| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$24,608 |
— |
| Abdomen 1 View (74018) |
— |
$902 |
— |
| Abdomen 2 views (74019) |
— |
$1,197 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,225 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$3,742 |
— |
| Angio internal mammary (75756) |
— |
$14,246 |
— |
| Angio pulmonary bilat (75743) |
— |
$10,072 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$8,307 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$15,862 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$7,930 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$8,315 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$7,724 |
— |
| Ankle 2 views (73600) |
— |
$518 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$7,930 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$5,042 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$7,930 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$8,307 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$8,683 |
— |
| Artery X-Rays Spine (75705) |
— |
$10,712 |
— |
| Arthrogram ankle (73615) |
— |
$2,927 |
— |
| Arthrogram hip (73525) |
— |
$2,795 |
— |
| Arthrogram Wrist (73115) |
— |
$2,927 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,371 |
— |
| Bone age studies (77072) |
— |
$706 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$3,891 |
— |
| Bone Imaging Limited Area (78300) |
— |
$3,185 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$2,310 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,962 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,933 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$3,383 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$2,795 |
— |
| Bone survey infant (77076) |
— |
$567 |
— |
| Brachytx isodose complex (77318) |
— |
$4,928 |
— |
| Brachytx isodose intermed (77317) |
— |
$4,112 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$3,485 |
— |
| Brain Flow Imaging Only (78610) |
— |
$1,654 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$1,654 |
— |
| Brain imaging < 4 static views (78600) |
— |
$1,654 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$3,395 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$1,654 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$6,171 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$4,286 |
— |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
— |
$5,531 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$10,758 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$3,150 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$2,077 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,980 |
— |
| Chest 1 view (71045) |
— |
$759 |
— |
| Chest 2 views (71046) |
— |
$849 |
— |
| Chest 3 views (71047) |
— |
$935 |
— |
| Chest 4 or more views (71048) |
— |
$1,025 |
— |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
— |
$185 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$993 |
— |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
— |
$2,784 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$5,774 |
— |
| Clavicle complete (73000) |
— |
$787 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$2,509 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$2,190 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$7,930 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,606 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$3,059 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$2,927 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$1,202 |
— |
| Corpora cavernosography (74445) |
— |
$1,130 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,535 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$5,710 |
— |
| CT abdomen w contrast (74160) |
— |
$5,968 |
— |
| CT abdomen w wo contrast (74170) |
— |
$6,535 |
— |
| CT abdomen w/o contrast (74150) |
— |
$5,968 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$8,419 |
— |
| CT Angio Chest (71275) |
— |
$6,695 |
— |
| CT Angio Head (70496) |
— |
$5,619 |
— |
| CT angio hrt w/3d image (75574) |
— |
$1,684 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$6,736 |
— |
| CT Angio Neck (70498) |
— |
$5,619 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$7,381 |
— |
| CT bone density (77078) |
— |
$715 |
— |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
— |
$233 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$5,968 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$5,143 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$5,968 |
— |
| CT chest w contrast (71260) |
— |
$5,968 |
— |
| CT chest w/wo contrast (71270) |
— |
$6,535 |
— |
| CT colonography screening (74263) |
— |
$5,429 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$5,243 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$3,991 |
— |
| CT head/brain with contrast (70460) |
— |
$5,968 |
— |
| CT head/brain without and with contrast (70470) |
— |
$6,535 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$1,684 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$992 |
— |
| CT hrt w/3d image congen (75573) |
— |
$1,609 |
— |
| CT iac w contrast (70481) |
— |
$5,968 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$6,535 |
— |
| CT lower ext w/o (73700) |
— |
$5,143 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$5,968 |
— |
| CT lumbar spine w contrast (72132) |
— |
$5,968 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$5,143 |
— |
| CT maxillofacial w contrast (70487) |
— |
$5,968 |
— |
CT maxillofacial wo contrast (70486)
range across 2 matching MRF lines |
— |
$908–$5,143 |
— |
| CT neck tissue combo (70492) |
— |
$5,385 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$6,535 |
— |
| CT orbits w/o contrast (70480) |
— |
$5,143 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$6,535 |
— |
| CT pelvis w/o contrast (72192) |
— |
$5,143 |
— |
| CT scan of leg combo (73702) |
— |
$6,535 |
— |
| CT scans face/jaw combo (70488) |
— |
$6,535 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$4,594 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$3,795 |
— |
| CT thoracic spine w contrast (72129) |
— |
$5,968 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$5,143 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$6,252 |
— |
CT thorax w/o contrast (71250)
range across 2 matching MRF lines |
— |
$2,760–$5,143 |
— |
| CT upper ext wo (73200) |
— |
$5,143 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$6,252 |
— |
| CT upper extremity with contrast (73201) |
— |
$5,968 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$9,147 |
— |
| Cta Abdomen (74175) |
— |
$8,419 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$464 |
— |
| CTA pelvis (72191) |
— |
$8,419 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$8,083 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$5,845 |
