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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 72142 thru 79005)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
L 72142 MRI NECK SPINE W/DYE 76.69 $292.96 --- -- 005 0 0 0.26 $0.00 Y
L 72146 MRI CHEST SPINE W/O DYE 52.63 $201.05 --- -- 005 0 0 0.31 $0.00 Y
L 72147 MRI CHEST SPINE W/DYE 76.17 $290.97 --- -- 005 0 0 0.26 $0.00 Y
L 72148 MRI LUMBAR SPINE W/O DYE 52.37 $200.05 --- -- 005 0 0 0.32 $0.00 Y
L 72149 MRI LUMBAR SPINE W/DYE 75.74 $289.33 --- -- 005 0 0 0.26 $0.00 Y
L 72156 MRI NECK SPINE W/O & W/DYE 89.77 $342.92 --- -- 005 0 0 0.29 $0.00 Y
L 72157 MRI CHEST SPINE W/O & W/DYE 89.97 $343.69 --- -- 005 0 0 0.29 $0.00 Y
L 72158 MRI LUMBAR SPINE W/O & W/DYE 89.45 $341.70 --- -- 005 0 0 0.29 $0.00 Y
L 72159 MR ANGIO SPINE W/O&W/DYE 99.43 $379.82 --- -- 005 0 0 0.21 $0.00 Y
L 72170 XRAY EXAM OF PELVIS 5.66 $21.62 --- -- 005 0 0 0.26 $0.00 Y
L 72190 XRAY EXAM OF PELVIS 8.26 $31.55 --- -- 005 0 0 0.27 $0.00 Y
L 72191 CT ANGIOGRAPH PELV W/O&W/DYE 71.96 $274.89 --- -- 005 0 0 0.28 $0.00 Y
L 72192 CT PELVIS W/O DYE 34.40 $131.41 --- -- 005 0 0 0.36 $0.00 Y
L 72193 CT PELVIS W/DYE 53.52 $204.45 --- -- 005 0 0 0.24 $0.00 Y
L 72194 CT PELVIS W/O & W/DYE 61.87 $236.34 --- -- 005 0 0 0.22 $0.00 Y
L 72195 MRI PELVIS W/O DYE 89.65 $342.46 --- -- 005 0 0 0.18 $0.00 Y
L 72196 MRI PELVIS W/DYE 97.99 $374.32 --- -- 005 0 0 0.20 $0.00 Y
L 72197 MRI PELVIS W/O & W/DYE 120.45 $460.12 --- -- 005 0 0 0.21 $0.00 Y
L 72198 MR ANGIO PELVIS W/O & W/DYE 95.68 $365.50 --- -- 005 0 0 0.21 $0.00 Y
L 72200 X-RAY EXAM SI JOINTS 5.66 $21.62 --- -- 005 0 0 0.30 $0.00 Y
L 72202 X-RAY EXAM SI JOINTS 3/> VWS 7.74 $29.57 --- -- 005 0 0 0.27 $0.00 Y
L 72220 X-RAY EXAM SACRUM TAILBONE 6.55 $25.02 --- -- 005 0 0 0.30 $0.00 Y
L 72240 MYELOGRAPHY NECK SPINE 22.92 $87.55 --- -- 005 0 0 0.44 $0.00 Y
L 72255 MYELOGRAPHY THORACIC SPINE 22.78 $87.02 --- -- 005 0 0 0.46 $0.00 Y
L 72265 MYELOGRAPHY L-S SPINE 21.46 $81.98 --- -- 005 0 0 0.43 $0.00 Y
L 72270 MYELOGPHY 2/> SPINE REGIONS 29.56 $112.92 --- -- 005 0 0 0.51 $0.00 Y
L 72275 EPIDUROGRAPHY 20.87 $79.72 --- -- 005 1 0 0.32 $0.00 Y
L 72285 DISCOGRAPHY CERV/THOR SPINE 26.30 $100.47 --- -- 005 0 0 0.52 $0.00 Y
L 72295 X-RAY OF LOWER SPINE DISK 22.90 $87.48 --- -- 005 0 0 0.42 $0.00 Y
L 73000 XRAY EXAM OF COLLAR BONE 5.44 $20.78 --- -- 005 0 0 0.29 $0.00 Y
L 73010 XRAY EXAM OF SHOULDER BLADE 6.49 $24.79 --- -- 005 0 0 0.29 $0.00 Y
L 73020 XRAY EXAM OF SHOULDER 4.53 $17.30 --- -- 005 0 0 0.34 $0.00 Y
L 73030 XRAY EXAM OF SHOULDER 6.77 $25.86 --- -- 005 0 0 0.31 $0.00 Y
L 73040 CONTRAST X-RAY OF SHOULDER 13.27 $50.69 --- -- 005 0 0 0.26 $0.00 Y
L 73050 XRAY EXAM OF SHOULDERS 7.93 $30.29 --- -- 005 0 0 0.28 $0.00 Y
L 73060 XRAY EXAM OF HUMERUS 5.44 $20.78 --- -- 005 0 0 0.28 $0.00 Y
L 73070 XRAY EXAM OF ELBOW 5.44 $20.78 --- -- 005 0 0 0.28 $0.00 Y
L 73080 XRAY EXAM OF ELBOW 6.80 $25.98 --- -- 005 0 0 0.27 $0.00 Y
L 73085 CONTRAST X-RAY OF ELBOW 18.80 $71.82 --- -- 005 0 0 0.29 $0.00 Y
L 73090 XRAY EXAM OF FOREARM 5.44 $20.78 --- -- 005 0 0 0.31 $0.00 Y
L 73092 X-RAY EXAM OF ARM INFANT 5.44 $20.78 --- -- 005 0 0 0.28 $0.00 Y
L 73100 XRAY EXAM OF WRIST 4.53 $17.30 --- -- 005 0 0 0.28 $0.00 Y
L 73110 XRAY EXAM OF WRIST 6.58 $25.14 --- -- 005 0 0 0.24 $0.00 Y
L 73115 CONTRAST X-RAY OF WRIST 10.77 $41.14 --- -- 005 0 0 0.25 $0.00 Y
L 73120 XRAY EXAM OF HAND 4.53 $17.30 --- -- 005 0 0 0.31 $0.00 Y
L 73130 XRAY EXAM OF HAND 6.58 $25.14 --- -- 005 0 0 0.27 $0.00 Y
L 73140 XRAY EXAM OF FINGER(S) 4.08 $15.59 --- -- 005 0 0 0.21 $0.00 Y
L 73200 CT UPPER EXTREMITY W/O DYE 42.35 $161.78 --- -- 005 0 0 0.26 $0.00 Y
L 73201 CT UPPER EXTREMITY W/DYE 52.75 $201.51 --- -- 005 0 0 0.25 $0.00 Y
L 73202 CT UPPR EXTREMITY W/O&W/DYE 66.11 $252.54 --- -- 005 0 0 0.21 $0.00 Y
L 73206 CT ANGIO UPR EXTRM W/O&W/DYE 77.33 $295.40 --- -- 005 0 0 0.26 $0.00 Y
L 73218 MRI UPPER EXTREMITY W/O DYE 86.91 $332.00 --- -- 005 0 0 0.18 $0.00 Y
L 73219 MRI UPPER EXTREMITY W/DYE 96.22 $367.56 --- -- 005 0 0 0.19 $0.00 Y
L 73220 MRI UPPR EXTREMITY W/O&W/DYE 102.22 $390.48 --- -- 005 0 0 0.20 $0.00 Y
L 73221 MRI JOINT UPR EXTREM W/O DYE 55.76 $213.00 --- -- 005 0 0 0.27 $0.00 Y
L 73222 MRI JOINT UPR EXTREM W/DYE 90.18 $344.49 --- -- 005 0 0 0.20 $0.00 Y
L 73223 MRI JOINT UPR EXTR W/O&W/DYE 111.60 $426.31 --- -- 005 0 0 0.22 $0.00 Y
L 73225 MR ANGIO UPR EXTR W/O&W/DYE 96.14 $367.25 --- -- 005 0 0 0.20 $0.00 Y
L 73501 X-RAY EXAM HIP UNI 1 VIEW 6.94 $26.51 --- -- 005 0 0 0.31 $0.00 Y
L 73502 X-RAY EXAM HIP UNI 2-3 VIEWS 9.76 $37.28 --- -- 005 0 0 0.26 $0.00 Y
L 73503 X-RAY EXAM HIP UNI 4/> VIEWS 12.19 $46.57 --- -- 005 0 0 0.26 $0.00 Y
L 73521 X-RAY EXAM HIPS BI 2 VIEWS 9.33 $35.64 --- -- 005 0 0 0.28 $0.00 Y
L 73522 X-RAY EXAM HIPS BI 3-4 VIEWS 11.48 $43.85 --- -- 005 0 0 0.29 $0.00 Y
L 73523 X-RAY EXAM HIPS BI 5/> VIEWS 13.36 $51.04 --- -- 005 0 0 0.27 $0.00 Y
L 73525 CONTRAST XRAY OF HIP 19.71 $75.29 --- -- 005 0 0 0.27 $0.00 Y
