| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$11,618.40 |
— |
| Abdomen 2 views (74019) |
— |
$529.90 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$5,654.25 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$7,672.55 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$9,911.60 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,607.75 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$7,672.55 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$12,117.15 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$9,911.60 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,607.75 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$12,754.85 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$11,780.25 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$3,364.15 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,318 |
— |
| Ankle 2 views (73600) |
— |
$380.55 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$1,461.55 |
— |
| Aortogram thoracic (75605) |
— |
$12,754.85 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$8,056.15 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$7,672.55 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$3,318 |
— |
| Arthrogram elbow (73085) |
— |
$835.75 |
— |
| Arthrogram hip (73525) |
— |
$796.20 |
— |
| Arthrogram shoulder (73040) |
— |
$1,065 |
— |
| Arthrogram wrist (73115) |
— |
$835.75 |
— |
| Arthrography knee lt (73580) |
— |
$1,118.05 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,768.45 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$3,948.65 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$4,005 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$6,864.90 |
— |
| Bone age studies (77072) |
— |
$722.35 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$5,536 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$2,521.50 |
— |
| Bone survey complete (77075) |
— |
$1,836.45 |
— |
| Brachytx isodose complex (77318) |
— |
$6,378.75 |
— |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
— |
$2,237.15 |
— |
| Brain image w/flow 4 + views (78606) |
— |
$3,427 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$2,627.80 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$9,469.15 |
— |
| Brain Imaging Vascular Flow Only (78610) |
— |
$2,029.10 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$1,743.50 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$3,900.65 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$5,326.95 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$380.55 |
— |
| Chest 1 view (71045) |
— |
$421.90 |
— |
| Chest 3 views (71047) |
— |
$572.25 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$929 |
— |
| Clavicle complete (73000) |
— |
$461.70 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,232.45 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,995.50 |
— |
| Corpora cavernosography (74445) |
— |
$638.25 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,505 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,349.45 |
— |
| CT abdomen w contrast (74160) |
— |
$3,926.65 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,708.50 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,411.95 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,373.15 |
— |
| CT angiography upper extremity lt (73206) |
— |
$3,091.70 |
— |
| CT c-spine w/o contrast (72125) |
— |
$2,513.35 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$3,091.70 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,933.15 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,284.95 |
— |
| CT chest with contrast (71260) |
— |
$3,221.35 |
— |
| CT colonography screening (74263) |
— |
$2,006 |
— |
| CT colonography w/dye (74262) |
— |
$3,381.20 |
— |
| CT colonography w/o cntrst (74261) |
— |
$2,298.95 |
— |
| CT head/brain with contrast (70460) |
— |
$2,933.15 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,415.20 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,092.35 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$1,015.45 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,933.15 |
— |
| CT iac w contrast (70481) |
— |
$2,933.15 |
— |
| CT limited/localized follow up study (76380) |
— |
$975.70 |
— |
| CT lower ext w/o (73700) |
— |
$1,158.50 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$3,091.70 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,933.15 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$3,091.70 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,351.05 |
— |
| CT lumbar spine with contrast (72132) |
— |
$2,749.80 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,373.15 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,813.45 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,400.90 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,159.75 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$3,091.70 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,035.70 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$3,091.70 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,492.15 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$4,830.80 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,140.40 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,449.05 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,413.45 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$3,091.70 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,803.80 |
— |
| CT unlisted procedure (76497) |
— |
$4,462.92 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,091.70 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$2,461.45 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,933.15 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,473.35 |
— |
| Cta Abdomen (74175) |
— |
$3,927.75 |
— |
| CTA abdomen pelvis (74174) |
— |
$6,888.40 |
— |
| CTA chest (71275) |
— |
$3,790.70 |
— |
| Cta Head (70496) |
— |
$3,221.90 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$3,091.70 |
— |
| Cta Neck (70498) |
— |
$3,221.90 |
— |
| Cta Pelvis (72191) |
— |
$3,091.70 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$744.95 |
— |
| Diskogram cervical (72285) |
— |
$4,827.40 |
— |
| Diskography lumbar (72295) |
— |
$5,081.50 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$2,048.55 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$1,285.20 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$298.45 |
