| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$10,905 |
— |
| Acute gi blood loss imaging (78278) |
— |
$2,981.40 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$11,296.25 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$11,341.90 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$17,876.65 |
— |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
— |
$11,341.90 |
— |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
— |
$11,296.25 |
— |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
— |
$11,341.90 |
— |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
— |
$10,731.40 |
— |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
— |
$17,876.65 |
— |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
— |
$11,296.25 |
— |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
— |
$18,817.50 |
— |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
— |
$11,296.25 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$11,296.25 |
— |
| Ankle 2 views (73600) |
— |
$420.50 |
— |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
— |
$11,341.90 |
— |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
— |
$11,296.25 |
— |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
— |
$18,817.50 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,465.80 |
— |
| Brain flow imaging only - nm brain flow only brain death (78610) |
— |
$2,896.55 |
— |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
— |
$2,231.25 |
— |
| Card MRI w/stress img & dye (75563) |
— |
$5,154.40 |
— |
| Cardiac MRI morphology & function w/o contrast (75557) |
— |
$1,657.75 |
— |
| Cardiac MRI w/stress img (75559) |
— |
$3,481.15 |
— |
| Cardiac MRI w/wo contrast & further seq (75561) |
— |
$3,183.70 |
— |
| Cisternography, positive contrast, radiological supervision and interpretation Age Under 21 (70015) |
— |
$4,048.10 |
— |
| Clavicle complete (73000) |
— |
$398 |
— |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
— |
$3,342.65 |
— |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
— |
$2,655 |
— |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
— |
$3,375.95 |
— |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
— |
$3,102.45 |
— |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
— |
$3,083.20 |
— |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
— |
$2,790.40 |
— |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
— |
$2,488 |
— |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
— |
$2,569.35 |
— |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
— |
$2,484.75 |
— |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
— |
$1,893.20 |
— |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
— |
$2,569.10 |
— |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
— |
$2,484.75 |
— |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
— |
$2,536.55 |
— |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
— |
$1,343.60 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$2,290.65 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
— |
$1,972.65 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
— |
$2,934.15 |
— |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
— |
$3,838.40 |
— |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
— |
$2,484.75 |
— |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
— |
$3,913.50 |
— |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
— |
$1,427.15 |
— |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
— |
$937.20 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$4,034.75 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,481.70 |
— |
| CT abdomen w & w/o contrast (74170) |
— |
$2,981.70 |
— |
| CT abdomen w/contrast (74160) |
— |
$2,115.45 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,371.25 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,697.80 |
— |
| CT cervical spine w/contrast (72126) |
— |
$2,113.80 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,923.90 |
— |
| CT chest w/contrast (71260) |
— |
$3,720.40 |
— |
| CT extremity upper w & w/o contrast (73202) |
— |
$2,572.70 |
— |
| CT extremity upper w/o contrast (73200) |
— |
$2,009.40 |
— |
| CT head/brain with contrast (70460) |
— |
$2,109.20 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,484.75 |
— |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
— |
$1,343.90 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$1,292.35 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$958.55 |
— |
| CT l-spine w/contrast (72132) |
— |
$2,113.80 |
— |
| CT limited/localized follow up study (76380) |
— |
$958.55 |
— |
| CT lower extremity w/dye (73701) |
— |
$2,290.65 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,603.25 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$2,852.85 |
— |
| CT neck w/contrast (70491) |
— |
$3,720.40 |
— |
| CT neck w/o contrast (70490) |
