| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$5,828 |
— |
| Abdomen 2 views (74019) |
— |
$2,218 |
— |
| Acute gi blood loss imaging (78278) |
— |
$6,815.50 |
— |
| Angio Adrenal Bilat Select (75733) |
— |
$19,841 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$17,849 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$8,613 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$3,340 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$19,956 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$21,418 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$9,627 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$18,185.50 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$14,091 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$12,606 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$14,285 |
— |
| Ankle 2 views (73600) |
— |
$1,828 |
— |
| Aortogram thoracic (75605) |
— |
$29,603 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$14,177.50 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$6,470 |
— |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
— |
$10,403.50 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$9,315 |
— |
| Arthrogram ankle (73615) |
— |
$2,888 |
— |
| Arthrogram elbow (73085) |
— |
$2,951 |
— |
| Arthrogram hip (73525) |
— |
$6,537 |
— |
| Arthrogram knee (73580) |
— |
$4,907 |
— |
| Arthrogram shoulder (73040) |
— |
$6,805 |
— |
| Arthrogram wrist (73115) |
— |
$2,951 |
— |
| Basic dosimetry (77300) |
— |
$5,828 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$4,849 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$5,988 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$7,972 |
— |
| Bone age studies (77072) |
— |
$1,109.50 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$8,159 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$6,351 |
— |
| Bone survey complete (77075) |
— |
$4,521 |
— |
| Bone survey infant (77076) |
— |
$4,032 |
— |
| Bowel imaging (78290) |
— |
$7,278 |
— |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
— |
$5,371 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$9,424 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$16,926 |
— |
| Brain Imaging Vascular Flow Only (78610) |
— |
$9,134 |
— |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
— |
$6,768 |
— |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
— |
$7,416 |
— |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
— |
$5,577 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$7,197 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$2,015 |
— |
| Chest 1 view (71045) |
— |
$1,662 |
— |
| Chest xray 3 views (71047) |
— |
$2,088 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$3,000 |
— |
| Cineradiography/videoradiography (76120) |
— |
$396 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$8,682 |
— |
| Clavicle complete (73000) |
— |
$1,423 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$4,855.50 |
— |
| Contrast Xray Throat/Cerv Esopha (74210) |
— |
$1,448 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$24,978 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$17,186 |
— |
| CT abdomen w contrast (74160) |
— |
$9,415 |
— |
| CT abdomen w wo contrast (74170) |
— |
$11,996 |
— |
| CT abdomen w/o contrast (74150) |
— |
$9,622.50 |
— |
| CT angio hrt w/3d image (75574) |
— |
$23,869 |
— |
| CT angio lwr extr w/o&w/dye (73706) |
— |
$21,123 |
— |
| CT angiography upper extremity lt (73206) |
— |
$21,167 |
— |
| CT c-spine w/contrast (72126) |
— |
$10,669 |
— |
| CT c-spine w/o contrast (72125) |
— |
$7,989 |
— |
| CT cere prfu aly c+wo CT/CTA (70473) |
— |
$6,589 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$9,994.50 |
— |
| CT chest w contrast (71260) |
— |
$10,933.50 |
— |
| CT chest w/wo contrast (71270) |
— |
$15,721 |
— |
| CT head/brain with contrast (70460) |
— |
$11,839 |
— |
| CT head/brain without and with contrast (70470) |
— |
$11,502 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$14,491 |
— |
| CT heart w/o contrast quant eval coronary calcium (75571) |
— |
$16,720 |
— |
| CT hrt w/3d image congen (75573) |
— |
$14,347 |
— |
| CT iac w contrast (70481) |
— |
$7,871 |
— |
| CT limited/localized follow up study (76380) |
— |
$8,015 |
— |
| CT lower ext w/o (73700) |
— |
$8,680 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$11,284 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$10,507 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$13,721 |
— |
| CT lumbar spine w/contrast (72132) |
— |
$11,964 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$7,859.50 |
— |
| CT maxillofacial w contrast (70487) |
— |
$8,247.50 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$10,538 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$7,257.50 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$14,758 |
— |
| CT orbits w/o contrast (70480) |
— |
$8,714 |
— |
| CT pelvis w/o contrast (72192) |
— |
$7,372.50 |
— |
| CT pelvis w/wo contrast (72194) |
— |
$12,954 |
— |
| CT scan of arm combo (73202) |
— |
$12,903 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$8,894 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$14,211 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$7,206.50 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$10,655 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$6,834 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$12,084 |
— |
| CT thorax w/o contrast (71250) |
— |
$7,762.50 |
— |
| CT upper ext wo (73200) |
— |
$8,444 |
— |
| CT upper extremity with contrast (73201) |
— |
$9,792 |
— |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
— |
$22,314 |
— |
| Cta Abdomen (74175) |
— |
$19,969 |
— |
| CTA abdomen pelvis (74174) |
— |
$44,785 |
— |
| CTA chest (71275) |
— |
$16,281.50 |
— |
| Cta Head (70496) |
— |
$11,983.50 |
— |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
— |
$13,373 |
— |
| Cta Neck (70498) |
— |
$11,983.50 |
— |
| Cta Pelvis (72191) |
— |
