20 Miss. Code. R. 2-II

Current through October 18, 2024

Section 20-2-II - GUIDELINES

A.Total Fee. A total fee includes both the professional component for the radiologist and the technical component needed to accomplish the procedure. Explanations of the professional component and the technical component are listed below. The values as listed in the MAR column represent the total reimbursement.

B.Professional Component. The professional component represents the reimbursement allowance of the professional radiological services of the physician and is identified by the use of modifier 26. This includes examination of the patient when indicated, performance or supervision of the procedure, interpretation and written report of the examination, and consultation with the referring physician. In the majority of hospital radiology departments, the radiologist submits a separate statement to the patient for professional services rendered, which are listed as the professional component. Values in the PC Amount column are intended for the services of a radiologist for the professional component only and do not include any other charges. To identify a charge for a professional component only, use the five-digit code followed by modifier 26.

C.Technical Component. The technical component includes charges made by the institution or clinic to cover the services of technologists and other staff members, the film, contrast media, chemicals and other materials, and the use of the space and facilities of the x-ray department. To identify a charge for a technical component only, use the five-digit code followed by HCPCS modifier TC. The technical component amount is listed in the TC Amount column of the Fee Schedule.

D.Review of X-rays. Billing code 76140 is not appropriate in the following circumstances because review of the x-rays is inherent to the evaluation and management code:

* The physician, during the course of an office visit or consultation, reviews an x-ray made elsewhere; . The treating or consulting physician reviews x-rays at an emergency room or hospital visit;

* CPT code 76140, Consultation on x-ray examination made elsewhere, written report, will only be paid when there is a documented need for the service and when performed by a radiologist or physician certified to perform radiological services;

* This provision is for payment of a second interpretation under unusual circumstances such as a questionable finding for which the physician performing the initial interpretation requests the expertise of another physician (i.e., expertise of a radiologist). CPT code 76140 is to be used when a second opinion is required for a radiological procedure. Reimbursement is limited to the PC Amount listed in the Fee Schedule for the radiological procedure.

E.Additional X-rays. No payment shall be made for additional x-rays when recent x-rays are available except when supported by adequate information regarding the need to retake x-rays. The use of photographic or digital media and/or imaging is not reported separately, but is considered to be a component of the basic procedure and shall not merit any additional payment.

F.Comparison X-rays. Comparison x-rays are reimbursable when appropriate. Any repeat comparison x-ray requires prior approval and will not be reimbursed without prior approval.

G.Contrast Material

1. Complete procedures, interventional radiological procedures, or diagnostic studies involving injection of contrast media include all usual pre-injection and post-injection services (e.g., necessary local anesthesia, placement of needle catheter, injection of contrast media, supervision of the study, and interpretation of results).

2. Low osmolar contrast material and paramagnetic contrast materials shall only be billed when not included in the descriptor of the procedure. When appropriately billed, the contrast media is reimbursed according to the lesser of the billed charges or MAR listed in the HCPCS section of the Fee Schedule. Supplies are considered incidental to the administration of the contrast and are not separately reimbursable.

3. When contrast can be administered orally (upper G.I.) or rectally (barium enema), the administration of contrast is included as part of the procedure and not separately reimbursed.

4. When an intravenous line is placed simply for access in the event of a problem with a procedure or for administration of contrast, it is considered part of the procedure and is not separately reimbursed.

H.Urologic Procedures. In the case of urologic procedures (e.g., CPT codes 74400-74485), insertion of a urethral catheter is part of the procedure and is not separately billed.

I.Vertebral Motion Analysis (VMA). Vertebral Motion Analysis, generally done on the cervical and lumbar spine, is typically billed with CPT code 76496, unlisted fluoroscopic procedure (e.g., diagnostic, interventional). There is no specific CPT for this radiological test. For the cervical spine, pay the combination of 76000 and 72052. For the lumbar spine, pay the combination of 76000 and 72110.

J.Separate or Multiple Procedures.

1. When multiple procedures are performed on the same day or at the same session, it is appropriate to designate them by separate entries. Surgical procedures performed in conjunction with a radiology procedure will be subject to the rules and regulations of the Surgery section.

2. When x-rays of multiple sections of a body area are billed separately, the total reimbursement must not exceed the maximum reimbursement allowance of the complete body area.

K. Outpatient CT and MRI imaging. CT and MRI imaging, when performed on an outpatient basis, are subject to the limitations of the Fee Schedule, regardless of site of service.

L.Unlisted Service or Procedure When reporting a service or procedure that is not listed in this fee schedule, use the appropriate unlisted procedure code. The bill must be accompanied by a Special Report as described below. If a HCPCS or CPT code has been established subsequent to the release of this fee schedule, include the code(s) with the Special Report.

M.Special Report. Any test/service that is not provided routinely should be reported with the appropriate code designating the service and the billing for that test/service should include a description of the procedure, the process used, and a full report of the findings. Additional information provided should include an acceptable definition or description of the extent and nature of the procedure, as well as information regarding the need for the procedure. Also essential are data regarding the equipment necessary to perform the service, as well as the time and effort required. Special reports to justify the necessity of a service do not warrant a separate fee.

N.By Report (BR). "BR" in the Amount column indicates services that are too new, unusual, or variable in the nature of their performance to permit the assignment of a definable fee. Such services should be substantiated by documentation submitted with the bill. Sufficient information should be included to permit proper identification and a sound evaluation.

O.Radiology Supervision and Interpretation Procedures. There are times when a single physician may perform the procedure and supervise the imaging and interpretation. On other occasions, one physician may perform the procedure, and the imaging supervision with interpretation may be performed by another physician. The appropriate radiology codes are to be used for supervision and interpretation of the imaging. The appropriate surgical codes are to be used for the procedure, including necessary local anesthesia, placement of needle or catheters, injection of contrast media, etc. The surgical codes are subject to the rules and regulations of the Surgery section, and the radiology codes are subject to this section of radiology rules and regulations.

P.Written Report(s). A written report, signed by the interpreting physician, should be considered an integral part of a radiological procedure or interpretation and must be submitted with the billing.

Q.Facility Fee. The facility fee for outpatient services is the APC Amount.

