $154.08 $9.02 $9.02 $9.00 $77.04 N/A N/A N/A $9.00 $17.14 $9.00 $9.02 $115.56 $9.92 $97.07 $112.63 $10.80 $9.00 $92.45 $123.26 $30.67 $51.41 $9.00 $9.02 $100.15 $12.60 $123.26 $9.00 $9.00 $10.80 $12.63 $9.00 $9.02 $9.02 $9.83 $123.26 $130.97 $12.15 $115.56 $18.45 $12.15 $77.04 $100.15 $12.67 $12.67 $12.67 $12.67 $15.23 $9.47 $9.02 $15.23 $9.00 $9.00 $6.76 $6.76 $6.76 $6.76 $130.97 330104 84436 398 301 HC ASSAY OF TOTAL THYROXINE O $112.35 $6.87 $6.87 $5.70 $56.17 N/A N/A N/A $5.70 $13.05 $5.70 $6.87 $84.26 $7.56 $70.78 $82.13 $6.84 $5.70 $67.41 $89.88 $23.36 $39.16 $5.70 $6.87 $73.03 $7.98 $89.88 $5.70 $5.70 $6.84 $9.62 $5.70 $6.87 $6.87 $7.49 $89.88 $95.50 $7.70 $84.26 $11.68 $7.70 $56.17 $73.03 $9.65 $9.65 $9.65 $9.65 $11.60 $7.21 $6.87 $11.60 $5.70 $5.70 $5.15 $5.15 $5.15 $5.15 $95.50 330104 84432 398 301 HC ASSAY OF THYROGLOBULIN O $254.66 $16.06 $16.06 N/A $127.33 N/A N/A N/A N/A $30.51 N/A $16.06 $191.00 $17.67 $160.44 $186.16 N/A N/A $152.80 $203.73 $54.60 $91.54 N/A $16.06 $165.53 N/A $203.73 N/A N/A N/A $22.48 N/A $16.06 $16.06 $17.51 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $22.56 $22.56 $22.56 $22.56 $27.13 $16.86 $16.06 $27.13 N/A N/A $12.04 $12.04 $12.04 $12.04 $216.46 330104 84425 400 301 HC ASSAY OF VITAMIN B-1 O $814.27 $21.23 $21.23 $15.00 $407.13 N/A N/A N/A $15.00 $40.34 $15.00 $21.23 $610.70 $23.35 $512.99 $595.23 $18.00 $15.00 $488.56 $651.42 $72.18 $121.01 $15.00 $21.23 $529.28 $21.00 $651.42 $15.00 $15.00 $18.00 $29.72 $15.00 $21.23 $21.23 $23.14 $651.42 $692.13 $20.25 $610.70 $30.75 $20.25 $407.13 $529.28 $29.83 $29.83 $29.83 $29.83 $35.86 $22.29 $21.23 $35.86 $15.00 $15.00 $15.92 $15.92 $15.92 $15.00 $692.13 330104 84403 398 301 HC ASSAY OF TOTAL TESTOSTERONE O $800.36 $25.81 $25.81 $25.81 $400.18 N/A N/A N/A $25.81 $49.04 $25.81 $25.81 $600.27 $28.39 $504.23 $585.06 $30.97 $25.81 $480.22 $640.29 $87.75 $147.12 $25.81 $25.81 $520.23 $36.13 $640.29 $25.81 $25.81 $30.97 $36.13 $25.81 $25.81 $25.81 $28.13 $640.29 $680.31 $34.84 $600.27 $52.91 $34.84 $400.18 $520.23 $36.26 $36.26 $36.26 $36.26 $43.60 $27.10 $25.81 $43.60 $25.81 $25.81 $19.36 $19.36 $19.36 $19.36 $680.31 330104 84402 398 301 HC ASSAY OF FREE TESTOSTERONE O $404.46 $25.47 $25.47 $25.47 $202.23 N/A N/A N/A $25.47 $48.39 $25.47 $25.47 $303.34 $28.02 $254.81 $295.66 $30.56 $25.47 $242.68 $323.57 $86.60 $145.18 $25.47 $25.47 $262.90 $35.66 $323.57 $25.47 $25.47 $30.56 $35.66 $25.47 $25.47 $25.47 $27.76 $323.57 $343.79 $34.38 $303.34 $52.21 $34.38 $202.23 $262.90 $35.79 $35.79 $35.79 $35.79 $43.01 $26.74 $25.47 $43.01 $25.47 $25.47 $19.10 $19.10 $19.10 $19.10 $343.79 330104 84378 400 301 HC SUGARS SINGLE QUANT O $53.50 $11.53 $11.53 $11.53 $26.75 N/A N/A N/A $11.53 $21.91 $11.53 $11.53 $40.12 $12.68 $33.70 $39.11 $13.84 $11.53 $32.10 $42.80 $39.20 $65.72 $11.53 $11.53 $34.77 $16.14 $42.80 $11.53 $11.53 $13.84 $16.14 $11.53 $11.53 $11.53 $12.57 $42.80 $45.48 $15.57 $40.12 $23.64 $15.57 $26.75 $34.77 $16.20 $16.20 $16.20 $16.20 $19.46 $12.11 $11.53 $19.46 $11.53 $11.53 $8.65 $8.65 $8.65 $8.65 $65.72 330104 84481 398 301 HC FREE ASSAY (FT-3) O "$1,009.01 " $16.94 $16.94 $9.00 $504.50 N/A N/A N/A $9.00 $32.19 $9.00 $16.94 $756.76 $18.63 $635.68 $737.59 $10.80 $9.00 $605.41 $807.21 $57.60 $96.56 $9.00 $16.94 $655.86 $12.60 $807.21 $9.00 $9.00 $10.80 $23.72 $9.00 $16.94 $16.94 $18.46 $807.21 $857.66 $12.15 $756.76 $18.45 $12.15 $504.50 $655.86 $23.80 $23.80 $23.80 $23.80 $28.61 $17.79 $16.94 $28.61 $9.00 $9.00 $12.71 $12.71 $12.71 $9.00 $857.66 330104 84311 402 301 HC SPECTROPHOTOMETRY O $254.66 $8.10 $8.10 N/A $127.33 N/A N/A N/A N/A $15.39 N/A $8.10 $191.00 $8.91 $160.44 $186.16 N/A N/A $152.80 $203.73 $27.54 $46.17 N/A $8.10 $165.53 N/A $203.73 N/A N/A N/A $11.34 N/A $8.10 $8.10 $8.83 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $11.38 $11.38 $11.38 $11.38 $11.80 $8.51 $8.10 $11.80 N/A N/A $6.07 $6.07 $6.07 $6.07 $216.46 330104 84482 398 301 HC T3 REVERSE O $864.56 $15.76 $15.76 $5.70 $432.28 N/A N/A N/A $5.70 $29.94 $5.70 $15.76 $648.42 $17.34 $544.67 $631.99 $6.84 $5.70 $518.74 $691.65 $53.58 $89.83 $5.70 $15.76 $561.96 $7.98 $691.65 $5.70 $5.70 $6.84 $22.06 $5.70 $15.76 $15.76 $17.18 $691.65 $734.88 $7.70 $648.42 $11.68 $7.70 $432.28 $561.96 $22.14 $22.14 $22.14 $22.14 $26.62 $16.55 $15.76 $26.62 $5.70 $5.70 $11.82 $11.82 $11.82 $5.70 $734.88 330104 84520 402 301 HC ASSAY OF UREA NITROGEN O $79.18 $3.95 $3.95 $3.95 $39.59 N/A N/A N/A $3.95 $7.50 $3.95 $3.95 $59.39 $4.35 $49.88 $57.88 $4.74 $3.95 $47.51 $63.34 $13.43 $22.52 $3.95 $3.95 $51.47 $5.53 $63.34 $3.95 $3.95 $4.74 $5.53 $3.95 $3.95 $3.95 $4.31 $63.34 $67.30 $5.33 $59.39 $8.10 $5.33 $39.59 $51.47 $5.55 $5.55 $5.55 $5.55 $6.67 $4.15 $3.95 $6.67 $3.95 $3.95 $2.96 $2.96 $2.96 $2.96 $67.30 330104 87529 397 301 HC HERPES S AMPLIF NA PROBE O $222.56 $35.09 $35.09 $32.15 $111.28 N/A N/A N/A $32.15 $66.67 $32.15 $35.09 $166.92 $38.60 $140.21 $162.69 $38.58 $32.15 $133.54 $178.05 $119.31 $200.01 $32.15 $35.09 $144.66 $45.01 $178.05 $32.15 $32.15 $38.58 $49.13 $32.15 $35.09 $35.09 $38.25 $178.05 $189.18 $43.40 $166.92 $65.91 $43.40 $111.28 $144.66 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $32.15 $32.15 $26.32 $26.32 $26.32 $26.32 $200.01 330104 87158 396 301 HC CULTURE TYPING ADDED METHOD O $155.15 $7.74 $7.74 N/A $77.58 N/A N/A N/A N/A $14.71 N/A $7.74 $116.36 $8.51 $97.74 $113.41 N/A N/A $93.09 $124.12 $26.32 $44.12 N/A $7.74 $100.85 N/A $124.12 N/A N/A N/A $10.84 N/A $7.74 $7.74 $8.44 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $10.87 $10.87 $10.87 $10.87 $8.83 $8.13 $7.74 $8.83 N/A N/A $5.80 $5.80 $5.80 $5.80 $131.88 330104 86352 395 301 HC CELL FUNCTION ASSAY W/STIM O $505.04 $135.86 $135.86 N/A $252.52 N/A N/A N/A N/A $258.13 N/A $135.86 $378.78 $149.45 $318.18 $369.18 N/A N/A $303.02 $404.03 $461.92 $774.40 N/A $135.86 $328.28 N/A $404.03 N/A N/A N/A $190.20 N/A $135.86 $135.86 $148.09 $404.03 $429.28 N/A $378.78 N/A N/A $252.52 $328.28 $190.88 $190.88 $190.88 $190.88 $229.43 $142.65 $135.86 $229.43 N/A N/A $101.90 $101.90 $101.90 $101.90 $774.40 330104 86336 394 301 HC INHIBIN A O $528.58 $15.59 $15.59 $6.50 $264.29 N/A N/A N/A $6.50 $29.62 $6.50 $15.59 $396.44 $17.15 $333.01 $386.39 $7.80 $6.50 $317.15 $422.86 $53.01 $88.86 $6.50 $15.59 $343.58 $9.10 $422.86 $6.50 $6.50 $7.80 $21.83 $6.50 $15.59 $15.59 $16.99 $422.86 $449.29 $8.78 $396.44 $13.32 $8.78 $264.29 $343.58 $21.90 $21.90 $21.90 $21.90 $26.32 $16.37 $15.59 $26.32 $6.50 $6.50 $11.69 $11.69 $11.69 $6.50 $449.29 330104 86335 395 301 HC IMMUNFIX E-PHORSIS/URINE/CSF O $465.45 $29.35 $29.35 $29.35 $232.72 N/A N/A N/A $29.35 $55.77 $29.35 $29.35 $349.09 $32.29 $293.23 $340.24 $35.22 $29.35 $279.27 $372.36 $99.79 $167.30 $29.35 $29.35 $302.54 $41.09 $372.36 $29.35 $29.35 $35.22 $41.09 $29.35 $29.35 $29.35 $31.99 $372.36 $395.63 $39.62 $349.09 $60.17 $39.62 $232.72 $302.54 $41.24 $41.24 $41.24 $41.24 $49.56 $30.82 $29.35 $49.56 $29.35 $29.35 $22.01 $22.01 $22.01 $22.01 $395.63 330104 85415 406 301 HC FIBRINOLYTIC PLASMINOGEN ACTIVATOR O $333.84 $17.19 $17.19 N/A $166.92 N/A N/A N/A N/A $32.66 N/A $17.19 $250.38 $18.91 $210.32 $244.04 N/A N/A $200.30 $267.07 $58.45 $97.98 N/A $17.19 $217.00 N/A $267.07 N/A N/A N/A $24.07 N/A $17.19 $17.19 $18.74 $267.07 $283.76 N/A $250.38 N/A N/A $166.92 $217.00 $24.15 $24.15 $24.15 $24.15 $29.04 $18.05 $17.19 $29.04 N/A N/A $12.89 $12.89 $12.89 $12.89 $283.76 330104 84703 402 301 HC CHORIONIC GONADOTROPIN ASSAY O $79.18 $7.52 $7.52 $2.00 $39.59 N/A N/A N/A $2.00 $14.29 $2.00 $7.52 $59.39 $8.27 $49.88 $57.88 $2.40 $2.00 $47.51 $63.34 $25.57 $42.86 $2.00 $7.52 $51.47 $2.80 $63.34 $2.00 $2.00 $2.40 $10.53 $2.00 $7.52 $7.52 $8.20 $63.34 $67.30 $2.70 $59.39 $4.10 $2.70 $39.59 $51.47 $10.57 $10.57 $10.57 $10.57 $12.68 $7.90 $7.52 $12.68 $2.00 $2.00 $5.64 $5.64 $5.64 $2.00 $67.30 330104 84702 398 301 HC CHORIONIC GONADOTROPIN TEST O $284.62 $15.05 $15.05 $12.37 $142.31 N/A N/A N/A $12.37 $28.59 $12.37 $15.05 $213.47 $16.56 $179.31 $208.06 $14.84 $12.37 $170.77 $227.70 $51.17 $85.79 $12.37 $15.05 $185.00 $17.32 $227.70 $12.37 $12.37 $14.84 $21.07 $12.37 $15.05 $15.05 $16.40 $227.70 $241.93 $16.70 $213.47 $25.36 $16.70 $142.31 $185.00 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 $12.37 $12.37 $11.29 $11.29 $11.29 $11.29 $241.93 330104 84681 400 301 HC ASSAY OF C-PEPTIDE O "$1,153.46 " $20.81 $20.81 $20.81 $576.73 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $865.10 $22.89 $726.68 $843.18 $24.97 $20.81 $692.08 $922.77 $70.75 $118.62 $20.81 $20.81 $749.75 $29.13 $922.77 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $922.77 $980.44 $28.09 $865.10 $42.66 $28.09 $576.73 $749.75 $29.24 $29.24 $29.24 $29.24 $35.14 $21.85 $20.81 $35.14 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $980.44 330104 84630 404 301 HC ASSAY OF ZINC O $194.74 $11.39 $11.39 $7.90 $97.37 N/A N/A N/A $7.90 $21.64 $7.90 $11.39 $146.06 $12.53 $122.69 $142.35 $9.48 $7.90 $116.84 $155.79 $38.73 $64.92 $7.90 $11.39 $126.58 $11.06 $155.79 $7.90 $7.90 $9.48 $15.95 $7.90 $11.39 $11.39 $12.42 $155.79 $165.53 $10.67 $146.06 $16.20 $10.67 $97.37 $126.58 $16.00 $16.00 $16.00 $16.00 $19.22 $11.96 $11.39 $19.22 $7.90 $7.90 $8.54 $8.54 $8.54 $7.90 $165.53 330104 84597 400 301 HC ASSAY OF VITAMIN K O $218.28 $13.72 $13.72 $13.72 $109.14 N/A N/A N/A $13.72 $26.07 $13.72 $13.72 $163.71 $15.09 $137.52 $159.56 $16.46 $13.72 $130.97 $174.62 $46.65 $78.20 $13.72 $13.72 $141.88 $19.21 $174.62 $13.72 $13.72 $16.46 $19.21 $13.72 $13.72 $13.72 $14.95 $174.62 $185.54 $18.52 $163.71 $28.13 $18.52 $109.14 $141.88 $19.28 $19.28 $19.28 $19.28 $23.15 $14.41 $13.72 $23.15 $13.72 $13.72 $10.29 $10.29 $10.29 $10.29 $185.54 330104 84591 400 301 HC ASSAY OF NOS VITAMIN O $129.47 $17.06 $17.06 N/A $64.73 N/A N/A N/A N/A $32.41 N/A $17.06 $97.10 $18.77 $81.57 $94.64 N/A N/A $77.68 $103.58 $58.00 $97.24 N/A $17.06 $84.16 N/A $103.58 N/A N/A N/A $23.88 N/A $17.06 $17.06 $18.60 $103.58 $110.05 N/A $97.10 N/A N/A $64.73 $84.16 $23.97 $23.97 $23.97 $23.97 $19.58 $17.91 $17.06 $19.58 N/A N/A $12.79 $12.79 $12.79 $12.79 $110.05 330104 84590 400 301 HC ASSAY OF VITAMIN A O $235.40 $11.61 $11.61 $11.61 $117.70 N/A N/A N/A $11.61 $22.06 $11.61 $11.61 $176.55 $12.77 $148.30 $172.08 $13.93 $11.61 $141.24 $188.32 $39.47 $66.18 $11.61 $11.61 $153.01 $16.25 $188.32 $11.61 $11.61 $13.93 $16.25 $11.61 $11.61 $11.61 $12.65 $188.32 $200.09 $15.67 $176.55 $23.80 $15.67 $117.70 $153.01 $16.31 $16.31 $16.31 $16.31 $19.58 $12.19 $11.61 $19.58 $11.61 $11.61 $8.71 $8.71 $8.71 $8.71 $200.09 330104 84586 399 301 HC ASSAY OF VASOACTIVE INTESTINAL PEPTIDE O $760.77 $35.33 $35.33 N/A $380.38 N/A N/A N/A N/A $67.13 N/A $35.33 $570.58 $38.86 $479.29 $556.12 N/A N/A $456.46 $608.62 $120.12 $201.38 N/A $35.33 $494.50 N/A $608.62 N/A N/A N/A $49.46 N/A $35.33 $35.33 $38.51 $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $49.64 $49.64 $49.64 $49.64 $59.66 $37.10 $35.33 $59.66 N/A N/A $26.50 $26.50 $26.50 $26.50 $646.65 330104 84560 402 301 HC ASSAY OF URINE/URIC ACID O $182.97 $5.08 $5.08 $5.03 $91.48 N/A N/A N/A $5.03 $9.65 $5.03 $5.08 $137.23 $5.59 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.27 $28.96 $5.03 $5.08 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.11 $5.03 $5.08 $5.08 $5.54 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.14 $7.14 $7.14 $7.14 $8.02 $5.33 $5.08 $8.02 $5.03 $5.03 $3.81 $3.81 $3.81 $3.81 $155.52 330104 84550 402 301 HC ASSAY OF BLOOD/URIC ACID O $79.18 $4.52 $4.52 $4.52 $39.59 N/A N/A N/A $4.52 $8.59 $4.52 $4.52 $59.39 $4.97 $49.88 $57.88 $5.42 $4.52 $47.51 $63.34 $15.37 $25.76 $4.52 $4.52 $51.47 $6.33 $63.34 $4.52 $4.52 $5.42 $6.33 $4.52 $4.52 $4.52 $4.93 $63.34 $67.30 $6.10 $59.39 $9.27 $6.10 $39.59 $51.47 $6.35 $6.35 $6.35 $6.35 $7.63 $4.75 $4.52 $7.63 $4.52 $4.52 $3.39 $3.39 $3.39 $3.39 $67.30 330104 84540 402 301 HC ASSAY OF URINE/UREA-N O $182.97 $5.56 $5.56 $5.03 $91.48 N/A N/A N/A $5.03 $10.56 $5.03 $5.56 $137.23 $6.12 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $18.90 $31.69 $5.03 $5.56 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.78 $5.03 $5.56 $5.56 $6.06 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.81 $7.81 $7.81 $7.81 $8.02 $5.84 $5.56 $8.02 $5.03 $5.03 $4.17 $4.17 $4.17 $4.17 $155.52 330104 84484 400 301 HC ASSAY OF TROPONIN QUANT O $311.37 $12.47 $12.47 $8.05 $155.69 N/A N/A N/A $8.05 $23.69 $8.05 $12.47 $233.53 $13.72 $196.16 $227.61 $9.66 $8.05 $186.82 $249.10 $42.40 $71.08 $8.05 $12.47 $202.39 $11.27 $249.10 $8.05 $8.05 $9.66 $17.46 $8.05 $12.47 $12.47 $13.59 $249.10 $264.66 $10.87 $233.53 $16.50 $10.87 $155.69 $202.39 $17.52 $17.52 $17.52 $17.52 $16.62 $13.09 $12.47 $16.62 $8.05 $8.05 $9.35 $9.35 $9.35 $8.05 $264.66 330104 83880 401 301 HC ASSAY OF NATRIURETIC PEPTIDE O $210.79 $39.26 $39.26 $34.07 $105.39 N/A N/A N/A $34.07 $74.59 $34.07 $39.26 $158.09 $43.19 $132.80 $154.09 $40.88 $34.07 $126.47 $168.63 $133.48 $223.78 $34.07 $39.26 $137.01 $47.70 $168.63 $34.07 $34.07 $40.88 $54.96 $34.07 $39.26 $39.26 $42.79 $168.63 $179.17 $45.99 $158.09 $69.84 $45.99 $105.39 $137.01 $55.16 $55.16 $55.16 $55.16 $57.32 $41.22 $39.26 $57.32 $34.07 $34.07 $29.45 $29.45 $29.45 $29.45 $223.78 330104 84305 398 301 HC ASSAY OF SOMATOMEDIN O $432.28 $21.26 $21.26 $20.50 $216.14 N/A N/A N/A $20.50 $40.39 $20.50 $21.26 $324.21 $23.39 $272.34 $316.00 $24.60 $20.50 $259.37 $345.82 $72.28 $121.18 $20.50 $21.26 $280.98 $28.70 $345.82 $20.50 $20.50 $24.60 $29.76 $20.50 $21.26 $21.26 $23.17 $345.82 $367.44 $27.68 $324.21 $42.02 $27.68 $216.14 $280.98 $29.87 $29.87 $29.87 $29.87 $35.90 $22.32 $21.26 $35.90 $20.50 $20.50 $15.95 $15.95 $15.95 $15.95 $367.44 330104 84295 402 301 HC ASSAY OF SERUM SODIUM O $79.18 $4.81 $4.81 $4.81 $39.59 N/A N/A N/A $4.81 $9.14 $4.81 $4.81 $59.39 $5.29 $49.88 $57.88 $5.77 $4.81 $47.51 $63.34 $16.35 $27.42 $4.81 $4.81 $51.47 $6.73 $63.34 $4.81 $4.81 $5.77 $6.73 $4.81 $4.81 $4.81 $5.24 $63.34 $67.30 $6.49 $59.39 $9.86 $6.49 $39.59 $51.47 $6.76 $6.76 $6.76 $6.76 $8.12 $5.05 $4.81 $8.12 $4.81 $4.81 $3.61 $3.61 $3.61 $3.61 $67.30 330104 84132 402 301 HC ASSAY OF SERUM POTASSIUM O $79.18 $4.76 $4.76 $4.76 $39.59 N/A N/A N/A $4.76 $9.04 $4.76 $4.76 $59.39 $5.24 $49.88 $57.88 $5.71 $4.76 $47.51 $63.34 $16.18 $27.13 $4.76 $4.76 $51.47 $6.66 $63.34 $4.76 $4.76 $5.71 $6.66 $4.76 $4.76 $4.76 $5.19 $63.34 $67.30 $6.43 $59.39 $9.76 $6.43 $39.59 $51.47 $6.69 $6.69 $6.69 $6.69 $7.76 $5.00 $4.76 $7.76 $4.76 $4.76 $3.57 $3.57 $3.57 $3.57 $67.30 330104 84120 400 301 HC ASSAY OF URINE PORPHYRINS O $475.08 $14.71 $14.71 $14.71 $237.54 N/A N/A N/A $14.71 $27.95 $14.71 $14.71 $356.31 $16.18 $299.30 $347.28 $17.65 $14.71 $285.05 $380.06 $50.01 $83.85 $14.71 $14.71 $308.80 $20.59 $380.06 $14.71 $14.71 $17.65 $20.59 $14.71 $14.71 $14.71 $16.03 $380.06 $403.82 $19.86 $356.31 $30.16 $19.86 $237.54 $308.80 $20.67 $20.67 $20.67 $20.67 $24.84 $15.45 $14.71 $24.84 $14.71 $14.71 $11.03 $11.03 $11.03 $11.03 $403.82 330104 84110 402 301 HC ASSAY OF PORPHOBILINOGEN O $34.24 $8.44 $8.44 $8.44 $17.12 N/A N/A N/A $8.44 $16.04 $8.44 $8.44 $25.68 $9.28 $21.57 $25.03 $10.13 $8.44 $20.54 $27.39 $28.70 $48.11 $8.44 $8.44 $22.26 $11.82 $27.39 $8.44 $8.44 $10.13 $11.82 $8.44 $8.44 $8.44 $9.20 $27.39 $29.10 $11.39 $25.68 $17.30 $11.39 $17.12 $22.26 $11.86 $11.86 $11.86 $11.86 $14.26 $8.86 $8.44 $14.26 $8.44 $8.44 $6.33 $6.33 $6.33 $6.33 $48.11 330104 84105 402 301 HC ASSAY OF URINE PHOSPHORUS O $79.18 $5.78 $5.78 $5.03 $39.59 N/A N/A N/A $5.03 $10.98 $5.03 $5.78 $59.39 $6.36 $49.88 $57.88 $6.04 $5.03 $47.51 $63.34 $19.65 $32.95 $5.03 $5.78 $51.47 $7.04 $63.34 $5.03 $5.03 $6.04 $8.09 $5.03 $5.78 $5.78 $6.30 $63.34 $67.30 $6.79 $59.39 $10.31 $6.79 $39.59 $51.47 $8.12 $8.12 $8.12 $8.12 $8.74 $6.07 $5.78 $8.74 $5.03 $5.03 $4.33 $4.33 $4.33 $4.33 $67.30 330104 84100 402 301 HC ASSAY OF PHOSPHORUS O $182.97 $4.74 $4.74 $4.74 $91.48 N/A N/A N/A $4.74 $9.01 $4.74 $4.74 $137.23 $5.21 $115.27 $133.75 $5.69 $4.74 $109.78 $146.38 $16.12 $27.02 $4.74 $4.74 $118.93 $6.64 $146.38 $4.74 $4.74 $5.69 $6.64 $4.74 $4.74 $4.74 $5.17 $146.38 $155.52 $6.40 $137.23 $9.72 $6.40 $91.48 $118.93 $6.66 $6.66 $6.66 $6.66 $8.00 $4.98 $4.74 $8.00 $4.74 $4.74 $3.56 $3.56 $3.56 $3.56 $155.52 330104 84080 400 301 HC ASSAY ALKALINE PHOSPHATASES O $236.47 $14.78 $14.78 $9.91 $118.23 N/A N/A N/A $9.91 $28.08 $9.91 $14.78 $177.35 $16.26 $148.98 $172.86 $11.89 $9.91 $141.88 $189.18 $50.25 $84.25 $9.91 $14.78 $153.71 $13.87 $189.18 $9.91 $9.91 $11.89 $20.69 $9.91 $14.78 $14.78 $16.11 $189.18 $201.00 $13.38 $177.35 $20.32 $13.38 $118.23 $153.71 $20.77 $20.77 $20.77 $20.77 $24.98 $15.52 $14.78 $24.98 $9.91 $9.91 $11.08 $11.08 $11.08 $9.91 $201.00 330104 84075 402 301 HC ASSAY ALKALINE PHOSPHATASE O $306.02 $5.18 $5.18 $5.03 $153.01 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $229.51 $5.70 $192.79 $223.70 $6.04 $5.03 $183.61 $244.82 $17.61 $29.53 $5.03 $5.18 $198.91 $7.04 $244.82 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $244.82 $260.12 $6.79 $229.51 $10.31 $6.79 $153.01 $198.91 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $260.12 330104 84030 402 301 HC ASSAY OF BLOOD PKU O $263.22 $5.50 $5.50 $5.50 $131.61 N/A N/A N/A $5.50 $10.45 $5.50 $5.50 $197.42 $6.05 $165.83 $192.41 $6.60 $5.50 $157.93 $210.58 $18.70 $31.35 $5.50 $5.50 $171.09 $7.70 $210.58 $5.50 $5.50 $6.60 $7.70 $5.50 $5.50 $5.50 $6.00 $210.58 $223.74 $7.43 $197.42 $11.27 $7.43 $131.61 $171.09 $7.73 $7.73 $7.73 $7.73 $9.29 $5.78 $5.50 $9.29 $5.50 $5.50 $4.12 $4.12 $4.12 $4.12 $223.74 330104 83993 400 301 HC ASSAY FOR CALPROTECTIN FECAL O $121.98 $19.63 $19.63 $11.28 $60.99 N/A N/A N/A $11.28 $37.30 $11.28 $19.63 $91.48 $21.59 $76.85 $89.17 $13.54 $11.28 $73.19 $97.58 $66.74 $111.89 $11.28 $19.63 $79.29 $15.79 $97.58 $11.28 $11.28 $13.54 $27.48 $11.28 $19.63 $19.63 $21.40 $97.58 $103.68 $15.23 $91.48 $23.12 $15.23 $60.99 $79.29 $27.58 $27.58 $27.58 $27.58 $33.14 $20.61 $19.63 $33.14 $11.28 $11.28 $14.72 $14.72 $14.72 $11.28 $111.89 330104 83992 404 301 HC PHENCYCLIDINE O $235.40 N/A N/A N/A $117.70 N/A N/A N/A N/A N/A N/A N/A $176.55 N/A $148.30 $172.08 N/A N/A $141.24 $188.32 N/A N/A N/A N/A $153.01 N/A $188.32 N/A N/A N/A N/A N/A N/A N/A N/A $188.32 $200.09 N/A $176.55 N/A N/A $117.70 $153.01 N/A N/A N/A N/A $24.82 N/A N/A $24.82 N/A N/A N/A N/A N/A $24.82 $200.09 330104 83986 402 301 HC ASSAY PH BODY FLUID NOS O $182.97 $3.58 $3.58 N/A $91.48 N/A N/A N/A N/A $6.80 N/A $3.58 $137.23 $3.94 $115.27 $133.75 N/A N/A $109.78 $146.38 $12.17 $20.41 N/A $3.58 $118.93 N/A $146.38 N/A N/A N/A $5.01 N/A $3.58 $3.58 $3.90 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $5.03 $5.03 $5.03 $5.03 $6.05 $3.76 $3.58 $6.05 N/A N/A $2.69 $2.69 $2.69 $2.69 $155.52 330104 83970 399 301 HC ASSAY OF PARATHORMONE O $859.21 $41.28 $41.28 $41.28 $429.61 N/A N/A N/A $41.28 $78.43 $41.28 $41.28 $644.41 $45.41 $541.30 $628.08 $49.54 $41.28 $515.53 $687.37 $140.35 $235.30 $41.28 $41.28 $558.49 $57.79 $687.37 $41.28 $41.28 $49.54 $57.79 $41.28 $41.28 $41.28 $45.00 $687.37 $730.33 $55.73 $644.41 $84.62 $55.73 $429.61 $558.49 $58.00 $58.00 $58.00 $58.00 $69.70 $43.34 $41.28 $69.70 $41.28 $41.28 $30.96 $30.96 $30.96 $30.96 $730.33 330104 83937 399 301 HC ASSAY OF OSTEOCALCIN O $112.35 $29.85 $29.85 N/A $56.17 N/A N/A N/A N/A $56.72 N/A $29.85 $84.26 $32.84 $70.78 $82.13 N/A N/A $67.41 $89.88 $101.49 $170.15 N/A $29.85 $73.03 N/A $89.88 N/A N/A N/A $41.79 N/A $29.85 $29.85 $32.54 $89.88 $95.50 N/A $84.26 N/A N/A $56.17 $73.03 $41.94 $41.94 $41.94 $41.94 $50.41 $31.34 $29.85 $50.41 N/A N/A $22.39 $22.39 $22.39 $22.39 $170.15 330104 83935 402 301 HC ASSAY OF URINE OSMOLALITY O $182.97 $6.82 $6.82 $6.04 $91.48 N/A N/A N/A $6.04 $12.96 $6.04 $6.82 $137.23 $7.50 $115.27 $133.75 $7.25 $6.04 $109.78 $146.38 $23.19 $38.87 $6.04 $6.82 $118.93 $8.46 $146.38 $6.04 $6.04 $7.25 $9.55 $6.04 $6.82 $6.82 $7.43 $146.38 $155.52 $8.15 $137.23 $12.38 $8.15 $91.48 $118.93 $9.58 $9.58 $9.58 $9.58 $11.51 $7.16 $6.82 $11.51 $6.04 $6.04 $5.12 $5.12 $5.12 $5.12 $155.52 330104 83930 402 301 HC ASSAY OF BLOOD OSMOLALITY O $151.94 $6.61 $6.61 $6.04 $75.97 N/A N/A N/A $6.04 $12.56 $6.04 $6.61 $113.95 $7.27 $95.72 $111.07 $7.25 $6.04 $91.16 $121.55 $22.47 $37.68 $6.04 $6.61 $98.76 $8.46 $121.55 $6.04 $6.04 $7.25 $9.25 $6.04 $6.61 $6.61 $7.20 $121.55 $129.15 $8.15 $113.95 $12.38 $8.15 $75.97 $98.76 $9.29 $9.29 $9.29 $9.29 $11.16 $6.94 $6.61 $11.16 $6.04 $6.04 $4.96 $4.96 $4.96 $4.96 $129.15 330104 83921 400 301 HC ORGANIC ACID SINGLE QUANT O $439.77 $21.21 $21.21 $21.21 $219.88 N/A N/A N/A $21.21 $40.30 $21.21 $21.21 $329.83 $23.33 $277.06 $321.47 $25.45 $21.21 $263.86 $351.82 $72.11 $120.90 $21.21 $21.21 $285.85 $29.69 $351.82 $21.21 $21.21 $25.45 $29.69 $21.21 $21.21 $21.21 $23.12 $351.82 $373.80 $28.63 $329.83 $43.48 $28.63 $219.88 $285.85 $29.80 $29.80 $29.80 $29.80 $27.79 $22.27 $21.21 $27.79 $21.21 $21.21 $15.91 $15.91 $15.91 $15.91 $373.80 330104 83916 401 301 HC OLIGOCLONAL BANDS O $548.91 $27.39 $27.39 N/A $274.45 N/A N/A N/A N/A $52.04 N/A $27.39 $411.68 $30.13 $345.81 $401.25 N/A N/A $329.35 $439.13 $93.13 $156.12 N/A $27.39 $356.79 N/A $439.13 N/A N/A N/A $38.35 N/A $27.39 $27.39 $29.86 $439.13 $466.57 N/A $411.68 N/A N/A $274.45 $356.79 $38.48 $38.48 $38.48 $38.48 $33.96 $28.76 $27.39 $33.96 N/A N/A $20.54 $20.54 $20.54 $20.54 $466.57 330104 84133 402 301 HC ASSAY OF URINE POTASSIUM O $182.97 $4.73 $4.73 $4.73 $91.48 N/A N/A N/A $4.73 $8.99 $4.73 $4.73 $137.23 $5.20 $115.27 $133.75 $5.68 $4.73 $109.78 $146.38 $16.08 $26.96 $4.73 $4.73 $118.93 $6.62 $146.38 $4.73 $4.73 $5.68 $6.62 $4.73 $4.73 $4.73 $5.16 $146.38 $155.52 $6.39 $137.23 $9.70 $6.39 $91.48 $118.93 $6.65 $6.65 $6.65 $6.65 $7.26 $4.97 $4.73 $7.26 $4.73 $4.73 $3.55 $3.55 $3.55 $3.55 $155.52 330104 84300 402 301 HC ASSAY OF URINE SODIUM O $182.97 $5.06 $5.06 $5.03 $91.48 N/A N/A N/A $5.03 $9.61 $5.03 $5.06 $137.23 $5.57 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.20 $28.84 $5.03 $5.06 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.08 $5.03 $5.06 $5.06 $5.52 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.11 $7.11 $7.11 $7.11 $8.22 $5.31 $5.06 $8.22 $5.03 $5.03 $3.79 $3.79 $3.79 $3.79 $155.52 330104 84134 400 301 HC ASSAY OF PREALBUMIN O "$1,023.99 " $14.59 $14.59 $7.32 $512.00 N/A N/A N/A $7.32 $27.72 $7.32 $14.59 $767.99 $16.05 $645.11 $748.54 $8.78 $7.32 $614.39 $819.19 $49.61 $83.16 $7.32 $14.59 $665.59 $10.25 $819.19 $7.32 $7.32 $8.78 $20.43 $7.32 $14.59 $14.59 $15.90 $819.19 $870.39 $9.88 $767.99 $15.01 $9.88 $512.00 $665.59 $20.50 $20.50 $20.50 $20.50 $24.62 $15.32 $14.59 $24.62 $7.32 $7.32 $10.94 $10.94 $10.94 $7.32 $870.39 330104 84144 398 301 HC ASSAY OF PROGESTERONE O $527.51 $20.86 $20.86 $20.86 $263.75 N/A N/A N/A $20.86 $39.63 $20.86 $20.86 $395.63 $22.95 $332.33 $385.61 $25.03 $20.86 $316.51 $422.01 $70.92 $118.90 $20.86 $20.86 $342.88 $29.20 $422.01 $20.86 $20.86 $25.03 $29.20 $20.86 $20.86 $20.86 $22.74 $422.01 $448.38 $28.16 $395.63 $42.76 $28.16 $263.75 $342.88 $29.31 $29.31 $29.31 $29.31 $35.23 $21.90 $20.86 $35.23 $20.86 $20.86 $15.64 $15.64 $15.64 $15.64 $448.38 330104 84270 400 301 HC ASSAY OF SEX HORMONE GLOBUL O "$1,088.19 " $21.73 $21.73 N/A $544.10 N/A N/A N/A N/A $41.29 N/A $21.73 $816.14 $23.90 $685.56 $795.47 N/A N/A $652.91 $870.55 $73.88 $123.86 N/A $21.73 $707.32 N/A $870.55 N/A N/A N/A $30.42 N/A $21.73 $21.73 $23.69 $870.55 $924.96 N/A $816.14 N/A N/A $544.10 $707.32 $30.53 $30.53 $30.53 $30.53 $36.70 $22.82 $21.73 $36.70 N/A N/A $16.30 $16.30 $16.30 $16.30 $924.96 330104 84260 399 301 HC ASSAY OF SEROTONIN O $439.77 $30.98 $30.98 N/A $219.88 N/A N/A N/A N/A $58.86 N/A $30.98 $329.83 $34.08 $277.06 $321.47 N/A N/A $263.86 $351.82 $105.33 $176.59 N/A $30.98 $285.85 N/A $351.82 N/A N/A N/A $43.37 N/A $30.98 $30.98 $33.77 $351.82 $373.80 N/A $329.83 N/A N/A $219.88 $285.85 $43.53 $43.53 $43.53 $43.53 $52.31 $32.53 $30.98 $52.31 N/A N/A $23.23 $23.23 $23.23 $23.23 $373.80 330104 84252 400 301 HC ASSAY OF VITAMIN B-2 O $590.64 $20.24 $20.24 N/A $295.32 N/A N/A N/A N/A $38.46 N/A $20.24 $442.98 $22.26 $372.10 $431.76 N/A N/A $354.38 $472.51 $68.82 $115.37 N/A $20.24 $383.92 N/A $472.51 N/A N/A N/A $28.34 N/A $20.24 $20.24 $22.06 $472.51 $502.04 N/A $442.98 N/A N/A $295.32 $383.92 $28.44 $28.44 $28.44 $28.44 $34.18 $21.25 $20.24 $34.18 N/A N/A $15.18 $15.18 $15.18 $15.18 $502.04 330104 84244 398 301 HC ASSAY OF RENIN O $621.67 $21.99 $21.99 N/A $310.83 N/A N/A N/A N/A $41.78 N/A $21.99 $466.25 $24.19 $391.65 $454.44 N/A N/A $373.00 $497.34 $74.77 $125.34 N/A $21.99 $404.09 N/A $497.34 N/A N/A N/A $30.79 N/A $21.99 $21.99 $23.97 $497.34 $528.42 N/A $466.25 N/A N/A $310.83 $404.09 $30.90 $30.90 $30.90 $30.90 $37.14 $23.09 $21.99 $37.14 N/A N/A $16.49 $16.49 $16.49 $16.49 $528.42 330104 84220 402 301 HC ASSAY OF PYRUVATE KINASE O $263.22 $9.44 $9.44 $9.44 $131.61 N/A N/A N/A $9.44 $17.94 $9.44 $9.44 $197.42 $10.38 $165.83 $192.41 $11.33 $9.44 $157.93 $210.58 $32.10 $53.81 $9.44 $9.44 $171.09 $13.22 $210.58 $9.44 $9.44 $11.33 $13.22 $9.44 $9.44 $9.44 $10.29 $210.58 $223.74 $12.74 $197.42 $19.35 $12.74 $131.61 $171.09 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $9.44 $9.44 $7.08 $7.08 $7.08 $7.08 $223.74 330104 84207 401 301 HC ASSAY OF VITAMIN B-6 O $892.38 $28.10 $28.10 $28.10 $446.19 N/A N/A N/A $28.10 $53.39 $28.10 $28.10 $669.28 $30.91 $562.20 $652.33 $33.72 $28.10 $535.43 $713.90 $95.54 $160.17 $28.10 $28.10 $580.05 $39.34 $713.90 $28.10 $28.10 $33.72 $39.34 $28.10 $28.10 $28.10 $30.63 $713.90 $758.52 $37.94 $669.28 $57.60 $37.94 $446.19 $580.05 $39.48 $39.48 $39.48 $39.48 $47.45 $29.51 $28.10 $47.45 $28.10 $28.10 $21.08 $21.08 $21.08 $21.08 $758.52 330104 84206 398 301 HC ASSAY OF PROINSULIN O $449.40 $26.69 $26.69 N/A $224.70 N/A N/A N/A N/A $50.71 N/A $26.69 $337.05 $29.36 $283.12 $328.51 N/A N/A $269.64 $359.52 $90.75 $152.13 N/A $26.69 $292.11 N/A $359.52 N/A N/A N/A $37.37 N/A $26.69 $26.69 $29.09 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $37.50 $37.50 $37.50 $37.50 $30.08 $28.02 $26.69 $30.08 N/A N/A $20.02 $20.02 $20.02 $20.02 $381.99 330104 84182 395 301 HC PROTEIN WESTERN BLOT TEST O $283.55 $29.21 $29.21 N/A $141.78 N/A N/A N/A N/A $55.50 N/A $29.21 $212.66 $32.13 $178.64 $207.28 N/A N/A $170.13 $226.84 $99.31 $166.50 N/A $29.21 $184.31 N/A $226.84 N/A N/A N/A $40.89 N/A $29.21 $29.21 $31.84 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $41.04 $41.04 $41.04 $41.04 $30.40 $30.67 $29.21 $30.40 N/A N/A $21.91 $21.91 $21.91 $21.91 $241.02 330104 82482 402 301 HC ASSAY RBC CHOLINESTERASE O $400.18 $9.81 $9.81 N/A $200.09 N/A N/A N/A N/A $18.64 N/A $9.81 $300.13 $10.79 $252.11 $292.53 N/A N/A $240.11 $320.14 $33.35 $55.92 N/A $9.81 $260.12 N/A $320.14 N/A N/A N/A $13.73 N/A $9.81 $9.81 $10.69 $320.14 $340.15 N/A $300.13 N/A N/A $200.09 $260.12 $13.78 $13.78 $13.78 $13.78 $12.97 $10.30 $9.81 $12.97 N/A N/A $7.36 $7.36 $7.36 $7.36 $340.15 330104 84165 402 301 HC PROTEIN E-PHORESIS SERUM O $321.00 $10.74 $10.74 $8.00 $160.50 N/A N/A N/A $8.00 $20.41 $8.00 $10.74 $240.75 $11.81 $202.23 $234.65 $9.60 $8.00 $192.60 $256.80 $36.52 $61.22 $8.00 $10.74 $208.65 $11.20 $256.80 $8.00 $8.00 $9.60 $15.04 $8.00 $10.74 $10.74 $11.71 $256.80 $272.85 $10.80 $240.75 $16.40 $10.80 $160.50 $208.65 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $8.00 $8.00 $8.05 $8.05 $8.05 $8.00 $272.85 330104 84157 402 301 HC ASSAY OF PROTEIN OTHER O $182.97 $4.00 $4.00 $4.00 $91.48 N/A N/A N/A $4.00 $7.60 $4.00 $4.00 $137.23 $4.40 $115.27 $133.75 $4.80 $4.00 $109.78 $146.38 $13.60 $22.80 $4.00 $4.00 $118.93 $5.60 $146.38 $4.00 $4.00 $4.80 $5.60 $4.00 $4.00 $4.00 $4.36 $146.38 $155.52 $5.40 $137.23 $8.20 $5.40 $91.48 $118.93 $5.62 $5.62 $5.62 $5.62 $6.19 $4.20 $4.00 $6.19 $4.00 $4.00 $3.00 $3.00 $3.00 $3.00 $155.52 330104 84156 402 301 HC ASSAY OF PROTEIN URINE O $63.13 $3.67 $3.67 $3.67 $31.57 N/A N/A N/A $3.67 $6.97 $3.67 $3.67 $47.35 $4.04 $39.77 $46.15 $4.40 $3.67 $37.88 $50.50 $12.48 $20.92 $3.67 $3.67 $41.03 $5.14 $50.50 $3.67 $3.67 $4.40 $5.14 $3.67 $3.67 $3.67 $4.00 $50.50 $53.66 $4.95 $47.35 $7.52 $4.95 $31.57 $41.03 $5.16 $5.16 $5.16 $5.16 $6.19 $3.85 $3.67 $6.19 $3.67 $3.67 $2.75 $2.75 $2.75 $2.75 $53.66 330104 84155 402 301 HC ASSAY OF PROTEIN SERUM O $79.18 $3.67 $3.67 $3.67 $39.59 N/A N/A N/A $3.67 $6.97 $3.67 $3.67 $59.39 $4.04 $49.88 $57.88 $4.40 $3.67 $47.51 $63.34 $12.48 $20.92 $3.67 $3.67 $51.47 $5.14 $63.34 $3.67 $3.67 $4.40 $5.14 $3.67 $3.67 $3.67 $4.00 $63.34 $67.30 $4.95 $59.39 $7.52 $4.95 $39.59 $51.47 $5.16 $5.16 $5.16 $5.16 $6.19 $3.85 $3.67 $6.19 $3.67 $3.67 $2.75 $2.75 $2.75 $2.75 $67.30 330104 84154 400 301 HC ASSAY OF PSA FREE O $296.39 $18.39 $18.39 $18.39 $148.19 N/A N/A N/A $18.39 $34.94 $18.39 $18.39 $222.29 $20.23 $186.73 $216.66 $22.07 $18.39 $177.83 $237.11 $62.53 $104.82 $18.39 $18.39 $192.65 $25.75 $237.11 $18.39 $18.39 $22.07 $25.75 $18.39 $18.39 $18.39 $20.05 $237.11 $251.93 $24.83 $222.29 $37.70 $24.83 $148.19 $192.65 $25.84 $25.84 $25.84 $25.84 $31.07 $19.31 $18.39 $31.07 $18.39 $18.39 $13.79 $13.79 $13.79 $13.79 $251.93 330104 84153 400 301 HC ASSAY OF PSA TOTAL -SCREENING O $507.18 $18.39 $18.39 $18.39 $253.59 N/A N/A N/A $18.39 $34.94 $18.39 $18.39 $380.38 $20.23 $319.52 $370.75 $22.07 $18.39 $304.31 $405.74 $62.53 $104.82 $18.39 $18.39 $329.67 $25.75 $405.74 $18.39 $18.39 $22.07 $25.75 $18.39 $18.39 $18.39 $20.05 $405.74 $431.10 $24.83 $380.38 $37.70 $24.83 $253.59 $329.67 $25.84 $25.84 $25.84 $25.84 $31.07 $19.31 $18.39 $31.07 $18.39 $18.39 $13.79 $13.79 $13.79 $13.79 $431.10 330104 84146 398 301 HC ASSAY OF PROLACTIN O $590.64 $19.38 $19.38 $19.38 $295.32 N/A N/A N/A $19.38 $36.82 $19.38 $19.38 $442.98 $21.32 $372.10 $431.76 $23.26 $19.38 $354.38 $472.51 $65.89 $110.47 $19.38 $19.38 $383.92 $27.13 $472.51 $19.38 $19.38 $23.26 $27.13 $19.38 $19.38 $19.38 $21.12 $472.51 $502.04 $26.16 $442.98 $39.73 $26.16 $295.32 $383.92 $27.23 $27.23 $27.23 $27.23 $32.72 $20.35 $19.38 $32.72 $19.38 $19.38 $14.54 $14.54 $14.54 $14.54 $502.04 330104 84145 398 301 HC PROCALCITONIN (PCT) O $182.97 $27.22 $27.22 N/A $91.48 N/A N/A N/A N/A $51.72 N/A $27.22 $137.23 $29.94 $115.27 $133.75 N/A N/A $109.78 $146.38 $92.55 $155.15 N/A $27.22 $118.93 N/A $146.38 N/A N/A N/A $38.11 N/A $27.22 $27.22 $29.67 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $38.24 $38.24 $38.24 $38.24 $45.23 $28.58 $27.22 $45.23 N/A N/A $20.41 $20.41 $20.41 $20.41 $155.52 330104 84143 398 301 HC ASSAY OF 17-HYDROXYPREGNENO O $332.77 $22.81 $22.81 $22.81 $166.38 N/A N/A N/A $22.81 $43.34 $22.81 $22.81 $249.58 $25.09 $209.65 $243.25 $27.37 $22.81 $199.66 $266.22 $77.55 $130.02 $22.81 $22.81 $216.30 $31.93 $266.22 $22.81 $22.81 $27.37 $31.93 $22.81 $22.81 $22.81 $24.86 $266.22 $282.85 $30.79 $249.58 $46.76 $30.79 $166.38 $216.30 $32.05 $32.05 $32.05 $32.05 $38.54 $23.95 $22.81 $38.54 $22.81 $22.81 $17.11 $17.11 $17.11 $17.11 $282.85 330104 82480 402 301 HC ASSAY SERUM CHOLINESTERASE O $143.38 $7.87 $7.87 $7.87 $71.69 N/A N/A N/A $7.87 $14.95 $7.87 $7.87 $107.53 $8.66 $90.33 $104.81 $9.44 $7.87 $86.03 $114.70 $26.76 $44.86 $7.87 $7.87 $93.20 $11.02 $114.70 $7.87 $7.87 $9.44 $11.02 $7.87 $7.87 $7.87 $8.58 $114.70 $121.87 $10.62 $107.53 $16.13 $10.62 $71.69 $93.20 $11.06 $11.06 $11.06 $11.06 $13.31 $8.26 $7.87 $13.31 $7.87 $7.87 $5.90 $5.90 $5.90 $5.90 $121.87 330104 83021 408 301 HC HEMOGLOBIN CHROMOTOGRAPHY O $283.55 $18.06 $18.06 $18.06 $141.78 N/A N/A N/A $18.06 $34.31 $18.06 $18.06 $212.66 $19.87 $178.64 $207.28 $21.67 $18.06 $170.13 $226.84 $61.40 $102.94 $18.06 $18.06 $184.31 $25.28 $226.84 $18.06 $18.06 $21.67 $25.28 $18.06 $18.06 $18.06 $19.69 $226.84 $241.02 $24.38 $212.66 $37.02 $24.38 $141.78 $184.31 $25.37 $25.37 $25.37 $25.37 $30.49 $18.96 $18.06 $30.49 $18.06 $18.06 $13.54 $13.54 $13.54 $13.54 $241.02 330104 82436 402 301 HC ASSAY OF URINE CHLORIDE O $182.97 $5.75 $5.75 $5.03 $91.48 N/A N/A N/A $5.03 $10.92 $5.03 $5.75 $137.23 $6.33 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $19.55 $32.77 $5.03 $5.75 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $8.05 $5.03 $5.75 $5.75 $6.27 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $8.08 $8.08 $8.08 $8.08 $8.48 $6.04 $5.75 $8.48 $5.03 $5.03 $4.31 $4.31 $4.31 $4.31 $155.52 330104 80176 405 301 HC ASSAY OF LIDOCAINE O $85.60 $14.69 $14.69 N/A $42.80 N/A N/A N/A N/A $27.91 N/A $14.69 $64.20 $16.16 $53.93 $62.57 N/A N/A $51.36 $68.48 $49.95 $83.73 N/A $14.69 $55.64 N/A $68.48 N/A N/A N/A $20.57 N/A $14.69 $14.69 $16.01 $68.48 $72.76 N/A $64.20 N/A N/A $42.80 $55.64 $20.64 $20.64 $20.64 $20.64 $24.80 $15.42 $14.69 $24.80 N/A N/A $11.02 $11.02 $11.02 $11.02 $83.73 330104 80177 405 301 HC DRUG SCRN QUAN LEVETIRACETAM O $141.24 $13.25 $13.25 $10.50 $70.62 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $105.93 $14.58 $88.98 $103.25 $12.60 $10.50 $84.74 $112.99 $45.05 $75.53 $10.50 $13.25 $91.81 $14.70 $112.99 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $112.99 $120.05 $14.18 $105.93 $21.52 $14.18 $70.62 $91.81 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $120.05 330104 80178 405 301 HC ASSAY OF LITHIUM O $162.64 $6.61 $6.61 $6.61 $81.32 N/A N/A N/A $6.61 $12.56 $6.61 $6.61 $121.98 $7.27 $102.46 $118.89 $7.93 $6.61 $97.58 $130.11 $22.47 $37.68 $6.61 $6.61 $105.72 $9.25 $130.11 $6.61 $6.61 $7.93 $9.25 $6.61 $6.61 $6.61 $7.20 $130.11 $138.24 $8.92 $121.98 $13.55 $8.92 $81.32 $105.72 $9.29 $9.29 $9.29 $9.29 $11.16 $6.94 $6.61 $11.16 $6.61 $6.61 $4.96 $4.96 $4.96 $4.96 $138.24 330104 80179 405 301 HC DRUG ASSAY SALICYLATE O $169.06 $18.64 $18.64 N/A $84.53 N/A N/A N/A N/A $35.42 N/A $18.64 $126.80 $20.50 $106.51 $123.58 N/A N/A $101.44 $135.25 $63.38 $106.25 N/A $18.64 $109.89 N/A $135.25 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 N/A N/A $13.98 $13.98 $13.98 $13.98 $143.70 330104 80181 405 301 HC DRUG ASSAY FLECAINIDE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80183 405 301 HC DRUG SCRN QUANT OXCARBAZEPIN O $115.56 $13.25 $13.25 $10.50 $57.78 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $86.67 $14.58 $72.80 $84.47 $12.60 $10.50 $69.34 $92.45 $45.05 $75.53 $10.50 $13.25 $75.11 $14.70 $92.45 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $92.45 $98.23 $14.18 $86.67 $21.52 $14.18 $57.78 $75.11 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $98.23 330104 80184 405 301 HC ASSAY OF PHENOBARBITAL O $326.35 $15.30 $15.30 $10.50 $163.18 N/A N/A N/A $10.50 $29.07 $10.50 $15.30 $244.76 $16.83 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $52.02 $87.21 $10.50 $15.30 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $21.42 $10.50 $15.30 $15.30 $16.68 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $21.50 $21.50 $21.50 $21.50 $19.34 $16.07 $15.30 $19.34 $10.50 $10.50 $11.48 $11.48 $11.48 $10.50 $277.40 330104 80185 405 301 HC ASSAY OF PHENYTOIN TOTAL O $306.02 $13.25 $13.25 $10.50 $153.01 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $229.51 $14.58 $192.79 $223.70 $12.60 $10.50 $183.61 $244.82 $45.05 $75.53 $10.50 $13.25 $198.91 $14.70 $244.82 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $244.82 $260.12 $14.18 $229.51 $21.52 $14.18 $153.01 $198.91 $18.62 $18.62 $18.62 $18.62 $22.39 $13.91 $13.25 $22.39 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $260.12 330104 80186 405 301 HC ASSAY OF PHENYTOIN FREE O $218.28 $13.76 $13.76 $10.50 $109.14 N/A N/A N/A $10.50 $26.14 $10.50 $13.76 $163.71 $15.14 $137.52 $159.56 $12.60 $10.50 $130.97 $174.62 $46.78 $78.43 $10.50 $13.76 $141.88 $14.70 $174.62 $10.50 $10.50 $12.60 $19.26 $10.50 $13.76 $13.76 $15.00 $174.62 $185.54 $14.18 $163.71 $21.52 $14.18 $109.14 $141.88 $19.33 $19.33 $19.33 $19.33 $23.24 $14.45 $13.76 $23.24 $10.50 $10.50 $10.32 $10.32 $10.32 $10.32 $185.54 330104 80189 405 301 HC DRUG ASSAY ITRACONAZOLE O $169.06 $27.11 $27.11 N/A $84.53 N/A N/A N/A N/A $51.51 N/A $27.11 $126.80 $29.82 $106.51 $123.58 N/A N/A $101.44 $135.25 $92.17 $154.53 N/A $27.11 $109.89 N/A $135.25 N/A N/A N/A $37.95 N/A $27.11 $27.11 $29.55 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $38.09 $38.09 $38.09 $38.09 N/A $28.47 $27.11 $112.76 N/A N/A $20.33 $20.33 $20.33 $20.33 $154.53 330104 80193 405 301 HC DRUG ASSAY LEFLUNOMIDE O $169.06 $38.57 $38.57 $23.14 $84.53 N/A N/A N/A $23.14 $73.28 $23.14 $38.57 $126.80 $42.43 $106.51 $123.58 $27.77 $23.14 $101.44 $135.25 $131.14 $219.85 $23.14 $38.57 $109.89 $32.40 $135.25 $23.14 $23.14 $27.77 $54.00 $23.14 $38.57 $38.57 $42.04 $135.25 $143.70 $31.24 $126.80 $47.44 $31.24 $84.53 $109.89 $54.19 $54.19 $54.19 $54.19 N/A $40.50 $38.57 $112.76 $23.14 $23.14 $28.93 $28.93 $28.93 $23.14 $219.85 330104 80197 405 301 HC ASSAY OF TACROLIMUS O $249.31 $13.73 $13.73 $10.50 $124.66 N/A N/A N/A $10.50 $26.09 $10.50 $13.73 $186.98 $15.10 $157.07 $182.25 $12.60 $10.50 $149.59 $199.45 $46.68 $78.26 $10.50 $13.73 $162.05 $14.70 $199.45 $10.50 $10.50 $12.60 $19.22 $10.50 $13.73 $13.73 $14.97 $199.45 $211.91 $14.18 $186.98 $21.52 $14.18 $124.66 $162.05 $19.29 $19.29 $19.29 $19.29 $23.18 $14.42 $13.73 $23.18 $10.50 $10.50 $10.30 $10.30 $10.30 $10.30 $211.91 330104 80198 405 301 HC ASSAY OF THEOPHYLLINE O $300.67 $14.14 $14.14 $8.00 $150.34 N/A N/A N/A $8.00 $26.87 $8.00 $14.14 $225.50 $15.55 $189.42 $219.79 $9.60 $8.00 $180.40 $240.54 $48.08 $80.60 $8.00 $14.14 $195.44 $11.20 $240.54 $8.00 $8.00 $9.60 $19.80 $8.00 $14.14 $14.14 $15.41 $240.54 $255.57 $10.80 $225.50 $16.40 $10.80 $150.34 $195.44 $19.87 $19.87 $19.87 $19.87 $23.89 $14.85 $14.14 $23.89 $8.00 $8.00 $10.61 $10.61 $10.61 $8.00 $255.57 330104 80200 405 301 HC ASSAY OF TOBRAMYCIN O $420.51 $16.13 $16.13 $10.50 $210.25 N/A N/A N/A $10.50 $30.65 $10.50 $16.13 $315.38 $17.74 $264.92 $307.39 $12.60 $10.50 $252.31 $336.41 $54.84 $91.94 $10.50 $16.13 $273.33 $14.70 $336.41 $10.50 $10.50 $12.60 $22.58 $10.50 $16.13 $16.13 $17.58 $336.41 $357.43 $14.18 $315.38 $21.52 $14.18 $210.25 $273.33 $22.66 $22.66 $22.66 $22.66 $27.22 $16.94 $16.13 $27.22 $10.50 $10.50 $12.10 $12.10 $12.10 $10.50 $357.43 330104 80202 405 301 HC ASSAY OF VANCOMYCIN O $245.03 $13.54 $13.54 $10.50 $122.52 N/A N/A N/A $10.50 $25.73 $10.50 $13.54 $183.77 $14.89 $154.37 $179.12 $12.60 $10.50 $147.02 $196.02 $46.04 $77.18 $10.50 $13.54 $159.27 $14.70 $196.02 $10.50 $10.50 $12.60 $18.96 $10.50 $13.54 $13.54 $14.76 $196.02 $208.28 $14.18 $183.77 $21.52 $14.18 $122.52 $159.27 $19.02 $19.02 $19.02 $19.02 $22.87 $14.22 $13.54 $22.87 $10.50 $10.50 $10.15 $10.15 $10.15 $10.15 $208.28 330104 80203 405 301 HC DRUG SCREEN QUANT ZONISAMIDE O $133.75 $13.25 $13.25 $10.50 $66.88 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $100.31 $14.58 $84.26 $97.77 $12.60 $10.50 $80.25 $107.00 $45.05 $75.53 $10.50 $13.25 $86.94 $14.70 $107.00 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $107.00 $113.69 $14.18 $100.31 $21.52 $14.18 $66.88 $86.94 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $113.69 330104 80204 405 301 HC DRUG ASSAY METHOTREXATE O $169.06 $38.57 $38.57 $23.14 $84.53 N/A N/A N/A $23.14 $73.28 $23.14 $38.57 $126.80 $42.43 $106.51 $123.58 $27.77 $23.14 $101.44 $135.25 $131.14 $219.85 $23.14 $38.57 $109.89 $32.40 $135.25 $23.14 $23.14 $27.77 $54.00 $23.14 $38.57 $38.57 $42.04 $135.25 $143.70 $31.24 $126.80 $47.44 $31.24 $84.53 $109.89 $54.19 $54.19 $54.19 $54.19 N/A $40.50 $38.57 $112.76 $23.14 $23.14 $28.93 $28.93 $28.93 $23.14 $219.85 330104 80210 405 301 HC DRUG ASSAY RUFINAMIDE O $169.06 $27.11 $27.11 $16.27 $84.53 N/A N/A N/A $16.27 $51.51 $16.27 $27.11 $126.80 $29.82 $106.51 $123.58 $19.52 $16.27 $101.44 $135.25 $92.17 $154.53 $16.27 $27.11 $109.89 $22.78 $135.25 $16.27 $16.27 $19.52 $37.95 $16.27 $27.11 $27.11 $29.55 $135.25 $143.70 $21.96 $126.80 $33.35 $21.96 $84.53 $109.89 $38.09 $38.09 $38.09 $38.09 N/A $28.47 $27.11 $112.76 $16.27 $16.27 $20.33 $20.33 $20.33 $16.27 $154.53 330104 80220 405 301 HC DRUG ASSAY HYDROXYCHLOROQUINE O $107.00 $18.64 $18.64 $10.50 $53.50 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $80.25 $20.50 $67.41 $78.22 $12.60 $10.50 $64.20 $85.60 $63.38 $106.25 $10.50 $18.64 $69.55 $14.70 $85.60 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $85.60 $90.95 $14.18 $80.25 $21.52 $14.18 $53.50 $69.55 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $71.37 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $106.25 330104 80175 405 301 HC DRUG SCREEN QUAN LAMOTRIGINE O $112.35 $13.25 $13.25 $10.50 $56.17 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $84.26 $14.58 $70.78 $82.13 $12.60 $10.50 $67.41 $89.88 $45.05 $75.53 $10.50 $13.25 $73.03 $14.70 $89.88 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $89.88 $95.50 $14.18 $84.26 $21.52 $14.18 $56.17 $73.03 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $95.50 330104 80170 405 301 HC ASSAY OF GENTAMICIN O $418.37 $16.38 $16.38 $10.50 $209.19 N/A N/A N/A $10.50 $31.12 $10.50 $16.38 $313.78 $18.02 $263.57 $305.83 $12.60 $10.50 $251.02 $334.70 $55.69 $93.37 $10.50 $16.38 $271.94 $14.70 $334.70 $10.50 $10.50 $12.60 $22.93 $10.50 $16.38 $16.38 $17.85 $334.70 $355.61 $14.18 $313.78 $21.52 $14.18 $209.19 $271.94 $23.01 $23.01 $23.01 $23.01 $27.68 $17.20 $16.38 $27.68 $10.50 $10.50 $12.29 $12.29 $12.29 $10.50 $355.61 330104 80167 405 301 HC DRUG ASSAY FELBAMATE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80164 405 301 HC ASSAY DIPROPYLACETIC ACID O $326.35 $13.54 $13.54 $10.50 $163.18 N/A N/A N/A $10.50 $25.73 $10.50 $13.54 $244.76 $14.89 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $46.04 $77.18 $10.50 $13.54 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $18.96 $10.50 $13.54 $13.54 $14.76 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $19.02 $19.02 $19.02 $19.02 $22.87 $14.22 $13.54 $22.87 $10.50 $10.50 $10.15 $10.15 $10.15 $10.15 $277.40 330104 82465 402 301 HC ASSAY BLD/SERUM CHOLESTEROL O $71.69 $4.35 $4.35 $4.35 $35.84 N/A N/A N/A $4.35 $8.26 $4.35 $4.35 $53.77 $4.79 $45.16 $52.41 $5.22 $4.35 $43.01 $57.35 $14.79 $24.79 $4.35 $4.35 $46.60 $6.09 $57.35 $4.35 $4.35 $5.22 $6.09 $4.35 $4.35 $4.35 $4.74 $57.35 $60.94 $5.87 $53.77 $8.92 $5.87 $35.84 $46.60 $6.11 $6.11 $6.11 $6.11 $7.36 $4.57 $4.35 $7.36 $4.35 $4.35 $3.26 $3.26 $3.26 $3.26 $60.94 330104 82105 400 301 HC ALPHA-FETOPROTEIN (AFP); SERUM O $522.16 $16.77 $16.77 $6.50 $261.08 N/A N/A N/A $6.50 $31.86 $6.50 $16.77 $391.62 $18.45 $328.96 $381.70 $7.80 $6.50 $313.30 $417.73 $57.02 $95.59 $6.50 $16.77 $339.40 $9.10 $417.73 $6.50 $6.50 $7.80 $23.48 $6.50 $16.77 $16.77 $18.28 $417.73 $443.84 $8.78 $391.62 $13.32 $8.78 $261.08 $339.40 $23.56 $23.56 $23.56 $23.56 $28.33 $17.61 $16.77 $28.33 $6.50 $6.50 $12.58 $12.58 $12.58 $6.50 $443.84 330104 82945 402 301 HC GLUCOSE OTHER FLUID O $182.97 $3.93 $3.93 $3.93 $91.48 N/A N/A N/A $3.93 $7.47 $3.93 $3.93 $137.23 $4.32 $115.27 $133.75 $4.72 $3.93 $109.78 $146.38 $13.36 $22.40 $3.93 $3.93 $118.93 $5.50 $146.38 $3.93 $3.93 $4.72 $5.50 $3.93 $3.93 $3.93 $4.28 $146.38 $155.52 $5.31 $137.23 $8.06 $5.31 $91.48 $118.93 $5.52 $5.52 $5.52 $5.52 $6.62 $4.13 $3.93 $6.62 $3.93 $3.93 $2.95 $2.95 $2.95 $2.95 $155.52 330104 82948 402 301 HC REAGENT STRIP/BLOOD GLUCOSE O $52.43 $5.04 $5.04 $2.00 $26.21 N/A N/A N/A $2.00 $9.58 $2.00 $5.04 $39.32 $5.54 $33.03 $38.33 $2.40 $2.00 $31.46 $41.94 $17.14 $28.73 $2.00 $5.04 $34.08 $2.80 $41.94 $2.00 $2.00 $2.40 $7.06 $2.00 $5.04 $5.04 $5.49 $41.94 $44.57 $2.70 $39.32 $4.10 $2.70 $26.21 $34.08 $7.08 $7.08 $7.08 $7.08 $5.34 $5.29 $5.04 $5.34 $2.00 $2.00 $3.78 $3.78 $3.78 $2.00 $44.57 330104 82962 402 301 HC GLUCOSE BLOOD TEST O $33.17 $3.28 $3.28 N/A $16.59 N/A N/A N/A N/A $6.23 N/A $3.28 $24.88 $3.61 $20.90 $24.25 N/A N/A $19.90 $26.54 $11.15 $18.70 N/A $3.28 $21.56 N/A $26.54 N/A N/A N/A $4.59 N/A $3.28 $3.28 $3.58 $26.54 $28.19 N/A $24.88 N/A N/A $16.59 $21.56 $4.61 $4.61 $4.61 $4.61 $3.95 $3.44 $3.28 $3.95 N/A N/A $2.46 $2.46 $2.46 $2.46 $28.19 330104 84238 401 301 HC ASSAY NONENDOCRINE RECEPTOR O "$1,043.25 " $36.57 $36.57 N/A $521.62 N/A N/A N/A N/A $69.48 N/A $36.57 $782.44 $40.23 $657.25 $762.62 N/A N/A $625.95 $834.60 $124.34 $208.45 N/A $36.57 $678.11 N/A $834.60 N/A N/A N/A $51.20 N/A $36.57 $36.57 $39.86 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $51.38 $51.38 $51.38 $51.38 $61.75 $38.40 $36.57 $61.75 N/A N/A $27.43 $27.43 $27.43 $27.43 $886.76 330104 80048 403 301 HC METABOLIC PANEL TOTAL CA O $186.18 $8.46 $8.46 $7.25 $93.09 N/A N/A N/A $7.25 $16.07 $7.25 $8.46 $139.63 $9.31 $117.29 $136.10 $8.70 $7.25 $111.71 $148.94 $28.76 $48.22 $7.25 $8.46 $121.02 $10.15 $148.94 $7.25 $7.25 $8.70 $11.84 $7.25 $8.46 $8.46 $9.22 $148.94 $158.25 $9.79 $139.63 $14.86 $9.79 $93.09 $121.02 $11.89 $11.89 $11.89 $11.89 $14.29 $8.88 $8.46 $14.29 $7.25 $7.25 $6.35 $6.35 $6.35 $6.35 $158.25 330104 80051 403 301 HC ELECTROLYTE PANEL O $107.00 $7.01 $7.01 $6.04 $53.50 N/A N/A N/A $6.04 $13.32 $6.04 $7.01 $80.25 $7.71 $67.41 $78.22 $7.25 $6.04 $64.20 $85.60 $23.83 $39.96 $6.04 $7.01 $69.55 $8.46 $85.60 $6.04 $6.04 $7.25 $9.81 $6.04 $7.01 $7.01 $7.64 $85.60 $90.95 $8.15 $80.25 $12.38 $8.15 $53.50 $69.55 $9.85 $9.85 $9.85 $9.85 $11.84 $7.36 $7.01 $11.84 $6.04 $6.04 $5.26 $5.26 $5.26 $5.26 $90.95 330104 80053 403 301 HC COMPREHEN METABOLIC PANEL O $151.94 $10.56 $10.56 $10.00 $75.97 N/A N/A N/A $10.00 $20.06 $10.00 $10.56 $113.95 $11.62 $95.72 $111.07 $12.00 $10.00 $91.16 $121.55 $35.90 $60.19 $10.00 $10.56 $98.76 $14.00 $121.55 $10.00 $10.00 $12.00 $14.78 $10.00 $10.56 $10.56 $11.51 $121.55 $129.15 $13.50 $113.95 $20.50 $13.50 $75.97 $98.76 $14.84 $14.84 $14.84 $14.84 $17.84 $11.09 $10.56 $17.84 $10.00 $10.00 $7.92 $7.92 $7.92 $7.92 $129.15 330104 80235 405 301 HC DRUG ASSAY LACOSAMIDE O $182.97 $27.11 $27.11 $10.50 $91.48 N/A N/A N/A $10.50 $51.51 $10.50 $27.11 $137.23 $29.82 $115.27 $133.75 $12.60 $10.50 $109.78 $146.38 $92.17 $154.53 $10.50 $27.11 $118.93 $14.70 $146.38 $10.50 $10.50 $12.60 $37.95 $10.50 $27.11 $27.11 $29.55 $146.38 $155.52 $14.18 $137.23 $21.52 $14.18 $91.48 $118.93 $38.09 $38.09 $38.09 $38.09 $32.53 $28.47 $27.11 $32.53 $10.50 $10.50 $20.33 $20.33 $20.33 $10.50 $155.52 330104 80061 403 301 HC LIPID PANEL O $182.97 $13.39 $13.39 $6.04 $91.48 N/A N/A N/A $6.04 $25.44 $6.04 $13.39 $137.23 $14.73 $115.27 $133.75 $7.25 $6.04 $109.78 $146.38 $45.53 $76.32 $6.04 $13.39 $118.93 $8.46 $146.38 $6.04 $6.04 $7.25 $18.75 $6.04 $13.39 $13.39 $14.60 $146.38 $155.52 $8.15 $137.23 $12.38 $8.15 $91.48 $118.93 $18.81 $18.81 $18.81 $18.81 $22.62 $14.06 $13.39 $22.62 $6.04 $6.04 $10.04 $10.04 $10.04 $6.04 $155.52 330104 80076 403 301 HC HEPATIC FUNCTION PANEL O $254.66 $8.17 $8.17 $7.25 $127.33 N/A N/A N/A $7.25 $15.52 $7.25 $8.17 $191.00 $8.99 $160.44 $186.16 $8.70 $7.25 $152.80 $203.73 $27.78 $46.57 $7.25 $8.17 $165.53 $10.15 $203.73 $7.25 $7.25 $8.70 $11.44 $7.25 $8.17 $8.17 $8.91 $203.73 $216.46 $9.79 $191.00 $14.86 $9.79 $127.33 $165.53 $11.48 $11.48 $11.48 $11.48 $13.79 $8.58 $8.17 $13.79 $7.25 $7.25 $6.13 $6.13 $6.13 $6.13 $216.46 330104 80143 405 301 HC DRUG ASSAY ACETAMINOPHEN O $67.41 $18.64 $18.64 N/A $33.70 N/A N/A N/A N/A $35.42 N/A $18.64 $50.56 $20.50 $42.47 $49.28 N/A N/A $40.45 $53.93 $63.38 $106.25 N/A $18.64 $43.82 N/A $53.93 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $53.93 $57.30 N/A $50.56 N/A N/A $33.70 $43.82 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $44.96 N/A N/A $13.98 $13.98 $13.98 $13.98 $106.25 330104 80150 405 301 HC ASSAY OF AMIKACIN O $326.35 $15.08 $15.08 $10.50 $163.18 N/A N/A N/A $10.50 $28.65 $10.50 $15.08 $244.76 $16.59 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $51.27 $85.96 $10.50 $15.08 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $21.11 $10.50 $15.08 $15.08 $16.44 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $10.50 $10.50 $11.31 $11.31 $11.31 $10.50 $277.40 330104 80151 405 301 HC DRUG ASSAY AMIODARONE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80156 405 301 HC ASSAY CARBAMAZEPINE TOTAL O $311.37 $14.57 $14.57 $10.50 $155.69 N/A N/A N/A $10.50 $27.68 $10.50 $14.57 $233.53 $16.03 $196.16 $227.61 $12.60 $10.50 $186.82 $249.10 $49.54 $83.05 $10.50 $14.57 $202.39 $14.70 $249.10 $10.50 $10.50 $12.60 $20.40 $10.50 $14.57 $14.57 $15.88 $249.10 $264.66 $14.18 $233.53 $21.52 $14.18 $155.69 $202.39 $20.47 $20.47 $20.47 $20.47 $24.59 $15.30 $14.57 $24.59 $10.50 $10.50 $10.93 $10.93 $10.93 $10.50 $264.66 330104 80158 405 301 HC ASSAY OF CYCLOSPORINE O $792.87 $18.05 $18.05 $10.50 $396.44 N/A N/A N/A $10.50 $34.30 $10.50 $18.05 $594.65 $19.86 $499.51 $579.59 $12.60 $10.50 $475.72 $634.30 $61.37 $102.89 $10.50 $18.05 $515.37 $14.70 $634.30 $10.50 $10.50 $12.60 $25.27 $10.50 $18.05 $18.05 $19.67 $634.30 $673.94 $14.18 $594.65 $21.52 $14.18 $396.44 $515.37 $25.36 $25.36 $25.36 $25.36 $30.48 $18.95 $18.05 $30.48 $10.50 $10.50 $13.54 $13.54 $13.54 $10.50 $673.94 330104 80159 405 301 HC DRUG SCREEN QUANT CLOZAPINE O $69.55 $20.15 $20.15 $10.50 $34.77 N/A N/A N/A $10.50 $38.28 $10.50 $20.15 $52.16 $22.16 $43.82 $50.84 $12.60 $10.50 $41.73 $55.64 $68.51 $114.85 $10.50 $20.15 $45.21 $14.70 $55.64 $10.50 $10.50 $12.60 $28.21 $10.50 $20.15 $20.15 $21.96 $55.64 $59.12 $14.18 $52.16 $21.52 $14.18 $34.77 $45.21 $28.31 $28.31 $28.31 $28.31 $30.28 $21.16 $20.15 $30.28 $10.50 $10.50 $15.11 $15.11 $15.11 $10.50 $114.85 330104 80161 405 301 "HC DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE" O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80162 405 301 HC ASSAY OF DIGOXIN O $306.02 $13.28 $13.28 $10.50 $153.01 N/A N/A N/A $10.50 $25.23 $10.50 $13.28 $229.51 $14.61 $192.79 $223.70 $12.60 $10.50 $183.61 $244.82 $45.15 $75.70 $10.50 $13.28 $198.91 $14.70 $244.82 $10.50 $10.50 $12.60 $18.59 $10.50 $13.28 $13.28 $14.48 $244.82 $260.12 $14.18 $229.51 $21.52 $14.18 $153.01 $198.91 $18.66 $18.66 $18.66 $18.66 $22.43 $13.94 $13.28 $22.43 $10.50 $10.50 $9.96 $9.96 $9.96 $9.96 $260.12 330104 80074 403 301 HC HEPATITIS PANELACUTE O $752.21 $47.63 $47.63 N/A $376.11 N/A N/A N/A N/A $90.50 N/A $47.63 $564.16 $52.39 $473.89 $549.87 N/A N/A $451.33 $601.77 $161.94 $271.49 N/A $47.63 $488.94 N/A $601.77 N/A N/A N/A $66.68 N/A $47.63 $47.63 $51.92 $601.77 $639.38 N/A $564.16 N/A N/A $376.11 $488.94 $66.92 $66.92 $66.92 $66.92 $80.41 $50.01 $47.63 $80.41 N/A N/A $35.72 $35.72 $35.72 $35.72 $639.38 330104 80299 405 301 HC QUANTITATIVE ASSAY DRUG O $449.40 $18.64 $18.64 N/A $224.70 N/A N/A N/A N/A $35.42 N/A $18.64 $337.05 $20.50 $283.12 $328.51 N/A N/A $269.64 $359.52 $63.38 $106.25 N/A $18.64 $292.11 N/A $359.52 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $26.19 $26.19 $26.19 $26.19 $23.12 $19.57 $18.64 $23.12 N/A N/A $13.98 $13.98 $13.98 $13.98 $381.99 330104 80069 403 301 HC RENAL FUNCTION PANEL O $117.70 $8.68 $8.68 $8.68 $58.85 N/A N/A N/A $8.68 $16.49 $8.68 $8.68 $88.28 $9.55 $74.15 $86.04 $10.42 $8.68 $70.62 $94.16 $29.51 $49.48 $8.68 $8.68 $76.51 $12.15 $94.16 $8.68 $8.68 $10.42 $12.15 $8.68 $8.68 $8.68 $9.46 $94.16 $100.05 $11.72 $88.28 $17.79 $11.72 $58.85 $76.51 $12.20 $12.20 $12.20 $12.20 $14.66 $9.11 $8.68 $14.66 $8.68 $8.68 $6.51 $6.51 $6.51 $6.51 $100.05 330104 80377 2040 301 HC DRUG/SUBSTANCE NOS 7/MORE O $182.97 N/A N/A N/A $91.48 N/A N/A N/A N/A N/A N/A N/A $137.23 N/A $115.27 $133.75 N/A N/A $109.78 $146.38 N/A N/A N/A N/A $118.93 N/A $146.38 N/A N/A N/A N/A N/A N/A N/A N/A $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 N/A N/A N/A N/A $29.66 N/A N/A $29.66 N/A N/A N/A N/A N/A $29.66 $155.52 330104 82232 398 301 HC ASSAY OF BETA-2 PROTEIN O $548.91 $16.18 $16.18 $12.50 $274.45 N/A N/A N/A $12.50 $30.74 $12.50 $16.18 $411.68 $17.80 $345.81 $401.25 $15.00 $12.50 $329.35 $439.13 $55.01 $92.23 $12.50 $16.18 $356.79 $17.50 $439.13 $12.50 $12.50 $15.00 $22.65 $12.50 $16.18 $16.18 $17.64 $439.13 $466.57 $16.88 $411.68 $25.62 $16.88 $274.45 $356.79 $22.73 $22.73 $22.73 $22.73 $27.31 $16.99 $16.18 $27.31 $12.50 $12.50 $12.13 $12.13 $12.13 $12.13 $466.57 330104 82239 400 301 HC BILE ACIDS TOTAL O $226.84 $17.12 $17.12 $13.05 $113.42 N/A N/A N/A $13.05 $32.53 $13.05 $17.12 $170.13 $18.83 $142.91 $165.82 $15.66 $13.05 $136.10 $181.47 $58.21 $97.58 $13.05 $17.12 $147.45 $18.27 $181.47 $13.05 $13.05 $15.66 $23.97 $13.05 $17.12 $17.12 $18.66 $181.47 $192.81 $17.62 $170.13 $26.75 $17.62 $113.42 $147.45 $24.05 $24.05 $24.05 $24.05 $28.93 $17.98 $17.12 $28.93 $13.05 $13.05 $12.84 $12.84 $12.84 $12.84 $192.81 330104 82247 402 301 HC BILIRUBIN TOTAL O $84.53 $5.02 $5.02 $5.02 $42.27 N/A N/A N/A $5.02 $9.54 $5.02 $5.02 $63.40 $5.52 $53.25 $61.79 $6.02 $5.02 $50.72 $67.62 $17.07 $28.61 $5.02 $5.02 $54.94 $7.03 $67.62 $5.02 $5.02 $6.02 $7.03 $5.02 $5.02 $5.02 $5.47 $67.62 $71.85 $6.78 $63.40 $10.29 $6.78 $42.27 $54.94 $7.05 $7.05 $7.05 $7.05 $8.47 $5.27 $5.02 $8.47 $5.02 $5.02 $3.76 $3.76 $3.76 $3.76 $71.85 330104 82248 402 301 HC BILIRUBIN DIRECT O $84.53 $5.02 $5.02 $5.02 $42.27 N/A N/A N/A $5.02 $9.54 $5.02 $5.02 $63.40 $5.52 $53.25 $61.79 $6.02 $5.02 $50.72 $67.62 $17.07 $28.61 $5.02 $5.02 $54.94 $7.03 $67.62 $5.02 $5.02 $6.02 $7.03 $5.02 $5.02 $5.02 $5.47 $67.62 $71.85 $6.78 $63.40 $10.29 $6.78 $42.27 $54.94 $7.05 $7.05 $7.05 $7.05 $8.47 $5.27 $5.02 $8.47 $5.02 $5.02 $3.76 $3.76 $3.76 $3.76 $71.85 330104 82271 402 301 HC OCCULT BLOOD OTHER SOURCES O $121.98 $5.32 $5.32 N/A $60.99 N/A N/A N/A N/A $10.11 N/A $5.32 $91.48 $5.85 $76.85 $89.17 N/A N/A $73.19 $97.58 $18.09 $30.32 N/A $5.32 $79.29 N/A $97.58 N/A N/A N/A $7.45 N/A $5.32 $5.32 $5.80 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $7.47 $7.47 $7.47 $7.47 $5.50 $5.59 $5.32 $5.50 N/A N/A $3.99 $3.99 $3.99 $3.99 $103.68 330104 82306 401 301 HC VITAMIN D 25 HYDROXY O $466.52 $29.60 $29.60 $29.60 $233.26 N/A N/A N/A $29.60 $56.24 $29.60 $29.60 $349.89 $32.56 $293.91 $341.03 $35.52 $29.60 $279.91 $373.22 $100.64 $168.72 $29.60 $29.60 $303.24 $41.44 $373.22 $29.60 $29.60 $35.52 $41.44 $29.60 $29.60 $29.60 $32.26 $373.22 $396.54 $39.96 $349.89 $60.68 $39.96 $233.26 $303.24 $41.59 $41.59 $41.59 $41.59 $49.99 $31.08 $29.60 $49.99 $29.60 $29.60 $22.20 $22.20 $22.20 $22.20 $396.54 330104 82308 398 301 HC ASSAY OF CALCITONIN O $712.62 $26.79 $26.79 $26.79 $356.31 N/A N/A N/A $26.79 $50.90 $26.79 $26.79 $534.47 $29.47 $448.95 $520.93 $32.15 $26.79 $427.57 $570.10 $91.09 $152.70 $26.79 $26.79 $463.20 $37.51 $570.10 $26.79 $26.79 $32.15 $37.51 $26.79 $26.79 $26.79 $29.20 $570.10 $605.73 $36.17 $534.47 $54.92 $36.17 $356.31 $463.20 $37.64 $37.64 $37.64 $37.64 $45.23 $28.13 $26.79 $45.23 $26.79 $26.79 $20.09 $20.09 $20.09 $20.09 $605.73 330104 82310 402 301 HC CALCIUM; TOTAL O $182.97 $5.16 $5.16 $5.03 $91.48 N/A N/A N/A $5.03 $9.80 $5.03 $5.16 $137.23 $5.68 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.54 $29.41 $5.03 $5.16 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.22 $5.03 $5.16 $5.16 $5.62 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.25 $7.25 $7.25 $7.25 $8.71 $5.42 $5.16 $8.71 $5.03 $5.03 $3.87 $3.87 $3.87 $3.87 $155.52 330104 82330 400 301 HC CALCIUM; IONIZED O $963.00 $13.68 $13.68 $5.03 $481.50 N/A N/A N/A $5.03 $25.99 $5.03 $13.68 $722.25 $15.05 $606.69 $703.95 $6.04 $5.03 $577.80 $770.40 $46.51 $77.98 $5.03 $13.68 $625.95 $7.04 $770.40 $5.03 $5.03 $6.04 $19.15 $5.03 $13.68 $13.68 $14.91 $770.40 $818.55 $6.79 $722.25 $10.31 $6.79 $481.50 $625.95 $19.22 $19.22 $19.22 $19.22 $23.08 $14.36 $13.68 $23.08 $5.03 $5.03 $10.26 $10.26 $10.26 $5.03 $818.55 330104 82180 402 301 HC ASSAY OF ASCORBIC ACID O $260.01 $9.89 $9.89 $9.89 $130.00 N/A N/A N/A $9.89 $18.79 $9.89 $9.89 $195.01 $10.88 $163.81 $190.07 $11.87 $9.89 $156.01 $208.01 $33.63 $56.37 $9.89 $9.89 $169.01 $13.85 $208.01 $9.89 $9.89 $11.87 $13.85 $9.89 $9.89 $9.89 $10.78 $208.01 $221.01 $13.35 $195.01 $20.27 $13.35 $130.00 $169.01 $13.90 $13.90 $13.90 $13.90 $16.69 $10.38 $9.89 $16.69 $9.89 $9.89 $7.42 $7.42 $7.42 $7.42 $221.01 330104 82340 402 301 HC ASSAY OF CALCIUM IN URINE O $182.97 $6.03 $6.03 $6.03 $91.48 N/A N/A N/A $6.03 $11.46 $6.03 $6.03 $137.23 $6.63 $115.27 $133.75 $7.24 $6.03 $109.78 $146.38 $20.50 $34.37 $6.03 $6.03 $118.93 $8.44 $146.38 $6.03 $6.03 $7.24 $8.44 $6.03 $6.03 $6.03 $6.57 $146.38 $155.52 $8.14 $137.23 $12.36 $8.14 $91.48 $118.93 $8.47 $8.47 $8.47 $8.47 $10.19 $6.33 $6.03 $10.19 $6.03 $6.03 $4.52 $4.52 $4.52 $4.52 $155.52 330104 82374 402 301 HC ASSAY BLOOD CARBON DIOXIDE O $97.37 $4.88 $4.88 $4.88 $48.69 N/A N/A N/A $4.88 $9.27 $4.88 $4.88 $73.03 $5.37 $61.34 $71.18 $5.86 $4.88 $58.42 $77.90 $16.59 $27.82 $4.88 $4.88 $63.29 $6.83 $77.90 $4.88 $4.88 $5.86 $6.83 $4.88 $4.88 $4.88 $5.32 $77.90 $82.76 $6.59 $73.03 $10.00 $6.59 $48.69 $63.29 $6.86 $6.86 $6.86 $6.86 $8.26 $5.12 $4.88 $8.26 $4.88 $4.88 $3.66 $3.66 $3.66 $3.66 $82.76 330104 82375 400 301 HC ASSAY CARBOXYHB QUANT O $466.52 $12.32 $12.32 $11.00 $233.26 N/A N/A N/A $11.00 $23.41 $11.00 $12.32 $349.89 $13.55 $293.91 $341.03 $13.20 $11.00 $279.91 $373.22 $41.89 $70.22 $11.00 $12.32 $303.24 $15.40 $373.22 $11.00 $11.00 $13.20 $17.25 $11.00 $12.32 $12.32 $13.43 $373.22 $396.54 $14.85 $349.89 $22.55 $14.85 $233.26 $303.24 $17.31 $17.31 $17.31 $17.31 $20.82 $12.94 $12.32 $20.82 $11.00 $11.00 $9.24 $9.24 $9.24 $9.24 $396.54 330104 82435 402 301 HC ASSAY OF BLOOD CHLORIDE O $112.35 $4.60 $4.60 $4.60 $56.17 N/A N/A N/A $4.60 $8.74 $4.60 $4.60 $84.26 $5.06 $70.78 $82.13 $5.52 $4.60 $67.41 $89.88 $15.64 $26.22 $4.60 $4.60 $73.03 $6.44 $89.88 $4.60 $4.60 $5.52 $6.44 $4.60 $4.60 $4.60 $5.01 $89.88 $95.50 $6.21 $84.26 $9.43 $6.21 $56.17 $73.03 $6.46 $6.46 $6.46 $6.46 $7.76 $4.83 $4.60 $7.76 $4.60 $4.60 $3.45 $3.45 $3.45 $3.45 $95.50 330104 82379 400 301 HC ASSAY OF CARNITINE O "$1,668.13 " $16.87 $16.87 $10.50 $834.07 N/A N/A N/A $10.50 $32.05 $10.50 $16.87 "$1,251.10 " $18.56 "$1,050.92 " "$1,219.40 " $12.60 $10.50 "$1,000.88 " "$1,334.50 " $57.36 $96.16 $10.50 $16.87 "$1,084.28 " $14.70 "$1,334.50 " $10.50 $10.50 $12.60 $23.62 $10.50 $16.87 $16.87 $18.39 "$1,334.50 " "$1,417.91 " $14.18 "$1,251.10 " $21.52 $14.18 $834.07 "$1,084.28 " $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $10.50 $10.50 $12.65 $12.65 $12.65 $10.50 "$1,417.91 " 330104 82380 402 301 HC ASSAY OF CAROTENE O $263.22 $9.22 $9.22 N/A $131.61 N/A N/A N/A N/A $17.52 N/A $9.22 $197.42 $10.14 $165.83 $192.41 N/A N/A $157.93 $210.58 $31.35 $52.55 N/A $9.22 $171.09 N/A $210.58 N/A N/A N/A $12.91 N/A $9.22 $9.22 $10.05 $210.58 $223.74 N/A $197.42 N/A N/A $131.61 $171.09 $12.95 $12.95 $12.95 $12.95 $15.58 $9.68 $9.22 $15.58 N/A N/A $6.92 $6.92 $6.92 $6.92 $223.74 330104 82384 398 301 HC ASSAY THREE CATECHOLAMINES O $996.17 $25.25 $25.25 $18.40 $498.08 N/A N/A N/A $18.40 $47.97 $18.40 $25.25 $747.13 $27.78 $627.59 $728.20 $22.08 $18.40 $597.70 $796.94 $85.85 $143.93 $18.40 $25.25 $647.51 $25.76 $796.94 $18.40 $18.40 $22.08 $35.35 $18.40 $25.25 $25.25 $27.52 $796.94 $846.74 $24.84 $747.13 $37.72 $24.84 $498.08 $647.51 $35.48 $35.48 $35.48 $35.48 $42.64 $26.51 $25.25 $42.64 $18.40 $18.40 $18.94 $18.94 $18.94 $18.40 $846.74 330104 82390 402 301 HC ASSAY OF CERULOPLASMIN O $326.35 $10.74 $10.74 $8.10 $163.18 N/A N/A N/A $8.10 $20.41 $8.10 $10.74 $244.76 $11.81 $205.60 $238.56 $9.72 $8.10 $195.81 $261.08 $36.52 $61.22 $8.10 $10.74 $212.13 $11.34 $261.08 $8.10 $8.10 $9.72 $15.04 $8.10 $10.74 $10.74 $11.71 $261.08 $277.40 $10.94 $244.76 $16.60 $10.94 $163.18 $212.13 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $8.10 $8.10 $8.05 $8.05 $8.05 $8.05 $277.40 330104 82397 400 301 HC CHEMILUMINESCENT ASSAY O $318.86 $14.12 $14.12 N/A $159.43 N/A N/A N/A N/A $26.83 N/A $14.12 $239.15 $15.53 $200.88 $233.09 N/A N/A $191.32 $255.09 $48.01 $80.48 N/A $14.12 $207.26 N/A $255.09 N/A N/A N/A $19.77 N/A $14.12 $14.12 $15.39 $255.09 $271.03 N/A $239.15 N/A N/A $159.43 $207.26 $19.84 $19.84 $19.84 $19.84 $23.86 $14.83 $14.12 $23.86 N/A N/A $10.59 $10.59 $10.59 $10.59 $271.03 330104 80307 2041 301 HC DRUG TEST PRSMV CHEM ANLYZR O $227.91 $62.14 $62.14 $7.50 $113.95 N/A N/A N/A $7.50 $118.07 $7.50 $62.14 $170.93 $68.35 $143.58 $166.60 $9.00 $7.50 $136.75 $182.33 $211.28 $354.20 $7.50 $62.14 $148.14 $10.50 $182.33 $7.50 $7.50 $9.00 $87.00 $7.50 $62.14 $62.14 $67.73 $182.33 $193.72 $10.12 $170.93 $15.37 $10.12 $113.95 $148.14 $87.31 $87.31 $87.31 $87.31 $95.77 $65.25 $62.14 $95.77 $7.50 $7.50 $46.61 $46.61 $46.61 $7.50 $354.20 330104 82360 400 301 HC CALCULUS ASSAY QUANT O $306.02 $12.87 $12.87 $12.87 $153.01 N/A N/A N/A $12.87 $24.45 $12.87 $12.87 $229.51 $14.16 $192.79 $223.70 $15.44 $12.87 $183.61 $244.82 $43.76 $73.36 $12.87 $12.87 $198.91 $18.02 $244.82 $12.87 $12.87 $15.44 $18.02 $12.87 $12.87 $12.87 $14.03 $244.82 $260.12 $17.37 $229.51 $26.38 $17.37 $153.01 $198.91 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $12.87 $12.87 $9.65 $9.65 $9.65 $9.65 $260.12 330104 82175 404 301 HC ASSAY OF ARSENIC O $475.08 $18.97 $18.97 $18.97 $237.54 N/A N/A N/A $18.97 $36.04 $18.97 $18.97 $356.31 $20.87 $299.30 $347.28 $22.76 $18.97 $285.05 $380.06 $64.50 $108.13 $18.97 $18.97 $308.80 $26.56 $380.06 $18.97 $18.97 $22.76 $26.56 $18.97 $18.97 $18.97 $20.68 $380.06 $403.82 $25.61 $356.31 $38.89 $25.61 $237.54 $308.80 $26.65 $26.65 $26.65 $26.65 $32.04 $19.92 $18.97 $32.04 $18.97 $18.97 $14.23 $14.23 $14.23 $14.23 $403.82 330104 82378 400 301 HC CARCINOEMBRYONIC ANTIGEN O $340.26 $18.96 $18.96 $18.96 $170.13 N/A N/A N/A $18.96 $36.02 $18.96 $18.96 $255.19 $20.86 $214.36 $248.73 $22.75 $18.96 $204.16 $272.21 $64.46 $108.07 $18.96 $18.96 $221.17 $26.54 $272.21 $18.96 $18.96 $22.75 $26.54 $18.96 $18.96 $18.96 $20.67 $272.21 $289.22 $25.60 $255.19 $38.87 $25.60 $170.13 $221.17 $26.64 $26.64 $26.64 $26.64 $32.04 $19.91 $18.96 $32.04 $18.96 $18.96 $14.22 $14.22 $14.22 $14.22 $289.22 330104 82164 400 301 HC ANGIOTENSIN I ENZYME TEST O $479.36 $14.60 $14.60 N/A $239.68 N/A N/A N/A N/A $27.74 N/A $14.60 $359.52 $16.06 $302.00 $350.41 N/A N/A $287.62 $383.49 $49.64 $83.22 N/A $14.60 $311.58 N/A $383.49 N/A N/A N/A $20.44 N/A $14.60 $14.60 $15.91 $383.49 $407.46 N/A $359.52 N/A N/A $239.68 $311.58 $20.51 $20.51 $20.51 $20.51 $24.65 $15.33 $14.60 $24.65 N/A N/A $10.95 $10.95 $10.95 $10.95 $407.46 330104 81105 385 301 HC HPA-1 GENOTYPING O $606.69 $122.22 $122.22 N/A $303.35 N/A N/A N/A N/A $232.22 N/A $122.22 $455.02 $134.44 $382.21 $443.49 N/A N/A $364.01 $485.35 $415.55 $696.65 N/A $122.22 $394.35 N/A $485.35 N/A N/A N/A $171.11 N/A $122.22 $122.22 $133.22 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 $171.72 $171.72 $171.72 $171.72 $181.07 $128.33 $122.22 $181.07 N/A N/A $91.66 $91.66 $91.66 $91.66 $696.65 330104 82172 400 301 HC ASSAY OF APOLIPOPROTEIN O $96.30 $21.09 $21.09 $15.93 $48.15 N/A N/A N/A $15.93 $40.07 $15.93 $21.09 $72.22 $23.20 $60.67 $70.40 $19.12 $15.93 $57.78 $77.04 $71.71 $120.21 $15.93 $21.09 $62.59 $22.30 $77.04 $15.93 $15.93 $19.12 $29.53 $15.93 $21.09 $21.09 $22.99 $77.04 $81.85 $21.51 $72.22 $32.66 $21.51 $48.15 $62.59 $29.63 $29.63 $29.63 $29.63 $26.17 $22.14 $21.09 $26.17 $15.93 $15.93 $15.82 $15.82 $15.82 $15.82 $120.21 330104 81162 2045 301 HC BRCA 1 BRCA 2 COMPREHENSIVE ANALYSIS O "$7,972.57 " "$1,824.88 " "$1,824.88 " N/A "$3,986.28 " N/A N/A N/A N/A "$3,467.27 " N/A "$1,824.88 " "$5,979.43 " "$2,007.37 " "$5,022.72 " "$5,827.95 " N/A N/A "$4,783.54 " "$6,378.06 " "$6,204.59 " "$10,401.82 " N/A "$1,824.88 " "$5,182.17 " N/A "$6,378.06 " N/A N/A N/A "$2,554.83 " N/A "$1,824.88 " "$1,824.88 " "$1,989.12 " "$6,378.06 " "$6,776.68 " N/A "$5,979.43 " N/A N/A "$3,986.28 " "$5,182.17 " "$2,563.96 " "$2,563.96 " "$2,563.96 " "$2,563.96 " "$2,983.03 " "$1,916.12 " "$1,824.88 " "$2,983.03 " N/A N/A "$1,368.66 " "$1,368.66 " "$1,368.66 " "$1,368.66 " "$10,401.82 " 330104 81263 386 301 HC IGH VARI REGIONAL MUTATION O "$1,855.38 " $294.52 $294.52 N/A $927.69 N/A N/A N/A N/A $559.59 N/A $294.52 "$1,391.54 " $323.97 "$1,168.89 " "$1,356.28 " N/A N/A "$1,113.23 " "$1,484.30 " "$1,001.37 " "$1,678.76 " N/A $294.52 "$1,206.00 " N/A "$1,484.30 " N/A N/A N/A $412.33 N/A $294.52 $294.52 $321.03 "$1,484.30 " "$1,577.07 " N/A "$1,391.54 " N/A N/A $927.69 "$1,206.00 " $413.80 $413.80 $413.80 $413.80 $482.15 $309.25 $294.52 $482.15 N/A N/A $220.89 $220.89 $220.89 $220.89 "$1,678.76 " 330104 82024 399 301 HC ASSAY OF ACTH O "$1,231.57 " $38.62 $38.62 $38.62 $615.78 N/A N/A N/A $38.62 $73.38 $38.62 $38.62 $923.68 $42.48 $775.89 $900.28 $46.34 $38.62 $738.94 $985.26 $131.31 $220.13 $38.62 $38.62 $800.52 $54.07 $985.26 $38.62 $38.62 $46.34 $54.07 $38.62 $38.62 $38.62 $42.10 $985.26 "$1,046.83 " $52.14 $923.68 $79.17 $52.14 $615.78 $800.52 $54.26 $54.26 $54.26 $54.26 $65.22 $40.55 $38.62 $65.22 $38.62 $38.62 $28.96 $28.96 $28.96 $28.96 "$1,046.83 " 330104 82040 402 301 HC ASSAY OF SERUM ALBUMIN O $117.70 $4.95 $4.95 $4.95 $58.85 N/A N/A N/A $4.95 $9.40 $4.95 $4.95 $88.28 $5.45 $74.15 $86.04 $5.94 $4.95 $70.62 $94.16 $16.83 $28.22 $4.95 $4.95 $76.51 $6.93 $94.16 $4.95 $4.95 $5.94 $6.93 $4.95 $4.95 $4.95 $5.40 $94.16 $100.05 $6.68 $88.28 $10.15 $6.68 $58.85 $76.51 $6.95 $6.95 $6.95 $6.95 $8.35 $5.20 $4.95 $8.35 $4.95 $4.95 $3.71 $3.71 $3.71 $3.71 $100.05 330104 82042 402 301 HC ASSAY OF URINE ALBUMIN O $82.39 $7.78 $7.78 $5.03 $41.20 N/A N/A N/A $5.03 $14.78 $5.03 $7.78 $61.79 $8.56 $51.91 $60.23 $6.04 $5.03 $49.43 $65.91 $26.45 $44.35 $5.03 $7.78 $53.55 $7.04 $65.91 $5.03 $5.03 $6.04 $10.89 $5.03 $7.78 $7.78 $8.48 $65.91 $70.03 $6.79 $61.79 $10.31 $6.79 $41.20 $53.55 $10.93 $10.93 $10.93 $10.93 $8.74 $8.17 $7.78 $8.74 $5.03 $5.03 $5.83 $5.83 $5.83 $5.03 $70.03 330104 82043 410 301 HC MICROALBUMIN QUANTITATIVE O $160.50 $5.78 $5.78 $5.03 $80.25 N/A N/A N/A $5.03 $10.98 $5.03 $5.78 $120.38 $6.36 $101.11 $117.33 $6.04 $5.03 $96.30 $128.40 $19.65 $32.95 $5.03 $5.78 $104.33 $7.04 $128.40 $5.03 $5.03 $6.04 $8.09 $5.03 $5.78 $5.78 $6.30 $128.40 $136.42 $6.79 $120.38 $10.31 $6.79 $80.25 $104.33 $8.12 $8.12 $8.12 $8.12 $9.77 $6.07 $5.78 $9.77 $5.03 $5.03 $4.33 $4.33 $4.33 $4.33 $136.42 330104 82077 2040 301 HC ASSAY SPEC XCP UR&BREATH IA O $58.85 $17.27 $17.27 N/A $29.43 N/A N/A N/A N/A $32.81 N/A $17.27 $44.14 $19.00 $37.08 $43.02 N/A N/A $35.31 $47.08 $58.72 $98.44 N/A $17.27 $38.25 N/A $47.08 N/A N/A N/A $24.18 N/A $17.27 $17.27 $18.82 $47.08 $50.02 N/A $44.14 N/A N/A $29.43 $38.25 $24.26 $24.26 $24.26 $24.26 N/A $18.13 $17.27 $39.25 N/A N/A $12.95 $12.95 $12.95 $12.95 $98.44 330104 82010 402 301 HC ACETONE ASSAY O $131.61 $8.17 $8.17 N/A $65.81 N/A N/A N/A N/A $15.52 N/A $8.17 $98.71 $8.99 $82.91 $96.21 N/A N/A $78.97 $105.29 $27.78 $46.57 N/A $8.17 $85.55 N/A $105.29 N/A N/A N/A $11.44 N/A $8.17 $8.17 $8.91 $105.29 $111.87 N/A $98.71 N/A N/A $65.81 $85.55 $11.48 $11.48 $11.48 $11.48 $13.80 $8.58 $8.17 $13.80 N/A N/A $6.13 $6.13 $6.13 $6.13 $111.87 330104 82139 400 301 HC AMINO ACIDS QUAN 6 OR MORE O $227.91 $16.87 $16.87 $14.00 $113.95 N/A N/A N/A $14.00 $32.05 $14.00 $16.87 $170.93 $18.56 $143.58 $166.60 $16.80 $14.00 $136.75 $182.33 $57.36 $96.16 $14.00 $16.87 $148.14 $19.60 $182.33 $14.00 $14.00 $16.80 $23.62 $14.00 $16.87 $16.87 $18.39 $182.33 $193.72 $18.90 $170.93 $28.70 $18.90 $113.95 $148.14 $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $14.00 $14.00 $12.65 $12.65 $12.65 $12.65 $193.72 330104 82085 402 301 HC ASSAY OF ALDOLASE O $332.77 $9.71 $9.71 N/A $166.38 N/A N/A N/A N/A $18.45 N/A $9.71 $249.58 $10.68 $209.65 $243.25 N/A N/A $199.66 $266.22 $33.01 $55.35 N/A $9.71 $216.30 N/A $266.22 N/A N/A N/A $13.59 N/A $9.71 $9.71 $10.58 $266.22 $282.85 N/A $249.58 N/A N/A $166.38 $216.30 $13.64 $13.64 $13.64 $13.64 $16.39 $10.20 $9.71 $16.39 N/A N/A $7.28 $7.28 $7.28 $7.28 $282.85 330104 82140 400 301 HC ASSAY OF AMMONIA O $210.79 $14.57 $14.57 $14.57 $105.39 N/A N/A N/A $14.57 $27.68 $14.57 $14.57 $158.09 $16.03 $132.80 $154.09 $17.48 $14.57 $126.47 $168.63 $49.54 $83.05 $14.57 $14.57 $137.01 $20.40 $168.63 $14.57 $14.57 $17.48 $20.40 $14.57 $14.57 $14.57 $15.88 $168.63 $179.17 $19.67 $158.09 $29.87 $19.67 $105.39 $137.01 $20.47 $20.47 $20.47 $20.47 $24.61 $15.30 $14.57 $24.61 $14.57 $14.57 $10.93 $10.93 $10.93 $10.93 $179.17 330104 82135 400 301 HC ASSAY AMINOLEVULINIC ACID O $442.98 $16.45 $16.45 N/A $221.49 N/A N/A N/A N/A $31.25 N/A $16.45 $332.24 $18.10 $279.08 $323.82 N/A N/A $265.79 $354.38 $55.93 $93.77 N/A $16.45 $287.94 N/A $354.38 N/A N/A N/A $23.03 N/A $16.45 $16.45 $17.93 $354.38 $376.53 N/A $332.24 N/A N/A $221.49 $287.94 $23.11 $23.11 $23.11 $23.11 $27.79 $17.27 $16.45 $27.79 N/A N/A $12.34 $12.34 $12.34 $12.34 $376.53 330104 82131 400 301 HC AMINO ACIDS SINGLE QUANT O $507.18 $22.98 $22.98 $14.00 $253.59 N/A N/A N/A $14.00 $43.66 $14.00 $22.98 $380.38 $25.28 $319.52 $370.75 $16.80 $14.00 $304.31 $405.74 $78.13 $130.99 $14.00 $22.98 $329.67 $19.60 $405.74 $14.00 $14.00 $16.80 $32.17 $14.00 $22.98 $22.98 $25.05 $405.74 $431.10 $18.90 $380.38 $28.70 $18.90 $253.59 $329.67 $32.29 $32.29 $32.29 $32.29 $28.49 $24.13 $22.98 $28.49 $14.00 $14.00 $17.23 $17.23 $17.23 $14.00 $431.10 330104 82150 402 301 HC ASSAY OF AMYLASE O $182.97 $6.48 $6.48 $5.03 $91.48 N/A N/A N/A $5.03 $12.31 $5.03 $6.48 $137.23 $7.13 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $22.03 $36.94 $5.03 $6.48 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $9.07 $5.03 $6.48 $6.48 $7.06 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $9.10 $9.10 $9.10 $9.10 $10.94 $6.80 $6.48 $10.94 $5.03 $5.03 $4.86 $4.86 $4.86 $4.86 $155.52 330104 82157 398 301 HC ASSAY OF ANDROSTENEDIONE O $740.44 $29.28 $29.28 $29.28 $370.22 N/A N/A N/A $29.28 $55.63 $29.28 $29.28 $555.33 $32.21 $466.48 $541.26 $35.14 $29.28 $444.26 $592.35 $99.55 $166.90 $29.28 $29.28 $481.29 $40.99 $592.35 $29.28 $29.28 $35.14 $40.99 $29.28 $29.28 $29.28 $31.92 $592.35 $629.37 $39.53 $555.33 $60.02 $39.53 $370.22 $481.29 $41.14 $41.14 $41.14 $41.14 $49.44 $30.74 $29.28 $49.44 $29.28 $29.28 $21.96 $21.96 $21.96 $21.96 $629.37 330104 82103 400 301 HC ALPHA-1-ANTITRYPSIN; TOTAL O $449.40 $13.44 $13.44 $12.50 $224.70 N/A N/A N/A $12.50 $25.54 $12.50 $13.44 $337.05 $14.78 $283.12 $328.51 $15.00 $12.50 $269.64 $359.52 $45.70 $76.61 $12.50 $13.44 $292.11 $17.50 $359.52 $12.50 $12.50 $15.00 $18.82 $12.50 $13.44 $13.44 $14.65 $359.52 $381.99 $16.88 $337.05 $25.62 $16.88 $224.70 $292.11 $18.88 $18.88 $18.88 $18.88 $22.69 $14.11 $13.44 $22.69 $12.50 $12.50 $10.08 $10.08 $10.08 $10.08 $381.99 330104 82088 399 301 HC ASSAY OF ALDOSTERONE O "$1,121.36 " $40.75 $40.75 $40.75 $560.68 N/A N/A N/A $40.75 $77.42 $40.75 $40.75 $841.02 $44.83 $706.46 $819.71 $48.90 $40.75 $672.82 $897.09 $138.55 $232.28 $40.75 $40.75 $728.88 $57.05 $897.09 $40.75 $40.75 $48.90 $57.05 $40.75 $40.75 $40.75 $44.42 $897.09 $953.16 $55.01 $841.02 $83.54 $55.01 $560.68 $728.88 $57.25 $57.25 $57.25 $57.25 $68.82 $42.79 $40.75 $68.82 $40.75 $40.75 $30.56 $30.56 $30.56 $30.56 $953.16 330104 82104 400 301 HC ALPHA-1-ANTITRYPSIN; PHENOTYPE O $129.47 $14.46 $14.46 $13.72 $64.73 N/A N/A N/A $13.72 $27.47 $13.72 $14.46 $97.10 $15.91 $81.57 $94.64 $16.46 $13.72 $77.68 $103.58 $49.16 $82.42 $13.72 $14.46 $84.16 $19.21 $103.58 $13.72 $13.72 $16.46 $20.24 $13.72 $14.46 $14.46 $15.76 $103.58 $110.05 $18.52 $97.10 $28.13 $18.52 $64.73 $84.16 $20.32 $20.32 $20.32 $20.32 $24.42 $15.18 $14.46 $24.42 $13.72 $13.72 $10.85 $10.85 $10.85 $10.85 $110.05 330104 86256 394 302 HC FLUORESCENT ANTIBODY TITER O $432.28 $12.05 $12.05 N/A $216.14 N/A N/A N/A N/A $22.89 N/A $12.05 $324.21 $13.26 $272.34 $316.00 N/A N/A $259.37 $345.82 $40.97 $68.69 N/A $12.05 $280.98 N/A $345.82 N/A N/A N/A $16.87 N/A $12.05 $12.05 $13.13 $345.82 $367.44 N/A $324.21 N/A N/A $216.14 $280.98 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 N/A N/A $9.04 $9.04 $9.04 $9.04 $367.44 330104 86309 394 302 HC HETEROPHILE ANTIBODY TITER O $108.07 $6.47 $6.47 $6.47 $54.03 N/A N/A N/A $6.47 $12.29 $6.47 $6.47 $81.05 $7.12 $68.08 $79.00 $7.76 $6.47 $64.84 $86.46 $22.00 $36.88 $6.47 $6.47 $70.25 $9.06 $86.46 $6.47 $6.47 $7.76 $9.06 $6.47 $6.47 $6.47 $7.05 $86.46 $91.86 $8.73 $81.05 $13.26 $8.73 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $6.47 $6.47 $4.85 $4.85 $4.85 $4.85 $91.86 330104 86300 394 302 HC IMMUNOASSAY TUMOR CA 15-3 O "$1,006.87 " $20.81 $20.81 $20.81 $503.44 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $755.15 $22.89 $634.33 $736.02 $24.97 $20.81 $604.12 $805.50 $70.75 $118.62 $20.81 $20.81 $654.47 $29.13 $805.50 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $805.50 $855.84 $28.09 $755.15 $42.66 $28.09 $503.44 $654.47 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $855.84 330104 86301 394 302 HC IMMUNOASSAY TUMOR CA 19-9 O "$1,023.99 " $20.81 $20.81 $20.81 $512.00 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $767.99 $22.89 $645.11 $748.54 $24.97 $20.81 $614.39 $819.19 $70.75 $118.62 $20.81 $20.81 $665.59 $29.13 $819.19 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $819.19 $870.39 $28.09 $767.99 $42.66 $28.09 $512.00 $665.59 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $870.39 330104 86304 394 302 HC IMMUNOASSAY TUMOR CA 125 O $704.06 $20.81 $20.81 $20.81 $352.03 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $528.04 $22.89 $443.56 $514.67 $24.97 $20.81 $422.44 $563.25 $70.75 $118.62 $20.81 $20.81 $457.64 $29.13 $563.25 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $563.25 $598.45 $28.09 $528.04 $42.66 $28.09 $352.03 $457.64 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $598.45 330104 86308 394 302 HC HETEROPHILE ANTIBODY SCREEN O $112.35 $5.18 $5.18 $4.73 $56.17 N/A N/A N/A $4.73 $9.84 $4.73 $5.18 $84.26 $5.70 $70.78 $82.13 $5.68 $4.73 $67.41 $89.88 $17.61 $29.53 $4.73 $5.18 $73.03 $6.62 $89.88 $4.73 $4.73 $5.68 $7.25 $4.73 $5.18 $5.18 $5.65 $89.88 $95.50 $6.39 $84.26 $9.70 $6.39 $56.17 $73.03 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $4.73 $4.73 $3.88 $3.88 $3.88 $3.88 $95.50 330104 86340 394 302 HC INTRINSIC FACTOR ANTIBODY O $557.47 $15.08 $15.08 $11.36 $278.74 N/A N/A N/A $11.36 $28.65 $11.36 $15.08 $418.10 $16.59 $351.21 $407.51 $13.63 $11.36 $334.48 $445.98 $51.27 $85.96 $11.36 $15.08 $362.36 $15.90 $445.98 $11.36 $11.36 $13.63 $21.11 $11.36 $15.08 $15.08 $16.44 $445.98 $473.85 $15.34 $418.10 $23.29 $15.34 $278.74 $362.36 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $11.36 $11.36 $11.31 $11.31 $11.31 $11.31 $473.85 330104 86331 394 302 HC IMMUNODIFFUSION OUCHTERLONY O $190.46 $11.98 $11.98 N/A $95.23 N/A N/A N/A N/A $22.76 N/A $11.98 $142.84 $13.18 $119.99 $139.23 N/A N/A $114.28 $152.37 $40.73 $68.29 N/A $11.98 $123.80 N/A $152.37 N/A N/A N/A $16.77 N/A $11.98 $11.98 $13.06 $152.37 $161.89 N/A $142.84 N/A N/A $95.23 $123.80 $16.83 $16.83 $16.83 $16.83 $20.23 $12.58 $11.98 $20.23 N/A N/A $8.98 $8.98 $8.98 $8.98 $161.89 330104 86317 394 302 HC IMMUNOASSAY INFECTIOUS AGENT NOS O $205.44 $14.99 $14.99 N/A $102.72 N/A N/A N/A N/A $28.48 N/A $14.99 $154.08 $16.49 $129.43 $150.18 N/A N/A $123.26 $164.35 $50.97 $85.44 N/A $14.99 $133.54 N/A $164.35 N/A N/A N/A $20.99 N/A $14.99 $14.99 $16.34 $164.35 $174.62 N/A $154.08 N/A N/A $102.72 $133.54 $21.06 $21.06 $21.06 $21.06 $25.32 $15.74 $14.99 $25.32 N/A N/A $11.24 $11.24 $11.24 $11.24 $174.62 330104 86329 394 302 HC IMMUNODIFFUSION NES O $126.26 $14.05 $14.05 $12.50 $63.13 N/A N/A N/A $12.50 $26.70 $12.50 $14.05 $94.70 $15.46 $79.54 $92.30 $15.00 $12.50 $75.76 $101.01 $47.77 $80.09 $12.50 $14.05 $82.07 $17.50 $101.01 $12.50 $12.50 $15.00 $19.67 $12.50 $14.05 $14.05 $15.31 $101.01 $107.32 $16.88 $94.70 $25.62 $16.88 $63.13 $82.07 $19.74 $19.74 $19.74 $19.74 $23.72 $14.75 $14.05 $23.72 $12.50 $12.50 $10.54 $10.54 $10.54 $10.54 $107.32 330104 86332 394 302 HC IMMUNE COMPLEX ASSAY O $387.34 $24.37 $24.37 N/A $193.67 N/A N/A N/A N/A $46.30 N/A $24.37 $290.50 $26.81 $244.02 $283.15 N/A N/A $232.40 $309.87 $82.86 $138.91 N/A $24.37 $251.77 N/A $309.87 N/A N/A N/A $34.12 N/A $24.37 $24.37 $26.56 $309.87 $329.24 N/A $290.50 N/A N/A $193.67 $251.77 $34.24 $34.24 $34.24 $34.24 $41.16 $25.59 $24.37 $41.16 N/A N/A $18.28 $18.28 $18.28 $18.28 $329.24 330104 86334 394 302 HC IMMUNOFIX E-PHORESIS SERUM O $352.03 $22.34 $22.34 $22.34 $176.01 N/A N/A N/A $22.34 $42.45 $22.34 $22.34 $264.02 $24.57 $221.78 $257.33 $26.81 $22.34 $211.22 $281.62 $75.96 $127.34 $22.34 $22.34 $228.82 $31.28 $281.62 $22.34 $22.34 $26.81 $31.28 $22.34 $22.34 $22.34 $24.35 $281.62 $299.23 $30.16 $264.02 $45.80 $30.16 $176.01 $228.82 $31.39 $31.39 $31.39 $31.39 $37.73 $23.46 $22.34 $37.73 $22.34 $22.34 $16.75 $16.75 $16.75 $16.75 $299.23 330104 86255 394 302 HC FLUORESCENT ANTIBODY SCREEN O $466.52 $12.05 $12.05 $5.20 $233.26 N/A N/A N/A $5.20 $22.89 $5.20 $12.05 $349.89 $13.26 $293.91 $341.03 $6.24 $5.20 $279.91 $373.22 $40.97 $68.69 $5.20 $12.05 $303.24 $7.28 $373.22 $5.20 $5.20 $6.24 $16.87 $5.20 $12.05 $12.05 $13.13 $373.22 $396.54 $7.02 $349.89 $10.66 $7.02 $233.26 $303.24 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 $5.20 $5.20 $9.04 $9.04 $9.04 $5.20 $396.54 330104 86337 394 302 HC INSULIN ANTIBODIES O $169.06 $21.41 $21.41 $12.50 $84.53 N/A N/A N/A $12.50 $40.68 $12.50 $21.41 $126.80 $23.55 $106.51 $123.58 $15.00 $12.50 $101.44 $135.25 $72.79 $122.04 $12.50 $21.41 $109.89 $17.50 $135.25 $12.50 $12.50 $15.00 $29.97 $12.50 $21.41 $21.41 $23.34 $135.25 $143.70 $16.88 $126.80 $25.62 $16.88 $84.53 $109.89 $30.08 $30.08 $30.08 $30.08 $36.16 $22.48 $21.41 $36.16 $12.50 $12.50 $16.06 $16.06 $16.06 $12.50 $143.70 330104 86316 394 302 HC IMMUNOASSAY TUMOR OTHER O $330.63 $20.81 $20.81 N/A $165.31 N/A N/A N/A N/A $39.54 N/A $20.81 $247.97 $22.89 $208.30 $241.69 N/A N/A $198.38 $264.50 $70.75 $118.62 N/A $20.81 $214.91 N/A $264.50 N/A N/A N/A $29.13 N/A $20.81 $20.81 $22.68 $264.50 $281.04 N/A $247.97 N/A N/A $165.31 $214.91 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 N/A N/A $15.61 $15.61 $15.61 $15.61 $281.04 330104 86235 394 302 HC NUCLEAR ANTIGEN ANTIBODY O $568.17 $17.93 $17.93 $5.20 $284.08 N/A N/A N/A $5.20 $34.07 $5.20 $17.93 $426.13 $19.72 $357.95 $415.33 $6.24 $5.20 $340.90 $454.54 $60.96 $102.20 $5.20 $17.93 $369.31 $7.28 $454.54 $5.20 $5.20 $6.24 $25.10 $5.20 $17.93 $17.93 $19.54 $454.54 $482.94 $7.02 $426.13 $10.66 $7.02 $284.08 $369.31 $25.19 $25.19 $25.19 $25.19 $30.28 $18.83 $17.93 $30.28 $5.20 $5.20 $13.45 $13.45 $13.45 $5.20 $482.94 330104 86146 394 302 HC BETA-2 GLYCOPROTEIN ANTIBODY O $277.13 $25.45 $25.45 $7.82 $138.56 N/A N/A N/A $7.82 $48.35 $7.82 $25.45 $207.85 $28.00 $174.59 $202.58 $9.38 $7.82 $166.28 $221.70 $86.53 $145.06 $7.82 $25.45 $180.13 $10.95 $221.70 $7.82 $7.82 $9.38 $35.63 $7.82 $25.45 $25.45 $27.74 $221.70 $235.56 $10.56 $207.85 $16.03 $10.56 $138.56 $180.13 $35.76 $35.76 $35.76 $35.76 $42.96 $26.72 $25.45 $42.96 $7.82 $7.82 $19.09 $19.09 $19.09 $7.82 $235.56 330104 86225 394 302 HC DNA ANTIBODY NATIVE O $454.75 $13.74 $13.74 $5.20 $227.38 N/A N/A N/A $5.20 $26.11 $5.20 $13.74 $341.06 $15.11 $286.49 $332.42 $6.24 $5.20 $272.85 $363.80 $46.72 $78.32 $5.20 $13.74 $295.59 $7.28 $363.80 $5.20 $5.20 $6.24 $19.24 $5.20 $13.74 $13.74 $14.98 $363.80 $386.54 $7.02 $341.06 $10.66 $7.02 $227.38 $295.59 $19.30 $19.30 $19.30 $19.30 $23.20 $14.43 $13.74 $23.20 $5.20 $5.20 $10.30 $10.30 $10.30 $5.20 $386.54 330104 86021 394 302 HC WBC ANTIBODY IDENTIFICATION O $92.02 $15.05 $15.05 N/A $46.01 N/A N/A N/A N/A $28.59 N/A $15.05 $69.02 $16.56 $57.97 $67.27 N/A N/A $55.21 $73.62 $51.17 $85.79 N/A $15.05 $59.81 N/A $73.62 N/A N/A N/A $21.07 N/A $15.05 $15.05 $16.40 $73.62 $78.22 N/A $69.02 N/A N/A $46.01 $59.81 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 N/A N/A $11.29 $11.29 $11.29 $11.29 $85.79 330104 86003 394 302 HC ALLERGEN SPECIFIC IGE CRUDE XTRC EA O $84.53 $5.22 $5.22 $3.65 $42.27 N/A N/A N/A $3.65 $9.92 $3.65 $5.22 $63.40 $5.74 $53.25 $61.79 $4.38 $3.65 $50.72 $67.62 $17.75 $29.75 $3.65 $5.22 $54.94 $5.11 $67.62 $3.65 $3.65 $4.38 $7.31 $3.65 $5.22 $5.22 $5.69 $67.62 $71.85 $4.93 $63.40 $7.48 $4.93 $42.27 $54.94 $7.33 $7.33 $7.33 $7.33 $8.81 $5.48 $5.22 $8.81 $3.65 $3.65 $3.92 $3.92 $3.92 $3.65 $71.85 330104 86022 394 302 HC PLATELET ANTIBODIES O $572.45 $18.37 $18.37 N/A $286.23 N/A N/A N/A N/A $34.90 N/A $18.37 $429.34 $20.21 $360.64 $418.46 N/A N/A $343.47 $457.96 $62.46 $104.71 N/A $18.37 $372.09 N/A $457.96 N/A N/A N/A $25.72 N/A $18.37 $18.37 $20.02 $457.96 $486.58 N/A $429.34 N/A N/A $286.23 $372.09 $25.81 $25.81 $25.81 $25.81 $31.02 $19.29 $18.37 $31.02 N/A N/A $13.78 $13.78 $13.78 $13.78 $486.58 330104 86038 394 302 HC ANTINUCLEAR ANTIBODIES O $239.68 $12.09 $12.09 $5.20 $119.84 N/A N/A N/A $5.20 $22.97 $5.20 $12.09 $179.76 $13.30 $151.00 $175.21 $6.24 $5.20 $143.81 $191.74 $41.11 $68.91 $5.20 $12.09 $155.79 $7.28 $191.74 $5.20 $5.20 $6.24 $16.93 $5.20 $12.09 $12.09 $13.18 $191.74 $203.73 $7.02 $179.76 $10.66 $7.02 $119.84 $155.79 $16.99 $16.99 $16.99 $16.99 $20.41 $12.69 $12.09 $20.41 $5.20 $5.20 $9.07 $9.07 $9.07 $5.20 $203.73 330104 86039 394 302 HC ANTINUCLEAR ANTIBODIES (ANA) O $176.55 $11.16 $11.16 $5.20 $88.28 N/A N/A N/A $5.20 $21.20 $5.20 $11.16 $132.41 $12.28 $111.23 $129.06 $6.24 $5.20 $105.93 $141.24 $37.94 $63.61 $5.20 $11.16 $114.76 $7.28 $141.24 $5.20 $5.20 $6.24 $15.62 $5.20 $11.16 $11.16 $12.16 $141.24 $150.07 $7.02 $132.41 $10.66 $7.02 $88.28 $114.76 $15.68 $15.68 $15.68 $15.68 $18.85 $11.72 $11.16 $18.85 $5.20 $5.20 $8.37 $8.37 $8.37 $5.20 $150.07 330104 86060 394 302 HC ANTISTREPTOLYSIN O TITER O $117.70 $7.30 $7.30 $5.20 $58.85 N/A N/A N/A $5.20 $13.87 $5.20 $7.30 $88.28 $8.03 $74.15 $86.04 $6.24 $5.20 $70.62 $94.16 $24.82 $41.61 $5.20 $7.30 $76.51 $7.28 $94.16 $5.20 $5.20 $6.24 $10.22 $5.20 $7.30 $7.30 $7.96 $94.16 $100.05 $7.02 $88.28 $10.66 $7.02 $58.85 $76.51 $10.26 $10.26 $10.26 $10.26 $12.32 $7.67 $7.30 $12.32 $5.20 $5.20 $5.47 $5.47 $5.47 $5.20 $100.05 330104 86140 394 302 HC C-REACTIVE PROTEIN O $71.69 $5.18 $5.18 $4.10 $35.84 N/A N/A N/A $4.10 $9.84 $4.10 $5.18 $53.77 $5.70 $45.16 $52.41 $4.92 $4.10 $43.01 $57.35 $17.61 $29.53 $4.10 $5.18 $46.60 $5.74 $57.35 $4.10 $4.10 $4.92 $7.25 $4.10 $5.18 $5.18 $5.65 $57.35 $60.94 $5.54 $53.77 $8.40 $5.54 $35.84 $46.60 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $4.10 $4.10 $3.88 $3.88 $3.88 $3.88 $60.94 330104 86141 394 302 HC C-REACTIVE PROTEIN HS O $162.64 $12.95 $12.95 $10.25 $81.32 N/A N/A N/A $10.25 $24.60 $10.25 $12.95 $121.98 $14.25 $102.46 $118.89 $12.30 $10.25 $97.58 $130.11 $44.03 $73.81 $10.25 $12.95 $105.72 $14.35 $130.11 $10.25 $10.25 $12.30 $18.13 $10.25 $12.95 $12.95 $14.12 $130.11 $138.24 $13.84 $121.98 $21.01 $13.84 $81.32 $105.72 $18.19 $18.19 $18.19 $18.19 $21.86 $13.60 $12.95 $21.86 $10.25 $10.25 $9.71 $9.71 $9.71 $9.71 $138.24 330104 86147 394 302 HC CARDIOLIPIN ANTIBODY EA IG O $277.13 $25.45 $25.45 $7.82 $138.56 N/A N/A N/A $7.82 $48.35 $7.82 $25.45 $207.85 $28.00 $174.59 $202.58 $9.38 $7.82 $166.28 $221.70 $86.53 $145.06 $7.82 $25.45 $180.13 $10.95 $221.70 $7.82 $7.82 $9.38 $35.63 $7.82 $25.45 $25.45 $27.74 $221.70 $235.56 $10.56 $207.85 $16.03 $10.56 $138.56 $180.13 $35.76 $35.76 $35.76 $35.76 $42.96 $26.72 $25.45 $42.96 $7.82 $7.82 $19.09 $19.09 $19.09 $7.82 $235.56 330104 86148 394 302 HC ANTI-PHOSPHOLIPID ANTIBODY O $176.55 $16.07 $16.07 $7.82 $88.28 N/A N/A N/A $7.82 $30.53 $7.82 $16.07 $132.41 $17.68 $111.23 $129.06 $9.38 $7.82 $105.93 $141.24 $54.64 $91.60 $7.82 $16.07 $114.76 $10.95 $141.24 $7.82 $7.82 $9.38 $22.50 $7.82 $16.07 $16.07 $17.52 $141.24 $150.07 $10.56 $132.41 $16.03 $10.56 $88.28 $114.76 $22.58 $22.58 $22.58 $22.58 $27.13 $16.87 $16.07 $27.13 $7.82 $7.82 $12.05 $12.05 $12.05 $7.82 $150.07 330104 86157 394 302 HC COLD AGGLUTININ TITER O $306.02 $8.06 $8.06 $5.20 $153.01 N/A N/A N/A $5.20 $15.31 $5.20 $8.06 $229.51 $8.87 $192.79 $223.70 $6.24 $5.20 $183.61 $244.82 $27.40 $45.94 $5.20 $8.06 $198.91 $7.28 $244.82 $5.20 $5.20 $6.24 $11.28 $5.20 $8.06 $8.06 $8.79 $244.82 $260.12 $7.02 $229.51 $10.66 $7.02 $153.01 $198.91 $11.32 $11.32 $11.32 $11.32 $13.62 $8.46 $8.06 $13.62 $5.20 $5.20 $6.04 $6.04 $6.04 $5.20 $260.12 330104 86160 394 302 HC COMPLEMENT ANTIGEN O $671.96 $12.00 $12.00 $10.50 $335.98 N/A N/A N/A $10.50 $22.80 $10.50 $12.00 $503.97 $13.20 $423.33 $491.20 $12.60 $10.50 $403.18 $537.57 $40.80 $68.40 $10.50 $12.00 $436.77 $14.70 $537.57 $10.50 $10.50 $12.60 $16.80 $10.50 $12.00 $12.00 $13.08 $537.57 $571.17 $14.18 $503.97 $21.52 $14.18 $335.98 $436.77 $16.86 $16.86 $16.86 $16.86 $20.27 $12.60 $12.00 $20.27 $10.50 $10.50 $9.00 $9.00 $9.00 $9.00 $571.17 330104 86161 394 302 HC COMPLEMENT/FUNCTION ACTIVITY O $84.53 $12.00 $12.00 $12.00 $42.27 N/A N/A N/A $12.00 $22.80 $12.00 $12.00 $63.40 $13.20 $53.25 $61.79 $14.40 $12.00 $50.72 $67.62 $40.80 $68.40 $12.00 $12.00 $54.94 $16.80 $67.62 $12.00 $12.00 $14.40 $16.80 $12.00 $12.00 $12.00 $13.08 $67.62 $71.85 $16.20 $63.40 $24.60 $16.20 $42.27 $54.94 $16.86 $16.86 $16.86 $16.86 $20.27 $12.60 $12.00 $20.27 $12.00 $12.00 $9.00 $9.00 $9.00 $9.00 $71.85 330104 86162 394 302 HC COMPLEMENT TOTAL (CH50) O $645.21 $20.32 $20.32 $19.39 $322.61 N/A N/A N/A $19.39 $38.61 $19.39 $20.32 $483.91 $22.35 $406.48 $471.65 $23.27 $19.39 $387.13 $516.17 $69.09 $115.82 $19.39 $20.32 $419.39 $27.15 $516.17 $19.39 $19.39 $23.27 $28.45 $19.39 $20.32 $20.32 $22.15 $516.17 $548.43 $26.18 $483.91 $39.75 $26.18 $322.61 $419.39 $28.55 $28.55 $28.55 $28.55 $34.31 $21.34 $20.32 $34.31 $19.39 $19.39 $15.24 $15.24 $15.24 $15.24 $548.43 330104 86215 394 302 HC DEOXYRIBONUCLEASE ANTIBODY O $166.92 $13.25 $13.25 $5.20 $83.46 N/A N/A N/A $5.20 $25.17 $5.20 $13.25 $125.19 $14.58 $105.16 $122.02 $6.24 $5.20 $100.15 $133.54 $45.05 $75.53 $5.20 $13.25 $108.50 $7.28 $133.54 $5.20 $5.20 $6.24 $18.55 $5.20 $13.25 $13.25 $14.44 $133.54 $141.88 $7.02 $125.19 $10.66 $7.02 $83.46 $108.50 $18.62 $18.62 $18.62 $18.62 $22.38 $13.91 $13.25 $22.38 $5.20 $5.20 $9.94 $9.94 $9.94 $5.20 $141.88 330104 86226 394 302 HC DNA ANTIBODY SINGLE STRAND O $191.53 $12.11 $12.11 N/A $95.77 N/A N/A N/A N/A $23.01 N/A $12.11 $143.65 $13.32 $120.66 $140.01 N/A N/A $114.92 $153.22 $41.17 $69.03 N/A $12.11 $124.49 N/A $153.22 N/A N/A N/A $16.95 N/A $12.11 $12.11 $13.20 $153.22 $162.80 N/A $143.65 N/A N/A $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.45 $12.72 $12.11 $20.45 N/A N/A $9.08 $9.08 $9.08 $9.08 $162.80 330104 86356 395 302 HC MONONUCLEAR CELL ANTIGEN O $192.60 $26.78 $26.78 N/A $96.30 N/A N/A N/A N/A $50.88 N/A $26.78 $144.45 $29.46 $121.34 $140.79 N/A N/A $115.56 $154.08 $91.05 $152.65 N/A $26.78 $125.19 N/A $154.08 N/A N/A N/A $37.49 N/A $26.78 $26.78 $29.19 $154.08 $163.71 N/A $144.45 N/A N/A $96.30 $125.19 $37.63 $37.63 $37.63 $37.63 $45.20 $28.12 $26.78 $45.20 N/A N/A $20.09 $20.09 $20.09 $20.09 $163.71 330104 86665 394 302 HC EPSTEIN-BARR CAPSID VCA O $284.62 $18.14 $18.14 $18.14 $142.31 N/A N/A N/A $18.14 $34.47 $18.14 $18.14 $213.47 $19.95 $179.31 $208.06 $21.77 $18.14 $170.77 $227.70 $61.68 $103.40 $18.14 $18.14 $185.00 $25.40 $227.70 $18.14 $18.14 $21.77 $25.40 $18.14 $18.14 $18.14 $19.77 $227.70 $241.93 $24.49 $213.47 $37.19 $24.49 $142.31 $185.00 $25.49 $25.49 $25.49 $25.49 $30.64 $19.05 $18.14 $30.64 $18.14 $18.14 $13.61 $13.61 $13.61 $13.61 $241.93 330104 86382 394 302 HC NEUTRALIZATION TEST VIRAL O $80.25 $16.91 $16.91 $5.00 $40.12 N/A N/A N/A $5.00 $32.13 $5.00 $16.91 $60.19 $18.60 $50.56 $58.66 $6.00 $5.00 $48.15 $64.20 $57.49 $96.39 $5.00 $16.91 $52.16 $7.00 $64.20 $5.00 $5.00 $6.00 $23.67 $5.00 $16.91 $16.91 $18.43 $64.20 $68.21 $6.75 $60.19 $10.25 $6.75 $40.12 $52.16 $23.76 $23.76 $23.76 $23.76 $28.56 $17.76 $16.91 $28.56 $5.00 $5.00 $12.68 $12.68 $12.68 $5.00 $96.39 330104 86666 394 302 HC EHRLICHIA ANTIBODY O $368.08 $10.18 $10.18 $8.03 $184.04 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $276.06 $11.20 $231.89 $269.07 $9.64 $8.03 $220.85 $294.46 $34.61 $58.03 $8.03 $10.18 $239.25 $11.24 $294.46 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $294.46 $312.87 $10.84 $276.06 $16.46 $10.84 $184.04 $239.25 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $312.87 330104 86671 394 302 HC FUNGUS NES ANTIBODY O $82.39 $12.25 $12.25 N/A $41.20 N/A N/A N/A N/A $23.27 N/A $12.25 $61.79 $13.48 $51.91 $60.23 N/A N/A $49.43 $65.91 $41.65 $69.83 N/A $12.25 $53.55 N/A $65.91 N/A N/A N/A $17.15 N/A $12.25 $12.25 $13.35 $65.91 $70.03 N/A $61.79 N/A N/A $41.20 $53.55 $17.21 $17.21 $17.21 $17.21 $20.70 $12.86 $12.25 $20.70 N/A N/A $9.19 $9.19 $9.19 $9.19 $70.03 330104 86677 394 302 HC HELICOBACTER PYLORI ANTIBODY O $186.18 $16.85 $16.85 $8.03 $93.09 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $139.63 $18.54 $117.29 $136.10 $9.64 $8.03 $111.71 $148.94 $57.29 $96.05 $8.03 $16.85 $121.02 $11.24 $148.94 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $148.94 $158.25 $10.84 $139.63 $16.46 $10.84 $93.09 $121.02 $23.67 $23.67 $23.67 $23.67 $24.50 $17.69 $16.85 $24.50 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $158.25 330104 86692 394 302 HC HEPATITIS DELTA AGENT ANTBDY O $191.53 $17.16 $17.16 $17.16 $95.77 N/A N/A N/A $17.16 $32.60 $17.16 $17.16 $143.65 $18.88 $120.66 $140.01 $20.59 $17.16 $114.92 $153.22 $58.34 $97.81 $17.16 $17.16 $124.49 $24.02 $153.22 $17.16 $17.16 $20.59 $24.02 $17.16 $17.16 $17.16 $18.70 $153.22 $162.80 $23.17 $143.65 $35.18 $23.17 $95.77 $124.49 $24.11 $24.11 $24.11 $24.11 $28.98 $18.02 $17.16 $28.98 $17.16 $17.16 $12.87 $12.87 $12.87 $12.87 $162.80 330104 86694 394 302 HC HERPES SIMPLEX NES ANTBDY O $453.68 $14.39 $14.39 N/A $226.84 N/A N/A N/A N/A $27.34 N/A $14.39 $340.26 $15.83 $285.82 $331.64 N/A N/A $272.21 $362.94 $48.93 $82.02 N/A $14.39 $294.89 N/A $362.94 N/A N/A N/A $20.15 N/A $14.39 $14.39 $15.69 $362.94 $385.63 N/A $340.26 N/A N/A $226.84 $294.89 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 N/A N/A $10.79 $10.79 $10.79 $10.79 $385.63 330104 86695 394 302 HC HERPES SIMPLEX TYPE 1 TEST O $419.44 $13.19 $13.19 N/A $209.72 N/A N/A N/A N/A $25.06 N/A $13.19 $314.58 $14.51 $264.25 $306.61 N/A N/A $251.66 $335.55 $44.85 $75.18 N/A $13.19 $272.64 N/A $335.55 N/A N/A N/A $18.47 N/A $13.19 $13.19 $14.38 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 N/A N/A $9.89 $9.89 $9.89 $9.89 $356.52 330104 86704 394 302 HC HEP B CORE ANTIBODY TOTAL O $340.26 $12.05 $12.05 $10.10 $170.13 N/A N/A N/A $10.10 $22.89 $10.10 $12.05 $255.19 $13.26 $214.36 $248.73 $12.12 $10.10 $204.16 $272.21 $40.97 $68.69 $10.10 $12.05 $221.17 $14.14 $272.21 $10.10 $10.10 $12.12 $16.87 $10.10 $12.05 $12.05 $13.13 $272.21 $289.22 $13.63 $255.19 $20.70 $13.63 $170.13 $221.17 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 $10.10 $10.10 $9.04 $9.04 $9.04 $9.04 $289.22 330104 86705 394 302 HC HEP B CORE ANTIBODY IGM O $186.18 $11.77 $11.77 $10.10 $93.09 N/A N/A N/A $10.10 $22.36 $10.10 $11.77 $139.63 $12.95 $117.29 $136.10 $12.12 $10.10 $111.71 $148.94 $40.02 $67.09 $10.10 $11.77 $121.02 $14.14 $148.94 $10.10 $10.10 $12.12 $16.48 $10.10 $11.77 $11.77 $12.83 $148.94 $158.25 $13.63 $139.63 $20.70 $13.63 $93.09 $121.02 $16.54 $16.54 $16.54 $16.54 $19.87 $12.36 $11.77 $19.87 $10.10 $10.10 $8.83 $8.83 $8.83 $8.83 $158.25 330104 86706 394 302 HC HEP B SURFACE ANTIBODY O $363.80 $10.74 $10.74 $10.10 $181.90 N/A N/A N/A $10.10 $20.41 $10.10 $10.74 $272.85 $11.81 $229.19 $265.94 $12.12 $10.10 $218.28 $291.04 $36.52 $61.22 $10.10 $10.74 $236.47 $14.14 $291.04 $10.10 $10.10 $12.12 $15.04 $10.10 $10.74 $10.74 $11.71 $291.04 $309.23 $13.63 $272.85 $20.70 $13.63 $181.90 $236.47 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $10.10 $10.10 $8.05 $8.05 $8.05 $8.05 $309.23 330104 86707 394 302 HC HEPATITIS BE ANTIBODY O $548.91 $11.57 $11.57 $10.10 $274.45 N/A N/A N/A $10.10 $21.98 $10.10 $11.57 $411.68 $12.73 $345.81 $401.25 $12.12 $10.10 $329.35 $439.13 $39.34 $65.95 $10.10 $11.57 $356.79 $14.14 $439.13 $10.10 $10.10 $12.12 $16.20 $10.10 $11.57 $11.57 $12.61 $439.13 $466.57 $13.63 $411.68 $20.70 $13.63 $274.45 $356.79 $16.26 $16.26 $16.26 $16.26 $19.54 $12.15 $11.57 $19.54 $10.10 $10.10 $8.68 $8.68 $8.68 $8.68 $466.57 330104 86708 394 302 HC HEPATITIS A TOTAL ANTIBODY O $330.63 $12.39 $12.39 $10.00 $165.31 N/A N/A N/A $10.00 $23.54 $10.00 $12.39 $247.97 $13.63 $208.30 $241.69 $12.00 $10.00 $198.38 $264.50 $42.13 $70.62 $10.00 $12.39 $214.91 $14.00 $264.50 $10.00 $10.00 $12.00 $17.35 $10.00 $12.39 $12.39 $13.51 $264.50 $281.04 $13.50 $247.97 $20.50 $13.50 $165.31 $214.91 $17.41 $17.41 $17.41 $17.41 $20.92 $13.01 $12.39 $20.92 $10.00 $10.00 $9.29 $9.29 $9.29 $9.29 $281.04 330104 86709 394 302 HC HEPATITIS A IGM ANTIBODY O $210.79 $11.26 $11.26 $10.00 $105.39 N/A N/A N/A $10.00 $21.39 $10.00 $11.26 $158.09 $12.39 $132.80 $154.09 $12.00 $10.00 $126.47 $168.63 $38.28 $64.18 $10.00 $11.26 $137.01 $14.00 $168.63 $10.00 $10.00 $12.00 $15.76 $10.00 $11.26 $11.26 $12.27 $168.63 $179.17 $13.50 $158.09 $20.50 $13.50 $105.39 $137.01 $15.82 $15.82 $15.82 $15.82 $19.01 $11.82 $11.26 $19.01 $10.00 $10.00 $8.45 $8.45 $8.45 $8.45 $179.17 330104 86710 394 302 HC INFLUENZA VIRUS O $430.14 $13.55 $13.55 $13.55 $215.07 N/A N/A N/A $13.55 $25.75 $13.55 $13.55 $322.61 $14.91 $270.99 $314.43 $16.26 $13.55 $258.08 $344.11 $46.07 $77.23 $13.55 $13.55 $279.59 $18.97 $344.11 $13.55 $13.55 $16.26 $18.97 $13.55 $13.55 $13.55 $14.77 $344.11 $365.62 $18.29 $322.61 $27.78 $18.29 $215.07 $279.59 $19.04 $19.04 $19.04 $19.04 $22.90 $14.23 $13.55 $22.90 $13.55 $13.55 $10.16 $10.16 $10.16 $10.16 $365.62 330104 86689 394 302 HC HTLV/HIV CONFIRMJ ANTIBODY O $69.55 $19.35 $19.35 $19.35 $34.77 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $52.16 $21.29 $43.82 $50.84 $23.22 $19.35 $41.73 $55.64 $65.79 $110.30 $19.35 $19.35 $45.21 $27.09 $55.64 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $55.64 $59.12 $26.12 $52.16 $39.67 $26.12 $34.77 $45.21 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $110.30 330104 86711 394 302 HC JOHN CUNNINGHAM ANTIBODY O $606.69 $16.89 $16.89 N/A $303.35 N/A N/A N/A N/A $32.09 N/A $16.89 $455.02 $18.58 $382.21 $443.49 N/A N/A $364.01 $485.35 $57.43 $96.27 N/A $16.89 $394.35 N/A $485.35 N/A N/A N/A $23.65 N/A $16.89 $16.89 $18.41 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 $23.73 $23.73 $23.73 $23.73 $23.75 $17.73 $16.89 $23.75 N/A N/A $12.67 $12.67 $12.67 $12.67 $515.69 330104 86664 394 302 HC EPSTEIN-BARR NUCLEAR ANTIGEN O $241.82 $15.29 $15.29 $15.29 $120.91 N/A N/A N/A $15.29 $29.05 $15.29 $15.29 $181.37 $16.82 $152.35 $176.77 $18.35 $15.29 $145.09 $193.46 $51.99 $87.15 $15.29 $15.29 $157.18 $21.41 $193.46 $15.29 $15.29 $18.35 $21.41 $15.29 $15.29 $15.29 $16.67 $193.46 $205.55 $20.64 $181.37 $31.34 $20.64 $120.91 $157.18 $21.48 $21.48 $21.48 $21.48 $25.84 $16.05 $15.29 $25.84 $15.29 $15.29 $11.47 $11.47 $11.47 $11.47 $205.55 330104 86376 394 302 HC MICROSOMAL ANTIBODY EACH O $619.53 $14.55 $14.55 $14.55 $309.76 N/A N/A N/A $14.55 $27.64 $14.55 $14.55 $464.65 $16.01 $390.30 $452.88 $17.46 $14.55 $371.72 $495.62 $49.47 $82.94 $14.55 $14.55 $402.69 $20.37 $495.62 $14.55 $14.55 $17.46 $20.37 $14.55 $14.55 $14.55 $15.86 $495.62 $526.60 $19.64 $464.65 $29.83 $19.64 $309.76 $402.69 $20.44 $20.44 $20.44 $20.44 $24.58 $15.28 $14.55 $24.58 $14.55 $14.55 $10.91 $10.91 $10.91 $10.91 $526.60 330104 86663 394 302 HC EPSTEIN-BARR ANTIBODY O $207.58 $13.12 $13.12 $13.12 $103.79 N/A N/A N/A $13.12 $24.93 $13.12 $13.12 $155.69 $14.43 $130.78 $151.74 $15.74 $13.12 $124.55 $166.06 $44.61 $74.78 $13.12 $13.12 $134.93 $18.37 $166.06 $13.12 $13.12 $15.74 $18.37 $13.12 $13.12 $13.12 $14.30 $166.06 $176.44 $17.71 $155.69 $26.90 $17.71 $103.79 $134.93 $18.43 $18.43 $18.43 $18.43 $22.15 $13.78 $13.12 $22.15 $13.12 $13.12 $9.84 $9.84 $9.84 $9.84 $176.44 330104 86653 394 302 HC ENCEPHAL ANTIBODY ST LOUIS O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86406 394 302 HC PARTICLE AGGLUT ANTBDY TITR O $182.97 $10.64 $10.64 N/A $91.48 N/A N/A N/A N/A $20.22 N/A $10.64 $137.23 $11.70 $115.27 $133.75 N/A N/A $109.78 $146.38 $36.18 $60.65 N/A $10.64 $118.93 N/A $146.38 N/A N/A N/A $14.90 N/A $10.64 $10.64 $11.60 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $14.95 $14.95 $14.95 $14.95 $17.96 $11.17 $10.64 $17.96 N/A N/A $7.98 $7.98 $7.98 $7.98 $155.52 330104 86431 394 302 HC RHEUMATOID FACTOR QUANT O $88.81 $5.67 $5.67 $5.20 $44.41 N/A N/A N/A $5.20 $10.77 $5.20 $5.67 $66.61 $6.24 $55.95 $64.92 $6.24 $5.20 $53.29 $71.05 $19.28 $32.32 $5.20 $5.67 $57.73 $7.28 $71.05 $5.20 $5.20 $6.24 $7.94 $5.20 $5.67 $5.67 $6.18 $71.05 $75.49 $7.02 $66.61 $10.66 $7.02 $44.41 $57.73 $7.97 $7.97 $7.97 $7.97 $9.58 $5.95 $5.67 $9.58 $5.20 $5.20 $4.25 $4.25 $4.25 $4.25 $75.49 330104 86603 394 302 HC ADENOVIRUS ANTIBODY O $449.40 $12.87 $12.87 $8.03 $224.70 N/A N/A N/A $8.03 $24.45 $8.03 $12.87 $337.05 $14.16 $283.12 $328.51 $9.64 $8.03 $269.64 $359.52 $43.76 $73.36 $8.03 $12.87 $292.11 $11.24 $359.52 $8.03 $8.03 $9.64 $18.02 $8.03 $12.87 $12.87 $14.03 $359.52 $381.99 $10.84 $337.05 $16.46 $10.84 $224.70 $292.11 $18.08 $18.08 $18.08 $18.08 $21.73 $13.51 $12.87 $21.73 $8.03 $8.03 $9.65 $9.65 $9.65 $8.03 $381.99 330104 86606 394 302 HC ASPERGILLUS ANTIBODY O $277.13 $15.05 $15.05 $8.03 $138.56 N/A N/A N/A $8.03 $28.59 $8.03 $15.05 $207.85 $16.56 $174.59 $202.58 $9.64 $8.03 $166.28 $221.70 $51.17 $85.79 $8.03 $15.05 $180.13 $11.24 $221.70 $8.03 $8.03 $9.64 $21.07 $8.03 $15.05 $15.05 $16.40 $221.70 $235.56 $10.84 $207.85 $16.46 $10.84 $138.56 $180.13 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 $8.03 $8.03 $11.29 $11.29 $11.29 $8.03 $235.56 330104 86609 394 302 HC BACTERIUM ANTIBODY O $186.18 $12.88 $12.88 N/A $93.09 N/A N/A N/A N/A $24.47 N/A $12.88 $139.63 $14.17 $117.29 $136.10 N/A N/A $111.71 $148.94 $43.79 $73.42 N/A $12.88 $121.02 N/A $148.94 N/A N/A N/A $18.03 N/A $12.88 $12.88 $14.04 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 N/A N/A $9.66 $9.66 $9.66 $9.66 $158.25 330104 86611 394 302 HC BARTONELLA ANTIBODY O $368.08 $10.18 $10.18 $8.03 $184.04 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $276.06 $11.20 $231.89 $269.07 $9.64 $8.03 $220.85 $294.46 $34.61 $58.03 $8.03 $10.18 $239.25 $11.24 $294.46 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $294.46 $312.87 $10.84 $276.06 $16.46 $10.84 $184.04 $239.25 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $312.87 330104 86617 394 302 HC LYME DISEASE ANTIBODY; CONFIRMATORY TEST O $490.06 $15.49 $15.49 $15.49 $245.03 N/A N/A N/A $15.49 $29.43 $15.49 $15.49 $367.55 $17.04 $308.74 $358.23 $18.59 $15.49 $294.04 $392.05 $52.67 $88.29 $15.49 $15.49 $318.54 $21.69 $392.05 $15.49 $15.49 $18.59 $21.69 $15.49 $15.49 $15.49 $16.88 $392.05 $416.55 $20.91 $367.55 $31.75 $20.91 $245.03 $318.54 $21.76 $21.76 $21.76 $21.76 $26.16 $16.26 $15.49 $26.16 $15.49 $15.49 $11.62 $11.62 $11.62 $11.62 $416.55 330104 86618 394 302 HC LYME DISEASE ANTIBODY O $570.31 $17.03 $17.03 $17.03 $285.15 N/A N/A N/A $17.03 $32.36 $17.03 $17.03 $427.73 $18.73 $359.30 $416.90 $20.44 $17.03 $342.19 $456.25 $57.90 $97.07 $17.03 $17.03 $370.70 $23.84 $456.25 $17.03 $17.03 $20.44 $23.84 $17.03 $17.03 $17.03 $18.56 $456.25 $484.76 $22.99 $427.73 $34.91 $22.99 $285.15 $370.70 $23.93 $23.93 $23.93 $23.93 $28.76 $17.88 $17.03 $28.76 $17.03 $17.03 $12.77 $12.77 $12.77 $12.77 $484.76 330104 86635 394 302 HC COCCIDIOIDES ANTIBODY O $238.61 $11.47 $11.47 $8.03 $119.31 N/A N/A N/A $8.03 $21.79 $8.03 $11.47 $178.96 $12.62 $150.32 $174.42 $9.64 $8.03 $143.17 $190.89 $39.00 $65.38 $8.03 $11.47 $155.10 $11.24 $190.89 $8.03 $8.03 $9.64 $16.06 $8.03 $11.47 $11.47 $12.50 $190.89 $202.82 $10.84 $178.96 $16.46 $10.84 $119.31 $155.10 $16.12 $16.12 $16.12 $16.12 $19.38 $12.04 $11.47 $19.38 $8.03 $8.03 $8.60 $8.60 $8.60 $8.03 $202.82 330104 86638 394 302 HC Q FEVER ANTIBODY O $527.51 $12.12 $12.12 $8.03 $263.75 N/A N/A N/A $8.03 $23.03 $8.03 $12.12 $395.63 $13.33 $332.33 $385.61 $9.64 $8.03 $316.51 $422.01 $41.21 $69.08 $8.03 $12.12 $342.88 $11.24 $422.01 $8.03 $8.03 $9.64 $16.97 $8.03 $12.12 $12.12 $13.21 $422.01 $448.38 $10.84 $395.63 $16.46 $10.84 $263.75 $342.88 $17.03 $17.03 $17.03 $17.03 $20.47 $12.73 $12.12 $20.47 $8.03 $8.03 $9.09 $9.09 $9.09 $8.03 $448.38 330104 86644 394 302 HC CMV ANTIBODY O $332.77 $14.39 $14.39 $14.39 $166.38 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $249.58 $15.83 $209.65 $243.25 $17.27 $14.39 $199.66 $266.22 $48.93 $82.02 $14.39 $14.39 $216.30 $20.15 $266.22 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $266.22 $282.85 $19.43 $249.58 $29.50 $19.43 $166.38 $216.30 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $282.85 330104 86645 394 302 HC CMV ANTIBODY IGM O $332.77 $16.85 $16.85 $8.03 $166.38 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $249.58 $18.54 $209.65 $243.25 $9.64 $8.03 $199.66 $266.22 $57.29 $96.05 $8.03 $16.85 $216.30 $11.24 $266.22 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $266.22 $282.85 $10.84 $249.58 $16.46 $10.84 $166.38 $216.30 $23.67 $23.67 $23.67 $23.67 $28.44 $17.69 $16.85 $28.44 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $282.85 330104 86648 394 302 HC DIPHTHERIA ANTIBODY O $53.50 $15.21 $15.21 N/A $26.75 N/A N/A N/A N/A $28.90 N/A $15.21 $40.12 $16.73 $33.70 $39.11 N/A N/A $32.10 $42.80 $51.71 $86.70 N/A $15.21 $34.77 N/A $42.80 N/A N/A N/A $21.29 N/A $15.21 $15.21 $16.58 $42.80 $45.48 N/A $40.12 N/A N/A $26.75 $34.77 $21.37 $21.37 $21.37 $21.37 $25.69 $15.97 $15.21 $25.69 N/A N/A $11.41 $11.41 $11.41 $11.41 $86.70 330104 86651 394 302 HC ENCEPHAL ANTIBODY CALIF O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86652 394 302 HC ENCEPHAL ANTIBODY EAST EQU O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86654 394 302 HC ENCEPHAL ANTIBODY WEST EQU O $466.52 $13.19 $13.19 $8.03 $233.26 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $349.89 $14.51 $293.91 $341.03 $9.64 $8.03 $279.91 $373.22 $44.85 $75.18 $8.03 $13.19 $303.24 $11.24 $373.22 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $373.22 $396.54 $10.84 $349.89 $16.46 $10.84 $233.26 $303.24 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $396.54 330104 86735 394 302 HC MUMPS ANTIBODY O $522.16 $13.05 $13.05 $8.03 $261.08 N/A N/A N/A $8.03 $24.80 $8.03 $13.05 $391.62 $14.36 $328.96 $381.70 $9.64 $8.03 $313.30 $417.73 $44.37 $74.39 $8.03 $13.05 $339.40 $11.24 $417.73 $8.03 $8.03 $9.64 $18.27 $8.03 $13.05 $13.05 $14.22 $417.73 $443.84 $10.84 $391.62 $16.46 $10.84 $261.08 $339.40 $18.34 $18.34 $18.34 $18.34 $22.04 $13.70 $13.05 $22.04 $8.03 $8.03 $9.79 $9.79 $9.79 $8.03 $443.84 330104 86727 394 302 HC LYMPH CHORIOMENINGITIS O $72.76 $12.87 $12.87 $8.03 $36.38 N/A N/A N/A $8.03 $24.45 $8.03 $12.87 $54.57 $14.16 $45.84 $53.19 $9.64 $8.03 $43.66 $58.21 $43.76 $73.36 $8.03 $12.87 $47.29 $11.24 $58.21 $8.03 $8.03 $9.64 $18.02 $8.03 $12.87 $12.87 $14.03 $58.21 $61.85 $10.84 $54.57 $16.46 $10.84 $36.38 $47.29 $18.08 $18.08 $18.08 $18.08 $21.73 $13.51 $12.87 $21.73 $8.03 $8.03 $9.65 $9.65 $9.65 $8.03 $73.36 330104 86747 394 302 HC PARVOVIRUS ANTIBODY O $475.08 $15.03 $15.03 $15.03 $237.54 N/A N/A N/A $15.03 $28.56 $15.03 $15.03 $356.31 $16.53 $299.30 $347.28 $18.04 $15.03 $285.05 $380.06 $51.10 $85.67 $15.03 $15.03 $308.80 $21.04 $380.06 $15.03 $15.03 $18.04 $21.04 $15.03 $15.03 $15.03 $16.38 $380.06 $403.82 $20.29 $356.31 $30.81 $20.29 $237.54 $308.80 $21.12 $21.12 $21.12 $21.12 $25.39 $15.78 $15.03 $25.39 $15.03 $15.03 $11.27 $11.27 $11.27 $11.27 $403.82 330104 86713 394 302 HC LEGIONELLA ANTIBODY O $722.25 $15.30 $15.30 $15.30 $361.12 N/A N/A N/A $15.30 $29.07 $15.30 $15.30 $541.69 $16.83 $455.02 $527.96 $18.36 $15.30 $433.35 $577.80 $52.02 $87.21 $15.30 $15.30 $469.46 $21.42 $577.80 $15.30 $15.30 $18.36 $21.42 $15.30 $15.30 $15.30 $16.68 $577.80 $613.91 $20.66 $541.69 $31.36 $20.66 $361.12 $469.46 $21.50 $21.50 $21.50 $21.50 $25.84 $16.07 $15.30 $25.84 $15.30 $15.30 $11.48 $11.48 $11.48 $11.48 $613.91 330104 87389 396 302 HC HIV-1 AG W/HIV-1 & HIV-2 AB O $250.38 $24.08 $24.08 $18.49 $125.19 N/A N/A N/A $18.49 $45.75 $18.49 $24.08 $187.78 $26.49 $157.74 $183.03 $22.19 $18.49 $150.23 $200.30 $81.87 $137.26 $18.49 $24.08 $162.75 $25.89 $200.30 $18.49 $18.49 $22.19 $33.71 $18.49 $24.08 $24.08 $26.25 $200.30 $212.82 $24.96 $187.78 $37.90 $24.96 $125.19 $162.75 $33.83 $33.83 $33.83 $33.83 $40.94 $25.28 $24.08 $40.94 $18.49 $18.49 $18.06 $18.06 $18.06 $18.06 $212.82 330104 86985 5672 499 302 HC SPLIT BLOOD OR PRODUCTS O $728.67 $188.66 $188.66 $46.95 $364.33 N/A N/A $186.77 $46.95 $358.45 $46.95 $188.66 $546.50 $207.53 $459.06 $532.66 $56.35 $46.95 $437.20 $582.94 $641.44 "$1,075.36 " $46.95 $188.66 $226.39 $65.74 $582.94 $46.95 $46.95 $56.35 $264.12 $46.95 $188.66 $188.66 $205.64 $582.94 $619.37 $46.95 $546.50 $96.26 $46.95 $364.33 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 $46.95 $46.95 $141.49 $141.49 $141.49 $17.92 "$1,075.36 " 330104 86941 486 302 HC HEMOLYSINS/AGGLUTININS O $191.53 $12.11 $12.11 $10.27 $95.77 N/A N/A N/A $10.27 $23.01 $10.27 $12.11 $143.65 $13.32 $120.66 $140.01 $12.32 $10.27 $114.92 $153.22 $41.17 $69.03 $10.27 $12.11 $124.49 $14.38 $153.22 $10.27 $10.27 $12.32 $16.95 $10.27 $12.11 $12.11 $13.20 $153.22 $162.80 $13.86 $143.65 $21.05 $13.86 $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.45 $12.72 $12.11 $20.45 $10.27 $10.27 $9.08 $9.08 $9.08 $9.08 $162.80 330104 86922 5672 2043 302 HC COMPATIBILITY TEST ANTIGLOB O "$1,332.15 " $188.66 $188.66 N/A $666.08 N/A N/A $186.77 N/A $358.45 N/A $188.66 $999.11 $207.53 $839.25 $973.80 N/A N/A $799.29 "$1,065.72 " $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A "$1,065.72 " N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 "$1,065.72 " "$1,132.33 " N/A $999.11 N/A N/A $666.08 $507.49 $265.07 $265.07 $265.07 $265.07 $30.10 $198.09 $188.66 $30.10 N/A N/A $141.49 $141.49 $141.49 $30.10 "$1,132.33 " 330104 86920 5672 2043 302 HC COMPATIBILITY TEST SPIN O "$1,332.15 " $188.66 $188.66 N/A $666.08 N/A N/A $186.77 N/A $358.45 N/A $188.66 $999.11 $207.53 $839.25 $973.80 N/A N/A $799.29 "$1,065.72 " $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A "$1,065.72 " N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 "$1,065.72 " "$1,132.33 " N/A $999.11 N/A N/A $666.08 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 N/A N/A $141.49 $141.49 $141.49 $17.92 "$1,132.33 " 330104 86902 5673 486 302 HC BLOOD TYPE ANTIGEN DONOR EA O "$1,308.61 " $388.85 $388.85 $47.59 $654.30 N/A N/A $384.96 $47.59 $738.81 $47.59 $388.85 $981.46 $427.73 $824.42 $956.59 $57.11 $47.59 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $47.59 $388.85 $466.62 $66.63 "$1,046.89 " $47.59 $47.59 $57.11 $544.39 $47.59 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $47.59 $981.46 $97.56 $47.59 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $6.46 $408.29 $388.85 $6.46 $47.59 $47.59 $291.64 $291.64 $291.64 $6.46 "$2,216.43 " 330104 86812 486 302 HC HLA TYPING A B OR C; SINGLE ANTIGEN O $584.22 $25.81 $25.81 $47.59 $292.11 N/A N/A N/A $47.59 $49.04 $47.59 $25.81 $438.17 $28.39 $368.06 $427.06 $57.11 $47.59 $350.53 $467.38 $87.75 $147.12 $47.59 $25.81 $379.74 $66.63 $467.38 $47.59 $47.59 $57.11 $36.13 $47.59 $25.81 $25.81 $28.13 $467.38 $496.59 $64.25 $438.17 $97.56 $64.25 $292.11 $379.74 $36.26 $36.26 $36.26 $36.26 $43.58 $27.10 $25.81 $43.58 $47.59 $47.59 $19.36 $19.36 $19.36 $19.36 $496.59 330104 86804 394 302 HC HEP C AB TEST CONFIRM O $226.84 $15.49 $15.49 $15.49 $113.42 N/A N/A N/A $15.49 $29.43 $15.49 $15.49 $170.13 $17.04 $142.91 $165.82 $18.59 $15.49 $136.10 $181.47 $52.67 $88.29 $15.49 $15.49 $147.45 $21.69 $181.47 $15.49 $15.49 $18.59 $21.69 $15.49 $15.49 $15.49 $16.88 $181.47 $192.81 $20.91 $170.13 $31.75 $20.91 $113.42 $147.45 $21.76 $21.76 $21.76 $21.76 $26.16 $16.26 $15.49 $26.16 $15.49 $15.49 $11.62 $11.62 $11.62 $11.62 $192.81 330104 86803 394 302 HC HEPATITIS C AB TEST O $276.06 $14.27 $14.27 $10.00 $138.03 N/A N/A N/A $10.00 $27.11 $10.00 $14.27 $207.05 $15.70 $173.92 $201.80 $12.00 $10.00 $165.64 $220.85 $48.52 $81.34 $10.00 $14.27 $179.44 $14.00 $220.85 $10.00 $10.00 $12.00 $19.98 $10.00 $14.27 $14.27 $15.55 $220.85 $234.65 $13.50 $207.05 $20.50 $13.50 $138.03 $179.44 $20.05 $20.05 $20.05 $20.05 $24.10 $14.98 $14.27 $24.10 $10.00 $10.00 $10.70 $10.70 $10.70 $10.00 $234.65 330104 86800 394 302 HC THYROGLOBULIN ANTIBODY O $512.53 $15.91 $15.91 $13.35 $256.26 N/A N/A N/A $13.35 $30.23 $13.35 $15.91 $384.40 $17.50 $322.89 $374.66 $16.02 $13.35 $307.52 $410.02 $54.09 $90.69 $13.35 $15.91 $333.14 $18.69 $410.02 $13.35 $13.35 $16.02 $22.27 $13.35 $15.91 $15.91 $17.34 $410.02 $435.65 $18.02 $384.40 $27.37 $18.02 $256.26 $333.14 $22.35 $22.35 $22.35 $22.35 $26.86 $16.71 $15.91 $26.86 $13.35 $13.35 $11.93 $11.93 $11.93 $11.93 $435.65 330104 86885 5672 486 302 HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL O $662.33 $188.66 $188.66 $47.59 $331.17 N/A N/A $186.77 $47.59 $358.45 $47.59 $188.66 $496.75 $207.53 $417.27 $484.16 $57.11 $47.59 $397.40 $529.86 $641.44 "$1,075.36 " $47.59 $188.66 $226.39 $66.63 $529.86 $47.59 $47.59 $57.11 $264.12 $47.59 $188.66 $188.66 $205.64 $529.86 $562.98 $47.59 $496.75 $97.56 $47.59 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $9.67 $198.09 $188.66 $9.67 $47.59 $47.59 $141.49 $141.49 $141.49 $9.67 "$1,075.36 " 330104 86789 394 302 HC WEST NILE VIRUS ANTIBODY O $166.92 $14.39 $14.39 $14.39 $83.46 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $125.19 $15.83 $105.16 $122.02 $17.27 $14.39 $100.15 $133.54 $48.93 $82.02 $14.39 $14.39 $108.50 $20.15 $133.54 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $133.54 $141.88 $19.43 $125.19 $29.50 $19.43 $83.46 $108.50 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $141.88 330104 86753 394 302 HC PROTOZOA ANTIBODY NOS O $186.18 $12.39 $12.39 N/A $93.09 N/A N/A N/A N/A $23.54 N/A $12.39 $139.63 $13.63 $117.29 $136.10 N/A N/A $111.71 $148.94 $42.13 $70.62 N/A $12.39 $121.02 N/A $148.94 N/A N/A N/A $17.35 N/A $12.39 $12.39 $13.51 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $17.41 $17.41 $17.41 $17.41 $20.92 $13.01 $12.39 $20.92 N/A N/A $9.29 $9.29 $9.29 $9.29 $158.25 330104 86790 394 302 HC VIRUS ANTIBODY NOS O $186.18 $12.88 $12.88 N/A $93.09 N/A N/A N/A N/A $24.47 N/A $12.88 $139.63 $14.17 $117.29 $136.10 N/A N/A $111.71 $148.94 $43.79 $73.42 N/A $12.88 $121.02 N/A $148.94 N/A N/A N/A $18.03 N/A $12.88 $12.88 $14.04 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 N/A N/A $9.66 $9.66 $9.66 $9.66 $158.25 330104 86762 394 302 HC RUBELLA ANTIBODY O $814.27 $14.39 $14.39 $14.39 $407.13 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $610.70 $15.83 $512.99 $595.23 $17.27 $14.39 $488.56 $651.42 $48.93 $82.02 $14.39 $14.39 $529.28 $20.15 $651.42 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $651.42 $692.13 $19.43 $610.70 $29.50 $19.43 $407.13 $529.28 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $692.13 330104 86765 394 302 HC RUBEOLA ANTIBODY O $284.62 $12.88 $12.88 $12.88 $142.31 N/A N/A N/A $12.88 $24.47 $12.88 $12.88 $213.47 $14.17 $179.31 $208.06 $15.46 $12.88 $170.77 $227.70 $43.79 $73.42 $12.88 $12.88 $185.00 $18.03 $227.70 $12.88 $12.88 $15.46 $18.03 $12.88 $12.88 $12.88 $14.04 $227.70 $241.93 $17.39 $213.47 $26.40 $17.39 $142.31 $185.00 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 $12.88 $12.88 $9.66 $9.66 $9.66 $9.66 $241.93 330104 86774 394 302 HC TETANUS ANTIBODY O $53.50 $14.80 $14.80 N/A $26.75 N/A N/A N/A N/A $28.12 N/A $14.80 $40.12 $16.28 $33.70 $39.11 N/A N/A $32.10 $42.80 $50.32 $84.36 N/A $14.80 $34.77 N/A $42.80 N/A N/A N/A $20.72 N/A $14.80 $14.80 $16.13 $42.80 $45.48 N/A $40.12 N/A N/A $26.75 $34.77 $20.79 $20.79 $20.79 $20.79 $24.98 $15.54 $14.80 $24.98 N/A N/A $11.10 $11.10 $11.10 $11.10 $84.36 330104 86757 394 302 HC RICKETTSIA ANTIBODY O $306.02 $19.35 $19.35 $19.35 $153.01 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $229.51 $21.29 $192.79 $223.70 $23.22 $19.35 $183.61 $244.82 $65.79 $110.30 $19.35 $19.35 $198.91 $27.09 $244.82 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $244.82 $260.12 $26.12 $229.51 $39.67 $26.12 $153.01 $198.91 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $260.12 330104 86778 394 302 HC TOXOPLASMA ANTIBODY IGM O $434.42 $14.41 $14.41 $14.12 $217.21 N/A N/A N/A $14.12 $27.38 $14.12 $14.41 $325.81 $15.85 $273.68 $317.56 $16.94 $14.12 $260.65 $347.54 $48.99 $82.14 $14.12 $14.41 $282.37 $19.77 $347.54 $14.12 $14.12 $16.94 $20.17 $14.12 $14.41 $14.41 $15.71 $347.54 $369.26 $19.06 $325.81 $28.95 $19.06 $217.21 $282.37 $20.25 $20.25 $20.25 $20.25 $24.32 $15.13 $14.41 $24.32 $14.12 $14.12 $10.81 $10.81 $10.81 $10.81 $369.26 330104 86780 394 302 HC TREPONEMA PALLIDUM O $186.18 $13.24 $13.24 $12.63 $93.09 N/A N/A N/A $12.63 $25.16 $12.63 $13.24 $139.63 $14.56 $117.29 $136.10 $15.16 $12.63 $111.71 $148.94 $45.02 $75.47 $12.63 $13.24 $121.02 $17.68 $148.94 $12.63 $12.63 $15.16 $18.54 $12.63 $13.24 $13.24 $14.43 $148.94 $158.25 $17.05 $139.63 $25.89 $17.05 $93.09 $121.02 $18.60 $18.60 $18.60 $18.60 $22.36 $13.90 $13.24 $22.36 $12.63 $12.63 $9.93 $9.93 $9.93 $9.93 $158.25 330104 86787 394 302 HC VARICELLA-ZOSTER ANTIBODY O $186.18 $12.88 $12.88 $8.03 $93.09 N/A N/A N/A $8.03 $24.47 $8.03 $12.88 $139.63 $14.17 $117.29 $136.10 $9.64 $8.03 $111.71 $148.94 $43.79 $73.42 $8.03 $12.88 $121.02 $11.24 $148.94 $8.03 $8.03 $9.64 $18.03 $8.03 $12.88 $12.88 $14.04 $148.94 $158.25 $10.84 $139.63 $16.46 $10.84 $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 $8.03 $8.03 $9.66 $9.66 $9.66 $8.03 $158.25 330104 86788 394 302 HC WEST NILE VIRUS AB IGM O $72.76 $16.85 $16.85 $8.03 $36.38 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $54.57 $18.54 $45.84 $53.19 $9.64 $8.03 $43.66 $58.21 $57.29 $96.05 $8.03 $16.85 $47.29 $11.24 $58.21 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $58.21 $61.85 $10.84 $54.57 $16.46 $10.84 $36.38 $47.29 $23.67 $23.67 $23.67 $23.67 $28.44 $17.69 $16.85 $28.44 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $96.05 330104 86777 394 302 HC TOXOPLASMA ANTIBODY O $390.55 $14.39 $14.39 $14.39 $195.28 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $292.91 $15.83 $246.05 $285.49 $17.27 $14.39 $234.33 $312.44 $48.93 $82.02 $14.39 $14.39 $253.86 $20.15 $312.44 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $312.44 $331.97 $19.43 $292.91 $29.50 $19.43 $195.28 $253.86 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $331.97 330104 86738 394 302 HC MYCOPLASMA ANTIBODY O $439.77 $13.24 $13.24 $13.24 $219.88 N/A N/A N/A $13.24 $25.16 $13.24 $13.24 $329.83 $14.56 $277.06 $321.47 $15.89 $13.24 $263.86 $351.82 $45.02 $75.47 $13.24 $13.24 $285.85 $18.54 $351.82 $13.24 $13.24 $15.89 $18.54 $13.24 $13.24 $13.24 $14.43 $351.82 $373.80 $17.87 $329.83 $27.14 $17.87 $219.88 $285.85 $18.60 $18.60 $18.60 $18.60 $22.37 $13.90 $13.24 $22.37 $13.24 $13.24 $9.93 $9.93 $9.93 $9.93 $373.80 330104 85597 406 305 HC PHOSPHOLIPID PLTLT NEUTRALIZ O $80.25 $17.98 $17.98 N/A $40.12 N/A N/A N/A N/A $34.16 N/A $17.98 $60.19 $19.78 $50.56 $58.66 N/A N/A $48.15 $64.20 $61.13 $102.49 N/A $17.98 $52.16 N/A $64.20 N/A N/A N/A $25.17 N/A $17.98 $17.98 $19.60 $64.20 $68.21 N/A $60.19 N/A N/A $40.12 $52.16 $25.26 $25.26 $25.26 $25.26 $30.36 $18.88 $17.98 $30.36 N/A N/A $13.48 $13.48 $13.48 $13.48 $102.49 330104 85306 406 305 HC CLOT INHIBIT PROT S FREE O $227.91 $15.32 $15.32 $15.32 $113.95 N/A N/A N/A $15.32 $29.11 $15.32 $15.32 $170.93 $16.85 $143.58 $166.60 $18.38 $15.32 $136.75 $182.33 $52.09 $87.32 $15.32 $15.32 $148.14 $21.45 $182.33 $15.32 $15.32 $18.38 $21.45 $15.32 $15.32 $15.32 $16.70 $182.33 $193.72 $20.68 $170.93 $31.41 $20.68 $113.95 $148.14 $21.52 $21.52 $21.52 $21.52 $25.87 $16.09 $15.32 $25.87 $15.32 $15.32 $11.49 $11.49 $11.49 $11.49 $193.72 330104 85307 408 305 HC ASSAY ACTIVATED PROTEIN C O $227.91 $15.32 $15.32 $14.73 $113.95 N/A N/A N/A $14.73 $29.11 $14.73 $15.32 $170.93 $16.85 $143.58 $166.60 $17.68 $14.73 $136.75 $182.33 $52.09 $87.32 $14.73 $15.32 $148.14 $20.62 $182.33 $14.73 $14.73 $17.68 $21.45 $14.73 $15.32 $15.32 $16.70 $182.33 $193.72 $19.89 $170.93 $30.20 $19.89 $113.95 $148.14 $21.52 $21.52 $21.52 $21.52 $25.87 $16.09 $15.32 $25.87 $14.73 $14.73 $11.49 $11.49 $11.49 $11.49 $193.72 330104 85335 406 305 HC FACTOR INHIBITOR TEST O $859.21 $12.87 $12.87 $12.87 $429.61 N/A N/A N/A $12.87 $24.45 $12.87 $12.87 $644.41 $14.16 $541.30 $628.08 $15.44 $12.87 $515.53 $687.37 $43.76 $73.36 $12.87 $12.87 $558.49 $18.02 $687.37 $12.87 $12.87 $15.44 $18.02 $12.87 $12.87 $12.87 $14.03 $687.37 $730.33 $17.37 $644.41 $26.38 $17.37 $429.61 $558.49 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $12.87 $12.87 $9.65 $9.65 $9.65 $9.65 $730.33 330104 85362 406 305 HC FIBRIN DEGRADATION PRODUCTS O $112.35 $6.89 $6.89 $6.89 $56.17 N/A N/A N/A $6.89 $13.09 $6.89 $6.89 $84.26 $7.58 $70.78 $82.13 $8.27 $6.89 $67.41 $89.88 $23.43 $39.27 $6.89 $6.89 $73.03 $9.65 $89.88 $6.89 $6.89 $8.27 $9.65 $6.89 $6.89 $6.89 $7.51 $89.88 $95.50 $9.30 $84.26 $14.12 $9.30 $56.17 $73.03 $9.68 $9.68 $9.68 $9.68 $11.63 $7.23 $6.89 $11.63 $6.89 $6.89 $5.17 $5.17 $5.17 $5.17 $95.50 330104 85379 406 305 HC D-DIMER - QUAN O $129.47 $10.18 $10.18 $10.18 $64.73 N/A N/A N/A $10.18 $19.34 $10.18 $10.18 $97.10 $11.20 $81.57 $94.64 $12.22 $10.18 $77.68 $103.58 $34.61 $58.03 $10.18 $10.18 $84.16 $14.25 $103.58 $10.18 $10.18 $12.22 $14.25 $10.18 $10.18 $10.18 $11.10 $103.58 $110.05 $13.74 $97.10 $20.87 $13.74 $64.73 $84.16 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $10.18 $10.18 $7.63 $7.63 $7.63 $7.63 $110.05 330104 85384 406 305 HC FIBRINOGEN ACTIVITY O $226.84 $9.72 $9.72 $6.90 $113.42 N/A N/A N/A $6.90 $18.47 $6.90 $9.72 $170.13 $10.69 $142.91 $165.82 $8.28 $6.90 $136.10 $181.47 $33.05 $55.40 $6.90 $9.72 $147.45 $9.66 $181.47 $6.90 $6.90 $8.28 $13.61 $6.90 $9.72 $9.72 $10.59 $181.47 $192.81 $9.32 $170.13 $14.14 $9.32 $113.42 $147.45 $13.66 $13.66 $13.66 $13.66 $14.34 $10.21 $9.72 $14.34 $6.90 $6.90 $7.29 $7.29 $7.29 $6.90 $192.81 330104 85397 407 305 HC CLOTTING FUNCT ACTIVITY O $129.47 $30.86 $30.86 $9.40 $64.73 N/A N/A N/A $9.40 $58.63 $9.40 $30.86 $97.10 $33.95 $81.57 $94.64 $11.28 $9.40 $77.68 $103.58 $104.92 $175.90 $9.40 $30.86 $84.16 $13.16 $103.58 $9.40 $9.40 $11.28 $43.20 $9.40 $30.86 $30.86 $33.64 $103.58 $110.05 $12.69 $97.10 $19.27 $12.69 $64.73 $84.16 $43.36 $43.36 $43.36 $43.36 $38.75 $32.40 $30.86 $38.75 $9.40 $9.40 $23.14 $23.14 $23.14 $9.40 $175.90 330104 85460 408 305 HC HEMOGLOBIN FETAL O $69.55 $7.73 $7.73 $7.73 $34.77 N/A N/A N/A $7.73 $14.69 $7.73 $7.73 $52.16 $8.50 $43.82 $50.84 $9.28 $7.73 $41.73 $55.64 $26.28 $44.06 $7.73 $7.73 $45.21 $10.82 $55.64 $7.73 $7.73 $9.28 $10.82 $7.73 $7.73 $7.73 $8.43 $55.64 $59.12 $10.44 $52.16 $15.85 $10.44 $34.77 $45.21 $10.86 $10.86 $10.86 $10.86 $13.07 $8.12 $7.73 $13.07 $7.73 $7.73 $5.80 $5.80 $5.80 $5.80 $59.12 330104 99000 304 305 HC SPECIMEN HANDLING OFFICE-LAB O $28.89 N/A N/A $40.26 $14.45 N/A N/A N/A $40.26 N/A $40.26 N/A $21.67 N/A $18.20 $21.12 $48.31 $40.26 $17.33 $23.11 N/A N/A $40.26 N/A $18.78 $56.37 $23.11 $40.26 $40.26 $48.31 N/A $40.26 N/A N/A N/A $23.11 $24.56 $54.35 $21.67 $82.54 $54.35 $14.45 $18.78 N/A N/A N/A N/A $8.16 N/A N/A $8.16 $40.26 $40.26 N/A N/A N/A $8.16 $82.54 330104 85610 406 305 HC PROTHROMBIN TIME O $142.31 $4.29 $4.29 $3.91 $71.16 N/A N/A N/A $3.91 $8.15 $3.91 $4.29 $106.73 $4.72 $89.66 $104.03 $4.69 $3.91 $85.39 $113.85 $14.59 $24.45 $3.91 $4.29 $92.50 $5.47 $113.85 $3.91 $3.91 $4.69 $6.01 $3.91 $4.29 $4.29 $4.68 $113.85 $120.96 $5.28 $106.73 $8.02 $5.28 $71.16 $92.50 $6.03 $6.03 $6.03 $6.03 $6.64 $4.50 $4.29 $6.64 $3.91 $3.91 $3.22 $3.22 $3.22 $3.22 $120.96 330104 85613 406 305 HC RUSSELL VIPER VENOM DILUTED O $151.94 $9.58 $9.58 $7.82 $75.97 N/A N/A N/A $7.82 $18.20 $7.82 $9.58 $113.95 $10.54 $95.72 $111.07 $9.38 $7.82 $91.16 $121.55 $32.57 $54.61 $7.82 $9.58 $98.76 $10.95 $121.55 $7.82 $7.82 $9.38 $13.41 $7.82 $9.58 $9.58 $10.44 $121.55 $129.15 $10.56 $113.95 $16.03 $10.56 $75.97 $98.76 $13.46 $13.46 $13.46 $13.46 $16.16 $10.06 $9.58 $16.16 $7.82 $7.82 $7.19 $7.19 $7.19 $7.19 $129.15 330104 85651 408 305 HC RBC SED RATE NONAUTOMATED O $84.53 $4.27 $4.27 $2.00 $42.27 N/A N/A N/A $2.00 $8.11 $2.00 $4.27 $63.40 $4.70 $53.25 $61.79 $2.40 $2.00 $50.72 $67.62 $14.52 $24.34 $2.00 $4.27 $54.94 $2.80 $67.62 $2.00 $2.00 $2.40 $5.98 $2.00 $4.27 $4.27 $4.65 $67.62 $71.85 $2.70 $63.40 $4.10 $2.70 $42.27 $54.94 $6.00 $6.00 $6.00 $6.00 $6.00 $4.48 $4.27 $6.00 $2.00 $2.00 $3.20 $3.20 $3.20 $2.00 $71.85 330104 85660 408 305 HC RBC SICKLE CELL TEST O $87.74 $5.51 $5.51 N/A $43.87 N/A N/A N/A N/A $10.47 N/A $5.51 $65.80 $6.06 $55.28 $64.14 N/A N/A $52.64 $70.19 $18.73 $31.41 N/A $5.51 $57.03 N/A $70.19 N/A N/A N/A $7.71 N/A $5.51 $5.51 $6.01 $70.19 $74.58 N/A $65.80 N/A N/A $43.87 $57.03 $7.74 $7.74 $7.74 $7.74 $9.31 $5.79 $5.51 $9.31 N/A N/A $4.13 $4.13 $4.13 $4.13 $74.58 330104 85670 406 305 HC THROMBIN TIME PLASMA O $182.97 $5.77 $5.77 $5.30 $91.48 N/A N/A N/A $5.30 $10.96 $5.30 $5.77 $137.23 $6.35 $115.27 $133.75 $6.36 $5.30 $109.78 $146.38 $19.62 $32.89 $5.30 $5.77 $118.93 $7.42 $146.38 $5.30 $5.30 $6.36 $8.08 $5.30 $5.77 $5.77 $6.29 $146.38 $155.52 $7.16 $137.23 $10.86 $7.16 $91.48 $118.93 $8.11 $8.11 $8.11 $8.11 $9.76 $6.06 $5.77 $9.76 $5.30 $5.30 $4.33 $4.33 $4.33 $4.33 $155.52 330104 85730 406 305 HC THROMBOPLASTIN TIME PART (PTT);PLASMA/WHLE BLD O $142.31 $6.01 $6.01 $6.01 $71.16 N/A N/A N/A $6.01 $11.42 $6.01 $6.01 $106.73 $6.61 $89.66 $104.03 $7.21 $6.01 $85.39 $113.85 $20.43 $34.26 $6.01 $6.01 $92.50 $8.41 $113.85 $6.01 $6.01 $7.21 $8.41 $6.01 $6.01 $6.01 $6.55 $113.85 $120.96 $8.11 $106.73 $12.32 $8.11 $71.16 $92.50 $8.44 $8.44 $8.44 $8.44 $10.14 $6.31 $6.01 $10.14 $6.01 $6.01 $4.51 $4.51 $4.51 $4.51 $120.96 330104 85732 406 305 HC THROMBOPLASTIN TIME PARTIAL (PTT); SUBST PLASMA EA O $108.07 $6.47 $6.47 $6.19 $54.03 N/A N/A N/A $6.19 $12.29 $6.19 $6.47 $81.05 $7.12 $68.08 $79.00 $7.43 $6.19 $64.84 $86.46 $22.00 $36.88 $6.19 $6.47 $70.25 $8.67 $86.46 $6.19 $6.19 $7.43 $9.06 $6.19 $6.47 $6.47 $7.05 $86.46 $91.86 $8.36 $81.05 $12.69 $8.36 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $6.19 $6.19 $4.85 $4.85 $4.85 $4.85 $91.86 330104 85810 408 305 HC BLOOD VISCOSITY EXAMINATION O $300.67 $11.67 $11.67 $11.67 $150.34 N/A N/A N/A $11.67 $22.17 $11.67 $11.67 $225.50 $12.84 $189.42 $219.79 $14.00 $11.67 $180.40 $240.54 $39.68 $66.52 $11.67 $11.67 $195.44 $16.34 $240.54 $11.67 $11.67 $14.00 $16.34 $11.67 $11.67 $11.67 $12.72 $240.54 $255.57 $15.75 $225.50 $23.92 $15.75 $150.34 $195.44 $16.40 $16.40 $16.40 $16.40 $19.72 $12.25 $11.67 $19.72 $11.67 $11.67 $8.75 $8.75 $8.75 $8.75 $255.57 330104 89055 390 305 HC LEUKOCYTE COUNTFECAL O $71.69 $4.27 $4.27 $3.40 $35.84 N/A N/A N/A $3.40 $8.11 $3.40 $4.27 $53.77 $4.70 $45.16 $52.41 $4.08 $3.40 $43.01 $57.35 $14.52 $24.34 $3.40 $4.27 $46.60 $4.76 $57.35 $3.40 $3.40 $4.08 $5.98 $3.40 $4.27 $4.27 $4.65 $57.35 $60.94 $4.59 $53.77 $6.97 $4.59 $35.84 $46.60 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.40 $3.40 $3.20 $3.20 $3.20 $3.20 $60.94 330104 89190 390 305 HC NASAL SMEAR FOR EOSINOPHILS O $142.31 $5.79 $5.79 $4.70 $71.16 N/A N/A N/A $4.70 $11.00 $4.70 $5.79 $106.73 $6.37 $89.66 $104.03 $5.64 $4.70 $85.39 $113.85 $19.69 $33.00 $4.70 $5.79 $92.50 $6.58 $113.85 $4.70 $4.70 $5.64 $8.11 $4.70 $5.79 $5.79 $6.31 $113.85 $120.96 $6.35 $106.73 $9.63 $6.35 $71.16 $92.50 $8.13 $8.13 $8.13 $8.13 $8.02 $6.08 $5.79 $8.02 $4.70 $4.70 $4.34 $4.34 $4.34 $4.34 $120.96 330104 85305 406 305 HC CLOT INHIBIT PROT S TOTAL O $185.11 $11.61 $11.61 $11.61 $92.56 N/A N/A N/A $11.61 $22.06 $11.61 $11.61 $138.83 $12.77 $116.62 $135.32 $13.93 $11.61 $111.07 $148.09 $39.47 $66.18 $11.61 $11.61 $120.32 $16.25 $148.09 $11.61 $11.61 $13.93 $16.25 $11.61 $11.61 $11.61 $12.65 $148.09 $157.34 $15.67 $138.83 $23.80 $15.67 $92.56 $120.32 $16.31 $16.31 $16.31 $16.31 $19.58 $12.19 $11.61 $19.58 $11.61 $11.61 $8.71 $8.71 $8.71 $8.71 $157.34 330104 85598 406 305 HC HEXAGNAL PHOSPH PLTLT NEUTRL O $155.15 $17.98 $17.98 N/A $77.58 N/A N/A N/A N/A $34.16 N/A $17.98 $116.36 $19.78 $97.74 $113.41 N/A N/A $93.09 $124.12 $61.13 $102.49 N/A $17.98 $100.85 N/A $124.12 N/A N/A N/A $25.17 N/A $17.98 $17.98 $19.60 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $25.26 $25.26 $25.26 $25.26 $30.36 $18.88 $17.98 $30.36 N/A N/A $13.48 $13.48 $13.48 $13.48 $131.88 330104 85303 406 305 HC CLOT INHIBIT PROT C ACTIVITY O $219.35 $13.84 $13.84 $13.84 $109.67 N/A N/A N/A $13.84 $26.30 $13.84 $13.84 $164.51 $15.22 $138.19 $160.34 $16.61 $13.84 $131.61 $175.48 $47.06 $78.89 $13.84 $13.84 $142.58 $19.38 $175.48 $13.84 $13.84 $16.61 $19.38 $13.84 $13.84 $13.84 $15.09 $175.48 $186.45 $18.68 $164.51 $28.37 $18.68 $109.67 $142.58 $19.45 $19.45 $19.45 $19.45 $23.35 $14.53 $13.84 $23.35 $13.84 $13.84 $10.38 $10.38 $10.38 $10.38 $186.45 330104 85230 406 305 HC CLOT FACTOR VII PROCONVERTIN O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85301 406 305 HC ANTITHROMBIN III ANTIGEN O $146.59 $10.81 $10.81 $10.81 $73.30 N/A N/A N/A $10.81 $20.54 $10.81 $10.81 $109.94 $11.89 $92.35 $107.16 $12.97 $10.81 $87.95 $117.27 $36.75 $61.62 $10.81 $10.81 $95.28 $15.13 $117.27 $10.81 $10.81 $12.97 $15.13 $10.81 $10.81 $10.81 $11.78 $117.27 $124.60 $14.59 $109.94 $22.16 $14.59 $73.30 $95.28 $15.19 $15.19 $15.19 $15.19 $18.25 $11.35 $10.81 $18.25 $10.81 $10.81 $8.11 $8.11 $8.11 $8.11 $124.60 330104 85007 408 305 HC BL SMEAR W/DIFF WBC COUNT O $71.69 $3.80 $3.80 $1.43 $35.84 N/A N/A N/A $1.43 $7.22 $1.43 $3.80 $53.77 $4.18 $45.16 $52.41 $1.72 $1.43 $43.01 $57.35 $12.92 $21.66 $1.43 $3.80 $46.60 $2.00 $57.35 $1.43 $1.43 $1.72 $5.32 $1.43 $3.80 $3.80 $4.14 $57.35 $60.94 $1.93 $53.77 $2.93 $1.93 $35.84 $46.60 $5.34 $5.34 $5.34 $5.34 $5.81 $3.99 $3.80 $5.81 $1.43 $1.43 $2.85 $2.85 $2.85 $1.43 $60.94 330104 85008 408 305 HC BL SMEAR W/O DIFF WBC COUNT O $306.02 $3.43 $3.43 N/A $153.01 N/A N/A N/A N/A $6.52 N/A $3.43 $229.51 $3.77 $192.79 $223.70 N/A N/A $183.61 $244.82 $11.66 $19.55 N/A $3.43 $198.91 N/A $244.82 N/A N/A N/A $4.80 N/A $3.43 $3.43 $3.74 $244.82 $260.12 N/A $229.51 N/A N/A $153.01 $198.91 $4.82 $4.82 $4.82 $4.82 $5.81 $3.60 $3.43 $5.81 N/A N/A $2.57 $2.57 $2.57 $2.57 $260.12 330104 85014 408 305 HC HEMATOCRIT O $37.45 $2.37 $2.37 $2.00 $18.73 N/A N/A N/A $2.00 $4.50 $2.00 $2.37 $28.09 $2.61 $23.59 $27.38 $2.40 $2.00 $22.47 $29.96 $8.06 $13.51 $2.00 $2.37 $24.34 $2.80 $29.96 $2.00 $2.00 $2.40 $3.32 $2.00 $2.37 $2.37 $2.58 $29.96 $31.83 $2.70 $28.09 $4.10 $2.70 $18.73 $24.34 $3.33 $3.33 $3.33 $3.33 $4.00 $2.49 $2.37 $4.00 $2.00 $2.00 $1.78 $1.78 $1.78 $1.78 $31.83 330104 85018 408 305 HC HEMOGLOBIN O $131.61 $2.37 $2.37 $2.00 $65.81 N/A N/A N/A $2.00 $4.50 $2.00 $2.37 $98.71 $2.61 $82.91 $96.21 $2.40 $2.00 $78.97 $105.29 $8.06 $13.51 $2.00 $2.37 $85.55 $2.80 $105.29 $2.00 $2.00 $2.40 $3.32 $2.00 $2.37 $2.37 $2.58 $105.29 $111.87 $2.70 $98.71 $4.10 $2.70 $65.81 $85.55 $3.33 $3.33 $3.33 $3.33 $4.00 $2.49 $2.37 $4.00 $2.00 $2.00 $1.78 $1.78 $1.78 $1.78 $111.87 330104 85025 408 305 HC COMPLETE CBC W/AUTO DIFF WBC O $121.98 $7.77 $7.77 $3.17 $60.99 N/A N/A N/A $3.17 $14.76 $3.17 $7.77 $91.48 $8.55 $76.85 $89.17 $3.80 $3.17 $73.19 $97.58 $26.42 $44.29 $3.17 $7.77 $79.29 $4.44 $97.58 $3.17 $3.17 $3.80 $10.88 $3.17 $7.77 $7.77 $8.47 $97.58 $103.68 $4.28 $91.48 $6.50 $4.28 $60.99 $79.29 $10.92 $10.92 $10.92 $10.92 $13.13 $8.16 $7.77 $13.13 $3.17 $3.17 $5.83 $5.83 $5.83 $3.17 $103.68 330104 85027 408 305 HC COMPLETE CBC AUTOMATED O $97.37 $6.47 $6.47 $3.17 $48.69 N/A N/A N/A $3.17 $12.29 $3.17 $6.47 $73.03 $7.12 $61.34 $71.18 $3.80 $3.17 $58.42 $77.90 $22.00 $36.88 $3.17 $6.47 $63.29 $4.44 $77.90 $3.17 $3.17 $3.80 $9.06 $3.17 $6.47 $6.47 $7.05 $77.90 $82.76 $4.28 $73.03 $6.50 $4.28 $48.69 $63.29 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $3.17 $3.17 $4.85 $4.85 $4.85 $3.17 $82.76 330104 85041 408 305 HC AUTOMATED RBC COUNT O $52.43 $3.02 $3.02 $3.02 $26.21 N/A N/A N/A $3.02 $5.74 $3.02 $3.02 $39.32 $3.32 $33.03 $38.33 $3.62 $3.02 $31.46 $41.94 $10.27 $17.21 $3.02 $3.02 $34.08 $4.23 $41.94 $3.02 $3.02 $3.62 $4.23 $3.02 $3.02 $3.02 $3.29 $41.94 $44.57 $4.08 $39.32 $6.19 $4.08 $26.21 $34.08 $4.24 $4.24 $4.24 $4.24 $5.09 $3.17 $3.02 $5.09 $3.02 $3.02 $2.27 $2.27 $2.27 $2.27 $44.57 330104 85045 408 305 HC AUTOMATED RETICULOCYTE COUNT O $64.20 $3.99 $3.99 $3.17 $32.10 N/A N/A N/A $3.17 $7.58 $3.17 $3.99 $48.15 $4.39 $40.45 $46.93 $3.80 $3.17 $38.52 $51.36 $13.57 $22.74 $3.17 $3.99 $41.73 $4.44 $51.36 $3.17 $3.17 $3.80 $5.59 $3.17 $3.99 $3.99 $4.35 $51.36 $54.57 $4.28 $48.15 $6.50 $4.28 $32.10 $41.73 $5.61 $5.61 $5.61 $5.61 $6.76 $4.19 $3.99 $6.76 $3.17 $3.17 $2.99 $2.99 $2.99 $2.99 $54.57 330104 85048 408 305 HC AUTOMATED LEUKOCYTE COUNT O $131.61 $2.54 $2.54 $2.54 $65.81 N/A N/A N/A $2.54 $4.83 $2.54 $2.54 $98.71 $2.79 $82.91 $96.21 $3.05 $2.54 $78.97 $105.29 $8.64 $14.48 $2.54 $2.54 $85.55 $3.56 $105.29 $2.54 $2.54 $3.05 $3.56 $2.54 $2.54 $2.54 $2.77 $105.29 $111.87 $3.43 $98.71 $5.21 $3.43 $65.81 $85.55 $3.57 $3.57 $3.57 $3.57 $4.28 $2.67 $2.54 $4.28 $2.54 $2.54 $1.91 $1.91 $1.91 $1.91 $111.87 330104 85049 408 305 HC AUTOMATED PLATELET COUNT O $72.76 $4.48 $4.48 $3.17 $36.38 N/A N/A N/A $3.17 $8.51 $3.17 $4.48 $54.57 $4.93 $45.84 $53.19 $3.80 $3.17 $43.66 $58.21 $15.23 $25.54 $3.17 $4.48 $47.29 $4.44 $58.21 $3.17 $3.17 $3.80 $6.27 $3.17 $4.48 $4.48 $4.88 $58.21 $61.85 $4.28 $54.57 $6.50 $4.28 $36.38 $47.29 $6.29 $6.29 $6.29 $6.29 $7.55 $4.70 $4.48 $7.55 $3.17 $3.17 $3.36 $3.36 $3.36 $3.17 $61.85 330104 85210 406 305 HC CLOT FACTOR II PROTHROM SPEC O "$1,013.29 " $12.98 $12.98 $12.98 $506.64 N/A N/A N/A $12.98 $24.66 $12.98 $12.98 $759.97 $14.28 $638.37 $740.71 $15.58 $12.98 $607.97 $810.63 $44.13 $73.99 $12.98 $12.98 $658.64 $18.17 $810.63 $12.98 $12.98 $15.58 $18.17 $12.98 $12.98 $12.98 $14.15 $810.63 $861.30 $17.52 $759.97 $26.61 $17.52 $506.64 $658.64 $18.24 $18.24 $18.24 $18.24 $21.92 $13.63 $12.98 $21.92 $12.98 $12.98 $9.73 $9.73 $9.73 $9.73 $861.30 330104 85220 406 305 HC BLOOC CLOT FACTOR V TEST O $686.94 $17.65 $17.65 $17.65 $343.47 N/A N/A N/A $17.65 $33.53 $17.65 $17.65 $515.21 $19.41 $432.77 $502.15 $21.18 $17.65 $412.16 $549.55 $60.01 $100.60 $17.65 $17.65 $446.51 $24.71 $549.55 $17.65 $17.65 $21.18 $24.71 $17.65 $17.65 $17.65 $19.24 $549.55 $583.90 $23.83 $515.21 $36.18 $23.83 $343.47 $446.51 $24.80 $24.80 $24.80 $24.80 $29.80 $18.53 $17.65 $29.80 $17.65 $17.65 $13.24 $13.24 $13.24 $13.24 $583.90 330104 85240 406 305 HC CLOT FACTOR VIII AHG 1 STAGE O "$1,277.58 " $17.90 $17.90 $9.40 $638.79 N/A N/A N/A $9.40 $34.01 $9.40 $17.90 $958.18 $19.69 $804.88 $933.91 $11.28 $9.40 $766.55 "$1,022.06 " $60.86 $102.03 $9.40 $17.90 $830.43 $13.16 "$1,022.06 " $9.40 $9.40 $11.28 $25.06 $9.40 $17.90 $17.90 $19.51 "$1,022.06 " "$1,085.94 " $12.69 $958.18 $19.27 $12.69 $638.79 $830.43 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $9.40 $9.40 $13.42 $13.42 $13.42 $9.40 "$1,085.94 " 330104 85246 407 305 HC CLOT FACTOR VIII VW ANTIGEN O $142.31 $22.94 $22.94 $9.40 $71.16 N/A N/A N/A $9.40 $43.59 $9.40 $22.94 $106.73 $25.23 $89.66 $104.03 $11.28 $9.40 $85.39 $113.85 $78.00 $130.76 $9.40 $22.94 $92.50 $13.16 $113.85 $9.40 $9.40 $11.28 $32.12 $9.40 $22.94 $22.94 $25.00 $113.85 $120.96 $12.69 $106.73 $19.27 $12.69 $71.16 $92.50 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $9.40 $9.40 $17.21 $17.21 $17.21 $9.40 $130.76 330104 85247 407 305 HC CLOT FACTOR VIII MULTIMETRIC O $361.66 $22.94 $22.94 $11.77 $180.83 N/A N/A N/A $11.77 $43.59 $11.77 $22.94 $271.25 $25.23 $227.85 $264.37 $14.12 $11.77 $217.00 $289.33 $78.00 $130.76 $11.77 $22.94 $235.08 $16.48 $289.33 $11.77 $11.77 $14.12 $32.12 $11.77 $22.94 $22.94 $25.00 $289.33 $307.41 $15.89 $271.25 $24.13 $15.89 $180.83 $235.08 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $11.77 $11.77 $17.21 $17.21 $17.21 $11.77 $307.41 330104 85250 407 305 HC CLOT FACTOR IX PTC/CHRSTMAS O $760.77 $19.04 $19.04 $19.04 $380.38 N/A N/A N/A $19.04 $36.18 $19.04 $19.04 $570.58 $20.94 $479.29 $556.12 $22.85 $19.04 $456.46 $608.62 $64.74 $108.53 $19.04 $19.04 $494.50 $26.66 $608.62 $19.04 $19.04 $22.85 $26.66 $19.04 $19.04 $19.04 $20.75 $608.62 $646.65 $25.70 $570.58 $39.03 $25.70 $380.38 $494.50 $26.75 $26.75 $26.75 $26.75 $32.16 $19.99 $19.04 $32.16 $19.04 $19.04 $14.28 $14.28 $14.28 $14.28 $646.65 330104 85260 406 305 HC CLOT FACTOR X STUART-POWER O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85270 406 305 HC CLOT FACTOR XI PTA O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85290 406 305 HC CLOT FACTOR XIII FIBRIN STAB O $151.94 $16.34 $16.34 $7.93 $75.97 N/A N/A N/A $7.93 $31.05 $7.93 $16.34 $113.95 $17.97 $95.72 $111.07 $9.52 $7.93 $91.16 $121.55 $55.56 $93.14 $7.93 $16.34 $98.76 $11.10 $121.55 $7.93 $7.93 $9.52 $22.88 $7.93 $16.34 $16.34 $17.81 $121.55 $129.15 $10.71 $113.95 $16.26 $10.71 $75.97 $98.76 $22.96 $22.96 $22.96 $22.96 $27.60 $17.16 $16.34 $27.60 $7.93 $7.93 $12.25 $12.25 $12.25 $7.93 $129.15 330104 85291 406 305 HC CLOT FACTOR XIII FIBRIN SCRN O $117.70 $9.11 $9.11 $7.10 $58.85 N/A N/A N/A $7.10 $17.31 $7.10 $9.11 $88.28 $10.02 $74.15 $86.04 $8.52 $7.10 $70.62 $94.16 $30.97 $51.93 $7.10 $9.11 $76.51 $9.94 $94.16 $7.10 $7.10 $8.52 $12.75 $7.10 $9.11 $9.11 $9.93 $94.16 $100.05 $9.59 $88.28 $14.55 $9.59 $58.85 $76.51 $12.80 $12.80 $12.80 $12.80 $15.01 $9.57 $9.11 $15.01 $7.10 $7.10 $6.83 $6.83 $6.83 $6.83 $100.05 330104 85300 406 305 HC ANTITHROMBIN III ACTIVITY O $311.37 $11.85 $11.85 $9.43 $155.69 N/A N/A N/A $9.43 $22.51 $9.43 $11.85 $233.53 $13.04 $196.16 $227.61 $11.32 $9.43 $186.82 $249.10 $40.29 $67.55 $9.43 $11.85 $202.39 $13.20 $249.10 $9.43 $9.43 $11.32 $16.59 $9.43 $11.85 $11.85 $12.92 $249.10 $264.66 $12.73 $233.53 $19.33 $12.73 $155.69 $202.39 $16.65 $16.65 $16.65 $16.65 $20.02 $12.44 $11.85 $20.02 $9.43 $9.43 $8.89 $8.89 $8.89 $8.89 $264.66 330104 85302 406 305 HC CLOT INHIBIT PROT C ANTIGEN O $190.46 $12.01 $12.01 $12.01 $95.23 N/A N/A N/A $12.01 $22.82 $12.01 $12.01 $142.84 $13.21 $119.99 $139.23 $14.41 $12.01 $114.28 $152.37 $40.83 $68.46 $12.01 $12.01 $123.80 $16.81 $152.37 $12.01 $12.01 $14.41 $16.81 $12.01 $12.01 $12.01 $13.09 $152.37 $161.89 $16.21 $142.84 $24.62 $16.21 $95.23 $123.80 $16.87 $16.87 $16.87 $16.87 $20.30 $12.61 $12.01 $20.30 $12.01 $12.01 $9.01 $9.01 $9.01 $9.01 $161.89 330104 85280 407 305 HC CLOT FACTOR XII HAGEMAN O $760.77 $19.35 $19.35 $19.35 $380.38 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $570.58 $21.29 $479.29 $556.12 $23.22 $19.35 $456.46 $608.62 $65.79 $110.30 $19.35 $19.35 $494.50 $27.09 $608.62 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $608.62 $646.65 $26.12 $570.58 $39.67 $26.12 $380.38 $494.50 $27.19 $27.19 $27.19 $27.19 $32.66 $20.32 $19.35 $32.66 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $646.65 330104 85245 407 305 HC CLOT FACTOR VIII VW RISTOCTN O $942.67 $22.94 $22.94 $9.40 $471.33 N/A N/A N/A $9.40 $43.59 $9.40 $22.94 $707.00 $25.23 $593.88 $689.09 $11.28 $9.40 $565.60 $754.14 $78.00 $130.76 $9.40 $22.94 $612.74 $13.16 $754.14 $9.40 $9.40 $11.28 $32.12 $9.40 $22.94 $22.94 $25.00 $754.14 $801.27 $12.69 $707.00 $19.27 $12.69 $471.33 $612.74 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $9.40 $9.40 $17.21 $17.21 $17.21 $9.40 $801.27 330104 87449 396 306 HC AG DETECT NOS EIA MULT O $590.64 $11.98 $11.98 $5.20 $295.32 N/A N/A N/A $5.20 $22.76 $5.20 $11.98 $442.98 $13.18 $372.10 $431.76 $6.24 $5.20 $354.38 $472.51 $40.73 $68.29 $5.20 $11.98 $383.92 $7.28 $472.51 $5.20 $5.20 $6.24 $16.77 $5.20 $11.98 $11.98 $13.06 $472.51 $502.04 $7.02 $442.98 $10.66 $7.02 $295.32 $383.92 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $5.20 $5.20 $8.98 $8.98 $8.98 $5.20 $502.04 330104 87184 396 306 HC MICROBE SUSCEPTIBLE DISK O $151.94 $7.48 $7.48 $6.59 $75.97 N/A N/A N/A $6.59 $14.21 $6.59 $7.48 $113.95 $8.23 $95.72 $111.07 $7.91 $6.59 $91.16 $121.55 $25.43 $42.64 $6.59 $7.48 $98.76 $9.23 $121.55 $6.59 $6.59 $7.91 $10.47 $6.59 $7.48 $7.48 $8.15 $121.55 $129.15 $8.90 $113.95 $13.51 $8.90 $75.97 $98.76 $10.51 $10.51 $10.51 $10.51 $11.65 $7.85 $7.48 $11.65 $6.59 $6.59 $5.61 $5.61 $5.61 $5.61 $129.15 330104 87186 396 306 HC MICROBE SUSCEPTIBLE MIC O $160.50 $8.65 $8.65 $6.59 $80.25 N/A N/A N/A $6.59 $16.43 $6.59 $8.65 $120.38 $9.52 $101.11 $117.33 $7.91 $6.59 $96.30 $128.40 $29.41 $49.31 $6.59 $8.65 $104.33 $9.23 $128.40 $6.59 $6.59 $7.91 $12.11 $6.59 $8.65 $8.65 $9.43 $128.40 $136.42 $8.90 $120.38 $13.51 $8.90 $80.25 $104.33 $12.15 $12.15 $12.15 $12.15 $14.60 $9.08 $8.65 $14.60 $6.59 $6.59 $6.49 $6.49 $6.49 $6.49 $136.42 330104 87188 396 306 HC SENSITIVITY - MACROBROTH EA AGNT O $88.81 $6.64 $6.64 $4.50 $44.41 N/A N/A N/A $4.50 $12.62 $4.50 $6.64 $66.61 $7.30 $55.95 $64.92 $5.40 $4.50 $53.29 $71.05 $22.58 $37.85 $4.50 $6.64 $57.73 $6.30 $71.05 $4.50 $4.50 $5.40 $9.30 $4.50 $6.64 $6.64 $7.24 $71.05 $75.49 $6.08 $66.61 $9.22 $6.08 $44.41 $57.73 $9.33 $9.33 $9.33 $9.33 $11.21 $6.97 $6.64 $11.21 $4.50 $4.50 $4.98 $4.98 $4.98 $4.50 $75.49 330104 87205 396 306 HC SMEAR GRAM STAIN O $129.47 $4.27 $4.27 $3.40 $64.73 N/A N/A N/A $3.40 $8.11 $3.40 $4.27 $97.10 $4.70 $81.57 $94.64 $4.08 $3.40 $77.68 $103.58 $14.52 $24.34 $3.40 $4.27 $84.16 $4.76 $103.58 $3.40 $3.40 $4.08 $5.98 $3.40 $4.27 $4.27 $4.65 $103.58 $110.05 $4.59 $97.10 $6.97 $4.59 $64.73 $84.16 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.40 $3.40 $3.20 $3.20 $3.20 $3.20 $110.05 330104 87206 396 306 HC SMEAR FLUORESCENT/ACID STAI O $182.97 $5.39 $5.39 $5.39 $91.48 N/A N/A N/A $5.39 $10.24 $5.39 $5.39 $137.23 $5.93 $115.27 $133.75 $6.47 $5.39 $109.78 $146.38 $18.33 $30.72 $5.39 $5.39 $118.93 $7.55 $146.38 $5.39 $5.39 $6.47 $7.55 $5.39 $5.39 $5.39 $5.88 $146.38 $155.52 $7.28 $137.23 $11.05 $7.28 $91.48 $118.93 $7.57 $7.57 $7.57 $7.57 $9.07 $5.66 $5.39 $9.07 $5.39 $5.39 $4.04 $4.04 $4.04 $4.04 $155.52 330104 87220 396 306 HC TISSUE EXAM FOR FUNGI O $121.98 $4.27 $4.27 N/A $60.99 N/A N/A N/A N/A $8.11 N/A $4.27 $91.48 $4.70 $76.85 $89.17 N/A N/A $73.19 $97.58 $14.52 $24.34 N/A $4.27 $79.29 N/A $97.58 N/A N/A N/A $5.98 N/A $4.27 $4.27 $4.65 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 N/A N/A $3.20 $3.20 $3.20 $3.20 $103.68 330104 87252 396 306 HC VIRUS INOCULATION TISSUE O $409.81 $26.07 $26.07 $26.07 $204.91 N/A N/A N/A $26.07 $49.53 $26.07 $26.07 $307.36 $28.68 $258.18 $299.57 $31.28 $26.07 $245.89 $327.85 $88.64 $148.60 $26.07 $26.07 $266.38 $36.50 $327.85 $26.07 $26.07 $31.28 $36.50 $26.07 $26.07 $26.07 $28.42 $327.85 $348.34 $35.19 $307.36 $53.44 $35.19 $204.91 $266.38 $36.63 $36.63 $36.63 $36.63 $44.02 $27.37 $26.07 $44.02 $26.07 $26.07 $19.55 $19.55 $19.55 $19.55 $348.34 330104 87253 396 306 HC VIRUS INOCULATE TISSUE ADDL O $318.86 $20.20 $20.20 $20.20 $159.43 N/A N/A N/A $20.20 $38.38 $20.20 $20.20 $239.15 $22.22 $200.88 $233.09 $24.24 $20.20 $191.32 $255.09 $68.68 $115.14 $20.20 $20.20 $207.26 $28.28 $255.09 $20.20 $20.20 $24.24 $28.28 $20.20 $20.20 $20.20 $22.02 $255.09 $271.03 $27.27 $239.15 $41.41 $27.27 $159.43 $207.26 $28.38 $28.38 $28.38 $28.38 $34.10 $21.21 $20.20 $34.10 $20.20 $20.20 $15.15 $15.15 $15.15 $15.15 $271.03 330104 87254 396 306 HC VIRUS INOCULATION SHELL VIA O $616.32 $19.56 $19.56 $6.76 $308.16 N/A N/A N/A $6.76 $37.16 $6.76 $19.56 $462.24 $21.52 $388.28 $450.53 $8.11 $6.76 $369.79 $493.06 $66.50 $111.49 $6.76 $19.56 $400.61 $9.46 $493.06 $6.76 $6.76 $8.11 $27.38 $6.76 $19.56 $19.56 $21.32 $493.06 $523.87 $9.13 $462.24 $13.86 $9.13 $308.16 $400.61 $27.48 $27.48 $27.48 $27.48 $33.02 $20.54 $19.56 $33.02 $6.76 $6.76 $14.67 $14.67 $14.67 $6.76 $523.87 330104 87255 397 306 HC VIRUS IDNON-IMMUNOLOGIC METHOD O $535.00 $33.86 $33.86 $6.76 $267.50 N/A N/A N/A $6.76 $64.33 $6.76 $33.86 $401.25 $37.25 $337.05 $391.08 $8.11 $6.76 $321.00 $428.00 $115.12 $193.00 $6.76 $33.86 $347.75 $9.46 $428.00 $6.76 $6.76 $8.11 $47.40 $6.76 $33.86 $33.86 $36.91 $428.00 $454.75 $9.13 $401.25 $13.86 $9.13 $267.50 $347.75 $47.57 $47.57 $47.57 $47.57 $57.19 $35.55 $33.86 $57.19 $6.76 $6.76 $25.39 $25.39 $25.39 $6.76 $454.75 330104 87281 396 306 HC PNEUMOCYSTIS CARINII AG IF O $97.37 $11.98 $11.98 $8.03 $48.69 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $73.03 $13.18 $61.34 $71.18 $9.64 $8.03 $58.42 $77.90 $40.73 $68.29 $8.03 $11.98 $63.29 $11.24 $77.90 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $77.90 $82.76 $10.84 $73.03 $16.46 $10.84 $48.69 $63.29 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $82.76 330104 87290 396 306 HC VARICELLA ZOSTER AG IF O $103.79 $13.42 $13.42 $8.03 $51.90 N/A N/A N/A $8.03 $25.50 $8.03 $13.42 $77.84 $14.76 $65.39 $75.87 $9.64 $8.03 $62.27 $83.03 $45.63 $76.49 $8.03 $13.42 $67.46 $11.24 $83.03 $8.03 $8.03 $9.64 $18.79 $8.03 $13.42 $13.42 $14.63 $83.03 $88.22 $10.84 $77.84 $16.46 $10.84 $51.90 $67.46 $18.86 $18.86 $18.86 $18.86 $20.26 $14.09 $13.42 $20.26 $8.03 $8.03 $10.06 $10.06 $10.06 $8.03 $88.22 330104 87299 396 306 HC ANTIBODY DETECTION NOS IF O $142.31 $16.10 $16.10 $16.10 $71.16 N/A N/A N/A $16.10 $30.59 $16.10 $16.10 $106.73 $17.71 $89.66 $104.03 $19.32 $16.10 $85.39 $113.85 $54.74 $91.77 $16.10 $16.10 $92.50 $22.54 $113.85 $16.10 $16.10 $19.32 $22.54 $16.10 $16.10 $16.10 $17.55 $113.85 $120.96 $21.74 $106.73 $33.01 $21.74 $71.16 $92.50 $22.62 $22.62 $22.62 $22.62 $20.26 $16.91 $16.10 $20.26 $16.10 $16.10 $12.08 $12.08 $12.08 $12.08 $120.96 330104 87305 396 306 HC FUNGUS NES ANTIBODY O $361.66 $11.98 $11.98 $8.03 $180.83 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $271.25 $13.18 $227.85 $264.37 $9.64 $8.03 $217.00 $289.33 $40.73 $68.29 $8.03 $11.98 $235.08 $11.24 $289.33 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $289.33 $307.41 $10.84 $271.25 $16.46 $10.84 $180.83 $235.08 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $307.41 330104 87329 396 306 HC GIARDIA AG EIA O $190.46 $11.98 $11.98 $11.98 $95.23 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $142.84 $13.18 $119.99 $139.23 $14.38 $11.98 $114.28 $152.37 $40.73 $68.29 $11.98 $11.98 $123.80 $16.77 $152.37 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $152.37 $161.89 $16.17 $142.84 $24.56 $16.17 $95.23 $123.80 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $161.89 330104 87177 396 306 HC OVA AND PARASITES SMEARS O $143.38 $8.90 $8.90 $8.90 $71.69 N/A N/A N/A $8.90 $16.91 $8.90 $8.90 $107.53 $9.79 $90.33 $104.81 $10.68 $8.90 $86.03 $114.70 $30.26 $50.73 $8.90 $8.90 $93.20 $12.46 $114.70 $8.90 $8.90 $10.68 $12.46 $8.90 $8.90 $8.90 $9.70 $114.70 $121.87 $12.02 $107.53 $18.24 $12.02 $71.69 $93.20 $12.50 $12.50 $12.50 $12.50 $15.02 $9.35 $8.90 $15.02 $8.90 $8.90 $6.68 $6.68 $6.68 $6.68 $121.87 330104 87332 396 306 "HC CYTOMEGALOVIRUS AG,EIA" O $142.31 $11.98 $11.98 $11.98 $71.16 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $106.73 $13.18 $89.66 $104.03 $14.38 $11.98 $85.39 $113.85 $40.73 $68.29 $11.98 $11.98 $92.50 $16.77 $113.85 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $113.85 $120.96 $16.17 $106.73 $24.56 $16.17 $71.16 $92.50 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $120.96 330104 87168 396 306 HC MACROSCOPIC EXAM ARTHROPOD O $79.18 $4.27 $4.27 N/A $39.59 N/A N/A N/A N/A $8.11 N/A $4.27 $59.39 $4.70 $49.88 $57.88 N/A N/A $47.51 $63.34 $14.52 $24.34 N/A $4.27 $51.47 N/A $63.34 N/A N/A N/A $5.98 N/A $4.27 $4.27 $4.65 $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 N/A N/A $3.20 $3.20 $3.20 $3.20 $67.30 330104 87149 396 306 HC DNA/RNA DIRECT PROBE O $318.86 $20.05 $20.05 N/A $159.43 N/A N/A N/A N/A $38.09 N/A $20.05 $239.15 $22.06 $200.88 $233.09 N/A N/A $191.32 $255.09 $68.17 $114.29 N/A $20.05 $207.26 N/A $255.09 N/A N/A N/A $28.07 N/A $20.05 $20.05 $21.85 $255.09 $271.03 N/A $239.15 N/A N/A $159.43 $207.26 $28.17 $28.17 $28.17 $28.17 $33.86 $21.05 $20.05 $33.86 N/A N/A $15.04 $15.04 $15.04 $15.04 $271.03 330104 87040 396 306 HC BLOOD CULTURE FOR BACTERIA O $340.26 $10.32 $10.32 $8.15 $170.13 N/A N/A N/A $8.15 $19.61 $8.15 $10.32 $255.19 $11.35 $214.36 $248.73 $9.78 $8.15 $204.16 $272.21 $35.09 $58.82 $8.15 $10.32 $221.17 $11.41 $272.21 $8.15 $8.15 $9.78 $14.45 $8.15 $10.32 $10.32 $11.25 $272.21 $289.22 $11.00 $255.19 $16.71 $11.00 $170.13 $221.17 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $8.15 $8.15 $7.74 $7.74 $7.74 $7.74 $289.22 330104 87045 396 306 HC FECES CULTURE AEROBIC BACT O $306.02 $9.44 $9.44 $8.15 $153.01 N/A N/A N/A $8.15 $17.94 $8.15 $9.44 $229.51 $10.38 $192.79 $223.70 $9.78 $8.15 $183.61 $244.82 $32.10 $53.81 $8.15 $9.44 $198.91 $11.41 $244.82 $8.15 $8.15 $9.78 $13.22 $8.15 $9.44 $9.44 $10.29 $244.82 $260.12 $11.00 $229.51 $16.71 $11.00 $153.01 $198.91 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $8.15 $8.15 $7.08 $7.08 $7.08 $7.08 $260.12 330104 87070 396 306 HC CULTURE OTHR SPECIMN AEROBIC O $206.51 $8.62 $8.62 $8.15 $103.25 N/A N/A N/A $8.15 $16.38 $8.15 $8.62 $154.88 $9.48 $130.10 $150.96 $9.78 $8.15 $123.91 $165.21 $29.31 $49.13 $8.15 $8.62 $134.23 $11.41 $165.21 $8.15 $8.15 $9.78 $12.07 $8.15 $8.62 $8.62 $9.40 $165.21 $175.53 $11.00 $154.88 $16.71 $11.00 $103.25 $134.23 $12.11 $12.11 $12.11 $12.11 $14.54 $9.05 $8.62 $14.54 $8.15 $8.15 $6.46 $6.46 $6.46 $6.46 $175.53 330104 87076 396 306 HC CULTURE ANAEROBE IDENT EACH O $189.39 $8.08 $8.08 $8.08 $94.69 N/A N/A N/A $8.08 $15.35 $8.08 $8.08 $142.04 $8.89 $119.32 $138.44 $9.70 $8.08 $113.63 $151.51 $27.47 $46.06 $8.08 $8.08 $123.10 $11.31 $151.51 $8.08 $8.08 $9.70 $11.31 $8.08 $8.08 $8.08 $8.81 $151.51 $160.98 $10.91 $142.04 $16.56 $10.91 $94.69 $123.10 $11.35 $11.35 $11.35 $11.35 $13.64 $8.48 $8.08 $13.64 $8.08 $8.08 $6.06 $6.06 $6.06 $6.06 $160.98 330104 87077 396 306 HC CULTURE AEROBIC IDENTIFY O $129.47 $8.08 $8.08 $8.08 $64.73 N/A N/A N/A $8.08 $15.35 $8.08 $8.08 $97.10 $8.89 $81.57 $94.64 $9.70 $8.08 $77.68 $103.58 $27.47 $46.06 $8.08 $8.08 $84.16 $11.31 $103.58 $8.08 $8.08 $9.70 $11.31 $8.08 $8.08 $8.08 $8.81 $103.58 $110.05 $10.91 $97.10 $16.56 $10.91 $64.73 $84.16 $11.35 $11.35 $11.35 $11.35 $13.64 $8.48 $8.08 $13.64 $8.08 $8.08 $6.06 $6.06 $6.06 $6.06 $110.05 330104 87081 396 306 HC CULTURE SCREEN ONLY O $142.31 $6.63 $6.63 $5.20 $71.16 N/A N/A N/A $5.20 $12.60 $5.20 $6.63 $106.73 $7.29 $89.66 $104.03 $6.24 $5.20 $85.39 $113.85 $22.54 $37.79 $5.20 $6.63 $92.50 $7.28 $113.85 $5.20 $5.20 $6.24 $9.28 $5.20 $6.63 $6.63 $7.23 $113.85 $120.96 $7.02 $106.73 $10.66 $7.02 $71.16 $92.50 $9.32 $9.32 $9.32 $9.32 $11.20 $6.96 $6.63 $11.20 $5.20 $5.20 $4.97 $4.97 $4.97 $4.97 $120.96 330104 87086 396 306 HC URINE CULTURE/COLONY COUNT O $206.51 $8.07 $8.07 $8.07 $103.25 N/A N/A N/A $8.07 $15.33 $8.07 $8.07 $154.88 $8.88 $130.10 $150.96 $9.68 $8.07 $123.91 $165.21 $27.44 $46.00 $8.07 $8.07 $134.23 $11.30 $165.21 $8.07 $8.07 $9.68 $11.30 $8.07 $8.07 $8.07 $8.80 $165.21 $175.53 $10.89 $154.88 $16.54 $10.89 $103.25 $134.23 $11.34 $11.34 $11.34 $11.34 $13.63 $8.47 $8.07 $13.63 $8.07 $8.07 $6.05 $6.05 $6.05 $6.05 $175.53 330104 87101 396 306 HC SKIN FUNGI CULTURE O $125.19 $7.71 $7.71 $7.71 $62.59 N/A N/A N/A $7.71 $14.65 $7.71 $7.71 $93.89 $8.48 $78.87 $91.51 $9.25 $7.71 $75.11 $100.15 $26.21 $43.95 $7.71 $7.71 $81.37 $10.79 $100.15 $7.71 $7.71 $9.25 $10.79 $7.71 $7.71 $7.71 $8.40 $100.15 $106.41 $10.41 $93.89 $15.81 $10.41 $62.59 $81.37 $10.83 $10.83 $10.83 $10.83 $13.03 $8.10 $7.71 $13.03 $7.71 $7.71 $5.78 $5.78 $5.78 $5.78 $106.41 330104 87102 396 306 HC FUNGUS ISOLATION CULTURE O $289.97 $8.41 $8.41 $8.41 $144.99 N/A N/A N/A $8.41 $15.98 $8.41 $8.41 $217.48 $9.25 $182.68 $211.97 $10.09 $8.41 $173.98 $231.98 $28.59 $47.94 $8.41 $8.41 $188.48 $11.77 $231.98 $8.41 $8.41 $10.09 $11.77 $8.41 $8.41 $8.41 $9.17 $231.98 $246.47 $11.35 $217.48 $17.24 $11.35 $144.99 $188.48 $11.82 $11.82 $11.82 $11.82 $14.20 $8.83 $8.41 $14.20 $8.41 $8.41 $6.31 $6.31 $6.31 $6.31 $246.47 330104 87103 396 306 HC BLOOD FUNGUS CULTURE O $125.19 $20.46 $20.46 $11.37 $62.59 N/A N/A N/A $11.37 $38.87 $11.37 $20.46 $93.89 $22.51 $78.87 $91.51 $13.64 $11.37 $75.11 $100.15 $69.56 $116.62 $11.37 $20.46 $81.37 $15.92 $100.15 $11.37 $11.37 $13.64 $28.64 $11.37 $20.46 $20.46 $22.30 $100.15 $106.41 $15.35 $93.89 $23.31 $15.35 $62.59 $81.37 $28.75 $28.75 $28.75 $28.75 $15.23 $21.48 $20.46 $15.23 $11.37 $11.37 $15.35 $15.35 $15.35 $11.37 $116.62 330104 87106 396 306 HC FUNGI IDENTIFICATION YEAST O $166.92 $10.32 $10.32 $9.70 $83.46 N/A N/A N/A $9.70 $19.61 $9.70 $10.32 $125.19 $11.35 $105.16 $122.02 $11.64 $9.70 $100.15 $133.54 $35.09 $58.82 $9.70 $10.32 $108.50 $13.58 $133.54 $9.70 $9.70 $11.64 $14.45 $9.70 $10.32 $10.32 $11.25 $133.54 $141.88 $13.10 $125.19 $19.88 $13.10 $83.46 $108.50 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $9.70 $9.70 $7.74 $7.74 $7.74 $7.74 $141.88 330104 87107 396 306 HC FUNGI IDENTIFICATION MOLD O $340.26 $10.32 $10.32 $9.70 $170.13 N/A N/A N/A $9.70 $19.61 $9.70 $10.32 $255.19 $11.35 $214.36 $248.73 $11.64 $9.70 $204.16 $272.21 $35.09 $58.82 $9.70 $10.32 $221.17 $13.58 $272.21 $9.70 $9.70 $11.64 $14.45 $9.70 $10.32 $10.32 $11.25 $272.21 $289.22 $13.10 $255.19 $19.88 $13.10 $170.13 $221.17 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $9.70 $9.70 $7.74 $7.74 $7.74 $7.74 $289.22 330104 87110 396 306 HC CHLAMYDIA CULTURE O $142.31 $19.60 $19.60 $8.15 $71.16 N/A N/A N/A $8.15 $37.24 $8.15 $19.60 $106.73 $21.56 $89.66 $104.03 $9.78 $8.15 $85.39 $113.85 $66.64 $111.72 $8.15 $19.60 $92.50 $11.41 $113.85 $8.15 $8.15 $9.78 $27.44 $8.15 $19.60 $19.60 $21.36 $113.85 $120.96 $11.00 $106.73 $16.71 $11.00 $71.16 $92.50 $27.54 $27.54 $27.54 $27.54 $33.08 $20.58 $19.60 $33.08 $8.15 $8.15 $14.70 $14.70 $14.70 $8.15 $120.96 330104 87116 396 306 HC MYCOBACTERIA CULTURE O $175.48 $10.80 $10.80 $10.80 $87.74 N/A N/A N/A $10.80 $20.52 $10.80 $10.80 $131.61 $11.88 $110.55 $128.28 $12.96 $10.80 $105.29 $140.38 $36.72 $61.56 $10.80 $10.80 $114.06 $15.12 $140.38 $10.80 $10.80 $12.96 $15.12 $10.80 $10.80 $10.80 $11.77 $140.38 $149.16 $14.58 $131.61 $22.14 $14.58 $87.74 $114.06 $15.17 $15.17 $15.17 $15.17 $18.25 $11.34 $10.80 $18.25 $10.80 $10.80 $8.10 $8.10 $8.10 $8.10 $149.16 330104 87140 396 306 HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM O $88.81 $5.57 $5.57 N/A $44.41 N/A N/A N/A N/A $10.58 N/A $5.57 $66.61 $6.13 $55.95 $64.92 N/A N/A $53.29 $71.05 $18.94 $31.75 N/A $5.57 $57.73 N/A $71.05 N/A N/A N/A $7.80 N/A $5.57 $5.57 $6.07 $71.05 $75.49 N/A $66.61 N/A N/A $44.41 $57.73 $7.83 $7.83 $7.83 $7.83 $9.41 $5.85 $5.57 $9.41 N/A N/A $4.18 $4.18 $4.18 $4.18 $75.49 330104 87153 388 306 HC DNA/RNA SEQUENCING O "$1,145.97 " $115.36 $115.36 $61.77 $572.99 N/A N/A N/A $61.77 $219.18 $61.77 $115.36 $859.48 $126.90 $721.96 $837.70 $74.12 $61.77 $687.58 $916.78 $392.22 $657.55 $61.77 $115.36 $744.88 $86.47 $916.78 $61.77 $61.77 $74.12 $161.50 $61.77 $115.36 $115.36 $125.74 $916.78 $974.07 $83.38 $859.48 $126.62 $83.38 $572.99 $744.88 $162.08 $162.08 $162.08 $162.08 $194.80 $121.13 $115.36 $194.80 $61.77 $61.77 $86.52 $86.52 $86.52 $61.77 $974.07 330104 87015 396 306 HC SPECIMEN INFECT AGNT CONCNTJ O $111.28 $6.68 $6.68 $3.25 $55.64 N/A N/A N/A $3.25 $12.69 $3.25 $6.68 $83.46 $7.35 $70.11 $81.35 $3.90 $3.25 $66.77 $89.02 $22.71 $38.08 $3.25 $6.68 $72.33 $4.55 $89.02 $3.25 $3.25 $3.90 $9.35 $3.25 $6.68 $6.68 $7.28 $89.02 $94.59 $4.39 $83.46 $6.66 $4.39 $55.64 $72.33 $9.39 $9.39 $9.39 $9.39 $11.28 $7.01 $6.68 $11.28 $3.25 $3.25 $5.01 $5.01 $5.01 $3.25 $94.59 330104 87337 396 306 HC IAAD IA ENTAMOEBA HISTOLYTICA GRP O $418.37 $11.98 $11.98 $8.03 $209.19 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $313.78 $13.18 $263.57 $305.83 $9.64 $8.03 $251.02 $334.70 $40.73 $68.29 $8.03 $11.98 $271.94 $11.24 $334.70 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $334.70 $355.61 $10.84 $313.78 $16.46 $10.84 $209.19 $271.94 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $355.61 330104 87340 396 306 HC HEPATITIS B SURFACE AG EIA O $296.39 $10.33 $10.33 $10.33 $148.19 N/A N/A N/A $10.33 $19.63 $10.33 $10.33 $222.29 $11.36 $186.73 $216.66 $12.40 $10.33 $177.83 $237.11 $35.12 $58.88 $10.33 $10.33 $192.65 $14.46 $237.11 $10.33 $10.33 $12.40 $14.46 $10.33 $10.33 $10.33 $11.26 $237.11 $251.93 $13.95 $222.29 $21.18 $13.95 $148.19 $192.65 $14.51 $14.51 $14.51 $14.51 $17.44 $10.85 $10.33 $17.44 $10.33 $10.33 $7.75 $7.75 $7.75 $7.75 $251.93 330104 87590 396 306 HC N.GONORRHOEAE DNA DIR PROB O $316.72 $26.88 $26.88 $8.03 $158.36 N/A N/A N/A $8.03 $51.07 $8.03 $26.88 $237.54 $29.57 $199.53 $231.52 $9.64 $8.03 $190.03 $253.38 $91.39 $153.22 $8.03 $26.88 $205.87 $11.24 $253.38 $8.03 $8.03 $9.64 $37.63 $8.03 $26.88 $26.88 $29.30 $253.38 $269.21 $10.84 $237.54 $16.46 $10.84 $158.36 $205.87 $37.77 $37.77 $37.77 $37.77 $33.86 $28.22 $26.88 $33.86 $8.03 $8.03 $20.16 $20.16 $20.16 $8.03 $269.21 330104 87591 397 306 HC N.GONORRHOEAE DNA AMP PROB O $466.52 $35.09 $35.09 $21.43 $233.26 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $349.89 $38.60 $293.91 $341.03 $25.72 $21.43 $279.91 $373.22 $119.31 $200.01 $21.43 $35.09 $303.24 $30.00 $373.22 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $373.22 $396.54 $28.93 $349.89 $43.93 $28.93 $233.26 $303.24 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $396.54 330104 87623 397 306 HC HPV LOW-RISK TYPES O $552.12 $35.09 $35.09 $27.85 $276.06 N/A N/A N/A $27.85 $66.67 $27.85 $35.09 $414.09 $38.60 $347.84 $403.60 $33.42 $27.85 $331.27 $441.70 $119.31 $200.01 $27.85 $35.09 $358.88 $38.99 $441.70 $27.85 $27.85 $33.42 $49.13 $27.85 $35.09 $35.09 $38.25 $441.70 $469.30 $37.60 $414.09 $57.09 $37.60 $276.06 $358.88 $49.30 $49.30 $49.30 $49.30 $57.31 $36.84 $35.09 $57.31 $27.85 $27.85 $26.32 $26.32 $26.32 $26.32 $469.30 330104 87624 397 306 HC HPV HIGH-RISK TYPES O $273.92 $35.09 $35.09 $27.85 $136.96 N/A N/A N/A $27.85 $66.67 $27.85 $35.09 $205.44 $38.60 $172.57 $200.24 $33.42 $27.85 $164.35 $219.14 $119.31 $200.01 $27.85 $35.09 $178.05 $38.99 $219.14 $27.85 $27.85 $33.42 $49.13 $27.85 $35.09 $35.09 $38.25 $219.14 $232.83 $37.60 $205.44 $57.09 $37.60 $136.96 $178.05 $49.30 $49.30 $49.30 $49.30 $57.31 $36.84 $35.09 $57.31 $27.85 $27.85 $26.32 $26.32 $26.32 $26.32 $232.83 330104 87625 397 306 HC HPV TYPES 16 & 18 ONLY O $155.15 $40.55 $40.55 $27.85 $77.58 N/A N/A N/A $27.85 $77.04 $27.85 $40.55 $116.36 $44.61 $97.74 $113.41 $33.42 $27.85 $93.09 $124.12 $137.87 $231.13 $27.85 $40.55 $100.85 $38.99 $124.12 $27.85 $27.85 $33.42 $56.77 $27.85 $40.55 $40.55 $44.20 $124.12 $131.88 $37.60 $116.36 $57.09 $37.60 $77.58 $100.85 $56.97 $56.97 $56.97 $56.97 $57.31 $42.58 $40.55 $57.31 $27.85 $27.85 $30.41 $30.41 $30.41 $27.85 $231.13 330104 87631 388 306 HC RESP VIRUS 3-5 TARGETS O $393.76 $142.63 $142.63 $96.31 $196.88 N/A N/A N/A $96.31 $271.00 $96.31 $142.63 $295.32 $156.89 $248.07 $287.84 $115.57 $96.31 $236.26 $315.01 $484.94 $812.99 $96.31 $142.63 $255.94 $134.83 $315.01 $96.31 $96.31 $115.57 $199.68 $96.31 $142.63 $142.63 $155.47 $315.01 $334.70 $130.02 $295.32 $197.44 $130.02 $196.88 $255.94 $200.40 $200.40 $200.40 $200.40 $211.61 $149.76 $142.63 $211.61 $96.31 $96.31 $106.97 $106.97 $106.97 $96.31 $812.99 330104 87635 397 306 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ O $189.39 $51.31 $51.31 $51.31 $94.69 N/A N/A N/A $51.31 $97.49 $51.31 $51.31 $142.04 $56.44 $119.32 $138.44 $61.57 $51.31 $113.63 $151.51 $174.45 $292.47 $51.31 $51.31 $123.10 $71.83 $151.51 $51.31 $51.31 $61.57 $71.83 $51.31 $51.31 $51.31 $55.93 $151.51 $160.98 $69.27 $142.04 $105.19 $69.27 $94.69 $123.10 $72.09 $72.09 $72.09 $72.09 N/A $53.88 $51.31 $126.32 $51.31 $51.31 $38.48 $38.48 $38.48 $38.48 $292.47 330104 87661 397 306 HB TRICHOMONAS VAGINALIS AMPLIF O $149.80 $35.09 $35.09 $21.43 $74.90 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $112.35 $38.60 $94.37 $109.50 $25.72 $21.43 $89.88 $119.84 $119.31 $200.01 $21.43 $35.09 $97.37 $30.00 $119.84 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $119.84 $127.33 $28.93 $112.35 $43.93 $28.93 $74.90 $97.37 $49.30 $49.30 $49.30 $49.30 $57.44 $36.84 $35.09 $57.44 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $200.01 330104 87798 397 306 HC DETECT AGENT NOS DNA AMP O "$1,101.03 " $35.09 $35.09 N/A $550.51 N/A N/A N/A N/A $66.67 N/A $35.09 $825.77 $38.60 $693.65 $804.85 N/A N/A $660.62 $880.82 $119.31 $200.01 N/A $35.09 $715.67 N/A $880.82 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $880.82 $935.88 N/A $825.77 N/A N/A $550.51 $715.67 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $935.88 330104 87799 397 306 HC DETECT AGENT NOS DNA QUANT O $836.74 $42.84 $42.84 N/A $418.37 N/A N/A N/A N/A $81.40 N/A $42.84 $627.56 $47.12 $527.15 $611.66 N/A N/A $502.04 $669.39 $145.66 $244.19 N/A $42.84 $543.88 N/A $669.39 N/A N/A N/A $59.98 N/A $42.84 $42.84 $46.70 $669.39 $711.23 N/A $627.56 N/A N/A $418.37 $543.88 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 N/A N/A $32.13 $32.13 $32.13 $32.13 $711.23 330104 87801 397 306 HC DETECT AGNT MULT DNA AMPLI O $812.13 $70.20 $70.20 $40.00 $406.06 N/A N/A N/A $40.00 $133.38 $40.00 $70.20 $609.10 $77.22 $511.64 $593.67 $48.00 $40.00 $487.28 $649.70 $238.68 $400.14 $40.00 $70.20 $527.88 $56.00 $649.70 $40.00 $40.00 $48.00 $98.28 $40.00 $70.20 $70.20 $76.52 $649.70 $690.31 $54.00 $609.10 $82.00 $54.00 $406.06 $527.88 $98.63 $98.63 $98.63 $98.63 $118.54 $73.71 $70.20 $118.54 $40.00 $40.00 $52.65 $52.65 $52.65 $40.00 $690.31 330104 87811 396 306 HC IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS O $169.06 $41.38 $41.38 $41.38 $84.53 N/A N/A N/A $41.38 $78.62 $41.38 $41.38 $126.80 $45.52 $106.51 $123.58 $49.66 $41.38 $101.44 $135.25 $140.69 $235.87 $41.38 $41.38 $109.89 $57.93 $135.25 $41.38 $41.38 $49.66 $57.93 $41.38 $41.38 $41.38 $45.10 $135.25 $143.70 $55.86 $126.80 $84.83 $55.86 $84.53 $109.89 $58.14 $58.14 $58.14 $58.14 N/A $43.45 $41.38 $112.76 $41.38 $41.38 $31.04 $31.04 $31.04 $31.04 $235.87 330104 87880 396 306 HC STREP A ASSAY W/OPTIC O $185.11 $16.53 $16.53 $3.75 $92.56 N/A N/A N/A $3.75 $31.41 $3.75 $16.53 $138.83 $18.18 $116.62 $135.32 $4.50 $3.75 $111.07 $148.09 $56.20 $94.22 $3.75 $16.53 $120.32 $5.25 $148.09 $3.75 $3.75 $4.50 $23.14 $3.75 $16.53 $16.53 $18.02 $148.09 $157.34 $5.06 $138.83 $7.69 $5.06 $92.56 $120.32 $23.22 $23.22 $23.22 $23.22 $20.26 $17.36 $16.53 $20.26 $3.75 $3.75 $12.40 $12.40 $12.40 $3.75 $157.34 330104 87899 396 306 HC AGENT NOS ASSAY W/OPTIC O $418.37 $16.07 $16.07 $8.03 $209.19 N/A N/A N/A $8.03 $30.53 $8.03 $16.07 $313.78 $17.68 $263.57 $305.83 $9.64 $8.03 $251.02 $334.70 $54.64 $91.60 $8.03 $16.07 $271.94 $11.24 $334.70 $8.03 $8.03 $9.64 $22.50 $8.03 $16.07 $16.07 $17.52 $334.70 $355.61 $10.84 $313.78 $16.46 $10.84 $209.19 $271.94 $22.58 $22.58 $22.58 $22.58 $20.26 $16.87 $16.07 $20.26 $8.03 $8.03 $12.05 $12.05 $12.05 $8.03 $355.61 330104 87902 386 306 HC GENOTYPE DNA/RNA HEP C O "$4,603.14 " $257.45 $257.45 $257.45 "$2,301.57 " N/A N/A N/A $257.45 $489.15 $257.45 $257.45 "$3,452.36 " $283.19 "$2,899.98 " "$3,364.90 " $308.94 $257.45 "$2,761.88 " "$3,682.51 " $875.33 "$1,467.46 " $257.45 $257.45 "$2,992.04 " $360.43 "$3,682.51 " $257.45 $257.45 $308.94 $360.43 $257.45 $257.45 $257.45 $280.62 "$3,682.51 " "$3,912.67 " $347.56 "$3,452.36 " $527.77 $347.56 "$2,301.57 " "$2,992.04 " $361.72 $361.72 $361.72 $361.72 $434.74 $270.32 $257.45 $434.74 $257.45 $257.45 $193.09 $193.09 $193.09 $193.09 "$3,912.67 " 330104 87563 397 306 HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH O $133.75 $35.09 $35.09 $21.43 $66.88 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $100.31 $38.60 $84.26 $97.77 $25.72 $21.43 $80.25 $107.00 $119.31 $200.01 $21.43 $35.09 $86.94 $30.00 $107.00 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $107.00 $113.69 $28.93 $100.31 $43.93 $28.93 $66.88 $86.94 $49.30 $49.30 $49.30 $49.30 $42.11 $36.84 $35.09 $42.11 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $200.01 330104 87338 396 306 HC HPYLORI STOOL EIA O $227.91 $14.38 $14.38 $8.03 $113.95 N/A N/A N/A $8.03 $27.32 $8.03 $14.38 $170.93 $15.82 $143.58 $166.60 $9.64 $8.03 $136.75 $182.33 $48.89 $81.97 $8.03 $14.38 $148.14 $11.24 $182.33 $8.03 $8.03 $9.64 $20.13 $8.03 $14.38 $14.38 $15.67 $182.33 $193.72 $10.84 $170.93 $16.46 $10.84 $113.95 $148.14 $20.20 $20.20 $20.20 $20.20 $24.29 $15.10 $14.38 $24.29 $8.03 $8.03 $10.79 $10.79 $10.79 $8.03 $193.72 330104 87556 397 306 HC M.TUBERCULO DNA AMP PROBE O $659.12 $41.68 $41.68 $41.68 $329.56 N/A N/A N/A $41.68 $79.19 $41.68 $41.68 $494.34 $45.85 $415.25 $481.82 $50.02 $41.68 $395.47 $527.30 $141.71 $237.58 $41.68 $41.68 $428.43 $58.35 $527.30 $41.68 $41.68 $50.02 $58.35 $41.68 $41.68 $41.68 $45.43 $527.30 $560.25 $56.27 $494.34 $85.44 $56.27 $329.56 $428.43 $58.56 $58.56 $58.56 $58.56 $59.27 $43.76 $41.68 $59.27 $41.68 $41.68 $31.26 $31.26 $31.26 $31.26 $560.25 330104 87529 397 306 HC HSV DNA AMP PROBE O $169.06 $35.09 $35.09 $32.15 $84.53 N/A N/A N/A $32.15 $66.67 $32.15 $35.09 $126.80 $38.60 $106.51 $123.58 $38.58 $32.15 $101.44 $135.25 $119.31 $200.01 $32.15 $35.09 $109.89 $45.01 $135.25 $32.15 $32.15 $38.58 $49.13 $32.15 $35.09 $35.09 $38.25 $135.25 $143.70 $43.40 $126.80 $65.91 $43.40 $84.53 $109.89 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $32.15 $32.15 $26.32 $26.32 $26.32 $26.32 $200.01 330104 87341 396 306 HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION O $124.12 $10.33 $10.33 $10.33 $62.06 N/A N/A N/A $10.33 $19.63 $10.33 $10.33 $93.09 $11.36 $78.20 $90.73 $12.40 $10.33 $74.47 $99.30 $35.12 $58.88 $10.33 $10.33 $80.68 $14.46 $99.30 $10.33 $10.33 $12.40 $14.46 $10.33 $10.33 $10.33 $11.26 $99.30 $105.50 $13.95 $93.09 $21.18 $13.95 $62.06 $80.68 $14.51 $14.51 $14.51 $14.51 $17.44 $10.85 $10.33 $17.44 $10.33 $10.33 $7.75 $7.75 $7.75 $7.75 $105.50 330104 87350 396 306 HC HEPATITIS BE AG EIA O $548.91 $11.53 $11.53 $10.10 $274.45 N/A N/A N/A $10.10 $21.91 $10.10 $11.53 $411.68 $12.68 $345.81 $401.25 $12.12 $10.10 $329.35 $439.13 $39.20 $65.72 $10.10 $11.53 $356.79 $14.14 $439.13 $10.10 $10.10 $12.12 $16.14 $10.10 $11.53 $11.53 $12.57 $439.13 $466.57 $13.63 $411.68 $20.70 $13.63 $274.45 $356.79 $16.20 $16.20 $16.20 $16.20 $19.46 $12.11 $11.53 $19.46 $10.10 $10.10 $8.65 $8.65 $8.65 $8.65 $466.57 330104 87385 396 306 HC HISTOPLASMA CAPSUL AG EIA O $146.59 $13.25 $13.25 $12.41 $73.30 N/A N/A N/A $12.41 $25.17 $12.41 $13.25 $109.94 $14.58 $92.35 $107.16 $14.89 $12.41 $87.95 $117.27 $45.05 $75.53 $12.41 $13.25 $95.28 $17.37 $117.27 $12.41 $12.41 $14.89 $18.55 $12.41 $13.25 $13.25 $14.44 $117.27 $124.60 $16.75 $109.94 $25.44 $16.75 $73.30 $95.28 $18.62 $18.62 $18.62 $18.62 $20.26 $13.91 $13.25 $20.26 $12.41 $12.41 $9.94 $9.94 $9.94 $9.94 $124.60 330104 87425 396 306 HC ROTAVIRUS AG EIA O $185.11 $11.98 $11.98 $11.98 $92.56 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $138.83 $13.18 $116.62 $135.32 $14.38 $11.98 $111.07 $148.09 $40.73 $68.29 $11.98 $11.98 $120.32 $16.77 $148.09 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $148.09 $157.34 $16.17 $138.83 $24.56 $16.17 $92.56 $120.32 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $157.34 330104 87427 396 306 HC SHIGA-LIKE TOXIN AG EIA O $134.82 $11.98 $11.98 $11.98 $67.41 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $101.11 $13.18 $84.94 $98.55 $14.38 $11.98 $80.89 $107.86 $40.73 $68.29 $11.98 $11.98 $87.63 $16.77 $107.86 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $107.86 $114.60 $16.17 $101.11 $24.56 $16.17 $67.41 $87.63 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $114.60 330104 87471 397 306 HC BARTONELLA DNA AMP PROBE O $435.49 $35.09 $35.09 N/A $217.75 N/A N/A N/A N/A $66.67 N/A $35.09 $326.62 $38.60 $274.36 $318.34 N/A N/A $261.29 $348.39 $119.31 $200.01 N/A $35.09 $283.07 N/A $348.39 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $348.39 $370.17 N/A $326.62 N/A N/A $217.75 $283.07 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $370.17 330104 87476 397 306 HC LYME DIS DNA AMP PROBE O $861.35 $35.09 $35.09 $21.43 $430.68 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $646.01 $38.60 $542.65 $629.65 $25.72 $21.43 $516.81 $689.08 $119.31 $200.01 $21.43 $35.09 $559.88 $30.00 $689.08 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $689.08 $732.15 $28.93 $646.01 $43.93 $28.93 $430.68 $559.88 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $732.15 330104 87481 397 306 HC CANDIDA DNA AMP PROBE O $117.70 $35.09 $35.09 N/A $58.85 N/A N/A N/A N/A $66.67 N/A $35.09 $88.28 $38.60 $74.15 $86.04 N/A N/A $70.62 $94.16 $119.31 $200.01 N/A $35.09 $76.51 N/A $94.16 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $94.16 $100.05 N/A $88.28 N/A N/A $58.85 $76.51 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $200.01 330104 87490 396 306 HC CHYLMD TRACH DNA DIR PROBE O $316.72 $22.75 $22.75 $8.03 $158.36 N/A N/A N/A $8.03 $43.23 $8.03 $22.75 $237.54 $25.03 $199.53 $231.52 $9.64 $8.03 $190.03 $253.38 $77.35 $129.68 $8.03 $22.75 $205.87 $11.24 $253.38 $8.03 $8.03 $9.64 $31.85 $8.03 $22.75 $22.75 $24.80 $253.38 $269.21 $10.84 $237.54 $16.46 $10.84 $158.36 $205.87 $31.96 $31.96 $31.96 $31.96 $33.86 $23.89 $22.75 $33.86 $8.03 $8.03 $17.06 $17.06 $17.06 $8.03 $269.21 330104 87491 397 306 HC CHYLMD TRACH DNA AMP PROBE O $466.52 $35.09 $35.09 $21.43 $233.26 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $349.89 $38.60 $293.91 $341.03 $25.72 $21.43 $279.91 $373.22 $119.31 $200.01 $21.43 $35.09 $303.24 $30.00 $373.22 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $373.22 $396.54 $28.93 $349.89 $43.93 $28.93 $233.26 $303.24 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $396.54 330104 87493 397 306 HC C DIFF AMPLIFIED PROBE O $419.44 $37.27 $37.27 N/A $209.72 N/A N/A N/A N/A $70.81 N/A $37.27 $314.58 $41.00 $264.25 $306.61 N/A N/A $251.66 $335.55 $126.72 $212.44 N/A $37.27 $272.64 N/A $335.55 N/A N/A N/A $52.18 N/A $37.27 $37.27 $40.62 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $52.36 $52.36 $52.36 $52.36 $59.27 $39.13 $37.27 $59.27 N/A N/A $27.95 $27.95 $27.95 $27.95 $356.52 330104 87496 397 306 HC CYTOMEG DNA AMP PROBE O $263.22 $35.09 $35.09 $23.39 $131.61 N/A N/A N/A $23.39 $66.67 $23.39 $35.09 $197.42 $38.60 $165.83 $192.41 $28.07 $23.39 $157.93 $210.58 $119.31 $200.01 $23.39 $35.09 $171.09 $32.75 $210.58 $23.39 $23.39 $28.07 $49.13 $23.39 $35.09 $35.09 $38.25 $210.58 $223.74 $31.58 $197.42 $47.95 $31.58 $131.61 $171.09 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $23.39 $23.39 $26.32 $26.32 $26.32 $23.39 $223.74 330104 87497 397 306 HC CYTOMEG DNA QUANT O $625.95 $42.84 $42.84 $28.56 $312.98 N/A N/A N/A $28.56 $81.40 $28.56 $42.84 $469.46 $47.12 $394.35 $457.57 $34.27 $28.56 $375.57 $500.76 $145.66 $244.19 $28.56 $42.84 $406.87 $39.98 $500.76 $28.56 $28.56 $34.27 $59.98 $28.56 $42.84 $42.84 $46.70 $500.76 $532.06 $38.56 $469.46 $58.55 $38.56 $312.98 $406.87 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 $28.56 $28.56 $32.13 $32.13 $32.13 $28.56 $532.06 330104 87517 397 306 HC HEPATITIS B DNA QUANT O $671.96 $42.84 $42.84 N/A $335.98 N/A N/A N/A N/A $81.40 N/A $42.84 $503.97 $47.12 $423.33 $491.20 N/A N/A $403.18 $537.57 $145.66 $244.19 N/A $42.84 $436.77 N/A $537.57 N/A N/A N/A $59.98 N/A $42.84 $42.84 $46.70 $537.57 $571.17 N/A $503.97 N/A N/A $335.98 $436.77 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 N/A N/A $32.13 $32.13 $32.13 $32.13 $571.17 330104 87522 397 306 HC HEPATITIS C REVRS TRNSCRPJ O "$1,258.32 " $42.84 $42.84 $42.84 $629.16 N/A N/A N/A $42.84 $81.40 $42.84 $42.84 $943.74 $47.12 $792.74 $919.83 $51.41 $42.84 $754.99 "$1,006.66 " $145.66 $244.19 $42.84 $42.84 $817.91 $59.98 "$1,006.66 " $42.84 $42.84 $51.41 $59.98 $42.84 $42.84 $42.84 $46.70 "$1,006.66 " "$1,069.57 " $57.83 $943.74 $87.82 $57.83 $629.16 $817.91 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 $42.84 $42.84 $32.13 $32.13 $32.13 $32.13 "$1,069.57 " 330104 87536 397 306 HC HIV-1 QUANT&REVRSE TRNSCRPJ O "$1,319.31 " $85.10 $85.10 $85.10 $659.65 N/A N/A N/A $85.10 $161.69 $85.10 $85.10 $989.48 $93.61 $831.17 $964.42 $102.12 $85.10 $791.59 "$1,055.45 " $289.34 $485.07 $85.10 $85.10 $857.55 $119.14 "$1,055.45 " $85.10 $85.10 $102.12 $119.14 $85.10 $85.10 $85.10 $92.76 "$1,055.45 " "$1,121.41 " $114.89 $989.48 $174.45 $114.89 $659.65 $857.55 $119.57 $119.57 $119.57 $119.57 $143.70 $89.36 $85.10 $143.70 $85.10 $85.10 $63.82 $63.82 $63.82 $63.82 "$1,121.41 " 330104 87521 397 306 HC HEPATITIS C PROBE&RVRS TRNSC O $449.40 $35.09 $35.09 $35.09 $224.70 N/A N/A N/A $35.09 $66.67 $35.09 $35.09 $337.05 $38.60 $283.12 $328.51 $42.11 $35.09 $269.64 $359.52 $119.31 $200.01 $35.09 $35.09 $292.11 $49.13 $359.52 $35.09 $35.09 $42.11 $49.13 $35.09 $35.09 $35.09 $38.25 $359.52 $381.99 $47.37 $337.05 $71.93 $47.37 $224.70 $292.11 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $35.09 $35.09 $26.32 $26.32 $26.32 $26.32 $381.99 330104 87046 396 306 HC STOOL CULTR AEROBIC BACT EA O $306.02 $9.44 $9.44 $2.95 $153.01 N/A N/A N/A $2.95 $17.94 $2.95 $9.44 $229.51 $10.38 $192.79 $223.70 $3.54 $2.95 $183.61 $244.82 $32.10 $53.81 $2.95 $9.44 $198.91 $4.13 $244.82 $2.95 $2.95 $3.54 $13.22 $2.95 $9.44 $9.44 $10.29 $244.82 $260.12 $3.98 $229.51 $6.05 $3.98 $153.01 $198.91 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $2.95 $2.95 $7.08 $7.08 $7.08 $2.95 $260.12 330104 87635 397 306 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ- CEPHEID O $202.23 $51.31 $51.31 $51.31 $101.11 N/A N/A N/A $51.31 $97.49 $51.31 $51.31 $151.67 $56.44 $127.40 $147.83 $61.57 $51.31 $121.34 $161.78 $174.45 $292.47 $51.31 $51.31 $131.45 $71.83 $161.78 $51.31 $51.31 $61.57 $71.83 $51.31 $51.31 $51.31 $55.93 $161.78 $171.90 $69.27 $151.67 $105.19 $69.27 $101.11 $131.45 $72.09 $72.09 $72.09 $72.09 N/A $53.88 $51.31 $134.89 $51.31 $51.31 $38.48 $38.48 $38.48 $38.48 $292.47 330104 86360 395 309 HC T CELL ABSOLUTE COUNT/RATIO O $739.37 $46.98 $46.98 $46.98 $369.69 N/A N/A N/A $46.98 $89.26 $46.98 $46.98 $554.53 $51.68 $465.80 $540.48 $56.38 $46.98 $443.62 $591.50 $159.73 $267.79 $46.98 $46.98 $480.59 $65.77 $591.50 $46.98 $46.98 $56.38 $65.77 $46.98 $46.98 $46.98 $51.21 $591.50 $628.46 $63.42 $554.53 $96.31 $63.42 $369.69 $480.59 $66.01 $66.01 $66.01 $66.01 $79.34 $49.33 $46.98 $79.34 $46.98 $46.98 $35.23 $35.23 $35.23 $35.23 $628.46 330104 88237 308 310 HC TISSUE CULTURE BONE MARROW O $404.46 $143.75 $143.75 $100.03 $202.23 N/A N/A N/A $100.03 $273.12 $100.03 $143.75 $303.34 $158.12 $254.81 $295.66 $120.04 $100.03 $242.68 $323.57 $488.75 $819.38 $100.03 $143.75 $262.90 $140.04 $323.57 $100.03 $100.03 $120.04 $201.25 $100.03 $143.75 $143.75 $156.69 $323.57 $343.79 $135.04 $303.34 $205.06 $135.04 $202.23 $262.90 $201.97 $201.97 $201.97 $201.97 $213.29 $150.94 $143.75 $213.29 $100.03 $100.03 $107.81 $107.81 $107.81 $100.03 $819.38 330104 88233 308 310 HC TISSUE CULTURE SKIN/BIOPSY O $939.46 $140.73 $140.73 $131.91 $469.73 N/A N/A N/A $131.91 $267.39 $131.91 $140.73 $704.60 $154.80 $591.86 $686.75 $158.29 $131.91 $563.68 $751.57 $478.48 $802.16 $131.91 $140.73 $610.65 $184.67 $751.57 $131.91 $131.91 $158.29 $197.02 $131.91 $140.73 $140.73 $153.40 $751.57 $798.54 $178.08 $704.60 $270.42 $178.08 $469.73 $610.65 $197.73 $197.73 $197.73 $197.73 $237.65 $147.77 $140.73 $237.65 $131.91 $131.91 $105.55 $105.55 $105.55 $105.55 $802.16 330104 88230 308 310 HC TISSUE CULTURE LYMPHOCYTE O $326.35 $116.49 $116.49 $40.00 $163.18 N/A N/A N/A $40.00 $221.33 $40.00 $116.49 $244.76 $128.14 $205.60 $238.56 $48.00 $40.00 $195.81 $261.08 $396.07 $663.99 $40.00 $116.49 $212.13 $56.00 $261.08 $40.00 $40.00 $48.00 $163.09 $40.00 $116.49 $116.49 $126.97 $261.08 $277.40 $54.00 $244.76 $82.00 $54.00 $163.18 $212.13 $163.67 $163.67 $163.67 $163.67 $196.73 $122.31 $116.49 $196.73 $40.00 $40.00 $87.37 $87.37 $87.37 $40.00 $663.99 330104 88175 392 310 HC CYTOPATCER/VAGTHIN LAYERMAN RESINTER O $419.44 $26.61 $26.61 $26.61 $209.72 N/A N/A N/A $26.61 $50.56 $26.61 $26.61 $314.58 $29.27 $264.25 $306.61 $31.93 $26.61 $251.66 $335.55 $90.47 $151.68 $26.61 $26.61 $272.64 $37.25 $335.55 $26.61 $26.61 $31.93 $37.25 $26.61 $26.61 $26.61 $29.00 $335.55 $356.52 $35.92 $314.58 $54.55 $35.92 $209.72 $272.64 $37.39 $37.39 $37.39 $37.39 $44.74 $27.94 $26.61 $44.74 $26.61 $26.61 $19.96 $19.96 $19.96 $19.96 $356.52 330104 85097 5674 2044 310 HC BONE MARROW INTERPRETATION O $606.69 $931.61 $931.61 $20.22 $303.35 $68.03 $61.50 $922.29 $20.22 "$1,770.06 " $20.22 $931.61 $455.02 "$1,024.77 " $382.21 $443.49 $24.26 $20.22 $364.01 $485.35 "$3,167.47 " "$5,310.18 " $20.22 $931.61 "$1,117.93 " $28.31 $485.35 $20.22 $20.22 $24.26 "$1,304.25 " $20.22 $931.61 $931.61 "$1,015.46 " $485.35 $515.69 $20.22 $455.02 $41.45 $20.22 $303.35 "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $43.78 $978.19 $931.61 $43.78 $20.22 $20.22 $698.71 $698.71 $698.71 $20.22 "$5,310.18 " 330104 82725 400 310 HC ASSAY OF BLOOD FATTY ACIDS O $208.65 $18.77 $18.77 N/A $104.33 N/A N/A N/A N/A $35.66 N/A $18.77 $156.49 $20.65 $131.45 $152.52 N/A N/A $125.19 $166.92 $63.82 $106.99 N/A $18.77 $135.62 N/A $166.92 N/A N/A N/A $26.28 N/A $18.77 $18.77 $20.46 $166.92 $177.35 N/A $156.49 N/A N/A $104.33 $135.62 $26.37 $26.37 $26.37 $26.37 $22.49 $19.71 $18.77 $22.49 N/A N/A $14.08 $14.08 $14.08 $14.08 $177.35 330104 81554 2045 310 HC PULM DS IPF MRNA 190 GEN ALG O $169.06 "$5,520.00 " "$5,520.00 " N/A $84.53 N/A N/A N/A N/A "$10,488.00 " N/A "$5,520.00 " $126.80 "$6,072.00 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$18,768.00 " "$31,464.00 " N/A "$5,520.00 " $109.89 N/A $135.25 N/A N/A N/A "$7,728.00 " N/A "$5,520.00 " "$5,520.00 " "$6,016.80 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$7,755.60 " "$7,755.60 " "$7,755.60 " "$7,755.60 " N/A "$5,796.00 " "$5,520.00 " $112.76 N/A N/A "$4,140.00 " "$4,140.00 " "$4,140.00 " $84.53 "$31,464.00 " 330104 81546 2045 310 "HC ONC THYR MRNA 10,196 GEN ALG" O $169.06 "$3,600.00 " "$3,600.00 " N/A $84.53 N/A N/A N/A N/A "$6,840.00 " N/A "$3,600.00 " $126.80 "$3,960.00 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$12,240.00 " "$20,520.00 " N/A "$3,600.00 " $109.89 N/A $135.25 N/A N/A N/A "$5,040.00 " N/A "$3,600.00 " "$3,600.00 " "$3,924.00 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$5,058.00 " "$5,058.00 " "$5,058.00 " "$5,058.00 " N/A "$3,780.00 " "$3,600.00 " $112.76 N/A N/A "$2,700.00 " "$2,700.00 " "$2,700.00 " $84.53 "$20,520.00 " 330104 81529 2045 310 HC ONC CUTAN MLNMA MRNA 31 GENE O $169.06 "$7,193.00 " "$7,193.00 " N/A $84.53 N/A N/A N/A N/A "$13,666.70 " N/A "$7,193.00 " $126.80 "$7,912.30 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$24,456.20 " "$41,000.10 " N/A "$7,193.00 " $109.89 N/A $135.25 N/A N/A N/A "$10,070.20 " N/A "$7,193.00 " "$7,193.00 " "$7,840.37 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$10,106.17 " "$10,106.17 " "$10,106.17 " "$10,106.17 " N/A "$7,552.65 " "$7,193.00 " $112.76 N/A N/A "$5,394.75 " "$5,394.75 " "$5,394.75 " $84.53 "$41,000.10 " 330104 81514 386 310 HC NFCT DS BV&VAGINITIS DNA ALG O $169.06 $262.99 $262.99 N/A $84.53 N/A N/A N/A N/A $499.68 N/A $262.99 $126.80 $289.29 $106.51 $123.58 N/A N/A $101.44 $135.25 $894.17 "$1,499.04 " N/A $262.99 $109.89 N/A $135.25 N/A N/A N/A $368.19 N/A $262.99 $262.99 $286.66 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $369.50 $369.50 $369.50 $369.50 N/A $276.14 $262.99 $112.76 N/A N/A $197.24 $197.24 $197.24 $84.53 "$1,499.04 " 330104 81513 386 310 HC NFCT DS BV RNA VAG FLU ALG O $169.06 $142.63 $142.63 N/A $84.53 N/A N/A N/A N/A $271.00 N/A $142.63 $126.80 $156.89 $106.51 $123.58 N/A N/A $101.44 $135.25 $484.94 $812.99 N/A $142.63 $109.89 N/A $135.25 N/A N/A N/A $199.68 N/A $142.63 $142.63 $155.47 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $200.40 $200.40 $200.40 $200.40 N/A $149.76 $142.63 $112.76 N/A N/A $106.97 $106.97 $106.97 $84.53 $812.99 330104 81450 2044 310 HC TARGETED GENOMIC SEQ ANALYS HEMATOLYMPHO O "$3,229.26 " $759.53 $759.53 N/A "$1,614.63 " N/A N/A N/A N/A "$1,443.11 " N/A $759.53 "$2,421.95 " $835.48 "$2,034.43 " "$2,360.59 " N/A N/A "$1,937.56 " "$2,583.41 " "$2,582.40 " "$4,329.32 " N/A $759.53 "$2,099.02 " N/A "$2,583.41 " N/A N/A N/A "$1,063.34 " N/A $759.53 $759.53 $827.89 "$2,583.41 " "$2,744.87 " N/A "$2,421.95 " N/A N/A "$1,614.63 " "$2,099.02 " "$1,067.14 " "$1,067.14 " "$1,067.14 " "$1,067.14 " $107.80 $797.51 $759.53 $107.80 N/A N/A $569.65 $569.65 $569.65 $107.80 "$4,329.32 " 330104 81419 2045 310 HC EPILEPSY GEN SEQ ALYS PANEL O $169.06 "$2,448.56 " "$2,448.56 " N/A $84.53 N/A N/A N/A N/A "$4,652.26 " N/A "$2,448.56 " $126.80 "$2,693.42 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$8,325.10 " "$13,956.79 " N/A "$2,448.56 " $109.89 N/A $135.25 N/A N/A N/A "$3,427.98 " N/A "$2,448.56 " "$2,448.56 " "$2,668.93 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$3,440.23 " "$3,440.23 " "$3,440.23 " "$3,440.23 " N/A "$2,570.99 " "$2,448.56 " $112.76 N/A N/A "$1,836.42 " "$1,836.42 " "$1,836.42 " $84.53 "$13,956.79 " 330104 81404 386 310 HC MOPATH PROCEDURE LEVEL 5 O $177.62 $274.83 $274.83 N/A $88.81 N/A N/A N/A N/A $522.18 N/A $274.83 $133.22 $302.31 $111.90 $129.84 N/A N/A $106.57 $142.10 $934.42 "$1,566.53 " N/A $274.83 $115.45 N/A $142.10 N/A N/A N/A $384.76 N/A $274.83 $274.83 $299.56 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $386.14 $386.14 $386.14 $386.14 $329.80 $288.57 $274.83 $329.80 N/A N/A $206.12 $206.12 $206.12 $88.81 "$1,566.53 " 330104 81206 386 310 HC BCR/ABL1 GENE MAJOR BP O $524.30 $163.96 $163.96 $163.96 $262.15 N/A N/A N/A $163.96 $311.52 $163.96 $163.96 $393.22 $180.36 $330.31 $383.26 $196.75 $163.96 $314.58 $419.44 $557.46 $934.57 $163.96 $163.96 $340.79 $229.54 $419.44 $163.96 $163.96 $196.75 $229.54 $163.96 $163.96 $163.96 $178.72 $419.44 $445.65 $221.35 $393.22 $336.12 $221.35 $262.15 $340.79 $230.36 $230.36 $230.36 $230.36 $268.43 $172.16 $163.96 $268.43 $163.96 $163.96 $122.97 $122.97 $122.97 $122.97 $934.57 330104 81403 386 310 HC MOPATH PROCEDURE LEVEL 4 O $177.62 $185.20 $185.20 N/A $88.81 N/A N/A N/A N/A $351.88 N/A $185.20 $133.22 $203.72 $111.90 $129.84 N/A N/A $106.57 $142.10 $629.68 "$1,055.64 " N/A $185.20 $115.45 N/A $142.10 N/A N/A N/A $259.28 N/A $185.20 $185.20 $201.87 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $260.21 $260.21 $260.21 $260.21 $222.24 $194.46 $185.20 $222.24 N/A N/A $138.90 $138.90 $138.90 $88.81 "$1,055.64 " 330104 81402 386 310 HC MOPATH PROCEDURE LEVEL 3 O $642.00 $150.33 $150.33 N/A $321.00 N/A N/A N/A N/A $285.63 N/A $150.33 $481.50 $165.36 $404.46 $469.30 N/A N/A $385.20 $513.60 $511.12 $856.88 N/A $150.33 $417.30 N/A $513.60 N/A N/A N/A $210.46 N/A $150.33 $150.33 $163.86 $513.60 $545.70 N/A $481.50 N/A N/A $321.00 $417.30 $211.21 $211.21 $211.21 $211.21 $180.40 $157.85 $150.33 $180.40 N/A N/A $112.75 $112.75 $112.75 $112.75 $856.88 330104 88264 386 310 HC CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS O "$1,951.68 " $144.61 $144.61 N/A $975.84 N/A N/A N/A N/A $274.76 N/A $144.61 "$1,463.76 " $159.07 "$1,229.56 " "$1,426.68 " N/A N/A "$1,171.01 " "$1,561.34 " $491.67 $824.28 N/A $144.61 "$1,268.59 " N/A "$1,561.34 " N/A N/A N/A $202.45 N/A $144.61 $144.61 $157.62 "$1,561.34 " "$1,658.93 " N/A "$1,463.76 " N/A N/A $975.84 "$1,268.59 " $203.18 $203.18 $203.18 $203.18 $210.48 $151.84 $144.61 $210.48 N/A N/A $108.46 $108.46 $108.46 $108.46 "$1,658.93 " 330104 88267 386 310 HC CHROMOSOME ANALYS PLACENTA O $728.67 $188.57 $188.57 $90.00 $364.33 N/A N/A N/A $90.00 $358.28 $90.00 $188.57 $546.50 $207.43 $459.06 $532.66 $108.00 $90.00 $437.20 $582.94 $641.14 "$1,074.85 " $90.00 $188.57 $473.64 $126.00 $582.94 $90.00 $90.00 $108.00 $264.00 $90.00 $188.57 $188.57 $205.54 $582.94 $619.37 $121.50 $546.50 $184.50 $121.50 $364.33 $473.64 $264.94 $264.94 $264.94 $264.94 $303.58 $198.00 $188.57 $303.58 $90.00 $90.00 $141.43 $141.43 $141.43 $90.00 "$1,074.85 " 330104 81207 386 310 HC BCR/ABL1 GENE MINOR BP O $524.30 $144.84 $144.84 $144.84 $262.15 N/A N/A N/A $144.84 $275.20 $144.84 $144.84 $393.22 $159.32 $330.31 $383.26 $173.81 $144.84 $314.58 $419.44 $492.46 $825.59 $144.84 $144.84 $340.79 $202.78 $419.44 $144.84 $144.84 $173.81 $202.78 $144.84 $144.84 $144.84 $157.88 $419.44 $445.65 $195.53 $393.22 $296.92 $195.53 $262.15 $340.79 $203.50 $203.50 $203.50 $203.50 $237.11 $152.08 $144.84 $237.11 $144.84 $144.84 $108.63 $108.63 $108.63 $108.63 $825.59 330104 88300 5731 305 310 HC SURGICAL PATH GROSS LEVEL 1 O $226.84 $29.95 $29.95 $57.35 $113.42 $25.04 $22.64 $29.65 $57.35 $56.90 $57.35 $29.95 $170.13 $32.94 $142.91 $165.82 $68.82 $57.35 $136.10 $181.47 $101.81 $170.69 $57.35 $29.95 $35.93 $80.29 $181.47 $57.35 $57.35 $68.82 $41.92 $57.35 $29.95 $29.95 $32.64 $181.47 $192.81 $57.35 $170.13 $117.57 $57.35 $113.42 $80.55 $42.07 $42.07 $42.07 $42.07 $20.48 $31.44 $29.95 $20.48 $57.35 $57.35 $22.46 $22.46 $22.46 $20.48 $192.81 330104 81168 386 310 HC CCND1/IGH TRANSLOCATION ALYS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81175 2044 310 HC ASXL1 FULL GENE SEQUENCE O "$2,912.54 " $676.50 $676.50 N/A "$1,456.27 " N/A N/A N/A N/A "$1,285.35 " N/A $676.50 "$2,184.40 " $744.15 "$1,834.90 " "$2,129.07 " N/A N/A "$1,747.52 " "$2,330.03 " "$2,300.10 " "$3,856.05 " N/A $676.50 "$1,893.15 " N/A "$2,330.03 " N/A N/A N/A $947.10 N/A $676.50 $676.50 $737.39 "$2,330.03 " "$2,475.66 " N/A "$2,184.40 " N/A N/A "$1,456.27 " "$1,893.15 " $950.48 $950.48 $950.48 $950.48 $848.42 $710.33 $676.50 $848.42 N/A N/A $507.38 $507.38 $507.38 $507.38 "$3,856.05 " 330104 81191 386 310 HC NTRK1 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81192 386 310 HC NTRK2 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81193 386 310 HC NTRK3 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81194 387 310 HC NTRK TRANSLOCATION ANALYSIS O $169.06 $518.28 $518.28 $310.97 $84.53 N/A N/A N/A $310.97 $984.73 $310.97 $518.28 $126.80 $570.11 $106.51 $123.58 $373.16 $310.97 $101.44 $135.25 "$1,762.15 " "$2,954.20 " $310.97 $518.28 $109.89 $435.36 $135.25 $310.97 $310.97 $373.16 $725.59 $310.97 $518.28 $518.28 $564.93 $135.25 $143.70 $419.81 $126.80 $637.49 $419.81 $84.53 $109.89 $728.18 $728.18 $728.18 $728.18 N/A $544.19 $518.28 $112.76 $310.97 $310.97 $388.71 $388.71 $388.71 $84.53 "$2,954.20 " 330104 88323 5671 158 310 HC MICROSLIDE CONSULTATION;REQUIRING SLIDE PREP O $204.37 $60.15 $60.15 N/A $102.19 $162.36 $146.77 $59.55 N/A $114.29 N/A $60.15 $153.28 $66.17 $128.75 $149.39 N/A N/A $122.62 $163.50 $204.53 $342.88 N/A $60.15 $72.19 N/A $163.50 N/A N/A N/A $84.22 N/A $60.15 $60.15 $65.57 $163.50 $173.71 N/A $153.28 N/A N/A $102.19 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 N/A N/A $45.12 $45.12 $45.12 $43.78 $342.88 330104 88319 5674 306 310 HC ENZYME HISTOCHEMISTRY O "$2,895.42 " $931.61 $931.61 $35.19 "$1,447.71 " $205.30 $185.59 $922.29 $35.19 "$1,770.06 " $35.19 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $42.23 $35.19 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $35.19 $931.61 "$1,117.93 " $49.27 "$2,316.34 " $35.19 $35.19 $42.23 "$1,304.25 " $35.19 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $35.19 "$2,171.57 " $72.14 $35.19 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $43.78 $978.19 $931.61 $43.78 $35.19 $35.19 $698.71 $698.71 $698.71 $35.19 "$5,310.18 " 330104 88314 306 310 HC HISTOCHEMICAL STAINS ADD-ON O $449.40 N/A N/A $80.82 $224.70 $136.57 $123.46 $108.16 $80.82 N/A $80.82 N/A $337.05 N/A $283.12 $328.51 $96.99 $80.82 $269.64 $359.52 N/A N/A $80.82 N/A $292.11 $113.15 $359.52 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $359.52 $381.99 $109.11 $337.05 $165.68 $109.11 $224.70 $292.11 N/A N/A N/A N/A $20.48 N/A N/A $20.48 $80.82 $80.82 N/A N/A N/A $20.48 $381.99 330104 88313 5732 305 310 HC SPECIAL STAINS GROUP 2 O $260.01 $40.74 $40.74 $9.88 $130.00 $124.61 $112.65 $40.34 $9.88 $77.41 $9.88 $40.74 $195.01 $44.82 $163.81 $190.07 $11.86 $9.88 $156.01 $208.01 $138.53 $232.24 $9.88 $40.74 $48.89 $13.83 $208.01 $9.88 $9.88 $11.86 $57.04 $9.88 $40.74 $40.74 $44.41 $208.01 $221.01 $9.88 $195.01 $20.25 $9.88 $130.00 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $9.88 $9.88 $30.56 $30.56 $30.56 $9.88 $232.24 330104 88312 5671 305 310 HC SPECIAL STAINS GROUP 1 O $300.67 $60.15 $60.15 $13.18 $150.34 $169.35 $153.09 $59.55 $13.18 $114.29 $13.18 $60.15 $225.50 $66.17 $189.42 $219.79 $15.82 $13.18 $180.40 $240.54 $204.53 $342.88 $13.18 $60.15 $72.19 $18.45 $240.54 $13.18 $13.18 $15.82 $84.22 $13.18 $60.15 $60.15 $65.57 $240.54 $255.57 $13.18 $225.50 $27.02 $13.18 $150.34 $161.82 $84.52 $84.52 $84.52 $84.52 $20.48 $63.16 $60.15 $20.48 $13.18 $13.18 $45.12 $45.12 $45.12 $13.18 $342.88 330104 88311 305 310 HC DECALCIFY TISSUE O $249.31 N/A N/A $57.35 $124.66 $30.66 $27.72 $24.28 $57.35 N/A $57.35 N/A $186.98 N/A $157.07 $182.25 $68.82 $57.35 $149.59 $199.45 N/A N/A $57.35 N/A $162.05 $80.29 $199.45 $57.35 $57.35 $68.82 N/A $57.35 N/A N/A N/A $199.45 $211.91 $77.43 $186.98 $117.57 $77.43 $124.66 $162.05 N/A N/A N/A N/A $13.25 N/A N/A $13.25 $57.35 $57.35 N/A N/A N/A $13.25 $211.91 330104 88309 5674 306 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL VI O "$2,895.42 " $931.61 $931.61 $264.99 "$1,447.71 " $654.16 $591.36 $922.29 $264.99 "$1,770.06 " $264.99 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $317.99 $264.99 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $264.99 $931.61 "$1,117.93 " $370.99 "$2,316.34 " $264.99 $264.99 $317.99 "$1,304.25 " $264.99 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $264.99 "$2,171.57 " $543.23 $264.99 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $67.70 $978.19 $931.61 $67.70 $264.99 $264.99 $698.71 $698.71 $698.71 $67.70 "$5,310.18 " 330104 88307 5673 306 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL V O "$1,676.69 " $388.85 $388.85 $174.41 $838.35 $436.77 $394.84 $384.96 $174.41 $738.81 $174.41 $388.85 "$1,257.52 " $427.73 "$1,056.31 " "$1,225.66 " $209.29 $174.41 "$1,006.01 " "$1,341.35 " "$1,322.08 " "$2,216.43 " $174.41 $388.85 $466.62 $244.17 "$1,341.35 " $174.41 $174.41 $209.29 $544.39 $174.41 $388.85 $388.85 $423.84 "$1,341.35 " "$1,425.19 " $174.41 "$1,257.52 " $357.54 $174.41 $838.35 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $67.70 $408.29 $388.85 $67.70 $174.41 $174.41 $291.64 $291.64 $291.64 $67.70 "$2,216.43 " 330104 88305 5671 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL IV O "$1,035.76 " $60.15 $60.15 $43.19 $517.88 $104.81 $94.75 $59.55 $43.19 $114.29 $43.19 $60.15 $776.82 $66.17 $652.53 $757.14 $51.83 $43.19 $621.46 $828.61 $204.53 $342.88 $43.19 $60.15 $72.19 $60.47 $828.61 $43.19 $43.19 $51.83 $84.22 $43.19 $60.15 $60.15 $65.57 $828.61 $880.40 $43.19 $776.82 $88.54 $43.19 $517.88 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $43.19 $43.19 $45.12 $45.12 $45.12 $43.19 $880.40 330104 88304 5671 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL III O $823.90 $60.15 $60.15 $25.33 $411.95 $64.67 $58.47 $59.55 $25.33 $114.29 $25.33 $60.15 $617.92 $66.17 $519.06 $602.27 $30.40 $25.33 $494.34 $659.12 $204.53 $342.88 $25.33 $60.15 $72.19 $35.46 $659.12 $25.33 $25.33 $30.40 $84.22 $25.33 $60.15 $60.15 $65.57 $659.12 $700.31 $25.33 $617.92 $51.93 $25.33 $411.95 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $25.33 $25.33 $45.12 $45.12 $45.12 $25.33 $700.31 330104 88302 5731 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL II O $527.51 $29.95 $29.95 $19.31 $263.75 $50.38 $45.54 $29.65 $19.31 $56.90 $19.31 $29.95 $395.63 $32.94 $332.33 $385.61 $23.17 $19.31 $316.51 $422.01 $101.81 $170.69 $19.31 $29.95 $35.93 $27.03 $422.01 $19.31 $19.31 $23.17 $41.92 $19.31 $29.95 $29.95 $32.64 $422.01 $448.38 $19.31 $395.63 $39.59 $19.31 $263.75 $80.55 $42.07 $42.07 $42.07 $42.07 $20.48 $31.44 $29.95 $20.48 $19.31 $19.31 $22.46 $22.46 $22.46 $19.31 $448.38 330104 81401 386 310 HC MOPATH PROCEDURE LEVEL 2 O $177.62 $137.00 $137.00 N/A $88.81 N/A N/A N/A N/A $260.30 N/A $137.00 $133.22 $150.70 $111.90 $129.84 N/A N/A $106.57 $142.10 $465.80 $780.90 N/A $137.00 $115.45 N/A $142.10 N/A N/A N/A $191.80 N/A $137.00 $137.00 $149.33 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $192.49 $192.49 $192.49 $192.49 $164.40 $143.85 $137.00 $164.40 N/A N/A $102.75 $102.75 $102.75 $88.81 $780.90 330104 88271 385 310 HC CYTOGENETICS DNA PROBE O $284.62 $21.42 $21.42 $21.42 $142.31 N/A N/A N/A $21.42 $40.70 $21.42 $21.42 $213.47 $23.56 $179.31 $208.06 $25.70 $21.42 $170.77 $227.70 $72.83 $122.09 $21.42 $21.42 $185.00 $29.99 $227.70 $21.42 $21.42 $25.70 $29.99 $21.42 $21.42 $21.42 $23.35 $227.70 $241.93 $28.92 $213.47 $43.91 $28.92 $142.31 $185.00 $30.10 $30.10 $30.10 $30.10 $36.17 $22.49 $21.42 $36.17 $21.42 $21.42 $16.07 $16.07 $16.07 $16.07 $241.93 330104 81400 385 310 HC MOPATH PROCEDURE LEVEL 1 O $328.49 $63.96 $63.96 N/A $164.25 N/A N/A N/A N/A $121.52 N/A $63.96 $246.37 $70.36 $206.95 $240.13 N/A N/A $197.09 $262.79 $217.46 $364.57 N/A $63.96 $213.52 N/A $262.79 N/A N/A N/A $89.54 N/A $63.96 $63.96 $69.72 $262.79 $279.22 N/A $246.37 N/A N/A $164.25 $213.52 $89.86 $89.86 $89.86 $89.86 $76.75 $67.16 $63.96 $76.75 N/A N/A $47.97 $47.97 $47.97 $47.97 $364.57 330104 81377 385 310 HC HLA II TYPE 1 AG EQUIV LR O $276.06 $94.74 $94.74 N/A $138.03 N/A N/A N/A N/A $180.01 N/A $94.74 $207.05 $104.21 $173.92 $201.80 N/A N/A $165.64 $220.85 $322.12 $540.02 N/A $94.74 $179.44 N/A $220.85 N/A N/A N/A $132.64 N/A $94.74 $94.74 $103.27 $220.85 $234.65 N/A $207.05 N/A N/A $138.03 $179.44 $133.11 $133.11 $133.11 $133.11 $150.30 $99.48 $94.74 $150.30 N/A N/A $71.05 $71.05 $71.05 $71.05 $540.02 330104 81276 386 310 HC KRAS GENE ADDL VARIANTS O $918.06 $193.25 $193.25 $118.31 $459.03 N/A N/A N/A $118.31 $367.17 $118.31 $193.25 $688.54 $212.58 $578.38 $671.10 $141.97 $118.31 $550.84 $734.45 $657.05 "$1,101.53 " $118.31 $193.25 $596.74 $165.63 $734.45 $118.31 $118.31 $141.97 $270.55 $118.31 $193.25 $193.25 $210.64 $734.45 $780.35 $159.72 $688.54 $242.54 $159.72 $459.03 $596.74 $271.52 $271.52 $271.52 $271.52 $236.63 $202.91 $193.25 $236.63 $118.31 $118.31 $144.94 $144.94 $144.94 $118.31 "$1,101.53 " 330104 81275 386 310 HC KRAS GENE O $786.45 $193.25 $193.25 $193.25 $393.23 N/A N/A N/A $193.25 $367.17 $193.25 $193.25 $589.84 $212.58 $495.46 $574.89 $231.90 $193.25 $471.87 $629.16 $657.05 "$1,101.53 " $193.25 $193.25 $511.19 $270.55 $629.16 $193.25 $193.25 $231.90 $270.55 $193.25 $193.25 $193.25 $210.64 $629.16 $668.48 $260.89 $589.84 $396.16 $260.89 $393.23 $511.19 $271.52 $271.52 $271.52 $271.52 $236.98 $202.91 $193.25 $236.98 $193.25 $193.25 $144.94 $144.94 $144.94 $144.94 "$1,101.53 " 330104 81273 385 310 HC KIT GENE ANALYS D816 VARIANT O $532.86 $124.87 $124.87 N/A $266.43 N/A N/A N/A N/A $237.25 N/A $124.87 $399.64 $137.36 $335.70 $389.52 N/A N/A $319.72 $426.29 $424.56 $711.76 N/A $124.87 $346.36 N/A $426.29 N/A N/A N/A $174.82 N/A $124.87 $124.87 $136.11 $426.29 $452.93 N/A $399.64 N/A N/A $266.43 $346.36 $175.44 $175.44 $175.44 $175.44 $149.84 $131.11 $124.87 $149.84 N/A N/A $93.65 $93.65 $93.65 $93.65 $711.76 330104 81270 385 310 HC JAK2 GENE O $916.99 $91.66 $91.66 N/A $458.50 N/A N/A N/A N/A $174.15 N/A $91.66 $687.74 $100.83 $577.70 $670.32 N/A N/A $550.19 $733.59 $311.64 $522.46 N/A $91.66 $596.04 N/A $733.59 N/A N/A N/A $128.32 N/A $91.66 $91.66 $99.91 $733.59 $779.44 N/A $687.74 N/A N/A $458.50 $596.04 $128.78 $128.78 $128.78 $128.78 $150.07 $96.24 $91.66 $150.07 N/A N/A $68.75 $68.75 $68.75 $68.75 $779.44 330104 81256 385 310 HC HFE GENE O "$1,043.25 " $65.36 $65.36 N/A $521.62 N/A N/A N/A N/A $124.18 N/A $65.36 $782.44 $71.90 $657.25 $762.62 N/A N/A $625.95 $834.60 $222.22 $372.55 N/A $65.36 $678.11 N/A $834.60 N/A N/A N/A $91.50 N/A $65.36 $65.36 $71.24 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $91.83 $91.83 $91.83 $91.83 $107.00 $68.63 $65.36 $107.00 N/A N/A $49.02 $49.02 $49.02 $49.02 $886.76 330104 81251 385 310 HC GBA GENE O $155.15 $47.25 $47.25 N/A $77.58 N/A N/A N/A N/A $89.77 N/A $47.25 $116.36 $51.98 $97.74 $113.41 N/A N/A $93.09 $124.12 $160.65 $269.32 N/A $47.25 $100.85 N/A $124.12 N/A N/A N/A $66.15 N/A $47.25 $47.25 $51.50 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $66.39 $66.39 $66.39 $66.39 $56.70 $49.61 $47.25 $56.70 N/A N/A $35.44 $35.44 $35.44 $35.44 $269.32 330104 81246 385 310 HC FLT3 GENE ANALYSIS O $303.88 $83.00 $83.00 $83.00 $151.94 N/A N/A N/A $83.00 $157.70 $83.00 $83.00 $227.91 $91.30 $191.44 $222.14 $99.60 $83.00 $182.33 $243.10 $282.20 $473.10 $83.00 $83.00 $197.52 $116.20 $243.10 $83.00 $83.00 $99.60 $116.20 $83.00 $83.00 $83.00 $90.47 $243.10 $258.30 $112.05 $227.91 $170.15 $112.05 $151.94 $197.52 $116.62 $116.62 $116.62 $116.62 $99.61 $87.15 $83.00 $99.61 $83.00 $83.00 $62.25 $62.25 $62.25 $62.25 $473.10 330104 81245 386 310 HC FLT3 GENE O $606.69 $165.51 $165.51 $165.51 $303.35 N/A N/A N/A $165.51 $314.47 $165.51 $165.51 $455.02 $182.06 $382.21 $443.49 $198.61 $165.51 $364.01 $485.35 $562.73 $943.41 $165.51 $165.51 $394.35 $231.71 $485.35 $165.51 $165.51 $198.61 $231.71 $165.51 $165.51 $165.51 $180.41 $485.35 $515.69 $223.44 $455.02 $339.30 $223.44 $303.35 $394.35 $232.54 $232.54 $232.54 $232.54 $199.10 $173.79 $165.51 $199.10 $165.51 $165.51 $124.13 $124.13 $124.13 $124.13 $943.41 330104 81244 385 310 HC FMR1 GENE CHARACTERIZATION O $169.06 $44.89 $44.89 N/A $84.53 N/A N/A N/A N/A $85.29 N/A $44.89 $126.80 $49.38 $106.51 $123.58 N/A N/A $101.44 $135.25 $152.63 $255.87 N/A $44.89 $109.89 N/A $135.25 N/A N/A N/A $62.85 N/A $44.89 $44.89 $48.93 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $63.07 $63.07 $63.07 $63.07 $53.87 $47.13 $44.89 $53.87 N/A N/A $33.67 $33.67 $33.67 $33.67 $255.87 330104 81241 385 310 HC F5 GENE O $842.09 $73.37 $73.37 $73.37 $421.05 N/A N/A N/A $73.37 $139.40 $73.37 $73.37 $631.57 $80.71 $530.52 $615.57 $88.04 $73.37 $505.25 $673.67 $249.46 $418.21 $73.37 $73.37 $547.36 $102.72 $673.67 $73.37 $73.37 $88.04 $102.72 $73.37 $73.37 $73.37 $79.97 $673.67 $715.78 $99.05 $631.57 $150.41 $99.05 $421.05 $547.36 $103.08 $103.08 $103.08 $103.08 $100.04 $77.04 $73.37 $100.04 $73.37 $73.37 $55.03 $55.03 $55.03 $55.03 $715.78 330104 81240 385 310 HC F2 GENE O $503.97 $65.69 $65.69 $65.69 $251.99 N/A N/A N/A $65.69 $124.81 $65.69 $65.69 $377.98 $72.26 $317.50 $368.40 $78.83 $65.69 $302.38 $403.18 $223.35 $374.43 $65.69 $65.69 $327.58 $91.97 $403.18 $65.69 $65.69 $78.83 $91.97 $65.69 $65.69 $65.69 $71.60 $403.18 $428.37 $88.68 $377.98 $134.66 $88.68 $251.99 $327.58 $92.29 $92.29 $92.29 $92.29 $80.56 $68.97 $65.69 $80.56 $65.69 $65.69 $49.27 $49.27 $49.27 $49.27 $428.37 330104 81235 387 310 HC EGFR GENE COM VARIANTS O "$1,417.75 " $324.58 $324.58 N/A $708.88 N/A N/A N/A N/A $616.70 N/A $324.58 "$1,063.31 " $357.04 $893.18 "$1,036.38 " N/A N/A $850.65 "$1,134.20 " "$1,103.57 " "$1,850.11 " N/A $324.58 $921.54 N/A "$1,134.20 " N/A N/A N/A $454.41 N/A $324.58 $324.58 $353.79 "$1,134.20 " "$1,205.09 " N/A "$1,063.31 " N/A N/A $708.88 $921.54 $456.03 $456.03 $456.03 $456.03 $396.01 $340.81 $324.58 $396.01 N/A N/A $243.44 $243.44 $243.44 $243.44 "$1,850.11 " 330104 81229 2045 310 HC CYTOGEN M ARRAY COPY NO&SNP O "$1,606.07 " "$1,160.00 " "$1,160.00 " N/A $803.03 N/A N/A N/A N/A "$2,204.00 " N/A "$1,160.00 " "$1,204.55 " "$1,276.00 " "$1,011.82 " "$1,174.04 " N/A N/A $963.64 "$1,284.86 " "$3,944.00 " "$6,612.00 " N/A "$1,160.00 " "$1,043.95 " N/A "$1,284.86 " N/A N/A N/A "$1,624.00 " N/A "$1,160.00 " "$1,160.00 " "$1,264.40 " "$1,284.86 " "$1,365.16 " N/A "$1,204.55 " N/A N/A $803.03 "$1,043.95 " "$1,629.80 " "$1,629.80 " "$1,629.80 " "$1,629.80 " "$1,392.00 " "$1,218.00 " "$1,160.00 " "$1,392.00 " N/A N/A $870.00 $870.00 $870.00 $803.03 "$6,612.00 " 330104 81220 387 310 HC CFTR GENE COM VARIANTS O "$2,272.68 " $556.60 $556.60 $325.00 "$1,136.34 " N/A N/A N/A $325.00 "$1,057.54 " $325.00 $556.60 "$1,704.51 " $612.26 "$1,431.79 " "$1,661.33 " $390.00 $325.00 "$1,363.61 " "$1,818.14 " "$1,892.44 " "$3,172.62 " $325.00 $556.60 "$1,477.24 " $455.00 "$1,818.14 " $325.00 $325.00 $390.00 $779.24 $325.00 $556.60 $556.60 $606.69 "$1,818.14 " "$1,931.78 " $438.75 "$1,704.51 " $666.25 $438.75 "$1,136.34 " "$1,477.24 " $782.02 $782.02 $782.02 $782.02 $667.92 $584.43 $556.60 $667.92 $325.00 $325.00 $417.45 $417.45 $417.45 $325.00 "$3,172.62 " 330104 81121 386 310 HC IDH2 COMMON VARIANTS O "$1,092.47 " $295.79 $295.79 N/A $546.24 N/A N/A N/A N/A $562.00 N/A $295.79 $819.35 $325.37 $688.26 $798.60 N/A N/A $655.48 $873.98 "$1,005.69 " "$1,686.00 " N/A $295.79 $710.11 N/A $873.98 N/A N/A N/A $414.11 N/A $295.79 $295.79 $322.41 $873.98 $928.60 N/A $819.35 N/A N/A $546.24 $710.11 $415.58 $415.58 $415.58 $415.58 $354.95 $310.58 $295.79 $354.95 N/A N/A $221.84 $221.84 $221.84 $221.84 "$1,686.00 " 330104 81219 385 310 HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 O $642.00 $121.63 $121.63 N/A $321.00 N/A N/A N/A N/A $231.10 N/A $121.63 $481.50 $133.79 $404.46 $469.30 N/A N/A $385.20 $513.60 $413.54 $693.29 N/A $121.63 $417.30 N/A $513.60 N/A N/A N/A $170.28 N/A $121.63 $121.63 $132.58 $513.60 $545.70 N/A $481.50 N/A N/A $321.00 $417.30 $170.89 $170.89 $170.89 $170.89 $198.82 $127.71 $121.63 $198.82 N/A N/A $91.22 $91.22 $91.22 $91.22 $693.29 330104 81210 386 310 HC BRAF GENE O $674.10 $175.40 $175.40 $175.40 $337.05 N/A N/A N/A $175.40 $333.26 $175.40 $175.40 $505.58 $192.94 $424.68 $492.77 $210.48 $175.40 $404.46 $539.28 $596.36 $999.78 $175.40 $175.40 $438.17 $245.56 $539.28 $175.40 $175.40 $210.48 $245.56 $175.40 $175.40 $175.40 $191.19 $539.28 $572.99 $236.79 $505.58 $359.57 $236.79 $337.05 $438.17 $246.44 $246.44 $246.44 $246.44 $215.10 $184.17 $175.40 $215.10 $175.40 $175.40 $131.55 $131.55 $131.55 $131.55 $999.78 330104 81278 386 310 HC IGH@/BCL2 TRANSLOCATION ALYS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81383 385 310 HC HLA II TYPING 1 ALLELE HR O $739.37 $109.13 $109.13 N/A $369.69 N/A N/A N/A N/A $207.35 N/A $109.13 $554.53 $120.04 $465.80 $540.48 N/A N/A $443.62 $591.50 $371.04 $622.04 N/A $109.13 $480.59 N/A $591.50 N/A N/A N/A $152.78 N/A $109.13 $109.13 $118.95 $591.50 $628.46 N/A $554.53 N/A N/A $369.69 $480.59 $153.33 $153.33 $153.33 $153.33 $178.66 $114.59 $109.13 $178.66 N/A N/A $81.85 $81.85 $81.85 $81.85 $628.46 330104 81279 386 310 HC JAK2 GENE TRGT SEQUENCE ALYS O $169.06 $185.20 $185.20 $111.12 $84.53 N/A N/A N/A $111.12 $351.88 $111.12 $185.20 $126.80 $203.72 $106.51 $123.58 $133.34 $111.12 $101.44 $135.25 $629.68 "$1,055.64 " $111.12 $185.20 $109.89 $155.57 $135.25 $111.12 $111.12 $133.34 $259.28 $111.12 $185.20 $185.20 $201.87 $135.25 $143.70 $150.01 $126.80 $227.80 $150.01 $84.53 $109.89 $260.21 $260.21 $260.21 $260.21 N/A $194.46 $185.20 $112.76 $111.12 $111.12 $138.90 $138.90 $138.90 $84.53 "$1,055.64 " 330104 81301 386 310 HC MICROSATELLITE INSTABILITY O "$1,826.49 " $348.56 $348.56 $348.56 $913.25 N/A N/A N/A $348.56 $662.26 $348.56 $348.56 "$1,369.87 " $383.42 "$1,150.69 " "$1,335.16 " $418.27 $348.56 "$1,095.89 " "$1,461.19 " "$1,185.10 " "$1,986.79 " $348.56 $348.56 "$1,187.22 " $487.98 "$1,461.19 " $348.56 $348.56 $418.27 $487.98 $348.56 $348.56 $348.56 $379.93 "$1,461.19 " "$1,552.52 " $470.56 "$1,369.87 " $714.55 $470.56 $913.25 "$1,187.22 " $489.73 $489.73 $489.73 $489.73 $474.05 $365.99 $348.56 $474.05 $348.56 $348.56 $261.42 $261.42 $261.42 $261.42 "$1,986.79 " 330104 81376 385 310 HC HLA II TYPING 1 LOCUS LR O $485.78 $122.22 $122.22 N/A $242.89 N/A N/A N/A N/A $232.22 N/A $122.22 $364.33 $134.44 $306.04 $355.11 N/A N/A $291.47 $388.62 $415.55 $696.65 N/A $122.22 $315.76 N/A $388.62 N/A N/A N/A $171.11 N/A $122.22 $122.22 $133.22 $388.62 $412.91 N/A $364.33 N/A N/A $242.89 $315.76 $171.72 $171.72 $171.72 $171.72 $200.09 $128.33 $122.22 $200.09 N/A N/A $91.66 $91.66 $91.66 $91.66 $696.65 330104 81360 386 310 HC ZRSR2 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81357 386 310 HC U2AF1 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81353 386 310 HC TP53 GENE KNOWN FAMIL VRNT O $169.06 $308.00 $308.00 $184.80 $84.53 N/A N/A N/A $184.80 $585.20 $184.80 $308.00 $126.80 $338.80 $106.51 $123.58 $221.76 $184.80 $101.44 $135.25 "$1,047.20 " "$1,755.60 " $184.80 $308.00 $109.89 $258.72 $135.25 $184.80 $184.80 $221.76 $431.20 $184.80 $308.00 $308.00 $335.72 $135.25 $143.70 $249.48 $126.80 $378.84 $249.48 $84.53 $109.89 $432.74 $432.74 $432.74 $432.74 N/A $323.40 $308.00 $112.76 $184.80 $184.80 $231.00 $231.00 $231.00 $84.53 "$1,755.60 " 330104 81352 386 310 HC TP53 GENE TRGT SEQUENCE ALYS O $169.06 $329.51 $329.51 $197.71 $84.53 N/A N/A N/A $197.71 $626.07 $197.71 $329.51 $126.80 $362.46 $106.51 $123.58 $237.25 $197.71 $101.44 $135.25 "$1,120.33 " "$1,878.21 " $197.71 $329.51 $109.89 $276.79 $135.25 $197.71 $197.71 $237.25 $461.31 $197.71 $329.51 $329.51 $359.17 $135.25 $143.70 $266.91 $126.80 $405.31 $266.91 $84.53 $109.89 $462.96 $462.96 $462.96 $462.96 N/A $345.99 $329.51 $112.76 $197.71 $197.71 $247.13 $247.13 $247.13 $84.53 "$1,878.21 " 330104 81351 2044 310 HC TP53 GENE FULL GENE SEQUENCE O $169.06 $641.85 $641.85 $385.11 $84.53 N/A N/A N/A $385.11 "$1,219.51 " $385.11 $641.85 $126.80 $706.04 $106.51 $123.58 $462.13 $385.11 $101.44 $135.25 "$2,182.29 " "$3,658.55 " $385.11 $641.85 $109.89 $539.15 $135.25 $385.11 $385.11 $462.13 $898.59 $385.11 $641.85 $641.85 $699.62 $135.25 $143.70 $519.90 $126.80 $789.48 $519.90 $84.53 $109.89 $901.80 $901.80 $901.80 $901.80 N/A $673.94 $641.85 $112.76 $385.11 $385.11 $481.39 $481.39 $481.39 $84.53 "$3,658.55 " 330104 81350 386 310 HC UGT1A1 GENE O $916.99 $234.00 $234.00 N/A $458.50 N/A N/A N/A N/A $444.60 N/A $234.00 $687.74 $257.40 $577.70 $670.32 N/A N/A $550.19 $733.59 $795.60 "$1,333.80 " N/A $234.00 $596.04 N/A $733.59 N/A N/A N/A $327.60 N/A $234.00 $234.00 $255.06 $733.59 $779.44 N/A $687.74 N/A N/A $458.50 $596.04 $328.77 $328.77 $328.77 $328.77 $280.80 $245.70 $234.00 $280.80 N/A N/A $175.50 $175.50 $175.50 $175.50 "$1,333.80 " 330104 81348 386 310 HC SRSF2 GENE COMMON VARIANTS O $169.06 $175.40 $175.40 $105.24 $84.53 N/A N/A N/A $105.24 $333.26 $105.24 $175.40 $126.80 $192.94 $106.51 $123.58 $126.29 $105.24 $101.44 $135.25 $596.36 $999.78 $105.24 $175.40 $109.89 $147.34 $135.25 $105.24 $105.24 $126.29 $245.56 $105.24 $175.40 $175.40 $191.19 $135.25 $143.70 $142.07 $126.80 $215.74 $142.07 $84.53 $109.89 $246.44 $246.44 $246.44 $246.44 N/A $184.17 $175.40 $112.76 $105.24 $105.24 $131.55 $131.55 $131.55 $84.53 $999.78 330104 81347 386 310 HC SF3B1 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81342 386 310 HC TRG GENE REARRANGEMENT ANAL O "$1,274.37 " $201.50 $201.50 N/A $637.18 N/A N/A N/A N/A $382.85 N/A $201.50 $955.78 $221.65 $802.85 $931.56 N/A N/A $764.62 "$1,019.50 " $685.10 "$1,148.55 " N/A $201.50 $828.34 N/A "$1,019.50 " N/A N/A N/A $282.10 N/A $201.50 $201.50 $219.64 "$1,019.50 " "$1,083.21 " N/A $955.78 N/A N/A $637.18 $828.34 $283.11 $283.11 $283.11 $283.11 $329.88 $211.58 $201.50 $329.88 N/A N/A $151.12 $151.12 $151.12 $151.12 "$1,148.55 " 330104 81340 386 310 HC TRB@ GENE REARRANGE AMPLIFY O "$1,317.17 " $208.92 $208.92 N/A $658.59 N/A N/A N/A N/A $396.95 N/A $208.92 $987.88 $229.81 $829.82 $962.85 N/A N/A $790.30 "$1,053.74 " $710.33 "$1,190.84 " N/A $208.92 $856.16 N/A "$1,053.74 " N/A N/A N/A $292.49 N/A $208.92 $208.92 $227.72 "$1,053.74 " "$1,119.59 " N/A $987.88 N/A N/A $658.59 $856.16 $293.53 $293.53 $293.53 $293.53 $342.02 $219.37 $208.92 $342.02 N/A N/A $156.69 $156.69 $156.69 $156.69 "$1,190.84 " 330104 81339 386 310 HC MPL GENE SEQ ALYS EXON 10 O $169.06 $185.20 $185.20 $111.12 $84.53 N/A N/A N/A $111.12 $351.88 $111.12 $185.20 $126.80 $203.72 $106.51 $123.58 $133.34 $111.12 $101.44 $135.25 $629.68 "$1,055.64 " $111.12 $185.20 $109.89 $155.57 $135.25 $111.12 $111.12 $133.34 $259.28 $111.12 $185.20 $185.20 $201.87 $135.25 $143.70 $150.01 $126.80 $227.80 $150.01 $84.53 $109.89 $260.21 $260.21 $260.21 $260.21 N/A $194.46 $185.20 $112.76 $111.12 $111.12 $138.90 $138.90 $138.90 $84.53 "$1,055.64 " 330104 81338 386 310 HC MPL GENE COMMON VARIANTS O $169.06 $150.33 $150.33 $90.20 $84.53 N/A N/A N/A $90.20 $285.63 $90.20 $150.33 $126.80 $165.36 $106.51 $123.58 $108.24 $90.20 $101.44 $135.25 $511.12 $856.88 $90.20 $150.33 $109.89 $126.28 $135.25 $90.20 $90.20 $108.24 $210.46 $90.20 $150.33 $150.33 $163.86 $135.25 $143.70 $121.77 $126.80 $184.91 $121.77 $84.53 $109.89 $211.21 $211.21 $211.21 $211.21 N/A $157.85 $150.33 $112.76 $90.20 $90.20 $112.75 $112.75 $112.75 $84.53 $856.88 330104 81334 386 310 HC RUNX1 GENE TARGETED SEQ O "$1,213.38 " $329.51 $329.51 N/A $606.69 N/A N/A N/A N/A $626.07 N/A $329.51 $910.04 $362.46 $764.43 $886.98 N/A N/A $728.03 $970.70 "$1,120.33 " "$1,878.21 " N/A $329.51 $788.70 N/A $970.70 N/A N/A N/A $461.31 N/A $329.51 $329.51 $359.17 $970.70 "$1,031.37 " N/A $910.04 N/A N/A $606.69 $788.70 $462.96 $462.96 $462.96 $462.96 $395.41 $345.99 $329.51 $395.41 N/A N/A $247.13 $247.13 $247.13 $247.13 "$1,878.21 " 330104 81329 386 310 HC SMN1 GENE DOS/DELETION ALYS O $539.28 $137.00 $137.00 N/A $269.64 N/A N/A N/A N/A $260.30 N/A $137.00 $404.46 $150.70 $339.75 $394.21 N/A N/A $323.57 $431.42 $465.80 $780.90 N/A $137.00 $350.53 N/A $431.42 N/A N/A N/A $191.80 N/A $137.00 $137.00 $149.33 $431.42 $458.39 N/A $404.46 N/A N/A $269.64 $350.53 $192.49 $192.49 $192.49 $192.49 $164.40 $143.85 $137.00 $164.40 N/A N/A $102.75 $102.75 $102.75 $102.75 $780.90 330104 81321 2044 310 HC PTEN GENE FULL SEQUENCE O "$2,184.94 " $600.00 $600.00 N/A "$1,092.47 " N/A N/A N/A N/A "$1,140.00 " N/A $600.00 "$1,638.70 " $660.00 "$1,376.51 " "$1,597.19 " N/A N/A "$1,310.96 " "$1,747.95 " "$2,040.00 " "$3,420.00 " N/A $600.00 "$1,420.21 " N/A "$1,747.95 " N/A N/A N/A $840.00 N/A $600.00 $600.00 $654.00 "$1,747.95 " "$1,857.20 " N/A "$1,638.70 " N/A N/A "$1,092.47 " "$1,420.21 " $843.00 $843.00 $843.00 $843.00 $720.84 $630.00 $600.00 $720.84 N/A N/A $450.00 $450.00 $450.00 $450.00 "$3,420.00 " 330104 81310 386 310 HC NPM1 GENE O $910.57 $246.52 $246.52 $246.52 $455.29 N/A N/A N/A $246.52 $468.39 $246.52 $246.52 $682.93 $271.17 $573.66 $665.63 $295.82 $246.52 $546.34 $728.46 $838.17 "$1,405.16 " $246.52 $246.52 $591.87 $345.13 $728.46 $246.52 $246.52 $295.82 $345.13 $246.52 $246.52 $246.52 $268.71 $728.46 $773.98 $332.80 $682.93 $505.37 $332.80 $455.29 $591.87 $346.36 $346.36 $346.36 $346.36 $296.57 $258.85 $246.52 $296.57 $246.52 $246.52 $184.89 $184.89 $184.89 $184.89 "$1,405.16 " 330104 81291 385 310 HC MTHFR GENE O "$1,043.25 " $65.34 $65.34 N/A $521.62 N/A N/A N/A N/A $124.15 N/A $65.34 $782.44 $71.87 $657.25 $762.62 N/A N/A $625.95 $834.60 $222.16 $372.44 N/A $65.34 $678.11 N/A $834.60 N/A N/A N/A $91.48 N/A $65.34 $65.34 $71.22 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $91.80 $91.80 $91.80 $91.80 $71.46 $68.61 $65.34 $71.46 N/A N/A $49.01 $49.01 $49.01 $49.01 $886.76 330104 81120 386 310 HC IDH1 COMMON VARIANTS O $728.67 $193.25 $193.25 N/A $364.33 N/A N/A N/A N/A $367.17 N/A $193.25 $546.50 $212.58 $459.06 $532.66 N/A N/A $437.20 $582.94 $657.05 "$1,101.53 " N/A $193.25 $473.64 N/A $582.94 N/A N/A N/A $270.55 N/A $193.25 $193.25 $210.64 $582.94 $619.37 N/A $546.50 N/A N/A $364.33 $473.64 $271.52 $271.52 $271.52 $271.52 $231.90 $202.91 $193.25 $231.90 N/A N/A $144.94 $144.94 $144.94 $144.94 "$1,101.53 " 330104 80506 158 310 HC PATHOLOGY CLINICAL CONSLTJ PROLNG SVC EA ADDL 30 O $107.00 N/A N/A $25.96 $53.50 $61.77 $55.84 $48.92 $25.96 N/A $25.96 N/A $80.25 N/A $67.41 $78.22 $31.15 $25.96 $64.20 $85.60 N/A N/A $25.96 N/A $69.55 $36.34 $85.60 $25.96 $25.96 $31.15 N/A $25.96 N/A N/A N/A $85.60 $90.95 $35.05 $80.25 $53.22 $35.05 $53.50 $69.55 N/A N/A N/A N/A N/A N/A N/A $71.37 $25.96 $25.96 N/A N/A N/A $25.96 $90.95 330104 80505 5672 158 310 HC PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN O $642.00 $188.66 $188.66 $57.93 $321.00 $129.90 $117.43 $186.77 $57.93 $358.45 $57.93 $188.66 $481.50 $207.53 $404.46 $469.30 $69.52 $57.93 $385.20 $513.60 $641.44 "$1,075.36 " $57.93 $188.66 $226.39 $81.10 $513.60 $57.93 $57.93 $69.52 $264.12 $57.93 $188.66 $188.66 $205.64 $513.60 $545.70 $57.93 $481.50 $118.76 $57.93 $321.00 $507.49 $265.07 $265.07 $265.07 $265.07 N/A $198.09 $188.66 $428.21 $57.93 $57.93 $141.49 $141.49 $141.49 $57.93 "$1,075.36 " 330104 88333 5674 158 310 HC INTRAOPERATIVE CYTO PATH CONSULT INITIAL SITE O "$2,895.42 " $931.61 $931.61 N/A "$1,447.71 " $135.16 $122.18 $922.29 N/A "$1,770.06 " N/A $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " N/A N/A "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " N/A $931.61 "$1,117.93 " N/A "$2,316.34 " N/A N/A N/A "$1,304.25 " N/A $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " N/A "$2,171.57 " N/A N/A "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $20.48 $978.19 $931.61 $20.48 N/A N/A $698.71 $698.71 $698.71 $20.48 "$5,310.18 " 330104 88381 305 310 HC MICRODISSECTION MANUAL O $359.52 N/A N/A $57.35 $179.76 $307.88 $278.32 $243.84 $57.35 N/A $57.35 N/A $269.64 N/A $226.50 $262.81 $68.82 $57.35 $215.71 $287.62 N/A N/A $57.35 N/A $233.69 $80.29 $287.62 $57.35 $57.35 $68.82 N/A $57.35 N/A N/A N/A $287.62 $305.59 $77.43 $269.64 $117.57 $77.43 $179.76 $233.69 N/A N/A N/A N/A $126.82 N/A N/A $126.82 $57.35 $57.35 N/A N/A N/A $57.35 $307.88 330104 88377 5672 306 310 HC M/PHMTRC ALYS ISHQUANT/SEMIQ O "$1,162.02 " $188.66 $188.66 $80.82 $581.01 $598.46 $541.00 $186.77 $80.82 $358.45 $80.82 $188.66 $871.51 $207.53 $732.07 $849.44 $96.99 $80.82 $697.21 $929.62 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $929.62 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $929.62 $987.72 $80.82 $871.51 $165.68 $80.82 $581.01 $507.49 $265.07 $265.07 $265.07 $265.07 $220.34 $198.09 $188.66 $220.34 $80.82 $80.82 $141.49 $141.49 $141.49 $80.82 "$1,075.36 " 330104 88374 5672 306 310 HC M/PHMTRC ALYS ISHQUANT/SEMIQ O $662.33 $188.66 $188.66 $80.82 $331.17 $458.89 $414.83 $186.77 $80.82 $358.45 $80.82 $188.66 $496.75 $207.53 $417.27 $484.16 $96.99 $80.82 $397.40 $529.86 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $529.86 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $529.86 $562.98 $80.82 $496.75 $165.68 $80.82 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $220.34 $198.09 $188.66 $220.34 $80.82 $80.82 $141.49 $141.49 $141.49 $80.82 "$1,075.36 " 330104 88373 306 310 HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH O $298.53 N/A N/A $80.82 $149.26 $100.90 $91.21 $79.91 $80.82 N/A $80.82 N/A $223.90 N/A $188.07 $218.23 $96.99 $80.82 $179.12 $238.82 N/A N/A $80.82 N/A $194.04 $113.15 $238.82 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $238.82 $253.75 $109.11 $223.90 $165.68 $109.11 $149.26 $194.04 N/A N/A N/A N/A $46.82 N/A N/A $46.82 $80.82 $80.82 N/A N/A N/A $46.82 $253.75 330104 88369 306 310 HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH O $424.79 N/A N/A $80.82 $212.40 $183.18 $165.59 $145.08 $80.82 N/A $80.82 N/A $318.59 N/A $267.62 $310.52 $96.99 $80.82 $254.87 $339.83 N/A N/A $80.82 N/A $276.11 $113.15 $339.83 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $339.83 $361.07 $109.11 $318.59 $165.68 $109.11 $212.40 $276.11 N/A N/A N/A N/A $58.43 N/A N/A $58.43 $80.82 $80.82 N/A N/A N/A $58.43 $361.07 330104 88368 5673 306 310 HC INSITU HYBRIDIZATION MANUAL O "$1,308.61 " $388.85 $388.85 $80.82 $654.30 $213.25 $192.78 $384.96 $80.82 $738.81 $80.82 $388.85 $981.46 $427.73 $824.42 $956.59 $96.99 $80.82 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $80.82 $388.85 $466.62 $113.15 "$1,046.89 " $80.82 $80.82 $96.99 $544.39 $80.82 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $80.82 $981.46 $165.68 $80.82 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $67.70 $408.29 $388.85 $67.70 $80.82 $80.82 $291.64 $291.64 $291.64 $67.70 "$2,216.43 " 330104 88365 5672 306 310 HC INSITU HYBRIDIZATION (FISH) O $662.33 $188.66 $188.66 $80.82 $331.17 $271.78 $245.69 $186.77 $80.82 $358.45 $80.82 $188.66 $496.75 $207.53 $417.27 $484.16 $96.99 $80.82 $397.40 $529.86 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $529.86 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $529.86 $562.98 $80.82 $496.75 $165.68 $80.82 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $67.70 $198.09 $188.66 $67.70 $80.82 $80.82 $141.49 $141.49 $141.49 $67.70 "$1,075.36 " 330104 88364 306 310 HC INSITU HYBRIDIZATION (FISH) O $224.70 N/A N/A $80.82 $112.35 $205.25 $185.55 $162.56 $80.82 N/A $80.82 N/A $168.52 N/A $141.56 $164.26 $96.99 $80.82 $134.82 $179.76 N/A N/A $80.82 N/A $146.06 $113.15 $179.76 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $179.76 $190.99 $109.11 $168.52 $165.68 $109.11 $112.35 $146.06 N/A N/A N/A N/A $84.20 N/A N/A $84.20 $80.82 $80.82 N/A N/A N/A $80.82 $205.25 330104 88363 5731 391 310 HC XM ARCHIVE TISSUE MOLEC ANAL O $108.07 $29.95 $29.95 N/A $54.03 $27.75 $25.08 $29.65 N/A $56.90 N/A $29.95 $81.05 $32.94 $68.08 $79.00 N/A N/A $64.84 $86.46 $101.81 $170.69 N/A $29.95 $35.93 N/A $86.46 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $86.46 $91.86 N/A $81.05 N/A N/A $54.03 $80.55 $42.07 $42.07 $42.07 $42.07 $13.25 $31.44 $29.95 $13.25 N/A N/A $22.46 $22.46 $22.46 $13.25 $170.69 330104 88362 5674 306 310 HC NERVE TEASING PREPARATIONS O "$2,895.42 " $931.61 $931.61 $80.82 "$1,447.71 " $338.48 $305.98 $922.29 $80.82 "$1,770.06 " $80.82 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $96.99 $80.82 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $80.82 $931.61 "$1,117.93 " $113.15 "$2,316.34 " $80.82 $80.82 $96.99 "$1,304.25 " $80.82 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $80.82 "$2,171.57 " $165.68 $80.82 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $67.70 $978.19 $931.61 $67.70 $80.82 $80.82 $698.71 $698.71 $698.71 $67.70 "$5,310.18 " 330104 88332 158 310 HC PATH CONSULT INTRAOP ADDL O $219.35 N/A N/A N/A $109.67 $80.71 $72.96 $63.92 N/A N/A N/A N/A $164.51 N/A $138.19 $160.34 N/A N/A $131.61 $175.48 N/A N/A N/A N/A $142.58 N/A $175.48 N/A N/A N/A N/A N/A N/A N/A N/A $175.48 $186.45 N/A $164.51 N/A N/A $109.67 $142.58 N/A N/A N/A N/A $20.48 N/A N/A $20.48 N/A N/A N/A N/A N/A $20.48 $186.45 330104 88348 5674 306 310 HC ELECTRON MICROSCOPY O "$2,895.42 " $931.61 $931.61 $80.82 "$1,447.71 " $718.54 $649.56 $922.29 $80.82 "$1,770.06 " $80.82 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $96.99 $80.82 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $80.82 $931.61 "$1,117.93 " $113.15 "$2,316.34 " $80.82 $80.82 $96.99 "$1,304.25 " $80.82 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $80.82 "$2,171.57 " $165.68 $80.82 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $180.94 $978.19 $931.61 $180.94 $80.82 $80.82 $698.71 $698.71 $698.71 $80.82 "$5,310.18 " 330104 88360 5672 306 310 HC TUMOR IMMUNOHISTOCHEM/MANUAL O $662.33 $188.66 $188.66 $25.37 $331.17 $176.02 $159.13 $186.77 $25.37 $358.45 $25.37 $188.66 $496.75 $207.53 $417.27 $484.16 $30.44 $25.37 $397.40 $529.86 $641.44 "$1,075.36 " $25.37 $188.66 $226.39 $35.52 $529.86 $25.37 $25.37 $30.44 $264.12 $25.37 $188.66 $188.66 $205.64 $529.86 $562.98 $25.37 $496.75 $52.01 $25.37 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 $25.37 $25.37 $141.49 $141.49 $141.49 $25.37 "$1,075.36 " 330104 80503 5671 158 310 HC PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN O $214.00 $60.15 $60.15 $15.99 $107.00 $31.46 $28.44 $59.55 $15.99 $114.29 $15.99 $60.15 $160.50 $66.17 $134.82 $156.43 $19.19 $15.99 $128.40 $171.20 $204.53 $342.88 $15.99 $60.15 $72.19 $22.39 $171.20 $15.99 $15.99 $19.19 $84.22 $15.99 $60.15 $60.15 $65.57 $171.20 $181.90 $15.99 $160.50 $32.78 $15.99 $107.00 $161.82 $84.52 $84.52 $84.52 $84.52 N/A $63.16 $60.15 $142.74 $15.99 $15.99 $45.12 $45.12 $45.12 $15.99 $342.88 330104 0037U 2045 310 HC FOUNDATIONONE CDX O "$12,740.49 " "$3,500.00 " "$3,500.00 " N/A "$6,370.24 " N/A N/A "$8,332.28 " N/A "$6,650.00 " N/A "$3,500.00 " "$9,555.37 " "$3,850.00 " "$8,026.51 " "$9,313.30 " N/A N/A "$7,644.29 " "$10,192.39 " "$11,900.00 " "$19,950.00 " N/A "$3,500.00 " N/A N/A "$10,192.39 " N/A N/A N/A "$4,900.00 " N/A "$3,500.00 " "$3,500.00 " "$3,815.00 " "$10,192.39 " "$10,829.42 " N/A "$9,555.37 " N/A N/A "$6,370.24 " "$8,281.32 " "$4,917.50 " "$4,917.50 " "$4,917.50 " "$4,917.50 " "$4,200.00 " "$3,675.00 " "$3,500.00 " "$4,200.00 " N/A N/A "$2,625.00 " "$2,625.00 " "$2,625.00 " "$2,625.00 " "$19,950.00 " 330104 88342 5672 306 310 HC IMMUNOHISTO ANTIBODY SLIDE O $662.33 $188.66 $188.66 $25.37 $331.17 $149.29 $134.96 $186.77 $25.37 $358.45 $25.37 $188.66 $496.75 $207.53 $417.27 $484.16 $30.44 $25.37 $397.40 $529.86 $641.44 "$1,075.36 " $25.37 $188.66 $226.39 $35.52 $529.86 $25.37 $25.37 $30.44 $264.12 $25.37 $188.66 $188.66 $205.64 $529.86 $562.98 $25.37 $496.75 $52.01 $25.37 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 $25.37 $25.37 $141.49 $141.49 $141.49 $25.37 "$1,075.36 " 330104 80504 5672 158 310 HC PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN O $642.00 $188.66 $188.66 $31.97 $321.00 $67.72 $61.22 $186.77 $31.97 $358.45 $31.97 $188.66 $481.50 $207.53 $404.46 $469.30 $38.36 $31.97 $385.20 $513.60 $641.44 "$1,075.36 " $31.97 $188.66 $226.39 $44.76 $513.60 $31.97 $31.97 $38.36 $264.12 $31.97 $188.66 $188.66 $205.64 $513.60 $545.70 $31.97 $481.50 $65.54 $31.97 $321.00 $507.49 $265.07 $265.07 $265.07 $265.07 N/A $198.09 $188.66 $428.21 $31.97 $31.97 $141.49 $141.49 $141.49 $31.97 "$1,075.36 " 330104 81243 385 310 HC FMR1 GENE DETECTION O $544.63 $57.04 $57.04 N/A $272.31 N/A N/A N/A N/A $108.38 N/A $57.04 $408.47 $62.74 $343.12 $398.12 N/A N/A $326.78 $435.70 $193.94 $325.13 N/A $57.04 $354.01 N/A $435.70 N/A N/A N/A $79.86 N/A $57.04 $57.04 $62.17 $435.70 $462.94 N/A $408.47 N/A N/A $272.31 $354.01 $80.14 $80.14 $80.14 $80.14 $68.45 $59.89 $57.04 $68.45 N/A N/A $42.78 $42.78 $42.78 $42.78 $462.94 330104 88331 5672 158 310 HC PATH CONSULT INTRAOP 1 BLOC O $662.33 $188.66 $188.66 N/A $331.17 $149.09 $134.77 $186.77 N/A $358.45 N/A $188.66 $496.75 $207.53 $417.27 $484.16 N/A N/A $397.40 $529.86 $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A $529.86 N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 $529.86 $562.98 N/A $496.75 N/A N/A $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 N/A N/A $141.49 $141.49 $141.49 $43.78 "$1,075.36 " 330104 88334 158 310 HC INTRAOPERATIVE CYTO PATH CONSULT ADD SITES O $151.94 N/A N/A N/A $75.97 $81.38 $73.56 $64.45 N/A N/A N/A N/A $113.95 N/A $95.72 $111.07 N/A N/A $91.16 $121.55 N/A N/A N/A N/A $98.76 N/A $121.55 N/A N/A N/A N/A N/A N/A N/A N/A $121.55 $129.15 N/A $113.95 N/A N/A $75.97 $98.76 N/A N/A N/A N/A $20.48 N/A N/A $20.48 N/A N/A N/A N/A N/A $20.48 $129.15 330104 88341 306 310 HC IMMUNOHISTO ANTIBODY SLIDE PER EA ADDL O $157.29 N/A N/A $25.37 $78.64 $128.70 $116.35 $101.93 $25.37 N/A $25.37 N/A $117.97 N/A $99.09 $114.98 $30.44 $25.37 $94.37 $125.83 N/A N/A $25.37 N/A $102.24 $35.52 $125.83 $25.37 $25.37 $30.44 N/A $25.37 N/A N/A N/A $125.83 $133.70 $34.25 $117.97 $52.01 $34.25 $78.64 $102.24 N/A N/A N/A N/A $54.56 N/A N/A $54.56 $25.37 $25.37 N/A N/A N/A $25.37 $133.70 330104 81257 385 310 HC HBA1/HBA2 GENE O "$1,127.78 " $102.26 $102.26 N/A $563.89 N/A N/A N/A N/A $194.29 N/A $102.26 $845.84 $112.49 $710.50 $824.41 N/A N/A $676.67 $902.22 $347.68 $582.88 N/A $102.26 $733.06 N/A $902.22 N/A N/A N/A $143.16 N/A $102.26 $102.26 $111.46 $902.22 $958.61 N/A $845.84 N/A N/A $563.89 $733.06 $143.68 $143.68 $143.68 $143.68 $122.71 $107.37 $102.26 $122.71 N/A N/A $76.70 $76.70 $76.70 $76.70 $958.61 330104 88164 392 311 HC CYTOPATH TBS C/V MANUAL O $53.50 $17.31 $17.31 $14.65 $26.75 N/A N/A N/A $14.65 $32.89 $14.65 $17.31 $40.12 $19.04 $33.70 $39.11 $17.58 $14.65 $32.10 $42.80 $58.85 $98.67 $14.65 $17.31 $34.77 $20.51 $42.80 $14.65 $14.65 $17.58 $24.23 $14.65 $17.31 $17.31 $18.87 $42.80 $45.48 $19.78 $40.12 $30.03 $19.78 $26.75 $34.77 $24.32 $24.32 $24.32 $24.32 $17.84 $18.18 $17.31 $17.84 $14.65 $14.65 $12.98 $12.98 $12.98 $12.98 $98.67 330104 88291 158 311 HC CYTO/MOLECULAR REPORT O $359.52 N/A N/A $20.00 $179.76 $46.78 $42.29 $37.05 $20.00 N/A $20.00 N/A $269.64 N/A $226.50 $262.81 $24.00 $20.00 $215.71 $287.62 N/A N/A $20.00 N/A $233.69 $28.00 $287.62 $20.00 $20.00 $24.00 N/A $20.00 N/A N/A N/A $287.62 $305.59 $27.00 $269.64 $41.00 $27.00 $179.76 $233.69 N/A N/A N/A N/A $35.06 N/A N/A $35.06 $20.00 $20.00 N/A N/A N/A $20.00 $305.59 330104 88280 385 311 HC CHROMOSOME KARYOTYPE STUDY O $398.04 $33.47 $33.47 $10.00 $199.02 N/A N/A N/A $10.00 $63.59 $10.00 $33.47 $298.53 $36.82 $250.77 $290.97 $12.00 $10.00 $238.82 $318.43 $113.80 $190.78 $10.00 $33.47 $258.73 $14.00 $318.43 $10.00 $10.00 $12.00 $46.86 $10.00 $33.47 $33.47 $36.48 $318.43 $338.33 $13.50 $298.53 $20.50 $13.50 $199.02 $258.73 $47.03 $47.03 $47.03 $47.03 $42.38 $35.14 $33.47 $42.38 $10.00 $10.00 $25.10 $25.10 $25.10 $10.00 $338.33 330104 88275 385 311 HC CYTOGENETICS 100-300 O $846.37 $51.19 $51.19 $51.19 $423.19 N/A N/A N/A $51.19 $97.26 $51.19 $51.19 $634.78 $56.31 $533.21 $618.70 $61.43 $51.19 $507.82 $677.10 $174.05 $291.78 $51.19 $51.19 $550.14 $71.67 $677.10 $51.19 $51.19 $61.43 $71.67 $51.19 $51.19 $51.19 $55.80 $677.10 $719.41 $69.11 $634.78 $104.94 $69.11 $423.19 $550.14 $71.92 $71.92 $71.92 $71.92 $67.81 $53.75 $51.19 $67.81 $51.19 $51.19 $38.39 $38.39 $38.39 $38.39 $719.41 330104 88235 308 311 HC TISSUE CULTURE PLACENTA O $553.19 $150.30 $150.30 $131.91 $276.60 N/A N/A N/A $131.91 $285.57 $131.91 $150.30 $414.89 $165.33 $348.51 $404.38 $158.29 $131.91 $331.91 $442.55 $511.02 $856.71 $131.91 $150.30 $359.57 $184.67 $442.55 $131.91 $131.91 $158.29 $210.42 $131.91 $150.30 $150.30 $163.83 $442.55 $470.21 $178.08 $414.89 $270.42 $178.08 $276.60 $359.57 $211.17 $211.17 $211.17 $211.17 $248.66 $157.82 $150.30 $248.66 $131.91 $131.91 $112.73 $112.73 $112.73 $112.73 $856.71 330104 88177 391 311 HC CYTP FNA EVAL EA ADDL O $99.51 N/A N/A N/A $49.76 $42.35 $38.29 $33.54 N/A N/A N/A N/A $74.63 N/A $62.69 $72.74 N/A N/A $59.71 $79.61 N/A N/A N/A N/A $64.68 N/A $79.61 N/A N/A N/A N/A N/A N/A N/A N/A $79.61 $84.58 N/A $74.63 N/A N/A $49.76 $64.68 N/A N/A N/A N/A $13.25 N/A N/A $13.25 N/A N/A N/A N/A N/A $13.25 $84.58 330104 88173 5671 158 311 HC CYTOPATH EVAL FNA REPORT O $306.02 $60.15 $60.15 $19.12 $153.01 $240.54 $217.45 $59.55 $19.12 $114.29 $19.12 $60.15 $229.51 $66.17 $192.79 $223.70 $22.94 $19.12 $183.61 $244.82 $204.53 $342.88 $19.12 $60.15 $72.19 $26.77 $244.82 $19.12 $19.12 $22.94 $84.22 $19.12 $60.15 $60.15 $65.57 $244.82 $260.12 $19.12 $229.51 $39.20 $19.12 $153.01 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $19.12 $19.12 $45.12 $45.12 $45.12 $19.12 $342.88 330104 88172 5672 308 311 HC CYTP DX EVAL FNA 1ST EA SITE O $671.96 $188.66 $188.66 $86.27 $335.98 $81.08 $73.29 $186.77 $86.27 $358.45 $86.27 $188.66 $503.97 $207.53 $423.33 $491.20 $103.53 $86.27 $403.18 $537.57 $641.44 "$1,075.36 " $86.27 $188.66 $226.39 $120.78 $537.57 $86.27 $86.27 $103.53 $264.12 $86.27 $188.66 $188.66 $205.64 $537.57 $571.17 $86.27 $503.97 $176.86 $86.27 $335.98 $507.49 $265.07 $265.07 $265.07 $265.07 $20.48 $198.09 $188.66 $20.48 $86.27 $86.27 $141.49 $141.49 $141.49 $20.48 "$1,075.36 " 330104 88108 5732 391 311 HC CYTOPATH CONCENTRATE TECH O $340.26 $40.74 $40.74 $19.12 $170.13 $99.16 $89.64 $40.34 $19.12 $77.41 $19.12 $40.74 $255.19 $44.82 $214.36 $248.73 $22.94 $19.12 $204.16 $272.21 $138.53 $232.24 $19.12 $40.74 $48.89 $26.77 $272.21 $19.12 $19.12 $22.94 $57.04 $19.12 $40.74 $40.74 $44.41 $272.21 $289.22 $19.12 $255.19 $39.20 $19.12 $170.13 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $19.12 $19.12 $30.56 $30.56 $30.56 $19.12 $289.22 330104 88104 5732 391 311 HC CYTOPATH FL NONGYN SMEARS O $260.01 $40.74 $40.74 $19.12 $130.00 $103.45 $93.52 $40.34 $19.12 $77.41 $19.12 $40.74 $195.01 $44.82 $163.81 $190.07 $22.94 $19.12 $156.01 $208.01 $138.53 $232.24 $19.12 $40.74 $48.89 $26.77 $208.01 $19.12 $19.12 $22.94 $57.04 $19.12 $40.74 $40.74 $44.41 $208.01 $221.01 $19.12 $195.01 $39.20 $19.12 $130.00 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $19.12 $19.12 $30.56 $30.56 $30.56 $19.12 $232.24 330104 88263 386 311 HC MICROBIOLOGY PROCEDURE O $606.69 $150.29 $150.29 $100.00 $303.35 N/A N/A N/A $100.00 $285.55 $100.00 $150.29 $455.02 $165.32 $382.21 $443.49 $120.00 $100.00 $364.01 $485.35 $510.99 $856.65 $100.00 $150.29 $394.35 $140.00 $485.35 $100.00 $100.00 $120.00 $210.41 $100.00 $150.29 $150.29 $163.82 $485.35 $515.69 $135.00 $455.02 $205.00 $135.00 $303.35 $394.35 $211.16 $211.16 $211.16 $211.16 $253.78 $157.80 $150.29 $253.78 $100.00 $100.00 $112.72 $112.72 $112.72 $100.00 $856.65 330104 88189 391 311 HC FLOWCYTOMETRY/READ 16 & > O $129.47 $95.02 $95.02 $30.00 $64.73 $118.77 $107.37 $94.07 $30.00 $180.53 $30.00 $95.02 $97.10 $104.52 $81.57 $94.64 $36.00 $30.00 $77.68 $103.58 $323.06 $541.60 $30.00 $95.02 $84.16 $42.00 $103.58 $30.00 $30.00 $36.00 $133.02 $30.00 $95.02 $95.02 $103.57 $103.58 $110.05 $40.50 $97.10 $61.50 $40.50 $64.73 $84.16 $133.50 $133.50 $133.50 $133.50 $43.78 $99.77 $95.02 $43.78 $30.00 $30.00 $71.26 $71.26 $71.26 $30.00 $541.60 330104 88188 391 311 HC FLOWCYTOMETRY/READ 9-15 O $107.00 $70.63 $70.63 $25.00 $53.50 $88.29 $79.81 $69.93 $25.00 $134.20 $25.00 $70.63 $80.25 $77.70 $67.41 $78.22 $30.00 $25.00 $64.20 $85.60 $240.15 $402.60 $25.00 $70.63 $69.55 $35.00 $85.60 $25.00 $25.00 $30.00 $98.89 $25.00 $70.63 $70.63 $76.99 $85.60 $90.95 $33.75 $80.25 $51.25 $33.75 $53.50 $69.55 $99.24 $99.24 $99.24 $99.24 $43.78 $74.16 $70.63 $43.78 $25.00 $25.00 $52.97 $52.97 $52.97 $25.00 $402.60 330104 88187 391 311 HC FLOWCYTOMETRY/READ 2-8 O $205.44 $40.29 $40.29 $20.00 $102.72 $50.36 $45.52 $39.88 $20.00 $76.54 $20.00 $40.29 $154.08 $44.32 $129.43 $150.18 $24.00 $20.00 $123.26 $164.35 $136.97 $229.63 $20.00 $40.29 $133.54 $28.00 $164.35 $20.00 $20.00 $24.00 $56.40 $20.00 $40.29 $40.29 $43.91 $164.35 $174.62 $27.00 $154.08 $41.00 $27.00 $102.72 $133.54 $56.60 $56.60 $56.60 $56.60 $13.25 $42.30 $40.29 $13.25 $20.00 $20.00 $30.21 $30.21 $30.21 $13.25 $229.63 330104 88185 391 311 HC FLOWCYTOMETRY/TC ADD-ON O $218.28 N/A N/A $15.45 $109.14 $36.45 $32.95 $28.87 $15.45 N/A $15.45 N/A $163.71 N/A $137.52 $159.56 $18.54 $15.45 $130.97 $174.62 N/A N/A $15.45 N/A $141.88 $21.63 $174.62 $15.45 $15.45 $18.54 N/A $15.45 N/A N/A N/A $174.62 $185.54 $20.86 $163.71 $31.67 $20.86 $109.14 $141.88 N/A N/A N/A N/A $20.48 N/A N/A $20.48 $15.45 $15.45 N/A N/A N/A $15.45 $185.54 330104 88184 5673 308 311 HC FLOWCYTOMETRY/ TC 1 MARKER O "$1,308.61 " $388.85 $388.85 $23.17 $654.30 $114.90 $103.87 $384.96 $23.17 $738.81 $23.17 $388.85 $981.46 $427.73 $824.42 $956.59 $27.80 $23.17 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $23.17 $388.85 $466.62 $32.44 "$1,046.89 " $23.17 $23.17 $27.80 $544.39 $23.17 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $23.17 $981.46 $47.50 $23.17 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $20.48 $408.29 $388.85 $20.48 $23.17 $23.17 $291.64 $291.64 $291.64 $20.48 "$2,216.43 " 330104 88142 392 311 HC SCREEN CYTOPATH C/V THIN LAYER O $318.86 $20.26 $20.26 $20.26 $159.43 N/A N/A N/A $20.26 $38.49 $20.26 $20.26 $239.15 $22.29 $200.88 $233.09 $24.31 $20.26 $191.32 $255.09 $68.88 $115.48 $20.26 $20.26 $207.26 $28.36 $255.09 $20.26 $20.26 $24.31 $28.36 $20.26 $20.26 $20.26 $22.08 $255.09 $271.03 $27.35 $239.15 $41.53 $27.35 $159.43 $207.26 $28.47 $28.47 $28.47 $28.47 $34.21 $21.27 $20.26 $34.21 $20.26 $20.26 $15.20 $15.20 $15.20 $15.20 $271.03 330104 88262 385 311 HC CHROMOSOME ANALYSIS 15-20 O "$1,959.17 " $125.49 $125.49 $100.00 $979.59 N/A N/A N/A $100.00 $238.43 $100.00 $125.49 "$1,469.38 " $138.04 "$1,234.28 " "$1,432.15 " $120.00 $100.00 "$1,175.50 " "$1,567.34 " $426.67 $715.29 $100.00 $125.49 "$1,273.46 " $140.00 "$1,567.34 " $100.00 $100.00 $120.00 $175.69 $100.00 $125.49 $125.49 $136.78 "$1,567.34 " "$1,665.29 " $135.00 "$1,469.38 " $205.00 $135.00 $979.59 "$1,273.46 " $176.31 $176.31 $176.31 $176.31 $210.48 $131.76 $125.49 $210.48 $100.00 $100.00 $94.12 $94.12 $94.12 $94.12 "$1,665.29 " 330104 88350 306 312 HC IMMUNOFLUOR ANTB ADDL STAIN O $160.50 N/A N/A $16.25 $80.25 $175.18 $158.36 $138.74 $16.25 N/A $16.25 N/A $120.38 N/A $101.11 $117.33 $19.50 $16.25 $96.30 $128.40 N/A N/A $16.25 N/A $104.33 $22.75 $128.40 $16.25 $16.25 $19.50 N/A $16.25 N/A N/A N/A $128.40 $136.42 $21.94 $120.38 $33.31 $21.94 $80.25 $104.33 N/A N/A N/A N/A $52.45 N/A N/A $52.45 $16.25 $16.25 N/A N/A N/A $16.25 $175.18 330104 88346 5673 306 312 HC IMMUNOFLUORESCENT STDY EA ANTIBDY; DRCT MTHD O "$1,308.61 " $388.85 $388.85 $19.25 $654.30 $228.60 $206.66 $384.96 $19.25 $738.81 $19.25 $388.85 $981.46 $427.73 $824.42 $956.59 $23.10 $19.25 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $19.25 $388.85 $466.62 $26.95 "$1,046.89 " $19.25 $19.25 $23.10 $544.39 $19.25 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $19.25 $981.46 $39.46 $19.25 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $43.78 $408.29 $388.85 $43.78 $19.25 $19.25 $291.64 $291.64 $291.64 $19.25 "$2,216.43 " 330104 73501 5521 471 320 HC X-RAY EXAM HIP UNI 1 VIEW O $476.15 $104.23 $104.23 $9.03 $238.07 $57.85 $52.59 $103.19 $9.03 $198.04 $9.03 $104.23 $357.11 $114.66 $299.97 $348.07 $10.84 $9.03 $285.69 $380.92 $354.39 $594.13 $9.03 $104.23 $125.08 $12.64 $380.92 $9.03 $9.03 $10.84 $145.93 $9.03 $104.23 $104.23 $113.61 $380.92 $404.73 $9.03 $357.11 $18.51 $9.03 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $9.03 $9.03 $88.60 $88.60 $104.23 $9.03 $594.13 330104 72190 5522 471 320 HC X-RAY EXAM OF PELVIS; COMPLETE MIN 3 VIEWS O $518.95 $128.23 $128.23 $20.00 $259.48 $73.76 $67.06 $126.95 $20.00 $243.63 $20.00 $128.23 $389.21 $141.05 $326.94 $379.35 $24.00 $20.00 $311.37 $415.16 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $415.16 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $415.16 $441.11 $20.00 $389.21 $41.00 $20.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72170 5522 471 320 HC X-RAY EXAM OF PELVIS 1 OR 2 VIEWS O "$1,006.87 " $128.23 $128.23 $12.50 $503.44 $49.11 $44.65 $126.95 $12.50 $243.63 $12.50 $128.23 $755.15 $141.05 $634.33 $736.02 $15.00 $12.50 $604.12 $805.50 $435.98 $730.90 $12.50 $128.23 $153.87 $17.50 $805.50 $12.50 $12.50 $15.00 $179.52 $12.50 $128.23 $128.23 $139.77 $805.50 $855.84 $12.50 $755.15 $25.62 $12.50 $503.44 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $12.50 $12.50 $108.99 $108.99 $128.23 $12.50 $855.84 330104 72120 5522 471 320 HC X-RAY BEND ONLY L-S SPINE O $589.57 $128.23 $128.23 $20.00 $294.79 $71.05 $64.59 $126.95 $20.00 $243.63 $20.00 $128.23 $442.18 $141.05 $371.43 $430.98 $24.00 $20.00 $353.74 $471.66 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $471.66 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $471.66 $501.13 $20.00 $442.18 $41.00 $20.00 $294.79 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72114 5522 471 320 HC X-RAY EXAM L-S SPINE BENDING O $480.43 $128.23 $128.23 $30.00 $240.22 $108.57 $98.70 $126.95 $30.00 $243.63 $30.00 $128.23 $360.32 $141.05 $302.67 $351.19 $36.00 $30.00 $288.26 $384.34 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $384.34 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $384.34 $408.37 $30.00 $360.32 $61.50 $30.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $730.90 330104 72110 5522 471 320 HC X-RAY EXAM L-2 SPINE 4/>VWS O $934.11 $128.23 $128.23 $30.00 $467.06 $89.54 $81.40 $126.95 $30.00 $243.63 $30.00 $128.23 $700.58 $141.05 $588.49 $682.83 $36.00 $30.00 $560.47 $747.29 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $747.29 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $747.29 $793.99 $30.00 $700.58 $61.50 $30.00 $467.06 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $793.99 330104 72100 5522 471 320 HC X-RAY EXAM L-S SPINE 2/3 VWS O $934.11 $128.23 $128.23 $15.00 $467.06 $69.88 $63.52 $126.95 $15.00 $243.63 $15.00 $128.23 $700.58 $141.05 $588.49 $682.83 $18.00 $15.00 $560.47 $747.29 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $747.29 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $747.29 $793.99 $15.00 $700.58 $30.75 $15.00 $467.06 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $793.99 330104 72084 5522 471 320 HC X-RAY EXAM ENTIRE SPI 6/> VWS O $480.43 $128.23 $128.23 $24.30 $240.22 $174.04 $158.22 $126.95 $24.30 $243.63 $24.30 $128.23 $360.32 $141.05 $302.67 $351.19 $29.16 $24.30 $288.26 $384.34 $435.98 $730.90 $24.30 $128.23 $153.87 $34.02 $384.34 $24.30 $24.30 $29.16 $179.52 $24.30 $128.23 $128.23 $139.77 $384.34 $408.37 $24.30 $360.32 $49.81 $24.30 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $307.15 $134.64 $128.23 $307.15 $24.30 $24.30 $108.99 $108.99 $128.23 $24.30 $730.90 330104 72083 5522 471 320 HC X-RAY EXAM ENTIRE SPI 4/5 VW O $480.43 $128.23 $128.23 $20.43 $240.22 $137.61 $125.10 $126.95 $20.43 $243.63 $20.43 $128.23 $360.32 $141.05 $302.67 $351.19 $24.52 $20.43 $288.26 $384.34 $435.98 $730.90 $20.43 $128.23 $153.87 $28.60 $384.34 $20.43 $20.43 $24.52 $179.52 $20.43 $128.23 $128.23 $139.77 $384.34 $408.37 $20.43 $360.32 $41.88 $20.43 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $307.15 $134.64 $128.23 $307.15 $20.43 $20.43 $108.99 $108.99 $128.23 $20.43 $730.90 330104 72082 5522 471 320 HC X-RAY ENTIRE SPINE 2/3 VWS O $518.95 $128.23 $128.23 $18.81 $259.48 $123.17 $111.98 $126.95 $18.81 $243.63 $18.81 $128.23 $389.21 $141.05 $326.94 $379.35 $22.57 $18.81 $311.37 $415.16 $435.98 $730.90 $18.81 $128.23 $153.87 $26.33 $415.16 $18.81 $18.81 $22.57 $179.52 $18.81 $128.23 $128.23 $139.77 $415.16 $441.11 $18.81 $389.21 $38.56 $18.81 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $18.81 $18.81 $108.99 $108.99 $128.23 $18.81 $730.90 330104 72081 5521 471 320 HC X-RAY ENTIRE SPINE 1 VW O $376.64 $104.23 $104.23 $11.72 $188.32 $74.27 $67.52 $103.19 $11.72 $198.04 $11.72 $104.23 $282.48 $114.66 $237.28 $275.32 $14.06 $11.72 $225.98 $301.31 $354.39 $594.13 $11.72 $104.23 $125.08 $16.41 $301.31 $11.72 $11.72 $14.06 $145.93 $11.72 $104.23 $104.23 $113.61 $301.31 $320.14 $11.72 $282.48 $24.03 $11.72 $188.32 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $11.72 $11.72 $88.60 $88.60 $104.23 $11.72 $594.13 330104 72072 5522 471 320 HC X-RAY EXAM THORAC SPINE 3VIEWS O $518.95 $128.23 $128.23 $30.00 $259.48 $68.63 $62.39 $126.95 $30.00 $243.63 $30.00 $128.23 $389.21 $141.05 $326.94 $379.35 $36.00 $30.00 $311.37 $415.16 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $415.16 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $415.16 $441.11 $30.00 $389.21 $61.50 $30.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $730.90 330104 72070 5522 471 320 HC X-RAY EXAM THORAC SPINE 2VIEWS O $930.90 $128.23 $128.23 $15.00 $465.45 $57.69 $52.45 $126.95 $15.00 $243.63 $15.00 $128.23 $698.17 $141.05 $586.47 $680.49 $18.00 $15.00 $558.54 $744.72 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $744.72 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $744.72 $791.26 $15.00 $698.17 $30.75 $15.00 $465.45 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $791.26 330104 72052 5522 471 320 HC X-RAY EXAM NECK SPINE 6/>VWS O $996.17 $128.23 $128.23 $30.00 $498.08 $109.15 $99.23 $126.95 $30.00 $243.63 $30.00 $128.23 $747.13 $141.05 $627.59 $728.20 $36.00 $30.00 $597.70 $796.94 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $796.94 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $796.94 $846.74 $30.00 $747.13 $61.50 $30.00 $498.08 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $846.74 330104 72050 5522 471 320 HC X-RAY EXAM NECK SPINE 4/5VWS O $826.04 $128.23 $128.23 $20.00 $413.02 $92.99 $84.54 $126.95 $20.00 $243.63 $20.00 $128.23 $619.53 $141.05 $520.41 $603.84 $24.00 $20.00 $495.62 $660.83 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $660.83 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $660.83 $702.13 $20.00 $619.53 $41.00 $20.00 $413.02 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72040 5521 471 320 HC X-RAY EXAM NECK SPINE 2-3 VW O $861.35 $104.23 $104.23 $15.00 $430.68 $69.29 $62.99 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 72020 5521 471 320 HC X-RAY EXAM OF SPINE 1 VIEW O $772.54 $104.23 $104.23 $10.00 $386.27 $43.31 $39.38 $103.19 $10.00 $198.04 $10.00 $104.23 $579.40 $114.66 $486.70 $564.73 $12.00 $10.00 $463.52 $618.03 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $618.03 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $618.03 $656.66 $10.00 $579.40 $20.50 $10.00 $386.27 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $656.66 330104 72200 5522 471 320 HC X-RAY EXAM SI JOINTS; <3VIEWS O $480.43 $128.23 $128.23 $12.50 $240.22 $57.92 $52.66 $126.95 $12.50 $243.63 $12.50 $128.23 $360.32 $141.05 $302.67 $351.19 $15.00 $12.50 $288.26 $384.34 $435.98 $730.90 $12.50 $128.23 $153.87 $17.50 $384.34 $12.50 $12.50 $15.00 $179.52 $12.50 $128.23 $128.23 $139.77 $384.34 $408.37 $12.50 $360.32 $25.62 $12.50 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $12.50 $12.50 $108.99 $108.99 $128.23 $12.50 $730.90 330104 72202 5522 471 320 HC X-RAY EXAM SI JOINTS 3 OR MORE VIEWS O $728.67 $128.23 $128.23 $20.00 $364.33 $68.63 $62.39 $126.95 $20.00 $243.63 $20.00 $128.23 $546.50 $141.05 $459.06 $532.66 $24.00 $20.00 $437.20 $582.94 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $582.94 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $582.94 $619.37 $20.00 $546.50 $41.00 $20.00 $364.33 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72220 5521 471 320 HC X-RAY EXAM SACRUM TAILBONE O $600.27 $104.23 $104.23 $15.00 $300.13 $57.33 $52.12 $103.19 $15.00 $198.04 $15.00 $104.23 $450.20 $114.66 $378.17 $438.80 $18.00 $15.00 $360.16 $480.22 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $480.22 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $480.22 $510.23 $15.00 $450.20 $30.75 $15.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 72270 5573 284 320 HC MYELOGPHY 2/> SPINE REGIONS O "$4,351.69 " $888.71 $888.71 N/A "$2,175.85 " $284.33 $258.48 $879.82 N/A "$1,688.54 " N/A $888.71 "$3,263.77 " $977.58 "$2,741.56 " "$3,181.09 " N/A N/A "$2,611.01 " "$3,481.35 " "$3,021.61 " "$5,065.63 " N/A $888.71 "$1,066.45 " N/A "$3,481.35 " N/A N/A N/A "$1,244.19 " N/A $888.71 $888.71 $968.69 "$3,481.35 " "$3,698.94 " N/A "$3,263.77 " N/A N/A "$2,175.85 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $798.56 $933.14 $888.71 $798.56 N/A N/A $755.40 $755.40 $888.71 $258.48 "$5,065.63 " 330104 73140 5521 471 320 HC X-RAY EXAM OF FINGER(S); MIN 2 VIEWS O $708.34 $104.23 $104.23 $7.50 $354.17 $67.03 $60.94 $103.19 $7.50 $198.04 $7.50 $104.23 $531.25 $114.66 $446.25 $517.80 $9.00 $7.50 $425.00 $566.67 $354.39 $594.13 $7.50 $104.23 $125.08 $10.50 $566.67 $7.50 $7.50 $9.00 $145.93 $7.50 $104.23 $104.23 $113.61 $566.67 $602.09 $7.50 $531.25 $15.37 $7.50 $354.17 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $7.50 $7.50 $88.60 $88.60 $104.23 $7.50 $602.09 330104 73130 5521 471 320 HC X-RAY EXAM OF HAND; MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $64.97 $59.06 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73120 5522 471 320 HC X-RAY EXAM OF HAND; 2 VIEWS O $518.95 $128.23 $128.23 $10.00 $259.48 $55.06 $50.05 $126.95 $10.00 $243.63 $10.00 $128.23 $389.21 $141.05 $326.94 $379.35 $12.00 $10.00 $311.37 $415.16 $435.98 $730.90 $10.00 $128.23 $153.87 $14.00 $415.16 $10.00 $10.00 $12.00 $179.52 $10.00 $128.23 $128.23 $139.77 $415.16 $441.11 $10.00 $389.21 $20.50 $10.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $10.00 $10.00 $108.99 $108.99 $128.23 $10.00 $730.90 330104 73100 5521 471 320 HC X-RAY EXAM OF WRIST; 2 VIEWS O $792.87 $104.23 $104.23 $10.00 $396.44 $59.76 $54.33 $103.19 $10.00 $198.04 $10.00 $104.23 $594.65 $114.66 $499.51 $579.59 $12.00 $10.00 $475.72 $634.30 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $634.30 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $634.30 $673.94 $10.00 $594.65 $20.50 $10.00 $396.44 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $673.94 330104 73092 5522 471 320 HC X-RAY EXAM OF ARM INFANT O $518.95 $128.23 $128.23 $10.00 $259.48 $55.65 $50.59 $126.95 $10.00 $243.63 $10.00 $128.23 $389.21 $141.05 $326.94 $379.35 $12.00 $10.00 $311.37 $415.16 $435.98 $730.90 $10.00 $128.23 $153.87 $14.00 $415.16 $10.00 $10.00 $12.00 $179.52 $10.00 $128.23 $128.23 $139.77 $415.16 $441.11 $10.00 $389.21 $20.50 $10.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $10.00 $10.00 $108.99 $108.99 $128.23 $10.00 $730.90 330104 73090 5521 471 320 HC X-RAY EXAM OF FOREARM; 2 VIEWS O $861.35 $104.23 $104.23 $10.00 $430.68 $51.54 $46.85 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 73080 5521 471 320 HC X-RAY EXAM OF ELBOW;COMPLETE MIN 3 VIEWS O $465.45 $104.23 $104.23 $12.50 $232.72 $57.33 $52.12 $103.19 $12.50 $198.04 $12.50 $104.23 $349.09 $114.66 $293.23 $340.24 $15.00 $12.50 $279.27 $372.36 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $372.36 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $372.36 $395.63 $12.50 $349.09 $25.62 $12.50 $232.72 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 73502 5521 471 320 HC X-RAY EXAM HIP UNI 2-3 VIEWS O $988.68 $104.23 $104.23 $12.47 $494.34 $82.21 $74.74 $103.19 $12.47 $198.04 $12.47 $104.23 $741.51 $114.66 $622.87 $722.73 $14.96 $12.47 $593.21 $790.94 $354.39 $594.13 $12.47 $104.23 $125.08 $17.46 $790.94 $12.47 $12.47 $14.96 $145.93 $12.47 $104.23 $104.23 $113.61 $790.94 $840.38 $12.47 $741.51 $25.56 $12.47 $494.34 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $12.47 $12.47 $88.60 $88.60 $104.23 $12.47 $840.38 330104 73070 5521 471 320 HC X-RAY EXAM OF ELBOW;2 VIEWS O $861.35 $104.23 $104.23 $10.00 $430.68 $51.54 $46.85 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 70355 5521 471 320 HC PANORAMIC X-RAY OF JAWS O $861.35 $104.23 $104.23 $13.00 $430.68 $31.26 $28.42 $103.19 $13.00 $198.04 $13.00 $104.23 $646.01 $114.66 $542.65 $629.65 $15.60 $13.00 $516.81 $689.08 $354.39 $594.13 $13.00 $104.23 $125.08 $18.20 $689.08 $13.00 $13.00 $15.60 $145.93 $13.00 $104.23 $104.23 $113.61 $689.08 $732.15 $13.00 $646.01 $26.65 $13.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $48.77 $109.45 $104.23 $48.77 $13.00 $13.00 $88.60 $88.60 $104.23 $13.00 $732.15 330104 73050 5521 471 320 HC X-RAY EXAM OF SHOULDERS O $792.87 $104.23 $104.23 $17.50 $396.44 $50.21 $45.65 $103.19 $17.50 $198.04 $17.50 $104.23 $594.65 $114.66 $499.51 $579.59 $21.00 $17.50 $475.72 $634.30 $354.39 $594.13 $17.50 $104.23 $125.08 $24.50 $634.30 $17.50 $17.50 $21.00 $145.93 $17.50 $104.23 $104.23 $113.61 $634.30 $673.94 $17.50 $594.65 $35.88 $17.50 $396.44 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $17.50 $17.50 $88.60 $88.60 $104.23 $17.50 $673.94 330104 73030 5521 471 320 HC X-RAY EXAM OF SHOULDER; COMPLETE MIN 2 VIEWS O $861.35 $104.23 $104.23 $15.00 $430.68 $60.78 $55.26 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 73020 5521 471 320 HC X-RAY EXAM OF SHOULDER; 1 VIEW O $666.61 $104.23 $104.23 $10.00 $333.31 $38.10 $34.64 $103.19 $10.00 $198.04 $10.00 $104.23 $499.96 $114.66 $419.96 $487.29 $12.00 $10.00 $399.97 $533.29 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $533.29 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $533.29 $566.62 $10.00 $499.96 $20.50 $10.00 $333.31 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73010 5522 471 320 HC X-RAY EXAM OF SHOULDER BLADE O $600.27 $128.23 $128.23 $15.00 $300.13 $41.48 $37.71 $126.95 $15.00 $243.63 $15.00 $128.23 $450.20 $141.05 $378.17 $438.80 $18.00 $15.00 $360.16 $480.22 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $480.22 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $480.22 $510.23 $15.00 $450.20 $30.75 $15.00 $300.13 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 73000 5521 471 320 HC X-RAY EXAM OF COLLAR BONE O $844.23 $104.23 $104.23 $10.00 $422.12 $56.82 $51.66 $103.19 $10.00 $198.04 $10.00 $104.23 $633.17 $114.66 $531.86 $617.13 $12.00 $10.00 $506.54 $675.38 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $675.38 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $675.38 $717.60 $10.00 $633.17 $20.50 $10.00 $422.12 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $717.60 330104 72275 474 320 HC EPIDUROGRAPHY O "$2,726.36 " N/A N/A $358.61 "$1,363.18 " N/A N/A "$1,783.04 " $358.61 N/A $358.61 N/A "$2,044.77 " N/A "$1,717.61 " "$1,992.97 " $430.34 $358.61 "$1,635.82 " "$2,181.09 " N/A N/A $358.61 N/A N/A $502.06 "$2,181.09 " $358.61 $358.61 $430.34 N/A $358.61 N/A N/A N/A "$2,181.09 " "$2,317.41 " $484.13 "$2,044.77 " $735.16 $484.13 "$1,363.18 " "$1,772.13 " N/A N/A N/A N/A N/A N/A N/A "$1,818.48 " $358.61 $358.61 N/A N/A N/A $358.61 "$2,317.41 " 330104 73060 5521 471 320 HC X-RAY EXAM OF HUMERUS O $600.27 $104.23 $104.23 $10.00 $300.13 $56.82 $51.66 $103.19 $10.00 $198.04 $10.00 $104.23 $450.20 $114.66 $378.17 $438.80 $12.00 $10.00 $360.16 $480.22 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $480.22 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $480.22 $510.23 $10.00 $450.20 $20.50 $10.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73110 5521 471 320 HC X-RAY EXAM OF WRIST; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $72.02 $65.47 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 77091 5521 291 320 HC TBS TECHNICAL CALCULATION ONLY O $321.00 $104.23 $104.23 N/A $160.50 $49.87 $45.33 $103.19 N/A $198.04 N/A $104.23 $240.75 $114.66 $202.23 $234.65 N/A N/A $192.60 $256.80 $354.39 $594.13 N/A $104.23 $125.08 N/A $256.80 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $256.80 $272.85 N/A $240.75 N/A N/A $160.50 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $214.11 N/A N/A $88.60 $88.60 $104.23 $45.33 $594.13 330104 71130 5521 471 320 HC X-RAY STRENOCLAVIC JT 3/>VWS O $800.36 $104.23 $104.23 $20.00 $400.18 $72.23 $65.66 $103.19 $20.00 $198.04 $20.00 $104.23 $600.27 $114.66 $504.23 $585.06 $24.00 $20.00 $480.22 $640.29 $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 $640.29 $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 $640.29 $680.31 $20.00 $600.27 $41.00 $20.00 $400.18 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 $680.31 330104 75989 474 320 HC ABSCESS DRAINAGE UNDER X-RAY O "$1,809.37 " N/A N/A $40.00 $904.68 $194.29 $176.63 $134.51 $40.00 N/A $40.00 N/A "$1,357.03 " N/A "$1,139.90 " "$1,322.65 " $48.00 $40.00 "$1,085.62 " "$1,447.50 " N/A N/A $40.00 N/A "$1,176.09 " $56.00 "$1,447.50 " $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A "$1,447.50 " "$1,537.96 " $54.00 "$1,357.03 " $82.00 $54.00 $904.68 "$1,176.09 " N/A N/A N/A N/A N/A N/A N/A "$1,206.85 " $40.00 $40.00 N/A N/A N/A $40.00 "$1,537.96 " 330104 75984 474 320 HC XR BILIARY TUBE CHNG O "$1,521.54 " N/A N/A $30.00 $760.77 $165.53 $150.48 $114.60 $30.00 N/A $30.00 N/A "$1,141.15 " N/A $958.57 "$1,112.25 " $36.00 $30.00 $912.92 "$1,217.23 " N/A N/A $30.00 N/A $989.00 $42.00 "$1,217.23 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$1,217.23 " "$1,293.31 " $40.50 "$1,141.15 " $61.50 $40.50 $760.77 $989.00 N/A N/A N/A N/A N/A N/A N/A "$1,014.87 " $30.00 $30.00 N/A N/A N/A $30.00 "$1,293.31 " 330104 75898 5183 277 320 HC FOLLOW-UP ANGIOGRAPHY O "$7,515.68 " "$3,573.99 " "$3,573.99 " $322.76 "$3,757.84 " N/A N/A "$3,538.25 " $322.76 "$6,790.58 " $322.76 "$3,573.99 " "$5,636.76 " "$3,931.39 " "$4,734.88 " "$5,493.96 " $387.31 $322.76 "$4,509.41 " "$6,012.54 " "$12,151.56 " "$20,371.74 " $322.76 "$3,573.99 " "$4,288.79 " $451.86 "$6,012.54 " $322.76 $322.76 $387.31 "$5,003.59 " $322.76 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$6,012.54 " "$6,388.33 " $322.76 "$5,636.76 " $661.65 $322.76 "$3,757.84 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " $121.38 "$3,752.69 " "$3,573.99 " $121.38 $322.76 $322.76 "$3,037.89 " "$3,037.89 " "$3,573.99 " $121.38 "$20,371.74 " 330104 75893 5184 280 320 HC VENOUS SAMPLING BY CATHETER O "$21,176.37 " "$6,166.38 " "$6,166.38 " $936.59 "$10,588.18 " $181.76 $165.23 "$6,104.71 " $936.59 "$11,716.11 " $936.59 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " "$1,123.91 " $936.59 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $936.59 "$6,166.38 " "$7,399.65 " "$1,311.22 " "$16,941.10 " $936.59 $936.59 "$1,123.91 " "$8,632.93 " $936.59 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $936.59 "$15,882.28 " "$1,920.01 " $936.59 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $936.59 $936.59 "$5,241.42 " "$5,241.42 " "$6,166.38 " $165.23 "$35,148.34 " 330104 75860 5183 279 320 HC VEIN X-RAY NECK O "$12,768.31 " "$3,573.99 " "$3,573.99 " $135.00 "$6,384.15 " $219.76 $199.78 "$3,538.25 " $135.00 "$6,790.58 " $135.00 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,044.04 " "$9,333.63 " $162.00 $135.00 "$7,660.99 " "$10,214.65 " "$12,151.56 " "$20,371.74 " $135.00 "$3,573.99 " "$4,288.79 " $189.00 "$10,214.65 " $135.00 $135.00 $162.00 "$5,003.59 " $135.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $135.00 "$9,576.23 " $276.75 $135.00 "$6,384.15 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$1,149.92 " "$3,752.69 " "$3,573.99 " "$1,149.92 " $135.00 $135.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $135.00 "$20,371.74 " 330104 75842 5184 280 320 HC VEIN X-RAY ADRENAL GLANDS O "$21,176.37 " "$6,166.38 " "$6,166.38 " $135.00 "$10,588.18 " $274.19 $249.27 "$6,104.71 " $135.00 "$11,716.11 " $135.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $162.00 $135.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $135.00 "$6,166.38 " "$7,399.65 " $189.00 "$16,941.10 " $135.00 $135.00 $162.00 "$8,632.93 " $135.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $135.00 "$15,882.28 " $276.75 $135.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $135.00 $135.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $135.00 "$35,148.34 " 330104 75833 5183 279 320 HC VEIN X-RAY KIDNEYS O "$13,083.96 " "$3,573.99 " "$3,573.99 " $110.00 "$6,541.98 " $257.77 $234.34 "$3,538.25 " $110.00 "$6,790.58 " $110.00 "$3,573.99 " "$9,812.97 " "$3,931.39 " "$8,242.89 " "$9,564.37 " $132.00 $110.00 "$7,850.38 " "$10,467.17 " "$12,151.56 " "$20,371.74 " $110.00 "$3,573.99 " "$4,288.79 " $154.00 "$10,467.17 " $110.00 $110.00 $132.00 "$5,003.59 " $110.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,467.17 " "$11,121.37 " $110.00 "$9,812.97 " $225.50 $110.00 "$6,541.98 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $110.00 $110.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $110.00 "$20,371.74 " 330104 75831 5183 279 320 HC VEIN X-RAY KIDNEY O "$15,510.72 " "$3,573.99 " "$3,573.99 " $80.00 "$7,755.36 " $209.77 $190.70 "$3,538.25 " $80.00 "$6,790.58 " $80.00 "$3,573.99 " "$11,633.04 " "$3,931.39 " "$9,771.75 " "$11,338.34 " $96.00 $80.00 "$9,306.43 " "$12,408.58 " "$12,151.56 " "$20,371.74 " $80.00 "$3,573.99 " "$4,288.79 " $112.00 "$12,408.58 " $80.00 $80.00 $96.00 "$5,003.59 " $80.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,408.58 " "$13,184.11 " $80.00 "$11,633.04 " $164.00 $80.00 "$7,755.36 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $80.00 $80.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $80.00 "$20,371.74 " 330104 75827 5182 277 320 HC VEIN X-RAY CHEST O "$4,515.40 " "$1,785.03 " "$1,785.03 " $40.00 "$2,257.70 " $209.60 $190.55 "$1,767.18 " $40.00 "$3,391.56 " $40.00 "$1,785.03 " "$3,386.55 " "$1,963.54 " "$2,844.70 " "$3,300.76 " $48.00 $40.00 "$2,709.24 " "$3,612.32 " "$6,069.11 " "$10,174.69 " $40.00 "$1,785.03 " "$2,142.04 " $56.00 "$3,612.32 " $40.00 $40.00 $48.00 "$2,499.05 " $40.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$3,612.32 " "$3,838.09 " $40.00 "$3,386.55 " $82.00 $40.00 "$2,257.70 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $40.00 $40.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $40.00 "$10,174.69 " 330104 75822 5182 277 320 HC VEIN X-RAY ARMS/LEGS O "$7,515.68 " "$1,785.03 " "$1,785.03 " $64.00 "$3,757.84 " $229.46 $208.60 "$1,767.18 " $64.00 "$3,391.56 " $64.00 "$1,785.03 " "$5,636.76 " "$1,963.54 " "$4,734.88 " "$5,493.96 " $76.80 $64.00 "$4,509.41 " "$6,012.54 " "$6,069.11 " "$10,174.69 " $64.00 "$1,785.03 " "$2,142.04 " $89.60 "$6,012.54 " $64.00 $64.00 $76.80 "$2,499.05 " $64.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,012.54 " "$6,388.33 " $64.00 "$5,636.76 " $131.20 $64.00 "$3,757.84 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $64.00 $64.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $64.00 "$10,174.69 " 330104 75820 5182 277 320 HC VEIN X-RAY ARM/LEG O "$4,289.63 " "$1,785.03 " "$1,785.03 " $40.00 "$2,144.82 " $188.89 $171.72 "$1,767.18 " $40.00 "$3,391.56 " $40.00 "$1,785.03 " "$3,217.22 " "$1,963.54 " "$2,702.47 " "$3,135.72 " $48.00 $40.00 "$2,573.78 " "$3,431.70 " "$6,069.11 " "$10,174.69 " $40.00 "$1,785.03 " "$2,142.04 " $56.00 "$3,431.70 " $40.00 $40.00 $48.00 "$2,499.05 " $40.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$3,431.70 " "$3,646.19 " $40.00 "$3,217.22 " $82.00 $40.00 "$2,144.82 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $40.00 $40.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $40.00 "$10,174.69 " 330104 75809 5522 389 320 HC NONVASCULAR SHUNT X-RAY O "$1,430.59 " $128.23 $128.23 $258.22 $715.29 $144.17 $131.06 $126.95 $258.22 $243.63 $258.22 $128.23 "$1,072.94 " $141.05 $901.27 "$1,045.76 " $309.86 $258.22 $858.35 "$1,144.47 " $435.98 $730.90 $258.22 $128.23 $153.87 $361.51 "$1,144.47 " $258.22 $258.22 $309.86 $179.52 $258.22 $128.23 $128.23 $139.77 "$1,144.47 " "$1,216.00 " $258.22 "$1,072.94 " $529.35 $258.22 $715.29 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $258.22 $258.22 $108.99 $108.99 $128.23 $108.99 "$1,216.00 " 330104 75736 5184 280 320 HC ARTERY X-RAYS PELVIS O "$21,176.37 " "$6,166.38 " "$6,166.38 " $80.00 "$10,588.18 " $250.18 $227.44 "$6,104.71 " $80.00 "$11,716.11 " $80.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $96.00 $80.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $80.00 "$6,166.38 " "$7,399.65 " $112.00 "$16,941.10 " $80.00 $80.00 $96.00 "$8,632.93 " $80.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $80.00 "$15,882.28 " $164.00 $80.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $80.00 $80.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $80.00 "$35,148.34 " 330104 74740 5523 389 320 HC HYSTEROSALPINGOGRAM O "$1,535.45 " $280.16 $280.16 $25.00 $767.73 $167.87 $152.61 $277.36 $25.00 $532.31 $25.00 $280.16 "$1,151.59 " $308.18 $967.33 "$1,122.41 " $30.00 $25.00 $921.27 "$1,228.36 " $952.56 "$1,596.93 " $25.00 $280.16 $336.20 $35.00 "$1,228.36 " $25.00 $25.00 $30.00 $392.23 $25.00 $280.16 $280.16 $305.38 "$1,228.36 " "$1,305.13 " $25.00 "$1,151.59 " $51.25 $25.00 $767.73 $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $25.00 $25.00 $238.14 $238.14 $280.16 $25.00 "$1,596.93 " 330104 74455 5523 389 320 HC X-RAY URETHRA/BLADDER; VOIDING O "$1,823.28 " $280.16 $280.16 $35.00 $911.64 $183.57 $166.88 $277.36 $35.00 $532.31 $35.00 $280.16 "$1,367.46 " $308.18 "$1,148.67 " "$1,332.82 " $42.00 $35.00 "$1,093.97 " "$1,458.62 " $952.56 "$1,596.93 " $35.00 $280.16 $336.20 $49.00 "$1,458.62 " $35.00 $35.00 $42.00 $392.23 $35.00 $280.16 $280.16 $305.38 "$1,458.62 " "$1,549.79 " $35.00 "$1,367.46 " $71.75 $35.00 $911.64 $753.64 $441.26 $441.26 $441.26 $441.26 $281.79 $294.17 $280.16 $281.79 $35.00 $35.00 $238.14 $238.14 $280.16 $35.00 "$1,596.93 " 330104 76000 5523 389 320 HC FLUOROSCOPE EXAMINATION O "$1,572.90 " $280.16 $280.16 $10.00 $786.45 $76.74 $69.76 $277.36 $10.00 $532.31 $10.00 $280.16 "$1,179.68 " $308.18 $990.93 "$1,149.79 " $12.00 $10.00 $943.74 "$1,258.32 " $952.56 "$1,596.93 " $10.00 $280.16 $336.20 $14.00 "$1,258.32 " $10.00 $10.00 $12.00 $392.23 $10.00 $280.16 $280.16 $305.38 "$1,258.32 " "$1,336.97 " $10.00 "$1,179.68 " $20.50 $10.00 $786.45 $753.64 $441.26 $441.26 $441.26 $441.26 $133.60 $294.17 $280.16 $133.60 $10.00 $10.00 $238.14 $238.14 $280.16 $10.00 "$1,596.93 " 330104 74450 5523 389 320 HC X-RAY URETHRA/BLADDER; RETROGRADE O "$1,256.18 " $280.16 $280.16 $20.00 $628.09 N/A N/A $277.36 $20.00 $532.31 $20.00 $280.16 $942.13 $308.18 $791.39 $918.27 $24.00 $20.00 $753.71 "$1,004.94 " $952.56 "$1,596.93 " $20.00 $280.16 $336.20 $28.00 "$1,004.94 " $20.00 $20.00 $24.00 $392.23 $20.00 $280.16 $280.16 $305.38 "$1,004.94 " "$1,067.75 " $20.00 $942.13 $41.00 $20.00 $628.09 $753.64 $441.26 $441.26 $441.26 $441.26 $281.79 $294.17 $280.16 $281.79 $20.00 $20.00 $238.14 $238.14 $280.16 $20.00 "$1,596.93 " 330104 76010 5521 471 320 HC X-RAY NOSE TO RECTUM O $761.84 $104.23 $104.23 $10.00 $380.92 $52.56 $47.78 $103.19 $10.00 $198.04 $10.00 $104.23 $571.38 $114.66 $479.96 $556.91 $12.00 $10.00 $457.10 $609.47 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $609.47 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $609.47 $647.56 $10.00 $571.38 $20.50 $10.00 $380.92 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $647.56 330104 76098 5524 389 320 HC X-RAY EXAM BREAST SPECIMEN O "$2,365.77 " $603.63 $603.63 $258.22 "$1,182.88 " $73.25 $66.59 $597.59 $258.22 "$1,146.89 " $258.22 $603.63 "$1,774.33 " $663.99 "$1,490.44 " "$1,729.38 " $309.86 $258.22 "$1,419.46 " "$1,892.62 " "$2,052.33 " "$3,440.66 " $258.22 $603.63 $724.35 $361.51 "$1,892.62 " $258.22 $258.22 $309.86 $845.08 $258.22 $603.63 $603.63 $657.95 "$1,892.62 " "$2,010.90 " $258.22 "$1,774.33 " $529.35 $258.22 "$1,182.88 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $651.38 $633.81 $603.63 $651.38 $258.22 $258.22 $513.08 $513.08 $603.63 $66.59 "$3,440.66 " 330104 77090 5521 291 320 HC TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR O $321.00 $104.23 $104.23 N/A $160.50 $5.23 $4.75 $103.19 N/A $198.04 N/A $104.23 $240.75 $114.66 $202.23 $234.65 N/A N/A $192.60 $256.80 $354.39 $594.13 N/A $104.23 $125.08 N/A $256.80 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $256.80 $272.85 N/A $240.75 N/A N/A $160.50 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $214.11 N/A N/A $88.60 $88.60 $104.23 $4.75 $594.13 330104 77081 5521 291 320 HC DXA BONE DENSITY/PERIPHERAL O "$2,324.04 " $104.23 $104.23 $52.00 "$1,162.02 " $54.76 $49.78 $103.19 $52.00 $198.04 $52.00 $104.23 "$1,743.03 " $114.66 "$1,464.15 " "$1,698.87 " $62.40 $52.00 "$1,394.42 " "$1,859.23 " $354.39 $594.13 $52.00 $104.23 $125.08 $72.80 "$1,859.23 " $52.00 $52.00 $62.40 $145.93 $52.00 $104.23 $104.23 $113.61 "$1,859.23 " "$1,975.43 " $52.00 "$1,743.03 " $106.60 $52.00 "$1,162.02 " $280.39 $164.17 $164.17 $164.17 $164.17 $51.38 $109.45 $104.23 $51.38 $52.00 $52.00 $88.60 $88.60 $104.23 $49.78 "$1,975.43 " 330104 77080 5522 291 320 HC DXA BONE DENSITY AXIAL O "$1,735.54 " $128.23 $128.23 $100.00 $867.77 $66.50 $60.46 $126.95 $100.00 $243.63 $100.00 $128.23 "$1,301.65 " $141.05 "$1,093.39 " "$1,268.68 " $120.00 $100.00 "$1,041.32 " "$1,388.43 " $435.98 $730.90 $100.00 $128.23 $153.87 $140.00 "$1,388.43 " $100.00 $100.00 $120.00 $179.52 $100.00 $128.23 $128.23 $139.77 "$1,388.43 " "$1,475.21 " $100.00 "$1,301.65 " $205.00 $100.00 $867.77 $344.93 $201.96 $201.96 $201.96 $201.96 $112.83 $134.64 $128.23 $112.83 $100.00 $100.00 $108.99 $108.99 $128.23 $60.46 "$1,475.21 " 330104 77077 5522 471 320 HC JOINT SURVEY SINGLE VIEW O $485.78 $128.23 $128.23 $50.00 $242.89 $81.91 $74.46 $126.95 $50.00 $243.63 $50.00 $128.23 $364.33 $141.05 $306.04 $355.11 $60.00 $50.00 $291.47 $388.62 $435.98 $730.90 $50.00 $128.23 $153.87 $70.00 $388.62 $50.00 $50.00 $60.00 $179.52 $50.00 $128.23 $128.23 $139.77 $388.62 $412.91 $50.00 $364.33 $102.50 $50.00 $242.89 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $50.00 $50.00 $108.99 $108.99 $128.23 $50.00 $730.90 330104 77076 5522 471 320 HC X-RAYS BONE SURVEY INFANT O $942.67 $128.23 $128.23 $35.00 $471.33 $187.60 $170.54 $126.95 $35.00 $243.63 $35.00 $128.23 $707.00 $141.05 $593.88 $689.09 $42.00 $35.00 $565.60 $754.14 $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 $754.14 $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 $754.14 $801.27 $35.00 $707.00 $71.75 $35.00 $471.33 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 $801.27 330104 77075 5522 389 320 HC X-RAYS BONE SURVEY COMPLETE O "$1,827.56 " $128.23 $128.23 $50.00 $913.78 $175.22 $159.29 $126.95 $50.00 $243.63 $50.00 $128.23 "$1,370.67 " $141.05 "$1,151.36 " "$1,335.95 " $60.00 $50.00 "$1,096.54 " "$1,462.05 " $435.98 $730.90 $50.00 $128.23 $153.87 $70.00 "$1,462.05 " $50.00 $50.00 $60.00 $179.52 $50.00 $128.23 $128.23 $139.77 "$1,462.05 " "$1,553.43 " $50.00 "$1,370.67 " $102.50 $50.00 $913.78 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $50.00 $50.00 $108.99 $108.99 $128.23 $50.00 "$1,553.43 " 330104 77074 5522 471 320 HC X-RAYS BONE SURVEY LIMITED O "$1,464.83 " $128.23 $128.23 $35.00 $732.41 $112.79 $102.54 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,098.62 " $141.05 $922.84 "$1,070.79 " $42.00 $35.00 $878.90 "$1,171.86 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,171.86 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,171.86 " "$1,245.11 " $35.00 "$1,098.62 " $71.75 $35.00 $732.41 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$1,245.11 " 330104 77073 5522 471 320 HC X-RAYS BONE LENGTH STUDIES O $480.43 $128.23 $128.23 $25.00 $240.22 $78.91 $71.74 $126.95 $25.00 $243.63 $25.00 $128.23 $360.32 $141.05 $302.67 $351.19 $30.00 $25.00 $288.26 $384.34 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $384.34 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $384.34 $408.37 $25.00 $360.32 $51.25 $25.