| CPT |
M1 |
Description |
Prices |
| 0042T |
|
CT PERFUSION W/CONTRAST CBF |
183.00 |
| 0159T |
26 |
CAD BREAST MRI |
13.00 |
| 0200T |
|
PERQ SACRAL AUGMT UNILAT INJ |
1,654.00 |
| 0201T |
|
PERQ SACRAL AUGMT BILAT INJ |
2,069.00 |
| 0346T |
|
ULTRASOUND ELASTOGRAPHY |
93.00 |
| 0346T |
26 |
ULTRASOUND ELASTOGRAPHY |
93.00 |
| 10021 |
|
FNA W/O IMAGE |
205.00 |
| 10022 |
|
FNA W/IMAGE |
193.00 |
| 10022 |
76 |
FNA W/IMAGE |
193.00 |
| 10030 |
|
GUIDE CATHET FLUID DRAINAGE |
501.00 |
| 10030 |
50 |
GUIDE CATHET FLUID DRAINAGE |
1,002.00 |
| 10035 |
|
PERQ DEV SOFT TISS 1ST IMAG |
257.00 |
| 10036 |
|
PERQ DEV SOFT TISS ADD IMAG |
130.00 |
| 10060 |
|
DRAINAGE OF SKIN ABSCESS |
278.00 |
| 10061 |
|
DRAINAGE OF SKIN ABSCESS |
517.00 |
| 10120 |
|
REMOVE FOREIGN BODY |
296.00 |
| 10121 |
|
REMOVE FOREIGN BODY |
539.00 |
| 10140 |
|
DRAINAGE OF HEMATOMA/FLUID |
341.00 |
| 10160 |
|
PUNCTURE DRAINAGE OF LESION |
276.00 |
| 10160 |
76 |
PUNCTURE DRAINAGE OF LESION |
276.00 |
| 11100 |
|
BIOPSY SKIN LESION |
143.00 |
| 11976 |
|
REMOVE CONTRACEPTIVE CAPSULE |
276.00 |
| 11982 |
|
REMOVE DRUG IMPLANT DEVICE |
295.00 |
| 12020 |
|
CLOSURE OF SPLIT WOUND |
566.00 |
| 19000 |
|
DRAINAGE OF BREAST LESION |
130.00 |
| 19001 |
|
DRAIN BREAST LESION ADD-ON |
65.00 |
| 19001 |
76 |
DRAIN BREAST LESION ADD-ON |
65.00 |
| 19020 |
|
INCISION OF BREAST LESION |
885.00 |
| 19030 |
|
INJECTION FOR BREAST X-RAY |
230.00 |
| 19081 |
|
BX BREAST 1ST LESION STRTCTC |
504.00 |
| 19081 |
50 |
BX BREAST 1ST LESION STRTCTC |
1,008.00 |
| 19082 |
|
BX BREAST ADD LESION STRTCTC |
252.00 |
| 19083 |
|
BX BREAST 1ST LESION US IMAG |
472.00 |
| 19083 |
50 |
BX BREAST 1ST LESION US IMAG |
944.00 |
| 19084 |
|
BX BREAST ADD LESION US IMAG |
236.00 |
| 19084 |
76 |
BX BREAST ADD LESION US IMAG |
236.00 |
| 19085 |
|
BX BREAST 1ST LESION MR IMAG |
554.00 |
| 19086 |
|
BX BREAST ADD LESION MR IMAG |
274.00 |
| 19100 |
|
BX BREAST PERCUT W/O IMAGE |
208.00 |
| 19102 |
|
BX BREAST PERCUT W/IMAGE |
294.00 |
| 19103 |
|
BX BREAST PERCUT W/DEVICE |
695.00 |
| 19103 |
50 |
BX BREAST PERCUT W/DEVICE |
1,390.00 |
| 19103 |
52 |
BX BREAST PERCUT W/DEVICE |
695.00 |
| 19103 |
76 |
BX BREAST PERCUT W/DEVICE |
695.00 |
| 19105 |
|
CRYOSURG ABLATE FA EACH |
576.00 |
| 19281 |
|
PERQ DEVICE BREAST 1ST IMAG |
301.00 |
| 19282 |
|
PERQ DEVICE BREAST EA IMAG |
151.00 |
| 19283 |
|
PERQ DEV BREAST 1ST STRTCTC |
303.00 |
| 19284 |
|
PERQ DEV BREAST ADD STRTCTC |
153.00 |
| 19285 |
|
PERQ DEV BREAST 1ST US IMAG |
257.00 |
| 19285 |
50 |
PERQ DEV BREAST 1ST US IMAG |
514.00 |
| 19286 |
|
PERQ DEV BREAST ADD US IMAG |
130.00 |
| 19287 |
|
PERQ DEV BREAST 1ST MR GUIDE |
385.00 |
| 19288 |
|
PERQ DEV BREAST ADD MR GUIDE |
192.00 |
| 19290 |
|
PLACE NEEDLE WIRE BREAST |
192.00 |
| 19291 |
|
PLACE NEEDLE WIRE BREAST |
101.00 |
| 19295 |
|
PLACE BREAST CLIP PERCUT |
101.00 |
| 19295 |
76 |
PLACE BREAST CLIP PERCUT |
101.00 |
| 20000 |
|
INCISION OF ABSCESS |
432.00 |
| 20200 |
|
MUSCLE BIOPSY |
282.00 |
| 20205 |
|
DEEP MUSCLE BIOPSY |
460.00 |
| 20206 |
|
NEEDLE BIOPSY MUSCLE |
174.00 |
| 20206 |
76 |
NEEDLE BIOPSY MUSCLE |
174.00 |
| 20220 |
|
BONE BIOPSY TROCAR/NEEDLE |
214.00 |
| 20225 |
|
BONE BIOPSY TROCAR/NEEDLE |
320.00 |
| 20500 |
|
INJECTION OF SINUS TRACT |
245.00 |
| 20500 |
76 |
INJECTION OF SINUS TRACT |
245.00 |
| 20501 |
|
INJECT SINUS TRACT FOR X-RAY |
113.00 |
| 20520 |
|
REMOVAL OF FOREIGN BODY |
422.00 |
| 20550 |
|
INJ TENDON SHEATH/LIGAMENT |
123.00 |
| 20551 |
|
INJ TENDON ORIGIN/INSERTION |
125.00 |
| 20600 |
|
DRAIN/INJ JOINT/BURSA W/O US |
105.00 |
| 20604 |
|
DRAIN/INJ JOINT/BURSA W/US |
136.00 |
| 20605 |
|
DRAIN/INJ JOINT/BURSA W/O US |
110.00 |
| 20605 |
50 |
DRAIN/INJ JOINT/BURSA W/O US |
220.00 |
| 20606 |
|
DRAIN/INJ JOINT/BURSA W/US |
155.00 |
| 20610 |
|
DRAIN/INJ JOINT/BURSA W/O US |
135.00 |
| 20610 |
50 |
DRAIN/INJ JOINT/BURSA W/O US |
270.00 |
| 20610 |
52 |
DRAIN/INJ JOINT/BURSA W/O US |
135.00 |
| 20611 |
|
DRAIN/INJ JOINT/BURSA W/US |
181.00 |
| 20611 |
50 |
DRAIN/INJ JOINT/BURSA W/US |
362.00 |
| 20612 |
|
ASPIRATE/INJ GANGLION CYST |
122.00 |
| 20982 |
|
ABLATE BONE TUMOR(S) PERQ |
1,133.00 |
| 20983 |
|
ABLATE BONE TUMOR(S) PERQ |
1,204.00 |
| 21116 |
|
INJECTION JAW JOINT X-RAY |
130.00 |
| 21501 |
|
DRAIN NECK/CHEST LESION |
934.00 |
| 21550 |
|
BIOPSY OF NECK/CHEST |
459.00 |
| 21925 |
|
BIOPSY SOFT TISSUE OF BACK |
1,031.00 |
| 22510 |
|
PERQ CERVICOTHORACIC INJECT |
1,340.00 |
| 22511 |
|
PERQ LUMBOSACRAL INJECTION |
1,258.00 |
| 22512 |
|
VERTEBROPLASTY ADDL INJECT |
626.00 |
| 22513 |
|
PERQ VERTEBRAL AUGMENTATION |
1,595.00 |
| 22514 |
|
PERQ VERTEBRAL AUGMENTATION |
1,486.00 |
| 22515 |
|
PERQ VERTEBRAL AUGMENTATION |
676.00 |
| 22520 |
|
PERCUT VERTEBROPLASTY THOR |
1,445.00 |
| 22521 |
|
PERCUT VERTEBROPLASTY LUMB |
1,355.00 |
| 22522 |
|
PERCUT VERTEBROPLASTY ADDL |
471.00 |
| 22523 |
|
PERCUT KYPHOPLASTY THOR |
1,710.00 |
| 22524 |
|
PERCUT KYPHOPLASTY LUMBAR |
1,639.00 |
| 22525 |
|
PERCUT KYPHOPLASTY ADD-ON |
784.00 |
| 22526 |
|
IDET SINGLE LEVEL |
978.00 |
| 22527 |
|
IDET 1 OR MORE LEVELS |
453.00 |
| 23330 |
|
REMOVE SHOULDER FOREIGN BODY |
435.00 |
| 23350 |
|
INJECTION FOR SHOULDER X-RAY |
151.00 |
| 23550 |
|
TREAT CLAVICLE DISLOCATION |
1,636.00 |
| 24220 |
|
INJECTION FOR ELBOW X-RAY |
204.00 |
| 25246 |
|
INJECTION FOR WRIST X-RAY |
223.00 |
| 27086 |
|
REMOVE HIP FOREIGN BODY |
479.00 |
| 27093 |
|
INJECTION FOR HIP X-RAY |
207.00 |
| 27093 |
50 |
INJECTION FOR HIP X-RAY |
414.00 |
| 27093 |
76 |
INJECTION FOR HIP X-RAY |
207.00 |
| 27095 |
|
INJECTION FOR HIP X-RAY |
244.00 |
| 27096 |
|
INJECT SACROILIAC JOINT |
248.00 |
| 27096 |
50 |
INJECT SACROILIAC JOINT |
496.00 |
| 27370 |
|
INJECTION FOR KNEE X-RAY |
150.00 |
| 27603 |
|
DRAIN LOWER LEG LESION |
1,132.00 |
| 27648 |
|
INJECTION FOR ANKLE X-RAY |
156.00 |
| 32201 |
|
DRAIN PERCUT LUNG LESION |
775.00 |
| 32400 |
|
NEEDLE BIOPSY CHEST LINING |
259.00 |
| 32405 |
|
PERCUT BX LUNG/MEDIASTINUM |
307.00 |
| 32405 |
52 |
PERCUT BX LUNG/MEDIASTINUM |
307.00 |
| 32420 |
|
PUNCTURE/CLEAR LUNG |
345.00 |
| 32421 |
|
THORACENTESIS FOR ASPIRATION |
219.00 |
| 32421 |
52 |
THORACENTESIS FOR ASPIRATION |
219.00 |
| 32550 |
|
INSERT PLEURAL CATH |
661.00 |
| 32550 |
50 |
INSERT PLEURAL CATH |
1,322.00 |
| 32550 |
76 |
INSERT PLEURAL CATH |
661.00 |
| 32551 |
|
INSERTION OF CHEST TUBE |
507.00 |
| 32552 |
|
REMOVE LUNG CATHETER |
469.00 |
| 32553 |
|
INS MARK THOR FOR RT PERQ |
577.00 |
| 32555 |
|
ASPIRATE PLEURA W/ IMAGING |
334.00 |
| 32555 |
50 |
ASPIRATE PLEURA W/ IMAGING |
668.00 |
| 32555 |
52 |
ASPIRATE PLEURA W/ IMAGING |
334.00 |
| 32555 |
76 |
ASPIRATE PLEURA W/ IMAGING |
334.00 |
| 32556 |
|
INSERT CATH PLEURA W/O IMAGE |
368.00 |
| 32557 |
|
INSERT CATH PLEURA W/ IMAGE |
458.00 |
| 32557 |
50 |
INSERT CATH PLEURA W/ IMAGE |
916.00 |
| 32557 |
50 |
INSERT CATH PLEURA W/ IMAGE |
916.00 |
| 32557 |
52 |
INSERT CATH PLEURA W/ IMAGE |
458.00 |
| 32557 |
76 |
INSERT CATH PLEURA W/ IMAGE |
458.00 |
| 32560 |
|
TREAT PLEURODESIS W/AGENT |
233.00 |
| 32561 |
|
LYSE CHEST FIBRIN INIT DAY |
204.00 |
| 32998 |
|
PERQ RF ABLATE TX PUL TUMOR |
847.00 |
| 33015 |
|
INCISION OF HEART SAC |
1,511.00 |
| 34401 |
|
REMOVAL OF VEIN CLOT |
4,384.00 |
| 34421 |
|
REMOVAL OF VEIN CLOT |
2,218.00 |
| 34471 |
|
REMOVAL OF VEIN CLOT |
3,299.00 |
| 34825 |
|
ENDOVASC EXTEND PROSTH INIT |
2,113.00 |
| 34826 |
|
ENDOVASC EXTEN PROSTH ADDL |
628.00 |
| 35286 |
|
REPAIR BLOOD VESSEL LESION |
2,846.00 |
| 35471 |
|
REPAIR ARTERIAL BLOCKAGE |
1,581.00 |
| 35471 |
50 |
REPAIR ARTERIAL BLOCKAGE |
3,162.00 |
| 35472 |
|
REPAIR ARTERIAL BLOCKAGE |
1,077.00 |
| 35475 |
|
REPAIR ARTERIAL BLOCKAGE |
1,004.00 |
| 35476 |
|
REPAIR VENOUS BLOCKAGE |
808.00 |
| 35476 |
50 |
REPAIR VENOUS BLOCKAGE |
1,616.00 |
| 35476 |
50 |
REPAIR VENOUS BLOCKAGE |
1,616.00 |
| 35476 |
76 |
REPAIR VENOUS BLOCKAGE |
808.00 |
| 35875 |
|
REMOVAL OF CLOT IN GRAFT |
1,811.00 |
| 36000 |
|
PLACE NEEDLE IN VEIN |
126.00 |
| 36002 |
|
PSEUDOANEURYSM INJECTION TRT |
318.00 |
| 36005 |
|
INJECTION EXT VENOGRAPHY |
145.00 |
| 36005 |
50 |
INJECTION EXT VENOGRAPHY |
290.00 |
| 36005 |
76 |
INJECTION EXT VENOGRAPHY |
145.00 |
| 36010 |
|
PLACE CATHETER IN VEIN |
368.00 |
| 36010 |
50 |
PLACE CATHETER IN VEIN |
736.00 |
| 36011 |
|
PLACE CATHETER IN VEIN |
472.00 |
| 36011 |
50 |
PLACE CATHETER IN VEIN |
944.00 |
| 36011 |
76 |
PLACE CATHETER IN VEIN |
472.00 |
| 36012 |
|
PLACE CATHETER IN VEIN |
524.00 |
| 36012 |
50 |
PLACE CATHETER IN VEIN |
1,048.00 |
| 36012 |
50 |
PLACE CATHETER IN VEIN |
1,048.00 |
| 36012 |
76 |
PLACE CATHETER IN VEIN |
524.00 |
| 36013 |
|
PLACE CATHETER IN ARTERY |
376.00 |
| 36014 |
|
PLACE CATHETER IN ARTERY |
450.00 |
| 36014 |
50 |
PLACE CATHETER IN ARTERY |
900.00 |
| 36015 |
|
PLACE CATHETER IN ARTERY |
515.00 |
| 36015 |
50 |
PLACE CATHETER IN ARTERY |
