Department Name Charge Description CPT Mnemonic Charge Amount MRI REVENUE MRI GADOLINIUM CONTRAST PER ML A $ MRI REVENUE ABDOMEN

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1 Department Name Charge Description CPT Mnemonic Charge Amount MRI REVENUE MRI GADOLINIUM CONTRAST PER ML A $ MRI REVENUE ABDOMEN W/CONTRAST $ 2, MRI REVENUE BONE MARROW $ MRI REVENUE MRI BRAIN WITH CONTRAST $ 2, MRI REVENUE CERVICAL SPINE, WITH CONTRAST $ 2, MRI REVENUE CERVICAL SPINE, W/O CONTRAST $ 1, MRI REVENUE CERVICAL SPINE, W/WO CONTRAST $ 2, MRI REVENUE CHEST WITH CONTRAST $ 1, MRI REVENUE BRAIN (IAC) WO/CONTRAST $ 2, MRI REVENUE BRAIN (IAC) W/WO/CONTRAST $ 3, MRI REVENUE Low RT Ext Joint W/O Contrast $ 2, MRI REVENUE Low BIL Ext Joint W/O Contrast BIL $ 2, MRI REVENUE Low LT Ext Joint W/O Contrast LT $ 2, MRI REVENUE LOW EXTREMITY JOINT W/CONTRAST $ 1, MRI REVENUE LUMBAR SPINE WO/CONTRAST $ 1, MRI REVENUE LUMBAR SPINE W/WO CONTRAST $ 2, MRI REVENUE LUMBAR SPINE W/CONTRAST $ 2, MRI REVENUE ORBITFACENECK W/CONTRAST $ 1, MRI REVENUE PELVIC $ MRI REVENUE BRAIN (PIT) WO/CONTRAST $ 2, MRI REVENUE BRAIN (PIT) W/WO CONTRAST $ 3, MRI REVENUE THORACIC SPINE W/CONTRAST $ 2, MRI REVENUE THORACIC SPINE W/O/ CONTRAST $ 1, MRI REVENUE THORACIC SPINE W/WO CONTRAST $ 2, MRI REVENUE Upper RT Ext No JT W/WO Cont $ 2, MRI REVENUE Upper LT Ext No JT W/WO Cont LT $ 2, MRI REVENUE Upper RT Ext Any Joint W/O Con $ 1, MRI REVENUE Upper LT Ext Any Joint W/O Con LT $ 1, MRI REVENUE ANGIOGRAM CHEST W/O CONTRAST C $ 1, MRI REVENUE ABDOMEN W/WO CONTRAST $ 2, MRI REVENUE ABDOMEN W/O CONTRAST $ 1, MRI REVENUE ANGIOGRAM ABDOMEN W/CONTRAST C $ 1, MRI REVENUE ANGIOGRAM HEAD W/CONTRAST $ 1,930.00

2 MRI REVENUE ANGIOGRAM NECK W/CONTRAST $ 2, MRI REVENUE ANGIOGRAM CHEST W/CONTRAST C $ 1, MRI REVENUE ANGIOGRAM ABD W/O CNTRAST C $ 1, MRI REVENUE BRACHIAL PLEXUS $ 1, MRI REVENUE ANGIOGRAM ABD W/WO CONTRAST C $ 2, MRI REVENUE ANGIOGRAM CHEST W/WO CONTRAST C $ 2, MRI REVENUE BREAST BILATERAL $ 2, MRI REVENUE BREAST UNILATERAL $ 1, MRI REVENUE ANGIOGRAM HEAD W/O CONTRAST $ 1, MRI REVENUE ANGIOGRAM HEAD W/WO CONTRAST $ 2, MRI REVENUE CHEST W/O CONTRAST $ 1, MRI REVENUE CHEST W/WO CONTRAST $ 2, MRI REVENUE Angiogram RT Lower Extremity C $ MRI REVENUE Angiogram BIL Lower Extremity C BIL $ MRI REVENUE Angiogram LT Lower Extremity C LT $ MRI REVENUE ANGIOGRAM NECK W/O CONTRAST $ 1, MRI REVENUE BRAIN W/O CONTRAST $ 2, MRI REVENUE BRAIN W/WO CONTRAST $ 3, MRI REVENUE BRAIN W/WO CONTRAST $ 3, MRI REVENUE ANGIOGRAM NECK W/WO CONTRAST $ 2, MRI REVENUE ANGIOGRAM PELVIS W/CONTRAST C $ 1, MRI REVENUE ANGIOGRAM PELVIS W/O CONTRAST C $ 1, MRI REVENUE ANGIOGRAM PELVIS W/WO CONTRAST C $ 2, MRI REVENUE ANGIOGRAM UPPER EXTREMITY $ 2, MRI REVENUE Lower RT Ext Joint W/WO Contr $ 2, MRI REVENUE Lower BIL Ext Joint W/WO Contr BIL $ 2, MRI REVENUE Lower LT Ext Joint W/WO Contr LT $ 2, MRI REVENUE Lwr RT Ext No Joint W/WO Cont $ 2, MRI REVENUE Lwr BIL Ext No Joint W/WO Cont BIL $ 2, MRI REVENUE Lwr LT Ext No Joint W/WO Cont LT $ 2, MRI REVENUE ORBITFACENECK W/O CONTRAST $ 1, MRI REVENUE LYMPH ABDOMEN C $ 1, MRI REVENUE LYMPH CHEST $ 1, MRI REVENUE PELVIS W/CONTRAST $ 2,037.00

