X127

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DIAGNOSTIC RADIOLOGY
 COMPUTED TOMOGRAPHY (CT)
                                                                                                H    P
     Extremities (one or more)
   X412 - without IV contrast..............................................................     -    43.25
   X413 - with IV contrast...................................................................   -    64.95
   X127 - with and without IV contrast ...............................................          -    75.85
     Spine(s)
   X415 - without IV contrast..............................................................     -    86.60
   X416 - with IV contrast...................................................................   -    97.50
   X128 - with and without IV contrast ...............................................          -   108.30
   X168 CT guidance of biopsy ............................................................      -    42.50
   X417 Three dimensional CT acquisition sequencing, including post-
          processing (minimum of 60 slices; maximum 1 scan per
          patient per day) ..................................................................   -    32.70

Master, record 6575. Record Layout PDF, page 1.

X12720250401999999990000000000000000000000000000000000000000000000000758500

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