2017 Payment Rate Payment Rate

Transcription

1 0042T C Ct perfusion w/contrast cbf $0.00 $ T C Us leiomyomata ablate <200 $0.00 $ T C Us leiomyomata ablate >200 $0.00 $ T C Perq stent/chest vert art $0.00 $ T 26 C Perq stent/chest vert art $0.00 $ T C Perq stent/chest vert art $0.00 $ T TC C S&i stent/chest vert art $0.00 $ T 26 C S&i stent/chest vert art $0.00 $ T TC C S&i stent/chest vert art $0.00 $ T C Cad breast mri $0.00 $ T 26 C Cad breast mri $0.00 $ T TC C Cad breast mri $0.00 $ T C Cad cxr with interp $0.00 $ T C Cad cxr remote $0.00 $ T C Perq sacral augmt unilat inj $0.00 $ T C Perq sacral augmt bilat inj $0.00 $ T C Post vert arthrplst 1 lumbar $0.00 $ T C Njx paravert w/us cer/thor $0.00 $ T C Njx paravert w/us cer/thor $0.00 $ T C Njx paravert w/us cer/thor $0.00 $ T C Njx paravert w/us lumb/sac $0.00 $ T C Njx paravert w/us lumb/sac $0.00 $ T C Njx paravert w/us lumb/sac $0.00 $ T C Njx tfrml eprl w/us cer/thor $0.00 $ T C Njx tfrml eprl w/us cer/thor $0.00 $ T C Njx tfrml eprl w/us lumb/sac $0.00 $ T C Njx tfrml eprl w/us lumb/sac $0.00 $ T C Trluml perip athrc renal art $0.00 $ T C Trluml perip athrc visceral $0.00 $ T C Trluml perip athrc abd aorta $0.00 $ T C Trluml perip athrc brchiocph $0.00 $ T C Trluml perip athrc iliac art $0.00 $ T C Evasc rpr iliac art bifur $0.00 $ T C Heart symp image plnr $0.00 $ T C Heart symp image plnr spect $0.00 $ T C Trnscth renal symp denrv unl $0.00 $ T C Trnscth renal symp denrv bil $0.00 $ T C Ultrasound elastography $0.00 $ T C Hdr elctrnc skn surf brchytx $0.00 $ T C Hdr elctr ntrst/ntrcv brchtx $0.00 $ T C Abltj perc uxtr/perph nrv $0.00 $ T C Abltj perc lxtr/perph nrv $0.00 $ T C Abltj perc plex/trncl nrv $0.00 $ A Fna w/o image $ $ % 1 of 20

2 10022 A Fna w/image $ $ % A Guide cathet fluid drainage $ $ % A Perq dev soft tiss 1st imag $ $ % A Perq dev soft tiss add imag $ $ % A Drainage of skin abscess $ $ % A Drainage of skin abscess $ $ % A Drainage of hematoma/fluid $ $ % A Puncture drainage of lesion $ $ % C Skin tissue procedure $0.00 $ A Drainage of breast lesion $ $ % A Drain breast lesion add-on $27.63 $ % A Injection for breast x-ray $ $ % A Bx breast 1st lesion strtctc $ $ % A Bx breast add lesion strtctc $ $ % A Bx breast 1st lesion us imag $ $ % A Bx breast add lesion us imag $ $ % A Bx breast 1st lesion mr imag $1, $1, % A Bx breast add lesion mr imag $ $ % A Bx breast percut w/o image $ $ % A Perq device breast 1st imag $ $ % A Perq device breast ea imag $ $ % A Perq dev breast 1st strtctc $ $ % A Perq dev breast add strtctc $ $ % A Perq dev breast 1st us imag $ $ % A Perq dev breast add us imag $ $ % A Perq dev breast 1st mr guide $ $ % A Perq dev breast add mr guide $ $ % A Place po breast cath for rad $4, $4, % A Place breast cath for rad $98.69 $ % A Place breast rad tube/caths $ $1, % A I&d abscess subfascial $ $ % A Needle biopsy muscle $ $ % A Bone biopsy trocar/needle $ $ % A Bone biopsy trocar/needle $ $ % A Injection of sinus tract $ $ % A Inject sinus tract for x-ray $ $ % A Removal of foreign body $ $ % A Removal of foreign body $ $ % A Inj tendon sheath/ligament $53.83 $ % A Inj trigger point 1/2 muscl $56.35 $ % A Inject trigger points 3/> $64.96 $ % A Place ndl musc/tis for rt $ $ % A Drain/inj joint/bursa w/o us $48.81 $ % A Drain/inj joint/bursa w/us $73.93 $ % 2 of 20

