| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$11,618.40 |
— |
| Acute gi blood loss imaging (78278) |
— |
$5,654.25 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$7,672.55 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$9,911.60 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$11,780.25 |
— |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
— |
$7,672.55 |
— |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
— |
$3,318 |
— |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
— |
$9,911.60 |
— |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
— |
$6,607.75 |
— |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
— |
$12,117.15 |
— |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
— |
$6,607.75 |
— |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
— |
$12,754.85 |
— |
| 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 |
— |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
— |
$8,056.15 |
— |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
— |
$7,672.55 |
— |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
— |
$12,754.85 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,768.45 |
— |
| Brain flow imaging only - nm brain flow only brain death (78610) |
— |
$2,029.10 |
— |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
— |
$3,427 |
— |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
— |
$9,469.15 |
— |
| Card MRI w/stress img & dye (75563) |
— |
$3,945.65 |
— |
| Cardiac MRI morphology & function w/o contrast (75557) |
— |
$2,933.15 |
— |
| Cardiac MRI w/stress img (75559) |
— |
$3,838.55 |
— |
| Cardiac MRI w/wo contrast & further seq (75561) |
— |
$3,900.65 |
— |
| Clavicle complete (73000) |
— |
$461.70 |
— |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
— |
$3,381.20 |
— |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
— |
$2,298.95 |
— |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
— |
$2,006 |
— |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
— |
$6,888.40 |
— |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
— |
$3,927.75 |
— |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
— |
$2,473.35 |
— |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
— |
$3,790.70 |
— |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
— |
$3,091.70 |
— |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
— |
$3,221.90 |
— |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
— |
$3,091.70 |
— |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
— |
$3,091.70 |
— |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
— |
$3,091.70 |
— |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
— |
$1,158.50 |
— |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
— |
$3,091.70 |
— |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
— |
$3,091.70 |
— |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
— |
$3,373.15 |
— |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
— |
$1,813.45 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$2,933.15 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
— |
$2,035.70 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
— |
$3,091.70 |
— |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
— |
$4,830.80 |
— |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
— |
$3,091.70 |
— |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
— |
$3,284.95 |
— |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
— |
$1,995.50 |
— |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
— |
$638.25 |
— |
| Csf shunt evaluation (78645) |
— |
$5,326.95 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,505 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,349.45 |
— |
| CT abdomen w & w/o contrast (74170) |
— |
$4,708.50 |
— |
| CT abdomen w/contrast (74160) |
— |
$3,926.65 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,411.95 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,373.15 |
— |
| CT cervical spine w/contrast (72126) |
— |
$2,933.15 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,513.35 |
— |
| CT chest w/contrast (71260) |
— |
$3,221.35 |
— |
| CT extremity upper w & w/o contrast (73202) |
— |
$3,091.70 |
— |
| CT extremity upper w/o contrast (73200) |
— |
$2,461.45 |
— |
| CT head/brain with contrast (70460) |
— |
$2,933.15 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,415.20 |
— |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
— |
$2,933.15 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,092.35 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$1,015.45 |
— |
| CT l-spine w/contrast (72132) |
— |
$2,749.80 |
— |
| CT limited/localized follow up study (76380) |
— |
$975.70 |
— |
| CT lower extremity w/dye (73701) |
— |
$2,933.15 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,351.05 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,400.90 |
— |
| CT neck w/contrast (70491) |
— |
$2,159.75 |
— |
| CT neck w/o contrast (70490) |
— |
$2,140.40 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$3,091.70 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,492.15 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,449.05 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,413.45 |
— |
| CT thorax lung cancer scr c- (71271) |
