UH Procedures and Services
Our Commitment to Quality
Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.
NOTE: Charges are displayed for the procedure only. These do not include any medications, supplies or pre-procedure laboratory tests that may be needed prior to the study (for example - CT Scan of the Abdomen with Contrast does not include the contrast medication given. If the contrast is IV, you may have additional charges for the IV supplies). Please contact Scheduling and Benefits for a more accurate estimate of what the procedure will cost.
University Hospital/University Summerville: 706-774-8209 or 706-774-8210
University Hospital McDuffie: 706-597-5219
| Service | Charge Code | Charge Description | Charge |
|---|---|---|---|
| ROOM & BOARD | 11100001 | HC R&B - PRIVATE | $580 |
| ROOM & BOARD | 11900001 | HC R&B - SWING BED PRIVATE | $350 |
| ROOM & BOARD | 12200001 | HC R&B - SEMIPRIVATE | $580 |
| ROOM & BOARD | 17000001 | HC R&B - NURSERY LVL 1 Well Baby | $441 |
| ROOM & BOARD | 17200001 | HC R&B - NURSERY LVL 2 Level 2 | $896 |
| ROOM & BOARD | 17300001 | HC R&B - NURSERY LVL 3 Intermediate | $1,198 |
| ROOM & BOARD | 17400001 | HC R&B - NURSERY LVL 4 Intensive | $1,625 |
| ROOM & BOARD | 20000001 | HC R&B - ICU (Intensive Care) | $1,574 |
| ROOM & BOARD | 20600001 | HC R&B - TELEMETRY (Intermediate or Remote Telemetry) | $973 |
| ROOM & BOARD | 21000001 | HC R&B - CCU (Coronary Care Unit) | $1,625 |
| IV Therapy | 26000001 | HC PICC LINE INSERTION | $1,137 |
| IV Therapy | 26000002 | HC PICC LINE REPLACEMENT | $1,137 |
| IV Therapy | 26000003 | HC DECLOT VASCULAR DEVICE | $417 |
| IV Therapy | 26000005 | HC REFILL IMPLANT PUMP/RESERVOIR | $264 |
| IV Therapy | 26000006 | HC HYDRATION INFUSION INITIAL HOUR | $324 |
| IV Therapy | 26000007 | HC HYDRATION INFUSION EACH ADDL HOUR | $70 |
| IV Therapy | 26000008 | HC INFUSION INITIAL HOUR | $324 |
| IV Therapy | 26000009 | HC INFUSION EACH ADDL HOUR | $70 |
| IV Therapy | 26000010 | HC INFUSION ADDL SEQUENTIAL HOUR | $81 |
| IV Therapy | 26000011 | HC IV TX- INITIATION IV ACCESS | $63 |
| IV Therapy | 26000012 | HC MIDLINE CATHETER INSERTION | $118 |
| IV Therapy | 26000013 | HC IVAD ACCESS | $48 |
| IV Therapy | 26000014 | HC THER/DIAG CONCURRENT INF | $70 |
| IV Therapy | 26000015 | HC TX/PRO/DX INJ SAME DRUG ADDON | $189 |
| IV Therapy | 26000025 | HC HYDRATION INFUSION INITIAL HOUR | $324 |
| IV Therapy | 26000026 | HC HYDRATION INFUSION EACH ADDL HOUR | $70 |
| IV Therapy | 26000027 | HC THERAP INFUSION INITIAL HOUR | $324 |
| IV Therapy | 26000028 | HC THERAP INFUSION EACH ADDL HOUR | $70 |
| IV Therapy | 26000029 | HC INFUSION ADDL SEQUENTIAL HOUR | $70 |
| IV Therapy | 26000030 | HC TX/PRO/DX INJ SAME DRUG ADDON | $189 |
| IV Therapy | 26000031 | HC THER/DIAG CONCURRENT INF | $70 |
| IV Therapy | 26000034 | HC THER/DIAG CONCURRENT INF - ER | $70 |
| IV Therapy | 26000035 | HC TX/PRO/DX INJ SAME DRUG ADDON - ER | $189 |
| Laboratory | 30000001 | HC VENIPUNCTURE ROUTINE | $18 |
| Laboratory | 30000052 | HC BLOOD COLLECTION FROM PORT | $147 |
| Laboratory | 30000053 | HC COLLECT BLOOD FROM PICC | $147 |
| Laboratory | 30200129 | HC TB INTRADERMAL TEST | $23 |
| Diagnostic Radiology Imaging | 32000001 | HC CISTERNOGRAPHY | $713 |
| Diagnostic Radiology Imaging | 32000002 | HC EYE FOREIGN BODY DETECTION | $274 |
| Diagnostic Radiology Imaging | 32000003 | HC MANDIBLE < 4 VIEWS | $248 |
| Diagnostic Radiology Imaging | 32000004 | HC MANDIBLE MINIMUM 4 VIEWS | $307 |
| Diagnostic Radiology Imaging | 32000005 | HC MASTOIDS COMPLETE | $387 |
| Diagnostic Radiology Imaging | 32000006 | HC INTERNAL AUDITORY CANAL | $387 |
| Diagnostic Radiology Imaging | 32000007 | HC FACIAL BONES < THREE VIEWS | $244 |
| Diagnostic Radiology Imaging | 32000008 | HC FACIAL BONES, MINIMUM 3 VIEWS | $515 |
| Diagnostic Radiology Imaging | 32000009 | HC NASAL BONES MINIMUM 3 VIEWS | $239 |
| Diagnostic Radiology Imaging | 32000010 | HC OPTIC FORAMINA | $336 |
| Diagnostic Radiology Imaging | 32000011 | HC ORBITS MINIMUM 4 VIEWS | $362 |
| Diagnostic Radiology Imaging | 32000012 | HC SINUSES <3 VIEWS | $392 |
| Diagnostic Radiology Imaging | 32000013 | HC SINUSES MINIMUM 3 VIEWS | $515 |
| Diagnostic Radiology Imaging | 32000014 | HC SELLA TURCIA | $279 |
| Diagnostic Radiology Imaging | 32000015 | HC SKULL LESS THAN FOUR VIEWS | $392 |
| Diagnostic Radiology Imaging | 32000016 | HC SKULLS MINIMUM 4 VIEWS | $515 |
| Diagnostic Radiology Imaging | 32000017 | HC TEMPEROMANDIBULAR JOINTS | $387 |