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $730.90 330104 77072 5522 471 320 HC X-RAYS FOR BONE AGE O $518.95 $128.23 $128.23 $15.00 $259.48 $45.44 $41.31 $126.95 $15.00 $243.63 $15.00 $128.23 $389.21 $141.05 $326.94 $379.35 $18.00 $15.00 $311.37 $415.16 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $415.16 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $415.16 $441.11 $15.00 $389.21 $30.75 $15.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 77003 474 320 HC FLUOROGUIDE FOR SPINE INJECT O "$1,692.74 " N/A N/A $25.00 $846.37 $184.88 $168.08 $128.00 $25.00 N/A $25.00 N/A "$1,269.56 " N/A "$1,066.43 " "$1,237.39 " $30.00 $25.00 "$1,015.64 " "$1,354.19 " N/A N/A $25.00 N/A "$1,100.28 " $35.00 "$1,354.19 " $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A "$1,354.19 " "$1,438.83 " $33.75 "$1,269.56 " $51.25 $33.75 $846.37 "$1,100.28 " N/A N/A N/A N/A N/A N/A N/A "$1,129.06 " $25.00 $25.00 N/A N/A N/A $25.00 "$1,438.83 " 330104 77002 474 320 HC NEEDLE LOCALIZATION BY XRAY O "$2,010.53 " N/A N/A $25.00 "$1,005.26 " $204.13 $185.58 $141.32 $25.00 N/A $25.00 N/A "$1,507.90 " N/A "$1,266.63 " "$1,469.70 " $30.00 $25.00 "$1,206.32 " "$1,608.42 " N/A N/A $25.00 N/A "$1,306.84 " $35.00 "$1,608.42 " $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A "$1,608.42 " "$1,708.95 " $33.75 "$1,507.90 " $51.25 $33.75 "$1,005.26 " "$1,306.84 " N/A N/A N/A N/A N/A N/A N/A "$1,341.02 " $25.00 $25.00 N/A N/A N/A $25.00 "$1,708.95 " 330104 77001 474 320 HC FLUOROGUIDE FOR VEIN DEVICE O "$1,460.55 " N/A N/A $21.00 $730.27 $177.15 $161.05 $122.64 $21.00 N/A $21.00 N/A "$1,095.41 " N/A $920.15 "$1,067.66 " $25.20 $21.00 $876.33 "$1,168.44 " N/A N/A $21.00 N/A $949.36 $29.40 "$1,168.44 " $21.00 $21.00 $25.20 N/A $21.00 N/A N/A N/A "$1,168.44 " "$1,241.47 " $28.35 "$1,095.41 " $43.05 $28.35 $730.27 $949.36 N/A N/A N/A N/A N/A N/A N/A $974.19 $21.00 $21.00 N/A N/A N/A $21.00 "$1,241.47 " 330104 76497 5521 299 320 HC CT PROCEDURE O $964.07 $104.23 $104.23 N/A $482.04 N/A N/A $103.19 N/A $198.04 N/A $104.23 $723.05 $114.66 $607.36 $704.74 N/A N/A $578.44 $771.26 $354.39 $594.13 N/A $104.23 $125.08 N/A $771.26 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $771.26 $819.46 N/A $723.05 N/A N/A $482.04 $280.39 $164.17 $164.17 $164.17 $164.17 $181.58 $109.45 $104.23 $181.58 N/A N/A $88.60 $88.60 $104.23 $88.60 $819.46 330104 76496 5521 471 320 HC FLUOROSCOPIC PROCEDURE O $342.40 $104.23 $104.23 N/A $171.20 N/A N/A $103.19 N/A $198.04 N/A $104.23 $256.80 $114.66 $215.71 $250.29 N/A N/A $205.44 $273.92 $354.39 $594.13 N/A $104.23 $125.08 N/A $273.92 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $273.92 $291.04 N/A $256.80 N/A N/A $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $133.60 $109.45 $104.23 $133.60 N/A N/A $88.60 $88.60 $104.23 $88.60 $594.13 330104 76376 2002 320 HC 3D RENDER W/INTRP POSTPROCES (NOT INDEP WKSTATION) O $94.16 N/A N/A $100.00 $47.08 $41.84 $38.03 $28.96 $100.00 N/A $100.00 N/A $70.62 N/A $59.32 $68.83 $120.00 $100.00 $56.50 $75.33 N/A N/A $100.00 N/A $61.20 $140.00 $75.33 $100.00 $100.00 $120.00 N/A $100.00 N/A N/A N/A $75.33 $80.04 $135.00 $70.62 $205.00 $135.00 $47.08 $61.20 N/A N/A N/A N/A N/A N/A N/A $62.80 $100.00 $100.00 N/A N/A N/A $28.96 $205.00 330104 76080 5524 389 320 HC X-RAY EXAM OF FISTULA O "$2,220.25 " $603.63 $603.63 $15.00 "$1,110.12 " $104.29 $94.81 $597.59 $15.00 "$1,146.89 " $15.00 $603.63 "$1,665.19 " $663.99 "$1,398.76 " "$1,623.00 " $18.00 $15.00 "$1,332.15 " "$1,776.20 " "$2,052.33 " "$3,440.66 " $15.00 $603.63 $724.35 $21.00 "$1,776.20 " $15.00 $15.00 $18.00 $845.08 $15.00 $603.63 $603.63 $657.95 "$1,776.20 " "$1,887.21 " $15.00 "$1,665.19 " $30.75 $15.00 "$1,110.12 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $367.94 $633.81 $603.63 $367.94 $15.00 $15.00 $513.08 $513.08 $603.63 $15.00 "$3,440.66 " 330104 76377 2002 320 HC 3D CT RENDER W/INTRP POSTPROCES (INDEP WKSTATION) O "$1,070.00 " N/A N/A $100.00 $535.00 $130.00 $118.18 $90.00 $100.00 N/A $100.00 N/A $802.50 N/A $674.10 $782.17 $120.00 $100.00 $642.00 $856.00 N/A N/A $100.00 N/A $695.50 $140.00 $856.00 $100.00 $100.00 $120.00 N/A $100.00 N/A N/A N/A $856.00 $909.50 $135.00 $802.50 $205.00 $135.00 $535.00 $695.50 N/A N/A N/A N/A N/A N/A N/A $713.69 $100.00 $100.00 N/A N/A N/A $90.00 $909.50 330104 74430 5572 389 320 HC CONTRAST X-RAY BLADDER O "$1,760.15 " $442.02 $442.02 $20.00 $880.08 $72.00 $65.45 $437.60 $20.00 $839.84 $20.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $24.00 $20.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $20.00 $442.02 $530.42 $28.00 "$1,408.12 " $20.00 $20.00 $24.00 $618.83 $20.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $20.00 "$1,320.11 " $41.00 $20.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $20.00 $20.00 $375.72 $375.72 $442.02 $20.00 "$2,519.52 " 330104 74420 5572 389 320 HC UROGRAPHY/PYELOGRAPHY RETROGRADE W/OR WITHOUT KUB O "$1,760.15 " $442.02 $442.02 $25.00 $880.08 $133.33 $121.21 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $30.00 $25.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,408.12 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $25.00 "$1,320.11 " $51.25 $25.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 73650 5521 471 320 HC X-RAY EXAM OF HEEL; MIN 2 VIEWS O $600.27 $104.23 $104.23 $10.00 $300.13 $50.36 $45.78 $103.19 $10.00 $198.04 $10.00 $104.23 $450.20 $114.66 $378.17 $438.80 $12.00 $10.00 $360.16 $480.22 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $480.22 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $480.22 $510.23 $10.00 $450.20 $20.50 $10.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73630 5521 471 320 HC X-RAY EXAM OF FOOT; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $60.27 $54.79 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73620 5521 471 320 HC X-RAY EXAM OF FOOT; 2 VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $49.77 $45.25 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73610 5521 471 320 HC ANKLE(S) (COMPLETE) XR EACH O $861.35 $104.23 $104.23 $12.50 $430.68 $64.97 $59.06 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73600 5521 471 320 HC RAD EXAM ANK;AP&LAT VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $57.41 $52.19 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73592 5521 471 320 HC X-RAY EXAM OF LEG INFANT; MIN 2 VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $55.65 $50.59 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 73590 5521 471 320 HC X-RAY EXAM OF LOWER LEG; 2 VIEWS O $708.34 $104.23 $104.23 $10.00 $354.17 $55.65 $50.59 $103.19 $10.00 $198.04 $10.00 $104.23 $531.25 $114.66 $446.25 $517.80 $12.00 $10.00 $425.00 $566.67 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $566.67 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $566.67 $602.09 $10.00 $531.25 $20.50 $10.00 $354.17 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $602.09 330104 73565 5521 471 320 HC X-RAY EXAM OF KNEES; BOTH KNEES STANDING AP O $721.18 $104.23 $104.23 $10.00 $360.59 $70.33 $63.94 $103.19 $10.00 $198.04 $10.00 $104.23 $540.89 $114.66 $454.34 $527.18 $12.00 $10.00 $432.71 $576.94 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $576.94 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $576.94 $613.00 $10.00 $540.89 $20.50 $10.00 $360.59 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $613.00 330104 73564 5522 471 320 HC X-RAY EXAM KNEE 4 OR MORE O $930.90 $128.23 $128.23 $20.00 $465.45 $81.62 $74.20 $126.95 $20.00 $243.63 $20.00 $128.23 $698.17 $141.05 $586.47 $680.49 $24.00 $20.00 $558.54 $744.72 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $744.72 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $744.72 $791.26 $20.00 $698.17 $41.00 $20.00 $465.45 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $791.26 330104 73562 5521 471 320 HC X-RAY EXAM OF KNEE 3 VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $71.35 $64.87 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 73560 5521 471 320 HC X-RAY EXAM OF KNEE 1 OR 2 VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $60.35 $54.86 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73552 5521 471 320 HC X-RAY EXAM OF FEMUR 2/> VWS O $799.29 $104.23 $104.23 $9.78 $399.64 $62.54 $56.86 $103.19 $9.78 $198.04 $9.78 $104.23 $599.47 $114.66 $503.55 $584.28 $11.74 $9.78 $479.57 $639.43 $354.39 $594.13 $9.78 $104.23 $125.08 $13.69 $639.43 $9.78 $9.78 $11.74 $145.93 $9.78 $104.23 $104.23 $113.61 $639.43 $679.40 $9.78 $599.47 $20.05 $9.78 $399.64 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $9.78 $9.78 $88.60 $88.60 $104.23 $9.78 $679.40 330104 73551 5521 471 320 HC X-RAY EXAM OF FEMUR 1VIEW O $828.18 $104.23 $104.23 $8.39 $414.09 $51.54 $46.85 $103.19 $8.39 $198.04 $8.39 $104.23 $621.14 $114.66 $521.75 $605.40 $10.07 $8.39 $496.91 $662.54 $354.39 $594.13 $8.39 $104.23 $125.08 $11.75 $662.54 $8.39 $8.39 $10.07 $145.93 $8.39 $104.23 $104.23 $113.61 $662.54 $703.95 $8.39 $621.14 $17.20 $8.39 $414.09 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $8.39 $8.39 $88.60 $88.60 $104.23 $8.39 $703.95 330104 73522 5522 471 320 HC X-RAY EXAM HIPS BI 3-4 VIEWS O "$1,158.81 " $128.23 $128.23 $14.73 $579.40 $93.43 $84.93 $126.95 $14.73 $243.63 $14.73 $128.23 $869.11 $141.05 $730.05 $847.09 $17.68 $14.73 $695.29 $927.05 $435.98 $730.90 $14.73 $128.23 $153.87 $20.62 $927.05 $14.73 $14.73 $17.68 $179.52 $14.73 $128.23 $128.23 $139.77 $927.05 $984.99 $14.73 $869.11 $30.20 $14.73 $579.40 $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $14.73 $14.73 $108.99 $108.99 $128.23 $14.73 $984.99 330104 73521 5522 471 320 HC X-RAY EXAM HIPS BIL 2 VIEWS O "$2,784.14 " $128.23 $128.23 $12.04 "$1,392.07 " $72.23 $65.66 $126.95 $12.04 $243.63 $12.04 $128.23 "$2,088.11 " $141.05 "$1,754.01 " "$2,035.21 " $14.45 $12.04 "$1,670.48 " "$2,227.31 " $435.98 $730.90 $12.04 $128.23 $153.87 $16.86 "$2,227.31 " $12.04 $12.04 $14.45 $179.52 $12.04 $128.23 $128.23 $139.77 "$2,227.31 " "$2,366.52 " $12.04 "$2,088.11 " $24.68 $12.04 "$1,392.07 " $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $12.04 $12.04 $108.99 $108.99 $128.23 $12.04 "$2,366.52 " 330104 73660 5521 471 320 HC X-RAY EXAM OF TOE(S); MIN 2 VIEWS O $557.47 $104.23 $104.23 $7.50 $278.74 $51.76 $47.06 $103.19 $7.50 $198.04 $7.50 $104.23 $418.10 $114.66 $351.21 $407.51 $9.00 $7.50 $334.48 $445.98 $354.39 $594.13 $7.50 $104.23 $125.08 $10.50 $445.98 $7.50 $7.50 $9.00 $145.93 $7.50 $104.23 $104.23 $113.61 $445.98 $473.85 $7.50 $418.10 $15.37 $7.50 $278.74 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $7.50 $7.50 $88.60 $88.60 $104.23 $7.50 $594.13 330104 74425 5572 389 320 HC UROGRAPHY ANTEGRADE (NEPHROSTOGRAM/LOOPOGRAM) O "$1,760.15 " $442.02 $442.02 $20.00 $880.08 $239.71 $217.92 $437.60 $20.00 $839.84 $20.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $24.00 $20.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $20.00 $442.02 $530.42 $28.00 "$1,408.12 " $20.00 $20.00 $24.00 $618.83 $20.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $20.00 "$1,320.11 " $41.00 $20.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $20.00 $20.00 $375.72 $375.72 $442.02 $20.00 "$2,519.52 " 330104 74019 5522 471 320 HC X-RAY EXAM ABDOMEN 2 VIEWS O "$1,151.32 " $128.23 $128.23 $15.00 $575.66 $64.52 $58.65 $126.95 $15.00 $243.63 $15.00 $128.23 $863.49 $141.05 $725.33 $841.61 $18.00 $15.00 $690.79 $921.06 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $921.06 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $921.06 $978.62 $15.00 $863.49 $30.75 $15.00 $575.66 $344.93 $201.96 $201.96 $201.96 $201.96 $189.98 $134.64 $128.23 $189.98 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $978.62 330104 74220 5571 471 320 HC CONTRAST X-RAY ESOPHAGUS O $916.99 $216.36 $216.36 $20.00 $458.50 $173.73 $157.93 $214.20 $20.00 $411.09 $20.00 $216.36 $687.74 $238.00 $577.70 $670.32 $24.00 $20.00 $550.19 $733.59 $735.63 "$1,233.26 " $20.00 $216.36 $259.63 $28.00 $733.59 $20.00 $20.00 $24.00 $302.91 $20.00 $216.36 $216.36 $235.83 $733.59 $779.44 $20.00 $687.74 $41.00 $20.00 $458.50 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $20.00 $20.00 $183.91 $183.91 $216.36 $20.00 "$1,233.26 " 330104 74360 474 320 HC X-RAY GUIDE GI DILATION O "$2,324.04 " N/A N/A $40.00 "$1,162.02 " N/A N/A N/A $40.00 N/A $40.00 N/A "$1,743.03 " N/A "$1,464.15 " "$1,698.87 " $48.00 $40.00 "$1,394.42 " "$1,859.23 " N/A N/A $40.00 N/A "$1,510.63 " $56.00 "$1,859.23 " $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A "$1,859.23 " "$1,975.43 " $54.00 "$1,743.03 " $82.00 $54.00 "$1,162.02 " "$1,510.63 " N/A N/A N/A N/A N/A N/A N/A "$1,550.13 " $40.00 $40.00 N/A N/A N/A $40.00 "$1,975.43 " 330104 74330 474 320 HC X-RAY BILE/PANC ENDOSCOPY O "$3,616.60 " N/A N/A $36.00 "$1,808.30 " N/A N/A N/A $36.00 N/A $36.00 N/A "$2,712.45 " N/A "$2,278.46 " "$2,643.73 " $43.20 $36.00 "$2,169.96 " "$2,893.28 " N/A N/A $36.00 N/A "$2,350.79 " $50.40 "$2,893.28 " $36.00 $36.00 $43.20 N/A $36.00 N/A N/A N/A "$2,893.28 " "$3,074.11 " $48.60 "$2,712.45 " $73.80 $48.60 "$1,808.30 " "$2,350.79 " N/A N/A N/A N/A N/A N/A N/A "$2,412.27 " $36.00 $36.00 N/A N/A N/A $36.00 "$3,074.11 " 330104 74329 474 320 HC X-RAY FOR PANCREAS ENDOSCOPY O "$3,405.81 " N/A N/A $30.00 "$1,702.90 " N/A N/A N/A $30.00 N/A $30.00 N/A "$2,554.36 " N/A "$2,145.66 " "$2,489.65 " $36.00 $30.00 "$2,043.49 " "$2,724.65 " N/A N/A $30.00 N/A "$2,213.78 " $42.00 "$2,724.65 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$2,724.65 " "$2,894.94 " $40.50 "$2,554.36 " $61.50 $40.50 "$1,702.90 " "$2,213.78 " N/A N/A N/A N/A N/A N/A N/A "$2,271.68 " $30.00 $30.00 N/A N/A N/A $30.00 "$2,894.94 " 330104 74328 474 320 HC X-RAY BILE DUCT ENDOSCOPY O "$3,421.86 " N/A N/A $30.00 "$1,710.93 " N/A N/A N/A $30.00 N/A $30.00 N/A "$2,566.39 " N/A "$2,155.77 " "$2,501.38 " $36.00 $30.00 "$2,053.12 " "$2,737.49 " N/A N/A $30.00 N/A "$2,224.21 " $42.00 "$2,737.49 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$2,737.49 " "$2,908.58 " $40.50 "$2,566.39 " $61.50 $40.50 "$1,710.93 " "$2,224.21 " N/A N/A N/A N/A N/A N/A N/A "$2,282.38 " $30.00 $30.00 N/A N/A N/A $30.00 "$2,908.58 " 330104 74300 474 320 HC CHOLANGIOGRAP &/OR PANCREATO INTERP S&I O "$1,189.84 " N/A N/A $358.61 $594.92 N/A N/A N/A $358.61 N/A $358.61 N/A $892.38 N/A $749.60 $869.77 $430.34 $358.61 $713.90 $951.87 N/A N/A $358.61 N/A $773.40 $502.06 $951.87 $358.61 $358.61 $430.34 N/A $358.61 N/A N/A N/A $951.87 "$1,011.36 " $484.13 $892.38 $735.16 $484.13 $594.92 $773.40 N/A N/A N/A N/A N/A N/A N/A $793.62 $358.61 $358.61 N/A N/A N/A $358.61 "$1,011.36 " 330104 74280 5571 389 320 HC CONTRAST X-RAY EXAM COLON;W/BARIUM W/ W/O GLUCAGON O "$1,774.06 " $216.36 $216.36 $40.00 $887.03 $390.52 $355.02 $214.20 $40.00 $411.09 $40.00 $216.36 "$1,330.55 " $238.00 "$1,117.66 " "$1,296.84 " $48.00 $40.00 "$1,064.44 " "$1,419.25 " $735.63 "$1,233.26 " $40.00 $216.36 $259.63 $56.00 "$1,419.25 " $40.00 $40.00 $48.00 $302.91 $40.00 $216.36 $216.36 $235.83 "$1,419.25 " "$1,507.95 " $40.00 "$1,330.55 " $82.00 $40.00 $887.03 $582.01 $340.77 $340.77 $340.77 $340.77 $227.17 $227.18 $216.36 $227.17 $40.00 $40.00 $183.91 $183.91 $216.36 $40.00 "$1,507.95 " 330104 74270 5571 389 320 HC CONTRAST X-RAY EXAM OF COLON; ENEMA W/ W/O KUB O "$1,373.88 " $216.36 $216.36 $25.00 $686.94 $269.07 $244.61 $214.20 $25.00 $411.09 $25.00 $216.36 "$1,030.41 " $238.00 $865.54 "$1,004.31 " $30.00 $25.00 $824.33 "$1,099.10 " $735.63 "$1,233.26 " $25.00 $216.36 $259.63 $35.00 "$1,099.10 " $25.00 $25.00 $30.00 $302.91 $25.00 $216.36 $216.36 $235.83 "$1,099.10 " "$1,167.80 " $25.00 "$1,030.41 " $51.25 $25.00 $686.94 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $25.00 $25.00 $183.91 $183.91 $216.36 $25.00 "$1,233.26 " 330104 74250 5571 389 320 HC X-RAY EXAM OF SMALL BOWEL O "$1,582.53 " $216.36 $216.36 $30.00 $791.26 $215.01 $195.47 $214.20 $30.00 $411.09 $30.00 $216.36 "$1,186.90 " $238.00 $996.99 "$1,156.83 " $36.00 $30.00 $949.52 "$1,266.02 " $735.63 "$1,233.26 " $30.00 $216.36 $259.63 $42.00 "$1,266.02 " $30.00 $30.00 $36.00 $302.91 $30.00 $216.36 $216.36 $235.83 "$1,266.02 " "$1,345.15 " $30.00 "$1,186.90 " $61.50 $30.00 $791.26 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $30.00 $30.00 $183.91 $183.91 $216.36 $30.00 "$1,345.15 " 330104 74248 389 320 HC X-RAY SM INT F-THRU STD O $910.57 N/A N/A $17.09 $455.29 $144.78 $131.62 $100.23 $17.09 N/A $17.09 N/A $682.93 N/A $573.66 $665.63 $20.51 $17.09 $546.34 $728.46 N/A N/A $17.09 N/A $591.87 $23.93 $728.46 $17.09 $17.09 $20.51 N/A $17.09 N/A N/A N/A $728.46 $773.98 $23.07 $682.93 $35.03 $23.07 $455.29 $591.87 N/A N/A N/A N/A N/A N/A N/A $607.35 $17.09 $17.09 N/A N/A N/A $17.09 $773.98 330104 74246 5571 389 320 HC CONTRST X-RAY UPPR GI TRACT W/O KUB O "$2,060.82 " $216.36 $216.36 $50.00 "$1,030.41 " $244.87 $222.61 $214.20 $50.00 $411.09 $50.00 $216.36 "$1,545.62 " $238.00 "$1,298.32 " "$1,506.46 " $60.00 $50.00 "$1,236.49 " "$1,648.66 " $735.63 "$1,233.26 " $50.00 $216.36 $259.63 $70.00 "$1,648.66 " $50.00 $50.00 $60.00 $302.91 $50.00 $216.36 $216.36 $235.83 "$1,648.66 " "$1,751.70 " $50.00 "$1,545.62 " $102.50 $50.00 "$1,030.41 " $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $50.00 $50.00 $183.91 $183.91 $216.36 $50.00 "$1,751.70 " 330104 74245 389 320 HC X-RAY UPPER GI&SMALL INTEST O "$2,038.35 " N/A N/A $258.22 "$1,019.17 " N/A N/A "$1,333.08 " $258.22 N/A $258.22 N/A "$1,528.76 " N/A "$1,284.16 " "$1,490.03 " $309.86 $258.22 "$1,223.01 " "$1,630.68 " N/A N/A $258.22 N/A N/A $361.51 "$1,630.68 " $258.22 $258.22 $309.86 N/A $258.22 N/A N/A N/A "$1,630.68 " "$1,732.60 " $348.60 "$1,528.76 " $529.35 $348.60 "$1,019.17 " "$1,324.93 " N/A N/A N/A N/A N/A N/A N/A "$1,359.58 " $258.22 $258.22 N/A N/A N/A $258.22 "$1,732.60 " 330104 74241 389 320 HC X-RAYUPPER GI DELAY W/KUB O "$2,038.35 " N/A N/A $258.22 "$1,019.17 " N/A N/A "$1,333.08 " $258.22 N/A $258.22 N/A "$1,528.76 " N/A "$1,284.16 " "$1,490.03 " $309.86 $258.22 "$1,223.01 " "$1,630.68 " N/A N/A $258.22 N/A N/A $361.51 "$1,630.68 " $258.22 $258.22 $309.86 N/A $258.22 N/A N/A N/A "$1,630.68 " "$1,732.60 " $348.60 "$1,528.76 " $529.35 $348.60 "$1,019.17 " "$1,324.93 " N/A N/A N/A N/A N/A N/A N/A "$1,359.58 " $258.22 $258.22 N/A N/A N/A $258.22 "$1,732.60 " 330104 74240 5571 389 320 HC X-RAY UPPER GI DELAY W/O KUB O "$2,038.35 " $216.36 $216.36 $30.00 "$1,019.17 " $216.26 $196.60 $214.20 $30.00 $411.09 $30.00 $216.36 "$1,528.76 " $238.00 "$1,284.16 " "$1,490.03 " $36.00 $30.00 "$1,223.01 " "$1,630.68 " $735.63 "$1,233.26 " $30.00 $216.36 $259.63 $42.00 "$1,630.68 " $30.00 $30.00 $36.00 $302.91 $30.00 $216.36 $216.36 $235.83 "$1,630.68 " "$1,732.60 " $30.00 "$1,528.76 " $61.50 $30.00 "$1,019.17 " $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $30.00 $30.00 $183.91 $183.91 $216.36 $30.00 "$1,732.60 " 330104 74230 5571 389 320 HC CINE/VID X-RAY THROAT/ESOPH O "$1,481.95 " $216.36 $216.36 $20.00 $740.98 $223.00 $202.73 $214.20 $20.00 $411.09 $20.00 $216.36 "$1,111.46 " $238.00 $933.63 "$1,083.31 " $24.00 $20.00 $889.17 "$1,185.56 " $735.63 "$1,233.26 " $20.00 $216.36 $259.63 $28.00 "$1,185.56 " $20.00 $20.00 $24.00 $302.91 $20.00 $216.36 $216.36 $235.83 "$1,185.56 " "$1,259.66 " $20.00 "$1,111.46 " $41.00 $20.00 $740.98 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $20.00 $20.00 $183.91 $183.91 $216.36 $20.00 "$1,259.66 " 330104 74221 5571 389 320 HC X-RAY XM ESOPHAGUS 2CNTRST O $778.96 $216.36 $216.36 $24.94 $389.48 $194.70 $177.00 $214.20 $24.94 $411.09 $24.94 $216.36 $584.22 $238.00 $490.74 $569.42 $29.93 $24.94 $467.38 $623.17 $735.63 "$1,233.26 " $24.94 $216.36 $259.63 $34.92 $623.17 $24.94 $24.94 $29.93 $302.91 $24.94 $216.36 $216.36 $235.83 $623.17 $662.12 $24.94 $584.22 $51.13 $24.94 $389.48 $582.01 $340.77 $340.77 $340.77 $340.77 $291.52 $227.18 $216.36 $291.52 $24.94 $24.94 $183.91 $183.91 $216.36 $24.94 "$1,233.26 " 330104 74022 5522 471 320 HC X-RAY EXAM SERIES ABDOMEN O "$1,271.16 " $128.23 $128.23 $26.00 $635.58 $87.27 $79.34 $126.95 $26.00 $243.63 $26.00 $128.23 $953.37 $141.05 $800.83 $929.22 $31.20 $26.00 $762.70 "$1,016.93 " $435.98 $730.90 $26.00 $128.23 $153.87 $36.40 "$1,016.93 " $26.00 $26.00 $31.20 $179.52 $26.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $26.00 $953.37 $53.30 $26.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $26.00 $26.00 $108.99 $108.99 $128.23 $26.00 "$1,080.49 " 330104 71120 5521 471 320 HC X-RAY EXAM BREASTBONE 2/>VWS O $861.35 $104.23 $104.23 $15.00 $430.68 $58.87 $53.52 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 74018 5521 471 320 HC X-RAY EXAM ABDOMEN 1 VIEW O $861.35 $104.23 $104.23 $10.00 $430.68 $52.56 $47.78 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 71110 5522 471 320 HC X-RAY EXAM RIBS BIL 3 VIEWS O "$1,127.78 " $128.23 $128.23 $25.00 $563.89 $76.40 $69.45 $126.95 $25.00 $243.63 $25.00 $128.23 $845.84 $141.05 $710.50 $824.41 $30.00 $25.00 $676.67 $902.22 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $902.22 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $902.22 $958.61 $25.00 $845.84 $51.25 $25.00 $563.89 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $958.61 330104 61055 5441 214 320 HC RAD INJECTION INTO BRAIN CANAL O "$5,246.21 " $326.20 $326.20 $468.48 "$2,623.11 " $208.85 $189.86 $322.94 $468.48 $619.77 $468.48 $326.20 "$3,934.66 " $358.82 "$3,305.11 " "$3,834.98 " $562.18 $468.48 "$3,147.73 " "$4,196.97 " "$1,109.07 " "$1,859.32 " $468.48 $326.20 $391.44 $655.88 "$4,196.97 " $468.48 $468.48 $562.18 $456.68 $468.48 $326.20 $326.20 $355.56 "$4,196.97 " "$4,459.28 " $468.48 "$3,883.00 " $960.39 $468.48 "$2,623.11 " $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 "$3,499.22 " $468.48 $468.48 $277.27 $277.27 $326.20 $189.86 "$4,459.28 " 330104 49406 5072 150 320 HC IMAGE CATH FLUID PERI/RETRO O "$12,955.56 " "$1,799.07 " "$1,799.07 " $609.85 "$6,477.78 " $323.52 $294.11 "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$9,716.67 " "$1,978.98 " "$8,162.00 " "$9,470.51 " $731.82 $609.85 "$7,773.34 " "$10,364.45 " "$6,116.84 " "$10,254.70 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$10,364.45 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,364.45 " "$11,012.23 " $609.85 "$9,716.67 " "$1,250.19 " $609.85 "$6,477.78 " "$4,839.50 " "$2,833.54 " "$2,833.54 " "$2,833.54 " "$2,833.54 " N/A "$1,889.02 " "$1,799.07 " "$8,641.36 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $294.11 "$11,012.23 " 330104 47533 5341 151 320 HC PLMT BILIARY DRAINAGE CATH O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$4,280.00 " $440.75 $400.68 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,392.80 " "$6,257.36 " "$1,756.35 " "$1,463.63 " "$5,136.00 " "$6,848.00 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$6,848.00 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,463.63 " "$6,420.00 " "$3,000.43 " "$1,463.63 " "$4,280.00 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$5,709.52 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $400.68 "$24,221.55 " 330104 47531 5341 279 320 HC INJECTION FOR CHOLANGIOGRAM O "$14,326.23 " "$4,249.40 " "$4,249.40 " $358.62 "$7,163.11 " $116.94 $106.31 "$4,206.90 " $358.62 "$8,073.85 " $358.62 "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " $430.34 $358.62 "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " $358.62 "$4,249.40 " "$5,099.27 " $502.06 "$11,460.98 " $358.62 $358.62 $430.34 "$5,949.15 " $358.62 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " $358.62 "$10,744.67 " $735.16 $358.62 "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " $358.62 $358.62 "$3,611.99 " "$3,611.99 " "$4,249.40 " $106.31 "$24,221.55 " 330104 47490 5341 151 320 HC PERCUTANEOUS CHOLECYSTOSTOMY O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$7,163.11 " $565.76 $514.33 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " "$1,756.35 " "$1,463.63 " "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$11,460.98 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$1,463.63 " "$3,883.00 " "$3,000.43 " "$1,463.63 " "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $514.33 "$24,221.55 " 330104 36598 5693 278 320 HC CATHETER CHECK O "$1,443.43 " $247.83 $247.83 $468.99 $721.72 $59.79 $54.35 $245.35 $468.99 $470.88 $468.99 $247.83 "$1,082.57 " $272.61 $909.36 "$1,055.15 " $562.78 $468.99 $866.06 "$1,154.74 " $842.62 "$1,412.63 " $468.99 $247.83 $297.40 $656.58 "$1,154.74 " $468.99 $468.99 $562.78 $346.96 $468.99 $247.83 $247.83 $270.14 "$1,154.74 " "$1,226.92 " $468.99 "$1,082.57 " $961.42 $468.99 $721.72 $666.66 $390.33 $390.33 $390.33 $390.33 N/A $260.22 $247.83 $962.77 $468.99 $468.99 $210.66 $210.66 $247.83 $54.35 "$1,412.63 " 330104 36556 5183 75 320 HC RAD INS NON-TUNNEL CV CATH 5 YRS/> O "$7,469.67 " "$3,573.99 " "$3,573.99 " $235.81 "$3,734.84 " $144.10 $131.00 "$3,538.25 " $235.81 "$6,790.58 " $235.81 "$3,573.99 " "$5,602.25 " "$3,931.39 " "$4,705.89 " "$5,460.33 " $282.97 $235.81 "$4,481.80 " "$5,975.74 " "$12,151.56 " "$20,371.74 " $235.81 "$3,573.99 " "$4,288.79 " $330.13 "$5,975.74 " $235.81 $235.81 $282.97 "$5,003.59 " $235.81 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$5,975.74 " "$6,349.22 " $235.81 "$3,883.00 " $483.41 $235.81 "$3,734.84 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " N/A "$3,752.69 " "$3,573.99 " "$4,982.27 " $235.81 $235.81 "$3,037.89 " "$3,037.89 " "$3,573.99 " $131.00 "$20,371.74 " 330104 27093 278 320 HC HIP ARTHROGRAPHY INJ WO ANESTH O "$1,814.72 " N/A N/A $468.99 $907.36 $118.42 $107.65 $81.98 $468.99 N/A $468.99 N/A "$1,361.04 " N/A "$1,143.27 " "$1,326.56 " $562.78 $468.99 "$1,088.83 " "$1,451.78 " N/A N/A $468.99 N/A "$1,179.57 " $656.58 "$1,451.78 " $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A "$1,451.78 " "$1,542.51 " $633.13 "$1,361.04 " $961.42 $633.13 $907.36 "$1,179.57 " N/A N/A N/A N/A N/A N/A N/A "$1,210.42 " $468.99 $468.99 N/A N/A N/A $81.98 "$1,542.51 " 330104 20610 5441 49 320 HC DRAIN/INJECT MAJOR JOINT/BURSA FL O "$1,206.96 " $326.20 $326.20 $296.51 $603.48 "$1,296.00 " "$1,180.00 " $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 $882.29 $355.81 $296.51 $724.18 $965.57 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,859.32 " 330104 20605 5441 49 320 HC DRAIN/INJECT INTERMED. JOINT/BURSA FL O "$1,206.96 " $326.20 $326.20 $296.51 $603.48 $64.77 $58.88 $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 $882.29 $355.81 $296.51 $724.18 $965.57 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $58.88 "$1,859.32 " 330104 20600 5441 49 320 HC DRAIN/INJECT SMALL JOINT/BURSA FL O "$1,277.58 " $326.20 $326.20 $296.51 $638.79 $60.92 $55.39 $322.94 $296.51 $619.77 $296.51 $326.20 $958.18 $358.82 $804.88 $933.91 $355.81 $296.51 $766.55 "$1,022.06 " "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 "$1,022.06 " $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 "$1,022.06 " "$1,085.94 " $296.51 $958.18 $607.85 $296.51 $638.79 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $852.15 $296.51 $296.51 $277.27 $277.27 $326.20 $55.39 "$1,859.32 " 330104 20501 278 320 HC SINUS TRACT INJ DX O $529.65 N/A N/A $468.99 $264.82 $61.40 $55.82 $42.51 $468.99 N/A $468.99 N/A $397.24 N/A $333.68 $387.17 $562.78 $468.99 $317.79 $423.72 N/A N/A $468.99 N/A $344.27 $656.58 $423.72 $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A $423.72 $450.20 $633.13 $397.24 $961.42 $633.13 $264.82 $344.27 N/A N/A N/A N/A N/A N/A N/A $353.28 $468.99 $468.99 N/A N/A N/A $42.51 $961.42 330104 0701T 177 320 HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS EA ADDL O $331.70 N/A N/A $43.08 $165.85 N/A N/A N/A $43.08 N/A $43.08 N/A $248.77 N/A $208.97 $242.47 $51.70 $43.08 $199.02 $265.36 N/A N/A $43.08 N/A $215.60 $60.31 $265.36 $43.08 $43.08 $51.70 N/A $43.08 N/A N/A N/A $265.36 $281.94 $58.16 $248.77 $88.31 $58.16 $165.85 $215.60 N/A N/A N/A N/A N/A N/A N/A $221.24 $43.08 $43.08 N/A N/A N/A $43.08 $281.94 330104 0700T 177 320 HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS 1ST LES O $663.40 N/A N/A $43.08 $331.70 N/A N/A N/A $43.08 N/A $43.08 N/A $497.55 N/A $417.94 $484.95 $51.70 $43.08 $398.04 $530.72 N/A N/A $43.08 N/A $431.21 $60.31 $530.72 $43.08 $43.08 $51.70 N/A $43.08 N/A N/A N/A $530.72 $563.89 $58.16 $497.55 $88.31 $58.16 $331.70 $431.21 N/A N/A N/A N/A N/A N/A N/A $442.49 $43.08 $43.08 N/A N/A N/A $43.08 $563.89 330104 0694T 2002 320 HC REAL-TIME 3D VOLUMETRIC IMG&RCNSTJ BRST/AX LYMPH NODE TISS - I&R O "$2,140.00 " N/A N/A N/A "$1,070.00 " N/A N/A N/A N/A N/A N/A N/A "$1,605.00 " N/A "$1,348.20 " "$1,564.34 " N/A N/A "$1,284.00 " "$1,712.00 " N/A N/A N/A N/A "$1,391.00 " N/A "$1,712.00 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,712.00 " "$1,819.00 " N/A "$1,605.00 " N/A N/A "$1,070.00 " "$1,391.00 " N/A N/A N/A N/A N/A N/A N/A "$1,427.38 " N/A N/A N/A N/A N/A "$1,070.00 " "$1,819.00 " 330104 0693T 1505 213 320 HC COMPRE FUL BDY CPTR MRKRLS 3D KNMTC&KIN MTN ALYS W/I&R O $905.22 $420.51 $420.51 $138.60 $452.61 N/A N/A $416.30 $138.60 $798.97 $138.60 $420.51 $678.91 $462.56 $570.29 $661.72 $166.32 $138.60 $543.13 $724.18 "$1,429.73 " "$2,396.90 " $138.60 $420.51 $504.61 $194.04 $724.18 $138.60 $138.60 $166.32 $588.71 $138.60 $420.51 $420.51 $458.35 $724.18 $769.44 $138.60 $678.91 $284.13 $138.60 $452.61 "$1,131.17 " $662.30 $662.30 $662.30 $662.30 N/A $441.53 $420.51 $603.78 $138.60 $138.60 $357.43 $357.43 $420.51 $138.60 "$2,396.90 " 330104 71111 5522 471 320 HC X-RAY EXAM RIBS/CHEST4/> VWS O $826.04 $128.23 $128.23 $27.50 $413.02 $91.97 $83.61 $126.95 $27.50 $243.63 $27.50 $128.23 $619.53 $141.05 $520.41 $603.84 $33.00 $27.50 $495.62 $660.83 $435.98 $730.90 $27.50 $128.23 $153.87 $38.50 $660.83 $27.50 $27.50 $33.00 $179.52 $27.50 $128.23 $128.23 $139.77 $660.83 $702.13 $27.50 $619.53 $56.37 $27.50 $413.02 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $27.50 $27.50 $108.99 $108.99 $128.23 $27.50 $730.90 330104 62321 5442 53 320 HC RAD NJX INTERLAMINAR CRV/THRC O "$3,033.45 " $773.04 $773.04 $560.61 "$1,516.72 " $180.35 $163.95 $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,275.09 " $850.34 "$1,911.07 " "$2,217.45 " $672.74 $560.61 "$1,820.07 " "$2,426.76 " "$2,628.34 " "$4,406.33 " $560.61 $773.04 $927.65 $784.86 "$2,426.76 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 $773.04 $842.61 "$2,426.76 " "$2,578.43 " $560.61 "$2,275.09 " "$1,149.26 " $560.61 "$1,516.72 " "$2,079.48 " "$1,217.54 " "$1,217.54 " "$1,217.54 " "$1,217.54 " N/A $811.69 $773.04 "$2,023.31 " $560.61 $560.61 $657.08 $657.08 $773.04 $163.95 "$4,406.33 " 330104 62323 5442 53 320 HC RAD NJX INTERLAMINAR LMBR/SAC O "$2,667.51 " $773.04 $773.04 $560.61 "$1,333.76 " $167.44 $152.22 $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,000.63 " $850.34 "$1,680.53 " "$1,949.95 " $672.74 $560.61 "$1,600.51 " "$2,134.01 " "$2,628.34 " "$4,406.33 " $560.61 $773.04 $927.65 $784.86 "$2,134.01 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 $773.04 $842.61 "$2,134.01 " "$2,267.38 " $560.61 "$2,000.63 " "$1,149.26 " $560.61 "$1,333.76 " "$2,079.48 " "$1,217.54 " "$1,217.54 " "$1,217.54 " "$1,217.54 " N/A $811.69 $773.04 "$1,779.23 " $560.61 $560.61 $657.08 $657.08 $773.04 $152.22 "$4,406.33 " 330104 47536 5341 151 320 HC EXCHANGE BILIARY DRG CATH O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$7,163.11 " $219.01 $199.10 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " "$1,756.35 " "$1,463.63 " "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$11,460.98 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$1,463.63 " "$10,744.67 " "$3,000.43 " "$1,463.63 " "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $199.10 "$24,221.55 " 330104 70100 5521 471 320 HC X-RAY EXAM OF JAW <4VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $67.83 $61.66 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 71101 5522 471 320 HC X-RAY EXAM UNILAT RIBS/CHEST; MIN 3 VIEWS O "$1,271.16 " $128.23 $128.23 $17.50 $635.58 $73.61 $66.92 $126.95 $17.50 $243.63 $17.50 $128.23 $953.37 $141.05 $800.83 $929.22 $21.00 $17.50 $762.70 "$1,016.93 " $435.98 $730.90 $17.50 $128.23 $153.87 $24.50 "$1,016.93 " $17.50 $17.50 $21.00 $179.52 $17.50 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $17.50 $953.37 $35.88 $17.50 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $17.50 $17.50 $108.99 $108.99 $128.23 $17.50 "$1,080.49 " 330104 71100 5521 471 320 HC X-RAY EXAM RIBS UNI 2 VIEWS O $342.40 $104.23 $104.23 $15.00 $171.20 $64.59 $58.72 $103.19 $15.00 $198.04 $15.00 $104.23 $256.80 $114.66 $215.71 $250.29 $18.00 $15.00 $205.44 $273.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $273.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $273.92 $291.04 $15.00 $256.80 $30.75 $15.00 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 70390 5523 389 320 HC X-RAY EXAM OF SALIVARY DUCT O "$1,945.26 " $280.16 $280.16 $20.00 $972.63 $207.22 $188.38 $277.36 $20.00 $532.31 $20.00 $280.16 "$1,458.94 " $308.18 "$1,225.51 " "$1,421.99 " $24.00 $20.00 "$1,167.16 " "$1,556.21 " $952.56 "$1,596.93 " $20.00 $280.16 $336.20 $28.00 "$1,556.21 " $20.00 $20.00 $24.00 $392.23 $20.00 $280.16 $280.16 $305.38 "$1,556.21 " "$1,653.47 " $20.00 "$1,458.94 " $41.00 $20.00 $972.63 $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $20.00 $20.00 $238.14 $238.14 $280.16 $20.00 "$1,653.47 " 330104 70371 5523 389 320 HC SPEECH EVALUATION COMPLEX O "$3,046.29 " $280.16 $280.16 $35.00 "$1,523.14 " $187.18 $170.17 $277.36 $35.00 $532.31 $35.00 $280.16 "$2,284.72 " $308.18 "$1,919.16 " "$2,226.84 " $42.00 $35.00 "$1,827.77 " "$2,437.03 " $952.56 "$1,596.93 " $35.00 $280.16 $336.20 $49.00 "$2,437.03 " $35.00 $35.00 $42.00 $392.23 $35.00 $280.16 $280.16 $305.38 "$2,437.03 " "$2,589.35 " $35.00 "$2,284.72 " $71.75 $35.00 "$1,523.14 " $753.64 $441.26 $441.26 $441.26 $441.26 $133.60 $294.17 $280.16 $133.60 $35.00 $35.00 $238.14 $238.14 $280.16 $35.00 "$2,589.35 " 330104 70360 5521 471 320 HC X-RAY EXAM OF NECK; SOFT TISSUE O $861.35 $104.23 $104.23 $10.00 $430.68 $55.50 $50.45 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 70030 5521 471 320 HC X-RAY EYE FOR FOREIGN BODY O $476.15 $104.23 $104.23 $40.00 $238.07 $57.26 $52.05 $103.19 $40.00 $198.04 $40.00 $104.23 $357.11 $114.66 $299.97 $348.07 $48.00 $40.00 $285.69 $380.92 $354.39 $594.13 $40.00 $104.23 $125.08 $56.00 $380.92 $40.00 $40.00 $48.00 $145.93 $40.00 $104.23 $104.23 $113.61 $380.92 $404.73 $40.00 $357.11 $82.00 $40.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $40.00 $40.00 $88.60 $88.60 $104.23 $40.00 $594.13 330104 70260 5522 471 320 HC X-RAY EXAM OF SKULL; COMPLETE MIN 4 VIEWS O "$1,271.16 " $128.23 $128.23 $25.00 $635.58 $77.65 $70.59 $126.95 $25.00 $243.63 $25.00 $128.23 $953.37 $141.05 $800.83 $929.22 $30.00 $25.00 $762.70 "$1,016.93 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,016.93 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $25.00 $953.37 $51.25 $25.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,080.49 " 330104 70250 5522 471 320 HC X-RAY EXAM OF SKULL; < 4 VIEWS O $606.69 $128.23 $128.23 $15.00 $303.35 $63.13 $57.39 $126.95 $15.00 $243.63 $15.00 $128.23 $455.02 $141.05 $382.21 $443.49 $18.00 $15.00 $364.01 $485.35 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $485.35 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $485.35 $515.69 $15.00 $455.02 $30.75 $15.00 $303.35 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 70240 5521 471 320 HC X-RAY EXAM PITUITARY SADDLE (SELLA TURCICA) O $342.40 $104.23 $104.23 $12.50 $171.20 $57.77 $52.52 $103.19 $12.50 $198.04 $12.50 $104.23 $256.80 $114.66 $215.71 $250.29 $15.00 $12.50 $205.44 $273.92 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $273.92 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $273.92 $291.04 $12.50 $256.80 $25.62 $12.50 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 70330 5521 471 320 HC X-RAY EXAM OF JAW JOINTS; BILATERAL O $921.27 $104.23 $104.23 $20.00 $460.63 $92.63 $84.21 $103.19 $20.00 $198.04 $20.00 $104.23 $690.95 $114.66 $580.40 $673.45 $24.00 $20.00 $552.76 $737.02 $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 $737.02 $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 $737.02 $783.08 $20.00 $690.95 $41.00 $20.00 $460.63 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 $783.08 330104 70210 5521 471 320 HC X-RAY EXAM OF SINUSES; <3 VIEWS O $342.40 $104.23 $104.23 $12.50 $171.20 $56.75 $51.59 $103.19 $12.50 $198.04 $12.50 $104.23 $256.80 $114.66 $215.71 $250.29 $15.00 $12.50 $205.44 $273.92 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $273.92 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $273.92 $291.04 $12.50 $256.80 $25.62 $12.50 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 70200 5522 471 320 HC X-RAY EXAM OF EYE SOCKETS;COMPLETE MIN 4 VIEWS O "$1,346.06 " $128.23 $128.23 $25.00 $673.03 $83.52 $75.93 $126.95 $25.00 $243.63 $25.00 $128.23 "$1,009.54 " $141.05 $848.02 $983.97 $30.00 $25.00 $807.64 "$1,076.85 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,076.85 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,076.85 " "$1,144.15 " $25.00 "$1,009.54 " $51.25 $25.00 $673.03 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,144.15 " 330104 70160 5521 471 320 HC X-RAY EXAM OF NASAL BONES; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $15.00 $430.68 $67.32 $61.20 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 70150 5522 471 320 HC X-RAY EXAM OF FACIAL BONES; COMPLETE MIN 3 VIEWS O "$1,271.16 " $128.23 $128.23 $25.00 $635.58 $81.91 $74.46 $126.95 $25.00 $243.63 $25.00 $128.23 $953.37 $141.05 $800.83 $929.22 $30.00 $25.00 $762.70 "$1,016.93 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,016.93 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $25.00 $953.37 $51.25 $25.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,080.49 " 330104 70140 5521 471 320 HC X-RAY EXAM OF FACIAL BONES; <3VIEWS O $468.66 $104.23 $104.23 $15.00 $234.33 $56.59 $51.45 $103.19 $15.00 $198.04 $15.00 $104.23 $351.50 $114.66 $295.26 $342.59 $18.00 $15.00 $281.20 $374.93 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $374.93 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $374.93 $398.36 $15.00 $351.50 $30.75 $15.00 $234.33 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 70220 5521 471 320 HC X-RAY EXAM OF SINUSES;COMPLETE MIN 3 VIEWS O "$1,271.16 " $104.23 $104.23 $20.00 $635.58 $65.77 $59.79 $103.19 $20.00 $198.04 $20.00 $104.23 $953.37 $114.66 $800.83 $929.22 $24.00 $20.00 $762.70 "$1,016.93 " $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 "$1,016.93 " $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 "$1,016.93 " "$1,080.49 " $20.00 $953.37 $41.00 $20.00 $635.58 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 "$1,080.49 " 330104 70130 5522 471 320 HC X-RAY EXAM OF MASTOIDS; MIN 3 VIEWS /SIDE O "$1,189.84 " $128.23 $128.23 $25.00 $594.92 $109.44 $99.49 $126.95 $25.00 $243.63 $25.00 $128.23 $892.38 $141.05 $749.60 $869.77 $30.00 $25.00 $713.90 $951.87 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $951.87 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $951.87 "$1,011.36 " $25.00 $892.38 $51.25 $25.00 $594.92 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,011.36 " 330104 70120 5522 471 320 HC X-RAY EXAM OF MASTOIDS; <3VIEWS/SIDE O $480.43 $128.23 $128.23 $15.00 $240.22 $67.83 $61.66 $126.95 $15.00 $243.63 $15.00 $128.23 $360.32 $141.05 $302.67 $351.19 $18.00 $15.00 $288.26 $384.34 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $384.34 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $384.34 $408.37 $15.00 $360.32 $30.75 $15.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 70110 5522 471 320 HC X-RAY EXAM OF JAW 4/> VIEWS O $996.17 $128.23 $128.23 $25.00 $498.08 $75.52 $68.66 $126.95 $25.00 $243.63 $25.00 $128.23 $747.13 $141.05 $627.59 $728.20 $30.00 $25.00 $597.70 $796.94 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $796.94 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $796.94 $846.74 $25.00 $747.13 $51.25 $25.00 $498.08 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $846.74 330104 73040 5572 389 322 HC CONTRAST X-RAY OF SHOULDER O "$1,857.52 " $442.02 $442.02 $25.00 $928.76 $231.15 $210.14 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,393.14 " $486.22 "$1,170.24 " "$1,357.85 " $30.00 $25.00 "$1,114.51 " "$1,486.02 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,486.02 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,486.02 " "$1,578.89 " $25.00 "$1,393.14 " $51.25 $25.00 $928.76 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $440.06 $464.12 $442.02 $440.06 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 73525 5572 389 322 HC CONTRAST X-RAY OF HIP O "$1,857.52 " $442.02 $442.02 $25.00 $928.76 $229.39 $208.53 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,393.14 " $486.22 "$1,170.24 " "$1,357.85 " $30.00 $25.00 "$1,114.51 " "$1,486.02 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,486.02 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,486.02 " "$1,578.89 " $25.00 "$1,393.14 " $51.25 $25.00 $928.76 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $440.06 $464.12 $442.02 $440.06 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 75741 5183 279 323 HC ARTERY X-RAYS LUNG UNILATERAL SELECTIVE O "$15,510.72 " "$3,573.99 " "$3,573.99 " $90.00 "$7,755.36 " $226.69 $206.09 "$3,538.25 " $90.00 "$6,790.58 " $90.00 "$3,573.99 " "$11,633.04 " "$3,931.39 " "$9,771.75 " "$11,338.34 " $108.00 $90.00 "$9,306.43 " "$12,408.58 " "$12,151.56 " "$20,371.74 " $90.00 "$3,573.99 " "$4,288.79 " $126.00 "$12,408.58 " $90.00 $90.00 $108.00 "$5,003.59 " $90.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,408.58 " "$13,184.11 " $90.00 "$11,633.04 " $184.50 $90.00 "$7,755.36 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $90.00 $90.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $90.00 "$20,371.74 " 330104 75733 5183 279 323 HC ARTERY X-RAYS ADRENALS O "$16,245.81 " "$3,573.99 " "$3,573.99 " $110.00 "$8,122.90 " $291.53 $265.02 "$3,538.25 " $110.00 "$6,790.58 " $110.00 "$3,573.99 " "$12,184.36 " "$3,931.39 " "$10,234.86 " "$11,875.69 " $132.00 $110.00 "$9,747.49 " "$12,996.65 " "$12,151.56 " "$20,371.74 " $110.00 "$3,573.99 " "$4,288.79 " $154.00 "$12,996.65 " $110.00 $110.00 $132.00 "$5,003.59 " $110.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,996.65 " "$13,808.94 " $110.00 "$12,184.36 " $225.50 $110.00 "$8,122.90 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $110.00 $110.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $110.00 "$20,371.74 " 330104 75731 5183 279 323 HC ARTERY X-RAYS ADRENAL GLAND O "$14,513.48 " "$3,573.99 " "$3,573.99 " $80.00 "$7,256.74 " $266.27 $242.06 "$3,538.25 " $80.00 "$6,790.58 " $80.00 "$3,573.99 " "$10,885.11 " "$3,931.39 " "$9,143.49 " "$10,609.35 " $96.00 $80.00 "$8,708.09 " "$11,610.78 " "$12,151.56 " "$20,371.74 " $80.00 "$3,573.99 " "$4,288.79 " $112.00 "$11,610.78 " $80.00 $80.00 $96.00 "$5,003.59 " $80.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,610.78 " "$12,336.46 " $80.00 "$10,885.11 " $164.00 $80.00 "$7,256.74 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $80.00 $80.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $80.00 "$20,371.74 " 330104 75716 5183 279 323 HC ARTERY X-RAYS ARMS/LEGS O "$16,734.80 " "$3,573.99 " "$3,573.99 " $56.00 "$8,367.40 " $282.22 $256.56 "$3,538.25 " $56.00 "$6,790.58 " $56.00 "$3,573.99 " "$12,551.10 " "$3,931.39 " "$10,542.92 " "$12,233.14 " $67.20 $56.00 "$10,040.88 " "$13,387.84 " "$12,151.56 " "$20,371.74 " $56.00 "$3,573.99 " "$4,288.79 " $78.40 "$13,387.84 " $56.00 $56.00 $67.20 "$5,003.59 " $56.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$13,387.84 " "$14,224.58 " $56.00 "$12,551.10 " $114.80 $56.00 "$8,367.40 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $56.00 $56.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $56.00 "$20,371.74 " 330104 75630 5183 279 323 HC X-RAY AORTA LEG ARTERIES O "$16,734.80 " "$3,573.99 " "$3,573.99 " $75.00 "$8,367.40 " $271.48 $246.80 "$3,538.25 " $75.00 "$6,790.58 " $75.00 "$3,573.99 " "$12,551.10 " "$3,931.39 " "$10,542.92 " "$12,233.14 " $90.00 $75.00 "$10,040.88 " "$13,387.84 " "$12,151.56 " "$20,371.74 " $75.00 "$3,573.99 " "$4,288.79 " $105.00 "$13,387.84 " $75.00 $75.00 $90.00 "$5,003.59 " $75.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$13,387.84 " "$14,224.58 " $75.00 "$12,551.10 " $153.75 $75.00 "$8,367.40 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $75.00 $75.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $75.00 "$20,371.74 " 330104 75625 5183 279 323 HC CONTRAST EXAM ABDOMINL AORTA O "$12,768.31 " "$3,573.99 " "$3,573.99 " $50.00 "$6,384.15 " $221.73 $201.58 "$3,538.25 " $50.00 "$6,790.58 " $50.00 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,044.04 " "$9,333.63 " $60.00 $50.00 "$7,660.99 " "$10,214.65 " "$12,151.56 " "$20,371.74 " $50.00 "$3,573.99 " "$4,288.79 " $70.00 "$10,214.65 " $50.00 $50.00 $60.00 "$5,003.59 " $50.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $50.00 "$9,576.23 " $102.50 $50.00 "$6,384.15 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $50.00 $50.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $50.00 "$20,371.74 " 330104 75605 5184 280 323 HC CONTRAST EXAM THORACIC AORTA BY SERIALOGRAPHY O "$21,176.37 " "$6,166.38 " "$6,166.38 " $50.00 "$10,588.18 " $210.30 $191.18 "$6,104.71 " $50.00 "$11,716.11 " $50.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $60.00 $50.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $50.00 "$6,166.38 " "$7,399.65 " $70.00 "$16,941.10 " $50.00 $50.00 $60.00 "$8,632.93 " $50.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $50.00 "$15,882.28 " $102.50 $50.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $50.00 $50.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $50.00 "$35,148.34 " 330104 75743 5183 279 323 HC ARTERY X-RAYS LUNGS BILATERAL SELECTIVE O "$14,513.48 " "$3,573.99 " "$3,573.99 " $120.00 "$7,256.74 " $255.65 $232.41 "$3,538.25 " $120.00 "$6,790.58 " $120.00 "$3,573.99 " "$10,885.11 " "$3,931.39 " "$9,143.49 " "$10,609.35 " $144.00 $120.00 "$8,708.09 " "$11,610.78 " "$12,151.56 " "$20,371.74 " $120.00 "$3,573.99 " "$4,288.79 " $168.00 "$11,610.78 " $120.00 $120.00 $144.00 "$5,003.59 " $120.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,610.78 " "$12,336.46 " $120.00 "$10,885.11 " $246.00 $120.00 "$7,256.74 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $120.00 $120.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $120.00 "$20,371.74 " 330104 75710 5183 279 323 HC ARTERY X-RAYS ARM/LEG O "$13,768.76 " "$3,573.99 " "$3,573.99 " $35.00 "$6,884.38 " $263.80 $239.82 "$3,538.25 " $35.00 "$6,790.58 " $35.00 "$3,573.99 " "$10,326.57 " "$3,931.39 " "$8,674.32 " "$10,064.96 " $42.00 $35.00 "$8,261.26 " "$11,015.01 " "$12,151.56 " "$20,371.74 " $35.00 "$3,573.99 " "$4,288.79 " $49.00 "$11,015.01 " $35.00 $35.00 $42.00 "$5,003.59 " $35.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,015.01 " "$11,703.45 " $35.00 "$10,326.57 " $71.75 $35.00 "$6,884.38 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $35.00 $35.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $35.00 "$20,371.74 " 330104 71045 5521 471 324 HC X-RAY EXAM CHEST 1 VIEW O $961.93 $104.23 $104.23 $10.00 $480.96 $45.51 $41.37 $103.19 $10.00 $198.04 $10.00 $104.23 $721.45 $114.66 $606.02 $703.17 $12.00 $10.00 $577.16 $769.54 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $769.54 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $769.54 $817.64 $10.00 $721.45 $20.50 $10.00 $480.96 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $817.64 330104 71046 5521 471 324 HC X-RAY EXAM CHEST 2 VIEWS O $998.31 $104.23 $104.23 $15.00 $499.15 $58.72 $53.38 $103.19 $15.00 $198.04 $15.00 $104.23 $748.73 $114.66 $628.94 $729.76 $18.00 $15.00 $598.99 $798.65 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $798.65 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $798.65 $848.56 $15.00 $748.73 $30.75 $15.00 $499.15 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $848.56 330104 71047 5521 471 324 HC X-RAY EXAM CHEST 3 VIEWS O "$1,165.23 " $104.23 $104.23 $15.00 $582.62 $73.61 $66.92 $103.19 $15.00 $198.04 $15.00 $104.23 $873.92 $114.66 $734.09 $851.78 $18.00 $15.00 $699.14 $932.18 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $932.18 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $932.18 $990.45 $15.00 $873.92 $30.75 $15.00 $582.62 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $990.45 330104 71048 5522 471 324 HC X-RAY EXAM CHEST 4+ VIEWS O "$1,031.48 " $128.23 $128.23 $20.00 $515.74 $80.36 $73.05 $126.95 $20.00 $243.63 $20.00 $128.23 $773.61 $141.05 $649.83 $754.01 $24.00 $20.00 $618.89 $825.18 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $825.18 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $825.18 $876.76 $20.00 $773.61 $41.00 $20.00 $515.74 $344.93 $201.96 $201.96 $201.96 $201.96 $189.98 $134.64 $128.23 $189.98 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $876.76 330104 96411 5692 109 331 HC CHEMO IV PUSH ADDL DRUG O $707.27 $80.95 $80.95 $38.26 $353.63 $97.52 $88.65 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96401 5692 109 331 HC CHEMO ANTI-NEOPL SQ/IM O $707.27 $80.95 $80.95 $38.26 $353.63 $127.98 $116.35 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96402 5692 109 331 HC CHEMO HORMON ANTINEOPL SQ/IM O $707.27 $80.95 $80.95 $38.26 $353.63 $58.94 $53.59 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96409 5693 109 331 HC CHEMO IV PUSH SNGL DRUG O "$1,136.34 " $247.83 $247.83 $15.00 $568.17 $178.15 $161.96 $245.35 $15.00 $470.88 $15.00 $247.83 $852.25 $272.61 "$1,609.63 " $862.48 $18.00 $15.00 $681.80 "$3,881.00 " $842.62 "$2,934.00 " $15.00 $247.83 $297.40 $21.00 "$2,883.13 " $15.00 $15.00 $18.00 $346.96 $15.00 $247.83 $247.83 $270.14 $909.07 $965.89 $15.00 $852.25 $30.75 $15.00 $568.17 "$1,515.00 " $390.33 $390.33 $390.33 $390.33 "$2,066.00 " $260.22 $247.83 "$2,424.00 " $15.00 $15.00 $270.00 $270.00 $247.83 $15.00 "$3,881.00 " 330104 96450 5694 110 331 HC CHEMOTHERAPY INTO CNS O "$1,535.45 " $399.06 $399.06 $723.83 $767.73 $129.18 $117.44 $395.07 $723.83 $758.21 $723.83 $399.06 "$1,151.59 " $438.96 "$1,609.63 " "$1,165.41 " $868.59 $723.83 $921.27 "$3,881.00 " "$1,356.80 " "$2,934.00 " $723.83 $399.06 $478.87 "$1,013.36 " "$2,883.13 " $723.83 $723.83 $868.59 $558.68 $723.83 $399.06 $399.06 $434.97 "$1,228.36 " "$1,305.13 " $723.83 "$1,151.59 " "$1,483.84 " $723.83 $767.73 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $723.83 $723.83 $270.00 $270.00 $399.06 $117.44 "$3,881.00 " 330104 77336 5611 476 333 HC RADIATION PHYSICS CONSULT O "$1,346.06 " $160.02 $160.02 $41.80 $673.03 $155.77 $141.61 $158.42 $41.80 $304.04 $41.80 $160.02 "$1,009.54 " $176.02 $848.02 $983.97 $50.16 $41.80 $807.64 "$1,076.85 " $544.07 $912.12 $41.80 $160.02 $192.03 $58.52 "$1,076.85 " $41.80 $41.80 $50.16 $224.03 $41.80 $160.02 $160.02 $174.42 "$1,076.85 " "$1,144.15 " $41.80 "$1,009.54 " $85.69 $41.80 $673.03 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $897.82 $41.80 $41.80 $136.02 $136.02 $160.02 $41.80 "$1,144.15 " 330104 77338 5612 477 333 HC DESIGN MLC DEVICE FOR IMRT O "$2,038.35 " $430.37 $430.37 $446.44 "$1,019.17 " $795.39 $723.08 $426.07 $446.44 $817.70 $446.44 $430.37 "$1,528.76 " $473.41 "$1,284.16 " "$1,490.03 " $535.73 $446.44 "$1,223.01 " "$1,630.68 " "$1,463.26 " "$2,453.11 " $446.44 $430.37 $516.44 $625.01 "$1,630.68 " $446.44 $446.44 $535.73 $602.52 $446.44 $430.37 $430.37 $469.10 "$1,630.68 " "$1,732.60 " $446.44 "$1,528.76 " $915.20 $446.44 "$1,019.17 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,359.58 " $446.44 $446.44 $365.82 $365.82 $430.37 $365.82 "$2,453.11 " 330104 77373 5626 348 333 HC SBRT DELIVERY O "$8,149.12 " "$2,120.48 " "$2,120.48 " $63.70 "$4,074.56 " "$1,778.27 " "$1,616.61 " "$2,099.28 " $63.70 "$4,028.91 " $63.70 "$2,120.48 " "$6,111.84 " "$2,332.53 " "$5,133.95 " "$5,957.01 " $76.44 $63.70 "$4,889.47 " "$6,519.30 " "$7,209.63 " "$12,086.74 " $63.70 "$2,120.48 " "$2,544.58 " $89.18 "$6,519.30 " $63.70 $63.70 $76.44 "$2,968.67 " $63.70 "$2,120.48 " "$2,120.48 " "$2,311.32 " "$6,519.30 " "$6,926.75 " $63.70 "$6,111.84 " $130.59 $63.70 "$4,074.56 " "$5,704.09 " "$3,339.76 " "$3,339.76 " "$3,339.76 " "$3,339.76 " N/A "$2,226.50 " "$2,120.48 " "$5,435.46 " $63.70 $63.70 "$1,802.41 " "$1,802.41 " "$2,120.48 " $63.70 "$12,086.74 " 330104 77370 5611 476 333 HC SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION O "$1,562.20 " $160.02 $160.02 $472.72 $781.10 $251.17 $228.33 $158.42 $472.72 $304.04 $472.72 $160.02 "$1,171.65 " $176.02 $984.19 "$1,141.97 " $567.26 $472.72 $937.32 "$1,249.76 " $544.07 $912.12 $472.72 $160.02 $192.03 $661.80 "$1,249.76 " $472.72 $472.72 $567.26 $224.03 $472.72 $160.02 $160.02 $174.42 "$1,249.76 " "$1,327.87 " $472.72 "$1,171.65 " $969.07 $472.72 $781.10 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 "$1,041.99 " $472.72 $472.72 $136.02 $136.02 $160.02 $136.02 "$1,327.87 " 330104 77470 5623 347 333 HC SPECIAL RADIATION TREATMENT O "$3,847.72 " $686.82 $686.82 $77.40 "$1,923.86 " $234.76 $213.42 $679.95 $77.40 "$1,304.95 " $77.40 $686.82 "$2,885.79 " $755.50 "$2,424.06 " "$2,812.68 " $92.88 $77.40 "$2,308.63 " "$3,078.18 " "$2,335.17 " "$3,914.85 " $77.40 $686.82 $824.18 $108.36 "$3,078.18 " $77.40 $77.40 $92.88 $961.54 $77.40 $686.82 $686.82 $748.63 "$3,078.18 " "$3,270.56 " $77.40 "$2,885.79 " $158.67 $77.40 "$1,923.86 " "$1,847.53 " "$1,081.73 " "$1,081.73 " "$1,081.73 " "$1,081.73 " N/A $721.16 $686.82 "$2,566.43 " $77.40 $77.40 $583.79 $583.79 $686.82 $77.40 "$3,914.85 " 330104 77334 5612 477 333 HC RADIATION TREATMENT AID(S); COMPLEX O "$1,558.99 " $430.37 $430.37 $79.20 $779.50 $213.03 $193.66 $426.07 $79.20 $817.70 $79.20 $430.37 "$1,169.24 " $473.41 $982.16 "$1,139.62 " $95.04 $79.20 $935.39 "$1,247.19 " "$1,463.26 " "$2,453.11 " $79.20 $430.37 $516.44 $110.88 "$1,247.19 " $79.20 $79.20 $95.04 $602.52 $79.20 $430.37 $430.37 $469.10 "$1,247.19 " "$1,325.14 " $79.20 "$1,169.24 " $162.36 $79.20 $779.50 "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,039.85 " $79.20 $79.20 $365.82 $365.82 $430.37 $79.20 "$2,453.11 " 330104 77387 476 333 HC NTSTY MODUL RAD TX DLVR SMPL O $815.34 N/A N/A $89.99 $407.67 N/A N/A N/A $89.99 N/A $89.99 N/A $611.50 N/A $513.66 $596.01 $107.99 $89.99 $489.20 $652.27 N/A N/A $89.99 N/A $529.97 $125.99 $652.27 $89.99 $89.99 $107.99 N/A $89.99 N/A N/A N/A $652.27 $693.04 $121.49 $611.50 $184.48 $121.49 $407.67 $529.97 N/A N/A N/A N/A N/A N/A N/A $543.83 $89.99 $89.99 N/A N/A N/A $89.99 $693.04 330104 77333 5611 476 333 HC RADIATION TREATMENT AID(S); INTERMEDIATE O "$1,308.61 " $160.02 $160.02 $58.40 $654.30 $238.96 $217.24 $158.42 $58.40 $304.04 $58.40 $160.02 $981.46 $176.02 $824.42 $956.59 $70.08 $58.40 $785.17 "$1,046.89 " $544.07 $912.12 $58.40 $160.02 $192.03 $81.76 "$1,046.89 " $58.40 $58.40 $70.08 $224.03 $58.40 $160.02 $160.02 $174.42 "$1,046.89 " "$1,112.32 " $58.40 $981.46 $119.72 $58.40 $654.30 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $872.84 $58.40 $58.40 $136.02 $136.02 $160.02 $58.40 "$1,112.32 " 330104 77300 5611 477 333 HC RADIATION THERAPY DOSE PLAN O $772.54 $160.02 $160.02 $31.00 $386.27 $113.67 $103.33 $158.42 $31.00 $304.04 $31.00 $160.02 $579.40 $176.02 $486.70 $564.73 $37.20 $31.00 $463.52 $618.03 $544.07 $912.12 $31.00 $160.02 $192.03 $43.40 $618.03 $31.00 $31.00 $37.20 $224.03 $31.00 $160.02 $160.02 $174.42 $618.03 $656.66 $31.00 $579.40 $63.55 $31.00 $386.27 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $515.28 $31.00 $31.00 $136.02 $136.02 $160.02 $31.00 $912.12 330104 77301 5613 478 333 HC RADIOTHERAPY DOSE PLAN IMRT O "$9,456.66 " "$1,608.46 " "$1,608.46 " $103.60 "$4,728.33 " "$3,200.82 " "$2,909.84 " "$1,592.37 " $103.60 "$3,056.07 " $103.60 "$1,608.46 " "$7,092.49 " "$1,769.30 " "$5,957.70 " "$6,912.82 " $124.32 $103.60 "$5,674.00 " "$7,565.33 " "$5,468.75 " "$9,168.20 " $103.60 "$1,608.46 " "$1,930.15 " $145.04 "$7,565.33 " $103.60 $103.60 $124.32 "$2,251.84 " $103.60 "$1,608.46 " "$1,608.46 " "$1,753.22 " "$7,565.33 " "$8,038.16 " $103.60 "$7,092.49 " $212.38 $103.60 "$4,728.33 " "$4,326.75 " "$2,533.32 " "$2,533.32 " "$2,533.32 " "$2,533.32 " N/A "$1,688.88 " "$1,608.46 " "$6,307.59 " $103.60 $103.60 "$1,367.19 " "$1,367.19 " "$1,608.46 " $103.60 "$9,168.20 " 330104 77295 5613 478 333 HC 3-D RADIOTHERAPY PLAN O "$12,485.83 " "$1,608.46 " "$1,608.46 " $103.60 "$6,242.91 " $820.11 $745.56 "$1,592.37 " $103.60 "$3,056.07 " $103.60 "$1,608.46 " "$9,364.37 " "$1,769.30 " "$7,866.07 " "$9,127.14 " $124.32 $103.60 "$7,491.50 " "$9,988.66 " "$5,468.75 " "$9,168.20 " $103.60 "$1,608.46 " "$1,930.15 " $145.04 "$9,988.66 " $103.60 $103.60 $124.32 "$2,251.84 " $103.60 "$1,608.46 " "$1,608.46 " "$1,753.22 " "$9,988.66 " "$10,612.96 " $103.60 "$9,364.37 " $212.38 $103.60 "$6,242.91 " "$4,326.75 " "$2,533.32 " "$2,533.32 " "$2,533.32 " "$2,533.32 " N/A "$1,688.88 " "$1,608.46 " "$8,328.05 " $103.60 $103.60 "$1,367.19 " "$1,367.19 " "$1,608.46 " $103.60 "$10,612.96 " 330104 77290 5612 477 333 HC SET RADIATION THERAPY FIELD; COMPLEX O "$2,907.19 " $430.37 $430.37 $103.60 "$1,453.60 " $788.21 $716.56 $426.07 $103.60 $817.70 $103.60 $430.37 "$2,180.39 " $473.41 "$1,831.53 " "$2,125.16 " $124.32 $103.60 "$1,744.31 " "$2,325.75 " "$1,463.26 " "$2,453.11 " $103.60 $430.37 $516.44 $145.04 "$2,325.75 " $103.60 $103.60 $124.32 $602.52 $103.60 $430.37 $430.37 $469.10 "$2,325.75 " "$2,471.11 " $103.60 "$2,180.39 " $212.38 $103.60 "$1,453.60 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,939.10 " $103.60 $103.60 $365.82 $365.82 $430.37 $103.60 "$2,471.11 " 330104 77280 5611 476 333 HC SET RADIATION THERAPY FIELD; SIMPLE O "$1,546.15 " $160.02 $160.02 $47.40 $773.08 $471.33 $428.48 $158.42 $47.40 $304.04 $47.40 $160.02 "$1,159.61 " $176.02 $974.07 "$1,130.24 " $56.88 $47.40 $927.69 "$1,236.92 " $544.07 $912.12 $47.40 $160.02 $192.03 $66.36 "$1,236.92 " $47.40 $47.40 $56.88 $224.03 $47.40 $160.02 $160.02 $174.42 "$1,236.92 " "$1,314.23 " $47.40 "$1,159.61 " $97.17 $47.40 $773.08 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 "$1,031.28 " $47.40 $47.40 $136.02 $136.02 $160.02 $47.40 "$1,314.23 " 330104 76145 5723 476 333 HC MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT O $561.75 $579.99 $579.99 $260.90 $280.88 "$1,630.44 " "$1,482.22 " $574.19 $260.90 "$1,101.98 " $260.90 $579.99 $421.31 $637.99 $353.90 $410.64 $313.08 $260.90 $337.05 $449.40 "$1,971.97 " "$3,305.94 " $260.90 $579.99 $695.99 $365.26 $449.40 $260.90 $260.90 $313.08 $811.99 $260.90 $579.99 $579.99 $632.19 $449.40 $477.49 $260.90 $421.31 $534.84 $260.90 $280.88 "$1,560.17 " $913.48 $913.48 $913.48 $913.48 N/A $608.99 $579.99 $374.69 $260.90 $260.90 $492.99 $492.99 $579.99 $260.90 "$3,305.94 " 330104 77307 5612 477 333 HC TELETHERAPY ISODOSE COMPLEX PLAN O "$2,038.35 " $430.37 $430.37 $84.50 "$1,019.17 " $488.14 $443.76 $426.07 $84.50 $817.70 $84.50 $430.37 "$1,528.76 " $473.41 "$1,284.16 " "$1,490.03 " $101.40 $84.50 "$1,223.01 " "$1,630.68 " "$1,463.26 " "$2,453.11 " $84.50 $430.37 $516.44 $118.30 "$1,630.68 " $84.50 $84.50 $101.40 $602.52 $84.50 $430.37 $430.37 $469.10 "$1,630.68 " "$1,732.60 " $84.50 "$1,528.76 " $173.22 $84.50 "$1,019.17 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,359.58 " $84.50 $84.50 $365.82 $365.82 $430.37 $84.50 "$2,453.11 " 330104 96521 5693 109 335 HC REFILL/MAINT PORTABLE PUMP O $856.00 $247.83 $247.83 $15.00 $428.00 $223.55 $203.22 $245.35 $15.00 $470.88 $15.00 $247.83 $642.00 $272.61 "$1,609.63 " $649.70 $18.00 $15.00 $513.60 "$3,881.00 " $842.62 "$2,934.00 " $15.00 $247.83 $297.40 $21.00 "$2,883.13 " $15.00 $15.00 $18.00 $346.96 $15.00 $247.83 $247.83 $270.14 $684.80 $727.60 $15.00 $642.00 $30.75 $15.00 $428.00 "$1,515.00 " $390.33 $390.33 $390.33 $390.33 "$2,066.00 " $260.22 $247.83 "$2,424.00 " $15.00 $15.00 $270.00 $270.00 $247.83 $15.00 "$3,881.00 " 330104 G0498 5694 110 335 HC CHEMO EXTEND IV INFUS W/PUMP O "$1,912.09 " $399.06 $399.06 $723.83 $956.04 N/A N/A $395.07 $723.83 $758.21 $723.83 $399.06 "$1,434.07 " $438.96 "$1,609.63 " "$1,451.28 " $868.59 $723.83 "$1,147.25 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $723.83 $399.06 $478.87 "$1,013.36 " "$2,883.13 " $723.83 $723.83 $868.59 $558.68 $723.83 $399.06 $399.06 $434.97 "$1,529.67 " "$1,625.28 " $723.83 "$1,434.07 " "$1,483.84 " $723.83 $956.04 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $723.83 $723.83 $270.00 $270.00 $399.06 $270.00 "$3,881.00 " 330104 96413 5694 111 335 HC CHEMO IV INFUSION 1 HR O "$2,022.30 " $399.06 $399.06 $35.00 "$1,011.15 " $230.65 $209.68 $395.07 $35.00 $758.21 $35.00 $399.06 "$1,516.72 " $438.96 "$1,609.63 " "$1,534.93 " $42.00 $35.00 "$1,213.38 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $35.00 $399.06 $478.87 $49.00 "$2,883.13 " $35.00 $35.00 $42.00 $558.68 $35.00 $399.06 $399.06 $434.97 "$1,617.84 " "$1,718.95 " $35.00 "$1,516.72 " $71.75 $35.00 "$1,011.15 " "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $35.00 $35.00 $270.00 $270.00 $399.06 $35.00 "$3,881.00 " 330104 96415 5692 110 335 HC CHEMO IV INFUSION ADDL HR O "$1,863.94 " $80.95 $80.95 $5.00 $931.97 $48.96 $44.51 $80.14 $5.00 $153.80 $5.00 $80.95 "$1,397.95 " $89.04 "$1,609.63 " "$1,414.73 " $6.00 $5.00 "$1,118.36 " "$3,881.00 " $275.22 "$2,934.00 " $5.00 $80.95 $97.14 $7.00 "$2,883.13 " $5.00 $5.00 $6.00 $113.33 $5.00 $80.95 $80.95 $88.23 "$1,491.15 " "$1,584.35 " $5.00 "$1,397.95 " $10.25 $5.00 $931.97 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $5.00 $5.00 $270.00 $270.00 $80.95 $5.00 "$3,881.00 " 330104 96416 5694 110 335 HC CHEMO PROLONG INFUSE W/PUMP O "$1,778.34 " $399.06 $399.06 $35.00 $889.17 $227.07 $206.43 $395.07 $35.00 $758.21 $35.00 $399.06 "$1,333.75 " $438.96 "$1,609.63 " "$1,349.76 " $42.00 $35.00 "$1,067.00 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $35.00 $399.06 $478.87 $49.00 "$2,883.13 " $35.00 $35.00 $42.00 $558.68 $35.00 $399.06 $399.06 $434.97 "$1,422.67 " "$1,511.59 " $35.00 "$1,333.75 " $71.75 $35.00 $889.17 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $35.00 $35.00 $270.00 $270.00 $399.06 $35.00 "$3,881.00 " 330104 96523 5733 109 335 HC IRRIG DRUG DELIVERY DEVICE O $282.48 $68.96 $68.96 $38.26 $141.24 $44.86 $40.79 $68.27 $38.26 $131.03 $38.26 $68.96 $211.86 $75.86 "$1,609.63 " $214.40 $45.91 $38.26 $169.49 "$3,881.00 " $234.47 "$2,934.00 " $38.26 $68.96 $82.75 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $96.55 $38.26 $68.96 $68.96 $75.17 $225.98 $240.11 $38.26 $211.86 $78.43 $38.26 $141.24 "$1,515.00 " $108.61 $108.61 $108.61 $108.61 "$2,066.00 " $72.41 $68.96 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $68.96 $38.26 "$3,881.00 " 330104 96417 5692 111 335 HC CHEMO IV INFUS EACH ADDL SEQ O "$1,863.94 " $80.95 $80.95 $271.09 $931.97 $113.30 $103.00 $80.14 $271.09 $153.80 $271.09 $80.95 "$1,397.95 " $89.04 "$1,609.63 " "$1,414.73 " $325.31 $271.09 "$1,118.36 " "$3,881.00 " $275.22 "$2,934.00 " $271.09 $80.95 $97.14 $379.53 "$2,883.13 " $271.09 $271.09 $325.31 $113.33 $271.09 $80.95 $80.95 $88.23 "$1,491.15 " "$1,584.35 " $271.09 "$1,397.95 " $555.74 $271.09 $931.97 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $271.09 $271.09 $270.00 $270.00 $80.95 $80.14 "$3,881.00 " 330104 78452 5593 332 340 HC HT MUSCLE IMAGE SPECT MULT O "$7,564.90 " "$1,592.38 " "$1,592.38 " $238.74 "$3,782.45 " $764.63 $695.12 "$1,576.46 " $238.74 "$3,025.52 " $238.74 "$1,592.38 " "$5,673.67 " "$1,751.62 " "$4,765.89 " "$5,529.94 " $286.49 $238.74 "$4,538.94 " "$6,051.92 " "$5,414.09 " "$9,076.56 " $238.74 "$1,592.38 " "$1,910.85 " $334.24 "$6,051.92 " $238.74 $238.74 $286.49 "$2,229.33 " $238.74 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$6,051.92 " "$6,430.16 " $238.74 "$5,673.67 " $489.42 $238.74 "$3,782.45 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,215.84 " "$1,672.00 " "$1,592.38 " "$1,215.84 " $238.74 $238.74 "$1,353.52 " "$1,353.52 " "$1,592.38 " $238.74 "$9,076.56 " 330104 78451 5593 332 340 HC HT MUSCLE IMAGE SPECT SING O "$7,957.59 " "$1,592.38 " "$1,592.38 " $139.13 "$3,978.80 " $548.83 $498.94 "$1,576.46 " $139.13 "$3,025.52 " $139.13 "$1,592.38 " "$5,968.19 " "$1,751.62 " "$5,013.28 " "$5,817.00 " $166.96 $139.13 "$4,774.55 " "$6,366.07 " "$5,414.09 " "$9,076.56 " $139.13 "$1,592.38 " "$1,910.85 " $194.78 "$6,366.07 " $139.13 $139.13 $166.96 "$2,229.33 " $139.13 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$6,366.07 " "$6,763.95 " $139.13 "$5,968.19 " $285.22 $139.13 "$3,978.80 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,215.84 " "$1,672.00 " "$1,592.38 " "$1,215.84 " $139.13 $139.13 "$1,353.52 " "$1,353.52 " "$1,592.38 " $139.13 "$9,076.56 " 330104 78645 5592 332 341 HC CSF SHUNT EVALUATION O "$6,615.81 " $605.27 $605.27 $75.00 "$3,307.91 " $526.87 $478.98 $599.22 $75.00 "$1,150.01 " $75.00 $605.27 "$4,961.86 " $665.80 "$4,167.96 " "$4,836.16 " $90.00 $75.00 "$3,969.49 " "$5,292.65 " "$2,057.91 " "$3,450.03 " $75.00 $605.27 $726.32 $105.00 "$5,292.65 " $75.00 $75.00 $90.00 $847.38 $75.00 $605.27 $605.27 $659.74 "$5,292.65 " "$5,623.44 " $75.00 "$4,961.86 " $153.75 $75.00 "$3,307.91 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $384.37 $635.53 $605.27 $384.37 $75.00 $75.00 $514.48 $514.48 $605.27 $75.00 "$5,623.44 " 330104 78630 5592 332 341 HC CEREBROSPINAL FLUID SCAN CISTERNOGRAPHY O "$3,042.01 " $605.27 $605.27 $75.00 "$1,521.01 " $551.18 $501.08 $599.22 $75.00 "$1,150.01 " $75.00 $605.27 "$2,281.51 " $665.80 "$1,916.47 " "$2,223.71 " $90.00 $75.00 "$1,825.21 " "$2,433.61 " "$2,057.91 " "$3,450.03 " $75.00 $605.27 $726.32 $105.00 "$2,433.61 " $75.00 $75.00 $90.00 $847.38 $75.00 $605.27 $605.27 $659.74 "$2,433.61 " "$2,585.71 " $75.00 "$2,281.51 " $153.75 $75.00 "$1,521.01 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $954.03 $635.53 $605.27 $954.03 $75.00 $75.00 $514.48 $514.48 $605.27 $75.00 "$3,450.03 " 330104 78606 5592 331 341 HC BRAIN IMAGE W/FLOW 4 + VIEWS O "$5,488.03 " $605.27 $605.27 $70.00 "$2,744.01 " $535.04 $486.40 $599.22 $70.00 "$1,150.01 " $70.00 $605.27 "$4,116.02 " $665.80 "$3,457.46 " "$4,011.75 " $84.00 $70.00 "$3,292.82 " "$4,390.42 " "$2,057.91 " "$3,450.03 " $70.00 $605.27 $726.32 $98.00 "$4,390.42 " $70.00 $70.00 $84.00 $847.38 $70.00 $605.27 $605.27 $659.74 "$4,390.42 " "$4,664.83 " $70.00 "$4,116.02 " $143.50 $70.00 "$2,744.01 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $954.03 $635.53 $605.27 $954.03 $70.00 $70.00 $514.48 $514.48 $605.27 $70.00 "$4,664.83 " 330104 78580 5591 332 341 HC LUNG PERFUSION IMAGING O "$2,538.04 " $466.31 $466.31 $60.00 "$1,269.02 " $387.46 $352.23 $461.65 $60.00 $886.00 $60.00 $466.31 "$1,903.53 " $512.95 "$1,598.97 " "$1,855.31 " $72.00 $60.00 "$1,522.82 " "$2,030.43 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,030.43 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,030.43 " "$2,157.33 " $60.00 "$1,903.53 " $123.00 $60.00 "$1,269.02 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $314.93 $489.63 $466.31 $314.93 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,658.00 " 330104 78472 5591 331 341 HC GATED HEART PLANAR SINGLE O "$2,924.31 " $466.31 $466.31 $150.00 "$1,462.15 " $370.96 $337.24 $461.65 $150.00 $886.00 $150.00 $466.31 "$2,193.23 " $512.95 "$1,842.32 " "$2,137.67 " $180.00 $150.00 "$1,754.59 " "$2,339.45 " "$1,585.47 " "$2,658.00 " $150.00 $466.31 $559.58 $210.00 "$2,339.45 " $150.00 $150.00 $180.00 $652.84 $150.00 $466.31 $466.31 $508.28 "$2,339.45 " "$2,485.66 " $150.00 "$2,193.23 " $307.50 $150.00 "$1,462.15 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 $150.00 $150.00 $396.37 $396.37 $466.31 $150.00 "$2,658.00 " 330104 78466 5591 331 341 HC HEART INFARCT IMAGE O "$2,639.69 " $466.31 $466.31 $60.00 "$1,319.85 " $305.02 $277.29 $461.65 $60.00 $886.00 $60.00 $466.31 "$1,979.77 " $512.95 "$1,663.00 " "$1,929.61 " $72.00 $60.00 "$1,583.81 " "$2,111.75 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,111.75 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,111.75 " "$2,243.74 " $60.00 "$1,979.77 " $123.00 $60.00 "$1,319.85 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,658.00 " 330104 78264 5591 331 341 HC GASTRIC EMPTYING STUDY O "$2,576.56 " $466.31 $466.31 $40.00 "$1,288.28 " $539.78 $490.71 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,932.42 " $512.95 "$1,623.23 " "$1,883.47 " $48.00 $40.00 "$1,545.94 " "$2,061.25 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,061.25 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,061.25 " "$2,190.08 " $40.00 "$1,932.42 " $82.00 $40.00 "$1,288.28 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78320 331 341 HC BONE IMAGING (3D) O "$5,862.53 " N/A N/A N/A "$2,931.26 " N/A N/A "$3,834.09 " N/A N/A N/A N/A "$4,396.90 " N/A "$3,693.39 " "$4,285.51 " N/A N/A "$3,517.52 " "$4,690.02 " N/A N/A N/A N/A N/A N/A "$4,690.02 " N/A N/A N/A N/A N/A N/A N/A N/A "$4,690.02 " "$4,983.15 " N/A "$4,396.90 " N/A N/A "$2,931.26 " "$3,810.64 " N/A N/A N/A N/A N/A N/A N/A "$3,910.31 " N/A N/A N/A N/A N/A "$2,931.26 " "$4,983.15 " 330104 78315 5591 331 341 HC BONE IMAGING 3 PHASE O "$3,447.54 " $466.31 $466.31 $80.00 "$1,723.77 " $563.88 $512.62 $461.65 $80.00 $886.00 $80.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $96.00 $80.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $80.00 $466.31 $559.58 $112.00 "$2,758.03 " $80.00 $80.00 $96.00 $652.84 $80.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $80.00 "$2,585.65 " $164.00 $80.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $80.00 $80.00 $396.37 $396.37 $466.31 $80.00 "$2,930.41 " 330104 78305 5591 331 341 HC BONE IMAGING MULTIPLE AREAS O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $451.38 $410.35 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78300 5591 331 341 HC BONE IMAGING LIMITED AREA O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $372.51 $338.64 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78290 5591 331 341 HC MECKELS DIVERT EXAM O "$2,576.56 " $466.31 $466.31 $40.00 "$1,288.28 " $540.03 $490.93 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,932.42 " $512.95 "$1,623.23 " "$1,883.47 " $48.00 $40.00 "$1,545.94 " "$2,061.25 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,061.25 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,061.25 " "$2,190.08 " $40.00 "$1,932.42 " $82.00 $40.00 "$1,288.28 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78278 5591 332 341 HC ACUTE GI BLOOD LOSS IMAGING O "$2,639.69 " $466.31 $466.31 $40.00 "$1,319.85 " $567.64 $516.03 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,979.77 " $512.95 "$1,663.00 " "$1,929.61 " $48.00 $40.00 "$1,583.81 " "$2,111.75 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,111.75 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,111.75 " "$2,243.74 " $40.00 "$1,979.77 " $82.00 $40.00 "$1,319.85 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78266 5592 331 341 HC GASTRIC EMPTY IMG STUDY W/SM BOWEL/COLON O "$3,211.07 " $605.27 $605.27 $148.35 "$1,605.54 " $725.95 $659.95 $599.22 $148.35 "$1,150.01 " $148.35 $605.27 "$2,408.30 " $665.80 "$2,022.97 " "$2,347.29 " $178.02 $148.35 "$1,926.64 " "$2,568.86 " "$2,057.91 " "$3,450.03 " $148.35 $605.27 $726.32 $207.69 "$2,568.86 " $148.35 $148.35 $178.02 $847.38 $148.35 $605.27 $605.27 $659.74 "$2,568.86 " "$2,729.41 " $148.35 "$2,408.30 " $304.12 $148.35 "$1,605.54 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $706.18 $635.53 $605.27 $706.18 $148.35 $148.35 $514.48 $514.48 $605.27 $148.35 "$3,450.03 " 330104 78650 5593 332 341 HC CSF LEAKAGE IMAGING O "$10,003.43 " "$1,592.38 " "$1,592.38 " $75.00 "$5,001.72 " $442.06 $401.87 "$1,576.46 " $75.00 "$3,025.52 " $75.00 "$1,592.38 " "$7,502.57 " "$1,751.62 " "$6,302.16 " "$7,312.51 " $90.00 $75.00 "$6,002.06 " "$8,002.74 " "$5,414.09 " "$9,076.56 " $75.00 "$1,592.38 " "$1,910.85 " $105.00 "$8,002.74 " $75.00 $75.00 $90.00 "$2,229.33 " $75.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$8,002.74 " "$8,502.92 " $75.00 "$7,502.57 " $153.75 $75.00 "$5,001.72 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $954.03 "$1,672.00 " "$1,592.38 " $954.03 $75.00 $75.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $75.00 "$9,076.56 " 330104 78428 5591 331 341 HC CARDIAC SHUNT IMAGING O "$1,571.83 " $466.31 $466.31 N/A $785.91 $307.28 $279.34 $461.65 N/A $886.00 N/A $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " N/A N/A $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " N/A $466.31 $559.58 N/A "$1,257.46 " N/A N/A N/A $652.84 N/A $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " N/A "$1,178.87 " N/A N/A $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 N/A N/A $396.37 $396.37 $466.31 $279.34 "$2,658.00 " 330104 78262 5591 331 341 HC GASTROESOPHAGEAL REFLUX EXAM O "$1,571.83 " $466.31 $466.31 $40.00 $785.91 $404.35 $367.60 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $48.00 $40.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$1,257.46 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $40.00 "$1,178.87 " $82.00 $40.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78226 5591 331 341 HC HEPATOBILIARY SYSTEM IMAGING O "$2,753.11 " $466.31 $466.31 $103.74 "$1,376.56 " $531.35 $483.05 $461.65 $103.74 $886.00 $103.74 $466.31 "$2,064.83 " $512.95 "$1,734.46 " "$2,012.52 " $124.49 $103.74 "$1,651.87 " "$2,202.49 " "$1,585.47 " "$2,658.00 " $103.74 $466.31 $559.58 $145.24 "$2,202.49 " $103.74 $103.74 $124.49 $652.84 $103.74 $466.31 $466.31 $508.28 "$2,202.49 " "$2,340.14 " $103.74 "$2,064.83 " $212.67 $103.74 "$1,376.56 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $469.49 $489.63 $466.31 $469.49 $103.74 $103.74 $396.37 $396.37 $466.31 $103.74 "$2,658.00 " 330104 78306 5591 331 341 HC BONE IMAGING WHOLE BODY O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $482.28 $438.44 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78700 5591 331 341 HC KIDNEY IMAGING MORPHOL O "$1,571.83 " $466.31 $466.31 $40.00 $785.91 $282.28 $256.62 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $48.00 $40.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$1,257.46 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $40.00 "$1,178.87 " $82.00 $40.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $514.34 $489.63 $466.31 $514.34 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78012 5591 331 341 HC THYROID UPTAKE MEASUREMENT O "$1,697.02 " $466.31 $466.31 $26.34 $848.51 $143.35 $130.32 $461.65 $26.34 $886.00 $26.34 $466.31 "$1,272.76 " $512.95 "$1,069.12 " "$1,240.52 " $31.61 $26.34 "$1,018.21 " "$1,357.62 " "$1,585.47 " "$2,658.00 " $26.34 $466.31 $559.58 $36.88 "$1,357.62 " $26.34 $26.34 $31.61 $652.84 $26.34 $466.31 $466.31 $508.28 "$1,357.62 " "$1,442.47 " $26.34 "$1,272.76 " $54.00 $26.34 $848.51 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $182.45 $489.63 $466.31 $182.45 $26.34 $26.34 $396.37 $396.37 $466.31 $26.34 "$2,658.00 " 330104 78014 5591 331 341 HC THYROID IMAGING W/BLOOD FLOW O "$3,149.01 " $466.31 $466.31 $82.78 "$1,574.51 " $390.56 $355.05 $461.65 $82.78 $886.00 $82.78 $466.31 "$2,361.76 " $512.95 "$1,983.88 " "$2,301.93 " $99.34 $82.78 "$1,889.41 " "$2,519.21 " "$1,585.47 " "$2,658.00 " $82.78 $466.31 $559.58 $115.89 "$2,519.21 " $82.78 $82.78 $99.34 $652.84 $82.78 $466.31 $466.31 $508.28 "$2,519.21 " "$2,676.66 " $82.78 "$2,361.76 " $169.70 $82.78 "$1,574.51 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $372.70 $489.63 $466.31 $372.70 $82.78 $82.78 $396.37 $396.37 $466.31 $82.78 "$2,676.66 " 330104 78015 5591 331 341 HC THYROID MET IMAGING O "$1,578.25 " $466.31 $466.31 $45.00 $789.12 $379.18 $344.71 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,183.69 " $512.95 $994.30 "$1,153.70 " $54.00 $45.00 $946.95 "$1,262.60 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$1,262.60 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$1,262.60 " "$1,341.51 " $45.00 "$1,183.69 " $92.25 $45.00 $789.12 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $464.18 $489.63 $466.31 $464.18 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78018 5592 331 341 HC THYROID MET IMAGING BODY O "$3,350.17 " $605.27 $605.27 $90.00 "$1,675.09 " $508.71 $462.47 $599.22 $90.00 "$1,150.01 " $90.00 $605.27 "$2,512.63 " $665.80 "$2,110.61 " "$2,448.97 " $108.00 $90.00 "$2,010.10 " "$2,680.14 " "$2,057.91 " "$3,450.03 " $90.00 $605.27 $726.32 $126.00 "$2,680.14 " $90.00 $90.00 $108.00 $847.38 $90.00 $605.27 $605.27 $659.74 "$2,680.14 " "$2,847.64 " $90.00 "$2,512.63 " $184.50 $90.00 "$1,675.09 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $464.18 $635.53 $605.27 $464.18 $90.00 $90.00 $514.48 $514.48 $605.27 $90.00 "$3,450.03 " 330104 78020 331 341 HC THYROID MET UPTAKE O "$1,061.44 " N/A N/A $40.00 $530.72 $135.61 $123.28 $93.88 $40.00 N/A $40.00 N/A $796.08 N/A $668.71 $775.91 $48.00 $40.00 $636.86 $849.15 N/A N/A $40.00 N/A $689.94 $56.00 $849.15 $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A $849.15 $902.22 $54.00 $796.08 $82.00 $54.00 $530.72 $689.94 N/A N/A N/A N/A N/A N/A N/A $707.98 $40.00 $40.00 N/A N/A N/A $40.00 $902.22 330104 78070 5591 332 341 HC PARATHYROID PLANAR IMAGING O "$3,350.17 " $466.31 $466.31 $60.00 "$1,675.09 " $479.21 $435.65 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,512.63 " $512.95 "$2,110.61 " "$2,448.97 " $72.00 $60.00 "$2,010.10 " "$2,680.14 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,680.14 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,680.14 " "$2,847.64 " $60.00 "$2,512.63 " $123.00 $60.00 "$1,675.09 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $351.18 $489.63 $466.31 $351.18 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,847.64 " 330104 78071 5591 331 341 HC PARATHYRD PLANAR W/WO SUBTRJ O "$1,571.83 " $466.31 $466.31 $114.81 $785.91 $570.63 $518.76 $461.65 $114.81 $886.00 $114.81 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $137.77 $114.81 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $114.81 $466.31 $559.58 $160.73 "$1,257.46 " $114.81 $114.81 $137.77 $652.84 $114.81 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $114.81 "$1,178.87 " $235.36 $114.81 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $515.26 $489.63 $466.31 $515.26 $114.81 $114.81 $396.37 $396.37 $466.31 $114.81 "$2,658.00 " 330104 78598 5592 332 341 HC LUNG PERF&VENTILAT DIFERENTL O "$2,014.81 " $605.27 $605.27 $95.46 "$1,007.40 " $493.52 $448.65 $599.22 $95.46 "$1,150.01 " $95.46 $605.27 "$1,511.11 " $665.80 "$1,269.33 " "$1,472.83 " $114.55 $95.46 "$1,208.89 " "$1,611.85 " "$2,057.91 " "$3,450.03 " $95.46 $605.27 $726.32 $133.64 "$1,611.85 " $95.46 $95.46 $114.55 $847.38 $95.46 $605.27 $605.27 $659.74 "$1,611.85 " "$1,712.59 " $95.46 "$1,511.11 " $195.69 $95.46 "$1,007.40 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $506.27 $635.53 $605.27 $506.27 $95.46 $95.46 $514.48 $514.48 $605.27 $95.46 "$3,450.03 " 330104 78072 5592 331 341 HC PARATHYRD PLANAR W/SPECT&CT O "$2,014.81 " $605.27 $605.27 N/A "$1,007.40 " $709.15 $644.68 $599.22 N/A "$1,150.01 " N/A $605.27 "$1,511.11 " $665.80 "$1,269.33 " "$1,472.83 " N/A N/A "$1,208.89 " "$1,611.85 " "$2,057.91 " "$3,450.03 " N/A $605.27 $726.32 N/A "$1,611.85 " N/A N/A N/A $847.38 N/A $605.27 $605.27 $659.74 "$1,611.85 " "$1,712.59 " N/A "$1,511.11 " N/A N/A "$1,007.40 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $515.26 $635.53 $605.27 $515.26 N/A N/A $514.48 $514.48 $605.27 $514.48 "$3,450.03 " 330104 78102 5591 331 341 HC BONE MARROW IMAGING LTD O "$2,554.09 " $466.31 $466.31 $45.00 "$1,277.05 " $284.46 $258.60 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,915.57 " $512.95 "$1,609.08 " "$1,867.04 " $54.00 $45.00 "$1,532.45 " "$2,043.27 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$2,043.27 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$2,043.27 " "$2,170.98 " $45.00 "$1,915.57 " $92.25 $45.00 "$1,277.05 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $411.23 $489.63 $466.31 $411.23 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78103 5591 331 341 HC BONE MARROW IMAGING MULT O "$1,571.83 " $466.31 $466.31 $45.00 $785.91 $303.56 $275.97 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $54.00 $45.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$1,257.46 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $45.00 "$1,178.87 " $92.25 $45.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $411.23 $489.63 $466.31 $411.23 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78195 5592 332 341 HC LYMPH SYSTEM IMAGING O "$4,208.31 " $605.27 $605.27 $40.00 "$2,104.16 " $575.92 $523.56 $599.22 $40.00 "$1,150.01 " $40.00 $605.27 "$3,156.23 " $665.80 "$2,651.24 " "$3,076.27 " $48.00 $40.00 "$2,524.99 " "$3,366.65 " "$2,057.91 " "$3,450.03 " $40.00 $605.27 $726.32 $56.00 "$3,366.65 " $40.00 $40.00 $48.00 $847.38 $40.00 $605.27 $605.27 $659.74 "$3,366.65 " "$3,577.06 " $40.00 "$3,156.23 " $82.00 $40.00 "$2,104.16 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $411.23 $635.53 $605.27 $411.23 $40.00 $40.00 $514.48 $514.48 $605.27 $40.00 "$3,577.06 " 330104 78215 5591 332 341 HC LIVER AND SPLEEN IMAGING O "$3,864.84 " $466.31 $466.31 $60.00 "$1,932.42 " $323.68 $294.25 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,898.63 " $512.95 "$2,434.85 " "$2,825.20 " $72.00 $60.00 "$2,318.90 " "$3,091.87 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$3,091.87 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$3,091.87 " "$3,285.11 " $60.00 "$2,898.63 " $123.00 $60.00 "$1,932.42 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $424.21 $489.63 $466.31 $424.21 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$3,285.11 " 330104 78227 5592 331 341 HC HEPATOBIL SYST IMAGE W/DRUG O "$3,514.95 " $605.27 $605.27 $142.01 "$1,757.47 " $714.98 $649.98 $599.22 $142.01 "$1,150.01 " $142.01 $605.27 "$2,636.21 " $665.80 "$2,214.42 " "$2,569.43 " $170.41 $142.01 "$2,108.97 " "$2,811.96 " "$2,057.91 " "$3,450.03 " $142.01 $605.27 $726.32 $198.81 "$2,811.96 " $142.01 $142.01 $170.41 $847.38 $142.01 $605.27 $605.27 $659.74 "$2,811.96 " "$2,987.71 " $142.01 "$2,636.21 " $291.12 $142.01 "$1,757.47 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $469.49 $635.53 $605.27 $469.49 $142.01 $142.01 $514.48 $514.48 $605.27 $142.01 "$3,450.03 " 330104 78582 5592 332 341 HC LUNG VENTILAT&PERFUS IMAGING O "$3,330.91 " $605.27 $605.27 $101.59 "$1,665.45 " $540.01 $490.92 $599.22 $101.59 "$1,150.01 " $101.59 $605.27 "$2,498.18 " $665.80 "$2,098.47 " "$2,434.90 " $121.91 $101.59 "$1,998.55 " "$2,664.73 " "$2,057.91 " "$3,450.03 " $101.59 $605.27 $726.32 $142.23 "$2,664.73 " $101.59 $101.59 $121.91 $847.38 $101.59 $605.27 $605.27 $659.74 "$2,664.73 " "$2,831.27 " $101.59 "$2,498.18 " $208.26 $101.59 "$1,665.45 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $506.27 $635.53 $605.27 $506.27 $101.59 $101.59 $514.48 $514.48 $605.27 $101.59 "$3,450.03 " 330104 78707 5592 331 341 HC K FLOW/FUNCT IMAGE W/O DRUG O "$2,349.72 " $605.27 $605.27 $95.00 "$1,174.86 " $381.09 $346.45 $599.22 $95.00 "$1,150.01 " $95.00 $605.27 "$1,762.29 " $665.80 "$1,480.32 " "$1,717.65 " $114.00 $95.00 "$1,409.83 " "$1,879.78 " "$2,057.91 " "$3,450.03 " $95.00 $605.27 $726.32 $133.00 "$1,879.78 " $95.00 $95.00 $114.00 $847.38 $95.00 $605.27 $605.27 $659.74 "$1,879.78 " "$1,997.26 " $95.00 "$1,762.29 " $194.75 $95.00 "$1,174.86 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $95.00 $95.00 $514.48 $514.48 $605.27 $95.00 "$3,450.03 " 330104 78709 5592 331 341 HC K FLOW/FUNCT IMAGE MULTIPLE O "$9,878.24 " $605.27 $605.27 $104.00 "$4,939.12 " $603.00 $548.18 $599.22 $104.00 "$1,150.01 " $104.00 $605.27 "$7,408.68 " $665.80 "$6,223.29 " "$7,220.99 " $124.80 $104.00 "$5,926.94 " "$7,902.59 " "$2,057.91 " "$3,450.03 " $104.00 $605.27 $726.32 $145.60 "$7,902.59 " $104.00 $104.00 $124.80 $847.38 $104.00 $605.27 $605.27 $659.74 "$7,902.59 " "$8,396.50 " $104.00 "$7,408.68 " $213.20 $104.00 "$4,939.12 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $104.00 $104.00 $514.48 $514.48 $605.27 $104.00 "$8,396.50 " 330104 78708 5592 331 341 HC K FLOW/FUNCT IMAGE W/DRUG O "$3,418.65 " $605.27 $605.27 $100.00 "$1,709.33 " $300.50 $273.19 $599.22 $100.00 "$1,150.01 " $100.00 $605.27 "$2,563.99 " $665.80 "$2,153.75 " "$2,499.03 " $120.00 $100.00 "$2,051.19 " "$2,734.92 " "$2,057.91 " "$3,450.03 " $100.00 $605.27 $726.32 $140.00 "$2,734.92 " $100.00 $100.00 $120.00 $847.38 $100.00 $605.27 $605.27 $659.74 "$2,734.92 " "$2,905.85 " $100.00 "$2,563.99 " $205.00 $100.00 "$1,709.33 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $100.00 $100.00 $514.48 $514.48 $605.27 $100.00 "$3,450.03 " 330104 78830 5593 332 341 HC RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING O "$3,033.45 " "$1,592.38 " "$1,592.38 " $134.05 "$1,516.72 " $781.52 $710.48 "$1,576.46 " $134.05 "$3,025.52 " $134.05 "$1,592.38 " "$2,275.09 " "$1,751.62 " "$1,911.07 " "$2,217.45 " $160.86 $134.05 "$1,820.07 " "$2,426.76 " "$5,414.09 " "$9,076.56 " $134.05 "$1,592.38 " "$1,910.85 " $187.67 "$2,426.76 " $134.05 $134.05 $160.86 "$2,229.33 " $134.05 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$2,426.76 " "$2,578.43 " $134.05 "$2,275.09 " $274.80 $134.05 "$1,516.72 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,035.28 " "$1,672.00 " "$1,592.38 " "$2,035.28 " $134.05 $134.05 "$1,353.52 " "$1,353.52 " "$1,592.38 " $134.05 "$9,076.56 " 330104 78806 332 341 HC ABSCESS IMAGING WHOLE BODY O "$3,447.54 " N/A N/A N/A "$1,723.77 " N/A N/A "$2,254.69 " N/A N/A N/A N/A "$2,585.65 " N/A "$2,171.95 " "$2,520.15 " N/A N/A "$2,068.52 " "$2,758.03 " N/A N/A N/A N/A N/A N/A "$2,758.03 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,758.03 " "$2,930.41 " N/A "$2,585.65 " N/A N/A "$1,723.77 " "$2,240.90 " N/A N/A N/A N/A N/A N/A N/A "$2,299.51 " N/A N/A N/A N/A N/A "$1,723.77 " "$2,930.41 " 330104 78805 332 341 HC ABSCESS IMAGING LTD AREA O "$3,447.54 " N/A N/A N/A "$1,723.77 " N/A N/A "$2,254.69 " N/A N/A N/A N/A "$2,585.65 " N/A "$2,171.95 " "$2,520.15 " N/A N/A "$2,068.52 " "$2,758.03 " N/A N/A N/A N/A N/A N/A "$2,758.03 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,758.03 " "$2,930.41 " N/A "$2,585.65 " N/A N/A "$1,723.77 " "$2,240.90 " N/A N/A N/A N/A N/A N/A N/A "$2,299.51 " N/A N/A N/A N/A N/A "$1,723.77 " "$2,930.41 " 330104 78804 5593 332 341 HC LOCALIZATION OF TUMOR WH/BODY MULTP DAYS O "$6,573.01 " "$1,592.38 " "$1,592.38 " $60.00 "$3,286.51 " "$1,057.67 " $961.52 "$1,576.46 " $60.00 "$3,025.52 " $60.00 "$1,592.38 " "$4,929.76 " "$1,751.62 " "$4,141.00 " "$4,804.87 " $72.00 $60.00 "$3,943.81 " "$5,258.41 " "$5,414.09 " "$9,076.56 " $60.00 "$1,592.38 " "$1,910.85 " $84.00 "$5,258.41 " $60.00 $60.00 $72.00 "$2,229.33 " $60.