| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$7,281.22 |
— |
| Abdomen 1 View (74018) |
— |
$599.72 |
— |
| Abdomen 2 views (74019) |
— |
$946.90 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$3,902.29 |
— |
| Ankle 2 views (73600) |
— |
$677.83 |
— |
| Arthrogram hip (73525) |
— |
$2,241.07 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$908.73 |
— |
| Bone age studies (77072) |
— |
$711.06 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$4,066.74 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,943.74 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,757.07 |
— |
| Chest 1 view (71045) |
— |
$667.85 |
— |
| Chest 2 views (71046) |
— |
$767.54 |
— |
| Chest 3 views (71047) |
— |
$1,061.59 |
— |
| Chest 4 or more views (71048) |
— |
$578.15 |
— |
| Clavicle complete (73000) |
— |
$800.76 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$3,063.37 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,054.88 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$14,107.21 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$827.33 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,445.27 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$11,362.82 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$7,287.86 |
— |
| CT abdomen w contrast (74160) |
— |
$5,068.43 |
— |
| CT abdomen w wo contrast (74170) |
— |
$6,857.61 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,621.49 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$7,287.86 |
— |
| CT Angio Chest (71275) |
— |
$5,674.78 |
— |
| CT Angio Head (70496) |
— |
$6,643.34 |
— |
| CT Angio Neck (70498) |
— |
$8,641.75 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$5,408.99 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$4,377.33 |
— |
| CT chest w contrast (71260) |
— |
$3,766.05 |
— |
| CT chest w/wo contrast (71270) |
— |
$4,756.16 |
— |
| CT head/brain with contrast (70460) |
— |
$5,013.64 |
— |
| CT head/brain without and with contrast (70470) |
— |
$6,191.45 |
— |
| CT iac w contrast (70481) |
— |
$6,600.12 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,790.97 |
— |
| CT lower ext w/o (73700) |
— |
$3,373.96 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$4,035.21 |
— |
| CT lumbar spine w contrast (72132) |
— |
$7,503.82 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$6,068.54 |
— |
| CT maxillofacial w contrast (70487) |
— |
$5,709.68 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$4,653.13 |
— |
| CT neck tissue combo (70492) |
— |
$5,134.88 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$7,714.81 |
— |
| CT orbits w/o contrast (70480) |
— |
$5,570.17 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$6,620.01 |
— |
| CT pelvis w/o contrast (72192) |
— |
$4,065.08 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$4,061.71 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$3,300.91 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,016.79 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$5,550.18 |
— |
| CT thorax w/o contrast (71250) |
— |
$3,063.37 |
— |
| CT upper ext wo (73200) |
— |
$3,299.22 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,895.60 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,795.91 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$5,588.45 |
— |
| Cta Abdomen (74175) |
— |
$5,055.18 |
— |
| CTA pelvis (72191) |
— |
$4,393.96 |
— |
| Diskography lumbar (72295) |
— |
$7,791.17 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,119.72 |
— |
| Esophagram (74220) |
— |
$1,365.57 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,799.16 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$672.79 |
— |
| Foot 2 views (73620) |
— |
$573.12 |
— |
| Forearm 2 views (73090) |
— |
$790.76 |
— |
| Gastric emptying imaging study (78264) |
— |
$4,020.18 |
— |
| Gated Heart Planar Single (78472) |
— |
$4,918.90 |
— |
| Hand 2 views (73120) |
— |
$832.29 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$4,719.58 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$4,163.06 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,676.46 |
— |
| Hysterosalpingogram (74740) |
— |
$2,086.52 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$4,138.15 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$3,153.06 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$3,153.06 |
— |
| Knee 3 Views (73562) |
— |
$815.68 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$3,570.04 |
— |
| Liver imaging static only (78201) |
— |
$2,327.41 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$4,913.96 |
— |
| Meckels Divert Exam (78290) |
— |
$3,094.93 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$2,574.90 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$7,842.69 |
— |
| MRA head w/o contrast (70544) |
— |
$4,008.60 |
— |
| MRA neck w contrast (70548) |
— |
$2,084.84 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$7,842.69 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,008.60 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$6,448.94 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$6,229.62 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$10,382.69 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$6,841 |
— |
| MRI bone marrow blood supply (77084) |
— |
$7,819.44 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$7,020.38 |
— |
| MRI chest w/o contrast (71550) |
— |
$6,209.73 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$10,382.69 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$6,065.17 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$7,446.96 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$11,211.71 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$5,586.77 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$8,786.32 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,457.14 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$6,450.61 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$4,101.65 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,789.39 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$6,841 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$11,710.08 |
— |
| MRI, abdomen, combo (74183) |
— |
$10,141.81 |
— |
| MRI, dorsal spine combo (72157) |
— |
$9,248.12 |
— |
| MRI, joint upper extrem (73221) |
— |
$6,841 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$11,710.08 |
— |
| MRI, lumbar spine combo (72158) |
— |
$10,618.61 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,689.90 |
— |
| Neck soft tissue (70360) |
— |
$775.83 |
— |
| Nm whole blood volume (78122) |
— |
$5,096.70 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$29,973.65 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$10,347.88 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$3,006.83 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$857.20 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$12,637.02 |
— |
| PET image w/CT, full body (78816) |
— |