— |
$1,232.45 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,803.80 |
— |
| CT upper extremity w/dye (73201) |
— |
$2,933.15 |
— |
| CTA head w contrast (70496) |
— |
$3,221.90 |
— |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
— |
$744.95 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$5,345.55 |
— |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
— |
$4,827.40 |
— |
| Diskography lumbar s&i (72295) |
— |
$5,081.50 |
— |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
— |
$2,048.55 |
— |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
— |
$1,285.20 |
— |
| Dxa bone density study axial skeleton (77085) |
— |
$1,515.35 |
— |
| Dxa bone density/peripheral (77081) |
— |
$298.45 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
— |
$3,288.55 |
— |
| Fetal biophys profile w/o nst (76819) |
— |
$1,694.35 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$2,085.20 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$1,805.45 |
— |
| Full mouth X-ray of teeth (70320) |
— |
$260.10 |
— |
| Gastroesophageal reflux study (78262) |
— |
$2,827.40 |
— |
| Gated heart planar single (78472) |
— |
$3,908.20 |
— |
| 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 |
— |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
— |
$7,672.55 |
— |
| 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 |
— |
| Hyperthermia ntrstl prb 5/< (77610) |
— |
$1,822.15 |
— |
| Image fusion (77399) |
— |
$1,286.70 |
— |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
— |
$1,762.50 |
— |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
— |
$10,276.10 |
— |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
— |
$5,950.10 |
— |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
— |
$3,461.35 |
— |
| Isodose brachytherapy complex 10+ sources (77318) |
— |
$6,378.75 |
— |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
— |
$2,237.15 |
— |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
— |
$4,601.55 |
— |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
— |
$2,208.75 |
— |
| Kidney imaging morphol - nm kidney cortex (78700) |
— |
$3,132.05 |
— |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
— |
$3,271.25 |
— |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
— |
$6,409.60 |
— |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
— |
$3,404.30 |
— |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
— |
$5,473 |
— |
| Leveen/shunt patency exam (78291) |
— |
$3,461.35 |
— |
| Liver and spleen imaging (78215) |
— |
$2,960.05 |
— |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
— |
$3,020.65 |
— |
| Liver imaging with flow (78202) |
— |
$3,235.95 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$11,105.85 |
— |
| Lung perfusion imaging (78580) |
— |
$3,334.30 |
— |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Age Under 21 (75803) |
— |
$2,223.60 |
— |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
— |
$1,914.45 |
— |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
— |
$7,672.55 |
— |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
— |
$3,319.40 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
— |
$4,823.40 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
— |
$2,943.80 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
— |
$2,643.80 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$4,823.40 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
— |
$3,679.75 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
— |
$3,592.10 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
— |
$2,943.80 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$4,248.65 |
— |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
— |
$3,679.75 |
— |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
— |
$5,094 |
— |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
— |
$5,094 |
— |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
— |
$2,298.95 |
— |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
— |
$2,298.95 |
— |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
— |
$1,853.85 |
— |
| Mammary ductogram single (77053) |
— |
$1,153.40 |
— |
| Mandible min 4v (70110) |
— |
$819.70 |
— |
| MRA head w/o contrast (70544) |
— |
$3,280 |
— |
| MRA neck w/ contrast (70548) |
— |
$3,679.75 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,280 |
— |
| MRI abdomen w/contrast (74182) |
— |
$3,391.85 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,643.80 |
— |
| MRI abdomen w/wo contrast (74183) |
— |
$4,452.80 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,943.80 |
— |
| MRI brain w/dye (70558) |
— |
$3,391.85 |
— |
| MRI brain w/o & w/dye (70559) |
— |
$4,452.80 |
— |
| MRI brain w/o dye (70557) |
— |
$3,207.80 |
— |
| MRI breast c- bilateral (77047) |
— |
$6,232.90 |
— |
| MRI breast without contrast material unilateral (77046) |
— |
$3,448.40 |
— |
| MRI c-spine w&w/o cont (72156) |
— |
$4,452.80 |
— |
| MRI cervical spine w/contrast (72142) |
— |
$3,311.75 |
— |
| MRI chest w/contrast (71551) |
— |
$2,943.80 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,298.95 |
— |
| MRI chest w/wo contrast (71552) |
— |
$3,391.85 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$2,541.80 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$4,248.65 |