3 20605 A Drain/inj joint/bursa w/o us $51.32 $ % A Drain/inj joint/bursa w/us $81.83 $ % A Drain/inj joint/bursa w/o us $61.73 $ % A Drain/inj joint/bursa w/us $92.95 $ % A Ablate bone tumor(s) perq $1, $4, % A Ablate bone tumor(s) perq $6, $6, % A Injection jaw joint x-ray $ $ % A Perq cervicothoracic inject $1, $1, % A Perq lumbosacral injection $1, $1, % A Vertebroplasty addl inject $ $ % A Perq vertebral augmentation $7, $7, % A Perq vertebral augmentation $7, $7, % A Perq vertebral augmentation $4, $4, % N Idet single level $2, $2, % N Idet 1 or more levels $1, $2, % A Injection for shoulder x-ray $ $ % A Injection for elbow x-ray $ $ % A Injection for wrist x-ray $ $ % A Injection for hip x-ray $ $ % A Injection for hip x-ray $ $ % A Inject sacroiliac joint $ $ % A Injection for knee x-ray $ $ % A Injection for ankle x-ray $ $ % A Insert emergency airway $ $ % A Dx bronchoscope/wash $ $ % A Bronchoscopy w/biopsy(s) $ $ % A Bronchoscopy/lung bx each $ $ % A Bronchoscopy/needle bx each $ $ % A Bronchoscopy dilate/fx repr $ $ % A Bronchoscopy dilate w/stent $ $ % A Diag bronchoscope/catheter $ $ % A Bronchial brush biopsy $ $ % A Needle biopsy chest lining $ $ % A Percut bx lung/mediastinum $ $ % A Insert pleural cath $ $ % A Insertion of chest tube $ $ % A Remove lung catheter $ $ % A Ins mark thor for rt perq $ $ % A Aspirate pleura w/o imaging $ $ % A Aspirate pleura w/ imaging $ $ % A Insert cath pleura w/o image $ $ % A Insert cath pleura w/ image $ $ % A Treat pleurodesis w/agent $ $ % A Lyse chest fibrin init day $94.75 $ % 3 of 20

4 32562 A Lyse chest fibrin subq day $85.06 $ % A Thorax stereo rad targetw/tx $ $ % A Therapeutic pneumothorax $ $ % A Ablate pulm tumor perq rf $1, $3, % A Drainage of heart sac $ $ % A Repeat drainage of heart sac $ $ % A Endovasc taa repr incl subcl $1, $1, % A Endovasc taa repr w/o subcl $1, $1, % A Insert endovasc prosth taa $1, $1, % A Endovasc prosth taa add-on $ $ % A Endovasc prosth delayed $1, $1, % A Endovas iliac a device addon $ $ % A Femoral endovas graft add-on $ $ % B Plnning pt spec fenest graft $0.00 $ C Endovasc visc aorta 1 graft $0.00 $ C Endovasc visc aorta 2 graft $0.00 $ C Endovasc visc aorta 3 graft $0.00 $ C Endovasc visc aorta 4 graft $0.00 $ C Visc & infraren abd 1 prosth $0.00 $ C Visc & infraren abd 2 prosth $0.00 $ C Visc & infraren abd 3 prosth $0.00 $ C Visc & infraren abd 4+ prost $0.00 $ B Place needle in vein $26.20 $ % A Pseudoaneurysm injection trt $ $ % A Injection ext venography $ $ % A Place catheter in vein $ $ % A Place catheter in vein $ $ % A Place catheter in vein $ $ % A Place catheter in artery $ $ % A Place catheter in artery $ $ % A Place catheter in artery $ $ % A Establish access to artery $ $ % A Intro ndl icath upr/lxtr art $ $ % A Establish access to aorta $ $ % A Place catheter in aorta $ $ % A Place catheter in artery $1, $1, % A Place catheter in artery $1, $1, % A Place catheter in artery $1, $1, % A Place catheter in artery $ $ % A Place cath thoracic aorta $1, $1, % A Place cath carotid/inom art $1, $1, % A Place cath carotid/inom art $1, $1, % A Place cath carotd art $1, $1, % A Place cath subclavian art $1, $1, % 4 of 20

5 36226 A Place cath vertebral art $1, $1, % A Place cath xtrnl carotid $ $ % A Place cath intracranial art $1, $1, % A Ins cath abd/l-ext art 1st $1, $1, % A Ins cath abd/l-ext art 2nd $ $ % A Ins cath abd/l-ext art 3rd $1, $1, % A Ins cath abd/l-ext art addl $ $ % A Ins cath ren art 1st unilat $1, $1, % A Ins cath ren art 1st bilat $1, $1, % A Ins cath ren art 2nd+ unilat $2, $2, % A Ins cath ren art 2nd+ bilat $2, $2, % A Bl draw < 3 yrs fem/jugular $27.63 $ % A Bl draw <3 yrs scalp vein $26.20 $ % A Bl draw <3 yrs other vein $19.02 $ % A Non-routine bl draw 3/> yrs $17.23 $ % A Vein access cutdown < 1 yr $55.99 $ % A Vein access cutdown > 1 yr $41.63 $ % A Njx sclrsnt 1 incmptnt vein $ $ % A Njx sclrsnt mlt incmptnt vn $ $ % A Endovenous mchnchem 1st vein $1, $1, % A Endovenous mchnchem add-on $ $ % A Endovenous rf 1st vein $1, $1, % A Endovenous rf vein add-on $ $ % A Endovenous laser 1st vein $1, $1, % A Endovenous laser vein addon $ $ % A Insertion of catheter vein $1, $2, % A Insertion of catheter vein $ $ % A Insertion of catheter vein $88.65 $ % A Insert non-tunnel cv cath $ $ % A Insert non-tunnel cv cath $ $ % A Insert tunneled cv cath $ $ % A Insert tunneled cv cath $ $ % A Insert tunneled cv cath $1, $1, % A Insert tunneled cv cath $1, $1, % A Insert tunneled cv cath $1, $1, % A Insert tunneled cv cath $ $ % A Insert tunneled cv cath $5, $5, % A Insert picc cath $ $ % A Insert picc cath $ $ % A Insert picvad cath $1, $1, % A Insert picvad cath $1, $1, % A Repair tunneled cv cath $ $ % A Repair tunneled cv cath $ $ % A Replace tunneled cv cath $ $ % 5 of 20

