| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$7,425.35 |
— |
| Abdomen 1 View (74018) |
— |
$308 |
— |
| Abdomen 2 views (74019) |
— |
$432.75 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,030.25 |
— |
| Angio internal mammary (75756) |
— |
$10,852.40 |
— |
| Angio pulmonary bilat (75743) |
— |
$10,852.40 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$10,852.40 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$6,283.50 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,082.95 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$9,948.05 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$5,505.95 |
— |
| Ankle 2 views (73600) |
— |
$290.65 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$18,041.15 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$7,916.35 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$5,505.95 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$7,916.35 |
— |
| Arthrogram ankle (73615) |
— |
$1,449.20 |
— |
| Arthrogram hip (73525) |
— |
$706.75 |
— |
| Arthrogram Wrist (73115) |
— |
$1,206.60 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$729.05 |
— |
| Bone age studies (77072) |
— |
$223.80 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,004.85 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,205.85 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,451.90 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,577 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,361.40 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$1,975.85 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$2,279 |
— |
| Bone survey infant (77076) |
— |
$538.65 |
— |
| Brain Flow Imaging Only (78610) |
— |
$1,634.95 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$2,021.05 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$1,176.60 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$5,640.45 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$3,027.65 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,303.80 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$2,007.20 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$2,064.85 |
— |
| Chest 1 view (71045) |
— |
$269.50 |
— |
| Chest 2 views (71046) |
— |
$308 |
— |
| Chest 3 views (71047) |
— |
$505.45 |
— |
| Chest 4 or more views (71048) |
— |
$642.35 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$1,373.10 |
— |
| Clavicle complete (73000) |
— |
$240.25 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$410.95 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$793.70 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$7,405.55 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$706.75 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$1,178.80 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,281.05 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$462.35 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,186.80 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$2,442.10 |
— |
| CT abdomen w contrast (74160) |
— |
$2,266.05 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,545.65 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,691.60 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,529.70 |
— |
| CT Angio Chest (71275) |
— |
$2,631.55 |
— |
| CT Angio Head (70496) |
— |
$2,675 |
— |
| CT angio hrt w/3d image (75574) |
— |
$2,879.30 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,532.65 |
— |
| CT Angio Neck (70498) |
— |
$2,676.55 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,225.85 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$3,228.50 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,888.05 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,270.60 |
— |
| CT chest w contrast (71260) |
— |
$2,294.60 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,266.95 |
— |
| CT colonography screening (74263) |
— |
$4,994.45 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$5,153.40 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$2,873.30 |
— |
| CT head/brain with contrast (70460) |
— |
$2,567.95 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,639.60 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$1,867.40 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$699 |
— |
| CT hrt w/3d image congen (75573) |
— |
$3,566.20 |
— |
| CT iac w contrast (70481) |
— |
$2,794.45 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,865.25 |
— |
| CT lower ext w/o (73700) |
— |
$2,032.80 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,246.90 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,616.50 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,804.90 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,265.35 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,771 |
— |
| CT neck tissue combo (70492) |
— |
$2,729.05 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,086.85 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,286.40 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,300.85 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,863.40 |
— |
| CT scan of leg combo (73702) |
— |
$3,298.55 |
— |
| CT scans face/jaw combo (70488) |
— |
$4,164.45 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,293.10 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,866.50 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,773.25 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,726.35 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$4,391.40 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,633.95 |
— |
| CT unlisted procedure (76497) |
— |
$3,212.35 |
— |
| CT upper ext wo (73200) |
— |
$1,927.05 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,945.40 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,377.10 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,726.75 |
— |
| Cta Abdomen (74175) |
— |
$2,037.15 |
— |
| CTA pelvis (72191) |
— |
$3,607.05 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$6,588.60 |
— |
| Diskography lumbar (72295) |
— |
$7,187.55 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$368.20 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$448.50 |
— |
| Dxa Bone Density Axial (77080) |
— |
$390.75 |
— |
| Dxa bone density study (77085) |
— |
$317.40 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$167.20 |
— |
| Echo exam of fetal heart (76825) |
— |
$1,531 |
— |
| Echo exam uterus (76831) |
— |
$653.35 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,370.40 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$963.45 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,370.80 |
— |
| Esophagram (74220) |
— |
$761.10 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$949.10 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$759.30 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$708.40 |
— |
| Follow-Up Angiography (75898) |
— |
$5,505.95 |
— |
| Foot 2 views (73620) |
— |
$267.30 |
— |
| Forearm 2 views (73090) |
— |
$223.30 |
— |
| Gastric emptying imaging study (78264) |
— |
$2,014.10 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$1,418.85 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,777.50 |
— |
| Gated Heart, Multiple (78473) |
— |
$2,143.65 |
— |
| Hand 2 views (73120) |
— |
$208.95 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$12,480.30 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$12,138.15 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,736.25 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,993.35 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$2,748.95 |
— |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
— |
$1,759.70 |
— |
| Hysterosalpingogram (74740) |
— |
$934.75 |
— |
| Image fusion (77399) |
— |
$956.35 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$861.05 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$622.95 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$3,369.10 |
