Standard Charge Information Augusta

Service Charge Description Code          CDM      3/1/2023 Rate

  • Room & Board   11100001             HC R&B - PRIVATE            $853
  • Room & Board   11900001             HC R&B - SWING BED PRIVATE   $662
  • Room & Board   20600001             HC R&B - TELEMETRY      $1,430
  • Room & Board   12100001             HC R&B - SEMIPRIVATE $853
  • Room & Board   17000001             HC R&B - WELL BABY      $648
  • Room & Board   17100001             HC R&B - NURSERY LVL 1               $978
  • Room & Board   17200001             HC R&B - NURSERY LVL 2               $1,317
  • Room & Board   17300001             HC R&B - NURSERY LVL 3               $1,761
  • Room & Board   17400001             HC R&B - NURSERY LVL 4               $2,389
  • Room & Board   20000001             HC R&B - ICU      $2,314
  • Room & Board   21000001             HC R&B - CCU    $2,389
  • Room & Board   21400001             HC R&B - PCU    $1,910
  • Supplements     25000042             HC ENSURE CLEAR            $7
  • Supplements     25000043             HC ENSURE ENLIVE          $4
  • Supplements     25000044             HC ENSURE COMPACT   $1
  • Supplements     25000045             HC JEVITY 1.5-LITER         $7
  • Supplements     25000046             HC JEVITY 1.5-CAN           $4
  • Supplements     25000047             HC SUPLENA (CANS)       $4
  • Supplements     25000048             HC GELATEIN 20                $5
  • Supplements     25000003             HC NEPRO (CANS)            $4
  • Supplements     25000004             HC PULMOCARE/CAN    $7
  • Supplements     25000005             HC GLUCERNA 1.5 CAN  $4
  • Supplements     25000007             HC GLUCERNA 1.5 LITER $14
  • Supplements     25000008             HC PULMOCARE/LITER  $31
  • Supplements     25000010             HC GREAT SHAKES           $1
  • Supplements     25000011             HC JEVITY 1.2-LITER         $7
  • Supplements     25000012             HC JEVITY 1.2-CAN           $7
  • Supplements     25000014             HC NUTRIHEP-TF (CANS)               $22
  • Supplements     25000015             HC GLUCERNA SHAKES (CANS)   $4
  • Supplements     25000018             HC NEPRO (LITER)            $11
  • Supplements     25000021             HC ENTERAL SUPPLEMENT (OLD NAME JUVEN)  $8
  • Supplements     25000022             HC MCT OIL TABLESPOON            $5
  • Supplements     25000023             HC OSMOLITE 1 CAL 8 OZ CAN    $4
  • Supplements     25000024             HC OSMOLITE 1 CAL LITER            $7
  • Supplements     25000026             HC POLYCOSE 1 TABLESPOON     $4
  • Supplements     25000028             HC TWOCAL HN 8 OZ CAN            $4
  • Supplements     25000029             HC TWOCAL HN LITER     $5
  • Supplements     25000030             HC JUICE NUTRITIONAL 206         $14
  • Supplements     25000031             HC FIBERBASICS $5
  • Supplements     25000033             HC ENSURE PLUS              $4
  • Supplements     25000034             HC MAGIC CUPS MEAL REPLACEMENT    $5
  • Supplements     25000036             HC PROSOURCE PLUS LIQUID PROTEIN   $7
  • Supplements     25000037             HC BODY QUEST PROTEIN SUPPLEMENT $5
  • Supplements     25000038             HC NUTRITIONAL SUPP VITAL 1.2 CAN    $12
  • Supplements     25000039             HC NUTRITIONAL SUPP VITAL 1.2 LTR      $36