3 MRI REVENUE ORBITFACENECK W/WO CONTRAST $ 2, MRI REVENUE Lower RT Ext Joint W/Contrast $ 2, MRI REVENUE Lower BIL Ext Joint W/Contrast BIL $ 2, MRI REVENUE Lower LT Ext Joint W/Contrast LT $ 2, MRI REVENUE Lwr RT Ext No Joint W/O Cont $ 1, MRI REVENUE Lwr LT Ext No Joint W/O Cont LT $ 1, MRI REVENUE PELVIS W/O CONTRAST $ 1, MRI REVENUE PELVIS W/WO CONTRAST $ 2, MRI REVENUE Upper RT Ext Joint W/Contrast $ 1, MRI REVENUE Upper LT Ext Joint W/Contrast LT $ 1, MRI REVENUE Upper RT Ext Joint W/WO Contr $ 2, MRI REVENUE Upper LT Ext Joint W/WO Contr LT $ 2, MRI REVENUE Upper RT Ext No Joint W/Contr $ 1, MRI REVENUE Upper LT Ext No Joint W/Contr LT $ 1, MRI REVENUE Upper RT Ext No Joint W/O Cont $ 1, MRI REVENUE Upper LT Ext No Joint W/O Cont LT $ 1, MRI REVENUE Lower BIL Ext Joint W/Cont BIL $ 2, MRI REVENUE Lower LT Ext Joint W/Cont LT $ 2, MRI REVENUE Lower RT Ext Joint W/Cont RT $ 2, MRI REVENUE ANGIOGRAM HEAD W/O CONTRAST $ 1, MRI REVENUE MOD SED SAME PHYS/QHP 5/>YRS $ MRI REVENUE MOD SEDAT PHYS/QHP & LT;5 YRS $ MRI REVENUE CONSC SED EACH ADD'L 15 MIN $ MRI REVENUE FACE/NECK/ORBIT WITH CONTRAST $ 1, MRI REVENUE BONE MARROW STUDY $ 1, MRI REVENUE CAD FOR BREAST MRI 0159T $ MRI REVENUE L EXTREMITY WO CONTRAST LTD $ 2, MRI REVENUE Unilat RT Breast W/Contrast C $ 1, MRI REVENUE Unilat LT Breast W/Contrast C LT $ 1, MRI REVENUE Unilat RT Breast W/O Contrast C $ 1, MRI REVENUE Unilat LT Breast W/O Contrast C LT $ 1, MRI REVENUE Unilat RT Breast W/WO Contrast C $ 1, MRI REVENUE Unilat LT Breast W/WO Contrast C LT $ 1, MRI REVENUE BILATERAL BREAST W/CONTRAST C $ 1,674.00

4 MRI REVENUE BILAT BREAST W/O CONTRAST C $ 1, MRI REVENUE BILAT BREAST W/WO CONTRAST C $ 2, MRI REVENUE TEMPOROMANDIBULAR JOINT $ 1, MRI REVENUE ANGIO NECK W/O CONTRAST $ 1, MRI REVENUE MRI CHEST W/O & W/DYE $ 2, ECHOCARDIOGRAM ECHO, ANOMALIES $ 1, ECHOCARDIOGRAM ECHO COMPLETE $ 1, ECHOCARDIOGRAM ECHOCARDIOGRAPHY,LMT $ ECHOCARDIOGRAM ECHO, FOLLOWUP $ ECHOCARDIOGRAM ECHO, TRANESOPHOGEAL $ 1, ECHOCARDIOGRAM ECHO,TRANSESOPHOGEAL,ANOMALIES $ ECHOCARDIOGRAM ECHOCARDIOGRAPHY,DOPPLER,COMP $ ECHOCARDIOGRAM ECHOCARDIOGRAPHY,DOPPLER,WAVE $ ECHOCARDIOGRAM STRESS ECHO $ ECHOCARDIOGRAM ECHO COMPLETE WITH CONTRAST C $ 1, ECHOCARDIOGRAM ECHOCARD CONTRAST PER ML Q $ ECHOCARDIOGRAM DEFINITY ECHO CONTRAST A $ EKG PRO FEE REVENUE EKG Pro Fee Mathis $ ELECTROCARDIOLOGY REVENUE ELECTROCARDIOGRAM $ CT SCAN REVENUE THORAX LOW DOSE CT G G0297 $ 1, CT SCAN REVENUE INTRAPERIT CATH PLACEMENT $ 4, CT SCAN REVENUE Angio RT Upper Ext W/WO Cont $ 1, CT SCAN REVENUE Angio LT Upper Ext W/WO Cont LT $ 1, CT SCAN REVENUE CT CONTRAST PER ML Q $ CT SCAN REVENUE CT RT Upper Ext W/WO Contrast $ 1, CT SCAN REVENUE CT LT Upper Ext W/WO Contrast LT $ 1, CT SCAN REVENUE CT HEAD WITH CONTRAST $ 1, CT SCAN REVENUE CT HEAD WITHOUT CONTRAST $ 1, CT SCAN REVENUE CT HEAD WITH AND W/O CONTRAST $ 1, CT SCAN REVENUE CT SINUS W/WO CONTRAST $ 1, CT SCAN REVENUE CT I.A.C. WITH CONTRAST $ 1, CT SCAN REVENUE CT RT I.A.C. Without Contrast $ CT SCAN REVENUE CT BIL I.A.C. Without Contrast BIL $ CT SCAN REVENUE CT LT I.A.C. Without Contrast LT $