6 36580 A Replace cvad cath $ $ % A Replace tunneled cv cath $ $ % A Replace tunneled cv cath $1, $1, % A Replace tunneled cv cath $1, $1, % A Replace picc cath $ $ % A Replace picvad cath $1, $1, % A Removal tunneled cv cath $ $ % A Removal tunneled cv cath $ $ % T Draw blood off venous device $24.05 $ % T Collect blood from picc $26.92 $ % A Declot vascular device $31.94 $ % A Mech remov tunneled cv cath $ $ % A Mech remov tunneled cv cath $ $ % A Reposition venous catheter $ $ % T Inj w/fluor eval cv device $ $ % A Withdrawal of arterial blood $31.94 $ % A Insertion catheter artery $52.76 $ % A Insertion catheter artery $ $ % A Insertion catheter artery $ $ % A Insertion catheter artery $76.44 $ % A Intro cath dialysis circuit $ $ % A Intro cath dialysis circuit $1, $1, % A Intro cath dialysis circuit $5, $5, % A Thrmbc/nfs dialysis circuit $1, $1, % A Thrmbc/nfs dialysis circuit $2, $2, % A Thrmbc/nfs dialysis circuit $6, $6, % A Balo angiop ctr dialysis seg $ $ % A Stent plmt ctr dialysis seg $2, $2, % A Dialysis circuit embolj $1, $2, % A Insert hepatic shunt (tips) $ $ % A Remove hepatic shunt (tips) $5, $5, % A Prim art m-thrmbc 1st vsl $2, $2, % A Prim art m-thrmbc sbsq vsl $ $ % A Sec art thrombectomy add-on $1, $1, % A Venous mech thrombectomy $2, $2, % A Venous m-thrombectomy add-on $1, $1, % A Ins endovas vena cava filtr $2, $2, % A Redo endovas vena cava filtr $1, $1, % A Rem endovas vena cava filter $1, $1, % C Thrombolytic therapy stroke $0.00 $ A Remove intrvas foreign body $1, $1, % A Transcatheter biopsy $ $ % A Thrombolytic art therapy $ $ % A Thrombolytic venous therapy $ $ % 6 of 20

7 37213 A Thromblytic art/ven therapy $ $ % A Cessj therapy cath removal $ $ % R Transcath stent cca w/eps $1, $1, % N Transcath stent cca w/o eps $0.00 $1, A Stent placemt ante carotid $ $ % A Iliac revasc $3, $3, % A Iliac revasc w/stent $4, $4, % A Iliac revasc add-on $ $ % A Iliac revasc w/stent add-on $2, $2, % A Fem/popl revas w/tla $3, $3, % A Fem/popl revas w/ather $11, $11, % A Fem/popl revasc w/stent $9, $9, % A Fem/popl revasc stnt & ather $14, $15, % A Tib/per revasc w/tla $5, $5, % A Tib/per revasc w/ather $10, $10, % A Tib/per revasc w/stent $8, $8, % A Tib/per revasc stent & ather $13, $13, % A Tib/per revasc add-on $1, $1, % A Tibper revasc w/ather add-on $1, $1, % A Revsc opn/prq tib/pero stent $3, $3, % A Tib/per revasc stnt & ather $4, $4, % A Open/perq place stent 1st $4, $3, % A Open/perq place stent ea add $2, $2, % A Open/perq place stent same $4, $4, % A Open/perq place stent ea add $2, $2, % A Vasc embolize/occlude venous $4, $4, % A Vasc embolize/occlude artery $7, $7, % A Vasc embolize/occlude organ $9, $9, % A Vasc embolize/occlude bleed $6, $6, % A Trluml balo angiop 1st art $2, $2, % A Trluml balo angiop addl art $ $ % A Trluml balo angiop 1st vein $1, $1, % A Trluml balo angiop addl vein $ $ % A Intrvasc us noncoronary 1st $1, $1, % A Intrvasc us noncoronary addl $ $ % A Injection for spleen x-ray $ $ % A Dx bone marrow aspirations $ $ % A Dx bone marrow biopsies $ $ % A Needle biopsy lymph nodes $ $ % A Inject for lymphatic x-ray $86.13 $ % A Ra tracer id of sentinl node $41.27 $ % A Place needles h&n for rt $ $ % A Biopsy of salivary gland $ $ % A Injection for salivary x-ray $ $ % 7 of 20

8 42650 A Dilation of salivary duct $86.13 $ % A Dilation of salivary duct $ $ % A Esophagoscopy retro balloon $1, $1, % A Esophagosc dilate balloon 30 $ $ % A Esophagoscopy flex remove fb $ $ % A Esoph endoscopy dilation $ $ % A Egd balloon dil esoph30 mm/> $ $ % A Egd tube/cath insertion $ $ % A Egd place gastrostomy tube $ $ % A Egd guide wire insertion $ $ % A Ercp w/specimen collection $ $ % A Dilate esophagus $ $ % A Nasal/orogastric w/tube plmt $42.35 $ % A gastrostomy tube $ $ % A Reposition gastrostomy tube $ $ % A Small bowel endoscopy $ $ % A Small bowel endoscopy $ $ % A Intro gastrointestinal tube $20.10 $ % A Drainage of pelvic abscess $ $ % A Needle biopsy of liver $ $ % A Needle biopsy liver add-on $ $ % A Percut ablate liver rf $4, $4, % A Perq abltj lvr cryoablation $6, $7, % A Incision of gallbladder $ $ % A Injection for cholangiogram $ $ % A Injection for cholangiogram $ $ % A Plmt biliary drainage cath $1, $1, % A Plmt biliary drainage cath $1, $1, % A Conversion ext bil drg cath $1, $1, % A Exchange biliary drg cath $ $ % A Removal biliary drg cath $ $ % A Perq plmt bile duct stent $4, $4, % A Perq plmt bile duct stent $4, $4, % A Perq plmt bile duct stent $4, $5, % A Plmt access bil tree sm bwl $1, $1, % A Dilate biliary duct/ampulla $ $ % A Endoluminal bx biliary tree $ $ % A Removal duct glbldr calculi $1, $1, % A Bile duct endoscopy add-on $ $ % A Biliary endo perq dx w/speci $ $ % A Biliary endoscopy thru skin $ $ % A Biliary endoscopy thru skin $ $ % A Biliary endoscopy thru skin $ $ % A Biliary endoscopy thru skin $ $ % 8 of 20

