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185.00 254.00 00013 Bentso PROC DESCRIPTION CHARGE OUTPT_FEE OVCH_FEE NOTE 00009 SHORT SHEATH 82.00 - 00012 AMPLATZ WIRE (ALL) 185.00 254.00 00013 BENTSON GUIDEWIRE 82.00 - 00014 EXCHANGE GUIDEWIRE 297.00 684.00 00015 GLIDEWIRE 185.00 199.00 00016 GUIDEWIRE PTCA CHOICE 396.00 835.00 00017 J GUIDEWIRE 56.00 - 00018 LONG GLIDEWIRE 380.00 262.00 00019 ROSEN GUIDEWIRE 529.00 365.00 00020 NANOCROSS BLN CATH 663.00 1,250.00 00029 EVERCROSS BLN CATH 659.00 455.00 00030 EYE FOREIGN BODY 257.00 257.00 00031 FB NOSE-RECTUM CHILD 1V 257.00 257.00 00110 MANDIBLE MIN 4V 408.00 408.00 00130 MASTOIDS MIN 3V 257.00 257.00 00140 FACIAL < 3V 257.00 257.00 00150 FACIAL MIN 3V 408.00 408.00 00160 NASAL MIN 3V 257.00 257.00 00190 OPTIC FORAMINA 257.00 257.00 001KXREHAB REHAB THERAPY CAP_KX MOD 0.02 00200 ORBITS MIN 4V 257.00 257.00 00211 SINUSES <3V 257.00 257.00 00220 SINUSES MIN 3V 257.00 257.00 00240 SELLA TURCICA 257.00 257.00 00250 SKULL < 4V 257.00 257.00 00260 SKULL MIN 4V 408.00 408.00 00330 TMJS OPEN & CLOSED 257.00 257.00 00360 NECK SOFT TISSUE 257.00 257.00 00380 SALIVARY GLAND CALCULUS 257.00 257.00 0090177 LAMOTRIGINE 9.17 9.17 0090213 MYCOPHENOLIC ACID 32.00 93.00 0098841 CAMPYLOBACTER JEJUNI IgG 113.90 90.00 01010 CHEST AP 257.00 257.00 01011 CHEST-EMPLOYEE-HOSP - 01013 RADIOLOGY EXAM - SAVIERS - 01015 RADIOLOGY EXAM - FILLMORE - 01016 RADIOLOGY EXAM - SANTA PAULA - 01020 CHEST AP AND LAT 257.00 257.00 01021 CHEST AP/LAT/APICAL LORDOTIC 257.00 257.00 01030 CHEST MIN 4V 408.00 408.00 01060 BRONCHOGRAPHY BILAT 287.00 287.00 01082 CRYOABLATION PROBE 9,857.00 9,857.00 01084 TIPPS KIT WITH GUIDEWIRE 3,425.00 2,363.00 01088 EXCHANGE WIRE 014 609.00 420.00 01090 PACER INSERT TEMP-HOSP 3,641.00 3,641.00 01091 PACER INSERT PERM HOSP 6,043.00 6,043.00 01092 GASTRO GJ CATHETER 2,692.00 2,692.00 01094 VEREBROPLASTY INJ EA LEVEL 25,004.00 25,004.00 01095 ACRYLIC RESIN 932.00 643.00 01096 BONE CEMENT PER 5CC 746.00 746.00 01097 DELIVERY SYSTEM KIT 3,380.00 2,332.00 01100 RIBS RT W PA CHEST MIN 3V 408.00 408.00 01103 ROTOWIRE 1,060.00 731.00 01104 QUADRIPOLAR CATHETHER 1,124.00 776.00 01105 DECAPOLAR/CSL 3,412.00 2,354.00 01108 DUO/TRIO SHEATH 301.00 208.00 01109 EP GUIDING CATHETHER 3,959.00 2,732.00 01110 RIBS LT W PA CHEST MIN 3V 408.00 408.00 01111 ABLATION CATHETHER CONDUCTOR 5,408.00 3,732.00 01113 ABLATION CATHETHER RF MARINRC 4,917.00 3,393.00 01114 