% Change in Payment Rate Payment Rate. CPT Code Mod Descriptor Payment Rate

Transcription

1 2013 CPT Code Mod Descriptor Payment Rate 2014 Payment Rate % Change in Payment Rate Fna w/o image $ $ % Fna w/image $ $ % Guide cathet fluid drainage $ Drainage of skin abscess $ $ % Drainage of skin abscess $ $ % Puncture drainage of lesion $ $ % Skin tissue procedure $0.00 $ Drainage of breast lesion $ $ % Drain breast lesion add on $26.54 $ % Injection for breast x ray $ $ % Bx breast 1st lesion strtctc $ Bx breast add lesion strtctc $ Bx breast 1st lesion us imag $ Bx breast add lesion us imag $ Bx breast 1st lesion mr imag $1, Bx breast add lesion mr imag $ Bx breast percut w/o image $ $ % Perq device breast 1st imag $ Perq device breast ea imag $ Perq dev breast 1st strtctc $ Perq dev breast add strtctc $ Perq dev breast 1st us imag $ Perq dev breast add us imag $ Perq dev breast 1st mr guide $ Perq dev breast add mr guide $ Place po breast cath for rad $4, $3, % Place breast cath for rad $93.56 $ % Place breast rad tube/caths $1, $1, % I&d abscess subfascial $ $ % Needle biopsy muscle $ $ % Bone biopsy trocar/needle $ $ % Bone biopsy trocar/needle $ $ % Injection of sinus tract $ $ % Inject sinus tract for x ray $ $ % Removal of foreign body $ $ % Removal of foreign body $ $ % Inj tendon sheath/ligament $58.52 $ % Place ndl musc/tis for rt $ $ % Drain/inject joint/bursa $47.29 $ % Drain/inject joint/bursa $65.66 $ % Drain/inject joint/bursa $60.56 $ % Ablate bone tumor(s) perq $3, $3, %

2 21116 Injection jaw joint x ray $ $ % Percut vertebroplasty thor $2, $2, % Percut vertebroplasty lumb $2, $2, % Percut vertebroplasty addl $ $ % Percut kyphoplasty thor $7, $7, % Percut kyphoplasty lumbar $7, $7, % Percut kyphoplasty add on $4, $4, % Idet single level $2, $2, % Idet 1 or more levels $2, $1, % Injection for shoulder x ray $ $ % Injection for elbow x ray $ $ % Injection for wrist x ray $ $ % Injection for hip x ray $ $ % Injection for hip x ray $ $ % Inject sacroiliac joint $ $ % Injection for knee x ray $ $ % Injection for ankle x ray $ $ % Insert emergency airway $ $ % Dx bronchoscope/wash $ $ % Bronchoscopy w/biopsy(s) $ $ % Bronchoscopy/lung bx each $ $ % Bronchoscopy/needle bx each $ $ % Bronchoscopy dilate/fx repr $ $ % Bronchoscopy dilate w/stent $ $ % Diag bronchoscope/catheter $ $ % Bronchial brush biopsy $ $ % Needle biopsy chest lining $ $ % Percut bx lung/mediastinum $ $ % Insert pleural cath $ $ % Insertion of chest tube $ $ % Remove lung catheter $ $ % Ins mark thor for rt perq $ $ % Aspirate pleura w/o imaging $ $ % Aspirate pleura w/ imaging $ $ % Insert cath pleura w/o image $ $ % Insert cath pleura w/ image $ $ % Treat pleurodesis w/agent $ $ % Lyse chest fibrin init day $96.63 $ % Lyse chest fibrin subq day $87.44 $ % Thorax stereo rad targetw/tx $ $ % Therapeutic pneumothorax $ $ % Perq rf ablate tx pul tumor $3, $2, % Drainage of heart sac $ $ % Repeat drainage of heart sac $ $ % Endovasc taa repr incl subcl $1, $1, % Endovasc taa repr w/o subcl $1, $1, % Insert endovasc prosth taa $1, $1, %