1,030.00 |
| 36100 |
|
ESTABLISH ACCESS TO ARTERY |
467.00 |
| 36120 |
|
ESTABLISH ACCESS TO ARTERY |
303.00 |
| 36120 |
50 |
ESTABLISH ACCESS TO ARTERY |
606.00 |
| 36140 |
|
ESTABLISH ACCESS TO ARTERY |
311.00 |
| 36140 |
50 |
ESTABLISH ACCESS TO ARTERY |
622.00 |
| 36140 |
76 |
ESTABLISH ACCESS TO ARTERY |
311.00 |
| 36147 |
|
ACCESS AV DIAL GRFT FOR EVAL |
560.00 |
| 36147 |
52 |
ACCESS AV DIAL GRFT FOR EVAL |
560.00 |
| 36148 |
|
ACCESS AV DIAL GRFT FOR PROC |
147.00 |
| 36148 |
76 |
ACCESS AV DIAL GRFT FOR PROC |
147.00 |
| 36160 |
|
ESTABLISH ACCESS TO AORTA |
371.00 |
| 36200 |
|
PLACE CATHETER IN AORTA |
463.00 |
| 36215 |
|
PLACE CATHETER IN ARTERY |
706.00 |
| 36215 |
76 |
PLACE CATHETER IN ARTERY |
706.00 |
| 36216 |
|
PLACE CATHETER IN ARTERY |
829.00 |
| 36216 |
76 |
PLACE CATHETER IN ARTERY |
829.00 |
| 36217 |
|
PLACE CATHETER IN ARTERY |
985.00 |
| 36217 |
76 |
PLACE CATHETER IN ARTERY |
985.00 |
| 36218 |
|
PLACE CATHETER IN ARTERY |
160.00 |
| 36218 |
76 |
PLACE CATHETER IN ARTERY |
160.00 |
| 36221 |
|
PLACE CATH THORACIC AORTA |
649.00 |
| 36223 |
|
PLACE CATH CAROTID/INOM ART |
970.00 |
| 36223 |
50 |
PLACE CATH CAROTID/INOM ART |
1,940.00 |
| 36223 |
76 |
PLACE CATH CAROTID/INOM ART |
970.00 |
| 36224 |
|
PLACE CATH CAROTD ART |
1,079.00 |
| 36224 |
50 |
PLACE CATH CAROTD ART |
2,158.00 |
| 36225 |
|
PLACE CATH SUBCLAVIAN ART |
956.00 |
| 36225 |
50 |
PLACE CATH SUBCLAVIAN ART |
1,912.00 |
| 36226 |
|
PLACE CATH VERTEBRAL ART |
1,082.00 |
| 36226 |
50 |
PLACE CATH VERTEBRAL ART |
2,164.00 |
| 36227 |
|
PLACE CATH XTRNL CAROTID |
342.00 |
| 36245 |
|
INS CATH ABD/L-EXT ART 1ST |
760.00 |
| 36245 |
76 |
INS CATH ABD/L-EXT ART 1ST |
760.00 |
| 36246 |
|
INS CATH ABD/L-EXT ART 2ND |
811.00 |
| 36246 |
50 |
INS CATH ABD/L-EXT ART 2ND |
1,622.00 |
| 36247 |
|
INS CATH ABD/L-EXT ART 3RD |
959.00 |
| 36247 |
50 |
INS CATH ABD/L-EXT ART 3RD |
1,918.00 |
| 36247 |
76 |
INS CATH ABD/L-EXT ART 3RD |
959.00 |
| 36248 |
|
INS CATH ABD/L-EXT ART ADDL |
149.00 |
| 36248 |
76 |
INS CATH ABD/L-EXT ART ADDL |
149.00 |
| 36251 |
|
INS CATH REN ART 1ST UNILAT |
847.00 |
| 36252 |
|
INS CATH REN ART 1ST BILAT |
1,128.00 |
| 36253 |
|
INS CATH REN ART 2ND+ UNILAT |
1,134.00 |
| 36410 |
|
NON-ROUTINE BL DRAW 3/> YRS |
28.00 |
| 36473 |
|
ENDOVENOUS MCHNCHEM 1ST VEIN |
518.00 |
| 36474 |
|
ENDOVENOUS MCHNCHEM ADD-ON |
260.00 |
| 36476 |
76 |
ENDOVENOUS RF VEIN ADD-ON |
411.00 |
| 36478 |
|
ENDOVENOUS LASER 1ST VEIN |
841.00 |
| 36481 |
|
INSERTION OF CATHETER VEIN |
1,043.00 |
| 36500 |
|
INSERTION OF CATHETER VEIN |
546.00 |
| 36500 |
50 |
INSERTION OF CATHETER VEIN |
1,092.00 |
| 36500 |
76 |
INSERTION OF CATHETER VEIN |
546.00 |
| 36555 |
|
INSERT NON-TUNNEL CV CATH |
354.00 |
| 36556 |
|
INSERT NON-TUNNEL CV CATH |
360.00 |
| 36556 |
52 |
INSERT NON-TUNNEL CV CATH |
360.00 |
| 36556 |
76 |
INSERT NON-TUNNEL CV CATH |
360.00 |
| 36557 |
|
INSERT TUNNELED CV CATH |
974.00 |
| 36558 |
|
INSERT TUNNELED CV CATH |
822.00 |
| 36558 |
52 |
INSERT TUNNELED CV CATH |
822.00 |
| 36560 |
|
INSERT TUNNELED CV CATH |
1,157.00 |
| 36561 |
|
INSERT TUNNELED CV CATH |
1,052.00 |
| 36561 |
52 |
INSERT TUNNELED CV CATH |
1,052.00 |
| 36565 |
|
INSERT TUNNELED CV CATH |
1,044.00 |
| 36566 |
|
INSERT TUNNELED CV CATH |
1,146.00 |
| 36568 |
|
INSERT PICC CATH |
289.00 |
| 36569 |
|
INSERT PICC CATH |
272.00 |
| 36569 |
52 |
INSERT PICC CATH |
272.00 |
| 36570 |
|
INSERT PICVAD CATH |
920.00 |
| 36571 |
|
INSERT PICVAD CATH |
959.00 |
| 36575 |
|
REPAIR TUNNELED CV CATH |
105.00 |
| 36576 |
|
REPAIR TUNNELED CV CATH |
587.00 |
| 36578 |
|
REPLACE TUNNELED CV CATH |
640.00 |
| 36580 |
|
REPLACE CVAD CATH |
199.00 |
| 36580 |
76 |
REPLACE CVAD CATH |
199.00 |
| 36581 |
|
REPLACE TUNNELED CV CATH |
583.00 |
| 36582 |
|
REPLACE TUNNELED CV CATH |
910.00 |
| 36584 |
|
REPLACE PICC CATH |
197.00 |
| 36584 |
52 |
REPLACE PICC CATH |
197.00 |
| 36585 |
|
REPLACE PICVAD CATH |
844.00 |
| 36589 |
|
REMOVAL TUNNELED CV CATH |
407.00 |
| 36590 |
|
REMOVAL TUNNELED CV CATH |
607.00 |
| 36593 |
|
DECLOT VASCULAR DEVICE |
85.00 |
| 36595 |
|
MECH REMOV TUNNELED CV CATH |
550.00 |
| 36595 |
52 |
MECH REMOV TUNNELED CV CATH |
550.00 |
| 36596 |
|
MECH REMOV TUNNELED CV CATH |
133.00 |
| 36596 |
52 |
MECH REMOV TUNNELED CV CATH |
133.00 |
| 36597 |
|
REPOSITION VENOUS CATHETER |
183.00 |
| 36598 |
|
INJ W/FLUOR EVAL CV DEVICE |
110.00 |
| 36620 |
|
INSERTION CATHETER ARTERY |
152.00 |
| 36860 |
|
EXTERNAL CANNULA DECLOTTING |
326.00 |
| 36861 |
|
CANNULA DECLOTTING |
397.00 |
| 36870 |
|
PERCUT THROMBECT AV FISTULA |
892.00 |
| 36870 |
52 |
PERCUT THROMBECT AV FISTULA |
892.00 |
| 36901 |
|
INTRO CATH DIALYSIS CIRCUIT |
435.00 |
| 36902 |
|
INTRO CATH DIALYSIS CIRCUIT |
647.00 |
| 36903 |
|
INTRO CATH DIALYSIS CIRCUIT |
886.00 |
| 36904 |
|
THRMBC/NFS DIALYSIS CIRCUIT |
1,020.00 |
| 36905 |
|
THRMBC/NFS DIALYSIS CIRCUIT |
1,281.00 |
| 36906 |
|
THRMBC/NFS DIALYSIS CIRCUIT |
1,495.00 |
| 36907 |
|
BALO ANGIOP CTR DIALYSIS SEG |
373.00 |
| 36908 |
|
STENT PLMT CTR DIALYSIS SEG |
559.00 |
| 36909 |
|
DIALYSIS CIRCUIT EMBOLJ |
531.00 |
| 37182 |
|
INSERT HEPATIC SHUNT (TIPS) |
2,496.00 |
| 37183 |
|
REMOVE HEPATIC SHUNT (TIPS) |
1,178.00 |
| 37184 |
|
PRIM ART M-THRMBC 1ST VSL |
1,388.00 |
| 37185 |
|
PRIM ART M-THRMBC SBSQ VSL |
508.00 |
| 37186 |
|
SEC ART THROMBECTOMY ADD-ON |
755.00 |
| 37187 |
|
VENOUS MECH THROMBECTOMY |
1,229.00 |
| 37187 |
50 |
VENOUS MECH THROMBECTOMY |
2,458.00 |
| 37188 |
|
VENOUS M-THROMBECTOMY ADD-ON |
882.00 |
| 37188 |
50 |
VENOUS M-THROMBECTOMY ADD-ON |
1,764.00 |
| 37191 |
|
INS ENDOVAS VENA CAVA FILTR |
718.00 |
| 37192 |
|
REDO ENDOVAS VENA CAVA FILTR |
1,109.00 |
| 37193 |
|
REM ENDOVAS VENA CAVA FILTER |
1,102.00 |
| 37193 |
22 |
REM ENDOVAS VENA CAVA FILTER |
1,102.00 |
| 37193 |
52 |
REM ENDOVAS VENA CAVA FILTER |
1,102.00 |
| 37197 |
|
REMOVE INTRVAS FOREIGN BODY |
953.00 |
| 37200 |
|
TRANSCATHETER BIOPSY |
659.00 |
| 37201 |
|
TRANSCATHETER THERAPY INFUSE |
1,445.00 |
| 37202 |
|
TRANSCATHETER THERAPY INFUSE |
1,131.00 |
| 37203 |
|
TRANSCATHETER RETRIEVAL |
1,006.00 |
| 37203 |
52 |
TRANSCATHETER RETRIEVAL |
1,006.00 |
| 37204 |
|
TRANSCATHETER OCCLUSION |
3,613.00 |
| 37204 |
76 |
TRANSCATHETER OCCLUSION |
3,613.00 |
| 37205 |
|
TRANSCATH IV STENT PERCUT |
1,495.00 |
| 37206 |
|
TRANSCATH IV STENT/PERC ADDL |
747.00 |
| 37206 |
76 |
TRANSCATH IV STENT/PERC ADDL |
747.00 |
| 37207 |
|
TRANSCATH IV STENT OPEN |
1,377.00 |
| 37209 |
|
CHANGE IV CATH AT THROMB TX |
397.00 |
| 37210 |
|
EMBOLIZATION UTERINE FIBROID |
2,625.00 |
| 37211 |
|
THROMBOLYTIC ART THERAPY |
1,207.00 |
| 37211 |
50 |
THROMBOLYTIC ART THERAPY |
2,414.00 |
| 37211 |
76 |
THROMBOLYTIC ART THERAPY |
1,207.00 |
| 37212 |
|
THROMBOLYTIC VENOUS THERAPY |
1,061.00 |
| 37212 |
50 |
THROMBOLYTIC VENOUS THERAPY |
2,122.00 |
| 37212 |
76 |
THROMBOLYTIC VENOUS THERAPY |
1,061.00 |
| 37213 |
|
THROMBLYTIC ART/VEN THERAPY |
745.00 |
| 37213 |
50 |
THROMBLYTIC ART/VEN THERAPY |
1,490.00 |
| 37213 |
76 |
THROMBLYTIC ART/VEN THERAPY |
745.00 |
| 37214 |
|
CESSJ THERAPY CATH REMOVAL |
409.00 |
| 37214 |
50 |
CESSJ THERAPY CATH REMOVAL |
818.00 |
| 37214 |
76 |
CESSJ THERAPY CATH REMOVAL |
409.00 |
| 37215 |
|
TRANSCATH STENT CCA W/EPS |
3,024.00 |
| 37216 |
|
TRANSCATH STENT CCA W/O EPS |
3,214.00 |
| 37218 |
|
STENT PLACEMT ANTE CAROTID |
2,473.00 |
| 37220 |
|
ILIAC REVASC |
1,262.00 |
| 37221 |
|
ILIAC REVASC W/STENT |
1,551.00 |
| 37222 |
|
ILIAC REVASC ADD-ON |
570.00 |
| 37223 |
|
ILIAC REVASC W/STENT ADD-ON |
653.00 |
| 37224 |
|
FEM/POPL REVAS W/TLA |
1,389.00 |
| 37225 |
|
FEM/POPL REVAS W/ATHER |
1,882.00 |
| 37226 |
|
FEM/POPL REVASC W/STENT |
1,632.00 |
| 37227 |
|
FEM/POPL REVASC STNT & ATHER |
2,264.00 |
| 37228 |
|
TIB/PER REVASC W/TLA |
1,697.00 |
| 37229 |
|
TIB/PER REVASC W/ATHER |
2,196.00 |
| 37230 |
|
TIB/PER REVASC W/STENT |
2,162.00 |
| 37231 |
|
TIB/PER REVASC STENT & ATHER |
2,352.00 |
| 37232 |
|
TIB/PER REVASC ADD-ON |
617.00 |
| 37233 |
|
TIBPER REVASC W/ATHER ADD-ON |
1,004.00 |
| 37234 |
|
REVSC OPN/PRQ TIB/PERO STENT |
864.00 |
| 37235 |
|
TIB/PER REVASC STNT & ATHER |
1,228.00 |
| 37236 |
|
OPEN/PERQ PLACE STENT 1ST |
1,372.00 |
| 37237 |
|
OPEN/PERQ PLACE STENT EA ADD |
648.00 |
| 37238 |
|
OPEN/PERQ PLACE STENT SAME |
950.00 |
| 37238 |
50 |
OPEN/PERQ PLACE STENT SAME |
1,900.00 |
| 37239 |
|
OPEN/PERQ PLACE STENT EA ADD |
453.00 |
| 37241 |
|
VASC EMBOLIZE/OCCLUDE VENOUS |
1,361.00 |
| 37242 |
|
VASC EMBOLIZE/OCCLUDE ARTERY |
1,488.00 |
| 37243 |
|
VASC EMBOLIZE/OCCLUDE ORGAN |
1,756.00 |
| 37244 |
|
VASC EMBOLIZE/OCCLUDE BLEED |
2,055.00 |
| 37246 |
|
TRLUML BALO ANGIOP 1ST ART |
1,063.00 |
| 37247 |
|
TRLUML BALO ANGIOP ADDL ART |
527.00 |
| 37248 |
|
TRLUML BALO ANGIOP 1ST VEIN |
914.00 |
| 37249 |
|
TRLUML BALO ANGIOP ADDL VEIN |
449.00 |
| 37250 |
|
IV US FIRST VESSEL ADD-ON |