— |
| Diskography lumbar (72295) |
— |
$5,587 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$1,311 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,282 |
— |
| Dxa bone density study (77085) |
— |
$1,282 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$585 |
— |
| Echo exam uterus (76831) |
— |
$1,260 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$3,661 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,835 |
— |
| Esophageal Motility Study (78258) |
— |
$2,726 |
— |
| Esophagram (74220) |
— |
$1,852 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,420 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,707 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$8,803 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$2,387 |
— |
| Follow-Up Angiography (75898) |
— |
$8,702 |
— |
| Foot 2 views (73620) |
— |
$518 |
— |
| Forearm 2 views (73090) |
— |
$928 |
— |
| Gastric emptying imaging study (78264) |
— |
$2,850 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$2,726 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,806 |
— |
| Gated Heart, Multiple (78473) |
— |
$5,531 |
— |
| Hand 2 views (73120) |
— |
$518 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$17,791 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$17,680 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$17,453 |
— |
| Heart first pass single,planar (78481) |
— |
$3,190 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$7,930 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$4,857 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,973 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,020 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$3,401 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,352 |
— |
| Hysterosalpingogram (74740) |
— |
$1,495 |
— |
| Image fusion (77399) |
— |
$904 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,788 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$1,260 |
— |
| Infusion Ivp (74410) |
— |
$1,493 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$26,004 |
— |
| Intracavitary Radiation Source Applic Complex (77763) |
— |
$24,050 |
— |
| Intracavitary Radiation Source Applic Intermed (77762) |
— |
$25,141 |
— |
| Intracavitary radiation source applic simple (77761) |
— |
$24,050 |
— |
| Intraop radiaj tx deliver xray single tx session (77424) |
— |
$15,120 |
— |
| Joint Survey Single View (77077) |
— |
$1,934 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$4,631 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$4,594 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$3,612 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$1,320 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$2,250 |
— |
| Knee 3 Views (73562) |
— |
$928 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$2,077 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$1,902 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$2,313 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$1,495 |
— |
| Lung perfusion differential (78597) |
— |
$960 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$4,480 |
— |
| Lung Ventilation Imaging (78579) |
— |
$960 |
— |
| Lymph System Imaging (78195) |
— |
$2,795 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$8,091 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$3,917 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$7,724 |
— |
| Magnetic Resonance Elastography (76391) |
— |
$584 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,852 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,580 |
— |
| Meckels Divert Exam (78290) |
— |
$2,168 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$13,977 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$372 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$16,459 |
— |
| MRA head w/o contrast (70544) |
— |
$11,154 |
— |
| MRA head with contrast (70545) |
— |
$11,154 |
— |
| MRA neck w contrast (70548) |
— |
$10,187 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$15,026 |
— |
| MRA neck w/o contrast (70547) |
— |
$11,154 |
— |
| MRI abdomen w contrast (74182) |
— |
$12,630 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$9,683 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$13,204 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$16,985 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$13,204 |
— |
| MRI brain functional w/o physician admnistration (70554) |
— |
$9,242 |
— |
| MRI brain functional w/physician admnistration (70555) |
— |
$8,788 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$8,243 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$7,724 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$8,067 |
— |
| MRI cervical spine w contrast (72142) |
— |
$10,606 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$8,841 |
— |
| MRI chest w/o contrast (71550) |
— |
$8,843 |
— |
| MRI chest with contrast (71551) |
— |
$12,058 |
— |
| MRI chest wo w contrast (71552) |
— |
$17,441 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$13,204 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$14,363 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$11,003 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$10,606 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$11,787 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$8,843 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$12,058 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$17,477 |
— |
| MRI pelvis w contrast (72196) |
— |
$10,524 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$17,477 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$9,683 |
— |
| MRI spectroscopy (76390) |
— |
$8,841 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$8,841 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$12,630 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$11,003 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$14,363 |
— |
| MRI, abdomen, combo (74183) |
— |
$16,985 |
— |
| MRI, dorsal spine combo (72157) |
— |
$11,787 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$10,606 |
— |
| MRI, joint upper extrem (73221) |
— |
$11,003 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$16,985 |
— |
| MRI, lumbar spine combo (72158) |
— |
$11,787 |
— |
| Myelogram cervical (72240) |
— |
$5,053 |
— |
| Myelogram Lumbar (72265) |
— |
$5,107 |
— |
| Myelography thoracic (72255) |
— |
$4,593 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$6,454 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$1,452 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$3,401 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$3,970 |
— |
| N-invas est c ffr sw aly CTA (75580) |
— |
$1,561 |
— |
| Neck soft tissue (70360) |
— |
$690 |