3 33884 Endovasc prosth taa add on $ $ % Endovasc prosth delayed $1, $1, % Endovas aaa repr w/sm tube $1, $1, % Endovas aaa repr w/2 p part $1, $1, % Endovas aaa repr w/3 p part $1, $1, % Endovas aaa repr w/1 p part $1, $1, % Endovas aaa repr w/long tube $1, $1, % Aneurysm press sensor add on $ $ % Endovas iliac a device addon $ $ % Femoral endovas graft add on $ $ % Endovasc extend prosth init $ $ % Endovasc exten prosth addl $ $ % Endovasc visc aorta 1 graft $ Endovasc visc aorta 2 graft $ Endovasc visc aorta 3 graft $ Endovasc visc aorta 4 graft $ Visc & infraren abd 1 prosth $ Visc & infraren abd 2 prosth $ Visc & infraren abd 3 prosth $ Visc & infraren abd 4+ prost $ Endovasc iliac repr w/graft $ $ % Repair arterial blockage $2, $2, % Repair arterial blockage $2, $1, % Repair arterial blockage $1, $1, % Repair venous blockage $1, $1, % Place needle in vein $26.54 $ % Pseudoaneurysm injection trt $ $ % Injection ext venography $ $ % Place catheter in vein $ $ % Place catheter in vein $ $ % Place catheter in vein $ $ % Place catheter in artery $ $ % Place catheter in artery $ $ % Place catheter in artery $ $ % Establish access to artery $ $ % Establish access to artery $ $ % Establish access to artery $ $ % Access av dial grft for eval $ $ % Access av dial grft for proc $ $ % Establish access to aorta $ $ % Place catheter in aorta $ $ % Place catheter in artery $1, $1, % Place catheter in artery $1, $1, % Place catheter in artery $2, $2, % Place catheter in artery $ $ % Place cath thoracic aorta $1, $1, % Place cath carotid/inom art $1, $1, %

4 36223 Place cath carotid/inom art $1, $1, % Place cath carotd art $1, $1, % Place cath subclavian art $1, $1, % Place cath vertebral art $1, $1, % Place cath xtrnl carotid $ $ % Place cath intracranial art $1, $1, % Ins cath abd/l ext art 1st $1, $1, % Ins cath abd/l ext art 2nd $ $ % Ins cath abd/l ext art 3rd $1, $1, % Ins cath abd/l ext art addl $ $ % Ins cath ren art 1st unilat $1, $1, % Ins cath ren art 1st bilat $1, $1, % Ins cath ren art 2nd+ unilat $2, $2, % Ins cath ren art 2nd+ bilat $2, $2, % Bl draw < 3 yrs fem/jugular $29.60 $ % Bl draw <3 yrs scalp vein $26.88 $ % Bl draw <3 yrs other vein $20.07 $ % Non routine bl draw 3/> yrs $17.35 $ % Vein access cutdown < 1 yr $52.40 $ % Vein access cutdown > 1 yr $40.15 $ % Injection therapy of vein $ $ % Injection therapy of veins $ $ % Endovenous rf 1st vein $1, $1, % Endovenous rf vein add on $ $ % Endovenous laser 1st vein $1, $1, % Endovenous laser vein addon $ $ % Insertion of catheter vein $2, $2, % Insertion of catheter vein $ $ % Insertion of catheter vein $97.65 $ % Insert non tunnel cv cath $ $ % Insert non tunnel cv cath $ $ % Insert tunneled cv cath $ $1, % Insert tunneled cv cath $ $ % Insert tunneled cv cath $1, $1, % Insert tunneled cv cath $1, $1, % Insert tunneled cv cath $1, $1, % Insert tunneled cv cath $1, $1, % Insert tunneled cv cath $5, $5, % Insert picc cath $ $ % Insert picc cath $ $ % Insert picvad cath $1, $1, % Insert picvad cath $1, $1, % Repair tunneled cv cath $ $ % Repair tunneled cv cath $ $ % Replace tunneled cv cath $ $ % Replace cvad cath $ $ % Replace tunneled cv cath $ $ %