$19,969 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$2,460 |
— |
| Diskography lumbar (72295) |
— |
$8,160 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$1,462 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$1,040 |
— |
| Esophagus (74220) |
— |
$2,195.50 |
— |
| Facial bones min 3 views (70150) |
— |
$3,319 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$2,402.50 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$2,044 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$2,966 |
— |
| Foot 2 views (73620) |
— |
$1,830 |
— |
| Forearm 2 views (73090) |
— |
$1,822 |
— |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
— |
$1,332 |
— |
| Hand 2 views (73120) |
— |
$1,568 |
— |
| Heart first pass single,planar (78481) |
— |
$4,928 |
— |
| Heart Infarct Image (78466) |
— |
$4,261 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$10,311.50 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$8,360 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$9,060.50 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$8,157 |
— |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
— |
$5,828 |
— |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
— |
$5,828 |
— |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
— |
$5,828 |
— |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
— |
$5,828 |
— |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
— |
$4,855.50 |
— |
| Hysterosalpingogram (74740) |
— |
$4,520.50 |
— |
| Image fusion (77399) |
— |
$6,351 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,828 |
— |
| Intracavitary Radiation Source Applic Complex (77763) |
— |
$5,828 |
— |
| Intracavitary Radiation Source Applic Intermed (77762) |
— |
$5,828 |
— |
| Intracavitary Radiation Source Applic Simple (77761) |
— |
$4,855.50 |
— |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
— |
$4,795.50 |
— |
| Kidney imaging morphology (78700) |
— |
$7,013 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$8,081 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$12,367 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$12,202 |
— |
| Knee 3 views (73562) |
— |
$2,265 |
— |
| Liver & spleen imaging static only (78215) |
— |
$5,779 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$7,002 |
— |
| Liver imaging static only (78201) |
— |
$5,750 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$5,422 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$7,902 |
— |
| Lung perfusion differential (78597) |
— |
$5,079 |
— |
| Lung ventilation imaging (78579) |
— |
$5,079 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$13,360.50 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$11,528 |
— |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
— |
$13,150 |
— |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
— |
$16,085 |
— |
| Lymphoscintigraphy (78195) |
— |
$19,649.50 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
— |
$13,746 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
— |
$13,746 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$16,592 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$4,379 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$2,319 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$321 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$89 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$334 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$217 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$881 |
— |
| MRA head w & w/o contrast (70546) |
— |
$14,609 |
— |
| MRA head w/o contrast (70544) |
— |
$8,987 |
— |
| MRA head with contrast (70545) |
— |
$11,837 |
— |
| MRA neck w contrast (70548) |
— |
$7,007 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$13,373 |
— |
| MRA neck w/o contrast (70547) |
— |
$6,371 |
— |
| MRI abdomen w contrast (74182) |
— |
$9,557 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$9,913 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$11,396 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$14,295 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$16,038 |
— |
| MRI bone marrow blood supply (77084) |
— |
$7,373 |
— |
| MRI breast wo contrast unilateral (77046) |
— |
$2,990 |
— |
| MRI c-spine with contrast (72142) |
— |
$11,877.50 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$10,866 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$19,819 |
— |
| MRI chest w/o contrast (71550) |
— |
$11,393 |
— |
| MRI chest with contrast (71551) |
— |
$14,334 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$16,495 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$12,608 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$15,129 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$10,346.50 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$10,528 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$9,409.50 |
— |
| MRI pelvis w/contrast (72196) |
— |
$11,109.50 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$11,583.50 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$10,044 |
— |
| MRI spectroscopy (76390) |
— |
$14,386 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$18,777 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$13,608.50 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$15,479 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$14,029.50 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$15,136 |
— |
| MRI temporomandibular joint (70336) |
— |
$10,780 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$8,812 |
— |
| MRI up ext w/o contrast (73218) |
— |
$15,129 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$13,277 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$16,040 |
— |
| Myelogram Cervical (72240) |
— |
$8,561 |
— |
| Myelogram Lumbar (72265) |
— |
$7,199.50 |
— |
| Myelogram thoracic (72255) |
— |
$5,630 |
— |
| Myelography 2 or more regions (72270) |
— |
$10,225 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$15,671 |
— |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
