| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$2,739.25 |
— |
| Abdomen 2 views (74019) |
— |
$263.50 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$3,463 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$3,103 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$2,758.75 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$3,103 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$3,103 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$7,892 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$7,892 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$6,726.25 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$7,245.75 |
— |
| Ankle 2 views (73600) |
— |
$202.50 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$3,665.50 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$3,551.50 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$7,892 |
— |
| Arthrogram hip (73525) |
— |
$511.75 |
— |
| Arthrography knee lt (73580) |
— |
$548 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$262.75 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$1,374.25 |
— |
| Bone age studies (77072) |
— |
$281.25 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,640.75 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$907.25 |
— |
| Brachytx isodose complex (77318) |
— |
$725.75 |
— |
| Brain image w/flow 4 + views (78606) |
— |
$982.75 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$3,391.75 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$371.25 |
— |
| Chest 1 view (71045) |
— |
$278.50 |
— |
| Chest 3 views (71047) |
— |
$390 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$780 |
— |
| 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 |
— |
| 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 angiography upper extremity lt (73206) |
— |
$2,307.50 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,921.75 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,151.25 |
— |
| CT chest with 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) |
— |
$556.38 |
— |
| CT iac w contrast (70481) |
— |
$2,151 |
— |
| CT limited/localized follow up study (76380) |
— |
$983.25 |
— |
| CT lower ext w/o (73700) |
— |
$2,081.75 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$2,137.75 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,104.50 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,081.75 |
— |
| CT lumbar spine with contrast (72132) |
— |
$2,330.50 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,762.75 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,081.75 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,921.75 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$2,743.75 |
— |
| CT scan for measuring calcium and other minerals in bone (77078) |
— |
$162.25 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$2,471 |
— |
| 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 extremity w/o & w/contrast material (73202) |
— |
$2,165.75 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,434.50 |
— |
| 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 chest (71275) |
— |
$2,653.50 |
— |
| Cta Head (70496) |
— |
$2,653.50 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$2,307.50 |
— |
| Cta Neck (70498) |
— |
$1,962.75 |
— |
| Cta Pelvis (72191) |
— |
$1,183.25 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$342.75 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,408.25 |
— |
| 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 |
— |
| Hand 3 views (73130) |
— |
$335.25 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$7,892 |
— |
| Ht muscle image spect sing (78451) |
— |
$3,001.50 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$298.50 |
— |
| Hysterosalpingogram (74740) |
— |
$838.50 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,493.25 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$1,406.25 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$1,682.50 |
— |
| Knee 3 views (73562) |
— |
$354.25 |
— |
| Liver & spleen imaging static only (78215) |
— |
$1,677.50 |
— |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
— |
$1,298.50 |
— |
| Lymphangiography extremity only bilateral rs&i (75803) |
— |
$3,245.75 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$6,876 |
— |
| MRA head w/o contrast (70544) |
— |
$2,270.50 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,270.50 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$1,763 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$2,383.50 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$2,870 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,465.25 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$3,080.25 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$3,080.25 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,465.25 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,465.25 |
— |
| 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 |
— |
| Nm cisternogram (78630) |
— |
$1,570 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$1,001 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$3,513.25 |
— |
| Osseous survey infant (77076) |
— |
$273.25 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$1,480.50 |
— |
| Parathyroid imaging (78070) |
— |
$408 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$237 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$2,758.75 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$926.25 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$645.50 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$256.25 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$519.25 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$446.50 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$278.50 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$263.50 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$294.50 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,218 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$600 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$301.25 |
— |
| Ribs bilateral 3 views (71110) |
— |
$924.25 |
— |
| 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 |
— |
| Scanogram (77073) |
— |
$337 |
— |
| Scapula complete (73010) |
— |
$335.25 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$585.75 |
— |
| Small bowel series (74250) |
— |
$554.25 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$2,758.75 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$403 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$863.25 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,018.75 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$141.75 |
— |
| Upper Extremity Infant (73092) |
— |
$335.25 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$464.25 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,158.25 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$328.75 |
— |
| Us breast unilateral complete (76641) |
— |
$513.50 |
— |
| Us breast unilateral limited (76642) |
— |
$513.50 |
— |
| Us chest (76604) |
— |
$286.38 |
— |
| Us elastography parenchyma (76981) |
— |
$117 |
— |
| Us guided compression repair (76936) |
— |
$739.25 |
— |
| Us infant hips limited static (76886) |
— |
$393 |
— |
| Us ob transvaginal (76817) |
— |
$722.62 |
— |
| Us pelvic non ob complete (76856) |
— |
$739.25 |
— |
| Us pregnancy ltd (76815) |
— |
$644.50 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$1,153.75 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,218.25 |
— |
| Us scrotum and contents (76870) |
— |
$722.75 |
— |
| Us soft tissue head/neck (76536) |
— |
$817.75 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$563.50 |
— |
| Venogram extremity bilateral (75822) |
— |
$2,758.75 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,305.25 |
— |
| Venography Renal Bilateral (75833) |
— |
$7,892 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$7,892 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$7,245.75 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$7,892 |
— |
| Wrist 2 views (73100) |
— |
$361 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$354.50 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$354.25 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$361 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$959.75 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$216 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$335.25 |
— |
| 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 3-4 Views (73522) |
— |
$277.50 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$527.50 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$483.50 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$335.25 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$298.50 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$308.25 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$460.75 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$335.25 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$426.50 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$169.25 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$371.25 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$169.25 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$426.50 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$371.25 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$602.50 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$463 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$738.50 |
— |
| 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 Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$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 Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$354.25 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$180.25 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$335.25 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$335.25 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$263.25 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$361 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$645.50 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$312.50 |
— |
| Xr shoulder 1 view (73020) |
— |
$91.75 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$645.50 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$335.25 |
— |
| Xr tmj bilateral (70330) |
— |
$367.25 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$324.75 |
— |