5 CT SCAN REVENUE CT I.A.C. WITH W/O CONTRAST $ 1, CT SCAN REVENUE CT RT Lwr Ext W/WO Contrast $ 1, CT SCAN REVENUE CT LT Lwr Ext W/WO Contrast LT $ 1, CT SCAN REVENUE CT LUMBAR SPINE W/CONTRAST $ 1, CT SCAN REVENUE CT FACIAL BONES W/CONTRAST $ 1, CT SCAN REVENUE CT FACIAL BONES W/O CONTRAST $ 1, CT SCAN REVENUE CT RT Orbits W/O Contrast $ CT SCAN REVENUE CT BIL Orbits W/O Contrast BIL $ CT SCAN REVENUE CT LT Orbits W/O Contrast LT $ CT SCAN REVENUE CT ORBITS WITH CONTRAST $ 1, CT SCAN REVENUE CT SFT TISSUE NECK W/O $ 1, CT SCAN REVENUE CONTRAST INJ VIA DRAIN TUBE $ CT SCAN REVENUE CT SFT TISSUE NECK WITH $ 1, CT SCAN REVENUE CT SFT TISSUE NECK WITHW/O $ 1, CT SCAN REVENUE CT RT Upper Ext W/Contrast $ 1, CT SCAN REVENUE CT LT Upper Ext W/Contrast LT $ 1, CT SCAN REVENUE CT Angio RT Ext W/WO Cont $ 3, CT SCAN REVENUE CT Angio BIL Ext W/WO Cont BIL $ 3, CT SCAN REVENUE CT Angio LT Ext W/WO Cont LT $ 3, CT SCAN REVENUE CT ANGIO AORTIC/ILIOFEM $ 3, CT SCAN REVENUE ANGIOGRAPHY ABD AND PELVIS $ 3, CT SCAN REVENUE CT THORAX W/O CONTRAST $ 1, CT SCAN REVENUE CT THORAX WITH CONTRAST $ 1, CT SCAN REVENUE CT THORAX WITH/W/O CONTRAST $ 2, CT SCAN REVENUE CT ANGIO ABD W/WO CONTRAST $ 2, CT SCAN REVENUE CT ABDOMEN W/O CONTRAST $ 1, CT SCAN REVENUE CT ABDOMEN WITH CONTRAST $ 1, CT SCAN REVENUE CT PE STUDY $ 2, CT SCAN REVENUE CT ABDOMEN W/WO CONTRAST $ 2, CT SCAN REVENUE CT MASTOIDS $ CT SCAN REVENUE CT CERVICAL SPINE $ 1, CT SCAN REVENUE CT RT Ext CT Upper Single Area $ 1, CT SCAN REVENUE CT LT Ext CT Upper Single Area LT $ 1, CT SCAN REVENUE CT IUP $ 2,093.00

6 CT SCAN REVENUE CT COPY OUTSIDE FILMS $ CT SCAN REVENUE CT PULMOGRAM $ 1, CT SCAN REVENUE BONE DENSITY CT $ CT SCAN REVENUE CT CSPINE W/CONTRAST $ 1, CT SCAN REVENUE CT CSPINE W/WO CONTRAST $ 1, CT SCAN REVENUE CT TSPINE W/CONTRAST $ 1, CT SCAN REVENUE CT TSPINE W/WO CONTRAST $ 1, CT SCAN REVENUE CT LSPINE W/O CONTRAST $ 1, CT SCAN REVENUE CT LSPINE W/WO CONTRAST $ 2, CT SCAN REVENUE CT LUMBAR SP $ 1, CT SCAN REVENUE CT PELVIS WITHOUT CONTRAST $ 1, CT SCAN REVENUE CT PELVIS WITH CONTRAST $ 1, CT SCAN REVENUE CT THORACIC SPINE $ 1, CT SCAN REVENUE CT RT Lower Extremity W/O Cont $ 1, CT SCAN REVENUE CT LT Lower Extremity W/O Cont LT $ 1, CT SCAN REVENUE CT SINUS SCREENING $ 1, CT SCAN REVENUE CT EXTRA SLICESPER SLICE $ CT SCAN REVENUE CT Biopsy With Guidance $ CT SCAN REVENUE CT STAT EMERGENCY REQUEST $ CT SCAN REVENUE CT NEEDLE 19 GA BUTTERFLY $ CT SCAN REVENUE CT BARIUM $ CT SCAN REVENUE CT SPINAL NEEDLE 20 GA 3 1/2" $ CT SCAN REVENUE CT 60 CC SYRINGE $ CT SCAN REVENUE CT ORBITS W/WO CONTRAST $ 1, CT SCAN REVENUE CT SINUS INTERMEDIATE $ CT SCAN REVENUE CT SINUS FOR RECONSTRUCTION $ 1, CT SCAN REVENUE CT OMNIPAQUE 300 MG/50 ML $ CT SCAN REVENUE CT OPTIRAY 320/50 ML $ CT SCAN REVENUE CT OMNIPAQUE 350 MG/50 ML $ CT SCAN REVENUE CT OPTIRAY 350/50 ML $ CT SCAN REVENUE CT NEEDLEANGIO $ CT SCAN REVENUE CT OMNIPAQUE 300 MG/150 ML $ CT SCAN REVENUE CT OPTIRAY 240/100 ML $ CT SCAN REVENUE ER CALL STAFF ONLY $

