| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$2,570 |
— |
| Abdomen 1 View (74018) |
— |
$168 |
— |
| Abdomen 2 views (74019) |
— |
$309 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$879 |
— |
Angio internal mammary (75756)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angio pulmonary bilat (75743)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angiography Adrenal Bilateral Slctv Rs&I (75733)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angiography extremity bilateral rs&i (75716)
range across 4 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angiography extremity unilateral rs&i (75710)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angiography pulmonary unilateral slctv rs&i (75741)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Angrph pulmonary nonslctv cath/ven njx rs&i (75746)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
| Ankle 2 views (73600) |
— |
$154 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$11,856 |
— |
Aortography thoracic w/o serialography rs&i (75600)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Artery X-Rays Abdomen (75726)
range across 2 matching MRF lines |
— |
$10,822–$16,233 |
— |
Artery X-Rays Adrenal Gland (75731)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Artery X-Rays Pelvis (75736)
range across 2 matching MRF lines |
— |
$10,822–$16,233 |
— |
Artery X-Rays Spine (75705)
range across 2 matching MRF lines |
— |
$10,822–$16,233 |
— |
| Arthrogram ankle (73615) |
— |
$950 |
— |
Arthrogram hip (73525)
range across 3 matching MRF lines |
— |
$822–$950 |
— |
| Arthrogram Wrist (73115) |
— |
$950 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$325 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$867 |
— |
| Bone Imaging Limited Area (78300) |
— |
$867 |
— |
| Bone Imaging Whole Body (78306) |
— |
$867 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$355 |
— |
| Chest 1 view (71045) |
— |
$168 |
— |
| Chest 2 views (71046) |
— |
$168 |
— |
| Chest 3 views (71047) |
— |
$168 |
— |
| Chest 4 or more views (71048) |
— |
$309 |
— |
| Clavicle complete (73000) |
— |
$154 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$550 |
— |
Continuing medical physics consltj pr wk (77336)
range across 2 matching MRF lines |
— |
$225–$325 |
— |
Contrast Exam Abdominl Aorta (75625)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
Contrast X-Ray Bladder (74430)
range across 3 matching MRF lines |
— |
$835–$1,254 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$950 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$950 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$1,050 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$550 |
— |
| CT abdomen w contrast (74160) |
— |
$925 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,050 |
— |
| CT abdomen w/o contrast (74150) |
— |
$550 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$1,050 |
— |
| CT Angio Chest (71275) |
— |
$1,070 |
— |
| CT Angio Head (70496) |
— |
$1,050 |
— |
| CT Angio Neck (70498) |
— |
$1,050 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$608 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$925 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$550 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$1,050 |
— |
| CT chest w contrast (71260) |
— |
$925 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,050 |
— |
| CT head/brain with contrast (70460) |
— |
$925 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,050 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$233 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,050 |
— |
| CT lower ext w/o (73700) |
— |
$550 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$925 |
— |
| CT lumbar spine w contrast (72132) |
— |
$925 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$550 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$550 |
— |
| CT neck tissue combo (70492) |
— |
$1,050 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,050 |
— |
| CT orbits w/o contrast (70480) |
— |
$550 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,050 |
— |
| CT pelvis w/o contrast (72192) |
— |
$550 |
— |
| CT scan of leg combo (73702) |
— |
$1,050 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$925 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$550 |
— |
| CT thoracic spine w contrast (72129) |
— |
$925 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$550 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,050 |
— |
| CT thorax w/o contrast (71250) |
— |
$550 |
— |
| CT upper ext wo (73200) |
— |
$550 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$1,050 |
— |
| CT upper extremity with contrast (73201) |
— |
$925 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,070 |
— |
| Cta Abdomen (74175) |
— |
$1,050 |
— |
Dilation ureters/urethra rs&i (74485)
range across 2 matching MRF lines |
— |
$4,067–$6,100.50 |
— |
Discography Cerv/Thor Spine (72285)
range across 2 matching MRF lines |
— |
$4,000–$6,000 |
— |
Diskography lumbar (72295)
range across 2 matching MRF lines |
— |
$4,000–$6,000 |
— |
Echo Guide For Artery Repair (76936)
range across 2 matching MRF lines |
— |
$613–$919.50 |
— |
| Esophagram (74220) |
— |
$300 |
— |
Fluoroscopy up to 1 hr (76000)
range across 3 matching MRF lines |
— |
$418–$745.50 |
— |
Follow-Up Angiography (75898)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
| Foot 2 views (73620) |
— |
$154 |
— |
| Forearm 2 views (73090) |