354.00 |
| 37251 |
|
IV US EACH ADD VESSEL ADD-ON |
270.00 |
| 37252 |
|
INTRVASC US NONCORONARY 1ST |
279.00 |
| 37253 |
|
INTRVASC US NONCORONARY ADDL |
223.00 |
| 37620 |
|
REVISION OF MAJOR VEIN |
2,109.00 |
| 38200 |
|
INJECTION FOR SPLEEN X-RAY |
349.00 |
| 38220 |
|
BONE MARROW ASPIRATION |
181.00 |
| 38221 |
|
BONE MARROW BIOPSY |
220.00 |
| 38221 |
50 |
BONE MARROW BIOPSY |
440.00 |
| 38505 |
|
NEEDLE BIOPSY LYMPH NODES |
209.00 |
| 38505 |
50 |
NEEDLE BIOPSY LYMPH NODES |
418.00 |
| 38505 |
76 |
NEEDLE BIOPSY LYMPH NODES |
209.00 |
| 38790 |
|
INJECT FOR LYMPHATIC X-RAY |
244.00 |
| 38792 |
|
RA TRACER ID OF SENTINL NODE |
116.00 |
| 38792 |
50 |
RA TRACER ID OF SENTINL NODE |
232.00 |
| 40800 |
|
DRAINAGE OF MOUTH LESION |
385.00 |
| 41019 |
|
PLACE NEEDLES H&N FOR RT |
1,386.00 |
| 42400 |
|
BIOPSY OF SALIVARY GLAND |
162.00 |
| 42550 |
|
INJECTION FOR SALIVARY X-RAY |
188.00 |
| 42660 |
|
DILATION OF SALIVARY DUCT |
264.00 |
| 42806 |
|
BIOPSY OF UPPER NOSE/THROAT |
387.00 |
| 43456 |
|
DILATE ESOPHAGUS |
438.00 |
| 43752 |
|
NASAL/OROGASTRIC W/TUBE PLMT |
121.00 |
| 43752 |
52 |
NASAL/OROGASTRIC W/TUBE PLMT |
121.00 |
| 43760 |
|
CHANGE GASTROSTOMY TUBE |
140.00 |
| 43761 |
|
REPOSITION GASTROSTOMY TUBE |
305.00 |
| 44015 |
|
INSERT NEEDLE CATH BOWEL |
427.00 |
| 44373 |
|
SMALL BOWEL ENDOSCOPY |
593.00 |
| 44500 |
|
INTRO GASTROINTESTINAL TUBE |
73.00 |
| 44901 |
|
DRAIN APP ABSCESS PERCUT |
516.00 |
| 45100 |
|
BIOPSY OF RECTUM |
874.00 |
| 45303 |
|
PROCTOSIGMOIDOSCOPY DILATE |
273.00 |
| 47000 |
|
NEEDLE BIOPSY OF LIVER |
305.00 |
| 47000 |
52 |
NEEDLE BIOPSY OF LIVER |
305.00 |
| 47000 |
76 |
NEEDLE BIOPSY OF LIVER |
305.00 |
| 47001 |
|
NEEDLE BIOPSY LIVER ADD-ON |
311.00 |
| 47011 |
|
PERCUT DRAIN LIVER LESION |
718.00 |
| 47011 |
52 |
PERCUT DRAIN LIVER LESION |
718.00 |
| 47015 |
|
INJECT/ASPIRATE LIVER CYST |
3,391.00 |
| 47382 |
|
PERCUT ABLATE LIVER RF |
2,296.00 |
| 47383 |
|
PERQ ABLTJ LVR CRYOABLATION |
1,459.00 |
| 47490 |
|
INCISION OF GALLBLADDER |
970.00 |
| 47500 |
|
INJECTION FOR LIVER X-RAYS |
391.00 |
| 47500 |
76 |
INJECTION FOR LIVER X-RAYS |
391.00 |
| 47505 |
|
INJECTION FOR LIVER X-RAYS |
261.00 |
| 47505 |
52 |
INJECTION FOR LIVER X-RAYS |
261.00 |
| 47510 |
|
INSERT CATHETER BILE DUCT |
1,132.00 |
| 47511 |
|
INSERT BILE DUCT DRAIN |
1,405.00 |
| 47511 |
76 |
INSERT BILE DUCT DRAIN |
1,405.00 |
| 47525 |
|
CHANGE BILE DUCT CATHETER |
772.00 |
| 47530 |
|
REVISE/REINSERT BILE TUBE |
768.00 |
| 47531 |
|
INJECTION FOR CHOLANGIOGRAM |
285.00 |
| 47532 |
|
INJECTION FOR CHOLANGIOGRAM |
645.00 |
| 47533 |
|
PLMT BILIARY DRAINAGE CATH |
913.00 |
| 47534 |
|
PLMT BILIARY DRAINAGE CATH |
1,212.00 |
| 47535 |
|
CONVERSION EXT BIL DRG CATH |
697.00 |
| 47536 |
|
EXCHANGE BILIARY DRG CATH |
439.00 |
| 47537 |
|
REMOVAL BILIARY DRG CATH |
296.00 |
| 47538 |
|
PERQ PLMT BILE DUCT STENT |
982.00 |
| 47539 |
|
PERQ PLMT BILE DUCT STENT |
1,328.00 |
| 47540 |
|
PERQ PLMT BILE DUCT STENT |
1,586.00 |
| 47541 |
|
PLMT ACCESS BIL TREE SM BWL |
844.00 |
| 47542 |
|
DILATE BILIARY DUCT/AMPULLA |
400.00 |
| 47543 |
|
ENDOLUMINAL BX BILIARY TREE |
503.00 |
| 47544 |
|
REMOVAL DUCT GLBLDR CALCULI |
644.00 |
| 47552 |
|
BILIARY ENDO PERQ DX W/SPECI |
928.00 |
| 47553 |
|
BILIARY ENDOSCOPY THRU SKIN |
919.00 |
| 47555 |
|
BILIARY ENDOSCOPY THRU SKIN |
1,100.00 |
| 47555 |
76 |
BILIARY ENDOSCOPY THRU SKIN |
1,100.00 |
| 47556 |
|
BILIARY ENDOSCOPY THRU SKIN |
1,251.00 |
| 47630 |
|
REMOVE BILE DUCT STONE |
1,344.00 |
| 47801 |
|
PLACEMENT BILE DUCT SUPPORT |
2,958.00 |
| 48102 |
|
NEEDLE BIOPSY PANCREAS |
722.00 |
| 48511 |
|
DRAIN PANCREATIC PSEUDOCYST |
775.00 |
| 49021 |
|
DRAIN ABDOMINAL ABSCESS |
841.00 |
| 49021 |
76 |
DRAIN ABDOMINAL ABSCESS |
841.00 |
| 49041 |
|
DRAIN PERCUT ABDOM ABSCESS |
775.00 |
| 49061 |
|
DRAIN PERCUT RETROPER ABSC |
718.00 |
| 49080 |
|
PUNCTURE PERITONEAL CAVITY |
246.00 |
| 49081 |
|
REMOVAL OF ABDOMINAL FLUID |
225.00 |
| 49082 |
|
ABD PARACENTESIS |
219.00 |
| 49083 |
|
ABD PARACENTESIS W/IMAGING |
322.00 |
| 49083 |
76 |
ABD PARACENTESIS W/IMAGING |
322.00 |
| 49180 |
|
BIOPSY ABDOMINAL MASS |
255.00 |
| 49185 |
|
SCLEROTX FLUID COLLECTION |
366.00 |
| 49400 |
|
AIR INJECTION INTO ABDOMEN |
280.00 |
| 49405 |
|
IMAGE CATH FLUID COLXN VISC |
631.00 |
| 49406 |
|
IMAGE CATH FLUID PERI/RETRO |
631.00 |
| 49407 |
|
IMAGE CATH FLUID TRNS/VGNL |
678.00 |
| 49411 |
|
INS MARK ABD/PEL FOR RT PERQ |
588.00 |
| 49418 |
|
INSERT TUN IP CATH PERC |
651.00 |
| 49419 |
|
INSERT TUN IP CATH W/PORT |
1,313.00 |
| 49422 |
|
REMOVE TUNNELED IP CATH |
1,129.00 |
| 49423 |
|
EXCHANGE DRAINAGE CATHETER |
215.00 |
| 49424 |
|
ASSESS CYST CONTRAST INJECT |
114.00 |
| 49424 |
76 |
ASSESS CYST CONTRAST INJECT |
114.00 |
| 49427 |
|
INJECTION ABDOMINAL SHUNT |
138.00 |
| 49440 |
|
PLACE GASTROSTOMY TUBE PERC |
659.00 |
| 49441 |
|
PLACE DUOD/JEJ TUBE PERC |
764.00 |
| 49446 |
|
CHANGE G-TUBE TO G-J PERC |
486.00 |
| 49450 |
|
REPLACE G/C TUBE PERC |
201.00 |
| 49451 |
|
REPLACE DUOD/JEJ TUBE PERC |
272.00 |
| 49452 |
|
REPLACE G-J TUBE PERC |
418.00 |
| 49460 |
|
FIX G/COLON TUBE W/DEVICE |
144.00 |
| 49465 |
|
FLUORO EXAM OF G/COLON TUBE |
93.00 |
| 50021 |
|
RENAL ABSCESS PERCUT DRAIN |
1,362.00 |
| 50200 |
|
RENAL BIOPSY PERQ |
421.00 |
| 50200 |
50 |
RENAL BIOPSY PERQ |
842.00 |
| 50200 |
76 |
RENAL BIOPSY PERQ |
421.00 |
| 50382 |
|
CHANGE URETER STENT PERCUT |
807.00 |
| 50384 |
|
REMOVE URETER STENT PERCUT |
733.00 |
| 50385 |
|
CHANGE STENT VIA TRANSURETH |
689.00 |
| 50386 |
|
REMOVE STENT VIA TRANSURETH |
523.00 |
| 50387 |
|
CHANGE NEPHROURETERAL CATH |
290.00 |
| 50389 |
|
REMOVE RENAL TUBE W/FLUORO |
162.00 |
| 50389 |
50 |
REMOVE RENAL TUBE W/FLUORO |
324.00 |
| 50390 |
|
DRAINAGE OF KIDNEY LESION |
288.00 |
| 50390 |
50 |
DRAINAGE OF KIDNEY LESION |
576.00 |
| 50392 |
|
INSERT KIDNEY DRAIN |
1,758.00 |
| 50392 |
50 |
INSERT KIDNEY DRAIN |
3,516.00 |
| 50392 |
52 |
INSERT KIDNEY DRAIN |
1,758.00 |
| 50393 |
|
INSERT URETERAL TUBE |
2,188.00 |
| 50393 |
50 |
INSERT URETERAL TUBE |
4,376.00 |
| 50394 |
|
INJECTION FOR KIDNEY X-RAY |
424.00 |
| 50394 |
50 |
INJECTION FOR KIDNEY X-RAY |
848.00 |
| 50395 |
|
CREATE PASSAGE TO KIDNEY |
530.00 |
| 50398 |
|
CHANGE KIDNEY TUBE |
466.00 |
| 50398 |
50 |
CHANGE KIDNEY TUBE |
932.00 |
| 50430 |
|
NJX PX NFROSGRM &/URTRGRM |
496.00 |
| 50431 |
|
NJX PX NFROSGRM &/URTRGRM |
195.00 |
| 50431 |
50 |
NJX PX NFROSGRM &/URTRGRM |
390.00 |
| 50432 |
|
PLMT NEPHROSTOMY CATHETER |
657.00 |
| 50432 |
50 |
PLMT NEPHROSTOMY CATHETER |
1,314.00 |
| 50433 |
|
PLMT NEPHROURETERAL CATHETER |
810.00 |
| 50434 |
|
CONVERT NEPHROSTOMY CATHETER |
621.00 |
| 50435 |
|
EXCHANGE NEPHROSTOMY CATH |
300.00 |
| 50435 |
50 |
EXCHANGE NEPHROSTOMY CATH |
600.00 |
| 50592 |
|
PERC RF ABLATE RENAL TUMOR |
1,072.00 |
| 50593 |
|
PERC CRYO ABLATE RENAL TUM |
1,422.00 |
| 50606 |
|
ENDOLUMINAL BX URTR RNL PLVS |
470.00 |
| 50684 |
|
INJECTION FOR URETER X-RAY |
147.00 |
| 50688 |
|
CHANGE OF URETER TUBE/STENT |
233.00 |
| 50690 |
|
INJECTION FOR URETER X-RAY |
207.00 |
| 50690 |
52 |
INJECTION FOR URETER X-RAY |
207.00 |
| 50693 |
|
PLMT URETERAL STENT PRQ |
649.00 |
| 50693 |
50 |
PLMT URETERAL STENT PRQ |
1,298.00 |
| 50694 |
|
PLMT URETERAL STENT PRQ |
840.00 |
| 50695 |
|
PLMT URETERAL STENT PRQ |
1,066.00 |
| 50695 |
50 |
PLMT URETERAL STENT PRQ |
2,132.00 |
| 50705 |
|
URETERAL EMBOLIZATION/OCCL |
601.00 |
| 50706 |
|
BALLOON DILATE URTRL STRIX |
559.00 |
| 51100 |
|
DRAIN BLADDER BY NEEDLE |
116.00 |
| 51101 |
|
DRAIN BLADDER BY TROCAR/CATH |
154.00 |
| 51102 |
|
DRAIN BL W/CATH INSERTION |
428.00 |
| 51600 |
|
INJECTION FOR BLADDER X-RAY |
132.00 |
| 51600 |
52 |
INJECTION FOR BLADDER X-RAY |
132.00 |
| 51610 |
|
INJECTION FOR BLADDER X-RAY |
188.00 |
| 51701 |
|
INSERT BLADDER CATHETER |
82.00 |
| 51702 |
|
INSERT TEMP BLADDER CATH |
89.00 |
| 51705 |
|
CHANGE OF BLADDER TUBE |
152.00 |
| 51710 |
|
CHANGE OF BLADDER TUBE |
235.00 |
| 54235 |
|
PENILE INJECTION |
215.00 |
| 55000 |
|
DRAINAGE OF HYDROCELE |
250.00 |
| 55700 |
|
BIOPSY OF PROSTATE |
411.00 |
| 55876 |
|
PLACE RT DEVICE/MARKER PROS |
295.00 |
| 58340 |
|
CATHETER FOR HYSTEROGRAPHY |
168.00 |
| 58340 |
52 |
CATHETER FOR HYSTEROGRAPHY |
168.00 |
| 58345 |
|
REOPEN FALLOPIAN TUBE |
788.00 |
| 60100 |
|
BIOPSY OF THYROID |
234.00 |
| 60100 |
76 |
BIOPSY OF THYROID |
234.00 |
| 60300 |
|
ASPIR/INJ THYROID CYST |
148.00 |
| 61055 |
|
INJECTION INTO BRAIN CANAL |
357.00 |
| 61070 |
|
BRAIN CANAL SHUNT PROCEDURE |
170.00 |
| 61623 |
|
ENDOVASC TEMPORY VESSEL OCCL |
1,702.00 |
| 61624 |
|
TRANSCATH OCCLUSION CNS |
3,421.00 |
| 61626 |
|
TRANSCATH OCCLUSION NON-CNS |
2,573.00 |
| 61645 |
|
PERQ ART M-THROMBECT &/NFS |
2,331.00 |
| 61650 |
|
EVASC PRLNG ADMN RX AGNT 1ST |
1,553.00 |
| 61651 |
|
EVASC PRLNG ADMN RX AGNT ADD |
660.00 |
| 62267 |
|
INTERDISCAL PERQ ASPIR DX |
