| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,505 |
$7,129.87 |
1.0× |
| Abdomen 2 views (74019) |
$113 |
$554.13 |
1.0× |
| Acute gi blood loss imaging (78278) |
$434 |
$2,093.90 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,434 |
$16,401.30 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,434 |
$15,648.10 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,434 |
$3,280.26 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,052 |
$28,168.60 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,434 |
$8,833.28 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,434 |
$8,162.30 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$6,052 |
$8,531.49 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,052 |
$28,168.60 |
1.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,434 |
$3,280.26 |
1.0× |
| Ankle 2 views (73600) |
$94 |
$458.82 |
1.0× |
| Aortogram thoracic (75605) |
$6,052 |
$7,932.03 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,434 |
$16,401.30 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,434 |
$16,401.30 |
1.0× |
| Arthrogram ankle (73615) |
$379 |
$1,763.36 |
1.0× |
| Arthrogram elbow (73085) |
$379 |
$1,583.11 |
1.0× |
| Arthrogram hip (73525) |
$379 |
$1,975.59 |
1.0× |
| Arthrogram knee (73580) |
$379 |
$1,856.51 |
1.0× |
| Arthrogram shoulder (73040) |
$379 |
$1,863.52 |
1.0× |
| Arthrogram wrist (73115) |
$379 |
$1,632.44 |
1.0× |
| Basic dosimetry (77300) |
$146 |
$830.22 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$434 |
$777.65 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$434 |
$2,026.01 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$434 |
$2,093.90 |
1.0× |
| Bone age studies (77072) |
$113 |
$545.25 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$434 |
$2,026.01 |
1.0× |
| Bone survey complete (77075) |
$113 |
$1,000.13 |
1.0× |
| Bone survey infant (77076) |
$113 |
$579.43 |
1.0× |
| Bowel imaging (78290) |
$434 |
$1,911.68 |
1.0× |
| Brachytx isodose complex (77318) |
$407 |
$1,899.32 |
1.0× |
| Brachytx isodose intermed (77317) |
$407 |
$1,994.08 |
1.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$407 |
$1,657.37 |
1.0× |
| Brain imaging < 4 static views (78600) |
$434 |
$1,632.55 |
1.0× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$434 |
$1,632.55 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$590 |
$2,273.21 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,555 |
$10,410.20 |
1.0× |
| Brain Imaging Vascular Flow Only (78610) |
$590 |
$2,574.95 |
1.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$434 |
$2,779.97 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$379 |
$2,099.14 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$590 |
$1,879.75 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$94 |
$458.82 |
1.0× |
| Chest 1 view (71045) |
$94 |
$458.82 |
1.0× |
| Chest xray 3 views (71047) |
$94 |
$458.82 |
1.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$190 |
$742.63 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$190 |
$927.64 |
1.0× |
| Clavicle complete (73000) |
$94 |
$458.82 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$113 |
$608.73 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$146 |
$691.85 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$379 |
$4,151.93 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$259 |
$2,561 |
1.0× |
| CT abdomen w contrast (74160) |
$190 |
$2,957.13 |
1.0× |
| CT abdomen w wo contrast (74170) |
$190 |
$3,231.11 |
1.0× |
| CT abdomen w/o contrast (74150) |
$113 |
$2,240.25 |
1.0× |
| CT angio hrt w/3d image (75574) |
$379 |
$2,237.16 |
1.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$190 |
$1,889.02 |
1.0× |
| CT angiography upper extremity lt (73206) |
$190 |
$1,306.04 |
1.0× |
| CT c-spine w/contrast (72126) |
$379 |
$4,151.93 |
1.0× |
| CT c-spine w/o contrast (72125) |
$113 |
$2,637.83 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$190 |
$3,077.64 |
1.0× |
| CT chest w contrast (71260) |
$190 |
$2,870.61 |
1.0× |
| CT chest w/wo contrast (71270) |
$190 |
$3,224.93 |
1.0× |
| CT head/brain with contrast (70460) |
$190 |
$2,448.31 |
1.0× |
| CT head/brain without and with contrast (70470) |
$190 |
$3,104.42 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$379 |
$1,860.97 |
1.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$94 |
$814.45 |
1.0× |
| CT iac w contrast (70481) |
$190 |
$2,331.92 |
1.0× |
| CT limited/localized follow up study (76380) |
$94 |
$475.86 |
1.0× |
| CT lower ext w/o (73700) |
$113 |
$1,889.02 |
1.0× |
| CT lower extremity w wo contrast (73702) |
$190 |
$3,989.19 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$190 |
$1,748.94 |
1.0× |
| CT lumbar spine w & w/o contrast (72133) |
$190 |
$3,077.64 |
1.0× |
| CT lumbar spine w/contrast (72132) |
$379 |
$4,284.80 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$113 |
$2,563.67 |
1.0× |
| CT maxillofacial w contrast (70487) |
$190 |
$2,331.92 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$190 |