Code	Description	Amount	PC Amount	TC Amount	FUD	Assist Surg	APC Amount
.	70010	MYELOGRAPY POST FOSSA RS&I	109.86	XXX	N	547.95
.	70015	CISTERNOGRAPHY POSITIVE CONTRAST RS&I	276.23	107.95	168.28	XXX	N
.	70030	RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY	52.71	15.24	37.47	XXX	N
.	70100	RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS	61.60	16.51	45.09	XXX	N
.	70110	RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS	71.76	22.86	48.90	XXX	N
.	70120	RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE	61.60	16.51	45.09	XXX	N
.	70130	RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE	102.24	31.12	71.12	XXX	N
.	70134	RADEX INTERNAL AUDITORY MEATI COMPLETE	95.89	31.75	64.14	XXX	N
.	70140	RADEX FACIAL BONES < 3 VIEWS	54.61	18.42	36.19	XXX	N
.	70150	RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	78.11	24.13	53.98	XXX	N
.	70160	RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	61.60	15.88	45.72	XXX	N
.	70170	DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I	93.98	27.31	66.67	XXX	N
.	70190	RADEX OPTIC FORAMINA	65.41	19.69	45.72	XXX	N
.	70200	RADEX ORBITS COMPLETE MINIMUM 4 VIEWS	78.74	25.40	53.34	XXX	N
.	70210	RADEX SINUSES PARANASAL <3 VIEWS	56.52	15.88	40.64	XXX	N
.	70220	RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	69.85	22.86	46.99	XXX	N
.	70240	RADIOLOGIC EXAMINATION SELLA TURCICA	56.52	17.78	38.74	XXX	N
.	70250	RADIOLOGIC EXAMINATION SKULL 4/> VIEWS	67.95	22.86	45.09	XXX	N
.	70260	RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS	85.09	31.75	53.34	XXX	N
.	70300	RADIOLOGIC EXAMINATION TEETH 1 VIEW	25.40	10.16	15.24	XXX	N
.	70310	RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH	67.31	13.97	53.34	XXX	N
.	70320	RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH	97.16	22.23	74.93	XXX	N
.	70328	RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT	56.52	16.51	40.01	XXX	N
.	70330	RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT	88.27	22.23	66.04	XXX	N
.	70332	TEMPOROMANDBLE JT ARTHROGRAPHY RS&I	136.53	48.90	87.63	XXX	N
.	70336	MRI TEMPOROMANDIBULAR JOINT	562.61	132.72	429.89	XXX	N
.	70350	CEPHALOGRAM ORTHODONTIC	33.66	17.78	15.88	XXX	N
.	70355	ORTHOPANTOGRAM	35.56	19.69	15.87	XXX	N
.	70360	RADIOLOGIC EXAMINATION NECK SOFT TISSUE	53.98	15.24	38.74	XXX	N
.	70370	RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ	144.15	26.67	117.48	XXX	N
.	70371	CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC	175.90	76.84	99.06	XXX	N
.	70380	RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS	60.33	15.24	45.09	XXX	N
.	70390	SIALOGRAPHY RS&I	184.15	34.29	149.86	XXX	N
.	70450	CT HEAD/BRAIN W/O CONTRAST MATERIAL	207.01	76.84	130.17	XXX	N
.	70460	CT HEAD/BRAIN W/CONTRAST MATERIAL	292.74	102.87	189.87	XXX	N
.	70470	CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	342.27	114.94	227.33	XXX	N
.	70480	CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL	415.93	115.57	300.36	XXX	N
.	70481	CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL	492.76	125.10	367.66	XXX	N
.	70482	CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR	536.58	130.81	405.77	XXX	N
.	70486	CT MAXILLOFACIAL W/O CONTRAST MATERIAL	248.92	77.47	171.45	XXX	N
.	70487	CT MAXILLOFACIAL W/CONTRAST MATERIAL	299.09	101.60	197.49	XXX	N
.	70488	CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL	364.49	114.94	249.55	XXX	N
.	70490	CT SOFT TISSUE NECK W/O CONTRAST MATERIAL	294.01	115.57	178.44	XXX	N
.	70491	CT SOFT TISSUE NECK W/CONTRAST MATERIAL	362.59	125.10	237.49	XXX	N
.	70492	CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL	436.88	146.05	290.83	XXX	N
.	70496	CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST	527.69	158.12	369.57	XXX	N
.	70498	CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST	526.42	158.12	368.30	XXX	N
.	70540	MRI ORBIT FACE &/NECK W/O CONTRAST	474.98	121.92	353.06	XXX	N
.	70542	MRI ORBIT FACE & NECK W/CONTRAST MATERIAL	564.52	146.69	417.83	XXX	N
.	70543	MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL	709.30	193.04	516.26	XXX	N
.	70544	MRA HEAD W/O CONTRST MATERIAL	497.84	108.59	389.25	XXX	N
.	70545	MRA HEAD W/CONTRAST MATERIAL	494.03	108.59	385.44	XXX	N
.	70546	MRA HEAD W/O & W/CONTRAST MATERIAL	730.25	133.35	596.90	XXX	N
.	70547	MRA NECK W/O CONTRST MATERIAL	499.75	108.59	391.16	XXX	N
.	70548	MRA NECK W/CONTRAST MATERIAL	549.91	135.89	414.02	XXX	N
.	70549	MRA NECK W/O &W/CONTRAST MATERIAL	763.27	162.56	600.71	XXX	N
.	70551	MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	405.13	133.99	271.14	XXX	N
.	70552	MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL	562.61	161.29	401.32	XXX	N
.	70553	MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	663.58	206.38	457.20	XXX	N
.	70554	MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION	787.40	190.50	596.90	XXX	N
.	70555	MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION	1337.31	227.33	1109.98	XXX	N
.	70557	MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL	2417.42	281.94	2135.48	XXX	N
.	70558	MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL	2661.59	310.52	2351.07	XXX	N
.	70559	MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST	2684.60	296.55	2388.05	XXX	N
.	71045	RADIOLOGIC EXAM CHEST SINGLE VIEW	44.45	16.51	27.94	XXX	N
.	71046	RADIOLOGIC EXAM CHEST 2 VIEWS	56.52	19.69	36.83	XXX	N
.	71047	RADIOLOGIC EXAM CHEST 3 VIEWS	71.12	25.40	45.72	XXX	N
.	71048	RADIOLOGIC EXAM CHEST 4+ VIEWS	76.84	29.21	47.63	XXX	N
.	71100	RADEX RIBS UNILATERAL 2 VIEWS	61.60	20.32	41.28	XXX	N
.	71101	RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	70.49	24.77	45.72	XXX	N
.	71110	RADEX RIBS BILATERAL 3 VIEWS	73.66	26.67	46.99	XXX	N
.	71111	RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS	87.63	29.85	57.78	XXX	N
.	71120	RADEX STERNUM MINIMUM 2 VIEWS	55.88	18.42	37.46	XXX	N
.	71130	RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS	66.68	19.69	46.99	XXX	N
.	71250	CT THORAX W/O CONTRAST MATERIAL	283.85	105.41	178.44	XXX	N
.	71260	CT THORAX W/CONTRAST MATERIAL	351.16	112.40	238.76	XXX	N
.	71270	CT THORAX W/O & W/CONTRAST MATERIAL	416.56	125.10	291.46	XXX	N
.	71275	CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	539.75	164.47	375.28	XXX	N
.	71550	MRI CHEST W/O CONTRAST MATERIAL	724.54	131.45	593.09	XXX	N
.	71551	MRI CHEST W/CONTRAST MATERIAL	802.01	156.21	645.80	XXX	N
.	71552	MRI CHEST W/O & W/CONTRAST MATERIAL	1012.83	203.84	808.99	XXX	N
.	71555	MRA CHEST W/O & W/CONTRAST MATERIAL	700.41	161.29	539.12	XXX	N
.	72020	RADEX SPINE 1 VIEW SPECIFY LEVEL	41.28	13.97	27.31	XXX	N
.	72040	RADEX SPINE CERVICAL 2 OR 3 VIEWS	65.41	20.32	45.09	XXX	N
.	72050	RADEX SPINE CERVICAL 4 OR 5 VIEWS	90.17	28.58	61.59	XXX	N
.	72052	RADEX SPINE CERVICAL 6 OR MORE VIEWS	107.32	33.02	74.30	XXX	N
.	72070	RADEX SPINE THORACIC 2 VIEWS	60.96	20.32	40.64	XXX	N
.	72072	RADEX SPINE THORACIC 3 VIEWS	64.77	19.69	45.08	XXX	N
.	72074	RADEX SPINE THORACIC MINIMUM 4 VIEWS	71.12	19.69	51.43	XXX	N
.	72080	RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS	60.33	20.32	40.01	XXX	N
.	72081	RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW	72.39	24.77	47.62	XXX	N
.	72082	RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW	116.21	29.21	87.00	XXX	N
.	72083	RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW	137.16	33.02	104.14	XXX	N
.	72084	RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW	160.02	38.10	121.92	XXX	N
.	72100	RADEX SPINE LUMBOSACRAL 2/3 VIEWS	65.41	20.32	45.09	XXX	N
.	72110	RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	91.44	28.58	62.86	XXX	N