— |
| MRI joint upr extrem w/dye (73222) |
— |
$2,943.80 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$2,783.65 |
— |
| MRI lumbar spine w/contrast (72149) |
— |
$3,391.85 |
— |
| MRI lumbar spine w/wo contrast (72158) |
— |
$4,452.80 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$4,711.75 |
— |
| MRI pelvis w & w/o contrast (72197) |
— |
$4,822.50 |
— |
| MRI pelvis w/contrast (72196) |
— |
$3,219.80 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,114.40 |
— |
| MRI spectroscopy (76390) |
— |
$4,120.25 |
— |
| MRI spine cervical w/o contrast (72141) |
— |
$3,124.70 |
— |
| MRI t-spine w&w/o cont (72157) |
— |
$5,227.55 |
— |
| MRI thoracic spine w/contrast (72147) |
— |
$3,391.85 |
— |
| MRI thoracic spine w/o contrst (72146) |
— |
$3,316.35 |
— |
| MRI tmj (70336) |
— |
$3,079.65 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,383.05 |
— |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
— |
$5,036.60 |
— |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
— |
$2,940 |
— |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
— |
$9,917.05 |
— |
| Myocardial spect multiple studies (78452) |
— |
$12,348.90 |
— |
| Myocrd img PET metab eval single study (78459) |
— |
$9,482.30 |
— |
| 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 |
— |
| Nm adrenal imaging (78075) |
— |
$14,014.60 |
— |
| Nm bone 3 phase (78315) |
— |
$5,536 |
— |
| Nm bone imaging whole body (78306) |
— |
$6,864.90 |
— |
| Nm bone marrow ltd (78102) |
— |
$2,521.50 |
— |
| Nm bone marrow multi (78103) |
— |
$3,102.45 |
— |
| Nm csf cisternogram (78630) |
— |
$5,604.50 |
— |
| Nm csf leak detection (78650) |
— |
$4,670.40 |
— |
| Nm gastric emptying (78264) |
— |
$6,094.65 |
— |
| Nm lung ventilation imaging (78579) |
— |
$3,259.85 |
— |
| Nm lymph system (78195) |
— |
$3,225.60 |
— |
| Nm myocard infarct spect (78469) |
— |
$6,476.30 |
— |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
— |
$3,052.60 |
— |
| Nuclear medicine study of bone and/or joint limited area (78300) |
— |
$3,948.65 |
— |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
— |
$4,005 |
— |
| Nuclear medicine study of brain, 4 static views or more (78605) |
— |
$2,627.80 |
— |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
— |
$1,743.50 |
— |
| Nuclear medicine study of salivary gland function (78232) |
— |
$2,373.50 |
— |
| Ob us limited fetus(s) (76815) |
— |
$1,408.75 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$2,472.55 |
— |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
— |
$900.70 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$6,108.75 |
— |
| Parathyroid planar imaging (78070) |
— |
$2,718.90 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$5,333 |
— |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
— |
$7,672.55 |
— |
| PET imaging CT attenuation skull base mid-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 whole body (78813) |
— |
$13,070.75 |
— |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
— |
$7,583.25 |
— |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
— |
$7,928.90 |
— |
| Proton treatment complex (77525) |
— |
$4,861.60 |
— |
| Proton treatment delivery; simple, without compensation (77520) |
— |
$1,822.15 |
— |
| Proton trmt intermediate (77523) |
— |
$4,419.65 |
— |
| Proton trmt simple w/comp (77522) |
— |
$4,017.90 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$3,318 |
— |
| Pulmonary ventilation & perfusion imaging (78582) |
— |
$7,427.45 |
— |
| Quant differential pulm perfusion w/wo imaging (78597) |
— |
$2,424.90 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,370.20 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
— |
$281.25 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$539.70 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
— |
$551.65 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
— |
$611.50 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$535.70 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$545.90 |
— |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
— |
$566.50 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$670 |
— |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
— |
$841.15 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$380.55 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$513.10 |
— |
| Radex spine cervical 6 or more views (72052) |
— |
$852 |
— |
| Radex spine thoracolumbar junction min 2 views (72080) |
— |
$521.50 |
— |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
— |
$29,843.90 |
— |
| Radiation tx delivery lvl 1 (77402) |
— |
$1,324.20 |
— |
| Radiation tx delivery lvl 2 (77407) |
— |
$2,432.45 |
— |
| Radiation tx delivery lvl 3 (77412) |
— |
$3,329.60 |
— |
| Radiologic exam abdomen 3+ views (74021) |
— |
$542.60 |
— |
| Radiologic exam chest 3 views (71047) |
— |
$572.25 |
— |
| Radiologic exam chest 4+ views (71048) |
— |
$510.95 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,427.95 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,163 |
— |
| Radiologic exam esophagus single contrast study (74220) |
— |
$913.25 |
— |
| Radiologic exam small int single contrast study (74250) |
— |
$1,582.70 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$929 |
