| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$6,773 |
— |
| Abdomen 2 views (74019) |
— |
$425 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$1,708 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$10,563 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$9,552 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$13,228 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$8,341 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$13,228 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$657 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$1,708 |
— |
| Bone age studies (77072) |
— |
$556 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,708 |
— |
| Bone survey complete (77075) |
— |
$556 |
— |
| Brachytx isodose complex (77318) |
— |
$2,389 |
— |
| Brachytx isodose intermed (77317) |
— |
$2,142 |
— |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
— |
$1,647 |
— |
| Brain imaging < 4 static views w vascular flow (78601) |
— |
$1,708 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$4,423 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$470 |
— |
| Chest 1 view (71045) |
— |
$409 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$593 |
— |
| Clavicle complete (73000) |
— |
$353 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$657 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$3,647 |
— |
| CT abdomen w contrast (74160) |
— |
$2,686 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,967 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,861 |
— |
| CT angiography upper extremity lt (73206) |
— |
$713 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,861 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,686 |
— |
| CT chest with contrast (71260) |
— |
$2,686 |
— |
| CT head/brain with contrast (70460) |
— |
$2,686 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,967 |
— |
| CT iac w contrast (70481) |
— |
$2,686 |
— |
| CT limited/localized follow up study (76380) |
— |
$1,061 |
— |
| CT lower ext w/o (73700) |
— |
$1,954 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$4,542 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,638 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,861 |
— |
| CT lumbar spine with contrast (72132) |
— |
$2,686 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,686 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,861 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$3,967 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,686 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$3,967 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,861 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,861 |
— |
| CT scan for measuring calcium and other minerals in bone (77078) |
— |
$1,220 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$3,967 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,861 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,686 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,861 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,861 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$4,326 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$1,861 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,512 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,666 |
— |
| Cta Abdomen (74175) |
— |
$3,451 |
— |
| CTA abdomen pelvis (74174) |
— |
$4,314 |
— |
| CTA chest (71275) |
— |
$3,451 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$1,426 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$3,451 |
— |
| Cta Pelvis (72191) |
— |
$3,451 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$556 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$353 |
— |
| Dxa bone density study axial skeleton (77085) |
— |
$556 |
— |
| Echoencephalography real time imaging (76506) |
— |
$930 |
— |
| Esophagus (74220) |
— |
$996 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,221 |
— |
| Forearm 2 views (73090) |
— |
$353 |
— |
| Functional MRI brain by tech (70554) |
— |
$3,142 |
— |
| Hand 2 views (73120) |
— |
$521 |
— |
| Hand 3 views (73130) |
— |
$375 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
— |
$3,122 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
— |
$4,059 |
— |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
— |
$4,527 |
— |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
— |
$1,179 |
— |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
— |
$1,052 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$2,516 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$1,708 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$353 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$3,374 |
— |
| Intracavitary Radiation Source Applic Complex (77763) |
— |
$3,775 |
— |
| Intracavitary Radiation Source Applic Intermed (77762) |
— |
$3,384 |
— |
| Intracavitary radiation source applic simple (77761) |
— |
$2,603 |
— |
| Kidney funcj study non-img radioisotopic study (78725) |
— |
$1,708 |
— |
| Kidney imaging morphology (78700) |
— |
$1,708 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$2,154 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$2,154 |
— |
| Knee 3 views (73562) |
— |
$465 |
— |
| Liver & spleen imaging static only (78215) |
— |
$1,708 |
— |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
— |
$8,960 |
— |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
— |
$2,473 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$6,493 |
— |
| Lymphoscintigraphy (78195) |
— |
$2,516 |
— |
| Meckels Diverticulum (78290) |
— |
$1,708 |
— |
| Medical physics dose eval radiation expos w/rprt (76145) |
— |
$2,122 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$1,812 |
— |
| Mr elastography (76391) |
— |
$1,213 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$353 |
— |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
— |
$238 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$98 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$368 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$967 |
— |
| MRA head w/o contrast (70544) |
— |
$3,142 |
— |
| MRA head with contrast (70545) |
— |
$3,928 |
— |
| MRA neck w contrast (70548) |
— |
$3,928 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,556 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,142 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$4,728 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,142 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$3,928 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,928 |
— |
| MRI c-spine with contrast (72142) |
— |
$3,928 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,142 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,142 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$4,728 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,142 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$3,928 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,928 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$3,142 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,142 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$4,728 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$3,928 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$4,728 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,142 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$4,728 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$4,728 |