L 73551 X-RAY EXAM OF FEMUR 1 6.53 $24.94 --- -- 005 0 0 0.29 $0.00 Y
L 73552 X-RAY EXAM OF FEMUR 2/> 7.63 $29.15 --- -- 005 0 0 0.28 $0.00 Y
L 73560 X-RAY EXAM OF KNEE 1 OR 2 4.98 $19.02 --- -- 005 0 0 0.26 $0.00 Y
L 73562 X-RAY EXAM OF KNEE 3 6.12 $23.38 --- -- 005 0 0 0.25 $0.00 Y
L 73564 X-RAY EXAM KNEE 4 OR MORE 7.25 $27.70 --- -- 005 0 0 0.27 $0.00 Y
L 73565 XRAY EXAM OF KNEES 4.98 $19.02 --- -- 005 0 0 0.23 $0.00 Y
L 73580 CONTRAST XRAY OF KNEE JOINT 18.12 $69.22 --- -- 005 0 0 0.23 $0.00 Y
L 73590 XRAY EXAM OF LOWER LEG 5.44 $20.78 --- -- 005 0 0 0.28 $0.00 Y
P 73590 XRAY EXAM OF LOWER LEG 5.44 $20.78 --- -- 010 0 0 0.35 $0.00 Y
L 73592 X-RAY EXAM OF LEG INFANT 5.44 $20.78 --- -- 005 0 0 0.28 $0.00 Y
L 73600 XRAY EXAM OF ANKLE 4.98 $19.02 --- -- 005 0 0 0.27 $0.00 Y
P 73600 XRAY EXAM OF ANKLE 4.98 $19.02 --- -- 010 0 0 0.35 $0.00 Y
P 73610 XRAY EXAM OF ANKLE 6.58 $25.14 --- -- 010 0 0 0.33 $0.00 Y
L 73610 XRAY EXAM OF ANKLE 6.58 $25.14 --- -- 005 0 0 0.27 $0.00 Y
L 73615 CONTRAST XRAY OF ANKLE 19.71 $75.29 --- -- 005 0 0 0.26 $0.00 Y
P 73615 CONTRAST XRAY OF ANKLE 19.71 $75.29 --- -- 010 0 0 0.33 $0.00 Y
P 73620 XRAY EXAM OF FOOT 4.53 $17.30 --- -- 010 0 0 0.35 $0.00 Y
L 73620 XRAY EXAM OF FOOT 4.53 $17.30 --- -- 005 0 0 0.28 $0.00 Y
L 73630 XRAY EXAM OF FOOT 6.34 $24.22 --- -- 005 0 0 0.28 $0.00 Y
P 73630 XRAY EXAM OF FOOT 6.34 $24.22 --- -- 010 0 0 0.35 $0.00 Y
P 73650 XRAY EXAM OF HEEL 4.98 $19.02 --- -- 010 0 0 0.35 $0.00 Y
L 73650 XRAY EXAM OF HEEL 4.98 $19.02 --- -- 005 0 0 0.29 $0.00 Y
L 73660 XRAY EXAM OF TOE(S) 4.08 $15.59 --- -- 005 0 0 0.23 $0.00 Y
P 73660 XRAY EXAM OF TOE(S) 4.08 $15.59 --- -- 010 0 0 0.33 $0.00 Y
L 73700 CT LOWER EXTREMITY W/O DYE 42.35 $161.78 --- -- 005 0 0 0.26 $0.00 Y
L 73701 CT LOWER EXTREMITY W/DYE 53.52 $204.45 --- -- 005 0 0 0.24 $0.00 Y
L 73702 CT LWR EXTREMITY W/O&W/DYE 65.01 $248.34 --- -- 005 0 0 0.21 $0.00 Y
L 73706 CT ANGIO LWR EXTR W/O&W/DYE 83.26 $318.05 --- -- 005 0 0 0.25 $0.00 Y
L 73718 MRI LOWER EXTREMITY W/O DYE 87.09 $332.68 --- -- 005 0 0 0.17 $0.00 Y
P 73718 MRI LOWER EXTREMITY W/O D 111.85 $427.27 --- -- 010 0 0 1.00 $0.00 N
P 73719 MRI LOWER EXTREMITY W/DYE 125.21 $478.30 --- -- 010 0 0 1.00 $0.00 N
L 73719 MRI LOWER EXTREMITY W/DYE 96.47 $368.52 --- -- 005 0 0 0.19 $0.00 Y
L 73720 MRI LWR EXTREMITY W/O&W/DYE 102.22 $390.48 --- -- 005 0 0 0.20 $0.00 Y
P 73720 MRI LWR EXTREMITY W/O&W/D 102.22 $390.48 --- -- 010 0 0 1.00 $0.00 N
P 73721 MRI JNT OF LWR EXTRE W/O 102.22 $390.48 --- -- 010 0 0 1.00 $0.00 N
L 73721 MRI JNT OF LWR EXTRE W/O DYE 55.67 $212.66 --- -- 005 0 0 0.27 $0.00 Y
L 73722 MRI JOINT OF LWR EXTR W/DYE 90.93 $347.35 --- -- 005 0 0 0.20 $0.00 Y
P 73722 MRI JOINT OF LWR EXTR W/D 119.53 $456.60 --- -- 010 0 0 1.00 $0.00 N
P 73723 MRI JOINT LWR EXTR W/O&W/ 150.05 $573.19 --- -- 010 0 0 1.00 $0.00 N
L 73723 MRI JOINT LWR EXTR W/O&W/DYE 112.12 $428.30 --- -- 005 0 0 0.22 $0.00 Y
L 73725 MR ANG LWR EXT W OR W/O DYE 95.93 $366.45 --- -- 005 0 0 0.21 $0.00 Y
L 74018 X-RAY EXAM ABDOMEN 1 VIEW 6.44 $24.63 --- -- 005 0 0 0.32 $0.00 Y
L 74019 X-RAY EXAM ABDOMEN 2 VIEWS 7.87 $30.10 --- -- 005 0 0 0.33 $0.00 Y
L 74021 X-RAY EXAM ABDOMEN 3+ VIEWS 9.79 $35.12 --- -- 005 0 0 0.33 $0.00 Y
L 74022 X-RAY EXAM COMPLETE ABDOMEN 10.32 $39.42 --- -- 005 0 0 0.35 $0.00 Y
L 74150 CT ABDOMEN W/O DYE 35.15 $134.27 --- -- 005 0 0 0.38 $0.00 Y
L 74160 CT ABDOMEN W/DYE 54.65 $208.76 --- -- 005 0 0 0.26 $0.00 Y
L 74170 CT ABDOMEN W/O & W/DYE 62.21 $237.64 --- -- 005 0 0 0.25 $0.00 Y
L 74174 CT ANGIO ABD&PELV W/O&W/DYE 92.09 $351.77 --- -- 005 0 0 0.27 $0.00 Y
L 74175 CT ANGIO ABDOM W/O & W/DYE 72.56 $277.18 --- -- 005 0 0 0.28 $0.00 Y
L 74176 CT ABD & PELVIS W/O CONTRAST 46.87 $179.04 --- -- 005 0 0 0.42 $0.00 Y
L 74177 CT ABD & PELV W/CONTRAST 73.77 $281.80 --- -- 005 0 0 0.28 $0.00 Y
L 74178 CT ABD & PELV 1/> REGNS 83.57 $319.24 --- -- 005 0 0 0.27 $0.00 Y
L 74181 MRI ABDOMEN W/O DYE 79.21 $302.58 --- -- 005 0 0 0.21 $0.00 Y
L 74182 MRI ABDOMEN W/DYE 108.55 $414.66 --- -- 005 0 0 0.18 $0.00 Y
L 74183 MRI ABDOMEN W/O & W/DYE 120.71 $461.11 --- -- 005 0 0 0.21 $0.00 Y
L 74185 MRI ANGIO ABDOM W ORW/O DYE 95.94 $366.49 --- -- 005 0 0 0.21 $0.00 Y
L 74190 X-RAY EXAM OF PERITONEUM 9.04 $34.53 --- -- 005 0 0 0.27 $0.00 Y
L 74210 X-RAY XM PHRNX&/CRV ESOPH C+ 9.97 $38.09 --- -- 005 0 0 0.22 $0.00 Y
L 74220 X-RAY XM ESOPHAGUS 1CNTRST 9.97 $38.09 --- -- 005 0 0 0.25 $0.00 Y
L 74221 X-RAY XM ESOPHAGUS 2CNTRST 26.01 $99.39 --- -- 005 0 0 0.31 $0.00 Y
L 74230 X-RAY XM SWLNG FUNCJ C+ 13.59 $51.91 --- -- 005 0 0 0.20 $0.00 Y
L 74235 REMOVE ESOPHAGUS OBSTRUCTION 31.55 $120.52 --- -- 005 0 0 0.40 $0.00 Y
L 74240 X-RAY XM UPR GI TRC 1CNTRST 26.71 $102.03 --- -- 005 0 0 0.29 $0.00 Y
L 74246 X-RAY XM UPR GI TRC 2CNTRST 30.17 $115.25 --- -- 005 0 0 0.26 $0.00 Y
L 74248 X-RAY SM INT F-THRU STD 19.58 $74.80 --- -- 005 0 0 0.41 $0.00 Y
L 74250 X-RAY XM SM INT 1CNTRST STD 24.77 $94.62 --- -- 005 0 0 0.22 $0.00 Y
L 74251 X-RAY XM SM INT 2CNTRST STD 101.43 $387.46 --- -- 005 0 0 0.08 $0.00 Y
