RADIOLOGY DIAGNOSTIC
SERVICE CHARGE CODE	SERVICE DESCRIPTION	SERVICE CHARGE PRICE
2000003	CISTERN/LAT CERVIC, W/O INJ	62.25
2000006	X-RAY CONTROL CATH CHANGE	30.23
2000009	PLACE CATH BILIARY DRAINAGE	162.80
2000010	INSTILL AIRWAY CONTRAST DYE	124.49
2000014	INSERT URETERAL TUBE	248.99
2000015	CISTERN/LAT CERVIC, W/ INJ	124.49
2000017	INJECTION FOR URETER X-RAY	124.49
2000019	INJECTION OF URETER X-RAY	124.49
2000020	ESTABLISH ACCESS TO AORTA	248.99
2000021	INJECT FOR TEAR SAC X-RAY	62.25
2000022	ACROMIOCLAVICULAR JT, BIL	47.72
2000024	PUNCTURE SHUNT TUBING	124.49
2000025	X-RAY AORTA, LEG ARTERIES	45.35
2000028	INJECTION FOR MYELOGRAM	93.37
2000032	INJECT FOR LYMPHATIC X-RAY	124.49
2000034	INJECTION FOR SIALOGRAPHY	124.49
2000035	BIOPSY, ABDOMINAL MASS	124.49
2000038	INJECTION FOR HIP X-RAY	62.25
2000040	INJECT FOR BRONCHUS X-RAY	62.25
2000046	INJECT FOR URETHROCYSTOGRAPHY	80.71
2000047	BIOPSY OF THYROID	62.25
2000048	ABDOMEN, INCL CHEST PA	63.62
2000052	CHANGE BILE DUCT CATHETER	124.49
2000055	INJECT FOR URETEROPYELOGRAPHY	124.49
2000057	INJECTION, VENOGRAPHY	248.99
2000059	PREP FOR BLADDER X-RAY	62.25
2000061	ABSCESS DRAIN UNDER X-RAY	60.47
2000063	ABDOMEN, MULTIPLE VIEWS	47.72
2000065	INSERT BILE DUCT DRAIN	124.49
2000067	MAMMOGRAPHY, BREAST SPECIMEN	77.26
2000070	KNEE, APL W/ OBLIQUE, MIN 3 VIEWS	69.06
2000073	INJECT SINUS TRACT FOR XRAY	124.49
2000074	CHANGE KIDNEY TUBE	124.49
2000077	INJECT UTERUS/TUBE X-RAY	62.25
2000089	ABDOMEN, SINGLE AP	66.66
2000099	DRAINAGE OF CHEST	124.49
2000100	BARIUM SPEECH EVAL, COMPLEX	72.45
2000101	DRAINAGE OF HEART SAC	124.49
2000103	DRAINAGE OF KIDNEY LESION	230.29
2000105	DRAINAGE OF LUNG LESION	124.49
2000109	INJECTION FOR BREAST X-RAY	62.25
2000115	CHANGE GASTROSTOMY TUBE	124.49
2000117	CHEST, W/ APICAL LORDOTIC	55.28
2000118	BRONCHOSCOPY INJECT X-RAY	62.25
2000120	NEEDLE BIOPSY, PANCREAS	315.95
2000122	PREOP NDLE LOCAL'N, BREAST	62.25
2000124	REVISE, REINSERT BILE TUBE	124.49
2000125	NEEDLE BIOPSY, CHEST LINING	149.97
2000126	NEEDLE BIOPSY, MUSCLE	149.97
2000127	BIOPSY OF KIDNEY	124.49
2000128	NEEDLE BIOPSY, LIVER	199.96
2000129	JT(S) SURVEY, SINGLE FILM	47.62
2000130	BIOPSY OF HEART LINING	124.49
2000132	BIOPSY, LUNG/MEDIASTINUM	124.49
2000134	MAMMOGRAM, SCREENING	94.18
2000135	CHANGE URETER TUBE	124.49
2000137	REMOVAL BILE DUCT STONE	124.49
2000139	KNEE, BOTH, STANDING AP	50.16
2000142	INSERT CATHETER, BILE DUCT	124.49
2000143	INSERT OF AIRWAY CATHETER	124.49
