| 3-D radiotherapy plan dose-volume histograms (77295) |
$21.60 |
$72 |
0.0× |
| Abdomen 2 views (74019) |
$21.60 |
$72 |
0.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$21.60 |
$72 |
0.1× |
| Basic radiation dosimetry calculation (77300) |
$88.50 |
$295 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$105.37 |
$351.24 |
0.3× |
| Bone &/joint imaging whole body (78306) |
$105.37 |
$351.24 |
0.3× |
| Bone age studies (77072) |
$105.37 |
$351.24 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$105.37 |
$351.24 |
0.3× |
| Bone survey complete (77075) |
$9.90 |
$33 |
0.1× |
| Cervical spine 2 or 3 views (72040) |
$9 |
$30 |
0.1× |
| Chest 1 view (71045) |
$16.20 |
$54 |
0.2× |
| Chest 3 views (71047) |
$16.20 |
$54 |
0.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$9 |
$30 |
0.1× |
| Clavicle complete (73000) |
$21.60 |
$72 |
0.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$108.90 |
$363 |
1.2× |
| Continuing medical physics consltj pr wk (77336) |
$22.20 |
$74 |
0.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$108.90 |
$363 |
0.4× |
| CT abdomen and pelvis without contrast (74176) |
$108.90 |
$363 |
0.5× |
| CT abdomen w contrast (74160) |
$108.90 |
$363 |
0.7× |
| CT abdomen w wo contrast (74170) |
$108.90 |
$363 |
0.7× |
| CT abdomen w/o contrast (74150) |
$108.90 |
$363 |
1.2× |
| CT angiography upper extremity lt (73206) |
$108.90 |
$363 |
0.7× |
| CT c-spine w/o contrast (72125) |
$108.90 |
$363 |
1.2× |
| CT cervical spine with contrast (72126) |
$108.90 |
$363 |
0.4× |
| CT chest w/wo contrast (71270) |
$108.90 |
$363 |
0.7× |
| CT chest with contrast (71260) |
$108.90 |
$363 |
0.7× |
| CT head/brain with contrast (70460) |
$108.90 |
$363 |
0.7× |
| CT head/brain without and with contrast (70470) |
$108.90 |
$363 |
0.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$108.90 |
$363 |
1.5× |
| CT iac w contrast (70481) |
$108.90 |
$363 |
0.7× |
| CT limited/localized follow up study (76380) |
$108.90 |
$363 |
1.5× |
| CT lower ext w/o (73700) |
$108.90 |
$363 |
1.2× |
| CT lower extremity w wo contrast (73702) |
$108.90 |
$363 |
0.7× |
| CT lower extremity with contrast (73701) |
$108.90 |
$363 |
0.7× |
| CT lumbar spine w & w/o contrast (72133) |
$108.90 |
$363 |
0.7× |
| CT lumbar spine w/o contrast (72131) |
$108.90 |
$363 |
1.2× |
| CT lumbar spine with contrast (72132) |
$108.90 |
$363 |
0.4× |
| CT maxillofacial w contrast (70487) |
$108.90 |
$363 |
0.7× |
| CT maxillofacial w/o contrast (70486) |
$108.90 |
$363 |
1.2× |
| CT maxillofacial w/wo contrast (70488) |
$108.90 |
$363 |
0.7× |
| CT neck soft tissue w contrast (70491) |
$108.90 |
$363 |
0.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$108.90 |
$363 |
0.7× |
| CT orbits w/o contrast (70480) |
$108.90 |
$363 |
1.2× |
| CT pelvis w & w/o contrast (72194) |
$108.90 |
$363 |
0.7× |
| CT pelvis w/o contrast (72192) |
$108.90 |
$363 |
1.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$108.90 |
$363 |
1.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$108.90 |
$363 |
0.7× |
| CT soft tissue neck w/o contrast (70490) |
$108.90 |
$363 |
1.2× |
| CT thoracic spine w/contrast (72129) |
$108.90 |
$363 |
0.7× |
| CT thoracic spine w/o contrast (72128) |
$108.90 |
$363 |
1.2× |
| CT thorax w/o contrast (71250) |
$108.90 |
$363 |
1.2× |
| CT upper extremity w/o contrast rt (73200) |
$108.90 |
$363 |
1.2× |
| CT upper extremity with contrast (73201) |
$108.90 |
$363 |
0.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$108.90 |
$363 |
0.7× |
| Cta Abdomen (74175) |
$108.90 |
$363 |
0.7× |
| CTA abdomen pelvis (74174) |
$108.90 |
$363 |
0.4× |
| CTA chest (71275) |
$108.90 |
$363 |
0.7× |
| Cta Head (70496) |
$108.90 |
$363 |
0.7× |
| CTA lwr ext w&w/o contrast (73706) |
$108.90 |
$363 |
0.7× |
| Cta Neck (70498) |
$108.90 |
$363 |
0.7× |
| Cta Pelvis (72191) |
$108.90 |
$363 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$108.90 |
$363 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$108.90 |
$363 |
1.5× |
| Esophagus (74220) |
$395.40 |
$1,318 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$29.69 |
$98.98 |
0.1× |
| Foot 2 views (73620) |
$29.69 |
$98.98 |
0.4× |
| Forearm 2 views (73090) |
$29.69 |
$98.98 |
0.4× |
| Gated Heart Planar Single (78472) |
$16.20 |
$54 |
0.0× |
| Hand 3 views (73130) |
$29.69 |
$98.98 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$29.69 |
$98.98 |
0.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$29.69 |
$98.98 |
0.1× |
| Humerus Min 2 Views Left (73060) |
$203.36 |
$677.88 |
2.7× |
| Hysterosalpingogram (74740) |
$203.36 |
$677.88 |
1.0× |
| Image fusion (77399) |
$86.10 |
$287 |
0.7× |
| Interstitial radiation source applic complex (77778) |
$6.60 |
$22 |
0.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$44.10 |
$147 |