5 36582 Replace tunneled cv cath $1, $1, % Replace tunneled cv cath $1, $1, % Replace picc cath $ $ % Replace picvad cath $1, $1, % Removal tunneled cv cath $ $ % Removal tunneled cv cath $ $ % Draw blood off venous device $23.82 $ % Collect blood from picc $27.56 $ % Declot vascular device $31.64 $ % Mech remov tunneled cv cath $ $ % Mech remov tunneled cv cath $ $ % Reposition venous catheter $ $ % Inj w/fluor eval cv device $ $ % Withdrawal of arterial blood $31.98 $ % Insertion catheter artery $50.69 $ % Insertion catheter artery $ $ % Insertion catheter artery $ $ % Insertion catheter artery $74.17 $ % Percut thrombect av fistula $1, $1, % Insert hepatic shunt (tips) $ $ % Remove hepatic shunt (tips) $6, $5, % Prim art mech thrombectomy $2, $2, % Prim art m thrombect add on $ $ % Sec art m thrombect add on $1, $1, % Venous mech thrombectomy $2, $2, % Venous m thrombectomy add on $1, $1, % Ins endovas vena cava filtr $2, $2, % Redo endovas vena cava filtr $1, $1, % Rem endovas vena cava filter $1, $1, % Thrombolytic therapy stroke $0.00 $ Remove intrvas foreign body $1, $1, % Transcatheter biopsy $ $ % Transcatheter therapy infuse $ $ % Thrombolytic art therapy $ $ % Thrombolytic venous therapy $ $ % Thromblytic art/ven therapy $ $ % Cessj therapy cath removal $ $ % Transcath stent cca w/eps $1, $1, % Transcath stent cca w/o eps $1, $1, % Iliac revasc $3, $3, % Iliac revasc w/stent $5, $4, % Iliac revasc add on $ $ % Iliac revasc w/stent add on $2, $2, % Fem/popl revas w/tla $4, $3, % Fem/popl revas w/ather $11, $11, % Fem/popl revasc w/stent $9, $9, % Fem/popl revasc stnt & ather $16, $15, %

6 37228 Tib/per revasc w/tla $5, $5, % Tib/per revasc w/ather $11, $11, % Tib/per revasc w/stent $8, $8, % Tib/per revasc stent & ather $14, $13, % Tib/per revasc add on $1, $1, % Tibper revasc w/ather add on $1, $1, % Revsc opn/prq tib/pero stent $4, $3, % Tib/per revasc stnt & ather $4, $4, % Open/perq place stent 1st $2, Open/perq place stent ea add $1, Open/perq place stent same $4, Open/perq place stent ea add $2, Vasc embolize/occlude venous $4, Vasc embolize/occlude artery $7, Vasc embolize/occlude organ $9, Vasc embolize/occlude bleed $6, Iv us first vessel add on $ $ % Iv us each add vessel add on $81.66 $ % Injection for spleen x ray $ $ % Bone marrow aspiration $ $ % Bone marrow biopsy $ $ % Needle biopsy lymph nodes $ $ % Inject for lymphatic x ray $84.04 $ % Ra tracer id of sentinl node $41.17 $ % Place needles h&n for rt $ $ % Biopsy of salivary gland $ $ % Injection for salivary x ray $ $ % Dilation of salivary duct $88.12 $ % Dilation of salivary duct $ $ % Esophagoscopy retro balloon $1, Esophagosc dilate balloon 30 $ Esophagoscopy flex remove fb $ $ % Esoph endoscopy dilation $ $ % Egd balloon dil esoph30 mm/> $ Egd tube/cath insertion $ $ % Egd place gastrostomy tube $ $ % Egd guide wire insertion $ $ % Ercp w/specimen collection $ $ % Dilate esophagus $ $ % Nasal/orogastric w/tube plmt $40.49 $ % Change gastrostomy tube $ $ % Reposition gastrostomy tube $ $ % Small bowel endoscopy $ $ % Small bowel endoscopy $ $ % Intro gastrointestinal tube $24.16 $ % Drainage of pelvic abscess $ $ % Repr of anal fistula w/glue $ $ %

7 47000 Needle biopsy of liver $ $ % Needle biopsy liver add on $ $ % Percut ablate liver rf $5, $5, % Incision of gallbladder $ $ % Injection for liver x rays $96.63 $ % Injection for liver x rays $37.09 $ % Insert catheter bile duct $ $ % Insert bile duct drain $ $ % Change bile duct catheter $ $ % Revise/reinsert bile tube $1, $1, % Bile duct endoscopy add on $ $ % Biliary endo perq dx w/speci $ $ % Biliary endoscopy thru skin $ $ % Biliary endoscopy thru skin $ $ % Biliary endoscopy thru skin $ $ % Biliary endoscopy thru skin $ $ % Remove bile duct stone $ $ % Placement bile duct support $1, $1, % Needle biopsy pancreas $ $ % Abd paracentesis $ $ % Abd paracentesis w/imaging $ $ % Biopsy abdominal mass $ $ % Air injection into abdomen $ $ % Image cath fluid colxn visc $ Image cath fluid peri/retro $ Image cath fluid trns/vgnl $ Ins mark abd/pel for rt perq $ $ % Insert tun ip cath perc $1, $1, % Ins tun ip cath for dial opn $ $ % Remove tunneled ip cath $ $ % Exchange drainage catheter $ $ % Assess cyst contrast inject $ $ % Injection abdominal shunt $44.91 $ % Place gastrostomy tube perc $1, $1, % Place duod/jej tube perc $1, $1, % Place cecostomy tube perc $ $ % Change g tube to g j perc $1, $1, % Replace g/c tube perc $ $ % Replace duod/jej tube perc $ $ % Replace g j tube perc $ $ % Fix g/colon tube w/device $ $ % Fluoro exam of g/colon tube $ $ % Removal of kidney stone $ $ % Removal of kidney stone $1, $1, % Renal biopsy perq $ $ % Change ureter stent percut $1, $1, % Remove ureter stent percut $ $ %