| Diagnostic Radiology Imaging | 32000018 | HC PANOREX/ORTHOPANTOGRAM | $146 |
| Diagnostic Radiology Imaging | 32000019 | HC NECK FOR SOFT TISSUE | $202 |
| Diagnostic Radiology Imaging | 32000020 | HC PHARYNX AND LARYNX W FLUORO | $316 |
| Diagnostic Radiology Imaging | 32000022 | HC PORTABLE CHEST FRONTAL SINGLE VIEW | $241 |
| Diagnostic Radiology Imaging | 32000023 | HC XRAY EXAM CHEST 2 VIEWS | $244 |
| Diagnostic Radiology Imaging | 32000024 | HC XRAY EXAM CHEST 3 VIEWS | $325 |
| Diagnostic Radiology Imaging | 32000026 | HC CHEST 2 VIEWS W/FLUORO | $385 |
| Diagnostic Radiology Imaging | 32000027 | HC XRAY CHEST 4+ VIEWS | $356 |
| Diagnostic Radiology Imaging | 32000028 | HC CHEST 4 OR MORE VIEWS W/FLUORO | $448 |
| Diagnostic Radiology Imaging | 32000031 | HC RIBS-UNILATERAL | $319 |
| Diagnostic Radiology Imaging | 32000032 | HC RIBS-UNI W PA CHEST | $450 |
| Diagnostic Radiology Imaging | 32000033 | HC RIBS-BILATERAL | $319 |
| Diagnostic Radiology Imaging | 32000034 | HC RIBS-BIL W PA CHEST | $586 |
| Diagnostic Radiology Imaging | 32000035 | HC STERNUM MINIMUM 2 VIEWS | $292 |
| Diagnostic Radiology Imaging | 32000036 | HC STERNOCLAVICULAR JOINTS 3 VIEW | $345 |
| Diagnostic Radiology Imaging | 32000037 | HC SPINE ENTIRE AP/LAT | $577 |
| Diagnostic Radiology Imaging | 32000038 | HC CERVICAL SPINE,SINGLE VIEW | $247 |
| Diagnostic Radiology Imaging | 32000039 | HC SPINE SINGLE VIEW | $273 |
| Diagnostic Radiology Imaging | 32000040 | HC CERVICAL SPINE 2-3 VIEWS | $322 |
| Diagnostic Radiology Imaging | 32000041 | HC CERVICAL SPINE,MINIMUM 4 VIEWS | $451 |
| Diagnostic Radiology Imaging | 32000042 | HC CERVICAL SPINE WITH FLEX/EXTEN | $552 |
| Diagnostic Radiology Imaging | 32000043 | HC SCOLIOSIS/THORACOLUMBAR 1 VIEW (INCL SUPINE & STAND) | $387 |
| Diagnostic Radiology Imaging | 32000044 | HC THORACIC SPINE AP AND LAT | $427 |
| Diagnostic Radiology Imaging | 32000045 | HC THORACOLUMBAR AP / LATERAL | $427 |
| Diagnostic Radiology Imaging | 32000046 | HC SCOLIOSIS SERIES SUPINE/ERECT | $683 |
| Diagnostic Radiology Imaging | 32000047 | HC LUMBAR SPINE AP / LATERAL | $422 |
| Diagnostic Radiology Imaging | 32000048 | HC LUMBAR SPINE COMPLETE W OBL | $586 |
| Diagnostic Radiology Imaging | 32000049 | HC LUMBAR SPINE COMPLETE W BENDIN | $683 |
| Diagnostic Radiology Imaging | 32000050 | HC LUMBAR BENDING ONLY, MINIMUM 4 | $427 |
| Diagnostic Radiology Imaging | 32000051 | HC PELVIS AP | $295 |
| Diagnostic Radiology Imaging | 32000052 | HC PELVIS MINIMUM 3 VIEWS | $512 |
| Diagnostic Radiology Imaging | 32000053 | HC SACRO-ILIAC JOINTS 3 VIEWS | $336 |
| Diagnostic Radiology Imaging | 32000054 | HC SACRUM OR COCCYX 2 VIEWS | $336 |
| Diagnostic Radiology Imaging | 32000059 | HC EPIDUROGRAPHY | $675 |
| Diagnostic Radiology Imaging | 32000060 | HC PERQ VERTEBROPLASTY, CERVICOTHORACIC | $3,427 |
| Diagnostic Radiology Imaging | 32000061 | HC DISCOGRAPHY, LUMBAR | $2,279 |
| Diagnostic Radiology Imaging | 32000062 | HC CLAVICLE COMPLETE | $352 |
| Diagnostic Radiology Imaging | 32000063 | HC CLAVICLE, BILATERAL | $689 |
| Diagnostic Radiology Imaging | 32000064 | HC SCAPULA COMPLETE | $292 |
| Diagnostic Radiology Imaging | 32000065 | HC SCAPULA, BILATERAL | $661 |
| Diagnostic Radiology Imaging | 32000066 | HC SHOULDER ONE VIEW | $247 |
| Diagnostic Radiology Imaging | 32000067 | HC SHOULDER, ONE VIEW BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000068 | HC SHOULDER 2 VIEWS | $355 |
| Diagnostic Radiology Imaging | 32000069 | HC SHOULDER TWO VIEWS, BILATERAL | $697 |
| Diagnostic Radiology Imaging | 32000070 | HC ACROMIO-CLAVICULAR JOINTS | $314 |
| Diagnostic Radiology Imaging | 32000071 | HC HUMERUS MINIMUM 2 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000072 | HC HUMERUS, BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000073 | HC ELBOW AP / LATERAL | $247 |
| Diagnostic Radiology Imaging | 32000074 | HC ELBOW, TWO VIEWS BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000075 | HC ELBOW,MINIMUM 3 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000076 | HC ELBOW, THREE VIEWS BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000077 | HC FOREARM AP / LATERAL | $273 |
| Diagnostic Radiology Imaging | 32000078 | HC FOREARM, BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000079 | HC UPPER EXTREMITY INFANT | $247 |
| Diagnostic Radiology Imaging | 32000080 | HC UPPER EXTREMITY INFANT BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000081 | HC WRIST MINIMUM 2 VIEWS | $247 |
