| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$10,261 |
— |
| Abdomen 1 View (74018) |
— |
$345.25 |
— |
| Abdomen 2 views (74019) |
— |
$491.25 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,858.75 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$5,627 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$5,627 |
— |
| Ankle 2 views (73600) |
— |
$480 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$16,801.50 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$16,801.50 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$16,801.50 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,039.25 |
— |
| Bone age studies (77072) |
— |
$569.25 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,489.25 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,256.75 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,503.25 |
— |
| Bone survey infant (77076) |
— |
$545 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$3,646.25 |
— |
| Chest 1 view (71045) |
— |
$266.25 |
— |
| Chest 2 views (71046) |
— |
$350.75 |
— |
| Clavicle complete (73000) |
— |
$557 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$287.25 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,266.25 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$5,627 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,332.75 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,805.75 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,568.25 |
— |
| CT abdomen w contrast (74160) |
— |
$3,406 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,733.25 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,847.50 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$7,020.25 |
— |
| CT Angio Chest (71275) |
— |
$3,607 |
— |
| CT Angio Head (70496) |
— |
$3,854 |
— |
| CT angio hrt w/3d image (75574) |
— |
$4,840 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$4,008.50 |
— |
| CT Angio Neck (70498) |
— |
$3,898.25 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$5,373 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,168.50 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,276.25 |
— |
| CT chest w contrast (71260) |
— |
$2,434.75 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,361.75 |
— |
| CT colonography screening (74263) |
— |
$1,072 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$1,678.25 |
— |
| CT head/brain with contrast (70460) |
— |
$2,444.50 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,666.75 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,317.50 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$82.50 |
— |
| CT iac w contrast (70481) |
— |
$4,721.75 |
— |
| CT lower ext w/o (73700) |
— |
$2,917.50 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,432 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,616 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,287.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,889.75 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$3,159 |
— |
| CT neck tissue combo (70492) |
— |
$3,675.25 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$6,926.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,059 |
— |
| CT pelvis w/o contrast (72192) |
— |
$7,201.75 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,568.25 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,005.50 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,251.75 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,363.25 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,405.75 |
— |
| CT upper ext wo (73200) |
— |
$3,236 |
— |
| CT upper extremity with contrast (73201) |
— |
$5,295.50 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,143.50 |
— |
| Cta Abdomen (74175) |
— |
$4,145.25 |
— |
| CTA pelvis (72191) |
— |
$2,934.25 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$571.25 |
— |
| Dxa Bone Density Axial (77080) |
— |
$858.50 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$612 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$2,075.50 |
— |
| Esophagram (74220) |
— |
$948.75 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$766.50 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$3,390 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$882.75 |
— |
| Foot 2 views (73620) |
— |
$286 |
— |
| Forearm 2 views (73090) |
— |
$460 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,686.25 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,796.50 |
— |
| Hand 2 views (73120) |
— |
$371.75 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$9,097.50 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$7,239.50 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,177.25 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$4,177.25 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,653.75 |
— |
| Hysterosalpingogram (74740) |
— |
$1,385 |
— |
| Image fusion (77399) |
— |
$925 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,113.75 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$894.25 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,802.25 |
— |
| Kidney Imaging Morphol (78700) |
— |
$2,832 |
— |
| Knee 3 Views (73562) |
— |
$464.50 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,074 |
— |
| Lymph System Imaging (78195) |
— |
$2,601 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,104.75 |
— |
| Magnetic Resonance Elastography (76391) |
— |
$2,293 |
— |
| Meckels Divert Exam (78290) |
— |
$1,630.25 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$2,936.75 |
— |
| MRA head w/o contrast (70544) |
— |
$3,738.75 |
— |
| MRA head with contrast (70545) |
— |
$4,027.75 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,804.25 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,872.50 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,107.25 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,594.75 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,342.25 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,747 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$4,256.75 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$2,968.75 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,419.75 |
— |
| MRI chest w/o contrast (71550) |
— |
$4,069 |
— |
| MRI chest wo w contrast (71552) |
— |
$5,391.50 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,966.25 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,523.75 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,905 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,021.25 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,550.25 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$5,671.25 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$5,435.25 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,435.25 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,419.75 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,646.25 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$5,561 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,075.50 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,834.50 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,374 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,590.25 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,101.50 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,330.50 |
