| RADIOLOGY - MD | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| MD70010 | CONTRAST X-RAY OF BRAIN | 96.48 |
| MD70015 | CONTRAST X-RAY OF BRAIN | 173.66 |
| MD70030 | X-RAY EYE FOR FOREIGN BODY | 36.45 |
| MD70100 | X-RAY EXAM OF JAW | 26.80 |
| MD70110 | X-RAY EXAM OF JAW | 41.81 |
| MD70120 | X-RAY EXAM OF MASTOIDS | 26.80 |
| MD70130 | X-RAY EXAM OF MASTOIDS | 51.46 |
| MD70134 | X-RAY EXAM OF MIDDLE EAR | 48.24 |
| MD70140 | X-RAY EXAM OF FACIAL BONES | 30.02 |
| MD70150 | X-RAY EXAM OF FACIAL BONES | 45.02 |
| MD70160 | X-RAY EXAM OF NASAL BONES | 27.87 |
| MD70170 | X-RAY EXAM OF TEAR DUCT | 41.81 |
| MD70190 | X-RAY EXAM OF EYE SOCKETS | 34.30 |
| MD70200 | X-RAY EXAM OF EYE SOCKETS | 47.17 |
| MD70210 | X-RAY EXAM OF SINUSES | 32.16 |
| MD70220 | X-RAY EXAM OF SINUSES | 46.10 |
| MD70240 | X-RAY EXAM, PITUITARY SADDLE | 30.02 |
| MD70250 | X-RAY EXAM OF SKULL | 35.38 |
| MD70260 | X-RAY EXAM OF SKULL | 49.31 |
| MD70300 | X-RAY EXAM OF TEETH | 9.65 |
| MD70310 | X-RAY EXAM OF TEETH | 16.08 |
| MD70320 | FULL MOUTH X-RAY OF TEETH | 34.30 |
| MD70328 | X-RAY EXAM OF JAW JOINT | 36.45 |
| MD70330 | X-RAY EXAM OF JAW JOINTS | 49.31 |
| MD70332 | X-RAY EXAM OF JAW JOINT | 73.97 |
| MD70336 | MAGNETIC IMAGE, JAW JOINT | 214.40 |
| MD70350 | X-RAY HEAD FOR ORTHODONTIA | 30.02 |
| MD70355 | PANORAMIC X-RAY OF JAWS | 28.94 |
| MD70360 | X-RAY EXAM OF NECK | 26.80 |
| MD70370 | THROAT X-RAY & FLUOROSCOPY | 45.02 |
| MD70371 | SPEECH EVALUATION, COMPLEX | 0.00 |
| MD70373 | CONTRAST X-RAY OF LARYNX | 60.03 |
| MD70380 | X-RAY EXAM OF SALIVARY GLAND | 24.66 |
| MD70390 | X-RAY EXAM OF SALIVARY DUCT | 75.04 |
| MD70450 | CAT SCAN OF HEAD OR BRAIN | 195.10 |
| MD70460 | CONTRAST CAT SCAN OF HEAD | 228.34 |
| MD70470 | CONTRAST CAT SCANS OF HEAD | 258.35 |
| MD70480 | CAT SCAN OF SKULL | 187.60 |
| MD70481 | CONTRAST CAT SCAN OF SKULL | 229.41 |
| MD70482 | CONTRAST CAT SCANS OF SKULL | 263.71 |
| MD70486 | CAT SCAN OF FACE, JAW | 195.10 |
| MD70487 | CONTRAST CAT SCAN, FACE/JAW | 209.04 |
| MD70488 | CONTRAST CAT SCANS, FACE/JAW | 258.35 |
| MD70490 | CAT SCAN OF NECK TISSUE | 225.12 |
| MD70491 | CONTRAST CAT OF NECK TISSUE | 228.34 |
| MD70492 | CONTRAST CAT OF NECK TISSUE | 258.35 |
| MD70540 | MAGNETIC IMAGE, FACE/NECK | 260.50 |
| MD70551 | MAGNETIC IMAGE, BRAIN (MRI) | 261.57 |
| MD70552 | MAGNETIC IMAGE, BRAIN (MRI) | 285.15 |
| MD70553 | MAGNETIC IMAGE, BRAIN (MRI) | 376.27 |
| MD71010 | CHEST X-RAY | 23.58 |
| MD71015 | CHEST X-RAY | 32.16 |
| MD71020 | CHEST X-RAY | 33.23 |
| MD71021 | CHEST X-RAY | 43.95 |
| MD71022 | CHEST X-RAY | 49.31 |
| MD71023 | CHEST X-RAY AND FLUOROSCOPY | 53.60 |
| MD71030 | CHEST X-RAY | 46.10 |
| MD71034 | CHEST X-RAY AND FLUOROSCOPY | 79.33 |
| MD71035 | CHEST X-RAY | 32.16 |
| MD71040 | CONTRAST X-RAY OF BRONCHI | 79.33 |
| MD71060 | CONTRAST X-RAY OF BRONCHI | 112.56 |
| MD71090 | X-RAY & PACEMAKER INSERTION | 90.05 |
| MD71100 | X-RAY EXAM OF RIBS | 36.45 |
| MD71101 | Y-RAY EXAM OF RIBS/CHEST | 45.02 |
| MD71110 | X-RAY EXAM OF RIBS | 48.24 |
| MD71111 | X-RAY EXAM OF RIBS/CHEST | 61.10 |
| MD71120 | X-RAY EXAM OF BREASTBONE | 35.38 |
| MD71130 | X-RAY EXAM OF BREASTBONE | 38.59 |
| MD71250 | CAT SCAN OF CHEST | 187.60 |
| MD71260 | CONTRAST CAT SCAN OF CHEST | 172.59 |
| MD71270 | CONTRAST CAT SCANS OF CHEST | 211.18 |
| MD71550 | MAGNETIC IMAGE, CHEST (MRI) | 279.79 |
| MD71555 | MAGNETIC IMAGE, CHEST (MRA) | 268.00 |
| MD72010 | X-RAY EXAM OF SPINE | 83.62 |
| MD72020 | X-RAY EXAM OF SPINE | 26.80 |
| MD72040 | X-RAY EXAM OF NECK SPINE | 37.52 |
| MD72050 | X-RAY EXAM OF NECK SPINE | 56.82 |
| MD72052 | X-RAY EXAM OF NECK SPINE | 68.61 |