9 47801 A Placement bile duct support $1, $1, % A Needle biopsy pancreas $ $ % A Abd paracentesis $ $ % A Abd paracentesis w/imaging $ $ % A Biopsy abdominal mass $ $ % A Sclerotx fluid collection $ $ % A Air injection into abdomen $ $ % A Image cath fluid colxn visc $ $ % A Image cath fluid peri/retro $ $ % A Image cath fluid trns/vgnl $ $ % A Ins mark abd/pel for rt perq $ $ % A Insert tun ip cath perc $1, $1, % A Ins tun ip cath for dial opn $ $ % A Remove tunneled ip cath $ $ % A Exchange drainage catheter $ $ % A Assess cyst contrast inject $ $ % A Injection abdominal shunt $47.73 $ % A Place gastrostomy tube perc $ $ % A Place duod/jej tube perc $1, $1, % A Place cecostomy tube perc $ $ % A g-tube to g-j perc $ $ % A Replace g/c tube perc $ $ % A Replace duod/jej tube perc $ $ % A Replace g-j tube perc $ $ % A Fix g/colon tube w/device $ $ % A Fluoro exam of g/colon tube $ $ % A Removal of kidney stone $ $ % A Removal of kidney stone $1, $1, % A Renal biopsy perq $ $ % A ureter stent percut $1, $1, % A Remove ureter stent percut $ $ % A stent via transureth $1, $1, % A Remove stent via transureth $ $ % A nephroureteral cath $ $ % A Remove renal tube w/fluoro $ $ % A Drainage of kidney lesion $ $ % A Create passage to kidney $ $ % A Measure kidney pressure $ $ % A Njx px nfrosgrm &/urtrgrm $ $ % A Njx px nfrosgrm &/urtrgrm $ $ % A Plmt nephrostomy catheter $ $ % A Plmt nephroureteral catheter $1, $1, % A Convert nephrostomy catheter $ $ % A Exchange nephrostomy cath $ $ % 9 of 20

10 50553 A Kidney endoscopy $ $ % A Fragmenting of kidney stone $ $ % A Perc rf ablate renal tumor $1, $3, % A Perc cryo ablate renal tum $4, $4, % A Injection for ureter x-ray $ $ % A Measure ureter pressure $ $ % A of ureter tube/stent $82.19 $ % A Injection for ureter x-ray $ $ % A Plmt ureteral stent prq $1, $1, % A Plmt ureteral stent prq $1, $1, % A Plmt ureteral stent prq $1, $1, % A Ureteral embolization/occl $1, $1, % A Balloon dilate urtrl strix $1, $1, % A Ureter endoscopy $ $ % A Incise & treat bladder $ $ % A Remove ureter calculus $ $ % A Drainage of bladder abscess $ $ % A Drain bladder by needle $63.16 $ % A Drain bladder by trocar/cath $ $ % A Drain bl w/cath insertion $ $ % A Injection for bladder x-ray $ $ % A Preparation for bladder xray $39.84 $ % A Injection for bladder x-ray $ $ % A Irrigation of bladder $74.29 $ % A Insert bladder catheter $48.45 $ % A Insert temp bladder cath $64.24 $ % A Insert bladder cath complex $ $ % A of bladder tube $92.95 $ % A of bladder tube $ $ % A Cystoscopy $ $ % A Cystoscopy & duct catheter $ $ % A Prepare penis study $99.41 $ % A Dynamic cavernosometry $ $ % A Penile injection $92.95 $ % A Prepare sperm duct x-ray $ $ % A Biopsy of prostate $ $ % A Transperi needle place pros $ $ % A Place rt device/marker pros $ $ % A Place needles pelvic for rt $ $ % A Insert uteri tandem/ovoids $ $ % A Ins vag brachytx device $ $ % A Catheter for hysterography $ $ % A Reopen fallopian tube $ $ % A Insert heyman uteri capsule $ $ % 10 of 20