| Diagnostic Radiology Imaging | 32000082 | HC WRIST TWO VIEWS, BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000083 | HC WRIST MINIMUM 3 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000084 | HC WRIST, THREE VIEWS BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000085 | HC HAND 2 VIEWS | $247 |
| Diagnostic Radiology Imaging | 32000086 | HC HAND, TWO VIEW BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000087 | HC HAND MINIMUM 3 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000088 | HC HAND, THREE VIEW BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000089 | HC FINGER(S) MINIMUM 2 VIEWS | $234 |
| Diagnostic Radiology Imaging | 32000090 | HC HIP UNILATERAL 1 VIEW | $295 |
| Diagnostic Radiology Imaging | 32000091 | HC HIP UNILAT COMPLETE MIN 2 VIEWS | $380 |
| Diagnostic Radiology Imaging | 32000092 | HC HIPS BILAT & PELVIS MIN 2 VIEWS | $418 |
| Diagnostic Radiology Imaging | 32000093 | HC PELVIS AND BILAT HIPS 2 VIEWS | $512 |
| Diagnostic Radiology Imaging | 32000094 | HC ARTHROGRAM HIP | $675 |
| Diagnostic Radiology Imaging | 32000095 | HC HIP 1 VIEW/OR | $380 |
| Diagnostic Radiology Imaging | 32000096 | HC PELVIS / HIPS,INFANT MIN 2 VIEWS BILAT | $273 |
| Diagnostic Radiology Imaging | 32000098 | HC FEMUR AP / LATERAL 1 VIEW | $292 |
| Diagnostic Radiology Imaging | 32000099 | HC FEMUR, BILATERAL 2 or > VIEWS | $568 |
| Diagnostic Radiology Imaging | 32000100 | HC XRAY KNEE 1 OR 2 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000101 | HC XRAY KNEE 1 OR 2 VIEWS | $533 |
| Diagnostic Radiology Imaging | 32000102 | HC KNEE MINIMUM 3 VIEWS | $321 |
| Diagnostic Radiology Imaging | 32000103 | HC KNEE, THREE VIEWS BILATERAL | $632 |
| Diagnostic Radiology Imaging | 32000104 | HC KNEE TUNNEL/PATELLAR/STANDING | $321 |
| Diagnostic Radiology Imaging | 32000105 | HC KNEE COMPLETE W/MULTI VIEWS | $372 |
| Diagnostic Radiology Imaging | 32000106 | HC KNEE, MULTI VIEW BILATERAL | $724 |
| Diagnostic Radiology Imaging | 32000107 | HC KNEES STANDING AP | $273 |
| Diagnostic Radiology Imaging | 32000108 | HC TIBIA/FIBULA AP / LATERAL | $273 |
| Diagnostic Radiology Imaging | 32000109 | HC TIBIA/FIBULA, BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000110 | HC LOWER EXTREMITY,INFANT 2V | $247 |
| Diagnostic Radiology Imaging | 32000111 | HC LOWER EXTREMITY,INFANT 2V BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000112 | HC ANKLE 2 VIEWS | $247 |
| Diagnostic Radiology Imaging | 32000113 | HC ANKLE, TWO VIEWS BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000114 | HC ANKLE 3 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000115 | HC ANKLE, THREE VIEWS BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000116 | HC FOOT 2 VIEWS | $247 |
| Diagnostic Radiology Imaging | 32000117 | HC FOOT, TWO VIEWS BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000118 | HC FOOT MINIMUM 3 VIEWS | $273 |
| Diagnostic Radiology Imaging | 32000119 | HC FOOT, THREE VIEWS BILATERAL | $533 |
| Diagnostic Radiology Imaging | 32000120 | HC CALCANEOUS/OS CAL.MIN.2 VIEW | $247 |
| Diagnostic Radiology Imaging | 32000121 | HC CALCANEOUS/OS CALCIS BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000122 | HC TOES MINIMUM 2 VIEWS | $255 |
| Diagnostic Radiology Imaging | 32000123 | HC TOES, BILATERAL | $485 |
| Diagnostic Radiology Imaging | 32000124 | HC XRAY EXAM ABDOMEN 1 VIEW | $202 |
| Diagnostic Radiology Imaging | 32000125 | HC XRAY EXAM KUB SINGLE VIEW | $237 |
| Diagnostic Radiology Imaging | 32000126 | HC XRAY ABDOMEN 2 VIEWS | $367 |
| Diagnostic Radiology Imaging | 32000127 | HC XRAY ABDOMEN 3+ VIEWS | $385 |
| Diagnostic Radiology Imaging | 32000128 | HC ABDOMEN SERIES W PA CHEST | $554 |
| Diagnostic Radiology Imaging | 32000129 | HC ESOPHAGUS,BARIUM SWALLOW | $480 |
| Diagnostic Radiology Imaging | 32000130 | HC GI SERIES UPPER | $1,125 |
| Diagnostic Radiology Imaging | 32000131 | HC GI SERIES WITH SMALL BOWEL | $842 |
| Diagnostic Radiology Imaging | 32000132 | HC GI SERIES WITH AIR CONTRAST | $653 |
| Diagnostic Radiology Imaging | 32000133 | HC GI AIR CONTRAST W SMALL BOWEL | $842 |
| Diagnostic Radiology Imaging | 32000134 | HC SMALL BOWEL SERIES | $524 |
| Diagnostic Radiology Imaging | 32000135 | HC SMALL BOWEL SERIES ENTEROCLYSIS | $1,107 |
| Diagnostic Radiology Imaging | 32000136 | HC COLON,BARIUM ENEMA | $844 |
| Diagnostic Radiology Imaging | 32000137 | HC COLON,BARIUM AIR CONTRAST | $967 |
