| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$10,905 |
— |
| Abdomen 2 views (74019) |
— |
$616.05 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$2,981.40 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$11,341.90 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$11,341.90 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$10,731.40 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$11,296.25 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$17,876.65 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$11,341.90 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$11,296.25 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$18,817.50 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$17,876.65 |
— |
| 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 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$2,083.65 |
— |
| Aortogram thoracic (75605) |
— |
$18,817.50 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$11,341.90 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$11,296.25 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$11,296.25 |
— |
| Arthrogram elbow (73085) |
— |
$2,207.70 |
— |
| Arthrogram hip (73525) |
— |
$2,137.15 |
— |
| Arthrogram shoulder (73040) |
— |
$2,090.65 |
— |
| Arthrogram wrist (73115) |
— |
$2,207.70 |
— |
| Arthrography knee lt (73580) |
— |
$2,103.10 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,465.80 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$2,291.30 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$2,861.95 |
— |
| Bone age studies (77072) |
— |
$632.80 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$2,976.50 |
— |
| Bone survey complete (77075) |
— |
$1,092.15 |
— |
| Brachytx isodose complex (77318) |
— |
$4,526.80 |
— |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
— |
$2,716 |
— |
| Brain imaging < 4 static views w vascular flow (78601) |
— |
$2,231.25 |
— |
| Brain Imaging Vascular Flow Only (78610) |
— |
$2,896.55 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$3,633.75 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$3,183.70 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$457.70 |
— |
| Chest 1 view (71045) |
— |
$487.80 |
— |
| Chest 3 views (71047) |
— |
$561.25 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$752.10 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$4,048.10 |
— |
| Clavicle complete (73000) |
— |
$398 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$958.55 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,427.15 |
— |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
— |
$1,010.70 |
— |
| Corpora cavernosography (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 contrast (74160) |
— |
$2,115.45 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,981.70 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,371.25 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,697.80 |
— |
| CT angiography upper extremity lt (73206) |
— |
$2,569.35 |
— |
| CT c-spine w/o contrast (72125) |
— |
$1,923.90 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$2,484.75 |
— |
| CT cervical spine with contrast (72126) |
— |
$2,113.80 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,913.50 |
— |
| CT chest with contrast (71260) |
— |
$3,720.40 |
— |
| CT head/brain with contrast (70460) |
— |
$2,109.20 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,484.75 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$1,292.35 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$958.55 |
— |
| CT hrt w/3d image congen (75573) |
— |
$1,343.90 |
— |
| CT iac w contrast (70481) |
— |
$2,290.65 |
— |
| CT limited/localized follow up study (76380) |
— |
$958.55 |
— |
| CT lower ext w/o (73700) |
— |
$1,893.20 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$2,569.10 |
— |
| CT lower extremity with contrast (73701) |
— |
$2,290.65 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$2,484.75 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,603.25 |
— |
| CT lumbar spine with contrast (72132) |
— |
$2,113.80 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,536.55 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,343.60 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$2,852.85 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$3,720.40 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$2,934.15 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,972.65 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$3,361.70 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,603.25 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$3,838.40 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,455.85 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,113.80 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,546.85 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$2,484.75 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,603.25 |
— |
| CT unlisted procedure (76497) |
— |
$2,325.45 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,572.70 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$2,009.40 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,290.65 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,375.95 |
— |
| Cta Abdomen (74175) |
— |
$2,655 |
— |
| CTA abdomen pelvis (74174) |
— |
$3,342.65 |
— |
| CTA chest (71275) |
— |
$3,102.45 |
— |
| Cta Head (70496) |
— |
$3,102.45 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$3,083.20 |
— |
| Cta Neck (70498) |
— |
$2,790.40 |
— |
| Cta Pelvis (72191) |
— |
$2,488 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$1,979.45 |
— |
| Dacryocystography (70170) |
— |
$1,138.55 |
— |
| Diskography lumbar (72295) |
— |
$9,935.45 |
— |
| Echo exam of fetal heart (76825) |
— |
$3,289.05 |
— |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
— |
$1,566.25 |
— |
| Echoencephalography real time imaging (76506) |
— |
$1,691.25 |
— |
| Esophagus (74220) |
— |
$1,209.25 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,561.65 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,536.05 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,562.35 |
— |
| Foot 2 views (73620) |
— |
$420.50 |
— |
| Forearm 2 views (73090) |
— |
$549.20 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,460.70 |
— |
| Hand 2 views (73120) |
— |
$535.65 |
— |
| Hand 3 views (73130) |
— |
$670.50 |
— |
| 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 |
— |
| 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 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$457.70 |
— |
| Hyperthermia ntrstl prb 5/< (77610) |
— |
$1,800.30 |
— |
| Hysterosalpingogram (74740) |
— |
$1,965.50 |
— |
| Image fusion (77399) |
— |
$1,057.45 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$3,383.35 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$654.70 |
— |
| Kidney funcj study non-img radioisotopic study (78725) |
— |
$2,231.25 |
— |
| Kidney imaging morphology (78700) |
— |
$3,125.10 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$3,218.25 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$3,302.15 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$3,906.35 |
— |
| Knee 3 views (73562) |
— |
$457.70 |
— |
| Liver imaging static only (78201) |
— |
$2,775.85 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$2,896.55 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$7,372.55 |