— |
$154 |
— |
| Gastric emptying imaging study (78264) |
— |
$879 |
— |
| Gated Heart Planar Single (78472) |
— |
$867 |
— |
GI Endoscopic US S&I (76975)
range across 2 matching MRF lines |
— |
$634–$951 |
— |
| Hand 2 views (73120) |
— |
$154 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,125 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$879 |
— |
Infusion Ivp (74410)
range across 2 matching MRF lines |
— |
$405–$607.50 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$943 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,125 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,125 |
— |
| Knee 3 Views (73562) |
— |
$154 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$879 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,750 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,125 |
— |
| Lymph System Imaging (78195) |
— |
$1,125 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,391 |
— |
| Meckels Divert Exam (78290) |
— |
$879 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$700 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$1,750 |
— |
| MRA head w/o contrast (70544) |
— |
$1,450 |
— |
| MRA head with contrast (70545) |
— |
$1,600 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$1,750 |
— |
| MRA neck w/o contrast (70547) |
— |
$1,450 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,450 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$1,600 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$1,750 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$1,600 |
— |
| MRI cervical spine w contrast (72142) |
— |
$1,600 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$1,450 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,450 |
— |
| MRI chest with contrast (71551) |
— |
$1,600 |
— |
| MRI chest wo w contrast (71552) |
— |
$1,750 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,600 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$1,750 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,450 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$1,600 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$1,750 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,450 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$1,600 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$1,750 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,600 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$1,750 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$1,450 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$1,450 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$1,600 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$1,450 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$1,750 |
— |
| MRI, abdomen, combo (74183) |
— |
$1,750 |
— |
| MRI, dorsal spine combo (72157) |
— |
$1,750 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$1,600 |
— |
| MRI, joint upper extrem (73221) |
— |
$1,750 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$1,750 |
— |
| MRI, lumbar spine combo (72158) |
— |
$1,750 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$2,960 |
— |
| Neck soft tissue (70360) |
— |
$154 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$732 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$2,570 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$476 |
— |
| Optic foramina (70190) |
— |
$154 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$879 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$1,750 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$154 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$256 |
— |
Radex abscess/fistula/sinus tract rs&i (76080)
range across 3 matching MRF lines |
— |
$988–$1,482 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$154 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$154 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$154 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$225 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$154 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$154 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$154 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$154 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$154 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$154 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$154 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$154 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$154 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$154 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$325 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$325 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$570 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$83 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$309 |
— |
Radiologic exam colon double contrast study (74280)
range across 2 matching MRF lines |
— |
$405–$607.50 |
— |
Radiologic exam colon single contrast study (74270)
range across 4 matching MRF lines |
— |
$486–$729 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$495 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$225 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$154 |
— |
Radiologic Exam Small Int Single Contrast Study (74250)
range across 2 matching MRF lines |
— |
$331–$497 |
— |
Radiologic exam swallow function contrast study (74230)
range across 2 matching MRF lines |
— |
$487–$731 |
— |