11 58800 A Drainage of ovarian cyst(s) $ $ % A Drainage of ovarian cyst(s) $ $ % A Drain ovary abscess percut $ $ % A Retrieval of oocyte $ $ % A Amniocentesis diagnostic $ $ % A Amniocentesis therapeutic $ $ % A Biopsy of thyroid $ $ % A Aspir/inj thyroid cyst $ $ % A Remove brain canal fluid $89.00 $ % A Injection into brain canal $ $ % A Brain canal shunt procedure $59.58 $ % A Endovasc tempory vessel occl $ $ % A Transcath occlusion cns $1, $1, % A Transcath occlusion non-cns $ $ % R Intracranial angioplasty $1, $1, % R Intracran angioplsty w/stent $1, $1, % N Dilate ic vasospasm init $ $ % N Dilate ic vasospasm add-on $ $ % N Dilate ic vasospasm add-on $ $ % A Perq art m-thrombect &/nfs $ $ % A Evasc prlng admn rx agnt 1st $ $ % A Evasc prlng admn rx agnt add $ $ % A Revise circulation to head $2, $2, % A Revise circulation to head $2, $2, % A Interdiscal perq aspir dx $ $ % A Drain spinal cord cyst $ $ % A Needle biopsy spinal cord $ $ % A Spinal fluid tap diagnostic $ $ % A Drain cerebro spinal fluid $ $ % A Inject epidural patch $ $ % A Treat spinal cord lesion $ $ % A Treat spinal cord lesion $ $ % A Treat spinal canal lesion $ $ % A Injection for myelogram $ $ % A Percutaneous diskectomy $ $ % A Njx px discography lumbar $ $ % A Njx px discography crv/thrc $ $ % A Njx chemonucleolysis lmbr $ $ % A Injection into spinal artery $ $1, % A Myelography lumbar injection $ $ % A Myelography lumbar injection $ $ % A Myelography lumbar injection $ $ % A Myelography lumbar injection $ $ % A Njx interlaminar crv/thrc $ $ % 11 of 20

12 62321 A Njx interlaminar crv/thrc $ $ % A Njx interlaminar lmbr/sac $ $ % A Njx interlaminar lmbr/sac $ $ % A Njx interlaminar crv/thrc $ $ % A Njx interlaminar crv/thrc $ $ % A Njx interlaminar lmbr/sac $ $ % A Njx interlaminar lmbr/sac $ $ % A Remove lesion of spinal cord $1, $1, % A N block inj intercost sng $ $ % A N block inj intercost mlt $ $ % A Pvb thoracic single inj site $ $ % A Pvb thoracic 2nd+ inj site $85.77 $ % A Pvb thoracic cont infusion $ $ % A Inj foramen epidural c/t $ $ % A Inj foramen epidural add-on $ $ % A Inj foramen epidural l/s $ $ % A Inj foramen epidural add-on $89.00 $ % A Inj paravert f jnt c/t 1 lev $ $ % A Inj paravert f jnt c/t 2 lev $95.11 $ % A Inj paravert f jnt c/t 3 lev $95.46 $ % A Inj paravert f jnt l/s 1 lev $ $ % A Inj paravert f jnt l/s 2 lev $87.57 $ % A Inj paravert f jnt l/s 3 lev $87.93 $ % A N block spenopalatine gangl $ $ % A N block carotid sinus s/p $61.37 $ % A N block stellate ganglion $ $ % A N block lumbar/thoracic $ $ % A N block inj celiac pelus $ $ % A Injection treatment of nerve $ $ % A Injection treatment of nerve $ $ % A Injection treatment of nerve $ $ % A Destroy nerve face muscle $ $ % A Injection treatment of nerve $ $ % A Injection treatment of nerve $ $ % A Destroy cerv/thor facet jnt $ $ % A Destroy c/th facet jnt addl $ $ % A Destroy lumb/sac facet jnt $ $ % A Destroy l/s facet jnt addl $ $ % A Injection treatment of nerve $ $ % A Injection treatment of nerve $ $ % A Injection for tear sac x-ray $62.81 $ % A Echo transthoracic $ $ % A Echo transthoracic $64.96 $ % TC A Echo transthoracic $ $ % 12 of 20

13 93304 A Echo transthoracic $ $ % A Echo transthoracic $37.32 $ % TC A Echo transthoracic $ $ % A Tte w/doppler complete $ $ % A Tte w/doppler complete $64.96 $ % TC A Tte w/doppler complete $ $ % A Tte w/o doppler complete $ $ % A Tte w/o doppler complete $45.94 $ % TC A Tte w/o doppler complete $85.77 $ % A Tte f-up or lmtd $ $ % A Tte f-up or lmtd $26.20 $ % TC A Tte f-up or lmtd $ $ % A Echo transesophageal $ $ % A Echo transesophageal $ $ % TC A Echo transesophageal $ $ % A Echo transesophageal $11.84 $ % A Echo transesophageal $ $ % A Echo transesophageal $93.31 $ % TC A Echo transesophageal $ $ % A Echo transesophageal $ $ % C Echo transesophageal $0.00 $ TC C Echo transesophageal $0.00 $ A Echo transesophageal $27.63 $ % A Echo transesophageal $95.46 $ % C Echo transesophageal $0.00 $ TC C Echo transesophageal $0.00 $ A Echo transesophageal intraop $ $ % C Echo transesophageal intraop $0.00 $ TC C Echo transesophageal intraop $0.00 $ A Doppler echo exam heart $54.91 $ % A Doppler echo exam heart $18.66 $ % TC A Doppler echo exam heart $36.25 $ % A Doppler echo exam heart $27.63 $ % A Doppler echo exam heart $7.54 $ % TC A Doppler echo exam heart $20.10 $ % A Doppler color flow add-on $25.84 $ % A Doppler color flow add-on $3.23 $ % TC A Doppler color flow add-on $22.61 $ % A Stress tte only $ $ % A Stress tte only $72.50 $ % TC A Stress tte only $ $ % A Stress tte complete $ $ % A Stress tte complete $86.85 $ % TC A Stress tte complete $ $ % 13 of 20