L 74270 X-RAY XM COLON 1CNTRST STD 13.59 $51.91 --- -- 005 0 0 0.22 $0.00 Y
L 74280 X-RAY XM COLON 2CNTRST STD 16.45 $62.84 --- -- 005 0 0 0.22 $0.00 Y
L 74283 THER NMA RDCTJ INTUS/OBSTRCJ 0.00 $0.00 --- -- 005 0 0 0.48 $0.00 Y
L 74290 CONTRAST X-RAY GALLBLADDER 10.06 $38.43 --- -- 005 0 0 0.22 $0.00 Y
L 74300 X-RAY BILE DUCTS/PANCREAS 11.33 $43.28 --- -- 005 0 0 0.33 $0.00 Y
L 74301 X-RAYS AT SURGERY ADD-ON 5.66 $21.62 --- -- 005 0 0 0.33 $0.00 Y
L 74328 X-RAY BILE DUCT ENDOSCOPY 30.14 $115.13 --- -- 005 0 0 0.33 $0.00 Y
L 74329 X-RAY FOR PANCREAS ENDOSCOPY 30.14 $115.13 --- -- 005 0 0 0.33 $0.00 Y
L 74330 X-RAY BILE/PANC ENDOSCOPY 30.14 $115.13 --- -- 005 0 0 0.33 $0.00 Y
L 74340 X-RAY GUIDE FOR GI TUBE 16.54 $63.18 --- -- 005 0 0 0.80 $0.00 Y
L 74355 X-RAY GUIDE INTESTINAL TUBE 26.98 $103.06 --- -- 005 0 0 0.40 $0.00 Y
L 74360 X-RAY GUIDE GI DILATION 28.53 $108.98 --- -- 005 0 0 0.40 $0.00 Y
L 74363 X-RAY BILE DUCT DILATION 34.60 $132.17 --- -- 005 0 0 0.40 $0.00 Y
L 74400 CONTRST X-RAY URINARY TRACT 17.21 $65.74 --- -- 005 0 0 0.21 $0.00 Y
L 74410 CONTRST X-RAY URINARY TRACT 22.65 $86.52 --- -- 005 0 0 0.21 $0.00 Y
L 74415 CONTRST X-RAY URINARY TRACT 26.00 $99.32 --- -- 005 0 0 0.17 $0.00 Y
L 74420 CONTRST X-RAY URINARY TRACT 14.77 $56.42 --- -- 005 0 0 0.33 $0.00 Y
L 74425 CONTRST X-RAY URINARY TRACT 13.14 $50.19 --- -- 005 0 0 0.33 $0.00 Y
L 74430 CONTRAST X-RAY BLADDER 8.68 $33.16 --- -- 005 0 0 0.41 $0.00 Y
L 74440 X-RAY MALE GENITAL TRACT 9.97 $38.09 --- -- 005 0 0 0.22 $0.00 Y
L 74445 X-RAY EXAM OF PENIS 13.59 $51.91 --- -- 005 0 0 0.33 $0.00 Y
L 74450 X-RAY URETHRA/BLADDER 10.87 $41.52 --- -- 005 0 0 0.33 $0.00 Y
L 74455 X-RAY URETHRA/BLADDER 15.86 $60.59 --- -- 005 0 0 0.19 $0.00 Y
L 74470 X-RAY EXAM OF KIDNEY LESION 11.33 $43.28 --- -- 005 0 0 0.34 $0.00 Y
L 74485 X-RAY GUIDE GU DILATION 21.73 $83.01 --- -- 005 0 0 0.27 $0.00 Y
L 74710 X-RAY MEASUREMENT OF PELVIS 8.59 $32.81 --- -- 005 0 0 0.45 $0.00 Y
L 74712 MRI FETAL SNGL/1ST GESTATION 113.80 $434.72 --- -- 005 0 0 0.30 $0.00 Y
L 74713 MRI FETAL EA ADDL GESTATION 54.43 $207.92 --- -- 005 0 0 0.38 $0.00 Y
L 74740 X-RAY FEMALE GENITAL TRACT 12.23 $46.72 --- -- 005 0 0 0.24 $0.00 Y
L 74775 XRAY EXAM OF PERINEUM 0.00 $0.00 --- -- 005 0 0 0.40 $0.00 Y
L 75561 CARDIAC MRI FOR MORPH W/DYE 101.00 $385.82 --- -- 005 0 0 0.29 $0.00 Y
L 75565 CARD MRI VELOC FLOW MAPPING 13.15 $50.23 --- -- 005 0 0 0.21 $0.00 Y
L 75571 CT HRT W/O DYE W/CA TEST 21.29 $81.33 --- -- 005 0 0 0.27 $0.00 Y
L 75572 CT HRT W/3D IMAGE 62.46 $238.60 --- -- 005 0 0 0.29 $0.00 Y
L 75573 CT HRT W/3D IMAGE CONGEN 88.68 $338.76 --- -- 005 0 0 0.31 $0.00 Y
L 75574 CT ANGIO HRT W/3D IMAGE 99.23 $379.04 --- -- 005 0 0 0.27 $0.00 Y
L 75600 CONTRAST EXAM THORACIC AORTA 47.58 $181.76 --- -- 005 0 0 0.11 $0.00 Y
L 75605 CONTRAST EXAM THORACIC AORTA 32.34 $123.54 --- -- 005 0 0 0.38 $0.00 Y
L 75625 CONTRAST EXAM ABDOMINL AORTA 32.06 $122.47 --- -- 005 0 0 0.38 $0.00 Y
L 75630 X-RAY AORTA LEG ARTERIES 39.41 $150.55 --- -- 005 0 0 0.49 $0.00 Y
L 75635 CT ANGIO ABDOMINAL ARTERIES 89.67 $342.54 --- -- 005 0 0 0.30 $0.00 Y
L 75705 ARTERY X-RAYS SPINE 55.33 $211.36 --- -- 005 0 0 0.44 $0.00 Y
L 75710 ARTERY X-RAYS ARM/LEG 37.99 $145.12 --- -- 005 0 0 0.33 $0.00 Y
L 75716 ARTERY X-RAYS ARMS/LEGS 43.84 $167.47 --- -- 005 0 0 0.32 $0.00 Y
L 75726 ARTERY X-RAYS ABDOMEN 35.18 $134.39 --- -- 005 0 0 0.35 $0.00 Y
L 75731 ARTERY X-RAYS ADRENAL GLAND 40.42 $154.40 --- -- 005 0 0 0.32 $0.00 Y
L 75733 ARTERY X-RAYS ADRENALS 43.19 $164.99 --- -- 005 0 0 0.33 $0.00 Y
L 75736 ARTERY X-RAYS PELVIS 37.66 $143.86 --- -- 005 0 0 0.33 $0.00 Y
L 75741 ARTERY X-RAYS LUNG 35.39 $135.19 --- -- 005 0 0 0.40 $0.00 Y
L 75743 ARTERY X-RAYS LUNGS 39.39 $150.47 --- -- 005 0 0 0.46 $0.00 Y
L 75746 ARTERY X-RAYS LUNG 36.17 $138.17 --- -- 005 0 0 0.35 $0.00 Y
L 75756 ARTERY X-RAYS CHEST 39.73 $151.77 --- -- 005 0 0 0.31 $0.00 Y
L 75774 ARTERY X-RAY EACH VESSEL 20.63 $78.81 --- -- 005 0 0 0.19 $0.00 Y
L 75801 LYMPH VESSEL X-RAY ARM/LEG 33.98 $129.80 --- -- 005 0 0 0.33 $0.00 Y
L 75803 LYMPH VESSEL X-RAY ARMS/LEGS 33.98 $129.80 --- -- 005 0 0 0.33 $0.00 Y
L 75805 LYMPH VESSEL X-RAY TRUNK 34.23 $130.76 --- -- 005 0 0 0.40 $0.00 Y
L 75807 LYMPH VESSEL X-RAY TRUNK 36.25 $138.48 --- -- 005 0 0 0.40 $0.00 Y
L 75809 NONVASCULAR SHUNT X-RAY 6.50 $24.83 --- -- 005 0 0 0.23 $0.00 Y
L 75810 VEIN X-RAY SPLEEN/LIVER 102.67 $392.20 --- -- 005 0 0 0.33 $0.00 Y
L 75820 VEIN X-RAY ARM/LEG 16.00 $61.12 --- -- 005 0 0 0.28 $0.00 Y
L 75822 VEIN X-RAY ARMS/LEGS 24.56 $93.82 --- -- 005 0 0 0.36 $0.00 Y
L 75825 VEIN X-RAY TRUNK 31.63 $120.83 --- -- 005 0 0 0.39 $0.00 Y
L 75827 VEIN X-RAY CHEST 32.28 $123.31 --- -- 005 0 0 0.38 $0.00 Y
L 75831 VEIN X-RAY KIDNEY 0.00 $0.00 --- -- 005 0 0 0.37 $0.00 Y
L 75833 VEIN X-RAY KIDNEYS 0.00 $0.00 --- -- 005 0 0 0.42 $0.00 Y
L 75840 VEIN X-RAY ADRENAL GLAND 0.00 $0.00 --- -- 005 0 0 0.37 $0.00 Y
L 75842 VEIN X-RAY ADRENAL GLANDS 42.13 $160.94 --- -- 005 0 0 0.39 $0.00 Y