$972.52 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$113 |
$2,614.14 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$190 |
$2,718.17 |
1.0× |
| CT orbits w/o contrast (70480) |
$113 |
$1,945.67 |
1.0× |
| CT pelvis w/o contrast (72192) |
$113 |
$2,148.58 |
1.0× |
| CT pelvis w/wo contrast (72194) |
$190 |
$3,077.64 |
1.0× |
| CT scan of arm combo (73202) |
$190 |
$3,989.19 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$190 |
$2,448.31 |
1.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$190 |
$3,663.71 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$113 |
$1,804.56 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$190 |
$1,926.10 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$113 |
$3,197.12 |
1.0× |
| CT thoracic spine w/wo contrast (72130) |
$190 |
$3,077.64 |
1.0× |
| CT thorax w/o contrast (71250) |
$113 |
$2,255.70 |
1.0× |
| CT unlisted procedure (76497) |
$94 |
$633.45 |
1.0× |
| CT upper ext wo (73200) |
$113 |
$1,885.93 |
1.0× |
| CT upper extremity with contrast (73201) |
$379 |
$2,331.92 |
1.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$190 |
$1,474.96 |
1.0× |
| Cta Abdomen (74175) |
$190 |
$4,601.01 |
1.0× |
| CTA abdomen pelvis (74174) |
$379 |
$3,212.38 |
1.0× |
| CTA chest (71275) |
$190 |
$4,830.70 |
1.0× |
| Cta Head (70496) |
$190 |
$1,306.04 |
1.0× |
| Cta Neck (70498) |
$190 |
$1,306.04 |
1.0× |
| Cta Pelvis (72191) |
$190 |
$1,306.04 |
1.0× |
| Cystography minimum 3 views rs&i (74430) |
$379 |
$1,860.97 |
1.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,273 |
$3,316.70 |
1.0× |
| Diskogram cervical (72285) |
$2,124 |
$6,201.63 |
1.0× |
| Diskography lumbar (72295) |
$2,124 |
$4,443.42 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$113 |
$579.43 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$94 |
$320.85 |
1.0× |
| Esophagus (74220) |
$190 |
$986.74 |
1.0× |
| Facial bones min 3 views (70150) |
$113 |
$705.55 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$113 |
$565.47 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$113 |
$818.85 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$259 |
$1,259.58 |
1.0× |
| Foot 2 views (73620) |
$94 |
$458.82 |
1.0× |
| Forearm 2 views (73090) |
$94 |
$458.82 |
1.0× |
| Hand 2 views (73120) |
$113 |
$579.43 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$757 |
$3,764.65 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$757 |
$5,647.49 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$757 |
$6,274.60 |
1.0× |
| Heart Infarct Image (78466) |
$434 |
$2,206.26 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,434 |
$7,663.20 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,434 |
$3,978.89 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$590 |
$2,804.87 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$434 |
$2,093.90 |
1.0× |
| Hysterosalpingogram (74740) |
$259 |
$1,330.76 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$757 |
$6,853.62 |
1.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$757 |
$2,005.41 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$601 |
$2,005.41 |
1.0× |
| Intracavitary Radiation Source Applic Simple (77761) |
$601 |
$2,005.41 |
1.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$113 |
$475.89 |
1.0× |
| Kidney imaging morphology (78700) |
$434 |
$885.80 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$590 |
$2,695.51 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$590 |
$2,804.87 |
1.0× |
| Knee 3 views (73562) |
$94 |
$628.66 |
1.0× |
| Liver & spleen imaging static only (78215) |
$434 |
$2,507.02 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$434 |
$2,113.56 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$590 |
$1,063.99 |
1.0× |
| Lung perfusion differential (78597) |
$434 |
$1,330.76 |
1.0× |
| Lung ventilation imaging (78579) |
$434 |
$1,330.76 |
1.0× |
| Lymphoscintigraphy (78195) |
$590 |
$1,848.85 |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$852 |
$4,854.39 |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$379 |
$5,958.55 |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$379 |
$6,412.78 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$259 |
$431.57 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$259 |
$630.36 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$407 |
$2,666.67 |
1.0× |
| MRA head w & w/o contrast (70546) |
$379 |
$2,524.53 |
1.0× |
| MRA head w/o contrast (70544) |
$259 |
$3,922.24 |
1.0× |
| MRA head with contrast (70545) |
$379 |
$3,922.24 |
1.0× |
| MRA neck w contrast (70548) |
$379 |
$4,327.03 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$379 |
$2,547.19 |
1.0× |
| MRA neck w/o contrast (70547) |
$259 |
$3,922.24 |
1.0× |
| MRI abdomen w contrast (74182) |
$379 |
$3,480.37 |
1.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$379 |
$9,006.32 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$259 |
$2,851.04 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$852 |
$4,623.67 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$379 |