14 93352 A Admin ecg contrast agent $34.45 $ % A Heart flow reserve measure $99.77 $ % C Heart flow reserve measure $0.00 $ TC C Heart flow reserve measure $0.00 $ A Heart flow reserve measure $80.03 $ % C Heart flow reserve measure $0.00 $ TC C Heart flow reserve measure $0.00 $ A Extracranial bilat study $ $ % A Extracranial bilat study $40.91 $ % TC A Extracranial bilat study $ $ % A Extracranial uni/ltd study $ $ % A Extracranial uni/ltd study $25.84 $ % TC A Extracranial uni/ltd study $ $ % A Intracranial complete study $ $ % A Intracranial complete study $48.09 $ % TC A Intracranial complete study $ $ % A Intracranial limited study $ $ % A Intracranial limited study $26.56 $ % TC A Intracranial limited study $ $ % A Tcd vasoreactivity study $ $ % A Tcd vasoreactivity study $52.40 $ % TC A Tcd vasoreactivity study $ $ % A Tcd emboli detect w/o inj $ $ % A Tcd emboli detect w/o inj $61.37 $ % TC A Tcd emboli detect w/o inj $ $ % A Tcd emboli detect w/inj $ $ % A Tcd emboli detect w/inj $61.01 $ % TC A Tcd emboli detect w/inj $ $ % N Carotid intima atheroma eval $0.00 $ N Carotid intima atheroma eval $0.00 $ TC N Carotid intima atheroma eval $0.00 $ A Upr/l xtremity art 2 levels $90.08 $ % A Upr/l xtremity art 2 levels $12.92 $ % TC A Upr/l xtremity art 2 levels $77.16 $ % A Upr/lxtr art stdy 3+ lvls $ $ % A Upr/lxtr art stdy 3+ lvls $22.97 $ % TC A Upr/lxtr art stdy 3+ lvls $ $ % A Lwr xtr vasc stdy bilat $ $ % A Lwr xtr vasc stdy bilat $25.48 $ % TC A Lwr xtr vasc stdy bilat $ $ % A Lower extremity study $ $ % A Lower extremity study $40.20 $ % TC A Lower extremity study $ $ % A Lower extremity study $ $ % 14 of 20

15 A Lower extremity study $24.76 $ % TC A Lower extremity study $ $ % A Upper extremity study $ $ % A Upper extremity study $40.91 $ % TC A Upper extremity study $ $ % A Upper extremity study $ $ % A Upper extremity study $25.12 $ % TC A Upper extremity study $ $ % A Extremity study $ $ % A Extremity study $35.53 $ % TC A Extremity study $ $ % A Extremity study $ $ % A Extremity study $22.61 $ % TC A Extremity study $99.41 $ % A Vascular study $ $ % A Vascular study $59.22 $ % TC A Vascular study $ $ % A Vascular study $ $ % A Vascular study $40.91 $ % TC A Vascular study $ $ % A Vascular study $ $ % A Vascular study $40.55 $ % TC A Vascular study $ $ % A Vascular study $ $ % A Vascular study $25.48 $ % TC A Vascular study $96.18 $ % A Penile vascular study $ $ % A Penile vascular study $62.81 $ % TC A Penile vascular study $60.65 $ % A Penile vascular study $75.01 $ % A Penile vascular study $22.61 $ % TC A Penile vascular study $52.40 $ % A Doppler flow testing $ $ % A Doppler flow testing $25.12 $ % TC A Doppler flow testing $ $ % A Eeg monitoring/function test $ $ % A Eeg monitoring/function test $ $ % TC A Eeg monitoring/function test $ $ % A Chemo ia push tecnique $ $ % A Chemo ia infusion up to 1 hr $ $ % A Chemo ia infuse each addl hr $76.08 $ % A Chemotherapy infusion method $ $ % A Chemotherapy intracavitary $ $ % A Chemotherapy into cns $ $ % 15 of 20

16 99090 B Computer data analysis $0.00 $ A Mod sed same phys/qhp <5 yrs $78.24 $ % A Mod sed same phys/qhp 5/>yrs $52.04 $ % A Mod sed same phys/qhp ea $11.13 $ % A Mod sed oth phys/qhp <5 yrs $94.39 $ % A Mod sed oth phys/qhp 5/>yrs $77.16 $ % A Mod sed other phys/qhp ea $58.50 $ % B Interprof phone/online 5-10 $0.00 $18.36 A4218 X Sterile saline or water $0.00 $0.00 A4641 C Radiopharm dx agent noc $0.00 $0.00 A4642 C In111 satumomab $0.00 $0.00 A4648 X Implantable tissue marker $0.00 $0.00 A4649 P Surgical supplies $0.00 $0.00 A4650 X Implant radiation dosimeter $0.00 $0.00 A9500 C Tc99m sestamibi $0.00 $0.00 A9501 C Technetium tc-99m teboroxime $0.00 $0.00 A9502 C Tc99m tetrofosmin $0.00 $0.00 A9503 C Tc99m medronate $0.00 $0.00 A9504 C Tc99m apcitide $0.00 $0.00 A9505 C Tl201 thallium $0.00 $0.00 A9507 C In111 capromab $0.00 $0.00 A9508 C I131 iodobenguate, dx $0.00 $0.00 A9509 C Iodine i-123 sod iodide mil $0.00 $0.00 A9510 C Tc99m disofenin $0.00 $0.00 A9512 C Tc99m pertechnetate $0.00 $0.00 A9515 X Choline c-11 $0.00 $0.00 A9516 C Iodine i-123 sod iodide mic $0.00 $0.00 A9517 C I131 iodide cap, rx $0.00 $0.00 A9520 X Tc99 tilmanocept diag 0.5mci $0.00 $0.00 A9521 C Tc99m exametazime $0.00 $0.00 A9524 C I131 serum albumin, dx $0.00 $0.00 A9526 C Nitrogen n-13 ammonia $0.00 $0.00 A9527 C Iodine i-125 sodium iodide $0.00 $0.00 A9528 C Iodine i-131 iodide cap, dx $0.00 $0.00 A9529 C I131 iodide sol, dx $0.00 $0.00 A9530 C I131 iodide sol, rx $0.00 $0.00 A9531 C I131 max 100uci $0.00 $0.00 A9532 C I125 serum albumin, dx $0.00 $0.00 A9536 C Tc99m depreotide $0.00 $0.00 A9537 C Tc99m mebrofenin $0.00 $0.00 A9538 C Tc99m pyrophosphate $0.00 $0.00 A9539 C Tc99m pentetate $0.00 $0.00 A9540 C Tc99m maa $0.00 $0.00 A9541 C Tc99m sulfur colloid $0.00 $ of 20