| MD72069 | X-RAY EXAM OF TRUNK SPINE | 31.09 |
| MD72070 | X-RAY EXAM OF THORACIC SPINE | 36.45 |
| MD72072 | Z-RAY EXAM OF THORACIC SPINE | 37.52 |
| MD72074 | X-RAY EXAM OF THORACIC SPINE | 47.17 |
| MD72080 | X-RAY EXAM OF TRUNK SPINE | 38.59 |
| MD72090 | X-RAY EXAM OF TRUNK SPINE | 47.17 |
| MD72100 | X-RAY EXAM OF L0WER SPINE | 37.52 |
| MD72110 | X-RAY EXAM OF LOWER SPINE | 60.03 |
| MD72114 | X-RAY EXAM OF LOWER SPINE | 75.04 |
| MD72120 | X-RAY EXAM OF LOWER SPINE | 46.10 |
| MD72125 | CAT SCAN OF NECK SPINE | 187.60 |
| MD72126 | CONTRAST CAT SCAN OF NECK | 161.87 |
| MD72127 | CONTRAST CAT SCANS OF NECK | 196.18 |
| MD72128 | CAT SCAN OF THORAX SPINE | 187.60 |
| MD72129 | CONTRAST CAT SCAN OF THORAX | 161.87 |
| MD72130 | CONTRAST CAT SCANS OF THORAX | 196.18 |
| MD72131 | CAT SCAN OF LOWER SPINE | 187.60 |
| MD72132 | CONTRAST CAT OF LOWER SPINE | 161.87 |
| MD72133 | CONTRST CAT SCANS, LOW SPINE | 196.18 |
| MD72141 | MAGNETIC IMAGE, NECK SPINE | 248.70 |
| MD72142 | MAGNETIC IMAGE, NECK SPINE | 298.02 |
| MD72146 | MAGNETIC IMAGE, CHEST SPINE | 271.22 |
| MD72147 | MAGNETIC IMAGE, CHEST SPINE | 298.02 |
| MD72148 | MAGNETIC IMAGE, LUMBAR SPINE | 269.07 |
| MD72149 | MAGNETIC IMAGE, LUMBAR SPINE | 294.80 |
| MD72156 | MAGNETIC IMAGE, NECK SPINE | 405.22 |
| MD72157 | MAGNETIC IMAGE, CHEST SPINE | 405.22 |
| MD72158 | MAGNETIC IMAGE, LUMBAR SPINE | 391.28 |
| MD72159 | MAGNETIC IMAGE, SPINE (MRA) | 292.66 |
| MD72170 | X-RAY EXAM OF PELVIS | 28.94 |
| MD72190 | X-RAY EXAM OF PELVIS | 42.88 |
| MD72192 | CAT SCAN OF PELVIS | 160.80 |
| MD72193 | CONTRAST CAT SCAN OF PELVIS | 152.22 |
| MD72194 | CONTRAST CAT SCANS OF PELVIS | 176.88 |
| MD72196 | MAGNETIC IMAGE, PELVIS | 264.78 |
| MD72198 | MAGNETIC IMAGE, PELVIS (MRA) | 269.07 |
| MD72200 | X-RAY EXAM SACROILIAC JOINTS | 36.45 |
| MD72202 | X-RAY EXAM SACROILIAC JOINTS | 38.59 |
| MD72220 | X-RAY EXAM OF TAILBONE | 35.38 |
| MD72240 | 3ONTRAST X-RAY OF NECK SPINE | 161.87 |
| MD72255 | CONTRAST X-RAY, THORAX SPINE | 145.79 |
| MD72265 | CONTRAST X-RAY, LOWER SPINE | 145.79 |
| MD72270 | CONTRAST X-RAY OF SPINE | 220.83 |
| MD72275 | EPIDUROGRAPHY | 0.00 |
| MD72285 | X-RAY C/T SPINE DISK | 206.90 |
| MD72295 | X-RAY OF LOWER SPINE DISK | 196.18 |
| MD73000 | X-RAY EXAM OF COLLAR BONE | 26.80 |
| MD73010 | X-RAY EXAM OF SHOULDER BLADE | 32.16 |
| MD73020 | X-RAY EXAM OF SHOULDER | 25.73 |
| MD73030 | X-RAY EXAM OF SHOULDER | 36.45 |
| MD73040 | CONTRAST X-RAY OF SHOULDER | 81.47 |
| MD73050 | X-RAY EXAM OF SHOULDERS | 30.02 |
| MD73060 | X-RAY EXAM OF HUMERUS | 26.80 |
| MD73070 | X-RAY EXAM OF ELBOW | 24.66 |
| MD73080 | X-RAY EXAM OF ELBOW | 31.09 |
| MD73085 | CONTRAST X-RAY OF ELBOW | 86.83 |
| MD73090 | X-RAY EXAM OF FOREARM | 27.87 |
| MD73092 | X-RAY EXAM OF ARM, INFANT | 32.16 |
| MD73100 | X-RAY EXAM OF WRIST | 27.87 |
| MD73110 | X-RAY EXAM OF WRIST | 33.23 |
| MD73115 | CONTRAST X-RAY OF WRIST | 83.62 |
| MD73120 | X-RAY EXAM OF HAND | 26.80 |
| MD73130 | X-RAY EXAM OF HAND | 33.23 |
| MD73140 | X-RAY EXAM OF FINGER(S) | 25.73 |
| MD73200 | CAT SCAN OF ARM | 196.18 |
| MD73201 | CONTRAST CAT SCAN OF ARM | 221.90 |
| MD73202 | CONTRAST CAT SCANS OF ARM | 179.02 |
| MD73220 | MAGNETIC IMAGE, ARM/HAND | 260.50 |
| MD73221 | MAGNETIC IMAGE, JOINT OF ARM | 258.35 |
| MD73225 | MAGNETIC IMAGE, UPPER (MRA) | 266.93 |
| MD73500 | X-RAY EXAM OF HIP | 28.94 |
| MD73510 | X-RAY EXAM OF HIP | 37.52 |
| MD73520 | X-RAY EXAM OF HIPS | 48.24 |
| MD73525 | CONTRAST X-RAY OF HIP | 82.54 |
| MD73530 | X-RAY EXAM OF HIP | 53.60 |
| MD73540 | X-RAY EXAM OF PELVIS & HIPS | 36.45 |
| MD73542 | X-RAY EXAM, SACROILIAC JOINT | 103.98 |