  • Supplements     25000041             HC ENSURE (CANS)          $4
  • Supplements     25000049             HC CORE POWER ELITE HI PROT MILKSHAKE         $7
  • Supplements     25000050             HC ENSURE CLEAR NUTRITION DRINK (PRE-SURGERY)      $4
  • Supplements     25000051             HC VITAL HIGH PROTEIN CAN      $12
  • Supplements     25000052             HC VITAL HIGH PROTEIN LTR        $36
  • Supplements     25000053             HC PREMIER PROTEIN BOTTLE (SUMMERVILLE ONLY)      $7
  • Supplements     25000054             HC ENSURE SURGERY : IMMUNONUTRITION SHAKE         $3
  • Supplements     25000055             HC ENSURE MAX PROTEIN  (SUMMERVILLE ONLY)             $7
  • Radiopharm Drugs           25500001             HC RADIONUCLIDE SESTAMIBI   $495
  • Radiopharm Drugs           25500003             HC RADIONUCLIDE TETROFOSMIN           $560
  • Radiopharm Drugs           25500004             HC RADIONUCLIDE THALLIUM    $643
  • Radiopharm Drugs           25500005             HC RADIONUCLIDE PROSTASCINT             $7,551
  • Radiopharm Drugs           25500006             HC RADIONUCLIDE NEOTECT       $4,510
  • Radiopharm Drugs           25500007             HC RADIONUCLIDE CHOLETEC     $217
  • Radiopharm Drugs           25500008             HC RADIONUCLIDE ALBUMIN MAA          $324
  • Radiopharm Drugs           25500009             HC RADIONUCLIDE TC99M SULFUR COLL                $324
  • Radiopharm Drugs           25500010             HC RADIONUCLIDE INDIUM III OXINE      $4,162
  • Radiopharm Drugs           25500011             HC RADIONUCLIDE INDIUM 111 DPTA     $2,900
  • Radiopharm Drugs           25500012             HC RADIONUCLIDE FDG/DOSE 4-40 MCI $1,385
  • Radiopharm Drugs           25500013             HC RADIONUCLIDE RCM/CR 51   $1,685
  • Radiopharm Drugs           25500014             HC RADIONUCLIDE PV/I 125         $799
  • Radiopharm Drugs           25500015             HC RADIONUCLIDE GALLIUM      $495
  • Radiopharm Drugs           25500016             HC RADIONUCLIDE TC99M LABELED RBC                $392
  • Radiopharm Drugs           25500017             HC RADIONUCLIDE RENAL MAG 3              $598
  • Radiopharm Drugs           25500018             HC RADIONUCLIDE TC99 / NEUTROSPEC $3,983
  • Radiopharm Drugs           25500019             HC RADIONUCLIDE TC HMPAO   $2,568
  • Radiopharm Drugs           25500020             HC RADIONUCLIDE IN 111 OCTREOTIDE  $8,735
  • Radiopharm Drugs           25500023             HC RADIONUCLIDE SESTAMIBI   $495
  • Radiopharm Drugs           25500024             HC RADIONUCLIDE TC99M TETROFOSMIN            $560
  • Radiopharm Drugs           25500025             HC RADIONUCLIDE THALLIUM    $643
  • Radiopharm Drugs           25500026             HC RADIONUCLIDE TC99M ULTRATAG LABELED RBC         $392
  • Radiopharm Drugs           25500027             HC RADIONUCLIDE TC99M PENTETATE =< 25 MCI              $217
  • Radiopharm Drugs           25500028             HC RADIONUCLIDE I131 PER 1 UCI TO 100 UCI     $217
  • Radiopharm Drugs           25500029             HC RADIONUCLIDE IODINE I-131 IODIDE CAP DX PER 1 MCI            $217
  • Radiopharm Drugs           25500036             HC RADIONUCLIDE TC99M ULTRATAG LABELED RBC         $392
  • Radiopharm Drugs           25500039             HC RADIONUCLIDE TC99M PYROPHOSPHATE =<25 MCI   $473
  • IV Therapy          26000026             HC HYDRATION INFUSION EACH ADDL HOUR       $95