| Diagnostic Radiology Imaging | 32000138 | HC THERAPEUTIC ENEMA | $912 |
| Diagnostic Radiology Imaging | 32000139 | HC GALLBLADDER SERIES | $411 |
| Diagnostic Radiology Imaging | 32000141 | HC OR CHOLANGIOGRAM | $211 |
| Diagnostic Radiology Imaging | 32000142 | HC OR CHOLANGIOGRAM ADDTNL SET | $211 |
| Procedurals | 32000145 | HC BILIARY STONE RETREIVAL OR REMOVAL | $395 |
| Diagnostic Radiology Imaging | 32000146 | HC ERCP/BILIARY | $609 |
| Diagnostic Radiology Imaging | 32000147 | HC ERCP/PANCREATIC | $609 |
| Diagnostic Radiology Imaging | 32000147 | HC ERCP PANCREATIC (REDUCED SVC) | $609 |
| Diagnostic Radiology Imaging | 32000148 | HC ERCP/BILIARY / PANCREATIC | $609 |
| Diagnostic Radiology Imaging | 32000148 | HC ERCP BILIARY/PANCR REDUCED SVC | $609 |
| Diagnostic Radiology Imaging | 32000149 | HC GI TUBE PLACEMENT WITH FLUOROSCOPY | $411 |
| Diagnostic Radiology Imaging | 32000150 | HC PERC PLACEMENT ENTEROCLYSIS TUBE | $423 |
| Diagnostic Radiology Imaging | 32000151 | HC ESOPHAGEAL DILATION | $609 |
| Procedurals | 32000152 | HC ARTHROGRAM TMJ | $418 |
| Procedurals | 32000153 | HC TRANSHEPATIC DUCT DILATION | $674 |
| Diagnostic Radiology Imaging | 32000154 | HC INTRAVENOUS PYELOGRAM | $643 |
| Diagnostic Radiology Imaging | 32000155 | HC RETRO PYELOGRAM UNILATERAL | $520 |
| Procedurals | 32000156 | HC UROGRAPHY, ANTEGRADE | $319 |
| Diagnostic Radiology Imaging | 32000157 | HC VASOGRAM/OR | $349 |
| Procedurals | 32000158 | HC CYSTOGRAM/RETROGRADE URETHROGRAM | $436 |
| Diagnostic Radiology Imaging | 32000159 | HC RENAL CYST STUDY TRANSLUMBAR | $423 |
| Diagnostic Radiology Imaging | 32000161 | HC PELVIMETRY | $316 |
| Diagnostic Radiology Imaging | 32000162 | HC VAGINOGRAM/PERINEOGRAM | $379 |
| Diagnostic Radiology Imaging | 32000163 | HC THORACIC AORTOGRAM WO SERIALOGRAPHY | $2,762 |
| Diagnostic Radiology Imaging | 32000164 | HC THORACIC AORTOGRAM | $2,762 |
| Diagnostic Radiology Imaging | 32000165 | HC ABDOMINAL AORTOGRAM | $2,762 |
| Diagnostic Radiology Imaging | 32000166 | HC ABDOMINAL ART W/FEMORAL RUNOFF | $2,762 |
| Diagnostic Radiology Imaging | 32000176 | HC SELECTIVE SPINAL ANGIOGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000177 | HC EXTREMITY ANGIOGRAM UNILATERAL | $2,789 |
| Diagnostic Radiology Imaging | 32000178 | HC ARTERIOGRAM EXTREMITIES BILAT | $2,666 |
| Diagnostic Radiology Imaging | 32000181 | HC VISCERAL SELECTIVE SINGLE VES. | $2,666 |
| Diagnostic Radiology Imaging | 32000182 | HC ADRENAL SELECTIVE UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000183 | HC ADRENAL SELECTIVE BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000184 | HC PELVIC ANGIOGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000185 | HC PULMONARY ANGIOGRAM UNILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000186 | HC PULMONARY ANGIOGRAM BILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000187 | HC ANGIOGRAPHY PULM NON-SELECTIVE | $1,634 |
| Diagnostic Radiology Imaging | 32000188 | HC INTERNAL MAMMARY ANGIOGRAM | $1,879 |
| Diagnostic Radiology Imaging | 32000189 | HC ANGIO SELECTIVE ADDITIONAL VESSEL | $1,660 |
| Diagnostic Radiology Imaging | 32000191 | HC LYMPHANGIOGRAM, ABDOMNL/PELVIC | $937 |
| Diagnostic Radiology Imaging | 32000192 | HC SHUNTOGRAM, NONVASCULAR | $248 |
| Diagnostic Radiology Imaging | 32000193 | HC VENOGRAM EXTREMITY UNILATERAL | $980 |
| Diagnostic Radiology Imaging | 32000194 | HC VENOGRAM EXTREMITY BILATERAL | $824 |
| Diagnostic Radiology Imaging | 32000195 | HC INFERIOR VENACAVAGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000197 | HC RENAL VENOGRAM UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000198 | HC RENAL VENOGRAM BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000199 | HC ADRENAL VENOGRAM UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000200 | HC ADRENAL VENOGRAM BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000201 | HC CORONARY SINUS VENOGRAM | $1,759 |
| Diagnostic Radiology Imaging | 32000203 | HC HEPATIC VENOGRAM WO HEMODYNAMICS | $2,666 |
| Diagnostic Radiology Imaging | 32000204 | HC EMBOLIZATION | $2,709 |
| Diagnostic Radiology Imaging | 32000205 | HC TRANSCATHETER THERAPY INFUSION 1ST AGENT | $2,668 |
| Diagnostic Radiology Imaging | 32000210 | HC TRANSCATHETER THERAPY FOLLOWUP | $521 |
| Diagnostic Radiology Imaging | 32000212 | HC REMOVAL CVA DEVICE OBSTRUCTION | $392 |
| Diagnostic Radiology Imaging | 32000213 | HC REMOVAL CVA LUMEN OBSTRUCTION | $266 |