472.00 |
| 62267 |
76 |
INTERDISCAL PERQ ASPIR DX |
472.00 |
| 62270 |
|
SPINAL FLUID TAP DIAGNOSTIC |
230.00 |
| 62272 |
|
DRAIN CEREBRO SPINAL FLUID |
247.00 |
| 62284 |
|
INJECTION FOR MYELOGRAM |
254.00 |
| 62287 |
|
PERCUTANEOUS DISKECTOMY |
1,664.00 |
| 62290 |
|
INJECT FOR SPINE DISK X-RAY |
508.00 |
| 62290 |
76 |
INJECT FOR SPINE DISK X-RAY |
508.00 |
| 62291 |
|
INJECT FOR SPINE DISK X-RAY |
502.00 |
| 62302 |
|
MYELOGRAPHY LUMBAR INJECTION |
363.00 |
| 62303 |
|
MYELOGRAPHY LUMBAR INJECTION |
368.00 |
| 62304 |
|
MYELOGRAPHY LUMBAR INJECTION |
357.00 |
| 62305 |
|
MYELOGRAPHY LUMBAR INJECTION |
373.00 |
| 62310 |
|
INJECT SPINE CERV/THORACIC |
319.00 |
| 62311 |
|
INJECT SPINE LUMBAR/SACRAL |
263.00 |
| 62311 |
76 |
INJECT SPINE LUMBAR/SACRAL |
263.00 |
| 62320 |
|
NJX INTERLAMINAR CRV/THRC |
301.00 |
| 62321 |
|
NJX INTERLAMINAR CRV/THRC |
325.00 |
| 62322 |
|
NJX INTERLAMINAR LMBR/SAC |
259.00 |
| 62323 |
|
NJX INTERLAMINAR LMBR/SAC |
296.00 |
| 62324 |
|
NJX INTERLAMINAR CRV/THRC |
277.00 |
| 62325 |
|
NJX INTERLAMINAR CRV/THRC |
319.00 |
| 62326 |
|
NJX INTERLAMINAR LMBR/SAC |
271.00 |
| 62327 |
|
NJX INTERLAMINAR LMBR/SAC |
289.00 |
| 63600 |
|
REMOVE SPINAL CORD LESION |
2,667.00 |
| 64400 |
|
N BLOCK INJ TRIGEMINAL |
208.00 |
| 64461 |
|
PVB THORACIC SINGLE INJ SITE |
256.00 |
| 64462 |
|
PVB THORACIC 2ND+ INJ SITE |
162.00 |
| 64463 |
|
PVB THORACIC CONT INFUSION |
249.00 |
| 64483 |
|
INJ FORAMEN EPIDURAL L/S |
331.00 |
| 64483 |
50 |
INJ FORAMEN EPIDURAL L/S |
662.00 |
| 64490 |
|
INJ PARAVERT F JNT C/T 1 LEV |
313.00 |
| 64493 |
|
INJ PARAVERT F JNT L/S 1 LEV |
268.00 |
| 64493 |
50 |
INJ PARAVERT F JNT L/S 1 LEV |
536.00 |
| 68850 |
|
INJECTION FOR TEAR SAC X-RAY |
161.00 |
| 70010 |
26 |
CONTRAST X-RAY OF BRAIN |
180.00 |
| 70030 |
26 |
X-RAY EYE FOR FOREIGN BODY |
25.00 |
| 70030 |
26 |
X-RAY EYE FOR FOREIGN BODY |
25.00 |
| 70100 |
26 |
X-RAY EXAM OF JAW <4VIEWS |
27.00 |
| 70110 |
26 |
X-RAY EXAM OF JAW 4/> VIEWS |
37.00 |
| 70110 |
26 |
X-RAY EXAM OF JAW 4/> VIEWS |
37.00 |
| 70120 |
26 |
X-RAY EXAM OF MASTOIDS |
27.00 |
| 70130 |
26 |
X-RAY EXAM OF MASTOIDS |
50.00 |
| 70134 |
26 |
X-RAY EXAM OF MIDDLE EAR |
51.00 |
| 70140 |
26 |
X-RAY EXAM OF FACIAL BONES |
31.00 |
| 70150 |
26 |
X-RAY EXAM OF FACIAL BONES |
39.00 |
| 70160 |
26 |
X-RAY EXAM OF NASAL BONES |
26.00 |
| 70160 |
26 |
X-RAY EXAM OF NASAL BONES |
26.00 |
| 70170 |
26 |
X-RAY EXAM OF TEAR DUCT |
44.00 |
| 70190 |
26 |
X-RAY EXAM OF EYE SOCKETS |
33.00 |
| 70200 |
26 |
X-RAY EXAM OF EYE SOCKETS |
41.00 |
| 70200 |
26 |
X-RAY EXAM OF EYE SOCKETS |
41.00 |
| 70210 |
26 |
X-RAY EXAM OF SINUSES |
26.00 |
| 70220 |
26 |
X-RAY EXAM OF SINUSES |
37.00 |
| 70240 |
26 |
X-RAY EXAM PITUITARY SADDLE |
29.00 |
| 70250 |
26 |
X-RAY EXAM OF SKULL |
37.00 |
| 70250 |
26 |
X-RAY EXAM OF SKULL |
37.00 |
| 70260 |
26 |
X-RAY EXAM OF SKULL |
51.00 |
| 70328 |
26 |
X-RAY EXAM OF JAW JOINT |
27.00 |
| 70330 |
26 |
X-RAY EXAM OF JAW JOINTS |
37.00 |
| 70332 |
26 |
X-RAY EXAM OF JAW JOINT |
91.00 |
| 70336 |
26 |
MAGNETIC IMAGE JAW JOINT |
216.00 |
| 70355 |
26 |
PANORAMIC X-RAY OF JAWS |
33.00 |
| 70360 |
26 |
X-RAY EXAM OF NECK |
25.00 |
| 70370 |
26 |
THROAT X-RAY & FLUOROSCOPY |
47.00 |
| 70371 |
26 |
SPEECH EVALUATION COMPLEX |
125.00 |
| 70380 |
26 |
X-RAY EXAM OF SALIVARY GLAND |
27.00 |
| 70390 |
26 |
X-RAY EXAM OF SALIVARY DUCT |
55.00 |
| 70450 |
26 |
CT HEAD/BRAIN W/O DYE |
125.00 |
| 70450 |
26 |
CT HEAD/BRAIN W/O DYE |
125.00 |
| 70460 |
26 |
CT HEAD/BRAIN W/DYE |
165.00 |
| 70470 |
26 |
CT HEAD/BRAIN W/O & W/DYE |
187.00 |
| 70480 |
26 |
CT ORBIT/EAR/FOSSA W/O DYE |
188.00 |
| 70481 |
26 |
CT ORBIT/EAR/FOSSA W/DYE |
202.00 |
| 70482 |
26 |
CT ORBIT/EAR/FOSSA W/O&W/DYE |
212.00 |
| 70486 |
26 |
CT MAXILLOFACIAL W/O DYE |
125.00 |
| 70486 |
26 |
CT MAXILLOFACIAL W/O DYE |
125.00 |
| 70487 |
26 |
CT MAXILLOFACIAL W/DYE |
165.00 |
| 70488 |
26 |
CT MAXILLOFACIAL W/O & W/DYE |
186.00 |
| 70490 |
26 |
CT SOFT TISSUE NECK W/O DYE |
188.00 |
| 70491 |
26 |
CT SOFT TISSUE NECK W/DYE |
203.00 |
| 70492 |
26 |
CT SFT TSUE NCK W/O & W/DYE |
213.00 |
| 70496 |
26 |
CT ANGIOGRAPHY HEAD |
256.00 |
| 70498 |
26 |
CT ANGIOGRAPHY NECK |
256.00 |
| 70540 |
26 |
MRI ORBIT/FACE/NECK W/O DYE |
197.00 |
| 70542 |
26 |
MRI ORBIT/FACE/NECK W/DYE |
237.00 |
| 70543 |
26 |
MRI ORBT/FAC/NCK W/O & W/DYE |
314.00 |
| 70543 |
26 |
MRI ORBT/FAC/NCK W/O & W/DYE |
314.00 |
| 70544 |
26 |
MR ANGIOGRAPHY HEAD W/O DYE |
177.00 |
| 70544 |
26 |
MR ANGIOGRAPHY HEAD W/O DYE |
177.00 |
| 70545 |
26 |
MR ANGIOGRAPHY HEAD W/DYE |
176.00 |
| 70546 |
26 |
MR ANGIOGRAPH HEAD W/O&W/DYE |
264.00 |
| 70547 |
26 |
MR ANGIOGRAPHY NECK W/O DYE |
177.00 |
| 70548 |
26 |
MR ANGIOGRAPHY NECK W/DYE |
177.00 |
| 70549 |
26 |
MR ANGIOGRAPH NECK W/O&W/DYE |
264.00 |
| 70551 |
26 |
MRI BRAIN STEM W/O DYE |
217.00 |
| 70552 |
26 |
MRI BRAIN STEM W/DYE |
261.00 |
| 70553 |
26 |
MRI BRAIN STEM W/O & W/DYE |
336.00 |
| 70554 |
26 |
FMRI BRAIN BY TECH |
311.00 |
| 70555 |
26 |
FMRI BRAIN BY PHYS/PSYCH |
370.00 |
| 71010 |
26 |
CHEST X-RAY 1 VIEW FRONTAL |
27.00 |
| 71010 |
26 |
CHEST X-RAY 1 VIEW FRONTAL |
27.00 |
| 71010 |
26 |
CHEST X-RAY 1 VIEW FRONTAL |
27.00 |
| 71020 |
26 |
CHEST X-RAY 2VW FRONTAL&LATL |
32.00 |
| 71020 |
26 |
CHEST X-RAY 2VW FRONTAL&LATL |
32.00 |
| 71020 |
26 |
CHEST X-RAY 2VW FRONTAL&LATL |
32.00 |
| 71021 |
26 |
CHEST X-RAY FRNT LAT LORDOTC |
40.00 |
| 71022 |
26 |
CHEST X-RAY FRNT LAT OBLIQUE |
48.00 |
| 71022 |
26 |
CHEST X-RAY FRNT LAT OBLIQUE |
48.00 |
| 71023 |
26 |
CHEST X-RAY AND FLUOROSCOPY |
55.00 |
| 71030 |
26 |
CHEST X-RAY 4/> VIEWS |
46.00 |
| 71030 |
26 |
CHEST X-RAY 4/> VIEWS |
46.00 |
| 71034 |
26 |
CHEST X-RAY&FLUORO 4/> VIEWS |
69.00 |
| 71035 |
26 |
CHEST X-RAY SPECIAL VIEWS |
27.00 |
| 71035 |
26 |
CHEST X-RAY SPECIAL VIEWS |
27.00 |
| 71040 |
26 |
CONTRAST X-RAY OF BRONCHI |
96.00 |
| 71060 |
26 |
CONTRAST X-RAY OF BRONCHI |
120.00 |
| 71090 |
26 |
X-RAY & PACEMAKER INSERTION |
88.00 |
| 71090 |
26 |
X-RAY & PACEMAKER INSERTION |
88.00 |
| 71100 |
26 |
X-RAY EXAM RIBS UNI 2 VIEWS |
33.00 |
| 71101 |
26 |
X-RAY EXAM UNILAT RIBS/CHEST |
40.00 |
| 71110 |
26 |
X-RAY EXAM RIBS BIL 3 VIEWS |
40.00 |
| 71111 |
26 |
X-RAY EXAM RIBS/CHEST4/> VWS |
48.00 |
| 71120 |
26 |
X-RAY EXAM BREASTBONE 2/>VWS |
30.00 |
| 71130 |
26 |
X-RAY STRENOCLAVIC JT 3/>VWS |
33.00 |
| 71250 |
26 |
CT THORAX W/O DYE |
150.00 |
| 71260 |
26 |
CT THORAX W/DYE |
183.00 |
| 71270 |
26 |
CT THORAX W/O & W/DYE |
202.00 |
| 71275 |
26 |
CT ANGIOGRAPHY CHEST |
266.00 |
| 71275 |
26 |
CT ANGIOGRAPHY CHEST |
266.00 |
| 71550 |
26 |
MRI CHEST W/O DYE |
214.00 |
| 71551 |
26 |
MRI CHEST W/DYE |
253.00 |
| 71552 |
26 |
MRI CHEST W/O & W/DYE |
332.00 |
| 71555 |
26 |
MRI ANGIO CHEST W OR W/O DYE |
262.00 |
| 72010 |
26 |
X-RAY EXAM SPINE AP&LAT |
71.00 |
| 72020 |
26 |
X-RAY EXAM OF SPINE 1 VIEW |
23.00 |
| 72020 |
26 |
X-RAY EXAM OF SPINE 1 VIEW |
23.00 |
| 72040 |
26 |
X-RAY EXAM NECK SPINE 2-3 VW |
33.00 |
| 72040 |
26 |
X-RAY EXAM NECK SPINE 2-3 VW |
33.00 |
| 72050 |
26 |
X-RAY EXAM NECK SPINE 4/5VWS |
46.00 |
| 72052 |
26 |
X-RAY EXAM NECK SPINE 6/>VWS |
53.00 |
| 72069 |
26 |
X-RAY EXAM TRUNK SPINE STAND |
36.00 |
| 72069 |
26 |
X-RAY EXAM TRUNK SPINE STAND |
36.00 |
| 72070 |
26 |
X-RAY EXAM THORAC SPINE 2VWS |
33.00 |
| 72072 |
26 |
X-RAY EXAM THORAC SPINE 3VWS |
32.00 |
| 72074 |
26 |
X-RAY EXAM THORAC SPINE4/>VW |
32.00 |
| 72080 |
26 |
X-RAY EXAM THORACOLMB 2/> VW |
32.00 |
| 72080 |
26 |
X-RAY EXAM THORACOLMB 2/> VW |
32.00 |
| 72081 |
26 |
X-RAY EXAM ENTIRE SPI 1 VW |
39.00 |
| 72082 |
26 |
X-RAY EXAM ENTIRE SPI 2/3 VW |
47.00 |
| 72083 |
26 |
X-RAY EXAM ENTIRE SPI 4/5 VW |
51.00 |
| 72084 |
26 |
X-RAY EXAM ENTIRE SPI 6/> VW |
60.00 |
| 72090 |
26 |
X-RAY EXAM SCLOIOSIS ERECT |
46.00 |
| 72090 |
26 |
X-RAY EXAM SCLOIOSIS ERECT |
46.00 |
| 72100 |
26 |
X-RAY EXAM L-S SPINE 2/3 VWS |
33.00 |
| 72100 |
26 |
X-RAY EXAM L-S SPINE 2/3 VWS |
33.00 |
| 72110 |
26 |
X-RAY EXAM L-2 SPINE 4/>VWS |
46.00 |
| 72114 |
26 |
X-RAY EXAM L-S SPINE BENDING |
48.00 |
| 72120 |
26 |
X-RAY BEND ONLY L-S SPINE |
33.00 |
| 72125 |
26 |
CT NECK SPINE W/O DYE |
157.00 |
| 72125 |
26 |
CT NECK SPINE W/O DYE |
157.00 |
| 72125 |
26 |
CT NECK SPINE W/O DYE |
157.00 |
| 72126 |
26 |
CT NECK SPINE W/DYE |
179.00 |
| 72127 |
26 |
CT NECK SPINE W/O & W/DYE |
186.00 |
| 72128 |
26 |
CT CHEST SPINE W/O DYE |
147.00 |
| 72128 |
26 |
CT CHEST SPINE W/O DYE |
147.00 |
| 72129 |
26 |
CT CHEST SPINE W/DYE |
179.00 |
| 72130 |
26 |
CT CHEST SPINE W/O & W/DYE |
186.00 |
| 72131 |
26 |
CT LUMBAR SPINE W/O DYE |
147.00 |
| 72131 |
26 |
CT LUMBAR SPINE W/O DYE |
147.00 |
| 72132 |
26 |
CT LUMBAR SPINE W/DYE |
179.00 |
| 72132 |
26 |
CT LUMBAR SPINE W/DYE |
179.00 |
| 72133 |
26 |
CT LUMBAR SPINE W/O & W/DYE |
186.00 |
| 72141 |
26 |
MRI NECK SPINE W/O DYE |
218.00 |
