| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,305.71 |
$3,605 |
0.9× |
| Abdomen 1 View (74018) |
$85.63 |
$229 |
1.0× |
| Abdomen 2 views (74019) |
$103.60 |
$287 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$388.66 |
$2,355 |
1.0× |
| Adrenal Cortex & Medulla Img (78075) |
$1,338.07 |
$1,769 |
1.0× |
| Angio internal mammary (75756) |
$3,003.66 |
$3,914 |
0.9× |
| Angio pulmonary bilat (75743) |
$3,003.66 |
$4,954 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,003.66 |
$4,131 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,003.66 |
$3,690 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,003.66 |
$4,131 |
0.9× |
| Ankle 2 views (73600) |
$85.63 |
$288 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$5,178.43 |
$6,274 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$5,178.43 |
$6,274 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$5,178.43 |
$6,274 |
0.9× |
| Artery X-Rays Spine (75705) |
$5,178.43 |
$6,274 |
0.9× |
| Arthrogram ankle (73615) |
$362.40 |
$1,070 |
1.0× |
| Arthrogram Wrist (73115) |
$362.40 |
$909 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$127.86 |
$439 |
0.9× |
| Bone age studies (77072) |
$103.60 |
$216 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$388.66 |
$1,548 |
1.0× |
| Bone Imaging Limited Area (78300) |
$388.66 |
$1,096 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$388.66 |
$1,266 |
1.0× |
| Bone Imaging Whole Body (78306) |
$388.66 |
$1,452 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$388.66 |
$2,333 |
1.0× |
| Brachytx isodose complex (77318) |
$348.18 |
$1,041 |
0.9× |
| Brachytx isodose intermed (77317) |
$348.18 |
$809 |
0.9× |
| Brachytx Isodose Plan Simple (77316) |
$348.18 |
$540 |
0.9× |
| Brain Image W/Flow < 4 Views (78601) |
$388.66 |
$1,053 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$509.34 |
$1,394 |
0.9× |
| Brain Imaging Minimum 4 Static Views (78605) |
$509.34 |
$1,218 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$362.40 |
$3,429 |
1.0× |
| Cardiovasc nucl exam unlisted (78499) |
$388.66 |
$408 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$85.63 |
$556 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$509.34 |
$1,240 |
0.9× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$509.34 |
$1,240 |
0.9× |
| Cerebrospinal Fluid Scan (78630) |
$509.34 |
$1,579 |
0.9× |
| Chest 1 view (71045) |
$85.63 |
$251 |
1.0× |
| Chest 2 views (71046) |
$85.63 |
$292 |
1.0× |
| Chest 3 views (71047) |
$85.63 |
$429 |
1.0× |
| Chest 4 or more views (71048) |
$103.60 |
$478 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$173.14 |
$441 |
1.0× |
| Clavicle complete (73000) |
$85.63 |
$348 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$103.60 |
$122 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$127.86 |
$599 |
0.9× |
| Contrast Exam Abdominl Aorta (75625) |
$3,003.66 |
$3,690 |
0.9× |
| Contrast X-Ray Bladder (74430) |
$362.40 |
$666 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$362.40 |
$1,115 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$362.40 |
$1,290 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$362.40 |
$6,226 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$230.91 |
$4,511 |
1.0× |
| CT abdomen w contrast (74160) |
$173.14 |
$2,876 |
1.0× |
| CT abdomen w wo contrast (74170) |
$173.14 |
$3,447 |
1.0× |
| CT abdomen w/o contrast (74150) |
$103.60 |
$2,498 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$362.40 |
$871 |
1.0× |
| CT Angio Chest (71275) |
$173.14 |
$3,468 |
1.0× |
| CT Angio Head (70496) |
$173.14 |
$3,302 |
1.0× |
| CT angio hrt w/3d image (75574) |
$173.14 |
$323 |
0.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$173.14 |
$2,785 |
1.0× |
| CT Angio Neck (70498) |
$173.14 |
$3,522 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$173.14 |
$2,741 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$362.40 |
$2,765 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$103.60 |
$2,407 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$173.14 |
$3,324 |
1.0× |
| CT chest w contrast (71260) |
$173.14 |
$2,221 |
1.0× |
| CT chest w/wo contrast (71270) |
$173.14 |
$2,669 |
1.0× |
| CT colonography screening (74263) |
$702 |
$702 |
2.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$173.14 |
$403 |
1.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$103.60 |
$355 |
1.0× |
| CT head/brain with contrast (70460) |
$173.14 |
$2,137 |
1.0× |