7 CT SCAN REVENUE CT RETROPERITONEAL DRAINAGE $ CT SCAN REVENUE CT RETROPER NEEDLE PL/DRAIN $ 1, CT SCAN REVENUE FNA W/IMAGE $ 1, CT SCAN REVENUE CT DRN SOFT TISSUE TECH $ CT SCAN REVENUE ABDOMINAL NEEDLE BIOPSY $ 1, CT SCAN REVENUE Abd Needle Biopsy CT Guidance $ CT SCAN REVENUE EPIDURAL RAD S AND I $ CT SCAN REVENUE EPIDURAL INJ LUMBAR/SACRAL $ 1, CT SCAN REVENUE RENAL BIOPSY $ 1, CT SCAN REVENUE GUIDANCE FOR BIOPSY $ CT SCAN REVENUE BIOPSY NODE SUPERFICIAL GUIDE $ CT SCAN REVENUE BIOPSY NODE SUPERFICIAL $ 1, CT SCAN REVENUE BIOPSY PELVIS SUPERFIC GUIDE $ CT SCAN REVENUE BIOPSY PELVIS SUPERFICIAL $ 1, CT SCAN REVENUE BIOPSY SFT TISS NCK/THORAX $ 1, CT SCAN REVENUE BIOP SFT TISS NCK/THOR GUIDE $ CT SCAN REVENUE MUSCLE PERCUTANEOUS BIOPSY (F) $ 1, CT SCAN REVENUE INJECT KNEE ARTHROGRAM $ CT SCAN REVENUE INJECT ANKLE ARTHROGRAM $ CT SCAN REVENUE BX RT Lung or Mediastinum $ 1, CT SCAN REVENUE BX Bilateral Lung/Mediastinum BIL $ 1, CT SCAN REVENUE BX LT Lung/Mediastinum LT $ 1, CT SCAN REVENUE BIOPSY BONE DEEP $ 2, CT SCAN REVENUE CT GUIDANCE BIOPSY $ CT SCAN REVENUE BIOPSY PELVIS DEEP $ CT SCAN REVENUE BIOPSY BONE SUPERFICIAL $ CT SCAN REVENUE CT GUIDANCE BIOPSY $ CT SCAN REVENUE DRAINAGE OF PERIT ABSCESS $ CT SCAN REVENUE DRAINAGE OF SUBDIAP ABSCESS $ CT SCAN REVENUE DRAIN OF RETROPERIT ABSCESS $ CT SCAN REVENUE BIOPSY OF LIVER $ 1, CT SCAN REVENUE CT DRAIN VISCERA & MEDIASTINUM $ 2, CT SCAN REVENUE CT DRN RETRO OR PERITONEAL TEC $ 2, CT SCAN REVENUE BX of Kidney RT $ 1,512.00

8 CT SCAN REVENUE BX of Kidney LT LT $ 1, CT SCAN REVENUE CT ANGIO PELVIS $ 2, CT SCAN REVENUE CT PELVIS W AND W/O CONTRAST $ 1, CT SCAN REVENUE Ext Lower RT W/Contrast $ 1, CT SCAN REVENUE Ext Lower LT W/Contrast LT $ 1, CT SCAN REVENUE CT ANGIO HEAD $ 2, CT SCAN REVENUE CT FISTULAGRAM $ CT SCAN REVENUE CT FISTULAGRAM INJECTION $ CT SCAN REVENUE CT ANGIO NECK W/WO CONTRAST $ 1, CT SCAN REVENUE ABD AND PELVIS W/O CONTRAST $ 2, CT SCAN REVENUE ABD AND PELVIS W/ CONTRAST $ 3, CT SCAN REVENUE ABD AND PELVIS W/WO CONTRAST $ 4, CT SCAN REVENUE ANGIOGRAPHY PELVIS $ 1, ULTRASOUND REVENUE PARACENTESIS $ ULTRASOUND REVENUE ABDOMEN $ ULTRASOUND REVENUE AMNIOCENTESIS $ ULTRASOUND REVENUE US Guide RT $ ULTRASOUND REVENUE US Guide LT LT $ ULTRASOUND REVENUE BIOPHYSICAL PROFILE $ ULTRASOUND REVENUE CAROTID DOPPLER $ ULTRASOUND REVENUE CHEST LOCALIZATION $ ULTRASOUND REVENUE OUTSIDE FILM COPIES $ ULTRASOUND REVENUE CYST ASPIRATION $ ULTRASOUND REVENUE ExtremityNon Vascular RT $ ULTRASOUND REVENUE ExtremityNon Vascular LT LT $ ULTRASOUND REVENUE LIMITED ABDOMEN (SINGLE ORGAN) $ ULTRASOUND REVENUE OB (AFI/POSITION) $ ULTRASOUND REVENUE OB REEVALUATION SAME BEST $ ULTRASOUND REVENUE OB COMPLETE >14 WEEK BEST AGE $ ULTRASOUND REVENUE OB LIMITED <14 WEEKS BEST AGE $ ULTRASOUND REVENUE OB US >14 WEEKS $ ULTRASOUND REVENUE OBADD'L GEST >14 WEEKS $ ULTRASOUND REVENUE OB TWINS $ ULTRASOUND REVENUE OB US <14 WEEKS $