$8,977.48 |
1.0× |
| MRI bone marrow blood supply (77084) |
$259 |
$4,522.73 |
1.0× |
| MRI breast w/o contrast bilateral (77047) |
$259 |
$2,802.73 |
1.0× |
| MRI breast wo contrast unilateral (77046) |
$259 |
$2,802.73 |
1.0× |
| MRI c-spine with contrast (72142) |
$379 |
$4,706.07 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$259 |
$1,348.27 |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$259 |
$4,117.94 |
1.0× |
| MRI chest w/o & w/contrast material (71552) |
$379 |
$8,494.41 |
1.0× |
| MRI chest w/o contrast (71550) |
$259 |
$3,872.80 |
1.0× |
| MRI chest with contrast (71551) |
$852 |
$5,958.55 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$379 |
$1,829.28 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$379 |
$5,360.68 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$259 |
$1,507.92 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$259 |
$5,349.82 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$379 |
$4,923.40 |
1.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$379 |
$8,550.03 |
1.0× |
| MRI pelvis w/contrast (72196) |
$379 |
$2,422.56 |
1.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$379 |
$5,560.97 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$259 |
$3,297.03 |
1.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$379 |
$7,390.25 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$379 |
$3,529.81 |
1.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$379 |
$7,555.05 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$379 |
$3,529.81 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$379 |
$7,650.84 |
1.0× |
| MRI temporomandibular joint (70336) |
$259 |
$3,922.24 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$259 |
$4,569.08 |
1.0× |
| MRI up ext w/o contrast (73218) |
$259 |
$4,044.81 |
1.0× |
| MRI upper ext joint w/o contrast (73221) |
$259 |
$4,044.81 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$379 |
$6,412.78 |
1.0× |
| Myelogram Cervical (72240) |
$852 |
$1,454.36 |
1.0× |
| Myelogram Lumbar (72265) |
$852 |
$1,577.96 |
1.0× |
| Myelogram thoracic (72255) |
$852 |
$1,184.50 |
1.0× |
| Myelography 2 or more regions (72270) |
$852 |
$1,944.64 |
1.0× |
| Myocardial infarct spect (78469) |
$590 |
$798.46 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,408 |
$1,616.07 |
1.0× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,408 |
$4,130.30 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,408 |
$8,163.27 |
1.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,408 |
$2,082.25 |
1.0× |
| Neck soft tissue (70360) |
$94 |
$458.82 |
1.0× |
| Nm cisternogram (78630) |
$590 |
$1,633.89 |
1.0× |
| Nm csf leak detection (78650) |
$1,408 |
$2,337.07 |
1.0× |
| Nm gastric emptying study (78264) |
$434 |
$2,093.90 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$434 |
$3,126.05 |
1.0× |
| Nm peritoneal-venous shunt patency (78291) |
$434 |
$921.85 |
1.0× |
| Noncardiac Vascular Flow Imaging (78445) |
$434 |
$969.23 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$113 |
$2,145.49 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,505 |
$7,129.87 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$253 |
$1,694.35 |
1.0× |
| Orthopantogram (70355) |
$94 |
$458.82 |
1.0× |
| Osseous survey limited (77074) |
$113 |
$1,118.58 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$434 |
$2,093.90 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$113 |
$579.43 |
1.0× |
| Peritoneogram after injection (74190) |
$594 |
$1,409.04 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$1,555 |
$9,564.58 |
1.0× |
| PET imaging CT for attenuation limited area (78814) |
$1,555 |
$7,243.99 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$1,555 |
$9,564.58 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,434 |
$5,553.25 |
1.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,434 |
$6,023.44 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$434 |
$1,330.76 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$590 |
$2,804.87 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$594 |
$2,857.14 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$94 |
$458.82 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$94 |
$454.23 |
1.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$94 |
$557.23 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$94 |
$440.25 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$113 |
$1,147.42 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$94 |
$458.82 |
1.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$94 |
$458.82 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$94 |
$458.82 |
1.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$94 |
$458.82 |
1.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$113 |
$554.13 |
1.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$113 |
$988.65 |
1.0× |
| Radex Humerus Minimum 2 Views (73060) |
$94 |
$458.82 |
1.0× |
| Radex Kne 1/2 Views (73560) |
$94 |
$458.82 |
1.0× |
| Radex Kne Compl 4/More Views (73564) |
