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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | COMBINED MRI FOR TWO (2) AREAS IN ONE SETTING WITH CONTRAST | 240127 | 70540 | 3,600.00 | |||
0 | COMPLETE PELVIMETRY X-RAY | 59503-00[1981] | 240128 | 74710 | 390 | ||
0 | CORPORO CAVERNOSOGRAPHY | 240129 | 36522 | 3,840.00 | |||
0 | CSF LEAK | G69.0 | 240130 | 78650 | 1,680.00 | ||
0 | CSF SHUNT EVAL | 240131 | 62230 | 1,680.00 | |||
0 | CT - ABDOMEN | 56401-00[1962] | 240132 | 74150 | 1,000.00 | ||
0 | CT - ABDOMEN AND PELVIS | 56801-00[1961] | 240133 | 74150 | 2,200.00 | ||
0 | CT - ABDOMEN WITH CONTRAST | 56407-00[1962] | 240134 | 74160 | 1,400.00 | ||
0 | CT - ADRENALS WITH CONTRAST | 240135 | 72193 | 640 | |||
0 | CT - ANGIOGRAPHY | 240136 | 74175 | 2,400.00 | |||
0 | CT - ANKLE WITH / WITHOUT CONTRAST (UNILATERAL) | 56619-00[1965] | 240137 | 73700 | 640 | ||
0 | CT - ANY SCAN UNDER G.A. ADD. | 240138 | 74160 | 1,600.00 |
COMBINED MRI FOR TWO (2) AREAS IN ONE SETTING WITH CONTRAST
3,600.00
COMPLETE PELVIMETRY X-RAY
390
CORPORO CAVERNOSOGRAPHY
3,840.00
CSF LEAK
1,680.00
CSF SHUNT EVAL
1,680.00
CT - ABDOMEN
1,000.00
CT - ABDOMEN AND PELVIS
2,200.00
CT - ABDOMEN WITH CONTRAST
1,400.00
CT - ADRENALS WITH CONTRAST
640
CT - ANGIOGRAPHY
2,400.00
CT - ANKLE WITH / WITHOUT CONTRAST (UNILATERAL)
640
CT - ANY SCAN UNDER G.A. ADD.
1,600.00
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