9 ULTRASOUND REVENUE OB ADD'L GESTATION <14 WEEKS $ ULTRASOUND REVENUE OB TRANSVAGINAL $ ULTRASOUND REVENUE PERIPH ARTERIAL LOW LMTD $ ULTRASOUND REVENUE Low RT Ext Uni or Ltd Study US $ ULTRASOUND REVENUE Low LT Ext Uni or Ltd Study US LT $ ULTRASOUND REVENUE PERIPH ARTERIAL EXT MULTI $ ULTRASOUND REVENUE DUP SCAN LOWER EXT US $ 1, ULTRASOUND REVENUE PARACENTESIS $ ULTRASOUND REVENUE PERI ARTERIAL UP COM US $ ULTRASOUND REVENUE PELVIC $ ULTRASOUND REVENUE PERIPH VENOUS EXT.LTD $ ULTRASOUND REVENUE PERIPH VENOUS EXT BILAT.COMP $ ULTRASOUND REVENUE RENAL $ ULTRASOUND REVENUE TESTICAL $ ULTRASOUND REVENUE THORACENTESIS $ ULTRASOUND REVENUE THYROID/NECK $ ULTRASOUND REVENUE THYROID $ ULTRASOUND REVENUE TRANSVAGINAL $ ULTRASOUND REVENUE PELVIC LIMITED U/S $ ULTRASOUND REVENUE VASCULAR COMP US $ ULTRASOUND REVENUE VASCULAR LTD US $ ULTRASOUND REVENUE Carotid Artery Doppl RT Unilat $ ULTRASOUND REVENUE Carotid Artery Doppl LT Unilat LT $ ULTRASOUND REVENUE Arterial RT Upper Extr Unilat $ ULTRASOUND REVENUE Arterial LT Upper Extr Unilat LT $ ULTRASOUND REVENUE STERILE BIOPSY TRAY A $ ULTRASOUND REVENUE US PVE UNILATERAL RIGHT $ ULTRASOUND REVENUE US PVE UNILATERAL LEFT $ ULTRASOUND REVENUE Biopsy Guided (FNA) US RT $ ULTRASOUND REVENUE Biopsy Guided (FNA) US LT LT $ ULTRASOUND REVENUE US DRN SOFT TISSUE TECH $ ULTRASOUND REVENUE US Wire Loc 1st Les w/guide $ 1, ULTRASOUND REVENUE US NEEDLE PLACEMENT $ ULTRASOUND REVENUE US BIOPSY SUPERFICIAL NODE $

10 ULTRASOUND REVENUE US BIOPSY SUPERFICIAL NODE $ 1, ULTRASOUND REVENUE BX W VACUUM DEVICE INITIALTECH $ 1, ULTRASOUND REVENUE BX W VACUUM EACH ADD'L TECH $ 1, ULTRASOUND REVENUE ABDOMEN LIMITED ULTRASOUND $ ULTRASOUND REVENUE RETROPERITONEAL LIMITED U/S $ ULTRASOUND REVENUE US ABDL AORTA SCREEN AAA $ ULTRASOUND REVENUE Wire Localization Initial RT $ ULTRASOUND REVENUE Wire Localization Initial LT LT $ ULTRASOUND REVENUE Wire Localization Addl RT $ ULTRASOUND REVENUE Wire Localization Addl BIL BIL $ ULTRASOUND REVENUE Wire Localization Addl LT LT $ ULTRASOUND REVENUE US Wire Loc Initial RT $ ULTRASOUND REVENUE US Wire Loc Initial LT LT $ ULTRASOUND REVENUE US WIRE LOCAL ADDN LESION $ ULTRASOUND REVENUE BX.OF SUPERFICIAL MUSCLE TECH $ 2, ULTRASOUND REVENUE INJ OR DRAINAGE OF JOINT $ ULTRASOUND REVENUE BX Soft Tiss RT Pelvis/Hip $ 1, ULTRASOUND REVENUE BX Soft Tiss LT Pelvis/Hip LT $ 1, ULTRASOUND REVENUE PERCUT BX LUNG/MEDIASTINUM $ 2, ULTRASOUND REVENUE THORACENTESIS PROCEDURE $ ULTRASOUND REVENUE BIOPSY OF LYMPH NODE TECH $ 1, ULTRASOUND REVENUE BIOPSY OF LIVER $ 1, ULTRASOUND REVENUE US DRN VISCERA/MEDIASTINUM $ 2, ULTRASOUND REVENUE US DRN RETRO OR PERITONEAL TEC $ 2, ULTRASOUND REVENUE US BREAST UNILATERAL COMPLETE $ ULTRASOUND REVENUE US RT Breast Uni Limited $ ULTRASOUND REVENUE US LT Breast Uni Limited LT $ ULTRASOUND REVENUE RENAL TRANSPLANT $ ULTRASOUND REVENUE OB US NUCHAL TRANSLUCENCY TECH $ ULTRASOUND REVENUE NT ADDITIONAL FETUS US TECH $ ULTRASOUND REVENUE CORD DOPPLER (FETAL) $ ULTRASOUND REVENUE ECHO GUIDE FOR BIOPSY $ ULTRASOUND REVENUE US GUIDE INTRAOP $ ULTRASOUND REVENUE VENOUS INSUFF BILATERAL $