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$5,258.41 " "$5,587.06 " $60.00 "$4,929.76 " $123.00 $60.00 "$3,286.51 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,320.43 " "$1,672.00 " "$1,592.38 " "$1,320.43 " $60.00 $60.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $60.00 "$9,076.56 " 330104 78803 5593 332 341 HC TUMOR IMAGING (3D) O "$5,862.53 " "$1,592.38 " "$1,592.38 " $115.00 "$2,931.26 " $620.33 $563.93 "$1,576.46 " $115.00 "$3,025.52 " $115.00 "$1,592.38 " "$4,396.90 " "$1,751.62 " "$3,693.39 " "$4,285.51 " $138.00 $115.00 "$3,517.52 " "$4,690.02 " "$5,414.09 " "$9,076.56 " $115.00 "$1,592.38 " "$1,910.85 " $161.00 "$4,690.02 " $115.00 $115.00 $138.00 "$2,229.33 " $115.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$4,690.02 " "$4,983.15 " $115.00 "$4,396.90 " $235.75 $115.00 "$2,931.26 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $759.97 "$1,672.00 " "$1,592.38 " $759.97 $115.00 $115.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $115.00 "$9,076.56 " 330104 78832 5594 332 341 HC RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D O "$6,158.92 " "$1,786.83 " "$1,786.83 " $259.94 "$3,079.46 " "$1,482.85 " "$1,348.05 " "$1,768.96 " $259.94 "$3,394.98 " $259.94 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $311.93 $259.94 "$3,695.35 " "$4,927.14 " "$6,075.23 " "$10,184.95 " $259.94 "$1,786.83 " "$2,144.20 " $363.92 "$4,927.14 " $259.94 $259.94 $311.93 "$2,501.57 " $259.94 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $259.94 "$4,619.19 " $532.88 $259.94 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $259.94 $259.94 "$1,518.81 " "$1,518.81 " "$1,786.83 " $259.94 "$10,184.95 " 330104 78597 5591 332 341 HC LUNG PERFUSION DIFFERENTIAL O "$1,572.90 " $466.31 $466.31 $62.14 $786.45 $329.24 $299.31 $461.65 $62.14 $886.00 $62.14 $466.31 "$1,179.68 " $512.95 $990.93 "$1,149.79 " $74.57 $62.14 $943.74 "$1,258.32 " "$1,585.47 " "$2,658.00 " $62.14 $466.31 $559.58 $87.00 "$1,258.32 " $62.14 $62.14 $74.57 $652.84 $62.14 $466.31 $466.31 $508.28 "$1,258.32 " "$1,336.97 " $62.14 "$1,179.68 " $127.39 $62.14 $786.45 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $323.92 $489.63 $466.31 $323.92 $62.14 $62.14 $396.37 $396.37 $466.31 $62.14 "$2,658.00 " 330104 78761 5591 331 341 HC INJECTION TESTOSTERONE PROPIONATE UP TO 100 MG O "$5,904.26 " $466.31 $466.31 $50.00 "$2,952.13 " $350.68 $318.80 $461.65 $50.00 $886.00 $50.00 $466.31 "$4,428.19 " $512.95 "$3,719.68 " "$4,316.01 " $60.00 $50.00 "$3,542.56 " "$4,723.41 " "$1,585.47 " "$2,658.00 " $50.00 $466.31 $559.58 $70.00 "$4,723.41 " $50.00 $50.00 $60.00 $652.84 $50.00 $466.31 $466.31 $508.28 "$4,723.41 " "$5,018.62 " $50.00 "$4,428.19 " $102.50 $50.00 "$2,952.13 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $514.34 $489.63 $466.31 $514.34 $50.00 $50.00 $396.37 $396.37 $466.31 $50.00 "$5,018.62 " 330104 78801 5591 332 341 HC TUMOR IMAGING MULT AREAS O "$3,513.88 " $466.31 $466.31 $60.00 "$1,756.94 " $448.03 $407.30 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,635.41 " $512.95 "$2,213.74 " "$2,568.65 " $72.00 $60.00 "$2,108.33 " "$2,811.10 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,811.10 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,811.10 " "$2,986.80 " $60.00 "$2,635.41 " $123.00 $60.00 "$1,756.94 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $759.97 $489.63 $466.31 $759.97 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,986.80 " 330104 78802 5593 332 341 HC LOCALIZATION OF TUMOR WHOLE BODY SGL DAY O "$5,862.53 " "$1,592.38 " "$1,592.38 " $60.00 "$2,931.26 " $505.64 $459.67 "$1,576.46 " $60.00 "$3,025.52 " $60.00 "$1,592.38 " "$4,396.90 " "$1,751.62 " "$3,693.39 " "$4,285.51 " $72.00 $60.00 "$3,517.52 " "$4,690.02 " "$5,414.09 " "$9,076.56 " $60.00 "$1,592.38 " "$1,910.85 " $84.00 "$4,690.02 " $60.00 $60.00 $72.00 "$2,229.33 " $60.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$4,690.02 " "$4,983.15 " $60.00 "$4,396.90 " $123.00 $60.00 "$2,931.26 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $759.97 "$1,672.00 " "$1,592.38 " $759.97 $60.00 $60.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $60.00 "$9,076.56 " 330104 79101 5661 340 342 HC NUCLEAR RX IV ADMIN O "$2,479.19 " $299.61 $299.61 $30.00 "$1,239.60 " $247.20 $224.73 $296.61 $30.00 $569.26 $30.00 $299.61 "$1,859.39 " $329.57 "$1,561.89 " "$1,812.29 " $36.00 $30.00 "$1,487.51 " "$1,983.35 " "$1,018.68 " "$1,707.78 " $30.00 $299.61 $359.53 $42.00 "$1,983.35 " $30.00 $30.00 $36.00 $419.46 $30.00 $299.61 $299.61 $326.58 "$1,983.35 " "$2,107.31 " $30.00 "$1,859.39 " $61.50 $30.00 "$1,239.60 " $805.95 $471.89 $471.89 $471.89 $471.89 $358.59 $314.59 $299.61 $358.59 $30.00 $30.00 $254.67 $254.67 $299.61 $30.00 "$2,107.31 " 330104 79005 5661 340 342 HC NUCLEAR RX ORAL ADMIN O "$2,479.19 " $299.61 $299.61 $30.00 "$1,239.60 " $227.27 $206.61 $296.61 $30.00 $569.26 $30.00 $299.61 "$1,859.39 " $329.57 "$1,561.89 " "$1,812.29 " $36.00 $30.00 "$1,487.51 " "$1,983.35 " "$1,018.68 " "$1,707.78 " $30.00 $299.61 $359.53 $42.00 "$1,983.35 " $30.00 $30.00 $36.00 $419.46 $30.00 $299.61 $299.61 $326.58 "$1,983.35 " "$2,107.31 " $30.00 "$1,859.39 " $61.50 $30.00 "$1,239.60 " $805.95 $471.89 $471.89 $471.89 $471.89 $358.59 $314.59 $299.61 $358.59 $30.00 $30.00 $254.67 $254.67 $299.61 $30.00 "$2,107.31 " 330104 G6014 343 342 "HC RAD DELIV-3AREAS,>119M EV" O "$1,865.01 " $288.65 $288.65 $352.72 $932.50 $412.77 $375.25 $285.77 $352.72 $548.44 $352.72 $288.65 "$1,398.76 " $317.52 "$1,174.96 " "$1,363.32 " $423.27 $352.72 "$1,119.01 " "$1,492.01 " $981.42 "$1,645.32 " $352.72 $288.65 "$1,212.26 " $493.81 "$1,492.01 " $352.72 $352.72 $423.27 $404.11 $352.72 $288.65 $288.65 $314.63 "$1,492.01 " "$1,585.26 " $476.18 "$1,398.76 " $723.08 $476.18 $932.50 "$1,212.26 " $454.63 $454.63 $454.63 $454.63 N/A $303.08 $288.65 "$1,243.96 " $352.72 $352.72 $245.35 $245.35 $288.65 $245.35 "$1,645.32 " 330104 G6013 343 342 "HC RADIATION TREATMENT DELIVERY, 3 OR MORE" O "$1,127.78 " $290.29 $290.29 $352.72 $563.89 $415.12 $377.38 $287.39 $352.72 $551.56 $352.72 $290.29 $845.84 $319.32 $710.50 $824.41 $423.27 $352.72 $676.67 $902.22 $987.00 "$1,654.68 " $352.72 $290.29 $733.06 $493.81 $902.22 $352.72 $352.72 $423.27 $406.41 $352.72 $290.29 $290.29 $316.42 $902.22 $958.61 $476.18 $845.84 $723.08 $476.18 $563.89 $733.06 $457.21 $457.21 $457.21 $457.21 N/A $304.81 $290.29 $752.23 $352.72 $352.72 $246.75 $246.75 $290.29 $246.75 "$1,654.68 " 330104 G6012 343 342 HC RADIATION TREATMENT DELIVERY 3 OR MORE O "$1,127.78 " $289.47 $289.47 $352.72 $563.89 $413.95 $376.32 $286.58 $352.72 $550.00 $352.72 $289.47 $845.84 $318.42 $710.50 $824.41 $423.27 $352.72 $676.67 $902.22 $984.21 "$1,650.00 " $352.72 $289.47 $733.06 $493.81 $902.22 $352.72 $352.72 $423.27 $405.26 $352.72 $289.47 $289.47 $315.53 $902.22 $958.61 $476.18 $845.84 $723.08 $476.18 $563.89 $733.06 $455.92 $455.92 $455.92 $455.92 N/A $303.95 $289.47 $752.23 $352.72 $352.72 $246.05 $246.05 $289.47 $246.05 "$1,650.00 " 330104 G6015 347 342 HC RADIATION TX DELIVERY IMRT O "$3,585.57 " $443.82 $443.82 $162.35 "$1,792.79 " $634.67 $576.97 $439.38 $162.35 $843.26 $162.35 $443.82 "$2,689.18 " $488.20 "$2,258.91 " "$2,621.05 " $194.82 $162.35 "$2,151.34 " "$2,868.46 " "$1,508.99 " "$2,529.79 " $162.35 $443.82 "$2,330.62 " $227.28 "$2,868.46 " $162.35 $162.35 $194.82 $621.35 $162.35 $443.82 $443.82 $483.77 "$2,868.46 " "$3,047.73 " $219.17 "$2,689.18 " $332.81 $219.17 "$1,792.79 " "$2,330.62 " $699.02 $699.02 $699.02 $699.02 N/A $466.01 $443.82 "$2,391.58 " $162.35 $162.35 $377.25 $377.25 $443.82 $162.35 "$3,047.73 " 330104 A9560 2000 343 HC TC99M LABELED RBC O $40.00 N/A N/A $40.00 $20.00 N/A N/A N/A $40.00 N/A $40.00 N/A $30.00 N/A $25.20 $29.24 $48.00 $40.00 $24.00 $32.00 N/A N/A $40.00 N/A $26.00 $56.00 $32.00 $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A $32.00 $34.00 $54.00 $30.00 $82.00 $54.00 $20.00 $26.00 N/A N/A N/A N/A N/A N/A N/A $26.68 $40.00 $40.00 N/A N/A N/A $20.00 $82.00 330104 A9556 2000 343 HC GA67 GALLIUM O $93.00 N/A N/A N/A $46.50 N/A N/A N/A N/A N/A N/A N/A $69.75 N/A $58.59 $67.98 N/A N/A $55.80 $74.40 N/A N/A N/A N/A $60.45 N/A $74.40 N/A N/A N/A N/A N/A N/A N/A N/A $74.40 $79.05 N/A $69.75 N/A N/A $46.50 $60.45 N/A N/A N/A N/A N/A N/A N/A $62.03 N/A N/A N/A N/A N/A $46.50 $79.05 330104 A9521 2000 343 HC TC99M EXAMETAZIME O "$5,551.00 " N/A N/A "$5,551.00 " "$2,775.50 " N/A N/A N/A "$5,551.00 " N/A "$5,551.00 " N/A "$4,163.25 " N/A "$3,497.13 " "$4,057.78 " "$6,661.20 " "$5,551.00 " "$3,330.60 " "$4,440.80 " N/A N/A "$5,551.00 " N/A "$3,608.15 " "$7,771.40 " "$4,440.80 " "$5,551.00 " "$5,551.00 " "$6,661.20 " N/A "$5,551.00 " N/A N/A N/A "$4,440.80 " "$4,718.35 " "$7,493.85 " "$4,163.25 " "$11,379.55 " "$7,493.85 " "$2,775.50 " "$3,608.15 " N/A N/A N/A N/A N/A N/A N/A "$3,702.52 " "$5,551.00 " "$5,551.00 " N/A N/A N/A "$2,775.50 " "$11,379.55 " 330104 A9528 2000 343 HC IODINE I-131 IODIDE CAP DX O $183.00 N/A N/A $183.00 $91.50 N/A N/A N/A $183.00 N/A $183.00 N/A $137.25 N/A $115.29 $133.77 $219.60 $183.00 $109.80 $146.40 N/A N/A $183.00 N/A $118.95 $256.20 $146.40 $183.00 $183.00 $219.60 N/A $183.00 N/A N/A N/A $146.40 $155.55 $247.05 $137.25 $375.15 $247.05 $91.50 $118.95 N/A N/A N/A N/A N/A N/A N/A $122.06 $183.00 $183.00 N/A N/A N/A $91.50 $375.15 330104 A9512 2000 343 HC TC99M PERTECHNETATE O $5.00 N/A N/A $5.00 $2.50 N/A N/A N/A $5.00 N/A $5.00 N/A $3.75 N/A $3.15 $3.65 $6.00 $5.00 $3.00 $4.00 N/A N/A $5.00 N/A $3.25 $7.00 $4.00 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $4.00 $4.25 $6.75 $3.75 $10.25 $6.75 $2.50 $3.25 N/A N/A N/A N/A N/A N/A N/A $3.33 $5.00 $5.00 N/A N/A N/A $2.50 $10.25 330104 A9537 2000 343 HC TC99M MEBROFENIN O $297.00 N/A N/A $297.00 $148.50 N/A N/A N/A $297.00 N/A $297.00 N/A $222.75 N/A $187.11 $217.11 $356.40 $297.00 $178.20 $237.60 N/A N/A $297.00 N/A $193.05 $415.80 $237.60 $297.00 $297.00 $356.40 N/A $297.00 N/A N/A N/A $237.60 $252.45 $400.95 $222.75 $608.85 $400.95 $148.50 $193.05 N/A N/A N/A N/A N/A N/A N/A $198.10 $297.00 $297.00 N/A N/A N/A $148.50 $608.85 330104 A9538 2000 343 HC TC99M PYROPHOSPHATE O $252.00 N/A N/A $252.00 $126.00 N/A N/A N/A $252.00 N/A $252.00 N/A $189.00 N/A $158.76 $184.21 $302.40 $252.00 $151.20 $201.60 N/A N/A $252.00 N/A $163.80 $352.80 $201.60 $252.00 $252.00 $302.40 N/A $252.00 N/A N/A N/A $201.60 $214.20 $340.20 $189.00 $516.60 $340.20 $126.00 $163.80 N/A N/A N/A N/A N/A N/A N/A $168.08 $252.00 $252.00 N/A N/A N/A $126.00 $516.60 330104 A9539 2000 343 HC TC99M PENTETATE O $401.00 N/A N/A $401.00 $200.50 N/A N/A N/A $401.00 N/A $401.00 N/A $300.75 N/A $252.63 $293.13 $481.20 $401.00 $240.60 $320.80 N/A N/A $401.00 N/A $260.65 $561.40 $320.80 $401.00 $401.00 $481.20 N/A $401.00 N/A N/A N/A $320.80 $340.85 $541.35 $300.75 $822.05 $541.35 $200.50 $260.65 N/A N/A N/A N/A N/A N/A N/A $267.47 $401.00 $401.00 N/A N/A N/A $200.50 $822.05 330104 A9540 2000 343 HC TC99M MAA O $360.00 N/A N/A $360.00 $180.00 N/A N/A N/A $360.00 N/A $360.00 N/A $270.00 N/A $226.80 $263.16 $432.00 $360.00 $216.00 $288.00 N/A N/A $360.00 N/A $234.00 $504.00 $288.00 $360.00 $360.00 $432.00 N/A $360.00 N/A N/A N/A $288.00 $306.00 $486.00 $270.00 $738.00 $486.00 $180.00 $234.00 N/A N/A N/A N/A N/A N/A N/A $240.12 $360.00 $360.00 N/A N/A N/A $180.00 $738.00 330104 A9541 2000 343 HC TC99M SULFUR COLLOID UNFILTERED O $500.00 N/A N/A $500.00 $250.00 N/A N/A N/A $500.00 N/A $500.00 N/A $375.00 N/A $315.00 $365.50 $600.00 $500.00 $300.00 $400.00 N/A N/A $500.00 N/A $325.00 $700.00 $400.00 $500.00 $500.00 $600.00 N/A $500.00 N/A N/A N/A $400.00 $425.00 $675.00 $375.00 "$1,025.00 " $675.00 $250.00 $325.00 N/A N/A N/A N/A N/A N/A N/A $333.50 $500.00 $500.00 N/A N/A N/A $250.00 "$1,025.00 " 330104 A9547 2000 343 HC IN111 OXYQUINOLINE O $295.00 N/A N/A $295.00 $147.50 N/A N/A N/A $295.00 N/A $295.00 N/A $221.25 N/A $185.85 $215.64 $354.00 $295.00 $177.00 $236.00 N/A N/A $295.00 N/A $191.75 $413.00 $236.00 $295.00 $295.00 $354.00 N/A $295.00 N/A N/A N/A $236.00 $250.75 $398.25 $221.25 $604.75 $398.25 $147.50 $191.75 N/A N/A N/A N/A N/A N/A N/A $196.77 $295.00 $295.00 N/A N/A N/A $147.50 $604.75 330104 A9500 2000 343 HC TC99M SESTAMIBI DIAGNOSTIC PER STUDY DOSE O $888.00 N/A N/A $888.00 $444.00 N/A N/A N/A $888.00 N/A $888.00 N/A $666.00 N/A $559.44 $649.13 "$1,065.60 " $888.00 $532.80 $710.40 N/A N/A $888.00 N/A $577.20 "$1,243.20 " $710.40 $888.00 $888.00 "$1,065.60 " N/A $888.00 N/A N/A N/A $710.40 $754.80 "$1,198.80 " $666.00 "$1,820.40 " "$1,198.80 " $444.00 $577.20 N/A N/A N/A N/A N/A N/A N/A $592.30 $888.00 $888.00 N/A N/A N/A $444.00 "$1,820.40 " 330104 A9516 2000 343 HC IODINE I-123 SOD IODIDE MIC O $501.00 N/A N/A $501.00 $250.50 N/A N/A N/A $501.00 N/A $501.00 N/A $375.75 N/A $315.63 $366.23 $601.20 $501.00 $300.60 $400.80 N/A N/A $501.00 N/A $325.65 $701.40 $400.80 $501.00 $501.00 $601.20 N/A $501.00 N/A N/A N/A $400.80 $425.85 $676.35 $375.75 "$1,027.05 " $676.35 $250.50 $325.65 N/A N/A N/A N/A N/A N/A N/A $334.17 $501.00 $501.00 N/A N/A N/A $250.50 "$1,027.05 " 330104 A9509 2000 343 HC IODINE I-123 SOD IODIDE DIAG. PER MCI O $501.00 N/A N/A $501.00 $250.50 N/A N/A N/A $501.00 N/A $501.00 N/A $375.75 N/A $315.63 $366.23 $601.20 $501.00 $300.60 $400.80 N/A N/A $501.00 N/A $325.65 $701.40 $400.80 $501.00 $501.00 $601.20 N/A $501.00 N/A N/A N/A $400.80 $425.85 $676.35 $375.75 "$1,027.05 " $676.35 $250.50 $325.65 N/A N/A N/A N/A N/A N/A N/A $334.17 $501.00 $501.00 N/A N/A N/A $250.50 "$1,027.05 " 330104 A9503 2000 343 HC TC99M MEDRONATE DIAGNOSTIC UP TO 30 MCI O $213.00 N/A N/A $213.00 $106.50 N/A N/A N/A $213.00 N/A $213.00 N/A $159.75 N/A $134.19 $155.70 $255.60 $213.00 $127.80 $170.40 N/A N/A $213.00 N/A $138.45 $298.20 $170.40 $213.00 $213.00 $255.60 N/A $213.00 N/A N/A N/A $170.40 $181.05 $287.55 $159.75 $436.65 $287.55 $106.50 $138.45 N/A N/A N/A N/A N/A N/A N/A $142.07 $213.00 $213.00 N/A N/A N/A $106.50 $436.65 330104 A9567 2000 343 HC TECHNETIUM TC-99M AEROSOL O $105.00 N/A N/A $105.00 $52.50 N/A N/A N/A $105.00 N/A $105.00 N/A $78.75 N/A $66.15 $76.75 $126.00 $105.00 $63.00 $84.00 N/A N/A $105.00 N/A $68.25 $147.00 $84.00 $105.00 $105.00 $126.00 N/A $105.00 N/A N/A N/A $84.00 $89.25 $141.75 $78.75 $215.25 $141.75 $52.50 $68.25 N/A N/A N/A N/A N/A N/A N/A $70.04 $105.00 $105.00 N/A N/A N/A $52.50 $215.25 330104 A9570 2000 343 HC INDIUM IN-111 AUTO WBC O "$5,107.02 " N/A N/A "$5,107.02 " "$2,553.51 " N/A N/A N/A "$5,107.02 " N/A "$5,107.02 " N/A "$3,830.27 " N/A "$3,217.42 " "$3,733.23 " "$6,128.42 " "$5,107.02 " "$3,064.21 " "$4,085.62 " N/A N/A "$5,107.02 " N/A "$3,319.56 " "$7,149.83 " "$4,085.62 " "$5,107.02 " "$5,107.02 " "$6,128.42 " N/A "$5,107.02 " N/A N/A N/A "$4,085.62 " "$4,340.97 " "$6,894.48 " "$3,830.27 " "$10,469.39 " "$6,894.48 " "$2,553.51 " "$3,319.56 " N/A N/A N/A N/A N/A N/A N/A "$3,406.38 " "$5,107.02 " "$5,107.02 " N/A N/A N/A "$2,553.51 " "$10,469.39 " 330104 A9572 2000 343 HC INDIUM IN-111 PENTETREOTIDE O "$4,212.00 " N/A N/A "$4,212.00 " "$2,106.00 " N/A N/A N/A "$4,212.00 " N/A "$4,212.00 " N/A "$3,159.00 " N/A "$2,653.56 " "$3,078.97 " "$5,054.40 " "$4,212.00 " "$2,527.20 " "$3,369.60 " N/A N/A "$4,212.00 " N/A "$2,737.80 " "$5,896.80 " "$3,369.60 " "$4,212.00 " "$4,212.00 " "$5,054.40 " N/A "$4,212.00 " N/A N/A N/A "$3,369.60 " "$3,580.20 " "$5,686.20 " "$3,159.00 " "$8,634.60 " "$5,686.20 " "$2,106.00 " "$2,737.80 " N/A N/A N/A N/A N/A N/A N/A "$2,809.40 " "$4,212.00 " "$4,212.00 " N/A N/A N/A "$2,106.00 " "$8,634.60 " 330104 A9562 2000 343 HC TC99M MERTIATIDE O "$1,384.00 " N/A N/A "$1,384.00 " $692.00 N/A N/A N/A "$1,384.00 " N/A "$1,384.00 " N/A "$1,038.00 " N/A $871.92 "$1,011.70 " "$1,660.80 " "$1,384.00 " $830.40 "$1,107.20 " N/A N/A "$1,384.00 " N/A $899.60 "$1,937.60 " "$1,107.20 " "$1,384.00 " "$1,384.00 " "$1,660.80 " N/A "$1,384.00 " N/A N/A N/A "$1,107.20 " "$1,176.40 " "$1,868.40 " "$1,038.00 " "$2,837.20 " "$1,868.40 " $692.00 $899.60 N/A N/A N/A N/A N/A N/A N/A $923.13 "$1,384.00 " "$1,384.00 " N/A N/A N/A $692.00 "$2,837.20 " 330104 A4641 2000 343 HC SULFUR COLLOID(10MCI) =<20MCI O "$1,008.00 " N/A N/A "$1,008.00 " $504.00 N/A N/A N/A "$1,008.00 " N/A "$1,008.00 " N/A $756.00 N/A $635.04 $736.85 "$1,209.60 " "$1,008.00 " $604.80 $806.40 N/A N/A "$1,008.00 " N/A $655.20 "$1,411.20 " $806.40 "$1,008.00 " "$1,008.00 " "$1,209.60 " N/A "$1,008.00 " N/A N/A N/A $806.40 $856.80 "$1,360.80 " $756.00 "$2,066.40 " "$1,360.80 " $504.00 $655.20 N/A N/A N/A N/A N/A N/A N/A $672.34 "$1,008.00 " "$1,008.00 " N/A N/A N/A $504.00 "$2,066.40 " 330104 A4641 2000 343 HC PYPá TECHNETIUM O $438.00 N/A N/A $438.00 $219.00 N/A N/A N/A $438.00 N/A $438.00 N/A $328.50 N/A $275.94 $320.18 $525.60 $438.00 $262.80 $350.40 N/A N/A $438.00 N/A $284.70 $613.20 $350.40 $438.00 $438.00 $525.60 N/A $438.00 N/A N/A N/A $350.40 $372.30 $591.30 $328.50 $897.90 $591.30 $219.00 $284.70 N/A N/A N/A N/A N/A N/A N/A $292.15 $438.00 $438.00 N/A N/A N/A $219.00 $897.90 330104 A9541 2000 343 HC TC99M SULFUR COLLOID FILTERED O "$1,008.00 " N/A N/A "$1,008.00 " $504.00 N/A N/A N/A "$1,008.00 " N/A "$1,008.00 " N/A $756.00 N/A $635.04 $736.85 "$1,209.60 " "$1,008.00 " $604.80 $806.40 N/A N/A "$1,008.00 " N/A $655.20 "$1,411.20 " $806.40 "$1,008.00 " "$1,008.00 " "$1,209.60 " N/A "$1,008.00 " N/A N/A N/A $806.40 $856.80 "$1,360.80 " $756.00 "$2,066.40 " "$1,360.80 " $504.00 $655.20 N/A N/A N/A N/A N/A N/A N/A $672.34 "$1,008.00 " "$1,008.00 " N/A N/A N/A $504.00 "$2,066.40 " 330104 A9517 1064 244 344 HC I131 IODIDE CAP RX O $178.00 $28.47 $28.47 $178.00 $89.00 N/A N/A $28.19 $178.00 $54.09 $178.00 $28.47 $133.50 $31.32 $112.14 $130.12 $213.60 $178.00 $106.80 $142.40 $96.80 $162.28 $178.00 $28.47 $34.16 $249.20 $142.40 $178.00 $178.00 $213.60 $39.86 $178.00 $28.47 $28.47 $31.03 $142.40 $151.30 $178.00 $133.50 $364.90 $178.00 $89.00 $76.58 $44.84 $44.84 $44.84 $44.84 N/A $29.89 $28.47 $118.73 $178.00 $178.00 $24.20 $24.20 $28.47 $24.20 $364.90 330104 A9606 1745 245 344 HC RADIUM RA-223 DICHLORIDE TX PER MICROCUR O $520.00 $185.59 $185.59 $520.00 $260.00 N/A N/A $183.73 $520.00 $352.61 $520.00 $185.59 $390.00 $204.14 $327.60 $380.12 $624.00 $520.00 $312.00 $416.00 $630.99 "$1,057.84 " $520.00 $185.59 $222.70 $728.00 $416.00 $520.00 $520.00 $624.00 $259.82 $520.00 $185.59 $185.59 $202.29 $416.00 $442.00 $520.00 $390.00 "$1,066.00 " $520.00 $260.00 $499.22 $292.30 $292.30 $292.30 $292.30 N/A $194.86 $185.59 $346.84 $520.00 $520.00 $157.75 $157.75 $185.59 $157.75 "$1,066.00 " 330104 72191 5571 302 350 HC CT ANGIOGRAPH PELV W/O&W/DYE O "$5,698.82 " $216.36 $216.36 $254.00 "$2,849.41 " $552.29 $502.08 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,274.11 " $238.00 "$3,590.26 " "$4,165.84 " $304.80 $254.00 "$3,419.29 " "$4,559.06 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,559.06 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,559.06 " "$4,844.00 " $254.00 "$4,274.11 " $520.70 $254.00 "$2,849.41 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,844.00 " 330104 73200 5522 299 350 HC CT UPPER EXTREMITY W/O DYE O "$1,692.74 " $128.23 $128.23 $140.00 $846.37 $290.52 $264.10 $126.95 $140.00 $243.63 $140.00 $128.23 "$1,269.56 " $141.05 "$1,066.43 " "$1,237.39 " $168.00 $140.00 "$1,015.64 " "$1,354.19 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$1,354.19 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$1,354.19 " "$1,438.83 " $140.00 "$1,269.56 " $287.00 $140.00 $846.37 $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$1,438.83 " 330104 73201 5572 300 350 HC CT UPPER EXTREMITY W/DYE O "$3,589.85 " $442.02 $442.02 $170.00 "$1,794.92 " $364.31 $331.19 $437.60 $170.00 $839.84 $170.00 $442.02 "$2,692.39 " $486.22 "$2,261.61 " "$2,624.18 " $204.00 $170.00 "$2,153.91 " "$2,871.88 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$2,871.88 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$2,871.88 " "$3,051.37 " $170.00 "$2,692.39 " $348.50 $170.00 "$1,794.92 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$3,051.37 " 330104 73206 5571 302 350 HC CT ANGIO UPR EXTRM W/O&W/DYE O "$4,544.29 " $216.36 $216.36 $254.00 "$2,272.14 " $538.19 $489.26 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,408.22 " $238.00 "$2,862.90 " "$3,321.88 " $304.80 $254.00 "$2,726.57 " "$3,635.43 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,635.43 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,635.43 " "$3,862.65 " $254.00 "$3,408.22 " $520.70 $254.00 "$2,272.14 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,862.65 " 330104 73701 5571 300 350 HC CT LOWER EXTREMITY W/DYE O "$3,323.42 " $216.36 $216.36 $170.00 "$1,661.71 " $299.71 $272.46 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $204.00 $170.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,658.74 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $170.00 "$2,492.57 " $348.50 $170.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,824.91 " 330104 73706 5571 302 350 HC CT ANGIO LWR EXTR W/O&W/DYE O "$4,544.29 " $216.36 $216.36 $254.00 "$2,272.14 " $585.08 $531.89 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,408.22 " $238.00 "$2,862.90 " "$3,321.88 " $304.80 $254.00 "$2,726.57 " "$3,635.43 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,635.43 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,635.43 " "$3,862.65 " $254.00 "$3,408.22 " $520.70 $254.00 "$2,272.14 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,862.65 " 330104 74174 5572 302 350 HC CT ANGIO ABD&PELV W/O&W/DYE O "$5,698.82 " $442.02 $442.02 $177.48 "$2,849.41 " $688.42 $625.84 $437.60 $177.48 $839.84 $177.48 $442.02 "$4,274.11 " $486.22 "$3,590.26 " "$4,165.84 " $212.98 $177.48 "$3,419.29 " "$4,559.06 " "$1,502.87 " "$2,519.52 " $177.48 $442.02 $530.42 $248.47 "$4,559.06 " $177.48 $177.48 $212.98 $618.83 $177.48 $442.02 $442.02 $481.80 "$4,559.06 " "$4,844.00 " $177.48 "$4,274.11 " $363.83 $177.48 "$2,849.41 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $929.66 $464.12 $442.02 $929.66 $177.48 $177.48 $375.72 $375.72 $442.02 $177.48 "$4,844.00 " 330104 71275 5571 302 350 HC CT ANGIOGRAPHY CHEST O "$4,708.00 " $216.36 $216.36 $140.00 "$2,354.00 " $507.57 $461.43 $214.20 $140.00 $411.09 $140.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $168.00 $140.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $140.00 $216.36 $259.63 $196.00 "$3,766.40 " $140.00 $140.00 $168.00 $302.91 $140.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $140.00 "$3,531.00 " $287.00 $140.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $140.00 $140.00 $183.91 $183.91 $216.36 $140.00 "$4,001.80 " 330104 74175 5571 302 350 HC CT ANGIO ABDOM W/O & W/DYE O "$6,342.96 " $216.36 $216.36 $254.00 "$3,171.48 " $555.15 $504.68 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,757.22 " $238.00 "$3,996.06 " "$4,636.70 " $304.80 $254.00 "$3,805.78 " "$5,074.37 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$5,074.37 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$5,074.37 " "$5,391.52 " $254.00 "$4,757.22 " $520.70 $254.00 "$3,171.48 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$5,391.52 " 330104 75571 5521 299 350 HC CT HRT W/O DYE W/CA TEST O $656.98 $104.23 $104.23 N/A $328.49 $179.75 $163.41 $103.19 N/A $198.04 N/A $104.23 $492.74 $114.66 $413.90 $480.25 N/A N/A $394.19 $525.58 $354.39 $594.13 N/A $104.23 $125.08 N/A $525.58 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $525.58 $558.43 N/A $492.74 N/A N/A $328.49 $280.39 $164.17 $164.17 $164.17 $164.17 $73.97 $109.45 $104.23 $73.97 N/A N/A $88.60 $88.60 $104.23 $73.97 $594.13 330104 73700 5522 299 350 HC CT LOWER EXTREMITY W/O DYE O "$3,323.42 " $128.23 $128.23 $140.00 "$1,661.71 " $230.61 $209.64 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $168.00 $140.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,658.74 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $140.00 "$2,492.57 " $287.00 $140.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 71271 5522 299 350 HC CT THORAX LW DOSE LNG CA SCR C- O $337.05 $128.23 $128.23 $34.83 $168.53 $246.34 $223.94 $126.95 $34.83 $243.63 $34.83 $128.23 $252.79 $141.05 $212.34 $246.38 $41.80 $34.83 $202.23 $269.64 $435.98 $730.90 $34.83 $128.23 $153.87 $48.76 $269.64 $34.83 $34.83 $41.80 $179.52 $34.83 $128.23 $128.23 $139.77 $269.64 $286.49 $34.83 $252.79 $71.40 $34.83 $168.53 $344.93 $201.96 $201.96 $201.96 $201.96 N/A $134.64 $128.23 $224.81 $34.83 $34.83 $108.99 $108.99 $128.23 $34.83 $730.90 330104 70486 5522 299 350 HC CT MAXILLOFACIAL W/O DYE O "$3,323.42 " $128.23 $128.23 $120.00 "$1,661.71 " $229.98 $209.07 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $144.00 $120.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,658.74 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $120.00 "$2,492.57 " $246.00 $120.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 70492 5571 300 350 HC CT SFT TSUE NCK W/O & W/DYE O "$3,562.03 " $216.36 $216.36 $254.00 "$1,781.02 " $398.31 $362.10 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,671.52 " $238.00 "$2,244.08 " "$2,603.84 " $304.80 $254.00 "$2,137.22 " "$2,849.62 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,849.62 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,849.62 " "$3,027.73 " $254.00 "$2,671.52 " $520.70 $254.00 "$1,781.02 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,027.73 " 330104 70488 5571 300 350 HC CT MAXILLOFACIAL W/O & W/DYE O "$3,816.69 " $216.36 $216.36 $217.00 "$1,908.35 " $332.88 $302.62 $214.20 $217.00 $411.09 $217.00 $216.36 "$2,862.52 " $238.00 "$2,404.51 " "$2,790.00 " $260.40 $217.00 "$2,290.01 " "$3,053.35 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,053.35 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,053.35 " "$3,244.19 " $217.00 "$2,862.52 " $444.85 $217.00 "$1,908.35 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,244.19 " 330104 70487 5571 300 350 HC CT MAXILLOFACIAL W/DYE O "$3,323.42 " $216.36 $216.36 $145.00 "$1,661.71 " $272.39 $247.62 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $174.00 $145.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,658.74 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $145.00 "$2,492.57 " $297.25 $145.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$2,824.91 " 330104 49180 5072 150 350 HC PERCUT BIOPSY ABDOMINAL MASS O "$12,721.23 " "$1,799.07 " "$1,799.07 " $609.85 "$6,360.61 " $140.37 $127.61 "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$9,540.92 " "$1,978.98 " "$8,014.37 " "$9,299.22 " $731.82 $609.85 "$7,632.74 " "$10,176.98 " "$6,116.84 " "$10,254.70 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$10,176.98 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,176.98 " "$10,813.05 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$6,360.61 " "$4,839.50 " "$2,833.54 " "$2,833.54 " "$2,833.54 " "$2,833.54 " N/A "$1,889.02 " "$1,799.07 " "$8,485.06 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $127.61 "$10,813.05 " 330104 27369 278 350 HC NJX CNTRST KNE ARTHG/CT/MRI O "$1,011.15 " N/A N/A $468.99 $505.57 $69.96 $63.60 $48.44 $468.99 N/A $468.99 N/A $758.36 N/A $637.02 $739.15 $562.78 $468.99 $606.69 $808.92 N/A N/A $468.99 N/A $657.25 $656.58 $808.92 $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A $808.92 $859.48 $633.13 $758.36 $961.42 $633.13 $505.57 $657.25 N/A N/A N/A N/A N/A N/A N/A $674.44 $468.99 $468.99 N/A N/A N/A $48.44 $961.42 330104 20600 5441 49 350 HC DRAIN/INJECT SMALL JOINT/BURSA CT O "$1,182.35 " $326.20 $326.20 $296.51 $591.17 $60.92 $55.39 $322.94 $296.51 $619.77 $296.51 $326.20 $886.76 $358.82 $744.88 $864.30 $355.81 $296.51 $709.41 $945.88 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $945.88 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $945.88 "$1,005.00 " $296.51 $886.76 $607.85 $296.51 $591.17 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $788.63 $296.51 $296.51 $277.27 $277.27 $326.20 $55.39 "$1,859.32 " 330104 0712T 5521 301 350 HC N-INVAS ARTL PLAQ ALYS QUAN STRUX&COMPOS VSL WAL O $214.00 $104.23 $104.23 N/A $107.00 N/A N/A $103.19 N/A $198.04 N/A $104.23 $160.50 $114.66 $134.82 $156.43 N/A N/A $128.40 $171.20 $354.39 $594.13 N/A $104.23 $125.08 N/A $171.20 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $171.20 $181.90 N/A $160.50 N/A N/A $107.00 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $142.74 N/A N/A $88.60 $88.60 $104.23 $88.60 $594.13 330104 0711T 2002 350 HC N-INVAS ARTL PLAQ ALYS DATA PREP & TRANSMISSION O $181.90 N/A N/A N/A $90.95 N/A N/A N/A N/A N/A N/A N/A $136.43 N/A $114.60 $132.97 N/A N/A $109.14 $145.52 N/A N/A N/A N/A $118.24 N/A $145.52 N/A N/A N/A N/A N/A N/A N/A N/A $145.52 $154.62 N/A $136.43 N/A N/A $90.95 $118.24 N/A N/A N/A N/A N/A N/A N/A $121.33 N/A N/A N/A N/A N/A $90.95 $154.62 330104 0691T 291 350 HC AUTO ALYS XST CT VRT FX ASMT B1 DNS DATA PRP I&R O "$1,605.00 " N/A N/A N/A $802.50 N/A N/A N/A N/A N/A N/A N/A "$1,203.75 " N/A "$1,011.15 " "$1,173.25 " N/A N/A $963.00 "$1,284.00 " N/A N/A N/A N/A "$1,043.25 " N/A "$1,284.00 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,284.00 " "$1,364.25 " N/A "$1,203.75 " N/A N/A $802.50 "$1,043.25 " N/A N/A N/A N/A N/A N/A N/A "$1,070.54 " N/A N/A N/A N/A N/A $802.50 "$1,364.25 " 330104 72193 5571 300 350 HC CT PELVIS W/DYE O "$3,921.55 " $216.36 $216.36 $170.00 "$1,960.78 " $417.76 $379.78 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,941.16 " $238.00 "$2,470.58 " "$2,866.65 " $204.00 $170.00 "$2,352.93 " "$3,137.24 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$3,137.24 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$3,137.24 " "$3,333.32 " $170.00 "$2,941.16 " $348.50 $170.00 "$1,960.78 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,333.32 " 330104 72192 5522 299 350 HC CT PELVIS W/O DYE O "$3,921.55 " $128.23 $128.23 $140.00 "$1,960.78 " $238.04 $216.40 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,941.16 " $141.05 "$2,470.58 " "$2,866.65 " $168.00 $140.00 "$2,352.93 " "$3,137.24 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$3,137.24 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$3,137.24 " "$3,333.32 " $140.00 "$2,941.16 " $287.00 $140.00 "$1,960.78 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,333.32 " 330104 70498 5571 302 350 HC CT ANGIOGRAPHY NECK O "$4,708.00 " $216.36 $216.36 $254.00 "$2,354.00 " $498.12 $452.84 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $304.80 $254.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,766.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $254.00 "$3,531.00 " $520.70 $254.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,001.80 " 330104 0042T 300 350 HC CT PERFUSION W/CONTRAST CBF O "$3,033.45 " N/A N/A N/A "$1,516.72 " N/A N/A N/A N/A N/A N/A N/A "$2,275.09 " N/A "$1,911.07 " "$2,217.45 " N/A N/A "$1,820.07 " "$2,426.76 " N/A N/A N/A N/A "$1,971.74 " N/A "$2,426.76 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,426.76 " "$2,578.43 " N/A "$2,275.09 " N/A N/A "$1,516.72 " "$1,971.74 " N/A N/A N/A N/A N/A N/A N/A "$2,023.31 " N/A N/A N/A N/A N/A "$1,516.72 " "$2,578.43 " 330104 75635 5571 302 350 HC CT ANGIO ABDOMINAL ARTERIES O "$4,708.00 " $216.36 $216.36 $254.00 "$2,354.00 " $738.00 $670.91 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $304.80 $254.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,766.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $254.00 "$3,531.00 " $520.70 $254.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,001.80 " 330104 77012 473 350 HC CT SCAN FOR NEEDLE BIOPSY O "$3,237.82 " N/A N/A $90.00 "$1,618.91 " $243.52 $221.38 $168.59 $90.00 N/A $90.00 N/A "$2,428.37 " N/A "$2,039.83 " "$2,366.85 " $108.00 $90.00 "$1,942.69 " "$2,590.26 " N/A N/A $90.00 N/A "$2,104.58 " $126.00 "$2,590.26 " $90.00 $90.00 $108.00 N/A $90.00 N/A N/A N/A "$2,590.26 " "$2,752.15 " $121.50 "$2,428.37 " $184.50 $121.50 "$1,618.91 " "$2,104.58 " N/A N/A N/A N/A N/A N/A N/A "$2,159.63 " $90.00 $90.00 N/A N/A N/A $90.00 "$2,752.15 " 330104 75574 5571 302 350 HC CT ANGIO HRT W/3D IMAGE O "$1,311.82 " $216.36 $216.36 $126.31 $655.91 $573.02 $520.93 $214.20 $126.31 $411.09 $126.31 $216.36 $983.87 $238.00 $826.45 $958.94 $151.57 $126.31 $787.09 "$1,049.46 " $735.63 "$1,233.26 " $126.31 $216.36 $259.63 $176.83 "$1,049.46 " $126.31 $126.31 $151.57 $302.91 $126.31 $216.36 $216.36 $235.83 "$1,049.46 " "$1,115.05 " $126.31 $983.87 $258.94 $126.31 $655.91 $582.01 $340.77 $340.77 $340.77 $340.77 $410.98 $227.18 $216.36 $410.98 $126.31 $126.31 $183.91 $183.91 $216.36 $126.31 "$1,233.26 " 330104 77014 473 350 HC CT SCAN FOR THERAPY GUIDE O "$1,247.62 " N/A N/A N/A $623.81 $208.25 $189.32 $144.17 N/A N/A N/A N/A $935.71 N/A $786.00 $912.01 N/A N/A $748.57 $998.10 N/A N/A N/A N/A $810.95 N/A $998.10 N/A N/A N/A N/A N/A N/A N/A N/A $998.10 "$1,060.48 " N/A $935.71 N/A N/A $623.81 $810.95 N/A N/A N/A N/A N/A N/A N/A $832.16 N/A N/A N/A N/A N/A $144.17 "$1,060.48 " 330104 70496 5571 302 351 HC CT ANGIOGRAPHY HEAD O "$4,419.10 " $216.36 $216.36 $217.00 "$2,209.55 " $498.71 $453.37 $214.20 $217.00 $411.09 $217.00 $216.36 "$3,314.33 " $238.00 "$2,784.03 " "$3,230.36 " $260.40 $217.00 "$2,651.46 " "$3,535.28 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,535.28 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,535.28 " "$3,756.24 " $217.00 "$3,314.33 " $444.85 $217.00 "$2,209.55 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,756.24 " 330104 70491 5571 300 351 HC CT SOFT TISSUE NECK W/DYE O "$3,339.47 " $216.36 $216.36 $170.00 "$1,669.74 " $331.46 $301.33 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,504.60 " $238.00 "$2,103.87 " "$2,441.15 " $204.00 $170.00 "$2,003.68 " "$2,671.58 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,671.58 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,671.58 " "$2,838.55 " $170.00 "$2,504.60 " $348.50 $170.00 "$1,669.74 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,838.55 " 330104 70482 5571 300 351 HC CT ORBIT/EAR/FOSSA W/O&W/DYE O "$3,816.69 " $216.36 $216.36 $217.00 "$1,908.35 " $380.46 $345.87 $214.20 $217.00 $411.09 $217.00 $216.36 "$2,862.52 " $238.00 "$2,404.51 " "$2,790.00 " $260.40 $217.00 "$2,290.01 " "$3,053.35 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,053.35 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,053.35 " "$3,244.19 " $217.00 "$2,862.52 " $444.85 $217.00 "$1,908.35 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,244.19 " 330104 70481 5571 300 351 HC CT ORBIT/EAR/FOSSA W/DYE O "$2,816.24 " $216.36 $216.36 $145.00 "$1,408.12 " $325.78 $296.16 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,112.18 " $238.00 "$1,774.23 " "$2,058.67 " $174.00 $145.00 "$1,689.74 " "$2,252.99 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,252.99 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,252.99 " "$2,393.80 " $145.00 "$2,112.18 " $297.25 $145.00 "$1,408.12 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$2,393.80 " 330104 70480 5522 299 351 HC CT ORBIT/EAR/FOSSA W/O DYE O "$2,816.24 " $128.23 $128.23 $120.00 "$1,408.12 " $283.53 $257.75 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,112.18 " $141.05 "$1,774.23 " "$2,058.67 " $144.00 $120.00 "$1,689.74 " "$2,252.99 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,252.99 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,252.99 " "$2,393.80 " $120.00 "$2,112.18 " $246.00 $120.00 "$1,408.12 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,393.80 " 330104 70450 5522 300 351 HC CT HEAD/BRAIN W/O DYE O "$3,323.42 " $128.23 $128.23 $120.00 "$1,661.71 " $189.46 $172.23 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $144.00 $120.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,658.74 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $120.00 "$2,492.57 " $246.00 $120.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 70470 5571 300 351 HC CT HEAD/BRAIN W/O & W/DYE O "$4,054.23 " $216.36 $216.36 $217.00 "$2,027.12 " $312.33 $283.93 $214.20 $217.00 $411.09 $217.00 $216.36 "$3,040.67 " $238.00 "$2,554.16 " "$2,963.64 " $260.40 $217.00 "$2,432.54 " "$3,243.38 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,243.38 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,243.38 " "$3,446.10 " $217.00 "$3,040.67 " $444.85 $217.00 "$2,027.12 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,446.10 " 330104 70460 5571 300 351 HC CT HEAD/BRAIN W/DYE O "$3,657.26 " $216.36 $216.36 $145.00 "$1,828.63 " $264.75 $240.68 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $174.00 $145.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,925.81 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $145.00 "$2,742.95 " $297.25 $145.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$3,108.67 " 330104 70490 5522 299 351 HC CT SOFT TISSUE NECK W/O DYE O "$3,022.75 " $128.23 $128.23 $140.00 "$1,511.38 " $268.26 $243.87 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,267.06 " $141.05 "$1,904.33 " "$2,209.63 " $168.00 $140.00 "$1,813.65 " "$2,418.20 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,418.20 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,418.20 " "$2,569.34 " $140.00 "$2,267.06 " $287.00 $140.00 "$1,511.38 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,569.34 " 330104 71270 5571 300 352 HC CT THORAX W/O & W/DYE O "$3,657.26 " $216.36 $216.36 $254.00 "$1,828.63 " $353.65 $321.50 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $304.80 $254.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,925.81 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $254.00 "$2,742.95 " $520.70 $254.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,108.67 " 330104 74176 5523 300 352 HC CT ABD & PELVIS W/O CONTRAST O "$5,359.63 " $280.16 $280.16 $68.69 "$2,679.82 " $326.81 $297.10 $277.36 $68.69 $532.31 $68.69 $280.16 "$4,019.72 " $308.18 "$3,376.57 " "$3,917.89 " $82.43 $68.69 "$3,215.78 " "$4,287.70 " $952.56 "$1,596.93 " $68.69 $280.16 $336.20 $96.17 "$4,287.70 " $68.69 $68.69 $82.43 $392.23 $68.69 $280.16 $280.16 $305.38 "$4,287.70 " "$4,555.69 " $68.69 "$4,019.72 " $140.81 $68.69 "$2,679.82 " $753.64 $441.26 $441.26 $441.26 $441.26 $310.16 $294.17 $280.16 $310.16 $68.69 $68.69 $238.14 $238.14 $280.16 $68.69 "$4,555.69 " 330104 G0297 299 352 HB LDCT FOR LUNG CA SCREEN O $342.40 N/A N/A N/A $171.20 N/A N/A $223.93 N/A N/A N/A N/A $256.80 N/A $215.71 $250.29 N/A N/A $205.44 $273.92 N/A N/A N/A N/A N/A N/A $273.92 N/A N/A N/A N/A N/A N/A N/A N/A $273.92 $291.04 N/A $256.80 N/A N/A $171.20 $222.56 N/A N/A N/A N/A $179.98 N/A N/A $179.98 N/A N/A N/A N/A N/A $171.20 $291.04 330104 71250 5522 299 352 HC CT THORAX W/O DYE O "$3,022.75 " $128.23 $128.23 $140.00 "$1,511.38 " $238.11 $216.47 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,267.06 " $141.05 "$1,904.33 " "$2,209.63 " $168.00 $140.00 "$1,813.65 " "$2,418.20 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,418.20 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,418.20 " "$2,569.34 " $140.00 "$2,267.06 " $287.00 $140.00 "$1,511.38 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,569.34 " 330104 72125 5522 299 352 HC CT NECK SPINE W/O DYE O "$3,676.52 " $128.23 $128.23 $140.00 "$1,838.26 " $231.20 $210.18 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,757.39 " $141.05 "$2,316.21 " "$2,687.54 " $168.00 $140.00 "$2,205.91 " "$2,941.22 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,941.22 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,941.22 " "$3,125.04 " $140.00 "$2,757.39 " $287.00 $140.00 "$1,838.26 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,125.04 " 330104 72126 5572 300 352 HC CT NECK SPINE W/DYE O "$4,059.58 " $442.02 $442.02 $170.00 "$2,029.79 " $302.78 $275.25 $437.60 $170.00 $839.84 $170.00 $442.02 "$3,044.68 " $486.22 "$2,557.54 " "$2,967.55 " $204.00 $170.00 "$2,435.75 " "$3,247.66 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$3,247.66 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$3,247.66 " "$3,450.64 " $170.00 "$3,044.68 " $348.50 $170.00 "$2,029.79 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$3,450.64 " 330104 72127 5571 300 352 HC CT NECK SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $355.79 $323.44 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 74170 5571 300 352 HC CT ABDOMEN W/O & W/DYE O "$3,370.50 " $216.36 $216.36 $254.00 "$1,685.25 " $476.38 $433.07 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,527.88 " $238.00 "$2,123.41 " "$2,463.84 " $304.80 $254.00 "$2,022.30 " "$2,696.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,696.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,696.40 " "$2,864.92 " $254.00 "$2,527.88 " $520.70 $254.00 "$1,685.25 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$2,864.92 " 330104 72128 5522 299 352 HC CT CHEST SPINE W/O DYE O "$2,816.24 " $128.23 $128.23 $140.00 "$1,408.12 " $231.20 $210.18 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,112.18 " $141.05 "$1,774.23 " "$2,058.67 " $168.00 $140.00 "$1,689.74 " "$2,252.99 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,252.99 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,252.99 " "$2,393.80 " $140.00 "$2,112.18 " $287.00 $140.00 "$1,408.12 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,393.80 " 330104 72129 5571 300 352 HC CT CHEST SPINE W/DYE O "$3,323.42 " $216.36 $216.36 $170.00 "$1,661.71 " $305.66 $277.87 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $204.00 $170.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,658.74 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $170.00 "$2,492.57 " $348.50 $170.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,824.91 " 330104 72194 5571 300 352 HC CT PELVIS W/O & W/DYE O "$3,657.26 " $216.36 $216.36 $254.00 "$1,828.63 " $460.77 $418.88 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $304.80 $254.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,925.81 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $254.00 "$2,742.95 " $520.70 $254.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,108.67 " 330104 72132 5572 300 352 HC CT LUMBAR SPINE W/DYE O "$3,477.50 " $442.02 $442.02 $170.00 "$1,738.75 " $303.37 $275.79 $437.60 $170.00 $839.84 $170.00 $442.02 "$2,608.12 " $486.22 "$2,190.82 " "$2,542.05 " $204.00 $170.00 "$2,086.50 " "$2,782.00 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$2,782.00 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$2,782.00 " "$2,955.88 " $170.00 "$2,608.12 " $348.50 $170.00 "$1,738.75 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$2,955.88 " 330104 71260 5571 300 352 HC CT THORAX W/DYE O "$3,676.52 " $216.36 $216.36 $170.00 "$1,838.26 " $299.71 $272.46 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,757.39 " $238.00 "$2,316.21 " "$2,687.54 " $204.00 $170.00 "$2,205.91 " "$2,941.22 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,941.22 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,941.22 " "$3,125.04 " $170.00 "$2,757.39 " $348.50 $170.00 "$1,838.26 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,125.04 " 330104 74150 5522 299 352 HC CT ABDOMEN W/O DYE O "$2,767.02 " $128.23 $128.23 $140.00 "$1,383.51 " $243.74 $221.58 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,075.26 " $141.05 "$1,743.22 " "$2,022.69 " $168.00 $140.00 "$1,660.21 " "$2,213.62 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,213.62 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,213.62 " "$2,351.97 " $140.00 "$2,075.26 " $287.00 $140.00 "$1,383.51 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,351.97 " 330104 71250 5522 299 352 HC CT LUNG CANCER SCREENING O $342.40 $128.23 $128.23 $140.00 $171.20 $238.11 $216.47 $126.95 $140.00 $243.63 $140.00 $128.23 $256.80 $141.05 $215.71 $250.29 $168.00 $140.00 $205.44 $273.92 $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 $273.92 $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 $273.92 $291.04 $140.00 $256.80 $287.00 $140.00 $171.20 $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 $730.90 330104 72130 5571 300 352 HC CT CHEST SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $359.31 $326.65 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 72133 5571 300 352 HC CT LUMBAR SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $356.96 $324.51 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 74177 5572 300 352 HC CT ABD & PELV W/CONTRAST O "$7,472.88 " $442.02 $442.02 $107.93 "$3,736.44 " $551.74 $501.58 $437.60 $107.93 $839.84 $107.93 $442.02 "$5,604.66 " $486.22 "$4,707.91 " "$5,462.68 " $129.52 $107.93 "$4,483.73 " "$5,978.30 " "$1,502.87 " "$2,519.52 " $107.93 $442.02 $530.42 $151.10 "$5,978.30 " $107.93 $107.93 $129.52 $618.83 $107.93 $442.02 $442.02 $481.80 "$5,978.30 " "$6,351.95 " $107.93 "$5,604.66 " $221.26 $107.93 "$3,736.44 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $107.93 $107.93 $375.72 $375.72 $442.02 $107.93 "$6,351.95 " 330104 74178 5572 300 352 HC CT ABD & PELV 1/> REGNS O "$7,472.88 " $442.02 $442.02 $136.74 "$3,736.44 " $617.26 $561.14 $437.60 $136.74 $839.84 $136.74 $442.02 "$5,604.66 " $486.22 "$4,707.91 " "$5,462.68 " $164.09 $136.74 "$4,483.73 " "$5,978.30 " "$1,502.87 " "$2,519.52 " $136.74 $442.02 $530.42 $191.44 "$5,978.30 " $136.74 $136.74 $164.09 $618.83 $136.74 $442.02 $442.02 $481.80 "$5,978.30 " "$6,351.95 " $136.74 "$5,604.66 " $280.32 $136.74 "$3,736.44 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $534.78 $464.12 $442.02 $534.78 $136.74 $136.74 $375.72 $375.72 $442.02 $136.74 "$6,351.95 " 330104 74160 5571 300 352 HC CT ABDOMEN W/DYE O "$4,151.60 " $216.36 $216.36 $170.00 "$2,075.80 " $425.09 $386.45 $214.20 $170.00 $411.09 $170.00 $216.36 "$3,113.70 " $238.00 "$2,615.51 " "$3,034.82 " $204.00 $170.00 "$2,490.96 " "$3,321.28 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$3,321.28 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$3,321.28 " "$3,528.86 " $170.00 "$3,113.70 " $348.50 $170.00 "$2,075.80 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,528.86 " 330104 72131 5522 299 352 HC CT LUMBAR SPINE W/O DYE O "$3,676.52 " $128.23 $128.23 $140.00 "$1,838.26 " $230.02 $209.11 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,757.39 " $141.05 "$2,316.21 " "$2,687.54 " $168.00 $140.00 "$2,205.91 " "$2,941.22 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,941.22 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,941.22 " "$3,125.04 " $140.00 "$2,757.39 " $287.00 $140.00 "$1,838.26 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,125.04 " 330104 360 HC BIRTH CTR-PROC ROOM EA ADDL 1/2 HOUR O $677.31 N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $442.96 N/A N/A N/A N/A $507.98 $474.12 $440.25 $450.41 $237.06 $237.06 $406.39 "$14,074.00 " N/A "$9,788.00 " $237.06 N/A N/A N/A $541.85 N/A $541.85 N/A N/A $541.85 N/A N/A N/A $541.85 $575.71 $338.65 $507.98 $338.65 $338.65 N/A $440.25 "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " $338.65 N/A N/A N/A N/A $237.06 "$14,074.00 " 330104 360 HC LABOR AND DELIVERY OR INITIAL 30 MIN O "$5,423.83 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,547.18 " N/A N/A N/A N/A "$4,067.87 " "$3,796.68 " "$3,525.49 " "$3,606.85 " "$1,898.34 " "$1,898.34 " "$3,254.30 " "$14,074.00 " N/A "$9,788.00 " "$1,898.34 " N/A N/A N/A "$4,339.06 " N/A "$4,339.06 " N/A N/A "$4,339.06 " N/A N/A N/A "$4,339.06 " "$4,610.26 " "$2,711.91 " "$4,067.87 " "$2,711.91 " "$2,711.91 " N/A "$3,525.49 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,711.91 " N/A N/A N/A N/A "$1,898.34 " "$14,074.00 " 330104 360 HC LABOR AND DELIVERY OR 30 MIN EA ADDL O "$1,912.09 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,250.51 " N/A N/A N/A N/A "$1,434.07 " "$1,338.46 " "$1,242.86 " "$1,271.54 " $669.23 $669.23 "$1,147.25 " "$14,074.00 " N/A "$9,788.00 " $669.23 N/A N/A N/A "$1,529.67 " N/A "$1,529.67 " N/A N/A "$1,529.67 " N/A N/A N/A "$1,529.67 " "$1,625.28 " $956.04 "$1,434.07 " $956.04 $956.04 N/A "$1,242.86 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " $956.04 N/A N/A N/A N/A $669.23 "$14,074.00 " 330104 360 HC AAA-ENDO-VAS REPAIR O "$11,439.37 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,481.35 " N/A N/A N/A N/A "$8,579.53 " "$8,007.56 " "$7,435.59 " "$7,607.18 " "$4,003.78 " "$4,003.78 " "$6,863.62 " "$14,074.00 " N/A "$9,788.00 " "$4,003.78 " N/A N/A N/A "$9,151.50 " N/A "$9,151.50 " N/A N/A "$9,151.50 " N/A N/A N/A "$9,151.50 " "$9,723.46 " "$5,719.69 " "$8,579.53 " "$5,719.69 " "$5,719.69 " N/A "$7,435.59 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,719.69 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC 1.0 HR RAD SPECIAL PROCEDURE O "$5,855.04 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,829.20 " N/A N/A N/A N/A "$4,391.28 " "$4,098.53 " "$3,805.78 " "$3,893.60 " "$2,049.26 " "$2,049.26 " "$3,513.02 " "$14,074.00 " N/A "$9,788.00 " "$2,049.26 " N/A N/A N/A "$4,684.03 " N/A "$4,684.03 " N/A N/A "$4,684.03 " N/A N/A N/A "$4,684.03 " "$4,976.78 " "$2,927.52 " "$4,391.28 " "$2,927.52 " "$2,927.52 " N/A "$3,805.78 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,927.52 " N/A N/A N/A N/A "$2,049.26 " "$14,074.00 " 330104 360 HC D & C O "$2,861.18 " N/A N/A N/A N/A 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"$11,053.53 " "$11,744.37 " "$1,403.13 " "$3,883.00 " "$2,876.41 " "$1,403.13 " "$6,908.45 " "$10,523.23 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$5,375.00 " "$4,107.58 " "$3,911.98 " "$5,659.00 " "$1,403.13 " "$1,403.13 " "$3,325.18 " "$1,571.50 " "$3,911.98 " "$1,403.13 " "$14,074.00 " 330104 360 HC OR OVER 30 MIN LEV 1 O "$10,750.29 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,030.69 " N/A N/A N/A N/A "$8,062.72 " "$7,525.20 " "$6,987.69 " "$7,148.94 " "$3,762.60 " "$3,762.60 " "$6,450.17 " "$14,074.00 " N/A "$9,788.00 " "$3,762.60 " N/A N/A N/A "$8,600.23 " N/A "$8,600.23 " N/A N/A "$8,600.23 " N/A N/A N/A "$8,600.23 " "$9,137.75 " "$5,375.15 " "$8,062.72 " "$5,375.15 " "$5,375.15 " N/A "$6,987.69 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,375.15 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC OVARIAN CYSTECTOMY O "$16,825.75 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$11,004.04 " N/A N/A N/A N/A "$12,619.31 " "$11,778.02 " "$10,936.74 " "$11,189.12 " "$5,889.01 " "$5,889.01 " "$10,095.45 " "$14,074.00 " N/A "$9,788.00 " "$5,889.01 " N/A N/A N/A "$13,460.60 " N/A "$13,460.60 " N/A N/A "$13,460.60 " N/A N/A N/A "$13,460.60 " "$14,301.89 " "$8,412.88 " "$12,619.31 " "$8,412.88 " "$8,412.88 " N/A "$10,936.74 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$8,412.88 " N/A N/A N/A N/A "$2,215.00 " "$14,301.89 " 330104 360 HC LEV 2 OPERATING RM 30 MIN INITIAL O "$11,645.88 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,616.41 " N/A N/A N/A N/A "$8,734.41 " "$8,152.12 " "$7,569.82 " "$7,744.51 " "$4,076.06 " "$4,076.06 " "$6,987.53 " "$14,074.00 " N/A "$9,788.00 " "$4,076.06 " N/A N/A N/A "$9,316.70 " N/A "$9,316.70 " N/A N/A "$9,316.70 " N/A N/A N/A "$9,316.70 " "$9,899.00 " "$5,822.94 " "$8,734.41 " "$5,822.94 " "$5,822.94 " N/A "$7,569.82 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,822.94 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC LEV 3 OPERATING RM 30 MIN INITIAL O "$12,541.47 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$8,202.12 " N/A N/A N/A N/A "$9,406.10 " "$8,779.03 " "$8,151.96 " "$8,340.08 " "$4,389.51 " "$4,389.51 " "$7,524.88 " "$14,074.00 " N/A "$9,788.00 " "$4,389.51 " N/A N/A N/A "$10,033.18 " N/A "$10,033.18 " N/A N/A "$10,033.18 " N/A N/A N/A "$10,033.18 " "$10,660.25 " "$6,270.73 " "$9,406.10 " "$6,270.73 " "$6,270.73 " N/A "$8,151.96 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$6,270.73 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC TUBAL LIGATION O "$6,349.38 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,152.49 " N/A N/A N/A N/A "$4,762.03 " "$4,444.57 " "$4,127.10 " "$4,222.34 " "$2,222.28 " "$2,222.28 " "$3,809.63 " "$14,074.00 " N/A "$9,788.00 " "$2,222.28 " N/A N/A N/A "$5,079.50 " N/A "$5,079.50 " N/A N/A "$5,079.50 " N/A N/A N/A "$5,079.50 " "$5,396.97 " "$3,174.69 " "$4,762.03 " "$3,174.69 " "$3,174.69 " N/A "$4,127.10 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$3,174.69 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC C-SECTION W/ TUBAL LIGATION O "$16,056.42 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$10,500.90 " N/A N/A N/A N/A "$12,042.32 " "$11,239.49 " "$10,436.67 " "$10,677.52 " "$5,619.75 " "$5,619.75 " "$9,633.85 " "$14,074.00 " N/A "$9,788.00 " "$5,619.75 " N/A N/A N/A "$12,845.14 " N/A "$12,845.14 " N/A N/A "$12,845.14 " N/A N/A N/A "$12,845.14 " "$13,647.96 " "$8,028.21 " "$12,042.32 " "$8,028.21 " "$8,028.21 " N/A "$10,436.67 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$8,028.21 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC LEV 1 OPERATING RM 30 MIN EA ADDL O "$2,466.35 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,612.99 " N/A N/A N/A N/A "$1,849.76 " "$1,726.44 " "$1,603.13 " "$1,640.12 " $863.22 $863.22 "$1,479.81 " "$14,074.00 " N/A "$9,788.00 " $863.22 N/A N/A N/A 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"$2,303.18 " "$2,149.63 " "$1,996.09 " "$2,042.15 " "$1,074.82 " "$1,074.82 " "$1,842.54 " "$14,074.00 " N/A "$9,788.00 " "$1,074.82 " N/A N/A N/A "$2,456.72 " N/A "$2,456.72 " N/A N/A "$2,456.72 " N/A N/A N/A "$2,456.72 " "$2,610.26 " "$1,535.45 " "$2,303.18 " "$1,535.45 " "$1,535.45 " N/A "$1,996.09 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$1,535.45 " N/A N/A N/A N/A "$1,074.82 " "$14,074.00 " 330104 360 HC OOPHORECTOMY O "$23,451.19 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$15,337.08 " N/A N/A N/A N/A "$17,588.39 " "$16,415.83 " "$15,243.27 " "$15,595.04 " "$8,207.92 " "$8,207.92 " "$14,070.71 " "$14,074.00 " N/A "$9,788.00 " "$8,207.92 " N/A N/A N/A "$18,760.95 " N/A "$18,760.95 " N/A N/A "$18,760.95 " N/A N/A N/A "$18,760.95 " "$19,933.51 " "$11,725.59 " "$17,588.39 " "$11,725.59 " "$11,725.59 " N/A "$15,243.27 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$11,725.59 " N/A N/A N/A N/A "$2,215.00 " "$19,933.51 " 330104 360 HC DELIVERY RM C SECTION O "$12,158.41 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,951.60 " N/A N/A N/A N/A "$9,118.81 " "$8,510.89 " "$7,902.97 " "$8,085.34 " "$4,255.44 " "$4,255.44 " "$7,295.05 " "$14,074.00 " N/A "$9,788.00 " "$4,255.44 " N/A N/A N/A "$9,726.73 " N/A "$9,726.73 " N/A N/A "$9,726.73 " N/A N/A N/A "$9,726.73 " "$10,334.65 " "$6,079.20 " "$9,118.81 " "$6,079.20 " "$6,079.20 " N/A "$7,902.97 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$6,079.20 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 49505 5341 3033 360 Repair of groin hernia patient age 5 years or older O "$12,970.00 " "$4,249.40 " "$4,249.40 " "$2,246.26 " "$3,553.00 " "$2,973.00 " "$2,708.00 " "$4,206.90 " "$2,246.26 " "$8,073.85 " "$2,246.26 " "$4,249.40 " "$9,727.50 " "$4,674.33 " "$8,430.50 " "$8,625.05 " "$2,695.51 " "$2,246.26 " "$7,782.00 " "$14,074.00 " "$14,447.94 " "$9,788.00 " "$2,246.26 " "$4,249.40 " "$5,099.27 " "$3,144.77 " "$10,376.00 " "$2,246.26 " "$2,246.26 " "$2,695.51 " "$5,949.15 " "$2,246.26 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$10,376.00 " "$11,024.50 " "$2,246.26 " "$4,965.00 " "$4,604.84 " "$2,246.26 " "$6,485.00 " "$11,430.87 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,246.26 " "$2,246.26 " "$3,611.99 " "$2,515.81 " "$4,249.40 " "$2,246.26 " "$14,447.94 " 330104 36555 5183 75 361 HC INSERT NON-TUNNEL CV CATH; YOUNGER THAN 5YRS O "$7,469.67 " "$3,573.99 " "$3,573.99 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$5,602.25 " "$3,931.39 " "$4,855.29 " "$4,967.33 " $301.56 $251.30 "$4,481.80 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$5,975.74 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$5,975.74 " "$6,349.22 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,734.84 " "$9,614.03 " "$5,042.03 " "$5,042.03 " "$5,042.03 " "$5,042.03 " "$3,548.00 " "$3,752.69 " "$3,573.99 " "$3,780.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 19030 278 361 HC INJECTION FOR BREAST X-RAY O "$1,212.31 " N/A N/A $499.80 $482.00 "$1,717.00 " "$1,565.00 " $90.13 $499.80 N/A $499.80 N/A $909.23 N/A $788.00 $806.19 $599.76 $499.80 $727.39 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $788.00 $699.72 $969.85 $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A $969.85 "$1,030.46 " $674.73 $909.23 "$1,024.59 " $674.73 $606.15 $788.00 $818.31 $818.31 $818.31 $818.31 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $90.13 "$7,492.00 " 330104 11771 5073 11 361 HC EXCISION PILONIDAL CYST/SINUS EXTENSIVE O "$13,579.37 " "$3,099.23 " "$3,099.23 " "$2,234.79 " "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,068.24 " "$2,234.79 " "$5,888.53 " "$2,234.79 " "$3,099.23 " "$10,184.53 " "$3,409.15 " "$8,826.59 " "$9,030.28 " "$2,681.74 " "$2,234.79 " "$8,147.62 " "$7,492.00 " "$10,537.38 " "$4,407.00 " "$2,234.79 " "$3,099.23 " "$3,719.07 " "$3,128.70 " "$10,863.50 " "$2,234.79 " "$2,234.79 " "$2,681.74 " "$4,338.92 " "$2,234.79 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$10,863.50 " "$11,542.46 " "$2,234.79 " "$3,883.00 " "$4,581.31 " "$2,234.79 " "$6,789.69 " "$8,336.92 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$5,375.00 " "$3,254.19 " "$3,099.23 " "$5,659.00 " "$2,234.79 " "$2,234.79 " "$2,634.34 " "$2,502.96 " "$3,099.23 " "$2,234.79 " "$11,542.46 " 330104 10035 5071 4 361 HC PERQ DEV SOFT TISS 1ST IMAG O "$1,872.50 " $778.60 $778.60 $656.76 "$1,099.00 " "$2,802.00 " "$2,551.00 " $770.81 $656.76 "$1,479.33 " $656.76 $778.60 "$1,404.38 " $856.45 "$1,217.12 " "$1,245.21 " $788.11 $656.76 "$1,123.50 " "$7,492.00 " "$2,647.22 " "$4,407.00 " $656.76 $778.60 $934.31 $919.46 "$1,498.00 " $656.76 $656.76 $788.11 "$1,090.03 " $656.76 $778.60 $778.60 $848.67 "$1,498.00 " "$1,591.62 " $656.76 "$1,404.38 " "$1,346.35 " $656.76 $936.25 "$2,094.42 " "$1,263.94 " "$1,263.94 " "$1,263.94 " "$1,263.94 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " $656.76 $656.76 $661.81 $735.57 $778.60 $656.76 "$7,492.00 " 330104 0673T 5072 252 361 HC ABLTJ B9 THYR NDUL PERQ LASR O "$3,597.34 " "$1,799.07 " "$1,799.07 " "$1,342.60 " N/A "$2,432.00 " "$2,215.00 " "$1,781.08 " "$1,342.60 " "$3,418.23 " "$1,342.60 " "$1,799.07 " "$2,698.01 " "$1,978.98 " "$2,338.27 " "$2,392.23 " "$1,611.12 " "$1,342.60 " "$2,158.40 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,342.60 " "$1,799.07 " "$2,158.88 " "$1,879.64 " "$2,877.87 " "$1,342.60 " "$1,342.60 " "$1,611.12 " "$2,518.70 " "$1,342.60 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,877.87 " "$3,057.74 " "$1,342.60 " "$2,698.01 " "$2,752.33 " "$1,342.60 " "$1,798.67 " "$4,839.50 " "$2,428.20 " "$2,428.20 " "$2,428.20 " "$2,428.20 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,342.60 " "$1,342.60 " "$1,529.21 " "$1,503.71 " "$1,799.07 " "$1,342.60 " "$7,492.00 " 330104 0671T 5491 234 361 HC INSJ ANT SGM DRG DEV TRAB MW W/O RES&CTRC RMVL1+ O "$4,782.90 " "$2,590.77 " "$2,590.77 " "$1,764.31 " N/A "$2,432.00 " "$2,215.00 " "$2,564.86 " "$1,764.31 " "$4,922.46 " "$1,764.31 " "$2,590.77 " "$3,587.17 " "$2,849.84 " "$3,108.88 " "$3,180.63 " "$2,117.17 " "$1,764.31 " "$2,869.74 " "$7,492.00 " "$8,808.61 " "$4,407.00 " "$1,764.31 " "$2,590.77 " "$3,108.92 " "$2,470.03 " "$3,826.32 " "$1,764.31 " "$1,764.31 " "$2,117.17 " "$3,627.07 " "$1,764.31 " "$2,590.77 " "$2,590.77 " "$2,823.94 " "$3,826.32 " "$4,065.46 " "$1,764.31 " "$3,587.17 " "$3,616.84 " "$1,764.31 " "$2,391.45 " "$6,969.16 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$5,375.00 " "$2,720.30 " "$2,590.77 " "$5,659.00 " "$1,764.31 " "$1,764.31 " "$2,202.15 " "$1,976.03 " "$2,590.77 " "$1,764.31 " "$8,808.61 " 330104 361 HC LEV 2 ENDOSCOPY 30 MIN EA ADDL O "$1,248.69 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $816.64 N/A N/A N/A N/A $936.52 $874.08 $811.65 $830.38 $437.04 $437.04 $749.21 "$7,492.00 " N/A "$4,407.00 " $437.04 N/A N/A N/A $998.95 N/A $998.95 N/A N/A $998.95 N/A N/A N/A $998.95 "$1,061.39 " $624.35 $936.52 $624.35 $624.35 N/A $811.65 $842.87 $842.87 $842.87 $842.87 N/A N/A N/A "$3,372.00 " $624.35 N/A N/A N/A N/A $437.04 "$7,492.00 " 330104 361 HC ENDOSCOPY 30 MIN EA ADDL O "$1,216.59 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $795.65 N/A N/A N/A N/A $912.44 $851.61 $790.78 $809.03 $425.81 $425.81 $729.95 "$7,492.00 " N/A "$4,407.00 " $425.81 N/A N/A N/A $973.27 N/A $973.27 N/A N/A $973.27 N/A N/A N/A $973.27 "$1,034.10 " $608.29 $912.44 $608.29 $608.29 N/A $790.78 $821.20 $821.20 $821.20 $821.20 N/A N/A N/A "$3,372.00 " $608.29 N/A N/A N/A N/A $425.81 "$7,492.00 " 330104 361 HC LEV 2 ENDOSCOPY 30 MIN INITIAL O "$7,336.99 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,798.39 " N/A N/A N/A N/A "$5,502.74 " "$5,135.89 " "$4,769.04 " "$4,879.10 " "$2,567.95 " "$2,567.95 " "$4,402.19 " "$7,492.00 " N/A "$4,407.00 " "$2,567.95 " N/A N/A N/A "$5,869.59 " N/A "$5,869.59 " N/A N/A "$5,869.59 " N/A N/A N/A "$5,869.59 " "$6,236.44 " "$3,668.49 " "$5,502.74 " "$3,668.49 " "$3,668.49 " N/A "$4,769.04 " "$4,952.47 " "$4,952.47 " "$4,952.47 " "$4,952.47 " N/A N/A N/A "$3,372.00 " "$3,668.49 " N/A N/A N/A N/A "$2,215.00 " "$7,492.00 " 330104 361 HC IR PROCEDURE ADDTL 30 MINUTES O "$2,426.76 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,587.10 " N/A N/A N/A N/A "$1,820.07 " "$1,698.73 " "$1,577.39 " "$1,613.80 " $849.37 $849.37 "$1,456.06 " "$7,492.00 " N/A "$4,407.00 " $849.37 N/A N/A N/A "$1,941.41 " N/A "$1,941.41 " N/A N/A "$1,941.41 " N/A N/A N/A "$1,941.41 " "$2,062.75 " "$1,213.38 " "$1,820.07 " "$1,213.38 " "$1,213.38 " N/A "$1,577.39 " "$1,638.06 " "$1,638.06 " "$1,638.06 " "$1,638.06 " N/A N/A N/A "$3,372.00 " "$1,213.38 " N/A N/A N/A N/A $849.37 "$7,492.00 " 330104 361 HC IR PROCEDURE INITIAL 30 MINUTES O "$4,246.83 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,777.43 " N/A N/A N/A N/A "$3,185.12 " "$2,972.78 " "$2,760.44 " "$2,824.14 " "$1,486.39 " "$1,486.39 " "$2,548.10 " "$7,492.00 " N/A "$4,407.00 " "$1,486.39 " N/A N/A N/A "$3,397.46 " N/A "$3,397.46 " N/A N/A "$3,397.46 " N/A N/A N/A "$3,397.46 " "$3,609.81 " "$2,123.41 " "$3,185.12 " "$2,123.41 " "$2,123.41 " N/A "$2,760.44 " "$2,866.61 " "$2,866.61 " "$2,866.61 " "$2,866.61 " N/A N/A N/A "$3,372.00 " "$2,123.41 " N/A N/A N/A N/A "$1,486.39 " "$7,492.00 " 330104 361 HC ENDOSCOPY 30 MIN INITIAL O "$6,167.48 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,033.53 " N/A N/A N/A N/A "$4,625.61 " "$4,317.24 " "$4,008.86 " "$4,101.37 " "$2,158.62 " "$2,158.62 " "$3,700.49 " "$7,492.00 " N/A "$4,407.00 " "$2,158.62 " N/A N/A N/A "$4,933.98 " N/A "$4,933.98 " N/A N/A "$4,933.98 " N/A N/A N/A "$4,933.98 " "$5,242.36 " "$3,083.74 " "$4,625.61 " "$3,083.74 " "$3,083.74 " N/A "$4,008.86 " "$4,163.05 " "$4,163.05 " "$4,163.05 " "$4,163.05 " N/A N/A N/A "$3,372.00 " "$3,083.74 " N/A N/A N/A N/A "$2,158.62 " "$7,492.00 " 330104 361 HC PERC DR/STENT PLC URETER O "$11,439.37 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,481.35 " N/A N/A N/A N/A "$8,579.53 " "$8,007.56 " "$7,435.59 " "$7,607.18 " "$4,003.78 " "$4,003.78 " "$6,863.62 " "$7,492.00 " N/A "$4,407.00 " "$4,003.78 " N/A N/A N/A "$9,151.50 " N/A "$9,151.50 " N/A N/A "$9,151.50 " N/A N/A N/A "$9,151.50 " "$9,723.46 " "$5,719.69 " "$8,579.53 " "$5,719.69 " "$5,719.69 " N/A "$7,435.59 " "$7,721.57 " "$7,721.57 " "$7,721.57 " "$7,721.57 " N/A N/A N/A "$3,372.00 " "$5,719.69 " N/A N/A N/A N/A "$2,215.00 " "$9,723.46 " 330104 361 HC PAIN MANG PROC LEV MINOR O "$3,873.40 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,533.20 " N/A N/A N/A N/A "$2,905.05 " "$2,711.38 " "$2,517.71 " "$2,575.81 " "$1,355.69 " "$1,355.69 " "$2,324.04 " "$7,492.00 " N/A "$4,407.00 " "$1,355.69 " N/A N/A N/A "$3,098.72 " N/A "$3,098.72 " N/A N/A "$3,098.72 " N/A N/A N/A "$3,098.72 " "$3,292.39 " "$1,936.70 " "$2,905.05 " "$1,936.70 " "$1,936.70 " N/A "$2,517.71 " "$2,614.55 " "$2,614.55 " "$2,614.55 " "$2,614.55 " N/A N/A N/A "$3,372.00 " "$1,936.70 " N/A N/A N/A N/A "$1,355.69 " "$7,492.00 " 330104 361 HC PAIN MANG PROC LEV MAJOR O "$6,290.53 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,114.01 " N/A N/A N/A N/A "$4,717.90 " "$4,403.37 " "$4,088.84 " "$4,183.20 " "$2,201.69 " "$2,201.69 " "$3,774.32 " "$7,492.00 " N/A "$4,407.00 " "$2,201.69 " N/A N/A N/A "$5,032.42 " N/A "$5,032.42 " N/A N/A "$5,032.42 " N/A N/A N/A "$5,032.42 " "$5,346.95 " "$3,145.26 " "$4,717.90 " "$3,145.26 " "$3,145.26 " N/A "$4,088.84 " "$4,246.11 " "$4,246.11 " "$4,246.11 " "$4,246.11 " N/A N/A N/A "$3,372.00 " "$3,145.26 " N/A N/A N/A N/A "$2,201.69 " "$7,492.00 " 330104 361 HC PAIN MANG PROC LEV INTERM O "$4,836.40 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,163.01 " N/A N/A N/A N/A "$3,627.30 " "$3,385.48 " "$3,143.66 " "$3,216.21 " "$1,692.74 " "$1,692.74 " "$2,901.84 " "$7,492.00 " N/A "$4,407.00 " "$1,692.74 " N/A N/A N/A "$3,869.12 " N/A "$3,869.12 " N/A N/A "$3,869.12 " N/A N/A N/A "$3,869.12 " "$4,110.94 " "$2,418.20 " "$3,627.30 " "$2,418.20 " "$2,418.20 " N/A "$3,143.66 " "$3,264.57 " "$3,264.57 " "$3,264.57 " "$3,264.57 " N/A N/A N/A "$3,372.00 " "$2,418.20 " N/A N/A N/A N/A "$1,692.74 " "$7,492.00 " 330104 361 HC KYPHOPLASTY O "$23,717.62 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$15,511.32 " N/A N/A N/A N/A "$17,788.22 " "$16,602.33 " "$15,416.45 " "$15,772.22 " "$8,301.17 " "$8,301.17 " "$14,230.57 " "$7,492.00 " N/A "$4,407.00 " "$8,301.17 " N/A N/A N/A "$18,974.10 " N/A "$18,974.10 " N/A N/A "$18,974.10 " N/A N/A N/A "$18,974.10 " "$20,159.98 " "$11,858.81 " "$17,788.22 " "$11,858.81 " "$11,858.81 " N/A "$15,416.45 " "$16,009.39 " "$16,009.39 " "$16,009.39 " "$16,009.39 " N/A N/A N/A "$3,372.00 " "$11,858.81 " N/A N/A N/A N/A "$2,215.00 " "$20,159.98 " 330104 361 HC FNA O "$2,927.52 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,914.60 " N/A N/A N/A N/A "$2,195.64 " "$2,049.26 " "$1,902.89 " "$1,946.80 " "$1,024.63 " "$1,024.63 " "$1,756.51 " "$7,492.00 " N/A "$4,407.00 " "$1,024.63 " N/A N/A N/A "$2,342.02 " N/A "$2,342.02 " N/A N/A "$2,342.02 " N/A N/A N/A "$2,342.02 " "$2,488.39 " "$1,463.76 " "$2,195.64 " "$1,463.76 " "$1,463.76 " N/A "$1,902.89 " "$1,976.08 " "$1,976.08 " "$1,976.08 " "$1,976.08 " N/A N/A N/A "$3,372.00 " "$1,463.76 " N/A N/A N/A N/A "$1,024.63 " "$7,492.00 " 330104 361 HC BRONCH PROCEDURE O "$8,939.85 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$5,846.66 " N/A N/A N/A N/A "$6,704.89 " "$6,257.89 " "$5,810.90 " "$5,945.00 " "$3,128.95 " "$3,128.95 " "$5,363.91 " "$7,492.00 " N/A "$4,407.00 " "$3,128.95 " N/A N/A N/A "$7,151.88 " N/A "$7,151.88 " N/A N/A "$7,151.88 " N/A N/A N/A "$7,151.88 " "$7,598.87 " "$4,469.93 " "$6,704.89 " "$4,469.93 " "$4,469.93 " N/A "$5,810.90 " "$6,034.40 " "$6,034.40 " "$6,034.40 " "$6,034.40 " N/A N/A N/A "$3,372.00 " "$4,469.93 " N/A N/A N/A N/A "$2,215.00 " "$7,598.87 " 330104 36245 423 361 HC INS CATH ABD/L-EXT ART 1ST O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $284.39 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 19081 5072 20 361 HC BX BREAST 1ST LESION STRTCTC O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 19082 20 361 HC BX BREAST ADD LESION STRTCTC O $423.72 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $96.78 "$1,693.42 " N/A "$1,693.42 " N/A $317.79 N/A $275.42 $281.77 "$2,032.11 " "$1,693.42 " $254.23 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $275.42 "$2,370.79 " $338.98 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $338.98 $360.16 "$2,286.12 " $317.79 "$3,471.51 " "$2,286.12 " $211.86 $275.42 $286.01 $286.01 $286.01 $286.01 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $96.78 "$7,492.00 " 330104 19083 5072 20 361 HC BX BREAST 1ST LESION US IMAG O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 19084 20 361 HC BX BREAST ADD LESION US IMAG O $400.18 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $91.25 "$1,693.42 " N/A "$1,693.42 " N/A $300.13 N/A $260.12 $266.12 "$2,032.11 " "$1,693.42 " $240.11 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $260.12 "$2,370.79 " $320.14 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $320.14 $340.15 "$2,286.12 " $300.13 "$3,471.51 " "$2,286.12 " $200.09 $260.12 $270.12 $270.12 $270.12 $270.12 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $91.25 "$7,492.00 " 330104 36215 423 361 HC PLACE CATH EA 1ST ORDER THOR/BRACHIOCEPHALC BRANCH O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $251.58 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 36200 423 361 HC PLACE CATHETER IN AORTA O "$2,969.25 " N/A N/A $205.12 "$1,099.00 " "$2,802.00 " "$2,551.00 " $171.85 $205.12 N/A $205.12 N/A "$2,226.94 " N/A "$1,930.01 " "$1,974.55 " $246.15 $205.12 "$1,781.55 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$1,930.01 " $287.17 "$2,375.40 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$2,375.40 " "$2,523.86 " $276.91 "$3,883.00 " $420.50 $276.91 "$1,484.62 " "$1,930.01 " "$2,004.24 " "$2,004.24 " "$2,004.24 " "$2,004.24 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $171.85 "$7,492.00 " 330104 36140 423 361 HC ESTABLISH ACCESS TO EXTREMITY ARTERY O "$2,419.27 " N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $109.36 $205.12 N/A $205.12 N/A "$1,814.45 " N/A "$1,572.53 " "$1,608.81 " $246.15 $205.12 "$1,451.56 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$1,572.53 " $287.17 "$1,935.42 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$1,935.42 " "$2,056.38 " $276.91 "$3,883.00 " $420.50 $276.91 "$1,209.63 " "$1,572.53 " "$1,633.01 " "$1,633.01 " "$1,633.01 " "$1,633.01 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $109.36 "$7,492.00 " 330104 36005 423 361 HC INJECTION EXT VENOGRAPHY O "$6,505.60 " N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $58.60 $205.12 N/A $205.12 N/A "$4,879.20 " N/A "$4,228.64 " "$4,326.22 " $246.15 $205.12 "$3,903.36 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,228.64 " $287.17 "$5,204.48 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,204.48 " "$5,529.76 " $276.91 "$4,879.20 " $420.50 $276.91 "$3,252.80 " "$4,228.64 " "$4,391.28 " "$4,391.28 " "$4,391.28 " "$4,391.28 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $58.60 "$7,492.00 " 330104 33010 68 361 HC DRAINAGE OF HEART SAC O "$5,301.85 " N/A N/A $649.92 N/A "$2,432.00 " "$2,215.00 " "$3,467.41 " $649.92 N/A $649.92 N/A "$3,976.39 " N/A "$3,446.20 " "$3,525.73 " $779.90 $649.92 "$3,181.11 " "$7,492.00 " N/A "$4,407.00 " $649.92 N/A N/A $909.89 "$4,241.48 " $649.92 $649.92 $779.90 N/A $649.92 N/A N/A N/A "$4,241.48 " "$4,506.57 " $877.39 "$3,883.00 " "$1,332.34 " $877.39 "$2,650.93 " "$3,446.20 " "$3,578.75 " "$3,578.75 " "$3,578.75 " "$3,578.75 " N/A N/A N/A "$3,372.00 " $649.92 $649.92 N/A $727.91 N/A $649.92 "$7,492.00 " 330104 32551 5182 68 361 HC INSERTION OF CHEST TUBE O "$7,515.68 " "$1,785.03 " "$1,785.03 " $649.92 "$1,099.00 " "$2,802.00 " "$2,551.00 " "$1,767.18 " $649.92 "$3,391.56 " $649.92 "$1,785.03 " "$5,636.76 " "$1,963.54 " "$4,885.19 " "$4,997.93 " $779.90 $649.92 "$4,509.41 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $649.92 "$1,785.03 " "$2,142.04 " $909.89 "$6,012.54 " $649.92 $649.92 $779.90 "$2,499.05 " $649.92 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,012.54 " "$6,388.33 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$3,757.84 " "$4,801.74 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $649.92 $649.92 "$1,517.28 " $727.91 "$1,785.03 " $649.92 "$7,492.00 " 330104 32550 5341 68 361 HC INSERT PLEURAL CATH O "$5,350.00 " "$4,249.40 " "$4,249.40 " $649.92 "$4,069.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " $649.92 "$8,073.85 " $649.92 "$4,249.40 " "$4,012.50 " "$4,674.33 " "$3,477.50 " "$3,557.75 " $779.90 $649.92 "$3,210.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " $649.92 "$4,249.40 " "$5,099.27 " $909.89 "$4,280.00 " $649.92 $649.92 $779.90 "$5,949.15 " $649.92 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$4,280.00 " "$4,547.50 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$2,675.00 " "$11,430.87 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " $649.92 $649.92 "$3,611.99 " $727.91 "$4,249.40 " $649.92 "$14,447.94 " 330104 32405 68 361 HC PERCUT BX LUNG/MEDIASTINUM O "$14,326.23 " N/A N/A $649.92 N/A "$2,432.00 " "$2,215.00 " "$9,369.35 " $649.92 N/A $649.92 N/A "$10,744.67 " N/A "$9,312.05 " "$9,526.94 " $779.90 $649.92 "$8,595.74 " "$7,492.00 " N/A "$4,407.00 " $649.92 N/A N/A $909.89 "$11,460.98 " $649.92 $649.92 $779.90 N/A $649.92 N/A N/A N/A "$11,460.98 " "$12,177.30 " $877.39 "$3,883.00 " "$1,332.34 " $877.39 "$7,163.11 " "$9,312.05 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$9,670.21 " N/A N/A N/A "$3,372.00 " $649.92 $649.92 N/A $727.91 N/A $649.92 "$12,177.30 " 330104 31653 5154 71 361 HC BRONCHOSCOPY WITH EBUS 3 OR MORE NODES O "$13,532.29 " "$3,999.51 " "$3,999.51 " "$1,389.58 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$3,959.52 " "$1,389.58 " "$7,599.08 " "$1,389.58 " "$3,999.51 " "$10,149.22 " "$4,399.46 " "$8,795.99 " "$8,998.97 " "$1,667.49 " "$1,389.58 " "$8,119.37 " "$7,492.00 " "$13,598.35 " "$4,407.00 " "$1,389.58 " "$3,999.51 " "$4,799.42 " "$1,945.41 " "$10,825.83 " "$1,389.58 " "$1,389.58 " "$1,667.49 " "$5,599.32 " "$1,389.58 " "$3,999.51 " "$3,999.51 " "$4,359.47 " "$10,825.83 " "$11,502.45 " "$1,389.58 " "$10,149.22 " "$2,848.64 " "$1,389.58 " "$6,766.15 " "$10,758.69 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$5,375.00 " "$4,199.49 " "$3,999.51 " "$5,659.00 " "$1,389.58 " "$1,389.58 " "$3,399.59 " "$1,556.33 " "$3,999.51 " "$1,389.58 " "$13,598.35 " 330104 36246 423 361 HC INS CATH ABD/L-EXT ART 2ND O "$12,218.33 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $307.77 $205.12 N/A $205.12 N/A "$9,163.75 " N/A "$7,941.91 " "$8,125.19 " $246.15 $205.12 "$7,331.00 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$7,941.91 " $287.17 "$9,774.66 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$9,774.66 " "$10,385.58 " $276.91 "$3,883.00 " $420.50 $276.91 "$6,109.16 " "$7,941.91 " "$8,247.37 " "$8,247.37 " "$8,247.37 " "$8,247.37 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$10,385.58 " 330104 31652 5154 71 361 HC BRONCHOSCOPY WITH EBUS 1 OR 2 NODES O "$13,532.29 " "$3,999.51 " "$3,999.51 " "$1,389.58 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$3,959.52 " "$1,389.58 " "$7,599.08 " "$1,389.58 " "$3,999.51 " "$10,149.22 " "$4,399.46 " "$8,795.99 " "$8,998.97 " "$1,667.49 " "$1,389.58 " "$8,119.37 " "$7,492.00 " "$13,598.35 " "$4,407.00 " "$1,389.58 " "$3,999.51 " "$4,799.42 " "$1,945.41 " "$10,825.83 " "$1,389.58 " "$1,389.58 " "$1,667.49 " "$5,599.32 " "$1,389.58 " "$3,999.51 " "$3,999.51 " "$4,359.47 " "$10,825.83 " "$11,502.45 " "$1,389.58 " "$10,149.22 " "$2,848.64 " "$1,389.58 " "$6,766.15 " "$10,758.69 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$5,375.00 " "$4,199.49 " "$3,999.51 " "$5,659.00 " "$1,389.58 " "$1,389.58 " "$3,399.59 " "$1,556.33 " "$3,999.51 " "$1,389.58 " "$13,598.35 " 330104 19499 5091 20 361 HC BREAST SURGERY PROCEDURE O "$13,959.22 " "$4,124.47 " "$4,124.47 " "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " "$4,083.22 " "$1,693.42 " "$7,836.49 " "$1,693.42 " "$4,124.47 " "$10,469.41 " "$4,536.91 " "$9,073.49 " "$9,282.88 " "$2,032.11 " "$1,693.42 " "$8,375.53 " "$7,492.00 " "$14,023.18 " "$4,407.00 " "$1,693.42 " "$4,124.47 " "$4,949.36 " "$2,370.79 " "$11,167.38 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$5,774.25 " "$1,693.42 " "$4,124.47 " "$4,124.47 " "$4,495.67 " "$11,167.38 " "$11,865.34 " "$1,693.42 " "$10,469.41 " "$3,471.51 " "$1,693.42 " "$6,979.61 " "$11,094.81 " "$9,422.47 " "$9,422.47 " "$9,422.47 " "$9,422.47 " "$5,375.00 " "$4,330.69 " "$4,124.47 " "$5,659.00 " "$1,693.42 " "$1,693.42 " "$3,505.80 " "$1,896.63 " "$4,124.47 " "$1,565.00 " "$14,023.18 " 330104 19288 20 361 HC PERQ DEV BREAST ADD MR GUIDE O $296.39 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $72.97 "$1,693.42 " N/A "$1,693.42 " N/A $222.29 N/A $192.65 $197.10 "$2,032.11 " "$1,693.42 " $177.83 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $192.65 "$2,370.79 " $237.11 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $237.11 $251.93 "$2,286.12 " $222.29 "$3,471.51 " "$2,286.12 " $148.19 $192.65 $200.06 $200.06 $200.06 $200.06 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $72.97 "$7,492.00 " 330104 19287 5071 20 361 HC PERQ DEV BREAST 1ST MR GUIDE O "$2,813.03 " $778.60 $778.60 "$1,693.42 " $482.00 "$2,949.00 " "$2,686.00 " $770.81 "$1,693.42 " "$1,479.33 " "$1,693.42 " $778.60 "$2,109.77 " $856.45 "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$2,647.22 " "$4,407.00 " "$1,693.42 " $778.60 $934.31 "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$1,090.03 " "$1,693.42 " $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " "$1,693.42 " "$1,693.42 " $661.81 "$1,896.63 " $778.60 $482.00 "$7,492.00 " 330104 19286 20 361 HC PERQ DEV BREAST ADD US IMAG O $201.16 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $50.46 "$1,693.42 " N/A "$1,693.42 " N/A $150.87 N/A $130.75 $133.77 "$2,032.11 " "$1,693.42 " $120.70 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $130.75 "$2,370.79 " $160.93 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $160.93 $170.99 "$2,286.12 " $150.87 "$3,471.51 " "$2,286.12 " $100.58 $130.75 $135.78 $135.78 $135.78 $135.78 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $50.46 "$7,492.00 " 330104 19285 5071 20 361 HC PERQ DEV BREAST 1ST US IMAG O "$2,813.03 " $778.60 $778.60 "$1,693.42 " $482.00 "$2,802.00 " "$2,551.00 " $770.81 "$1,693.42 " "$1,479.33 " "$1,693.42 " $778.60 "$2,109.77 " $856.45 "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$2,647.22 " "$4,407.00 " "$1,693.42 " $778.60 $934.31 "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$1,090.03 " "$1,693.42 " $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " "$1,693.42 " "$1,693.42 " $661.81 "$1,896.63 " $778.60 $482.00 "$7,492.00 " 330104 19282 20 361 HC PERQ DEVICE BREAST EA IMAG O $227.91 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $58.21 "$1,693.42 " N/A "$1,693.42 " N/A $170.93 N/A $148.14 $151.56 "$2,032.11 " "$1,693.42 " $136.75 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $148.14 "$2,370.79 " $182.33 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $182.33 $193.72 "$2,286.12 " $170.93 "$3,471.51 " "$2,286.12 " $113.95 $148.14 $153.84 $153.84 $153.84 $153.84 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $58.21 "$7,492.00 " 330104 19281 5072 20 361 HC PERQ DEVICE BREAST 1ST IMAG O "$2,813.03 " "$1,799.07 " "$1,799.07 " "$1,693.42 " $482.00 "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$2,109.77 " "$1,978.98 " "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$4,839.50 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " "$1,889.02 " "$1,799.07 " "$3,780.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " $482.00 "$7,492.00 " 330104 19086 20 361 HC BX BREAST ADD LESION MR IMAG O $415.16 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $104.47 "$1,693.42 " N/A "$1,693.42 " N/A $311.37 N/A $269.85 $276.08 "$2,032.11 " "$1,693.42 " $249.10 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $269.85 "$2,370.79 " $332.13 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $332.13 $352.89 "$2,286.12 " $311.37 "$3,471.51 " "$2,286.12 " $207.58 $269.85 $280.23 $280.23 $280.23 $280.23 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $104.47 "$7,492.00 " 330104 19085 5072 20 361 HC BX BREAST 1ST LESION MR IMAG O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,949.00 " "$2,686.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 24071 5073 51 361 HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM O "$13,579.37 " "$3,099.23 " "$3,099.23 " "$1,157.33 " "$2,523.00 " "$2,949.00 " "$2,686.00 " "$3,068.24 " "$1,157.33 " "$5,888.53 " "$1,157.33 " "$3,099.23 " "$10,184.53 " "$3,409.15 " "$8,826.59 " "$9,030.28 " "$1,388.79 " "$1,157.33 " "$8,147.62 " "$7,492.00 " "$10,537.38 " "$4,407.00 " "$1,157.33 " "$3,099.23 " "$3,719.07 " "$1,620.26 " "$10,863.50 " "$1,157.33 " "$1,157.33 " "$1,388.79 " "$4,338.92 " "$1,157.33 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$10,863.50 " "$11,542.46 " "$1,157.33 " "$3,883.00 " "$2,372.52 " "$1,157.33 " "$6,789.69 " "$8,336.92 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$5,375.00 " "$3,254.19 " "$3,099.23 " "$5,659.00 " "$1,157.33 " "$1,157.33 " "$2,634.34 " "$1,296.21 " "$3,099.23 " "$1,157.33 " "$11,542.46 " 330104 36216 423 361 HC PLACE CATH; INITIAL 2ND ORDER THOR/BRACHIOCEPHALIC O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $330.74 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 36227 280 361 HC PLACE CATH XTRNL CAROTID O "$1,653.15 " N/A N/A $998.13 "$5,449.00 " "$1,717.00 " "$1,565.00 " $154.67 $998.13 N/A $998.13 N/A "$1,239.86 " N/A "$1,074.55 " "$1,099.34 " "$1,197.75 " $998.13 $991.89 "$7,492.00 " N/A "$4,407.00 " $998.13 N/A "$1,074.55 " "$1,397.38 " "$1,322.52 " $998.13 $998.13 "$1,197.75 " N/A $998.13 N/A N/A N/A "$1,322.52 " "$1,405.18 " "$1,347.47 " "$3,883.00 " "$2,046.16 " "$1,347.47 " $826.58 "$1,074.55 " "$1,115.88 " "$1,115.88 " "$1,115.88 " "$1,115.88 " "$2,688.00 " N/A N/A "$2,954.00 " $998.13 $998.13 N/A "$1,117.90 " N/A $154.67 "$7,492.00 " 330104 36558 5183 83 361 HC INSERT TUNNELED CV CATH W/O PORT; 5YRS AND OLDER O "$12,768.31 " "$3,573.99 " "$3,573.99 " "$1,495.25 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$3,538.25 " "$1,495.25 " "$6,790.58 " "$1,495.25 " "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " "$1,794.30 " "$1,495.25 " "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " "$1,495.25 " "$3,573.99 " "$4,288.79 " "$2,093.35 " "$10,214.65 " "$1,495.25 " "$1,495.25 " "$1,794.30 " "$5,003.59 " "$1,495.25 " "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " "$1,495.25 " "$3,883.00 " "$3,065.26 " "$1,495.25 " "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " "$1,495.25 " "$1,495.25 " "$3,037.89 " "$1,674.68 " "$3,573.99 " "$1,495.25 " "$12,151.56 " 330104 49405 5072 150 361 HC IMAGE CATH FLUID COLXN VISC O "$8,560.00 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$6,420.00 " "$1,978.98 " "$5,564.00 " "$5,692.40 " $779.90 $649.92 "$5,136.00 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$6,848.00 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$6,848.00 " "$7,276.00 " $649.92 "$6,420.00 " "$1,332.34 " $649.92 "$4,280.00 " "$4,839.50 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$7,492.00 " 330104 36556 5183 75 361 HC INSERT NON-TUNNEL CV CATH; 5YRS OR OLDER O "$7,515.68 " "$3,573.99 " "$3,573.99 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$5,636.76 " "$3,931.39 " "$4,885.19 " "$4,997.93 " $301.56 $251.30 "$4,509.41 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$6,012.54 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$6,012.54 " "$6,388.33 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,757.84 " "$9,614.03 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$3,548.00 " "$3,752.69 " "$3,573.99 " "$3,780.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 49421 5341 108 361 HC INS TUN IP CATH FOR DIAL OPN O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$2,241.88 " "$1,878.