.	72114	RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6	104.14	29.85	74.29	XXX	N
.	72120	RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS	76.84	20.32	56.52	XXX	N
.	72125	CT CERVICAL SPINE W/O CONTRAST MATERIAL	328.93	96.52	232.41	XXX	N
.	72126	CT CERVICAL SPINE W/CONTRAST MATERIAL	406.40	110.49	295.91	XXX	N
.	72127	CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL	481.33	114.30	367.03	XXX	N
.	72128	CT THORACIC SPINE W/O CONTRAST MATERIAL	322.58	90.81	231.77	XXX	N
.	72129	CT THORACIC SPINE W/CONTRAST MATERIAL	408.94	110.49	298.45	XXX	N
.	72130	CT THORACIC SPINE W/O & W/CONTRAST MATERIAL	481.97	114.30	367.67	XXX	N
.	72131	CT LUMBAR SPINE W/O CONTRAST MATERIAL	321.31	90.81	230.50	XXX	N
.	72132	CT LUMBAR SPINE W/CONTRAST MATERIAL	407.04	110.49	296.55	XXX	N
.	72133	CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL	480.06	114.94	365.12	XXX	N
.	72141	MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	394.97	134.62	260.35	XXX	N
.	72142	MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL	573.41	161.93	411.48	XXX	N
.	72146	MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	395.61	134.62	260.99	XXX	N
.	72147	MRI SPINAL CANAL THORACIC W/CONTRAST MATRL	570.23	161.29	408.94	XXX	N
.	72148	MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	395.61	134.62	260.99	XXX	N
.	72149	MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL	566.42	161.93	404.49	XXX	N
.	72156	MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	668.02	206.38	461.64	XXX	N
.	72157	MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL	669.93	206.38	463.55	XXX	N
.	72158	MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	666.75	206.38	460.37	XXX	N
.	72159	MRA SPINAL CANAL W/WO CONTRAST MATERIAL	725.81	162.56	563.25	XXX	N
.	72170	RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	59.06	15.88	43.18	XXX	N
.	72190	RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS	71.12	19.69	51.43	XXX	N
.	72191	CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST	561.98	162.56	399.42	XXX	N
.	72192	CT PELVIS W/O CONTRAST MATERIAL	260.35	98.43	161.92	XXX	N
.	72193	CT PELVIS W/CONTRAST MATERIAL	418.47	105.41	313.06	XXX	N
.	72194	CT PELVIS W/O & W/CONTRAST MATERIAL	474.98	109.86	365.12	XXX	N
.	72195	MRI PELVIS W/O CONTRAST MATERIAL	483.87	132.08	351.79	XXX	N
.	72196	MRI PELVIS W/CONTRAST MATERIAL	565.15	156.85	408.30	XXX	N
.	72197	MRI PELVIS W/O & W/CONTRAST MATERIAL	713.74	198.76	514.98	XXX	N
.	72198	MRA PELVIS W/WO CONTRAST MATERIAL	704.22	160.66	543.56	XXX	N
.	72200	RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS	55.25	15.88	39.37	XXX	N
.	72202	RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS	62.23	17.15	45.08	XXX	N
.	72220	RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	54.61	15.88	38.73	XXX	N
.	72240	MYELOGRAPHY CERVICAL RS&I	186.69	81.92	104.77	XXX	N
.	72255	MYELOGRAPHY THORACIC RS&I	189.87	85.73	104.14	XXX	N
.	72265	MYELOGRAPY LUMBOSACRAL RS&I	174.63	73.66	100.97	XXX	N
.	72270	MYELOGRAPY 2/MORE REGIONS RS&I	242.57	121.92	120.65	XXX	N
.	72275	EPIDUROGRAPY RS&I	220.98	70.49	150.49	XXX	N
.	72285	DISKOGRAPY CERVICAL/THORACIC RS&I	0.00	0.00	0.00	XXX	N	2316.70
.	72295	DISKOGRAPY LUMBAR RS&I	184.15	78.11	106.04	XXX	N
.	73000	RADEX CLAVICLE COMPLETE	52.07	15.24	36.83	XXX	N
.	73010	RADEX SCAPULA COMPLETE	57.15	16.51	40.64	XXX	N
.	73020	RADEX SHOULDER 1 VIEW	42.55	14.61	27.94	XXX	N
.	73030	RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	53.98	17.15	36.83	XXX	N
.	73040	RADEX SHOULDER ARTHROGRAPHY RS&I	198.12	49.53	148.59	XXX	N
.	73050	RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ	66.68	19.05	47.63	XXX	N
.	73060	RADEX HUMERUS MINIMUM 2 VIEWS	53.98	15.24	38.74	XXX	N
.	73070	RADEX ELBOW 2 VIEWS	48.26	14.61	33.65	XXX	N
.	73080	RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	53.34	15.88	37.46	XXX	N
.	73085	RADEX ELBOW ARTHROGRAPHY RS&I	189.87	52.07	137.80	XXX	N
.	73090	RADEX FOREARM 2 VIEWS	50.17	15.24	34.93	XXX	N
.	73092	RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS	51.44	14.61	36.83	XXX	N
.	73100	RADEX WRIST 2 VIEWS	57.15	15.24	41.91	XXX	N
.	73110	RADEX WRIST COMPLETE MINIMUM 3 VIEWS	65.41	15.88	49.53	XXX	N
.	73115	RADEX WRIST ARTHROGRAPHY RS&I	211.46	51.44	160.02	XXX	N
.	73120	RADEX HAND 2 VIEWS	52.07	15.24	36.83	XXX	N
.	73130	RADEX HAND MINIMUM 3 VIEWS	59.69	15.88	43.81	XXX	N
.	73140	RADEX FINGR MINIMUM 2 VIEWS	60.33	12.70	47.63	XXX	N
.	73200	CT UPPER EXTREMITY W/O CONTRAST MATERIAL	320.68	90.81	229.87	XXX	N
.	73201	CT UPPER EXTREMITY W/CONTRAST MATERIAL	398.78	105.41	293.37	XXX	N
.	73202	CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL	496.57	110.49	386.08	XXX	N
.	73206	CT ANGIOGRAPHY UPPER EXTREMITY	586.74	161.93	424.81	XXX	N
.	73218	MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL	642.62	122.56	520.06	XXX	N
.	73219	MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL	705.49	146.69	558.80	XXX	N
.	73220	MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS	873.13	193.68	679.45	XXX	N
.	73221	MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	417.20	123.19	294.01	XXX	N
.	73222	MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL	664.85	147.32	517.53	XXX	N
.	73223	MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL	824.87	194.31	630.56	XXX	N
.	73225	MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL	695.33	153.04	542.29	XXX	N
.	73501	RADEX HIP UNILATERAL WITH PELVIS 1 VIEW	55.25	17.15	38.10	XXX	N
.	73502	RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	76.84	20.32	56.52	XXX	N
.	73503	RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS	95.89	25.40	70.49	XXX	N
.	73521	RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS	68.58	20.32	48.26	XXX	N
.	73522	RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS	89.54	27.31	62.23	XXX	N
.	73523	RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS	104.78	29.21	75.57	XXX	N
.	73525	RADEX HIP ARTHROGRAPHY RS&I	201.93	52.71	149.22	XXX	N
.	73551	RADIOLOGIC EXAMINATION FEMUR 1 VIEW	50.80	15.24	35.56	XXX	N
.	73552	RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	59.69	16.51	43.18	XXX	N
.	73560	RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	57.79	15.24	42.55	XXX	N
.	73562	RADIOLOGIC EXAMINATION KNEE 3 VIEWS	66.68	17.15	49.53	XXX	N
.	73564	RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	74.30	20.32	53.98	XXX	N
.	73565	RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST	66.68	15.88	50.80	XXX	N
.	73580	RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I	227.97	52.07	175.90	XXX	N
.	73590	RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	52.71	14.61	38.10	XXX	N
.	73592	RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS	51.44	14.61	36.83	XXX	N
.	73600	RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	55.25	15.24	40.01	XXX	N
.	73610	RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	59.69	15.88	43.81	XXX	N
.	73615	RADEX ANKLE ARTHROGRAPHY RS&I	212.09	52.71	159.38	XXX	N
.	73620	RADIOLOGIC EXAMINATION FOOT 2 VIEWS	48.26	13.97	34.29	XXX	N
.	73630	RADEX FOOT COMPLETE MINIMUM 3 VIEWS	55.88	15.24	40.64	XXX	N
.	73650	RADEX CALCANEUS MINIMUM 2 VIEWS	48.26	14.61	33.65	XXX	N
.	73660	RADEX TOE MINIMUM 2 VIEWS	51.44	12.07	39.37	XXX	N
.	73700	CT LOWER EXTREMITY W/O CONTRAST MATERIAL	321.31	90.81	230.50	XXX	N
.	73701	CT LOWER EXTREMITY W/CONTRAST MATERIAL	403.86	105.41	298.45	XXX	N
.	73702	CT LOWER EXTREMITY W/O & W/CONTRAST MATRL	488.95	109.86	379.09	XXX	N
.	73706	CT ANGIOGRAPHY LOWER EXTREMITY	635.64	170.18	465.46	XXX	N