  • IV Therapy          26000027             HC THERAP INFUSION INITIAL HOUR        $437
  • IV Therapy          26000028             HC THERAP INFUSION EACH ADDL HOUR               $95
  • IV Therapy          26000029             HC INFUSION ADDL SEQUENTIAL HOUR  $95
  • IV Therapy          26000030             HC TX/PRO/DX INJ SAME DRUG ADDON $255
  • IV Therapy          26000031             HC THER/DIAG CONCURRENT INF             $95
  • IV Therapy          26000034             HC THER/DIAG CONCURRENT INF - ER     $95
  • IV Therapy          26000035             HC TX/PRO/DX INJ SAME DRUG ADDON - ER         $255
  • IV Therapy          26000001             HC PICC LINE INSERTION               $2,835
  • IV Therapy          26000002             HC PICC LINE REPLACEMENT       $2,835
  • IV Therapy          26000003             HC DECLOT VASCULAR DEVICE   $540
  • IV Therapy          26000005             HC REFILL IMPLANT PUMP/RESERVOIR   $356
  • IV Therapy          26000006             HC HYDRATION INFUSION INITIAL HOUR $437
  • IV Therapy          26000007             HC HYDRATION INFUSION EACH ADDL HOUR       $95
  • IV Therapy          26000008             HC INFUSION INITIAL HOUR        $437
  • IV Therapy          26000009             HC INFUSION EACH ADDL HOUR $95
  • IV Therapy          26000010             HC INFUSION ADDL SEQUENTIAL HOUR  $109
  • IV Therapy          26000011             HC IV TX- INITIATION IV ACCESS $85
  • IV Therapy          26000012             HC MIDLINE CATHETER INSERTION           $159
  • IV Therapy          26000013             HC IVAD ACCESS               $65
  • IV Therapy          26000014             HC THER/DIAG CONCURRENT INF             $95
  • IV Therapy          26000015             HC TX/PRO/DX INJ SAME DRUG ADDON $255
  • IV Therapy          26000016             HC IV TX- INITIATION IV ACCESS $85
  • IV Therapy          26000017             HC MIDLINE CATHETER INSERTION           $159
  • IV Therapy          26000022             HC DECLOT VASCULAR DEVICE   $340
  • IV Therapy          26000023             HC IVAD ACCESS               $65
  • IV Therapy          26000024             HC DECLOT VASCULAR DEVICE   $340
  • IV Therapy          26000025             HC HYDRATION INFUSION INITIAL HOUR $437
  • Laboratory          30000058             HC LBA COLLECTION FEE (UHMC)              $109
  • Laboratory          30000001             HC VENIPUNCTURE ROUTINE      $24
  • Laboratory          30000052             HC BLOOD COLLECTION FROM PORT       $198
  • Laboratory          30000053             HC COLLECT BLOOD FROM PICC $93
  • Laboratory          30000078             HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT      $34
  • Laboratory          30100001             HC ALCOHOL BREATH TEST INITIAL           $138
  • Laboratory          30200129             HC TB INTRADERMAL TEST           $31
  • Diagnostic Radiology Imaging      32000407             HC SCOLIOSIS/THORACOLUMBAR STAND 2-3 VIEWS         $630
  • Diagnostic Radiology Imaging      32000408             HC SCOLIOSIS/THORACOLUMBAR STAND 4-5 VIEWS         $738
  • Diagnostic Radiology Imaging      32000409             HC SCOLIOSIS/THORACOLUMBAR MIN 6 VIEWS (INCL. SUPINE & STAND) $846
  • Diagnostic Radiology Imaging      32000410             HC HIP UNILAT W PELVIS MINIMUM 4 VIEWS      $628