| MD73550 | X-RAY EXAM OF THIGH | 33.23 |
| MD73560 | X-RAY EXAM OF KNEE, 1 OR 2 | 33.23 |
| MD73562 | X-RAY EXAM OF KNEE, 3 | 36.45 |
| MD73564 | X-RAY EXAM, KNEE, 4 OR MORE | 42.88 |
| MD73565 | X-RAY EXAM OF KNEES | 35.38 |
| MD73580 | CONTRAST X-RAY OF KNEE JOINT | 92.19 |
| MD73590 | X-RAY EXAM OF LOWER LEG | 32.16 |
| MD73592 | X-RAY EXAM OF LEG, INFANT | 28.94 |
| MD73600 | X-RAY EXAM OF ANKLE | 28.94 |
| MD73610 | X-RAY EXAM OF ANKLE | 34.30 |
| MD73615 | CONTRAST X-RAY OF ANKLE | 66.46 |
| MD73620 | X-RAY EXAM OF FOOT | 27.87 |
| MD73630 | X-RAY EXAM OF FOOT | 34.30 |
| MD73650 | X-RAY EXAM OF HEEL | 30.02 |
| MD73660 | X-RAY EXAM OF TOE(S) | 24.66 |
| MD73700 | CAT SCAN OF LEG | 190.82 |
| MD73701 | CONTRAST CAT SCAN OF LEG | 229.41 |
| MD73702 | CONTRAST CAT SCANS OF LEG | 179.02 |
| MD73720 | MAGNETIC IMAGE, LEG/FOOT | 275.50 |
| MD73721 | MAGNETIC IMAGE, JOINT OF LEG | 259.42 |
| MD73725 | MAGNETIC IMAGE/LOWER (MRA) | 284.08 |
| MD74000 | X-RAY EXAM OF ABDOMEN | 27.87 |
| MD74010 | X-RAY EXAM OF ABDOMEN | 36.45 |
| MD74020 | X-RAY EXAM OF ABDOMEN | 38.59 |
| MD74022 | X-RAY EXAM SERIES, ABDOMEN | 46.10 |
| MD74150 | CAT SCAN OF ABDOMEN | 169.38 |
| MD74160 | CONTRAST CAT SCAN OF ABDOMEN | 199.39 |
| MD74170 | CONTRAST CAT SCANS, ABDOMEN | 241.20 |
| MD74181 | MAGNETIC IMAGE/ABDOMEN (MRI) | 248.70 |
| MD74185 | MAGNETIC IMAGE/ABDOMEN (MRA) | 284.08 |
| MD74190 | X-RAY EXAM OF PERITONEUM | 60.03 |
| MD74210 | CONTRST X-RAY EXAM OF THROAT | 62.18 |
| MD74220 | CONTRAST X-RAY, ESOPHAGUS | 70.75 |
| MD74230 | CINE/VIDEO X-RAY, THROAT/ESOPH | 85.76 |
| MD74235 | REMOVE ESOPHAGUS OBSTRUCTION | 167.23 |
| MD74240 | X-RAY EXAM, UPPER GI TRACT | 90.05 |
| MD74241 | X-RAY EXAM, UPPER GI TRACT | 100.77 |
| MD74245 | X-RAY EXAM, UPPER GI TRACT | 135.07 |
| MD74246 | CONTRST X-RAY UPPR GI TRACT | 96.48 |
| MD74247 | CONTRST X-RAY UPPR GI TRACT | 102.91 |
| MD74249 | CONTRST X-RAY UPPR GI TRACT | 141.50 |
| MD74250 | X-RAY EXAM OF SMALL BOWEL | 71.82 |
| MD74251 | X-RAY EXAM OF SMALL BOWEL | 91.12 |
| MD74260 | X-RAY EXAM OF SMALL BOWEL | 80.40 |
| MD74270 | CONTRAST X-RAY EXAM OF COLON | 98.62 |
| MD74280 | CONTRAST X-RAY EXAM OF COLON | 134.00 |
| MD74283 | CONTRAST X-RAY EXAM OF COLON | 183.31 |
| MD74290 | CONTRAST X-RAY, GALLBLADDER | 54.67 |
| MD74291 | CONTRAST X-RAYS, GALLBLADDER | 34.30 |
| MD74300 | X-RAY BILE DUCTS/PANCREAS | 0.00 |
| MD74301 | X-RAYS AT SURGERY ADD-ON | 0.00 |
| MD74305 | X-RAY BILE DUCTS/PANCREAS | 67.54 |
| MD74320 | CONTRAST X-RAY OF BILE DUCTS | 84.69 |
| MD74327 | X-RAY BILE STONE REMOVAL | 134.00 |
| MD74328 | X-RAY BILE DUCT ENDOSCOPY | 122.21 |
| MD74329 | X-RAY FOR PANCREAS ENDOSCOPY | 122.21 |
| MD74330 | X-RAY BILE/PANC ENDOSCOPY | 127.57 |
| MD74340 | X-RAY GUIDE FOR GI TUBE | 83.62 |
| MD74350 | X-RAY GUIDE, STOMACH TUBE | 116.85 |
| MD74355 | X-RAY GUIDE, INTESTINAL TUBE | 102.91 |
| MD74360 | X-RAY GUIDE, GI DILATION | 0.00 |
| MD74363 | X-RAY, BILE DUCT DILATION | 0.00 |
| MD74400 | CONTRST X-RAY, URINARY TRACT | 56.82 |
| MD74410 | CONTRST X-RAY, URINARY TRACT | 68.61 |
| MD74415 | CONTRST X-RAY, URINARY TRACT | 80.40 |
| MD74420 | CONTRST X-RAY, URINARY TRACT | 36.45 |
| MD74425 | CONTRST X-RAY, URINARY TRACT | 66.46 |
| MD74430 | CONTRAST X-RAY, BLADDER | 49.31 |
| MD74440 | X-RAY, MALE GENITAL TRACT | 0.00 |
| MD74445 | X-RAY EXAM OF PENIS | 125.42 |
| MD74450 | X-RAY, URETHRA/BLADDER | 57.89 |
| MD74455 | X-RAY, URETHRA/BLADDER | 62.18 |
| MD74470 | X-RAY EXAM OF KIDNEY LESION | 61.10 |
| MD74475 | X-RAY CONTROL, CATH INSERT | 0.00 |
| MD74480 | X-RAY CONTROL, CATH INSERT | 0.00 |
| MD74485 | X-RAY GUIDE, GU DILATION | 0.00 |
| MD74710 | X-RAY MEASUREMENT OF PELVIS | 60.03 |