.	73718	MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL	469.27	121.92	347.35	XXX	N
.	73719	MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL	554.99	146.69	408.30	XXX	N
.	73720	MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR	711.84	193.68	518.16	XXX	N
.	73721	MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	417.20	123.19	294.01	XXX	N
.	73722	MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL	668.02	147.32	520.70	XXX	N
.	73723	MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	822.96	193.68	629.28	XXX	N
.	73725	MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL	704.85	161.93	542.92	XXX	N
.	74018	RADIOLOGIC EXAM ABDOMEN 1 VIEW	50.80	16.51	34.29	XXX	N
.	74019	RADIOLOGIC EXAM ABDOMEN 2 VIEWS	62.23	20.96	41.27	XXX	N
.	74021	RADIOLOGIC EXAM ABDOMEN 3+ VIEWS	71.76	24.77	46.99	XXX	N
.	74022	RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH	83.19	29.21	53.98	XXX	N
.	74150	CT ABDOMEN W/O CONTRAST MATERIAL	267.97	107.95	160.02	XXX	N
.	74160	CT ABDOMEN W/CONTRAST MATERIAL	426.72	114.94	311.78	XXX	N
.	74170	CT ABDOMEN W/O & W/CONTRAST MATERIAL	483.87	126.37	357.50	XXX	N
.	74174	CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG	708.66	196.85	511.81	XXX	N
.	74175	CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST	563.25	163.20	400.05	XXX	N
.	74176	CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	358.78	157.48	201.30	XXX	N
.	74177	CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	570.87	165.10	405.77	XXX	N
.	74178	CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE	644.53	180.98	463.55	XXX	N
.	74181	MRI ABDOMEN W/O CONTRAST MATERIAL	436.88	132.08	304.80	XXX	N
.	74182	MRI ABDOMEN W/CONTRAST MATERIAL	641.99	156.85	485.14	XXX	N
.	74183	MRI ABDOMEN W/O & W/CONTRAST MATERIAL	714.38	198.76	515.62	XXX	N
.	74185	MRA ABDOMEN W/WO CONTRAST MATERIAL	706.76	161.29	545.47	XXX	N
.	74190	PERITONEOGRAM RS&I	107.38	41.91	65.47	XXX	N
.	74210	RADEX PHARYNX&/CERVICAL ESOPHAGUS	158.12	53.34	104.78	XXX	N
.	74220	RADEX ESOPHAGUS	173.36	60.96	112.40	XXX	N
.	74230	SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG	227.97	48.26	179.71	XXX	N
.	74235	RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I	323.43	107.95	215.48	XXX	N
.	74240	RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB	219.08	62.87	156.21	XXX	N
.	74241	RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB	227.97	62.23	165.74	XXX	N
.	74245	RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES	332.74	81.92	250.82	XXX	N
.	74246	RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB	243.84	62.23	181.61	XXX	N
.	74247	RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB	274.32	62.23	212.09	XXX	N
.	74249	RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU	356.87	81.92	274.95	XXX	N
.	74250	RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES	201.93	42.55	159.38	XXX	N
.	74251	RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE	772.16	62.23	709.93	XXX	N
.	74260	DUODENOGRAPY HYPOTONIC	629.92	45.72	584.20	XXX	N
.	74261	CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST	862.33	217.17	645.16	XXX	N
.	74262	CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST	968.38	226.06	742.32	XXX	N
.	74263	CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING	1352.55	204.47	1148.08	XXX	N
.	74270	RADEX COLON BARIUM ENEMA W/WO KUB	288.29	62.23	226.06	XXX	N
.	74280	RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON	407.04	89.54	317.50	XXX	N
.	74283	THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ	419.74	186.69	233.05	XXX	N
.	74290	CHOLECYSTOGRAPHY ORAL CONTRST	136.53	29.21	107.32	XXX	N
.	74300	CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I	109.86	33.02	76.84	XXX	N
+	74301	CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS	54.97	19.05	35.92	ZZZ	N
.	74328	ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I	215.41	64.14	151.27	XXX	N
.	74329	ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I	186.01	64.14	121.87	XXX	N
.	74330	CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I	303.53	81.92	221.61	XXX	N
.	74340	INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I	196.87	48.90	147.97	XXX	N
.	74355	PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I	260.16	68.58	191.58	XXX	N
.	74360	INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I	212.86	50.80	162.06	XXX	N
.	74363	PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I	223.08	77.47	145.61	XXX	N
.	74400	UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY	213.36	44.45	168.91	XXX	N
.	74410	UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE	216.54	43.82	172.72	XXX	N
.	74415	UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO	258.45	44.45	214.00	XXX	N
.	74420	X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL	128.27	46.36	81.91	XXX	N
.	74425	UROGRAPHY ANTEGRADE RS&I	117.48	31.75	85.73	XXX	N
.	74430	CYSTOGRAPHY MINIMUM 3 VIEWS RS&I	70.49	29.21	41.28	XXX	N
.	74440	VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I	154.94	33.02	121.92	XXX	N
.	74445	CORPORA CAVERNOSOGRAPY RS&I	174.63	99.70	74.93	XXX	N
.	74450	URETHROCYSTOGRAPHY RETROGRADE RS&I	129.54	29.85	99.69	XXX	N
.	74455	URETHROCYSTOGRAPHY VOIDING RS&I	161.93	29.85	132.08	XXX	N
.	74470	RADEX RENAL CYST STUDY TRANSLUMBAR RS&I	132.95	47.63	85.32	XXX	N
.	74485	DILATION URETERS/URETHRA RS&I	191.77	72.39	119.38	XXX	N
.	74710	PELVIMETRY W/WOPLACENTAL LOCALIZATION	68.58	31.12	37.46	XXX	N
.	74712	FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES	861.06	271.15	589.91	XXX	N
+	74713	FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES	419.10	168.28	250.82	ZZZ	N
.	74740	HYSTEROSALPINGOGRAPHY RS&I	147.32	34.29	113.03	XXX	N
.	74742	TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I	153.41	55.88	97.53	XXX	N
.	74775	PERINEOGRAM	182.25	56.52	125.73	XXX	N
.	75557	CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST	581.66	208.92	372.74	XXX	N
.	75559	CARDIAC MRI W/O CONTRAST W/STRESS IMAGING	810.90	257.18	553.72	XXX	N
.	75561	CARDIAC MRI W/WO CONTRAST & FURTHER SEQ	763.91	230.51	533.40	XXX	N
.	75563	CARDIAC MRI W/W/O CONTRAST W/STRESS	905.51	264.16	641.35	XXX	N
+	75565	CARDIAC MRI FOR VELOCITY FLOW MAPPING	95.89	22.23	73.66	ZZZ	N
.	75571	CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	185.42	52.07	133.35	XXX	N
.	75572	CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH	477.52	156.85	320.67	XXX	N
.	75573	CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D	646.43	227.97	418.46	XXX	N
.	75574	CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	701.04	213.36	487.68	XXX	N
.	75600	AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I	357.51	43.82	313.69	XXX	N
.	75605	AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I	240.03	100.33	139.70	XXX	N
.	75625	AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I	236.86	100.33	136.53	XXX	N
.	75630	AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I	297.18	158.12	139.06	XXX	N
.	75635	CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP	790.58	214.00	576.58	XXX	N
.	75705	ANGIOGRAPHY SPINAL SELECTIVE RS&I	452.76	210.82	241.94	XXX	N
.	75710	ANGIOGRAPHY EXTREMITY UNILATERAL RS&I	300.36	155.58	144.78	XXX	N
.	75716	ANGIOGRAPHY EXTREMITY BILATERAL RS&I	320.04	173.36	146.68	XXX	N
.	75726	ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I	259.08	99.06	160.02	XXX	N
.	75731	ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I	300.36	103.51	196.85	XXX	N
.	75733	ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I	323.22	114.94	208.28	XXX	N
.	75736	ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I	278.13	99.06	179.07	XXX	N