— |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
— |
$2,786 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$1,139 |
— |
| Nm csf leak detection (78650) |
— |
$1,980 |
— |
| Nm red cell survival study (78130) |
— |
$2,081 |
— |
| Nm unlisted gi procedure (78299) |
— |
$2,516 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$3,496 |
— |
Ntsty modul radthx pln dose-vol histos (77301)
range across 2 matching MRF lines |
— |
$11,978–$24,287 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$2,250 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$2,460 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$849 |
— |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
— |
$1,008 |
— |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
— |
$935 |
— |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
— |
$1,684 |
— |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
— |
$493 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$879 |
— |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
— |
$372 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$801 |
— |
| Optic foramina (70190) |
— |
$755 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$305 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$4,644 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$3,831 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$3,007 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$921 |
— |
| Perineogram (74775) |
— |
$1,150 |
— |
| Peritoneogram Rs&I (74190) |
— |
$1,381 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$6,171 |
— |
| PET image w/CT, full body (78816) |
— |
$6,171 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$6,171 |
— |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
— |
$3,242 |
— |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
— |
$2,303 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$7,930 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,991 |
— |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
— |
$1,646 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,221 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$2,286 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$928 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$358 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$928 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$1,690 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$810 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$928 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$928 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$741 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$1,580 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$810 |
— |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
— |
$1,150 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$484 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$921 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$473 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$484 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$950 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$950 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$810 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$810 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$928 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,052 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$1,371 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$1,564 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$2,107 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$1,416 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,493 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,129 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$3,202 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$1,262 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,186 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$1,186 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,147 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$2,784 |
— |
| Radiologic exam teeth complete full mouth (70320) |
— |
$161 |
— |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
— |
$129 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,255 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$948 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$999 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$518 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$799 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$755 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$1,599 |
— |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
— |
$591 |
— |
| Radiologic examination, teeth; single view Non-Facility (70300) |
— |
$81 |
— |
| Radiopharm Dacryocystography (78660) |
— |
$1,980 |
— |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
— |
$3,444 |
— |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
— |
$2,564 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
— |
$1,621 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
— |
$1,258 |
— |
| Renal Cyst Study (74470) |
— |
$4,170 |
— |
| Ribs bilateral 3 views (71110) |
— |
$810 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,225 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,795 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$5,504 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$2,795 |
— |
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 3 matching MRF lines |
— |
$2,918–$7,438 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$2,929 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$6,171 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$5,941 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$7,890 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$2,250 |
— |
| Salivary Gland Imaging (78230) |
— |
$2,077 |
— |
| Salivary Gland Imaging Serial Images (78231) |
— |
$2,081 |
— |
| Scapula (73010) |
— |
$810 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$92 |
— |
| Sella turcica (70240) |
— |
$1,183 |
— |
| Shoulder 1 view (73020) |
— |
$440 |
— |
| Shoulder Arthrography (73040) |
— |
$2,927 |
— |
| Sialogram (70390) |
— |
$1,227 |
— |
| Skull less than 4 views (70250) |
— |
$1,416 |
— |
| Special dosimetry (77331) |
— |
$916 |
— |
| Special Physics Consult (77370) |
— |
$3,190 |
— |
| Special teletherapy port plan (77321) |
— |
$3,368 |
— |
| Special treatment procedure (77470) |
— |
$9,125 |
— |
| Speech evaluation, complex (70371) |
— |
$3,172 |
— |
| Spleen Imaging (78185) |
— |
$1,846 |
— |
| Srs Multisource (77371) |
— |
$180,626 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$18,127 |
— |
| Sternoclavicular joints (71130) |
— |
$664 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$8,465 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$1,133 |