— |
| 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 1 view (73551) |
— |
$376.30 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$380.55 |
— |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
— |
$566.90 |
— |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
— |
$456.60 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$746.85 |
— |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
— |
$363.05 |
— |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
— |
$466.40 |
— |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
— |
$786.25 |
— |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
— |
$484.30 |
— |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
— |
$466.40 |
— |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
— |
$434.70 |
— |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
— |
$768.65 |
— |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
— |
$482 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
— |
$759.25 |
— |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
— |
$590.40 |
— |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
— |
$734.30 |
— |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
— |
$1,007.55 |
— |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
— |
$768.90 |
— |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
— |
$585.82 |
— |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
— |
$1,065 |
— |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
— |
$380.55 |
— |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
— |
$1,118.05 |
— |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
— |
$512.55 |
— |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
— |
$818.95 |
— |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
— |
$562.50 |
— |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
— |
$570.35 |
— |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
— |
$728.25 |
— |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
— |
$995.95 |
— |
| Radiologic examination, teeth; single view Age Under 21 (70300) |
— |
$247.35 |
— |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
— |
$466.40 |
— |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
— |
$340.35 |
— |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
— |
$380.55 |
— |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
— |
$538.40 |
— |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
— |
$749.80 |
— |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
— |
$669 |
— |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
— |
$423.95 |
— |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
— |
$538.40 |
— |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
— |
$3,630.75 |
— |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
— |
$1,584.65 |
— |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
— |
$7,642.70 |
— |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
— |
$7,781.05 |
— |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
— |
$5,962.45 |
— |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
— |
$976.55 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,147.65 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$3,081.85 |
— |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
— |
$22,759.80 |
— |
| Rp loclzj tum spect 2 areas (78831) |
— |
$6,834.20 |
— |
| Rp loclzj tum spect w/CT 1 (78830) |
— |
$6,940.20 |
— |
| Rp loclzj tum spect w/CT 2 (78832) |
— |
$7,522.55 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$1,584.65 |
— |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
— |
$2,265.10 |
— |
| Scapula complete (73010) |
— |
$624.80 |
— |
| Screening digital breast tomosynthesis bi (77063) |
— |
$63.90 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$366.40 |
— |
| Simulation intermediate (77285) |
— |
$2,953.60 |
— |
| Special dosimetry (77331) |
— |
$971.80 |
— |
| Special physics consult (77370) |
— |
$2,659.80 |
— |
| Special teletherapy port plan (77321) |
— |
$3,750.50 |
— |
| Special treatment procedure (77470) |
— |
$5,902 |
— |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
— |
$5,000.15 |
— |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
— |
$13,947.60 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
— |
$3,108.10 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$7,321.55 |
— |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
— |
$509 |
— |
| Thyroid imaging with vascular flow (78013) |
— |
$4,654.45 |
— |
| Thyroid met imaging body (78018) |
— |
$5,077.75 |
— |
| Thyroid uptake single/multiple quant measurement (78012) |
— |
$4,397.65 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
— |
$4,951.10 |
— |
| Tr simulation simple (77280) |
— |
$2,153.10 |
— |
| Treatment device complex (77334) |
— |
$3,741.35 |
— |
| Treatment device intermediate (77333) |
— |
$2,052.35 |
— |
| Treatment device simple (77332) |
— |
$1,559.35 |
— |
| Ultrasound breast limited (76642) |
— |
$826.20 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,482.85 |
— |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
— |
$951.25 |
— |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
— |
$1,977.05 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
— |