— |
$1,455.85 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$3,361.70 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,603.25 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,113.80 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,546.85 |
— |
| CT thorax lung cancer scr c- (71271) |
— |
$958.55 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,603.25 |
— |
| CT upper extremity w/dye (73201) |
— |
$2,290.65 |
— |
| CTA head w contrast (70496) |
— |
$3,102.45 |
— |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
— |
$1,979.45 |
— |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
— |
$1,138.55 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$7,065.50 |
— |
| Diskography lumbar s&i (72295) |
— |
$9,935.45 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
— |
$3,289.05 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$1,566.25 |
— |
| Fetal biophys profile w/o nst (76819) |
— |
$1,536.05 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,561.65 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$1,562.35 |
— |
| Gastroesophageal reflux study (78262) |
— |
$2,808.10 |
— |
| Gated heart planar single (78472) |
— |
$3,460.70 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
— |
$4,417.85 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
— |
$6,732.30 |
— |
| Heart infarct image (78466) |
— |
$2,808.10 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$11,296.25 |
— |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
— |
$11,296.25 |
— |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
— |
$2,877.60 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$2,478.10 |
— |
| Ht muscle image spect sing (78451) |
— |
$7,412.70 |
— |
| Hyperthermia ntrstl prb 5/< (77610) |
— |
$1,800.30 |
— |
| Image fusion (77399) |
— |
$1,057.45 |
— |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
— |
$2,231.25 |
— |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
— |
$12,511.25 |
— |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
— |
$3,383.35 |
— |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
— |
$2,981.40 |
— |
| Isodose brachytherapy complex 10+ sources (77318) |
— |
$4,526.80 |
— |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
— |
$2,716 |
— |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
— |
$3,091.85 |
— |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
— |
$2,004.45 |
— |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
— |
$2,231.25 |
— |
| Kidney imaging morphol - nm kidney cortex (78700) |
— |
$3,125.10 |
— |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
— |
$3,145.10 |
— |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
— |
$3,906.35 |
— |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
— |
$3,218.25 |
— |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
— |
$3,302.15 |
— |
| Leveen/shunt patency exam (78291) |
— |
$3,130.65 |
— |
| Liver imaging (78201) |
— |
$2,775.85 |
— |
| Liver imaging with flow (78202) |
— |
$2,896.55 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$7,372.55 |
— |
| Lung perfusion imaging (78580) |
— |
$2,531.30 |
— |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
— |
$11,341.90 |
— |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
— |
$11,296.25 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
— |
$4,236.95 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
— |
$3,240.95 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
— |
$2,777.90 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$4,236.95 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
— |
$3,180.10 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
— |
$2,880.85 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
— |
$3,772.90 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$4,166.90 |
— |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
— |
$4,028.80 |
— |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
— |
$4,864.50 |
— |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
— |
$4,218.40 |
— |
| Mandible min 4v (70110) |
— |
$616.05 |
— |
| MRA head w/o contrast (70544) |
— |
$3,031.65 |
— |
| MRA neck w/ contrast (70548) |
— |
$3,379.35 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,086.60 |
— |
| MRI abdomen w/contrast (74182) |
— |
$3,659.75 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,777.90 |
— |
| MRI abdomen w/wo contrast (74183) |
— |
$3,790 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,240.95 |
— |
| MRI bone marrow (77084) |
— |
$5,061.80 |
— |
| MRI brain w/dye (70558) |
— |
$2,947.20 |
— |
| MRI brain w/o & w/dye (70559) |
— |
$3,114.40 |
— |
| MRI brain w/o dye (70557) |
— |
$2,786.45 |
— |
| MRI c-spine w&w/o cont (72156) |
— |
$3,790 |
— |
| MRI cervical spine w/contrast (72142) |
— |
$3,240.95 |
— |
| MRI chest w/contrast (71551) |
— |