.	75741	ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I	262.26	114.30	147.96	XXX	N
.	75743	ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I	294.64	144.78	149.86	XXX	N
.	75746	ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I	264.16	100.33	163.83	XXX	N
.	75756	ANGIOGRAPHY INTERNAL MAMMARY RS&I	304.17	102.87	201.30	XXX	N
+	75774	ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I	147.96	31.12	116.84	ZZZ	N
.	75801	LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I	474.35	80.65	393.70	XXX	N
.	75803	LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I	485.15	106.68	378.47	XXX	N
.	75805	LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I	490.86	73.66	417.20	XXX	N
.	75807	LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I	536.92	101.60	435.32	XXX	N
.	75809	SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I	170.82	43.18	127.64	XXX	N
.	75810	SPLENOPORTOGRAPY RS&I	953.04	88.90	864.14	XXX	N
.	75820	VENOGRAPHY EXTREMITY UNILATERAL RS&I	200.03	62.87	137.16	XXX	N
.	75822	VENOGRAPHY EXTREMITY BILATERAL RS&I	233.68	93.35	140.33	XXX	N
.	75825	VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I	233.68	100.33	133.35	XXX	N
.	75827	VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I	242.57	101.60	140.97	XXX	N
.	75831	VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I	243.84	99.06	144.78	XXX	N
.	75833	VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I	288.93	131.45	157.48	XXX	N
.	75840	VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I	259.08	103.51	155.57	XXX	N
.	75842	VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I	314.33	135.26	179.07	XXX	N
.	75860	VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I	253.37	101.60	151.77	XXX	N
.	75870	VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I	336.55	116.21	220.34	XXX	N
.	75872	VENOGRAPHY EPIDURAL RS&I	259.08	103.51	155.57	XXX	N
.	75880	VENOGRAPHY ORBITAL RS&I	218.44	63.50	154.94	XXX	N
.	75885	PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I	272.42	121.92	150.50	XXX	N
.	75887	PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP	273.69	122.56	151.13	XXX	N
.	75889	HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I	249.56	98.43	151.13	XXX	N
.	75891	HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I	252.73	99.70	153.03	XXX	N
.	75893	VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&	210.82	48.90	161.92	XXX	N
.	75894	TRANSCATHETER EMBOLIZATION ANY METH RS&I	1868.81	130.81	1738.00	XXX	N
.	75898	ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS	243.84	163.20	80.64	XXX	N
.	75901	MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I	356.87	42.55	314.32	XXX	N
.	75902	MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I	140.97	34.29	106.68	XXX	N
.	75956	EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I	623.57	623.57	BR	XXX	N
.	75957	EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I	535.31	535.31	BR	XXX	N
.	75958	PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I	355.60	355.60	BR	XXX	N
.	75959	PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I	309.88	309.88	BR	XXX	N
.	75970	TRANSCATHETER BIOPSY RS&I	796.93	71.76	725.17	XXX	N
.	75984	CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I	183.52	62.87	120.65	XXX	N
.	75989	RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I	217.17	104.78	112.39	XXX	N
.	76000	FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME	84.46	27.94	56.52	XXX	N
.	76010	RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD	48.90	16.51	32.39	XXX	N
.	76080	RADEX ABSCESS/FISTULA/SINUS TRACT RS&I	102.24	46.99	55.25	XXX	N
.	76098	RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN	29.85	14.61	15.24	XXX	N
.	76100	RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY	169.55	56.52	113.03	XXX	N
.	76101	RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI	168.28	50.80	117.48	XXX	N
.	76102	RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI	309.88	60.96	248.92	XXX	N
.	76120	CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC	182.25	33.02	149.23	XXX	N
+	76125	CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION	81.92	25.40	56.52	ZZZ	N
.	76140	CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT	55.25	XXX	N	70.16
.	76376	3D RENDERING W/INTERP & POSTPROCESS SUPERVISION	41.28	17.78	23.50	XXX	N
.	76377	3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION	127.64	71.76	55.88	XXX	N
.	76380	CT LIMITED/LOCALIZED FOLLOW UP STUDY	258.45	87.63	170.82	XXX	N
.	76390	MRI SPECTROSCOPY	781.69	125.73	655.96	XXX	N
.	76391	MAGNETIC RESONANCE ELASTOGRAPHY	422.91	100.33	322.58	XXX	N
.	76496	UNLISTED FLUOROSCOPIC PROCEDURE	BR	BR	BR	XXX	N	88.47
.	76497	UNLISTED COMPUTED TOMOGRAPHY PROCEDURE	BR	BR	BR	XXX	N	88.47
.	76498	UNLISTED MAGNETIC RESONANCE PROCEDURE	BR	BR	BR	XXX	N	88.47
.	76499	UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE	BR	BR	BR	XXX	N	88.47
.	76506	ECHOENCEPHALOGRAPHY REAL TIME IMAGING	207.01	57.79	149.22	XXX	N
.	76510	OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR	200.03	104.78	95.25	XXX	N
.	76511	OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY	122.56	65.41	57.15	XXX	N
.	76512	OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN	109.86	62.87	46.99	XXX	N
.	76513	OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM	176.53	64.77	111.76	XXX	N
.	76514	OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI	22.86	14.61	8.25	XXX	N
.	76516	OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN	97.16	41.28	55.88	XXX	N
.	76519	OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL	118.75	56.52	62.23	XXX	N
.	76529	OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION	147.96	59.69	88.27	XXX	N
.	76536	US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	206.38	50.80	155.58	XXX	N
.	76604	US CHEST REAL TIME W/IMAGE DOCUMENTATION	159.39	48.90	110.49	XXX	N
.	76641	US BREAST UNI REAL TIME WITH IMAGE COMPLETE	191.77	66.04	125.73	XXX	N
.	76642	US BREAST UNI REAL TIME WITH IMAGE LIMITED	156.85	61.60	95.25	XXX	N
.	76700	US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	217.81	73.03	144.78	XXX	N
.	76705	US ABDOMINAL REAL TIME W/IMAGE LIMITED	162.56	52.71	109.85	XXX	N
.	76706	US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA	203.20	49.53	153.67	XXX	N
.	76770	US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	201.93	66.68	135.25	XXX	N
.	76775	US RETROPERITONEAL REAL TIME W/IMAGE LIMITED	104.78	52.07	52.71	XXX	N
.	76776	US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN	278.13	68.58	209.55	XXX	N
.	76800	ULTRASOUND SPINAL CANAL & CONTENTS	256.54	106.68	149.86	XXX	N
.	76801	US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	219.71	90.17	129.54	XXX	N
+	76802	US PREG UTERUS 14 WK TRANSABDL EACH GESTATION	114.94	76.20	38.74	ZZZ	N
.	76805	US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	252.10	90.81	161.29	XXX	N
+	76810	US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO	167.01	90.81	76.20	ZZZ	N
.	76811	US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	325.12	175.90	149.22	XXX	N
+	76812	US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT	363.22	166.37	196.85	ZZZ	N
.	76813	US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION	219.08	109.86	109.22	XXX	N
+	76814	US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION	144.15	92.71	51.44	XXX	N
.	76815	US PREGNANT UTERUS LIMITED 1/> FETUSES	151.13	59.06	92.07	XXX	N
.	76816	US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS	205.11	78.74	126.37	XXX	N