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " "$2,241.88 " "$8,073.85 " "$2,241.88 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,312.05 " "$9,526.94 " "$2,690.25 " "$2,241.88 " "$8,595.74 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$2,241.88 " "$4,249.40 " "$5,099.27 " "$3,138.63 " "$11,460.98 " "$2,241.88 " "$2,241.88 " "$2,690.25 " "$5,949.15 " "$2,241.88 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$2,241.88 " "$3,883.00 " "$4,595.85 " "$2,241.88 " "$7,163.11 " "$11,430.87 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,241.88 " "$2,241.88 " "$3,611.99 " "$2,510.90 " "$4,249.40 " "$1,878.00 " "$14,447.94 " 330104 49423 5302 150 361 HC EXCHANGE DRAINAGE CATHETER O "$5,350.00 " "$2,089.46 " "$2,089.46 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$2,068.56 " $649.92 "$3,969.96 " $649.92 "$2,089.46 " "$4,012.50 " "$2,298.40 " "$3,477.50 " "$3,557.75 " $779.90 $649.92 "$3,210.00 " "$7,492.00 " "$7,104.15 " "$4,407.00 " $649.92 "$2,089.46 " "$2,507.35 " $909.89 "$4,280.00 " $649.92 $649.92 $779.90 "$2,925.24 " $649.92 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$4,280.00 " "$4,547.50 " $649.92 "$4,012.50 " "$1,332.34 " $649.92 "$2,675.00 " "$5,620.63 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$4,838.00 " "$2,193.93 " "$2,089.46 " "$5,150.00 " $649.92 $649.92 "$1,776.04 " $727.91 "$2,089.46 " $649.92 "$7,492.00 " 330104 49424 278 361 HC ASSESS CYST CONTRAST INJECT O "$2,057.61 " N/A N/A $499.80 $482.00 "$1,717.00 " "$1,565.00 " $43.69 $499.80 N/A $499.80 N/A "$1,543.21 " N/A "$1,337.45 " "$1,368.31 " $599.76 $499.80 "$1,234.57 " "$7,492.00 " N/A "$4,407.00 " $499.80 N/A "$1,337.45 " $699.72 "$1,646.09 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,646.09 " "$1,748.97 " $674.73 "$1,543.21 " "$1,024.59 " $674.73 "$1,028.81 " "$1,337.45 " "$1,388.89 " "$1,388.89 " "$1,388.89 " "$1,388.89 " "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $43.69 "$7,492.00 " 330104 50389 5372 161 361 HC REMOVE RENAL TUBE W/FLUORO O "$2,354.00 " $750.25 $750.25 $458.30 "$1,099.00 " "$1,717.00 " "$1,565.00 " $742.74 $458.30 "$1,425.47 " $458.30 $750.25 "$1,765.50 " $825.27 "$1,530.10 " "$1,565.41 " $549.96 $458.30 "$1,412.40 " "$7,492.00 " "$2,550.83 " "$4,407.00 " $458.30 $750.25 $900.29 $641.62 "$1,883.20 " $458.30 $458.30 $549.96 "$1,050.34 " $458.30 $750.25 $750.25 $817.77 "$1,883.20 " "$2,000.90 " $458.30 "$1,765.50 " $939.52 $458.30 "$1,177.00 " "$2,018.16 " "$1,588.95 " "$1,588.95 " "$1,588.95 " "$1,588.95 " "$3,548.00 " $787.76 $750.25 "$3,780.00 " $458.30 $458.30 $637.71 $513.30 $750.25 $458.30 "$7,492.00 " 330104 50390 5071 161 361 HC DRAINAGE OF KIDNEY LESION O "$2,461.00 " $778.60 $778.60 $458.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " $770.81 $458.30 "$1,479.33 " $458.30 $778.60 "$1,845.75 " $856.45 "$1,599.65 " "$1,636.57 " $549.96 $458.30 "$1,476.60 " "$7,492.00 " "$2,647.22 " "$4,407.00 " $458.30 $778.60 $934.31 $641.62 "$1,968.80 " $458.30 $458.30 $549.96 "$1,090.03 " $458.30 $778.60 $778.60 $848.67 "$1,968.80 " "$2,091.85 " $458.30 "$3,883.00 " $939.52 $458.30 "$1,230.50 " "$2,094.42 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " $458.30 $458.30 $661.81 $513.30 $778.60 $458.30 "$7,492.00 " 330104 50694 5374 171 361 HC PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH O "$8,560.00 " "$3,845.31 " "$3,845.31 " "$1,558.06 " "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,806.86 " "$1,558.06 " "$7,306.09 " "$1,558.06 " "$3,845.31 " "$6,420.00 " "$4,229.84 " "$5,564.00 " "$5,692.40 " "$1,869.67 " "$1,558.06 " "$5,136.00 " "$7,492.00 " "$13,074.06 " "$4,407.00 " "$1,558.06 " "$3,845.31 " "$4,614.37 " "$2,181.28 " "$6,848.00 " "$1,558.06 " "$1,558.06 " "$1,869.67 " "$5,383.43 " "$1,558.06 " "$3,845.31 " "$3,845.31 " "$4,191.39 " "$6,848.00 " "$7,276.00 " "$1,558.06 " "$6,420.00 " "$3,194.02 " "$1,558.06 " "$4,280.00 " "$10,343.89 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,037.58 " "$3,845.31 " "$7,069.00 " "$1,558.06 " "$1,558.06 " "$3,268.51 " "$1,745.02 " "$3,845.31 " "$1,558.06 " "$13,074.06 " 330104 51102 5373 173 361 HC DRAIN BL W/CATH INSERTION O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$1,747.88 " "$2,886.00 " "$1,717.00 " "$1,565.00 " "$2,203.12 " "$1,747.88 " "$4,228.21 " "$1,747.88 " "$2,225.37 " "$6,123.08 " "$2,447.91 " "$5,306.66 " "$5,429.13 " "$2,097.46 " "$1,747.88 " "$4,898.46 " "$7,492.00 " "$7,566.27 " "$4,407.00 " "$1,747.88 " "$2,225.37 " "$2,670.45 " "$2,447.04 " "$6,531.28 " "$1,747.88 " "$1,747.88 " "$2,097.46 " "$3,115.52 " "$1,747.88 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$1,747.88 " "$3,883.00 " "$3,583.16 " "$1,747.88 " "$4,082.05 " "$5,986.26 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,375.00 " "$2,336.64 " "$2,225.37 " "$5,659.00 " "$1,747.88 " "$1,747.88 " "$1,891.57 " "$1,957.63 " "$2,225.37 " "$1,565.00 " "$7,566.27 " 330104 51600 278 361 HC INJ CYSTOGRAPHY/VOIDING URETHROCYSTOGRAPHY O "$2,325.11 " N/A N/A $499.80 $482.00 "$2,432.00 " "$2,215.00 " $51.52 $499.80 N/A $499.80 N/A "$1,743.83 " N/A "$1,511.32 " "$1,546.20 " $599.76 $499.80 "$1,395.07 " "$7,492.00 " N/A "$4,407.00 " $499.80 N/A "$1,511.32 " $699.72 "$1,860.09 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,860.09 " "$1,976.34 " $674.73 "$1,743.83 " "$1,024.59 " $674.73 "$1,162.56 " "$1,511.32 " "$1,569.45 " "$1,569.45 " "$1,569.45 " "$1,569.45 " "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $51.52 "$7,492.00 " 330104 51610 278 361 HC INJ FOR RETROGRADE URETHROCYSTOGRAPHY O $609.90 N/A N/A $499.80 $482.00 "$2,432.00 " "$2,215.00 " $75.76 $499.80 N/A $499.80 N/A $457.42 N/A $396.44 $405.58 $599.76 $499.80 $365.94 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $396.44 $699.72 $487.92 $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A $487.92 $518.41 $674.73 $457.42 "$1,024.59 " $674.73 $304.95 $396.44 $411.68 $411.68 $411.68 $411.68 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $75.76 "$7,492.00 " 330104 51703 5721 159 361 HC INSERT BLADDER CATH COMPLEX O $736.16 $174.48 $174.48 $421.95 $482.00 "$1,717.00 " "$1,565.00 " $172.73 $421.95 $331.51 $421.95 $174.48 $552.12 $191.93 $478.50 $489.55 $506.34 $421.95 $441.70 "$7,492.00 " $593.23 "$4,407.00 " $421.95 $174.48 $209.37 $590.73 $588.93 $421.95 $421.95 $506.34 $244.27 $421.95 $174.48 $174.48 $190.18 $588.93 $625.74 $421.95 $552.12 $864.99 $421.95 $368.08 $469.35 $496.91 $496.91 $496.91 $496.91 "$2,688.00 " $183.20 $174.48 "$2,954.00 " $421.95 $421.95 $148.31 $472.58 $174.48 $148.31 "$7,492.00 " 330104 55700 5373 176 361 HC BIOPSY OF PROSTATE O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$2,146.70 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$2,203.12 " "$2,146.70 " "$4,228.21 " "$2,146.70 " "$2,225.37 " "$6,123.08 " "$2,447.91 " "$5,306.66 " "$5,429.13 " "$2,576.04 " "$2,146.70 " "$4,898.46 " "$7,492.00 " "$7,566.27 " "$4,407.00 " "$2,146.70 " "$2,225.37 " "$2,670.45 " "$3,005.38 " "$6,531.28 " "$2,146.70 " "$2,146.70 " "$2,576.04 " "$3,115.52 " "$2,146.70 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$2,146.70 " "$6,123.08 " "$4,400.73 " "$2,146.70 " "$4,082.05 " "$5,986.26 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$4,838.00 " "$2,336.64 " "$2,225.37 " "$5,150.00 " "$2,146.70 " "$2,146.70 " "$1,891.57 " "$2,404.30 " "$2,225.37 " "$1,891.57 " "$7,566.27 " 330104 58340 278 361 HC CATHETER FOR HYSTEROGRAPHY O "$1,258.32 " N/A N/A $499.80 "$1,878.00 " "$1,717.00 " "$1,565.00 " $70.07 $499.80 N/A $499.80 N/A $943.74 N/A $817.91 $836.78 $599.76 $499.80 $754.99 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $817.91 $699.72 "$1,006.66 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,006.66 " "$1,069.57 " $674.73 $943.74 "$1,024.59 " $674.73 $629.16 $817.91 $849.37 $849.37 $849.37 $849.37 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $70.07 "$7,492.00 " 330104 20611 5441 50 361 HC US GUIDED JOINT ASP/INJECTION - LARGE O "$1,070.00 " $326.20 $326.20 $573.45 $482.00 "$1,717.00 " "$1,565.00 " $322.94 $573.45 $619.77 $573.45 $326.20 $802.50 $358.82 $695.50 $711.55 $688.14 $573.45 $642.00 "$7,492.00 " "$1,109.07 " "$4,407.00 " $573.45 $326.20 $391.44 $802.83 $856.00 $573.45 $573.45 $688.14 $456.68 $573.45 $326.20 $326.20 $355.56 $856.00 $909.50 $573.45 $802.50 "$1,175.57 " $573.45 $535.00 $877.47 $722.25 $722.25 $722.25 $722.25 "$2,688.00 " $342.51 $326.20 "$2,954.00 " $573.45 $573.45 $277.27 $642.26 $326.20 $277.27 "$7,492.00 " 330104 49180 5072 150 361 HC BIOPSY ABDOMINAL MASS O "$13,738.80 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$10,304.10 " "$1,978.98 " "$8,930.22 " "$9,136.30 " $779.90 $649.92 "$8,243.28 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$10,991.04 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,991.04 " "$11,677.98 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$6,869.40 " "$4,839.50 " "$9,273.69 " "$9,273.69 " "$9,273.69 " "$9,273.69 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$11,677.98 " 330104 47535 5341 151 361 HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,559.80 " $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " "$1,559.80 " "$8,073.85 " "$1,559.80 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$1,871.75 " "$1,559.80 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$1,559.80 " "$4,249.40 " "$5,099.27 " "$2,183.71 " "$6,848.00 " "$1,559.80 " "$1,559.80 " "$1,871.75 " "$5,949.15 " "$1,559.80 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,559.80 " "$6,420.00 " "$3,197.58 " "$1,559.80 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$1,559.80 " "$1,559.80 " "$3,611.99 " "$1,746.97 " "$4,249.40 " $482.00 "$14,447.94 " 330104 49418 5341 108 361 HC INSERT TUN IP CATH PERC O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$2,241.88 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " "$2,241.88 " "$8,073.85 " "$2,241.88 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$2,690.25 " "$2,241.88 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$2,241.88 " "$4,249.40 " "$5,099.27 " "$3,138.63 " "$6,848.00 " "$2,241.88 " "$2,241.88 " "$2,690.25 " "$5,949.15 " "$2,241.88 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$2,241.88 " "$3,883.00 " "$4,595.85 " "$2,241.88 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,241.88 " "$2,241.88 " "$3,611.99 " "$2,510.90 " "$4,249.40 " "$2,241.88 " "$14,447.94 " 330104 47532 5341 279 361 HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS O "$8,560.00 " "$4,249.40 " "$4,249.40 " $382.18 $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " $382.18 "$8,073.85 " $382.18 "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " $458.62 $382.18 "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " $382.18 "$4,249.40 " "$5,099.27 " $535.05 "$6,848.00 " $382.18 $382.18 $458.62 "$5,949.15 " $382.18 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " $382.18 "$6,420.00 " $783.47 $382.18 "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " $382.18 $382.18 "$3,611.99 " $428.04 "$4,249.40 " $382.18 "$14,447.94 " 330104 36568 5182 75 361 HC INSERT PICC CATH; YOUNGER THAN 5YRS O "$12,462.29 " "$1,785.03 " "$1,785.03 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $251.30 "$3,391.56 " $251.30 "$1,785.03 " "$9,346.72 " "$1,963.54 " "$8,100.49 " "$8,287.42 " $301.56 $251.30 "$7,477.37 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $251.30 "$1,785.03 " "$2,142.04 " $351.82 "$9,969.83 " $251.30 $251.30 $301.56 "$2,499.05 " $251.30 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$9,969.83 " "$10,592.95 " $251.30 "$3,883.00 " $515.17 $251.30 "$6,231.15 " "$4,801.74 " "$8,412.05 " "$8,412.05 " "$8,412.05 " "$8,412.05 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $251.30 $251.30 "$1,517.28 " $281.46 "$1,785.03 " $251.30 "$10,592.95 " 330104 36569 5182 75 361 HC INSERT PICC CATH; 5YRS OR OLDER O "$7,912.65 " "$1,785.03 " "$1,785.03 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $251.30 "$3,391.56 " $251.30 "$1,785.03 " "$5,934.49 " "$1,963.54 " "$5,143.22 " "$5,261.91 " $301.56 $251.30 "$4,747.59 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $251.30 "$1,785.03 " "$2,142.04 " $351.82 "$6,330.12 " $251.30 $251.30 $301.56 "$2,499.05 " $251.30 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,330.12 " "$6,725.75 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,956.32 " "$4,801.74 " "$5,341.04 " "$5,341.04 " "$5,341.04 " "$5,341.04 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $251.30 $251.30 "$1,517.28 " $281.46 "$1,785.03 " $251.30 "$7,492.00 " 330104 36571 5183 75 361 HC INSERT PICVAD CATH;5YRS OR OLDER O "$12,768.31 " "$3,573.99 " "$3,573.99 " $251.30 "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " $301.56 $251.30 "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$10,214.65 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $251.30 "$3,883.00 " $515.17 $251.30 "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 47534 5341 151 361 HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,559.80 " $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " "$1,559.80 " "$8,073.85 " "$1,559.80 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$1,871.75 " "$1,559.80 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$1,559.80 " "$4,249.40 " "$5,099.27 " "$2,183.71 " "$6,848.00 " "$1,559.80 " "$1,559.80 " "$1,871.75 " "$5,949.15 " "$1,559.80 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,559.80 " "$6,420.00 " "$3,197.58 " "$1,559.80 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$1,559.80 " "$1,559.80 " "$3,611.99 " "$1,746.97 " "$4,249.40 " $482.00 "$14,447.94 " 330104 36590 5182 76 361 HC REMOVAL TUNNELED CV CATH W/PORT/PUMP O "$2,906.12 " "$1,785.03 " "$1,785.03 " $885.24 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $885.24 "$3,391.56 " $885.24 "$1,785.03 " "$2,179.59 " "$1,963.54 " "$1,888.98 " "$1,932.57 " "$1,062.29 " $885.24 "$1,743.67 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $885.24 "$1,785.03 " "$2,142.04 " "$1,239.34 " "$2,324.90 " $885.24 $885.24 "$1,062.29 " "$2,499.05 " $885.24 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$2,324.90 " "$2,470.20 " $885.24 "$3,883.00 " "$1,814.74 " $885.24 "$1,453.06 " "$4,801.74 " "$1,961.63 " "$1,961.63 " "$1,961.63 " "$1,961.63 " "$4,838.00 " "$1,874.28 " "$1,785.03 " "$5,150.00 " $885.24 $885.24 "$1,517.28 " $991.47 "$1,785.03 " $885.24 "$7,492.00 " 330104 36620 423 361 HC INSERTION CATHETER ARTERY;PERCUT O $561.75 N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $51.71 $205.12 N/A $205.12 N/A $421.31 N/A $365.14 $373.56 $246.15 $205.12 $337.05 "$7,492.00 " N/A "$4,407.00 " $205.12 N/A $365.14 $287.17 $449.40 $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A $449.40 $477.49 $276.91 $421.31 $420.50 $276.91 $280.88 $365.14 $379.18 $379.18 $379.18 $379.18 "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $51.71 "$7,492.00 " 330104 37191 5184 77 361 HC INS ENDOVAS VENA CAVA FILTR O "$21,176.37 " "$6,166.38 " "$6,166.38 " "$2,386.19 " "$4,069.00 " "$2,949.00 " "$2,686.00 " "$6,104.71 " "$2,386.19 " "$11,716.11 " "$2,386.19 " "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,764.64 " "$14,082.29 " "$2,863.42 " "$2,386.19 " "$12,705.82 " "$7,492.00 " "$20,965.68 " "$4,407.00 " "$2,386.19 " "$6,166.38 " "$7,399.65 " "$3,340.66 " "$16,941.10 " "$2,386.19 " "$2,386.19 " "$2,863.42 " "$8,632.93 " "$2,386.19 " "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " "$2,386.19 " "$3,883.00 " "$4,891.68 " "$2,386.19 " "$10,588.18 " "$16,587.55 " "$14,294.05 " "$14,294.05 " "$14,294.05 " "$14,294.05 " "$8,611.00 " "$6,474.69 " "$6,166.38 " "$9,057.00 " "$2,386.19 " "$2,386.19 " "$5,241.42 " "$2,672.53 " "$6,166.38 " "$2,386.19 " "$20,965.68 " 330104 37200 5184 77 361 HC TRANSCATHETER BIOPSY O "$5,350.00 " "$6,166.38 " "$6,166.38 " "$2,386.19 " "$2,523.00 " "$2,973.00 " "$2,708.00 " "$6,104.71 " "$2,386.19 " "$11,716.11 " "$2,386.19 " "$6,166.38 " "$4,012.50 " "$6,783.01 " "$3,477.50 " "$3,557.75 " "$2,863.42 " "$2,386.19 " "$3,210.00 " "$7,492.00 " "$20,965.68 " "$4,407.00 " "$2,386.19 " "$6,166.38 " "$7,399.65 " "$3,340.66 " "$4,280.00 " "$2,386.19 " "$2,386.19 " "$2,863.42 " "$8,632.93 " "$2,386.19 " "$6,166.38 " "$6,166.38 " "$6,721.35 " "$4,280.00 " "$4,547.50 " "$2,386.19 " "$3,883.00 " "$4,891.68 " "$2,386.19 " "$2,675.00 " "$16,587.55 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$8,611.00 " "$6,474.69 " "$6,166.38 " "$9,057.00 " "$2,386.19 " "$2,386.19 " "$5,241.42 " "$2,672.53 " "$6,166.38 " "$2,386.19 " "$20,965.68 " 330104 36581 5183 83 361 HC REPLACE COMPLETE TUNNELED CV CATH; W/O PORT / PUMP O "$12,768.31 " "$3,573.99 " "$3,573.99 " "$1,495.25 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$3,538.25 " "$1,495.25 " "$6,790.58 " "$1,495.25 " "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " "$1,794.30 " "$1,495.25 " "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " "$1,495.25 " "$3,573.99 " "$4,288.79 " "$2,093.35 " "$10,214.65 " "$1,495.25 " "$1,495.25 " "$1,794.30 " "$5,003.59 " "$1,495.25 " "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " "$1,495.25 " "$3,883.00 " "$3,065.26 " "$1,495.25 " "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " "$1,495.25 " "$1,495.25 " "$3,037.89 " "$1,674.68 " "$3,573.99 " "$1,495.25 " "$12,151.56 " 330104 37225 5193 85 361 HC FEM/POPL REVAS W/ATHER O "$45,866.62 " "$12,735.61 " "$12,735.61 " "$2,877.70 " "$5,623.00 " "$2,973.00 " "$2,708.00 " "$12,608.26 " "$2,877.70 " "$24,197.66 " "$2,877.70 " "$12,735.61 " "$34,399.97 " "$14,009.17 " "$29,813.30 " "$30,501.30 " "$3,453.24 " "$2,877.70 " "$27,519.97 " "$7,492.00 " "$43,301.08 " "$4,407.00 " "$2,877.70 " "$12,735.61 " "$15,282.73 " "$4,028.78 " "$36,693.30 " "$2,877.70 " "$2,877.70 " "$3,453.24 " "$17,829.86 " "$2,877.70 " "$12,735.61 " "$12,735.61 " "$13,881.82 " "$36,693.30 " "$38,986.63 " "$2,877.70 " "$4,965.00 " "$5,899.28 " "$2,877.70 " "$22,933.31 " "$34,258.80 " "$30,959.97 " "$30,959.97 " "$30,959.97 " "$30,959.97 " "$11,327.00 " "$13,372.39 " "$12,735.61 " "$11,677.00 " "$2,877.70 " "$2,877.70 " "$10,825.27 " "$3,223.02 " "$12,735.61 " "$2,708.00 " "$43,301.08 " 330104 37236 5193 85 361 HC OPEN/PERQ PLACE STENT 1ST O "$53,644.45 " "$12,735.61 " "$12,735.61 " "$2,877.70 " "$7,500.00 " "$2,949.00 " "$2,686.00 " "$12,608.26 " "$2,877.70 " "$24,197.66 " "$2,877.70 " "$12,735.61 " "$40,233.34 " "$14,009.17 " "$34,868.89 " "$35,673.56 " "$3,453.24 " "$2,877.70 " "$32,186.67 " "$7,492.00 " "$43,301.08 " "$4,407.00 " "$2,877.70 " "$12,735.61 " "$15,282.73 " "$4,028.78 " "$42,915.56 " "$2,877.70 " "$2,877.70 " "$3,453.24 " "$17,829.86 " "$2,877.70 " "$12,735.61 " "$12,735.61 " "$13,881.82 " "$42,915.56 " "$45,597.78 " "$2,877.70 " "$40,233.34 " "$5,899.28 " "$2,877.70 " "$26,822.22 " "$34,258.80 " "$36,210.00 " "$36,210.00 " "$36,210.00 " "$36,210.00 " "$11,327.00 " "$13,372.39 " "$12,735.61 " "$11,677.00 " "$2,877.70 " "$2,877.70 " "$10,825.27 " "$3,223.02 " "$12,735.61 " "$2,686.00 " "$45,597.78 " 330104 37237 85 361 HC OPEN/PERQ PLACE STENT EA ADDL ARTERY O "$28,020.09 " N/A N/A "$2,877.70 " "$7,500.00 " "$1,717.00 " "$1,565.00 " $259.62 "$2,877.70 " N/A "$2,877.70 " N/A "$21,015.07 " N/A "$18,213.06 " "$18,633.36 " "$3,453.24 " "$2,877.70 " "$16,812.05 " "$7,492.00 " N/A "$4,407.00 " "$2,877.70 " N/A "$18,213.06 " "$4,028.78 " "$22,416.07 " "$2,877.70 " "$2,877.70 " "$3,453.24 " N/A "$2,877.70 " N/A N/A N/A "$22,416.07 " "$23,817.08 " "$3,884.89 " "$21,015.07 " "$5,899.28 " "$3,884.89 " "$14,010.05 " "$18,213.06 " "$18,913.56 " "$18,913.56 " "$18,913.56 " "$18,913.56 " "$8,611.00 " N/A N/A "$9,057.00 " "$2,877.70 " "$2,877.70 " N/A "$3,223.02 " N/A $259.62 "$23,817.08 " 330104 38792 5591 331 361 HC RA TRACER ID OF SENTINL NODE O "$3,460.38 " $466.31 $466.31 N/A $482.00 "$1,717.00 " "$1,565.00 " $461.65 N/A $886.00 N/A $466.31 "$2,595.28 " $512.95 "$2,249.25 " "$2,301.15 " N/A N/A "$2,076.23 " "$7,492.00 " "$1,585.47 " "$4,407.00 " N/A $466.31 $559.58 N/A "$2,768.30 " N/A N/A N/A $652.84 N/A $466.31 $466.31 $508.28 "$2,768.30 " "$2,941.32 " N/A "$2,595.28 " N/A N/A "$1,730.19 " "$1,254.39 " "$2,335.76 " "$2,335.76 " "$2,335.76 " "$2,335.76 " "$2,688.00 " $489.63 $466.31 "$2,954.00 " N/A N/A $396.37 N/A $466.31 $396.37 "$7,492.00 " 330104 43761 5371 130 361 HC REPOSITION GASTROSTOMY TUBE O "$2,295.15 " $257.79 $257.79 $541.26 "$1,878.00 " "$1,717.00 " "$1,565.00 " $255.21 $541.26 $489.80 $541.26 $257.79 "$1,721.36 " $283.57 "$1,491.85 " "$1,526.27 " $649.51 $541.26 "$1,377.09 " "$7,492.00 " $876.48 "$4,407.00 " $541.26 $257.79 $309.35 $757.76 "$1,836.12 " $541.26 $541.26 $649.51 $360.90 $541.26 $257.79 $257.79 $280.99 "$1,836.12 " "$1,950.88 " $541.26 "$3,883.00 " "$1,109.58 " $541.26 "$1,147.58 " $693.45 "$1,549.23 " "$1,549.23 " "$1,549.23 " "$1,549.23 " "$2,688.00 " $270.68 $257.79 "$2,954.00 " $541.26 $541.26 $219.12 $606.21 $257.79 $219.12 "$7,492.00 " 330104 46320 5312 141 361 HC REMOVAL OF HEMORRHOID CLOT O "$2,493.10 " "$1,299.21 " "$1,299.21 " "$1,175.03 " "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,286.22 " "$1,175.03 " "$2,468.50 " "$1,175.03 " "$1,299.21 " "$1,869.82 " "$1,429.13 " "$1,620.52 " "$1,657.91 " "$1,410.04 " "$1,175.03 " "$1,495.86 " "$7,492.00 " "$4,417.32 " "$4,407.00 " "$1,175.03 " "$1,299.21 " "$1,559.05 " "$1,645.05 " "$1,994.48 " "$1,175.03 " "$1,175.03 " "$1,410.04 " "$1,818.89 " "$1,175.03 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$1,994.48 " "$2,119.13 " "$1,175.03 " "$1,869.82 " "$2,408.82 " "$1,175.03 " "$1,246.55 " "$3,494.88 " "$1,682.84 " "$1,682.84 " "$1,682.84 " "$1,682.84 " "$4,838.00 " "$1,364.17 " "$1,299.21 " "$5,150.00 " "$1,175.03 " "$1,175.03 " "$1,104.33 " "$1,316.04 " "$1,299.21 " "$1,104.33 " "$7,492.00 " 330104 47000 5072 150 361 HC NEEDLE BIOPSY OF LIVER O "$6,324.77 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " $779.90 $649.92 "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$5,059.82 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$7,492.00 " 330104 37220 5192 79 361 HC ILIAC REVASC O "$22,823.10 " "$6,257.12 " "$6,257.12 " "$2,877.69 " "$5,623.00 " "$2,973.00 " "$2,708.00 " "$6,194.55 " "$2,877.69 " "$11,888.54 " "$2,877.69 " "$6,257.12 " "$17,117.32 " "$6,882.84 " "$14,835.01 " "$15,177.36 " "$3,453.23 " "$2,877.69 " "$13,693.86 " "$7,492.00 " "$21,274.22 " "$4,407.00 " "$2,877.69 " "$6,257.12 " "$7,508.55 " "$4,028.77 " "$18,258.48 " "$2,877.69 " "$2,877.69 " "$3,453.23 " "$8,759.97 " "$2,877.69 " "$6,257.12 " "$6,257.12 " "$6,820.27 " "$18,258.48 " "$19,399.63 " "$2,877.69 " "$4,965.00 " "$5,899.27 " "$2,877.69 " "$11,411.55 " "$16,831.66 " "$15,405.59 " "$15,405.59 " "$15,405.59 " "$15,405.59 " "$8,611.00 " "$6,569.98 " "$6,257.12 " "$9,057.00 " "$2,877.69 " "$2,877.69 " "$5,318.56 " "$3,223.01 " "$6,257.12 " "$2,708.00 " "$21,274.22 " 330104 369 HC TISSUE RECOVERY O "$4,477.95 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,928.58 " N/A N/A N/A N/A "$3,358.46 " "$3,134.56 " "$2,910.67 " "$2,977.84 " "$1,567.28 " "$1,567.28 " "$2,686.77 " "$14,074.00 " N/A "$9,788.00 " "$1,567.28 " N/A N/A N/A "$3,582.36 " N/A "$3,582.36 " N/A N/A "$3,582.36 " N/A N/A N/A "$3,582.36 " "$3,806.26 " "$2,238.97 " "$3,358.46 " "$2,238.97 " "$2,238.97 " N/A "$2,910.67 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,238.97 " N/A N/A N/A N/A "$1,567.28 " "$14,074.00 " 330104 369 HC ORGAN RECOVERY - DECEASED O "$20,155.59 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$13,181.76 " N/A N/A N/A N/A "$15,116.69 " "$14,108.91 " "$13,101.13 " "$13,403.47 " "$7,054.46 " "$7,054.46 " "$12,093.35 " "$14,074.00 " N/A "$9,788.00 " "$7,054.46 " N/A N/A N/A "$16,124.47 " N/A "$16,124.47 " N/A N/A "$16,124.47 " N/A N/A N/A "$16,124.47 " "$17,132.25 " "$10,077.80 " "$15,116.69 " "$10,077.80 " "$10,077.80 " N/A "$13,101.13 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$10,077.80 " N/A N/A N/A N/A "$2,215.00 " "$17,132.25 " 330104 370 HC ANESTHESIA-LOCAL O "$1,458.41 " N/A N/A N/A $729.21 $904.21 $904.21 $953.80 N/A N/A N/A N/A "$1,093.81 " "$1,020.89 " $947.97 "$1,066.10 " $510.44 $510.44 $875.05 "$7,492.00 " N/A "$4,407.00 " $510.44 N/A N/A N/A "$1,166.73 " N/A "$1,166.73 " N/A N/A "$1,166.73 " N/A N/A N/A "$1,166.73 " "$1,239.65 " $729.21 "$1,093.81 " $729.21 $729.21 N/A $947.97 $984.43 $984.43 $984.43 $984.43 N/A N/A N/A $972.76 $729.21 N/A N/A N/A N/A $510.44 "$7,492.00 " 330104 370 HC ANESTHESIA-REG/BLOCK O "$1,937.77 " N/A N/A N/A $968.88 "$1,201.42 " "$1,201.42 " "$1,267.30 " N/A N/A N/A N/A "$1,453.33 " "$1,356.44 " "$1,259.55 " "$1,416.51 " $678.22 $678.22 "$1,162.66 " "$7,492.00 " N/A "$4,407.00 " $678.22 N/A N/A N/A "$1,550.22 " N/A "$1,550.22 " N/A N/A "$1,550.22 " N/A N/A N/A "$1,550.22 " "$1,647.10 " $968.88 "$1,453.33 " $968.88 $968.88 N/A "$1,259.55 " "$1,307.99 " "$1,307.99 " "$1,307.99 " "$1,307.99 " N/A N/A N/A "$1,292.49 " $968.88 N/A N/A N/A N/A $678.22 "$7,492.00 " 330104 99151 380 370 HC MOD SED SAME PHYS/QHP <5 YRS O $268.57 N/A N/A N/A $134.28 $166.51 $166.51 $28.13 N/A N/A N/A N/A $201.43 N/A $174.57 $196.32 N/A N/A $161.14 "$7,492.00 " N/A "$4,407.00 " N/A N/A $174.57 N/A $214.86 N/A N/A N/A N/A N/A N/A N/A N/A $214.86 $228.28 N/A $201.43 N/A N/A $134.28 $174.57 $181.28 $181.28 $181.28 $181.28 N/A N/A N/A $179.14 N/A N/A N/A N/A N/A $28.13 "$7,492.00 " 330104 99152 380 370 HC MOD SED SAME PHYS/QHP 5/>YRS O $268.57 N/A N/A N/A $134.28 $166.51 $166.51 $15.21 N/A N/A N/A N/A $201.43 N/A $174.57 $196.32 N/A N/A $161.14 "$7,492.00 " N/A "$4,407.00 " N/A N/A $174.57 N/A $214.86 N/A N/A N/A N/A N/A N/A N/A N/A $214.86 $228.28 N/A $201.43 N/A N/A $134.28 $174.57 $181.28 $181.28 $181.28 $181.28 N/A N/A N/A $179.14 N/A N/A N/A N/A N/A $15.21 "$7,492.00 " 330104 99153 380 370 HC MOD SED SAME PHYS/QHP EA O $166.92 N/A N/A N/A $83.46 $103.49 $103.49 $14.15 N/A N/A N/A N/A $125.19 N/A $108.50 $122.02 N/A N/A $100.15 "$7,492.00 " N/A "$4,407.00 " N/A N/A $108.50 N/A $133.54 N/A N/A N/A N/A N/A N/A N/A N/A $133.54 $141.88 N/A $125.19 N/A N/A $83.46 $108.50 $112.67 $112.67 $112.67 $112.67 N/A N/A N/A $111.34 N/A N/A N/A N/A N/A $14.15 "$7,492.00 " 330104 99156 380 370 HC MOD SED OTH PHYS/QHP 5/>YRS O $656.98 N/A N/A N/A $328.49 $407.33 $407.33 $89.06 N/A N/A N/A N/A $492.74 N/A $427.04 $480.25 N/A N/A $394.19 "$7,492.00 " N/A "$4,407.00 " N/A N/A $427.04 N/A $525.58 N/A N/A N/A N/A N/A N/A N/A N/A $525.58 $558.43 N/A $492.74 N/A N/A $328.49 $427.04 $443.46 $443.46 $443.46 $443.46 N/A N/A N/A $438.21 N/A N/A N/A N/A N/A $89.06 "$7,492.00 " 330104 370 HC ANESTHESIS-MAC O "$2,175.31 " N/A N/A N/A "$1,087.65 " "$1,348.69 " "$1,348.69 " "$1,422.65 " N/A N/A N/A N/A "$1,631.48 " "$1,522.72 " "$1,413.95 " "$1,590.15 " $761.36 $761.36 "$1,305.19 " "$7,492.00 " N/A "$4,407.00 " $761.36 N/A N/A N/A "$1,740.25 " N/A "$1,740.25 " N/A N/A "$1,740.25 " N/A N/A N/A "$1,740.25 " "$1,849.01 " "$1,087.65 " "$1,631.48 " "$1,087.65 " "$1,087.65 " N/A "$1,413.95 " "$1,468.33 " "$1,468.33 " "$1,468.33 " "$1,468.33 " N/A N/A N/A "$1,450.93 " "$1,087.65 " N/A N/A N/A N/A $761.36 "$7,492.00 " 330104 P9011 9520 2061 390 HC BLOOD SPLIT UNIT O $675.00 $166.82 $166.82 $548.66 $337.50 $418.50 $418.50 $165.16 $548.66 $316.97 $548.66 $166.82 $506.25 $183.51 $438.75 $493.43 $658.39 $548.66 $405.00 "$7,492.00 " $567.20 "$4,407.00 " $548.66 $166.82 $200.19 $768.12 $540.00 $548.66 $548.66 $658.39 $233.55 $548.66 $166.82 $166.82 $181.84 $540.00 $573.75 $548.66 $506.25 "$1,124.75 " $548.66 $337.50 $275.26 $455.63 $455.63 $455.63 $455.63 $337.50 $175.17 $166.82 $337.50 $675.00 $548.66 $141.80 $141.80 $166.82 $141.80 "$7,492.00 " 330104 P9054 9527 2061 390 HC WSH LR FROZ DW WB/RBC EA UNIT O "$2,361.00 " $356.18 $356.18 $548.66 "$1,180.50 " "$1,463.82 " "$1,463.82 " $352.62 $548.66 $676.74 $548.66 $356.18 "$1,770.75 " $391.80 "$1,534.65 " "$1,725.89 " $658.39 $548.66 "$1,416.60 " "$7,492.00 " "$1,211.01 " "$4,407.00 " $548.66 $356.18 $427.41 $768.12 "$1,888.80 " $548.66 $548.66 $658.39 $498.65 $548.66 $356.18 $356.18 $388.23 "$1,888.80 " "$2,006.85 " $548.66 "$1,770.75 " "$1,124.75 " $548.66 "$1,180.50 " $587.70 "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,180.50 " $373.99 $356.18 "$1,180.50 " "$2,361.00 " $548.66 $302.75 $302.75 $356.18 $302.75 "$7,492.00 " 330104 P9021 9517 2061 390 HC RED BLOOD CELLS UNIT O $690.00 $162.59 $162.59 $548.66 $345.00 $427.80 $427.80 $160.96 $548.66 $308.92 $548.66 $162.59 $517.50 $178.85 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $552.80 "$4,407.00 " $548.66 $162.59 $195.11 $768.12 $552.00 $548.66 $548.66 $658.39 $227.62 $548.66 $162.59 $162.59 $177.22 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $268.27 $465.75 $465.75 $465.75 $465.75 $345.00 $170.72 $162.59 $345.00 $690.00 $548.66 $138.20 $138.20 $162.59 $138.20 "$7,492.00 " 330104 P9022 9518 2062 390 HC WASHED RED BLOOD CELLS UNIT O $975.00 $474.83 $474.83 $675.23 $487.50 $604.50 $604.50 $470.08 $675.23 $902.18 $675.23 $474.83 $731.25 $522.32 $633.75 $712.73 $810.27 $675.23 $585.00 "$7,492.00 " "$1,614.43 " "$4,407.00 " $675.23 $474.83 $569.80 $945.32 $780.00 $675.23 $675.23 $810.27 $664.77 $675.23 $474.83 $474.83 $517.57 $780.00 $828.75 $675.23 $731.25 "$1,384.22 " $675.23 $487.50 $783.47 $658.12 $658.12 $658.12 $658.12 $487.50 $498.57 $474.83 $487.50 $975.00 $675.23 $403.61 $403.61 $474.83 $403.61 "$7,492.00 " 330104 P9031 9526 2062 390 HC PLATELETS LEUKOCYTES REDUCED O "$1,605.00 " $157.03 $157.03 $675.23 $802.50 $995.10 $995.10 $155.46 $675.23 $298.36 $675.23 $157.03 "$1,203.75 " $172.74 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " $533.92 "$4,407.00 " $675.23 $157.03 $188.44 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $219.85 $675.23 $157.03 $157.03 $171.17 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $259.11 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $164.89 $157.03 $802.50 "$1,605.00 " $675.23 $133.48 $133.48 $157.03 $133.48 "$7,492.00 " 330104 P9032 9500 2062 390 HC PLATELETS IRRADIATED O "$1,605.00 " $172.52 $172.52 $675.23 $802.50 $995.10 $995.10 $170.80 $675.23 $327.79 $675.23 $172.52 "$1,203.75 " $189.77 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " $586.58 "$4,407.00 " $675.23 $172.52 $207.03 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $241.53 $675.23 $172.52 $172.52 $188.05 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $284.66 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $181.15 $172.52 $802.50 "$1,605.00 " $675.23 $146.64 $146.64 $172.52 $146.64 "$7,492.00 " 330104 P9035 9501 2062 390 HC PLATELET PHERES LEUKOREDUCED O "$1,605.00 " $582.67 $582.67 $675.23 $802.50 $995.10 $995.10 $576.84 $675.23 "$1,107.06 " $675.23 $582.67 "$1,203.75 " $640.93 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " "$1,981.06 " "$4,407.00 " $675.23 $582.67 $699.20 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $815.73 $675.23 $582.67 $582.67 $635.11 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $961.40 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $611.80 $582.67 $802.50 "$1,605.00 " $675.23 $495.27 $495.27 $582.67 $495.27 "$7,492.00 " 330104 P9010 9510 2061 390 HC WHOLE BLOOD FOR TRANSFUSION O $879.00 $273.07 $273.07 $548.66 $439.50 $544.98 $544.98 $270.34 $548.66 $518.84 $548.66 $273.07 $659.25 $300.38 $571.35 $642.55 $658.39 $548.66 $527.40 "$7,492.00 " $928.45 "$4,407.00 " $548.66 $273.07 $327.69 $768.12 $703.20 $548.66 $548.66 $658.39 $382.30 $548.66 $273.07 $273.07 $297.65 $703.20 $747.15 $548.66 $659.25 "$1,124.75 " $548.66 $439.50 $450.57 $593.33 $593.33 $593.33 $593.33 $439.50 $286.73 $273.07 $439.50 $879.00 $548.66 $232.11 $232.11 $273.07 $232.11 "$7,492.00 " 330104 P9019 9515 2061 390 HC PLATELETS EACH UNIT O $455.00 $92.66 $92.66 $548.66 $227.50 $282.10 $282.10 $91.73 $548.66 $176.05 $548.66 $92.66 $341.25 $101.92 $295.75 $332.61 $658.39 $548.66 $273.00 "$7,492.00 " $315.03 "$4,407.00 " $548.66 $92.66 $111.19 $768.12 $364.00 $548.66 $548.66 $658.39 $129.72 $548.66 $92.66 $92.66 $100.99 $364.00 $386.75 $548.66 $341.25 "$1,124.75 " $548.66 $227.50 $152.88 $307.12 $307.12 $307.12 $307.12 $227.50 $97.29 $92.66 $227.50 $455.00 $548.66 $78.76 $78.76 $92.66 $78.76 "$7,492.00 " 330104 P9054 9527 2061 390 HC WASHED LEUKO RED RBC O "$2,227.00 " $356.18 $356.18 $548.66 "$1,113.50 " "$1,380.74 " "$1,380.74 " $352.62 $548.66 $676.74 $548.66 $356.18 "$1,670.25 " $391.80 "$1,447.55 " "$1,627.94 " $658.39 $548.66 "$1,336.20 " "$7,492.00 " "$1,211.01 " "$4,407.00 " $548.66 $356.18 $427.41 $768.12 "$1,781.60 " $548.66 $548.66 $658.39 $498.65 $548.66 $356.18 $356.18 $388.23 "$1,781.60 " "$1,892.95 " $548.66 "$1,670.25 " "$1,124.75 " $548.66 "$1,113.50 " $587.70 "$1,503.23 " "$1,503.23 " "$1,503.23 " "$1,503.23 " "$1,113.50 " $373.99 $356.18 "$1,113.50 " "$2,227.00 " $548.66 $302.75 $302.75 $356.18 $302.75 "$7,492.00 " 330104 P9059 9513 2061 390 HC FFP 8-24 HRS OF COLLECT EA UNIT O $128.00 $91.42 $91.42 $548.66 $64.00 $79.36 $79.36 $90.51 $548.66 $173.70 $548.66 $91.42 $96.00 $100.56 $83.20 $93.57 $658.39 $548.66 $76.80 "$7,492.00 " $310.83 "$4,407.00 " $548.66 $91.42 $109.70 $768.12 $102.40 $548.66 $548.66 $658.39 $127.99 $548.66 $91.42 $91.42 $99.65 $102.40 $108.80 $548.66 $96.00 "$1,124.75 " $548.66 $64.00 $150.84 $86.40 $86.40 $86.40 $86.40 $64.00 $95.99 $91.42 $64.00 $128.00 $548.66 $77.71 $77.71 $91.42 $64.00 "$7,492.00 " 330104 P9058 9533 2061 390 HC CMV NEG LR IRR RBC EA UNIT O $690.00 $301.12 $301.12 $548.66 $345.00 $427.80 $427.80 $298.11 $548.66 $572.13 $548.66 $301.12 $517.50 $331.24 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " "$1,023.82 " "$4,407.00 " $548.66 $301.12 $361.35 $768.12 $552.00 $548.66 $548.66 $658.39 $421.57 $548.66 $301.12 $301.12 $328.22 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $496.85 $465.75 $465.75 $465.75 $465.75 $345.00 $316.18 $301.12 $345.00 $690.00 $548.66 $255.95 $255.95 $301.12 $255.95 "$7,492.00 " 330104 P9057 9532 2061 390 HC RBC FROZ LEUK REDUC IR EA O "$2,361.00 " $472.51 $472.51 $548.66 "$1,180.50 " "$1,463.82 " "$1,463.82 " $467.78 $548.66 $897.76 $548.66 $472.51 "$1,770.75 " $519.76 "$1,534.65 " "$1,725.89 " $658.39 $548.66 "$1,416.60 " "$7,492.00 " "$1,606.52 " "$4,407.00 " $548.66 $472.51 $567.01 $768.12 "$1,888.80 " $548.66 $548.66 $658.39 $661.51 $548.66 $472.51 $472.51 $515.03 "$1,888.80 " "$2,006.85 " $548.66 "$1,770.75 " "$1,124.75 " $548.66 "$1,180.50 " $779.63 "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,180.50 " $496.13 $472.51 "$1,180.50 " "$2,361.00 " $548.66 $401.63 $401.63 $472.51 $401.63 "$7,492.00 " 330104 P9037 9530 2062 390 HC PLATE PHERES LEUKOREDU IRRAD O "$1,605.00 " $765.66 $765.66 $675.23 $802.50 $995.10 $995.10 $758.01 $675.23 "$1,454.76 " $675.23 $765.66 "$1,203.75 " $842.23 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " "$2,603.25 " "$4,407.00 " $675.23 $765.66 $918.79 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 "$1,071.93 " $675.23 $765.66 $765.66 $834.57 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 "$1,263.34 " "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $803.95 $765.66 $802.50 "$1,605.00 " $675.23 $650.81 $650.81 $765.66 $650.81 "$7,492.00 " 330104 P9052 9525 2062 390 HC PLATELETS HLA-M L/R UNIT O "$7,728.00 " $994.06 $994.06 $675.23 "$3,864.00 " "$4,791.36 " "$4,791.36 " $984.12 $675.23 "$1,888.71 " $675.23 $994.06 "$5,796.00 " "$1,093.46 " "$5,023.20 " "$5,649.17 " $810.27 $675.23 "$4,636.80 " "$7,492.00 " "$3,379.79 " "$4,407.00 " $675.23 $994.06 "$1,192.87 " $945.32 "$6,182.40 " $675.23 $675.23 $810.27 "$1,391.68 " $675.23 $994.06 $994.06 "$1,083.52 " "$6,182.40 " "$6,568.80 " $675.23 "$5,796.00 " "$1,384.22 " $675.23 "$3,864.00 " "$1,640.19 " "$5,216.40 " "$5,216.40 " "$5,216.40 " "$5,216.40 " "$3,864.00 " "$1,043.76 " $994.06 "$3,864.00 " "$7,728.00 " $675.23 $844.95 $844.95 $994.06 $675.23 "$7,728.00 " 330104 P9051 9524 2061 390 HC CMV NEGATIVE UNITS O $916.00 $235.66 $235.66 $548.66 $458.00 $567.92 $567.92 $233.31 $548.66 $447.76 $548.66 $235.66 $687.00 $259.23 $595.40 $669.60 $658.39 $548.66 $549.60 "$7,492.00 " $801.26 "$4,407.00 " $548.66 $235.66 $282.80 $768.12 $732.80 $548.66 $548.66 $658.39 $329.93 $548.66 $235.66 $235.66 $256.87 $732.80 $778.60 $548.66 $687.00 "$1,124.75 " $548.66 $458.00 $388.85 $618.30 $618.30 $618.30 $618.30 $458.00 $247.45 $235.66 $458.00 $916.00 $548.66 $200.32 $200.32 $235.66 $200.32 "$7,492.00 " 330104 P9021 9517 2061 390 HC DIRECTED RBC O "$1,208.00 " $162.59 $162.59 $548.66 $604.00 $748.96 $748.96 $160.96 $548.66 $308.92 $548.66 $162.59 $906.00 $178.85 $785.20 $883.05 $658.39 $548.66 $724.80 "$7,492.00 " $552.80 "$4,407.00 " $548.66 $162.59 $195.11 $768.12 $966.40 $548.66 $548.66 $658.39 $227.62 $548.66 $162.59 $162.59 $177.22 $966.40 "$1,026.80 " $548.66 $906.00 "$1,124.75 " $548.66 $604.00 $268.27 $815.40 $815.40 $815.40 $815.40 $604.00 $170.72 $162.59 $604.00 "$1,208.00 " $548.66 $138.20 $138.20 $162.59 $138.20 "$7,492.00 " 330104 P9040 9522 2061 390 HC RBC LEUKOREDUCED IRRADIATED O $690.00 $310.88 $310.88 $548.66 $345.00 $427.80 $427.80 $307.77 $548.66 $590.67 $548.66 $310.88 $517.50 $341.96 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " "$1,056.98 " "$4,407.00 " $548.66 $310.88 $373.05 $768.12 $552.00 $548.66 $548.66 $658.39 $435.23 $548.66 $310.88 $310.88 $338.86 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $512.95 $465.75 $465.75 $465.75 $465.75 $345.00 $326.42 $310.88 $345.00 $690.00 $548.66 $264.25 $264.25 $310.88 $264.25 "$7,492.00 " 330104 P9017 9508 2061 390 HC PLASMA 1 DONOR FRZ W/IN 8 HR O $128.00 $102.54 $102.54 $548.66 $64.00 $79.36 $79.36 $101.52 $548.66 $194.83 $548.66 $102.54 $96.00 $112.80 $83.20 $93.57 $658.39 $548.66 $76.80 "$7,492.00 " $348.64 "$4,407.00 " $548.66 $102.54 $123.05 $768.12 $102.40 $548.66 $548.66 $658.39 $143.56 $548.66 $102.54 $102.54 $111.77 $102.40 $108.80 $548.66 $96.00 "$1,124.75 " $548.66 $64.00 $169.19 $86.40 $86.40 $86.40 $86.40 $64.00 $107.67 $102.54 $64.00 $128.00 $548.66 $87.16 $87.16 $102.54 $64.00 "$7,492.00 " 330104 P9012 9511 2062 390 HC CRYOPRECIPITATE EACH UNIT O $96.00 $89.25 $89.25 $675.23 $48.00 $59.52 $59.52 $88.36 $675.23 $169.57 $675.23 $89.25 $72.00 $98.17 $62.40 $70.18 $810.27 $675.23 $57.60 "$7,492.00 " $303.45 "$4,407.00 " $675.23 $89.25 $107.10 $945.32 $76.80 $675.23 $675.23 $810.27 $124.95 $675.23 $89.25 $89.25 $97.28 $76.80 $81.60 $675.23 $72.00 "$1,384.22 " $675.23 $48.00 $147.26 $64.80 $64.80 $64.80 $64.80 $48.00 $93.71 $89.25 $48.00 $96.00 $675.23 $75.86 $75.86 $89.25 $48.00 "$7,492.00 " 330104 P9016 9512 2061 390 HC RBC LEUKOCYTES REDUCED O $690.00 $227.00 $227.00 $548.66 $345.00 $427.80 $427.80 $224.73 $548.66 $431.31 $548.66 $227.00 $517.50 $249.70 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $771.81 "$4,407.00 " $548.66 $227.00 $272.40 $768.12 $552.00 $548.66 $548.66 $658.39 $317.80 $548.66 $227.00 $227.00 $247.43 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $374.55 $465.75 $465.75 $465.75 $465.75 $345.00 $238.35 $227.00 $345.00 $690.00 $548.66 $192.95 $192.95 $227.00 $192.95 "$7,492.00 " 330104 P9038 9505 2061 390 HC RBC IRRADIATED O $690.00 $235.39 $235.39 $548.66 $345.00 $427.80 $427.80 $233.04 $548.66 $447.24 $548.66 $235.39 $517.50 $258.93 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $800.32 "$4,407.00 " $548.66 $235.39 $282.47 $768.12 $552.00 $548.66 $548.66 $658.39 $329.54 $548.66 $235.39 $235.39 $256.57 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $388.39 $465.75 $465.75 $465.75 $465.75 $345.00 $247.16 $235.39 $345.00 $690.00 $548.66 $200.08 $200.08 $235.39 $200.08 "$7,492.00 " 330104 36430 5241 113 391 HC BLOOD TRANSFUSION SERVICE O "$4,136.62 " $489.19 $489.19 $8.00 "$2,068.31 " "$2,564.70 " "$2,564.70 " $484.30 $8.00 $929.47 $8.00 $489.19 "$3,102.47 " $538.11 "$2,688.80 " "$3,023.87 " $9.60 $8.00 "$2,481.97 " "$7,492.00 " "$1,663.26 " "$4,407.00 " $8.00 $489.19 $587.03 $11.20 "$3,309.30 " $8.00 $8.00 $9.60 $684.87 $8.00 $489.19 $489.19 $533.22 "$3,309.30 " "$3,516.13 " $8.00 "$3,102.47 " $16.40 $8.00 "$2,068.31 " $807.17 "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,068.31 " $513.65 $489.19 "$2,068.31 " $8.00 $8.00 $415.81 $415.81 $489.19 $8.00 "$7,492.00 " 330104 77053 5523 389 401 HC X-RAY OF MAMMARY DUCT O "$2,545.53 " $280.16 $280.16 $30.00 "$1,272.77 " $92.84 $84.40 $277.36 $30.00 $532.31 $30.00 $280.16 "$1,909.15 " $308.18 "$1,603.68 " "$1,860.78 " $36.00 $30.00 "$1,527.32 " "$7,492.00 " $952.56 "$1,596.93 " $30.00 $280.16 $336.20 $42.00 "$2,036.42 " $30.00 $30.00 $36.00 $392.23 $30.00 $280.16 $280.16 $305.38 "$2,036.42 " "$2,163.70 " $30.00 "$1,909.15 " $61.50 $30.00 "$1,272.77 " $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $30.00 $30.00 $238.14 $238.14 $280.16 $30.00 "$7,492.00 " 330104 77054 5523 389 401 HC X-RAY OF MAMMARY DUCTS O "$3,203.58 " $280.16 $280.16 $40.00 "$1,601.79 " $119.77 $108.88 $277.36 $40.00 $532.31 $40.00 $280.16 "$2,402.68 " $308.18 "$2,018.26 " "$2,341.82 " $48.00 $40.00 "$1,922.15 " "$7,492.00 " $952.56 "$1,596.93 " $40.00 $280.16 $336.20 $56.00 "$2,562.86 " $40.00 $40.00 $48.00 $392.23 $40.00 $280.16 $280.16 $305.38 "$2,562.86 " "$2,723.04 " $40.00 "$2,402.68 " $82.00 $40.00 "$1,601.79 " $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $40.00 $40.00 $238.14 $238.14 $280.16 $40.00 "$7,492.00 " 330104 77061 286 401 HC BREAST TOMOSYNTHESIS UNILATERAL O $43.87 N/A N/A N/A $21.93 N/A N/A N/A N/A N/A N/A N/A $32.90 N/A $27.64 $32.07 N/A N/A $26.32 "$7,492.00 " N/A N/A N/A N/A $28.52 N/A $35.10 N/A N/A N/A N/A N/A N/A N/A N/A $35.10 $37.29 N/A $32.90 N/A N/A $21.93 $28.52 N/A N/A N/A N/A $192.46 N/A N/A $192.46 N/A N/A N/A N/A N/A $21.93 "$7,492.00 " 330104 77062 286 401 HC BREAST TOMOSYNTHESIS BILATERAL O $57.78 N/A N/A N/A $28.89 N/A N/A N/A N/A N/A N/A N/A $43.34 N/A $36.40 $42.24 N/A N/A $34.67 "$7,492.00 " N/A N/A N/A N/A $37.56 N/A $46.22 N/A N/A N/A N/A N/A N/A N/A N/A $46.22 $49.11 N/A $43.34 N/A N/A $28.89 $37.56 N/A N/A N/A N/A $150.66 N/A N/A $150.66 N/A N/A N/A N/A N/A $28.89 "$7,492.00 " 330104 77065 286 401 HC DX MAMMO INCL CAD UNI O "$1,104.24 " $152.00 $152.00 $97.00 $552.12 $217.36 $197.60 $150.48 $97.00 $288.80 $97.00 $152.00 $828.18 $167.20 $695.67 $807.20 $116.40 $97.00 $662.54 "$7,492.00 " $516.80 $866.41 $97.00 $152.00 $717.76 $135.80 $883.39 $97.00 $97.00 $116.40 $212.80 $97.00 $152.00 $152.00 $165.68 $883.39 $938.60 $130.95 $828.18 $198.85 $130.95 $552.12 $717.76 $239.40 $239.40 $239.40 $239.40 $157.65 $159.60 $152.00 $157.65 $97.00 $97.00 $129.20 $129.20 $152.00 $97.00 "$7,492.00 " 330104 77066 286 401 HC DX MAMMO INCL CAD BI O "$1,370.67 " $191.25 $191.25 $97.00 $685.34 $273.48 $248.62 $189.33 $97.00 $363.37 $97.00 $191.25 "$1,028.00 " $210.37 $863.52 "$1,001.96 " $116.40 $97.00 $822.40 "$7,492.00 " $650.24 "$1,090.11 " $97.00 $191.25 $890.94 $135.80 "$1,096.54 " $97.00 $97.00 $116.40 $267.75 $97.00 $191.25 $191.25 $208.46 "$1,096.54 " "$1,165.07 " $130.95 "$1,028.00 " $198.85 $130.95 $685.34 $890.94 $301.21 $301.21 $301.21 $301.21 $201.14 $200.81 $191.25 $201.14 $97.00 $97.00 $162.56 $162.56 $191.25 $97.00 "$7,492.00 " 330104 76812 470 402 HC OB US DETAILED ADDL FETUS O $659.12 N/A N/A $36.00 $329.56 $327.44 $297.67 $226.69 $36.00 N/A $36.00 N/A $494.34 N/A $415.25 $481.82 $43.20 $36.00 $395.47 "$7,492.00 " N/A N/A $36.00 N/A $428.43 $50.40 $527.30 $36.00 $36.00 $43.20 N/A $36.00 N/A N/A N/A $527.30 $560.25 $48.60 $494.34 $73.80 $48.60 $329.56 $428.43 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $36.00 $36.00 N/A N/A N/A $36.00 "$7,492.00 " 330104 76811 5523 470 402 HC OB US DETAILED SNGL FETUS O "$2,312.27 " $280.16 $280.16 $72.00 "$1,156.13 " $299.40 $272.18 $277.36 $72.00 $532.31 $72.00 $280.16 "$1,734.20 " $308.18 "$1,456.73 " "$1,690.27 " $86.40 $72.00 "$1,387.36 " "$7,492.00 " $952.56 "$1,596.93 " $72.00 $280.16 $336.20 $100.80 "$1,849.82 " $72.00 $72.00 $86.40 $392.23 $72.00 $280.16 $280.16 $305.38 "$1,849.82 " "$1,965.43 " $72.00 "$1,734.20 " $147.60 $72.00 "$1,156.13 " $753.64 $441.26 $441.26 $441.26 $441.26 $244.78 $294.17 $280.16 $244.78 $72.00 $72.00 $238.14 $238.14 $280.16 $72.00 "$7,492.00 " 330104 76810 470 402 HC OB US >/= 14 WKS ADDL FETUS O "$1,035.76 " N/A N/A $41.00 $517.88 $150.88 $137.17 $104.46 $41.00 N/A $41.00 N/A $776.82 N/A $652.53 $757.14 $49.20 $41.00 $621.46 "$7,492.00 " N/A N/A $41.00 N/A $673.24 $57.40 $828.61 $41.00 $41.00 $49.20 N/A $41.00 N/A N/A N/A $828.61 $880.40 $55.35 $776.82 $84.05 $55.35 $517.88 $673.24 N/A N/A N/A N/A $154.05 N/A N/A $154.05 $41.00 $41.00 N/A N/A N/A $41.00 "$7,492.00 " 330104 76805 5522 470 402 HC OB US >/= 14 WKS SNGL FETUS O "$1,035.76 " $128.23 $128.23 $55.00 $517.88 $235.33 $213.93 $126.95 $55.00 $243.63 $55.00 $128.23 $776.82 $141.05 $652.53 $757.14 $66.00 $55.00 $621.46 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 $828.61 $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 $828.61 $880.40 $55.00 $776.82 $112.75 $55.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76802 470 402 HC OB US < 14 WKS ADDL FETUS O $659.12 N/A N/A $41.00 $329.56 $103.33 $93.93 $71.53 $41.00 N/A $41.00 N/A $494.34 N/A $415.25 $481.82 $49.20 $41.00 $395.47 "$7,492.00 " N/A N/A $41.00 N/A $428.43 $57.40 $527.30 $41.00 $41.00 $49.20 N/A $41.00 N/A N/A N/A $527.30 $560.25 $55.35 $494.34 $84.05 $55.35 $329.56 $428.43 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $41.00 $41.00 N/A N/A N/A $41.00 "$7,492.00 " 330104 76801 5522 470 402 HC OB US < 14 WKS SINGLE FETUS O "$1,148.11 " $128.23 $128.23 $55.00 $574.05 $203.08 $184.62 $126.95 $55.00 $243.63 $55.00 $128.23 $861.08 $141.05 $723.31 $839.27 $66.00 $55.00 $688.87 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 $918.49 $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 $918.49 $975.89 $55.00 $861.08 $112.75 $55.00 $574.05 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76800 5522 288 402 HC US EXAM SPINAL CANAL O "$1,170.58 " $128.23 $128.23 $60.00 $585.29 $277.58 $252.35 $126.95 $60.00 $243.63 $60.00 $128.23 $877.93 $141.05 $737.47 $855.69 $72.00 $60.00 $702.35 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $936.46 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $936.46 $994.99 $60.00 $877.93 $123.00 $60.00 $585.29 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76815 5522 470 402 HC OB US LIMITED FETUS(S) O "$1,031.48 " $128.23 $128.23 $25.00 $515.74 $141.63 $128.76 $126.95 $25.00 $243.63 $25.00 $128.23 $773.61 $141.05 $649.83 $754.01 $30.00 $25.00 $618.89 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $825.18 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $825.18 $876.76 $25.00 $773.61 $51.25 $25.00 $515.74 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76814 470 402 HC OB US NUCHAL MEAS ADD-ON O "$1,035.76 " N/A N/A $25.00 $517.88 $125.67 $114.24 $87.00 $25.00 N/A $25.00 N/A $776.82 N/A $652.53 $757.14 $30.00 $25.00 $621.46 "$7,492.00 " N/A N/A $25.00 N/A $673.24 $35.00 $828.61 $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A $828.61 $880.40 $33.75 $776.82 $51.25 $33.75 $517.88 $673.24 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $25.00 $25.00 N/A N/A N/A $25.00 "$7,492.00 " 330104 76857 5522 288 402 HC US EXAM PELVIC LIMITED O $702.99 $128.23 $128.23 $40.00 $351.50 $83.56 $75.96 $126.95 $40.00 $243.63 $40.00 $128.23 $527.24 $141.05 $442.88 $513.89 $48.00 $40.00 $421.79 "$7,492.00 " $435.98 $730.90 $40.00 $128.23 $153.87 $56.00 $562.39 $40.00 $40.00 $48.00 $179.52 $40.00 $128.23 $128.23 $139.77 $562.39 $597.54 $40.00 $527.24 $82.00 $40.00 $351.50 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $40.00 $40.00 $108.99 $108.99 $128.23 $40.00 "$7,492.00 " 330104 76816 5522 470 402 HC OB US FOLLOW-UP PER FETUS O "$1,203.75 " $128.23 $128.23 $25.00 $601.88 $188.39 $171.27 $126.95 $25.00 $243.63 $25.00 $128.23 $902.81 $141.05 $758.36 $879.94 $30.00 $25.00 $722.25 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $963.00 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $963.00 "$1,023.19 " $25.00 $902.81 $51.25 $25.00 $601.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76999 5521 288 402 HC ECHO EXAMINATION PROCEDURE O $439.77 $104.23 $104.23 N/A $219.88 N/A N/A $103.19 N/A $198.04 N/A $104.23 $329.83 $114.66 $277.06 $321.47 N/A N/A $263.86 "$7,492.00 " $354.39 $594.13 N/A $104.23 $125.08 N/A $351.82 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $351.82 $373.80 N/A $329.83 N/A N/A $219.88 $280.39 $164.17 $164.17 $164.17 $164.17 $99.60 $109.45 $104.23 $99.60 N/A N/A $88.60 $88.60 $104.23 $88.60 "$7,492.00 " 330104 76998 472 402 HC US GUIDE INTRAOP O "$2,059.75 " N/A N/A N/A "$1,029.88 " N/A N/A N/A N/A N/A N/A N/A "$1,544.81 " N/A "$1,297.64 " "$1,505.68 " N/A N/A "$1,235.85 " "$7,492.00 " N/A N/A N/A N/A "$1,338.84 " N/A "$1,647.80 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,647.80 " "$1,750.79 " N/A "$1,544.81 " N/A N/A "$1,029.88 " "$1,338.84 " N/A N/A N/A N/A N/A N/A N/A "$1,373.85 " N/A N/A N/A N/A N/A "$1,029.88 " "$7,492.00 " 330104 76981 5522 288 402 HC ULTRASOUND ELASTOGRAPHY; PARENCHYMA (EG ORGAN) O "$1,317.17 " $128.23 $128.23 N/A $658.59 $182.02 $165.48 $126.95 N/A $243.63 N/A $128.23 $987.88 $141.05 $829.82 $962.85 N/A N/A $790.30 "$7,492.00 " $435.98 $730.90 N/A $128.23 $153.87 N/A "$1,053.74 " N/A N/A N/A $179.52 N/A $128.23 $128.23 $139.77 "$1,053.74 " "$1,119.59 " N/A $987.88 N/A N/A $658.59 $344.93 $201.96 $201.96 $201.96 $201.96 $180.02 $134.64 $128.23 $180.02 N/A N/A $108.99 $108.99 $128.23 $108.99 "$7,492.00 " 330104 76946 472 402 HC ECHO GUIDE FOR AMNIOCENTESIS O "$2,059.75 " N/A N/A $20.00 "$1,029.88 " $55.75 $50.68 $38.59 $20.00 N/A $20.00 N/A "$1,544.81 " N/A "$1,297.64 " "$1,505.68 " $24.00 $20.00 "$1,235.85 " "$7,492.00 " N/A N/A $20.00 N/A "$1,338.84 " $28.00 "$1,647.80 " $20.00 $20.00 $24.00 N/A $20.00 N/A N/A N/A "$1,647.80 " "$1,750.79 " $27.00 "$1,544.81 " $41.00 $27.00 "$1,029.88 " "$1,338.84 " N/A N/A N/A N/A N/A N/A N/A "$1,373.85 " $20.00 $20.00 N/A N/A N/A $20.00 "$7,492.00 " 330104 76942 472 402 HC ECHO GUIDE FOR BIOPSY O "$1,365.32 " N/A N/A $55.00 $682.66 $99.78 $90.71 $69.08 $55.00 N/A $55.00 N/A "$1,023.99 " N/A $860.15 $998.05 $66.00 $55.00 $819.19 "$7,492.00 " N/A N/A $55.00 N/A $887.46 $77.00 "$1,092.26 " $55.00 $55.00 $66.00 N/A $55.00 N/A N/A N/A "$1,092.26 " "$1,160.52 " $74.25 "$1,023.99 " $112.75 $74.25 $682.66 $887.46 N/A N/A N/A N/A N/A N/A N/A $910.67 $55.00 $55.00 N/A N/A N/A $55.00 "$7,492.00 " 330104 76937 472 402 HC US GUIDE VASCULAR ACCESS O $667.68 N/A N/A $55.00 $333.84 $69.16 $62.87 $47.88 $55.00 N/A $55.00 N/A $500.76 N/A $420.64 $488.07 $66.00 $55.00 $400.61 "$7,492.00 " N/A N/A $55.00 N/A $433.99 $77.00 $534.14 $55.00 $55.00 $66.00 N/A $55.00 N/A N/A N/A $534.14 $567.53 $74.25 $500.76 $112.75 $74.25 $333.84 $433.99 N/A N/A N/A N/A N/A N/A N/A $445.34 $55.00 $55.00 N/A N/A N/A $47.88 "$7,492.00 " 330104 76936 5722 474 402 HC ECHO GUIDE FOR ARTERY REPAIR O "$1,332.15 " $336.00 $336.00 $358.61 $666.08 $454.51 $413.19 $332.64 $358.61 $638.40 $358.61 $336.00 $999.11 $369.60 $839.25 $973.80 $430.34 $358.61 $799.29 "$7,492.00 " "$1,142.40 " "$1,915.20 " $358.61 $336.00 $403.20 $502.06 "$1,065.72 " $358.61 $358.61 $430.34 $470.40 $358.61 $336.00 $336.00 $366.24 "$1,065.72 " "$1,132.33 " $358.61 $999.11 $735.16 $358.61 $666.08 $903.84 $529.20 $529.20 $529.20 $529.20 $170.37 $352.80 $336.00 $170.37 $358.61 $358.61 $285.60 $285.60 $336.00 $170.37 "$7,492.00 " 330104 76886 5521 288 402 HC US EXAM INFANT HIPS STATIC O $342.40 $104.23 $104.23 $25.00 $171.20 $176.51 $160.46 $103.19 $25.00 $198.04 $25.00 $104.23 $256.80 $114.66 $215.71 $250.29 $30.00 $25.00 $205.44 "$7,492.00 " $354.39 $594.13 $25.00 $104.23 $125.08 $35.00 $273.92 $25.00 $25.00 $30.00 $145.93 $25.00 $104.23 $104.23 $113.61 $273.92 $291.04 $25.00 $256.80 $51.25 $25.00 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $99.60 $109.45 $104.23 $99.60 $25.00 $25.00 $88.60 $88.60 $104.23 $25.00 "$7,492.00 " 330104 76882 5522 288 402 HC US XTR NON-VASC LMTD O "$1,250.83 " $128.23 $128.23 $9.87 $625.41 $71.44 $64.94 $126.95 $9.87 $243.63 $9.87 $128.23 $938.12 $141.05 $788.02 $914.36 $11.84 $9.87 $750.50 "$7,492.00 " $435.98 $730.90 $9.87 $128.23 $153.87 $13.82 "$1,000.66 " $9.87 $9.87 $11.84 $179.52 $9.87 $128.23 $128.23 $139.77 "$1,000.66 " "$1,063.21 " $9.87 $938.12 $20.23 $9.87 $625.41 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $9.87 $9.87 $108.99 $108.99 $128.23 $9.87 "$7,492.00 " 330104 76881 5522 288 402 HC US XTR NON-VASC COMPLETE O "$1,250.83 " $128.23 $128.23 $36.55 $625.41 $90.41 $82.19 $126.95 $36.55 $243.63 $36.55 $128.23 $938.12 $141.05 $788.02 $914.36 $43.86 $36.55 $750.50 "$7,492.00 " $435.98 $730.90 $36.55 $128.23 $153.87 $51.17 "$1,000.66 " $36.55 $36.55 $43.86 $179.52 $36.55 $128.23 $128.23 $139.77 "$1,000.66 " "$1,063.21 " $36.55 $938.12 $74.93 $36.55 $625.41 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $36.55 $36.55 $108.99 $108.99 $128.23 $36.55 "$7,492.00 " 330104 76873 5522 289 402 HC ECHOGRAP TRANS R PROS STUDY O "$1,907.81 " $128.23 $128.23 $60.00 $953.90 $299.70 $272.45 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,430.86 " $141.05 "$1,201.92 " "$1,394.61 " $72.00 $60.00 "$1,144.69 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,526.25 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,526.25 " "$1,621.64 " $60.00 "$1,430.86 " $123.00 $60.00 $953.90 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76776 5522 288 402 HC US EXAM K TRANSPL W/DOPPLER O "$1,365.32 " $128.23 $128.23 $60.00 $682.66 $259.38 $235.80 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,023.99 " $141.05 $860.15 $998.05 $72.00 $60.00 $819.19 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,092.26 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,092.26 " "$1,160.52 " $60.00 "$1,023.99 " $123.00 $60.00 $682.66 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76872 5522 288 402 HC US TRANSRECTAL O "$2,571.21 " $128.23 $128.23 $60.00 "$1,285.61 " $351.06 $319.15 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,928.41 " $141.05 "$1,619.86 " "$1,879.55 " $72.00 $60.00 "$1,542.73 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$2,056.97 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$2,056.97 " "$2,185.53 " $60.00 "$1,928.41 " $123.00 $60.00 "$1,285.61 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76856 5522 289 402 HC US EXAM PELVIC COMPLETE O "$1,501.21 " $128.23 $128.23 $55.00 $750.61 $184.20 $167.46 $126.95 $55.00 $243.63 $55.00 $128.23 "$1,125.91 " $141.05 $945.76 "$1,097.38 " $66.00 $55.00 $900.73 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 "$1,200.97 " $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 "$1,200.97 " "$1,276.03 " $55.00 "$1,125.91 " $112.75 $55.00 $750.61 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76831 5523 289 402 HC ECHO EXAM UTERUS O "$2,451.37 " $280.16 $280.16 $28.00 "$1,225.68 " $201.71 $183.37 $277.36 $28.00 $532.31 $28.00 $280.16 "$1,838.53 " $308.18 "$1,544.36 " "$1,791.95 " $33.60 $28.00 "$1,470.82 " "$7,492.00 " $952.56 "$1,596.93 " $28.00 $280.16 $336.20 $39.20 "$1,961.10 " $28.00 $28.00 $33.60 $392.23 $28.00 $280.16 $280.16 $305.38 "$1,961.10 " "$2,083.66 " $28.00 "$1,838.53 " $57.40 $28.00 "$1,225.68 " $753.64 $441.26 $441.26 $441.26 $441.26 $244.78 $294.17 $280.16 $244.78 $28.00 $28.00 $238.14 $238.14 $280.16 $28.00 "$7,492.00 " 330104 76830 5522 288 402 HC TRANSVAGINAL US NON-OB O "$2,571.21 " $128.23 $128.23 $60.00 "$1,285.61 " $209.46 $190.42 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,928.41 " $141.05 "$1,619.86 " "$1,879.55 " $72.00 $60.00 "$1,542.73 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$2,056.97 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$2,056.97 " "$2,185.53 " $60.00 "$1,928.41 " $123.00 $60.00 "$1,285.61 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76828 5522 470 402 HC DOPPLER ECHO EXAM OF FETAL HEART; F/U/REPEAT STUDY O "$1,035.76 " $128.23 $128.23 $25.00 $517.88 $83.16 $75.60 $126.95 $25.00 $243.63 $25.00 $128.23 $776.82 $141.05 $652.53 $757.14 $30.00 $25.00 $621.46 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $828.61 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $828.61 $880.40 $25.00 $776.82 $51.25 $25.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76827 5522 470 402 HC DOPPLER ECHO EXAM OF FETAL HEART;COMPLETE O "$1,599.65 " $128.23 $128.23 $25.00 $799.83 $119.96 $109.05 $126.95 $25.00 $243.63 $25.00 $128.23 "$1,199.74 " $141.05 "$1,007.78 " "$1,169.34 " $30.00 $25.00 $959.79 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,279.72 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,279.72 " "$1,359.70 " $25.00 "$1,199.74 " $51.25 $25.00 $799.83 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76825 5524 470 402 HC ECHO EXAM OF FETAL HEART O "$2,220.25 " $603.63 $603.63 $25.00 "$1,110.12 " $453.84 $412.58 $597.59 $25.00 "$1,146.89 " $25.00 $603.63 "$1,665.19 " $663.99 "$1,398.76 " "$1,623.00 " $30.00 $25.00 "$1,332.15 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $25.00 $603.63 $724.35 $35.00 "$1,776.20 " $25.00 $25.00 $30.00 $845.08 $25.00 $603.63 $603.63 $657.95 "$1,776.20 " "$1,887.21 " $25.00 "$1,665.19 " $51.25 $25.00 "$1,110.12 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $899.44 $633.81 $603.63 $899.44 $25.00 $25.00 $513.08 $513.08 $603.63 $25.00 "$7,492.00 " 330104 76821 5522 470 402 HC MIDDLE CEREBRAL ARTERY ECHO O $836.74 $128.23 $128.23 $29.78 $418.37 $152.53 $138.66 $126.95 $29.78 $243.63 $29.78 $128.23 $627.56 $141.05 $527.15 $611.66 $35.74 $29.78 $502.04 "$7,492.00 " $435.98 $730.90 $29.78 $128.23 $153.87 $41.69 $669.39 $29.78 $29.78 $35.74 $179.52 $29.78 $128.23 $128.23 $139.77 $669.39 $711.23 $29.78 $627.56 $61.05 $29.78 $418.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $29.78 $29.78 $108.99 $108.99 $128.23 $29.78 "$7,492.00 " 330104 76820 5522 470 402 HC UMBILICAL ARTERY ECHO O $836.74 $128.23 $128.23 $12.79 $418.37 $75.98 $69.07 $126.95 $12.79 $243.63 $12.79 $128.23 $627.56 $141.05 $527.15 $611.66 $15.35 $12.79 $502.04 "$7,492.00 " $435.98 $730.90 $12.79 $128.23 $153.87 $17.91 $669.39 $12.79 $12.79 $15.35 $179.52 $12.79 $128.23 $128.23 $139.77 $669.39 $711.23 $12.79 $627.56 $26.22 $12.79 $418.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $12.79 $12.79 $108.99 $108.99 $128.23 $12.79 "$7,492.00 " 330104 76819 5522 470 402 HC FETAL BIOPHYS PROFIL W/O NST O "$2,224.53 " $128.23 $128.23 $35.00 "$1,112.27 " $143.78 $130.70 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,668.40 " $141.05 "$1,401.45 " "$1,626.13 " $42.00 $35.00 "$1,334.72 " "$7,492.00 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,779.62 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,779.62 " "$1,890.85 " $35.00 "$1,668.40 " $71.75 $35.00 "$1,112.27 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$7,492.00 " 330104 76818 5522 470 402 HC FETAL BIOPHYS PROFILE W/NST O "$1,516.19 " $128.23 $128.23 $35.00 $758.10 $200.81 $182.55 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,137.14 " $141.05 $955.20 "$1,108.33 " $42.00 $35.00 $909.71 "$7,492.00 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,212.95 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,212.95 " "$1,288.76 " $35.00 "$1,137.14 " $71.75 $35.00 $758.10 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$7,492.00 " 330104 76817 5522 470 402 HC TRANSVAGINAL US OBSTETRIC O $659.12 $128.23 $128.23 $60.00 $329.56 $160.85 $146.22 $126.95 $60.00 $243.63 $60.00 $128.23 $494.34 $141.05 $415.25 $481.82 $72.00 $60.00 $395.47 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $527.30 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $527.30 $560.25 $60.00 $494.34 $123.00 $60.00 $329.56 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76870 5522 288 402 HC US EXAM SCROTUM O "$1,346.06 " $128.23 $128.23 $30.00 $673.03 $176.36 $160.33 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,009.54 " $141.05 $848.02 $983.97 $36.00 $30.00 $807.64 "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,076.85 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,076.85 " "$1,144.15 " $30.00 "$1,009.54 " $61.50 $30.00 $673.03 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 76775 5522 288 402 HC US EXAM ABDO BACK WALL LIM O "$1,545.08 " $128.23 $128.23 $60.00 $772.54 $102.22 $92.93 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,158.81 " $141.05 $973.40 "$1,129.45 " $72.00 $60.00 $927.05 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,236.06 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,236.06 " "$1,313.32 " $60.00 "$1,158.81 " $123.00 $60.00 $772.54 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76813 5522 470 402 HC OB US NUCHAL MEAS 1 GEST O "$1,035.76 " $128.23 $128.23 $39.00 $517.88 $200.47 $182.24 $126.95 $39.00 $243.63 $39.00 $128.23 $776.82 $141.05 $652.53 $757.14 $46.80 $39.00 $621.46 "$7,492.00 " $435.98 $730.90 $39.00 $128.23 $153.87 $54.60 $828.61 $39.00 $39.00 $46.80 $179.52 $39.00 $128.23 $128.23 $139.77 $828.61 $880.40 $39.00 $776.82 $79.95 $39.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $39.00 $39.00 $108.99 $108.99 $128.23 $39.00 "$7,492.00 " 330104 76706 5522 288 402 HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA O $480.43 $128.23 $128.23 $22.25 $240.22 $187.02 $170.02 $126.95 $22.25 $243.63 $22.25 $128.23 $360.32 $141.05 $302.67 $351.19 $26.70 $22.25 $288.26 "$7,492.00 " $435.98 $730.90 $22.25 $128.23 $153.87 $31.15 $384.34 $22.25 $22.25 $26.70 $179.52 $22.25 $128.23 $128.23 $139.77 $384.34 $408.37 $22.25 $360.32 $45.61 $22.25 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $180.30 $134.64 $128.23 $180.30 $22.25 $22.25 $108.99 $108.99 $128.23 $22.25 "$7,492.00 " 330104 76770 5522 289 402 HC US EXAM ABDO BACK WALL COMP O "$1,170.58 " $128.23 $128.23 $60.00 $585.29 $189.11 $171.92 $126.95 $60.00 $243.63 $60.00 $128.23 $877.93 $141.05 $737.47 $855.69 $72.00 $60.00 $702.35 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $936.46 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $936.46 $994.99 $60.00 $877.93 $123.00 $60.00 $585.29 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 0690T 288 402 HC QUANTITATIVE US TISS CHARAC I&R W/DX US SM ANAT O $267.50 N/A N/A N/A $133.75 N/A N/A N/A N/A N/A N/A N/A $200.62 N/A $168.53 $195.54 N/A N/A $160.50 "$7,492.00 " N/A N/A N/A N/A $173.88 N/A $214.00 N/A N/A N/A N/A N/A N/A N/A N/A $214.00 $227.38 N/A $200.62 N/A N/A $133.75 $173.88 N/A N/A N/A N/A N/A N/A N/A $178.42 N/A N/A N/A N/A N/A $133.75 "$7,492.00 " 330104 76506 5522 288 402 HC ECHO EXAM OF HEAD O "$1,432.73 " $128.23 $128.23 $30.00 $716.37 $198.17 $180.15 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,074.55 " $141.05 $902.62 "$1,047.33 " $36.00 $30.00 $859.64 "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,146.18 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,146.18 " "$1,217.82 " $30.00 "$1,074.55 " $61.50 $30.00 $716.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 76536 5522 288 402 HC US EXAM OF HEAD AND NECK O "$1,687.39 " $128.23 $128.23 $30.00 $843.70 $195.17 $177.43 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,265.54 " $141.05 "$1,063.06 " "$1,233.48 " $36.00 $30.00 "$1,012.43 " "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,349.91 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,349.91 " "$1,434.28 " $30.00 "$1,265.54 " $61.50 $30.00 $843.70 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 0689T 5521 288 402 HC QUAN US TISS CHARAC I&R W/O DX US SAME ANAT O $214.00 $104.23 $104.23 N/A $107.00 N/A N/A $103.19 N/A $198.04 N/A $104.23 $160.50 $114.66 $134.82 $156.43 N/A N/A $128.40 "$7,492.00 " $354.39 $594.13 N/A $104.23 $125.08 N/A $171.20 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $171.20 $181.90 N/A $160.50 N/A N/A $107.00 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $142.74 N/A N/A $88.60 $88.60 $104.23 $88.60 "$7,492.00 " 330104 76641 5522 288 402 HC US BREAST UNIL INCLUD.AXILLA COMPLETE O "$1,324.66 " $128.23 $128.23 $32.47 $662.33 $179.79 $163.45 $126.95 $32.47 $243.63 $32.47 $128.23 $993.50 $141.05 $834.54 $968.33 $38.96 $32.47 $794.80 "$7,492.00 " $435.98 $730.90 $32.47 $128.23 $153.87 $45.46 "$1,059.73 " $32.47 $32.47 $38.96 $179.52 $32.47 $128.23 $128.23 $139.77 "$1,059.73 " "$1,125.96 " $32.47 $993.50 $66.56 $32.47 $662.33 $344.93 $201.96 $201.96 $201.96 $201.96 $146.66 $134.64 $128.23 $146.66 $32.47 $32.47 $108.99 $108.99 $128.23 $32.47 "$7,492.00 " 330104 76642 5521 288 402 HC US BREAST UNIL INCLUD.AXILLA LIMITED O "$1,324.66 " $104.23 $104.23 $26.66 $662.33 $147.87 $134.42 $103.19 $26.66 $198.04 $26.66 $104.23 $993.50 $114.66 $834.54 $968.33 $31.99 $26.66 $794.80 "$7,492.00 " $354.39 $594.13 $26.66 $104.23 $125.08 $37.32 "$1,059.73 " $26.66 $26.66 $31.99 $145.93 $26.66 $104.23 $104.23 $113.61 "$1,059.73 " "$1,125.96 " $26.66 $993.50 $54.65 $26.66 $662.33 $280.39 $164.17 $164.17 $164.17 $164.17 $146.66 $109.45 $104.23 $146.66 $26.66 $26.66 $88.60 $88.60 $104.23 $26.66 "$7,492.00 " 330104 76700 5522 289 402 HC US EXAM ABDOM COMPLETE O "$1,756.94 " $128.23 $128.23 $60.00 $878.47 $202.68 $184.25 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,317.70 " $141.05 "$1,106.87 " "$1,284.32 " $72.00 $60.00 "$1,054.16 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,405.55 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,405.55 " "$1,493.40 " $60.00 "$1,317.70 " $123.00 $60.00 $878.47 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76705 5522 288 402 HC US/ECHO OF ABDOMEN O $870.98 $128.23 $128.23 $40.00 $435.49 $153.83 $139.85 $126.95 $40.00 $243.63 $40.00 $128.23 $653.24 $141.05 $548.72 $636.69 $48.00 $40.00 $522.59 "$7,492.00 " $435.98 $730.90 $40.00 $128.23 $153.87 $56.00 $696.78 $40.00 $40.00 $48.00 $179.52 $40.00 $128.23 $128.23 $139.77 $696.78 $740.33 $40.00 $653.24 $82.00 $40.00 $435.49 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $40.00 $40.00 $108.99 $108.99 $128.23 $40.00 "$7,492.00 " 330104 76604 5522 288 402 HC US EXAM CHEST O $907.36 $128.23 $128.23 $25.00 $453.68 $98.04 $89.12 $126.95 $25.00 $243.63 $25.00 $128.23 $680.52 $141.05 $571.64 $663.28 $30.00 $25.00 $544.42 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $725.89 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $725.89 $771.26 $25.00 $680.52 $51.25 $25.00 $453.68 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 77067 286 403 HC SCR MAMMO BI INCL CAD O "$1,269.02 " $155.96 $155.96 $97.00 $634.51 $223.03 $202.75 $154.40 $97.00 $296.33 $97.00 $155.96 $951.76 $171.56 $799.48 $927.65 $116.40 $97.00 $761.41 "$7,492.00 " $530.27 $888.98 $97.00 $155.96 $824.86 $135.80 "$1,015.22 " $97.00 $97.00 $116.40 $218.35 $97.00 $155.96 $155.96 $170.00 "$1,015.22 " "$1,078.67 " $130.95 $951.76 $198.85 $130.95 $634.51 $824.86 $245.64 $245.64 $245.64 $245.64 $166.35 $163.76 $155.96 $166.35 $97.00 $97.00 $132.57 $132.57 $155.96 $97.00 "$7,492.00 " 330104 77063 286 403 HC BREAST TOMOSYNTHESIS SCREENING BILAT O $57.78 $63.21 $63.21 $10.11 $28.89 $90.38 $82.17 $62.57 $10.11 $120.09 $10.11 $63.21 $43.34 $69.53 $36.40 $42.24 $12.13 $10.11 $34.67 "$7,492.00 " $214.90 $360.27 $10.11 $63.21 $37.56 $14.15 $46.22 $10.11 $10.11 $12.13 $88.49 $10.11 $63.21 $63.21 $68.89 $46.22 $49.11 $13.65 $43.34 $20.73 $13.65 $28.89 $37.56 $99.55 $99.55 $99.55 $99.55 $41.25 $66.37 $63.21 $41.25 $10.11 $10.11 $53.72 $53.72 $63.21 $10.11 "$7,492.00 " 330104 78816 5594 290 404 HC PET IMAGE W/CT FULL BODY O "$6,156.78 " "$1,786.83 " "$1,786.83 " $870.00 "$3,078.39 " N/A N/A "$1,768.96 " $870.00 "$3,394.98 " $870.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " "$1,044.00 " $870.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $870.00 "$1,786.83 " "$2,144.20 " "$1,218.00 " "$4,925.42 " $870.00 $870.00 "$1,044.00 " "$2,501.57 " $870.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $870.00 "$4,617.59 " "$1,783.50 " $870.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $870.00 $870.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $870.00 "$10,184.95 " 330104 78815 5594 290 404 HC PET IMAGE W/CT SKULL-THIGH O "$6,156.78 " "$1,786.83 " "$1,786.83 " $676.00 "$3,078.39 " N/A N/A "$1,768.96 " $676.00 "$3,394.98 " $676.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $811.20 $676.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $676.00 "$1,786.83 " "$2,144.20 " $946.40 "$4,925.42 " $676.00 $676.00 $811.20 "$2,501.57 " $676.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $676.00 "$4,617.59 " "$1,385.80 " $676.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $676.00 $676.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $676.00 "$10,184.95 " 330104 78814 5594 290 404 HC PET IMAGE W/CT LMTD O "$6,156.78 " "$1,786.83 " "$1,786.83 " $387.00 "$3,078.39 " N/A N/A "$1,768.96 " $387.00 "$3,394.98 " $387.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $464.40 $387.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $387.00 "$1,786.83 " "$2,144.20 " $541.80 "$4,925.42 " $387.00 $387.00 $464.40 "$2,501.57 " $387.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $387.00 "$4,617.59 " $793.35 $387.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $387.00 $387.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $387.00 "$10,184.95 " 330104 78608 5594 290 404 HC BRAIN IMAGING (PET) O "$6,156.78 " "$1,786.83 " "$1,786.83 " $742.00 "$3,078.39 " N/A N/A "$1,768.96 " $742.00 "$3,394.98 " $742.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $890.40 $742.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $742.00 "$1,786.83 " "$2,144.20 " "$1,038.80 " "$4,925.42 " $742.00 $742.00 $890.40 "$2,501.57 " $742.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $742.00 "$4,617.59 " "$1,521.10 " $742.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $742.00 $742.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $742.00 "$10,184.95 " 330104 78434 290 404 HC AQMBF PET REST AND PHARMACOLOGIC STRESS O $910.57 N/A N/A N/A $455.29 N/A N/A N/A N/A N/A N/A N/A $682.93 N/A $573.66 $665.63 N/A N/A $546.34 "$7,492.00 " N/A N/A N/A N/A $591.87 N/A $728.46 N/A N/A N/A N/A N/A N/A N/A N/A $728.46 $773.98 N/A $682.93 N/A N/A $455.29 $591.87 N/A N/A N/A N/A "$3,951.00 " N/A N/A "$4,300.00 " N/A N/A N/A N/A N/A $455.29 "$7,492.00 " 330104 78433 1521 290 404 HC MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT O "$11,735.76 " "$2,340.09 " "$2,340.09 " "$1,609.62 " "$5,867.88 " N/A N/A "$2,316.69 " "$1,609.62 " "$4,446.18 " "$1,609.62 " "$2,340.09 " "$8,801.82 " "$2,574.10 " "$7,393.53 " "$8,578.84 " "$1,931.54 " "$1,609.62 " "$7,041.46 " "$7,492.00 " "$7,956.32 " "$13,338.53 " "$1,609.62 " "$2,340.09 " "$2,808.11 " "$2,253.47 " "$9,388.61 " "$1,609.62 " "$1,609.62 " "$1,931.54 " "$3,276.13 " "$1,609.62 " "$2,340.09 " "$2,340.09 " "$2,550.70 " "$9,388.61 " "$9,975.40 " "$1,609.62 " "$8,801.82 " "$3,299.72 " "$1,609.62 " "$5,867.88 " "$6,294.85 " "$3,685.65 " "$3,685.65 " "$3,685.65 " "$3,685.65 " "$4,400.80 " "$2,457.10 " "$2,340.09 " "$4,400.80 " "$1,609.62 " "$1,609.62 " "$1,989.08 " "$1,989.08 " "$2,340.09 " "$1,609.62 " "$13,338.53 " 330104 78430 5594 290 404 HC MYOCRD IMG PET RST/STRS W/CT O "$6,158.92 " "$1,786.83 " "$1,786.83 " $60.62 "$3,079.46 " N/A N/A "$1,768.96 " $60.62 "$3,394.98 " $60.62 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $72.74 $60.62 "$3,695.35 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $60.62 "$1,786.83 " "$2,144.20 " $84.87 "$4,927.14 " $60.62 $60.62 $72.74 "$2,501.57 " $60.62 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $60.62 "$4,619.19 " $124.27 $60.62 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $60.62 $60.62 "$1,518.81 " "$1,518.81 " "$1,786.83 " $60.62 "$10,184.95 " 330104 78429 5594 290 404 HC MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT O "$6,158.92 " "$1,786.83 " "$1,786.83 " $63.32 "$3,079.46 " N/A N/A "$1,768.96 " $63.32 "$3,394.98 " $63.32 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $75.98 $63.32 "$3,695.35 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $63.32 "$1,786.83 " "$2,144.20 " $88.65 "$4,927.14 " $63.32 $63.32 $75.98 "$2,501.57 " $63.32 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $63.32 "$4,619.19 " $129.81 $63.32 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $63.32 $63.32 "$1,518.81 " "$1,518.81 " "$1,786.83 " $63.32 "$10,184.95 " 330104 78431 1523 290 404 HC MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT O "$9,616.09 " "$3,299.88 " "$3,299.88 " "$1,129.62 " "$4,808.05 " N/A N/A "$3,266.89 " "$1,129.62 " "$6,269.78 " "$1,129.62 " "$3,299.88 " "$7,212.07 " "$3,629.87 " "$6,058.14 " "$7,029.36 " "$1,355.54 " "$1,129.62 " "$5,769.65 " "$7,492.00 " "$11,219.61 " "$18,809.34 " "$1,129.62 " "$3,299.88 " "$3,959.86 " "$1,581.47 " "$7,692.87 " "$1,129.62 " "$1,129.62 " "$1,355.54 " "$4,619.84 " "$1,129.62 " "$3,299.88 " "$3,299.88 " "$3,596.87 " "$7,692.87 " "$8,173.68 " "$1,129.62 " "$7,212.07 " "$2,315.72 " "$1,129.62 " "$4,808.05 " "$8,876.69 " "$5,197.32 " "$5,197.32 " "$5,197.32 " "$5,197.32 " "$3,600.80 " "$3,464.88 " "$3,299.88 " "$3,600.80 " "$1,129.62 " "$1,129.62 " "$2,804.90 " "$2,804.90 " "$3,299.88 " "$1,129.62 " "$18,809.34 " 330104 94002 5801 67 410 HC VENT MGMT INPAT INIT DAY O "$2,142.14 " $667.92 $667.92 $190.31 N/A "$1,328.13 " "$1,328.13 " $661.24 $190.31 "$1,269.05 " $190.31 $667.92 "$1,606.61 " $734.71 "$1,392.39 " "$1,565.90 " $228.38 $190.31 "$1,285.28 " "$7,492.00 " "$2,270.93 " "$4,407.00 " $190.31 $667.92 $801.50 $266.44 "$1,713.71 " $190.31 $190.31 $228.38 $935.09 $190.31 $667.92 $667.92 $728.03 "$1,713.71 " "$1,820.82 " $190.31 "$1,606.61 " $390.14 $190.31 "$1,071.07 " "$1,102.07 " "$1,445.94 " "$1,445.94 " "$1,445.94 " "$1,445.94 " N/A $701.32 $667.92 "$1,428.81 " $190.31 $190.31 $567.73 $567.73 $667.92 $190.31 "$7,492.00 " 330104 94640 5791 412 410 HC AIRWAY INHALATION TREATMENT O $878.47 $229.75 $229.75 $3.00 N/A $544.65 $544.65 $227.45 $3.00 $436.53 $3.00 $229.75 $658.85 $252.73 $571.01 $642.16 $3.60 $3.00 $527.08 "$7,492.00 " $781.15 "$4,407.00 " $3.00 $229.75 $275.70 $4.20 $702.78 $3.00 $3.00 $3.60 $321.65 $3.00 $229.75 $229.75 $250.43 $702.78 $746.70 $3.00 $658.85 $6.15 $3.00 $439.24 $379.09 $592.97 $592.97 $592.97 $592.97 N/A $241.24 $229.75 $585.94 $3.00 $3.00 $195.29 $195.29 $229.75 $3.00 "$7,492.00 " 330104 94003 5801 67 410 HC VENT MGMT INPAT SUBQ DAY O "$2,142.14 " $667.92 $667.92 $190.31 N/A "$1,328.13 " "$1,328.13 " $661.24 $190.31 "$1,269.05 " $190.31 $667.92 "$1,606.61 " $734.71 "$1,392.39 " "$1,565.90 " $228.38 $190.31 "$1,285.28 " "$7,492.00 " "$2,270.93 " "$4,407.00 " $190.31 $667.92 $801.50 $266.44 "$1,713.71 " $190.31 $190.31 $228.38 $935.09 $190.31 $667.92 $667.92 $728.03 "$1,713.71 " "$1,820.82 " $190.31 "$1,606.61 " $390.14 $190.31 "$1,071.07 " "$1,102.07 " "$1,445.94 " "$1,445.94 " "$1,445.94 " "$1,445.94 " N/A $701.32 $667.92 "$1,428.81 " $190.31 $190.31 $567.73 $567.73 $667.92 $190.31 "$7,492.00 " 330104 94667 5734 412 410 HC CHEST WALL MANIPULATION INITIAL O $503.97 $139.30 $139.30 $74.80 N/A $312.46 $312.46 $137.91 $74.80 $264.67 $74.80 $139.30 $377.98 $153.23 $327.58 $368.40 $89.76 $74.80 $302.38 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 $403.18 $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 $403.18 $428.37 $74.80 $377.98 $153.34 $74.80 $251.99 $229.85 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 31720 5791 412 410 HC NASOTRACHEAL SUCTIONING O "$1,642.45 " $229.75 $229.75 $74.80 "$1,878.00 " "$1,018.32 " "$1,018.32 " $227.45 $74.80 $436.53 $74.80 $229.75 "$1,231.84 " $252.73 "$1,067.59 " "$1,200.63 " $89.76 $74.80 $985.47 "$7,492.00 " $781.15 "$4,407.00 " $74.80 $229.75 $275.70 $104.72 "$1,313.96 " $74.80 $74.80 $89.76 $321.65 $74.80 $229.75 $229.75 $250.43 "$1,313.96 " "$1,396.08 " $74.80 "$1,231.84 " $153.34 $74.80 $821.23 $379.09 "$1,108.65 " "$1,108.65 " "$1,108.65 " "$1,108.65 " N/A $241.24 $229.75 "$1,095.51 " $74.80 $74.80 $195.29 $195.29 $229.75 $74.80 "$7,492.00 " 330104 G0239 5732 66 410 HC PULMONARY REHAB GROUP O $182.97 $40.74 $40.74 N/A N/A $113.44 $113.44 $40.34 N/A $77.41 N/A $40.74 $137.23 $44.82 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $138.53 "$4,407.00 " N/A $40.74 $48.89 N/A $146.38 N/A N/A N/A $57.04 N/A $40.74 $40.74 $44.41 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $67.23 $123.50 $123.50 $123.50 $123.50 N/A $42.78 $40.74 $122.04 N/A N/A $34.63 $34.63 $40.74 $34.63 "$7,492.00 " 330104 G0238 5731 66 410 HC OTH RESP PROC INDIV O $182.97 $29.95 $29.95 N/A N/A $113.44 $113.44 $29.65 N/A $56.90 N/A $29.95 $137.23 $32.94 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $101.81 "$4,407.00 " N/A $29.95 $35.93 N/A $146.38 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $49.41 $123.50 $123.50 $123.50 $123.50 N/A $31.44 $29.95 $122.04 N/A N/A $25.45 $25.45 $29.95 $25.45 "$7,492.00 " 330104 G0237 5731 66 410 HC THERAPEUTIC PROCD STRG ENDUR O $182.97 $29.95 $29.95 N/A N/A $113.44 $113.44 $29.65 N/A $56.90 N/A $29.95 $137.23 $32.94 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $101.81 "$4,407.00 " N/A $29.95 $35.93 N/A $146.38 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $49.41 $123.50 $123.50 $123.50 $123.50 N/A $31.44 $29.95 $122.04 N/A N/A $25.45 $25.45 $29.95 $25.45 "$7,492.00 " 330104 94668 5734 412 410 HC CHEST WALL MANIPULATION SUBSEQUENT O $503.97 $139.30 $139.30 $74.80 N/A $312.46 $312.46 $137.91 $74.80 $264.67 $74.80 $139.30 $377.98 $153.23 $327.58 $368.40 $89.76 $74.80 $302.38 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 $403.18 $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 $403.18 $428.37 $74.80 $377.98 $153.34 $74.80 $251.99 $229.85 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 94644 5734 412 410 HC CBT 1ST HOUR O "$1,520.47 " $139.30 $139.30 $74.80 N/A $942.69 $942.69 $137.91 $74.80 $264.67 $74.80 $139.30 "$1,140.35 " $153.23 $988.31 "$1,111.46 " $89.76 $74.80 $912.28 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 "$1,216.38 " $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 "$1,216.38 " "$1,292.40 " $74.80 "$1,140.35 " $153.34 $74.80 $760.24 $229.85 "$1,026.32 " "$1,026.32 " "$1,026.32 " "$1,026.32 " N/A $146.27 $139.30 "$1,014.15 " $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 94645 412 410 HC CBT EACH ADDL HOUR O "$1,142.76 " N/A N/A $74.80 N/A $708.51 $708.51 $19.48 $74.80 N/A $74.80 N/A $857.07 N/A $742.79 $835.36 $89.76 $74.80 $685.66 "$7,492.00 " N/A "$4,407.00 " $74.80 N/A $742.79 $104.72 $914.21 $74.80 $74.80 $89.76 N/A $74.80 N/A N/A N/A $914.21 $971.35 $100.98 $857.07 $153.34 $100.98 $571.38 $742.79 $771.36 $771.36 $771.36 $771.36 N/A N/A N/A $762.22 $74.80 $74.80 N/A N/A N/A $19.48 "$7,492.00 " 330104 94660 5791 2020 410 HC POS AIRWAY PRESSURE CPAP O "$1,683.11 " $229.75 $229.75 $190.32 N/A "$1,043.53 " "$1,043.53 " $227.45 $190.32 $436.53 $190.32 $229.75 "$1,262.33 " $252.73 "$1,094.02 " "$1,230.35 " $228.38 $190.32 "$1,009.87 " "$7,492.00 " $781.15 "$4,407.00 " $190.32 $229.75 $275.70 $266.45 "$1,346.49 " $190.32 $190.32 $228.38 $321.65 $190.32 $229.75 $229.75 $250.43 "$1,346.49 " "$1,430.64 " $190.32 "$1,262.33 " $390.15 $190.32 $841.55 $379.09 "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $241.24 $229.75 "$1,122.63 " $190.32 $190.32 $195.29 $195.29 $229.75 $190.32 "$7,492.00 " 330104 94664 5791 412 410 HC EVALUATE PT USE OF INHALER O $878.47 $229.75 $229.75 $3.00 N/A $544.65 $544.65 $227.45 $3.00 $436.53 $3.00 $229.75 $658.85 $252.73 $571.01 $642.16 $3.60 $3.00 $527.08 "$7,492.00 " $781.15 "$4,407.00 " $3.00 $229.75 $275.70 $4.20 $702.78 $3.00 $3.00 $3.60 $321.65 $3.00 $229.75 $229.75 $250.43 $702.78 $746.70 $3.00 $658.85 $6.15 $3.00 $439.24 $379.09 $592.97 $592.97 $592.97 $592.97 N/A $241.24 $229.75 $585.94 $3.00 $3.00 $195.29 $195.29 $229.75 $3.00 "$7,492.00 " 330104 G0277 5061 17 413 HC HBOT FULL BODY CHAMBER PER 30MIN O "$1,966.66 " $150.05 $150.05 $705.44 $983.33 "$1,219.33 " "$1,219.33 " $148.55 $705.44 $285.10 $705.44 $150.05 "$1,475.00 " $165.06 "$1,278.33 " "$1,298.00 " $846.53 $705.44 "$1,180.00 " "$4,377.00 " $510.18 "$4,407.00 " $705.44 $150.05 $180.06 "$4,415.94 " "$1,573.33 " "$4,415.94 " $705.44 $846.53 $210.07 $705.44 $150.05 $150.05 $163.56 "$1,573.33 " "$1,671.66 " $705.44 "$1,475.00 " "$1,446.16 " $705.44 $983.33 $247.58 "$1,327.50 " "$1,327.50 " "$1,327.50 " "$1,327.50 " N/A $157.55 $150.05 "$1,311.76 " $705.44 $705.44 $127.54 $127.54 $150.05 $127.54 "$4,415.94 " 330104 99183 2003 413 HC HBO TREATMENT - PHYS. NP & PA SUPRVSION O "$2,123.95 " $127.46 $127.46 N/A "$1,061.97 " "$1,316.85 " "$1,316.85 " $126.18 N/A $242.17 N/A $127.46 "$1,592.96 " $140.20 "$1,380.57 " "$1,298.00 " N/A N/A "$1,274.37 " "$4,377.00 " $537.00 $912.00 N/A $127.46 "$1,380.57 " "$4,769.12 " "$1,699.16 " "$4,769.12 " N/A N/A $178.44 N/A $127.46 $127.46 $138.93 "$1,699.16 " "$1,805.36 " N/A "$1,592.96 " N/A N/A "$1,061.97 " "$1,380.57 " "$1,433.67 " "$1,433.67 " "$1,433.67 " "$1,433.67 " N/A $133.83 $127.46 "$1,416.67 " N/A N/A $108.34 $108.34 $127.46 $108.34 "$4,769.12 " 330104 97750 269 420 HC PHYSICAL PERFORMANCE TEST O $318.86 $39.47 $39.47 $72.07 $159.43 $197.69 $197.69 $39.08 $181.00 $238.00 $181.00 $125.00 $239.15 $43.42 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $39.47 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $55.26 $72.07 $39.47 $39.47 $43.03 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $41.45 $39.47 $396.00 $181.18 $190.00 $33.55 $33.55 $39.47 $33.55 "$7,492.00 " 330104 97760 269 420 HC ORTHOTIC MGMT AND TRAINING O $318.86 $57.28 $57.28 $72.07 $159.43 $197.69 $197.69 $56.71 $181.00 $238.00 $181.00 $125.00 $239.15 $63.01 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $57.28 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $80.19 $72.07 $57.28 $57.28 $62.44 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $60.15 $57.28 $396.00 $181.18 $190.00 $48.69 $48.69 $57.28 $48.69 "$7,492.00 " 330104 97016 493 420 HC VASOPNEUMATIC DEVICE THERAPY O $185.11 $13.79 $13.79 $25.56 $92.56 $114.77 $114.77 $13.66 $181.00 $238.00 $181.00 $125.00 $138.83 $15.17 $275.27 $294.00 $30.68 $25.56 $111.07 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $13.79 $120.32 $35.79 $476.00 $25.56 $25.56 $30.68 $19.31 $25.56 $13.79 $13.79 $15.04 $148.09 $157.34 $34.51 $223.00 $52.40 $34.51 $92.56 $120.32 $124.95 $124.95 $124.95 $124.95 $375.00 $14.48 $13.79 $396.00 $181.18 $190.00 $11.73 $11.73 $13.79 $11.73 "$7,492.00 " 330104 97110 269 420 HC THERAPEUTIC EXERCISES O $332.77 $34.13 $34.13 $72.07 $166.38 $206.32 $206.32 $33.79 $181.00 $238.00 $181.00 $125.00 $249.58 $37.55 $275.27 $294.00 $86.49 $72.07 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $34.13 $216.30 $100.90 $476.00 $72.07 $72.07 $86.49 $47.79 $72.07 $34.13 $34.13 $37.21 $266.22 $282.85 $97.30 $223.00 $147.75 $97.30 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $29.01 "$7,492.00 " 330104 97116 493 420 HC GAIT TRAINING THERAPY O $332.77 $34.13 $34.13 $25.56 $166.38 $206.32 $206.32 $33.79 $181.00 $238.00 $181.00 $125.00 $249.58 $37.55 $275.27 $294.00 $30.68 $25.56 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $34.13 $216.30 $35.79 $476.00 $25.56 $25.56 $30.68 $47.79 $25.56 $34.13 $34.13 $37.21 $266.22 $282.85 $34.51 $223.00 $52.40 $34.51 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $25.56 "$7,492.00 " 330104 97799 493 420 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $238.00 $181.00 $125.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $476.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 97530 269 420 HC THERAPEUTIC ACTIVITIES O $182.97 $43.63 $43.63 $2.35 $91.48 $113.44 $113.44 $43.20 $181.00 $238.00 $181.00 $125.00 $137.23 $48.00 $275.27 $294.00 $2.82 $2.35 $109.78 "$7,492.00 " $220.00 "$4,407.00 " $2.35 $43.63 $118.93 $3.29 $476.00 $2.35 $2.35 $2.82 $61.09 $2.35 $43.63 $43.63 $47.56 $146.38 $155.52 $3.17 $223.00 $4.82 $3.17 $91.48 $118.93 $123.50 $123.50 $123.50 $123.50 $375.00 $45.82 $43.63 $396.00 $181.18 $190.00 $37.09 $37.09 $43.63 $2.35 "$7,492.00 " 330104 97535 493 420 HC SELF CARE MNGMENT TRAINING O $361.66 $38.24 $38.24 $25.56 $180.83 $224.23 $224.23 $37.86 $181.00 $238.00 $181.00 $125.00 $271.25 $42.07 $275.27 $294.00 $30.68 $25.56 $217.00 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $38.24 $235.08 $35.79 $476.00 $25.56 $25.56 $30.68 $53.54 $25.56 $38.24 $38.24 $41.68 $289.33 $307.41 $34.51 $223.00 $52.40 $34.51 $180.83 $235.08 $244.12 $244.12 $244.12 $244.12 $375.00 $40.15 $38.24 $396.00 $181.18 $190.00 $32.51 $32.51 $38.24 $25.56 "$7,492.00 " 330104 97537 269 420 HC COMMUNITY/WORK REINTEGRATION O $318.86 $36.85 $36.85 $72.07 $159.43 $197.69 $197.69 $36.48 $181.00 $238.00 $181.00 $125.00 $239.15 $40.54 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $36.85 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $51.59 $72.07 $36.85 $36.85 $40.17 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $38.69 $36.85 $396.00 $181.18 $190.00 $31.32 $31.32 $36.85 $31.32 "$7,492.00 " 330104 97112 269 420 HC NEUROMUSCULAR REEDUCATION O $318.86 $39.21 $39.21 $72.07 $159.43 $197.69 $197.69 $38.82 $181.00 $238.00 $181.00 $125.00 $239.15 $43.13 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $39.21 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $54.89 $72.07 $39.21 $39.21 $42.74 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $41.17 $39.21 $396.00 $181.18 $190.00 $33.33 $33.33 $39.21 $33.33 "$7,492.00 " 330104 97161 271 424 HC PT EVAL LOW COMPLEX 20 MIN O $637.72 $116.56 $116.56 $126.55 $318.86 $395.39 $395.39 $115.39 $181.00 $238.00 $181.00 $125.00 $478.29 $128.21 $275.27 $294.00 $151.87 $126.55 $382.63 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $414.52 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $510.18 $542.06 $170.85 $223.00 $259.44 $170.85 $318.86 $414.52 $430.46 $430.46 $430.46 $430.46 $375.00 $318.86 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97163 271 424 HC PT EVAL HIGH COMPLEX 45 MIN O $758.63 $116.56 $116.56 $126.55 $379.31 $470.35 $470.35 $115.39 $181.00 $238.00 $181.00 $125.00 $568.97 $128.21 $275.27 $294.00 $151.87 $126.55 $455.18 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $493.11 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $606.90 $644.84 $170.85 $223.00 $259.44 $170.85 $379.31 $493.11 $512.08 $512.08 $512.08 $512.08 $375.00 $379.31 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97164 271 424 HC PT RE-EVAL EST PLAN CARE O $449.40 $81.84 $81.84 $126.55 $224.70 $278.63 $278.63 $81.02 $181.00 $238.00 $181.00 $125.00 $337.05 $90.02 $275.27 $294.00 $151.87 $126.55 $269.64 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $81.84 $292.11 $140.00 $476.00 $140.00 $126.55 $151.87 $114.57 $126.55 $81.84 $81.84 $89.20 $359.52 $381.99 $170.85 $223.00 $259.44 $170.85 $224.70 $292.11 $303.35 $303.35 $303.35 $303.35 $375.00 $224.70 $81.84 $396.00 $181.18 $190.00 $69.56 $69.56 $81.84 $69.56 "$7,492.00 " 330104 97162 271 424 HC PT EVAL MOD COMPLEX 30 MIN O $728.67 $116.56 $116.56 $126.55 $364.33 $451.78 $451.78 $115.39 $181.00 $238.00 $181.00 $125.00 $546.50 $128.21 $275.27 $294.00 $151.87 $126.55 $437.20 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $473.64 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $582.94 $619.37 $170.85 $223.00 $259.44 $170.85 $364.33 $473.64 $491.85 $491.85 $491.85 $491.85 $375.00 $364.33 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97799 493 430 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE - OT O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $239.00 $181.00 $126.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $631.