$3,903.75 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,460.75 |
— |
| MRI chest w/wo contrast (71552) |
— |
$5,237.85 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$3,732.45 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$4,427.30 |
— |
| MRI joint upr extrem w/dye (73222) |
— |
$2,823.15 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$2,296.25 |
— |
| MRI lumbar spine w/contrast (72149) |
— |
$3,240.95 |
— |
| MRI lumbar spine w/wo contrast (72158) |
— |
$4,548 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$3,567 |
— |
| MRI pelvis w & w/o contrast (72197) |
— |
$4,548 |
— |
| MRI pelvis w/contrast (72196) |
— |
$3,659.75 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,777.90 |
— |
| MRI spectroscopy (76390) |
— |
$1,521.95 |
— |
| MRI spine cervical w/o contrast (72141) |
— |
$2,108.95 |
— |
| MRI t-spine w&w/o cont (72157) |
— |
$4,876.85 |
— |
| MRI thoracic spine w/contrast (72147) |
— |
$3,240.95 |
— |
| MRI thoracic spine w/o contrst (72146) |
— |
$3,031.65 |
— |
| MRI tmj (70336) |
— |
$1,759.50 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,870.55 |
— |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
— |
$2,278.70 |
— |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
— |
$4,237.65 |
— |
| Myocardial spect multiple studies (78452) |
— |
$7,506.35 |
— |
| Myocrd img PET rst&strs CT (78431) |
— |
$7,876.75 |
— |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
— |
$5,181.80 |
— |
| Nm adrenal imaging (78075) |
— |
$7,735 |
— |
| Nm bone 3 phase (78315) |
— |
$2,976.50 |
— |
| Nm bone imaging whole body (78306) |
— |
$2,861.95 |
— |
| Nm csf cisternogram (78630) |
— |
$3,364.95 |
— |
| Nm gastric emptying (78264) |
— |
$3,428.60 |
— |
| Nm lung ventilation imaging (78579) |
— |
$2,231.25 |
— |
| Nm lymph system (78195) |
— |
$2,947.90 |
— |
| Nm myocard infarct spect (78469) |
— |
$3,364.95 |
— |
| Nuclear medicine study of bone and/or joint limited area (78300) |
— |
$2,291.30 |
— |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
— |
$3,633.75 |
— |
| Ob us limited fetus(s) (76815) |
— |
$599.10 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$894.75 |
— |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
— |
$1,378.05 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$4,228.90 |
— |
| Parathyroid planar imaging (78070) |
— |
$1,876.45 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$3,298.35 |
— |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
— |
$11,296.25 |
— |
| Proton treatment complex (77525) |
— |
$4,803.25 |
— |
| Proton treatment delivery; simple, without compensation (77520) |
— |
$1,800.30 |
— |
| Proton trmt intermediate (77523) |
— |
$4,366.60 |
— |
| Proton trmt simple w/comp (77522) |
— |
$3,969.65 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$11,296.25 |
— |
| Pulmonary ventilation & perfusion imaging (78582) |
— |
$7,330.45 |
— |
| Quant differential pulm perfusion w/wo imaging (78597) |
— |
$4,380.20 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,264.25 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
— |
$339.15 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$522.35 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
— |
$562.35 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
— |
$613.95 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$420.50 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$457.70 |
— |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
— |
$616.65 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$860.55 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$457.70 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$616.05 |
— |
| Radex spine cervical 6 or more views (72052) |
— |
$1,054.10 |
— |
| Radex spine thoracolumbar junction min 2 views (72080) |
— |
$623.90 |
— |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
— |
$34,289.75 |
— |
| Radiation tx delivery lvl 1 (77402) |
— |
$1,057.45 |
— |
| Radiation tx delivery lvl 2 (77407) |
— |
$1,070.45 |
— |
| Radiation tx delivery lvl 3 (77412) |
— |
$1,391.90 |
— |
| Radiologic exam abdomen 3+ views (74021) |
— |
$798.15 |
— |
| Radiologic exam chest 3 views (71047) |
— |
$561.25 |
— |
| Radiologic exam chest 4+ views (71048) |
— |
$739.25 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,739 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,448.50 |
— |
| Radiologic exam esophagus single contrast study (74220) |
— |
$1,209.25 |
— |
| Radiologic exam small int single contrast study (74250) |
— |
$1,455.70 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$752.10 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,241.55 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$1,143.52 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$420.50 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$457.70 |