— |
$4,233 |
— |
| Myocardial infarct spect (78469) |
— |
$10,164 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$7,989 |
— |
| Myocardial Perfusion Planar Multiple Studies (78454) |
— |
$12,634 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$29,825 |
— |
| Myocardial spect single study at rest or stress (78451) |
— |
$11,442 |
— |
| Neck soft tissue (70360) |
— |
$1,448.50 |
— |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
— |
$4,492 |
— |
| Nm adrenal scan (78075) |
— |
$9,321 |
— |
| Nm bone marrow wb (78104) |
— |
$9,321 |
— |
| Nm cardiac blood pool multiple (78473) |
— |
$6,569 |
— |
| Nm cisternogram (78630) |
— |
$7,944 |
— |
| Nm csf leak detection (78650) |
— |
$8,853 |
— |
| Nm gastric emptying study (78264) |
— |
$8,796 |
— |
| Nm gastroesophageal reflux study (78262) |
— |
$5,079 |
— |
| Nm kidney scan w/flow (78701) |
— |
$8,049 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$4,618 |
— |
| Noncardiac Vascular Flow Imaging (78445) |
— |
$4,729 |
— |
| Nonvascular shunt X-ray (75809) |
— |
$2,167 |
— |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
— |
$7,574 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$24,204 |
— |
| Orthopantogram (70355) |
— |
$1,580 |
— |
| Osseous survey limited (77074) |
— |
$2,048 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$2,097 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,845 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$2,097 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$1,565 |
— |
| Perineogram (74775) |
— |
$7,198 |
— |
| Peritoneogram after injection (74190) |
— |
$7,498 |
— |
| Proton tx delivery complex (77525) |
— |
$7,280 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$5,960.50 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$11,151 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$9,534 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$4,429.50 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$12,998 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$5,149 |
— |
| Radex Ankle Compl Minimum 3 Views (73610) |
— |
$2,064 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$1,664 |
— |
| Radex Elbw Compl Minimum 3 Views (73080) |
— |
$1,876 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$1,486 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
— |
$2,165 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$1,552 |
— |
| Radex Foot Compl Minimum 3 Views (73630) |
— |
$1,824 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$1,822 |
— |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
— |
$2,332 |
— |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
— |
$1,733 |
— |
| Radex Humerus Minimum 2 Views (73060) |
— |
$1,727 |
— |
| Radex Kne 1/2 Views (73560) |
— |
$1,673 |
— |
| Radex Kne Compl 4/More Views (73564) |
— |
$2,385 |
— |
| Radex Mndbl Compl Minimum 4 Views (70110) |
— |
$2,581 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$1,471.50 |
— |
| Radex Pelvis Compl Minimum 3 Views (72190) |
— |
$3,081 |
— |
| Radex Sho Compl Minimum 2 Views (73030) |
— |
$1,907 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$1,362 |
— |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
— |
$1,745 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$2,963 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$1,515 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$1,947 |
— |
| Radex Wrst Compl Minimum 3 Views (73110) |
— |
$2,016 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$7,499 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$1,202 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,683 |
— |
| Radiologic exam chest 2 views (71046) |
— |
$1,992 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$3,387.50 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$2,128 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$2,743 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$3,661.50 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$1,867 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
— |
$2,998 |
— |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
— |
$1,448 |
— |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
— |
$3,358 |
— |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
— |
$2,487 |
— |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
— |
$1,287 |
— |
| Radiological examination surgical specimen (76098) |
— |
$3,101 |
— |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
— |
$12,702 |
— |
| Renal Cyst Study (74470) |
— |
$3,993 |
— |
| Ribs bilateral 3 views (71110) |
— |
$2,264.50 |
— |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
— |
$10,552 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$8,803 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$21,319 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$10,864 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$7,049 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$11,088 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$11,756 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$1,392 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$5,068 |
— |
| Salivary gland imaging (78230) |
— |
$3,626 |
— |
| Scapula (73010) |
— |
$2,077 |
— |
| Sella turcica (70240) |
— |
$2,228 |
— |
| Shoulder 1 view (73020) |
— |
$1,272 |
— |
| Sialogram (70390) |
— |
$2,487 |
— |
| Simulation intermediate (77285) |
— |
$5,828 |
— |
| Small bowel series (74250) |
— |
$2,713 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$5,828 |
— |
| Special dosimetry (77331) |
— |
$5,828 |
— |
| Special Physics Consult (77370) |
— |
$4,855.50 |
— |
| Special treatment procedure (77470) |
— |
$5,828 |
— |
| Speech evaluation complex (70371) |
— |
$3,512 |
— |
| Spine thoracic 3 views (72072) |
— |
$2,434 |
— |
| Splenoportograpy rs&i (75810) |
— |
$10,478 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$8,364.50 |
— |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
— |