L 75860 VEIN X-RAY NECK 0.00 $0.00 --- -- 005 0 0 0.37 $0.00 Y
L 75870 VEIN X-RAY SKULL 34.99 $133.66 --- -- 005 0 0 0.37 $0.00 Y
L 75872 VEIN X-RAY SKULL EPIDURAL 0.00 $0.00 --- -- 005 0 0 0.35 $0.00 Y
L 75880 VEIN X-RAY EYE SOCKET 0.00 $0.00 --- -- 005 0 0 0.23 $0.00 Y
L 75885 VEIN X-RAY LIVER W/HEMODYNAM 36.66 $140.04 --- -- 005 0 0 0.42 $0.00 Y
L 75887 VEIN X-RAY LIVER W/O HEMODYN 0.00 $0.00 --- -- 005 0 0 0.42 $0.00 Y
L 75889 VEIN X-RAY LIVER W/HEMODYNAM 0.00 $0.00 --- -- 005 0 0 0.36 $0.00 Y
L 75891 VEIN X-RAY LIVER 0.00 $0.00 --- -- 005 0 0 0.37 $0.00 Y
L 75893 VENOUS SAMPLING BY CATHETER 0.00 $0.00 --- -- 005 0 0 0.21 $0.00 Y
L 75894 X-RAYS TRANSCATH THERAPY 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 75898 FOLLOW-UP ANGIOGRAPHY 27.20 $103.90 --- -- 005 0 0 0.33 $0.00 Y
L 75901 REMOVE CVA DEVICE OBSTRUCT 26.01 $99.36 --- -- 005 0 0 0.12 $0.00 Y
L 75902 REMOVE CVA LUMEN OBSTRUCT 16.95 $64.75 --- -- 005 0 0 0.25 $0.00 Y
L 75956 XRAY ENDOVASC THOR AO REPR 85.39 $326.18 --- -- 005 0 0 0.80 $0.00 Y
L 75957 XRAY ENDOVASC THOR AO REPR 73.15 $279.45 --- -- 005 0 0 0.80 $0.00 Y
L 75958 XRAY PLACE PROX EXT THOR AO 48.78 $186.35 --- -- 005 0 0 0.80 $0.00 Y
L 75959 XRAY PLACE DIST EXT THOR AO 42.72 $163.18 --- -- 005 0 0 0.80 $0.00 Y
L 75970 VASCULAR BIOPSY 0.00 $0.00 --- -- 005 0 0 0.40 $0.00 Y
L 75984 XRAY CONTROL CATHETER CHANGE 17.73 $67.73 --- -- 005 0 0 0.31 $0.00 Y
L 75989 ABSCESS DRAINAGE UNDER XRAY 28.23 $107.84 --- -- 005 0 0 0.46 $0.00 Y
L 76000 FLUOROSCOPE EXAMINATION 7.32 $27.96 --- -- 005 0 0 0.17 $0.00 Y
P 76000 FLUOROSCOPE EXAMINATION 7.32 $27.96 --- -- 010 0 0 0.50 $0.00 Y
L 76010 X-RAY NOSE TO RECTUM 6.11 $23.34 --- -- 005 0 0 0.33 $0.00 Y
L 76080 X-RAY EXAM OF FISTULA 10.94 $41.79 --- -- 005 0 0 0.46 $0.00 Y
L 76098 X-RAY EXAM SURGICAL SPECIMEN 3.79 $14.48 --- -- 005 0 0 0.47 $0.00 Y
L 76100 X-RAY EXAM OF BODY SECTION 14.95 $57.11 --- -- 005 0 0 0.33 $0.00 Y
L 76101 COMPLEX BODY SECTION X-RAY 23.00 $87.86 --- -- 005 0 0 0.25 $0.00 Y
L 76102 COMPLEX BODY SECTION X-RAYS 29.00 $110.78 --- -- 005 0 0 0.19 $0.00 Y
L 76120 CINE/VIDEO X-RAYS 13.80 $52.72 --- -- 005 0 0 0.22 $0.00 Y
L 76125 CINE/VIDEO X-RAYS ADD-ON 7.93 $30.29 --- -- 005 0 0 0.34 $0.00 Y
L 76140 XRAY CONSULTATION 4.87 $18.60 --- -- 005 0 1 0.00 $0.00 Y
P 76140 XRAY CONSULTATION 4.87 $18.60 --- -- 010 0 1 1.00 $0.00 Y
L 76380 CAT SCAN FOLLOW-UP STUDY 34.52 $131.87 --- -- 005 0 0 0.32 $0.00 Y
L 76391 MR ELASTOGRAPHY 56.63 $216.33 --- -- 005 0 0 0.22 $0.00 Y
L 76496 FLUOROSCOPIC PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.30 $0.00 Y
L 76497 CT PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.30 $0.00 Y
L 76498 MRI PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.30 $0.00 Y
L 76499 RADIOGRAPHIC PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.35 $0.00 Y
P 76499 RADIOGRAPHIC PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.35 $0.00 Y
L 76506 ECHO EXAM OF HEAD 16.29 $62.23 --- -- 005 0 0 0.26 $0.00 Y
L 76510 OPHTH US B & QUANT A 39.12 $149.44 --- -- 005 0 0 0.51 $0.00 Y
L 76511 OPHTH US QUANT A ONLY 14.35 $54.82 --- -- 005 0 0 0.51 $0.00 Y
L 76512 OPHTH US B W/NON-QUANT A 17.39 $66.43 --- -- 005 0 0 0.56 $0.00 Y
L 76513 ECHO EXAM OF EYE WATER BATH 17.39 $66.43 --- -- 005 0 0 0.36 $0.00 Y
L 76514 ECHO EXAM OF EYE THICKNESS 2.65 $10.12 --- -- 005 0 0 0.64 $0.00 Y
L 76516 OPHTHALMIC BIOMETRY BY ECHOGRAPHY, ASCA 14.35 $54.82 --- -- 005 0 0 0.38 $0.00 Y
L 76519 ECHO EXAM OF EYE 14.35 $54.82 --- -- 005 0 0 0.36 $0.00 Y
L 76529 ECHO EXAM OF EYE 15.38 $58.75 --- -- 005 0 0 0.39 $0.00 Y
L 76536 US EXAM OF HEAD AND NECK 15.64 $59.74 --- -- 005 0 0 0.23 $0.00 Y
L 76604 US EXAM CHEST 18.10 $69.14 --- -- 005 0 0 0.29 $0.00 Y
L 76641 ULTRASOUND BREAST COMPLETE 25.56 $97.64 --- -- 005 0 0 0.32 $0.00 Y
L 76642 ULTRASOUND BREAST LIMITED 20.94 $79.99 --- -- 005 0 0 0.37 $0.00 Y
L 76700 US EXAM ABDOM COMPLETE 21.78 $83.20 --- -- 005 0 0 0.31 $0.00 Y
L 76705 ECHO EXAM OF ABDOMEN 15.90 $60.74 --- -- 005 0 0 0.31 $0.00 Y
L 76706 US ABDL AORTA SCREEN AAA 22.37 $85.45 --- -- 005 0 0 0.28 $0.00 Y
L 76770 US EXAM ABDO BACK WALL COMP 21.13 $80.72 --- -- 005 0 0 0.31 $0.00 Y
L 76775 US EXAM ABDO BACK WALL LIM 13.45 $51.38 --- -- 005 0 0 0.47 $0.00 Y
L 76776 US EXAM K TRANSPL W/DOPPLER 28.90 $110.40 --- -- 005 0 0 0.23 $0.00 Y
L 76800 US EXAM SPINAL CANAL 21.20 $80.98 --- -- 005 0 0 0.40 $0.00 Y
L 76801 OB US < 14 WKS SINGLE FETUS 20.53 $78.42 --- -- 005 0 0 0.39 $0.00 Y
L 76802 OB US < 14 WKS ADDL FETUS 14.99 $57.26 --- -- 005 0 0 0.64 $0.00 Y
L 76805 OB US >= 14 WKS SNGL FETUS 24.69 $94.32 --- -- 005 0 0 0.33 $0.00 Y
L 76810 OB US >= 14 WKS ADDL FETUS 21.91 $83.70 --- -- 005 0 0 0.50 $0.00 Y
L 76811 OB US DETAILED SNGL FETUS 42.52 $162.43 --- -- 005 0 0 0.51 $0.00 Y
L 76812 OB US DETAILED ADDL FETUS 31.20 $119.18 --- -- 005 0 0 0.43 $0.00 Y
L 76813 OB US NUCHAL MEAS 1 GEST 28.52 $108.95 --- -- 005 0 0 0.48 $0.00 Y
L 76814 OB US NUCHAL MEAS ADD-ON 18.83 $71.93 --- -- 005 0 0 0.61 $0.00 Y