$113 |
$579.43 |
1.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$113 |
$579.43 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$94 |
$529.42 |
1.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$113 |
$664.35 |
1.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$94 |
$462.47 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$94 |
$320.85 |
1.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$113 |
$751.90 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$94 |
$342.99 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$94 |
$458.82 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$113 |
$451.23 |
1.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$94 |
$462.47 |
1.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$8,011 |
$60,600.80 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$110 |
$602.50 |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$419 |
$604.61 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$601 |
$1,370.36 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$94 |
$458.82 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$113 |
$579.43 |
1.0× |
| Radiologic exam chest 2 views (71046) |
$94 |
$458.82 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$190 |
$927.64 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$190 |
$1,038.96 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$190 |
$1,187.38 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$94 |
$458.82 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$94 |
$458.82 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$113 |
$1,182.44 |
1.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$113 |
$342.99 |
1.0× |
| Radiological examination surgical specimen (76098) |
$594 |
$1,537.24 |
1.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$253 |
$3,519.51 |
1.0× |
| Renal Cyst Study (74470) |
$594 |
$2,241.28 |
1.0× |
| Ribs bilateral 3 views (71110) |
$113 |
$531.70 |
1.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$434 |
$1,943.25 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$434 |
$3,181.67 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$590 |
$4,138.54 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$590 |
$3,176.52 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$590 |
$3,253.77 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,408 |
$3,319.48 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,555 |
$4,382.60 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,408 |
$2,235.92 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$253 |
$1,585.17 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$113 |
$534.40 |
1.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$259 |
$1,689.20 |
1.0× |
| Scapula (73010) |
$113 |
$579.43 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23 |
$610.79 |
1.0× |
| Sella turcica (70240) |
$94 |
$311.06 |
1.0× |
| Shoulder 1 view (73020) |
$94 |
$458.82 |
1.0× |
| Sialogram (70390) |
$259 |
$1,330.76 |
1.0× |
| Simulation intermediate (77285) |
$407 |
$1,187.59 |
1.0× |
| Small bowel series (74250) |
$190 |
$927.64 |
1.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$407 |
$1,187.59 |
1.0× |
| Special dosimetry (77331) |
$146 |
$508.82 |
1.0× |
| Special Physics Consult (77370) |
$146 |
$691.85 |
1.0× |
| Special treatment procedure (77470) |
$601 |
$3,014.35 |
1.0× |
| Spine thoracic 3 views (72072) |
$113 |
$609.76 |
1.0× |
| Splenoportograpy rs&i (75810) |
$3,434 |
$4,602.04 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$1,944 |
$17,976.60 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$407 |
$1,657.37 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$407 |
$683.30 |
1.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$259 |
$1,748.94 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$434 |
$1,585.17 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$407 |
$2,289.06 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$146 |
$830.22 |
1.0× |
| Thoracolumbar 2 views (72080) |
$94 |
$665.38 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$590 |
$4,714.31 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$434 |
$6,162.29 |
1.0× |
| Thyroid uptake measurement (78012) |
$434 |
$1,916.83 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$434 |
$1,916.83 |
1.0× |
| Tmj unilateral (70328) |
$94 |
$257.50 |
1.0× |
| Tomogram (76100) |
$113 |
$501.61 |
1.0× |
| Treatment device complex (77334) |
$407 |
$2,289.06 |
1.0× |
| Treatment device intermediate (77333) |
$146 |
$867.26 |
1.0× |
| Treatment devices simple (77332) |
$146 |
$910.52 |
1.0× |
| Ultrasound breast complete (76641) |
$113 |
$1,337.97 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$113 |
$567.24 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$113 |
$729.24 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$113 |
$779.71 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$113 |
$542.81 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$94 |
$2,973.61 |
1.0× |