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 29085 5101 39 430 HC APPLY HAND/WRIST CAST O $679.45 $174.87 $174.87 $293.16 $339.73 $421.26 $421.26 $173.13 $181.00 $239.00 $181.00 $126.00 $509.59 $192.36 $275.27 $294.00 $351.80 $293.16 $407.67 "$7,492.00 " $220.00 "$4,407.00 " $293.16 $174.87 $209.85 $410.43 $631.00 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $543.56 $577.53 $293.16 $223.00 $600.98 $293.16 $339.73 $259.00 $458.63 $458.63 $458.63 $458.63 $375.00 $183.62 $174.87 $396.00 $181.18 $190.00 $148.64 $148.64 $174.87 $126.00 "$7,492.00 " 330104 97110 269 430 HC OT THERAPEUTIC EXERCISES O $332.77 $34.13 $34.13 $72.07 $166.38 $206.32 $206.32 $33.79 $181.00 $239.00 $181.00 $126.00 $249.58 $37.55 $275.27 $294.00 $86.49 $72.07 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $34.13 $216.30 $100.90 $631.00 $72.07 $72.07 $86.49 $47.79 $72.07 $34.13 $34.13 $37.21 $266.22 $282.85 $97.30 $223.00 $147.75 $97.30 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $29.01 "$7,492.00 " 330104 97116 493 430 HC OT GAIT TRAINING O $332.77 $34.13 $34.13 $25.56 $166.38 $206.32 $206.32 $33.79 $181.00 $239.00 $181.00 $126.00 $249.58 $37.55 $275.27 $294.00 $30.68 $25.56 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $34.13 $216.30 $35.79 $631.00 $25.56 $25.56 $30.68 $47.79 $25.56 $34.13 $34.13 $37.21 $266.22 $282.85 $34.51 $223.00 $52.40 $34.51 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $25.56 "$7,492.00 " 330104 97530 269 430 HC OT THERAPEUTIC ACTIVITIES O $182.97 $43.63 $43.63 $2.35 $91.48 $113.44 $113.44 $43.20 $181.00 $239.00 $181.00 $126.00 $137.23 $48.00 $275.27 $294.00 $2.82 $2.35 $109.78 "$7,492.00 " $220.00 "$4,407.00 " $2.35 $43.63 $118.93 $3.29 $631.00 $2.35 $2.35 $2.82 $61.09 $2.35 $43.63 $43.63 $47.56 $146.38 $155.52 $3.17 $223.00 $4.82 $3.17 $91.48 $118.93 $123.50 $123.50 $123.50 $123.50 $375.00 $45.82 $43.63 $396.00 $181.18 $190.00 $37.09 $37.09 $43.63 $2.35 "$7,492.00 " 330104 97535 493 430 HC OT SELF CARE MNGMENT TRAINING O $361.66 $38.24 $38.24 $25.56 $180.83 $224.23 $224.23 $37.86 $181.00 $239.00 $181.00 $126.00 $271.25 $42.07 $275.27 $294.00 $30.68 $25.56 $217.00 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $38.24 $235.08 $35.79 $631.00 $25.56 $25.56 $30.68 $53.54 $25.56 $38.24 $38.24 $41.68 $289.33 $307.41 $34.51 $223.00 $52.40 $34.51 $180.83 $235.08 $244.12 $244.12 $244.12 $244.12 $375.00 $40.15 $38.24 $396.00 $181.18 $190.00 $32.51 $32.51 $38.24 $25.56 "$7,492.00 " 330104 97760 269 430 HC OT ORTHOTIC MGMT AND TRAINING O $318.86 $57.28 $57.28 $72.07 $159.43 $197.69 $197.69 $56.71 $181.00 $239.00 $181.00 $126.00 $239.15 $63.01 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $57.28 $207.26 $100.90 $631.00 $72.07 $72.07 $86.49 $80.19 $72.07 $57.28 $57.28 $62.44 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $60.15 $57.28 $396.00 $181.18 $190.00 $48.69 $48.69 $57.28 $48.69 "$7,492.00 " 330104 97166 270 434 HC OT DRIVER EVAL MOD COMPLEX 45 MIN O $588.50 $116.56 $116.56 $134.22 $294.25 $364.87 $364.87 $115.39 $181.00 $239.00 $181.00 $126.00 $441.38 $128.21 $275.27 $294.00 $161.07 $134.22 $353.10 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $382.53 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $470.80 $500.22 $181.20 $223.00 $275.16 $181.20 $294.25 $382.53 $397.24 $397.24 $397.24 $397.24 $375.00 $294.25 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97167 270 434 HC OT EVAL HIGH COMPLEX 60 MIN O $758.63 $116.56 $116.56 $134.22 $379.31 $470.35 $470.35 $115.39 $181.00 $239.00 $181.00 $126.00 $568.97 $128.21 $275.27 $294.00 $161.07 $134.22 $455.18 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $493.11 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $606.90 $644.84 $181.20 $223.00 $275.16 $181.20 $379.31 $493.11 $512.08 $512.08 $512.08 $512.08 $375.00 $379.31 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97165 270 434 HC OT EVAL LOW COMPLEX 30 MIN O $590.64 $116.56 $116.56 $134.22 $295.32 $366.20 $366.20 $115.39 $181.00 $239.00 $181.00 $126.00 $442.98 $128.21 $275.27 $294.00 $161.07 $134.22 $354.38 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $383.92 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $472.51 $502.04 $181.20 $223.00 $275.16 $181.20 $295.32 $383.92 $398.68 $398.68 $398.68 $398.68 $375.00 $295.32 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97130 269 440 HC ST THER IVNTJ EA ADDL 15 MIN O $98.44 $24.12 $24.12 $72.07 $49.22 $61.03 $61.03 $23.88 $181.00 $258.00 $181.00 $136.00 $73.83 $26.53 $275.27 $294.00 $86.49 $72.07 $59.06 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $24.12 $63.99 $100.90 $639.00 $72.07 $72.07 $86.49 $33.77 $72.07 $24.12 $24.12 $26.29 $78.75 $83.67 $97.30 $223.00 $147.75 $97.30 $49.22 $63.99 $66.45 $66.45 $66.45 $66.45 $375.00 $25.33 $24.12 $396.00 $181.18 $190.00 $20.50 $20.50 $24.12 $20.50 "$7,492.00 " 330104 97129 269 440 HC ST THER IVNTJ 1ST 15 MIN O $103.79 $24.83 $24.83 $72.07 $51.90 $64.35 $64.35 $24.59 $181.00 $258.00 $181.00 $136.00 $77.84 $27.32 $275.27 $294.00 $86.49 $72.07 $62.27 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $24.83 $67.46 $100.90 $639.00 $72.07 $72.07 $86.49 $34.77 $72.07 $24.83 $24.83 $27.07 $83.03 $88.22 $97.30 $223.00 $147.75 $97.30 $51.90 $67.46 $70.06 $70.06 $70.06 $70.06 $375.00 $26.08 $24.83 $396.00 $181.18 $190.00 $21.11 $21.11 $24.83 $21.11 "$7,492.00 " 330104 96125 310 440 HC COGNITIVE TEST BY HC PRO O $485.78 $118.51 $118.51 $153.40 $242.89 $301.18 $301.18 $117.32 $181.00 $258.00 $181.00 $136.00 $364.33 $130.36 $275.27 $294.00 $184.08 $153.40 $291.47 "$7,492.00 " $220.00 "$4,407.00 " $153.40 $118.51 $315.76 $214.76 $639.00 $153.40 $153.40 $184.08 $165.91 $153.40 $118.51 $118.51 $129.17 $388.62 $412.91 $207.09 $223.00 $314.47 $207.09 $242.89 $315.76 $327.90 $327.90 $327.90 $327.90 $375.00 $124.43 $118.51 $396.00 $181.18 $190.00 $100.73 $100.73 $118.51 $100.73 "$7,492.00 " 330104 97799 493 440 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE - ST O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $258.00 $181.00 $136.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $639.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 92524 272 440 HC BEHAVRAL QUALIT ANALYS VOICE O "$1,530.10 " $126.75 $126.75 $29.03 $765.05 $948.66 $948.66 $125.48 $181.00 $258.00 $181.00 $136.00 "$1,147.57 " $139.43 $275.27 $294.00 $34.84 $29.03 $918.06 "$7,492.00 " $220.00 "$4,407.00 " $29.03 $126.75 $994.56 $40.64 $639.00 $29.03 $29.03 $34.84 $177.45 $29.03 $126.75 $126.75 $138.16 "$1,224.08 " "$1,300.58 " $39.19 $223.00 $59.51 $39.19 $765.05 $994.56 "$1,032.82 " "$1,032.82 " "$1,032.82 " "$1,032.82 " $375.00 $133.09 $126.75 $396.00 $181.18 $190.00 $107.74 $107.74 $126.75 $29.03 "$7,492.00 " 330104 92523 272 440 HC SPEECH SOUND LANG COMPREHEN O $849.58 $262.28 $262.28 $57.84 $424.79 $526.74 $526.74 $259.66 $181.00 $258.00 $181.00 $136.00 $637.19 $288.51 $275.27 $294.00 $69.41 $57.84 $509.75 "$7,492.00 " $220.00 "$4,407.00 " $57.84 $262.28 $552.23 $80.98 $639.00 $57.84 $57.84 $69.41 $367.20 $57.84 $262.28 $262.28 $285.89 $679.66 $722.14 $78.08 $223.00 $118.57 $78.08 $424.79 $552.23 $573.47 $573.47 $573.47 $573.47 $375.00 $275.40 $262.28 $396.00 $181.18 $190.00 $222.94 $222.94 $262.28 $57.84 "$7,492.00 " 330104 92507 272 440 HC SPEECH/HEARING THERAPY; INDIVIDUAL O $511.46 $88.25 $88.25 $4.70 $255.73 $317.11 $317.11 $87.37 $181.00 $258.00 $181.00 $136.00 $383.59 $97.08 $275.27 $294.00 $5.64 $4.70 $306.88 "$7,492.00 " $220.00 "$4,407.00 " $4.70 $88.25 $332.45 $6.58 $639.00 $4.70 $4.70 $5.64 $123.56 $4.70 $88.25 $88.25 $96.20 $409.17 $434.74 $6.35 $223.00 $9.63 $6.35 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 $375.00 $92.67 $88.25 $396.00 $181.18 $190.00 $75.02 $75.02 $88.25 $4.70 "$7,492.00 " 330104 92526 269 440 HC ORAL FUNCTION THERAPY O $511.46 $98.31 $98.31 $72.07 $255.73 $317.11 $317.11 $97.33 $181.00 $258.00 $181.00 $136.00 $383.59 $108.14 $275.27 $294.00 $86.49 $72.07 $306.88 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $98.31 $332.45 $100.90 $639.00 $72.07 $72.07 $86.49 $137.64 $72.07 $98.31 $98.31 $107.16 $409.17 $434.74 $97.30 $223.00 $147.75 $97.30 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 $375.00 $103.23 $98.31 $396.00 $181.18 $190.00 $83.56 $83.56 $98.31 $72.07 "$7,492.00 " 330104 92611 389 444 HC MOTION FLUOROSCOPY/SWALLOW O "$1,021.85 " $108.01 $108.01 $258.22 $510.93 $633.55 $633.55 $106.93 $181.00 $258.00 $181.00 $136.00 $766.39 $118.81 $275.27 $294.00 $309.86 $258.22 $613.11 "$7,492.00 " $220.00 "$4,407.00 " $258.22 $108.01 $664.20 $140.00 $639.00 $140.00 $258.22 $309.86 $151.21 $258.22 $108.01 $108.01 $117.73 $817.48 $868.57 $348.60 $223.00 $529.35 $348.60 $510.93 $664.20 $689.75 $689.75 $689.75 $689.75 $375.00 $510.93 $108.01 $396.00 $181.18 $190.00 $91.81 $91.81 $108.01 $91.81 "$7,492.00 " 330104 92610 272 444 HC EVALUATE SWALLOWING FUNCTION O "$1,530.10 " $80.04 $80.04 $122.72 $765.05 $948.66 $948.66 $79.24 $181.00 $258.00 $181.00 $136.00 "$1,147.57 " $88.04 $275.27 $294.00 $147.26 $122.72 $918.06 "$7,492.00 " $220.00 "$4,407.00 " $122.72 $80.04 $994.56 $140.00 $639.00 $140.00 $122.72 $147.26 $112.06 $122.72 $80.04 $80.04 $87.24 "$1,224.08 " "$1,300.58 " $165.67 $223.00 $251.57 $165.67 $765.05 $994.56 "$1,032.82 " "$1,032.82 " "$1,032.82 " "$1,032.82 " $375.00 $765.05 $80.04 $396.00 $181.18 $190.00 $68.03 $68.03 $80.04 $68.03 "$7,492.00 " 330104 27266 5112 44 450 HC CLOSED RX POST HIP FIX DISLOCANESTH O "$5,510.50 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$2,523.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$4,132.88 " "$1,893.16 " N/A "$3,763.67 " "$1,209.40 " "$1,007.83 " "$3,306.30 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,408.40 " "$4,683.93 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$2,755.25 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,675.50 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$4,683.93 " 330104 27788 5111 41 450 HC CLSD TX DIST FIB FX/LAT MALL W/ MANIP O "$1,213.38 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $910.04 $273.19 N/A $828.74 $656.27 $546.89 $728.03 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $970.70 "$1,031.37 " $546.89 N/A "$1,121.12 " $546.89 $606.69 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $809.32 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27762 5112 41 450 HC CLTX MED ANKLE FX W/MNPJ O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 27560 5111 41 450 HC CLSD TX PATELLAR DISL O "$1,031.48 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $773.61 $273.19 N/A $704.50 $656.27 $546.89 $618.89 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $825.18 $876.76 $546.89 N/A "$1,121.12 " $546.89 $515.74 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $688.00 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27550 5111 41 450 HC CLSD TX KNEE DISLOC O $955.51 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $716.63 $273.19 N/A $652.61 $656.27 $546.89 $573.31 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $764.41 $812.18 $546.89 N/A "$1,121.12 " $546.89 $477.75 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $637.33 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27265 5111 41 450 HC CLSD TX DISLOC TOTAL HIP O $971.56 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $728.67 $273.19 N/A $663.58 $656.27 $546.89 $582.94 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $777.25 $825.83 $546.89 N/A "$1,121.12 " $546.89 $485.78 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $648.03 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 26742 5112 41 450 HC CLSD TX FING JT FX W/M O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 27250 5111 41 450 HC CLSD TX HIP DISL TRAUMATIC O $843.16 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $632.37 $273.19 N/A $575.88 $656.27 $546.89 $505.90 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $674.53 $716.69 $546.89 N/A "$1,121.12 " $546.89 $421.58 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $562.39 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27220 5111 41 450 HC CLSD TX HIP SOCKET FX W/O MANIP O "$1,092.47 " $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $819.35 $273.19 N/A $746.16 $656.27 $546.89 $655.48 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $873.98 $928.60 $546.89 N/A "$1,121.12 " $546.89 $546.24 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $728.68 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26755 5111 41 450 HC CLSD TX DISTAL PHAL W/ MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26700 5111 41 450 HC CLSD TX MCP DISL SINGLE W/ MANIP O $802.50 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $601.88 $273.19 N/A $548.11 $656.27 $546.89 $481.50 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $642.00 $682.12 $546.89 N/A "$1,121.12 " $546.89 $401.25 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $535.27 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26641 5111 41 450 HC CLSD TX CARPO/METAC DISL THUMB W/MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26410 5112 33 450 HC REPAIR HAND TENDON O "$5,674.21 " "$1,721.05 " "$1,721.05 " "$1,376.65 " "$2,886.00 " N/A N/A "$1,703.84 " "$1,376.65 " "$3,270.00 " "$1,376.65 " "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " "$1,651.98 " "$1,376.65 " "$3,404.53 " N/A N/A N/A "$1,376.65 " "$1,721.05 " "$2,065.26 " "$1,927.31 " N/A "$1,376.65 " "$1,376.65 " "$1,651.98 " "$2,409.47 " "$1,376.65 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " "$1,376.65 " N/A "$2,822.14 " "$1,376.65 " "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " "$1,376.65 " "$1,376.65 " N/A "$1,462.89 " "$1,721.05 " "$1,376.65 " "$4,823.08 " 330104 27256 5111 41 450 HC TX SPONTANEOUS HIP DISL W/O MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 27810 5112 41 450 HC CLSD TX BIMALLEOLAR ANK FX W/ MANIP O "$5,783.35 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,337.51 " "$1,893.16 " N/A "$3,950.03 " $656.27 $546.89 "$3,470.01 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,626.68 " "$4,915.85 " $546.89 N/A "$1,121.12 " $546.89 "$2,891.68 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,857.49 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,915.85 " 330104 27840 5111 41 450 HC TREAT ANKLE DISLOCATION O $843.16 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $632.37 $273.19 N/A $575.88 $656.27 $546.89 $505.90 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $674.53 $716.69 $546.89 N/A "$1,121.12 " $546.89 $421.58 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $562.39 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 25565 5112 41 450 HC CLSD TX RAD & ULNAR SJAFT FX W/MANIP O "$8,556.79 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " $656.27 $546.89 "$5,134.07 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " $546.89 N/A "$1,121.12 " $546.89 "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$7,273.27 " 330104 31238 5153 63 450 HC NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG O "$6,179.25 " "$1,917.86 " "$1,917.86 " "$1,833.44 " "$1,878.00 " N/A N/A "$1,898.68 " "$1,833.44 " "$3,643.93 " "$1,833.44 " "$1,917.86 " "$4,634.44 " "$2,109.64 " N/A "$4,220.43 " "$2,200.13 " "$1,833.44 " "$3,707.55 " N/A N/A N/A "$1,833.44 " "$1,917.86 " "$2,301.43 " "$2,566.82 " N/A "$1,833.44 " "$1,833.44 " "$2,200.13 " "$2,685.00 " "$1,833.44 " "$1,917.86 " "$1,917.86 " "$2,090.46 " "$4,943.40 " "$5,252.36 " "$1,833.44 " N/A "$3,758.56 " "$1,833.44 " "$3,089.62 " N/A N/A N/A N/A N/A N/A "$2,013.75 " "$1,917.86 " "$4,121.56 " "$1,833.44 " "$1,833.44 " N/A "$1,630.18 " "$1,917.86 " "$1,630.18 " "$5,252.36 " 330104 31500 5161 92 450 HC INSERT EMERGENCY AIRWAY O "$2,546.60 " $249.34 $249.34 $623.67 $482.00 N/A N/A $246.85 $623.67 $473.75 $623.67 $249.34 "$1,909.95 " $274.28 N/A "$1,739.33 " $748.41 $623.67 "$1,527.96 " N/A N/A N/A $623.67 $249.34 $299.21 $873.14 N/A $623.67 $623.67 $748.41 $349.08 $623.67 $249.34 $249.34 $271.78 "$2,037.28 " "$2,164.61 " $623.67 N/A "$1,278.53 " $623.67 "$1,273.30 " N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$1,698.58 " $623.67 $623.67 N/A $211.94 $249.34 $211.94 "$2,164.61 " 330104 31605 5161 72 450 HC TRACHEOSTOMY EMERGENCY; CRICOTHYROID MEMBRANE O "$3,170.41 " $249.34 $249.34 "$2,170.70 " "$1,099.00 " N/A N/A $246.85 "$2,170.70 " $473.75 "$2,170.70 " $249.34 "$2,377.81 " $274.28 N/A "$2,165.39 " "$2,604.84 " "$2,170.70 " "$1,902.25 " N/A N/A N/A "$2,170.70 " $249.34 $299.21 "$3,038.98 " N/A "$2,170.70 " "$2,170.70 " "$2,604.84 " $349.08 "$2,170.70 " $249.34 $249.34 $271.78 "$2,536.33 " "$2,694.85 " "$2,170.70 " N/A "$4,449.94 " "$2,170.70 " "$1,585.20 " N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$2,114.66 " "$2,170.70 " "$2,170.70 " N/A $211.94 $249.34 $211.94 "$4,449.94 " 330104 36680 5735 49 450 HC INSERT NEEDLE BONE CAVITY O "$1,676.69 " $452.99 $452.99 $318.87 $482.00 N/A N/A $448.46 $318.87 $860.67 $318.87 $452.99 "$1,257.52 " $498.28 N/A "$1,145.18 " $382.65 $318.87 "$1,006.01 " N/A N/A N/A $318.87 $452.99 $543.58 $446.42 N/A $318.87 $318.87 $382.65 $634.18 $318.87 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $318.87 N/A $653.69 $318.87 $838.35 N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,118.35 " $318.87 $318.87 N/A $385.04 $452.99 $318.87 "$1,425.19 " 330104 37195 5694 111 450 HC THROMBOLYTIC THERAPY STROKE O "$2,168.89 " $399.06 $399.06 $291.54 $482.00 N/A N/A $395.07 $291.54 $758.21 $291.54 $399.06 "$1,626.67 " $438.96 N/A "$1,481.35 " $349.84 $291.54 "$1,301.33 " N/A N/A N/A $291.54 $399.06 $478.87 $408.15 N/A $291.54 $291.54 $349.84 $558.68 $291.54 $399.06 $399.06 $434.97 "$1,735.11 " "$1,843.56 " $291.54 N/A $597.65 $291.54 "$1,084.44 " N/A N/A N/A N/A N/A N/A $419.01 $399.06 "$1,446.65 " $291.54 $291.54 N/A $339.20 $399.06 $291.54 "$1,843.56 " 330104 40650 5162 249 450 HC REPAIR LIP FULL THICKNESS; VERMILION ONLY O "$3,154.36 " $548.07 $548.07 $145.68 "$2,886.00 " N/A N/A $542.58 $145.68 "$1,041.32 " $145.68 $548.07 "$2,365.77 " $602.87 N/A "$2,154.43 " $174.82 $145.68 "$1,892.62 " N/A N/A N/A $145.68 $548.07 $657.68 $203.96 N/A $145.68 $145.68 $174.82 $767.29 $145.68 $548.07 $548.07 $597.39 "$2,523.49 " "$2,681.21 " $145.68 N/A $298.65 $145.68 "$1,577.18 " N/A N/A N/A N/A N/A N/A $575.47 $548.07 "$2,103.96 " $145.68 $145.68 N/A $465.86 $548.07 $145.68 "$2,886.00 " 330104 40652 5162 249 450 HC REPAIR LIP FULL THICKNESS; UPTO HALF VERTICL HEGHT O "$1,887.48 " $548.07 $548.07 $145.68 "$2,886.00 " N/A N/A $542.58 $145.68 "$1,041.32 " $145.68 $548.07 "$1,415.61 " $602.87 N/A "$1,289.15 " $174.82 $145.68 "$1,132.49 " N/A N/A N/A $145.68 $548.07 $657.68 $203.96 N/A $145.68 $145.68 $174.82 $767.29 $145.68 $548.07 $548.07 $597.39 "$1,509.98 " "$1,604.36 " $145.68 N/A $298.65 $145.68 $943.74 N/A N/A N/A N/A N/A N/A $575.47 $548.07 "$1,258.95 " $145.68 $145.68 N/A $465.86 $548.07 $145.68 "$2,886.00 " 330104 40654 5163 252 450 HC REPAIR LIP FULL THICK;OVR ONE-HALF VERT HT/CMPLX O "$5,350.00 " "$1,665.41 " "$1,665.41 " "$1,354.83 " "$2,886.00 " N/A N/A "$1,648.75 " "$1,354.83 " "$3,164.27 " "$1,354.83 " "$1,665.41 " "$4,012.50 " "$1,831.95 " N/A "$3,654.05 " "$1,625.80 " "$1,354.83 " "$3,210.00 " N/A N/A N/A "$1,354.83 " "$1,665.41 " "$1,998.49 " "$1,896.77 " N/A "$1,354.83 " "$1,354.83 " "$1,625.80 " "$2,331.57 " "$1,354.83 " "$1,665.41 " "$1,665.41 " "$1,815.29 " "$4,280.00 " "$4,547.50 " "$1,354.83 " N/A "$2,777.41 " "$1,354.83 " "$2,675.00 " N/A N/A N/A N/A N/A N/A "$1,748.68 " "$1,665.41 " "$3,568.45 " "$1,354.83 " "$1,354.83 " N/A "$1,415.60 " "$1,665.41 " "$1,354.83 " "$4,547.50 " 330104 40830 5161 249 450 HC CLS LACERATION VESTIBULE OF MOUTH; 2.5 CM OR LESS O "$1,722.70 " $249.34 $249.34 $145.68 "$1,099.00 " N/A N/A $246.85 $145.68 $473.75 $145.68 $249.34 "$1,292.03 " $274.28 N/A "$1,176.60 " $174.82 $145.68 "$1,033.62 " N/A N/A N/A $145.68 $249.34 $299.21 $203.96 N/A $145.68 $145.68 $174.82 $349.08 $145.68 $249.34 $249.34 $271.78 "$1,378.16 " "$1,464.30 " $145.68 N/A $298.65 $145.68 $861.35 N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$1,149.04 " $145.68 $145.68 N/A $211.94 $249.34 $145.68 "$1,464.30 " 330104 41800 5734 249 450 HC DRAINAGE OF GUM LESION O $506.11 $139.30 $139.30 $145.68 "$1,878.00 " N/A N/A $137.91 $145.68 $264.67 $145.68 $139.30 $379.58 $153.23 N/A $345.67 $174.82 $145.68 $303.67 N/A N/A N/A $145.68 $139.30 $167.16 $203.96 N/A $145.68 $145.68 $174.82 $195.02 $145.68 $139.30 $139.30 $151.84 $404.89 $430.19 $145.68 N/A $298.65 $145.68 $253.06 N/A N/A N/A N/A N/A N/A $146.27 $139.30 $337.58 $145.68 $145.68 N/A $118.41 $139.30 $118.41 "$1,878.00 " 330104 42809 5735 249 450 HC REMOVE PHARYNX FOREIGN BODY O "$2,189.22 " $452.99 $452.99 $145.68 $482.00 N/A N/A $448.46 $145.68 $860.67 $145.68 $452.99 "$1,641.92 " $498.28 N/A "$1,495.24 " $174.82 $145.68 "$1,313.53 " N/A N/A N/A $145.68 $452.99 $543.58 $203.96 N/A $145.68 $145.68 $174.82 $634.18 $145.68 $452.99 $452.99 $493.75 "$1,751.38 " "$1,860.84 " $145.68 N/A $298.65 $145.68 "$1,094.61 " N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,460.21 " $145.68 $145.68 N/A $385.04 $452.99 $145.68 "$1,860.84 " 330104 43752 5735 130 450 HC NASAL/OROGASTRIC W/TUBE PLMT O "$1,644.59 " $452.99 $452.99 $546.19 $482.00 N/A N/A $448.46 $546.19 $860.67 $546.19 $452.99 "$1,233.44 " $498.28 N/A "$1,123.25 " $655.43 $546.19 $986.75 N/A N/A N/A $546.19 $452.99 $543.58 $764.67 N/A $546.19 $546.19 $655.43 $634.18 $546.19 $452.99 $452.99 $493.75 "$1,315.67 " "$1,397.90 " $546.19 N/A "$1,119.69 " $546.19 $822.29 N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,096.94 " $546.19 $546.19 N/A $385.04 $452.99 $385.04 "$1,397.90 " 330104 43753 5722 2003 450 HC TX GASTRO INTUB W/ASP O "$1,884.27 " $336.00 $336.00 N/A $482.00 N/A N/A $332.64 N/A $638.40 N/A $336.00 "$1,413.20 " $369.60 N/A "$1,286.96 " N/A N/A "$1,130.56 " N/A N/A N/A N/A $336.00 $403.20 N/A N/A N/A N/A N/A $470.40 N/A $336.00 $336.00 $366.24 "$1,507.42 " "$1,601.63 " N/A N/A N/A N/A $942.13 N/A N/A N/A N/A N/A N/A $352.80 $336.00 "$1,256.81 " N/A N/A N/A $285.60 $336.00 $285.60 "$1,601.63 " 330104 45005 5312 141 450 HC I&D OF SUBMUCOSAL ABSCESS RECTUM O "$6,263.78 " "$1,299.21 " "$1,299.21 " "$1,185.74 " "$2,523.00 " N/A N/A "$1,286.22 " "$1,185.74 " "$2,468.50 " "$1,185.74 " "$1,299.21 " "$4,697.84 " "$1,429.13 " N/A "$4,278.16 " "$1,422.89 " "$1,185.74 " "$3,758.27 " N/A N/A N/A "$1,185.74 " "$1,299.21 " "$1,559.05 " "$1,660.04 " N/A "$1,185.74 " "$1,185.74 " "$1,422.89 " "$1,818.89 " "$1,185.74 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$5,011.02 " "$5,324.21 " "$1,185.74 " N/A "$2,430.77 " "$1,185.74 " "$3,131.89 " N/A N/A N/A N/A N/A N/A "$1,364.17 " "$1,299.21 " "$4,177.94 " "$1,185.74 " "$1,185.74 " N/A "$1,104.33 " "$1,299.21 " "$1,104.33 " "$5,324.21 " 330104 45915 5312 141 450 HC RMVL FECAL IMPACTION/FB SPX UNDER ANES O "$4,494.00 " "$1,299.21 " "$1,299.21 " "$1,185.74 " "$1,878.00 " N/A N/A "$1,286.22 " "$1,185.74 " "$2,468.50 " "$1,185.74 " "$1,299.21 " "$3,370.50 " "$1,429.13 " N/A "$3,069.40 " "$1,422.89 " "$1,185.74 " "$2,696.40 " N/A N/A N/A "$1,185.74 " "$1,299.21 " "$1,559.05 " "$1,660.04 " N/A "$1,185.74 " "$1,185.74 " "$1,422.89 " "$1,818.89 " "$1,185.74 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$3,595.20 " "$3,819.90 " "$1,185.74 " N/A "$2,430.77 " "$1,185.74 " "$2,247.00 " N/A N/A N/A N/A N/A N/A "$1,364.17 " "$1,299.21 " "$2,997.50 " "$1,185.74 " "$1,185.74 " N/A "$1,104.33 " "$1,299.21 " "$1,104.33 " "$3,819.90 " 330104 50435 5373 170 450 HC EXCHANGE NEPHROSTOMY CATH O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$1,193.01 " "$1,878.00 " N/A N/A "$2,203.12 " "$1,193.01 " "$4,228.21 " "$1,193.01 " "$2,225.37 " "$6,123.08 " "$2,447.91 " N/A "$5,576.08 " "$1,431.61 " "$1,193.01 " "$4,898.46 " N/A N/A N/A "$1,193.01 " "$2,225.37 " "$2,670.45 " "$1,670.21 " N/A "$1,193.01 " "$1,193.01 " "$1,431.61 " "$3,115.52 " "$1,193.01 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$1,193.01 " N/A "$2,445.67 " "$1,193.01 " "$4,082.05 " N/A N/A N/A N/A N/A N/A "$2,336.64 " "$2,225.37 " "$5,445.45 " "$1,193.01 " "$1,193.01 " N/A "$1,891.57 " "$2,225.37 " "$1,193.01 " "$6,939.49 " 330104 55100 5072 180 450 HC DRAINAGE OF SCROTUM ABSCESS O "$5,564.00 " "$1,799.07 " "$1,799.07 " "$1,414.56 " "$1,878.00 " N/A N/A "$1,781.08 " "$1,414.56 " "$3,418.23 " "$1,414.56 " "$1,799.07 " "$4,173.00 " "$1,978.98 " N/A "$3,800.21 " "$1,697.47 " "$1,414.56 " "$3,338.40 " N/A N/A N/A "$1,414.56 " "$1,799.07 " "$2,158.88 " "$1,980.39 " N/A "$1,414.56 " "$1,414.56 " "$1,697.47 " "$2,518.70 " "$1,414.56 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,451.20 " "$4,729.40 " "$1,414.56 " N/A "$2,899.85 " "$1,414.56 " "$2,782.00 " N/A N/A N/A N/A N/A N/A "$1,889.02 " "$1,799.07 " "$3,711.19 " "$1,414.56 " "$1,414.56 " N/A "$1,529.21 " "$1,799.07 " "$1,414.56 " "$4,729.40 " 330104 92953 5781 93 450 HC TEMPORARY EXTERNAL PACING O "$2,471.70 " $705.62 $705.62 $578.53 N/A N/A N/A $698.56 $578.53 "$1,340.67 " $578.53 $705.62 "$1,853.77 " $776.18 N/A "$1,688.17 " $694.24 $578.53 "$1,483.02 " N/A N/A N/A $578.53 $705.62 $846.74 $809.95 N/A $578.53 $578.53 $694.24 $987.86 $578.53 $705.62 $705.62 $769.12 "$1,977.36 " "$2,100.94 " $578.53 N/A "$1,185.99 " $578.53 "$1,235.85 " N/A N/A N/A N/A N/A N/A $740.90 $705.62 "$1,648.62 " $578.53 $578.53 N/A $599.77 $705.62 $578.53 "$2,100.94 " 330104 92977 5694 110 450 HC DISSOLVE CLOT HEART VESSEL;IV INFUSION O "$2,471.70 " $399.06 $399.06 $778.42 N/A N/A N/A $395.07 $778.42 $758.21 $778.42 $399.06 "$1,853.77 " $438.96 N/A "$1,688.17 " $934.10 $778.42 "$1,483.02 " N/A N/A N/A $778.42 $399.06 $478.87 "$1,089.78 " N/A $778.42 $778.42 $934.10 $558.68 $778.42 $399.06 $399.06 $434.97 "$1,977.36 " "$2,100.94 " $778.42 N/A "$1,595.75 " $778.42 "$1,235.85 " N/A N/A N/A N/A N/A N/A $419.01 $399.06 "$1,648.62 " $778.42 $778.42 N/A $339.20 $399.06 $339.20 "$2,100.94 " 330104 99281 5021 491 450 HC EMERGENCY DEPT VISIT LVL 1 O $731.88 $90.09 $90.09 $197.38 N/A $800.00 $729.00 $89.19 $197.38 $171.17 $197.38 $90.09 $548.91 $99.10 "$2,217.33 " $499.87 $236.86 $197.38 $439.13 "$2,946.00 " $323.42 "$2,689.00 " $197.38 $90.09 $108.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $126.12 $197.38 $90.09 $90.09 $98.20 $585.50 $622.10 $197.38 "$1,952.00 " $404.63 $197.38 $365.94 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $94.59 $90.09 "$1,819.00 " $197.38 $197.38 $250.00 $76.58 $90.09 $76.58 "$2,946.00 " 330104 99282 5022 491 450 HC EMERGENCY DEPT VISIT LVL 2 O $924.48 $167.59 $167.59 $197.38 N/A $800.00 $729.00 $165.92 $197.38 $318.42 $197.38 $167.59 $693.36 $184.35 "$2,217.33 " $631.42 $236.86 $197.38 $554.69 "$2,946.00 " $601.65 "$2,689.00 " $197.38 $167.59 $201.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $234.63 $197.38 $167.59 $167.59 $182.67 $739.58 $785.81 $197.38 "$1,952.00 " $404.63 $197.38 $462.24 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $175.97 $167.59 "$1,819.00 " $197.38 $197.38 $250.00 $142.45 $167.59 $142.45 "$2,946.00 " 330104 99283 5023 491 450 HC EMERGENCY DEPT VISIT LVL 3 O "$1,600.72 " $293.97 $293.97 $197.38 N/A $800.00 $729.00 $291.03 $197.38 $558.55 $197.38 $293.97 "$1,200.54 " $323.37 "$2,217.33 " "$1,093.29 " $236.86 $197.38 $960.43 "$2,946.00 " "$1,055.36 " "$2,689.00 " $197.38 $293.97 $352.77 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $411.56 $197.38 $293.97 $293.97 $320.43 "$1,280.58 " "$1,360.61 " $197.38 "$1,952.00 " $404.63 $197.38 $800.36 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $308.67 $293.97 "$1,819.00 " $197.38 $197.38 $250.00 $249.88 $293.97 $197.38 "$2,946.00 " 330104 99284 5024 491 450 HC EMERGENCY DEPT VISIT LVL 4 O "$2,086.50 " $457.83 $457.83 $197.38 N/A $800.00 $729.00 $453.25 $197.38 $869.88 $197.38 $457.83 "$1,564.88 " $503.62 "$2,217.33 " "$1,425.08 " $236.86 $197.38 "$1,251.90 " "$2,946.00 " "$1,643.62 " "$2,689.00 " $197.38 $457.83 $549.40 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $640.97 $197.38 $457.83 $457.83 $499.04 "$1,669.20 " "$1,773.52 " $197.38 "$1,952.00 " $404.63 $197.38 "$1,043.25 " "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $480.72 $457.83 "$1,819.00 " $197.38 $197.38 $250.00 $389.16 $457.83 $197.38 "$2,946.00 " 330104 99285 5025 491 450 HC EMERGENCY DEPT VISIT LVL 5 O "$2,571.21 " $657.59 $657.59 $197.38 N/A $800.00 $729.00 $651.01 $197.38 "$1,249.42 " $197.38 $657.59 "$1,928.41 " $723.35 "$2,217.33 " "$1,756.14 " $236.86 $197.38 "$1,542.73 " "$2,946.00 " "$2,360.75 " "$2,689.00 " $197.38 $657.59 $789.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $920.63 $197.38 $657.59 $657.59 $716.77 "$2,056.97 " "$2,185.53 " $197.38 "$1,952.00 " $404.63 $197.38 "$1,285.61 " "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $690.47 $657.59 "$1,819.00 " $197.38 $197.38 $250.00 $558.95 $657.59 $197.38 "$2,946.00 " 330104 99291 5041 491 450 HC CRITICAL CARE FIRST HOUR O "$6,260.57 " $921.06 $921.06 $197.38 N/A N/A N/A $911.85 $197.38 "$1,750.02 " $197.38 $921.06 "$4,695.43 " "$1,013.17 " N/A "$4,275.97 " $236.86 $197.38 "$3,756.34 " N/A N/A N/A $197.38 $921.06 "$1,105.28 " $276.33 N/A $197.38 $197.38 $236.86 "$1,289.49 " $197.38 $921.06 $921.06 "$1,003.96 " "$5,008.46 " "$5,321.48 " $197.38 N/A $404.63 $197.38 "$3,130.28 " N/A N/A N/A N/A N/A N/A $967.12 $921.06 "$4,175.80 " $197.38 $197.38 N/A $782.90 $921.06 $197.38 "$5,321.48 " 330104 27818 5112 41 450 HC CLSD TX TRIMALLEOLAR ANK FX W/ MANIP O "$6,179.25 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,634.44 " "$1,893.16 " N/A "$4,220.43 " $656.27 $546.89 "$3,707.55 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,943.40 " "$5,252.36 " $546.89 N/A "$1,121.12 " $546.89 "$3,089.62 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$4,121.56 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$5,252.36 " 330104 25505 5112 41 450 HC CLSD TX RAD SHAFT FX W/ MANIP O "$5,510.50 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,132.88 " "$1,893.16 " N/A "$3,763.67 " $656.27 $546.89 "$3,306.30 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,408.40 " "$4,683.93 " $546.89 N/A "$1,121.12 " $546.89 "$2,755.25 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,675.50 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,683.93 " 330104 99292 491 450 HC CRITICAL CARE ADDL 30 MIN O "$5,695.61 " N/A N/A N/A N/A N/A N/A $125.20 N/A N/A N/A N/A "$4,271.71 " N/A N/A "$3,890.10 " N/A N/A "$3,417.37 " N/A N/A N/A N/A N/A "$3,702.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,556.49 " "$4,841.27 " N/A N/A N/A N/A "$2,847.80 " N/A N/A N/A N/A N/A N/A N/A N/A "$3,798.97 " N/A N/A N/A N/A N/A $125.20 "$4,841.27 " 330104 24640 5111 41 450 HC CLSD TREAT CHILD NURSEMAID ELBOW DISLOCATION O "$1,845.75 " $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 "$1,384.31 " $273.19 N/A "$1,260.65 " $656.27 $546.89 "$1,107.45 " N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $546.89 N/A "$1,121.12 " $546.89 $922.88 N/A N/A N/A N/A N/A N/A $260.78 $248.36 "$1,231.12 " $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,568.89 " 330104 24655 5112 41 450 HC CLSD TX RAD HD/NK FX W/ MANIP O "$5,350.00 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,012.50 " "$1,893.16 " N/A "$3,654.05 " $656.27 $546.89 "$3,210.00 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,280.00 " "$4,547.50 " $546.89 N/A "$1,121.12 " $546.89 "$2,675.00 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,568.45 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,547.50 " 330104 11001 17 450 HC DEBRIDE INFECTED SKIN (ADD-ON) EA.ADDL.10%BODYSURF O $160.50 N/A N/A $758.65 $482.00 N/A N/A $17.79 $758.65 N/A $758.65 N/A $120.38 N/A N/A $109.62 $910.38 $758.65 $96.30 N/A N/A N/A $758.65 N/A $104.33 "$1,062.10 " N/A $758.65 $758.65 $910.38 N/A $758.65 N/A N/A N/A $128.40 $136.42 "$1,024.17 " N/A "$1,555.23 " "$1,024.17 " $80.25 N/A N/A N/A N/A N/A N/A N/A N/A $107.05 $758.65 $758.65 N/A N/A N/A $17.79 "$1,555.23 " 330104 11010 5071 17 450 HC DEBRIDE SKIN&SUBQ TISSUES AT FX SITE O "$3,143.66 " $778.60 $778.60 $758.65 "$2,523.00 " N/A N/A $770.81 $758.65 "$1,479.33 " $758.65 $778.60 "$2,357.74 " $856.45 N/A "$2,147.12 " $910.38 $758.65 "$1,886.20 " N/A N/A N/A $758.65 $778.60 $934.31 "$1,062.10 " N/A $758.65 $758.65 $910.38 "$1,090.03 " $758.65 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $758.65 N/A "$1,555.23 " $758.65 "$1,571.83 " N/A N/A N/A N/A N/A N/A $817.53 $778.60 "$2,096.82 " $758.65 $758.65 N/A $661.81 $778.60 $661.81 "$2,672.11 " 330104 11760 5053 5 450 HC REPAIR OF NAIL BED O "$3,210.00 " $696.99 $696.99 $99.85 $482.00 N/A N/A $690.02 $99.85 "$1,324.28 " $99.85 $696.99 "$2,407.50 " $766.69 N/A "$2,192.43 " $119.82 $99.85 "$1,926.00 " N/A N/A N/A $99.85 $696.99 $836.39 $139.79 N/A $99.85 $99.85 $119.82 $975.78 $99.85 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $99.85 N/A $204.69 $99.85 "$1,605.00 " N/A N/A N/A N/A N/A N/A $731.84 $696.99 "$2,141.07 " $99.85 $99.85 N/A $592.44 $696.99 $99.85 "$2,728.50 " 330104 12006 5052 16 450 HC SIMPLE RPR S/N/A/GEN/TRK20.1-30.0CM O "$1,685.25 " $447.59 $447.59 $498.28 "$2,523.00 " N/A N/A $443.11 $498.28 $850.42 $498.28 $447.59 "$1,263.94 " $492.35 N/A "$1,151.03 " $597.93 $498.28 "$1,011.15 " N/A N/A N/A $498.28 $447.59 $537.10 $697.59 N/A $498.28 $498.28 $597.93 $626.62 $498.28 $447.59 $447.59 $487.87 "$1,348.20 " "$1,432.46 " $498.28 N/A "$1,021.46 " $498.28 $842.62 N/A N/A N/A N/A N/A N/A $469.97 $447.59 "$1,124.06 " $498.28 $498.28 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 12057 5052 17 450 HC INTMD RPR FACE/MM >30.0 CM O "$1,415.61 " $447.59 $447.59 $758.65 "$2,523.00 " N/A N/A $443.11 $758.65 $850.42 $758.65 $447.59 "$1,061.71 " $492.35 N/A $966.86 $910.38 $758.65 $849.37 N/A N/A N/A $758.65 $447.59 $537.10 "$1,062.10 " N/A $758.65 $758.65 $910.38 $626.62 $758.65 $447.59 $447.59 $487.87 "$1,132.49 " "$1,203.27 " $758.65 N/A "$1,555.23 " $758.65 $707.80 N/A N/A N/A N/A N/A N/A $469.97 $447.59 $944.21 $758.65 $758.65 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 13120 5053 9 450 HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM O "$2,354.00 " $696.99 $696.99 $684.98 "$2,523.00 " N/A N/A $690.02 $684.98 "$1,324.28 " $684.98 $696.99 "$1,765.50 " $766.69 N/A "$1,607.78 " $821.98 $684.98 "$1,412.40 " N/A N/A N/A $684.98 $696.99 $836.39 $958.98 N/A $684.98 $684.98 $821.98 $975.78 $684.98 $696.99 $696.99 $759.72 "$1,883.20 " "$2,000.90 " $684.98 N/A "$1,404.22 " $684.98 "$1,177.00 " N/A N/A N/A N/A N/A N/A $731.84 $696.99 "$1,570.12 " $684.98 $684.98 N/A $592.44 $696.99 $592.44 "$2,523.00 " 330104 21337 5164 41 450 HC CLOSED TX SEPTAL&NOSE FX O "$11,179.36 " "$3,413.30 " "$3,413.30 " $546.89 "$2,523.00 " N/A N/A "$3,379.16 " $546.89 "$6,485.26 " $546.89 "$3,413.30 " "$8,384.52 " "$3,754.63 " N/A "$7,635.50 " $656.27 $546.89 "$6,707.62 " N/A N/A N/A $546.89 "$3,413.30 " "$4,095.96 " $765.64 N/A $546.89 $546.89 $656.27 "$4,778.61 " $546.89 "$3,413.30 " "$3,413.30 " "$3,720.49 " "$8,943.49 " "$9,502.46 " $546.89 N/A "$1,121.12 " $546.89 "$5,589.68 " N/A N/A N/A N/A N/A N/A "$3,583.96 " "$3,413.30 " "$7,456.63 " $546.89 $546.89 N/A "$2,901.30 " "$3,413.30 " $546.89 "$9,502.46 " 330104 12005 5052 16 450 HC SIMPLE RPR S/N/A/GEN/TRK12.6-20.0CM O "$2,346.51 " $447.59 $447.59 $498.28 "$2,523.00 " N/A N/A $443.11 $498.28 $850.42 $498.28 $447.59 "$1,759.88 " $492.35 N/A "$1,602.67 " $597.93 $498.28 "$1,407.91 " N/A N/A N/A $498.28 $447.59 $537.10 $697.59 N/A $498.28 $498.28 $597.93 $626.62 $498.28 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $498.28 N/A "$1,021.46 " $498.28 "$1,173.26 " N/A N/A N/A N/A N/A N/A $469.97 $447.59 "$1,565.12 " $498.28 $498.28 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 23650 5111 41 450 HC CLSD TX SHOULDER DISL W /MANIP O "$1,845.75 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 "$1,384.31 " $273.19 N/A "$1,260.65 " $656.27 $546.89 "$1,107.45 " N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $546.89 N/A "$1,121.12 " $546.89 $922.88 N/A N/A N/A N/A N/A N/A $260.78 $248.36 "$1,231.12 " $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 23655 5112 44 450 HC CLOSED RX SHLDR DISLOCANESTHESIA O "$8,556.79 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$1,878.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " "$1,209.40 " "$1,007.83 " "$5,134.07 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$7,273.27 " 330104 23665 5112 41 450 HC CLSD TREAT SHLDR W/HUMERAL DISLOCAT/FX W/MANIPULAT O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 24200 5072 51 450 HC REMOVAL OF ARM FOREIGN BODY O "$5,842.20 " "$1,799.07 " "$1,799.07 " "$1,167.87 " "$1,099.00 " N/A N/A "$1,781.08 " "$1,167.87 " "$3,418.23 " "$1,167.87 " "$1,799.07 " "$4,381.65 " "$1,978.98 " N/A "$3,990.22 " "$1,401.45 " "$1,167.87 " "$3,505.32 " N/A N/A N/A "$1,167.87 " "$1,799.07 " "$2,158.88 " "$1,635.02 " N/A "$1,167.87 " "$1,167.87 " "$1,401.45 " "$2,518.70 " "$1,167.87 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,673.76 " "$4,965.87 " "$1,167.87 " N/A "$2,394.14 " "$1,167.87 " "$2,921.10 " N/A N/A N/A N/A N/A N/A "$1,889.02 " "$1,799.07 " "$3,896.75 " "$1,167.87 " "$1,167.87 " N/A "$1,529.21 " "$1,799.07 " "$1,099.00 " "$4,965.87 " 330104 24577 5112 41 450 HC CLSD TX HYMERAL CONDYLAR FX W/ MANIP O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 24600 5111 41 450 HC CLSD TREAT ELBOW DISLOCATION W/O ANESTH O "$1,166.30 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $874.72 $273.19 N/A $796.58 $656.27 $546.89 $699.78 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $933.04 $991.35 $546.89 N/A "$1,121.12 " $546.89 $583.15 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $777.92 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 24605 5112 44 450 HC CLOSED RX ELBOW DISLOCATNANESTHESIA O "$8,556.79 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$2,523.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " "$1,209.40 " "$1,007.83 " "$5,134.07 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$7,273.27 " 330104 23605 5112 41 450 HC FX HUMERAL NECK CLOSED W/MAN O "$5,842.20 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,381.65 " "$1,893.16 " N/A "$3,990.22 " $656.27 $546.89 "$3,505.32 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,673.76 " "$4,965.87 " $546.89 N/A "$1,121.12 " $546.89 "$2,921.10 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,896.75 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,965.87 " 330104 94729 412 460 HC CO/MEMBANE DIFFUSE CAPACITY O $791.80 N/A N/A $16.88 $395.90 $490.92 $490.92 $68.46 $16.88 N/A $16.88 N/A $593.85 N/A $514.67 $578.81 $20.26 $16.88 $475.08 "$7,492.00 " N/A "$4,407.00 " $16.88 N/A $514.67 $23.63 $633.44 $16.88 $16.88 $20.26 N/A $16.88 N/A N/A N/A $633.44 $673.03 $22.79 $593.85 $34.60 $22.79 $395.90 $514.67 $534.47 $534.47 $534.47 $534.47 N/A N/A N/A $528.13 $16.88 $16.88 N/A N/A N/A $16.88 "$7,492.00 " 330104 94727 5721 412 460 HC PULM FUNCTION TEST BY GAS O $791.80 $174.48 $174.48 $13.33 $395.90 $490.92 $490.92 $172.73 $13.33 $331.51 $13.33 $174.48 $593.85 $191.93 $514.67 $578.81 $16.00 $13.33 $475.08 "$7,492.00 " $593.23 "$4,407.00 " $13.33 $174.48 $209.37 $18.66 $633.44 $13.33 $13.33 $16.00 $244.27 $13.33 $174.48 $174.48 $190.18 $633.44 $673.03 $13.33 $593.85 $27.33 $13.33 $395.90 $287.89 $534.47 $534.47 $534.47 $534.47 N/A $183.20 $174.48 $528.13 $13.33 $13.33 $148.31 $148.31 $174.48 $13.33 "$7,492.00 " 330104 94626 5733 66 460 HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR O $211.86 $68.96 $68.96 $6.02 $105.93 $131.35 $131.35 $68.27 $6.02 $131.03 $6.02 $68.96 $158.90 $75.86 $137.71 $154.87 $7.22 $6.02 $127.12 "$7,492.00 " $234.47 "$4,407.00 " $6.02 $68.96 $82.75 $8.43 $169.49 $6.02 $6.02 $7.22 $96.55 $6.02 $68.96 $68.96 $75.17 $169.49 $180.08 $6.02 $158.90 $12.34 $6.02 $105.93 $113.79 $143.01 $143.01 $143.01 $143.01 N/A $72.41 $68.96 $141.31 $6.02 $6.02 $58.62 $58.62 $68.96 $6.02 "$7,492.00 " 330104 94625 5733 66 460 HC HYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR O $211.86 $68.96 $68.96 $3.87 $105.93 $131.35 $131.35 $68.27 $3.87 $131.03 $3.87 $68.96 $158.90 $75.86 $137.71 $154.87 $4.64 $3.87 $127.12 "$7,492.00 " $234.47 "$4,407.00 " $3.87 $68.96 $82.75 $5.42 $169.49 $3.87 $3.87 $4.64 $96.55 $3.87 $68.96 $68.96 $75.17 $169.49 $180.08 $3.87 $158.90 $7.93 $3.87 $105.93 $113.79 $143.01 $143.01 $143.01 $143.01 N/A $72.41 $68.96 $141.31 $3.87 $3.87 $58.62 $58.62 $68.96 $3.87 "$7,492.00 " 330104 94060 5722 60 460 HC BRONCHODILATION RESPONSE SPIROMETRY PRE/POST ADMIN O "$1,403.84 " $336.00 $336.00 $25.00 $701.92 $870.38 $870.38 $332.64 $25.00 $638.40 $25.00 $336.00 "$1,052.88 " $369.60 $912.50 "$1,026.21 " $30.00 $25.00 $842.30 "$7,492.00 " "$1,142.40 " "$4,407.00 " $25.00 $336.00 $403.20 $35.00 "$1,123.07 " $25.00 $25.00 $30.00 $470.40 $25.00 $336.00 $336.00 $366.24 "$1,123.07 " "$1,193.26 " $25.00 "$1,052.88 " $51.25 $25.00 $701.92 $554.40 $947.59 $947.59 $947.59 $947.59 N/A $352.80 $336.00 $936.36 $25.00 $25.00 $285.60 $285.60 $336.00 $25.00 "$7,492.00 " 330104 94200 5733 412 460 HC LUNG FUNCTION TEST (MBC/MVV) O $372.36 $68.96 $68.96 $10.00 $186.18 $230.86 $230.86 $68.27 $10.00 $131.03 $10.00 $68.96 $279.27 $75.86 $242.03 $272.20 $12.00 $10.00 $223.42 "$7,492.00 " $234.47 "$4,407.00 " $10.00 $68.96 $82.75 $14.00 $297.89 $10.00 $10.00 $12.00 $96.55 $10.00 $68.96 $68.96 $75.17 $297.89 $316.51 $10.00 $279.27 $20.50 $10.00 $186.18 $113.79 $251.34 $251.34 $251.34 $251.34 N/A $72.41 $68.96 $248.36 $10.00 $10.00 $58.62 $58.62 $68.96 $10.00 "$7,492.00 " 330104 94150 5721 412 460 HC VITAL CAPACITY TEST O $639.86 $174.48 $174.48 $3.00 $319.93 $396.71 $396.71 $172.73 $3.00 $331.51 $3.00 $174.48 $479.89 $191.93 $415.91 $467.74 $3.60 $3.00 $383.92 "$7,492.00 " $593.23 "$4,407.00 " $3.00 $174.48 $209.37 $4.20 $511.89 $3.00 $3.00 $3.60 $244.27 $3.00 $174.48 $174.48 $190.18 $511.89 $543.88 $3.00 $479.89 $6.15 $3.00 $319.93 $287.89 $431.91 $431.91 $431.91 $431.91 N/A $183.20 $174.48 $426.79 $3.00 $3.00 $148.31 $148.31 $174.48 $3.00 "$7,492.00 " 330104 94761 2004 460 HC NONINVASIVE EAR OR PULSE OXIMETRY MULT O $914.85 N/A N/A N/A $457.43 $567.21 $567.21 $4.84 N/A N/A N/A N/A $686.14 N/A $594.65 $668.76 N/A N/A $548.91 "$7,492.00 " N/A "$4,407.00 " N/A N/A $594.65 N/A $731.88 N/A N/A N/A N/A N/A N/A N/A N/A $731.88 $777.62 N/A $686.14 N/A N/A $457.43 $594.65 $617.52 $617.52 $617.52 $617.52 N/A N/A N/A $610.20 N/A N/A N/A N/A N/A $4.84 "$7,492.00 " 330104 94618 5734 412 460 HC PULMONARY STRESS TESTING O $773.61 $139.30 $139.30 $4.84 $386.81 $479.64 $479.64 $137.91 $4.84 $264.67 $4.84 $139.30 $580.21 $153.23 $502.85 $565.51 $5.81 $4.84 $464.17 "$7,492.00 " $473.63 "$4,407.00 " $4.84 $139.30 $167.16 $6.78 $618.89 $4.84 $4.84 $5.81 $195.02 $4.84 $139.30 $139.30 $151.84 $618.89 $657.57 $4.84 $580.21 $9.92 $4.84 $386.81 $229.85 $522.19 $522.19 $522.19 $522.19 N/A $146.27 $139.30 $516.00 $4.84 $4.84 $118.41 $118.41 $139.30 $4.84 "$7,492.00 " 330104 94762 5721 412 460 HC MEASURE BLOOD OXYGEN LEVEL O "$1,388.86 " $174.48 $174.48 $74.80 $694.43 $861.09 $861.09 $172.73 $74.80 $331.51 $74.80 $174.48 "$1,041.64 " $191.93 $902.76 "$1,015.26 " $89.76 $74.80 $833.32 "$7,492.00 " $593.23 "$4,407.00 " $74.80 $174.48 $209.37 $104.72 "$1,111.09 " $74.80 $74.80 $89.76 $244.27 $74.80 $174.48 $174.48 $190.18 "$1,111.09 " "$1,180.53 " $74.80 "$1,041.64 " $153.34 $74.80 $694.43 $287.89 $937.48 $937.48 $937.48 $937.48 N/A $183.20 $174.48 $926.37 $74.80 $74.80 $148.31 $148.31 $174.48 $74.80 "$7,492.00 " 330104 94760 2004 460 HC MEASURE BLOOD OXYGEN LEVEL; SINGLE O $709.41 N/A N/A N/A $354.70 $439.83 $439.83 $3.21 N/A N/A N/A N/A $532.06 N/A $461.12 $518.58 N/A N/A $425.65 "$7,492.00 " N/A "$4,407.00 " N/A N/A $461.12 N/A $567.53 N/A N/A N/A N/A N/A N/A N/A N/A $567.53 $603.00 N/A $532.06 N/A N/A $354.70 $461.12 $478.85 $478.85 $478.85 $478.85 N/A N/A N/A $473.18 N/A N/A N/A N/A N/A $3.21 "$7,492.00 " 330104 94010 5721 412 460 HC BREATHING CAPACITY TEST O "$1,118.15 " $174.48 $174.48 $15.00 $559.08 $693.25 $693.25 $172.73 $15.00 $331.51 $15.00 $174.48 $838.61 $191.93 $726.80 $817.37 $18.00 $15.00 $670.89 "$7,492.00 " $593.23 "$4,407.00 " $15.00 $174.48 $209.37 $21.00 $894.52 $15.00 $15.00 $18.00 $244.27 $15.00 $174.48 $174.48 $190.18 $894.52 $950.43 $15.00 $838.61 $30.75 $15.00 $559.08 $287.89 $754.75 $754.75 $754.75 $754.75 N/A $183.20 $174.48 $745.81 $15.00 $15.00 $148.31 $148.31 $174.48 $15.00 "$7,492.00 " 330104 92653 5722 257 471 HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT O "$1,123.50 " $336.00 $336.00 $11.29 $561.75 $696.57 $696.57 $332.64 $11.29 $638.40 $11.29 $336.00 $842.62 $369.60 $730.27 $821.28 $13.55 $11.29 $674.10 "$7,492.00 " "$1,142.40 " "$4,407.00 " $11.29 $336.00 $403.20 $15.81 $898.80 $11.29 $11.29 $13.55 $470.40 $11.29 $336.00 $336.00 $366.24 $898.80 $954.98 $11.29 $842.62 $23.14 $11.29 $561.75 $554.40 $758.36 $758.36 $758.36 $758.36 N/A $352.80 $336.00 $749.37 $11.29 $11.29 $285.60 $285.60 $336.00 $11.29 "$7,492.00 " 330104 92558 229 471 HC EVOKED AUDITORY TEST QUAL O "$1,288.28 " N/A N/A $81.73 $644.14 $798.73 $798.73 $9.64 $81.73 N/A $81.73 N/A $966.21 N/A $837.38 $941.73 $98.08 $81.73 $772.97 "$7,492.00 " N/A "$4,407.00 " $81.73 N/A $837.38 $114.42 "$1,030.62 " $81.73 $81.73 $98.08 N/A $81.73 N/A N/A N/A "$1,030.62 " "$1,095.04 " $110.34 $966.21 $167.55 $110.34 $644.14 $837.38 $869.59 $869.59 $869.59 $869.59 N/A N/A N/A $859.28 $81.73 $81.73 N/A N/A N/A $9.64 "$7,492.00 " 330104 92950 5722 92 480 HC HEART/LUNG RESUSCITATION CPR O "$1,660.64 " $336.00 $336.00 $579.94 $830.32 "$1,029.60 " "$1,029.60 " $332.64 $579.94 $638.40 $579.94 $336.00 "$1,245.48 " $369.60 "$1,079.42 " "$1,213.93 " $695.93 $579.94 $996.38 "$7,492.00 " "$1,142.40 " "$1,915.20 " $579.94 $336.00 $403.20 $811.91 "$1,328.51 " $579.94 $579.94 $695.93 $470.40 $579.94 $336.00 $336.00 $366.24 "$1,328.51 " "$1,411.54 " $579.94 "$1,245.48 " "$1,188.87 " $579.94 $830.32 $554.40 "$1,120.93 " "$1,120.93 " "$1,120.93 " "$1,120.93 " N/A $352.80 $336.00 "$1,107.65 " $579.94 $579.94 $285.60 $285.60 $336.00 $285.60 "$7,492.00 " 330104 0502T 2002 480 HC COR FFR DATA PREP & TRANSMIS O "$1,070.00 " N/A N/A N/A $535.00 $663.40 $663.40 N/A N/A N/A N/A N/A $802.50 N/A $695.50 $782.17 N/A N/A $642.00 "$7,492.00 " N/A N/A N/A N/A $695.50 N/A $856.00 N/A N/A N/A N/A N/A N/A N/A N/A $856.00 $909.50 N/A $802.50 N/A N/A $535.00 $695.50 $722.25 $722.25 $722.25 $722.25 N/A N/A N/A $713.69 N/A N/A N/A N/A N/A $535.00 "$7,492.00 " 330104 0503T 5724 4001 480 HC COR FFR ALYS GNRJ FFR MDL O "$5,350.00 " "$1,121.01 " "$1,121.01 " $84.23 "$2,675.00 " "$3,317.00 " "$3,317.00 " "$1,109.80 " $84.23 "$2,129.92 " $84.23 "$1,121.01 " "$4,012.50 " "$1,233.11 " "$3,477.50 " "$3,910.85 " $101.08 $84.23 "$3,210.00 " "$7,492.00 " "$3,811.44 " "$6,389.77 " $84.23 "$1,121.01 " "$1,345.22 " $117.92 "$4,280.00 " $84.23 $84.23 $101.08 "$1,569.42 " $84.23 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$4,280.00 " "$4,547.50 " $84.23 "$4,012.50 " $172.68 $84.23 "$2,675.00 " "$1,849.67 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " N/A "$1,177.06 " "$1,121.01 " "$3,568.45 " $84.23 $84.23 $952.86 $952.86 "$1,121.01 " $84.23 "$7,492.00 " 330104 93280 5741 488 480 HC PM DEVICE PROGR EVAL DUAL O $515.74 $41.99 $41.99 $19.67 $257.87 $319.76 $319.76 $41.57 $19.67 $79.78 $19.67 $41.99 $386.81 $46.19 $335.23 $377.01 $23.60 $19.67 $309.44 "$7,492.00 " $142.77 $239.35 $19.67 $41.99 $50.39 $27.54 $412.59 $19.67 $19.67 $23.60 $58.79 $19.67 $41.99 $41.99 $45.77 $412.59 $438.38 $19.67 $386.81 $40.32 $19.67 $257.87 $69.28 $348.12 $348.12 $348.12 $348.12 N/A $44.09 $41.99 $344.00 $19.67 $19.67 $35.69 $35.69 $41.99 $19.67 "$7,492.00 " 330104 93308 5523 81 480 HC TTE F-UP OR LMTD O "$2,107.90 " $280.16 $280.16 $60.00 "$1,053.95 " "$1,306.90 " "$1,306.90 " $277.36 $60.00 $532.31 $60.00 $280.16 "$1,580.93 " $308.18 "$1,370.14 " "$1,540.87 " $72.00 $60.00 "$1,264.74 " "$7,492.00 " $952.56 "$1,596.93 " $60.00 $280.16 $336.20 $84.00 "$1,686.32 " $60.00 $60.00 $72.00 $392.23 $60.00 $280.16 $280.16 $305.38 "$1,686.32 " "$1,791.71 " $60.00 "$1,580.93 " $123.00 $60.00 "$1,053.95 " $462.27 "$1,422.83 " "$1,422.83 " "$1,422.83 " "$1,422.83 " N/A $294.17 $280.16 "$1,405.97 " $60.00 $60.00 $238.14 $238.14 $280.16 $60.00 "$7,492.00 " 330104 93312 5524 81 480 HC ECHO TRANSESOPHAGEAL;INCL PROBE &INTERP/RPRT O "$4,136.62 " $603.63 $603.63 $105.00 "$2,068.31 " "$2,564.70 " "$2,564.70 " $597.59 $105.00 "$1,146.89 " $105.00 $603.63 "$3,102.47 " $663.99 "$2,688.80 " "$3,023.87 " $126.00 $105.00 "$2,481.97 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $105.00 $603.63 $724.35 $147.00 "$3,309.30 " $105.00 $105.00 $126.00 $845.08 $105.00 $603.63 $603.63 $657.95 "$3,309.30 " "$3,516.13 " $105.00 "$3,102.47 " $215.25 $105.00 "$2,068.31 " $995.98 "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,792.22 " N/A $633.81 $603.63 "$2,759.13 " $105.00 $105.00 $513.08 $513.08 $603.63 $105.00 "$7,492.00 " 330104 93319 81 480 HC 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL O $535.00 N/A N/A $5.38 $267.50 $331.70 $331.70 $27.72 $5.38 N/A $5.38 N/A $401.25 N/A $347.75 $391.08 $6.46 $5.38 $321.00 "$7,492.00 " N/A N/A $5.38 N/A $347.75 $7.53 $428.00 $5.38 $5.38 $6.46 N/A $5.38 N/A N/A N/A $428.00 $454.75 $7.26 $401.25 $11.03 $7.26 $267.50 $347.75 $361.12 $361.12 $361.12 $361.12 N/A N/A N/A $356.85 $5.38 $5.38 N/A N/A N/A $5.38 "$7,492.00 " 330104 93321 81 480 HC DOPPLER ECHO EXAM HEART; F/U OR LIMITED O "$1,744.10 " N/A N/A $60.00 $872.05 "$1,081.34 " "$1,081.34 " $30.08 $60.00 N/A $60.00 N/A "$1,308.07 " N/A "$1,133.66 " "$1,274.94 " $72.00 $60.00 "$1,046.46 " "$7,492.00 " N/A N/A $60.00 N/A "$1,133.66 " $84.00 "$1,395.28 " $60.00 $60.00 $72.00 N/A $60.00 N/A N/A N/A "$1,395.28 " "$1,482.48 " $81.00 "$1,308.07 " $123.00 $81.00 $872.05 "$1,133.66 " "$1,177.27 " "$1,177.27 " "$1,177.27 " "$1,177.27 " N/A N/A N/A "$1,163.31 " $60.00 $60.00 N/A N/A N/A $30.08 "$7,492.00 " 330104 93325 288 480 HC DOPPLER COLOR FLOW ADD-ON O "$1,884.27 " N/A N/A $32.80 $942.13 "$1,168.25 " "$1,168.25 " $28.10 $32.80 N/A $32.80 N/A "$1,413.20 " N/A "$1,224.78 " "$1,377.40 " $39.36 $32.80 "$1,130.56 " "$7,492.00 " N/A N/A $32.80 N/A "$1,224.78 " $45.92 "$1,507.42 " $32.80 $32.80 $39.36 N/A $32.80 N/A N/A N/A "$1,507.42 " "$1,601.63 " $44.28 "$1,413.20 " $67.24 $44.28 $942.13 "$1,224.78 " "$1,271.88 " "$1,271.88 " "$1,271.88 " "$1,271.88 " N/A N/A N/A "$1,256.81 " $32.80 $32.80 N/A N/A N/A $28.10 "$7,492.00 " 330104 93351 5524 81 480 HC STRESS TTE COMPLETE O "$1,820.07 " $603.63 $603.63 $142.00 $910.03 "$1,128.44 " "$1,128.44 " $597.59 $142.00 "$1,146.89 " $142.00 $603.63 "$1,365.05 " $663.99 "$1,183.05 " "$1,330.47 " $170.40 $142.00 "$1,092.04 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $142.00 $603.63 $724.35 $198.80 "$1,456.06 " $142.00 $142.00 $170.40 $845.08 $142.00 $603.63 $603.63 $657.95 "$1,456.06 " "$1,547.06 " $142.00 "$1,365.05 " $291.10 $142.00 $910.03 $995.98 "$1,228.55 " "$1,228.55 " "$1,228.55 " "$1,228.55 " N/A $633.81 $603.63 "$1,213.99 " $142.00 $142.00 $513.08 $513.08 $603.63 $142.00 "$7,492.00 " 330104 92960 5781 93 480 HC CARDIOVERSION ELECTRIC EXT O "$2,936.08 " $705.62 $705.62 $537.96 "$1,468.04 " "$1,820.37 " "$1,820.37 " $698.56 $537.96 "$1,340.67 " $537.96 $705.62 "$2,202.06 " $776.18 "$1,908.45 " "$2,146.27 " $645.55 $537.96 "$1,761.65 " "$7,492.00 " "$2,399.09 " "$4,022.01 " $537.96 $705.62 $846.74 $753.15 "$2,348.86 " $537.96 $537.96 $645.55 $987.86 $537.96 $705.62 $705.62 $769.12 "$2,348.86 " "$2,495.67 " $537.96 "$2,202.06 " "$1,102.82 " $537.96 "$1,468.04 " "$1,164.26 " "$1,981.85 " "$1,981.85 " "$1,981.85 " "$1,981.85 " N/A $740.90 $705.62 "$1,958.37 " $537.96 $537.96 $599.77 $599.77 $705.62 $537.96 "$7,492.00 " 330104 93320 81 480 HC DOPPLER ECHO EXAM HEART; COMPLETE O "$1,884.27 " N/A N/A $87.00 $942.13 "$1,168.25 " "$1,168.25 " $60.14 $87.00 N/A $87.00 N/A "$1,413.20 " N/A "$1,224.78 " "$1,377.40 " $104.40 $87.00 "$1,130.56 " "$7,492.00 " N/A N/A $87.00 N/A "$1,224.78 " $121.80 "$1,507.42 " $87.00 $87.00 $104.40 N/A $87.00 N/A N/A N/A "$1,507.42 " "$1,601.63 " $117.45 "$1,413.20 " $178.35 $117.45 $942.13 "$1,224.78 " "$1,271.88 " "$1,271.88 " "$1,271.88 " "$1,271.88 " N/A N/A N/A "$1,256.81 " $87.00 $87.00 N/A N/A N/A $60.14 "$7,492.00 " 330104 93306 5524 81 480 HC TTE W/DOPPLER COMPLETE O "$2,548.74 " $603.63 $603.63 $206.50 "$1,274.37 " "$1,580.22 " "$1,580.22 " $597.59 $206.50 "$1,146.89 " $206.50 $603.63 "$1,911.55 " $663.99 "$1,656.68 " "$1,863.13 " $247.80 $206.50 "$1,529.24 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $206.50 $603.63 $724.35 $289.10 "$2,038.99 " $206.50 $206.50 $247.80 $845.08 $206.50 $603.63 $603.63 $657.95 "$2,038.99 " "$2,166.43 " $206.50 "$1,911.55 " $423.32 $206.50 "$1,274.37 " $995.98 "$1,720.40 " "$1,720.40 " "$1,720.40 " "$1,720.40 " N/A $633.81 $603.63 "$1,700.01 " $206.50 $206.50 $513.08 $513.08 $603.63 $206.50 "$7,492.00 " 330104 481 HC CARDIOLOGY: CARDIAC CATH LAB PER 30 MIN O N/A N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,492.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,372.00 " N/A N/A N/A N/A N/A "$2,215.00 " "$7,492.00 " 330104 0680T 223 481 HC INSJ/RPLCMT PG ONLY ISDSS O "$10,453.90 " N/A N/A "$12,479.94 " N/A "$2,432.00 " "$2,215.00 " N/A "$12,479.94 " N/A "$12,479.94 " N/A "$7,840.42 " N/A "$6,795.03 " "$7,641.80 " "$14,975.93 " "$12,479.94 " "$6,272.34 " "$7,492.00 " N/A N/A "$12,479.94 " N/A "$6,795.03 " "$17,471.92 " "$8,363.12 " "$12,479.94 " "$12,479.94 " "$14,975.93 " N/A "$12,479.94 " N/A N/A N/A "$8,363.12 " "$8,885.81 " "$16,847.92 " "$7,840.42 " "$25,583.88 " "$16,847.92 " "$5,226.95 " "$6,795.03 " "$7,056.38 " "$7,056.38 " "$7,056.38 " "$7,056.38 " N/A N/A N/A "$3,372.00 " "$12,479.94 " "$12,479.94 " N/A N/A N/A "$2,215.00 " "$25,583.88 " 330104 0695T 413 481 HC BODY SRF MAPG PM/CVDFB TM IMPL O $124.12 N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " N/A N/A N/A N/A N/A $93.09 N/A $80.68 $90.73 N/A N/A $74.47 "$7,492.00 " N/A N/A N/A N/A $80.68 N/A $99.30 N/A N/A N/A N/A N/A N/A N/A N/A $99.30 $105.50 N/A $93.09 N/A N/A $62.06 $80.68 $83.78 $83.78 $83.78 $83.78 N/A N/A N/A "$3,372.00 " N/A N/A N/A N/A N/A $62.06 "$7,492.00 " 330104 0696T 5741 413 481 HC BODY SURF MAPG PM/CVDFB F/UP O $99.51 $41.99 $41.99 N/A N/A "$2,432.00 " "$2,215.00 " $41.57 N/A $79.78 N/A $41.99 $74.63 $46.19 $64.68 $72.74 N/A N/A $59.71 "$7,492.00 " $142.77 $239.35 N/A $41.99 $50.39 N/A $79.61 N/A N/A N/A $58.79 N/A $41.99 $41.99 $45.77 $79.61 $84.58 N/A $74.63 N/A N/A $49.76 $69.28 $67.17 $67.17 $67.17 $67.17 N/A $44.09 $41.99 "$3,372.00 " N/A N/A $35.69 $35.69 $41.99 $35.69 "$7,492.00 " 330104 93017 5722 80 482 HC CARDIOVASCULAR STRESS TEST TRACING ONLY O "$2,403.22 " $336.00 $336.00 $30.00 "$1,201.61 " "$1,490.00 " "$1,490.00 " $332.64 $30.00 $638.40 $30.00 $336.00 "$1,802.42 " $369.60 "$1,562.09 " "$1,756.75 " $36.00 $30.00 "$1,441.93 " "$7,492.00 " "$1,142.40 " "$4,407.00 " $30.00 $336.00 $403.20 $42.00 "$1,922.58 " $30.00 $30.00 $36.00 $470.40 $30.00 $336.00 $336.00 $366.24 "$1,922.58 " "$2,042.74 " $30.00 "$1,802.42 " $61.50 $30.00 "$1,201.61 " $554.40 "$1,622.17 " "$1,622.17 " "$1,622.17 " "$1,622.17 " N/A $352.80 $336.00 "$1,602.95 " $30.00 $30.00 $285.60 $285.60 $336.00 $30.00 "$7,492.00 " 330104 93308 5523 81 483 HC 2D TTE W OR W/O FOL W/CONFU O "$2,278.03 " $280.16 $280.16 $60.00 "$1,139.02 " "$1,412.38 " "$1,412.38 " $277.36 $60.00 $532.31 $60.00 $280.16 "$1,708.52 " $308.18 "$1,480.72 " "$1,665.24 " $72.00 $60.00 "$1,366.82 " "$7,492.00 " $952.56 "$4,407.00 " $60.00 $280.16 $336.20 $84.00 "$1,822.42 " $60.00 $60.00 $72.00 $392.23 $60.00 $280.16 $280.16 $305.38 "$1,822.42 " "$1,936.33 " $60.00 "$1,708.52 " $123.00 $60.00 "$1,139.02 " $462.27 "$1,537.67 " "$1,537.67 " "$1,537.67 " "$1,537.67 " N/A $294.17 $280.16 "$1,519.45 " $60.00 $60.00 $238.14 $238.14 $280.16 $60.00 "$7,492.00 " 330104 93356 81 483 HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH O $143.38 N/A N/A $327.87 $71.69 $88.90 $88.90 $13.30 $327.87 N/A $327.87 N/A $107.53 N/A $93.20 $104.81 $393.44 $327.87 $86.03 "$7,492.00 " N/A "$4,407.00 " $327.87 N/A $93.20 $459.02 $114.70 $327.87 $327.87 $393.44 N/A $327.87 N/A N/A N/A $114.70 $121.87 $442.62 $107.53 $672.13 $442.62 $71.69 $93.20 $96.78 $96.78 $96.78 $96.78 N/A N/A N/A $95.63 $327.87 $327.87 N/A N/A N/A $13.30 "$7,492.00 " 330104 C8930 5573 81 483 HC TTE W OR W/O CONTR CONT ECG O "$2,295.15 " $888.71 $888.71 $327.87 "$1,147.58 " "$1,422.99 " "$1,422.99 " $879.82 $327.87 "$1,688.54 " $327.87 $888.71 "$1,721.36 " $977.58 "$1,491.85 " "$1,677.75 " $393.44 $327.87 "$1,377.09 " "$7,492.00 " "$3,021.61 " "$4,407.00 " $327.87 $888.71 "$1,066.45 " $459.02 "$1,836.12 " $327.87 $327.87 $393.44 "$1,244.19 " $327.87 $888.71 $888.71 $968.69 "$1,836.12 " "$1,950.88 " $327.87 "$1,721.36 " $672.13 $327.87 "$1,147.58 " "$1,466.37 " "$1,549.23 " "$1,549.23 " "$1,549.23 " "$1,549.23 " N/A $933.14 $888.71 "$1,530.87 " $327.87 $327.87 $755.40 $755.40 $888.71 $327.87 "$7,492.00 " 330104 93306 5524 81 483 HC TTE W OR WO FOL WCONDOPPLER O "$3,137.24 " $603.63 $603.63 $206.50 "$1,568.62 " "$1,945.09 " "$1,945.09 " $597.59 $206.50 "$1,146.89 " $206.50 $603.63 "$2,352.93 " $663.99 "$2,039.21 " "$2,293.32 " $247.80 $206.50 "$1,882.34 " "$7,492.00 " "$2,052.33 " "$4,407.00 " $206.50 $603.63 $724.35 $289.10 "$2,509.79 " $206.50 $206.50 $247.80 $845.08 $206.50 $603.63 $603.63 $657.95 "$2,509.79 " "$2,666.65 " $206.50 "$2,352.93 " $423.32 $206.50 "$1,568.62 " $995.98 "$2,117.64 " "$2,117.64 " "$2,117.64 " "$2,117.64 " N/A $633.81 $603.63 "$2,092.54 " $206.50 $206.50 $513.08 $513.08 $603.63 $206.50 "$7,492.00 " 330104 0399T 81 483 HC MYOCARDIAL STRAIN IMAGING QUAN ASSMT O $143.38 N/A N/A $327.87 $71.69 $88.90 $88.90 $93.77 $327.87 N/A $327.87 N/A $107.53 N/A $93.20 $104.81 $393.44 $327.87 $86.03 "$7,492.00 " N/A "$4,407.00 " $327.87 N/A N/A $459.02 $114.70 $327.87 $327.87 $393.44 N/A $327.87 N/A N/A N/A $114.70 $121.87 $442.62 $107.53 $672.13 $442.62 $71.69 $93.20 $96.78 $96.78 $96.78 $96.78 N/A N/A N/A $95.63 $327.87 $327.87 N/A N/A N/A $71.69 "$7,492.00 " 330104 93303 5524 81 483 HC TTE W OR W/O FOL W/CONT COM O "$2,621.50 " $603.63 $603.63 $90.00 "$1,310.75 " "$1,625.33 " "$1,625.33 " $597.59 $90.00 "$1,146.89 " $90.00 $603.63 "$1,966.12 " $663.99 "$1,703.98 " "$1,916.32 " $108.00 $90.00 "$1,572.90 " "$7,492.00 " "$2,052.33 " "$4,407.00 " $90.00 $603.63 $724.35 $126.00 "$2,097.20 " $90.00 $90.00 $108.00 $845.08 $90.00 $603.63 $603.63 $657.95 "$2,097.20 " "$2,228.28 " $90.00 "$1,966.12 " $184.50 $90.00 "$1,310.75 " $995.98 "$1,769.51 " "$1,769.51 " "$1,769.51 " "$1,769.51 " N/A $633.81 $603.63 "$1,748.54 " $90.00 $90.00 $513.08 $513.08 $603.63 $90.00 "$7,492.00 " 330104 31502 5161 249 510 HC CHANGE OF WINDPIPE AIRWAY O "$2,363.63 " $249.34 $249.34 $135.47 $482.00 "$1,465.45 " "$1,465.45 " $246.85 $135.47 $473.75 $135.47 $249.34 "$1,772.72 " $274.28 "$1,489.09 " N/A $162.56 $135.47 "$1,418.18 " "$1,890.90 " $847.76 "$1,181.82 " $135.47 $249.34 $299.21 $189.66 "$1,890.90 " $135.47 $135.47 $162.56 $349.08 $135.47 $249.34 $249.34 $271.78 "$1,890.90 " "$2,009.09 " $135.47 "$1,772.72 " $277.71 $135.47 "$1,181.82 " $670.73 "$1,595.45 " "$1,595.45 " "$1,595.45 " "$1,595.45 " N/A $261.81 $249.34 "$1,576.54 " $135.47 $135.47 $211.94 $211.94 $249.34 $135.47 "$2,009.09 " 330104 30905 5734 249 510 HC CONTROL OF NOSEBLEED W/NASAL PACKS OR CAUTERY O "$1,307.54 " $139.30 $139.30 $135.47 "$1,878.00 " $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 "$3,883.00 " $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$3,883.00 " 330104 28630 5111 41 510 HC TREAT- TOE DISLOCATION O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 $642.00 "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 30903 5734 249 510 HC CONTROL OF NOSEBLEED COMPLEX O $503.97 $139.30 $139.30 $135.47 "$1,878.00 " $312.46 $312.46 $137.91 $135.47 $264.67 $135.47 $139.30 $377.98 $153.23 $317.50 N/A $162.56 $135.47 $302.38 $403.18 $473.63 $251.99 $135.47 $139.30 $167.16 $189.66 $403.18 $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 $403.18 $428.37 $135.47 $377.98 $277.71 $135.47 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,878.00 " 330104 30901 5734 249 510 HC CONTROL OF NOSEBLEED SIMPLE O "$1,307.54 " $139.30 $139.30 $135.47 $482.00 $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 $980.65 $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,111.41 " 330104 30300 5734 249 510 HC REMOVE NASAL FOREIGN BODY O "$1,307.54 " $139.30 $139.30 $135.47 $482.00 $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 $980.65 $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,111.41 " 330104 29581 5101 39 510 HC APPLY MULTLAY COMPRS LWR LEG O $814.27 $174.87 $174.87 $293.16 $482.00 $504.85 $504.85 $173.13 $293.16 $332.26 $293.16 $174.87 $610.70 $192.36 $512.99 N/A $351.80 $293.16 $488.56 $651.42 $594.57 $407.13 $293.16 $174.87 $209.85 $410.43 $651.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $651.42 $692.13 $293.16 $610.70 $600.98 $293.16 $407.13 $470.41 $549.63 $549.63 $549.63 $549.63 N/A $183.62 $174.87 $543.12 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 $692.13 330104 29580 5101 39 510 HC APPLICATION OF PASTE BOOT O $814.27 $174.87 $174.87 $293.16 $482.00 $504.85 $504.85 $173.13 $293.16 $332.26 $293.16 $174.87 $610.70 $192.36 $512.99 N/A $351.80 $293.16 $488.56 $651.42 $594.57 $407.13 $293.16 $174.87 $209.85 $410.43 $651.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $651.42 $692.13 $293.16 $610.70 $600.98 $293.16 $407.13 $470.41 $549.63 $549.63 $549.63 $549.63 N/A $183.62 $174.87 $543.12 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 $692.13 330104 29540 5101 40 510 HC STRAPPING OF ANKLE AND/OR FT O $546.77 $174.87 $174.87 $214.50 $482.00 $339.00 $339.00 $173.13 $214.50 $332.26 $214.50 $174.87 $410.08 $192.36 $344.47 N/A $257.41 $214.50 $328.06 $437.42 $594.57 $273.38 $214.50 $174.87 $209.85 $300.31 $437.42 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $437.42 $464.75 $214.50 $410.08 $439.74 $214.50 $273.38 $470.41 $369.07 $369.07 $369.07 $369.07 N/A $183.62 $174.87 $364.70 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $594.57 330104 29530 5734 40 510 HC STRAPPING OF KNEE O $485.78 $139.30 $139.30 $214.50 $482.00 $301.18 $301.18 $137.91 $214.50 $264.67 $214.50 $139.30 $364.33 $153.23 $306.04 N/A $257.41 $214.50 $291.47 $388.62 $473.63 $242.89 $214.50 $139.30 $167.16 $300.31 $388.62 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $388.62 $412.91 $214.50 $364.33 $439.74 $214.50 $242.89 $374.72 $327.90 $327.90 $327.90 $327.90 N/A $146.27 $139.30 $324.02 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $482.00 330104 31575 5151 249 510 HC LARYNGOSCOPY; FLEXIBLE DIAGNOSTIC O "$1,719.49 " $214.45 $214.45 $135.47 $482.00 "$1,066.08 " "$1,066.08 " $212.31 $135.47 $407.46 $135.47 $214.45 "$1,289.62 " $235.90 "$1,083.28 " N/A $162.56 $135.47 "$1,031.69 " "$1,375.59 " $729.14 $859.75 $135.47 $214.45 $257.34 $189.66 "$1,375.59 " $135.47 $135.47 $162.56 $300.23 $135.47 $214.45 $214.45 $233.75 "$1,375.59 " "$1,461.57 " $135.47 "$1,289.62 " $277.71 $135.47 $859.75 $576.88 "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A $225.18 $214.45 "$1,146.90 " $135.47 $135.47 $182.29 $182.29 $214.45 $135.47 "$4,600.00 " 330104 29515 5101 40 510 HC APPLICATION LOWER LEG SPLINT O $789.66 $174.87 $174.87 $214.50 $482.00 $489.59 $489.59 $173.13 $214.50 $332.26 $214.50 $174.87 $592.25 $192.36 $497.49 N/A $257.41 $214.50 $473.80 $631.73 $594.57 $394.83 $214.50 $174.87 $209.85 $300.31 $631.73 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $631.73 $671.21 $214.50 $592.25 $439.74 $214.50 $394.83 $470.41 $533.02 $533.02 $533.02 $533.02 N/A $183.62 $174.87 $526.70 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $671.21 330104 32554 5181 68 510 HC ASPIRATE PLEURA W/O IMAGING O "$6,718.53 " $694.05 $694.05 $609.85 "$1,099.00 " "$4,165.49 " "$4,165.49 " $687.11 $609.85 "$1,318.69 " $609.85 $694.05 "$5,038.90 " $763.45 "$4,232.67 " N/A $731.82 $609.85 "$4,031.12 " "$5,374.82 " "$2,359.77 " "$3,359.26 " $609.85 $694.05 $832.86 $853.79 "$5,374.82 " $609.85 $609.85 $731.82 $971.67 $609.85 $694.05 $694.05 $756.51 "$5,374.82 " "$5,710.75 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$3,359.26 " "$1,866.99 " "$4,535.01 " "$4,535.01 " "$4,535.01 " "$4,535.01 " N/A $728.75 $694.05 "$4,481.26 " $609.85 $609.85 $589.94 $589.94 $694.05 $589.94 "$5,710.75 " 330104 36511 5242 114 510 HC APHERESIS WBC O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 46083 5371 141 510 HC INCISE EXTERNAL HEMORRHOID O "$1,123.50 " $257.79 $257.79 "$1,102.59 " $482.00 $696.57 $696.57 $255.21 "$1,102.59 " $489.80 "$1,102.59 " $257.79 $842.62 $283.57 $707.80 N/A "$1,323.10 " "$1,102.59 " $674.10 $898.80 $876.48 $561.75 "$1,102.59 " $257.79 $309.35 "$1,543.62 " $898.80 "$1,102.59 " "$1,102.59 " "$1,323.10 " $360.90 "$1,102.59 " $257.79 $257.79 $280.99 $898.80 $954.98 "$1,102.59 " $842.62 "$2,260.30 " "$1,102.59 " $561.75 $693.45 $758.36 $758.36 $758.36 $758.36 N/A $270.68 $257.79 $749.37 "$1,102.59 " "$1,102.59 " $219.12 $219.12 $257.79 $219.12 "$2,260.30 " 330104 46050 5311 141 510 HC INCISION OF ANAL ABSCESS O "$3,640.14 " $997.03 $997.03 "$1,102.59 " "$1,878.00 " "$2,256.89 " "$2,256.89 " $987.06 "$1,102.59 " "$1,894.36 " "$1,102.59 " $997.03 "$2,730.11 " "$1,096.74 " "$2,293.29 " N/A "$1,323.10 " "$1,102.59 " "$2,184.08 " "$2,912.11 " "$3,389.91 " "$1,820.07 " "$1,102.59 " $997.03 "$1,196.44 " "$1,543.62 " "$2,912.11 " "$1,102.59 " "$1,102.59 " "$1,323.10 " "$1,395.84 " "$1,102.59 " $997.03 $997.03 "$1,086.76 " "$2,912.11 " "$3,094.12 " "$1,102.59 " "$2,730.11 " "$2,260.30 " "$1,102.59 " "$1,820.07 " "$2,682.02 " "$2,457.09 " "$2,457.09 " "$2,457.09 " "$2,457.09 " N/A "$1,046.88 " $997.03 "$2,427.97 " "$1,102.59 " "$1,102.59 " $847.48 $847.48 $997.03 $847.48 "$3,389.91 " 330104 46040 5312 141 510 HC INCISION OF RECTAL ABSCESS O "$4,494.00 " "$1,299.21 " "$1,299.21 " "$1,102.59 " "$2,886.00 " "$2,786.28 " "$2,786.28 " "$1,286.22 " "$1,102.59 " "$2,468.50 " "$1,102.59 " "$1,299.21 " "$3,370.50 " "$1,429.13 " "$2,831.22 " N/A "$1,323.10 " "$1,102.59 " "$2,696.40 " "$3,595.20 " "$4,417.32 " "$2,247.00 " "$1,102.59 " "$1,299.21 " "$1,559.05 " "$1,543.62 " "$3,595.20 " "$1,102.59 " "$1,102.59 " "$1,323.10 " "$1,818.89 " "$1,102.59 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$3,595.20 " "$3,819.90 " "$1,102.59 " "$3,883.00 " "$2,260.30 " "$1,102.59 " "$2,247.00 " "$3,494.88 " "$3,033.45 " "$3,033.45 " "$3,033.45 " "$3,033.45 " N/A "$1,364.17 " "$1,299.21 " "$2,997.50 " "$1,102.59 " "$1,102.59 " "$1,104.33 " "$1,104.33 " "$1,299.21 " "$1,102.59 " "$4,417.32 " 330104 43262 5303 138 510 HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY O "$13,816.91 " "$3,911.98 " "$3,911.98 " "$1,316.62 " "$2,523.00 " "$8,566.48 " "$8,566.48 " "$3,872.86 " "$1,316.62 " "$7,432.76 " "$1,316.62 " "$3,911.98 " "$10,362.68 " "$4,303.18 " "$8,704.65 " N/A "$1,579.94 " "$1,316.62 " "$8,290.15 " "$11,053.53 " "$13,300.73 " "$6,908.45 " "$1,316.62 " "$3,911.98 " "$4,694.38 " "$1,843.27 " "$11,053.53 " "$1,316.62 " "$1,316.62 " "$1,579.94 " "$5,476.77 " "$1,316.62 " "$3,911.98 " "$3,911.98 " "$4,264.06 " "$11,053.53 " "$11,744.37 " "$1,316.62 " "$10,362.68 " "$2,699.07 " "$1,316.62 " "$6,908.45 " "$10,523.23 " "$9,326.41 " "$9,326.41 " "$9,326.41 " "$9,326.41 " N/A "$4,107.58 " "$3,911.98 " "$9,215.88 " "$1,316.62 " "$1,316.62 " "$3,325.18 " "$3,325.18 " "$3,911.98 " "$1,316.62 " "$13,300.73 " 330104 43260 5303 138 510 HC ERCP W/SPECIMEN COLLECTION O "$13,816.91 " "$3,911.98 " "$3,911.98 " "$1,316.62 " "$2,523.00 " "$1,792.00 " "$1,631.00 " "$3,872.86 " "$1,316.62 " "$7,432.76 " "$1,316.62 " "$3,911.98 " "$10,362.68 " "$4,303.18 " "$8,704.65 " N/A "$1,579.94 " "$1,316.62 " "$8,290.15 " "$11,053.53 " "$13,300.73 " "$6,908.45 " "$1,316.62 " "$3,911.98 " "$4,694.38 " "$1,843.27 " "$11,053.53 " "$1,316.62 " "$1,316.62 " "$1,579.94 " "$5,476.77 " "$1,316.62 " "$3,911.98 " "$3,911.98 " "$4,264.06 " "$11,053.53 " "$11,744.37 " "$1,316.62 " "$10,362.68 " "$2,699.07 " "$1,316.62 " "$6,908.45 " "$10,523.23 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$4,107.58 " "$3,911.98 " "$9,215.88 " "$1,316.62 " "$1,316.62 " "$3,325.18 " "$3,325.18 " "$3,911.98 " "$1,316.62 " "$13,300.73 " 330104 43247 5301 134 510 HC EGD REMOVE FOREIGN BODY O "$3,370.50 " $990.40 $990.40 $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " $980.49 $814.80 "$1,881.75 " $814.80 $990.40 "$2,527.88 " "$1,089.44 " "$2,123.41 " N/A $977.76 $814.80 "$2,022.30 " "$2,696.40 " "$3,367.35 " "$1,685.25 " $814.80 $990.40 "$1,188.48 " "$1,140.72 " "$2,696.40 " $814.80 $814.80 $977.76 "$1,386.56 " $814.80 $990.40 $990.40 "$1,079.53 " "$2,696.40 " "$2,864.92 " $814.80 "$2,527.88 " "$1,670.35 " $814.80 "$1,685.25 " "$2,664.17 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$1,039.92 " $990.40 "$2,248.12 " $814.80 $814.80 $841.84 $841.84 $990.40 $814.80 "$4,600.00 " 330104 43246 5302 134 510 HC EGD PLACE GASTROSTOMY TUBE O "$7,886.97 " "$2,089.46 " "$2,089.46 " $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " "$2,068.56 " $814.80 "$3,969.96 " $814.80 "$2,089.46 " "$5,915.23 " "$2,298.40 " "$4,968.79 " N/A $977.76 $814.80 "$4,732.18 " "$6,309.58 " "$7,104.15 " "$3,943.49 " $814.80 "$2,089.46 " "$2,507.35 " "$1,140.72 " "$6,309.58 " $814.80 $814.80 $977.76 "$2,925.24 " $814.80 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$6,309.58 " "$6,703.92 " $814.80 "$5,915.23 " "$1,670.35 " $814.80 "$3,943.49 " "$5,620.63 " "$5,323.70 " "$5,323.70 " "$5,323.70 " "$5,323.70 " N/A "$2,193.93 " "$2,089.46 " "$5,260.61 " $814.80 $814.80 "$1,776.04 " "$1,776.04 " "$2,089.46 " $814.80 "$7,104.15 " 330104 43239 5301 134 510 HC EGD BIOPSY SINGLE/MULTIPLE O "$3,210.00 " $990.40 $990.40 $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " $980.49 $814.80 "$1,881.75 " $814.80 $990.40 "$2,407.50 " "$1,089.44 " "$2,022.30 " N/A $977.76 $814.80 "$1,926.00 " "$2,568.00 " "$3,367.35 " "$1,605.00 " $814.80 $990.40 "$1,188.48 " "$1,140.72 " "$2,568.00 " $814.80 $814.80 $977.76 "$1,386.56 " $814.80 $990.40 $990.40 "$1,079.53 " "$2,568.00 " "$2,728.50 " $814.80 "$2,407.50 " "$1,670.35 " $814.80 "$1,605.00 " "$2,664.17 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$1,039.92 " $990.40 "$2,141.07 " $814.80 $814.80 $841.84 $841.84 $990.40 $814.80 "$4,600.00 " 330104 42700 5161 249 510 HC DRAINAGE OF TONSIL ABSCESS O "$1,722.70 " $249.34 $249.34 $135.47 "$1,878.00 " "$1,068.07 " "$1,068.07 " $246.85 $135.47 $473.75 $135.47 $249.34 "$1,292.03 " $274.28 "$1,085.30 " N/A $162.56 $135.47 "$1,033.62 " "$1,378.16 " $847.76 $861.35 $135.47 $249.34 $299.21 $189.66 "$1,378.16 " $135.47 $135.47 $162.56 $349.08 $135.47 $249.34 $249.34 $271.78 "$1,378.16 " "$1,464.30 " $135.47 "$1,292.03 " $277.71 $135.47 $861.35 $670.73 "$1,162.82 " "$1,162.82 " "$1,162.82 " "$1,162.82 " N/A $261.81 $249.34 "$1,149.04 " $135.47 $135.47 $211.94 $211.94 $249.34 $135.47 "$1,878.00 " 330104 32555 5181 68 510 HC ASPIRATE PLEURA W/ IMAGING O "$6,222.05 " $694.05 $694.05 $609.85 "$1,099.00 " "$3,857.67 " "$3,857.67 " $687.11 $609.85 "$1,318.69 " $609.85 $694.05 "$4,666.54 " $763.45 "$3,919.89 " N/A $731.82 $609.85 "$3,733.23 " "$4,977.64 " "$2,359.77 " "$3,111.03 " $609.85 $694.05 $832.86 $853.79 "$4,977.64 " $609.85 $609.85 $731.82 $971.67 $609.85 $694.05 $694.05 $756.51 "$4,977.64 " "$5,288.74 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$3,111.03 " "$1,866.99 " "$4,199.88 " "$4,199.88 " "$4,199.88 " "$4,199.88 " N/A $728.75 $694.05 "$4,150.11 " $609.85 $609.85 $589.94 $589.94 $694.05 $589.94 "$5,288.74 " 330104 38505 5072 10 510 HC NEEDLE BIOPSY LYMPH NODES O "$7,463.25 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,878.00 " "$4,627.22 " "$4,627.22 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$5,597.44 " "$1,978.98 " "$4,701.85 " N/A "$1,500.96 " "$1,250.80 " "$4,477.95 " "$5,970.60 " "$6,116.84 " "$3,731.62 " "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$5,970.60 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,970.60 " "$6,343.76 " "$1,250.80 " "$5,597.44 " "$2,564.14 " "$1,250.80 " "$3,731.62 " "$4,839.50 " "$5,037.69 " "$5,037.69 " "$5,037.69 " "$5,037.69 " N/A "$1,889.02 " "$1,799.07 " "$4,977.99 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,250.80 " "$6,343.76 " 330104 37799 5181 78 510 HB VASCULAR SURGERY PROCEDURE UNLIST O "$2,691.05 " $694.05 $694.05 "$2,585.49 " "$2,523.00 " "$1,668.45 " "$1,668.45 " $687.11 "$2,585.49 " "$1,318.69 " "$2,585.49 " $694.05 "$2,018.29 " $763.45 "$1,695.36 " N/A "$3,102.58 " "$2,585.49 " "$1,614.63 " "$2,152.84 " "$2,359.77 " "$1,345.53 " "$2,585.49 " $694.05 $832.86 "$3,619.68 " "$2,152.84 " "$2,585.49 " "$2,585.49 " "$3,102.58 " $971.67 "$2,585.49 " $694.05 $694.05 $756.51 "$2,152.84 " "$2,287.39 " "$2,585.49 " "$2,018.29 " "$5,300.24 " "$2,585.49 " "$1,345.53 " "$1,866.99 " "$1,816.46 " "$1,816.46 " "$1,816.46 " "$1,816.46 " N/A $728.75 $694.05 "$1,794.93 " "$2,585.49 " "$2,585.49 " $589.94 $589.94 $694.05 $589.94 "$5,300.24 " 330104 36600 5734 494 510 HC ARTERIAL PUNCTURE BLOOD FOR DX O $503.97 $139.30 $139.30 $32.33 $482.00 "$1,296.00 " "$1,180.00 " $137.91 $32.33 $264.67 $32.33 $139.30 $377.98 $153.23 $317.50 N/A $38.79 $32.33 $302.38 $403.18 $473.63 $251.99 $32.33 $139.30 $167.16 $45.26 $403.18 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $403.18 $428.37 $32.33 $377.98 $66.27 $32.33 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 "$1,296.00 " 330104 36593 5694 111 510 HC DECLOT VASCULAR DEVICE O "$1,760.15 " $399.06 $399.06 $271.09 $482.00 "$1,091.29 " "$1,091.29 " $395.07 $271.09 $758.21 $271.09 $399.06 "$1,320.11 " $438.96 "$1,108.89 " N/A $325.31 $271.09 "$1,056.09 " "$1,408.12 " "$1,356.80 " $880.08 $271.09 $399.06 $478.87 $379.53 "$1,408.12 " $271.09 $271.09 $325.31 $558.68 $271.09 $399.06 $399.06 $434.97 "$1,408.12 " "$1,496.13 " $271.09 "$1,320.11 " $555.74 $271.09 $880.08 "$1,073.46 " "$1,188.10 " "$1,188.10 " "$1,188.10 " "$1,188.10 " N/A $419.01 $399.06 "$1,174.02 " $271.09 $271.09 $339.20 $339.20 $399.06 $271.09 "$1,496.13 " 330104 36592 5734 494 510 HC COLLECT BLOOD FROM PICC O $503.97 $139.30 $139.30 $32.33 $482.00 $312.46 $312.46 $137.91 $32.33 $264.67 $32.33 $139.30 $377.98 $153.23 $317.50 N/A $38.79 $32.33 $302.38 $403.18 $473.63 $251.99 $32.33 $139.30 $167.16 $45.26 $403.18 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $403.18 $428.37 $32.33 $377.98 $66.27 $32.33 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 $482.00 330104 36591 5734 494 510 HC DRAW BLOOD OFF VENOUS DEVICE O $632.37 $139.30 $139.30 $32.33 $482.00 $392.07 $392.07 $137.91 $32.33 $264.67 $32.33 $139.30 $474.28 $153.23 $398.39 N/A $38.79 $32.33 $379.42 $505.90 $473.63 $316.19 $32.33 $139.30 $167.16 $45.26 $505.90 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $505.90 $537.51 $32.33 $474.28 $66.27 $32.33 $316.19 $374.72 $426.85 $426.85 $426.85 $426.85 N/A $146.27 $139.30 $421.79 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 $537.51 330104 20604 5441 50 510 HC US GUIDED JOINT ASP/INJECTION - SMALL O "$1,347.13 " $326.20 $326.20 $538.09 $482.00 $835.22 $835.22 $322.94 $538.09 $619.77 $538.09 $326.20 "$1,010.35 " $358.82 $848.69 N/A $645.71 $538.09 $808.28 "$1,077.70 " "$1,109.07 " $673.57 $538.09 $326.20 $391.44 $753.33 "$1,077.70 " $538.09 $538.09 $645.71 $456.68 $538.09 $326.20 $326.20 $355.56 "$1,077.70 " "$1,145.06 " $538.09 "$1,010.35 " "$1,103.09 " $538.09 $673.57 $877.47 $909.31 $909.31 $909.31 $909.31 N/A $342.51 $326.20 $898.54 $538.09 $538.09 $277.27 $277.27 $326.20 $277.27 "$1,145.06 " 330104 36514 5242 114 510 HC APHERESIS PLASMA O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 36513 5241 114 510 HC APHERESIS PLATELETS O "$8,062.45 " $489.19 $489.19 $150.00 "$1,878.00 " "$4,998.72 " "$4,998.72 " $484.30 $150.00 $929.47 $150.00 $489.19 "$6,046.84 " $538.11 "$5,079.34 " N/A $180.00 $150.00 "$4,837.47 " "$6,449.96 " "$1,663.26 " "$4,031.22 " $150.00 $489.19 $587.03 $210.00 "$6,449.96 " $150.00 $150.00 $180.00 $684.87 $150.00 $489.19 $489.19 $533.22 "$6,449.96 " "$6,853.08 " $150.00 "$6,046.84 " $307.50 $150.00 "$4,031.22 " "$1,315.93 " "$5,442.15 " "$5,442.15 " "$5,442.15 " "$5,442.15 " N/A $513.65 $489.19 "$5,377.65 " $150.00 $150.00 $415.81 $415.81 $489.19 $150.00 "$6,853.08 " 330104 36512 5242 114 510 HC APHERESIS RBC O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 38221 5072 124 510 HC BONE MARROW BIOPSY NEEDLE/TROCAR O "$6,324.77 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $614.75 $512.29 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $512.29 "$1,799.07 " "$2,158.88 " $717.20 "$5,059.82 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $512.29 "$4,743.58 " "$1,050.19 " $512.29 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 29505 5101 40 510 HC APPLICATION LONG LEG SPLINT O "$1,443.43 " $174.87 $174.87 $214.50 $482.00 $894.93 $894.93 $173.13 $214.50 $332.26 $214.50 $174.87 "$1,082.57 " $192.36 $909.36 N/A $257.41 $214.50 $866.06 "$1,154.74 " $594.57 $721.72 $214.50 $174.87 $209.85 $300.31 "$1,154.74 " $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 "$1,154.74 " "$1,226.92 " $214.50 "$1,082.57 " $439.74 $214.50 $721.72 $470.41 $974.32 $974.32 $974.32 $974.32 N/A $183.62 $174.87 $962.77 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 "$1,226.92 " 330104 29240 5734 40 510 HC STRAPPING OF SHOULDER O $385.20 $139.30 $139.30 $214.50 $482.00 $238.82 $238.82 $137.91 $214.50 $264.67 $214.50 $139.30 $288.90 $153.23 $242.68 N/A $257.41 $214.50 $231.12 $308.16 $473.63 $192.60 $214.50 $139.30 $167.16 $300.31 $308.16 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $308.16 $327.42 $214.50 $288.90 $439.74 $214.50 $192.60 $374.72 $260.01 $260.01 $260.01 $260.01 N/A $146.27 $139.30 $256.93 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $482.00 330104 29445 5102 39 510 HC APPLY RIGID LEG CAST O "$1,769.78 " $287.83 $287.83 $293.16 $482.00 "$1,097.26 " "$1,097.26 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,327.34 " $316.61 "$1,114.96 " N/A $351.80 $293.16 "$1,061.87 " "$1,415.82 " $978.62 $884.89 $293.16 $287.83 $345.40 $410.43 "$1,415.82 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,415.82 " "$1,504.31 " $293.16 "$3,883.00 " $600.98 $293.16 $884.89 $774.26 "$1,194.60 " "$1,194.60 " "$1,194.60 " "$1,194.60 " N/A $302.22 $287.83 "$1,180.44 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$3,883.00 " 330104 25560 5111 41 510 HC CLSD TREAT FRACTURE RADIUS & ULNA O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 25605 5112 41 510 HC CLSDFX RADIAL/ULNA (COLLES/SMITH)W/MANIP O "$8,556.79 " "$1,721.05 " "$1,721.05 " $508.54 "$2,886.00 " "$5,305.21 " "$5,305.21 " "$1,703.84 " $508.54 "$3,270.00 " $508.54 "$1,721.05 " "$6,417.59 " "$1,893.16 " "$5,390.78 " N/A $610.24 $508.54 "$5,134.07 " "$6,845.43 " "$5,851.57 " "$4,278.40 " $508.54 "$1,721.05 " "$2,065.26 " $711.95 "$6,845.43 " $508.54 $508.54 $610.24 "$2,409.47 " $508.54 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 "$4,278.40 " "$4,629.63 " "$5,775.83 " "$5,775.83 " "$5,775.83 " "$5,775.83 " N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " $508.54 $508.54 "$1,462.89 " "$1,462.89 " "$1,721.05 " $508.54 "$7,273.27 " 330104 25650 5111 41 510 HC CLSD TREAT ULNA STYLOID FX O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26010 5051 3 510 HC DRAINAGE OF FINGER ABSCESS; SIMPLE O $828.18 $216.65 $216.65 $325.60 $482.00 $513.47 $513.47 $214.48 $325.60 $411.63 $325.60 $216.65 $621.14 $238.31 $521.75 N/A $390.72 $325.60 $496.91 $662.54 $736.61 $414.09 $325.60 $216.65 $259.98 $455.84 $662.54 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $662.54 $703.95 $325.60 $621.14 $667.48 $325.60 $414.09 $582.79 $559.02 $559.02 $559.02 $559.02 N/A $227.48 $216.65 $552.40 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 $736.61 330104 26600 5111 41 510 HC CLSD TREAT METACARPAL FRCTR W/O MANIP EA O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26720 5111 41 510 HC CLSD TREAT FINGER FX EA. W/O MANIP O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$1,384.31 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,568.89 " 330104 26725 5111 41 510 HC CLSD.TREAT.FINGER FX EA. W/MANIP - EACH O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26750 5111 41 510 HC CLOSED TREAT FINGER FRACTR EA W/O MANIP O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 $642.00 "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 26770 5111 41 510 HC TREAT FINGER DISLOCATION O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 27096 50 510 HC INJECT SACROILIAC JOINT O "$1,095.68 " $98.00 $98.00 $538.09 $482.00 $679.32 $679.32 $97.02 $538.09 $186.19 $538.09 $98.00 $821.76 $107.80 $690.28 N/A $645.71 $538.09 $657.41 $876.54 $333.19 $547.84 $538.09 $98.00 $712.19 $753.33 $876.54 $538.09 $538.09 $645.71 $137.19 $538.09 $98.00 $98.00 $106.82 $876.54 $931.33 $726.42 $821.76 "$1,103.09 " $726.42 $547.84 $712.19 $739.58 $739.58 $739.58 $739.58 N/A $102.90 $98.00 $730.82 $538.09 $538.09 $83.30 $83.30 $98.00 $83.30 "$1,103.09 " 330104 27750 5111 41 510 HC TREATMENT.. OF TIBIA FRACTURE O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 27786 5111 41 510 HC CLSD TREAT DISTAL FIBULAR FX O $802.50 $248.36 $248.36 $508.54 "$1,878.00 " $497.55 $497.55 $245.87 $508.54 $471.88 $508.54 $248.36 $601.88 $273.19 $505.57 N/A $610.24 $508.54 $481.50 $642.00 $844.42 $401.25 $508.54 $248.36 $298.03 $711.95 $642.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $642.00 $682.12 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $401.25 $668.08 $541.69 $541.69 $541.69 $541.69 N/A $260.78 $248.36 $535.27 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 28190 5071 9 510 HC REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS O "$2,808.75 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,741.42 " "$1,741.42 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,106.56 " $856.45 "$1,769.51 " N/A $764.34 $636.95 "$1,685.25 " "$2,247.00 " "$2,647.22 " "$1,404.38 " $636.95 $778.60 $934.31 $891.73 "$2,247.00 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,247.00 " "$2,387.44 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,404.38 " "$2,094.42 " "$1,895.91 " "$1,895.91 " "$1,895.91 " "$1,895.91 " N/A $817.53 $778.60 "$1,873.44 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 28470 5111 41 510 HC TREAT METATARSAL FRACTURE O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 28515 5111 41 510 HC TREATMENT - OF TOE FRACTURE W/MANIP-EA O $843.16 $248.36 $248.36 $508.54 $482.00 $522.76 $522.76 $245.87 $508.54 $471.88 $508.54 $248.36 $632.37 $273.19 $531.19 N/A $610.24 $508.54 $505.90 $674.53 $844.42 $421.58 $508.54 $248.36 $298.03 $711.95 $674.53 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $674.53 $716.69 $508.54 $632.37 "$1,042.50 " $508.54 $421.58 $668.08 $569.13 $569.13 $569.13 $569.13 N/A $260.78 $248.36 $562.39 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 25500 5111 41 510 HC CLSD TREAT. FRACTURE OF RADIAL SHAFT O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 29450 5101 39 510 HC APPLICATION OF LEG CAST O $546.77 $174.87 $174.87 $293.16 $482.00 $339.00 $339.00 $173.13 $293.16 $332.26 $293.16 $174.87 $410.08 $192.36 $344.47 N/A $351.80 $293.16 $328.06 $437.42 $594.57 $273.38 $293.16 $174.87 $209.85 $410.43 $437.