— |
| Joint Survey Single View (77077) |
— |
$251 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$2,009.50 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,751.20 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,653.85 |
— |
| Kidney Imaging Morphol (78700) |
— |
$1,369.35 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$1,443 |
— |
| Knee 3 Views (73562) |
— |
$360.35 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$1,444.25 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,717.90 |
— |
| Liver imaging static only (78201) |
— |
$1,885.35 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$2,121 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$3,087.60 |
— |
| Lung perfusion differential (78597) |
— |
$1,128.15 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,910.30 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,898.15 |
— |
| Lymph System Imaging (78195) |
— |
$2,016.40 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,369.70 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
— |
$3,640.15 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
— |
$2,356.65 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
— |
$4,004.05 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,570.85 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$815 |
— |
| Meckels Divert Exam (78290) |
— |
$2,018.75 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$1,997.40 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,633.50 |
— |
| MRA head w/o contrast (70544) |
— |
$3,023.75 |
— |
| MRA head with contrast (70545) |
— |
$3,229.50 |
— |
| MRA neck w contrast (70548) |
— |
$3,215.50 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,665.45 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,039.75 |
— |
| MRI abdomen w contrast (74182) |
— |
$2,791.40 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,364.70 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$4,074.30 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,917.90 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,906 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,350.05 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$2,509.50 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$4,083.35 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,042 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,180.80 |
— |
| MRI chest w/o contrast (71550) |
— |
$4,639.90 |
— |
| MRI chest with contrast (71551) |
— |
$5,028.15 |
— |
| MRI chest wo w contrast (71552) |
— |
$6,327.10 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,947.90 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$2,995.80 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,704.25 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,042 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$3,412.65 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,477.55 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,904.95 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,058.85 |
— |
| MRI pelvis w contrast (72196) |
— |
$2,947.90 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$3,571 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,752.15 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,127.20 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$4,366.70 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,127.75 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$5,320.55 |
— |
| MRI, abdomen, combo (74183) |
— |
$2,985.80 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,401.90 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,042 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,296 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,102.30 |
— |
| MRI, lumbar spine combo (72158) |
— |
$3,398.80 |
— |
| Myelogram cervical (72240) |
— |
$1,373.10 |
— |
| Myelogram Lumbar (72265) |
— |
$1,373.10 |
— |
| Myelography thoracic (72255) |
— |
$1,373.10 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,270.70 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$2,285.40 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$7,781.50 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,877.90 |
— |
| Neck soft tissue (70360) |
— |
$258.70 |
— |
| Nm csf leak detection (78650) |
— |
$2,534.50 |
— |
| Nm myocard infarct spect (78469) |
— |
$2,639.60 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$584.20 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$10,084.40 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$759.70 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$884.90 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$481.70 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$304.15 |
— |
| Optic foramina (70190) |
— |
$501.85 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,767.25 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$2,753.05 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$318.80 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$5,640.45 |
— |
| PET image w/CT, full body (78816) |
— |
$5,820.85 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$5,751.65 |
— |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
— |
$4,980.15 |
— |
| Pet Myocardial Sngl Study (78491) |
— |
$5,640.45 |
— |
| PET whole body (78813) |
— |
$5,640.45 |
— |
| Proton trmt simple w/comp (77522) |
— |
$3,880.10 |
— |
| Proton tx delivery complex (77525) |
— |
$4,694.90 |
— |
| Proton tx delivery intermediate (77523) |
— |
$4,268.15 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$1,759.70 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$12,535.45 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,372.70 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$412.10 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,067.30 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$306.65 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$224.85 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$317.25 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$673.70 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$194.05 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$329.55 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$297.20 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$449.15 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$972.30 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$369.50 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$365 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$309.55 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$235.60 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$3,001.10 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$280.35 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$365.35 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$738.10 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$166.10 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$592.80 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$298.75 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$467.85 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$34,277 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$1,355.50 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$1,553.15 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,762.65 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$756.20 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$546.10 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,273.50 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$897 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$393.85 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$525.60 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$942.95 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$657.55 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$717.05 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$217.30 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$260.05 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$266.40 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$558.60 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$300.30 |