ROTOBLADER ATHERECTOMY CATH 16,557.00 01115 VASCULAR CLOSURE DEVICE 1,453.00 1,453.00 01116 KYPHOPAC TRAY W CEMENT 5CC 19,754.00 19,754.00 01120 STERNUM MIN 2V 257.00 257.00 01121 NITROUS OXIDE CATRIDGE 313.00 216.00 01130 STERNOCLAVICULAR JNT(S) MIN 3V 543.00 257.00 01139 REP SGL LEAD; SGL CHMB PM/AICD 9,122.00 9,122.00 01143 REM LEAD-SGL LEAD SYSTEM 9,122.00 9,122.00 01144 REM LEAD-DUAL LEAD SYSTEM 9,122.00 9,122.00 01150 ILIAC FEMORAL ANGIO WCARD CATH 4,464.00 4,464.00 01152 VENOGRAPHY SUP VC 3,631.00 3,709.00 01153 ANG INTRAVASC STENT INITIAL 24,381.00 24,381.00 01154 ANG INTRAVASC STENT EA ADDL 24,381.00 24,381.00 01156 INS TUNNELED CVC CATH <5 YRS 8,072.00 8,072.00 01157 INS TUNNELED CVC CATH >5 YRS 8,072.00 8,072.00 01158 INS NON-TUNNEL CVC CATH <5 YRS 3,129.00 3,129.00 01159 INS NON-TUNNEL CVC CATH >5 YRS 3,129.00 3,129.00 01160 INS PICC LINE <5 YRS 3,129.00 3,129.00 01161 INS PICC LINE >5 YRS 3,129.00 3,129.00 01162 EMBOLIZATION RENAL 31,319.00 31,319.00 01163 EMBOLIZATION LIVER 31,319.00 31,319.00 01164 KYPHOPLASTY EA ADD THOR/LUM 25,609.00 25,609.00 01165 KYPHOPLASTY INITIAL LUMBAR 25,609.00 25,609.00 01166 BONE MARROW BIOPSY 856.00 856.00 01167 BUNDLE OF HIS RECORDING 3,515.00 3,383.00 01168 INTRA-ATRIAL RECORDING 11,715.00 11,715.00 01170 INTRA-ATRIAL PACING 11,715.00 11,715.00 01172 EPS 3 D MAPPING 11,715.00 11,715.00 01176 COMP EP W ARRHYTHMIA INDUCT 12,208.00 12,208.00 01177 COMP EP W/L ATRIAL PACE/RECORD 12,208.00 12,208.00 01178 COMP EP W/L VENT PACE/RECORD 12,208.00 12,208.00 01179 ELECTROPHYSIOLOGY F/U STUDY 12,208.00 12,208.00 01180 EP EVAL OF AICD W PROG/REPROG 3,523.00 3,523.00 01190 PERC CORONARY THROMBECTOMY 13,439.00 13,439.00 01191 PERC THROMBECTOMY AV FISTULA 11,532.00 11,532.00 01192 INTRAVASC CORON U/S ADDL VES 11,497.00 11,497.00 01193 GUIDING CATHETER 264.00 182.00 011931 MAPPING EPCATH PATHFINDR 5,000.00 3,450.00 01194 REMOVE CVA DEVICE OBSTRUCTION 605.00 605.00 01195 MECH REMOV TUNNELED CV CATH 8,072.00 8,072.00 01196 PERC NEPHROSTOMY TUBE PLACE 6,846.00 6,846.00 01197 PERC NEPHROSTOMY TUBE S&I - 3,783.00 01198 CHG NEPHROSTOMY TUBE 2,664.00 2,664.00 01200 FRONTRUNNER 90CM CATHETER 5,946.00 4,103.00 01202 OUTBACK LTD OCCLUSION CATH 11,547.00 01203 FRONTRUNNER 140CM CATHETER 5,946.00 4,103.00 01205 THROMBOLYSIS CENTRAL VENOUS 743.00 743.00 01217 IVUS CORONARY U/S CATHETER 3,371.00 2,326.00 01218 PERC VENOUS THOMBECTOMY 13,439.00 13,439.00 01219 PER VEN THROMB