| Diagnostic Radiology Imaging | 32000215 | HC INTRAVASCULAR US IMAGING,NONCORONARY | $4,762 |
| Diagnostic Radiology Imaging | 32000216 | HC INTRAVASC US, NONCORONARY ADD' | $4,762 |
| Diagnostic Radiology Imaging | 32000220 | HC REPAIR ENDOVASC THORACIC AORTA | $785 |
| Diagnostic Radiology Imaging | 32000221 | HC EXTREMITY ANGIOGRAM UNILATERAL | $674 |
| Diagnostic Radiology Imaging | 32000222 | HC PLACEMENT PROX EXT THORAC AORT | $450 |
| Diagnostic Radiology Imaging | 32000223 | HC PLACEMENT DISTAL EXT THOR AORT | $393 |
| Procedurals | 32000225 | HC SIALOGRAM | $314 |
| Diagnostic Radiology Imaging | 32000232 | HC TRANSCATHETER BIOPSY | $1,289 |
| Diagnostic Radiology Imaging | 32000234 | HC PTH BILIARY DRAIN W CONTR MONI EXTERNAL | $200 |
| Diagnostic Radiology Imaging | 32000236 | HC CATHETER EXCHANGE | $427 |
| Diagnostic Radiology Imaging | 32000237 | HC ABCESS DRAIN W CATH PLACEMENT | $534 |
| Diagnostic Radiology Imaging | 32000240 | HC FLUOUROSCOPY CHECK OF LEADS | $416 |
| Diagnostic Radiology Imaging | 32000241 | HC FOREIGN BODY, CHILD | $202 |
| Diagnostic Radiology Imaging | 32000242 | HC ABCESS/FISTULA/SINUS TRACT | $300 |
| Diagnostic Radiology Imaging | 32000243 | HC BREAST SURGICAL SPECIMEN | $520 |
| Diagnostic Radiology Imaging | 32000245 | HC CINERADIOGRAPHY | $520 |
| Diagnostic Radiology Imaging | 32000246 | HC UNLISTED FLUOROSCOPIC EXAM | $116 |
| Diagnostic Radiology Imaging | 32000247 | HC UNLISTED/MISC DIAGN RADIOLOGY | $100 |
| Diagnostic Radiology Imaging | 32000248 | HC FLUORO GUIDANCE FOR CVAD | $244 |
| Diagnostic Radiology Imaging | 32000249 | HC FLUORO FOR NEEDLE PLACEMENT | $258 |
| Diagnostic Radiology Imaging | 32000250 | HC FLUORO FOR SPINE INJ PROCEDURE | $258 |
| Diagnostic Radiology Imaging | 32000252 | HC STRESS VIEW(S),ANY JOINT | $273 |
| Diagnostic Radiology Imaging | 32000253 | HC BONE AGE STUDIES | $370 |
| Diagnostic Radiology Imaging | 32000254 | HC BONE LENGTH STUDIES | $433 |
| Diagnostic Radiology Imaging | 32000255 | HC BONE SURVEY, LIMITED | $791 |
| Diagnostic Radiology Imaging | 32000256 | HC BONE SURVEY, COMPLETE | $900 |
| Diagnostic Radiology Imaging | 32000257 | HC OSSEOUS SURVEY INFANT | $312 |
| Diagnostic Radiology Imaging | 32000258 | HC JOINT SURVEY,1 VIEW,2/> JOINTS | $101 |
| Diagnostic Radiology Imaging | 32000259 | HC UNLISTED DX RAD PROC, ADD'L | $100 |
| Diagnostic Radiology Imaging | 32000260 | HC BARIUM ENEMA SCREEN/ALT G0104 | $773 |
| Diagnostic Radiology Imaging | 32000261 | HC BARIUM ENEMA,SCREEN/ALT G0105 | $773 |
| Diagnostic Radiology Imaging | 32000262 | HC BARIUM ENEMA,SCREEN NONCOVERED | $773 |
| Procedurals | 32000263 | HC BRONCHOGRAM UNILATERAL | $272 |
| Procedurals | 32000264 | HC BRONCHOGRAM BILATERAL | $391 |
| Procedurals | 32000269 | HC ARTHROGRAM SHOULDER | $403 |
| Procedurals | 32000270 | HC ARTHROGRAM ELBOW | $481 |
| Procedurals | 32000271 | HC ARTHROGRAM WRIST | $481 |
| Procedurals | 32000272 | HC ARTHROGRAM KNEE | $501 |
| Procedurals | 32000273 | HC PERITONEOGRAM | $478 |
| Procedurals | 32000274 | HC CYSTOGRAM | $242 |
| Procedurals | 32000275 | HC URETHROCYSTOGRAPHY VOIDING | $310 |
| Procedurals | 32000277 | HC DILATION NEPHROSTOMY/URETERS | $1,650 |
| Procedurals | 32000278 | HC HYSTEROSALPINGOGRAPHY | $423 |
| Procedurals | 32000279 | HC FALLOPIAN CATHETERIZATION | $1,638 |
| Procedurals | 32000280 | HC LYMPHANGIOGRAM, EXTREMITY | $2,581 |
| Procedurals | 32000281 | HC SPLENOPORTOGRAM | $2,967 |
| Diagnostic Radiology Imaging | 32000282 | HC TRANSHEPATIC PORTAL VENOGRAM | $2,666 |
| Procedurals | 32000283 | HC CATHETER VENOUS SAMPLING | $2,666 |
| Procedurals | 32000285 | HC MAMMARY DUCTOGRAM SINGLE | $383 |
| Procedurals | 32000286 | HC MAMMARY DUCTOGRAM MULTI | $482 |
| Nuclear Medicine | 32000287 | HC HEPATOBILIARY W CCK | $1,078 |
| Diagnostic Radiology Imaging | 32000288 | HC ANGIOGRAPHY PULM NON-SELECTIVE | $1,634 |
| Diagnostic Radiology Imaging | 32000289 | HC ABDOMINAL AORTOGRAM | $2,762 |
| Diagnostic Radiology Imaging | 32000291 | HC PULMONARY ANGIOGRAM BILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000292 | HC INTERNAL MAMMARY ANGIOGRAM | $1,879 |
| Diagnostic Radiology Imaging | 32000294 | HC VENOGRAM EXTREMITY UNILATERAL | $980 |
| Diagnostic Radiology Imaging | 32000295 | HC VENOGRAM EXTREMITY BILATERAL | $824 |
| Diagnostic Radiology Imaging | 32000296 | HC SUPERIOR VENACAVAGRAM | $1,905 |