  • Diagnostic Radiology Imaging      32000413             HC FEMUR AP/LATERAL MIN 2 VIEWS     $509
  • Diagnostic Radiology Imaging      32000414             HC GASTRIC EMPTYING IMAG STDY W SM BOWEL TRANSIT           $598
  • Diagnostic Radiology Imaging      32000415             HC GASTRIC EMPTYING IMAG STDY W SM BOWEL & COLON TRANSIT                $792
  • Diagnostic Radiology Imaging      32000420             HC PELVIS / HIPS,INFANT MIN 5 VIEWS BILAT       $756
  • Diagnostic Radiology Imaging      36000732             HC MYELOGRAPHY VIA LUMBAR INJ, CERVICAL   $2,790
  • Diagnostic Radiology Imaging      32000001             HC CISTERNOGRAPHY    $963
  • Diagnostic Radiology Imaging      32000002             HC EYE FOREIGN BODY DETECTION           $963
  • Diagnostic Radiology Imaging      32000003             HC MANDIBLE < 4 VIEWS              $335
  • Diagnostic Radiology Imaging      32000004             HC MANDIBLE MINIMUM 4 VIEWS           $414
  • Diagnostic Radiology Imaging      32000005             HC MASTOIDS COMPLETE             $522
  • Diagnostic Radiology Imaging      32000006             HC INTERNAL AUDITORY CANAL $522
  • Diagnostic Radiology Imaging      32000007             HC FACIAL BONES < THREE VIEWS             $329
  • Diagnostic Radiology Imaging      32000008             HC FACIAL BONES, MINIMUM 3 VIEWS   $695
  • Diagnostic Radiology Imaging      32000009             HC NASAL BONES MINIMUM 3 VIEWS     $323
  • Diagnostic Radiology Imaging      32000010             HC OPTIC FORAMINA     $454
  • Diagnostic Radiology Imaging      32000011             HC ORBITS MINIMUM 4 VIEWS  $489
  • Diagnostic Radiology Imaging      32000012             HC SINUSES <3 VIEWS    $529
  • Diagnostic Radiology Imaging      32000013             HC SINUSES MINIMUM 3 VIEWS $695
  • Diagnostic Radiology Imaging      32000014             HC SELLA TURCIA             $377
  • Diagnostic Radiology Imaging      32000015             HC SKULL LESS THAN FOUR VIEWS            $529
  • Diagnostic Radiology Imaging      32000016             HC SKULLS MINIMUM 4 VIEWS   $695
  • Diagnostic Radiology Imaging      32000017             HC TEMPEROMANDIBULAR JOINTS          $522
  • Diagnostic Radiology Imaging      32000018             HC PANOREX/ORTHOPANTOGRAM          $197
  • Diagnostic Radiology Imaging      32000019             HC NECK FOR SOFT TISSUE           $273
  • Diagnostic Radiology Imaging      32000020             HC PHARYNX AND LARYNX W FLUORO    $427
  • Diagnostic Radiology Imaging      32000022             HC PORTABLE CHEST FRONTAL SINGLE VIEW        $325
  • Diagnostic Radiology Imaging      32000023             HC XRAY EXAM CHEST 2 VIEWS  $329
  • Diagnostic Radiology Imaging      32000024             HC XRAY EXAM CHEST 3 VIEWS  $439
  • Diagnostic Radiology Imaging      32000026             HC CHEST 2 VIEWS W/FLUORO  $520
  • Diagnostic Radiology Imaging      32000027             HC XRAY CHEST 4+ VIEWS             $481
  • Diagnostic Radiology Imaging      32000028             HC CHEST 4 OR MORE VIEWS W/FLUORO              $605
  • Diagnostic Radiology Imaging      32000031             HC RIBS-UNILATERAL     $431
  • Diagnostic Radiology Imaging      32000032             HC RIBS-UNI W PA CHEST              $608
  • Diagnostic Radiology Imaging      32000033             HC RIBS-BILATERAL         $431