11 ULTRASOUND REVENUE VENOUS INSUFF LIMITED $ ULTRASOUND REVENUE VISCERAL DOPPLER LTD $ NUCLEAR MEDICINE REVENUE CHOLESCINTROGRAM $ 1, NUCLEAR MEDICINE REVENUE MYOCARD/INFARCT $ NUCLEAR MEDICINE REVENUE LUNG PERFUSION AND AEROSOL $ NUCLEAR MEDICINE REVENUE LUNG VENTILATION W AEROSOL $ NUCLEAR MEDICINE REVENUE NM/WALL MOTION ANALYSIS $ NUCLEAR MEDICINE REVENUE NM/EJECTION FRACTION ANALYSIS $ NUCLEAR MEDICINE REVENUE THYROID UPTAKE AND SCAN $ NUCLEAR MEDICINE REVENUE THYROID SCAN ONLY $ NUCLEAR MEDICINE REVENUE LYMPH NODE IMAGING $ NUCLEAR MEDICINE REVENUE LYMPHANG, SUPV & INTERP $ NUCLEAR MEDICINE REVENUE ISOTOPE MYOVIEW A A9502 $ NUCLEAR MEDICINE REVENUE HEMANGIOMA IMAGING $ NUCLEAR MEDICINE REVENUE BONE SCAN LIMITED $ NUCLEAR MEDICINE REVENUE BONE SCAN MULTIPLE AREA $ NUCLEAR MEDICINE REVENUE BONE SPECT $ 1, NUCLEAR MEDICINE REVENUE BONE SCAN WHOLE BODY $ 1, NUCLEAR MEDICINE REVENUE BONE 3PHASE $ 1, NUCLEAR MEDICINE REVENUE BRAIN PERFUSION SPECT $ 2, NUCLEAR MEDICINE REVENUE BRAIN SCAN FLOW ONLY $ NUCLEAR MEDICINE REVENUE BRAIN SCAN WITH FLOW $ NUCLEAR MEDICINE REVENUE OUTSIDE FILM COPIES $ NUCLEAR MEDICINE REVENUE CYSTOGRAM $ NUCLEAR MEDICINE REVENUE DACROSCINTOGRAM $ NUCLEAR MEDICINE REVENUE FIRST PASS CARDIAC FLOW $ NUCLEAR MEDICINE REVENUE GASTRIC EMPTYING IMAGING $ 1, NUCLEAR MEDICINE REVENUE GALLIUM STUDY $ 1, NUCLEAR MEDICINE REVENUE GASTROESOPHAGEAL REFLUX $ NUCLEAR MEDICINE REVENUE G.I. BLEED $ NUCLEAR MEDICINE REVENUE HEPATOBILIARY IMAGING $ NUCLEAR MEDICINE REVENUE HEPATOBILIARY IMAGING W/EF $ 1, NUCLEAR MEDICINE REVENUE LUNG SCAN PERF $ NUCLEAR MEDICINE REVENUE LIVER SPLEEN SCAN $

12 NUCLEAR MEDICINE REVENUE LIVER SPLEEN SPECT $ NUCLEAR MEDICINE REVENUE MECKLES DIVERTICULUM $ NUCLEAR MEDICINE REVENUE CARDIAC BLOOD POOL IMAGING $ 1, NUCLEAR MEDICINE REVENUE MYOCARDIAL PERF.SPECTSINGLE $ 1, NUCLEAR MEDICINE REVENUE MYOCARDIAL PERF/SPECTMULTIPLE $ 2, NUCLEAR MEDICINE REVENUE PARATHYROID SESTAMIBI IMAGING $ NUCLEAR MEDICINE REVENUE SALIVARY GLAND IMAGING $ NUCLEAR MEDICINE REVENUE PERSANTINE MYOCARDIO PERFUSION $ 2, NUCLEAR MEDICINE REVENUE RENAL IMAGING $ NUCLEAR MEDICINE REVENUE RENAL WITH LASIX $ NUCLEAR MEDICINE REVENUE RENAL WITH CAPTOPRIL $ NUCLEAR MEDICINE REVENUE RENAL WITH DMSA $ NUCLEAR MEDICINE REVENUE RENAL IMAGING WITH SPECT $ NUCLEAR MEDICINE REVENUE RENAL MULTIPLE STUDIES $ NUCLEAR MEDICINE REVENUE TESTICULAR WITH FLOW $ NUCLEAR MEDICINE REVENUE THALLIUM $ 2, NUCLEAR MEDICINE REVENUE TUMOR LOCALIZATION WITH SPECT $ 1, NUCLEAR MEDICINE REVENUE TUMOR LOCALIZATION SINGLE AREA $ 1, NUCLEAR MEDICINE REVENUE TUMOR LOCALIZATION MULT. AREA $ 1, NUCLEAR MEDICINE REVENUE TUMOR LOCALIZATION WHOLE BODY $ 1, NUCLEAR MEDICINE REVENUE LOC OF INFLAMMATION LIMITED $ 1, NUCLEAR MEDICINE REVENUE LOC OF INFLAMMATION SPECT $ NUCLEAR MEDICINE REVENUE LOC OF INFLAMMATION WHOLE BODY $ 1, NUCLEAR MEDICINE REVENUE EXERCISE TREADMILL $ NUCLEAR MEDICINE REVENUE MYOCARD PERFUSION STRESS ONLY $ 1, NUCLEAR MEDICINE REVENUE NAF18 ISOTOPE A $ NUCLEAR MEDICINE REVENUE LEXISCAN (REGADENOSON)/0.1MG J $ NUCLEAR MEDICINE REVENUE TUMOR LOC WHL BODY MULT DAYS $ 1, NUCLEAR MEDICINE REVENUE LYMPH NODE IMAGING $ NUCLEAR MEDICINE REVENUE PET/CT WHOLE BODY $ 4, NUCLEAR MEDICINE REVENUE PET/CT TRUNK $ 3, NUCLEAR MEDICINE REVENUE PET/CT LIMITED $ 2, NUCLEAR MEDICINE REVENUE LUNG VENTILATION $ NUCLEAR MEDICINE REVENUE LUNG VENTIL AND PERFUSION $