L 76815 OB US LIMITED FETUS(S) 16.48 $62.95 --- -- 005 0 0 0.37 $0.00 Y
L 76816 OB US FOLLOW-UP PER FETUS 13.57 $51.84 --- -- 005 0 0 0.36 $0.00 Y
L 76817 TRANSVAGINAL US OBSTETRIC 21.51 $82.17 --- -- 005 0 0 0.37 $0.00 Y
L 76819 FETAL BIOPHYS PROFIL W/O NST 21.39 $81.71 --- -- 005 0 0 0.42 $0.00 Y
L 76820 UMBILICAL ARTERY ECHO 10.14 $38.73 --- -- 005 0 0 0.52 $0.00 Y
L 76821 MIDDLE CEREBRAL ARTERY ECHO 21.97 $83.93 --- -- 005 0 0 0.37 $0.00 Y
L 76825 ECHO EXAM OF FETAL HEART 21.33 $81.48 --- -- 005 0 0 0.28 $0.00 Y
L 76826 ECHO EXAM OF FETAL HEART 15.59 $59.55 --- -- 005 0 0 0.24 $0.00 Y
L 76827 ECHO EXAM OF FETAL HEART 15.07 $57.57 --- -- 005 0 0 0.36 $0.00 Y
L 76828 ECHO EXAM OF FETAL HEART 8.90 $34.00 --- -- 005 0 0 0.51 $0.00 Y
L 76830 TRANSVAGINAL US NON-OB 17.71 $67.65 --- -- 005 0 0 0.27 $0.00 Y
L 76831 ECHO EXAM UTERUS 19.77 $75.52 --- -- 005 0 0 0.29 $0.00 Y
L 76856 US EXAM PELVIC COMPLETE 17.71 $67.65 --- -- 005 0 0 0.30 $0.00 Y
L 76857 US EXAM PELVIC LIMITED 11.04 $42.17 --- -- 005 0 0 0.50 $0.00 Y
L 76870 US EXAM SCROTUM 15.65 $59.78 --- -- 005 0 0 0.45 $0.00 Y
L 76872 US TRANSRECTAL 17.71 $67.65 --- -- 005 0 0 0.33 $0.00 Y
L 76873 ECHOGRAP TRANS R PROS STUDY 28.26 $107.95 --- -- 005 1 0 0.44 $0.00 Y
L 76881 US XTR NON-VASC COMPLETE 27.51 $105.10 --- -- 005 0 0 0.25 $0.00 Y
P 76881 US XTR NON-VASC COMPLETE 27.51 $105.10 --- -- 010 0 0 0.23 $0.00 Y
P 76882 US XTR NON-VASC LMTD 6.87 $26.25 --- -- 010 0 0 0.64 $0.00 Y
L 76882 US XTR NON-VASC LMTD 6.87 $26.25 --- -- 005 0 0 0.67 $0.00 Y
L 76885 US EXAM INFANT HIPS DYNAMIC 19.92 $76.09 --- -- 005 0 0 0.24 $0.00 Y
L 76886 US EXAM INFANT HIPS STATIC 17.75 $67.81 --- -- 005 0 0 0.26 $0.00 Y
L 76932 ECHO GUIDE FOR HEART BIOPSY 17.52 $66.93 --- -- 005 0 0 0.40 $0.00 Y
L 76937 US GUIDE VASCULAR ACCESS 7.37 $28.15 --- -- 005 0 0 0.44 $0.00 Y
L 76940 US GUIDE TISSUE ABLATION 36.57 $139.70 --- -- 005 0 0 0.40 $0.00 Y
L 76941 ECHO GUIDE FOR TRANSFUSION 29.57 $112.96 --- -- 005 0 0 0.54 $0.00 Y
L 76942 ECHO GUIDE FOR BIOPSY 14.01 $53.52 --- -- 005 0 0 0.52 $0.00 Y
L 76946 ECHO GUIDE FOR AMNIOCENTESIS 7.57 $28.92 --- -- 005 0 0 0.58 $0.00 Y
L 76965 ECHO GUIDANCE RADIOTHERAPY 20.70 $79.07 --- -- 005 0 0 0.72 $0.00 Y
L 76970 ULTRASOUND EXAM FOLLOWUP 11.37 $43.43 --- -- 005 0 0 0.20 $0.00 Y
L 76975 GI ENDOSCOPIC ULTRASOUND 12.54 $47.90 --- -- 005 0 0 0.46 $0.00 Y
L 76978 US TRGT DYN MBUBB 1ST LES 77.92 $297.65 --- -- 005 0 0 0.23 $0.00 Y
L 76979 US TRGT DYN MBUBB EA ADDL 53.19 $203.19 --- -- 005 0 0 0.18 $0.00 Y
L 76981 USE PARENCHYMA 25.70 $98.17 --- -- 005 0 0 0.19 $0.00 Y
L 76982 USE 1ST TARGET LESION 22.92 $87.55 --- -- 005 0 0 0.29 $0.00 Y
L 76983 USE EA ADDL TARGET LESION 13.95 $53.29 --- -- 005 0 0 0.00 $0.00 Y
L 76998 US GUIDE INTRAOP 30.51 $116.55 --- -- 005 0 0 0.00 $0.00 Y
L 76999 ECHO EXAMINATION PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.44 $0.00 Y
P 76999 ECHO EXAMINATION PROCEDURE 0.00 $0.00 --- -- 010 0 0 0.44 $0.00 Y
L 77001 FLUOROGUIDE FOR VEIN DEVICE 16.64 $63.56 --- -- 005 0 0 0.21 $0.00 Y
L 77002 NEEDLE LOCALIZATION BY XRAY 17.41 $66.51 --- -- 005 0 0 0.29 $0.00 Y
L 77003 FLUOROGUIDE FOR SPINE INJECT 14.89 $56.88 --- -- 005 0 0 0.30 $0.00 Y
L 77011 CT SCAN FOR LOCALIZATION 52.22 $199.48 --- -- 005 0 0 0.27 $0.00 Y
L 77012 CT SCAN FOR NEEDLE BIOPSY 29.07 $111.05 --- -- 005 0 0 0.44 $0.00 Y
L 77013 CT GUIDE FOR TISSUE ABLATION 42.10 $160.82 --- -- 005 0 0 0.32 $0.00 Y
L 77014 CT SCAN FOR THERAPY GUIDE 27.53 $105.16 --- -- 005 0 0 0.35 $0.00 Y
L 77021 MRI GUIDANCE NDL PLMT RS&I 96.01 $366.76 --- -- 005 0 0 0.17 $0.00 Y
L 77022 MRI GDN PARNCHYMA TISS ABLTJ 44.92 $171.59 --- -- 005 0 0 0.85 $0.00 Y
L 77046 MRI BREAST C- UNILATERAL 59.38 $226.83 --- -- 005 0 0 0.28 $0.00 Y
L 77047 MRI BREAST C- BILATERAL 60.86 $232.49 --- -- 005 0 0 0.30 $0.00 Y
L 77048 MRI BREAST C-+ W/CAD UNI 94.50 $360.99 --- -- 005 0 0 0.25 $0.00 Y
L 77049 MRI BREAST C-+ W/CAD BI 96.37 $368.13 --- -- 005 0 0 0.27 $0.00 Y
L 77053 XRAY OF MAMMARY DUCT 13.72 $52.41 --- -- 005 0 0 0.30 $0.00 Y
L 77054 XRAY OF MAMMARY DUCTS 18.03 $68.87 --- -- 005 0 0 0.28 $0.00 Y
L 77061 BREAST TOMOSYNTHESIS UNI 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77062 BREAST TOMOSYNTHESIS BI 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77063 BREAST TOMOSYNTHESIS BI 12.91 $49.32 --- -- 005 0 0 0.53 $0.00 Y
L 77065 DX MAMMO INCL CAD UNI 31.95 $122.05 --- -- 005 0 0 0.28 $0.00 Y
L 77066 DX MAMMO INCL CAD BI 40.51 $154.75 --- -- 005 0 0 0.27 $0.00 Y
L 77067 SCR MAMMO BI INCL CAD 32.80 $125.30 --- -- 005 0 0 0.26 $0.00 Y
L 77071 X-RAY STRESS VIEW 6.43 $24.56 --- -- 005 0 0 0.00 $0.00 Y
L 77072 XRAYS FOR BONE AGE 5.15 $19.67 --- -- 005 0 0 0.40 $0.00 Y
L 77073 X-RAYS BONE LENGTH STUDIES 8.39 $32.05 --- -- 005 0 0 0.39 $0.00 Y
L 77074 X-RAYS BONE SURVEY LIMITED 14.77 $56.42 --- -- 005 0 0 0.34 $0.00 Y
L 77075 X-RAYS BONE SURVEY COMPLETE 20.55 $78.50 --- -- 005 0 0 0.30 $0.00 Y