| Unlisted ultrasound procedure (76999) |
$94 |
$532.66 |
1.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$11 |
$580.32 |
1.0× |
| Ureteral reflux study (78740) |
$434 |
$1,804.56 |
1.0× |
| Urethrocystogram voiding (74455) |
$259 |
$1,186.56 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$259 |
$1,186.56 |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$190 |
$1,186.56 |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$190 |
$1,353.42 |
1.0× |
| Us breast unilateral limited (76642) |
$94 |
$675.91 |
1.0× |
| Us chest (76604) |
$113 |
$779.71 |
1.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$234 |
$1,182.44 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$113 |
$807.40 |
1.0× |
| Us encephalogram (76506) |
$113 |
$796.19 |
1.0× |
| Us hips infant static (76886) |
$94 |
$173.66 |
1.0× |
| Us infant hips w manipulation (76885) |
$94 |
$779.71 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$113 |
$566.50 |
1.0× |
| Us ob limited (76815) |
$113 |
$936.27 |
1.0× |
| Us ob transvaginal (76817) |
$113 |
$554.13 |
1.0× |
| Us pelvic non ob complete (76856) |
$113 |
$1,073.26 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$113 |
$612.85 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$113 |
$811.09 |
1.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$113 |
$582.98 |
1.0× |
| Us retroperitoneal complete (76770) |
$113 |
$1,481.14 |
1.0× |
| Us retroperitoneal limited (76775) |
$113 |
$825.65 |
1.0× |
| Us scrotum and contents (76870) |
$113 |
$929.88 |
1.0× |
| Us soft tissue head/neck (76536) |
$113 |
$1,014.55 |
1.0× |
| Us spinal canal and contents (76800) |
$113 |
$779.71 |
1.0× |
| Us transrectal (76872) |
$113 |
$1,335.91 |
1.0× |
| Us transrectal prostate volume (76873) |
$113 |
$472.77 |
1.0× |
| Us, eye b-scan (76512) |
$113 |
$796.04 |
1.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$113 |
$779.71 |
1.0× |
| Venogram extremity bilateral (75822) |
$1,712 |
$2,816.02 |
1.0× |
| Venogram Extremity Unilateral (75820) |
$1,712 |
$8,094.82 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,434 |
$5,553.76 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,712 |
$2,624.44 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,434 |
$5,553.25 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$3,434 |
$9,192.34 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,434 |
$15,737.50 |
1.0× |
| Venous sampling by catheter (75893) |
$6,052 |
$8,057.69 |
1.0× |
| Wrist 2 views (73100) |
$94 |
$458.82 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$113 |
$787.95 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94 |
$342.99 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$190 |
$1,144.33 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$94 |
$458.82 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$94 |
$493.37 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$113 |
$554.13 |
1.0× |
| X-ray exam of femur 2/> (73552) |
$94 |
$469.68 |
1.0× |
| X-ray eye for foreign body (70030) |
$94 |
$591.22 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$94 |
$1,341.06 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$190 |
$661.26 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$94 |
$342.99 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$94 |
$342.99 |
1.0× |
| X-ray leg, infant (73592) |
$94 |
$320.85 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$113 |
$751.90 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$113 |
$1,106.22 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$94 |
$196.73 |
1.0× |
| X-ray optic foramen (70190) |
$94 |
$368.74 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$113 |
$864.17 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$379 |
$1,955.59 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$94 |
$432.90 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$113 |
$554.13 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$113 |
$850.78 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$113 |
$778.68 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$94 |
$631.39 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$94 |
$711.73 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$113 |
$909.49 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$113 |
$875.50 |
1.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$190 |
$890.10 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$94 |
$458.82 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$94 |
$590.19 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$94 |
$342.99 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$113 |
$554.13 |
1.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$113 |
$554.13 |
1.0× |
| Xr bone length studies (77073) |
$113 |
$608.73 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$113 |
$593.28 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$113 |
$1,026.91 |
1.0× |
| Xr chest 4+ views (71048) |
$113 |
$845.63 |
1.0× |
| Xr urogram antegrade (74425) |
$379 |
$1,380.07 |
1.0× |