.	76817	US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	173.36	68.58	104.78	XXX	N
.	76818	FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING	218.44	97.79	120.65	XXX	N
.	76819	FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING	160.02	71.12	88.90	XXX	N
.	76820	DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY	85.73	46.36	39.37	XXX	N
.	76821	DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART	165.74	65.41	100.33	XXX	N
.	76825	ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING	494.67	151.13	343.54	XXX	N
.	76826	ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD	293.37	74.30	219.07	XXX	N
.	76827	DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE	133.99	52.07	81.92	XXX	N
.	76828	DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT	95.89	51.44	44.45	XXX	N
.	76830	US TRANSVAGINAL	218.44	62.87	155.57	XXX	N
.	76831	SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER	212.73	66.04	146.69	XXX	N
.	76856	US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	196.22	62.23	133.99	XXX	N
.	76857	US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	87.63	45.09	42.54	XXX	N
.	76870	US SCROTUM & CONTENTS	188.60	57.79	130.81	XXX	N
.	76872	US TRANSRECTAL	229.87	60.33	169.54	XXX	N
.	76873	US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX	311.79	140.97	170.82	XXX	N
.	76881	US COMPL JOINT R-T W/IMAGE DOCUMENTATION	159.39	57.15	102.24	XXX	N
.	76882	US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG	102.87	44.45	58.42	XXX	N
.	76885	US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ	257.18	67.31	189.87	XXX	N
.	76886	US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ	188.60	56.52	132.08	XXX	N
.	76930	US GUIDANCE PERICARDIOCENTESIS RS&I	161.29	59.69	101.60	XXX	N
.	76932	US ENDOMYOCARDIAL BIOPSY RS&I	161.29	59.69	101.60	YYY	N
.	76936	US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL	482.60	175.90	306.70	XXX	N
+	76937	US VASC ACCESS SITS VSL PATENCY NDL ENTRY	60.96	26.04	34.92	ZZZ	N
.	76940	US &MNTR PARENCHYMAL TISSUE ABLATION	300.36	186.06	114.30	YYY	N
.	76941	US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I	231.78	125.10	106.68	XXX	N
.	76942	US GUIDANCE NEEDLE PLACEMENT IMG S&I	102.24	57.79	44.45	XXX	N
.	76945	US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I	174.63	62.87	111.76	XXX	N
.	76946	US GUIDANCE AMNIOCENTESIS IMG S&I	58.42	34.93	23.49	XXX	N
.	76948	US GUIDANCE ASPIRATION OVA IMG S&I	134.62	62.87	71.75	XXX	N
.	76965	US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION	166.37	121.92	44.45	XXX	N
.	76970	US STUDY FOLLOW UP	161.29	34.93	126.36	XXX	N
.	76975	GI ENDOSCOPIC US S&I	186.06	76.20	109.86	XXX	N
.	76977	US BONE DENSITY MEAS & INTERP PERIPH ANY METHO	13.34	5.08	8.26	XXX	N
.	76978	ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION	582.93	146.05	436.88	XXX	N
+	76979	ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES	395.61	76.84	318.77	ZZZ	N
.	76981	ULTRASOUND ELASTOGRAPHY PARENCHYMA	193.04	53.98	139.06	XXX	N
.	76982	ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION	172.72	53.98	118.74	XXX	N
+	76983	ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION	106.05	45.72	60.33	ZZZ	N
.	76998	ULTRASONIC GUIDANCE INTRAOPERATIVE	114.94	114.94	BR	XXX	N
.	76999	UNLISTED US PROCEDURE	BR	BR	BR	XXX	N	88.47
+	77001	FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT	161.93	33.66	128.27	ZZZ	N
+	77002	FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON	181.61	50.17	131.44	ZZZ	N
+	77003	FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON	175.90	54.61	121.29	ZZZ	N
.	77011	CT GUIDANCE STEREOTACTIC LOCALIZATION	410.85	113.67	297.18	XXX	N
.	77012	CT GUIDANCE NEEDLE PLACEMENT	271.15	133.35	137.80	XXX	N
.	77013	CT GUIDANCE &MONITORING VISC TISS ABLATION	963.30	346.71	616.59	XXX	N
.	77014	CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT	216.54	80.65	135.89	XXX	N
.	77021	MRI GUIDANCE NEEDLE PLACEMENT RS&I	853.44	132.08	721.36	XXX	N
.	77022	MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION	1259.84	390.53	869.31	XXX	N
.	77046	MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL	445.77	130.81	314.96	XXX	N
.	77047	MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL	457.84	144.78	313.06	XXX	N
.	77048	MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL	708.03	189.23	518.80	XXX	N
.	77049	MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL	723.27	207.01	516.26	XXX	N
.	77053	MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE	102.87	32.39	70.48	XXX	N
.	77054	MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE	134.62	41.28	93.34	XXX	N
.	77061	DIGITAL BREAST TOMOSYNTHESIS UNILATERAL	93.98	63.28	30.70	XXX	N
.	77062	DIGITAL BREAST TOMOSYNTHESIS BILATERAL	102.24	79.26	22.98	XXX	N
+	77063	SCREENING DIGITAL BREAST TOMOSYNTHESIS BI	98.43	53.98	44.45	ZZZ	N
.	77065	DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	239.40	73.66	165.74	XXX	N
.	77066	DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	302.90	90.81	212.09	XXX	N
.	77067	SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	243.84	68.58	175.26	XXX	N
.	77071	MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS	90.81	XXX	N	88.47
.	77072	BONE AGE STUDIES	43.18	17.15	26.03	XXX	N
.	77073	BONE LENGTH STUDIES	67.31	26.04	41.27	XXX	N
.	77074	RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED	121.29	41.28	80.01	XXX	N
.	77075	RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL	165.10	48.90	116.20	XXX	N
.	77076	RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT	180.98	63.50	117.48	XXX	N
.	77077	JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS	69.22	29.21	40.01	XXX	N
.	77078	CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE	205.74	22.23	183.51	XXX	N
.	77080	DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	71.76	17.78	53.98	XXX	N
.	77081	DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	59.69	18.42	41.27	XXX	N
.	77084	BONE MARROW BLOOD SUPPLY	680.72	145.42	535.30	XXX	N
.	77085	DXA BONE DENSITY STUDY AXIAL SKELETON	97.79	27.31	70.48	XXX	N
.	77086	VERTEBRAL FRACTURE ASSESSMENT VIA DXA	62.87	15.24	47.63	XXX	N
.	77261	THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE	128.91	XXX	N
.	77262	THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE	194.31	XXX	N
.	77263	THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX	303.53	XXX	N
.	77280	THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE	497.84	67.31	430.53	XXX	N
.	77285	THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED	823.60	102.24	721.36	XXX	N
.	77290	THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX	916.31	147.96	768.35	XXX	N
+	77293	RESPIRATORY MOTION MANAGEMENT SIMULATION	829.31	189.87	639.44	ZZZ	N
.	77295	3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS	885.19	406.40	478.79	XXX	N
.	77299	UNLIS PX THER RADIOL CLINICAL TX PLANNING	BR	BR	BR	XXX	N	175.75
.	77300	BASIC RADIATION DOSIMETRY CALCULATION	120.02	59.06	60.96	XXX	N
.	77301	NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS	3495.68	756.92	2738.76	XXX	N
.	77306	TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION	269.88	132.72	137.16	XXX	N
.	77307	TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY	521.97	274.32	247.65	XXX	N
.	77316	BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL	367.03	133.35	233.68	XXX	N
.	77317	BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL	480.70	173.36	307.34	XXX	N
.	77318	BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL	690.88	274.32	416.56	XXX	N
.	77321	SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY	168.91	90.17	78.74	XXX	N