| CT head/brain without and with contrast (70470) |
$173.14 |
$2,565 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$173.14 |
$323 |
0.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$85.63 |
$113 |
1.0× |
| CT hrt w/3d image congen (75573) |
$173.14 |
$323 |
0.5× |
| CT iac w contrast (70481) |
$173.14 |
$2,325 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$173.14 |
$3,324 |
1.0× |
| CT lower ext w/o (73700) |
$103.60 |
$1,498 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$173.14 |
$1,724 |
1.0× |
| CT lumbar spine w contrast (72132) |
$362.40 |
$2,765 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$103.60 |
$2,407 |
1.0× |
| CT maxillofacial w contrast (70487) |
$173.14 |
$2,261 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$103.60 |
$1,965 |
1.0× |
| CT neck tissue combo (70492) |
$173.14 |
$2,787 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$173.14 |
$2,787 |
1.0× |
| CT orbits w/o contrast (70480) |
$103.60 |
$2,020 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$173.14 |
$2,779 |
1.0× |
| CT pelvis w/o contrast (72192) |
$103.60 |
$2,013 |
1.0× |
| CT scan of leg combo (73702) |
$173.14 |
$2,070 |
1.0× |
| CT scans face/jaw combo (70488) |
$173.14 |
$2,711 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$173.14 |
$2,325 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$103.60 |
$2,020 |
1.0× |
| CT thoracic spine w contrast (72129) |
$173.14 |
$2,765 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$103.60 |
$2,407 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$173.14 |
$3,324 |
1.0× |
| CT thorax w/o contrast (71250) |
$103.60 |
$1,932 |
1.0× |
| CT upper ext wo (73200) |
$103.60 |
$1,476 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$173.14 |
$2,039 |
1.0× |
| CT upper extremity with contrast (73201) |
$362.40 |
$1,698 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$173.14 |
$7,230 |
1.0× |
| Cta Abdomen (74175) |
$173.14 |
$846 |
1.0× |
| CTA pelvis (72191) |
$173.14 |
$3,743 |
1.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$230.91 |
$472 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$1,719 |
$1,719 |
0.8× |
| Diskography lumbar (72295) |
$1,819.43 |
$2,042 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$103.60 |
$166 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$103.60 |
$619 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$103.60 |
$746 |
1.0× |
| Dxa Bone Density Axial (77080) |
$103.60 |
$564 |
1.0× |
| Dxa bone density study (77085) |
$103.60 |
$140 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$66 |
$66 |
0.8× |
| Echo exam of fetal heart (76825) |
$518 |
$518 |
0.9× |
| Echo exam uterus (76831) |
$230.91 |
$953 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$295.78 |
$366 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$230.91 |
$581 |
1.0× |
| Esophageal Motility Study (78258) |
$388.66 |
$1,960 |
1.0× |
| Esophagram (74220) |
$173.14 |
$545 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$103.60 |
$766 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$103.60 |
$228 |
1.0× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$230.91 |
$402 |
1.0× |
Fluoroscopy up to 1 hr (76000)
range across 7 matching MRF lines |
$230.91–$328 |
$328 |
varies |
| Follow-Up Angiography (75898) |
$1,446 |
$1,446 |
0.5× |
| Foot 2 views (73620) |
$85.63 |
$299 |
1.0× |
| Forearm 2 views (73090) |
$85.63 |
$281 |
1.0× |
| Gastric emptying imaging study (78264) |
$388.66 |
$2,075 |
1.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$388.66 |
$489 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$388.66 |
$2,021 |
1.0× |
| Gated Heart Planar Single (78472) |
$388.66 |
$1,461 |
1.0× |
| GI Endoscopic US S&I (76975) |
$230.91 |
$1,078 |
1.0× |
| Hand 2 views (73120) |
$103.60 |
$264 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$675.63 |
$1,050 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$675.63 |
$1,050 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$675.63 |
$1,050 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,003.66 |
$3,441 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$509.34 |
$2,007 |
0.9× |
| Hepatobiliary System Imaging (78226) |
$388.66 |
$2,007 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,338.07 |
$2,271 |
1.0× |
| Hyperthermia external generated superficial (77600) |
$253.25 |
$1,040 |
0.7× |
| Hysterosalpingogram (74740) |
$230.91 |
$849 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$85.63 |