— |
| MRI spectroscopy (76390) |
— |
$2,747 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$4,728 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$3,928 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,728 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$3,928 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$4,728 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,142 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$3,142 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$4,728 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$3,142 |
— |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
— |
$7,293 |
— |
| Neck soft tissue (70360) |
— |
$352 |
— |
| Nm bone marrow wb (78104) |
— |
$1,708 |
— |
| Nm cisternogram (78630) |
— |
$2,516 |
— |
| Nm gastric emptying study (78264) |
— |
$1,708 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$6,773 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,048 |
— |
| Orthopantogram (70355) |
— |
$352 |
— |
| Osseous survey infant (77076) |
— |
$556 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$505 |
— |
| Peritoneogram rs&i (74190) |
— |
$2,114 |
— |
| PET imaging CT for attenuation limited area (78814) |
— |
$7,293 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$7,469 |
— |
| PET whole body (78813) |
— |
$5,963 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$4,728 |
— |
| Proton tx delivery complex (77525) |
— |
$6,314 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,708 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,221 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$409 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$552 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$639 |
— |
| Radiation treatment delivery 1 mev >= complex (77412) |
— |
$1,052 |
— |
| Radiation treatment delivery 1 mev >= simple (77402) |
— |
$590 |
— |
| Radiation tx delivery 1 mev >= intermediate (77407) |
— |
$821 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$556 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$352 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$470 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$996 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$848 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$848 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$375 |
— |
| Ribs bilateral 3 views (71110) |
— |
$613 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$5,222 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$2,379 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$5,548 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$6,219 |
— |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
— |
$5,222 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$953 |
— |
| Scanogram (77073) |
— |
$556 |
— |
| Scapula complete (73010) |
— |
$505 |
— |
| Simulation intermediate (77285) |
— |
$1,189 |
— |
| Small bowel series (74250) |
— |
$712 |
— |
| Spec medical radj physics consltj (77370) |
— |
$597 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$1,647 |
— |
| Special dosimetry (77331) |
— |
$597 |
— |
| Special treatment procedure (77470) |
— |
$2,603 |
— |
| Stereotactic body radiation delivery (77373) |
— |
$8,692 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$590 |
— |
| Tbs Technical Calculation Only (77091) |
— |
$347 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$2,142 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$1,647 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$1,376 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$759 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$2,516 |
— |
| Treatment device intermediate (77333) |
— |
$777 |
— |
| Treatment devices simple (77332) |
— |
$597 |
— |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
— |
$5,222 |
— |
| Tx devices design & construction complex (77334) |
— |
$1,527 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,060 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$930 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$938 |
— |
| Urethrocystography voiding (74455) |
— |
$1,148 |
— |
| Us chest (76604) |
— |
$930 |
— |
| Us elastography parenchyma (76981) |
— |
$593 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,106 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$930 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,106 |
— |
| Us retroperitoneal limited (76775) |
— |
$930 |
— |
| Us scrotum and contents (76870) |
— |
$930 |
— |
| Us soft tissue head/neck (76536) |
— |
$930 |
— |
| Us spinal canal and contents (76800) |
— |
$930 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$840 |
— |
| Us, eye b-scan (76512) |
— |
$745 |
— |
| Venogram extremity bilateral (75822) |
— |
$5,658 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$9,287 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$4,624 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,772 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$9,287 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$9,287 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$353 |
— |
| Wrist 2 views (73100) |
— |
$353 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$505 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$375 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$353 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$353 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$491 |
— |
| X-ray exam of femur 1 (73551) |
— |
$353 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$476 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$375 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$353 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$565 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$353 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$552 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$476 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$409 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$418 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$353 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$476 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$476 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$556 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$409 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$409 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$552 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$353 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$375 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$353 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$552 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$465 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$375 |
— |