— |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
— |
$1,340.35 |
— |
| Renal Cyst Study (74470) |
— |
$929.90 |
— |
| Ribs bilateral 3 views (71110) |
— |
$635.55 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,306.95 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,313.50 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$3,479.15 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,492.90 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$2,044.30 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$4,214 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$4,835.55 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$3,405.10 |
— |
| Salivary Gland Function Study (78232) |
— |
$1,221.30 |
— |
| Salivary Gland Imaging (78230) |
— |
$1,762.20 |
— |
| Scapula (73010) |
— |
$402.50 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$115.75 |
— |
| Sella turcica (70240) |
— |
$419.45 |
— |
| Shoulder 1 view (73020) |
— |
$160.55 |
— |
| Shoulder Arthrography (73040) |
— |
$1,064.45 |
— |
Sialogram (70390)
range across 2 matching MRF lines |
— |
$1,440–$2,159.15 |
— |
| Skull less than 4 views (70250) |
— |
$358.80 |
— |
| Special dosimetry (77331) |
— |
$426.10 |
— |
| Special Physics Consult (77370) |
— |
$1,307.30 |
— |
| Special teletherapy port plan (77321) |
— |
$1,653.10 |
— |
| Special treatment procedure (77470) |
— |
$2,073.70 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$8,917 |
— |
| Sternoclavicular joints (71130) |
— |
$381.85 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$909 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$835.10 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$866.45 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,852.10 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$2,847 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$2,498.60 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$1,555 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$819.50 |
— |
| Thoracic spine 2 views (72070) |
— |
$383.45 |
— |
| Thoracic spine 3 views (72072) |
— |
$497.45 |
— |
| Thoracolumbar 2 views (72080) |
— |
$386.10 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,169.70 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$1,841.05 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,362.75 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,467.30 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$1,307.30 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$1,224.30 |
— |
| Tx devices design & construction simple (77332) |
— |
$900.25 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$429.05–$429.90 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$552.20 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$646.70 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$318.65 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$487.25 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$208.95 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$390.75 |
— |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
— |
$3,358.35–$6,753.25 |
— |
| Unlisted us procedure (76999) |
— |
$442.20 |
— |
| Upper gi w/o kub (74240) |
— |
$983.40 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,764.15 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,394.50 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,038.60 |
— |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
— |
$463.70–$475.50 |
— |
| Us chest (76604) |
— |
$474.35 |
— |
| Us complete joint (76881) |
— |
$681.10 |
— |
| Us exam, pelvic, limited (76857) |
— |
$371.15 |
— |
| Us head (76506) |
— |
$1,074.95 |
— |
| Us kidney transplant (76776) |
— |
$935.75 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines |
— |
$596.40–$621.25 |
— |
| Us ob detailed single fetus (76811) |
— |
$894.35 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$409.75 |
— |
| Us ob transvaginal (76817) |
— |
$467.85 |
— |
| Us pelvic non ob complete (76856) |
— |
$601.25 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$578.65 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$567.55 |
— |
| Us retroperitoneal complete (76770) |
— |
$600.80 |
— |
| Us retroperitoneal limited (76775) |
— |
$520.15 |
— |
| Us scrotum and contents (76870) |
— |
$703.80 |
— |
| Us spinal canal and contents (76800) |
— |
$1,038.30 |
— |
| Us thyroid (76536) |
— |
$632.95 |
— |
| Us transrectal (76872) |
— |
$484.50 |
— |
| Vascular Flow Imaging (78445) |
— |
$1,065.90 |
— |
| Vein X-Ray Chest (75827) |
— |
$2,749.95 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$5,505.95 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$10,852.40 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$9,948.05 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$10,852.40 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$4,717.80 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,749.95 |
— |
| Venography Renal Bilateral (75833) |
— |
$10,852.40 |
— |
| Venography Renal Unilateral (75831) |
— |
$9,948.05 |
— |
| Venous sampling by catheter (75893) |
— |
$18,041.15 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$173.05 |
— |
| Wrist 2 views (73100) |
— |
$189.45 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$321.90 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$2,067.30 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$10,852.40 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$426.40 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$260.25 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$774.95 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$199.30 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$359.90 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$393.75 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$308 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$308 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$317.15 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$365 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$380.25 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$390 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$575.95 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$308 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$788.50 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$378.85 |
— |
| X-ray eye for foreign body (70030) |
— |
$262.40 |
— |
| X-ray humerus (73060) |
— |
$343.85 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,052.40 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$288.15 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$263.35 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$417.35 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$736.05 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$677.75 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$414.05 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$206.06 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$401.95 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$488.15 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$781.20 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$852.05 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$783.50 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$320.30 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$502.75 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$514.35 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$471.25 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$435.05 |
— |
| Xr orbits complete 4 views (70200) |
— |
$564.30 |
— |