— |
| Dxa bone density study axial skeleton (77085) |
— |
$1,515.35 |
— |
| Echo exam of fetal heart (76825) |
— |
$3,288.55 |
— |
| Echoencephalography real time imaging (76506) |
— |
$2,008.90 |
— |
| Esophagus (74220) |
— |
$913.25 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$2,085.20 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,694.35 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,805.45 |
— |
| Foot 2 views (73620) |
— |
$376.30 |
— |
| Forearm 2 views (73090) |
— |
$380.55 |
— |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
— |
$260.10 |
— |
| Functional MRI brain by phys/psych (70555) |
— |
$2,298.95 |
— |
| Functional MRI brain by tech (70554) |
— |
$2,298.95 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,908.20 |
— |
| Hand 2 views (73120) |
— |
$363.05 |
— |
| Hand 3 views (73130) |
— |
$466.40 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
— |
$8,919.80 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
— |
$13,815.15 |
— |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
— |
$17,816.15 |
— |
| Heart Infarct Image (78466) |
— |
$2,686.65 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$7,288.90 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$5,740.15 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$3,754.10 |
— |
| Ht muscle image spect sing (78451) |
— |
$5,893.55 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$380.55 |
— |
| Hyperthermia ntrstl prb 5/< (77610) |
— |
$1,822.15 |
— |
| Hysterosalpingogram (74740) |
— |
$734.30 |
— |
| Image fusion (77399) |
— |
$1,286.70 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,950.10 |
— |
| Kidney imaging morphology (78700) |
— |
$3,132.05 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$3,404.30 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$5,473 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$6,409.60 |
— |
| Knee 3 views (73562) |
— |
$484.30 |
— |
| Liver & spleen imaging static only (78215) |
— |
$2,960.05 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$3,020.65 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$3,235.95 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$11,105.85 |
— |
| Lung perfusion differential (78597) |
— |
$2,424.90 |
— |
| Lung Ventilation Imaging (78579) |
— |
$3,259.85 |
— |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
— |
$7,672.55 |
— |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
— |
$1,914.45 |
— |
| Lymphangiography extremity only bilateral rs&i (75803) |
— |
$2,223.60 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$3,319.40 |
— |
| Lymphoscintigraphy (78195) |
— |
$3,225.60 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,853.85 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,153.40 |
— |
| Meckels Diverticulum (78290) |
— |
$3,461.35 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$5,036.60 |
— |
| MRA head w & w/o contrast (70546) |
— |
$5,094 |
— |
| MRA head w/o contrast (70544) |
— |
$3,280 |
— |
| MRA head with contrast (70545) |
— |
$3,679.75 |
— |
| MRA neck w contrast (70548) |
— |
$3,679.75 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,094 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,280 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,391.85 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$4,452.80 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,643.80 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$2,943.80 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,943.80 |
— |
| MRI breast w/o contrast bilateral (77047) |
— |
$6,232.90 |
— |
| MRI breast w/o contrast unilat (77046) |
— |
$3,448.40 |
— |
| MRI c-spine with contrast (72142) |
— |
$3,311.75 |
— |
| MRI cardiac w/o cont stress (75559) |
— |
$3,838.55 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$2,933.15 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,124.70 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$3,391.85 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,298.95 |
— |
| MRI chest with contrast (71551) |
— |
$2,943.80 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$2,541.80 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$2,943.80 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,943.80 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,643.80 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,592.10 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$4,711.75 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$3,679.75 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,219.80 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$4,822.50 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,114.40 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$4,248.65 |
— |
| MRI scan of heart before and after contrast with stress imaging (75563) |
— |
$3,945.65 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$4,823.40 |
— |
| MRI spectroscopy (76390) |
— |
$4,120.25 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$4,452.80 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$3,391.85 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,452.80 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$3,391.85 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$5,227.55 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,316.35 |
— |
| MRI tmj (70336) |
— |
$3,079.65 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,783.65 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$4,248.65 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,383.05 |
— |
| Myelogram Cervical (72240) |
— |
$2,910.15 |
— |
| Myelogram Lumbar (72265) |
— |
$1,461.55 |
— |
| Myelogram thoracic (72255) |
— |
$2,677.10 |
— |
| Myelography 2 or more regions (72270) |
— |
$2,940 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$9,482.30 |
— |
| Myocardial infarct spect (78469) |
— |
$6,476.30 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$12,348.90 |
— |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
— |
$7,892.70 |
— |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
— |
$5,044.65 |
— |
| Neck soft tissue (70360) |
— |
$562.15 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$1,762.50 |
— |
| Nm adrenal scan (78075) |
— |
$14,014.60 |
— |