.	77331	SPEC DOSIM ONLY PRESCRIBED TREATING PHYS	116.84	82.55	34.29	XXX	N
.	77332	TX DEVICES DESIGN & CONSTRUCTION SIMPLE	94.62	43.18	51.44	XXX	N
.	77333	TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE	196.85	71.12	125.73	XXX	N
.	77334	TX DEVICES DESIGN & CONSTRUCTION COMPLEX	231.14	109.22	121.92	XXX	N
.	77336	CONTINUING MEDICAL PHYSICS CONSLTJ PR WK	143.51	XXX	N	175.75
.	77338	MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN	899.16	406.40	492.76	XXX	N
.	77370	SPEC MEDICAL RADJ PHYSICS CONSLTJ	223.52	XXX	N	175.75
.	J1	77371	RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT	4603.12	XXX	N	15277.40
.	J1	77372	RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR	1920.24	XXX	N	15277.40
.	77373	STEREOTACTIC BODY RADIATION DELIVERY	2324.74	XXX	N	2400.61
.	77385	INTENSITY MODULATED RADIATION TX DLVR SIMPLE	948.69	XXX	N	738.19
.	77386	INTENSITY MODULATED RADIATION TX DLVR COMPLEX	1323.98	XXX	N	738.19
.	77387	GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR	171.45	XXX	N
.	77399	UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS	BR	BR	BR	XXX	N	175.75
.	77401	RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA	44.45	XXX	N	166.13
.	77402	RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE	204.47	XXX	N	166.13
.	77407	RADIATION TX DELIVERY 1 MEV >= INTERMEDIATE	260.35	XXX	N	318.73
.	77412	RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX	279.40	XXX	N	318.73
.	77417	THERAPEUTIC RADIOLOGY PORT IMAGES(S)	20.32	XXX	N
.	77423	HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER	173.86	XXX	N	738.19
.	J1	77424	INTRAOP RADIAJ TX DELIVER XRAY SINGLE TX SESSION	BR	XXX	N	15277.40
.	J1	77425	INTRAOP RADIAJ TX DELIVER ELECTRONS SNGL TX SESS	BR	XXX	N	15277.40
.	77427	RADIATION TREATMENT MANAGEMENT 5 TREATMENTS	341.00	XXX	N
.	77431	RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY	187.96	XXX	N
.	77432	STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION	765.18	XXX	N
.	77435	STEREOTACTIC BODY RADIATION MANAGEMENT	1153.80	XXX	N
.	77469	INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT	571.50	XXX	N
.	77470	SPECIAL TREATMENT PROCEDURE	238.13	192.41	45.72	XXX	N
.	77499	UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT	BR	BR	BR	XXX	N
.	77520	PROTON TX DELIVERY SIMPLE W/O COMPENSATION	1715.77	XXX	N	738.19
.	77522	PROTON TX DELIVERY SIMPLE W/COMPENSATION	BR	XXX	N	1532.14
.	77523	PROTON TX DELIVERY INTERMEDIATE	BR	XXX	N	1532.14
.	77525	PROTON TX DELIVERY COMPLEX	3926.84	XXX	N	1532.14
.	77600	HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL	810.26	128.27	681.99	XXX	N
.	77605	HYPERTHERMIA EXTERNAL GENERATED DEEP	1400.18	185.42	1214.76	XXX	N
.	77610	HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS	1244.60	123.19	1121.41	XXX	N
.	77615	HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS	1910.72	173.36	1737.36	XXX	N
.	77620	HYPERTHERMIA INTRACAVITARY PROBES	931.55	156.21	775.34	XXX	N
.	77750	NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE	685.17	473.08	212.09	090	N
.	77761	INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE	719.46	365.13	354.33	090	N
.	77762	INTRACAVITARY RADIATION SOURCE APPLIC INTERMED	952.50	546.74	405.76	090	N
.	77763	INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX	1356.36	822.96	533.40	090	N
.	77767	HDR RDNCL SKN SURF BRACHYTX LES </2CM/1 CHAN	419.10	99.70	319.40	XXX	N
.	77768	HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES	643.89	133.35	510.54	XXX	N
.	77770	HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL	594.36	184.15	410.21	XXX	N
.	77771	HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL	1084.58	360.68	723.90	XXX	N
.	77772	HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS	1643.38	510.54	1132.84	XXX	N
.	77778	INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX	1528.45	829.95	698.50	000	N
.	77789	SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE	221.62	108.59	113.03	000	N
.	77790	SUPERVISION HANDLING LOADING RADIATION SOURCE	27.31	XXX	N
.	77799	UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY	BR	BR	BR	XXX	N	166.13
.	78012	THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT	148.59	17.15	131.44	XXX	N
.	78013	THYROID IMAGING WITH VASCULAR FLOW	351.79	33.02	318.77	XXX	N
.	78014	THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS	441.33	44.45	396.88	XXX	N
.	78015	THYROID CARCINOMA METASTASES IMG LMTD AREA	410.85	60.33	350.52	XXX	N
.	78016	THYROID CARCINOMA METASTASES IMG ADDL STUDY	515.62	61.60	454.02	XXX	N
.	78018	THYROID CARCINOMA METASTASES IMG WHOLE BODY	573.41	74.30	499.11	XXX	N
+	78020	THYROID CARCINOMA METASTASES UPTAKE	153.04	50.17	102.87	ZZZ	N
.	78070	PARATHYROID PLANAR IMAGING	546.74	70.49	476.25	XXX	N
.	78071	PARATHYROID PLANAR IMAGING W/WO SUBTRACTION	652.15	106.05	546.10	XXX	N
.	78072	PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT	711.84	139.07	572.77	XXX	N
.	78075	ADRENAL IMAGING CORTEX &/MEDULLA	825.50	67.31	758.19	XXX	N
.	78099	UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78102	BONE MARROW IMAGING LIMITED AREA	310.52	47.63	262.89	XXX	N
.	78103	BONE MARROW IMAGING MULTIPLE AREAS	398.15	63.50	334.65	XXX	N
.	78104	BONE MARROW IMAGING WHOLE BODY	454.03	69.85	384.18	XXX	N
.	78110	PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE	126.37	14.61	111.76	XXX	N
.	78111	PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES	133.99	17.15	116.84	XXX	N
.	78120	RED CELL VOLUME DETERMINATION SPX 1 SAMPLING	129.54	17.78	111.76	XXX	N
.	78121	RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS	141.61	24.77	116.84	XXX	N
.	78122	WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU	173.36	38.10	135.26	XXX	N
.	78130	RED CELL SURVIVAL STUDY	226.06	45.72	180.34	XXX	N
.	78135	RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS	509.27	48.26	461.01	XXX	N
.	78140	LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE	199.39	45.72	153.67	XXX	N
.	78185	SPLEEN IMAGING ONLY W/WO VASCULAR FLOW	309.25	30.48	278.77	XXX	N
.	78191	PLATELET SURVIVAL STUDY	226.06	45.72	180.34	XXX	N
.	78195	LYMPHATICS & LYMPH NODES IMAGING	652.15	106.05	546.10	XXX	N
.	78199	UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED	BR	BR	BR	XXX	N	501.96
.	78201	LIVER IMAGING STATIC ONLY	348.62	38.10	310.52	XXX	N
.	78202	LIVER IMAGING W/VASCULAR FLOW	369.57	42.55	327.02	XXX	N
.	78205	LIVER IMAGING SPECT	386.08	60.33	325.75	XXX	N
.	78206	LIVER IMAGING SPECT W/VASCULAR FLOW	621.03	83.82	537.21	XXX	N
.	78215	LIVER & SPLEEN IMAGING STATIC ONLY	356.24	43.82	312.42	XXX	N
.	78216	LIVER & SPLEEN IMAGING W/VASCULAR FLOW	233.68	49.53	184.15	XXX	N
.	78226	HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER	604.52	66.04	538.48	XXX	N
.	78227	HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ	817.25	80.65	736.60	XXX	N
.	78230	SALIVARY GLAND IMAGING	319.41	41.28	278.13	XXX	N
.	78231	SALIVARY GLAND IMAGING SERIAL IMAGES	189.23	39.37	149.86	XXX	N
.	78232	SALIVARY GLAND FUNCTION STUDY	185.42	35.56	149.86	XXX	N
.	78258	ESOPHAGEAL MOTILITY	400.69	64.77	335.92	XXX	N
.	78261	GASTRIC MUCOSA IMAGING	370.21	52.07	318.14	XXX	N
.	78262	GASTROESOPHAGEAL REFLUX STUDY	441.33	59.69	381.64	XXX	N
.	78264	GASTRIC EMPTYING IMAGING STUDY	612.78	69.85	542.93	XXX	N
.	78265	GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT	727.08	87.00	640.08	XXX	N
.	78266	GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY	862.33	95.89	766.44	XXX	N
.	78267	UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS	19.49	XXX	N
.	78268	UREA BREATH TEST C-14 ISOTOPIC ANALYSIS	166.35	XXX	N