  • Diagnostic Radiology Imaging      32000034             HC RIBS-BIL W PA CHEST               $791
  • Diagnostic Radiology Imaging      32000035             HC STERNUM MINIMUM 2 VIEWS             $394
  • Diagnostic Radiology Imaging      32000036             HC STERNOCLAVICULAR JOINTS 3 VIEW  $466
  • Diagnostic Radiology Imaging      32000037             HC SPINE ENTIRE AP/LAT              $779
  • Diagnostic Radiology Imaging      32000038             HC CERVICAL SPINE,SINGLE VIEW              $333
  • Diagnostic Radiology Imaging      32000039             HC SPINE SINGLE VIEW  $369
  • Diagnostic Radiology Imaging      32000040             HC CERVICAL SPINE 2-3 VIEWS   $435
  • Diagnostic Radiology Imaging      32000041             HC CERVICAL SPINE,MINIMUM 4 VIEWS $609
  • Diagnostic Radiology Imaging      32000042             HC CERVICAL SPINE WITH FLEX/EXTEN    $745
  • Diagnostic Radiology Imaging      32000043             HC SCOLIOSIS/THORACOLUMBAR 1 VIEW (INCL SUPINE & STAND)                $522
  • Diagnostic Radiology Imaging      32000044             HC THORACIC SPINE AP AND LAT               $576
  • Diagnostic Radiology Imaging      32000045             HC THORACOLUMBAR AP / LATERAL        $576
  • Diagnostic Radiology Imaging      32000046             HC SCOLIOSIS SERIES SUPINE/ERECT        $922
  • Diagnostic Radiology Imaging      32000047             HC LUMBAR SPINE AP / LATERAL               $570
  • Diagnostic Radiology Imaging      32000048             HC LUMBAR SPINE COMPLETE W OBL      $791
  • Diagnostic Radiology Imaging      32000049             HC LUMBAR SPINE COMPLETE W BENDIN              $922
  • Diagnostic Radiology Imaging      32000050             HC LUMBAR BENDING ONLY, MINIMUM 4            $576
  • Diagnostic Radiology Imaging      32000051             HC PELVIS AP     $398
  • Diagnostic Radiology Imaging      32000052             HC PELVIS MINIMUM 3 VIEWS    $691
  • Diagnostic Radiology Imaging      32000053             HC SACRO-ILIAC JOINTS 3 VIEWS               $454
  • Diagnostic Radiology Imaging      32000054             HC SACRUM OR COCCYX 2 VIEWS              $454
  • Diagnostic Radiology Imaging      32000060             HC PERQ VERTEBROPLASTY, CERVICOTHORACIC $4,626
  • Diagnostic Radiology Imaging      32000061             HC DISCOGRAPHY, LUMBAR        $3,077
  • Diagnostic Radiology Imaging      32000062             HC CLAVICLE COMPLETE                $475
  • Diagnostic Radiology Imaging      32000063             HC CLAVICLE, BILATERAL               $930
  • Diagnostic Radiology Imaging      32000064             HC SCAPULA COMPLETE $394
  • Diagnostic Radiology Imaging      32000065             HC SCAPULA, BILATERAL               $892
  • Diagnostic Radiology Imaging      32000066             HC SHOULDER ONE VIEW             $333
  • Diagnostic Radiology Imaging      32000067             HC SHOULDER, ONE VIEW BILATERAL      $655
  • Diagnostic Radiology Imaging      32000068             HC SHOULDER 2 VIEWS $479
  • Diagnostic Radiology Imaging      32000069             HC SHOULDER TWO VIEWS, BILATERAL   $941
  • Diagnostic Radiology Imaging      32000070             HC ACROMIO-CLAVICULAR JOINTS           $424
  • Diagnostic Radiology Imaging      32000071             HC HUMERUS MINIMUM 2 VIEWS            $369
  • Diagnostic Radiology Imaging      32000072             HC HUMERUS, BILATERAL             $720