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $437.42 $464.75 $293.16 "$3,883.00 " $600.98 $293.16 $273.38 $470.41 $369.07 $369.07 $369.07 $369.07 N/A $183.62 $174.87 $364.70 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 "$3,883.00 " 330104 24670 5111 41 510 HC CLSD TREAT PROX.END ULNAR FRACTURE O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 49083 5301 150 510 HC ABD PARACENTESIS W/IMAGING O "$3,773.89 " $990.40 $990.40 $609.85 "$2,523.00 " "$2,339.81 " "$2,339.81 " $980.49 $609.85 "$1,881.75 " $609.85 $990.40 "$2,830.42 " "$1,089.44 " "$2,377.55 " N/A $731.82 $609.85 "$2,264.33 " "$3,019.11 " "$3,367.35 " "$1,886.94 " $609.85 $990.40 "$1,188.48 " $853.79 "$3,019.11 " $609.85 $609.85 $731.82 "$1,386.56 " $609.85 $990.40 $990.40 "$1,079.53 " "$3,019.11 " "$3,207.81 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$1,886.94 " "$2,664.17 " "$2,547.38 " "$2,547.38 " "$2,547.38 " "$2,547.38 " N/A "$1,039.92 " $990.40 "$2,517.18 " $609.85 $609.85 $841.84 $841.84 $990.40 $609.85 "$3,883.00 " 330104 29425 5102 39 510 HC APPLICATION SHORT LEG CAST(BELOW KNEE-TOES)WALKING O "$1,959.17 " $287.83 $287.83 $293.16 $482.00 "$1,214.69 " "$1,214.69 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,469.38 " $316.61 "$1,234.28 " N/A $351.80 $293.16 "$1,175.50 " "$1,567.34 " $978.62 $979.59 $293.16 $287.83 $345.40 $410.43 "$1,567.34 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,567.34 " "$1,665.29 " $293.16 "$1,469.38 " $600.98 $293.16 $979.59 $774.26 "$1,322.44 " "$1,322.44 " "$1,322.44 " "$1,322.44 " N/A $302.22 $287.83 "$1,306.77 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,665.29 " 330104 29405 5102 39 510 HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) O "$1,683.11 " $287.83 $287.83 $293.16 $482.00 "$1,296.00 " "$1,180.00 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,262.33 " $316.61 "$1,060.36 " N/A $351.80 $293.16 "$1,009.87 " "$1,346.49 " $978.62 $841.55 $293.16 $287.83 $345.40 $410.43 "$1,346.49 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,346.49 " "$1,430.64 " $293.16 "$1,262.33 " $600.98 $293.16 $841.55 $774.26 "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $302.22 $287.83 "$1,122.63 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,430.64 " 330104 29260 5733 40 510 HC STRAPPING OF ELBOW OR WRIST O $546.77 $68.96 $68.96 $214.50 $482.00 $339.00 $339.00 $68.27 $214.50 $131.03 $214.50 $68.96 $410.08 $75.86 $344.47 N/A $257.41 $214.50 $328.06 $437.42 $234.47 $273.38 $214.50 $68.96 $82.75 $300.31 $437.42 $214.50 $214.50 $257.41 $96.55 $214.50 $68.96 $68.96 $75.17 $437.42 $464.75 $214.50 $410.08 $439.74 $214.50 $273.38 $185.51 $369.07 $369.07 $369.07 $369.07 N/A $72.41 $68.96 $364.70 $214.50 $214.50 $58.62 $58.62 $68.96 $58.62 $482.00 330104 29075 5102 39 510 HC APPLICATION OF FOREARM CAST O "$1,959.17 " $287.83 $287.83 $293.16 $482.00 "$1,296.00 " "$1,180.00 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,469.38 " $316.61 "$1,234.28 " N/A $351.80 $293.16 "$1,175.50 " "$1,567.34 " $978.62 $979.59 $293.16 $287.83 $345.40 $410.43 "$1,567.34 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,567.34 " "$1,665.29 " $293.16 "$1,469.38 " $600.98 $293.16 $979.59 $774.26 "$1,322.44 " "$1,322.44 " "$1,322.44 " "$1,322.44 " N/A $302.22 $287.83 "$1,306.77 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,665.29 " 330104 29130 5734 40 510 HC APPLICATION OF FINGER SPLINT; STATIC O "$1,060.37 " $139.30 $139.30 $214.50 $482.00 $657.43 $657.43 $137.91 $214.50 $264.67 $214.50 $139.30 $795.28 $153.23 $668.03 N/A $257.41 $214.50 $636.22 $848.30 $473.63 $530.18 $214.50 $139.30 $167.16 $300.31 $848.30 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $848.30 $901.31 $214.50 $795.28 $439.74 $214.50 $530.18 $374.72 $715.75 $715.75 $715.75 $715.75 N/A $146.27 $139.30 $707.27 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $901.31 330104 29126 5734 40 510 HC APPLICATION SHORT ARM SPLINT (FOREARM-HAND)DYNAMIC O $642.00 $139.30 $139.30 $214.50 $482.00 $398.04 $398.04 $137.91 $214.50 $264.67 $214.50 $139.30 $481.50 $153.23 $404.46 N/A $257.41 $214.50 $385.20 $513.60 $473.63 $321.00 $214.50 $139.30 $167.16 $300.31 $513.60 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $513.60 $545.70 $214.50 $481.50 $439.74 $214.50 $321.00 $374.72 $433.35 $433.35 $433.35 $433.35 N/A $146.27 $139.30 $428.21 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $545.70 330104 29125 5734 40 510 HC APPLICATION SHORT ARM SPLINT (FOREARM-HAND)STATIC O $728.67 $139.30 $139.30 $214.50 $482.00 "$1,296.00 " "$1,180.00 " $137.91 $214.50 $264.67 $214.50 $139.30 $546.50 $153.23 $459.06 N/A $257.41 $214.50 $437.20 $582.94 $473.63 $364.33 $214.50 $139.30 $167.16 $300.31 $582.94 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $582.94 $619.37 $214.50 $546.50 $439.74 $214.50 $364.33 $374.72 $491.85 $491.85 $491.85 $491.85 N/A $146.27 $139.30 $486.02 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 "$1,296.00 " 330104 29105 5101 40 510 HC APPLY LONG ARM SPLINT O $679.45 $174.87 $174.87 $214.50 $482.00 $421.26 $421.26 $173.13 $214.50 $332.26 $214.50 $174.87 $509.59 $192.36 $428.05 N/A $257.41 $214.50 $407.67 $543.56 $594.57 $339.73 $214.50 $174.87 $209.85 $300.31 $543.56 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $543.56 $577.53 $214.50 $509.59 $439.74 $214.50 $339.73 $470.41 $458.63 $458.63 $458.63 $458.63 N/A $183.62 $174.87 $453.19 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $594.57 330104 20605 5441 49 510 HC DRAIN/INJECT INTERMED. JOINT/BURSA O "$1,206.96 " $326.20 $326.20 $296.51 $482.00 $748.32 $748.32 $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 N/A $355.81 $296.51 $724.18 $965.57 "$1,109.07 " $603.48 $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $814.70 $814.70 $814.70 $814.70 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,109.07 " 330104 20610 5441 49 510 HC DRAIN/INJECT MAJOR JOINT/BURSA O "$1,206.96 " $326.20 $326.20 $296.51 $482.00 "$1,296.00 " "$1,180.00 " $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 N/A $355.81 $296.51 $724.18 $965.57 "$1,109.07 " $603.48 $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $814.70 $814.70 $814.70 $814.70 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,296.00 " 330104 20612 5441 49 510 HC ASPIRATE/INJ GANGLION CYST O "$1,346.06 " $326.20 $326.20 $296.51 $482.00 $834.56 $834.56 $322.94 $296.51 $619.77 $296.51 $326.20 "$1,009.54 " $358.82 $848.02 N/A $355.81 $296.51 $807.64 "$1,076.85 " "$1,109.07 " $673.03 $296.51 $326.20 $391.44 $415.11 "$1,076.85 " $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 "$1,076.85 " "$1,144.15 " $296.51 "$1,009.54 " $607.85 $296.51 $673.03 $877.47 $908.59 $908.59 $908.59 $908.59 N/A $342.51 $326.20 $897.82 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,144.15 " 330104 21320 5164 41 510 HC CLOSED TX NOSE FX W/ STABLJ O "$13,715.26 " "$3,413.30 " "$3,413.30 " $508.54 "$2,523.00 " "$8,503.46 " "$8,503.46 " "$3,379.16 " $508.54 "$6,485.26 " $508.54 "$3,413.30 " "$10,286.44 " "$3,754.63 " "$8,640.61 " N/A $610.24 $508.54 "$8,229.16 " "$10,972.21 " "$11,605.21 " "$6,857.63 " $508.54 "$3,413.30 " "$4,095.96 " $711.95 "$10,972.21 " $508.54 $508.54 $610.24 "$4,778.61 " $508.54 "$3,413.30 " "$3,413.30 " "$3,720.49 " "$10,972.21 " "$11,657.97 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 "$6,857.63 " "$9,181.77 " "$9,257.80 " "$9,257.80 " "$9,257.80 " "$9,257.80 " N/A "$3,583.96 " "$3,413.30 " "$9,148.08 " $508.54 $508.54 "$2,901.30 " "$2,901.30 " "$3,413.30 " $508.54 "$11,657.97 " 330104 21550 5072 69 510 HC BIOPSY OF NECK/CHEST O "$6,721.74 " "$1,799.07 " "$1,799.07 " "$1,816.61 " "$1,878.00 " "$4,167.48 " "$4,167.48 " "$1,781.08 " "$1,816.61 " "$3,418.23 " "$1,816.61 " "$1,799.07 " "$5,041.31 " "$1,978.98 " "$4,234.70 " N/A "$2,179.93 " "$1,816.61 " "$4,033.04 " "$5,377.39 " "$6,116.84 " "$3,360.87 " "$1,816.61 " "$1,799.07 " "$2,158.88 " "$2,543.25 " "$5,377.39 " "$1,816.61 " "$1,816.61 " "$2,179.93 " "$2,518.70 " "$1,816.61 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,377.39 " "$5,713.48 " "$1,816.61 " "$3,883.00 " "$3,724.05 " "$1,816.61 " "$3,360.87 " "$4,839.50 " "$4,537.17 " "$4,537.17 " "$4,537.17 " "$4,537.17 " N/A "$1,889.02 " "$1,799.07 " "$4,483.40 " "$1,816.61 " "$1,816.61 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$6,116.84 " 330104 23600 5111 41 510 HC CLSD TREAT PROX. HUMERUS FRACTURE O $910.57 $248.36 $248.36 $508.54 $482.00 $564.55 $564.55 $245.87 $508.54 $471.88 $508.54 $248.36 $682.93 $273.19 $573.66 N/A $610.24 $508.54 $546.34 $728.46 $844.42 $455.29 $508.54 $248.36 $298.03 $711.95 $728.46 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $728.46 $773.98 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $455.29 $668.08 $614.63 $614.63 $614.63 $614.63 N/A $260.78 $248.36 $607.35 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 24530 5111 41 510 HC CLSD TREATSUB/TRANS W/O INTER HUMERUS FX O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 24650 5111 41 510 HC CLSD TREAT HEAD / NECK RADIUS FRACTURE O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 49440 5302 130 510 HC PLACE GASTROSTOMY TUBE PERC O "$4,815.00 " "$2,089.46 " "$2,089.46 " $507.89 "$2,523.00 " "$2,985.30 " "$2,985.30 " "$2,068.56 " $507.89 "$3,969.96 " $507.89 "$2,089.46 " "$3,611.25 " "$2,298.40 " "$3,033.45 " N/A $609.46 $507.89 "$2,889.00 " "$3,852.00 " "$7,104.15 " "$2,407.50 " $507.89 "$2,089.46 " "$2,507.35 " $711.04 "$3,852.00 " $507.89 $507.89 $609.46 "$2,925.24 " $507.89 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$3,852.00 " "$4,092.75 " $507.89 "$3,883.00 " "$1,041.17 " $507.89 "$2,407.50 " "$5,620.63 " "$3,250.12 " "$3,250.12 " "$3,250.12 " "$3,250.12 " N/A "$2,193.93 " "$2,089.46 " "$3,211.61 " $507.89 $507.89 "$1,776.04 " "$1,776.04 " "$2,089.46 " $507.89 "$7,104.15 " 330104 67715 5503 258 510 HC INCISION OF EYELID FOLD O "$8,426.25 " "$2,536.51 " "$2,536.51 " "$1,205.26 " "$1,878.00 " "$5,224.27 " "$5,224.27 " "$2,511.15 " "$1,205.26 " "$4,819.38 " "$1,205.26 " "$2,536.51 " "$6,319.69 " "$2,790.17 " "$5,308.54 " N/A "$1,446.31 " "$1,205.26 " "$5,055.75 " "$6,741.00 " "$8,624.15 " "$4,213.12 " "$1,205.26 " "$2,536.51 " "$3,043.82 " "$1,687.36 " "$6,741.00 " "$1,205.26 " "$1,205.26 " "$1,446.31 " "$3,551.12 " "$1,205.26 " "$2,536.51 " "$2,536.51 " "$2,764.80 " "$6,741.00 " "$7,162.31 " "$1,205.26 " "$6,319.69 " "$2,470.78 " "$1,205.26 " "$4,213.12 " "$6,823.22 " "$5,687.72 " "$5,687.72 " "$5,687.72 " "$5,687.72 " N/A "$2,663.34 " "$2,536.51 " "$5,620.31 " "$1,205.26 " "$1,205.26 " "$2,156.04 " "$2,156.04 " "$2,536.51 " "$1,205.26 " "$8,624.15 " 330104 51701 5734 159 510 HC INSERT BLADDER CATHETER O $485.78 $139.30 $139.30 $395.93 $482.00 $301.18 $301.18 $137.91 $395.93 $264.67 $395.93 $139.30 $364.33 $153.23 $306.04 N/A $475.12 $395.93 $291.47 $388.62 $473.63 $242.89 $395.93 $139.30 $167.16 $554.30 $388.62 $395.93 $395.93 $475.12 $195.02 $395.93 $139.30 $139.30 $151.84 $388.62 $412.91 $395.93 $364.33 $811.66 $395.93 $242.89 $374.72 $327.90 $327.90 $327.90 $327.90 N/A $146.27 $139.30 $324.02 $395.93 $395.93 $118.41 $118.41 $139.30 $118.41 $811.66 330104 99204 491 510 HC OFFICE CONSULTATION 40 MINS O $544.63 $156.61 $156.61 N/A N/A $337.67 $337.67 $155.04 N/A $297.56 N/A $156.61 $408.47 $172.27 $343.12 N/A N/A N/A $326.78 $435.70 $532.48 $272.31 N/A $156.61 $354.01 N/A $435.70 N/A N/A N/A $219.25 N/A $156.61 $156.61 $170.71 $435.70 $462.94 N/A $408.47 N/A N/A $272.31 $354.01 $367.63 $367.63 $367.63 $367.63 N/A $164.44 $156.61 $363.27 N/A N/A $133.12 $133.12 $156.61 $133.12 $532.48 330104 99203 491 510 HC OFFICE CONSULTATION 30 MINS O $419.44 $98.47 $98.47 N/A N/A $260.05 $260.05 $97.49 N/A $187.10 N/A $98.47 $314.58 $108.32 $264.25 N/A N/A N/A $251.66 $335.55 $334.81 $209.72 N/A $98.47 $272.64 N/A $335.55 N/A N/A N/A $137.86 N/A $98.47 $98.47 $107.34 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $283.12 $283.12 $283.12 $283.12 N/A $103.40 $98.47 $279.77 N/A N/A $83.70 $83.70 $98.47 $83.70 $356.52 330104 99202 491 510 HC OFFICE CONSULTATION;EXPANDED PROBLEM FOCUS O $374.50 $56.37 $56.37 N/A N/A $232.19 $232.19 $55.81 N/A $107.11 N/A $56.37 $280.88 $62.01 $235.94 N/A N/A N/A $224.70 $299.60 $191.67 $187.25 N/A $56.37 $243.43 N/A $299.60 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $299.60 $318.32 N/A $280.88 N/A N/A $187.25 $243.43 $252.79 $252.79 $252.79 $252.79 N/A $59.19 $56.37 $249.79 N/A N/A $47.92 $47.92 $56.37 $47.92 $318.32 330104 99202 491 510 HC OFFICE CONSULTATION 15 MINS O $283.55 $56.37 $56.37 N/A N/A $175.80 $175.80 $55.81 N/A $107.11 N/A $56.37 $212.66 $62.01 $178.64 N/A N/A N/A $170.13 $226.84 $191.67 $141.78 N/A $56.37 $184.31 N/A $226.84 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $191.40 $191.40 $191.40 $191.40 N/A $59.19 $56.37 $189.13 N/A N/A $47.92 $47.92 $56.37 $47.92 $241.02 330104 99215 491 510 HC OFFICE VISIT EST PAT- HIGH COMPLX-LVL5 - 40-54 MINUTES O "$1,298.98 " $166.35 $166.35 N/A N/A $805.37 $805.37 $164.69 N/A $316.07 N/A $166.35 $974.24 $182.99 $818.36 N/A N/A N/A $779.39 "$1,039.18 " $565.59 $649.49 N/A $166.35 $844.34 N/A "$1,039.18 " N/A N/A N/A $232.89 N/A $166.35 $166.35 $181.32 "$1,039.18 " "$1,104.13 " N/A $974.24 N/A N/A $649.49 $844.34 $876.81 $876.81 $876.81 $876.81 N/A $174.67 $166.35 $866.42 N/A N/A $141.40 $141.40 $166.35 $141.40 "$1,104.13 " 330104 99214 491 510 HC OFFICE VISIT EST PAT- MOD COMPLX-LVL4 - 20-29 MINUTES O "$1,009.01 " $113.33 $113.33 N/A N/A $625.59 $625.59 $112.20 N/A $215.33 N/A $113.33 $756.76 $124.66 $635.68 N/A N/A N/A $605.41 $807.21 $385.32 $504.50 N/A $113.33 $655.86 N/A $807.21 N/A N/A N/A $158.66 N/A $113.33 $113.33 $123.53 $807.21 $857.66 N/A $756.76 N/A N/A $504.50 $655.86 $681.08 $681.08 $681.08 $681.08 N/A $119.00 $113.33 $673.01 N/A N/A $96.33 $96.33 $113.33 $96.33 $857.66 330104 99213 491 510 HC OFFICE VISIT EST PAT- EXPANDED PROB FOCUS-LVL3 - 20-29 MINUTES O $896.66 $76.93 $76.93 N/A N/A $555.93 $555.93 $76.16 N/A $146.16 N/A $76.93 $672.50 $84.62 $564.90 N/A N/A N/A $538.00 $717.33 $261.55 $448.33 N/A $76.93 $582.83 N/A $717.33 N/A N/A N/A $107.70 N/A $76.93 $76.93 $83.85 $717.33 $762.16 N/A $672.50 N/A N/A $448.33 $582.83 $605.25 $605.25 $605.25 $605.25 N/A $80.77 $76.93 $598.07 N/A N/A $65.39 $65.39 $76.93 $65.39 $762.16 330104 99212 491 510 HC OFFICE VISIT EST PAT- PROB FOCUS-LVL2 - 10 TO 19 MINS O $786.45 $41.65 $41.65 N/A N/A $174.00 $160.00 $41.23 N/A $79.14 N/A $41.65 $589.84 $45.82 $495.46 N/A N/A N/A $471.87 $629.16 $141.61 $393.23 N/A $41.65 $511.19 N/A $629.16 N/A N/A N/A $58.31 N/A $41.65 $41.65 $45.40 $629.16 $668.48 N/A $589.84 N/A N/A $393.23 $511.19 $530.85 $530.85 $530.85 $530.85 N/A $43.73 $41.65 $524.56 N/A N/A $35.40 $35.40 $41.65 $35.40 $668.48 330104 99211 491 510 HC OFFICE VISIT EST PAT- MINIMAL-LVL1 O $677.31 $10.10 $10.10 N/A N/A $419.93 $419.93 $10.00 N/A $19.19 N/A $10.10 $507.98 $11.11 $426.71 N/A N/A N/A $406.39 $541.85 $34.33 $338.65 N/A $10.10 $440.25 N/A $541.85 N/A N/A N/A $14.14 N/A $10.10 $10.10 $11.01 $541.85 $575.71 N/A $507.98 N/A N/A $338.65 $440.25 $457.18 $457.18 $457.18 $457.18 N/A $10.60 $10.10 $451.77 N/A N/A $8.58 $8.58 $10.10 $8.58 $575.71 330104 99205 491 510 HC OFFICE VISIT NEW PAT- COMPREHENSIVE-LVL5 - 50 TO 74 MINS O "$1,707.72 " $212.73 $212.73 N/A N/A "$1,058.79 " "$1,058.79 " $210.60 N/A $404.19 N/A $212.73 "$1,280.79 " $234.01 "$1,075.86 " N/A N/A N/A "$1,024.63 " "$1,366.18 " $723.29 $853.86 N/A $212.73 "$1,110.02 " N/A "$1,366.18 " N/A N/A N/A $297.82 N/A $212.73 $212.73 $231.88 "$1,366.18 " "$1,451.56 " N/A "$1,280.79 " N/A N/A $853.86 "$1,110.02 " "$1,152.71 " "$1,152.71 " "$1,152.71 " "$1,152.71 " N/A $223.37 $212.73 "$1,139.05 " N/A N/A $180.82 $180.82 $212.73 $180.82 "$1,451.56 " 330104 99204 491 510 HC OFFICE VISIT NEW PAT- MOD COMPLEXITY-LVL4 - 45 TO 59 MINS O "$1,298.98 " $156.61 $156.61 N/A N/A $805.37 $805.37 $155.04 N/A $297.56 N/A $156.61 $974.24 $172.27 $818.36 N/A N/A N/A $779.39 "$1,039.18 " $532.48 $649.49 N/A $156.61 $844.34 N/A "$1,039.18 " N/A N/A N/A $219.25 N/A $156.61 $156.61 $170.71 "$1,039.18 " "$1,104.13 " N/A $974.24 N/A N/A $649.49 $844.34 $876.81 $876.81 $876.81 $876.81 N/A $164.44 $156.61 $866.42 N/A N/A $133.12 $133.12 $156.61 $133.12 "$1,104.13 " 330104 99203 491 510 HC OFFICE VISIT NEW PAT- DETAILED EXAM- LVL3 - 33-44 MINS O "$1,007.94 " $98.47 $98.47 N/A N/A $624.92 $624.92 $97.49 N/A $187.10 N/A $98.47 $755.96 $108.32 $635.00 N/A N/A N/A $604.76 $806.35 $334.81 $503.97 N/A $98.47 $655.16 N/A $806.35 N/A N/A N/A $137.86 N/A $98.47 $98.47 $107.34 $806.35 $856.75 N/A $755.96 N/A N/A $503.97 $655.16 $680.36 $680.36 $680.36 $680.36 N/A $103.40 $98.47 $672.30 N/A N/A $83.70 $83.70 $98.47 $83.70 $856.75 330104 99202 491 510 HC OFFICE VISIT NEW PAT-EXPANDED PRBLM FOCUS- LVL2 15- 29 MINS O $760.77 $56.37 $56.37 N/A N/A $471.68 $471.68 $55.81 N/A $107.11 N/A $56.37 $570.58 $62.01 $479.29 N/A N/A N/A $456.46 $608.62 $191.67 $380.38 N/A $56.37 $494.50 N/A $608.62 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $513.52 $513.52 $513.52 $513.52 N/A $59.19 $56.37 $507.43 N/A N/A $47.92 $47.92 $56.37 $47.92 $646.65 330104 99201 491 510 HC OFFICE VISIT NEW PAT-PROBLEM FOCUSED-LVL 1 O $636.65 N/A N/A N/A N/A $394.72 $394.72 $416.37 N/A N/A N/A N/A $477.49 N/A $401.09 N/A N/A N/A $381.99 $509.32 N/A $318.32 N/A N/A N/A N/A $509.32 N/A N/A N/A N/A N/A N/A N/A N/A $509.32 $541.15 N/A $477.49 N/A N/A $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 N/A N/A N/A N/A N/A $318.32 $541.15 330104 99024 2005 510 HC POSTOP FOLLOW-UP VISIT O N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 330104 99205 491 510 HC OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN O $828.18 $212.73 $212.73 N/A N/A $513.47 $513.47 $210.60 N/A $404.19 N/A $212.73 $621.14 $234.01 $521.75 N/A N/A N/A $496.91 $662.54 $723.29 $414.09 N/A $212.73 $538.32 N/A $662.54 N/A N/A N/A $297.82 N/A $212.73 $212.73 $231.88 $662.54 $703.95 N/A $621.14 N/A N/A $414.09 $538.32 $559.02 $559.02 $559.02 $559.02 N/A $223.37 $212.73 $552.40 N/A N/A $180.82 $180.82 $212.73 $180.82 $723.29 330104 98967 491 510 HC NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN O $102.72 $24.80 $24.80 N/A N/A $63.69 $63.69 $24.55 N/A $47.11 N/A $24.80 $77.04 $27.27 $64.71 N/A N/A N/A $61.63 $82.18 $84.30 $51.36 N/A $24.80 $66.77 N/A $82.18 N/A N/A N/A $34.71 N/A $24.80 $24.80 $27.03 $82.18 $87.31 N/A $77.04 N/A N/A $51.36 $66.77 $69.34 $69.34 $69.34 $69.34 N/A $26.04 $24.80 $68.51 N/A N/A $21.08 $21.08 $24.80 $21.08 $87.31 330104 99201 491 510 HC OFFICE VISIT CBE AND/OR PAP O $69.55 N/A N/A N/A N/A $43.12 $43.12 $45.49 N/A N/A N/A N/A $52.16 N/A $43.82 N/A N/A N/A $41.73 $55.64 N/A $34.77 N/A N/A N/A N/A $55.64 N/A N/A N/A N/A N/A N/A N/A N/A $55.64 $59.12 N/A $52.16 N/A N/A $34.77 $45.21 $46.95 $46.95 $46.95 $46.95 N/A N/A N/A $46.39 N/A N/A N/A N/A N/A $34.77 $59.12 330104 99385 491 510 HC PREV VISIT NEW AGE 18-39 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $107.40 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $107.40 $301.95 330104 99499 491 510 HC UNLISTED EVALUATION AND MANAGEMENT SERV O $79.18 N/A N/A N/A N/A $49.09 $49.09 N/A N/A N/A N/A N/A $59.39 N/A $49.88 N/A N/A N/A $47.51 $63.34 N/A $39.59 N/A N/A $51.47 N/A $63.34 N/A N/A N/A N/A N/A N/A N/A N/A $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $53.45 $53.45 $53.45 $53.45 N/A N/A N/A $52.81 N/A N/A N/A N/A N/A $39.59 $67.30 330104 99439 260 510 HC CHRONIC CARE MANAGEMENT SERVICES EA ADDL 20 MIN O $281.41 N/A N/A N/A N/A $174.47 $174.47 $39.69 N/A N/A N/A N/A $211.06 N/A $177.29 N/A N/A N/A $168.85 $225.13 N/A $140.71 N/A N/A $182.92 N/A $225.13 N/A N/A N/A N/A N/A N/A N/A N/A $225.13 $239.20 N/A $211.06 N/A N/A $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 N/A N/A N/A N/A N/A $39.69 $239.20 330104 99427 260 510 HC PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MNTH O $140.17 N/A N/A N/A N/A $86.91 $86.91 $40.37 N/A N/A N/A N/A $105.13 N/A $88.31 N/A N/A N/A $84.10 $112.14 N/A $70.09 N/A N/A $91.11 N/A $112.14 N/A N/A N/A N/A N/A N/A N/A N/A $112.14 $119.14 N/A $105.13 N/A N/A $70.09 $91.11 $94.61 $94.61 $94.61 $94.61 N/A N/A N/A $93.49 N/A N/A N/A N/A N/A $40.37 $119.14 330104 99426 5822 260 510 HC PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO O $197.95 $91.00 $91.00 N/A N/A $122.73 $122.73 $90.09 N/A $172.90 N/A $91.00 $148.46 $100.10 $124.71 N/A N/A N/A $118.77 $158.36 $309.40 $98.97 N/A $91.00 $109.20 N/A $158.36 N/A N/A N/A $127.40 N/A $91.00 $91.00 $99.19 $158.36 $168.26 N/A $148.46 N/A N/A $98.97 $244.79 $133.62 $133.62 $133.62 $133.62 N/A $95.55 $91.00 $132.03 N/A N/A $77.35 $77.35 $91.00 $77.35 $309.40 330104 99417 2005 510 HC PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN O $281.41 N/A N/A N/A N/A $174.47 $174.47 $34.46 N/A N/A N/A N/A $211.06 N/A $177.29 N/A N/A N/A $168.85 $225.13 N/A $140.71 N/A N/A $182.92 N/A $225.13 N/A N/A N/A N/A N/A N/A N/A N/A $225.13 $239.20 N/A $211.06 N/A N/A $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 N/A N/A N/A N/A N/A $34.46 $239.20 330104 99407 5821 324 510 HC BEHAV CHNG SMOKING > 10 MIN O $194.74 $35.61 $35.61 $51.96 N/A $120.74 $120.74 $35.25 $51.96 $67.66 $51.96 $35.61 $146.06 $39.17 $122.69 N/A $62.35 $51.96 $116.84 $155.79 $121.07 $97.37 $51.96 $35.61 $42.73 $72.74 $155.79 $51.96 $51.96 $62.35 $49.85 $51.96 $35.61 $35.61 $38.81 $155.79 $165.53 $51.96 $146.06 $106.52 $51.96 $97.37 $95.79 $131.45 $131.45 $131.45 $131.45 N/A $37.39 $35.61 $129.89 $51.96 $51.96 $30.27 $30.27 $35.61 $30.27 $165.53 330104 99406 5821 324 510 HC BEHAV CHNG SMOKING 3-10 MIN O $146.59 $35.61 $35.61 $51.96 N/A $90.89 $90.89 $35.25 $51.96 $67.66 $51.96 $35.61 $109.94 $39.17 $92.35 N/A $62.35 $51.96 $87.95 $117.27 $121.07 $73.30 $51.96 $35.61 $42.73 $72.74 $117.27 $51.96 $51.96 $62.35 $49.85 $51.96 $35.61 $35.61 $38.81 $117.27 $124.60 $51.96 $109.94 $106.52 $51.96 $73.30 $95.79 $98.95 $98.95 $98.95 $98.95 N/A $37.39 $35.61 $97.78 $51.96 $51.96 $30.27 $30.27 $35.61 $30.27 $124.60 330104 99404 325 510 HC PREVENTIVE COUNSELING INDIV-60 MIN O $791.80 N/A N/A N/A N/A $490.92 $490.92 $109.27 N/A N/A N/A N/A $593.85 N/A $498.83 N/A N/A N/A $475.08 $633.44 N/A $395.90 N/A N/A $514.67 N/A $633.44 N/A N/A N/A N/A N/A N/A N/A N/A $633.44 $673.03 N/A $593.85 N/A N/A $395.90 $514.67 $534.47 $534.47 $534.47 $534.47 N/A N/A N/A $528.13 N/A N/A N/A N/A N/A $109.27 $673.03 330104 99403 325 510 HC PREVENTIVE COUNSELING INDIV-45MIN O $767.19 N/A N/A N/A N/A $475.66 $475.66 $82.64 N/A N/A N/A N/A $575.39 N/A $483.33 N/A N/A N/A $460.31 $613.75 N/A $383.60 N/A N/A $498.67 N/A $613.75 N/A N/A N/A N/A N/A N/A N/A N/A $613.75 $652.11 N/A $575.39 N/A N/A $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 N/A N/A N/A N/A N/A $82.64 $652.11 330104 99402 325 510 HC PREVENTIVE COUNSELING INDIV-30MIN O $760.77 N/A N/A N/A N/A $471.68 $471.68 $54.81 N/A N/A N/A N/A $570.58 N/A $479.29 N/A N/A N/A $456.46 $608.62 N/A $380.38 N/A N/A $494.50 N/A $608.62 N/A N/A N/A N/A N/A N/A N/A N/A $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $513.52 $513.52 $513.52 $513.52 N/A N/A N/A $507.43 N/A N/A N/A N/A N/A $54.81 $646.65 330104 99401 325 510 HC PREVENTIVE COUNSELING INDIV-15 MIN O $636.65 N/A N/A N/A N/A $394.72 $394.72 $27.83 N/A N/A N/A N/A $477.49 N/A $401.09 N/A N/A N/A $381.99 $509.32 N/A $318.32 N/A N/A $413.82 N/A $509.32 N/A N/A N/A N/A N/A N/A N/A N/A $509.32 $541.15 N/A $477.49 N/A N/A $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 N/A N/A N/A N/A N/A $27.83 $541.15 330104 99396 491 510 HC PREV VISIT EST AGE 40-64 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $105.91 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $360.00 $611.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $105.91 $611.00 330104 99395 491 510 HC PREV VISIT EST AGE 18-39 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $98.16 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $331.00 $561.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $98.16 $561.00 330104 99394 491 510 HC PREV VISIT EST AGE 12-17 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $94.80 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $321.00 $546.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $94.80 $546.00 330104 99386 491 510 HC PREV VISIT NEW AGE 40-64 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $129.97 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $129.97 $301.95 330104 99384 491 510 HC PREV VISIT NEW AGE 12-17 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $111.45 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $111.45 $301.95 330104 98966 491 510 HC NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN O $79.18 $12.60 $12.60 N/A N/A $49.09 $49.09 $12.48 N/A $23.95 N/A $12.60 $59.39 $13.86 $49.88 N/A N/A N/A $47.51 $63.34 $42.85 $39.59 N/A $12.60 $51.47 N/A $63.34 N/A N/A N/A $17.64 N/A $12.60 $12.60 $13.74 $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $53.45 $53.45 $53.45 $53.45 N/A $13.23 $12.60 $52.81 N/A N/A $10.71 $10.71 $12.60 $10.71 $67.30 330104 97606 5052 17 510 HC NEG PRESS WOUND TX >50 CM O "$1,474.46 " $447.59 $447.59 $705.44 N/A $914.17 $914.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,105.85 " $492.35 $928.91 N/A $846.53 $705.44 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $705.44 $447.59 $537.10 $987.62 "$1,179.57 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $705.44 "$1,105.85 " "$1,446.16 " $705.44 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$1,521.80 " 330104 97605 5051 16 510 HC NEG PRESS WOUND TX 4.0 CM O "$8,659.51 " "$1,799.07 " "$1,799.07 " "$2,097.00 " "$2,523.00 " "$5,368.90 " "$5,368.90 " "$1,781.08 " "$2,097.00 " "$3,418.23 " "$2,097.00 " "$1,799.07 " "$6,494.63 " "$1,978.98 " "$5,455.49 " N/A "$2,516.40 " "$2,097.00 " "$5,195.71 " "$6,927.61 " "$6,116.84 " "$4,329.76 " "$2,097.00 " "$1,799.07 " "$2,158.88 " "$2,935.80 " "$6,927.61 " "$2,097.00 " "$2,097.00 " "$2,516.40 " "$2,518.70 " "$2,097.00 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$6,927.61 " "$7,360.58 " "$2,097.00 " "$3,883.00 " "$4,298.85 " "$2,097.00 " "$4,329.76 " "$4,839.50 " "$5,845.17 " "$5,845.17 " "$5,845.17 " "$5,845.17 " N/A "$1,889.02 " "$1,799.07 " "$5,775.89 " "$2,097.00 " "$2,097.00 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$7,360.58 " 330104 11042 5052 17 510 HC DEB SUBQ TISSUE 20 SQ CM/< O "$1,989.13 " $447.59 $447.59 $705.44 "$2,523.00 " "$1,233.26 " "$1,233.26 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,491.85 " $492.35 "$1,253.15 " N/A $846.53 $705.44 "$1,193.48 " "$1,591.30 " "$1,521.80 " $994.57 $705.44 $447.59 $537.10 $987.62 "$1,591.30 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,591.30 " "$1,690.76 " $705.44 "$1,491.85 " "$1,446.16 " $705.44 $994.57 "$1,204.01 " "$1,342.66 " "$1,342.66 " "$1,342.66 " "$1,342.66 " N/A $469.97 $447.59 "$1,326.75 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$2,523.00 " 330104 11420 5072 10 510 HC EXC H-F-NK-SP B9+MARG 0.5/< O "$1,707.72 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,099.00 " "$1,296.00 " "$1,180.00 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$1,280.79 " "$1,978.98 " "$1,075.86 " N/A "$1,500.96 " "$1,250.80 " "$1,024.63 " "$1,366.18 " "$6,116.84 " $853.86 "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$1,366.18 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$1,366.18 " "$1,451.56 " "$1,250.80 " "$1,280.79 " "$2,564.14 " "$1,250.80 " $853.86 "$4,839.50 " "$1,152.71 " "$1,152.71 " "$1,152.71 " "$1,152.71 " N/A "$1,889.02 " "$1,799.07 " "$1,139.05 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " $853.86 "$6,116.84 " 330104 11440 5071 9 510 HC EXC FACE-MM B9+MARG 0.5 CM/< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,878.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11441 5071 9 510 HC EXC FACE-MM B9+MARG 0.6-1 CM O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11600 5071 9 510 HC EXC TR-EXT MAL+MARG 0.5 CM/< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11601 5071 9 510 HC EXC TR-EXT MAL+MARG 0.6-1 CM O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11603 5071 9 510 HC EXC TR-EXT MAL+MARG 2.1-3 CM O "$4,651.29 " $778.60 $778.60 $636.95 "$1,099.00 " "$2,883.80 " "$2,883.80 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$3,488.47 " $856.45 "$2,930.31 " N/A $764.34 $636.95 "$2,790.77 " "$3,721.03 " "$2,647.22 " "$2,325.64 " $636.95 $778.60 $934.31 $891.73 "$3,721.03 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$3,721.03 " "$3,953.60 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$2,325.64 " "$2,094.42 " "$3,139.62 " "$3,139.62 " "$3,139.62 " "$3,139.62 " N/A $817.53 $778.60 "$3,102.41 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,953.60 " 330104 11620 5072 10 510 HC EXC H-F-NK-SP MAL+MARG 0.5/< O "$3,143.66 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,099.00 " "$1,949.07 " "$1,949.07 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$2,357.74 " "$1,978.98 " "$1,980.51 " N/A "$1,500.96 " "$1,250.80 " "$1,886.20 " "$2,514.93 " "$6,116.84 " "$1,571.83 " "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$2,514.93 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,514.93 " "$2,672.11 " "$1,250.80 " "$2,357.74 " "$2,564.14 " "$1,250.80 " "$1,571.83 " "$4,839.50 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A "$1,889.02 " "$1,799.07 " "$2,096.82 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,099.00 " "$6,116.84 " 330104 11621 5071 9 510 HC EXC S/N/H/F/G MAL+MRG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11640 5071 9 510 HC EXC F/E/E/N/L MAL+MRG 0.5CM< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11641 5071 9 510 HC EXC F/E/E/N/L MAL+MRG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11719 5733 5 510 HC TRIM NAIL(S) ANY NUMBER O $254.66 $68.96 $68.96 $92.85 $482.00 $157.89 $157.89 $68.27 $92.85 $131.03 $92.85 $68.96 $191.00 $75.86 $160.44 N/A $111.41 $92.85 $152.80 $203.73 $234.47 $127.33 $92.85 $68.96 $82.75 $129.98 $203.73 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $203.73 $216.46 $92.85 $191.00 $190.33 $92.85 $127.33 $185.51 $171.90 $171.90 $171.90 $171.90 N/A $72.41 $68.96 $169.86 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $482.00 330104 11720 5733 5 510 HC DEBRIDE NAIL 1-5 O $589.57 $68.96 $68.96 $92.85 $482.00 $365.53 $365.53 $68.27 $92.85 $131.03 $92.85 $68.96 $442.18 $75.86 $371.43 N/A $111.41 $92.85 $353.74 $471.66 $234.47 $294.79 $92.85 $68.96 $82.75 $129.98 $471.66 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $471.66 $501.13 $92.85 $442.18 $190.33 $92.85 $294.79 $185.51 $397.96 $397.96 $397.96 $397.96 N/A $72.41 $68.96 $393.24 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $501.13 330104 11721 5733 5 510 HC DEBRIDE NAIL 6 OR MORE O $589.57 $68.96 $68.96 $92.85 $482.00 $365.53 $365.53 $68.27 $92.85 $131.03 $92.85 $68.96 $442.18 $75.86 $371.43 N/A $111.41 $92.85 $353.74 $471.66 $234.47 $294.79 $92.85 $68.96 $82.75 $129.98 $471.66 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $471.66 $501.13 $92.85 $442.18 $190.33 $92.85 $294.79 $185.51 $397.96 $397.96 $397.96 $397.96 N/A $72.41 $68.96 $393.24 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $501.13 330104 11730 5051 5 510 HC AVULSION NAIL PLATE PARTIAL/COMPLETE-SIMPLE/SINGLE O $806.78 $216.65 $216.65 $92.85 $482.00 $500.20 $500.20 $214.48 $92.85 $411.63 $92.85 $216.65 $605.09 $238.31 $508.27 N/A $111.41 $92.85 $484.07 $645.42 $736.61 $403.39 $92.85 $216.65 $259.98 $129.98 $645.42 $92.85 $92.85 $111.41 $303.31 $92.85 $216.65 $216.65 $236.15 $645.42 $685.76 $92.85 $605.09 $190.33 $92.85 $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 $92.85 $92.85 $184.15 $184.15 $216.65 $92.85 $736.61 330104 11421 5071 9 510 HC EXC H-F-NK-SP B9+MARG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$2,886.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,886.00 " 330104 11732 5 510 HC AVULSION NAIL PLATE PRT/COMPL-SIMPLE EA. ADDL NAIL O $636.65 N/A N/A $92.85 $482.00 $394.72 $394.72 $20.22 $92.85 N/A $92.85 N/A $477.49 N/A $401.09 N/A $111.41 $92.85 $381.99 $509.32 N/A $318.32 $92.85 N/A $413.82 $129.98 $509.32 $92.85 $92.85 $111.41 N/A $92.85 N/A N/A N/A $509.32 $541.15 $125.34 $477.49 $190.33 $125.34 $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 $92.85 $92.85 N/A N/A N/A $20.22 $541.15 330104 10180 5073 18 510 HC I&D COMPLEX POSTOPERATIVE WOUND INFECTION O "$9,630.00 " "$3,099.23 " "$3,099.23 " "$1,404.72 " "$2,523.00 " "$5,970.60 " "$5,970.60 " "$3,068.24 " "$1,404.72 " "$5,888.53 " "$1,404.72 " "$3,099.23 " "$7,222.50 " "$3,409.15 " "$6,066.90 " N/A "$1,685.66 " "$1,404.72 " "$5,778.00 " "$7,704.00 " "$10,537.38 " "$4,815.00 " "$1,404.72 " "$3,099.23 " "$3,719.07 " "$1,966.60 " "$7,704.00 " "$1,404.72 " "$1,404.72 " "$1,685.66 " "$4,338.92 " "$1,404.72 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$7,704.00 " "$8,185.50 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$4,815.00 " "$8,336.92 " "$6,500.25 " "$6,500.25 " "$6,500.25 " "$6,500.25 " N/A "$3,254.19 " "$3,099.23 " "$6,423.21 " "$1,404.72 " "$1,404.72 " "$2,634.34 " "$2,634.34 " "$3,099.23 " "$1,404.72 " "$10,537.38 " 330104 10140 5072 4 510 HC I&D HEMATOMA/ SEROMA OR FLUID COLLECTION O "$6,324.77 " "$1,799.07 " "$1,799.07 " $616.26 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $616.26 "$3,418.23 " $616.26 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $739.52 $616.26 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $616.26 "$1,799.07 " "$2,158.88 " $862.77 "$5,059.82 " $616.26 $616.26 $739.52 "$2,518.70 " $616.26 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $616.26 "$4,743.58 " "$1,263.34 " $616.26 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $616.26 $616.26 "$1,529.21 " "$1,529.21 " "$1,799.07 " $616.26 "$6,116.84 " 330104 20245 5073 51 510 HC BONE BIOPSY OPEN DEEP O "$15,221.82 " "$3,099.23 " "$3,099.23 " "$1,085.97 " "$2,886.00 " "$9,437.53 " "$9,437.53 " "$3,068.24 " "$1,085.97 " "$5,888.53 " "$1,085.97 " "$3,099.23 " "$11,416.36 " "$3,409.15 " "$9,589.75 " N/A "$1,303.17 " "$1,085.97 " "$9,133.09 " "$12,177.46 " "$10,537.38 " "$7,610.91 " "$1,085.97 " "$3,099.23 " "$3,719.07 " "$1,520.36 " "$12,177.46 " "$1,085.97 " "$1,085.97 " "$1,303.17 " "$4,338.92 " "$1,085.97 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$12,177.46 " "$12,938.55 " "$1,085.97 " "$4,965.00 " "$2,226.24 " "$1,085.97 " "$7,610.91 " "$8,336.92 " "$10,274.73 " "$10,274.73 " "$10,274.73 " "$10,274.73 " N/A "$3,254.19 " "$3,099.23 " "$10,152.95 " "$1,085.97 " "$1,085.97 " "$2,634.34 " "$2,634.34 " "$3,099.23 " "$1,085.97 " "$12,938.55 " 330104 G0246 5012 491 510 HC FOLLOWUP EVAL OF FOOT PT LOP O $678.38 $145.00 $145.00 N/A N/A $420.60 $420.60 $143.55 N/A $275.50 N/A $145.00 $508.78 $159.50 $427.38 N/A N/A N/A $407.03 $542.70 $493.00 $339.19 N/A $145.00 $174.00 N/A $542.70 N/A N/A N/A $203.00 N/A $145.00 $145.00 $158.05 $542.70 $576.62 N/A $508.78 N/A N/A $339.19 $390.05 $457.91 $457.91 $457.91 $457.91 N/A $152.25 $145.00 $452.48 N/A N/A $123.25 $123.25 $145.00 $123.25 $576.62 330104 G0247 5051 491 510 HC ROUTINE FOOTCARE PT W LOPS O $806.78 $216.65 $216.65 N/A N/A $500.20 $500.20 $214.48 N/A $411.63 N/A $216.65 $605.09 $238.31 $508.27 N/A N/A N/A $484.07 $645.42 $736.61 $403.39 N/A $216.65 $259.98 N/A $645.42 N/A N/A N/A $303.31 N/A $216.65 $216.65 $236.15 $645.42 $685.76 N/A $605.09 N/A N/A $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 N/A N/A $184.15 $184.15 $216.65 $184.15 $736.61 330104 G0463 5012 491 510 HC HOSPITAL OUTPT CLINIC VISIT O $621.67 $145.00 $145.00 N/A N/A $385.44 $385.44 $143.55 N/A $275.50 N/A $145.00 $466.25 $159.50 $391.65 N/A N/A N/A $373.00 $497.34 $493.00 $310.83 N/A $145.00 $174.00 N/A $497.34 N/A N/A N/A $203.00 N/A $145.00 $145.00 $158.05 $497.34 $528.42 N/A $466.25 N/A N/A $310.83 $390.05 $419.63 $419.63 $419.63 $419.63 N/A $152.25 $145.00 $414.65 N/A N/A $123.25 $123.25 $145.00 $123.25 $528.42 330104 T1013 2005 510 HC SIGN LANG/ORAL INTERPRETIVE SERV/15 MIN O $49.22 N/A N/A N/A N/A $30.52 $30.52 N/A N/A N/A N/A N/A $36.91 N/A $31.01 N/A N/A N/A $29.53 $39.38 N/A $24.61 N/A N/A $31.99 N/A $39.38 N/A N/A N/A N/A N/A N/A N/A N/A $39.38 $41.84 N/A $36.91 N/A N/A $24.61 $31.99 $33.22 $33.22 $33.22 $33.22 N/A N/A N/A $32.83 N/A N/A N/A N/A N/A $24.61 $41.84 330104 C5271 5053 56 510 HC LOWCOST-SKIN SUBST APP TR/AR/LG<=25SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$1,099.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5272 56 510 HC LOWCOST-SKIN TR/AR/LG EA.ADDL<=25SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 C5273 5054 56 510 HC LOWCOST-SKIN SUBSTAPP TR/AR/LG<=100SQCM O "$8,947.34 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,886.00 " "$5,547.35 " "$5,547.35 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$6,710.51 " "$2,277.64 " "$5,636.82 " N/A "$1,759.75 " "$1,466.46 " "$5,368.40 " "$7,157.87 " "$7,039.98 " "$4,473.67 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,157.87 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,157.87 " "$7,605.24 " "$1,466.46 " "$6,710.51 " "$3,006.25 " "$1,466.46 " "$4,473.67 " "$5,569.87 " "$6,039.45 " "$6,039.45 " "$6,039.45 " "$6,039.45 " N/A "$2,174.11 " "$2,070.58 " "$5,967.88 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,605.24 " 330104 C5274 56 510 HC LOWCOST-SKINSUB TR/AR/LGEA.ADD<=100SQCM O "$4,471.53 " N/A N/A "$1,466.46 " $482.00 "$2,772.35 " "$2,772.35 " "$2,924.38 " "$1,466.46 " N/A "$1,466.46 " N/A "$3,353.65 " N/A "$2,817.06 " N/A "$1,759.75 " "$1,466.46 " "$2,682.92 " "$3,577.22 " N/A "$2,235.76 " "$1,466.46 " N/A N/A "$2,053.05 " "$3,577.22 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$3,577.22 " "$3,800.80 " "$1,979.72 " "$3,353.65 " "$3,006.25 " "$1,979.72 " "$2,235.76 " "$2,906.49 " "$3,018.28 " "$3,018.28 " "$3,018.28 " "$3,018.28 " N/A N/A N/A "$2,982.51 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,800.80 " 330104 C5275 5053 56 510 HC LOWCOST-SKNSUB HEAD/NK/HND/FEET<=25SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$1,099.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5276 56 510 HC LOWCOST-SKN HD/NK/HND/FT EA.ADD<=25SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 C5277 5053 56 510 HC LOWCOST-SKNSUB HD/NK/HND/FEET<=100SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$2,523.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5278 56 510 HC LOWCOST-SKN HD/NK/HND/FTEA.ADD<=100SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 10160 5052 3 510 HC PUNCTURE ASPIRATION ABSCESS/HEMATOMA/BULLA OR CYST O "$1,474.46 " $447.59 $447.59 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $443.11 $325.60 $850.42 $325.60 $447.59 "$1,105.85 " $492.35 $928.91 N/A $390.72 $325.60 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $325.60 $447.59 $537.10 $455.84 "$1,179.57 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $325.60 "$1,105.85 " $667.48 $325.60 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$1,521.80 " 330104 0687T 419 510 HC TX AMBLYOPIA DEV SUPLY EDUCATIONAL SETUP 1ST SES O $65.27 N/A N/A $91.80 N/A $40.47 $40.47 N/A $91.80 N/A $91.80 N/A $48.95 N/A $41.12 N/A $110.16 $91.80 $39.16 $52.22 N/A $32.63 $91.80 N/A $42.43 $128.52 $52.22 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $52.22 $55.48 $123.93 $48.95 $188.19 $123.93 $32.63 $42.43 $44.06 $44.06 $44.06 $44.06 N/A N/A N/A $43.54 $91.80 $91.80 N/A N/A N/A $32.63 $188.19 330104 0702T 324 510 HC REM THER MNTR OL DIG COG BHV THER PRGRM SPLY TCH O $99.51 N/A N/A $51.96 N/A $61.70 $61.70 $65.08 $51.96 N/A $51.96 N/A $74.63 N/A $62.69 N/A $62.35 $51.96 $59.71 $79.61 N/A $49.76 $51.96 N/A N/A $72.74 $79.61 $51.96 $51.96 $62.35 N/A $51.96 N/A N/A N/A $79.61 $84.58 $70.15 $74.63 $106.52 $70.15 $49.76 $64.68 $67.17 $67.17 $67.17 $67.17 N/A N/A N/A $66.37 $51.96 $51.96 N/A N/A N/A $49.76 $106.52 330104 0704T 419 510 HC REM TX AMBLYOPIA DEV SUPPLY 1ST SETUP&PT EDUCAJ O $65.27 N/A N/A $91.80 N/A $40.47 $40.47 N/A $91.80 N/A $91.80 N/A $48.95 N/A $41.12 N/A $110.16 $91.80 $39.16 $52.22 N/A $32.63 $91.80 N/A $42.43 $128.52 $52.22 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $52.22 $55.48 $123.93 $48.95 $188.19 $123.93 $32.63 $42.43 $44.06 $44.06 $44.06 $44.06 N/A N/A N/A $43.54 $91.80 $91.80 N/A N/A N/A $32.63 $188.19 330104 0705T 488 510 HC REM TX AMBLYOPIA TCH SPRT MIN 18 TRAING HR EA 30 O $208.65 N/A N/A $84.24 N/A $129.36 $129.36 N/A $84.24 N/A $84.24 N/A $156.49 N/A $131.45 N/A $101.09 $84.24 $125.19 $166.92 N/A $104.33 $84.24 N/A $135.62 $117.93 $166.92 $84.24 $84.24 $101.09 N/A $84.24 N/A N/A N/A $166.92 $177.35 $113.72 $156.49 $172.69 $113.72 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $84.24 $84.24 N/A N/A N/A $84.24 $177.35 330104 0706T 419 510 HC REM TX AMBLYOPIA I&R PHYS/QHP PER CALENDAR MONTH O $208.65 N/A N/A $91.80 N/A $129.36 $129.36 N/A $91.80 N/A $91.80 N/A $156.49 N/A $131.45 N/A $110.16 $91.80 $125.19 $166.92 N/A $104.33 $91.80 N/A $135.62 $128.52 $166.92 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $166.92 $177.35 $123.93 $156.49 $188.19 $123.93 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $91.80 $91.80 N/A N/A N/A $91.80 $188.19 330104 S9442 428 510 HC CHILDBIRTH CLASS (NON-PHYSICIAN) O $155.15 N/A N/A N/A N/A $96.19 $96.19 N/A N/A N/A N/A N/A $116.36 N/A $97.74 N/A N/A N/A $93.09 $124.12 N/A $77.58 N/A N/A $100.85 N/A $124.12 N/A N/A N/A N/A N/A N/A N/A N/A $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $104.73 $104.73 $104.73 $104.73 N/A N/A N/A $103.49 N/A N/A N/A N/A N/A $77.58 $131.88 330104 S9445 428 510 HC PT EDUCATION NOC INDIVID O $284.62 N/A N/A $45.00 N/A $176.46 $176.46 N/A $45.00 N/A $45.00 N/A $213.47 N/A $179.31 N/A $54.00 $45.00 $170.77 $227.70 N/A $142.31 $45.00 N/A $185.00 $63.00 $227.70 $45.00 $45.00 $54.00 N/A $45.00 N/A N/A N/A $227.70 $241.93 $60.75 $213.47 $92.25 $60.75 $142.31 $185.00 $192.12 $192.12 $192.12 $192.12 N/A N/A N/A $189.84 $45.00 $45.00 N/A N/A N/A $45.00 $241.93 330104 S9446 429 510 HC PT EDUCATION NOC GROUP O $171.20 N/A N/A $15.00 N/A $106.14 $106.14 N/A $15.00 N/A $15.00 N/A $128.40 N/A $107.86 N/A $18.00 $15.00 $102.72 $136.96 N/A $85.60 $15.00 N/A $111.28 $21.00 $136.96 $15.00 $15.00 $18.00 N/A $15.00 N/A N/A N/A $136.96 $145.52 $20.25 $128.40 $30.75 $20.25 $85.60 $111.28 $115.56 $115.56 $115.56 $115.56 N/A N/A N/A $114.19 $15.00 $15.00 N/A N/A N/A $15.00 $145.52 330104 10021 5052 2 510 HC FNA W/O IMAGE O "$1,683.11 " $447.59 $447.59 $512.29 $482.00 "$1,043.53 " "$1,043.53 " $443.11 $512.29 $850.42 $512.29 $447.59 "$1,262.33 " $492.35 "$1,060.36 " N/A $614.75 $512.29 "$1,009.87 " "$1,346.49 " "$1,521.80 " $841.55 $512.29 $447.59 $537.10 $717.21 "$1,346.49 " $512.29 $512.29 $614.75 $626.62 $512.29 $447.59 $447.59 $487.87 "$1,346.49 " "$1,430.64 " $512.29 "$1,262.33 " "$1,050.20 " $512.29 $841.55 "$1,204.01 " "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $469.97 $447.59 "$1,122.63 " $512.29 $512.29 $380.45 $380.45 $447.59 $380.45 "$1,521.80 " 330104 10060 5051 3 510 HC DRAINAGE OF SKIN ABSCESS SIMPLE/SINGLE O "$1,041.11 " $216.65 $216.65 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $214.48 $325.60 $411.63 $325.60 $216.65 $780.83 $238.31 $655.90 N/A $390.72 $325.60 $624.67 $832.89 $736.61 $520.55 $325.60 $216.65 $259.98 $455.84 $832.89 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $832.89 $884.94 $325.60 $780.83 $667.48 $325.60 $520.55 $582.79 $702.75 $702.75 $702.75 $702.75 N/A $227.48 $216.65 $694.42 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 "$1,296.00 " 330104 10061 5052 3 510 HC DRAINAGE OF SKIN ABSCESS COMPLICATED/MULTIPLE O "$1,474.46 " $447.59 $447.59 $325.60 $482.00 $914.17 $914.17 $443.11 $325.60 $850.42 $325.60 $447.59 "$1,105.85 " $492.35 $928.91 N/A $390.72 $325.60 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $325.60 $447.59 $537.10 $455.84 "$1,179.57 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $325.60 "$3,883.00 " $667.48 $325.60 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$3,883.00 " 330104 10080 5071 3 510 HC I&D OF PILONIDAL CYST; SIMPLE O "$3,675.45 " $778.60 $778.60 $325.60 $482.00 "$2,278.78 " "$2,278.78 " $770.81 $325.60 "$1,479.33 " $325.60 $778.60 "$2,756.59 " $856.45 "$2,315.53 " N/A $390.72 $325.60 "$2,205.27 " "$2,940.36 " "$2,647.22 " "$1,837.72 " $325.60 $778.60 $934.31 $455.84 "$2,940.36 " $325.60 $325.60 $390.72 "$1,090.03 " $325.60 $778.60 $778.60 $848.67 "$2,940.36 " "$3,124.13 " $325.60 "$2,756.59 " $667.48 $325.60 "$1,837.72 " "$2,094.42 " "$2,480.93 " "$2,480.93 " "$2,480.93 " "$2,480.93 " N/A $817.53 $778.60 "$2,451.53 " $325.60 $325.60 $661.81 $661.81 $778.60 $325.60 "$3,124.13 " 330104 10081 5071 4 510 HC I&D OF PILONIDAL CYST; COMPLICATED O "$3,143.66 " $778.60 $778.60 $616.26 "$1,878.00 " "$1,949.07 " "$1,949.07 " $770.81 $616.26 "$1,479.33 " $616.26 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $739.52 $616.26 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $616.26 $778.60 $934.31 $862.77 "$2,514.93 " $616.26 $616.26 $739.52 "$1,090.03 " $616.26 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $616.26 "$3,883.00 " "$1,263.34 " $616.26 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $616.26 $616.26 $661.81 $661.81 $778.60 $616.26 "$3,883.00 " 330104 10120 5052 3 510 HC REMOVE FOREIGN BODY SIMPLE O "$2,346.51 " $447.59 $447.59 $325.60 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $325.60 $850.42 $325.60 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $390.72 $325.60 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $325.60 $447.59 $537.10 $455.84 "$1,877.21 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $325.60 "$1,759.88 " $667.48 $325.60 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$1,994.53 " 330104 0688T 418 510 HC TX AMBLYOPIA ASSMT PERF PHYS/QHP W/REPORT CAL MO O $208.65 N/A N/A $187.76 N/A $129.36 $129.36 N/A $187.76 N/A $187.76 N/A $156.49 N/A $131.45 N/A $225.31 $187.76 $125.19 $166.92 N/A $104.33 $187.76 N/A $135.62 $262.86 $166.92 $187.76 $187.76 $225.31 N/A $187.76 N/A N/A N/A $166.92 $177.35 $253.47 $156.49 $384.90 $253.47 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $187.76 $187.76 N/A N/A N/A $104.33 $384.90 330104 11740 5734 5 510 HC EVACUATION OF SUBUNGUAL HEMATOMA O "$1,060.37 " $139.30 $139.30 $92.85 $482.00 $657.43 $657.43 $137.91 $92.85 $264.67 $92.85 $139.30 $795.28 $153.23 $668.03 N/A $111.41 $92.85 $636.22 $848.30 $473.63 $530.18 $92.85 $139.30 $167.16 $129.98 $848.30 $92.85 $92.85 $111.41 $195.02 $92.85 $139.30 $139.30 $151.84 $848.30 $901.31 $92.85 $795.28 $190.33 $92.85 $530.18 $374.72 $715.75 $715.75 $715.75 $715.75 N/A $146.27 $139.30 $707.27 $92.85 $92.85 $118.41 $118.41 $139.30 $92.85 $901.31 330104 12051 5052 17 510 HC INTMD RPR FACE/MM 2.5 CM/< O $828.18 $447.59 $447.59 $705.44 $482.00 $513.47 $513.47 $443.11 $705.44 $850.42 $705.44 $447.59 $621.14 $492.35 $521.75 N/A $846.53 $705.44 $496.91 $662.54 "$1,521.80 " $414.09 $705.44 $447.59 $537.10 $987.62 $662.54 $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 $662.54 $703.95 $705.44 "$3,883.00 " "$1,446.16 " $705.44 $414.09 "$1,204.01 " $559.02 $559.02 $559.02 $559.02 N/A $469.97 $447.59 $552.40 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11765 5052 5 510 HC EXCISION OF NAIL FOLD TOE O "$2,346.51 " $447.59 $447.59 $92.85 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $92.85 $850.42 $92.85 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $111.41 $92.85 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $92.85 $447.59 $537.10 $129.98 "$1,877.21 " $92.85 $92.85 $111.41 $626.62 $92.85 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $92.85 "$1,759.88 " $190.33 $92.85 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $92.85 $92.85 $380.45 $380.45 $447.59 $92.85 "$1,994.53 " 330104 14040 5054 56 510 HC TIS TRNFR F/C/C/M/N/A/G/H/F 10 SQ CM/< O "$9,539.05 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$5,914.21 " "$5,914.21 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$7,154.29 " "$2,277.64 " "$6,009.60 " N/A "$1,759.75 " "$1,466.46 " "$5,723.43 " "$7,631.24 " "$7,039.98 " "$4,769.52 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,631.24 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,631.24 " "$8,108.19 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$4,769.52 " "$5,569.87 " "$6,438.86 " "$6,438.86 " "$6,438.86 " "$6,438.86 " N/A "$2,174.11 " "$2,070.58 " "$6,362.55 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$8,108.19 " 330104 14041 5054 56 510 HC TIS TRNFR F/C/C/M/N/A/G/H/F 10.1-30 SQCM O "$9,539.05 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,886.00 " "$5,914.21 " "$5,914.21 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$7,154.29 " "$2,277.64 " "$6,009.60 " N/A "$1,759.75 " "$1,466.46 " "$5,723.43 " "$7,631.24 " "$7,039.98 " "$4,769.52 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,631.24 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,631.24 " "$8,108.19 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$4,769.52 " "$5,569.87 " "$6,438.86 " "$6,438.86 " "$6,438.86 " "$6,438.86 " N/A "$2,174.11 " "$2,070.58 " "$6,362.55 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$8,108.19 " 330104 14301 5055 56 510 HC PBB-ADJ TIS TRNFR ANY 30.1 -60SQCM O "$15,651.96 " "$3,902.80 " "$3,902.80 " "$1,466.46 " "$3,553.00 " "$9,704.22 " "$9,704.22 " "$3,863.77 " "$1,466.46 " "$7,415.32 " "$1,466.46 " "$3,902.80 " "$11,738.97 " "$4,293.08 " "$9,860.73 " N/A "$1,759.75 " "$1,466.46 " "$9,391.18 " "$12,521.57 " "$13,269.53 " "$7,825.98 " "$1,466.46 " "$3,902.80 " "$4,683.36 " "$2,053.05 " "$12,521.57 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$5,463.92 " "$1,466.46 " "$3,902.80 " "$3,902.80 " "$4,254.05 " "$12,521.57 " "$13,304.17 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$7,825.98 " "$10,498.54 " "$10,565.07 " "$10,565.07 " "$10,565.07 " "$10,565.07 " N/A "$4,097.94 " "$3,902.80 " "$10,439.86 " "$1,466.46 " "$1,466.46 " "$3,317.38 " "$3,317.38 " "$3,902.80 " "$1,466.46 " "$13,304.17 " 330104 14302 56 510 HC TIS TRNFR ADDL 30 SQ CM O $767.19 N/A N/A "$1,466.46 " "$3,553.00 " $475.66 $475.66 $264.95 "$1,466.46 " N/A "$1,466.46 " N/A $575.39 N/A $483.33 N/A "$1,759.75 " "$1,466.46 " $460.31 $613.75 N/A $383.60 "$1,466.46 " N/A $498.67 "$2,053.05 " $613.75 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $613.75 $652.11 "$1,979.72 " "$3,883.00 " "$3,006.25 " "$1,979.72 " $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 "$1,466.46 " "$1,466.46 " N/A N/A N/A $264.95 "$3,883.00 " 330104 15002 5054 18 510 HC WOUND PREP TRK/ARM/LEG 1ST 100SQCM/1% AREA CHILD O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,404.72 " "$1,099.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,404.72 " "$3,934.11 " "$1,404.72 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,685.66 " "$1,404.72 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,404.72 " "$2,070.58 " "$2,484.70 " "$1,966.60 " "$5,981.73 " "$1,404.72 " "$1,404.72 " "$1,685.66 " "$2,898.82 " "$1,404.72 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,404.72 " "$1,404.72 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,099.00 " "$7,039.98 " 330104 15003 17 510 HC WOUND PREP PED TRK/ARM/LG ADDL 100 CM O "$3,481.78 " N/A N/A $705.44 "$1,099.00 " "$2,158.70 " "$2,158.70 " $56.91 $705.44 N/A $705.44 N/A "$2,611.34 " N/A "$2,193.52 " N/A $846.53 $705.44 "$2,089.07 " "$2,785.42 " N/A "$1,740.89 " $705.44 N/A "$2,263.16 " $987.62 "$2,785.42 " $705.44 $705.44 $846.53 N/A $705.44 N/A N/A N/A "$2,785.42 " "$2,959.51 " $952.35 "$2,611.34 " "$1,446.16 " $952.35 "$1,740.89 " "$2,263.16 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A N/A N/A "$2,322.35 " $705.44 $705.44 N/A N/A N/A $56.91 "$2,959.51 " 330104 15004 5053 18 510 HC WOUND PREP F/N/HF/G 1ST 100SQCM/1% AREA CHILD O "$3,481.78 " $696.99 $696.99 "$1,404.72 " "$1,099.00 " "$2,158.70 " "$2,158.70 " $690.02 "$1,404.72 " "$1,324.28 " "$1,404.72 " $696.99 "$2,611.34 " $766.69 "$2,193.52 " N/A "$1,685.66 " "$1,404.72 " "$2,089.07 " "$2,785.42 " "$2,369.76 " "$1,740.89 " "$1,404.72 " $696.99 $836.39 "$1,966.60 " "$2,785.42 " "$1,404.72 " "$1,404.72 " "$1,685.66 " $975.78 "$1,404.72 " $696.99 $696.99 $759.72 "$2,785.42 " "$2,959.51 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$1,740.89 " "$1,874.90 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A $731.84 $696.99 "$2,322.35 " "$1,404.72 " "$1,404.72 " $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 15005 17 510 HC WND PREP PED FACE/NCK/HND/FT/GEN ADD 100 CM O "$3,481.78 " N/A N/A $705.44 "$1,099.00 " "$2,158.70 " "$2,158.70 " $110.76 $705.44 N/A $705.44 N/A "$2,611.34 " N/A "$2,193.52 " N/A $846.53 $705.44 "$2,089.07 " "$2,785.42 " N/A "$1,740.89 " $705.44 N/A "$2,263.16 " $987.62 "$2,785.42 " $705.44 $705.44 $846.53 N/A $705.44 N/A N/A N/A "$2,785.42 " "$2,959.51 " $952.35 "$2,611.34 " "$1,446.16 " $952.35 "$1,740.89 " "$2,263.16 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A N/A N/A "$2,322.35 " $705.44 $705.44 N/A N/A N/A $110.76 "$2,959.51 " 330104 15271 5054 56 510 HC SKIN SUB GRAFT TRNK/ARM/LEG 1ST 25SQCM OR LESS O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$5,607.87 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15272 56 510 HC SKIN SUB GRAFT T/A/L ADD-ON EA. ADDL 25CM O $814.27 N/A N/A "$1,466.46 " "$1,878.00 " $504.85 $504.85 $19.67 "$1,466.46 " N/A "$1,466.46 " N/A $610.70 N/A $512.99 N/A "$1,759.75 " "$1,466.46 " $488.56 $651.42 N/A $407.13 "$1,466.46 " N/A $529.28 "$2,053.05 " $651.42 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $651.42 $692.13 "$1,979.72 " $610.70 "$3,006.25 " "$1,979.72 " $407.13 $529.28 $549.63 $549.63 $549.63 $549.63 N/A N/A N/A $543.12 "$1,466.46 " "$1,466.46 " N/A N/A N/A $19.67 "$3,006.25 " 330104 15273 5055 56 510 HC SKIN SUB GRFT T/ARM/LG 1ST 100SQCM OR 1%AREACHILD O "$13,717.40 " "$3,902.80 " "$3,902.80 " "$1,466.46 " "$2,523.00 " "$8,504.79 " "$8,504.79 " "$3,863.77 " "$1,466.46 " "$7,415.32 " "$1,466.46 " "$3,902.80 " "$10,288.05 " "$4,293.08 " "$8,641.96 " N/A "$1,759.75 " "$1,466.46 " "$8,230.44 " "$10,973.92 " "$13,269.53 " "$6,858.70 " "$1,466.46 " "$3,902.80 " "$4,683.36 " "$2,053.05 " "$10,973.92 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$5,463.92 " "$1,466.46 " "$3,902.80 " "$3,902.80 " "$4,254.05 " "$10,973.92 " "$11,659.79 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$6,858.70 " "$10,498.54 " "$9,259.25 " "$9,259.25 " "$9,259.25 " "$9,259.25 " N/A "$4,097.94 " "$3,902.80 " "$9,149.51 " "$1,466.46 " "$1,466.46 " "$3,317.38 " "$3,317.38 " "$3,902.80 " "$1,466.46 " "$13,269.53 " 330104 15274 56 510 HC SKN SUB GRFT T/A/L EA ADDL 100SQCM OR 1%AREA CHILD O "$2,198.85 " N/A N/A "$1,466.46 " "$1,878.00 " "$1,363.29 " "$1,363.29 " $56.50 "$1,466.46 " N/A "$1,466.46 " N/A "$1,649.14 " N/A "$1,385.28 " N/A "$1,759.75 " "$1,466.46 " "$1,319.31 " "$1,759.08 " N/A "$1,099.42 " "$1,466.46 " N/A "$1,429.25 " "$2,053.05 " "$1,759.08 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,759.08 " "$1,869.02 " "$1,979.72 " "$1,649.14 " "$3,006.25 " "$1,979.72 " "$1,099.42 " "$1,429.25 " "$1,484.22 " "$1,484.22 " "$1,484.22 " "$1,484.22 " N/A N/A N/A "$1,466.63 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $56.50 "$3,006.25 " 330104 15275 5054 56 510 HC SKIN SUB GRAFT FACE/NK/HF/G 1ST 25 SQCM O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15276 56 510 HC SKIN SUB GRAFT F/N/HF/G ADDL EA ADDL 25 SQCM O $814.27 N/A N/A "$1,466.46 " "$1,878.00 " $504.85 $504.85 $30.04 "$1,466.46 " N/A "$1,466.46 " N/A $610.70 N/A $512.99 N/A "$1,759.75 " "$1,466.46 " $488.56 $651.42 N/A $407.13 "$1,466.46 " N/A $529.28 "$2,053.05 " $651.42 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $651.42 $692.13 "$1,979.72 " $610.70 "$3,006.25 " "$1,979.72 " $407.13 $529.28 $549.63 $549.63 $549.63 $549.63 N/A N/A N/A $543.12 "$1,466.46 " "$1,466.46 " N/A N/A N/A $30.04 "$3,006.25 " 330104 15277 5054 56 510 HC SKN SUB GRFT F/N/HF/G 1ST 100SQCM OR 1%AREACHILD O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15278 56 510 HC SKN SUB GRFT F/N/HF/G EA ADDL 100SQCM/1%AREA CHILD O "$2,198.85 " N/A N/A "$1,466.46 " "$1,878.00 " "$1,363.29 " "$1,363.29 " $68.84 "$1,466.46 " N/A "$1,466.46 " N/A "$1,649.14 " N/A "$1,385.28 " N/A "$1,759.75 " "$1,466.46 " "$1,319.31 " "$1,759.08 " N/A "$1,099.42 " "$1,466.46 " N/A "$1,429.25 " "$2,053.05 " "$1,759.08 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,759.08 " "$1,869.02 " "$1,979.72 " "$1,649.14 " "$3,006.25 " "$1,979.72 " "$1,099.42 " "$1,429.25 " "$1,484.22 " "$1,484.22 " "$1,484.22 " "$1,484.22 " N/A N/A N/A "$1,466.63 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $68.84 "$3,006.25 " 330104 16000 5051 16 510 HC INITIAL TREATMENT OF BURN(S) O $485.78 $216.65 $216.65 $463.33 $482.00 $301.18 $301.18 $214.48 $463.33 $411.63 $463.33 $216.65 $364.33 $238.31 $306.04 N/A $556.00 $463.33 $291.47 $388.62 $736.61 $242.89 $463.33 $216.65 $259.98 $648.67 $388.62 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $388.62 $412.91 $463.33 $364.33 $949.83 $463.33 $242.89 $582.79 $327.90 $327.90 $327.90 $327.90 N/A $227.48 $216.65 $324.02 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 16020 5051 16 510 HC DRESS/DEBRID P-THICK BURN S O $921.27 $216.65 $216.65 $463.33 $482.00 $571.19 $571.19 $214.48 $463.33 $411.63 $463.33 $216.65 $690.95 $238.31 $580.40 N/A $556.00 $463.33 $552.76 $737.02 $736.61 $460.63 $463.33 $216.65 $259.98 $648.67 $737.02 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $737.02 $783.08 $463.33 $690.95 $949.83 $463.33 $460.63 $582.79 $621.86 $621.86 $621.86 $621.86 N/A $227.48 $216.65 $614.49 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 16025 5051 16 510 HC DRESS/DEBRID P-THICK BURN M O $921.27 $216.65 $216.65 $463.33 "$2,523.00 " $571.19 $571.19 $214.48 $463.33 $411.63 $463.33 $216.65 $690.95 $238.31 $580.40 N/A $556.00 $463.33 $552.76 $737.02 $736.61 $460.63 $463.33 $216.65 $259.98 $648.67 $737.02 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $737.02 $783.08 $463.33 "$3,883.00 " $949.83 $463.33 $460.63 $582.79 $621.86 $621.86 $621.86 $621.86 N/A $227.48 $216.65 $614.49 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$3,883.00 " 330104 16030 5052 17 510 HC DRESS/DEBRID P-THICK BURN L O "$1,474.46 " $447.59 $447.59 $705.44 "$2,523.00 " $914.17 $914.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,105.85 " $492.35 $928.91 N/A $846.53 $705.44 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $705.44 $447.59 $537.10 $987.62 "$1,179.57 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 17000 5051 3 510 HC DESTRUCT PREMALG LESION O $806.78 $216.65 $216.65 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $214.48 $325.60 $411.63 $325.60 $216.65 $605.09 $238.31 $508.27 N/A $390.72 $325.60 $484.07 $645.42 $736.61 $403.39 $325.60 $216.65 $259.98 $455.84 $645.42 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $645.42 $685.76 $325.60 $605.09 $667.48 $325.60 $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 "$1,296.00 " 330104 17250 5051 3 510 HC CHEMICAL CAUTERY TISSUE O "$1,043.25 " $216.65 $216.65 $325.60 $482.00 $646.81 $646.81 $214.48 $325.60 $411.63 $325.60 $216.65 $782.44 $238.31 $657.25 N/A $390.72 $325.60 $625.95 $834.60 $736.61 $521.62 $325.60 $216.65 $259.98 $455.84 $834.60 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $834.60 $886.76 $325.60 $782.44 $667.48 $325.60 $521.62 $582.79 $704.19 $704.19 $704.19 $704.19 N/A $227.48 $216.65 $695.85 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 $886.76 330104 19000 5071 2 510 HC DRAINAGE OF BREAST LESION O "$2,813.03 " $778.60 $778.60 $512.29 "$1,878.00 " "$1,296.00 " "$1,180.00 " $770.81 $512.29 "$1,479.33 " $512.29 $778.60 "$2,109.77 " $856.45 "$1,772.21 " N/A $614.75 $512.29 "$1,687.82 " "$2,250.42 " "$2,647.22 " "$1,406.52 " $512.29 $778.60 $934.31 $717.21 "$2,250.42 " $512.29 $512.29 $614.75 "$1,090.03 " $512.29 $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " $512.29 "$2,109.77 " "$1,050.20 " $512.29 "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " N/A $817.53 $778.60 "$1,876.29 " $512.29 $512.29 $661.81 $661.81 $778.60 $512.29 "$2,647.22 " 330104 19001 2 510 HC DRAIN BREAST LESION ADD-ON O $717.97 N/A N/A $512.29 $482.00 $445.14 $445.14 $24.07 $512.29 N/A $512.29 N/A $538.48 N/A $452.32 N/A $614.75 $512.29 $430.78 $574.38 N/A $358.99 $512.29 N/A $466.68 $717.21 $574.38 $512.29 $512.29 $614.75 N/A $512.29 N/A N/A N/A $574.38 $610.27 $691.59 $538.48 "$1,050.20 " $691.59 $358.99 $466.68 $484.63 $484.63 $484.63 $484.63 N/A N/A N/A $478.89 $512.29 $512.29 N/A N/A N/A $24.07 "$1,050.20 " 330104 19020 5072 20 510 HC INCISION OF BREAST LESION O "$5,564.00 " "$1,799.07 " "$1,799.07 " "$1,589.01 " "$2,523.00 " "$3,449.68 " "$3,449.68 " "$1,781.08 " "$1,589.01 " "$3,418.23 " "$1,589.01 " "$1,799.07 " "$4,173.00 " "$1,978.98 " "$3,505.32 " N/A "$1,906.82 " "$1,589.01 " "$3,338.40 " "$4,451.20 " "$6,116.84 " "$2,782.00 " "$1,589.01 " "$1,799.07 " "$2,158.88 " "$2,224.62 " "$4,451.20 " "$1,589.01 " "$1,589.01 " "$1,906.82 " "$2,518.70 " "$1,589.01 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,451.20 " "$4,729.40 " "$1,589.01 " "$3,883.00 " "$3,257.48 " "$1,589.01 " "$2,782.00 " "$4,839.50 " "$3,755.70 " "$3,755.70 " "$3,755.70 " "$3,755.70 " N/A "$1,889.02 " "$1,799.07 " "$3,711.19 " "$1,589.01 " "$1,589.01 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$6,116.84 " 330104 20206 5072 2 510 HC NEEDLE BIOPSY MUSCLE O "$5,885.00 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,648.70 " "$3,648.70 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,413.75 " "$1,978.98 " "$3,707.55 " N/A $614.75 $512.29 "$3,531.00 " "$4,708.00 " "$6,116.84 " "$2,942.50 " $512.29 "$1,799.07 " "$2,158.88 " $717.21 "$4,708.00 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,708.00 " "$5,002.25 " $512.29 "$4,413.75 " "$1,050.20 " $512.29 "$2,942.50 " "$4,839.50 " "$3,972.38 " "$3,972.38 " "$3,972.38 " "$3,972.38 " N/A "$1,889.02 " "$1,799.07 " "$3,925.30 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 20220 5072 2 510 HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL O "$6,324.77 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $614.75 $512.29 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $512.29 "$1,799.07 " "$2,158.88 " $717.21 "$5,059.82 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $512.29 "$4,743.58 " "$1,050.20 " $512.29 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 13152 5053 9 510 HC CMPLX RPR E/N/E/L 2.6-7.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13151 5053 9 510 HC CMPLX RPR E/N/E/L 1.1-2.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 17003 3 510 HC DESTRUCT PREMALG LES 2-14 O $434.42 N/A N/A $325.60 $482.00 $269.34 $269.34 $2.23 $325.60 N/A $325.60 N/A $325.81 N/A $273.68 N/A $390.72 $325.60 $260.65 $347.54 N/A $217.21 $325.60 N/A $282.37 $455.84 $347.54 $325.60 $325.60 $390.72 N/A $325.60 N/A N/A N/A $347.54 $369.26 $439.56 $325.81 $667.48 $439.56 $217.21 $282.37 $293.23 $293.23 $293.23 $293.23 N/A N/A N/A $289.76 $325.60 $325.60 N/A N/A N/A $2.23 $667.48 330104 13132 5053 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13133 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F EA. ADDL 5CM OR LESS O $561.75 N/A N/A $636.95 "$1,878.00 " $348.29 $348.29 $148.49 $636.95 N/A $636.95 N/A $421.31 N/A $353.90 N/A $764.34 $636.95 $337.05 $449.40 N/A $280.88 $636.95 N/A $365.14 $891.73 $449.40 $636.95 $636.95 $764.34 N/A $636.95 N/A N/A N/A $449.40 $477.49 $859.88 "$3,883.00 " "$1,305.74 " $859.88 $280.88 $365.14 $379.18 $379.18 $379.18 $379.18 N/A N/A N/A $374.69 $636.95 $636.95 N/A N/A N/A $148.49 "$3,883.00 " 330104 11976 5071 9 510 HC REMOVE CONTRACEPTIVE CAPSULE O "$2,461.00 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,525.82 " "$1,525.82 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$1,845.75 " $856.45 "$1,550.43 " N/A $764.34 $636.95 "$1,476.60 " "$1,968.80 " "$2,647.22 " "$1,230.50 " $636.95 $778.60 $934.31 $891.73 "$1,968.80 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$1,968.80 " "$2,091.85 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,230.50 " "$2,094.42 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$1,661.18 " N/A $817.53 $778.60 "$1,641.49 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11981 5734 3 510 HC INSERT DRUG IMPLANT DEVICE O $503.97 $139.30 $139.30 $325.60 $482.00 $312.46 $312.46 $137.91 $325.60 $264.67 $325.60 $139.30 $377.98 $153.23 $317.50 N/A $390.72 $325.60 $302.38 $403.18 $473.63 $251.99 $325.60 $139.30 $167.16 $455.84 $403.18 $325.60 $325.60 $390.72 $195.02 $325.60 $139.30 $139.30 $151.84 $403.18 $428.37 $325.60 $377.98 $667.48 $325.60 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $325.60 $325.60 $118.41 $118.41 $139.30 $118.41 $667.48 330104 11982 5735 3 510 HC REMOVE DRUG IMPLANT DEVICE O "$1,676.69 " $452.99 $452.99 $325.60 $482.00 "$1,039.55 " "$1,039.55 " $448.46 $325.60 $860.67 $325.60 $452.99 "$1,257.52 " $498.28 "$1,056.31 " N/A $390.72 $325.60 "$1,006.01 " "$1,341.35 " "$1,540.15 " $838.35 $325.60 $452.99 $543.58 $455.84 "$1,341.35 " $325.60 $325.60 $390.72 $634.18 $325.60 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $325.60 "$3,883.00 " $667.48 $325.60 $838.35 "$1,218.53 " "$1,131.77 " "$1,131.77 " "$1,131.77 " "$1,131.77 " N/A $475.64 $452.99 "$1,118.35 " $325.60 $325.60 $385.04 $385.04 $452.99 $325.60 "$3,883.00 " 330104 12001 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRNK 2.5CM/< O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12002 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRNK2.6-7.5CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12004 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRK7.6-12.5CM O "$1,592.16 " $216.65 $216.65 $463.33 $482.00 $987.14 $987.14 $214.48 $463.33 $411.63 $463.33 $216.65 "$1,194.12 " $238.31 "$1,003.06 " N/A $556.00 $463.33 $955.30 "$1,273.73 " $736.61 $796.08 $463.33 $216.65 $259.98 $648.67 "$1,273.73 " $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 "$1,273.73 " "$1,353.34 " $463.33 "$1,194.12 " $949.83 $463.33 $796.08 $582.79 "$1,074.71 " "$1,074.71 " "$1,074.71 " "$1,074.71 " N/A $227.48 $216.65 "$1,061.97 " $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$1,353.34 " 330104 12011 5051 16 510 HC SIMPLE SIMPLE RPR F/E/E/N/L/M 2.5 CM/< O $852.79 $216.65 $216.65 $463.33 $482.00 $528.73 $528.73 $214.48 $463.33 $411.63 $463.33 $216.65 $639.59 $238.31 $537.26 N/A $556.00 $463.33 $511.67 $682.23 $736.61 $426.39 $463.33 $216.65 $259.98 $648.67 $682.23 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $682.23 $724.87 $463.33 $639.59 $949.83 $463.33 $426.39 $582.79 $575.63 $575.63 $575.63 $575.63 N/A $227.48 $216.65 $568.81 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12013 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 2.6-5.0 CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12014 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 5.1-7.5 CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12015 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 7.6-12.5 CM O $828.18 $216.65 $216.65 $463.33 $482.00 $513.47 $513.47 $214.48 $463.33 $411.63 $463.33 $216.65 $621.14 $238.31 $521.75 N/A $556.00 $463.33 $496.91 $662.54 $736.61 $414.09 $463.33 $216.65 $259.98 $648.67 $662.54 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $662.54 $703.95 $463.33 "$3,883.00 " $949.83 $463.33 $414.09 $582.79 $559.02 $559.02 $559.02 $559.02 N/A $227.48 $216.65 $552.40 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$3,883.00 " 330104 12020 5053 17 510 HC CLOSURE OF SPLIT WOUND SIMPLE O "$2,140.00 " $696.99 $696.99 $705.44 "$1,878.00 " "$1,326.80 " "$1,326.80 " $690.02 $705.44 "$1,324.28 " $705.44 $696.99 "$1,605.00 " $766.69 "$1,348.20 " N/A $846.53 $705.44 "$1,284.00 " "$1,712.00 " "$2,369.76 " "$1,070.00 " $705.44 $696.99 $836.39 $987.62 "$1,712.00 " $705.44 $705.44 $846.53 $975.78 $705.44 $696.99 $696.99 $759.72 "$1,712.00 " "$1,819.00 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,070.00 " "$1,874.90 " "$1,444.50 " "$1,444.50 " "$1,444.50 " "$1,444.50 " N/A $731.84 $696.99 "$1,427.38 " $705.44 $705.44 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12031 5052 17 510 HC INTMD RPR S/A/T/EXT 2.5 CM/< O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12032 5052 17 510 HC INTMD RPR S/A/T/EXT 2.6-7.5CM O "$2,346.51 " $447.59 $447.59 $705.44 "$1,099.00 " "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11983 5735 3 510 HC REMOVE W/RE-INSERT DRUG IMPLANT O "$1,676.69 " $452.99 $452.99 $325.60 $482.00 "$1,039.55 " "$1,039.55 " $448.46 $325.60 $860.67 $325.60 $452.99 "$1,257.52 " $498.28 "$1,056.31 " N/A $390.72 $325.60 "$1,006.01 " "$1,341.35 " "$1,540.15 " $838.35 $325.60 $452.99 $543.58 $455.84 "$1,341.35 " $325.60 $325.60 $390.72 $634.18 $325.60 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $325.60 "$3,883.00 " $667.48 $325.60 $838.35 "$1,218.53 " "$1,131.77 " "$1,131.77 " "$1,131.77 " "$1,131.77 " N/A $475.64 $452.99 "$1,118.35 " $325.60 $325.60 $385.04 $385.04 $452.99 $325.60 "$3,883.00 " 330104 12035 5052 17 510 HC INTMD RPR S/A/T/EXT 12.6-20CM O "$1,582.53 " $447.59 $447.59 $705.44 "$2,523.00 " $981.17 $981.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,186.90 " $492.35 $996.99 N/A $846.53 $705.44 $949.52 "$1,266.02 " "$1,521.80 " $791.26 $705.44 $447.59 $537.10 $987.62 "$1,266.02 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,266.02 " "$1,345.15 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $791.26 "$1,204.01 " "$1,068.21 " "$1,068.21 " "$1,068.21 " "$1,068.21 " N/A $469.97 $447.59 "$1,055.55 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12034 5052 17 510 HC INTMD RPR S/TR/EXT 7.6-12.5CM O "$1,582.53 " $447.59 $447.59 $705.44 "$2,523.00 " $981.17 $981.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,186.90 " $492.35 $996.99 N/A $846.53 $705.44 $949.52 "$1,266.02 " "$1,521.80 " $791.26 $705.44 $447.59 $537.10 $987.62 "$1,266.02 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,266.02 " "$1,345.15 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $791.26 "$1,204.01 " "$1,068.21 " "$1,068.21 " "$1,068.21 " "$1,068.21 " N/A $469.97 $447.59 "$1,055.55 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13122 9 510 HC CMPLX RPR S/A/L EA. ADDL 5 CM OR LESS O $767.19 N/A N/A $636.95 "$1,878.00 " $475.66 $475.66 $100.16 $636.95 N/A $636.95 N/A $575.39 N/A $483.33 N/A $764.34 $636.95 $460.31 $613.75 N/A $383.60 $636.95 N/A $498.67 $891.73 $613.75 $636.95 $636.95 $764.34 N/A $636.95 N/A N/A N/A $613.75 $652.11 $859.88 $575.39 "$1,305.74 " $859.88 $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 $636.95 $636.95 N/A N/A N/A $100.16 "$1,878.00 " 330104 13121 5053 9 510 HC CMPLX RPR S/A/L 2.6-7.5 CM O "$2,184.94 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,354.66 " "$1,354.66 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$1,638.70 " $766.69 "$1,376.51 " N/A $764.34 $636.95 "$1,310.96 " "$1,747.95 " "$2,369.76 " "$1,092.47 " $636.95 $696.99 $836.39 $891.73 "$1,747.95 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$1,747.95 " "$1,857.20 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,092.47 " "$1,874.90 " "$1,474.83 " "$1,474.83 " "$1,474.83 " "$1,474.83 " N/A $731.84 $696.99 "$1,457.35 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13131 5052 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F 1.1-2.5CM O "$2,346.51 " $447.59 $447.59 $636.95 "$2,523.00 " "$1,454.84 " "$1,454.84 " $443.11 $636.95 $850.42 $636.95 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $764.34 $636.95 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $636.95 $447.59 $537.10 $891.73 "$1,877.21 " $636.95 $636.95 $764.34 $626.62 $636.95 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $636.95 $636.95 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13100 5053 9 510 HC CMPLX RPR TRUNK 1.1-2.5 CM O "$2,134.65 " $696.99 $696.99 $636.95 "$2,523.00 " "$1,323.48 " "$1,323.48 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$1,600.99 " $766.69 "$1,344.83 " N/A $764.34 $636.95 "$1,280.79 " "$1,707.72 " "$2,369.76 " "$1,067.33 " $636.95 $696.99 $836.39 $891.73 "$1,707.72 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$1,707.72 " "$1,814.45 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,067.33 " "$1,874.90 " "$1,440.89 " "$1,440.89 " "$1,440.89 " "$1,440.89 " N/A $731.84 $696.99 "$1,423.81 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12054 5052 17 510 HC INTMD RPR FACE/MM 7.6-12.5CM O "$1,685.25 " $447.59 $447.59 $705.44 "$2,523.00 " "$1,044.86 " "$1,044.86 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,263.94 " $492.35 "$1,061.71 " N/A $846.53 $705.44 "$1,011.15 " "$1,348.20 " "$1,521.80 " $842.62 $705.44 $447.59 $537.10 $987.62 "$1,348.20 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,348.20 " "$1,432.46 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $842.62 "$1,204.01 " "$1,137.54 " "$1,137.54 " "$1,137.54 " "$1,137.54 " N/A $469.97 $447.59 "$1,124.06 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13101 5053 9 510 HC CMPLX RPR TRUNK 2.6-7.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12053 5052 17 510 HC INTMD RPR FACE/MM 5.1-7.5 CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12052 5052 17 510 HC INTMD RPR FACE/MM 2.6-5.0 CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11750 5052 9 510 HC EXCISION NAIL/NAIL MATRIX PART/COMPL-PERMANENT O "$3,275.27 " $447.59 $447.59 $636.95 "$1,099.00 " "$2,030.67 " "$2,030.67 " $443.11 $636.95 $850.42 $636.95 $447.59 "$2,456.45 " $492.35 "$2,063.42 " N/A $764.34 $636.95 "$1,965.16 " "$2,620.22 " "$1,521.80 " "$1,637.63 " $636.95 $447.59 $537.10 $891.73 "$2,620.22 " $636.95 $636.95 $764.34 $626.62 $636.95 $447.59 $447.59 $487.87 "$2,620.22 " "$2,783.98 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,637.63 " "$1,204.01 " "$2,210.81 " "$2,210.81 " "$2,210.81 " "$2,210.81 " N/A $469.97 $447.59 "$2,184.61 " $636.95 $636.95 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12044 5053 17 510 HC INTMD RPR N-HF/GENIT 7.6-12.5CM O "$3,210.00 " $696.99 $696.99 $705.44 "$2,523.00 " "$1,990.20 " "$1,990.20 " $690.02 $705.44 "$1,324.28 " $705.44 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $846.53 $705.44 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $705.44 $696.99 $836.39 $987.62 "$2,568.00 " $705.44 $705.44 $846.53 $975.78 $705.44 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $705.44 $705.44 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12042 5052 17 510 HC INTMD RPR N-HF/GENIT 2.6-7.5CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12041 5052 17 510 HC INTMD RPR N-HF/GENIT 2.5CM/< O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 98968 491 521 HC TELEPHONE ASSESS & MGNT EST PT PARENT OR GUARD PROVIDED WITHIN THE PREVIOUS 7 DAYS -- 21-30 MINS O $117.70 $34.56 $34.56 N/A $58.85 $72.97 $72.97 $34.22 N/A $65.67 N/A $34.56 $88.28 $38.02 $76.51 $86.04 N/A N/A $70.62 $94.16 $117.51 $58.85 N/A $34.56 $76.51 N/A $94.16 N/A N/A N/A $48.39 N/A $34.56 $34.56 $37.67 $94.16 $100.05 N/A $88.28 N/A N/A $58.85 $76.51 $79.45 $79.45 $79.45 $79.45 N/A $36.29 $34.56 $78.51 N/A N/A $29.38 $29.38 $34.56 $29.38 $117.51 330104 73218 5523 293 610 HC MRI UPPER EXTREMITY W/O DYE O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 0697T 5523 386 610 HC QUAN MR ALYS TIS COMPJ WO MRI SAME SESS MLT ORGN - W/I&R O $606.69 $280.16 $280.16 N/A $303.35 "$1,575.00 " "$1,434.00 " $277.36 N/A $532.31 N/A $280.16 $455.02 $308.18 $382.21 $443.49 N/A N/A $364.01 $485.35 $952.56 "$1,596.93 " N/A $280.16 $336.20 N/A $485.35 N/A N/A N/A $392.23 N/A $280.16 $280.16 $305.38 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $753.64 $441.26 $441.26 $441.26 $441.26 N/A $294.17 $280.16 $404.66 N/A N/A $238.14 $238.14 $280.16 $238.14 "$1,596.93 " 330104 0698T 386 610 HC QUAN MR ALYS TISS COMPOSITION W/MRI MLT ORGANS - I&R O $606.69 N/A N/A N/A $303.35 "$1,575.00 " "$1,434.00 " N/A N/A N/A N/A N/A $455.02 N/A $382.21 $443.49 N/A N/A $364.01 $485.35 N/A N/A N/A N/A $394.35 N/A $485.35 N/A N/A N/A N/A N/A N/A N/A N/A $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 N/A N/A N/A N/A N/A N/A N/A $404.66 N/A N/A N/A N/A N/A $303.35 "$1,575.00 " 330104 74185 282 610 HC MRA W/O CONT ABD O "$7,545.64 " $428.98 $428.98 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $424.69 $500.00 $815.06 $500.00 $428.98 "$5,659.23 " $471.88 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,458.54 " "$2,445.19 " $500.00 $428.98 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $600.57 $500.00 $428.98 $428.98 $467.59 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $675.65 $675.65 $675.65 $675.65 $590.37 $450.43 $428.98 $590.37 $500.00 $500.00 $364.63 $364.63 $428.98 $364.63 "$6,413.79 " 330104 71555 282 610 HC MRA W/O CONT CHEST O "$8,123.44 " $424.41 $424.41 $500.00 "$4,061.72 " "$1,575.00 " "$1,434.00 " $420.17 $500.00 $806.38 $500.00 $424.41 "$6,092.58 " $466.85 "$5,117.77 " "$5,938.23 " $600.00 $500.00 "$4,874.06 " "$6,498.75 " "$1,443.00 " "$2,419.14 " $500.00 $424.41 "$5,280.24 " $700.00 "$6,498.75 " $500.00 $500.00 $600.00 $594.18 $500.00 $424.41 $424.41 $462.61 "$6,498.75 " "$6,904.92 " $675.00 "$6,092.58 " "$1,025.00 " $675.00 "$4,061.72 " "$5,280.24 " $668.45 $668.45 $668.45 $668.45 $590.91 $445.63 $424.41 $590.91 $500.00 $500.00 $360.75 $360.75 $424.41 $360.75 "$6,904.92 " 330104 73725 282 610 HC MRA W/O CONT LWR EXT O "$7,545.64 " $426.41 $426.41 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $422.15 $500.00 $810.18 $500.00 $426.41 "$5,659.23 " $469.05 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,449.80 " "$2,430.55 " $500.00 $426.41 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $596.98 $500.00 $426.41 $426.41 $464.79 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $671.60 $671.60 $671.60 $671.60 $592.54 $447.73 $426.41 $592.54 $500.00 $500.00 $362.45 $362.45 $426.41 $362.45 "$6,413.79 " 330104 C8937 2002 610 HC CAD BREAST MRI O $107.00 N/A N/A N/A $53.50 "$1,575.00 " "$1,434.00 " $69.98 N/A N/A N/A N/A $80.25 N/A $67.41 $78.22 N/A N/A $64.20 $85.60 N/A N/A N/A N/A N/A N/A $85.60 N/A N/A N/A N/A N/A N/A N/A N/A $85.60 $90.95 N/A $80.25 N/A N/A $53.50 $69.55 N/A N/A N/A N/A N/A N/A N/A $71.37 N/A N/A N/A N/A N/A $53.50 "$1,575.00 " 330104 73219 5572 295 610 HC MRI UPPER EXTREMITY W/DYE O "$4,559.27 " $442.02 $442.02 $500.00 "$2,279.64 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,419.45 " $486.22 "$2,872.34 " "$3,332.83 " $600.00 $500.00 "$2,735.56 " "$3,647.42 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,647.42 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,647.42 " "$3,875.38 " $500.00 "$3,419.45 " "$1,025.00 " $500.00 "$2,279.64 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,875.38 " 330104 70336 5523 293 610 HC MAGNETIC IMAGE JAW JOINT O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 70546 5572 282 610 HC MR ANGIOGRAPH HEAD W/O&W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70542 5572 295 610 HC MRI ORBIT/FACE/NECK W/DYE O "$6,560.17 " $442.02 $442.02 $500.00 "$3,280.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,920.13 " $486.22 "$4,132.91 " "$4,795.48 " $600.00 $500.00 "$3,936.10 " "$5,248.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,248.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,248.14 " "$5,576.14 " $500.00 "$4,920.13 " "$1,025.00 " $500.00 "$3,280.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,576.14 " 330104 70543 5572 295 610 HC MRI ORBT/FAC/NCK W/O &W/DYE O "$6,560.17 " $442.02 $442.02 $500.00 "$3,280.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,920.13 " $486.22 "$4,132.91 " "$4,795.48 " $600.00 $500.00 "$3,936.10 " "$5,248.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,248.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,248.14 " "$5,576.14 " $500.00 "$4,920.13 " "$1,025.00 " $500.00 "$3,280.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,576.14 " 330104 70544 5523 282 610 HC MR ANGIOGRAPHY HEAD W/O DYE O "$4,419.10 " $280.16 $280.16 $500.00 "$2,209.55 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,314.33 " $308.18 "$2,784.03 " "$3,230.36 " $600.00 $500.00 "$2,651.46 " "$3,535.28 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,535.28 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,535.28 " "$3,756.24 " $500.00 "$3,314.33 " "$1,025.00 " $500.00 "$2,209.55 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$3,756.24 " 330104 70545 5572 282 610 HC MR ANGIOGRAPHY HEAD W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70547 5523 282 610 HC MR ANGIOGRAPHY NECK W/O DYE O "$4,346.34 " $280.16 $280.16 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,259.76 " $308.18 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$3,694.39 " 330104 70548 5572 282 610 HC MR ANGIOGRAPHY NECK W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70549 5572 282 610 HC MR ANGIOGRAPH NECK W/O&W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 71550 5523 293 610 HC MRI CHEST W/O DYE O "$7,521.03 " $280.16 $280.16 $500.00 "$3,760.51 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,640.77 " $308.18 "$4,738.25 " "$5,497.87 " $600.00 $500.00 "$4,512.62 " "$6,016.82 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,016.82 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,016.82 " "$6,392.88 " $500.00 "$5,640.77 " "$1,025.00 " $500.00 "$3,760.51 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,392.88 " 330104 73220 5572 295 610 HC MRI UPPR EXTREMITY W/O&W/DYE O "$4,559.27 " $442.02 $442.02 $500.00 "$2,279.64 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,419.45 " $486.22 "$2,872.34 " "$3,332.83 " $600.00 $500.00 "$2,735.56 " "$3,647.42 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,647.42 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,647.42 " "$3,875.38 " $500.00 "$3,419.45 " "$1,025.00 " $500.00 "$2,279.64 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,875.38 " 330104 71551 5573 295 610 HC MRI CHEST W/DYE O "$7,521.03 " $888.71 $888.71 $500.00 "$3,760.51 " "$1,575.00 " "$1,434.00 " $879.82 $500.00 "$1,688.54 " $500.00 $888.71 "$5,640.77 " $977.58 "$4,738.25 " "$5,497.87 " $600.00 $500.00 "$4,512.62 " "$6,016.82 " "$3,021.61 " "$5,065.63 " $500.00 $888.71 "$1,066.45 " $700.00 "$6,016.82 " $500.00 $500.00 $600.00 "$1,244.19 " $500.00 $888.71 $888.71 $968.69 "$6,016.82 " "$6,392.88 " $500.00 "$5,640.77 " "$1,025.00 " $500.00 "$3,760.51 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $699.17 $933.14 $888.71 $699.17 $500.00 $500.00 $755.40 $755.40 $888.71 $500.00 "$6,392.88 " 330104 70540 5523 293 610 HC MRI ORBIT/FACE/NECK W/O DYE O "$2,698.54 " $280.16 $280.16 $500.00 "$1,349.27 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,023.90 " $308.18 "$1,700.08 " "$1,972.63 " $600.00 $500.00 "$1,619.12 " "$2,158.83 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,158.83 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,158.83 " "$2,293.76 " $500.00 "$2,023.90 " "$1,025.00 " $500.00 "$1,349.27 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,293.76 " 330104 73221 5523 293 610 HC MRI JOINT UPR EXTREM W/O DYE O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 75565 293 610 HC CARD MRI VELOC FLOW MAPPING O $856.00 N/A N/A $57.80 $428.00 "$1,575.00 " "$1,434.00 " $56.80 $57.80 N/A $57.80 N/A $642.00 N/A $539.28 $625.74 $69.36 $57.80 $513.60 $684.80 N/A N/A $57.80 N/A $556.40 $80.92 $684.80 $57.80 $57.80 $69.36 N/A $57.80 N/A N/A N/A $684.80 $727.60 $78.03 $642.00 $118.49 $78.03 $428.00 $556.40 N/A N/A N/A N/A N/A N/A N/A $570.95 $57.80 $57.80 N/A N/A N/A $56.80 "$1,575.00 " 330104 73223 5572 295 610 HC MRI JOINT UPR EXTR W/O&W/DYE O "$3,768.54 " $442.02 $442.02 $500.00 "$1,884.27 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,826.40 " $486.22 "$2,374.18 " "$2,754.80 " $600.00 $500.00 "$2,261.12 " "$3,014.83 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,014.83 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,014.83 " "$3,203.26 " $500.00 "$2,826.40 " "$1,025.00 " $500.00 "$1,884.27 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,203.26 " 330104 71552 5572 295 610 HC MRI CHEST W/O & W/DYE O "$8,210.11 " $442.02 $442.02 $500.00 "$4,105.06 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$6,157.58 " $486.22 "$5,172.37 " "$6,001.59 " $600.00 $500.00 "$4,926.07 " "$6,568.09 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,568.09 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,568.09 " "$6,978.59 " $500.00 "$6,157.58 " "$1,025.00 " $500.00 "$4,105.06 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,978.59 " 330104 77049 295 610 HC MRI BREAST BI LAT W/WITH CONTRAST O "$11,063.80 " $435.71 $435.71 $500.00 "$5,531.90 " "$1,575.00 " "$1,434.00 " $431.35 $500.00 $827.84 $500.00 $435.71 "$8,297.85 " $479.28 "$6,970.19 " "$8,087.64 " $600.00 $500.00 "$6,638.28 " "$8,851.04 " "$1,481.40 " "$2,483.52 " $500.00 $435.71 "$7,191.47 " $700.00 "$8,851.04 " $500.00 $500.00 $600.00 $609.99 $500.00 $435.71 $435.71 $474.92 "$8,851.04 " "$9,404.23 " $675.00 "$8,297.85 " "$1,025.00 " $675.00 "$5,531.90 " "$7,191.47 " $686.24 $686.24 $686.24 $686.24 $468.80 $457.49 $435.71 $468.80 $500.00 $500.00 $370.35 $370.35 $435.71 $370.35 "$9,404.23 " 330104 77048 295 610 HC MRI BREAST C-+ W/CAD UNI O "$8,381.31 " $427.36 $427.36 $500.00 "$4,190.65 " "$1,575.00 " "$1,434.00 " $423.08 $500.00 $811.98 $500.00 $427.36 "$6,285.98 " $470.09 "$5,280.23 " "$6,126.74 " $600.00 $500.00 "$5,028.79 " "$6,705.05 " "$1,453.01 " "$2,435.93 " $500.00 $427.36 "$5,447.85 " $700.00 "$6,705.05 " $500.00 $500.00 $600.00 $598.30 $500.00 $427.36 $427.36 $465.82 "$6,705.05 " "$7,124.11 " $675.00 "$6,285.98 " "$1,025.00 " $675.00 "$4,190.65 " "$5,447.85 " $673.09 $673.09 $673.09 $673.09 $471.10 $448.72 $427.36 $471.10 $500.00 $500.00 $363.25 $363.25 $427.36 $363.25 "$7,124.11 " 330104 77047 5523 293 610 HC MRI BREAST C- BILATERAL O "$8,380.24 " $280.16 $280.16 $500.00 "$4,190.12 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$6,285.18 " $308.18 "$5,279.55 " "$6,125.96 " $600.00 $500.00 "$5,028.14 " "$6,704.19 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,704.19 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,704.19 " "$7,123.20 " $500.00 "$6,285.18 " "$1,025.00 " $500.00 "$4,190.12 " $753.64 $441.26 $441.26 $441.26 $441.26 $368.90 $294.17 $280.16 $368.90 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$7,123.20 " 330104 77046 5523 293 610 HC MRI BREAST C- UNILATERAL O "$7,760.71 " $280.16 $280.16 $500.00 "$3,880.36 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,820.53 " $308.18 "$4,889.25 " "$5,673.08 " $600.00 $500.00 "$4,656.43 " "$6,208.57 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,208.57 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,208.57 " "$6,596.60 " $500.00 "$5,820.53 " "$1,025.00 " $500.00 "$3,880.36 " $753.64 $441.26 $441.26 $441.26 $441.26 $368.90 $294.17 $280.16 $368.90 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,596.60 " 330104 76390 5521 293 610 HC MR SPECTROSCOPY O "$3,815.62 " $104.23 $104.23 N/A "$1,907.81 " "$1,575.00 " "$1,434.00 " $103.19 N/A $198.04 N/A $104.23 "$2,861.72 " $114.66 "$2,403.84 " "$2,789.22 " N/A N/A "$2,289.37 " "$3,052.50 " $354.39 $594.13 N/A $104.23 $125.08 N/A "$3,052.50 " N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 "$3,052.50 " "$3,243.28 " N/A "$2,861.72 " N/A N/A "$1,907.81 " $280.39 $164.17 $164.17 $164.17 $164.17 $613.74 $109.45 $104.23 $613.74 N/A N/A $88.60 $88.60 $104.23 $88.60 "$3,243.28 " 330104 75561 5572 295 610 HC CARDIAC MRI W/WO CONTRAST FOR MORPH- FUNCTION & FURTHER SEQ W/DYE O "$3,482.85 " $442.02 $442.02 $500.00 "$1,741.42 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,612.14 " $486.22 "$2,194.20 " "$2,545.96 " $600.00 $500.00 "$2,089.71 " "$2,786.28 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$2,786.28 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$2,786.28 " "$2,960.42 " $500.00 "$2,612.14 " "$1,025.00 " $500.00 "$1,741.42 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$2,960.42 " 330104 73222 5573 295 610 HC MRI JOINT UPR EXTREM W/DYE O "$3,205.72 " $888.71 $888.71 $500.00 "$1,602.86 " "$1,575.00 " "$1,434.00 " $879.82 $500.00 "$1,688.54 " $500.00 $888.71 "$2,404.29 " $977.58 "$2,019.60 " "$2,343.38 " $600.00 $500.00 "$1,923.43 " "$2,564.58 " "$3,021.61 " "$5,065.63 " $500.00 $888.71 "$1,066.45 " $700.00 "$2,564.58 " $500.00 $500.00 $600.00 "$1,244.19 " $500.00 $888.71 $888.71 $968.69 "$2,564.58 " "$2,724.86 " $500.00 "$2,404.29 " "$1,025.00 " $500.00 "$1,602.86 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $699.17 $933.14 $888.71 $699.17 $500.00 $500.00 $755.40 $755.40 $888.71 $500.00 "$5,065.63 " 330104 74713 293 610 HC MRI FETAL EA ADDL GESTATION O "$1,213.38 " N/A N/A $69.88 $606.69 "$1,575.00 " "$1,434.00 " $247.27 $69.88 N/A $69.88 N/A $910.04 N/A $764.43 $886.98 $83.86 $69.88 $728.03 $970.70 N/A N/A $69.88 N/A $788.70 $97.83 $970.70 $69.88 $69.88 $83.86 N/A $69.88 N/A N/A N/A $970.70 "$1,031.37 " $94.34 $910.04 $143.25 $94.34 $606.69 $788.70 N/A N/A N/A N/A N/A N/A N/A $809.32 $69.88 $69.88 N/A N/A N/A $69.88 "$1,575.00 " 330104 75557 5523 293 610 HC CARDIAC MRI FOR MORPHOLOGY & FUNCTION W/O CONTRAST O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16