.	78278	ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING	638.81	88.27	550.54	XXX	N
.	78282	GASTROINTESTINAL PROTEIN LOSS	138.07	29.21	108.86	XXX	N
.	78290	INTESTINE IMAGING	605.16	60.33	544.83	XXX	N
.	78291	PERITONEAL-VENOUS SHUNT PATENCY TEST	469.27	76.84	392.43	XXX	N
.	78299	UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78300	BONE &/JOINT IMAGING LIMITED AREA	421.01	55.88	365.13	XXX	N
.	78305	BONE &/JOINT IMAGING MULTIPLE AREAS	513.08	74.30	438.78	XXX	N
.	78306	BONE &/JOINT IMAGING WHOLE BODY	553.09	76.20	476.89	XXX	N
.	78315	BONE &/JOINT IMAGING 3 PHASE STUDY	633.73	90.17	543.56	XXX	N
.	78320	BONE &/JOINT IMAGING TOMOGRAPHIC SPECT	418.47	91.44	327.03	XXX	N
.	78350	BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY	59.06	20.32	38.74	XXX	N
.	78351	BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR	27.94	XXX	N
.	78399	UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78414	CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM	134.23	40.01	94.22	XXX	N
.	78428	CARDIAC SHUNT DETECTION	335.92	67.95	267.97	XXX	N
.	78445	NONCARDIAC VASCULAR FLOW IMAGING	341.63	45.09	296.54	XXX	N
.	78451	MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS	620.40	121.29	499.11	XXX	N
.	78452	MYOCARDIAL SPECT MULTIPLE STUDIES	863.60	142.24	721.36	XXX	N
.	78453	MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS	557.53	89.54	467.99	XXX	N
.	78454	MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES	797.56	120.02	677.54	XXX	N
.	78456	ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE	567.06	87.63	479.43	XXX	N
.	78457	VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL	350.52	70.49	280.03	XXX	N
.	78458	VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL	375.92	81.28	294.64	XXX	N
.	78459	MYOCARDIAL IMAGING PET METABOLIC EVALUATION	755.52	127.64	627.88	XXX	N
.	78466	MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN	360.05	62.87	297.18	XXX	N
.	78468	MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ	373.38	71.12	302.26	XXX	N
.	78469	MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ	412.75	81.92	330.83	XXX	N
.	78472	CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS	418.47	87.00	331.47	XXX	N
.	78473	CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT	528.32	128.27	400.05	XXX	N
.	78481	CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT	321.31	87.00	234.31	XXX	N
.	78483	CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT	433.71	127.64	306.07	XXX	N
.	78491	MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS	811.14	128.27	682.87	XXX	N
.	78492	MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS	1015.04	161.93	853.11	XXX	N
.	78494	CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT	413.39	104.78	308.61	XXX	N
+	78496	CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT	79.38	43.82	35.56	ZZZ	N
.	78499	UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78579	PULMONARY VENTILATION IMAGING	340.36	43.18	297.18	XXX	N
.	78580	PULMONARY PERFUSION IMAGING PARTICULATE	436.25	66.04	370.21	XXX	N
.	78582	PULMONARY VENTILATION & PERFUSION IMAGING	612.14	95.25	516.89	XXX	N
.	78597	QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING	367.67	64.14	303.53	XXX	N
.	78598	QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN	558.80	74.30	484.50	XXX	N
.	78599	UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78600	BRAIN IMAGING <4 STATIC VIEWS	337.82	40.01	297.81	XXX	N
.	78601	BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW	396.88	45.72	351.16	XXX	N
.	78605	BRAIN IMAGING MINIMUM 4 STATIC VIEWS	364.49	48.26	316.23	XXX	N
.	78606	BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW	603.25	56.52	546.73	XXX	N
.	78607	BRAIN IMAGING TOMOGRAPHIC SPECT	634.37	106.68	527.69	XXX	N
.	78608	BRAIN IMAGING PET METABOLIC EVALUATION	1086.62	129.54	957.08	XXX	N
.	78609	BRAIN IMAGING PET PERFUSION EVALUATION	134.62	134.62	BR	XXX	N
.	78610	BRAIN IMAGING VASCULAR FLOW ONLY	320.04	27.31	292.73	XXX	N
.	78630	CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY	618.49	60.96	557.53	XXX	N
.	78635	CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY	620.40	55.88	564.52	XXX	N
.	78645	CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ	595.00	50.17	544.83	XXX	N
.	78647	CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT	636.91	81.28	555.63	XXX	N
.	78650	CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO	501.02	45.72	455.30	XXX	N
.	78660	RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY	334.01	47.63	286.38	XXX	N
.	78699	UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78700	KIDNEY IMAGING MORPHOLOGY	312.42	39.37	273.05	XXX	N
.	78701	KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW	397.51	43.82	353.69	XXX	N
.	78707	KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX	424.82	83.82	341.00	XXX	N
.	78708	KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX	323.22	106.68	216.54	XXX	N
.	78709	KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE	673.10	123.19	549.91	XXX	N
.	78710	KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC	324.49	49.53	274.96	XXX	N
.	78725	KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY	197.49	33.02	164.47	XXX	N
+	78730	URINARY BLADDER RESIDUAL STUDY	140.97	14.61	126.36	ZZZ	N
.	78740	URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM	399.42	49.53	349.89	XXX	N
.	78761	TESTICULAR IMAGING WITH VASCULAR FLOW	386.08	64.14	321.94	XXX	N
.	78799	UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	78800	RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA	356.24	60.96	295.28	XXX	N
.	78801	RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS	471.17	71.12	400.05	XXX	N
.	78802	RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY	589.92	74.93	514.99	XXX	N
.	78803	RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT	622.94	93.98	528.96	XXX	N
.	78804	RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY	1040.13	93.98	946.15	XXX	N
.	78805	RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA	336.55	64.77	271.78	XXX	N
.	78806	RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY	608.97	75.57	533.40	XXX	N
.	78807	RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT	622.94	93.98	528.96	XXX	N
.	78808	NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS	71.12	XXX	N	501.96
.	78811	PET IMAGING LIMITED AREA CHEST HEAD/NECK	1171.64	135.89	1035.75	XXX	N
.	78812	PET IMAGING SKULL BASE TO MID-THIGH	1422.21	167.01	1255.20	XXX	N
.	78813	PET IMAGING WHOLE BODY	1486.12	172.72	1313.40	XXX	N
.	78814	PET IMAGING CT FOR ATTENUATION LIMITED AREA	1640.81	191.77	1449.04	XXX	N
.	78815	PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	1810.83	214.63	1596.20	XXX	N
.	78816	PET IMAGING FOR CT ATTENUATION WHOLE BODY	1826.81	217.17	1609.64	XXX	N
.	78999	UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE	BR	BR	BR	XXX	N	501.96
.	79005	RP THERAPY ORAL ADMINISTRATION	248.29	158.75	89.54	XXX	N
.	79101	RP THERAPY INTRAVENOUS ADMINISTRATION	265.43	176.53	88.90	XXX	N
.	79200	RP THERAPY INRACAVITARY ADMINISTRATION	243.21	149.86	93.35	XXX	N
.	79300	RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN	240.98	121.29	119.69	XXX	N
.	79403	RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS	345.44	197.49	147.95	XXX	N
.	79440	RP THERAPY INTRA-ARTICULAR ADMINISTRATION	219.08	149.86	69.22	XXX	N
.	79445	RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN	376.56	207.01	169.55	XXX	N
.	79999	RP THERAPY UNLISTED PROCEDURE	BR	BR	BR	XXX	N	327.86

20 Miss. Code. R. 2-II

Amended 6/14/2017

Amended 6/15/2019.