  • Diagnostic Radiology Imaging      32000073             HC ELBOW AP / LATERAL               $333
  • Diagnostic Radiology Imaging      32000074             HC ELBOW, TWO VIEWS BILATERAL          $655
  • Diagnostic Radiology Imaging      32000075             HC ELBOW,MINIMUM 3 VIEWS  $369
  • Diagnostic Radiology Imaging      32000076             HC ELBOW, THREE VIEWS BILATERAL       $720
  • Diagnostic Radiology Imaging      32000077             HC FOREARM AP / LATERAL         $369
  • Diagnostic Radiology Imaging      32000078             HC FOREARM, BILATERAL             $720
  • Diagnostic Radiology Imaging      32000079             HC UPPER EXTREMITY INFANT    $333
  • Diagnostic Radiology Imaging      32000080             HC UPPER EXTREMITY INFANT BILATERAL              $655
  • Diagnostic Radiology Imaging      32000081             HC WRIST MINIMUM 2 VIEWS    $333
  • Diagnostic Radiology Imaging      32000082             HC WRIST TWO VIEWS, BILATERAL            $655
  • Diagnostic Radiology Imaging      32000083             HC WRIST MINIMUM 3 VIEWS    $369
  • Diagnostic Radiology Imaging      32000084             HC WRIST, THREE VIEWS BILATERAL         $720
  • Diagnostic Radiology Imaging      32000085             HC HAND 2 VIEWS           $333
  • Diagnostic Radiology Imaging      32000086             HC HAND, TWO VIEW BILATERAL               $655
  • Diagnostic Radiology Imaging      32000087             HC HAND MINIMUM 3 VIEWS     $369
  • Diagnostic Radiology Imaging      32000088             HC HAND, THREE VIEW BILATERAL            $720
  • Diagnostic Radiology Imaging      32000089             HC FINGER(S) MINIMUM 2 VIEWS             $316
  • Diagnostic Radiology Imaging      32000090             HC HIP UNILATERAL  1 VIEW        $398
  • Diagnostic Radiology Imaging      32000091             HC HIP UNILAT COMPLETE MIN 2 VIEWS $513
  • Diagnostic Radiology Imaging      32000092             HC HIPS BILAT & PELVIS MIN 2 VIEWS     $564
  • Diagnostic Radiology Imaging      32000093             HC PELVIS AND BILAT HIPS 2 VIEWS         $691
  • Diagnostic Radiology Imaging      32000094             HC ARTHROGRAM HIP   $911
  • Diagnostic Radiology Imaging      32000095             HC HIP 1 VIEW/OR           $513
  • Diagnostic Radiology Imaging      32000096             HC PELVIS / HIPS,INFANT MIN 2 VIEWS BILAT       $369
  • Diagnostic Radiology Imaging      32000098             HC FEMUR AP / LATERAL 1 VIEW               $394
  • Diagnostic Radiology Imaging      32000099             HC FEMUR, BILATERAL 2 or > VIEWS        $767
  • Diagnostic Radiology Imaging      32000100             HC XRAY KNEE 1 OR 2 VIEWS       $369
  • Diagnostic Radiology Imaging      32000101             HC XRAY KNEE 1 OR 2 VIEWS       $720
  • Diagnostic Radiology Imaging      32000102             HC KNEE MINIMUM 3 VIEWS      $433
  • Diagnostic Radiology Imaging      32000103             HC KNEE, THREE VIEWS BILATERAL           $853
  • Diagnostic Radiology Imaging      32000104             HC KNEE TUNNEL/PATELLAR/STANDING $433
  • Diagnostic Radiology Imaging      32000105             HC KNEE COMPLETE W/MULTI VIEWS     $502
  • Diagnostic Radiology Imaging      32000106             HC KNEE, MULTI VIEW BILATERAL             $977
  • Diagnostic Radiology Imaging      32000107             HC KNEES STANDING AP               $369
  • Diagnostic Radiology Imaging      32000108             HC TIBIA/FIBULA AP / LATERAL   $369