— |
| Lung perfusion differential (78597) |
— |
$4,380.20 |
— |
| Lung Ventilation Imaging (78579) |
— |
$2,231.25 |
— |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
— |
$11,341.90 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$11,296.25 |
— |
| Lymphoscintigraphy (78195) |
— |
$2,947.90 |
— |
| Meckels Diverticulum (78290) |
— |
$2,981.40 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$2,278.70 |
— |
| MRA head w & w/o contrast (70546) |
— |
$4,864.50 |
— |
| MRA head w/o contrast (70544) |
— |
$3,031.65 |
— |
| MRA head with contrast (70545) |
— |
$4,028.80 |
— |
| MRA neck w contrast (70548) |
— |
$3,379.35 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,218.40 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,086.60 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,659.75 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$3,790 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,777.90 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$3,240.95 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,823.15 |
— |
| MRI bone marrow blood supply (77084) |
— |
$5,061.80 |
— |
| MRI c-spine with contrast (72142) |
— |
$3,240.95 |
— |
| MRI cardiac w/o cont stress (75559) |
— |
$3,481.15 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$1,657.75 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$2,108.95 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$5,237.85 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,460.75 |
— |
| MRI chest with contrast (71551) |
— |
$3,903.75 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$3,732.45 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$3,772.90 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,240.95 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,777.90 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,880.85 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$3,567 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$3,180.10 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,659.75 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$4,548 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,777.90 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$4,427.30 |
— |
| MRI scan of heart before and after contrast with stress imaging (75563) |
— |
$5,154.40 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$4,236.95 |
— |
| MRI spectroscopy (76390) |
— |
$1,521.95 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$3,790 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$3,240.95 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$4,548 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$3,240.95 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$4,876.85 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,031.65 |
— |
| MRI tmj (70336) |
— |
$1,759.50 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$2,296.25 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$4,166.90 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,870.55 |
— |
| Myelogram Cervical (72240) |
— |
$4,237.65 |
— |
| Myelogram Lumbar (72265) |
— |
$4,237.65 |
— |
| Myelogram thoracic (72255) |
— |
$4,237.65 |
— |
| Myelography 2 or more regions (72270) |
— |
$4,237.65 |
— |
| Myocardial infarct spect (78469) |
— |
$3,364.95 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$7,506.35 |
— |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
— |
$7,876.75 |
— |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
— |
$5,181.80 |
— |
| Neck soft tissue (70360) |
— |
$567.45 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$2,231.25 |
— |
| Nm adrenal scan (78075) |
— |
$7,735 |
— |
| Nm cisternogram (78630) |
— |
$3,364.95 |
— |
| Nm gastric emptying study (78264) |
— |
$3,428.60 |
— |
| Nm gastroesophageal reflux study (78262) |
— |
$2,808.10 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$3,130.65 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$12,511.25 |
— |
| Nuclear medicine study of kidney and blood flow (78701) |
— |
$3,145.10 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,615.05 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$930.66 |
— |
| Osseous survey infant (77076) |
— |
$1,090.35 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$4,228.90 |
— |
| Parathyrd planar w/wo subtrj (78071) |
— |
$3,298.35 |
— |
| Parathyroid imaging (78070) |
— |
$1,876.45 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$535.60 |
— |
| Pr MRI brain w/ dye (70558) |
— |
$2,947.20 |
— |
| Pr MRI brain w/o & w/ dye (70559) |
— |
$3,114.40 |
— |
| Pr MRI brain w/o dye (70557) |
— |
$2,786.45 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$4,236.95 |
— |
| Proton trmt simple w/comp (77522) |
— |
$3,969.65 |
— |
| Proton tx delivery complex (77525) |
— |
$4,803.25 |
— |
| Proton tx delivery intermediate (77523) |
— |
$4,366.60 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$1,800.30 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$11,296.25 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$11,296.25 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,531.30 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$7,330.45 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,264.25 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$339.15 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$522.35 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$860.55 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$613.95 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$34,289.75 |
— |
| Radiation treatment delivery 1 mev >= complex (77412) |
— |
$1,391.90 |
— |
| Radiation treatment delivery 1 mev >= simple (77402) |
— |
$1,057.45 |
— |
| Radiation tx delivery 1 mev >= intermediate (77407) |
— |
$1,070.45 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$616.05 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$549.20 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$798.15 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$520.30 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,448.50 |
— |
| 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 Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$457.70 |
— |
| Review by radiologist of adrenal gland vein image (75840) |
— |
$11,296.25 |
— |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
— |
$11,296.25 |
— |
| Ribs bilateral 3 views (71110) |
— |
$859.10 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,884.25 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$7,735 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$7,348.25 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$7,735 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$8,760.50 |
— |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
— |
$7,735 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$2,746.30 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$998.50 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$6,501.90 |
— |
| Scanogram (77073) |
— |
$617.55 |
— |
| Scapula complete (73010) |
— |
$616.05 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$848.15 |
— |
| Simulation intermediate (77285) |
— |
$2,908.75 |
— |
| Small bowel series (74250) |
— |
$1,455.70 |
— |
| Spec medical radj physics consltj (77370) |
— |
$1,429.05 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$2,290.30 |
— |
| Special dosimetry (77331) |