$600 |
1.0× |
| Infusion Ivp (74410) |
$173.14 |
$1,046 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$554.71 |
$891 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$554.71 |
$884 |
1.0× |
| Joint Survey Single View (77077) |
$103.60 |
$202 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$509.34 |
$1,852 |
0.9× |
| K Flow/Funct Image W/Drug (78708) |
$484 |
$484 |
0.9× |
| K Flow/Funct Image W/O Drug (78707) |
$509.34 |
$1,450 |
0.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$388.66 |
$1,042 |
1.0× |
| Kidney Imaging Morphol (78700) |
$388.66 |
$926 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$388.66 |
$555 |
1.0× |
| Knee 3 Views (73562) |
$85.63 |
$350 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$388.66 |
$1,555 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$388.66 |
$2,138 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$388.66 |
$2,495 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$509.34 |
$1,769 |
0.9× |
| Lung Perf&Ventilat Diferentl (78598) |
$509.34 |
$836 |
0.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$509.34 |
$1,935 |
0.9× |
| Lung Ventilation Imaging (78579) |
$388.66 |
$654 |
1.0× |
| Lymph System Imaging (78195) |
$509.34 |
$2,153 |
0.9× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,509.18 |
$1,945 |
1.0× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$591.98 |
$1,613 |
0.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,003.66 |
$3,473 |
0.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,006 |
$1,006 |
0.3× |
| Magnetic Image Jaw Joint (70336) |
$230.91 |
$5,730 |
1.0× |
| Magnetic Resonance Elastography (76391) |
$230.91 |
$353 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$230.91 |
$724 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$230.91 |
$613 |
1.0× |
| Meckels Divert Exam (78290) |
$388.66 |
$1,788 |
1.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$191 |
$191 |
0.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$348.18 |
$395 |
0.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$362.40 |
$4,928 |
1.0× |
| MRA head w/o contrast (70544) |
$230.91 |
$3,493 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$362.40 |
$4,928 |
1.0× |
| MRA neck w/o contrast (70547) |
$230.91 |
$3,493 |
1.0× |
| MRI abdomen w contrast (74182) |
$362.40 |
$5,387 |
1.0× |
MRI abdomen w/o contrast (74181)
range across 2 matching MRF lines |
$230.91 |
$402–$4,684 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$701 |
$701 |
0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$362.40 |
$885 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$754.50 |
$3,462 |
1.0× |
| MRI bone marrow blood supply (77084) |
$230.91 |
$3,030 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$230.91 |
$3,371 |
1.0× |
| MRI cervical spine w contrast (72142) |
$362.40 |
$4,729 |
1.0× |
MRI cervical spine w/o cont (72141)
range across 2 matching MRF lines |
$230.91 |
$402–$4,111 |
1.0× |
MRI chest w/o contrast (71550)
range across 2 matching MRF lines |
$230.91 |
$402–$4,167 |
1.0× |
| MRI chest with contrast (71551) |
$754.50 |
$4,792 |
1.0× |
| MRI chest wo w contrast (71552) |
$362.40 |
$5,751 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$362.40 |
$3,604 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$362.40 |
$4,323 |
1.0× |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
$230.91 |
$402–$3,132 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$362.40 |
$4,898 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$362.40 |
$5,674 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$230.91 |
$4,313 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$362.40 |
$5,709 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$362.40 |
$5,804 |
1.0× |
MRI pelvis w/o contrast (72195)
range across 2 matching MRF lines |
$230.91 |
$402–$4,205 |
1.0× |
| MRI spectroscopy (76390) |
$85.63 |
$1,581 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$230.91 |
$4,483 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$362.40 |
$3,086 |
1.0× |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines |
$230.91 |
$402–$2,623 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$362.40 |
$3,702 |
1.0× |
| MRI, abdomen, combo (74183) |
$362.40 |
$6,466 |
1.0× |
| MRI, dorsal spine combo (72157) |
$362.40 |
$6,187 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$362.40 |
$5,156 |
1.0× |
| MRI, joint upper extrem (73221) |
$230.91 |