  • Diagnostic Radiology Imaging      32000109             HC TIBIA/FIBULA, BILATERAL       $720
  • Diagnostic Radiology Imaging      32000110             HC LOWER EXTREMITY,INFANT 2V            $333
  • Diagnostic Radiology Imaging      32000111             HC LOWER EXTREMITY,INFANT 2V BILATERAL      $655
  • Diagnostic Radiology Imaging      32000112             HC ANKLE 2 VIEWS          $333
  • Diagnostic Radiology Imaging      32000113             HC ANKLE, TWO VIEWS BILATERAL           $655
  • Diagnostic Radiology Imaging      32000114             HC ANKLE 3 VIEWS          $369
  • Diagnostic Radiology Imaging      32000115             HC ANKLE, THREE VIEWS BILATERAL         $720
  • Diagnostic Radiology Imaging      32000116             HC FOOT 2 VIEWS            $333
  • Diagnostic Radiology Imaging      32000117             HC FOOT, TWO VIEWS BILATERAL             $655
  • Diagnostic Radiology Imaging      32000118             HC FOOT MINIMUM 3 VIEWS      $369
  • Diagnostic Radiology Imaging      32000119             HC FOOT, THREE VIEWS BILATERAL          $720
  • Diagnostic Radiology Imaging      32000120             HC CALCANEOUS/OS CAL.MIN.2 VIEW    $333
  • Diagnostic Radiology Imaging      32000121             HC CALCANEOUS/OS CALCIS BILATERAL $655
  • Diagnostic Radiology Imaging      32000122             HC TOES MINIMUM 2 VIEWS       $344
  • Diagnostic Radiology Imaging      32000123             HC TOES, BILATERAL       $655
  • Diagnostic Radiology Imaging      32000124             HC XRAY EXAM ABDOMEN 1 VIEW            $273
  • Diagnostic Radiology Imaging      32000126             HC XRAY ABDOMEN 2 VIEWS      $495
  • Diagnostic Radiology Imaging      32000127             HC XRAY ABDOMEN 3+ VIEWS    $520
  • Diagnostic Radiology Imaging      32000128             HC ABDOMEN SERIES W PA CHEST            $748
  • Diagnostic Radiology Imaging      32000129             HC ESOPHAGUS,BARIUM SWALLOW        $648
  • Diagnostic Radiology Imaging      32000130             HC XRAY XM UPR GI TRC 1CNTRST            $1,519
  • Diagnostic Radiology Imaging      32000131             HC XRAY SM INTEST F-THRU STUDY          $1,137
  • Diagnostic Radiology Imaging      32000132             HC XRAY XM UPR GI TRC 2CNTRST            $1,137
  • Diagnostic Radiology Imaging      32000134             HC SMALL BOWEL SERIES              $707
  • Diagnostic Radiology Imaging      32000135             HC SMALL BOWEL SERIES ENTEROCLYSIS               $1,494
  • Diagnostic Radiology Imaging      32000136             HC COLON,BARIUM ENEMA        $1,139
  • Diagnostic Radiology Imaging      32000137             HC COLON,BARIUM AIR CONTRAST          $1,305
  • Diagnostic Radiology Imaging      32000138             HC THERAPEUTIC ENEMA             $1,231
  • Diagnostic Radiology Imaging      32000139             HC GALLBLADDER SERIES              $555
  • Diagnostic Radiology Imaging      32000141             HC OR CHOLANGIOGRAM            $285
  • Diagnostic Radiology Imaging      32000142             HC OR CHOLANGIOGRAM ADDTNL SET   $285
  • Diagnostic Radiology Imaging      32000145             HC BILIARY STONE RETREIVAL OR REMOVAL         $533
  • Diagnostic Radiology Imaging      32000146             HC ERCP/BILIARY              $822
  • Diagnostic Radiology Imaging      32000146             HC ERCP BILIARY (REDUCED SVC)              $822