| MD74740 | X-RAY, FEMALE GENITAL TRACT | 50.38 |
| MD74742 | X-RAY, FALLOPIAN TUBE | 0.00 |
| MD74775 | X-RAY EXAM OF PERINEUM | 87.90 |
| MD75552 | MAGNETIC IMAGE, MYOCARDIUM | 280.86 |
| MD75553 | MAGNETIC IMAGE, MYOCARDIUM | 288.37 |
| MD75554 | CARDIAC MRI/FUNCTION | 284.08 |
| MD75555 | CARDIAC MRI/LIMITED STUDY | 283.01 |
| MD75556 | CARDIAC MRI/FLOW MAPPING | 0.00 |
| MD75600 | CONTRAST X-RAY EXAM OF AORTA | 155.44 |
| MD75605 | CONTRAST X-RAY EXAM OF AORTA | 203.68 |
| MD75625 | CONTRAST X-RAY EXAM OF AORTA | 192.96 |
| MD75630 | X-RAY AORTA, LEG ARTERIES | 260.50 |
| MD75650 | ARTERY X-RAYS, HEAD & NECK | 302.30 |
| MD75658 | ARTERY X-RAYS, ARM | 235.84 |
| MD75660 | ARTERY X-RAYS, HEAD & NECK | 247.63 |
| MD75662 | ARTERY X-RAYS, HEAD & NECK | 293.73 |
| MD75665 | ARTERY X-RAYS, HEAD & NECK | 246.56 |
| MD75671 | ARTERY X-RAYS, HEAD & NECK | 300.16 |
| MD75676 | ARTERY X-RAYS, NECK | 284.08 |
| MD75680 | ARTERY X-RAYS, NECK | 279.79 |
| MD75685 | ARTERY X-RAYS, SPINE | 203.68 |
| MD75705 | ARTERY X-RAYS, SPINE | 228.34 |
| MD75710 | ARTERY X-RAYS, ARM/LEG | 233.70 |
| MD75716 | ARTERY X-RAYS, ARMS/LEGS | 258.35 |
| MD75722 | ARTERY X-RAYS, KIDNEY | 209.04 |
| MD75724 | ARTERY X-RAYS, KIDNEYS | 289.44 |
| MD75726 | ARTERY X-RAYS, ABDOMEN | 235.84 |
| MD75731 | ARTERY X-RAYS, ADRENAL GLAND | 246.56 |
| MD75733 | ARTERY X-RAYS, ADRENALS | 257.28 |
| MD75736 | ARTERY X-RAYS, PELVIS | 246.56 |
| MD75741 | ARTERY X-RAYS, LUNG | 247.63 |
| MD75743 | ARTERY X-RAYS, LUNGS | 309.81 |
| MD75746 | ARTERY X-RAYS, LUNG | 182.24 |
| MD75756 | ARTERY X-RAYS, CHEST | 225.12 |
| MD75774 | ARTERY X-RAY, EACH VESSEL | 121.14 |
| MD75790 | VISUALIZE A-V SHUNT | 235.84 |
| MD75801 | LYMPH VESSEL X-RAY, ARM/LEG | 116.85 |
| MD75803 | LYMPH VESSEL X-RAY, ARMS/LEGS | 166.16 |
| MD75805 | LYMPH VESSEL X-RAY, TRUNK | 142.58 |
| MD75807 | LYMPH VESSEL X-RAY, TRUNK | 202.61 |
| MD75809 | NON-VASCULAR SHUNT, X-RAY | 80.40 |
| MD75810 | VEIN X-RAY, SPLEEN/LIVER | 191.89 |
| MD75820 | VEIN X-RAY, ARM/LEG | 145.79 |
| MD75822 | VEIN X-RAY, ARMS/LEGS | 203.68 |
| MD75825 | VEIN X-RAY, TRUNK | 209.04 |
| MD75827 | VEIN X-RAY, CHEST | 209.04 |
| MD75831 | VEIN X-RAY, KIDNEY | 209.04 |
| MD75833 | VEIN X-RAY, KIDNEYS | 277.65 |
| MD75840 | VEIN X-RAY, ADRENAL GLAND | 219.76 |
| MD75842 | VEIN X-RAY, ADRENAL GLANDS | 278.72 |
| MD75860 | VEIN X-RAY, NECK | 187.60 |
| MD75870 | VEIN X-RAY, SKULL | 186.53 |
| MD75872 | VEIN X-RAY, SKULL | 187.60 |
| MD75880 | VEIN X-RAY, EYE SOCKET | 117.92 |
| MD75885 | VEIN X-RAY, LIVER | 246.56 |
| MD75887 | VEIN X-RAY, LIVER | 209.04 |
| MD75889 | VEIN X-RAY, LIVER | 203.68 |
| MD75891 | VEIN X-RAY, LIVER | 203.68 |
| MD75893 | VENOUS SAMPLING BY CATHETER | 171.52 |
| MD75894 | X-RAYS, TRANSCATH THERAPY | 268.00 |
| MD75896 | X-RAYS, TRANSCATH THERAPY | 268.00 |
| MD75898 | FOLLOW-UP ANGIOGRAPHY | 284.08 |
| MD75900 | ARTERIAL CATHETER EXCHANGE | 77.18 |
| MD75940 | X-RAY PLACEMENT, VEIN FILTER | 144.72 |
| MD75945 | INTRAVASCULAR US | 0.00 |
| MD75946 | INTRAVASCULAR US ADD-ON | 0.00 |
| MD75947 | INTRAVASCULAR US | 0.00 |
| MD75960 | TRANSCATHETER INTRO, STENT | 192.96 |
| MD75961 | RETRIEVAL, BROKEN CATHETER | 428.80 |
| MD75962 | REPAIR ARTERIAL BLOCKAGE | 192.96 |
| MD75964 | REPAIR ARTERY BLOCKAGE, EACH | 107.20 |
| MD75966 | REPAIR ARTERIAL BLOCKAGE | 235.84 |
| MD75968 | REPAIR ARTERY BLOCKAGE, EACH | 124.35 |
| MD75970 | VASCULAR BIOPSY | 96.48 |
| MD75978 | REPAIR VENOUS BLOCKAGE | 192.96 |
| MD75980 | CONTRAST X-RAY EXAM BILE DUCT | 235.84 |
| MD75982 | CONTRAST X-RAY EXAM BILE DUCT | 268.00 |
| MD75984 | X-RAY CONTROL CATHETER CHANGE | 128.64 |