$3,009 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$362.40 |
$4,157 |
1.0× |
| MRI, lumbar spine combo (72158) |
$362.40 |
$5,879 |
1.0× |
| Musculoskeletal Nuclear Exam (78399) |
$367 |
$367 |
0.9× |
| Myelogram cervical (72240) |
$754.50 |
$1,375 |
1.0× |
| Myelogram Lumbar (72265) |
$754.50 |
$1,348 |
1.0× |
| Myelography thoracic (72255) |
$754.50 |
$1,278 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$754.50 |
$1,810 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,338.07 |
$1,434 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,338.07 |
$3,479 |
1.0× |
| Neck soft tissue (70360) |
$85.63 |
$348 |
1.0× |
| Nm csf leak detection (78650) |
$1,338.07 |
$1,736 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$103.60 |
$564 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,305.71 |
$3,940 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$234.44 |
$919 |
1.0× |
| Ob us nuchal meas 1 gest (76813) |
$103.60 |
$160 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$37.12 |
$81.87 |
0.4× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$103.60 |
$200 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$17.33 |
$54 |
0.2× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$3.70 |
$14.65 |
0.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$103.60 |
$238 |
1.0× |
| Optic foramina (70190) |
$85.63 |
$358 |
1.0× |
| Panoramic X-ray of jaws (70355) |
$85.63 |
$331 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$509.34 |
$725 |
0.9× |
| Parathyroid Planar Imaging (78070) |
$388.66 |
$725 |
1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$388.66 |
$725 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$103.60 |
$226 |
1.0× |
| Perineogram (74775) |
$230.91 |
$1,012 |
1.0× |
| Peritoneogram Rs&I (74190) |
$519.86 |
$716 |
0.9× |
| Pet Image W/Ct Lmtd (78814) |
$1,474.23 |
$1,888 |
1.0× |
| PET image w/CT, full body (78816) |
$1,474.23 |
$1,888 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,474.23 |
$1,888 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,003.66 |
$3,570 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$388.66 |
$992 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$103.60 |
$442 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$379 |
$379 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$85.63 |
$311 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$85.63 |
$267 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$85.63 |
$325 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$103.60 |
$446 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$85.63 |
$222 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$85.63 |
$311 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$85.63 |
$292 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$85.63 |
$321 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$103.60 |
$475 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$85.63 |
$281 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$85.63 |
$333 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$85.63 |
$392 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$85.63 |
$310 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$173.14 |
$711 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$85.63 |
$326 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$85.63 |
$292 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$85.63 |
$671 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$85.63 |
$236 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$103.60 |
$297 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$85.63 |
$292 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$103.60 |
$282 |
1.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,338.17 |
$11,130 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$113 |
$395 |
1.1× |
| Radiation treatment delivery level 2 (77407) |
$253.25 |
$512 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$253.25 |
$649 |
0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$103.60 |
$424 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$103.60 |
$319 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$173.14 |
$1,123 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$173.14 |
$856 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$173.14 |
$268 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$103.60 |
$392 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$103.60 |