| 72142 |
26 |
MRI NECK SPINE W/DYE |
263.00 |
| 72146 |
26 |
MRI CHEST SPINE W/O DYE |
218.00 |
| 72147 |
26 |
MRI CHEST SPINE W/DYE |
261.00 |
| 72148 |
26 |
MRI LUMBAR SPINE W/O DYE |
218.00 |
| 72149 |
26 |
MRI LUMBAR SPINE W/DYE |
263.00 |
| 72156 |
26 |
MRI NECK SPINE W/O & W/DYE |
336.00 |
| 72157 |
26 |
MRI CHEST SPINE W/O & W/DYE |
336.00 |
| 72158 |
26 |
MRI LUMBAR SPINE W/O & W/DYE |
336.00 |
| 72159 |
26 |
MR ANGIO SPINE W/O&W/DYE |
265.00 |
| 72170 |
26 |
X-RAY EXAM OF PELVIS |
26.00 |
| 72170 |
26 |
X-RAY EXAM OF PELVIS |
26.00 |
| 72190 |
26 |
X-RAY EXAM OF PELVIS |
32.00 |
| 72190 |
26 |
X-RAY EXAM OF PELVIS |
32.00 |
| 72191 |
26 |
CT ANGIOGRAPH PELV W/O&W/DYE |
265.00 |
| 72192 |
26 |
CT PELVIS W/O DYE |
160.00 |
| 72192 |
26 |
CT PELVIS W/O DYE |
160.00 |
| 72193 |
26 |
CT PELVIS W/DYE |
171.00 |
| 72194 |
26 |
CT PELVIS W/O & W/DYE |
179.00 |
| 72195 |
26 |
MRI PELVIS W/O DYE |
215.00 |
| 72196 |
26 |
MRI PELVIS W/DYE |
255.00 |
| 72197 |
26 |
MRI PELVIS W/O & W/DYE |
332.00 |
| 72198 |
26 |
MR ANGIO PELVIS W/O & W/DYE |
262.00 |
| 72200 |
26 |
X-RAY EXAM SI JOINTS |
26.00 |
| 72202 |
26 |
X-RAY EXAM SI JOINTS 3/> VWS |
28.00 |
| 72220 |
26 |
X-RAY EXAM SACRUM TAILBONE |
26.00 |
| 72220 |
26 |
X-RAY EXAM SACRUM TAILBONE |
26.00 |
| 72240 |
26 |
MYELOGRAPHY NECK SPINE |
134.00 |
| 72240 |
26 |
MYELOGRAPHY NECK SPINE |
134.00 |
| 72240 |
26 |
MYELOGRAPHY NECK SPINE |
134.00 |
| 72255 |
26 |
MYELOGRAPHY THORACIC SPINE |
136.00 |
| 72255 |
26 |
MYELOGRAPHY THORACIC SPINE |
136.00 |
| 72265 |
26 |
MYELOGRAPHY L-S SPINE |
122.00 |
| 72265 |
26 |
MYELOGRAPHY L-S SPINE |
122.00 |
| 72270 |
26 |
MYELOGPHY 2/> SPINE REGIONS |
196.00 |
| 72270 |
26 |
MYELOGPHY 2/> SPINE REGIONS |
196.00 |
| 72285 |
26 |
DISCOGRAPHY CERV/THOR SPINE |
177.00 |
| 72291 |
26 |
PERQ VERTE/SACROPLSTY FLUOR |
196.00 |
| 72291 |
26 |
PERQ VERTE/SACROPLSTY FLUOR |
196.00 |
| 72291 |
26 |
PERQ VERTE/SACROPLSTY FLUOR |
196.00 |
| 72292 |
26 |
PERQ VERTE/SACROPLSTY CT |
201.00 |
| 72295 |
26 |
X-RAY OF LOWER SPINE DISK |
127.00 |
| 72295 |
26 |
X-RAY OF LOWER SPINE DISK |
127.00 |
| 72295 |
26 |
X-RAY OF LOWER SPINE DISK |
127.00 |
| 73000 |
26 |
X-RAY EXAM OF COLLAR BONE |
25.00 |
| 73000 |
26 |
X-RAY EXAM OF COLLAR BONE |
25.00 |
| 73010 |
26 |
X-RAY EXAM OF SHOULDER BLADE |
27.00 |
| 73020 |
26 |
X-RAY EXAM OF SHOULDER |
23.00 |
| 73020 |
26 |
X-RAY EXAM OF SHOULDER |
23.00 |
| 73030 |
26 |
X-RAY EXAM OF SHOULDER |
28.00 |
| 73030 |
26 |
X-RAY EXAM OF SHOULDER |
28.00 |
| 73040 |
26 |
CONTRAST X-RAY OF SHOULDER |
80.00 |
| 73040 |
26 |
CONTRAST X-RAY OF SHOULDER |
80.00 |
| 73050 |
26 |
X-RAY EXAM OF SHOULDERS |
31.00 |
| 73060 |
26 |
X-RAY EXAM OF HUMERUS |
25.00 |
| 73060 |
26 |
X-RAY EXAM OF HUMERUS |
25.00 |
| 73060 |
26 |
X-RAY EXAM OF HUMERUS |
25.00 |
| 73070 |
26 |
X-RAY EXAM OF ELBOW |
24.00 |
| 73070 |
26 |
X-RAY EXAM OF ELBOW |
24.00 |
| 73070 |
26 |
X-RAY EXAM OF ELBOW |
24.00 |
| 73070 |
26 |
X-RAY EXAM OF ELBOW |
24.00 |
| 73080 |
26 |
X-RAY EXAM OF ELBOW |
26.00 |
| 73080 |
26 |
X-RAY EXAM OF ELBOW |
26.00 |
| 73085 |
26 |
CONTRAST X-RAY OF ELBOW |
84.00 |
| 73085 |
26 |
CONTRAST X-RAY OF ELBOW |
84.00 |
| 73090 |
26 |
X-RAY EXAM OF FOREARM |
25.00 |
| 73090 |
26 |
X-RAY EXAM OF FOREARM |
25.00 |
| 73090 |
26 |
X-RAY EXAM OF FOREARM |
25.00 |
| 73092 |
26 |
X-RAY EXAM OF ARM INFANT |
24.00 |
| 73100 |
26 |
X-RAY EXAM OF WRIST |
25.00 |
| 73100 |
26 |
X-RAY EXAM OF WRIST |
25.00 |
| 73100 |
26 |
X-RAY EXAM OF WRIST |
25.00 |
| 73110 |
26 |
X-RAY EXAM OF WRIST |
26.00 |
| 73110 |
26 |
X-RAY EXAM OF WRIST |
26.00 |
| 73115 |
26 |
CONTRAST X-RAY OF WRIST |
83.00 |
| 73120 |
26 |
X-RAY EXAM OF HAND |
25.00 |
| 73120 |
26 |
X-RAY EXAM OF HAND |
25.00 |
| 73120 |
26 |
X-RAY EXAM OF HAND |
25.00 |
| 73120 |
26 |
X-RAY EXAM OF HAND |
25.00 |
| 73130 |
26 |
X-RAY EXAM OF HAND |
26.00 |
| 73130 |
26 |
X-RAY EXAM OF HAND |
26.00 |
| 73130 |
26 |
X-RAY EXAM OF HAND |
26.00 |
| 73140 |
26 |
X-RAY EXAM OF FINGER(S) |
20.00 |
| 73140 |
26 |
X-RAY EXAM OF FINGER(S) |
20.00 |
| 73140 |
26 |
X-RAY EXAM OF FINGER(S) |
20.00 |
| 73200 |
26 |
CT UPPER EXTREMITY W/O DYE |
147.00 |
| 73201 |
26 |
CT UPPER EXTREMITY W/DYE |
171.00 |
| 73201 |
26 |
CT UPPER EXTREMITY W/DYE |
171.00 |
| 73202 |
26 |
CT UPPR EXTREMITY W/O&W/DYE |
179.00 |
| 73206 |
26 |
CT ANGIO UPR EXTRM W/O&W/DYE |
263.00 |
| 73218 |
26 |
MRI UPPER EXTREMITY W/O DYE |
198.00 |
| 73218 |
26 |
MRI UPPER EXTREMITY W/O DYE |
198.00 |
| 73218 |
26 |
MRI UPPER EXTREMITY W/O DYE |
198.00 |
| 73219 |
26 |
MRI UPPER EXTREMITY W/DYE |
238.00 |
| 73220 |
26 |
MRI UPPR EXTREMITY W/O&W/DYE |
315.00 |
| 73220 |
26 |
MRI UPPR EXTREMITY W/O&W/DYE |
315.00 |
| 73221 |
26 |
MRI JOINT UPR EXTREM W/O DYE |
199.00 |
| 73221 |
26 |
MRI JOINT UPR EXTREM W/O DYE |
199.00 |
| 73222 |
26 |
MRI JOINT UPR EXTREM W/DYE |
238.00 |
| 73223 |
26 |
MRI JOINT UPR EXTR W/O&W/DYE |
315.00 |
| 73225 |
26 |
MR ANGIO UPR EXTR W/O&W/DYE |
251.00 |
| 73500 |
26 |
X-RAY EXAM OF HIP |
26.00 |
| 73500 |
26 |
X-RAY EXAM OF HIP |
26.00 |
| 73501 |
26 |
X-RAY EXAM HIP UNI 1 VIEW |
28.00 |
| 73502 |
26 |
X-RAY EXAM HIP UNI 2-3 VIEWS |
33.00 |
| 73503 |
26 |
X-RAY EXAM HIP UNI 4/> VIEWS |
42.00 |
| 73510 |
26 |
X-RAY EXAM OF HIP |
35.00 |
| 73510 |
26 |
X-RAY EXAM OF HIP |
35.00 |
| 73520 |
26 |
X-RAY EXAM OF HIPS |
43.00 |
| 73520 |
26 |
X-RAY EXAM OF HIPS |
43.00 |
| 73520 |
26 |
X-RAY EXAM OF HIPS |
43.00 |
| 73521 |
26 |
X-RAY EXAM HIPS BI 2 VIEWS |
34.00 |
| 73522 |
26 |
X-RAY EXAM HIPS BI 3-4 VIEWS |
44.00 |
| 73523 |
26 |
X-RAY EXAM HIPS BI 5/> VIEWS |
47.00 |
| 73525 |
26 |
CONTRAST X-RAY OF HIP |
84.00 |
| 73525 |
26 |
CONTRAST X-RAY OF HIP |
84.00 |
| 73525 |
26 |
CONTRAST X-RAY OF HIP |
84.00 |
| 73530 |
26 |
X-RAY EXAM OF HIP |
47.00 |
| 73540 |
26 |
X-RAY EXAM OF PELVIS & HIPS |
34.00 |
| 73540 |
26 |
X-RAY EXAM OF PELVIS & HIPS |
34.00 |
| 73542 |
26 |
X-RAY EXAM SACROILIAC JOINT |
76.00 |
| 73550 |
26 |
X-RAY EXAM OF THIGH |
26.00 |
| 73550 |
26 |
X-RAY EXAM OF THIGH |
26.00 |
| 73550 |
26 |
X-RAY EXAM OF THIGH |
26.00 |
| 73551 |
26 |
X-RAY EXAM OF FEMUR 1 |
25.00 |
| 73552 |
26 |
X-RAY EXAM OF FEMUR 2/> |
28.00 |
| 73560 |
26 |
X-RAY EXAM OF KNEE 1 OR 2 |
25.00 |
| 73560 |
26 |
X-RAY EXAM OF KNEE 1 OR 2 |
25.00 |
| 73562 |
26 |
X-RAY EXAM OF KNEE 3 |
28.00 |
| 73562 |
26 |
X-RAY EXAM OF KNEE 3 |
28.00 |
| 73564 |
26 |
X-RAY EXAM KNEE 4 OR MORE |
33.00 |
| 73564 |
26 |
X-RAY EXAM KNEE 4 OR MORE |
33.00 |
| 73565 |
26 |
X-RAY EXAM OF KNEES |
26.00 |
| 73580 |
26 |
CONTRAST X-RAY OF KNEE JOINT |
83.00 |
| 73590 |
26 |
X-RAY EXAM OF LOWER LEG |
25.00 |
| 73590 |
26 |
X-RAY EXAM OF LOWER LEG |
25.00 |
| 73590 |
26 |
X-RAY EXAM OF LOWER LEG |
25.00 |
| 73592 |
26 |
X-RAY EXAM OF LEG INFANT |
24.00 |
| 73600 |
26 |
X-RAY EXAM OF ANKLE |
25.00 |
| 73600 |
26 |
X-RAY EXAM OF ANKLE |
25.00 |
| 73600 |
26 |
X-RAY EXAM OF ANKLE |
25.00 |
| 73610 |
26 |
X-RAY EXAM OF ANKLE |
26.00 |
| 73610 |
26 |
X-RAY EXAM OF ANKLE |
26.00 |
| 73615 |
26 |
CONTRAST X-RAY OF ANKLE |
84.00 |
| 73620 |
26 |
X-RAY EXAM OF FOOT |
23.00 |
| 73620 |
26 |
X-RAY EXAM OF FOOT |
23.00 |
| 73620 |
26 |
X-RAY EXAM OF FOOT |
23.00 |
| 73630 |
26 |
X-RAY EXAM OF FOOT |
25.00 |
| 73630 |
26 |
X-RAY EXAM OF FOOT |
25.00 |
| 73630 |
26 |
X-RAY EXAM OF FOOT |
25.00 |
| 73650 |
26 |
X-RAY EXAM OF HEEL |
24.00 |
| 73650 |
26 |
X-RAY EXAM OF HEEL |
24.00 |
| 73650 |
26 |
X-RAY EXAM OF HEEL |
24.00 |
| 73660 |
26 |
X-RAY EXAM OF TOE(S) |
20.00 |
| 73660 |
26 |
X-RAY EXAM OF TOE(S) |
20.00 |
| 73660 |
26 |
X-RAY EXAM OF TOE(S) |
20.00 |
| 73700 |
26 |
CT LOWER EXTREMITY W/O DYE |
147.00 |
| 73700 |
26 |
CT LOWER EXTREMITY W/O DYE |
147.00 |
| 73701 |
26 |
CT LOWER EXTREMITY W/DYE |
171.00 |
| 73701 |
26 |
CT LOWER EXTREMITY W/DYE |
171.00 |
| 73702 |
26 |
CT LWR EXTREMITY W/O&W/DYE |
178.00 |
| 73706 |
26 |
CT ANGIO LWR EXTR W/O&W/DYE |
278.00 |
| 73718 |
26 |
MRI LOWER EXTREMITY W/O DYE |
198.00 |
| 73719 |
26 |
MRI LOWER EXTREMITY W/DYE |
237.00 |
| 73720 |
26 |
MRI LWR EXTREMITY W/O&W/DYE |
315.00 |
| 73721 |
26 |
MRI JNT OF LWR EXTRE W/O DYE |
199.00 |
| 73721 |
26 |
MRI JNT OF LWR EXTRE W/O DYE |
199.00 |
| 73722 |
26 |
MRI JOINT OF LWR EXTR W/DYE |
238.00 |
| 73723 |
26 |
MRI JOINT LWR EXTR W/O&W/DYE |
315.00 |
| 73723 |
26 |
MRI JOINT LWR EXTR W/O&W/DYE |
315.00 |
| 73725 |
26 |
MR ANG LWR EXT W OR W/O DYE |
264.00 |
| 74000 |
26 |
X-RAY EXAM OF ABDOMEN |
27.00 |
| 74000 |
26 |
X-RAY EXAM OF ABDOMEN |
27.00 |
| 74010 |
26 |
X-RAY EXAM OF ABDOMEN |
34.00 |
| 74020 |
26 |
X-RAY EXAM OF ABDOMEN |
40.00 |
| 74020 |
26 |
X-RAY EXAM OF ABDOMEN |
40.00 |
| 74020 |
26 |
X-RAY EXAM OF ABDOMEN |
40.00 |
| 74022 |
26 |
X-RAY EXAM SERIES ABDOMEN |
47.00 |
| 74022 |
26 |
X-RAY EXAM SERIES ABDOMEN |
47.00 |
| 74150 |
26 |
CT ABDOMEN W/O DYE |
175.00 |
| 74160 |
26 |
CT ABDOMEN W/DYE |
187.00 |
| 74170 |
26 |
CT ABDOMEN W/O & W/DYE |