| MD75989 | ABSCESS DRAINAGE UNDER X-RAY | 214.40 |
| MD75992 | ATHERECTOMY, X-RAY EXAM | 0.00 |
| MD75993 | ATHERECTOMY, X-RAY EXAM | 0.00 |
| MD75994 | ATHERECTOMY, X-RAY EXAM | 0.00 |
| MD75995 | ATHERECTOMY, X-RAY EXAM | 0.00 |
| MD75996 | ATHERECTOMY, X-RAY EXAM | 0.00 |
| MD76000 | FLUOROSCOPE EXAMINATION | 28.94 |
| MD76001 | FLUOROSCOPE EXAM, EXTENSIVE | 0.00 |
| MD76003 | NEEDLE LOCALIZATION BY X-RAY | 0.00 |
| MD76005 | FLUOROGUIDE FOR SPINE INJECT | 0.00 |
| MD76006 | X-RAY STRESS VIEW | 0.00 |
| MD76010 | X-RAY, NOSE TO RECTUM | 25.73 |
| MD76020 | X-RAYS FOR BONE AGE | 0.00 |
| MD76040 | X-RAYS, BONE EVALUATION | 45.02 |
| MD76061 | X-RAYS, BONE SURVEY | 69.68 |
| MD76062 | X-RAYS, BONE SURVEY | 90.05 |
| MD76065 | X-RAYS, BONE EVALUATION | 45.02 |
| MD76066 | JOINT SURVEY, SINGLE VIEW | 41.81 |
| MD76070 | CT SCAN, BONE DENSITY STUDY | 64.32 |
| MD76075 | DUAL ENERGY X-RAY STUDY | 55.74 |
| MD76076 | DUAL ENERGY X-RAY STUDY | 107.20 |
| MD76078 | RADIOGRAPHIC ABSORPTIOMETRY | 101.84 |
| MD76080 | X-RAY EXAM OF FISTULA | 67.54 |
| MD76086 | X-RAY OF MAMMARY DUCT | 47.17 |
| MD76088 | X-RAY OF MAMMARY DUCTS | 60.03 |
| MD76090 | MAMMOGRAM, ONE BREAST | 46.10 |
| MD76091 | MAMMOGRAM, BOTH BREASTS | 57.89 |
| MD76092 | MAMMOGRAM, SCREENING | 47.17 |
| MD76093 | MAGNETIC IMAGE, BREAST | 287.30 |
| MD76094 | MAGNETIC IMAGE, BOTH BREASTS | 379.49 |
| MD76095 | STEREOTACTIC BREAST BIOPSY | 199.39 |
| MD76096 | X-RAY OF NEEDLE WIRE, BREAST | 94.34 |
| MD76098 | X-RAY EXAM, BREAST SPECIMEN | 40.74 |
| MD76100 | X-RAY EXAM OF BODY SECTION | 91.12 |
| MD76101 | COMPLEX BODY SECTION X-RAY | 94.34 |
| MD76102 | COMPLEX BODY SECTION X-RAYS | 115.78 |
| MD76120 | CINE/VIDEO X-RAYS | 0.00 |
| MD76125 | CINE/VIDEO X-RAYS ADD-ON | 0.00 |
| MD76140 | X-RAY CONSULTATION | 63.25 |
| MD76150 | X-RAY EXAM, DRY PROCESS | 49.31 |
| MD76350 | SPECIAL X-RAY CONTRAST STUDY | 50.38 |
| MD76355 | CAT SCAN FOR LOCALIZATION | 149.01 |
| MD76360 | CAT SCAN FOR NEEDLE BIOPSY | 170.45 |
| MD76370 | CAT SCAN FOR THERAPY GUIDE | 134.00 |
| MD76375 | 3D/HOLOGRAPH RECONSTR ADD-ON | 0.00 |
| MD76380 | CAT SCAN FOLLOW-UP STUDY | 124.35 |
| MD76390 | MR SPECTROSCOPY | 177.95 |
| MD76400 | MAGNETIC IMAGE, BONE MARROW | 248.70 |
| MD76506 | ECHO EXAM OF HEAD | 92.19 |
| MD76511 | ECHO EXAM OF EYE | 116.85 |
| MD76512 | ECHO EXAM OF EYE | 100.77 |
| MD76513 | ECHO EXAM OF EYE, WATER BATH | 100.77 |
| MD76516 | ECHO EXAM OF EYE | 86.83 |
| MD76519 | ECHO EXAM OF EYE | 95.41 |
| MD76529 | ECHO EXAM OF EYE | 105.06 |
| MD76536 | ECHO EXAM OF HEAD AND NECK | 91.12 |
| MD76604 | ECHO EXAM OF CHEST | 85.76 |
| MD76645 | ECHO EXAM OF BREAST(S) | 102.91 |
| MD76700 | ECHO EXAM OF ABDOMEN | 114.70 |
| MD76705 | ECHO EXAM OF ABDOMEN | 86.83 |
| MD76770 | ECHO EXAM ABDOMEN BACK WALL | 111.49 |
| MD76775 | ECHO EXAM ABDOMEN BACK WALL | 80.40 |
| MD76778 | ECHO EXAM KIDNEY TRANSPLANT | 120.06 |
| MD76800 | ECHO EXAM SPINAL CANAL | 150.08 |
| MD76805 | ECHO EXAM OF PREGNANT UTERUS | 122.21 |
| MD76810 | ECHO EXAM OF PREGNANT UTERUS | 141.50 |
| MD76815 | ECHO EXAM OF PREGNANT UTERUS | 66.46 |
| MD76816 | ECHO EXAM FOLLOW-UP/REPEAT | 76.11 |
| MD76818 | FETAL BIOPHYSICAL PROFILE | 116.85 |
| MD76825 | ECHO EXAM OF FETAL HEART | 134.00 |
| MD76826 | ECHO EXAM OF FETAL HEART | 139.36 |
| MD76827 | ECHO EXAM OF FETAL HEART | 98.62 |
| MD76828 | ECHO EXAM OF FETAL HEART | 72.90 |
| MD76830 | ECHO EXAM, TRANSVAGINAL | 106.13 |
| MD76831 | ECHO EXAM, UTERUS | 189.74 |
| MD76856 | ECHO EXAM OF PELVIS | 95.41 |
| MD76857 | ECHO EXAM OF PELVIS | 55.74 |
| MD76870 | ECHO EXAM OF SCROTUM | 91.12 |
| MD76872 | ECHO EXAM, TRANSRECTAL | 115.78 |