| Diagnostic Radiology Imaging | 32000297 | HC PULMONARY ANGIOGRAM UNILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000298 | HC CORONARY SINUS VENOGRAM | $1,759 |
| Diagnostic Radiology Imaging | 32000299 | HC TRANSCATHETER THERAPY INFUSION | $2,668 |
| Diagnostic Radiology Imaging | 32000300 | HC TRANSCATHETER THERAPY FOLLOWUP | $521 |
| Diagnostic Radiology Imaging | 32000301 | HC CATHETER RETRIEVAL | $1,747 |
| Diagnostic Radiology Imaging | 32000303 | HC FLUORO GUIDANCE FOR CVAD | $244 |
| Diagnostic Radiology Imaging | 32000304 | HC ANGIOGRAPHY PULM NON-SELECTIVE | $1,634 |
| Diagnostic Radiology Imaging | 32000305 | HC VENOGRAM EXTREMITY UNILATERAL | $980 |
| Diagnostic Radiology Imaging | 32000306 | HC VENOGRAM EXTREMITY BILATERAL | $824 |
| Diagnostic Radiology Imaging | 32000307 | HC CORONARY SINUS VENOGRAM | $1,759 |
| Diagnostic Radiology Imaging | 32000308 | HC INFERIOR VENACAVAGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000310 | HC ESOPHAGUS,BARIUM SWALLOW | $480 |
| Procedurals | 32000313 | HC BILIARY STONE RETREIVAL | $395 |
| Diagnostic Radiology Imaging | 32000314 | HC THORACIC AORTOGRAM | $2,762 |
| Diagnostic Radiology Imaging | 32000315 | HC ABDOMINAL AORTOGRAM | $2,762 |
| Diagnostic Radiology Imaging | 32000316 | HC ABDOMINAL ART W/FEMORAL RUNOFF | $2,762 |
| Diagnostic Radiology Imaging | 32000319 | HC EXTERNAL CAROTID UNILATERAL | $4,031 |
| Diagnostic Radiology Imaging | 32000320 | HC EXTERNAL CAROTID BILATERAL | $4,031 |
| Diagnostic Radiology Imaging | 32000326 | HC SELECTIVE SPINAL ANGIOGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000327 | HC EXTREMITY ANGIOGRAM UNILATERAL | $2,789 |
| Diagnostic Radiology Imaging | 32000328 | HC ARTERIOGRAM EXTREMITIES BILAT | $2,666 |
| Procedurals | 32000329 | HC VISCERAL SELECTIVE SINGLE VES. | $2,666 |
| Diagnostic Radiology Imaging | 32000330 | HC ADRENAL SELECTIVE UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000331 | HC ADRENAL SELECTIVE BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000332 | HC PELVIC ANGIOGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000333 | HC PULMONARY ANGIOGRAM UNILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000334 | HC PULMONARY ANGIOGRAM BILATERAL | $2,762 |
| Diagnostic Radiology Imaging | 32000335 | HC INTERNAL MAMMARY ANGIOGRAM | $1,879 |
| Procedurals | 32000336 | HC ANGIO SELECTIVE ADDITIONAL VESSEL | $1,660 |
| Procedurals | 32000337 | HC VENOGRAM EXTREMITY UNILATERAL | $980 |
| Procedurals | 32000338 | HC VENOGRAM EXTREMITY BILATERAL | $824 |
| Diagnostic Radiology Imaging | 32000339 | HC INFERIOR VENACAVAGRAM | $2,666 |
| Diagnostic Radiology Imaging | 32000340 | HC SUPERIOR VENACAVAGRAM | $1,905 |
| Diagnostic Radiology Imaging | 32000341 | HC RENAL VENOGRAM UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000342 | HC RENAL VENOGRAM BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000343 | HC ADRENAL VENOGRAM UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000344 | HC ADRENAL VENOGRAM BILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000345 | HC CORONARY SINUS VENOGRAM | $1,759 |
| Procedurals | 32000346 | HC HEPATIC VENOGRAM W HEMODYNAMICS | $2,666 |
| Diagnostic Radiology Imaging | 32000347 | HC HEPATIC VENOGRAM WO HEMODYNAMICS | $2,666 |
| Diagnostic Radiology Imaging | 32000348 | HC TRANSCATHETER THERAPY FOLLOWUP | $521 |
| Procedurals | 32000349 | HC ARTERIAL CATH EXCHANGE | $1,985 |
| Procedurals | 32000353 | HC CATHETER RETRIEVAL | $1,747 |
| Procedurals | 32000357 | HC CATHETER EXCHANGE | $427 |
| Procedurals | 32000358 | HC ABCESS/FISTULA/SINUS TRACT | $300 |
| Diagnostic Radiology Imaging | 32000359 | HC UNLISTED/MISC DIAGN RADIOLOGY | $100 |
| Diagnostic Radiology Imaging | 32000360 | HC FLUORO GUIDANCE FOR CVAD | $244 |
| Diagnostic Radiology Imaging | 32000361 | HC FLUORO FOR NEEDLE PLACEMENT | $258 |
| Procedurals | 32000362 | HC TRANSHEPATIC PORTAL VENOGRAM | $2,666 |
| Procedurals | 32000363 | HC FLUOUROSCOPY PORTACATHOGRAM | $416 |
| Diagnostic Radiology Imaging | 32000365 | HC FLUOUROSCOPY CHECK OF LEADS | $416 |
| Procedurals | 32000367 | HC NEPHROSTOMY STENT PLACEMENT | $1,650 |
| Diagnostic Radiology Imaging | 32000368 | HC RENAL ANGIOGRAM UNILATERAL | $2,666 |
| Diagnostic Radiology Imaging | 32000369 | HC RENAL ANGIOGRAM BILATERAL | $2,666 |
| Procedurals | 32000370 | HC ANGIOGRAPHY PULM NON-SELECTIVE | $1,634 |
| Procedurals | 32000371 | HC EMBOLIZATION | $2,709 |
| Procedurals | 32000372 | HC EMBOLIZATION | $2,709 |