— |
$1,506.85 |
— |
| Special treatment procedure (77470) |
— |
$4,990.35 |
— |
| Spine thoracic 3 views (72072) |
— |
$762.30 |
— |
| Splenoportograpy rs&i (75810) |
— |
$11,296.25 |
— |
| Stereotactic body radiation delivery (77373) |
— |
$7,271.55 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$1,057.45 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$3,091.85 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$2,004.45 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$2,428.50 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$3,777.40 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$1,701.05 |
— |
| Therapeutic Enema (74283) |
— |
$1,201.50 |
— |
| Thoracolumbar 2 views (72080) |
— |
$623.90 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$4,235.75 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$2,231.25 |
— |
| Thyroid uptake measurement (78012) |
— |
$2,231.25 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,419.65 |
— |
| Tomogram (76100) |
— |
$440.10 |
— |
| Treatment device intermediate (77333) |
— |
$1,889.55 |
— |
| Treatment devices simple (77332) |
— |
$1,190.90 |
— |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
— |
$8,948.95 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$2,674.35 |
— |
| Tx devices design & construction complex (77334) |
— |
$2,970.45 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$784.50 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$894.75 |
— |
| Unlisted Diagnostic Radiographic Procedure (76499) |
— |
$1,461.22 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$707.90 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$2,321.10 |
— |
| Upper Extremity Infant (73092) |
— |
$616.05 |
— |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
— |
$2,897.90 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,725.25 |
— |
| Urethrocystography voiding (74455) |
— |
$1,859.50 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,991.95 |
— |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
— |
$1,933 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$677.55 |
— |
| Us breast unilateral complete (76641) |
— |
$666.30 |
— |
| Us breast unilateral limited (76642) |
— |
$621.15 |
— |
| Us chest (76604) |
— |
$724.20 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$1,161.15 |
— |
| Us fetal nuchal translucency 1st gestation (76813) |
— |
$894.75 |
— |
| Us guided compression repair (76936) |
— |
$2,074.90 |
— |
| Us infant hips dynamic (76885) |
— |
$1,660.05 |
— |
| Us infant hips limited static (76886) |
— |
$1,096.25 |
— |
| Us kidney transplant (76776) |
— |
$1,837.40 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,566.25 |
— |
| Us ob transvaginal (76817) |
— |
$708.20 |
— |
| Us pelvic non ob complete (76856) |
— |
$741.10 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$653.75 |
— |
| Us pregnancy ltd (76815) |
— |
$599.10 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$773.30 |
— |
| Us retroperitoneal complete (76770) |
— |
$617.55 |
— |
| Us retroperitoneal limited (76775) |
— |
$606.90 |
— |
| Us scrotum and contents (76870) |
— |
$784.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$653.75 |
— |
| Us spinal canal and contents (76800) |
— |
$1,612 |
— |
| Us transrectal (76872) |
— |
$653.40 |
— |
| Us transrectal prostate volume (76873) |
— |
$1,929.30 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$653.75 |
— |
| Us, eye b-scan (76512) |
— |
$1,378.05 |
— |
| Venogram extremity bilateral (75822) |
— |
$5,612.20 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$10,731.40 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$5,549 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$5,895.80 |
— |
| Venography Renal Bilateral (75833) |
— |
$11,341.90 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$11,296.25 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$11,296.25 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$18,817.50 |
— |
| Wrist 2 views (73100) |
— |
$420.50 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$827 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$420.50 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$549.20 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$1,739 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$420.50 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$457.70 |
— |
| X-ray exam entire spi 4/5 vw (72083) |
— |
$562.35 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$420.50 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$457.70 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$616.65 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$865.15 |
— |
| X-ray exam of femur 1 (73551) |
— |
$420.50 |
— |
| X-ray eye for foreign body (70030) |
— |
$398 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$637.05 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$567.45 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$457.70 |
— |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
— |
$7,065.50 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$457.70 |
— |
| X-ray IV pyelogram+drip infusn (74410) |
— |
$1,818.75 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$592.15 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$616.05 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$429.50 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$398 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$542.05 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$870.50 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$609.50 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$624.15 |
— |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$496.25 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$680.25 |
— |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
— |
$1,906.70 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,453.15 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$457.70 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$535.60 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$951.85 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$687.65 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$687.30 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$549.20 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$637.05 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$567.45 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,138.30 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$685.10 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$357.90 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$610.10 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$550.15 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$535.60 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$1,025.90 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$457.70 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$549.20 |
— |
| Xr arthrogram ankle (73615) |
— |
$2,207.70 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$1,054.10 |
— |
| Xr chest 4+ views (71048) |
— |
$739.25 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$549.20 |
— |
| Xr shoulder 1 view (73020) |
— |
$420.50 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$616.05 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$457.70 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$420.50 |
— |