| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$6,773 |
— |
| Abdomen 1 View (74018) |
— |
$352 |
— |
| Abdomen 2 views (74019) |
— |
$425 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,708 |
— |
| Angio pulmonary bilat (75743) |
— |
$8,341 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$10,563 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$9,552 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$13,228 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$13,228 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$657 |
— |
| Bone age studies (77072) |
— |
$556 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,708 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,708 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$1,708 |
— |
| Bone survey infant (77076) |
— |
$556 |
— |
| Brachytx isodose complex (77318) |
— |
$2,389 |
— |
| Brachytx isodose intermed (77317) |
— |
$2,142 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$1,647 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$1,708 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$4,423 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,061 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$2,516 |
— |
| Chest 1 view (71045) |
— |
$409 |
— |
| Chest 2 views (71046) |
— |
$470 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| 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 Angio Abdomen and Pelvis (74174) |
— |
$4,314 |
— |
| CT Angio Chest (71275) |
— |
$3,451 |
— |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 3 matching MRF lines |
— |
$3,451–$6,902 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$713 |
— |
| CT bone density (77078) |
— |
$1,220 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,686 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,861 |
— |
| CT chest w 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 lower ext w/o (73700)
range across 3 matching MRF lines |
— |
$1,954–$3,908 |
— |
CT lower extremity w/contrast material (73701)
range across 3 matching MRF lines |
— |
$2,638–$5,276 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,686 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,861 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,686 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,861 |
— |
| CT neck tissue combo (70492) |
— |
$3,967 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,967 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,861 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,861 |
— |
CT scan of leg combo (73702)
range across 2 matching MRF lines |
— |
$3,028–$6,056 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,967 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,686 |
— |
| 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 ext wo (73200)
range across 3 matching MRF lines |
— |
$1,861–$3,722 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 2 matching MRF lines |
— |
$2,884–$5,768 |
— |
CT upper extremity with contrast (73201)
range across 3 matching MRF lines |
— |
$2,512–$5,024 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$4,666 |
— |
| Cta Abdomen (74175) |
— |
$3,451 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$1,426 |
— |
| CTA pelvis (72191) |
— |
$3,451 |
— |
| Dxa Bone Density Axial (77080) |
— |
$556 |
— |
| Dxa bone density study (77085) |
— |
$556 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$353 |
— |
| Esophagram (74220) |
— |
$996 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,221 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,708 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$521–$1,042 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$4,527 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$4,059 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$3,122 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,516 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,708 |
— |
| 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 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,154 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,154 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$1,708 |
— |
| Kidney Imaging Morphol (78700) |
— |
$1,708 |
— |
Knee 3 Views (73562)
range across 3 matching MRF lines |
— |
$465–$930 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,708 |
— |
| Lymph System Imaging (78195) |
— |
$2,516 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$2,473 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$8,960 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$6,493 |
— |
| Magnetic Resonance Elastography (76391) |
— |
$1,213 |
— |
| Meckels Divert Exam (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 safety determination physician/other qhp (76016) |
— |
$353 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$98 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$368 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$238 |
— |
| 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 contrast (74181) |
— |
$3,142 |
— |
MRI any jt lower extrem w/contrast material (73722)
range across 6 matching MRF lines |
— |
$3,928–$7,856 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 6 matching MRF lines |
— |
$4,728–$9,456 |
— |
MRI any jt upper extremity w/contrast matrl (73222)
range across 6 matching MRF lines |
— |
$3,928–$7,856 |
— |
| MRI brain functional w/o physician admnistration (70554) |
— |
$3,142 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,142 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,928 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,142 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,142 |
— |
| MRI chest wo w contrast (71552) |
— |
$4,728 |
— |
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 3 matching MRF lines |
— |
$3,928–$7,856 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 3 matching MRF lines |
— |
$4,728–$9,456 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
— |
$3,142–$6,284 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,928 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,728 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,142 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,928 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,728 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,728 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,142 |
— |
| MRI spectroscopy (76390) |
— |
$2,747 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,142 |
