| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$2,739.25 |
— |
| Abdomen 1 View (74018) |
— |
$278.50 |
— |
| Abdomen 2 views (74019) |
— |
$263.50 |
— |
| Angio internal mammary (75756) |
— |
$2,758.75 |
— |
| Angio pulmonary bilat (75743) |
— |
$3,103 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$3,463 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$3,103 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$3,103 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$7,245.75 |
— |
| Ankle 2 views (73600) |
— |
$202.50 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$7,892 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$7,892 |
— |
| Artery X-Rays Spine (75705) |
— |
$7,892 |
— |
| Arthrogram hip (73525) |
— |
$511.75 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$262.75 |
— |
| Bone age studies (77072) |
— |
$281.25 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,640.75 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,374.25 |
— |
| Bone marrow imaging limited area (78102) |
— |
$907.25 |
— |
| Bone survey infant (77076) |
— |
$273.25 |
— |
| Brachytx isodose complex (77318) |
— |
$725.75 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$982.75 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$3,391.75 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$983.25 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,570 |
— |
| Chest 1 view (71045) |
— |
$278.50 |
— |
| Chest 2 views (71046) |
— |
$294.50 |
— |
| Chest 3 views (71047) |
— |
$390 |
— |
| Clavicle complete (73000) |
— |
$354.25 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$190.25 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$403 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$3,551.50 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$548 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,532 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,322 |
— |
| CT abdomen w contrast (74160) |
— |
$2,471 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,789.50 |
— |
| CT Angio Chest (71275) |
— |
$2,653.50 |
— |
| CT Angio Head (70496) |
— |
$2,653.50 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,307.50 |
— |
| CT Angio Neck (70498) |
— |
$1,962.75 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,307.50 |
— |
| CT bone density (77078) |
— |
$162.25 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,151.25 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,921.75 |
— |
| CT chest w contrast (71260) |
— |
$2,471 |
— |
| CT head/brain with contrast (70460) |
— |
$2,310.25 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,717.25 |
— |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
— |
$125–$987.75 |
— |
| CT iac w contrast (70481) |
— |
$2,151 |
— |
| CT lower ext w/o (73700) |
— |
$2,081.75 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,104.50 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,330.50 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,081.75 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,762.75 |
— |
| CT neck tissue combo (70492) |
— |
$2,471 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,921.75 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,743.75 |
— |
| CT scan of leg combo (73702) |
— |
$2,137.75 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,081.75 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,359.75 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,081.75 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,161.50 |
— |
| CT upper ext wo (73200) |
— |
$1,434.50 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,165.75 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,081.75 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,962.75 |
— |
| Cta Abdomen (74175) |
— |
$1,962.75 |
— |
| CTA pelvis (72191) |
— |
$1,183.25 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$342.75 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$739.25 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,408.25 |
— |
| Follow-Up Angiography (75898) |
— |
$6,726.25 |
— |
| Foot 2 views (73620) |
— |
$199.25 |
— |
| Forearm 2 views (73090) |
— |
$335.25 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,391.75 |
— |
| Hand 2 views (73120) |
— |
$177.25 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$7,892 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,001.50 |
— |
| Hysterosalpingogram (74740) |
— |
$838.50 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$393 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,493.25 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,682.50 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,406.25 |
— |
| Knee 3 Views (73562) |
— |
$354.25 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$1,001 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,677.50 |
— |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
— |
$3,245.75 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$1,298.50 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$6,876 |
— |
| MRA head w/o contrast (70544) |
— |
$2,270.50 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,270.50 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,763 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,080.25 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,383.50 |
— |
| MRI chest wo w contrast (71552) |
— |
$2,870 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,465.25 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,465.25 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,465.25 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,080.25 |
— |
| Myelogram cervical (72240) |
— |
$813.75 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,145.75 |
— |
| Neck soft tissue (70360) |
— |
$327 |
— |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
— |
$663 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$585.75 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$3,513.25 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$1,480.50 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$408 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$237 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$354.50 |
— |
Radex abscess/fistula/sinus tract rs&i (76080)
range across 2 matching MRF lines |
— |
$914.50–$938 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$361 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$298.50 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$335.25 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$483.50 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$312.50 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$335.25 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$335.25 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$335.25 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$519.25 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$371.25 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$463 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$354.25 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$180.25 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$335.25 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$367.25 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$263.25 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$335.25 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$361 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$446.50 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$263.50 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$959.75 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$308.25 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$371.25 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$554.25 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$780 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,218 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$301.25 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$324.75 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$335.25 |
— |
| Ribs bilateral 3 views (71110) |
— |
$924.25 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$863.25 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,237 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$3,184.25 |
— |
| Scapula (73010) |
— |
$335.25 |
— |
| Shoulder 1 view (73020) |
— |
$91.75 |
— |
| Skull less than 4 views (70250) |
— |
$354.25 |
— |
| Sternoclavicular joints (71130) |
— |
$335.25 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$2,758.75 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$403 |
— |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
— |
$143–$513.50 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$117 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$328.75 |
— |
Ultrasound, abdomen limited (76705)
range across 4 matching MRF lines |
— |
$291.50–$1,018.75 |
— |
| Unlisted us procedure (76999) |
— |
$141.75 |
— |
| Upper gi w/o kub (74240) |
— |
$600 |
— |
| Urethrocystography retrograde (74450) |
— |
$464.25 |
— |
| Us breast unilateral complete (76641) |
— |
$513.50 |
— |
Us chest (76604)
range across 2 matching MRF lines |
— |
$281.25–$291.50 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$563.50 |
— |
Us ob limited 1 or more fetuses (76815)
range across 3 matching MRF lines |
— |
$291.50–$644.50 |
— |
Us ob transvaginal (76817)
range across 2 matching MRF lines |
— |
$291.50–$1,153.75 |
— |
| Us pelvic non ob complete (76856) |
— |
$739.25 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,153.75 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,218.25 |
— |
| Us scrotum and contents (76870) |
— |
$722.75 |
— |
| Us thyroid (76536) |
— |
$817.75 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$2,758.75 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$7,245.75 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,758.75 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,305.25 |
— |
| Venography Renal Bilateral (75833) |
— |
$7,892 |
— |
| Venography Renal Unilateral (75831) |
— |
$7,892 |
— |
| Venous sampling by catheter (75893) |
— |
$7,892 |
— |
| Wrist 2 views (73100) |
— |
$361 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$354.25 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$3,665.50 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$169.25 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$216 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$645.50 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$967 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$126.75 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$403 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$256.25 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$277.50 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$527.50 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$371.25 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$645.50 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$738.50 |
— |
| X-ray humerus (73060) |
— |
$298.50 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,158.25 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$460.75 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$426.50 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$169.25 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,200 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$371.25 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$354.25 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$519.25 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$481.25 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$602.50 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$337 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$645.50 |
— |
| Xr orbits complete 4 views (70200) |
— |
$426.50 |
— |