REPEAT SUB DAY 13,439.00 13,439.00 01220 PERC ARTERIAL THROMBEC INIT VE 13,439.00 13,439.00 01221 INJECTION EXTREMITY VENOGRAPHY 481.00 481.00 01223 PERC ARTERIAL THROMBEC SUB VES 13,439.00 13,439.00 01224 PERC RETRVL VASCFOREIGN BODY 5,783.00 5,783.00 01227 REM RPL URET STENT INC RAD S&I 6,846.00 6,846.00 01228 REM URETERAL STENT INC RAD S&I 6,846.00 6,846.00 01229 GASTRO SET #G05274 827.00 571.00 01230 G-J SET #GJS-1020 1,262.00 871.00 01231 G-J SET #GJS-1650D 1,877.00 1,295.00 01232 G-J TUBE #169612 1,939.00 1,338.00 01233 LIVER BIOPSY KIT #LABS 200 2,475.00 1,708.00 01234 NEPHROSTOMY CATH ANY SIZE 507.00 507.00 01235 ACCUSTIC KIT #20-703 491.00 339.00 01236 URETERAL STENT ANY SIZE 622.00 622.00 01237 AMPLATZ WIRE (ALL) 261.00 180.00 01238 V 18 WIRES (ALL) 466.00 322.00 01239 FILTER RETRIEVAL #50100-150 1,476.00 1,018.00 01240 TEMP I J CATH (ALL) 381.00 263.00 01241 DERMABOND #545123 138.00 - 01242 FLUENCY STENT GRAFT 10,770.00 10,770.00 01245 PTA BALLOON NON-LASER 5,985.00 4,130.00 01247 PRIMUS STENT 4,188.00 4,188.00 01248 PROTEGE STANDARD STENT 5,004.00 5,004.00 01249 PROTEGE LONG STENT 7,637.00 7,637.00 01250 VOLCANO IVUS CATH 6,450.00 01280 RIBS RT 2V 257.00 257.00 01299 TRANSCATHETER BX 2,100.00 2,100.00 01300 SUTURE ANCHOR SET 357.00 357.00 01301 GLOW N TELL TAPE 196.00 - 01302 STATLOCK IAB 90.00 - 01305 KYPHYX 15/3 PTA W/ 5CC CEMENT 18,933.00 18,933.00 01308 KYPHX HRV BONE CEMENT 5CC 1,001.00 1,001.00 01314 THROMBECTOMY DEVICE 5,123.00 3,535.00 01315 ANGIOJET CATH SPIROFLEX ULTRA 9,717.00 01316 ANGIOJET CATH SPIROFLEX VG 9,717.00 01555 CORONARY STENT PLACE INITIAL 31,236.00 31,236.00 01556 CORONARY STENT EA ADDL VESSEL 31,236.00 31,236.00 01557 COR STENT DRUG ELUTING INITIAL 38,565.00 38,565.00 01558 COR STENT DRUG ELUTING EA ADDL 35,871.00 35,871.00 01891 KYPHOPLASTY INITIAL THORACIC 25,609.00 25,609.00 02040 CERVICAL 2 OR 3 V 257.00 257.00 02041 SINGLE VIEW SPINE 257.00 257.00 02050 CERVICAL MIN 4V 408.00 408.00 02052 CERVICAL W OBL & FLEX &/OR EXT 408.00 408.00 02070 THORACIC 3V 408.00 408.00 02080 THORACOLUMBAR 2V 257.00 257.00 02090 X-RAY EXAM ENTIRE SPI 1 VW 257.00 257.00 02091 X-RAY EXAM ENTIRE SPI 2/3 VW 725.00 02092 X-RAY EXAM ENTIRE SPI 4/5 VW 925.00 02100 LUMBAR 2 OR 3 V 257.00 257.00 02110 LUMBAR MIN 4V 408.00 408.00 02111.OV LUMBAR FLEX/EXT MIN 4V 1,151.00 408.00 02120 LUMBAR FLEX/EXTEND MIN 4V 408.00 408.00 02170 PELVIS 1V 257.00 257.00 02190 PELVIS MIN 3 V 257.00 