— |
MRI upper extremity oth than jt w/contr matrl (73219)
range across 3 matching MRF lines |
— |
$3,928–$7,856 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 3 matching MRF lines |
— |
$3,142–$6,284 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines |
— |
$4,728–$9,456 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,728 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,728 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,928 |
— |
MRI, joint upper extrem (73221)
range across 6 matching MRF lines |
— |
$3,142–$6,284 |
— |
MRI, joint upper extrem combo (73223)
range across 6 matching MRF lines |
— |
$4,728–$9,456 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,728 |
— |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
— |
$7,293 |
— |
| Neck soft tissue (70360) |
— |
$352 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$6,773 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$953 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,048 |
— |
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 3 matching MRF lines |
— |
$745–$1,490 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$352 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$505 |
— |
| Peritoneogram Rs&I (74190) |
— |
$2,114 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$7,293 |
— |
| PET image w/CT, full body (78816) |
— |
$7,469 |
— |
| PET whole body (78813) |
— |
$5,963 |
— |
| Proton tx delivery complex (77525) |
— |
$6,314 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,708 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$505 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,221 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 3 matching MRF lines |
— |
$375–$750 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
Radex fingr minimum 2 views (73140)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
Radex foot complete minimum 3 views (73630)
range across 3 matching MRF lines |
— |
$375–$750 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$375–$1,150 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$476 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$409 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$476 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$409 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$409 |
— |
Radex Toe Minimum 2 Views (73660)
range across 3 matching MRF lines |
— |
$353–$750 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 3 matching MRF lines |
— |
$375–$706 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$590 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$821 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,052 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$556 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$996 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 3 matching MRF lines |
— |
$565–$1,130 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$712 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$593 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$848 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$353 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 3 matching MRF lines |
— |
$375–$750 |
— |
Radiologic examination knee 1/2 views (73560)
range across 3 matching MRF lines |
— |
$375–$750 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$465–$930 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
— |
$1,179 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
— |
$1,052 |
— |
| Ribs bilateral 3 views (71110) |
— |
$613 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$5,222 |
— |
| 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/acquisj 1day img (78830) |
— |
$5,222 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$505–$1,010 |
— |
| Skull less than 4 views (70250) |
— |
$556 |
— |
| Special dosimetry (77331) |
— |
$597 |
— |
| Special Physics Consult (77370) |
— |
$597 |
— |
| Special teletherapy port plan (77321) |
— |
$1,647 |
— |
| 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 Intermed (77285) |
— |
$1,189 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$759 |
— |
| Thoracic spine 2 views (72070) |
— |
$552 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$2,516 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$1,527 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$777 |
— |
| Tx devices design & construction simple (77332) |
— |
$597 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$593 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,060 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$930 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$938 |
— |
| Upper gi w/o kub (74240) |
— |
$848 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,148 |
— |
| Us chest (76604) |
— |
$930 |
— |
| Us exam, pelvic, limited (76857) |
— |
$930 |
— |
| Us head (76506) |
— |
$930 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$840 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,106 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,106 |
— |
| Us retroperitoneal limited (76775) |
— |
$930 |
— |
| Us scrotum and contents (76870) |
— |
$930 |
— |
| Us spinal canal and contents (76800) |
— |
$930 |
— |
| Us thyroid (76536) |
— |
$930 |
— |
| Vein X-Ray Chest (75827) |
— |
$4,624 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$9,287 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$9,287 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$5,658 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,772 |
— |
| Venography Renal Unilateral (75831) |
— |
$9,287 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$353 |
— |
Wrist 2 views (73100)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$409 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$552 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$353 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$491 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$639 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$470 |
— |
X-ray humerus (73060)
range across 3 matching MRF lines |
— |
$353–$706 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$552 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$418 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$476 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$556 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$556 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$552 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$476 |
— |