— |
| Tbs technical calculation only (77091) |
— |
$62 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$5,028 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$3,207 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$1,624 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$2,119 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$9,125 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$6,318 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$5,013 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$3,326 |
— |
| Thoracic spine 2 views (72070) |
— |
$968 |
— |
| Thoracic spine 3 views (72072) |
— |
$723 |
— |
| Thoracolumbar 2 views (72080) |
— |
$1,130 |
— |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
— |
$4,732 |
— |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
— |
$1,835 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$706 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$3,742 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$537 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,114 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$3,508 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$2,186 |
— |
| Tx devices design & construction simple (77332) |
— |
$1,690 |
— |
| Ultrasound Breast Limited (76642) |
— |
$1,290 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$288 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$288 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$449 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$513 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,109 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$1,436 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$1,282 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$92 |
— |
| Unlisted Procedure Clinical Brachytherapy (77799) |
— |
$24,050 |
— |
| Upper gi w/o kub (74240) |
— |
$948 |
— |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
— |
$857 |
— |
| Urea breath test c-14 isotopic analysis (78268) |
— |
$1,014 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,066 |
— |
| Urethrocystogram voiding (74455) |
— |
$2,143 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,197 |
— |
| Us breast unilateral complete (76641) |
— |
$1,717 |
— |
| Us chest (76604) |
— |
$2,846 |
— |
| Us complete joint (76881) |
— |
$1,420 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,388 |
— |
| Us head (76506) |
— |
$3,542 |
— |
| Us kidney transplant (76776) |
— |
$2,313 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$987 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,735 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,147 |
— |
| Us ob transvaginal (76817) |
— |
$773 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,217 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$773 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$682 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,890 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,668 |
— |
| Us scrotum and contents (76870) |
— |
$2,254 |
— |
| Us spinal canal and contents (76800) |
— |
$1,934 |
— |
| Us thyroid (76536) |
— |
$1,741 |
— |
| Us transrectal (76872) |
— |
$3,716 |
— |
| Vascular Flow Imaging (78445) |
— |
$1,933 |
— |
| Vasogram (74440) |
— |
$1,202 |
— |
| Vein X-Ray Chest (75827) |
— |
$8,465 |
— |
| Vein X-Ray Skull Epidural (75872) |
— |
$8,094 |
— |
| Vein X-Ray Spleen/Liver (75810) |
— |
$4,884 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$8,465 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$3,942 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$8,465 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$4,523 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$4,329 |
— |
| Venography Orbital Rs&I (75880) |
— |
$8,094 |
— |
| Venography Renal Bilateral (75833) |
— |
$8,094 |
— |
| Venography Renal Unilateral (75831) |
— |
$7,724 |
— |
| Venous sampling by catheter (75893) |
— |
$8,465 |
— |
| Venous thrombosis imaging (78457) |
— |
$1,436 |
— |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
— |
$2,516 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$1,227 |
— |
| Wrist 2 views (73100) |
— |
$518 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$810 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,277 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$7,930 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$722 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$532 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$348 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$722 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$834 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$948 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$999 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$1,078 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$1,156 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$999 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,156 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,260 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$953 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$706 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,311 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,099 |
— |
| X-ray eye for foreign body (70030) |
— |
$1,436 |
— |
| X-ray head for orthodontia (70350) |
— |
$311 |
— |
| X-ray humerus (73060) |
— |
$928 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$2,049 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$2,126 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$437 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$682 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,416 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$484 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,447 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,043 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$509 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$690 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,064 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,502 |
— |
| X-Ray Stress View (77071) |
— |
$1,933 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$916 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$518 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,262 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$999 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$2,022 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,197 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$902 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$596 |
— |
| Xr orbits complete 4 views (70200) |
— |
$1,381 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$1,852 |
— |