  • Diagnostic Radiology Imaging      32000147             HC ERCP/PANCREATIC   $822
  • Diagnostic Radiology Imaging      32000147             HC ERCP PANCREATIC (REDUCED SVC)    $822
  • Diagnostic Radiology Imaging      32000148             HC ERCP/BILIARY / PANCREATIC $822
  • Diagnostic Radiology Imaging      32000148             HC ERCP BILIARY/PANCR REDUCED SVC  $822
  • Diagnostic Radiology Imaging      32000149             HC GI TUBE PLACEMENT WITH FLUOROSCOPY    $555
  • Diagnostic Radiology Imaging      32000150             HC PERC PLACEMENT ENTEROCLYSIS TUBE            $571
  • Diagnostic Radiology Imaging      32000151             HC ESOPHAGEAL DILATION          $822
  • Diagnostic Radiology Imaging      32000152             HC ARTHROGRAM TMJ  $564
  • Diagnostic Radiology Imaging      32000153             HC TRANSHEPATIC DUCT DILATION          $910
  • Diagnostic Radiology Imaging      32000154             HC INTRAVENOUS PYELOGRAM $868
  • Diagnostic Radiology Imaging      32000155             HC RETRO PYELOGRAM UNILATERAL       $702
  • Diagnostic Radiology Imaging      32000156             HC UROGRAPHY, ANTEGRADE    $431
  • Diagnostic Radiology Imaging      32000157             HC VASOGRAM/OR         $471
  • Diagnostic Radiology Imaging      32000158             HC CYSTOGRAM/RETROGRADE URETHROGRAM $589
  • Diagnostic Radiology Imaging      32000159             HC RENAL CYST STUDY TRANSLUMBAR  $571
  • Diagnostic Radiology Imaging      32000161             HC PELVIMETRY $427
  • Diagnostic Radiology Imaging      32000162             HC VAGINOGRAM/PERINEOGRAM           $512
  • Diagnostic Radiology Imaging      32000163             HC THORACIC AORTOGRAM WO SERIALOGRAPHY             $3,729
  • Diagnostic Radiology Imaging      32000164             HC THORACIC AORTOGRAM        $3,729
  • Diagnostic Radiology Imaging      32000165             HC ABDOMINAL AORTOGRAM   $3,729
  • Diagnostic Radiology Imaging      32000166             HC ABDOMINAL ART W/FEMORAL RUNOFF          $3,729
  • Diagnostic Radiology Imaging      32000176             HC SELECTIVE SPINAL ANGIOGRAM         $3,599
  • Diagnostic Radiology Imaging      32000177             HC EXTREMITY ANGIOGRAM UNILATERAL             $3,765
  • Diagnostic Radiology Imaging      32000178             HC ARTERIOGRAM EXTREMITIES BILAT   $3,599
  • Diagnostic Radiology Imaging      32000181             HC VISCERAL SELECTIVE SINGLE VES.        $3,599
  • Diagnostic Radiology Imaging      32000182             HC ADRENAL SELECTIVE UNILATERAL      $3,599
  • Diagnostic Radiology Imaging      32000183             HC ADRENAL SELECTIVE BILATERAL          $3,599
  • Diagnostic Radiology Imaging      32000184             HC PELVIC ANGIOGRAM $3,599
  • Diagnostic Radiology Imaging      32000185             HC PULMONARY ANGIOGRAM UNILATERAL         $3,729
  • Diagnostic Radiology Imaging      32000186             HC PULMONARY ANGIOGRAM BILATERAL             $3,729
  • Diagnostic Radiology Imaging      32000187             HC ANGIOGRAPHY PULM NON-SELECTIVE             $2,206
  • Diagnostic Radiology Imaging      32000188             HC INTERNAL MAMMARY ANGIOGRAM $2,537
  • Diagnostic Radiology Imaging      32000189             HC ANGIO SELECTIVE ADDITIONAL VESSEL            $2,241
  • Diagnostic Radiology Imaging      32000190             HC ANGIOGRAPHY, AV SHUNT   $1,798

See Part 2