0.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$44.10 |
$147 |
0.1× |
| Knee 3 views (73562) |
$2.40 |
$8 |
0.0× |
| Liver & spleen imaging static only (78215) |
$1.80 |
$6 |
0.0× |
| Lymphoscintigraphy (78195) |
$1.80 |
$6 |
0.0× |
| Meckels Diverticulum (78290) |
$5.40 |
$18 |
0.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$108.90 |
$363 |
0.3× |
| MRA head w & w/o contrast (70546) |
$85.05 |
$283.50 |
0.3× |
| MRA head w/o contrast (70544) |
$85.05 |
$283.50 |
0.4× |
| MRA head with contrast (70545) |
$85.05 |
$283.50 |
0.3× |
| MRA neck w contrast (70548) |
$85.05 |
$283.50 |
0.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$85.05 |
$283.50 |
0.3× |
| MRA neck w/o contrast (70547) |
$85.05 |
$283.50 |
0.4× |
| MRI abdomen w contrast (74182) |
$85.05 |
$283.50 |
0.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$85.05 |
$283.50 |
0.3× |
| MRI abdomen w/o contrast (74181) |
$85.05 |
$283.50 |
0.4× |
| MRI any jnt lwr ext with con lt (73722) |
$85.05 |
$283.50 |
0.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$6.60 |
$22 |
0.0× |
| MRI c-spine with contrast (72142) |
$85.05 |
$283.50 |
0.3× |
| MRI cervical spine w/o contrast (72141) |
$85.05 |
$283.50 |
0.4× |
| MRI chest w/o & w/contrast material (71552) |
$85.05 |
$283.50 |
0.3× |
| MRI chest w/o contrast (71550) |
$85.05 |
$283.50 |
0.4× |
| MRI chest with contrast (71551) |
$85.05 |
$283.50 |
0.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$6.60 |
$22 |
0.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$85.05 |
$283.50 |
0.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$85.05 |
$283.50 |
0.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$85.05 |
$283.50 |
0.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$85.05 |
$283.50 |
0.3× |
| MRI pelvis w contrast (72196) |
$85.05 |
$283.50 |
0.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$85.05 |
$283.50 |
0.3× |
| MRI pelvis w/o contrast (72195) |
$6.60 |
$22 |
0.0× |
| MRI scan of arm joint before and after contrast (73223) |
$6.60 |
$22 |
0.0× |
| MRI scan of leg joint before and after contrast (73723) |
$85.05 |
$283.50 |
0.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$85.05 |
$283.50 |
0.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$85.05 |
$283.50 |
0.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$85.05 |
$283.50 |
0.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$6.60 |
$22 |
0.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$6.60 |
$22 |
0.0× |
| MRI thoracic spine w/o contrast (72146) |
$6.60 |
$22 |
0.0× |
| MRI upper ext joint w/o contrast (73221) |
$6.60 |
$22 |
0.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$6.60 |
$22 |
0.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$6.60 |
$22 |
0.0× |
| Myelogram Cervical (72240) |
$6.60 |
$22 |
0.0× |
| Myelogram Lumbar (72265) |
$6.60 |
$22 |
0.0× |
| Myelogram thoracic (72255) |
$6.60 |
$22 |
0.0× |
| Myocardial Spect Multiple Studies (78452) |
$6.60 |
$22 |
0.0× |
| Neck soft tissue (70360) |
$6.60 |
$22 |
0.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$2.40 |
$8 |
0.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$2.40 |
$8 |
0.0× |
| Nm cisternogram (78630) |
$21.60 |
$72 |
0.0× |
| Nm gastric emptying study (78264) |
$29.69 |
$98.98 |
0.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$88.50 |
$295 |
0.1× |
| Nuclear Rx Oral Admin (79005) |
$2,085 |
$6,950 |
10.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$46.50 |
$155 |
0.5× |
| Parathyroid imaging (78070) |
$9.90 |
$33 |
0.0× |
| Pelvis 1 or 2 views (72170) |
$9.90 |
$33 |
0.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$85.05 |
$283.50 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1.80 |
$6 |
0.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$8.55 |
$28.50 |
0.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$15.60 |
$52 |
0.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$1.80 |
$6 |
0.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$21.60 |
$72 |
0.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$21.60 |
$72 |
0.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$16.20 |
$54 |
0.2× |
| Radiologic exam colon single contrast study (74270) |
$15.60 |
$52 |
0.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$447 |
$1,490 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$86.10 |
$287 |
1.1× |
| Radiological examination surgical specimen (76098) |
$105.37 |
$351.24 |
0.2× |
| Rp Therapy Intravenous Administration (79101) |
$22.20 |
$74 |
0.1× |
| Scanogram (77073) |
$105.37 |
$351.24 |
1.2× |
| Scapula complete (73010) |
$8.55 |
$28.50 |
0.1× |
| Screening digital breast tomosynthesis (77063) |
$4.35 |
$14.50 |
0.2× |
| Small bowel series (74250) |
$4.35 |
$14.50 |
0.0× |
| Spec medical radj physics consltj (77370) |
$9 |
$30 |
0.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$9 |