| Nm bone marrow multiple (78103) |
— |
$3,102.45 |
— |
| Nm cisternogram (78630) |
— |
$5,604.50 |
— |
| Nm csf leak detection (78650) |
— |
$4,670.40 |
— |
| Nm gastric emptying study (78264) |
— |
$6,094.65 |
— |
| Nm gastroesophageal reflux study (78262) |
— |
$2,827.40 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$3,461.35 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$10,276.10 |
— |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
— |
$9,917.05 |
— |
| Nuclear medicine study from skull base to mid-thigh (78812) |
— |
$7,928.90 |
— |
| Nuclear medicine study of kidney and blood flow (78701) |
— |
$3,271.25 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$7,781.05 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$926.80 |
— |
| Osseous survey infant (77076) |
— |
$1,275.50 |
— |
| Osseous survey limited (77074) |
— |
$1,330.10 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$6,108.75 |
— |
| Parathyrd planar w/wo subtrj (78071) |
— |
$5,333 |
— |
| Parathyroid imaging (78070) |
— |
$2,718.90 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$512.60 |
— |
| Peritoneogram rs&i (74190) |
— |
$1,461.55 |
— |
| PET image w/CT, skull-thigh (78815) |
— |
$12,193.90 |
— |
| PET imaging CT for attenuation limited area (78814) |
— |
$7,367.80 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$12,627.50 |
— |
| PET imaging limited area chest head/neck (78811) |
— |
$7,583.25 |
— |
| PET whole body (78813) |
— |
$13,070.75 |
— |
| Pr MRI brain w/ dye (70558) |
— |
$3,391.85 |
— |
| Pr MRI brain w/o & w/ dye (70559) |
— |
$4,452.80 |
— |
| Pr MRI brain w/o dye (70557) |
— |
$3,207.80 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$4,823.40 |
— |
| Proton trmt simple w/comp (77522) |
— |
$4,017.90 |
— |
| Proton tx delivery complex (77525) |
— |
$4,861.60 |
— |
| Proton tx delivery intermediate (77523) |
— |
$4,419.65 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$1,822.15 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$7,672.55 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$3,318 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,334.30 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$7,427.45 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,370.20 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$281.25 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$539.70 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$670 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$759.25 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$611.50 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$29,843.90 |
— |
| Radiation treatment delivery 1 mev >= complex (77412) |
— |
$3,329.60 |
— |
| Radiation treatment delivery 1 mev >= simple (77402) |
— |
$1,324.20 |
— |
| Radiation tx delivery 1 mev >= intermediate (77407) |
— |
$2,432.45 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$819.70 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$380.55 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$542.60 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$563.05 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,163 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,332.95 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$1,067 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$380.55 |
— |
| Radiological examination surgical specimen (76098) |
— |
$1,896.65 |
— |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
— |
$1,584.65 |
— |
| Review by radiologist of adrenal gland vein image (75840) |
— |
$7,672.55 |
— |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
— |
$7,672.55 |
— |
| Ribs bilateral 3 views (71110) |
— |
$950.75 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$3,081.85 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$3,630.75 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$6,834.20 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$7,522.55 |
— |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
— |
$6,940.20 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$5,962.45 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$1,584.65 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$7,642.70 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$585.82 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$2,265.10 |
— |
| Salivary gland function study (78232) |
— |
$2,373.50 |
— |
| Scanogram (77073) |
— |
$1,405.05 |
— |
| Scapula complete (73010) |
— |
$624.80 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$63.90 |
— |
| Sella turcica (70240) |
— |
$591.15 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$366.40 |
— |
| Sialogram (70390) |
— |
$1,140.45 |
— |
| Simulation intermediate (77285) |
— |
$2,953.60 |
— |
| Small bowel series (74250) |
— |
$1,582.70 |
— |
| Spec medical radj physics consltj (77370) |
— |
$2,659.80 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$3,750.50 |
— |
| Special dosimetry (77331) |
— |
$971.80 |
— |
| Special treatment procedure (77470) |
— |
$5,902 |
— |
| Spine thoracic 3 views (72072) |
— |
$736.55 |
— |
| Splenoportograpy rs&i (75810) |
— |
$5,000.15 |
— |
| Stereotactic body radiation delivery (77373) |
— |
$13,947.60 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$3,318 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$4,601.55 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$2,208.75 |
— |
| Testicular Imaging With Vascular Flow (78761) |
— |
$3,108.10 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$7,321.55 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$2,153.10 |
— |
| Therapeutic Enema (74283) |
— |
$509 |
— |
| Thoracolumbar 2 views (72080) |
— |
$521.50 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$5,077.75 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$4,654.45 |
— |
| Thyroid uptake measurement (78012) |
— |
$4,397.65 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$4,951.10 |
— |
| Tomogram (76100) |
— |
$1,118.05 |
— |
| Treatment device intermediate (77333) |
— |
$2,052.35 |
— |
| Treatment devices simple (77332) |
— |
$1,559.35 |
— |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
— |
$22,759.80 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$2,147.65 |
— |
| Tx devices design & construction complex (77334) |
— |