2000147	ANKLE COMPLETE MIN 3 VIEWS	47.72
2000148	EXTRACT BILIARY DUCT STONE	248.99
2000162	ANKLE, TWO VIEWS	66.66
2000402	BARIUM ENEMA, AIR CONTRAST	127.25
2000469	BONE AGE STUDIES	74.99
2000485	BONE LENGTH STUDIES	79.53
2000501	BONE SURVEY, COMPLETE	118.99
2000527	BONE SURVEY, INFANT	47.72
2000543	BRONCHOGRAPHY, BILATERAL	127.25
2000568	BRONCHOGRAPHY, UNILATERAL	79.53
2000600	CHEST, OBLIQUE VIEWS	63.62
2000626	CHEST, W/ FLUOROSCOPY	99.99
2000667	CHEST, SINGLE VIEW	66.66
2000683	CHEST, TWO VIEWS	74.99
2000725	CHOLANGIOGRAPHY, ADD SET OP	95.42
2000741	CHOLANGIOGRAPHY, INTRAOP	79.53
2000766	CHOLANGIOGRAPHY, PERCUTAN	95.42
2000782	CHOLANGIOGRAPHY, POST-OP	79.53
2000808	CHOLECYSTOGRAPHY, ORAL	79.53
2000824	CHOLECYSTOGRAPHY, ADD/RPT	83.32
2000865	CLAVICLE	74.99
2000881	BARIUM ENEMA, COLON	95.42
2000907	GU-CYSTOGRAPHY	63.62
2000964	ELBOW, PARTIAL	66.66
2000980	ELBOW, COMPLETE	47.72
2001004	BARIUM, ESOPHAGUS & PHARYNX	63.62
2001020	PORTABLE BEDSIDE	15.90
2001103	EYE, LOCALIZATION FB	79.53
2001129	FACIAL BONES, LESS 3 VIEWS	47.72
2001145	FACIAL BONES, MIN 3 VIEWS	79.53
2001160	FEMUR, INCL 1 JOINT	47.72
2001186	FINGERS	66.66
2001202	FISTULA/SINUS TRACT STUDY	79.53
2001244	FOOT, COMPLETE	47.72
2001269	OS CALCIS(HEEL), MIN 2 VIEWS	66.66
2001285	FOOT, PARTIAL	66.66
2001301	FOREARM, INCL 1 JOINT	66.66
2001327	HAND, COMPLETE	74.99
2001343	HIP, COMPLETE	57.26
2001368	HIP, PARTIAL	74.99
2001384	HIP OPER PROC ADD'L	15.90
2001400	HIP, OPERATIVE	127.25
2001426	HUMERUS, INCL 1 JOINT	47.72
2001442	HYSTEROSALPINGOGRAPHY	133.31
2001483	KNEE, COMPLETE	47.72
2001509	KNEE, PARTIAL	74.99
2001517	KNEE ARHTRO INJECTION	41.27
2001525	HAND, MACRO	47.72
2001566	LARYNGOGRAM	127.25
2001582	LOWER EXTREMITY, INFANT	66.66
2001608	LYMPHANGIOGRAM, BILATERAL	238.58
2001624	LYMPHANGIOGRAM, UNILATERAL	111.34
2001640	MAMMOGRAPHY, BILATERAL	95.42
2001665	MAMMOGRAPHY, UNILATERAL	63.62
2001681	MANDIBLE, COMPLETE	79.53
2001707	MANDIBLE, PARTIAL	47.72
2001723	MASTOIDS, COMPLETE	79.53
2001749	MASTOIDS, PARTIAL	57.26
2001764	MYELOGRAPHY, COMP, SPINAL CANAL	249.95
2001780	MYELOGRAPHY, CERVICAL	199.96
2001806	MYELOGRAPHY, LUMBAR	199.96
2001822	NASAL BONES	47.72
2001848	NASOLACRIMAL DUCT	63.62
2001863	NECK, SOFT TISSUE	74.99
2001871	LUNG NEEDLE BIOPSY	326.70
2001897	LIVER BIOPSY	261.25
2001905	GU-NEPHROTOMOGRAPHY INT	238.58
2001921	OPTIC FORAMINA	47.72
2001947	ORBIT, COMPLETE MIN 4 VIEWS	63.62
2001962	PARANASAL SINUS, COMPLETE	63.62