L 77076 X-RAYS BONE SURVEY INFANT 16.65 $63.60 --- -- 005 0 0 0.35 $0.00 Y
L 77077 JOINT SURVEY SINGLE VIEW 8.70 $33.23 --- -- 005 0 0 0.42 $0.00 Y
L 77080 DXA BONE DENSITY AXIAL 9.78 $37.36 --- -- 005 0 0 0.24 $0.00 Y
L 77081 DXA BONE DENSITY/PERIPHERAL 6.57 $25.10 --- -- 005 0 0 0.37 $0.00 Y
L 77085 DXA BONE DENSITY STUDY 13.29 $50.77 --- -- 005 0 0 0.26 $0.00 Y
L 77086 FRACTURE ASSESSMENT VIA DXA 8.41 $32.13 --- -- 005 0 0 0.24 $0.00 Y
L 77261 RADIATION THERAPY PLANNING 35.30 $134.85 --- -- 005 0 0 0.40 $0.00 Y
L 77262 RADIATION THERAPY PLANNING 38.20 $145.92 --- -- 005 0 0 0.40 $0.00 Y
L 77263 RADIATION THERAPY PLANNING 55.00 $210.10 --- -- 005 0 0 0.40 $0.00 Y
L 77280 SET RADIATION THERAPY FIELD 20.98 $80.14 --- -- 005 0 0 0.12 $0.00 Y
L 77285 SET RADIATION THERAPY FIELD 33.25 $127.02 --- -- 005 0 0 0.12 $0.00 Y
L 77290 SET RADIATION THERAPY FIELD 40.81 $155.89 --- -- 005 0 0 0.15 $0.00 Y
L 77293 RESPIRATOR MOTION MGMT SIMUL 108.50 $414.46 --- -- 005 0 0 0.21 $0.00 Y
L 77295 SET RADIATION THERAPY FIELD 114.07 $435.75 --- -- 005 0 0 0.43 $0.00 Y
L 77299 RADIATION THERAPY PLANNING 0.00 $0.00 --- -- 005 0 0 0.48 $0.00 Y
L 77300 RADIATION THERAPY DOSE PLAN 14.69 $56.12 --- -- 005 0 0 0.47 $0.00 Y
L 77301 RADIOTHERAPY DOSE PLAN IMRT 323.87 $1237.18 --- -- 005 0 0 0.20 $0.00 Y
L 77306 TELETHX ISODOSE PLAN SIMPLE 33.69 $128.69 --- -- 005 0 0 0.47 $0.00 Y
L 77307 TELETHX ISODOSE PLAN CPLX 65.74 $251.14 --- -- 005 0 0 0.50 $0.00 Y
L 77316 BRACHYTX ISODOSE PLAN SIMPLE 43.53 $166.29 --- -- 005 0 0 0.37 $0.00 Y
L 77317 BRACHYTX ISODOSE INTERMED 56.92 $217.44 --- -- 005 0 0 0.37 $0.00 Y
L 77318 BRACHYTX ISODOSE COMPLEX 82.04 $313.40 --- -- 005 0 0 0.40 $0.00 Y
L 77321 SPECIAL TELETX PORT PLAN 21.39 $81.71 --- -- 005 0 0 0.51 $0.00 Y
L 77331 SPECIAL DOSIMETRY ONLY BY PHYS 13.98 $53.40 --- -- 005 0 0 0.69 $0.00 Y
L 77332 RADIATION TREATMENT AID(S) 14.04 $53.63 --- -- 005 0 0 0.33 $0.00 Y
L 77333 RADIATION TREATMENT AID(S) 11.97 $45.73 --- -- 005 0 0 0.38 $0.00 Y
L 77334 RADIATION TREATMENT AID(S) 30.88 $117.96 --- -- 005 0 0 0.44 $0.00 Y
L 77336 RADIATION PHYSICS CONSULT 14.42 $55.08 --- -- 005 0 0 0.40 $0.00 Y
L 77338 DESIGN MLC DEVICE FOR IMRT 111.94 $427.61 --- -- 005 0 0 0.42 $0.00 Y
L 77370 SPECIAL PHYSICS CONSULTATION 24.92 $95.19 --- -- 005 0 0 0.40 $0.00 Y
L 77371 SRS MULTISOURCE 278.16 $1062.56 --- -- 005 0 0 0.00 $0.00 Y
L 77372 SRS LINEAR BASED 211.05 $806.21 --- -- 005 0 0 0.00 $0.00 Y
L 77373 SBRT DELIVERY 326.45 $1247.04 --- -- 005 0 0 0.00 $0.00 Y
L 77385 NTSTY MODUL RAD TX DLVR SMPL 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77386 NTSTY MODUL RAD TX DLVR CPLX 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77387 GUIDANCE FOR RADIAJ TX DLVR 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77399 EXTERNAL RADIATION DOSIMETRY 0.00 $0.00 --- -- 005 0 0 0.40 $0.00 Y
L 77401 RADIATION, SUPERFICIAL AND/OR ORTHO VOLT 4.99 $19.06 --- -- 005 0 0 0.00 $0.00 Y
L 77402 RADIATION TREATMENT DELIVERY 11.10 $42.40 --- -- 005 0 0 0.00 $0.00 Y
L 77407 RADIATION TREATMENT DELIVERY 10.15 $38.77 --- -- 005 0 0 0.00 $0.00 Y
L 77412 RADIATION TREATMENT DELIVERY 11.31 $43.20 --- -- 005 0 0 0.00 $0.00 Y
L 77417 RADIOLOGY PORT IMAGES(S) 2.57 $9.82 --- -- 005 0 0 0.00 $0.00 Y
L 77423 NEUTRON BEAM TX COMPLEX 22.88 $87.41 --- -- 005 0 0 0.40 $0.00 Y
L 77424 IO RAD TX DELIVERY BY X-RAY 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77425 *12IO RAD TX DELIVER BY ELCTRNS 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77427 RADIATION TX MANAGEMENT X5 29.94 $114.37 --- -- 005 1 0 0.00 $0.00 Y
L 77431 RADIATION, COMPLETE COURSE 20.77 $79.34 --- -- 005 0 0 0.40 $0.00 Y
L 77432 STEREOTACTIC RADIATION TRMT 74.43 $284.32 --- -- 005 0 0 0.00 $0.00 Y
L 77435 SBRT MANAGEMENT 140.35 $536.14 --- -- 005 0 0 0.00 $0.00 Y
L 77469 IO RADIATION TX MANAGEMENT 64.99 $248.27 --- -- 005 0 0 0.00 $0.00 Y
L 77470 SPECIAL RADIATION TREATMENT 33.29 $127.17 --- -- 005 0 0 0.72 $0.00 N
L 77499 RADIATION THERAPY MANAGEMENT 0.00 $0.00 --- -- 005 0 0 0.40 $0.00 Y
L 77520 PROTON TRMT SIMPLE W/O COMP 0.00 $0.00 --- -- 005 1 0 0.00 $0.00 Y
L 77522 PROTON TRMT SIMPLE W/COMP 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77523 PROTON TRMT INTERMEDIATE 0.00 $0.00 --- -- 005 1 0 0.00 $0.00 Y
L 77525 PROTON TREATMENT COMPLEX 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 77600 HYPERTHERMIA TREATMENT 44.34 $169.38 --- -- 005 0 0 0.16 $0.00 Y
L 77610 HYPERTHERMIA TREATMENT 44.34 $169.38 --- -- 005 0 0 0.07 $0.00 Y
L 77615 HYPERTHERMIA TREATMENT 59.55 $227.48 --- -- 005 0 0 0.09 $0.00 Y
L 77750 INFUSE RADIOACTIVE MATERIALS 35.35 $135.04 --- -- 005 0 0 0.00 $0.00 Y
L 77761 APPLY INTRCAV RADIAT SIMPLE 84.42 $322.48 --- -- 005 0 0 0.49 $0.00 Y
L 77762 APPLY INTRCAV RADIAT INTERM 111.89 $427.42 --- -- 005 0 0 0.55 $0.00 Y
L 77763 APPLY INTRCAV RADIAT COMPL 157.98 $603.48 --- -- 005 0 0 0.59 $0.00 Y
L 77767 HDR RDNCL SKN SURF BRACHYTX 53.65 $204.94 --- -- 005 0 0 0.23 $0.00 Y
L 77768 HDR RDNCL SKN SURF BRACHYTX 84.31 $322.06 --- -- 005 0 0 0.19 $0.00 Y