17 A9542 C In111 ibritumomab, dx $0.00 $0.00 A9543 C Y90 ibritumomab, rx $0.00 $0.00 A9546 C Co57/58 $0.00 $0.00 A9547 C In111 oxyquinoline $0.00 $0.00 A9548 C In111 pentetate $0.00 $0.00 A9550 C Tc99m gluceptate $0.00 $0.00 A9551 C Tc99m succimer $0.00 $0.00 A9552 C F18 fdg $0.00 $0.00 A9553 C Cr51 chromate $0.00 $0.00 A9554 C I125 iothalamate, dx $0.00 $0.00 A9555 C Rb82 rubidium $0.00 $0.00 A9556 C Ga67 gallium $0.00 $0.00 A9557 C Tc99m bicisate $0.00 $0.00 A9558 C Xe133 xenon 10mci $0.00 $0.00 A9559 C Co57 cyano $0.00 $0.00 A9560 C Tc99m labeled rbc $0.00 $0.00 A9561 C Tc99m oxidronate $0.00 $0.00 A9562 C Tc99m mertiatide $0.00 $0.00 A9563 C P32 na phosphate $0.00 $0.00 A9564 C P32 chromic phosphate $0.00 $0.00 A9566 C Tc99m fanolesomab $0.00 $0.00 A9567 C Technetium tc-99m aerosol $0.00 $0.00 A9568 C Technetium tc99m arcitumomab $0.00 $0.00 A9569 C Technetium tc-99m auto wbc $0.00 $0.00 A9570 C Indium in-111 auto wbc $0.00 $0.00 A9571 C Indium in-111 auto platelet $0.00 $0.00 A9572 C Indium in-111 pentetreotide $0.00 $0.00 A9576 X Inj prohance multipack $0.00 $0.00 A9577 X Inj multihance $0.00 $0.00 A9578 X Inj multihance multipack $0.00 $0.00 A9579 X Gad-base mr contrast nos,1ml $0.00 $0.00 A9580 C Sodium fluoride f-18 $0.00 $0.00 A9581 X Gadoxetate disodium inj $0.00 $0.00 A9582 X Iodine i-123 iobenguane $0.00 $0.00 A9583 X Gadofosveset trisodium inj $0.00 $0.00 A9584 X Iodine i-123 ioflupane $0.00 $0.00 A9586 C Florbetapir f18 $0.00 $0.00 A9587 X Gallium ga-68 $0.00 $0.00 A9588 X Fluciclovine f-18 $0.00 $0.00 A9597 X Pet, dx, for tumor id, noc $0.00 $0.00 A9598 X Pet dx for non-tumor id, noc $0.00 $0.00 A9600 C Sr89 strontium $0.00 $0.00 A9604 X Sm 153 lexidronam $0.00 $0.00 A9606 X Radium ra223 dichloride ther $0.00 $ of 20

18 A9698 X Non-rad contrast materialnoc $0.00 $0.00 A9699 C Radiopharm rx agent noc $0.00 $0.00 A9700 E Echocardiography contrast $0.00 $0.00 G0106 A Colon ca screen;barium enema $ $ % G A Colon ca screen;barium enema $49.89 $ % G0106 TC A Colon ca screen;barium enema $ $ % G0120 A Colon ca scrn; barium enema $ $ % G A Colon ca scrn; barium enema $53.83 $ % G0120 TC A Colon ca scrn; barium enema $ $ % G0122 N Colon ca scrn; barium enema $ $ % G N Colon ca scrn; barium enema $50.24 $ % G0122 TC N Colon ca scrn; barium enema $ $ % G0130 A Single energy x-ray study $34.81 $ % G A Single energy x-ray study $11.48 $ % G0130 TC A Single energy x-ray study $23.33 $ % G0219 N Pet img wholbod melano nonco $0.00 $0.00 G N Pet img wholbod melano nonco $0.00 $0.00 G0219 TC N Pet img wholbod melano nonco $0.00 $0.00 G0235 N Pet not otherwise specified $0.00 $0.00 G N Pet not otherwise specified $0.00 $0.00 G0235 TC N Pet not otherwise specified $0.00 $0.00 G0252 N Pet imaging initial dx $0.00 $0.00 G N Pet imaging initial dx $76.08 $ % G0252 TC N Pet imaging initial dx $0.00 $0.00 G0255 N Current percep threshold tst $0.00 $0.00 G N Current percep threshold tst $0.00 $0.00 G0255 TC N Current percep threshold tst $0.00 $0.00 G0259 E Inject for sacroiliac joint $0.00 $0.00 G0260 E Inj for sacroiliac jt anesth $0.00 $0.00 G0269 B Occlusive device in vein art $0.00 $0.00 G0278 A Iliac art angio,cardiac cath $14.36 $ % G0279 A Tomosynthesis, mammo $56.35 $ % G A Tomosynthesis, mammo $30.86 $ % G0279 TC A Tomosynthesis, mammo $25.48 $ % G0288 A Recon, cta for surg plan $36.61 $ % G0296 A Visit to determ ldct elig $28.71 $ % G0297 A Ldct for lung ca screen $ $ % G A Ldct for lung ca screen $51.68 $ % G0297 TC A Ldct for lung ca screen $ $ % G0339 C Robot lin-radsurg com, first $0.00 $0.00 G0340 C Robt lin-radsurg fractx 2-5 $0.00 $0.00 G0365 A Vessel mapping hemo access $ $ % G A Vessel mapping hemo access $12.56 $ % G0365 TC A Vessel mapping hemo access $ $ % 18 of 20