2001988	P/NASAL SIN CONT ST	124.98
2002002	PARANASAL SINUS, PARTIAL	74.99
2002044	PELVIMETRY	79.53
2002069	PELVIS, AP	66.66
2002085	PELVIS, COMPLETE	127.25
2002101	SACROILIAC JOINT	63.62
2002127	SACRUM & COCCYX	47.72
2002168	LARYNX-PHARYNX	63.62
2002275	RENAL CYST PUNCTURE	378.28
2002309	RIBS, BILATERAL	69.98
2002325	RIBS, UNILATERAL	47.72
2002341	SALIVARY GLAND CALCULUS	47.72
2002366	SCAPULA	47.72
2002382	SCOLIOSIS SURVEY REC	99.99
2002408	SELLA TURCICA	83.32
2002424	SHOULDER, COMPLETE	47.72
2002440	SHOULDER, PARTIAL	31.82
2002457	SHOULDER ARTHRO INJECTION	41.27
2002465	SIALOGRAPHY	149.97
2002481	SKULL, COMPLETE	79.53
2002507	SKULL, LESS 4 VIEWS	47.72
2002523	BARIUM, SMALL BOWEL	95.42
2002549	SPINE, CERVICAL, APL	47.72
2002564	SPINE, CERVICAL, COMPLETE	95.42
2002580	SPINE, CERVICAL, PARTIAL	79.53
2002606	SPINE, ENTIRE, PARTIAL	143.15
2002622	SPINE, L-SACRAL, PARTIAL	57.26
2002648	SPINE, L-SACRAL, BENDING	111.34
2002663	SPINE, L-SACRAL, COMPLETE	91.65
2002689	SPINE, T-LUMBAR, APL	47.72
2002705	SPINE, THORACIC, APL	47.72
2002721	STERNOCLAVICULAR JOINT	63.62
2002747	STERNUM	47.72
2002762	RENAL CYST, TRANSLUMBAR	183.30
2002788	T-MANDIBULAR JT, BILATERAL	63.62
2002887	TIBIA & FIBULA, APL	74.99
2002903	TOES	66.66
2002929	GU-URECYSTOGRAPHY, RETRO	79.53
2002945	GU-URETHROCYSTOGRAPHY, VOID	111.34
2002960	BARIUM, UPPER G-I	111.34
2002986	BARIUM, UGI W/ SMALL BOWEL	159.04
2003026	UPPER EXTREMITY, INFANT	66.66
2003042	GU-UROGRAPHY, IVP	122.17
2003067	GU-UROGRAPHY, ANTEGRADE	127.25
2003083	GU-UROGRAPHY, RETROGRADE	79.53
2003109	VENOGRAM, BILATERAL	269.13
2003125	ANG, VENOGRAM, INF V CAVA	254.48
2003166	VENOGRAM, UNILATERAL	127.25
2003208	WRIST, PARTIAL	66.66
2003224	WRIST, COMPLETE	74.99
2003265	ADDITIONAL VIEW	15.90
2003281	SPINE, T-LUMBAR, 4 VIEWS	95.42
2003331	ANG, AOR THO, S&I	481.45
2003360	INJECTION FOR AORTOGRAPHY	62.25
2003364	ANG, AOR THO CATH INJ	327.38
2003398	ANG, AOR T-LUMBAR, S&I	481.45
2003422	ANG, AOR T-LUMBAR INJ	231.09
2003455	ANG, AOR ABD CATH, S&I	481.45
2003489	ANG, AOR ABD CATH INJ	327.38
2003513	ANG, CERV CATH, S&I	240.72
2003547	ANG, CERV INJECTION	385.17
2003570	ANG, CERV, MIN 3VS, S&I	481.45
2003604	ANG, CERV, MIN 3VS INJ	577.73
2003638	ANG, CTD CD, UNI, S&I	481.45
2003661	ANG, CTD CB, UNI CP INJ	385.17
2003695	ANG, CTB CB, UNI CATH INJ	462.19
2003729	ANG, CTD CB, UNI EXT INJ	385.17
2003752	ANG, CTD CB, BIL S&I	722.16
2003786	ANG, CTD CB, BIL DP PRO	577.73