L 77770 HDR RDNCL NTRSTL/ICAV BRCHTX 76.15 $290.89 --- -- 005 0 0 0.30 $0.00 Y
L 77771 HDR RDNCL NTRSTL/ICAV BRCHTX 141.56 $540.76 --- -- 005 0 0 0.31 $0.00 Y
L 77772 HDR RDNCL NTRSTL/ICAV BRCHTX 216.63 $827.53 --- -- 005 0 0 0.29 $0.00 Y
L 77778 APPLY INTERSTIT RADIAT COMPL 192.30 $734.59 --- -- 005 0 0 0.53 $0.00 Y
L 77789 APPLY SURF LDR RADIONUCLIDE 27.94 $106.73 --- -- 005 0 0 0.48 $0.00 Y
L 77790 RADIATION HANDLING 20.78 $79.38 --- -- 005 0 0 0.54 $0.00 Y
L 77799 RADIUM/RADIOISOTOPE THERAPY 0.00 $0.00 --- -- 005 0 0 0.00 $0.00 Y
L 78013 THYROID IMAGING W/BLOOD FLOW 47.29 $180.63 --- -- 005 0 0 0.09 $0.00 Y
L 78014 THYROID IMAGING W/BLOOD FLOW 57.62 $220.11 --- -- 005 0 0 0.09 $0.00 Y
L 78015 NUCLEAR SCAN OF THYROID 21.18 $80.91 --- -- 005 0 0 0.13 $0.00 Y
L 78016 EXTENSIVE THYROID SCAN 28.66 $109.48 --- -- 005 0 0 0.11 $0.00 Y
L 78018 THYROID MET IMAGING BODY 33.98 $129.80 --- -- 005 0 0 0.12 $0.00 Y
L 78020 THYROID MET UPTAKE 7.65 $29.22 --- -- 005 0 0 0.31 $0.00 Y
L 78070 PARATHYROID PLANAR IMAGING 25.16 $96.11 --- -- 005 0 0 0.12 $0.00 Y
L 78071 PARATHYRD PLANAR W/WO SUBTRJ 85.54 $326.76 --- -- 005 0 0 0.15 $0.00 Y
L 78072 PARATHYRD PLANAR W/SPECT&CT 101.24 $386.74 --- -- 005 0 0 0.17 $0.00 Y
L 78075 ADRENAL CORTEX & MEDULLA IMG 57.02 $217.82 --- -- 005 0 0 0.07 $0.00 Y
L 78099 ENDOCRINE NUCLEAR PROCEDURE 6.68 $25.52 --- -- 005 0 0 0.36 $0.00 Y
L 78102 BONE MARROW IMAGING LTD 24.41 $93.25 --- -- 005 0 0 0.14 $0.00 Y
L 78103 BONE MARROW IMAGING MULT 0.00 $0.00 --- -- 005 0 0 0.15 $0.00 Y
L 78104 BONE MARROW IMAGING BODY 0.00 $0.00 --- -- 005 0 0 0.14 $0.00 Y
L 78110 PLASMA VOLUME SINGLE 9.06 $34.61 --- -- 005 0 0 0.09 $0.00 Y
L 78111 PLASMA VOLUME MULTIPLE 13.72 $52.41 --- -- 005 0 0 0.10 $0.00 Y
L 78120 RED CELL MASS SINGLE 13.59 $51.91 --- -- 005 0 0 0.11 $0.00 Y
L 78121 RED CELL MASS MULTIPLE 18.46 $70.52 --- -- 005 0 0 0.14 $0.00 Y
L 78122 WHOLE BLD VOL DETER,INC SEPARATE MEASURE 23.60 $90.15 --- -- 005 0 0 0.20 $0.00 Y
L 78130 RED CELL SURVIVAL EXAM 22.65 $86.52 --- -- 005 0 0 0.17 $0.00 Y
L 78135 RED CELL SURVIVAL; DIFFER ORGAN/TISSUE 33.98 $129.80 --- -- 005 0 0 0.08 $0.00 Y
L 78140 LABELED RED CELL SEQUESTRATION 22.65 $86.52 --- -- 005 0 0 0.20 $0.00 Y
L 78185 NUCLEAR SCAN OF SPLEEN 22.65 $86.52 --- -- 005 0 0 0.09 $0.00 Y
L 78191 PLATELET SURVIVAL STUDY 39.05 $149.17 --- -- 005 0 0 0.17 $0.00 Y
L 78195 LYMPH SYSTEM IMAGING 49.62 $189.55 --- -- 005 0 0 0.15 $0.00 Y
L 78199 NUCLEAR EXAM BLOOD/LYMPH 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 78201 NUCLEAR SCAN OF LIVER 20.39 $77.89 --- -- 005 0 0 0.10 $0.00 Y
L 78202 NUCLEAR SCAN OF LIVER 31.45 $120.14 --- -- 005 0 0 0.11 $0.00 Y
L 78215 NUCLEAR SCAN, LIVER & SPLEEN 22.65 $86.52 --- -- 005 0 0 0.11 $0.00 Y
L 78216 LIVER & SPLEEN IMAGE/FLOW 29.79 $113.80 --- -- 005 0 0 0.20 $0.00 Y
L 78226 HEPATOBILIARY SYSTEM IMAGING 78.01 $298.01 --- -- 005 0 0 0.10 $0.00 Y
L 78227 HEPATOBIL SYST IMAGE W/DRUG 106.95 $408.54 --- -- 005 0 0 0.09 $0.00 Y
L 78230 NUCLEAR SCAN, SALIVARY GLAND 15.86 $60.59 --- -- 005 0 0 0.12 $0.00 Y
L 78231 NUCLEAR SCANS,SALIVARY GLAND 18.37 $70.17 --- -- 005 0 0 0.18 $0.00 Y
L 78232 NUCLEAR EXAM, SALIVARY GLAND 22.65 $86.52 --- -- 005 0 0 0.18 $0.00 Y
L 78258 NUCLEAR IMAGING OF ESOPHAGUS 33.86 $129.35 --- -- 005 0 0 0.15 $0.00 Y
L 78261 NUCLEAR SCAN, GASTRIC MUCOSA 28.31 $108.14 --- -- 005 0 0 0.12 $0.00 Y
L 78262 GULLET REFLUX NUCLEAR EXAM 28.31 $108.14 --- -- 005 0 0 0.12 $0.00 Y
L 78264 GASTRIC EMPTYING IMAG STUDY 84.05 $321.07 --- -- 005 0 0 0.10 $0.00 Y
L 78265 GASTRIC EMPTYING IMAG STUDY 99.17 $378.83 --- -- 005 0 0 0.11 $0.00 Y
L 78266 GASTRIC EMPTYING IMAG STUDY 117.77 $449.88 --- -- 005 0 0 0.10 $0.00 Y
L 78278 NUCLEAR SCAN, GI BLOOD LOSS 33.98 $129.80 --- -- 005 0 0 0.13 $0.00 Y
L 78282 G.I. PROTEIN LOSS EXAM 13.59 $51.91 --- -- 005 0 0 0.33 $0.00 Y
L 78290 MECKELS DIVERT EXAM 28.31 $108.14 --- -- 005 0 0 0.09 $0.00 Y
L 78291 PERITONEAL-VENOUS SHUNT PATENCY TEST 36.94 $141.11 --- -- 005 0 0 0.15 $0.00 Y
L 78299 G.I. NUCLEAR PROCEDURE 0.00 $0.00 --- -- 005 0 0 0.35 $0.00 Y
L 78300 BONE IMAGING LIMITED AREA 21.18 $80.91 --- -- 005 0 0 0.16 $0.00 Y
L 78305 BONE IMAGING MULTIPLE AREAS 29.56 $112.92 --- -- 005 0 0 0.16 $0.00 Y
L 78306 BONE IMAGING WHOLE BODY 36.92 $141.03 --- -- 005 0 0 0.15 $0.00 Y
L 78315 BONE IMAGING 3 PHASE 34.32 $131.10 --- -- 005 0 0 0.13 $0.00 Y
L 78399 MUSCULOSKELETAL NUCLEAR EXAM 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 78414 DETERMINATION CENTRAL C-V HEMODYNAMICS 27.18 $103.83 --- -- 005 0 0 0.35 $0.00 Y
L 78428 NUCLEAR EXAM, HEART SHUNT 0.00 $0.00 --- -- 005 0 0 0.19 $0.00 Y
L 78429 MYOCRD IMG PET 1 STD W/CT 18.97 $72.50 --- -- 005 0 0 1.00 $0.00 Y
L 78430 MYOCRD IMG PET RST/STRS W/CT 18.00 $68.78 --- -- 005 0 0 1.00 $0.00 Y
L 78431 MYOCRD IMG PET RST&STRS CT 20.96 $80.10 --- -- 005 0 0 1.00 $0.00 Y
L 78432 MYOCRD IMG PET 2RTRACER 22.30 $85.21 --- -- 005 0 0 1.00 $0.00 Y
L 78433 MYOCRD IMG PET 2RTRACER CT 24.37 $93.13 --- -- 005 0 0 1.00 $0.00 Y