13 NUCLEAR MEDICINE REVENUE TC9950 MEDRONATE MDP A $ NUCLEAR MEDICINE REVENUE AGG ALBUMINMAA A $ NUCLEAR MEDICINE REVENUE MEDRONATEMDP per CC A $ NUCLEAR MEDICINE REVENUE SULPHUR COLLOID A $ NUCLEAR MEDICINE REVENUE TC9970 DISOFENIN A $ NUCLEAR MEDICINE REVENUE TC9943 DTPA AEROSOL A $ NUCLEAR MEDICINE REVENUE TC9980 PYROPHOSPHATE PYP A $ NUCLEAR MEDICINE REVENUE I12311 I123 SODIUM IODIDE 100 A $ NUCLEAR MEDICINE REVENUE I1320 I123 SODIUM IODIDE 200 A $ NUCLEAR MEDICINE REVENUE TC99LB SESTAMIBI TC99M A $ NUCLEAR MEDICINE REVENUE TC 9900 MAG 3 TC99M A $ NUCLEAR MEDICINE REVENUE TC 9910 CHOLETEC A $ NUCLEAR MEDICINE REVENUE PERSANTINE mg J $ NUCLEAR MEDICINE REVENUE PERSANTINE mg J $ NUCLEAR MEDICINE REVENUE PERSANTINE mg J $ NUCLEAR MEDICINE REVENUE TC2321I123 SODIUM IODIDE 300 A $ NUCLEAR MEDICINE REVENUE ISOTOPETC040109,PERTECHNETAT A $ 3.00 NUCLEAR MEDICINE REVENUE NM/ISOTOPE TC DTPA RENAL A $ NUCLEAR MEDICINE REVENUE THALLIUM ISOTOPE A $ NUCLEAR MEDICINE REVENUE KINEVAC ADMINISTRATION J $ NUCLEAR MEDICINE REVENUE FDG ISOTOPE A $ NUCLEAR MEDICINE REVENUE PERSANTINE PER 10MG J $ NUCLEAR MEDICINE REVENUE LYMPATHIC SYS INJECTION ONLY $ NUCLEAR MEDICINE REVENUE THYROID SCAN ONLY $ NUCLEAR MEDICINE REVENUE THYROID UPTAKE AND SCAN $ NUCLEAR MEDICINE REVENUE PARATHYROID SCAN WITH SPECT $ 1, NUCLEAR MEDICINE REVENUE LYMPHATIC SYSTEM IMAGING $ 1, NUCLEAR MEDICINE REVENUE LUNG PERFUSION DIFFERENTIAL $ NUCLEAR MEDICINE REVENUE LUNG QUANTIFICATION AND V/Q $ 1, NUCLEAR MEDICINE REVENUE ALLIANCERAD READ FEE ALREAD $ NUCLEAR MEDICINE REVENUE ALLIANCE PER PT FEE ALLPT $ NUCLEAR MEDICINE REVENUE ALLIANCE DAILY SITE FEE ALLSITE $ RADIOLOGY REVENUE Arthrogram Knee RT $ RADIOLOGY REVENUE Arthrogram Knee LT LT $

14 RADIOLOGY REVENUE Arthrogram Knee Injection RT $ RADIOLOGY REVENUE Arthrogram Knee Injection LT LT $ RADIOLOGY REVENUE ARTHROGRAM KNEE $ RADIOLOGY REVENUE Arthrogram Ankle RT $ RADIOLOGY REVENUE Arthrogram Ankle LT LT $ RADIOLOGY REVENUE Arthrogram Ankle Injection RT $ RADIOLOGY REVENUE Arthrogram Ankle Injection LT LT $ RADIOLOGY REVENUE TIB/FIB 2 VIEWS LEFT $ RADIOLOGY REVENUE TIB/FIB 2 VIEWS RIGHT $ RADIOLOGY REVENUE ANKLE LIMITED2 VIEWS $ RADIOLOGY REVENUE ANKLE 2 VIEWS RIGHT $ RADIOLOGY REVENUE ANKLE 2 VIEWS LEFT $ RADIOLOGY REVENUE ANKLE 3 VIEWS RIGHT $ RADIOLOGY REVENUE ANKLE 3 VIEWS LEFT $ RADIOLOGY REVENUE FOOT 2 VIEWS LEFT $ RADIOLOGY REVENUE FOOT 2 VIEWS RIGHT $ RADIOLOGY REVENUE FOOT 3 VIEWS LEFT $ RADIOLOGY REVENUE FOOT 3 VIEWS RIGHT $ RADIOLOGY REVENUE OS CALCIS 2 VIEWS LEFT $ RADIOLOGY REVENUE OS CALCIS 2 VIEWS RIGHT $ RADIOLOGY REVENUE TOES MIN 2 VIEWS LEFT $ RADIOLOGY REVENUE TOES MIN 2 VIEWS RIGHT $ RADIOLOGY REVENUE ABDOMEN (KUB) 1 VIEW $ RADIOLOGY REVENUE ABDOMEN2 VIEWS $ RADIOLOGY REVENUE ABDOMEN3 VIEWS $ RADIOLOGY REVENUE XRay Exam Series Abdomen $ RADIOLOGY REVENUE ABDOMENACUTE SERIES $ RADIOLOGY REVENUE ESOPHAGUS $ RADIOLOGY REVENUE UPPER GI $ RADIOLOGY REVENUE UGI WITH BAR SWALLOW $ RADIOLOGY REVENUE UGI LIMITED STUDY $ RADIOLOGY REVENUE UGI WITH SBFT $ RADIOLOGY REVENUE SMALL BOWEL SERIES $ RADIOLOGY REVENUE BARIUM ENEMA $