206.00 |
| 74174 |
26 |
CT ANGIO ABD&PELV W/O&W/DYE |
321.00 |
| 74175 |
26 |
CT ANGIO ABDOM W/O & W/DYE |
265.00 |
| 74176 |
26 |
CT ABD & PELVIS W/O CONTRAST |
256.00 |
| 74177 |
26 |
CT ABD & PELV W/CONTRAST |
267.00 |
| 74177 |
26 |
CT ABD & PELV W/CONTRAST |
267.00 |
| 74178 |
26 |
CT ABD & PELV 1/> REGNS |
295.00 |
| 74181 |
26 |
MRI ABDOMEN W/O DYE |
214.00 |
| 74181 |
26 |
MRI ABDOMEN W/O DYE |
214.00 |
| 74182 |
26 |
MRI ABDOMEN W/DYE |
254.00 |
| 74183 |
26 |
MRI ABDOMEN W/O & W/DYE |
332.00 |
| 74183 |
26 |
MRI ABDOMEN W/O & W/DYE |
332.00 |
| 74185 |
26 |
MRI ANGIO ABDOM W ORW/O DYE |
262.00 |
| 74190 |
26 |
X-RAY EXAM OF PERITONEUM |
69.00 |
| 74210 |
26 |
CONTRST X-RAY EXAM OF THROAT |
52.00 |
| 74220 |
26 |
CONTRAST X-RAY ESOPHAGUS |
68.00 |
| 74230 |
26 |
CINE/VID X-RAY THROAT/ESOPH |
78.00 |
| 74230 |
26 |
CINE/VID X-RAY THROAT/ESOPH |
78.00 |
| 74240 |
26 |
X-RAY UPPER GI DELAY W/O KUB |
102.00 |
| 74240 |
26 |
X-RAY UPPER GI DELAY W/O KUB |
102.00 |
| 74241 |
26 |
X-RAYUPPER GI DELAY W/KUB |
102.00 |
| 74245 |
26 |
X-RAY UPPER GI&SMALL INTEST |
134.00 |
| 74246 |
26 |
CONTRST X-RAY UPPR GI TRACT |
102.00 |
| 74247 |
26 |
CONTRST X-RAY UPPR GI TRACT |
102.00 |
| 74249 |
26 |
CONTRST X-RAY UPPR GI TRACT |
134.00 |
| 74250 |
26 |
X-RAY EXAM OF SMALL BOWEL |
69.00 |
| 74251 |
26 |
X-RAY EXAM OF SMALL BOWEL |
102.00 |
| 74260 |
26 |
X-RAY EXAM OF SMALL BOWEL |
74.00 |
| 74261 |
26 |
CT COLONOGRAPHY DX |
353.00 |
| 74262 |
26 |
CT COLONOGRAPHY DX W/DYE |
367.00 |
| 74263 |
26 |
CT COLONOGRAPHY SCREENING |
336.00 |
| 74270 |
26 |
CONTRAST X-RAY EXAM OF COLON |
102.00 |
| 74280 |
26 |
CONTRAST X-RAY EXAM OF COLON |
146.00 |
| 74283 |
26 |
CONTRAST X-RAY EXAM OF COLON |
299.00 |
| 74290 |
26 |
CONTRAST X-RAY GALLBLADDER |
47.00 |
| 74300 |
26 |
X-RAY BILE DUCTS/PANCREAS |
53.00 |
| 74300 |
26 |
X-RAY BILE DUCTS/PANCREAS |
53.00 |
| 74301 |
26 |
X-RAYS AT SURGERY ADD-ON |
31.00 |
| 74301 |
26 |
X-RAYS AT SURGERY ADD-ON |
31.00 |
| 74305 |
26 |
X-RAY BILE DUCTS/PANCREAS |
69.00 |
| 74305 |
26 |
X-RAY BILE DUCTS/PANCREAS |
69.00 |
| 74305 |
26 |
X-RAY BILE DUCTS/PANCREAS |
69.00 |
| 74320 |
26 |
CONTRAST X-RAY OF BILE DUCTS |
90.00 |
| 74320 |
26 |
CONTRAST X-RAY OF BILE DUCTS |
90.00 |
| 74320 |
26 |
CONTRAST X-RAY OF BILE DUCTS |
90.00 |
| 74327 |
26 |
X-RAY BILE STONE REMOVAL |
114.00 |
| 74327 |
26 |
X-RAY BILE STONE REMOVAL |
114.00 |
| 74328 |
26 |
X-RAY BILE DUCT ENDOSCOPY |
104.00 |
| 74328 |
26 |
X-RAY BILE DUCT ENDOSCOPY |
104.00 |
| 74329 |
26 |
X-RAY FOR PANCREAS ENDOSCOPY |
105.00 |
| 74329 |
26 |
X-RAY FOR PANCREAS ENDOSCOPY |
105.00 |
| 74330 |
26 |
X-RAY BILE/PANC ENDOSCOPY |
133.00 |
| 74330 |
26 |
X-RAY BILE/PANC ENDOSCOPY |
133.00 |
| 74340 |
26 |
X-RAY GUIDE FOR GI TUBE |
79.00 |
| 74355 |
26 |
X-RAY GUIDE INTESTINAL TUBE |
113.00 |
| 74360 |
26 |
X-RAY GUIDE GI DILATION |
82.00 |
| 74363 |
26 |
X-RAY BILE DUCT DILATION |
126.00 |
| 74363 |
26 |
X-RAY BILE DUCT DILATION |
126.00 |
| 74400 |
26 |
CONTRST X-RAY URINARY TRACT |
72.00 |
| 74400 |
26 |
CONTRST X-RAY URINARY TRACT |
72.00 |
| 74410 |
26 |
CONTRST X-RAY URINARY TRACT |
71.00 |
| 74415 |
26 |
CONTRST X-RAY URINARY TRACT |
72.00 |
| 74420 |
26 |
CONTRST X-RAY URINARY TRACT |
51.00 |
| 74420 |
26 |
CONTRST X-RAY URINARY TRACT |
51.00 |
| 74425 |
26 |
CONTRST X-RAY URINARY TRACT |
51.00 |
| 74425 |
26 |
CONTRST X-RAY URINARY TRACT |
51.00 |
| 74425 |
26 |
CONTRST X-RAY URINARY TRACT |
51.00 |
| 74430 |
26 |
CONTRAST X-RAY BLADDER |
47.00 |
| 74430 |
26 |
CONTRAST X-RAY BLADDER |
47.00 |
| 74445 |
26 |
X-RAY EXAM OF PENIS |
159.00 |
| 74450 |
26 |
X-RAY URETHRA/BLADDER |
48.00 |
| 74450 |
26 |
X-RAY URETHRA/BLADDER |
48.00 |
| 74455 |
26 |
X-RAY URETHRA/BLADDER |
48.00 |
| 74455 |
26 |
X-RAY URETHRA/BLADDER |
48.00 |
| 74470 |
26 |
X-RAY EXAM OF KIDNEY LESION |
77.00 |
| 74475 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74475 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74475 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74480 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74480 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74480 |
26 |
X-RAY CONTROL CATH INSERT |
90.00 |
| 74485 |
26 |
X-RAY GUIDE GU DILATION |
76.00 |
| 74485 |
26 |
X-RAY GUIDE GU DILATION |
76.00 |
| 74710 |
26 |
X-RAY MEASUREMENT OF PELVIS |
50.00 |
| 74712 |
26 |
MRI FETAL SNGL/1ST GESTATION |
441.00 |
| 74713 |
26 |
MRI FETAL EA ADDL GESTATION |
262.00 |
| 74740 |
26 |
X-RAY FEMALE GENITAL TRACT |
55.00 |
| 74740 |
26 |
X-RAY FEMALE GENITAL TRACT |
55.00 |
| 74742 |
26 |
X-RAY FALLOPIAN TUBE |
87.00 |
| 75557 |
26 |
CARDIAC MRI FOR MORPH |
338.00 |
| 75561 |
26 |
CARDIAC MRI FOR MORPH W/DYE |
374.00 |
| 75565 |
26 |
CARD MRI VELOC FLOW MAPPING |
36.00 |
| 75571 |
26 |
CT HRT W/O DYE W/CA TEST |
84.00 |
| 75572 |
26 |
CT HRT W/3D IMAGE |
254.00 |
| 75573 |
26 |
CT HRT W/3D IMAGE CONGEN |
369.00 |
| 75574 |
26 |
CT ANGIO HRT W/3D IMAGE |
347.00 |
| 75600 |
26 |
CONTRAST EXAM THORACIC AORTA |
71.00 |
| 75605 |
26 |
CONTRAST EXAM THORACIC AORTA |
164.00 |
| 75625 |
26 |
CONTRAST EXAM ABDOMINL AORTA |
164.00 |
| 75625 |
26 |
CONTRAST EXAM ABDOMINL AORTA |
164.00 |
| 75630 |
26 |
X-RAY AORTA LEG ARTERIES |
259.00 |
| 75635 |
26 |
CT ANGIO ABDOMINAL ARTERIES |
350.00 |
| 75658 |
26 |
ARTERY X-RAYS ARM |
188.00 |
| 75660 |
26 |
ARTERY X-RAYS HEAD & NECK |
216.00 |
| 75662 |
26 |
ARTERY X-RAYS HEAD & NECK |
271.00 |
| 75676 |
26 |
ARTERY X-RAYS NECK |
216.00 |
| 75676 |
26 |
ARTERY X-RAYS NECK |
216.00 |
| 75705 |
26 |
ARTERY X-RAYS SPINE |
335.00 |
| 75705 |
26 |
ARTERY X-RAYS SPINE |
335.00 |
| 75710 |
26 |
ARTERY X-RAYS ARM/LEG |
166.00 |
| 75710 |
26 |
ARTERY X-RAYS ARM/LEG |
166.00 |
| 75710 |
26 |
ARTERY X-RAYS ARM/LEG |
166.00 |
| 75716 |
26 |
ARTERY X-RAYS ARMS/LEGS |
190.00 |
| 75716 |
26 |
ARTERY X-RAYS ARMS/LEGS |
190.00 |
| 75716 |
26 |
ARTERY X-RAYS ARMS/LEGS |
190.00 |
| 75722 |
26 |
ARTERY X-RAYS KIDNEY |
188.00 |
| 75724 |
26 |
ARTERY X-RAYS KIDNEYS |
243.00 |
| 75726 |
26 |
ARTERY X-RAYS ABDOMEN |
163.00 |
| 75726 |
26 |
ARTERY X-RAYS ABDOMEN |
163.00 |
| 75731 |
26 |
ARTERY X-RAYS ADRENAL GLAND |
167.00 |
| 75733 |
26 |
ARTERY X-RAYS ADRENALS |
186.00 |
| 75736 |
26 |
ARTERY X-RAYS PELVIS |
163.00 |
| 75736 |
26 |
ARTERY X-RAYS PELVIS |
163.00 |
| 75741 |
26 |
ARTERY X-RAYS LUNG |
186.00 |
| 75743 |
26 |
ARTERY X-RAYS LUNGS |
237.00 |
| 75746 |
26 |
ARTERY X-RAYS LUNG |
165.00 |
| 75756 |
26 |
ARTERY X-RAYS CHEST |
165.00 |
| 75774 |
26 |
ARTERY X-RAY EACH VESSEL |
52.00 |
| 75774 |
26 |
ARTERY X-RAY EACH VESSEL |
52.00 |
| 75791 |
26 |
AV DIALYSIS SHUNT IMAGING |
254.00 |
| 75801 |
26 |
LYMPH VESSEL X-RAY ARM/LEG |
131.00 |
| 75803 |
26 |
LYMPH VESSEL X-RAY ARMS/LEGS |
172.00 |
| 75805 |
26 |
LYMPH VESSEL X-RAY TRUNK |
119.00 |
| 75807 |
26 |
LYMPH VESSEL X-RAY TRUNK |
173.00 |
| 75809 |
26 |
NONVASCULAR SHUNT X-RAY |
70.00 |
| 75810 |
26 |
VEIN X-RAY SPLEEN/LIVER |
168.00 |
| 75820 |
26 |
VEIN X-RAY ARM/LEG |
102.00 |
| 75820 |
26 |
VEIN X-RAY ARM/LEG |
102.00 |
| 75822 |
26 |
VEIN X-RAY ARMS/LEGS |
153.00 |
| 75825 |
26 |
VEIN X-RAY TRUNK |
166.00 |
| 75825 |
26 |
VEIN X-RAY TRUNK |
166.00 |
| 75827 |
26 |
VEIN X-RAY CHEST |
166.00 |
| 75831 |
26 |
VEIN X-RAY KIDNEY |
163.00 |
| 75833 |
26 |
VEIN X-RAY KIDNEYS |
213.00 |
| 75840 |
26 |
VEIN X-RAY ADRENAL GLAND |
167.00 |
| 75842 |
26 |
VEIN X-RAY ADRENAL GLANDS |
218.00 |
| 75860 |
26 |
VEIN X-RAY NECK |
164.00 |
| 75885 |
26 |
VEIN X-RAY LIVER W/HEMODYNAM |
204.00 |
| 75887 |
26 |
VEIN X-RAY LIVER W/O HEMODYN |
205.00 |
| 75889 |
26 |
VEIN X-RAY LIVER W/HEMODYNAM |
162.00 |
| 75891 |
26 |
VEIN X-RAY LIVER |
164.00 |
| 75893 |
26 |
VENOUS SAMPLING BY CATHETER |
79.00 |
| 75893 |
26 |
VENOUS SAMPLING BY CATHETER |
79.00 |
| 75894 |
26 |
X-RAYS TRANSCATH THERAPY |
195.00 |
| 75896 |
26 |
X-RAYS TRANSCATH THERAPY |
216.00 |
| 75896 |
26 |
X-RAYS TRANSCATH THERAPY |
216.00 |
| 75896 |
26 |
X-RAYS TRANSCATH THERAPY |
216.00 |
| 75898 |
26 |
FOLLOW-UP ANGIOGRAPHY |
247.00 |
| 75898 |
26 |
FOLLOW-UP ANGIOGRAPHY |
247.00 |
| 75901 |
26 |
REMOVE CVA DEVICE OBSTRUCT |
70.00 |
| 75901 |
26 |
REMOVE CVA DEVICE OBSTRUCT |
70.00 |
| 75902 |
26 |
REMOVE CVA LUMEN OBSTRUCT |
56.00 |
| 75940 |
26 |
X-RAY PLACEMENT VEIN FILTER |
90.00 |
| 75940 |
26 |
X-RAY PLACEMENT VEIN FILTER |
90.00 |
| 75945 |
26 |
INTRAVASCULAR US |
68.00 |
| 75946 |
26 |
INTRAVASCULAR US ADD-ON |
68.00 |
| 75952 |
26 |
ENDOVASC REPAIR ABDOM AORTA |
662.00 |
| 75953 |
26 |
ABDOM ANEURYSM ENDOVAS RPR |
201.00 |
| 75954 |
26 |
ILIAC ANEURYSM ENDOVAS RPR |
335.00 |
| 75960 |
26 |
TRANSCATH IV STENT RS&I |
131.00 |
| 75960 |
26 |
TRANSCATH IV STENT RS&I |
131.00 |
| 75962 |
26 |
REPAIR ARTERIAL BLOCKAGE |
78.00 |
| 75962 |
26 |
REPAIR ARTERIAL BLOCKAGE |
78.00 |
| 75964 |
26 |
REPAIR ARTERY BLOCKAGE EACH |
53.00 |
| 75966 |
26 |
REPAIR ARTERIAL BLOCKAGE |