L 78434 AQMBF PET REST & RX STRESS 7.07 $27.03 --- -- 005 0 0 1.00 $0.00 Y
L 78445 NUCLEAR SCAN OF BLOOD FLOW 31.63 $120.83 --- -- 005 0 0 0.12 $0.00 Y
L 78451 HT MUSCLE IMAGE SPECT SING 52.86 $201.93 --- -- 005 0 0 0.18 $0.00 Y
L 78452 HT MUSCLE IMAGE SPECT MULT 91.13 $348.12 --- -- 005 0 0 0.15 $0.00 Y
L 78453 HT MUSCLE IMAGE PLANAR SING 46.23 $176.60 --- -- 005 0 0 0.15 $0.00 Y
L 78454 HT MUSC IMAGE PLANAR MULT 44.06 $168.31 --- -- 005 0 0 0.14 $0.00 Y
L 78456 ACUTE VENOUS THROMBUS IMAGE 38.91 $148.64 --- -- 005 1 0 0.14 $0.00 Y
L 78457 VENOUS THROMBOSIS IMAGING 18.12 $69.22 --- -- 005 0 0 0.19 $0.00 Y
L 78458 VEN THROMBOSIS IMAGES BILAT 24.69 $94.32 --- -- 005 0 0 0.20 $0.00 Y
L 78459 MYOCRD IMG PET SINGLE STUDY 0.00 $0.00 --- -- 005 0 0 0.15 $0.00 Y
L 78466 NUCLEAR SCAN, HEART MUSCLE 22.91 $87.52 --- -- 005 0 0 0.16 $0.00 Y
L 78468 HEART INFARCT IMAGE (EF) 30.36 $115.98 --- -- 005 0 0 0.18 $0.00 Y
L 78472 GATED HEART PLANAR SINGLE 43.92 $167.77 --- -- 005 0 0 0.19 $0.00 Y
L 78473 GATED HEART MULTIPLE 65.66 $250.82 --- -- 005 0 0 0.23 $0.00 Y
L 78481 HEART FIRST PASS SINGLE 42.08 $160.75 --- -- 005 0 0 0.25 $0.00 Y
L 78483 HEART FIRST PASS MULTIPLE 58.20 $222.32 --- -- 005 0 0 0.27 $0.00 Y
L 78494 HEART IMAGE SPECT 54.97 $209.99 --- -- 005 0 0 0.24 $0.00 Y
L 78496 HEART FIRST PASS ADDON 10.45 $39.92 --- -- 005 0 0 0.52 $0.00 Y
L 78499 CARDIOVASCULAR NUCLEAR EXAM 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 78579 LUNG VENTILATION IMAGING 41.34 $157.94 --- -- 005 0 0 0.12 $0.00 Y
L 78580 LUNG PERFUSION IMAGING 29.45 $112.50 --- -- 005 0 0 0.14 $0.00 Y
L 78582 *12LUNG VENTILAT&PERFUS IMAGING 76.16 $290.92 --- -- 005 0 0 0.14 $0.00 Y
L 78597 LUNG PERFUSION DIFFERENTIAL 46.49 $177.59 --- -- 005 0 0 0.16 $0.00 Y
L 78598 LUNG PERF&VENTILAT DIFERENTL 71.67 $273.78 --- -- 005 0 0 0.12 $0.00 Y
L 78599 RESPIRATORY NUCLEAR EXAM 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 78600 BRAIN IMAGE < 4 VIEWS 30.72 $117.35 --- -- 005 0 0 0.11 $0.00 Y
L 78601 BRAIN IMAGE W/FLOW < 4 VIEWS 36.07 $137.79 --- -- 005 0 0 0.10 $0.00 Y
L 78605 BRAIN IMAGE 4+ VIEWS 35.11 $134.12 --- -- 005 0 0 0.12 $0.00 Y
L 78606 BRAIN IMAGE W/FLOW 4 + VIEWS 41.67 $159.18 --- -- 005 0 0 0.09 $0.00 Y
L 78608 BRAIN IMAGING (PET) 0.00 $0.00 --- -- 005 0 0 0.15 $0.00 Y
L 78609 BRAIN IMAGING (PET) 0.00 $0.00 --- -- 005 0 0 0.15 $0.00 Y
L 78610 NUCLEAR SCAN OF BRAIN 10.53 $40.22 --- -- 005 0 0 0.08 $0.00 Y
L 78630 CEREBROSPINAL FLUID SCAN 44.29 $169.19 --- -- 005 0 0 0.09 $0.00 Y
L 78635 CEREBROSPINAL FLUID SCAN 39.10 $149.36 --- -- 005 0 0 0.08 $0.00 Y
L 78645 CEREBROSPINAL FLUID SCAN 39.10 $149.36 --- -- 005 0 0 0.08 $0.00 Y
L 78650 CSF LEAKAGE IMAGING 38.73 $147.95 --- -- 005 0 0 0.08 $0.00 Y
L 78660 RADIOPHARM DACRYOCYSTOGRAPHY 22.65 $86.52 --- -- 005 0 0 0.13 $0.00 Y
L 78699 NERVOUS SYSTEM NUCLEAR EXAM 0.00 $0.00 --- -- 005 0 0 0.35 $0.00 Y
L 78700 KIDNEY IMAGING MORPHOL 20.39 $77.89 --- -- 005 0 0 0.12 $0.00 Y
L 78701 NUCLEAR SCAN OF KIDNEY 31.37 $119.83 --- -- 005 0 0 0.10 $0.00 Y
L 78707 K FLOW/FUNCT IMAGE W/O DRUG 50.51 $192.95 --- -- 005 0 0 0.18 $0.00 Y
L 78708 K FLOW/FUNCT IMAGE W/DRUG 40.73 $155.59 --- -- 005 0 0 0.31 $0.00 Y
L 78709 K FLOW/FUNCT IMAGE MULTIPLE 47.81 $182.63 --- -- 005 0 0 0.17 $0.00 Y
L 78725 KIDNEY FUNCTION STUDY 20.16 $77.01 --- -- 005 0 0 0.16 $0.00 Y
L 78730 URINARY BLADDER RETENTION 17.24 $65.86 --- -- 005 0 0 0.10 $0.00 Y
L 78740 URETER REFLUX STDY(RADIOPHARM VOID CYSTO 17.67 $67.50 --- -- 005 0 0 0.11 $0.00 Y
L 78761 TESTICULAR IMAGING W/FLOW 22.65 $86.52 --- -- 005 0 0 0.15 $0.00 Y
L 78799 GENITOURINARY NUCLEAR EXAM 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 78800 RP LOCLZJ TUM 1 AREA 1 D IMG 23.33 $89.12 --- -- 005 0 0 0.16 $0.00 Y
L 78801 RP LOCLZJ TUM 2+AREA 1+D IMG 34.66 $132.40 --- -- 005 0 0 0.14 $0.00 Y
L 78802 RP LOCLZJ TUM WHBDY 1 D IMG 40.55 $154.90 --- -- 005 0 0 0.12 $0.00 Y
L 78804 RP LOCLZJ TUM WHBDY 2+D IMG 49.66 $189.70 --- -- 005 0 0 0.08 $0.00 Y
L 78808 IV INJ RA DRUG DX STUDY 10.52 $40.19 --- -- 005 0 0 0.00 $0.00 Y
L 78811 PET IMAGE LTD AREA 530.63 $2027.00 --- -- 005 0 0 0.15 $0.00 Y
L 78812 PET IMAGE SKULL-THIGH 530.63 $2027.00 --- -- 005 0 0 0.15 $0.00 Y
L 78813 PET IMAGE FULL BODY 530.63 $2027.00 --- -- 005 0 0 0.15 $0.00 Y
L 78814 PET IMAGE W/CT LMTD 556.81 $2127.00 --- -- 005 0 0 0.15 $0.00 Y
L 78815 PET IMAGE W/CT SKULL-THIGH 556.81 $2127.00 --- -- 005 0 0 0.15 $0.00 Y
L 78816 PET IMAGE W/CT FULL BODY 556.81 $2127.00 --- -- 005 0 0 0.15 $0.00 Y
L 78830 RP LOCLZJ TUM SPECT W/CT 1 121.43 $463.87 --- -- 005 0 0 0.13 $0.00 Y
L 78831 RP LOCLZJ TUM SPECT 2 AREAS 175.88 $671.87 --- -- 005 0 0 0.11 $0.00 Y
L 78832 RP LOCLZJ TUM SPECT W/CT 2 229.23 $875.69 --- -- 005 0 0 0.10 $0.00 Y
L 78835 RP QUAN MEAS SINGLE AREA 25.29 $96.63 --- -- 005 0 0 0.20 $0.00 Y
L 78999 NUCLEAR DIAGNOSTIC EXAM 0.00 $0.00 --- -- 005 0 0 0.33 $0.00 Y
L 79005 NUCLEAR RX ORAL ADMIN 31.18 $119.11 --- -- 005 0 0 0.62 $0.00 Y