— |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
— |
$496.25 |
— |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
— |
$549.20 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$827 |
— |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
— |
$420.50 |
— |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
— |
$457.70 |
— |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
— |
$567.45 |
— |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
— |
$457.70 |
— |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
— |
$670.50 |
— |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
— |
$429.50 |
— |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
— |
$616.05 |
— |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
— |
$592.15 |
— |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
— |
$624.15 |
— |
| Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) |
— |
$1,010.70 |
— |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
— |
$1,906.70 |
— |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
— |
$951.85 |
— |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
— |
$535.60 |
— |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
— |
$2,090.65 |
— |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
— |
$549.20 |
— |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
— |
$440.10 |
— |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
— |
$567.45 |
— |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
— |
$685.10 |
— |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
— |
$542.05 |
— |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
— |
$609.50 |
— |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
— |
$870.50 |
— |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
— |
$1,025.90 |
— |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
— |
$549.20 |
— |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
— |
$420.50 |
— |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
— |
$457.70 |
— |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
— |
$398 |
— |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
— |
$610.10 |
— |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
— |
$457.70 |
— |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
— |
$616.05 |
— |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
— |
$7,348.25 |
— |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
— |
$6,501.90 |
— |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
— |
$1,615.05 |
— |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
— |
$2,746.30 |
— |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
— |
$1,859.50 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,674.35 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,884.25 |
— |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
— |
$8,948.95 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$7,735 |
— |
| Rp loclzj tum spect 2 areas (78831) |
— |
$7,735 |
— |
| Rp loclzj tum spect w/CT 1 (78830) |
— |
$7,735 |
— |
| Rp loclzj tum spect w/CT 2 (78832) |
— |
$8,760.50 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$998.50 |
— |
| Scapula complete (73010) |
— |
$616.05 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$848.15 |
— |
| Simulation intermediate (77285) |
— |
$2,908.75 |
— |
| Special dosimetry (77331) |
— |
$1,506.85 |
— |
| Special physics consult (77370) |
— |
$1,429.05 |
— |
| Special teletherapy port plan (77321) |
— |
$2,290.30 |
— |
| Special treatment procedure (77470) |
— |
$4,990.35 |
— |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
— |
$11,296.25 |
— |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
— |
$7,271.55 |
— |
| Surface application of low dose rate radionuclide source (77789) |
— |
$1,057.45 |
— |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
— |
$2,428.50 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$3,777.40 |
— |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
— |
$1,201.50 |
— |
| Thyroid imaging with vascular flow (78013) |
— |
$2,231.25 |
— |
| Thyroid met imaging body (78018) |
— |
$4,235.75 |
— |
| Thyroid uptake single/multiple quant measurement (78012) |
— |
$2,231.25 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
— |
$2,419.65 |
— |
| Tr simulation simple (77280) |
— |
$1,701.05 |
— |
| Treatment device complex (77334) |
— |
$2,970.45 |
— |
| Treatment device intermediate (77333) |
— |
$1,889.55 |
— |
| Treatment device simple (77332) |
— |
$1,190.90 |
— |
| Ultrasound breast limited (76642) |
— |
$621.15 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$784.50 |
— |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
— |
$653.75 |
— |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
— |
$741.10 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
— |
$1,566.25 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