$3,697.20 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
— |
$1,482.85 |
— |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
— |
$2,817.95 |
— |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
— |
$1,743.65 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$2,150.05 |
— |
| Unlisted CT procedure (76497) |
— |
$4,462.92 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,744.80 |
— |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
— |
$5,156.48 |
— |
| Ureteral reflux study (78740) |
— |
$1,743.50 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$914.30 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
— |
$1,046.35 |
— |
| Urography antegrade rs&i (74425) |
— |
$1,461.55 |
— |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
— |
$663.10 |
— |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
— |
$729.35 |
— |
| Us abdominal aorta real time screen study aaa (76706) |
— |
$1,145.70 |
— |
| Us breast uni real time with image complete (76641) |
— |
$1,795 |
— |
| Us chest (76604) |
— |
$824.40 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$771.35 |
— |
| Us elastography organ (76981) |
— |
$561.70 |
— |
| Us encephalogram (76506) |
— |
$2,008.90 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,458.25 |
— |
| Us guided compression repair (76936) |
— |
$1,698.80 |
— |
| US OB Follow-Up/Repeat (76816) |
— |
$926.80 |
— |
| Us ob transvaginal (76817) |
— |
$1,482.85 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,544.65 |
— |
| Us retroperitoneal ltd (76775) |
— |
$948.10 |
— |
| Us scrotum (76870) |
— |
$1,482.85 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,482.85 |
— |
| Us spinal canal (76800) |
— |
$2,779.60 |
— |
| Us transrectal (76872) |
— |
$871.15 |
— |
| Us trgt dyn mbubb 1st les (76978) |
— |
$1,938.15 |
— |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Age Under 21 (74440) |
— |
$571.25 |
— |
| Venogram sinus/jugular (75860) |
— |
$7,193 |
— |
| Venography adrenal unilateral selective rs&i (75840) |
— |
$7,672.55 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$6,607.75 |
— |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
— |
$7,672.55 |
— |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
— |
$2,223.60 |
— |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
— |
$2,872.50 |
— |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
— |
$1,915 |
— |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
— |
$3,318 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$12,754.85 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$543.70 |
— |
| X-ray exam hips bi 3-4 views (73522) |
— |
$787.50 |
— |
| X-ray exam of finger(s) (73140) |
— |
$380.55 |
— |
| X-ray exam of knee 1 or 2 (73560) |
— |
$413.20 |
— |
| X-ray exam ribs bil 3 views (71110) |
— |
$950.75 |
— |
| X-ray exam ribs uni 2 views (71100) |
— |
$741.35 |
— |
| X-ray heel (73650) |
— |
$399.35 |
— |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
— |
$644.75 |
— |
| X-ray retrograde pyelogram (74420) |
— |
$1,267.20 |
— |
| Xr abdomen 1 view (74018) |
— |
$380.55 |
— |
| Xr abdomen 2 views (74019) |
— |
$529.90 |
— |
| Xr arthrogram ankle (73615) |
— |
$796.20 |
— |
| Xr arthrogram elbow (73085) |
— |
$835.75 |
— |
| Xr arthrogram hip (73525) |
— |
$796.20 |
— |
| Xr arthrogram knee (73580) |
— |
$1,118.05 |
— |
| Xr arthrogram wrist (73115) |
— |
$835.75 |
— |
| Xr bone age studies (77072) |
— |
$722.35 |
— |
| Xr bone length study (77073) |
— |
$1,405.05 |
— |
| Xr bone survey infant (77076) |
— |
$1,275.50 |
— |
| Xr bone survey ltd (77074) |
— |
$1,330.10 |
— |
| Xr chest 1 view (71045) |
— |
$421.90 |
— |
| Xr chest 2 views (71046) |
— |
$563.05 |
— |
| Xr eye foreign body (70030) |
— |
$667.45 |
— |
| Xr facial bones 3+ views (70150) |
— |
$838.50 |
— |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
— |
$376.30 |
— |
| Xr forearm 2 views (73090) |
— |
$380.55 |
— |
| Xr hand 2v (73120) |
— |
$363.05 |
— |
| Xr hysterosalpingogram (74740) |
— |
$734.30 |
— |
| Xr myelogram c-spine (72240) |
— |
$2,910.15 |
— |
| Xr myelogram l-spine (72265) |
— |
$1,461.55 |
— |
| Xr myelogram t-spine (72255) |
— |
$2,677.10 |
— |
| Xr neck soft tissue (70360) |
— |
$562.15 |
— |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
— |
$484.30 |
— |
| Xr osseous survey complete (77075) |
— |
$1,836.45 |
— |
| Xr pelvis 1-2 views (72170) |
— |
$512.60 |
— |
| Xr pelvis min 3 view (72190) |
— |
$962.25 |
— |
| Xr peritoneogram (74190) |
— |
$1,461.55 |
— |
| Xr sacrum/coccyx 2+ views (72220) |
— |
$540.95 |
— |
| Xr sella turcica (70240) |
— |
$591.15 |
— |
| Xr shoulder 1 view (73020) |
— |
$372.85 |
— |
| Xr sialogram (70390) |
— |
$1,140.45 |
— |
| Xr sinuses 3+ views (70220) |
— |
$729.85 |
— |
| Xr skull min 4 view (70260) |
— |
$996.10 |
— |
| Xr spine 1 view (72020) |
— |
$362.25 |
— |
| Xr spine thoracic 3v (72072) |
— |
$736.55 |
— |
| Xr sternum 2+ views (71120) |
— |
$621 |
— |
| Xr surgical specimen (76098) |
— |
$1,896.65 |
— |
| Xr t-spine 2 views (72070) |
— |
$512.60 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$380.55 |
— |
| Xr tmj bilateral (70330) |
— |
$591.40 |
— |
| Xr venogram renal bilat (75833) |
— |
$9,911.60 |
— |
| Xr wrist 2 views (73100) |
— |
$363.05 |
— |