2003810	ANG, CTD CB, BIL CATH INJ	577.73
2003844	ANG, CTD CB, BIL EXT INJ	577.73
2003877	ANG, CTD CV, UNI S&I	240.72
2003901	ANG, CTD CV, UNI DP INJ	385.17
2003935	ANG, CTD CV, UNI CATH INJ	385.17
2003968	ANG, CTD CV, BIL S&I	361.07
2003992	ANG, CTD CV, BIL DP INJ	577.73
2004024	ANG, CTD CV, BIL CATH INJ	577.73
2004057	ANG, VTB S&I	481.45
2004081	ANG, VTB CATH INJ	462.19
2004149	ANG, VTB CV, UNI CATH INJ	462.19
2004172	ANG, VTB CV, BIL S&I	361.07
2004206	ANG, VTB CV, BIL CATH INJ	577.73
2004230	ANG, EXT, UNIL S&I	385.17
2004263	ANG, EXT, UNIL	216.65
2004297	ANG, EXT, UNIL SERI	154.07
2004321	ANG, EXT, BIL S&I	481.45
2004354	ANG, EXT, BIL INJ SERI	327.38
2004388	ANG, RENAL, UNIL, SEL S&I	481.45
2004412	ANG, RENAL, UNIL, SEL INJ	385.17
2004479	ANG, RENAL, BIL, SEL INJ	481.45
2004503	ANG, VISC, SEL S&I	481.45
2004537	ANG, VISC, SEL INJ	385.17
2004560	ANG, RENAL, BIL V&R STD	481.45
2004594	ANG, ADR, UNIL, SEL S&I	481.45
2004628	ANG, ADR, UNIL, SEL INJ	327.38
2004651	ANG, ADR, BIL, SEL S&I	722.16
2004685	ANG, ADR, BIL, SEL INJ	327.38
2004719	ANG, PELVIC, SEL S&I	481.45
2004743	ANG, PELVIC, SEL INJ	385.17
2004776	ANG, PUL, UNIL, SEL S&I	481.45
2004800	ANG, PUL, UNIL, SEL INJ	481.45
2004834	ANG, PUL, BIL, SEL S&I	722.16
2004867	ANG, PUL, BIL, SEL INJ	722.16
2004891	ANG, ADD SERI RUNS	144.43
2005428	POST MORTEM BODY	103.56
2050000	FLUOROSCOPY PER 5 MIN	149.97
2050010	FLUOROSCOPY (C-ARM)	78.85
2050020	GU-PEDIATRIC IVP	99.99
2050030	SHOULDER ARTHRO	74.14
2050040	TOMOGRAPHY (ANATOMICAL)	269.49
2050110	ZYGOMATIC ARCHES	51.40
2050120	ANG-SURGI PORTABLE	71.78
2050130	INTERNAL AUDITORY CANALS	83.32
2050140	PACEMAKER INSERT (PERM)	125.92
2050150	HAND, PARTIAL	74.99
2050170	NEPHROSTOMY INJECTION	169.16
2050184	NEPHROSTOMY PERCUTANEOUS	398.93
2050186	GU-NEPHROSTOGRAM	398.93
2050188	BILIARY STONE EXTRACTION	241.24
2050190	BREAST MASS LOCALIZATION	188.29
2076075	DEXA, BONE DENSITY, AXIAL	334.50
2076086	MAMMARY DUCTOGRAM, SINGLE	225.12
2076088	MAMMARY DUCTOGRAM, MULTIPLE	311.95
2076095	STEREOTACTIC LOCAL'N, BREAST BX	438.45
2096003	MRI-BRAIN, COMPLETE	1,050.00
2096018	UPPER GI, BARIUM, W/ KUB	174.57
2096022	MRI-SPINE, CERVICAL, COMPLETE	1,050.00
2096023	MRI-SPINE, THORACIC, COMPLETE	1,050.00
2098002	CHEST, DECUBITUS, LEFT	61.40
2098003	CHEST, DECUBITUS, RIGHT	61.40
2098004	ABDOMEN, DECUBITUS, BILATERAL	92.10
2098005	CHEST, DECUBITUS, BILATERAL	61.40
2098006	ABDOMEN, DECUBITUS, LEFT	92.10
2098007	ABDOMEN, DECUBITUS, RIGHT	92.10