189.00 |
| 75966 |
26 |
REPAIR ARTERIAL BLOCKAGE |
189.00 |
| 75968 |
26 |
REPAIR ARTERY BLOCKAGE EACH |
53.00 |
| 75970 |
26 |
VASCULAR BIOPSY |
118.00 |
| 75978 |
26 |
REPAIR VENOUS BLOCKAGE |
78.00 |
| 75978 |
26 |
REPAIR VENOUS BLOCKAGE |
78.00 |
| 75980 |
26 |
CONTRAST XRAY EXAM BILE DUCT |
236.00 |
| 75982 |
26 |
CONTRAST XRAY EXAM BILE DUCT |
236.00 |
| 75982 |
26 |
CONTRAST XRAY EXAM BILE DUCT |
236.00 |
| 75984 |
26 |
XRAY CONTROL CATHETER CHANGE |
103.00 |
| 75984 |
26 |
XRAY CONTROL CATHETER CHANGE |
103.00 |
| 75989 |
26 |
ABSCESS DRAINAGE UNDER X-RAY |
172.00 |
| 75989 |
26 |
ABSCESS DRAINAGE UNDER X-RAY |
172.00 |
| 76000 |
26 |
FLUOROSCOPE EXAMINATION |
26.00 |
| 76001 |
26 |
FLUOROSCOPE EXAM EXTENSIVE |
105.00 |
| 76010 |
26 |
X-RAY NOSE TO RECTUM |
27.00 |
| 76080 |
26 |
X-RAY EXAM OF FISTULA |
77.00 |
| 76080 |
26 |
X-RAY EXAM OF FISTULA |
77.00 |
| 76098 |
26 |
X-RAY EXAM BREAST SPECIMEN |
24.00 |
| 76098 |
26 |
X-RAY EXAM BREAST SPECIMEN |
24.00 |
| 76100 |
26 |
X-RAY EXAM OF BODY SECTION |
92.00 |
| 76101 |
26 |
COMPLEX BODY SECTION X-RAY |
98.00 |
| 76102 |
26 |
COMPLEX BODY SECTION X-RAYS |
99.00 |
| 76376 |
26 |
3D RENDER W/INTRP POSTPROCES |
29.00 |
| 76377 |
26 |
3D RENDER W/INTRP POSTPROCES |
116.00 |
| 76380 |
26 |
CAT SCAN FOLLOW-UP STUDY |
144.00 |
| 76390 |
26 |
MR SPECTROSCOPY |
204.00 |
| 76496 |
26 |
FLUOROSCOPIC PROCEDURE |
58.00 |
| 76506 |
26 |
ECHO EXAM OF HEAD |
95.00 |
| 76506 |
26 |
ECHO EXAM OF HEAD |
95.00 |
| 76536 |
26 |
US EXAM OF HEAD AND NECK |
82.00 |
| 76604 |
26 |
US EXAM CHEST |
79.00 |
| 76604 |
26 |
US EXAM CHEST |
79.00 |
| 76604 |
26 |
US EXAM CHEST |
79.00 |
| 76641 |
26 |
ULTRASOUND BREAST COMPLETE |
107.00 |
| 76642 |
26 |
ULTRASOUND BREAST LIMITED |
100.00 |
| 76645 |
26 |
US EXAM BREAST(S) |
92.00 |
| 76645 |
26 |
US EXAM BREAST(S) |
92.00 |
| 76700 |
26 |
US EXAM ABDOM COMPLETE |
118.00 |
| 76705 |
26 |
ECHO EXAM OF ABDOMEN |
86.00 |
| 76705 |
26 |
ECHO EXAM OF ABDOMEN |
86.00 |
| 76706 |
26 |
US ABDL AORTA SCREEN AAA |
82.00 |
| 76770 |
26 |
US EXAM ABDO BACK WALL COMP |
108.00 |
| 76775 |
26 |
US EXAM ABDO BACK WALL LIM |
84.00 |
| 76776 |
26 |
US EXAM K TRANSPL W/DOPPLER |
111.00 |
| 76800 |
26 |
US EXAM SPINAL CANAL |
177.00 |
| 76801 |
26 |
OB US < 14 WKS SINGLE FETUS |
147.00 |
| 76802 |
26 |
OB US < 14 WKS ADDL FETUS |
124.00 |
| 76805 |
26 |
OB US >/= 14 WKS SNGL FETUS |
148.00 |
| 76810 |
26 |
OB US >/= 14 WKS ADDL FETUS |
147.00 |
| 76811 |
26 |
OB US DETAILED SNGL FETUS |
288.00 |
| 76812 |
26 |
OB US DETAILED ADDL FETUS |
270.00 |
| 76813 |
26 |
OB US NUCHAL MEAS 1 GEST |
179.00 |
| 76814 |
26 |
OB US NUCHAL MEAS ADD-ON |
151.00 |
| 76815 |
26 |
OB US LIMITED FETUS(S) |
96.00 |
| 76816 |
26 |
OB US FOLLOW-UP PER FETUS |
128.00 |
| 76817 |
26 |
TRANSVAGINAL US OBSTETRIC |
112.00 |
| 76818 |
26 |
FETAL BIOPHYS PROFILE W/NST |
159.00 |
| 76819 |
26 |
FETAL BIOPHYS PROFIL W/O NST |
116.00 |
| 76825 |
26 |
ECHO EXAM OF FETAL HEART |
246.00 |
| 76830 |
26 |
TRANSVAGINAL US NON-OB |
102.00 |
| 76830 |
26 |
TRANSVAGINAL US NON-OB |
102.00 |
| 76831 |
26 |
ECHO EXAM UTERUS |
108.00 |
| 76856 |
26 |
US EXAM PELVIC COMPLETE |
101.00 |
| 76857 |
26 |
US EXAM PELVIC LIMITED |
73.00 |
| 76870 |
26 |
US EXAM SCROTUM |
94.00 |
| 76872 |
26 |
US TRANSRECTAL |
98.00 |
| 76872 |
26 |
US TRANSRECTAL |
98.00 |
| 76881 |
26 |
US XTR NON-VASC COMPLETE |
91.00 |
| 76882 |
26 |
US XTR NON-VASC LMTD |
72.00 |
| 76885 |
26 |
US EXAM INFANT HIPS DYNAMIC |
109.00 |
| 76886 |
26 |
US EXAM INFANT HIPS STATIC |
89.00 |
| 76936 |
26 |
ECHO GUIDE FOR ARTERY REPAIR |
290.00 |
| 76937 |
26 |
US GUIDE VASCULAR ACCESS |
42.00 |
| 76937 |
26 |
US GUIDE VASCULAR ACCESS |
42.00 |
| 76940 |
26 |
US GUIDE TISSUE ABLATION |
303.00 |
| 76942 |
26 |
ECHO GUIDE FOR BIOPSY |
98.00 |
| 76942 |
26 |
ECHO GUIDE FOR BIOPSY |
98.00 |
| 76942 |
26 |
ECHO GUIDE FOR BIOPSY |
98.00 |
| 76946 |
26 |
ECHO GUIDE FOR AMNIOCENTESIS |
57.00 |
| 76998 |
26 |
US GUIDE INTRAOP |
187.00 |
| 77001 |
26 |
FLUOROGUIDE FOR VEIN DEVICE |
56.00 |
| 77001 |
26 |
FLUOROGUIDE FOR VEIN DEVICE |
56.00 |
| 77002 |
26 |
NEEDLE LOCALIZATION BY XRAY |
82.00 |
| 77003 |
26 |
FLUOROGUIDE FOR SPINE INJECT |
88.00 |
| 77003 |
26 |
FLUOROGUIDE FOR SPINE INJECT |
88.00 |
| 77011 |
26 |
CT SCAN FOR LOCALIZATION |
183.00 |
| 77012 |
26 |
CT SCAN FOR NEEDLE BIOPSY |
169.00 |
| 77012 |
26 |
CT SCAN FOR NEEDLE BIOPSY |
169.00 |
| 77013 |
26 |
CT GUIDE FOR TISSUE ABLATION |
572.00 |
| 77014 |
26 |
CT SCAN FOR THERAPY GUIDE |
127.00 |
| 77021 |
|
MR GUIDANCE FOR NEEDLE PLACE |
220.00 |
| 77021 |
26 |
MR GUIDANCE FOR NEEDLE PLACE |
220.00 |
| 77022 |
26 |
MRI FOR TISSUE ABLATION |
621.00 |
| 77031 |
26 |
STEREOTACT GUIDE FOR BRST BX |
257.00 |
| 77031 |
26 |
STEREOTACT GUIDE FOR BRST BX |
257.00 |
| 77032 |
26 |
GUIDANCE FOR NEEDLE BREAST |
92.00 |
| 77032 |
26 |
GUIDANCE FOR NEEDLE BREAST |
92.00 |
| 77051 |
|
COMPUTER DX MAMMOGRAM ADD-ON |
8.00 |
| 77051 |
26 |
COMPUTER DX MAMMOGRAM ADD-ON |
8.00 |
| 77052 |
26 |
COMP SCREEN MAMMOGRAM ADD-ON |
8.00 |
| 77052 |
26 |
COMP SCREEN MAMMOGRAM ADD-ON |
8.00 |
| 77053 |
26 |
X-RAY OF MAMMARY DUCT |
52.00 |
| 77054 |
26 |
X-RAY OF MAMMARY DUCTS |
67.00 |
| 77055 |
26 |
MAMMOGRAM ONE BREAST |
103.00 |
| 77056 |
26 |
MAMMOGRAM BOTH BREASTS |
127.00 |
| 77057 |
26 |
MAMMOGRAM SCREENING |
103.00 |
| 77058 |
26 |
MRI ONE BREAST |
238.00 |
| 77059 |
26 |
MRI BOTH BREASTS |
238.00 |
| 77061 |
26 |
BREAST TOMOSYNTHESIS UNI |
158.00 |
| 77062 |
26 |
BREAST TOMOSYNTHESIS BI |
158.00 |
| 77063 |
26 |
BREAST TOMOSYNTHESIS BI |
87.00 |
| 77063 |
26 |
BREAST TOMOSYNTHESIS BI |
87.00 |
| 77065 |
26 |
DX MAMMO INCL CAD UNI |
105.00 |
| 77066 |
26 |
DX MAMMO INCL CAD BI |
129.00 |
| 77067 |
26 |
SCR MAMMO BI INCL CAD |
66.00 |
| 77071 |
26 |
X-RAY STRESS VIEW |
135.00 |
| 77072 |
26 |
X-RAYS FOR BONE AGE |
28.00 |
| 77073 |
26 |
X-RAYS BONE LENGTH STUDIES |
42.00 |
| 77074 |
26 |
X-RAYS BONE SURVEY LIMITED |
67.00 |
| 77074 |
26 |
X-RAYS BONE SURVEY LIMITED |
67.00 |
| 77075 |
26 |
X-RAYS BONE SURVEY COMPLETE |
79.00 |
| 77076 |
26 |
X-RAYS BONE SURVEY INFANT |
103.00 |
| 77077 |
26 |
JOINT SURVEY SINGLE VIEW |
47.00 |
| 77077 |
26 |
JOINT SURVEY SINGLE VIEW |
47.00 |
| 77078 |
26 |
CT BONE DENSITY AXIAL |
36.00 |
| 77079 |
26 |
CT BONE DENSITY PERIPHERAL |
32.00 |
| 77080 |
26 |
DXA BONE DENSITY AXIAL |
30.00 |
| 77081 |
26 |
DXA BONE DENSITY/PERIPHERAL |
32.00 |
| 77082 |
26 |
DXA BONE DENSITY VERT FX |
25.00 |
| 77083 |
26 |
RADIOGRAPHIC ABSORPTIOMETRY |
35.00 |
| 77084 |
26 |
MAGNETIC IMAGE BONE MARROW |
235.00 |
| 77085 |
26 |
DXA BONE DENSITY STUDY |
45.00 |
| 77086 |
26 |
FRACTURE ASSESSMENT VIA DXA |
26.00 |
| 77263 |
|
RADIATION THERAPY PLANNING |
480.00 |
| 77290 |
26 |
SET RADIATION THERAPY FIELD |
235.00 |
| 78012 |
26 |
THYROID UPTAKE MEASUREMENT |
28.00 |
| 78013 |
26 |
THYROID IMAGING W/BLOOD FLOW |
53.00 |
| 78014 |
26 |
THYROID IMAGING W/BLOOD FLOW |
72.00 |
| 78015 |
26 |
THYROID MET IMAGING |
96.00 |
| 78018 |
26 |
THYROID MET IMAGING BODY |
121.00 |
| 78020 |
26 |
THYROID MET UPTAKE |
81.00 |
| 78070 |
26 |
PARATHYROID PLANAR IMAGING |
114.00 |
| 78071 |
26 |
PARATHYRD PLANAR W/WO SUBTRJ |
172.00 |
| 78072 |
26 |
PARATHYRD PLANAR W/SPECT&CT |
225.00 |
| 78075 |
26 |
ADRENAL CORTEX & MEDULLA IMG |
103.00 |
| 78102 |
26 |
BONE MARROW IMAGING LTD |
78.00 |
| 78103 |
26 |
BONE MARROW IMAGING MULT |
106.00 |
| 78104 |
26 |
BONE MARROW IMAGING BODY |
112.00 |
| 78110 |
26 |
PLASMA VOLUME SINGLE |
28.00 |
| 78111 |
26 |
PLASMA VOLUME MULTIPLE |
32.00 |
| 78120 |
26 |
RED CELL MASS SINGLE |
34.00 |
| 78122 |
26 |
BLOOD VOLUME |
63.00 |
| 78135 |
26 |
RED CELL SURVIVAL KINETICS |
93.00 |
| 78185 |
26 |
SPLEEN IMAGING |
59.00 |
| 78195 |
26 |
LYMPH SYSTEM IMAGING |
173.00 |
| 78201 |
26 |
LIVER IMAGING |
62.00 |
| 78202 |
26 |
LIVER IMAGING WITH FLOW |
70.00 |
| 78205 |
26 |
LIVER IMAGING (3D) |
99.00 |
| 78206 |
26 |
LIVER IMAGE (3D) WITH FLOW |
137.00 |
| 78215 |
26 |
LIVER AND SPLEEN IMAGING |
71.00 |
| 78216 |
26 |
LIVER & SPLEEN IMAGE/FLOW |
80.00 |
| 78220 |
26 |
LIVER FUNCTION STUDY |
91.00 |
| 78223 |
26 |
HEPATOBILIARY IMAGING |
137.00 |
| 78223 |
26 |
HEPATOBILIARY IMAGING |
137.00 |
| 78226 |
26 |
HEPATOBILIARY SYSTEM IMAGING |
107.00 |
| 78227 |
26 |
HEPATOBIL SYST IMAGE W/DRUG |
131.00 |
| 78230 |
26 |
SALIVARY GLAND IMAGING |
56.00 |
| 78231 |
26 |
SERIAL SALIVARY IMAGING |
77.00 |
| 78232 |
26 |
SALIVARY GLAND FUNCTION EXAM |
58.00 |
| 78258 |
26 |
ESOPHAGEAL MOTILITY STUDY |
107.00 |
| 78261 |
26 |
GASTRIC MUCOSA IMAGING |
100.00 |
| 78262 |
26 |
GASTROESOPHAGEAL REFLUX EXAM |
97.00 |
| 78264 |
26 |
GASTRIC EMPTYING IMAG STUDY |
107.00 |
| 78265 |
26 |
GASTRIC EMPTYING IMAG STUDY |
141.00 |
| 78266 |
26 |
GASTRIC EMPTYING IMAG STUDY |
156.00 |
| 78270 |
26 |
VIT B-12 ABSORPTION EXAM |
31.00 |
| 78271 |
26 |
VIT B-12 ABSRP EXAM INT FAC |
30.00 |