| Diagnostic Radiology Imaging | 32000373 | HC TRANSCATHETER THERAPY INFUSION 1ST AGENT | $2,668 |
| Diagnostic Radiology Imaging | 32000374 | HC TRANSCATHETER THERAPY FOLLOWUP | $521 |
| Diagnostic Radiology Imaging | 32000378 | HC REPAIR ENDOVASC THORACIC AORTA | $785 |
| Diagnostic Radiology Imaging | 32000379 | HC EXTREMITY ANGIOGRAM UNILATERAL | $674 |
| Diagnostic Radiology Imaging | 32000380 | HC PLACEMENT PROX EXT THORAC AORT | $450 |
| Diagnostic Radiology Imaging | 32000381 | HC PLACEMENT PROX EXT THORAC AORT | $450 |
| Diagnostic Radiology Imaging | 32000383 | HC TRANSCATHETER BIOPSY | $1,289 |
| Diagnostic Radiology Imaging | 32000384 | HC BRONCHOGRAM UNILATERAL | $272 |
| Diagnostic Radiology Imaging | 32000385 | HC BRONCHOGRAM BILATERAL | $391 |
| Diagnostic Radiology Imaging | 32000386 | HC FALLOPIAN CATHETERIZATION | $1,638 |
| Diagnostic Radiology Imaging | 32000387 | HC CATHETER VENOUS SAMPLING | $2,666 |
| Diagnostic Radiology Imaging | 32000388 | HC CATHETER VENOUS SAMPLING | $2,666 |
| Diagnostic Radiology Imaging | 32000390 | HC FLUOUROSCOPY LESS THAN 1 HOUR | $416 |
| Diagnostic Radiology Imaging | 32000391 | HC FLUORO FOR NEEDLE PLACEMENT | $258 |
| Diagnostic Radiology Imaging | 32000392 | HC FLUOUROSCOPY LESS THAN 1 HOUR | $416 |
| Diagnostic Radiology Imaging | 32000393 | HC PERC PLACEMENT ENTEROCLYSIS TUBE | $423 |
| Procedurals | 32000394 | HC TRANSHEPATIC DUCT DILATION | $674 |
| Procedurals | 32000395 | HC ANGIO SELECTIVE ADDITIONAL VESSEL | |
| Procedurals | 32000400 | HC NEPHROSTOGRAM | $319 |
| Diagnostic Radiology Imaging | 32000401 | HC DISCOGRAPHY, CERVICAL OR THORACIC | $2,279 |
| Diagnostic Radiology Imaging | 32000402 | HC DXA BONE DENSITY AXIAL 1+ SITES | $166 |
| Diagnostic Radiology Imaging | 32000403 | HC DXA BONE DENSITY/PERIPHERAL 1+ SITES | $130 |
| Diagnostic Radiology Imaging | 32000404 | HC X-RAY EXAM OF THORACIC SPINE 3 VIEWS | $302 |
| Diagnostic Radiology Imaging | 32000405 | HC X-RAY EXAM OF THORACIC SPINE 4+ VIEWS | $374 |
| Diagnostic Radiology Imaging | 33200283 | HC CATHETER VENOUS SAMPLING | $2,666 |
| Procedurals | 32000406 | HC XR SKELETAL SURVEY, INFANT | $900 |
| Diagnostic Radiology Imaging | 32000407 | HC SCOLIOSIS/THORACOLUMBAR STAND 2-3 VIEWS | $467 |
| Diagnostic Radiology Imaging | 32000408 | HC SCOLIOSIS/THORACOLUMBAR STAND 4-5 VIEWS | $547 |
| Diagnostic Radiology Imaging | 32000409 | HC SCOLIOSIS/THORACOLUMBAR MIN 6 VIEWS (INCL. SUPINE & STAND) | $627 |
| Diagnostic Radiology Imaging | 32000410 | HC HIP UNILAT W PELVIS MINIMUM 4 VIEWS | $465 |
| Diagnostic Radiology Imaging | 32000411 | HC HIPS BILAT & PELVIS MIN 3-4 VIEWS BILAT | $495 |
| Diagnostic Radiology Imaging | 32000412 | HC HIPS BILAT & PELVIS MIN 5 VIEWS BILAT | $560 |
| Diagnostic Radiology Imaging | 32000413 | HC FEMUR AP/LATERAL MIN 2 VIEWS | $377 |
| Diagnostic Radiology Imaging | 32000414 | HC GASTRIC EMPTYING IMAG STDY W SM BOWEL TRANSIT | $443 |
| Diagnostic Radiology Imaging | 32000415 | HC GASTRIC EMPTYING IMAG STDY W SM BOWEL & COLON TRANSIT | $587 |
| Diagnostic Radiology Imaging | 32000416 | HC PELVIS / HIPS,INFANT MIN 2-3 VIEWS UNILAT | $380 |
| Diagnostic Radiology Imaging | 32000417 | HC PELVIS / HIPS,INFANT MIN 4 VIEWS UNILAT | $465 |
| Diagnostic Radiology Imaging | 32000418 | HC PELVIS / HIPS,INFANT MIN 1 VIEW UNILAT | $295 |
| Diagnostic Radiology Imaging | 32000419 | HC PELVIS / HIPS,INFANT MIN 3-4 VIEWS BILAT | $495 |
| Diagnostic Radiology Imaging | 32000420 | HC PELVIS / HIPS,INFANT MIN 5 VIEWS BILAT | $560 |
| Procedurals | 32000421 | HC FLUORO FOR NEEDLE PLACEMENT | $258 |
| Procedurals | 32000422 | HC ABLTJ PERC PLEX/TRNCL NERVE | $6,045 |
| Diagnostic Radiology Imaging | 32300001 | HC AORTOGRAPHY/THORACIC S/I | $2,030 |
| Chemotherapy | 33100001 | HC CHEMO SQ/IM INJ NONHORMONAL | $189 |
| IV Therapy | 33100002 | HC CHEMO SQ/IM INJECTION HORMONAL | $189 |
| IV Therapy | 33100003 | HC CHEMO INJ IV NOT INFUSION | $268 |
| Chemotherapy | 33100004 | HC CHEMO IV PUSH ADDL DRUG | $189 |
| Chemotherapy | 33100005 | HC CHEMO, CNS (INTRATHECAL), W LP | $389 |
| Chemotherapy | 33100006 | HC CHEMO IA PUSH TECHNIQUE | $389 |
| Procedurals | 33300002 | HC ULTRASOUND GUIDE FOR PROSTATE | $202 |
| Radiation Therapy | 33300003 | HC RADIATION PHYSICS CONSULT IVBT | $442 |
| Chemotherapy | 33500001 | HC CHEMO INFUSION IV UP TO 1 HR | $376 |
| Chemotherapy | 33500002 | HC CHEMO INF IV EA ADD HR UP TO 8 | $85 |
| Chemotherapy | 33500003 | HC CHEMO INFUS IV MORE THAN 8 HRS | $638 |