$3,741.35 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,938.15 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,482.85 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$2,150.05 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,744.80 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$5,156.48 |
— |
| Upper Extremity Infant (73092) |
— |
$538.40 |
— |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
— |
$1,743.50 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$914.30 |
— |
| Urethrocystography voiding (74455) |
— |
$976.55 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,046.35 |
— |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
— |
$729.35 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$1,145.70 |
— |
| Us breast unilateral complete (76641) |
— |
$1,795 |
— |
| Us breast unilateral limited (76642) |
— |
$826.20 |
— |
| Us chest (76604) |
— |
$824.40 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$771.35 |
— |
| Us elastography parenchyma (76981) |
— |
$561.70 |
— |
| Us fetal nuchal translucency 1st gestation (76813) |
— |
$2,472.55 |
— |
| Us guided compression repair (76936) |
— |
$1,698.80 |
— |
| Us kidney transplant (76776) |
— |
$2,817.95 |
— |
| Us ob detailed single fetus (76811) |
— |
$3,697.20 |
— |
| Us ob transvaginal (76817) |
— |
$1,482.85 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,977.05 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$1,458.25 |
— |
| Us pregnancy ltd (76815) |
— |
$1,408.75 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$1,482.85 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,544.65 |
— |
| Us retroperitoneal limited (76775) |
— |
$948.10 |
— |
| Us scrotum and contents (76870) |
— |
$1,482.85 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,482.85 |
— |
| Us spinal canal and contents (76800) |
— |
$2,779.60 |
— |
| Us transrectal (76872) |
— |
$871.15 |
— |
| Us transrectal prostate volume (76873) |
— |
$1,743.65 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$951.25 |
— |
| Us, eye b-scan (76512) |
— |
$900.70 |
— |
| Vascular flow imaging (78445) |
— |
$3,052.60 |
— |
| Vasogram (74440) |
— |
$571.25 |
— |
| Venogram extremity bilateral (75822) |
— |
$2,872.50 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$7,672.55 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$2,223.60 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,915 |
— |
| Venography Renal Bilateral (75833) |
— |
$9,911.60 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$6,607.75 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$7,193 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$12,754.85 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$543.70 |
— |
| Wrist 2 views (73100) |
— |
$363.05 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$746.85 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$340.35 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$456.60 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$1,427.95 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$363.05 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$466.40 |
— |
| X-ray exam entire spi 4/5 vw (72083) |
— |
$551.65 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$535.70 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$545.90 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$566.50 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$787.50 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$841.15 |
— |
| X-ray exam of femur 1 (73551) |
— |
$376.30 |
— |
| X-ray eye for foreign body (70030) |
— |
$667.45 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$838.50 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$786.25 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$484.30 |
— |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
— |
$5,345.55 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$399.35 |
— |
| X-ray IV pyelogram+drip infusn (74410) |
— |
$663.10 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$482 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$768.65 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$434.70 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$538.40 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$562.50 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$728.25 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$570.35 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$590.40 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$566.90 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$749.80 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$962.25 |
— |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
— |
$734.30 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,267.20 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$741.35 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$768.90 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,007.55 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$644.75 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$540.95 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$380.55 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$729.85 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$512.55 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$996.10 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$818.95 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$362.25 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$669 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$621 |
— |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
— |
$247.35 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$512.60 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$995.95 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$423.95 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$466.40 |
— |
| Xr arthrogram ankle (73615) |
— |
$796.20 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$852 |
— |
| Xr chest 4+ views (71048) |
— |
$510.95 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$380.55 |
— |
| Xr shoulder 1 view (73020) |
— |
$372.85 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$513.10 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$380.55 |
— |
| Xr tmj bilateral (70330) |
— |
$591.40 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$413.20 |
— |