| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,475 |
$12,097 |
1.0× |
| Abdomen 1 View (74018) |
$92 |
$550 |
1.0× |
| Abdomen 2 views (74019) |
$111 |
$605 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$426 |
$856 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,367 |
$15,738 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,367 |
$11,162 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,367 |
$3,328 |
1.0× |
| Ankle 2 views (73600) |
$92 |
$320 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$5,933 |
$3,091 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$143 |
$1,447 |
1.0× |
| Bone age studies (77072) |
$111 |
$334 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$426 |
$2,819 |
1.0× |
| Bone Imaging Whole Body (78306) |
$426 |
$1,995 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$372 |
$4,916 |
1.0× |
| Chest 1 view (71045) |
$92 |
$550 |
1.0× |
| Chest 2 views (71046) |
$92 |
$605 |
1.0× |
| Chest 3 views (71047) |
$92 |
$667 |
1.0× |
| Chest 4 or more views (71048) |
$111 |
$532 |
1.0× |
| Clavicle complete (73000) |
$92 |
$1,112 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$111 |
$113 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$143 |
$1,706 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,367 |
$4,768 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$372 |
$1,834 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$372 |
$7,026 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$254 |
$3,904 |
1.0× |
| CT abdomen w contrast (74160) |
$187 |
$5,655 |
1.0× |
| CT abdomen w wo contrast (74170) |
$187 |
$6,223 |
1.0× |
| CT abdomen w/o contrast (74150) |
$111 |
$3,678 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$372 |
$4,022 |
1.0× |
| CT Angio Chest (71275) |
$187 |
$3,016 |
1.0× |
| CT Angio Head (70496) |
$187 |
$2,103 |
1.0× |
| CT angio hrt w/3d image (75574) |
$372 |
$2,668 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$187 |
$4,240 |
1.0× |
| CT Angio Neck (70498) |
$187 |
$2,502 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$187 |
$2,233 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$372 |
$1,967 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$111 |
$1,793 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$187 |
$2,892 |
1.0× |
| CT chest w contrast (71260) |
$187 |
$2,464 |
1.0× |
| CT chest w/wo contrast (71270) |
$187 |
$3,036 |
1.0× |
| CT head/brain with contrast (70460) |
$187 |
$4,484 |
1.0× |
| CT head/brain without and with contrast (70470) |
$187 |
$4,932 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$372 |
$1,680 |
1.0× |
| CT iac w contrast (70481) |
$187 |
$2,245 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$187 |
$2,345 |
1.0× |
| CT lower ext w/o (73700) |
$111 |
$2,628 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$187 |
$2,770 |
1.0× |
| CT lumbar spine w contrast (72132) |
$372 |
$2,303 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$111 |
$1,516 |
1.0× |
| CT maxillofacial w contrast (70487) |
$187 |
$2,314 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$111 |
$2,103 |
1.0× |
| CT neck tissue combo (70492) |
$187 |
$2,502 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$187 |
$890 |
1.0× |
| CT orbits w/o contrast (70480) |
$111 |
$1,586 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$187 |
$2,278 |
1.0× |
| CT pelvis w/o contrast (72192) |
$111 |
$1,671 |
1.0× |
| CT scan of leg combo (73702) |
$187 |
$2,344 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$187 |
$2,025 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$111 |
$1,544 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$111 |
$1,246 |
1.0× |
| CT thorax w/o contrast (71250) |
$111 |
$1,825 |
1.0× |
| CT upper ext wo (73200) |
$111 |
$2,387 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$187 |
$2,884 |
1.0× |
| CT upper extremity with contrast (73201) |
$372 |
$2,627 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$187 |
$1,688 |
1.0× |
| Cta Abdomen (74175) |
$187 |
$2,176 |
1.0× |
| CTA pelvis (72191) |
$187 |
$890 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$111 |
$532 |
1.0× |
| Dxa Bone Density Axial (77080) |
$111 |
$1,317 |
1.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$254 |
$1,209 |
1.0× |
| Esophagram (74220) |
$187 |
$1,144 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$111 |
$777 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$111 |
$707 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$254 |
$1,222 |
1.0× |
| Foot 2 views (73620) |
$92 |
$624 |
1.0× |
| Forearm 2 views (73090) |
$92 |
$654 |
1.0× |
| Gastric emptying imaging study (78264) |
$426 |
$3,425 |
1.0× |
| Hand 2 views (73120) |
$111 |
$334 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$742 |
$3,469 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$579 |
$4,260 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$426 |
$957 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,380 |
$2,924 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$579 |
$1,431 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$579 |
$1,731 |
1.0× |
| Knee 3 Views (73562) |
$92 |
$800 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$579 |
$1,562 |
1.0× |
| Lymph System Imaging (78195) |
$579 |
$4,398 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$399 |
$5,305 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$372 |
$1,786 |
1.0× |
| MRA head w/o contrast (70544) |
$254 |
$2,167 |
1.0× |
| MRA neck w contrast (70548) |
$372 |
$2,924 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$372 |
$3,356 |
1.0× |
| MRA neck w/o contrast (70547) |
$254 |
$1,209 |
1.0× |
| MRI abdomen w contrast (74182) |
$372 |
$5,595 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$254 |
$2,762 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$372 |
$7,017 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$835 |
$6,752 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$254 |
$4,851 |
1.0× |
| MRI cervical spine w contrast (72142) |
$372 |
$1,786 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$254 |
$3,121 |
1.0× |
| MRI chest w/o contrast (71550) |
$254 |
$5,035 |
1.0× |
| MRI chest wo w contrast (71552) |
$372 |
$7,700 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$372 |
$6,587 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$254 |
$5,213 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$372 |
$4,501 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$254 |
$2,668 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$372 |
$3,896 |
1.0× |
| MRI pelvis w contrast (72196) |
$372 |
$1,786 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$372 |
$7,967 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$254 |
$5,115 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$254 |
$2,877 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$254 |
$4,930 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$372 |
$6,545 |
1.0× |
| MRI, abdomen, combo (74183) |
$372 |
$6,155 |
1.0× |
| MRI, dorsal spine combo (72157) |
$372 |
$3,900 |
1.0× |
| MRI, joint upper extrem (73221) |
$254 |
$6,325 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$372 |
$7,543 |
1.0× |
| MRI, lumbar spine combo (72158) |
$372 |
$4,336 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,380 |
$8,670 |
1.0× |
| Neck soft tissue (70360) |
$92 |
$676 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,475 |
$13,915 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$248 |