$285 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$173.14 |
$608 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$173.14 |
$663 |
1.0× |
| Radiologic exam teeth complete full mouth (70320) |
$230.91 |
$342 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$173.14 |
$783 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$85.63 |
$89 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$85.63 |
$89 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$85.63 |
$295 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$103.60 |
$331 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$85.63 |
$321 |
1.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$519.86 |
$549 |
0.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$8.24 |
$107 |
0.1× |
| Ribs bilateral 3 views (71110) |
$103.60 |
$404 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$388.66 |
$1,379 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,338.07 |
$1,752 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,338.07 |
$1,741 |
2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,338.07 |
$1,980 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,338.07 |
$1,664 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,474.23 |
$1,980 |
1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,196 |
$1,196 |
0.9× |
| Rp Therapy Intravenous Administration (79101) |
$234.44 |
$690 |
1.0× |
| Salivary Gland Imaging Serial Images (78231) |
$388.66 |
$1,367 |
1.0× |
| Scapula (73010) |
$103.60 |
$364 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23.36 |
$39 |
1.0× |
| Sella turcica (70240) |
$85.63 |
$310 |
1.0× |
| Shoulder 1 view (73020) |
$85.63 |
$308 |
1.0× |
| Shoulder Arthrography (73040) |
$362.40 |
$1,134 |
1.0× |
| Sialogram (70390) |
$230.91 |
$920 |
1.0× |
| Skull less than 4 views (70250) |
$103.60 |
$364 |
1.0× |
| Special dosimetry (77331) |
$127.86 |
$194 |
0.9× |
| Special Physics Consult (77370) |
$127.86 |
$934 |
0.9× |
| Special teletherapy port plan (77321) |
$348.18 |
$1,064 |
0.9× |
| Special treatment procedure (77470) |
$554.71 |
$694 |
1.0× |
| Spleen Imaging (78185) |
$388.66 |
$979 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$1,681.45 |
$2,399 |
0.9× |
| Sternoclavicular joints (71130) |
$85.63 |
$354 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$901 |
$901 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$348.18 |
$621 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$348.18 |
$606 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$230.91 |
$1,134 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$388.66 |
$1,108 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$348.18 |
$2,865 |
0.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$348.18 |
$2,237 |
0.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$127.86 |
$1,524 |
0.9× |
| Thoracic spine 2 views (72070) |
$103.60 |
$448 |
1.0× |
| Thoracic spine 3 views (72072) |
$103.60 |
$483 |
1.0× |
| Thoracolumbar 2 views (72080) |
$85.63 |
$470 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$388.66 |
$725 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$509.34 |
$2,612 |
0.9× |
| Thyroid Uptake Measurement (78012) |
$388.66 |
$461 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$388.66 |
$653 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$348.18 |
$1,017 |
0.9× |
| Tx devices design & construction intermediate (77333) |
$127.86 |
$479 |
0.9× |
| Tx devices design & construction simple (77332) |
$127.86 |
$408 |
0.9× |
| Ultrasound Breast Limited (76642) |
$85.63 |
$135 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$103.60 |
$163 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$103.60 |
$618 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$103.60 |
$576 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$85.63 |
$91 |
1.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$113 |
$811 |
1.1× |
| Upper gi w/o kub (74240) |
$173.14 |
$731 |
1.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$279 |
$279 |
25.2× |
Urea breath test c-14 isotopic analysis (78268)
range across 2 matching MRF lines |
$94.41–$278 |
$278 |
varies |
| Ureteral Reflux Study (78740) |
$388.66 |
$830 |
1.0× |
| Urethrocystogram voiding (74455) |
$230.91 |
$970 |
1.0× |
| Urethrocystography retrograde (74450) |
$230.91 |
$885 |
1.0× |
Us breast unilateral complete (76641)
range across 4 matching MRF lines |
$103.60–$614 |
$614 |
varies |
| Us chest (76604) |
$30.30 |
$43 |
0.3× |