Radiologic exam upr gi trc double contrast study (74246)
range across 2 matching MRF lines |
— |
$400–$600 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$213 |
— |
Radiologic examination knee 1/2 views (73560)
range across 3 matching MRF lines |
— |
$154–$220 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$154 |
— |
| Radiopharm Dacryocystography (78660) |
— |
$732 |
— |
| Ribs bilateral 3 views (71110) |
— |
$154 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,750 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$1,750 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$1,750 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$1,750 |
— |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 4 matching MRF lines |
— |
$2,960–$3,064 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$476 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$476 |
— |
| Scapula (73010) |
— |
$154 |
— |
| Shoulder 1 view (73020) |
— |
$154 |
— |
| Shoulder Arthrography (73040) |
— |
$950 |
— |
| Skull less than 4 views (70250) |
— |
$154 |
— |
| Special Physics Consult (77370) |
— |
$325 |
— |
| Special teletherapy port plan (77321) |
— |
$768 |
— |
| Special treatment procedure (77470) |
— |
$1,135 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$3,640 |
— |
| Sternoclavicular joints (71130) |
— |
$154 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$700 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$700 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$700 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$325 |
— |
| Thoracic spine 2 views (72070) |
— |
$154 |
— |
| Thoracic spine 3 views (72072) |
— |
$225 |
— |
| Thoracolumbar 2 views (72080) |
— |
$154 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$879 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$700 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$303 |
— |
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines |
— |
$285–$350 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$418 |
— |
Unlisted us procedure (76999)
range across 2 matching MRF lines |
— |
$221–$332 |
— |
Upper gi w/o kub (74240)
range across 3 matching MRF lines |
— |
$400–$600 |
— |
| Ureteral Reflux Study (78740) |
— |
$732 |
— |
Urethrocystogram voiding (74455)
range across 2 matching MRF lines |
— |
$634–$951 |
— |
Urethrocystography retrograde (74450)
range across 2 matching MRF lines |
— |
$522–$783 |
— |
Us chest (76604)
range across 3 matching MRF lines |
— |
$225–$285 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,750 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 4 matching MRF lines |
— |
$200–$285 |
— |
| Us pelvic non ob complete (76856) |
— |
$350 |
— |
| Us retroperitoneal complete (76770) |
— |
$350 |
— |
| Us scrotum and contents (76870) |
— |
$350 |
— |
Us thyroid (76536)
range across 2 matching MRF lines |
— |
$350–$400 |
— |
Us transrectal (76872)
range across 2 matching MRF lines |
— |
$359–$538.50 |
— |
| Vasogram (74440) |
— |
$690 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$6,492 |
— |
Venography extremity bilateral rs&i (75822)
range across 2 matching MRF lines |
— |
$3,190–$4,785 |
— |
Venography extremity unilateral rs&i (75820)
range across 2 matching MRF lines |
— |
$3,190–$4,785 |
— |
| Wrist 2 views (73100) |
— |
$154 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$154 |
— |
X-ray antegrade pyelogram tube (74425)
range across 2 matching MRF lines |
— |
$835–$1,252.50 |
— |
X-Ray Aorta Leg Arteries (75630)
range across 2 matching MRF lines |
— |
$6,492–$9,738 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$154 |
— |
X-Ray Exam Breast Specimen (76098)
range across 2 matching MRF lines |
— |
$1,159–$1,738.50 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$1,750 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$352 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$213 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$154 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$352 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$256 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$154 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$256 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$154 |
— |
| X-ray eye for foreign body (70030) |
— |
$154 |
— |
| X-ray humerus (73060) |
— |
$154 |
— |
X-ray IV pyelogram (ivp) (74400)
range across 3 matching MRF lines |
— |
$405–$607.50 |
— |
X-ray IV pyelogram+tomography (74415)
range across 2 matching MRF lines |
— |
$405–$607.50 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$107 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$154 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$300 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$256 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,750 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,750 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$195 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$256 |
— |
X-Ray Stress View (77071)
range across 2 matching MRF lines |
— |
$154–$231 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$154 |
— |
X-Ray Urinary Tract Exam With Contrast Material (74420)
range across 2 matching MRF lines |
— |
$835–$1,252.50 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$256 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$256 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$154 |
— |
| Xr orbits complete 4 views (70200) |
— |
$225 |
— |