| MD76873 | ECHOGRAP TRANS R, PROS STUDY | 215.47 |
| MD76880 | ECHO EXAM OF EXTREMITY | 98.62 |
| MD76885 | ECHO EXAM, INFANT HIPS | 264.78 |
| MD76886 | ECHO EXAM, INFANT HIPS | 236.91 |
| MD76930 | ECHO GUIDE FOR HEART SAC TAP | 97.55 |
| MD76932 | ECHO GUIDE FOR HEART BIOPSY | 105.06 |
| MD76936 | ECHO GUIDE FOR ARTERY REPAIR | 345.18 |
| MD76941 | ECHO GUIDE FOR TRANSFUSION | 127.57 |
| MD76942 | ECHO GUIDE FOR BIOPSY | 103.98 |
| MD76945 | ECHO GUIDE, VILLUS SAMPLING | 118.99 |
| MD76946 | ECHO GUIDE FOR AMNIOCENTESIS | 62.18 |
| MD76948 | ECHO GUIDE, OVA ASPIRATION | 75.04 |
| MD76950 | ECHO GUIDANCE RADIOTHERAPY | 83.62 |
| MD76965 | ECHO GUIDANCE RADIOTHERAPY | 246.56 |
| MD76970 | ULTRASOUND EXAM FOLLOW-UP | 57.89 |
| MD76975 | GI ENDOSCOPIC ULTRASOUND | 115.78 |
| MD76977 | US BONE DENSITY MEASURE | 0.00 |
| MD76986 | ECHO EXAM AT SURGERY | 265.86 |
| MD76999 | ECHO EXAMINATION PROCEDURE | 0.00 |
| MD77261 | RADIATION THERAPY PLANNING | 293.73 |
| MD77262 | RADIATION THERAPY PLANNING | 407.36 |
| MD77263 | RADIATION THERAPY PLANNING | 562.80 |
| MD77280 | SET RADIATION THERAPY FIELD | 124.35 |
| MD77285 | SET RADIATION THERAPY FIELD | 179.02 |
| MD77290 | SET RADIATION THERAPY FIELD | 226.19 |
| MD77295 | SET RADIATION THERAPY FIELD | 667.86 |
| MD77299 | RADIATION THERAPY PLANNING | 0.00 |
| MD77300 | RADIATION THERAPY DOSE PLAN | 113.63 |
| MD77305 | RADIATION THERAPY DOSE PLAN | 125.42 |
| MD77310 | RADIATION THERAPY DOSE PLAN | 167.23 |
| MD77315 | RADIATION THERAPY DOSE PLAN | 237.98 |
| MD77321 | RADIATION THERAPY PORT PLAN | 158.66 |
| MD77326 | RADIATION THERAPY DOSE PLAN | 135.07 |
| MD77327 | RADIATION THERAPY DOSE PLAN | 199.39 |
| MD77328 | RADIATION THERAPY DOSE PLAN | 290.51 |
| MD77331 | SPECIAL RADIATION DOSIMETRY | 154.37 |
| MD77332 | RADIATION TREATMENT AID(S) | 107.20 |
| MD77333 | RADIATION TREATMENT AID(S) | 120.06 |
| MD77334 | RADIATION TREATMENT AID(S) | 195.10 |
| MD77336 | RADIATION PHYSICS CONSULT | 225.12 |
| MD77370 | RADIATION PHYSICS CONSULT | 263.71 |
| MD77399 | EXTERNAL RADIATION DOSIMETRY | 0.00 |
| MD77401 | RADIATION TREATMENT DELIVERY | 140.43 |
| MD77402 | RADIATION TREATMENT DELIVERY | 140.43 |
| MD77403 | RADIATION TREATMENT DELIVERY | 140.43 |
| MD77404 | RADIATION TREATMENT DELIVERY | 140.43 |
| MD77406 | RADIATION TREATMENT DELIVERY | 140.43 |
| MD77407 | RADIATION TREATMENT DELIVERY | 165.09 |
| MD77408 | RADIATION TREATMENT DELIVERY | 165.09 |
| MD77409 | RADIATION TREATMENT DELIVERY | 165.09 |
| MD77411 | RADIATION TREATMENT DELIVERY | 165.09 |
| MD77412 | RADIATION TREATMENT DELIVERY | 184.38 |
| MD77413 | RADIATION TREATMENT DELIVERY | 184.38 |
| MD77414 | RADIATION TREATMENT DELIVERY | 184.38 |
| MD77416 | RADIATION TREATMENT DELIVERY | 184.38 |
| MD77417 | RADIOLOGY PORT FILM(S) | 68.61 |
| MD77427 | RADIATION TX MANAGEMENT, X5 | 0.00 |
| MD77431 | RADIATION THERAPY MANAGEMENT | 222.98 |
| MD77432 | STEREOTACTIC RADIATION TRMT | 1,175.98 |
| MD77470 | SPECIAL RADIATION TREATMENT | 243.34 |
| MD77499 | RADIATION THERAPY MANAGEMENT | 0.00 |
| MD77520 | PROTON BEAM DELIVERY | 0.00 |
| MD77523 | PROTON BEAM DELIVERY | 0.00 |
| MD77600 | HYPERTHERMIA TREATMENT | 294.80 |
| MD77605 | HYPERTHERMIA TREATMENT | 341.97 |
| MD77610 | HYPERTHERMIA TREATMENT | 257.28 |
| MD77615 | HYPERTHERMIA TREATMENT | 341.97 |
| MD77620 | HYPERTHERMIA TREATMENT | 257.28 |
| MD77750 | INFUSE RADIOACTIVE MATERIALS | 704.30 |
| MD77761 | RADIOELEMENT APPLICATION | 497.41 |
| MD77762 | RADIOELEMENT APPLICATION | 737.54 |
| MD77763 | RADIOELEMENT APPLICATION | 1,169.55 |
| MD77776 | RADIOELEMENT APPLICATION | 635.70 |
| MD77777 | RADIOELEMENT APPLICATION | 1,065.57 |