8 50385 Change stent via transureth $1, $1, % Remove stent via transureth $ $ % Change ext/int ureter stent $ $ % Remove renal tube w/fluoro $ $ % Drainage of kidney lesion $95.94 $ % Insert kidney drain $ $ % Insert ureteral tube $ $ % Injection for kidney x ray $ $ % Create passage to kidney $ $ % Measure kidney pressure $ $ % Change kidney tube $ $ % Kidney endoscopy $ $ % Fragmenting of kidney stone $ $ % Perc rf ablate renal tumor $3, $3, % Perc cryo ablate renal tum $4, $4, % Injection for ureter x ray $ $ % Measure ureter pressure $ $ % Change of ureter tube/stent $79.95 $ % Injection for ureter x ray $97.65 $ % Ureter endoscopy $ $ % Incise & treat bladder $ $ % Remove ureter calculus $ $ % Drainage of bladder abscess $ $ % Drain bladder by needle $61.92 $ % Drain bladder by trocar/cath $ $ % Drain bl w/cath insertion $ $ % Injection for bladder x ray $ $ % Preparation for bladder xray $37.77 $ % Injection for bladder x ray $ $ % Irrigation of bladder $83.02 $ % Insert bladder catheter $55.12 $ % Insert temp bladder cath $71.45 $ % Insert bladder cath complex $ $ % Change of bladder tube $91.18 $ % Change of bladder tube $92.88 $ % Cystoscopy $ $ % Cystoscopy & duct catheter $ $ % Prepare penis study $95.26 $ % Dynamic cavernosometry $ $ % Penile injection $89.48 $ % Prepare sperm duct x ray $ $ % Biopsy of prostate $ $ % Transperi needle place pros $ $ % Place rt device/marker pros $ $ % Place needles pelvic for rt $ $ % Insert uteri tandem/ovoids $ $ % Ins vag brachytx device $ $ %

9 58340 Catheter for hysterography $ $ % Reopen fallopian tube $ $ % Insert heyman uteri capsule $ $ % Drainage of ovarian cyst(s) $ $ % Drainage of ovarian cyst(s) $ $ % Drain ovary abscess percut $ $ % Retrieval of oocyte $ $ % Amniocentesis diagnostic $ $ % Amniocentesis therapeutic $ $ % Biopsy of thyroid $ $ % Aspir/inj thyroid cyst $ $ % Remove brain canal fluid $ $ % Injection into brain canal $ $ % Brain canal shunt procedure $88.12 $ % Endovasc tempory vessel occl $ $ % Transcath occlusion cns $1, $1, % Transcath occlusion non cns $ $ % Intracranial angioplasty $1, $1, % Intracran angioplsty w/stent $1, $1, % Dilate ic vasospasm init $ $ % Dilate ic vasospasm add on $ $ % Dilate ic vasospasm add on $ $ % Revise circulation to head $2, $2, % Revise circulation to head $1, $2, % Interdiscal perq aspir dx $ $ % Drain spinal cord cyst $ $ % Needle biopsy spinal cord $ $ % Spinal fluid tap diagnostic $ $ % Drain cerebro spinal fluid $ $ % Inject epidural patch $ $ % Treat spinal cord lesion $ $ % Treat spinal cord lesion $ $ % Treat spinal canal lesion $ $ % Injection for myelogram $ $ % Percutaneous diskectomy $ $ % Inject for spine disk x ray $ $ % Inject for spine disk x ray $ $ % Injection into disk lesion $ $ % Injection into spinal artery $ $ % Inject spine cerv/thoracic $ $ % Inject spine lumbar/sacral $ $ % Inject spine w/cath crv/thrc $ $ % Inject spine w/cath lmb/scrl $ $ % Remove lesion of spinal cord $1, $1, % Inj foramen epidural c/t $ $ % Inj foramen epidural add on $ $ % Inj foramen epidural l/s $ $ %