19 G6001 A Echo guidance radiotherapy $52.76 $ % G A Echo guidance radiotherapy $30.51 $ % G6001 TC A Echo guidance radiotherapy $22.25 $ % G6002 A Stereoscopic x-ray guidance $77.16 $ % G A Stereoscopic x-ray guidance $20.82 $ % G6002 TC A Stereoscopic x-ray guidance $56.35 $ % G6003 A Radiation treatment delivery $ $ % G6004 A Radiation treatment delivery $ $ % G6005 A Radiation treatment delivery $ $ % G6006 A Radiation treatment delivery $ $ % G6007 A Radiation treatment delivery $ $ % G6008 A Radiation treatment delivery $ $ % G6009 A Radiation treatment delivery $ $ % G6010 A Radiation treatment delivery $ $ % G6011 A Radiation treatment delivery $ $ % G6012 A Radiation treatment delivery $ $ % G6013 A Radiation treatment delivery $ $ % G6014 A Radiation treatment delivery $ $ % G6015 A Radiation tx delivery imrt $ $ % G6016 A Delivery comp imrt $ $ % G6017 C Intrafraction track motion $0.00 $0.00 J0153 E Adenosine inj 1mg $0.00 $0.00 J0280 E Aminophyllin 250 mg inj $0.00 $0.00 J0461 E Atropine sulfate injection $0.00 $0.00 J1100 E Dexamethasone sodium phos $0.00 $0.00 J1120 E Acetazolamid sodium injectio $0.00 $0.00 J1160 E Digoxin injection $0.00 $0.00 J1245 E Dipyridamole injection $0.00 $0.00 J1250 E Inj dobutamine hcl/250 mg $0.00 $0.00 J1265 E Dopamine injection $0.00 $0.00 J1610 E Glucagon hydrochloride/1 mg $0.00 $0.00 J1642 E Inj heparin sodium per 10 u $0.00 $0.00 J1800 E Propranolol injection $0.00 $0.00 J1940 E Furosemide injection $0.00 $0.00 J2270 E Morphine sulfate injection $0.00 $0.00 J2560 E Phenobarbital sodium inj $0.00 $0.00 J2785 E Regadenoson injection $0.00 $0.00 J2805 E Sincalide injection $0.00 $0.00 J3240 E Thyrotropin injection $0.00 $0.00 J3420 E Vitamin b12 injection $0.00 $0.00 J3490 E Drugs unclassified injection $0.00 $0.00 J3590 E Unclassified biologics $0.00 $0.00 J7030 E Normal saline solution infus $0.00 $0.00 J7040 E Normal saline solution infus $0.00 $ of 20

20 J7050 E Normal saline solution infus $0.00 $0.00 J9310 E Rituximab injection $0.00 $0.00 Q3001 C Brachytherapy radioelements $0.00 $0.00 Q5102 E Inj., infliximab biosimilar $0.00 $0.00 Q9951 E Locm >= 400 mg/ml iodine,1ml $0.00 $0.00 Q9953 E Inj fe-based mr contrast,1ml $0.00 $0.00 Q9954 E Oral mr contrast, 100 ml $0.00 $0.00 Q9955 E Inj perflexane lip micros,ml $0.00 $0.00 Q9956 E Inj octafluoropropane mic,ml $0.00 $0.00 Q9957 E Inj perflutren lip micros,ml $0.00 $0.00 Q9958 E Hocm <=149 mg/ml iodine, 1ml $0.00 $0.00 Q9959 E Hocm mg/ml iodine,1ml $0.00 $0.00 Q9960 E Hocm mg/ml iodine,1ml $0.00 $0.00 Q9961 E Hocm mg/ml iodine,1ml $0.00 $0.00 Q9962 E Hocm mg/ml iodine,1ml $0.00 $0.00 Q9963 E Hocm mg/ml iodine,1ml $0.00 $0.00 Q9964 E Hocm>= 400mg/ml iodine, 1ml $0.00 $0.00 Q9965 E Locm mg/ml iodine,1ml $0.00 $0.00 Q9966 E Locm mg/ml iodine,1ml $0.00 $0.00 Q9967 E Locm mg/ml iodine,1ml $0.00 $0.00 Q9968 E Visualization adjunct $0.00 $0.00 Q9982 E Flutemetamol f18 diagnostic $0.00 $0.00 Q9983 E Florbetaben f18 diagnostic $0.00 $0.00 R0070 C Transport portable x-ray $0.00 $0.00 R0075 C Transport port x-ray multipl $0.00 $0.00 S8030 I Tantalum ring application $0.00 $0.00 S8035 I Magnetic source imaging $0.00 $0.00 S8037 I Mrcp $0.00 $0.00 S8040 I Topographic brain mapping $0.00 $0.00 S8042 I Mri low field $0.00 $0.00 S8055 I Us guidance fetal reduct $0.00 $ of 20