| MD77778 | RADIOELEMENT APPLICATION | 1,500.80 |
| MD77781 | HIGH INTENSITY BRACHYTHERAPY | 209.04 |
| MD77782 | HIGH INTENSITY BRACHYTHERAPY | 439.52 |
| MD77783 | HIGH INTENSITY BRACHYTHERAPY | 705.38 |
| MD77784 | HIGH INTENSITY BRACHYTHERAPY | 726.82 |
| MD77789 | RADIOELEMENT APPLICATION | 145.79 |
| MD77790 | RADIOELEMENT HANDLING | 150.08 |
| MD77799 | RADIUM/RADIOISOTOPE THERAPY | 0.00 |
| MD78000 | THYROID, SINGLE UPTAKE | 37.52 |
| MD78001 | THYROID, MULTIPLE UPTAKES | 48.24 |
| MD78003 | THYROID SUPPRESS/STIMUL | 62.18 |
| MD78006 | THYROID IMAGING WITH UPTAKE | 87.90 |
| MD78007 | THYROID IMAGE, MULT UPTAKES | 96.48 |
| MD78010 | THYROID IMAGING | 66.46 |
| MD78011 | THYROID IMAGING WITH FLOW | 80.40 |
| MD78015 | THYROID MET IMAGING | 125.42 |
| MD78016 | THYROID MET IMAGING/STUDIES | 135.07 |
| MD78018 | THYROID MET IMAGING, BODY | 164.02 |
| MD78020 | THYROID MET UPTAKE | 94.34 |
| MD78070 | PARATHYROID NUCLEAR IMAGING | 77.18 |
| MD78075 | ADRENAL NUCLEAR IMAGING | 79.33 |
| MD78099 | ENDOCRINE NUCLEAR PROCEDURE | 0.00 |
| MD78102 | BONE MARROW IMAGING, LTD | 72.90 |
| MD78103 | BONE MARROW IMAGING, MULT | 109.34 |
| MD78104 | BONE MARROW IMAGING, BODY | 135.07 |
| MD78110 | PLASMA VOLUME, SINGLE | 38.59 |
| MD78111 | PLASMA VOLUME, MULTIPLE | 47.17 |
| MD78120 | RED CELL MASS, SINGLE | 32.16 |
| MD78121 | RED CELL MASS, MULTIPLE | 55.74 |
| MD78122 | BLOOD VOLUME | 91.12 |
| MD78130 | RED CELL SURVIVAL STUDY | 96.48 |
| MD78135 | RED CELL SURVIVAL KINETICS | 99.70 |
| MD78140 | RED CELL SEQUESTRATION | 90.05 |
| MD78160 | PLASMA IRON TURNOVER | 68.61 |
| MD78162 | IRON ABSORPTION EXAM | 64.32 |
| MD78170 | YED CELL IRON UTILIZATION | 92.19 |
| MD78172 | TOTAL BODY IRON ESTIMATION | 0.00 |
| MD78185 | SPLEEN IMAGING | 68.61 |
| MD78190 | PLATELET SURVIVAL, KINETICS | 141.50 |
| MD78191 | PLATELET SURVIVAL | 109.34 |
| MD78195 | LYMPH SYSTEM IMAGING | 144.72 |
| MD78199 | BLOOD/LYMPH NUCLEAR EXAM | 0.00 |
| MD78201 | LIVER IMAGING | 93.26 |
| MD78202 | LIVER IMAGING WITH FLOW | 106.13 |
| MD78205 | LIVER IMAGING (3D) | 164.02 |
| MD78206 | LIVER IMAGE (3D) W/FLOW | 547.79 |
| MD78215 | LIVER AND SPLEEN IMAGING | 101.84 |
| MD78216 | LIVER & SPLEEN IMAGE/FLOW | 121.14 |
| MD78220 | LIVER FUNCTION STUDY | 108.27 |
| MD78223 | HEPATOBILIARY IMAGING | 126.50 |
| MD78230 | SALIVARY GLAND IMAGING | 87.90 |
| MD78231 | SERIAL SALIVARY IMAGING | 84.69 |
| MD78232 | SALIVARY GLAND FUNCTION EXAM | 87.90 |
| MD78258 | ESOPHAGEAL MOTILITY STUDY | 101.84 |
| MD78261 | GASTRIC MUCOSA IMAGING | 110.42 |
| MD78262 | GASTROESOPHAGEAL REFLUX EXAM | 113.63 |
| MD78264 | GASTRIC EMPTYING STUDY | 164.02 |
| MD78267 | BREATH TST ATTAIN/ANAL C-14 | 0.00 |
| MD78268 | BREATH TEST ANALYSIS, C-14 | 0.00 |
| MD78270 | VIT B-12 ABSORPTION EXAM | 31.09 |
| MD78271 | VIT B-12 ABSORP EXAM, IF | 37.52 |
| MD78272 | VIT B-12 ABSORP EXAM, COMBINED IF | 47.17 |
| MD78278 | ACUTE GI BLOOD LOSS IMAGING | 162.94 |
| MD78282 | GI PROTEIN LOSS EXAM | 0.00 |
| MD78290 | MECKEL'S DIVERT EXAM | 101.84 |
| MD78291 | LEVEEN/SHUNT PATENCY EXAM | 100.77 |
| MD78299 | GI NUCLEAR PROCEDURE | 0.00 |
| MD78300 | BONE IMAGING, LIMITED AREA | 98.62 |
| MD78305 | BONE IMAGING, MULTIPLE AREAS | 125.42 |
| MD78306 | BONE IMAGING, WHOLE BODY | 152.22 |
| MD78315 | BONE IMAGING, 3 PHASE | 160.80 |
| MD78320 | BONE IMAGING (3D) | 159.73 |
| MD78350 | BONE MINERAL, SINGLE PHOTON | 51.46 |
| MD78351 | BONE MINERAL, DUAL PHOTON | 0.00 |
| MD78399 | MUSCULOSKELETAL NUCLEAR EXAM | 0.00 |
| MD78414 | NON-IMAGING HEART FUNCTION | 0.00 |
| MD78428 | CARDIAC SHUNT IMAGING | 124.35 |
| MD78445 | VASCULAR FLOW IMAGING | 88.98 |
| MD78455 | VENOUS THROMBOSIS STUDY | 121.14 |