10 64484 Inj foramen epidural add on $91.18 $ % Inj paravert f jnt c/t 1 lev $ $ % Inj paravert f jnt c/t 2 lev $97.99 $ % Inj paravert f jnt c/t 3 lev $98.33 $ % Inj paravert f jnt l/s 1 lev $ $ % Inj paravert f jnt l/s 2 lev $89.82 $ % Inj paravert f jnt l/s 3 lev $90.16 $ % N block spenopalatine gangl $ $ % N block carotid sinus s/p $65.66 $ % N block stellate ganglion $ $ % N block lumbar/thoracic $ $ % N block inj celiac pelus $ $ % Injection treatment of nerve $ $ % Injection treatment of nerve $ $ % Injection treatment of nerve $ $ % Destroy nerve face muscle $ $ % Injection treatment of nerve $ $ % Injection treatment of nerve $ $ % Destroy cerv/thor facet jnt $ $ % Destroy c/th facet jnt addl $ $ % Destroy lumb/sac facet jnt $ $ % Destroy l/s facet jnt addl $ $ % Injection treatment of nerve $ $ % Injection treatment of nerve $ $ % Injection for tear sac x ray $59.54 $ % Echo transthoracic $ $ % Echo transthoracic $62.26 $ % TC Echo transthoracic $ $ % Echo transthoracic $ $ % Echo transthoracic $36.06 $ % TC Echo transthoracic $95.26 $ % Tte w/doppler complete $ $ % Tte w/doppler complete $61.92 $ % TC Tte w/doppler complete $ $ % Tte w/o doppler complete $ $ % Tte w/o doppler complete $44.23 $ % TC Tte w/o doppler complete $70.09 $ % Tte f up or lmtd $ $ % Tte f up or lmtd $24.84 $ % TC Tte f up or lmtd $75.53 $ % Echo transesophageal $ $ % Echo transesophageal $ $ % TC Echo transesophageal $ $ % Echo transesophageal $41.17 $ % Echo transesophageal $ $ % Echo transesophageal $58.52 $ % TC Echo transesophageal $ $ %

11 93315 Echo transesophageal $0.00 $ Echo transesophageal $ $ % TC Echo transesophageal $0.00 $ Echo transesophageal $41.85 $ % Echo transesophageal $0.00 $ Echo transesophageal $91.52 $ % TC Echo transesophageal $0.00 $ Echo transesophageal intraop $0.00 $ Echo transesophageal intraop $ $ % TC Echo transesophageal intraop $0.00 $ Doppler echo exam heart $44.91 $ % Doppler echo exam heart $18.03 $ % TC Doppler echo exam heart $26.88 $ % Doppler echo exam heart $23.82 $ % Doppler echo exam heart $7.14 $ % TC Doppler echo exam heart $16.67 $ % Doppler color flow add on $20.07 $ % Doppler color flow add on $3.74 $ % TC Doppler color flow add on $16.33 $ % Stress tte only $ $ % Stress tte only $69.75 $ % TC Stress tte only $ $ % Stress tte complete $ $ % Stress tte complete $83.36 $ % TC Stress tte complete $ $ % Admin ecg contrast agent $34.70 $ % Heart flow reserve measure $0.00 $ Heart flow reserve measure $87.44 $ % TC Heart flow reserve measure $0.00 $ Extracranial bilat study $ $ % Extracranial bilat study $28.92 $ % TC Extracranial bilat study $ $ % Extracranial uni/ltd study $ $ % Extracranial uni/ltd study $19.73 $ % TC Extracranial uni/ltd study $ $ % Intracranial complete study $ $ % Intracranial complete study $47.29 $ % TC Intracranial complete study $ $ % Intracranial limited study $95.26 $ % Intracranial limited study $30.96 $ % TC Intracranial limited study $64.30 $ % Tcd vasoreactivity study $ $ % Tcd vasoreactivity study $49.33 $ % TC Tcd vasoreactivity study $99.35 $ % Tcd emboli detect w/o inj $ $ % Tcd emboli detect w/o inj $57.16 $ % TC Tcd emboli detect w/o inj $99.35 $ %