| Us complete joint (76881) |
$103.60 |
$153 |
1.0× |
| Us exam, pelvic, limited (76857) |
$103.60 |
$660 |
1.0× |
| Us head (76506) |
$103.60 |
$718 |
1.0× |
| Us kidney transplant (76776) |
$103.60 |
$854 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$103.60 |
$168 |
1.0× |
| Us ob detailed single fetus (76811) |
$230.91 |
$919 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$103.60 |
$535 |
1.0× |
| Us ob transvaginal (76817) |
$103.60 |
$723 |
1.0× |
| Us pelvic non ob complete (76856) |
$103.60 |
$721 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$103.60 |
$774 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$103.60 |
$471 |
1.0× |
| Us retroperitoneal complete (76770) |
$103.60 |
$787 |
1.0× |
| Us retroperitoneal limited (76775) |
$103.60 |
$198 |
1.0× |
| Us scrotum and contents (76870) |
$103.60 |
$618 |
1.0× |
| Us spinal canal and contents (76800) |
$103.60 |
$898 |
1.0× |
| Us thyroid (76536) |
$103.60 |
$655 |
1.0× |
| Us transrectal (76872) |
$103.60 |
$882 |
1.0× |
| Vascular Flow Imaging (78445) |
$388.66 |
$1,091 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,509.18 |
$3,309 |
1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,446 |
$1,446 |
0.5× |
| Vein X-Ray Skull Epidural (75872) |
$591.98 |
$3,460 |
0.9× |
| Vein X-Ray Spleen/Liver (75810) |
$3,003.66 |
$3,310 |
0.9× |
| Venogram Sinus/Jugular (75860) |
$3,003.66 |
$3,667 |
0.9× |
| Venography Adrenal Unilateral (75840) |
$3,003.66 |
$3,667 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,003.66 |
$3,309 |
0.9× |
| Venography extremity bilateral rs&i (75822) |
$1,446 |
$1,446 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,243 |
$1,243 |
0.8× |
| Venography Renal Bilateral (75833) |
$3,003.66 |
$3,853 |
0.9× |
| Venography Renal Unilateral (75831) |
$3,003.66 |
$3,223 |
0.9× |
| Venous sampling by catheter (75893) |
$5,178.43 |
$6,274 |
0.9× |
| Venous thrombosis imaging (78457) |
$509.34 |
$1,769 |
0.9× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$388.66 |
$1,418 |
1.0× |
| Wrist 2 views (73100) |
$85.63 |
$258 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$85.63 |
$348 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$362.40 |
$816 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,003.66 |
$4,131 |
0.9× |
| X-Ray Bend Only L-S Spine (72120) |
$103.60 |
$605 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$85.63 |
$292 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$519.86 |
$625 |
0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$85.63 |
$89 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$103.60 |
$282 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$85.63 |
$91 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$85.63 |
$89 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$103.60 |
$282 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$85.63 |
$467 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$103.60 |
$704 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$103.60 |
$383 |
1.0× |
| X-ray eye for foreign body (70030) |
$74 |
$74 |
0.8× |
| X-ray head for orthodontia (70350) |
$85.63 |
$91 |
1.0× |
| X-ray humerus (73060) |
$85.63 |
$325 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$173.14 |
$981 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$173.14 |
$776 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$85.63 |
$295 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$103.60 |
$424 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$103.60 |
$478 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$103.60 |
$282 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$103.60 |
$168 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$85.63 |
$243 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$85.63 |
$504 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$103.60 |
$504 |
1.0× |
| X-Ray Stress View (77071) |
$85.63 |
$113 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$362.40 |
$654 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$103.60 |
$253 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$103.60 |
$441 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$103.60 |
$595 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$85.63 |
$364 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$103.60 |
$251 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$362.40 |
$1,331 |
1.0× |
| Xr orbits complete 4 views (70200) |
$103.60 |
$453 |
1.0× |