15 RADIOLOGY REVENUE B.E. WITH AIR CONT $ 1, RADIOLOGY REVENUE CHOLECYSTO ORAL $ RADIOLOGY REVENUE CHOLANGIO OPERATIVE $ RADIOLOGY REVENUE MANIP N/G TUBE $ RADIOLOGY REVENUE GI TUBE PLACEMENT $ RADIOLOGY REVENUE IVP ROUTINE $ RADIOLOGY REVENUE IVP WITH TOMOGRAMS $ RADIOLOGY REVENUE NEPHROTOMOGRAPHY $ RADIOLOGY REVENUE RETROGRADE PYELOGRAM $ RADIOLOGY REVENUE NEPHROSTOGRAM $ RADIOLOGY REVENUE NEPHROSTOMY SET $ RADIOLOGY REVENUE NEPHROSTOMY REPLACEMENT SET $ RADIOLOGY REVENUE CYSTOGRAM $ RADIOLOGY REVENUE INTRO OF LONG GI TUBE $ RADIOLOGY REVENUE URETHROCYSTOGRAPHY $ RADIOLOGY REVENUE VCU $ RADIOLOGY REVENUE NEPHROSTOMY PYELOGRAM $ RADIOLOGY REVENUE NEPHROSTOMY REMOVAL FLUORO $ 1, RADIOLOGY REVENUE NEPHROSTOMY TUBE CHANGE $ RADIOLOGY REVENUE HYSTEROSALPINGOGRAM $ RADIOLOGY REVENUE FIX G/COLON TUBE W/DEVICE $ 1, RADIOLOGY REVENUE INJECT ILEAL $ RADIOLOGY REVENUE OPERATIVE ANGIOGRAM $ 5, RADIOLOGY REVENUE EXTUNILAT VENOGRAM $ 1, RADIOLOGY REVENUE Fluoro Ind/Procedure up to 1hr $ RADIOLOGY REVENUE EXT RM TIME EA/30 MIN $ RADIOLOGY REVENUE CARM UP TO FIRST HOUR $ RADIOLOGY REVENUE Fluoro Guidance/Needle Placed $ RADIOLOGY REVENUE BONE AGE STUDIES $ RADIOLOGY REVENUE BONE LGTHSCANOGRAM $ RADIOLOGY REVENUE BONE SURVEY/METS $ RADIOLOGY REVENUE BONE SURVEY/INF $ RADIOLOGY REVENUE SINUS TRACT INJ $ RADIOLOGY REVENUE Orbits 4V RT $

16 RADIOLOGY REVENUE Orbits 4V LT LT $ RADIOLOGY REVENUE TOMOGRAPHY IND PROC $ RADIOLOGY REVENUE TOMOGRAPHY TO COMP $ RADIOLOGY REVENUE DUPLICATION EACH $ RADIOLOGY REVENUE LUMBAR PUNCTURE $ 1, RADIOLOGY REVENUE LUMBAR PUNCTURE THERAPEUTIC $ RADIOLOGY REVENUE DENTAL PARTIAL $ RADIOLOGY REVENUE CARM EACH EXTRA HOUR $ RADIOLOGY REVENUE CHEST XRAY/DECUB $ RADIOLOGY REVENUE RIBS,UNILATERAL2 W/CXR $ RADIOLOGY REVENUE RIBS UNIL W/O PA CXR 2 VIEWS $ RADIOLOGY REVENUE RIBS VILAT W/OF PA CXR $ RADIOLOGY REVENUE T&L SPINE 1 VIEW $ RADIOLOGY REVENUE T&L SPINE 23 VIEWS $ RADIOLOGY REVENUE T&L SPINE 45 VIEWS $ RADIOLOGY REVENUE T&L SPINE 6+ VIEWS $ RADIOLOGY REVENUE LUMBAR PUNCTURE TRAY $ RADIOLOGY REVENUE CONRAY 60/50 ML $ RADIOLOGY REVENUE MDGASTIOVIEW $ RADIOLOGY REVENUE OPTIRAY 320/50 ML $ RADIOLOGY REVENUE OPTIRAY 350/50 ML $ RADIOLOGY REVENUE TOWEL PAK $ RADIOLOGY REVENUE ELBOW ARTHROGRAPHY $ RADIOLOGY REVENUE HIP 1 VIEW LEFT W/PEL IF PRFMD LT $ RADIOLOGY REVENUE HIP 1VIEW RIGHT W/PELVIS RT $ RADIOLOGY REVENUE HIP 23 VIEW LEFT W/PELVIS LT $ RADIOLOGY REVENUE HIP 23 VIEWS RIGHT W/PELVIS RT $ RADIOLOGY REVENUE HIP MIN 4VIEW LEFT W/PELVIS LT $ MAMMOGRAPHY REV Mammography RT Unilateral $ MAMMOGRAPHY REV Mammography LT Unilateral LT $ MAMMOGRAPHY REV MAMMOGRAM BILATERAL SCREENING $ MAMMOGRAPHY REV MAMMOGRAPHY ADD 1 VIEW $ MAMMOGRAPHY REV MAMMOGRAPHY BILATERAL DIAG $ MAMMOGRAPHY REV Mammo Unilateral Screening RT $

17 MAMMOGRAPHY REV Mammo Unilateral Screening LT LT $ MAMMOGRAPHY REV MAMMO UNICAD SCREENING $ MAMMOGRAPHY REV Specimen Radiography RT $ MAMMOGRAPHY REV Specimen Radiography LT LT $ MAMMOGRAPHY REV BREASTCADSCREENING $ MAMMOGRAPHY REV BREASTCAD/DIAG $ MAMMOGRAPHY REV BREASTCAD/DIAG LIMITED $ MAMMOGRAPHY REV Tomo Screening Mammogram $ MAMMOGRAPHY REV Tomo Diagnostic Mammogram G $ 75.00

We Accept Care Credit

We Accept Care Credit Standard Fee Schedule Valid 1-Jan-18 to 1-July-18 **Prices Subject to Change, Call 702-222-3544 For Verification** Exam CPT PAYMENT IN FULL AT TIME OF SERVICE EKG 93000 35 TREADMILL