— |
| Neck soft tissue (70360) |
— |
$542.50 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$10,526.50 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$3,126.25 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$301.50 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$16,558.50 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$482.50 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,819.75 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$568.25 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$307 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$436.25 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$754.25 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$301.50 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$455.50 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$450.50 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$341.50 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$436.25 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$374.75 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$427.25 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$246 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$479 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$361.75 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$542.50 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$540.50 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$15,606 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,740.25 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$761 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,643.75 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,231.50 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$504.75 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$353.75 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,080 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$597.25 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,247 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$267.75 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$419.25 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$517 |
— |
| Ribs bilateral 3 views (71110) |
— |
$636.50 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,893 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$3,600.75 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$1,647.25 |
— |
| Scapula (73010) |
— |
$463 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$198.75 |
— |
| Shoulder 1 view (73020) |
— |
$321.75 |
— |
| Skull less than 4 views (70250) |
— |
$533.50 |
— |
| Special Physics Consult (77370) |
— |
$1,714.50 |
— |
| Special teletherapy port plan (77321) |
— |
$2,589.75 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$13,666.25 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$3,338.25 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$1,697.50 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$1,773 |
— |
| Thoracic spine 2 views (72070) |
— |
$355.75 |
— |
| Thoracic spine 3 views (72072) |
— |
$543.50 |
— |
| Thoracolumbar 2 views (72080) |
— |
$389.50 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,897.75 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$2,217.75 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$1,495.75 |
— |
| Tx devices design & construction simple (77332) |
— |
$1,298 |
— |
| Ultrasound Breast Limited (76642) |
— |
$1,516 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,365.25 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,036.25 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$571.25 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$3,841.50 |
— |
| Upper gi w/o kub (74240) |
— |
$1,121.25 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,543.50 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,652.25 |
— |
| Us breast unilateral complete (76641) |
— |
$987.25 |
— |
| Us chest (76604) |
— |
$981 |
— |
| Us exam, pelvic, limited (76857) |
— |
$916.25 |
— |
| Us head (76506) |
— |
$891 |
— |
| Us kidney transplant (76776) |
— |
$1,067.75 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,025.75 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,606.75 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$792.50 |
— |
| Us ob transvaginal (76817) |
— |
$882.75 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,458.50 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,007.50 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$801 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,205.25 |
— |
| Us retroperitoneal limited (76775) |
— |
$748.75 |
— |
| Us scrotum and contents (76870) |
— |
$1,064.75 |
— |
| Us spinal canal and contents (76800) |
— |
$1,194.25 |
— |
| Us thyroid (76536) |
— |
$1,064.75 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$3,803.25 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,976.25 |
— |
| Venography Renal Unilateral (75831) |
— |
$6,252 |
— |
| Wrist 2 views (73100) |
— |
$410.50 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$374.75 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$5,627 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$438.25 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$327.25 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,703.50 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$298.50 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$823.25 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$199.25 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$301.50 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$504.75 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$320.50 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$320.50 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$492.25 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$596 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$958.75 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$569.25 |
— |
| X-ray eye for foreign body (70030) |
— |
$642.75 |
— |
| X-ray humerus (73060) |
— |
$419.25 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$474 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$352.75 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$438.25 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$531.25 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$711 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$663.25 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$422.75 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$873.75 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$658.25 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$474 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$287.25 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$568.25 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$869.50 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$540.50 |
— |
| Xr orbits complete 4 views (70200) |
— |
$674.25 |
— |