$30 |
0.0× |
| Special dosimetry (77331) |
$88.50 |
$295 |
0.8× |
| Special treatment procedure (77470) |
$9 |
$30 |
0.0× |
| Spine thoracic 3 views (72072) |
$9 |
$30 |
0.1× |
| Stereotactic body radiation delivery (77373) |
$8.55 |
$28.50 |
0.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$9 |
$30 |
0.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$4.35 |
$14.50 |
0.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,085 |
$6,950 |
4.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$2,085 |
$6,950 |
6.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,085 |
$6,950 |
6.1× |
| Treatment device intermediate (77333) |
$847.50 |
$2,825 |
7.3× |
| Treatment devices simple (77332) |
$847.50 |
$2,825 |
7.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$847.50 |
$2,825 |
2.5× |
| Tx devices design & construction complex (77334) |
$847.50 |
$2,825 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$46.50 |
$155 |
0.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$6.60 |
$22 |
0.1× |
| Urethrocystography voiding (74455) |
$395.40 |
$1,318 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$2.40 |
$8 |
0.0× |
| Us abdl aorta screen aaa (76706) |
$34.05 |
$113.50 |
0.4× |
| Us breast unilateral complete (76641) |
$46.50 |
$155 |
0.5× |
| Us breast unilateral limited (76642) |
$46.50 |
$155 |
0.6× |
| Us chest (76604) |
$46.50 |
$155 |
0.5× |
| Us compl joint r-t w/image documentation (76881) |
$46.50 |
$155 |
0.5× |
| Us pelvic non ob complete (76856) |
$46.50 |
$155 |
0.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$46.50 |
$155 |
0.5× |
| Us pregnancy ltd (76815) |
$46.50 |
$155 |
0.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$46.50 |
$155 |
0.5× |
| Us retroperitoneal complete (76770) |
$46.50 |
$155 |
0.5× |
| Us scrotum and contents (76870) |
$46.50 |
$155 |
0.5× |
| Us soft tissue head/neck (76536) |
$46.50 |
$155 |
0.5× |
| Us transrectal (76872) |
$46.50 |
$155 |
0.5× |
| Us transrectal prostate volume (76873) |
$22.20 |
$74 |
0.2× |
| Use of body cavity probe generated heat to increase temperature of cancer cell (77620) |
$203.36 |
$677.88 |
0.4× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$203.36 |
$677.88 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$395.40 |
$1,318 |
0.3× |
| Wrist 2 views (73100) |
$395.40 |
$1,318 |
5.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$21.60 |
$72 |
0.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$21.60 |
$72 |
0.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$140.25 |
$467.50 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$15.60 |
$52 |
0.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$108.90 |
$363 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$108.90 |
$363 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$203.36 |
$677.88 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$15.60 |
$52 |
0.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$15.60 |
$52 |
0.2× |
| X-ray exam of femur 1 (73551) |
$395.40 |
$1,318 |
5.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$86.10 |
$287 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$29.69 |
$98.98 |
0.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$105.37 |
$351.24 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$2.40 |
$8 |
0.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1.80 |
$6 |
0.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1.80 |
$6 |
0.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$6.60 |
$22 |
0.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$9.90 |
$33 |
0.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$44.10 |
$147 |
0.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$44.10 |
$147 |
0.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$8.55 |
$28.50 |
0.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$8.55 |
$28.50 |
0.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$4.35 |
$14.50 |
0.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$4.35 |
$14.50 |
0.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$4.35 |
$14.50 |
0.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$4.35 |
$14.50 |
0.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$1,050.60 |
$54 |
14.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$9 |
$30 |
0.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$2,085 |
$6,950 |
27.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$395.40 |
$1,318 |
5.3× |
| Xr c-spine 6 or more views (72052) |
$9 |
$30 |
0.1× |
| Xr finger(s) 2+ views (73140) |
$86.10 |
$287 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$9 |
$30 |
0.1× |
| Xr tibia/fibula 2 views (73590) |
$2,085 |
$6,950 |
27.8× |
| Xr tmj bilateral (70330) |
$2,085 |
$6,950 |
27.8× |
| Xray knee 1 or 2 views rt (73560) |
$2.40 |
$8 |
0.0× |