12 93893 Tcd emboli detect w/inj $ $ % Tcd emboli detect w/inj $57.84 $ % TC Tcd emboli detect w/inj $99.35 $ % Upr/l xtremity art 2 levels $94.24 $ % Upr/l xtremity art 2 levels $11.91 $ % TC Upr/l xtremity art 2 levels $82.34 $ % Upr/lxtr art stdy 3+ lvls $ $ % Upr/lxtr art stdy 3+ lvls $21.77 $ % TC Upr/lxtr art stdy 3+ lvls $ $ % Lwr xtr vasc stdy bilat $ $ % Lwr xtr vasc stdy bilat $24.16 $ % TC Lwr xtr vasc stdy bilat $ $ % Lower extremity study $ $ % Lower extremity study $38.79 $ % TC Lower extremity study $ $ % Lower extremity study $ $ % Lower extremity study $24.50 $ % TC Lower extremity study $99.35 $ % Upper extremity study $ $ % Upper extremity study $22.46 $ % TC Upper extremity study $ $ % Upper extremity study $ $ % Upper extremity study $14.97 $ % TC Upper extremity study $99.35 $ % Extremity study $ $ % Extremity study $17.01 $ % TC Extremity study $ $ % Extremity study $ $ % Extremity study $34.36 $ % TC Extremity study $ $ % Extremity study $ $ % Extremity study $21.77 $ % TC Extremity study $95.26 $ % Vascular study $ $ % Vascular study $87.44 $ % TC Vascular study $ $ % Vascular study $ $ % Vascular study $58.52 $ % TC Vascular study $ $ % Vascular study $ $ % Vascular study $31.98 $ % TC Vascular study $ $ % Vascular study $ $ % Vascular study $21.09 $ % TC Vascular study $99.35 $ % Penile vascular study $ $ % Penile vascular study $60.22 $ %

13 93980 TC Penile vascular study $ $ % Penile vascular study $ $ % Penile vascular study $21.09 $ % TC Penile vascular study $91.52 $ % Aneurysm pressure sens study $44.23 $ % Doppler flow testing $ $ % Doppler flow testing $12.25 $ % TC Doppler flow testing $99.35 $ % Eeg monitoring/function test $ $ % Eeg monitoring/function test $ $ % TC Eeg monitoring/function test $ $ % Chemo ia push tecnique $ $ % Chemo ia infusion up to 1 hr $ $ % Chemo ia infuse each addl hr $79.61 $ % Chemotherapy infusion method $ $ % Chemotherapy intracavitary $ $ % Chemotherapy into cns $ $ % Computer data analysis $0.00 $ Mod sedat phys/qhp <5 yrs $0.00 $ Mod sedat phys/qhp 5yrs/> $0.00 $ Mod sedat phys/qhp ea 15 min $0.00 $ Mod sed diff phys/qhp<5 yrs $0.00 $ Mod sed diff phys/qhp 5/>yrs $0.00 $ Mod sed diff phys/qhp add on $0.00 $ T Ct perfusion w/contrast cbf $0.00 $ T U/s leiomyomata ablate <200 $0.00 $ T U/s leiomyomata ablate >200 $0.00 $ T Delivery comp imrt $ $ % 0075T Perq stent/chest vert art $0.00 $ T 26 Perq stent/chest vert art $0.00 $ T TC Perq stent/chest vert art $0.00 $ T S&i stent/chest vert art $0.00 $ T 26 S&i stent/chest vert art $0.00 $ T TC S&i stent/chest vert art $0.00 $ T Cad breast mri $0.00 $ T 26 Cad breast mri $0.00 $ T TC Cad breast mri $0.00 $ T Cad cxr with interp $0.00 $ T Hdr elect brachytherapy $0.00 $ T 26 Hdr elect brachytherapy $0.00 $ T TC Hdr elect brachytherapy $0.00 $ T Intrafraction track motion $0.00 $ T Perq sacral augmt unilat inj $0.00 $ T Perq sacral augmt bilat inj $0.00 $ T Njx paravert w/us cer/thor $0.00 $ T Njx paravert w/us cer/thor $0.00 $ T Njx paravert w/us cer/thor $0.00 $0.00