$5,828 |
— |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
— |
$5,828 |
— |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
— |
$5,828 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$4,855.50 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$5,828 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$5,828 |
— |
| Testicular Imaging With Vascular Flow (78761) |
— |
$5,884 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$5,828 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$4,855.50 |
— |
| Thoracolumbar 2 views (72080) |
— |
$1,929 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$8,182 |
— |
| Thyroid imaging w/blood flow (78013) |
— |
$3,171 |
— |
| Thyroid uptake measurement (78012) |
— |
$1,693 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,963 |
— |
| Tmj unilateral (70328) |
— |
$2,142 |
— |
| Tomogram (76100) |
— |
$3,328 |
— |
| Treatment device complex (77334) |
— |
$5,828 |
— |
| Treatment device intermediate (77333) |
— |
$5,828 |
— |
| Treatment devices simple (77332) |
— |
$4,855.50 |
— |
| Ultrasound breast complete (76641) |
— |
$3,854 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$4,512.50 |
— |
| Unlisted Diagnostic Radiographic Procedure (76499) |
— |
$327 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,088 |
— |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
— |
$5,138 |
— |
| Unlisted Procedure Clinical Brachytherapy (77799) |
— |
$6,351 |
— |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
— |
$6,351 |
— |
| Unlisted ultrasound procedure (76999) |
— |
$1,882 |
— |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
— |
$7,085 |
— |
| Ureteral reflux study (78740) |
— |
$7,013 |
— |
| Urethrocystogram voiding (74455) |
— |
$3,411 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$2,167.50 |
— |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
— |
$2,764.50 |
— |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
— |
$4,470 |
— |
| Us breast unilateral limited (76642) |
— |
$2,006 |
— |
| Us chest (76604) |
— |
$2,238 |
— |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
— |
$5,975 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$2,925 |
— |
| Us encephalogram (76506) |
— |
$2,737 |
— |
| Us hips infant static (76886) |
— |
$2,817 |
— |
| Us infant hips w manipulation (76885) |
— |
$3,661 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$2,318 |
— |
| Us ob detailed single fetus (76811) |
— |
$5,940 |
— |
| Us ob limited (76815) |
— |
$3,298 |
— |
| Us ob transvaginal (76817) |
— |
$4,703 |
— |
| Us pelvic non ob complete (76856) |
— |
$4,364 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$2,512 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$3,540 |
— |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
— |
$2,767 |
— |
| Us retroperitoneal complete (76770) |
— |
$4,288 |
— |
| Us retroperitoneal limited (76775) |
— |
$4,003 |
— |
| Us scrotum and contents (76870) |
— |
$3,521.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$2,963 |
— |
| Us spinal canal and contents (76800) |
— |
$2,827.50 |
— |
| Us transrectal (76872) |
— |
$4,324.50 |
— |
| Us, eye b-scan (76512) |
— |
$2,121 |
— |
| Us,transplanted kidney, real time/ doppler (76776) |
— |
$5,432 |
— |
| Venogram adrenal unilat (75840) |
— |
$9,315 |
— |
| Venogram extremity bilateral (75822) |
— |
$8,925 |
— |
| Venogram Extremity Unilateral (75820) |
— |
$4,704 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$17,849 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$8,169 |
— |
| Venography Renal Bilateral (75833) |
— |
$7,598 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$8,726 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$12,021.50 |
— |
| Venous sampling by catheter (75893) |
— |
$6,796 |
— |
| Wrist 2 views (73100) |
— |
$1,860 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$2,736.50 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$1,177 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$2,858.50 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$1,636 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$1,982 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$2,352 |
— |
| X-ray exam of femur 2/> (73552) |
— |
$2,059 |
— |
| X-ray eye for foreign body (70030) |
— |
$1,817 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$1,650 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$4,114 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$1,895 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$1,192 |
— |
| X-ray leg, infant (73592) |
— |
$1,451 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$2,131 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$5,484 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$5,526 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$2,399.50 |
— |
| X-ray retrograde pyelogram (74420) |
— |
$4,684.50 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$2,320 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$2,060 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$3,434 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$1,428 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$2,274 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$2,259 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$3,222 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$2,006 |
— |
| X-Ray Small Bowel Enteroclysis (74251) |
— |
$3,590 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$1,667 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$1,119 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$1,631.50 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$2,306 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$3,073 |
— |
| Xr bone length studies (77073) |
— |
$2,636 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$2,727 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$2,459 |
— |
| Xr chest 4+ views (71048) |
— |
$2,348.50 |
— |
| Xr urogram antegrade (74425) |
— |
$5,760 |
— |