| IV Therapy | 33500004 | HC CHEMO IV INF EA ADDL SEQ =<1 HR | $85 |
| IV Therapy | 33500005 | HC REFILL/MAINT PORTABLE PUMP | $197 |
| Procedurals | 34000001 | HC PERITONEAL-VENOUS SHUNT | $968 |
| Nuclear Medicine | 34000002 | HC TUMOR LOC MULTI AREA | $846 |
| Nuclear Medicine | 34000003 | HC TUMOR LOC WHOLE BODY PROSTASCINT | $879 |
| Nuclear Medicine | 34000004 | HC TUMOR LOC SPECT | $1,506 |
| Nuclear Medicine | 34000005 | HC ABCESS LOC SPECT, GALLIUM | $762 |
| Nuclear Medicine | 34000006 | HC NUCLEAR MEDICINE MISCELLANEOUS | $620 |
| Nuclear Medicine | 34000007 | HC RADPHARM ABLATN THYROID | $649 |
| Nuclear Medicine | 34000008 | HC INJECT IV THERAPUETIC/DIAGNOST | $410 |
| Nuclear Medicine | 34000009 | HC LYMPHOSCINTOGRAPHY | $706 |
| Nuclear Medicine | 34000010 | HC CSF LEAKAGE IMAGING | $1,584 |
| Nuclear Medicine | 34100001 | HC MIBG ADRENAL SCAN W/I-123 | $1,584 |
| Nuclear Medicine | 34100002 | HC LIVER SPECT | $762 |
| Nuclear Medicine | 34100003 | HC GI BLEED SCAN | $1,267 |
| Nuclear Medicine | 34100004 | HC BONE SCAN TOMOGRAPHIC SPECT | $1,628 |
| Nuclear Medicine | 34100005 | HC UNLISTED MUSC-SKELETAL DX NUCM | $620 |
| Nuclear Medicine | 34100006 | HC BONE SCAN VASCULAR FLOW | $427 |
| Nuclear Medicine | 34100008 | HC TOMOGRAPHIC SPECT | $2,942 |
| Nuclear Medicine | 34100009 | HC (MUGA) CARD BLD PL IMAGE-SNGL | $1,218 |
| Nuclear Medicine | 34100010 | HC BRAIN SCAN TOMOGRAPHIC SPECT | $762 |
| Nuclear Medicine | 34100011 | HC BRAIN SCAN VASCULAR FLOW | $673 |
| Nuclear Medicine | 34100012 | HC CSF SHUNT EVALUATION | $515 |
| Nuclear Medicine | 34100013 | HC NUC MED DACRYOCYSTOGRAM | $300 |
| Nuclear Medicine | 34100014 | HC KIDNEY VASCULAR FLOW | $664 |
| Nuclear Medicine | 34100015 | HC KIDNEY FLOW/FUNCTION, LASIX | $658 |
| Nuclear Medicine | 34100016 | HC VUCG/URETERAL REFLUX STUDY | $689 |
| Nuclear Medicine | 34100017 | HC TUMOR LOC WHOLE BODY | $1,584 |
| Nuclear Medicine | 34100018 | HC TUMOR LOCALIZATION SPECT | $1,506 |
| Nuclear Medicine | 34100019 | HC TUMOR LOC WH BODY,TWO/MORE DAY | $1,661 |
| Nuclear Medicine | 34100020 | HC ABCESS LOCALIZATION LIMITED | $976 |
| Nuclear Medicine | 34100021 | HC TC99M WBC NEUTROSPEC SPECT | $762 |
| Nuclear Medicine | 34100022 | HC MYOCARDIAL PERFUSION IMAGE, PLANAR | $2,122 |
| Nuclear Medicine | 34100023 | HC MYOCARDIAL IMAGING, INFARCT | $509 |
| Nuclear Medicine | 34100024 | HC MYOCARDIAL IMAGING SPECT, INFARCT | $762 |
| Nuclear Medicine | 34100025 | HC HEART MUGA | $1,533 |
| Nuclear Medicine | 34100026 | HC HEART STRESS MUGA | $1,880 |
| Nuclear Medicine | 34100027 | HC LUNG PERFUSION SCAN | $818 |
| Nuclear Medicine | 34100028 | HC LUNG VENTILATION AEROSAL | $920 |
| Nuclear Medicine | 34100029 | HC LUNG PERFUSION W VENTILATION | $1,730 |
| Nuclear Medicine | 34100030 | HC BRAIN SCAN | $741 |
| Nuclear Medicine | 34100031 | HC BRAIN SCAN W VASCULAR FLOW | $741 |
| Nuclear Medicine | 34100032 | HC CISTERNOGRAM | $1,584 |
| Nuclear Medicine | 34100033 | HC KIDNEY VASCULAR FLOW AND FUNCTION | $772 |
| Nuclear Medicine | 34100034 | HC SCROTAL FLOW-TESTICULAR | $581 |
| Nuclear Medicine | 34100035 | HC ABCESS LOCALIZATION WHOLE BODY | $1,584 |
| Nuclear Medicine | 34100036 | HC THYROID UPTAKE | $289 |
| Nuclear Medicine | 34100037 | HC THYROID SCAN AND UPTAKE | $1,009 |
| Nuclear Medicine | 34100038 | HC THYROID SCAN | $581 |
| Nuclear Medicine | 34100039 | HC TOTAL BODY IODINE SCAN | $1,078 |
| Nuclear Medicine | 34100040 | HC PARATHYROID SCAN | $796 |
| Nuclear Medicine | 34100041 | HC PLASMA VOLUME | $923 |
| Nuclear Medicine | 34100042 | HC RBC VOLUME(RED CELL MASS) | $1,158 |
| Nuclear Medicine | 34100043 | HC RBC SURVIVAL | $1,215 |
| Nuclear Medicine | 34100044 | HC LIVER SPLEEN SCAN | $761 |
| Nuclear Medicine | 34100045 | HC LIVER SPLEEN WITH FLOW | $1,396 |
| Nuclear Medicine | 34100046 | HC HIDA (GALLBLADDER) SCAN | $1,078 |
| Nuclear Medicine | 34100047 | HC GASTR0ESOPHAGEAL REFLUX | $772 |
| Nuclear Medicine | 34100048 | HC GASTRIC EMPTYING SCAN | $906 |
| Nuclear Medicine | 34100049 | HC MECKELS DIVERTICULUM SCAN | $819 |
| Nuclear Medicine | 34100050 | HC BONE SCAN LIMITED AREA | $767 |
| Nuclear Medicine | 34100051 | HC BONE SCAN MULTIPLE AREAS | $767 |
| Nuclear Medicine | 34100052 | HC BONE SCAN WHOLE BODY | $1,274 |
| Nuclear Medicine | 34100053 | HC BONE SCAN 3 PHASE | $1,652 |
| Nuclear Medicine | 34100054 | HC MYOCARDIAL PERFUSION IMAGE, SINGLE | $1,471 |
| Nuclear Medicine | 34100055 | HC MYOCARDIAL PERFUSION IMAGE, MULTI | $2,942 |