| 78278 |
26 |
ACUTE GI BLOOD LOSS IMAGING |
143.00 |
| 78290 |
26 |
MECKELS DIVERT EXAM |
99.00 |
| 78291 |
26 |
LEVEEN/SHUNT PATENCY EXAM |
124.00 |
| 78300 |
26 |
BONE IMAGING LIMITED AREA |
91.00 |
| 78305 |
26 |
BONE IMAGING MULTIPLE AREAS |
120.00 |
| 78306 |
26 |
BONE IMAGING WHOLE BODY |
124.00 |
| 78315 |
26 |
BONE IMAGING 3 PHASE |
147.00 |
| 78320 |
26 |
BONE IMAGING (3D) |
147.00 |
| 78351 |
26 |
BONE MINERAL DUAL PHOTON |
96.00 |
| 78428 |
26 |
CARDIAC SHUNT IMAGING |
110.00 |
| 78445 |
26 |
VASCULAR FLOW IMAGING |
68.00 |
| 78451 |
26 |
HT MUSCLE IMAGE SPECT SING |
196.00 |
| 78452 |
26 |
HT MUSCLE IMAGE SPECT MULT |
230.00 |
| 78453 |
26 |
HT MUSCLE IMAGE PLANAR SING |
144.00 |
| 78454 |
26 |
HT MUSC IMAGE PLANAR MULT |
195.00 |
| 78456 |
26 |
ACUTE VENOUS THROMBUS IMAGE |
142.00 |
| 78457 |
26 |
VENOUS THROMBOSIS IMAGING |
112.00 |
| 78458 |
26 |
VEN THROMBOSIS IMAGES BILAT |
112.00 |
| 78459 |
26 |
HEART MUSCLE IMAGING (PET) |
207.00 |
| 78466 |
26 |
HEART INFARCT IMAGE |
102.00 |
| 78469 |
26 |
HEART INFARCT IMAGE (3D) |
133.00 |
| 78472 |
26 |
GATED HEART PLANAR SINGLE |
140.00 |
| 78473 |
26 |
GATED HEART MULTIPLE |
208.00 |
| 78481 |
26 |
HEART FIRST PASS SINGLE |
139.00 |
| 78483 |
26 |
HEART FIRST PASS MULTIPLE |
208.00 |
| 78491 |
26 |
HEART IMAGE (PET) SINGLE |
209.00 |
| 78492 |
26 |
HEART IMAGE (PET) MULTIPLE |
262.00 |
| 78494 |
26 |
HEART IMAGE SPECT |
170.00 |
| 78496 |
26 |
HEART FIRST PASS ADD-ON |
71.00 |
| 78579 |
26 |
LUNG VENTILATION IMAGING |
69.00 |
| 78580 |
26 |
LUNG PERFUSION IMAGING |
107.00 |
| 78582 |
26 |
LUNG VENTILAT&PERFUS IMAGING |
154.00 |
| 78584 |
26 |
LUNG V/Q IMAGE SINGLE BREATH |
152.00 |
| 78585 |
26 |
LUNG V/Q IMAGING |
166.00 |
| 78586 |
26 |
AEROSOL LUNG IMAGE SINGLE |
91.00 |
| 78587 |
26 |
AEROSOL LUNG IMAGE MULTIPLE |
137.00 |
| 78588 |
26 |
PERFUSION LUNG IMAGE |
162.00 |
| 78594 |
26 |
VENT IMAGE MULT PROJ GAS |
90.00 |
| 78596 |
26 |
LUNG DIFFERENTIAL FUNCTION |
205.00 |
| 78597 |
26 |
LUNG PERFUSION DIFFERENTIAL |
104.00 |
| 78598 |
26 |
LUNG PERF&VENTILAT DIFERENTL |
121.00 |
| 78600 |
26 |
BRAIN IMAGE < 4 VIEWS |
66.00 |
| 78601 |
26 |
BRAIN IMAGE W/FLOW < 4 VIEWS |
73.00 |
| 78605 |
26 |
BRAIN IMAGE 4+ VIEWS |
78.00 |
| 78606 |
26 |
BRAIN IMAGE W/FLOW 4 + VIEWS |
92.00 |
| 78607 |
26 |
BRAIN IMAGING (3D) |
173.00 |
| 78608 |
26 |
BRAIN IMAGING (PET) |
210.00 |
| 78609 |
26 |
BRAIN IMAGING (PET) |
238.00 |
| 78610 |
26 |
BRAIN FLOW IMAGING ONLY |
44.00 |
| 78630 |
26 |
CEREBROSPINAL FLUID SCAN |
99.00 |
| 78645 |
26 |
CSF SHUNT EVALUATION |
81.00 |
| 78647 |
26 |
CEREBROSPINAL FLUID SCAN |
132.00 |
| 78650 |
26 |
CSF LEAKAGE IMAGING |
87.00 |
| 78700 |
26 |
KIDNEY IMAGING MORPHOL |
65.00 |
| 78701 |
26 |
KIDNEY IMAGING WITH FLOW |
69.00 |
| 78707 |
26 |
K FLOW/FUNCT IMAGE W/O DRUG |
137.00 |
| 78708 |
26 |
K FLOW/FUNCT IMAGE W/DRUG |
173.00 |
| 78709 |
26 |
K FLOW/FUNCT IMAGE MULTIPLE |
201.00 |
| 78710 |
26 |
KIDNEY IMAGING (3D) |
90.00 |
| 78725 |
26 |
KIDNEY FUNCTION STUDY |
54.00 |
| 78740 |
26 |
URETERAL REFLUX STUDY |
80.00 |
| 78740 |
26 |
URETERAL REFLUX STUDY |
80.00 |
| 78761 |
26 |
TESTICULAR IMAGING W/FLOW |
105.00 |
| 78800 |
26 |
TUMOR IMAGING LIMITED AREA |
99.00 |
| 78801 |
26 |
TUMOR IMAGING MULT AREAS |
117.00 |
| 78802 |
26 |
TUMOR IMAGING WHOLE BODY |
122.00 |
| 78803 |
26 |
TUMOR IMAGING (3D) |
152.00 |
| 78804 |
26 |
TUMOR IMAGING WHOLE BODY |
152.00 |
| 78805 |
26 |
ABSCESS IMAGING LTD AREA |
105.00 |
| 78806 |
26 |
ABSCESS IMAGING WHOLE BODY |
122.00 |
| 78807 |
26 |
NUCLEAR LOCALIZATION/ABSCESS |
152.00 |
| 78808 |
26 |
IV INJ RA DRUG DX STUDY |
128.00 |
| 78811 |
26 |
PET IMAGE LTD AREA |
226.00 |
| 78812 |
26 |
PET IMAGE SKULL-THIGH |
275.00 |
| 78813 |
26 |
PET IMAGE FULL BODY |
287.00 |
| 78814 |
26 |
PET IMAGE W/CT LMTD |
317.00 |
| 78815 |
26 |
PET IMAGE W/CT SKULL-THIGH |
350.00 |
| 78816 |
26 |
PET IMAGE W/CT FULL BODY |
353.00 |
| 79005 |
26 |
NUCLEAR RX ORAL ADMIN |
257.00 |
| 79101 |
26 |
NUCLEAR RX IV ADMIN |
279.00 |
| 79200 |
26 |
NUCLEAR RX INTRACAV ADMIN |
296.00 |
| 79300 |
26 |
NUCLR RX INTERSTIT COLLOID |
232.00 |
| 79403 |
26 |
HEMATOPOIETIC NUCLEAR TX |
324.00 |
| 79440 |
26 |
NUCLEAR RX INTRA-ARTICULAR |
278.00 |
| 79445 |
26 |
NUCLEAR RX INTRA-ARTERIAL |
338.00 |
| 90772 |
26 |
THER/PROPH/DIAG INJ, SC/IM |
54.00 |
| 93010 |
|
ELECTROCARDIOGRAM REPORT |
25.00 |
| 93015 |
|
CARDIOVASCULAR STRESS TEST |
214.00 |
| 93503 |
26 |
INSERT/PLACE HEART CATHETER |
384.00 |
| 93875 |
26 |
EXTRACRANIAL STUDY |
79.00 |
| 93880 |
26 |
EXTRACRANIAL BILAT STUDY |
117.00 |
| 93882 |
26 |
EXTRACRANIAL UNI/LTD STUDY |
74.00 |
| 93886 |
26 |
INTRACRANIAL COMPLETE STUDY |
139.00 |
| 93888 |
26 |
INTRACRANIAL LIMITED STUDY |
75.00 |
| 93888 |
26 |
INTRACRANIAL LIMITED STUDY |
75.00 |
| 93922 |
26 |
UPR/L XTREMITY ART 2 LEVELS |
37.00 |
| 93923 |
26 |
UPR/LXTR ART STDY 3+ LVLS |
66.00 |
| 93924 |
26 |
LWR XTR VASC STDY BILAT |
73.00 |
| 93925 |
26 |
LOWER EXTREMITY STUDY |
115.00 |
| 93926 |
26 |
LOWER EXTREMITY STUDY |
71.00 |
| 93930 |
26 |
UPPER EXTREMITY STUDY |
117.00 |
| 93931 |
26 |
UPPER EXTREMITY STUDY |
73.00 |
| 93965 |
26 |
EXTREMITY STUDY |
51.00 |
| 93970 |
26 |
EXTREMITY STUDY |
102.00 |
| 93971 |
26 |
EXTREMITY STUDY |
66.00 |
| 93975 |
26 |
VASCULAR STUDY |
170.00 |
| 93975 |
26 |
VASCULAR STUDY |
170.00 |
| 93976 |
26 |
VASCULAR STUDY |
117.00 |
| 93976 |
26 |
VASCULAR STUDY |
117.00 |
| 93976 |
26 |
VASCULAR STUDY |
117.00 |
| 93978 |
26 |
VASCULAR STUDY |
118.00 |
| 93979 |
26 |
VASCULAR STUDY |
73.00 |
| 93980 |
26 |
PENILE VASCULAR STUDY |
179.00 |
| 93981 |
26 |
PENILE VASCULAR STUDY |
65.00 |
| 93990 |
26 |
DOPPLER FLOW TESTING |
73.00 |
| 94060 |
|
EVALUATION OF WHEEZING |
160.00 |
| 94060 |
26 |
EVALUATION OF WHEEZING |
36.00 |
| 96450 |
|
CHEMOTHERAPY INTO CNS |
236.00 |
| 96450 |
26 |
CHEMOTHERAPY INTO CNS |
236.00 |
| 99024 |
|
POSTOP FOLLOW-UP VISIT |
– |
| 99144 |
|
MOD SEDAT PHYS/QHP 5YRS/> |
58.00 |
| 99145 |
|
MOD SEDAT PHYS/QHP EA 15 MIN |
22.00 |
| 99145 |
76 |
MOD SEDAT PHYS/QHP EA 15 MIN |
22.00 |
| 99151 |
|
MOD SED SAME PHYS/QHP <5 YRS |
70.00 |
| 99152 |
|
MOD SED SAME PHYS/QHP 5/>YRS |
37.00 |
| 99153 |
|
MOD SED SAME PHYS/QHP EA |
30.00 |
| 99155 |
|
MOD SED OTH PHYS/QHP <5 YRS |
272.00 |
| 99156 |
|
MOD SED OTH PHYS/QHP 5/>YRS |
223.00 |
| 99157 |
|
MOD SED OTHER PHYS/QHP EA |
169.00 |
| 99201 |
|
OFFICE/OUTPATIENT VISIT NEW |
77.00 |
| 99202 |
|
OFFICE/OUTPATIENT VISIT NEW |
146.00 |
| 99203 |
|
OFFICE/OUTPATIENT VISIT NEW |
223.00 |
| 99204 |
|
OFFICE/OUTPATIENT VISIT NEW |
376.00 |
| 99205 |
|
OFFICE/OUTPATIENT VISIT NEW |
489.00 |
| 99211 |
|
OFFICE/OUTPATIENT VISIT EST |
27.00 |
| 99212 |
|
OFFICE/OUTPATIENT VISIT EST |
73.00 |
| 99213 |
|
OFFICE/OUTPATIENT VISIT EST |
148.00 |
| 99214 |
|
OFFICE/OUTPATIENT VISIT EST |
227.00 |
| 99215 |
|
OFFICE/OUTPATIENT VISIT EST |
321.00 |
| 99217 |
|
OBSERVATION CARE DISCHARGE |
209.00 |
| 99218 |
|
INITIAL OBSERVATION CARE |
289.00 |
| 99221 |
|
INITIAL HOSPITAL CARE |
294.00 |
| 99222 |
|
INITIAL HOSPITAL CARE |
396.00 |
| 99224 |
|
SUBSEQUENT OBSERVATION CARE |
115.00 |
| 99225 |
|
SUBSEQUENT OBSERVATION CARE |
210.00 |
| 99226 |
|
SUBSEQUENT OBSERVATION CARE |
304.00 |
| 99231 |
|
SUBSEQUENT HOSPITAL CARE |
114.00 |
| 99232 |
|
SUBSEQUENT HOSPITAL CARE |
208.00 |
| 99233 |
|
SUBSEQUENT HOSPITAL CARE |
301.00 |
| 99238 |
|
HOSPITAL DISCHARGE DAY |
208.00 |
| 99241 |
|
OFFICE CONSULTATION |
131.00 |
| 99242 |
|
OFFICE CONSULTATION |
208.00 |
| 99243 |
|
OFFICE CONSULTATION |
261.00 |
| 99244 |
|
OFFICE CONSULTATION |
387.00 |
| 99245 |
|
OFFICE CONSULTATION |
492.00 |
| 99251 |
|
INPATIENT CONSULTATION |
137.00 |
| 99252 |
|
INPATIENT CONSULTATION |
210.00 |
| 99253 |
|
INPATIENT CONSULTATION |
263.00 |
| 99281 |
|
EMERGENCY DEPT VISIT |
62.00 |
| G0202 |
26 |
SCR MAMMO BI INCL CAD |
102.00 |
| G0202 |
26 |
SCR MAMMO BI INCL CAD |
102.00 |
| G0202 |
26 |
SCR MAMMO BI INCL CAD |
102.00 |
| G0204 |
26 |
DX MAMMO INCL CAD BI |
127.00 |
| G0204 |
26 |
DX MAMMO INCL CAD BI |
127.00 |
| G0206 |
26 |
DX MAMMO INCL CAD UNI |
102.00 |
| G0206 |
26 |
DX MAMMO INCL CAD UNI |
102.00 |
| G0219 |
26 |
PET IMG WHOLBOD MELANO NONCO |
236.00 |
| G0235 |
26 |
PET NOT OTHERWISE SPECIFIED |
214.00 |
| G0279 |
|
TOMOSYNTHESIS, MAMMO |
87.00 |
| G0279 |
26 |
TOMOSYNTHESIS, MAMMO |
87.00 |
| G0297 |
26 |
LDCT FOR LUNG CA SCREEN |
148.00 |
| G0364 |
|
BONE MARROW ASPIRATE &BIOPSY |
26.00 |
| G0365 |
|
VESSEL MAPPING HEMO ACCESS |
36.00 |
| G0365 |
26 |
VESSEL MAPPING HEMO ACCESS |
36.00 |
| G0389 |
26 |
ULTRASOUND EXAM AAA SCREEN |
85.00 |
| G9500 |
|
RAD EXPOS IND/EXP TM DOC |
– |
| G9637 |
|
DOC >1 DOSE REDUC TECH |
– |
| NON S |
|
NON SUFFICIENT FUNDS |
26.00 |
| Q0083 |
|
CHEMO BY OTHER THAN INFUSION |
79.00 |
| S8032 |
|
LOW DOSE CT LUNG SCREENING |
152.00 |
| S8032 |
26 |
LOW DOSE CT LUNG SCREENING |
152.00 |