257.00 02202 SI JNTS 3 OR > 257.00 257.00 02220 SACRUM/COCCYX MIN 2V 257.00 257.00 02250 MYELOGRAM C-SPINE 2,680.00 2,680.00 02256 MYELOGRAM T-SPINE 2,680.00 2,680.00 02266 MYELOGRAM L-SPINE 2,680.00 2,680.00 02270 MYELOGRAM 2 OR MORE REGIONS 2,680.00 2,680.00 02289 OCCLUSIVE DEVICE PLACE POSTOP 402.00 402.00 02290 DISKOGRAM L-SPINE 4,227.00 024382 TOPERA CATHETER 21,700.00 02955 MRI SHOULDER LT W 1,913.00 1,913.00 02956 MRI SHOULDER RT W 1,913.00 1,913.00 02957 MRI ANKLE RT WO 1,322.00 1,322.00 02958 MRI WRIST RT WO 1,322.00 1,322.00 02959 MRI ANKLE RT W 1,913.00 1,913.00 02960 MRI ANKLE RT W/WO 2,211.00 2,211.00 02961 MRI WRIST RT W 1,913.00 1,913.00 02962 MRI WRIST RT W/WO 2,211.00 2,211.00 02963 MRI UEXT NOTJOINT WO CONT_RT 1,322.00 1,322.00 02964 MRI HAND RT W 1,913.00 1,913.00 02965 MRI UEXTR;NOTJOINT W&WO CON RT 2,211.00 2,211.00 02966 MRI ELBOW RT WO 1,322.00 1,322.00 02967 MRI ELBOW RT W 1,913.00 1,913.00 02968 MRI ELBOW RT W/WO 2,211.00 2,211.00 02970 MRI SHOULDER RT W/WO 2,211.00 2,211.00 02971 MRI ORBIT/FACE OR NECK W 1,913.00 1,913.00 02974 MRI ORBIT/FACE OR NECK W/WO 2,211.00 2,211.00 02975 MRI CHEST W/WO 2,211.00 2,211.00 02976 MRI C SPINE W/WO 2,211.00 2,211.00 03000 CLAVICLE RT 257.00 257.00 03010 SCAPULA RT 257.00 257.00 030111 PV ULTRASOUND CATH 3,371.00 2,326.00 030112 D-STAT THROMBIN GEL 554.00 382.00 030113 US GUIDE VASCULAR ACCESS 825.00 - 030114 ULTRASOUND VASCULAR ACCESS 825.00 - 03020 SHOULDER RT 1V 257.00 257.00 03030 SHOULDER RT MIN 2V 257.00 257.00 03040 SHOULDER ARTHROGRAM RT 1,522.00 1,522.00 03050 AC JNTS BILAT 257.00 257.00 03060 HUMERUS RT MIN 2V 257.00 257.00 03070 ELBOW RT 2V 257.00 257.00 03080 ELBOW RT MIN 3V 257.00 257.00 03082 ELBOW BILAT MIN 3V EA 257.00 257.00 03083 ELBOW BILAT 2V EA 257.00 257.00 03084 FINGER (S) BILAT MIN 2V EA 257.00 257.00 03085 FOREARM BILAT 2V EA 257.00 257.00 03086 HAND BILAT 3V EA 257.00 257.00 03087 HAND BILAT 2V EA 257.00 257.00 03088 HUMERUS BILAT MIN 2V EA 257.00 257.00 03089 SCAPULA BILAT 257.00 257.00 03090 FOREARM RT 2V 257.00 257.00 03100 WRIST RT 2V 257.00 257.00 03101 SHOULDER BILAT MIN 2V EA 257.00 257.00 03102 SHOULDER BILAT 1V EA 257.00 257.00 03103 UP EXT INFANT BILAT MIN 2V EA 408.00 408.00 03104 WRIST BILAT MIN 3V EA 257.00 257.00 03105 WRIST BILAT 2V EA 257.00 257.00 03106 ANKLE BILAT 3V EA 257.00 257.00 03107 ANKLE BILAT 2V EA 257.00 257.00 03108 FEMUR BILAT
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