— |
$773.30 |
— |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
— |
$1,837.40 |
— |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
— |
$1,929.30 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$894.75 |
— |
| Unlisted CT procedure (76497) |
— |
$2,325.45 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$707.90 |
— |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
— |
$2,321.10 |
— |
| Ureteral reflux study (78740) |
— |
$2,897.90 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,725.25 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
— |
$1,991.95 |
— |
| Urography antegrade rs&i (74425) |
— |
$2,083.65 |
— |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
— |
$1,818.75 |
— |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
— |
$1,933 |
— |
| Us abdominal aorta real time screen study aaa (76706) |
— |
$677.55 |
— |
| Us breast uni real time with image complete (76641) |
— |
$666.30 |
— |
| Us chest (76604) |
— |
$724.20 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$1,161.15 |
— |
| Us encephalogram (76506) |
— |
$1,691.25 |
— |
| Us exam, pelvic, limited (76857) |
— |
$653.75 |
— |
| Us guided compression repair (76936) |
— |
$2,074.90 |
— |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
— |
$1,660.05 |
— |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
— |
$1,096.25 |
— |
| US OB Follow-Up/Repeat (76816) |
— |
$930.66 |
— |
| Us ob transvaginal (76817) |
— |
$708.20 |
— |
| Us retroperitoneal complete (76770) |
— |
$617.55 |
— |
| Us retroperitoneal ltd (76775) |
— |
$606.90 |
— |
| Us scrotum (76870) |
— |
$784.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$653.75 |
— |
| Us spinal canal (76800) |
— |
$1,612 |
— |
| Us transrectal (76872) |
— |
$653.40 |
— |
| Venogram sinus/jugular (75860) |
— |
$11,296.25 |
— |
| Venography adrenal unilateral selective rs&i (75840) |
— |
$11,296.25 |
— |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
— |
$1,461.22 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$11,296.25 |
— |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
— |
$10,731.40 |
— |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
— |
$5,549 |
— |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
— |
$5,612.20 |
— |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
— |
$5,895.80 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$18,817.50 |
— |
| X-ray exam hips bi 3-4 views (73522) |
— |
$865.15 |
— |
| X-ray exam of finger(s) (73140) |
— |
$549.20 |
— |
| X-ray exam of knee 1 or 2 (73560) |
— |
$420.50 |
— |
| X-ray exam ribs bil 3 views (71110) |
— |
$859.10 |
— |
| X-ray exam ribs uni 2 views (71100) |
— |
$457.70 |
— |
| X-ray heel (73650) |
— |
$457.70 |
— |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
— |
$687.65 |
— |
| X-ray retrograde pyelogram (74420) |
— |
$1,453.15 |
— |
| Xr abdomen 1 view (74018) |
— |
$549.20 |
— |
| Xr abdomen 2 views (74019) |
— |
$616.05 |
— |
| Xr arthrogram ankle (73615) |
— |
$2,207.70 |
— |
| Xr arthrogram elbow (73085) |
— |
$2,207.70 |
— |
| Xr arthrogram hip (73525) |
— |
$2,137.15 |
— |
| Xr arthrogram knee (73580) |
— |
$2,103.10 |
— |
| Xr arthrogram wrist (73115) |
— |
$2,207.70 |
— |
| Xr bone age studies (77072) |
— |
$632.80 |
— |
| Xr bone length study (77073) |
— |
$617.55 |
— |
| Xr bone survey infant (77076) |
— |
$1,090.35 |
— |
| Xr chest 1 view (71045) |
— |
$487.80 |
— |
| Xr chest 2 views (71046) |
— |
$520.30 |
— |
| Xr eye foreign body (70030) |
— |
$398 |
— |
| Xr facial bones 3+ views (70150) |
— |
$637.05 |
— |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
— |
$420.50 |
— |
| Xr forearm 2 views (73090) |
— |
$549.20 |
— |
| Xr hand 2v (73120) |
— |
$535.65 |
— |
| Xr hysterosalpingogram (74740) |
— |
$1,965.50 |
— |
| Xr joint survey 1 view (77077) |
— |
$654.70 |
— |
| Xr myelogram c-spine (72240) |
— |
$4,237.65 |
— |
| Xr myelogram l-spine (72265) |
— |
$4,237.65 |
— |
| Xr myelogram t-spine (72255) |
— |
$4,237.65 |
— |
| Xr neck soft tissue (70360) |
— |
$567.45 |
— |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
— |
$457.70 |
— |
| Xr osseous survey complete (77075) |
— |
$1,092.15 |
— |
| Xr pelvis 1-2 views (72170) |
— |
$535.60 |
— |
| Xr pelvis min 3 view (72190) |
— |
$680.25 |
— |
| Xr sacrum/coccyx 2+ views (72220) |
— |
$687.30 |
— |
| Xr shoulder 1 view (73020) |
— |
$420.50 |
— |
| Xr sinuses 3+ views (70220) |
— |
$637.05 |
— |
| Xr skull min 4 view (70260) |
— |
$1,138.30 |
— |
| Xr spine 1 view (72020) |
— |
$357.90 |
— |
| Xr spine thoracic 3v (72072) |
— |
$762.30 |
— |
| Xr sternum 2+ views (71120) |
— |
$550.15 |
— |
| Xr t-spine 2 views (72070) |
— |
$535.60 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$457.70 |
— |
| Xr venogram renal bilat (75833) |
— |
$11,341.90 |
— |
| Xr wrist 2 views (73100) |
— |
$420.50 |
— |