$14,155.36 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$14,155.36 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,975.37 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,237.62 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,727.67 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$877.18 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$747.55 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$819.05 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$1,530.01 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$667.85 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$832.29 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$853.94 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$426.98 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$1,011.76 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$827.33 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$882.11 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$614.65 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$594.78 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$779.17 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$744.29 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$626.34 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$838.92 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$1,131.31 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$1,478.49 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$2,289.23 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$1,084.85 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,865.62 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$755.85 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,001.78 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$857.20 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,817.44 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,501.82 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$3,020.16 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$1,059.93 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$938.60 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$853.94 |
— |
| Ribs bilateral 3 views (71110) |
— |
$885.49 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$3,977.04 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$4,356.66 |
— |
| Scapula (73010) |
— |
$546.61 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$154.54 |
— |
| Shoulder 1 view (73020) |
— |
$912.09 |
— |
| Shoulder Arthrography (73040) |
— |
$2,249.37 |
— |
| Sialogram (70390) |
— |
$1,128.04 |
— |
| Skull less than 4 views (70250) |
— |
$561.56 |
— |
| Special dosimetry (77331) |
— |
$908.73 |
— |
| Special Physics Consult (77370) |
— |
$1,141.32 |
— |
| Special teletherapy port plan (77321) |
— |
$5,232.89 |
— |
| Special treatment procedure (77470) |
— |
$2,465.33 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$7,535.69 |
— |
| Sternoclavicular joints (71130) |
— |
$536.64 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$5,229.61 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$2,618.11 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$5,643.24 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$3,322.46 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$2,040.05 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,249.28 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,363.89 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$1,033.32 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,098.18 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$3,000.21 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$1,739.36 |
— |
| Tx devices design & construction simple (77332) |
— |
$2,611.49 |
— |
| Ultrasound Breast Limited (76642) |
— |
$805 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,375.55 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$2,260.95 |
— |
| Upper gi w/o kub (74240) |
— |
$1,540.01 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,701.16 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,126.37 |
— |
| Us breast unilateral complete (76641) |
— |
$1,319.08 |
— |
| Us chest (76604) |
— |
$860.56 |
— |
| Us complete joint (76881) |
— |
$1,576.58 |
— |
| Us exam, pelvic, limited (76857) |
— |
$769.92 |
— |
| Us head (76506) |
— |
$1,267.56 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$461.88 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,189.45 |
— |
| Us ob transvaginal (76817) |
— |
$2,486.90 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,927.04 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$629.67 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$2,368.93 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,541.66 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,460.31 |
— |
| Us scrotum and contents (76870) |
— |
$1,526.75 |
— |
| Us spinal canal and contents (76800) |
— |
$1,039.94 |
— |
| Us thyroid (76536) |
— |
$1,888.87 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$10,352.58 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$4,082.47 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,408.88 |
— |
| Wrist 2 views (73100) |
— |
$912.09 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$418.67 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$14,107.21 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$981.79 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$838.92 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$2,241.07 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$1,249.28 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$556.52 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$1,113.02 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,244.32 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,244.32 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,626.42 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$780.78 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,729.35 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,147.93 |
— |
| X-ray eye for foreign body (70030) |
— |
$792.46 |
— |
| X-ray humerus (73060) |
— |
$749.24 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$2,849.01 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,031.64 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$642.14 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,343.99 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$915.37 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$915.37 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,254.22 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,044.98 |
— |
| X-Ray Stress View (77071) |
— |
$299.04 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,579.84 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$681.11 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$2,241.07 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,488.48 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$561.56 |
— |
| Xr orbits complete 4 views (70200) |
— |
$937.01 |
— |