| MD78456 | ACUTE VENOUS THROMBUS IMAGE | 0.00 |
| MD78457 | VENOUS THROMBOSIS IMAGING | 87.90 |
| MD78458 | VEN THROMBOSIS IMAGES, BILAT | 146.86 |
| MD78459 | HEART MUSCLE IMAGING (PET) | 0.00 |
| MD78460 | HEART MUSCLE BLOOD, SINGLE | 149.01 |
| MD78461 | HEART MUSCLE BLOOD, MULTIPLE | 201.54 |
| MD78464 | HEART IMAGE (3D), SINGLE | 149.01 |
| MD78465 | HEART IMAGE (3D), MULTIPLE | 224.05 |
| MD78466 | HEART INFARCT IMAGE | 106.13 |
| MD78468 | HEART INFARCT IMAGE (EF) | 132.93 |
| MD78469 | HEART INFARCT IMAGE (3D) | 150.08 |
| MD78472 | YATED HEART, PLANAR, SINGLE | 180.10 |
| MD78473 | GATED HEART, MULTIPLE | 250.85 |
| MD78478 | HEART WALL MOTION ADD-ON | 79.33 |
| MD78480 | HEART FUNCTION ADD-ON | 80.40 |
| MD78481 | HEART FIRST PASS, SINGLE | 172.59 |
| MD78483 | HEART FIRST PASS, MULTIPLE | 172.59 |
| MD78491 | HEART IMAGE (PET), SINGLE | 0.00 |
| MD78492 | HEART IMAGE (PET), MULTIPLE | 0.00 |
| MD78494 | HEART IMAGE, SPECT | 609.97 |
| MD78496 | HEART FIRST PASS ADD-ON | 211.18 |
| MD78499 | CARDIOVASCULAR NUCLEAR EXAM | 0.00 |
| MD78580 | LUNG PERFUSION IMAGING | 108.27 |
| MD78584 | LUNG V/Q IMAGE SINGLE BREATH | 149.01 |
| MD78585 | LUNG V/Q IMAGING | 185.46 |
| MD78586 | AEROSOL LUNG IMAGE, SINGLE | 68.61 |
| MD78587 | AEROSOL LUNG IMAGE, MULTIPLE | 88.98 |
| MD78588 | PERFUSION LUNG IMAGE | 0.00 |
| MD78591 | VENT IMAGE, 1 BREATH, 1 PROJ | 80.40 |
| MD78593 | VENT IMAGE, 1 PROJ, GAS | 92.19 |
| MD78594 | VENT IMAGE, MULT PROJ, GAS | 124.35 |
| MD78596 | LUNG DIFFERENTIAL FUNCTION | 184.38 |
| MD78599 | RESPIRATORY NUCLEAR EXAM | 0.00 |
| MD78600 | BRAIN IMAGING, LTD STATIC | 81.47 |
| MD78601 | BRAIN IMAGING, LTD W/ FLOW | 95.41 |
| MD78605 | BRAIN IMAGING, COMPLETE | 96.48 |
| MD78606 | BRAIN IMAGING, COMPL W/ FLOW | 114.70 |
| MD78607 | BRAIN IMAGING (3D) | 191.89 |
| MD78608 | BRAIN IMAGING (PET) | 0.00 |
| MD78609 | BRAIN IMAGING (PET) | 0.00 |
| MD78610 | BRAIN FLOW IMAGING ONLY | 66.46 |
| MD78615 | CEREBRAL BLOOD FLOW IMAGING | 106.13 |
| MD78630 | CEREBROSPINAL FLUID SCAN | 141.50 |
| MD78635 | CSF VENTRICULOGRAPHY | 97.55 |
| MD78645 | CSF SHUNT EVALUATION | 99.70 |
| MD78647 | CEREBROSPINAL FLUID SCAN | 150.08 |
| MD78650 | CSF LEAKAGE IMAGING | 154.37 |
| MD78660 | NUCLEAR EXAM OF TEAR FLOW | 93.26 |
| MD78699 | NERVOUS SYSTEM NUCLEAR EXAM | 0.00 |
| MD78700 | KIDNEY IMAGING, STATIC | 90.05 |
| MD78701 | KIDNEY IMAGING WITH FLOW | 92.19 |
| MD78704 | IMAGING RENOGRAM | 129.71 |
| MD78707 | KIDNEY FLOW/FUNCTION IMAGE | 181.17 |
| MD78708 | KIDNEY FLOW/FUNCTION IMAGE | 162.94 |
| MD78709 | KIDNEY FLOW/FUNCTION IMAGE | 168.30 |
| MD78710 | KIDNEY IMAGING (3D) | 168.30 |
| MD78715 | RENAL VASCULAR FLOW EXAM | 58.96 |
| MD78725 | KIDNEY FUNCTION STUDY | 69.68 |
| MD78730 | URINARY BLADDER RETENTION | 57.89 |
| MD78740 | URETERAL REFLUX STUDY | 85.76 |
| MD78760 | TESTICULAR IMAGING | 106.13 |
| MD78761 | TESTICULAR IMAGING/FLOW | 124.35 |
| MD78799 | GENITOURINARY NUCLEAR EXAM | 0.00 |
| MD78800 | TUMOR IMAGING, LIMITED AREA | 105.06 |
| MD78801 | TUMOR IMAGING, MULT AREAS | 129.71 |
| MD78802 | TUMOR IMAGING, WHOLE BODY | 137.22 |
| MD78803 | TUMOR IMAGING (3D) | 164.02 |
| MD78805 | ABSCESS IMAGING, LTD AREA | 107.20 |
| MD78806 | ABSCESS IMAGING, WHOLE BODY | 155.44 |
| MD78807 | NUCLEAR LOCALIZATION/ABSCESS | 132.93 |
| MD78890 | NUCLEAR MEDICINE DATA PROC | 12.86 |
| MD78891 | NUCLEAR MEDICINE DATA PROC | 25.73 |
| MD78999 | NUCLEAR DIAGNOSTIC EXAM | 0.00 |
| MD79200 | INTRACAVITARY NUCLEAR TRTMT | 289.44 |
| MD79300 | INTERSTITIAL NUCLEAR THERAPY | 0.00 |
| MD79440 | NUCLEAR JOINT THERAPY | 280.86 |
| MD79999 | NUCLEAR MEDICINE THERAPY | 0.00 |