$3,201 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$426 |
$3,254 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$111 |
$283 |
1.0× |
| PET image w/CT, full body (78816) |
$1,524 |
$15,980 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,524 |
$15,840 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$426 |
$1,502 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$111 |
$569 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$582 |
$1,391 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$92 |
$797 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$92 |
$836 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$92 |
$1,275 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$111 |
$602 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$92 |
$609 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$92 |
$882 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$92 |
$820 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$92 |
$216 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$92 |
$602 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$92 |
$335 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$92 |
$1,384 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$92 |
$269 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$92 |
$356 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$92 |
$859 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$92 |
$603 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$111 |
$722 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$92 |
$828 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$111 |
$532 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$589 |
$2,370 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$111 |
$1,031 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$111 |
$647 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$187 |
$890 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$111 |
$1,107 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$111 |
$976 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$187 |
$505 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$187 |
$328 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$187 |
$1,418 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$92 |
$201 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$92 |
$300 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$92 |
$216 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$92 |
$161 |
1.0× |
| Ribs bilateral 3 views (71110) |
$111 |
$1,159 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$579 |
$6,527 |
1.0× |
| Scapula (73010) |
$111 |
$1,215 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23 |
$186 |
1.0× |
| Shoulder 1 view (73020) |
$92 |
$161 |
1.0× |
| Shoulder Arthrography (73040) |
$372 |
$2,657 |
1.0× |
| Skull less than 4 views (70250) |
$111 |
$217 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$1,906 |
$10,981 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$399 |
$4,128 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$399 |
$3,448 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$143 |
$1,767 |
1.0× |
| Thoracic spine 2 views (72070) |
$111 |
$272 |
1.0× |
| Thoracic spine 3 views (72072) |
$111 |
$463 |
1.0× |
| Thoracolumbar 2 views (72080) |
$92 |
$369 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$426 |
$2,397 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$399 |
$3,412 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$143 |
$2,195 |
1.0× |
| Ultrasound Breast Limited (76642) |
$92 |
$1,462 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$111 |
$1,222 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$111 |
$1,741 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$111 |
$342 |
1.0× |
| Unlisted us procedure (76999) |
$92 |
$440 |
1.0× |
| Upper gi w/o kub (74240) |
$187 |
$890 |
1.0× |
| Urethrocystography retrograde (74450) |
$254 |
$1,260 |
1.0× |
| Us breast unilateral complete (76641) |
$111 |
$1,608 |
1.0× |
| Us chest (76604) |
$111 |
$584 |
1.0× |
| Us complete joint (76881) |
$111 |
$1,723 |
1.0× |
| Us exam, pelvic, limited (76857) |
$111 |
$1,204 |
1.0× |
| Us head (76506) |
$111 |
$331 |
1.0× |
| Us kidney transplant (76776) |
$111 |
$1,533 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$111 |
$664 |
1.0× |
| Us ob detailed single fetus (76811) |
$254 |
$1,163 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$111 |
$1,130 |
1.0× |
| Us ob transvaginal (76817) |
$111 |
$1,429 |
1.0× |
| Us pelvic non ob complete (76856) |
$111 |
$2,060 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$111 |
$1,440 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$111 |
$787 |
1.0× |
| Us retroperitoneal complete (76770) |
$111 |
$1,787 |
1.0× |
| Us retroperitoneal limited (76775) |
$111 |
$1,626 |
1.0× |
| Us scrotum and contents (76870) |
$111 |
$1,684 |
1.0× |
| Us spinal canal and contents (76800) |
$111 |
$511 |
1.0× |
| Us thyroid (76536) |
$111 |
$1,732 |
1.0× |
| Us transrectal (76872) |
$111 |
$1,052 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,367 |
$15,738 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,678 |
$3,593 |
1.0× |
| Wrist 2 views (73100) |
$92 |
$1,004 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$92 |
$359 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,367 |
$5,351 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$92 |
$216 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$582 |
$1,130 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$92 |
$359 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$111 |
$937 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$111 |
$1,101 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$92 |
$196 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$92 |
$326 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$111 |
$728 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$111 |
$396 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$111 |
$505 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$111 |
$1,172 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$111 |
$1,406 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$92 |
$882 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$111 |
$1,522 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$111 |
$369 |
1.0× |
| X-ray humerus (73060) |
$92 |
$329 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$92 |
$465 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$92 |
$680 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$111 |
$431 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$92 |
$504 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$111 |
$1,564 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$111 |
$728 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$111 |
$517 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$92 |
$308 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$92 |
$1,102 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$111 |
$600 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$111 |
$509 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$92 |
$242 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$372 |
$1,577 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$111 |
$366 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$111 |
$1,299 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$92 |
$161 |
1.0× |
| Xr orbits complete 4 views (70200) |
$111 |
$692 |
1.0× |