14 0216T Njx paravert w/us lumb/sac $0.00 $ T Njx paravert w/us lumb/sac $0.00 $ T Njx paravert w/us lumb/sac $0.00 $ T Njx tfrml eprl w/us cer/thor $0.00 $ T Njx tfrml eprl w/us cer/thor $0.00 $ T Njx tfrml eprl w/us lumb/sac $0.00 $ T Njx tfrml eprl w/us lumb/sac $0.00 $ T Trluml perip athrc renal art $0.00 $ T Trluml perip athrc visceral $0.00 $ T Trluml perip athrc abd aorta $0.00 $ T Trluml perip athrc brchiocph $0.00 $ T Trluml perip athrc iliac art $0.00 $ T Evasc rpr iliac art bifur $0.00 $ T Evasc rpr iliac art bifr s&i $0.00 $ T 26 Evasc rpr iliac art bifr s&i $0.00 $ T TC Evasc rpr iliac art bifr s&i $0.00 $ T Mw therapy for breast tumor $0.00 $ T Cal & alys cntrl artl press $0.00 $ T Heart symp image plnr $0.00 $ T Heart symp image plnr spect $0.00 $ T Trnscth renal symp denrv unl $ T Trnscth renal symp denrv bil $ T Ablate pulm tumors + extnsn $ T Ultrasound elastography $ F Ct/mri brain done w/in 24hrs $0.00 $ F Ct/mri brain done 24 hrs $0.00 $0.00 A4641 Radiopharm dx agent noc $0.00 $0.00 G0106 Colon ca screen;barium enema $ $ % G Colon ca screen;barium enema $46.95 $ % G0106 TC Colon ca screen;barium enema $ $ % G0120 Colon ca scrn; barium enema $ $ % G Colon ca scrn; barium enema $46.95 $ % G0120 TC Colon ca scrn; barium enema $ $ % G0122 Colon ca scrn; barium enema $ $ % G Colon ca scrn; barium enema $48.65 $ % G0122 TC Colon ca scrn; barium enema $ $ % G0130 Single energy x ray study $34.70 $ % G Single energy x ray study $10.89 $ % G0130 TC Single energy x ray study $23.82 $ % G0173 Linear acc stereo radsur com $0.00 $0.00 G0202 Screening mammography digital $ $ % G Screening mammography digital $34.70 $ % G0202 TC Screening mammography digital $ $ % G0204 Diagnostic mammography digital $ $ % G Diagnostic mammography digital $43.21 $ % G0204 TC Diagnostic mammography digital $ $ % G0206 Diagnostic mammography digital $ $ %

15 G Diagnostic mammography digital $34.70 $ % G0206 TC Diagnostic mammography digital $98.67 $ % G0219 Pet img wholbod melano nonco $0.00 $0.00 G Pet img wholbod melano nonco $0.00 $0.00 G0219 TC Pet img wholbod melano nonco $0.00 $0.00 G0235 Pet not otherwise specified $0.00 $0.00 G Pet not otherwise specified $0.00 $0.00 G0235 TC Pet not otherwise specified $0.00 $0.00 G0251 Linear acc based stero radio $0.00 $0.00 G0252 Pet imaging initial dx $0.00 $0.00 G Pet imaging initial dx $75.19 $ % G0252 TC Pet imaging initial dx $0.00 $0.00 G0255 Current percep threshold tst $0.00 $0.00 G Current percep threshold tst $0.00 $0.00 G0255 TC Current percep threshold tst $0.00 $0.00 G0259 Inject for sacroiliac joint $0.00 $0.00 G0260 Inj for sacroiliac jt anesth $0.00 $0.00 G0269 Occlusive device in vein art $0.00 $0.00 G0278 Iliac art angio,cardiac cath $11.91 $ % G0288 Recon, cta for surg plan $39.13 $ % G0339 Robot lin radsurg com, first $0.00 $0.00 G0340 Robt lin radsurg fractx 2 5 $0.00 $0.00 G0364 Bone marrow aspirate &biopsy $12.25 $ % G0365 Vessel mapping hemo access $ $ % G Vessel mapping hemo access $12.25 $ % G0365 TC Vessel mapping hemo access $ $ % G0389 Ultrasound exam aaa screen $ $ % G Ultrasound exam aaa screen $27.90 $ % G0389 TC Ultrasound exam aaa screen $83.02 $ % G3001 Admin + supply, tositumomab $0.00 $0.00 Q3001 Brachytherapy radioelements $0.00 $0.00 R0070 Transport portable x ray $0.00 $0.00 R0075 Transport port x ray multipl $0.00 $0.00