| Acute gi blood loss imaging (78278) |
— |
$5,005.15 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$7,599.45 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$9,817.20 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$7,603.35 |
— |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
— |
$4,317.90 |
— |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
— |
$3,286.40 |
— |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
— |
$4,054.35 |
— |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
— |
$3,895.05 |
— |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
— |
$12,001.70 |
— |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
— |
$6,544.80 |
— |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
— |
$12,633.40 |
— |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
— |
$3,332.10 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,286.40 |
— |
| Ankle 2 views (73600) |
— |
$376.95 |
— |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
— |
$7,979.45 |
— |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
— |
$7,599.45 |
— |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
— |
$12,633.40 |
— |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
— |
$4,774.30 |
— |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
— |
$9,378.95 |
— |
| Clavicle complete (73000) |
— |
$445.75 |
— |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
— |
$6,822.80 |
— |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
— |
$3,768.05 |
— |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
— |
$2,116.80 |
— |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
— |
$3,754.60 |
— |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
— |
$2,371.15 |
— |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
— |
$3,191.20 |
— |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
— |
$2,420.50 |
— |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
— |
$2,141.25 |
— |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
— |
$3,062.25 |
— |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
— |
$1,147.45 |
— |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
— |
$2,600 |
— |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
— |
$2,326.55 |
— |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
— |
$2,361.95 |
— |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
— |
$1,796.20 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
— |
$1,849.45 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
— |
$1,832.90 |
— |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
— |
$2,069.05 |
— |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
— |
$2,917.40 |
— |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
— |
$2,284.60 |
— |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
— |
$3,253.65 |
— |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
— |
$1,581.20 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,983.15 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,308.05 |
— |
| CT abdomen w & w/o contrast (74170) |
— |
$4,663.65 |
— |
| CT abdomen w/contrast (74160) |
— |
$3,889.25 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,379.45 |
— |
| CT angio hrt w/3d image (75574) |
— |
$2,809.85 |
— |
| CT cervical spine w/contrast (72126) |
— |
$2,905.20 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,489.40 |
— |
| CT chest w/contrast (71260) |
— |
$3,190.65 |
— |
| CT extremity upper w & w/o contrast (73202) |
— |
$2,101.85 |
— |
| CT extremity upper w/o contrast (73200) |
— |
$1,734.35 |
— |
| CT head/brain with contrast (70460) |
— |
$2,380.25 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,313.65 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,062.90 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$887.90 |
— |
| CT l-spine w/contrast (72132) |
— |
$1,916.90 |
— |
| CT limited/localized follow up study (76380) |
— |
$966.40 |
— |
| CT lower extremity w/dye (73701) |
— |
$2,457.15 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,338.20 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$2,467.95 |
— |
| CT neck w/contrast (70491) |
— |
$2,139.20 |
— |
| CT neck w/o contrast (70490) |
— |
$1,288 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$2,841.10 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,468.45 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$2,176.85 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,077.45 |
— |
| CT thorax lung cancer scr c- (71271) |
— |
$887.75 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,777.10 |
— |
| CT upper extremity w/dye (73201) |
— |
$2,001.95 |
— |
| CTA head w contrast (70496) |
— |
$3,191.20 |
— |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
— |
$737.85 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$6,618.25 |
— |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
— |
$4,781.45 |
— |
| Diskography lumbar s&i (72295) |
— |
$5,033.10 |
— |
| Fetal biophys profile w/o nst (76819) |
— |
$1,678.20 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$2,295.75 |
— |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
— |
$1,788.25 |
— |
| Gated heart planar single (78472) |
— |
$3,490.05 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$5,256.40 |
— |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
— |
$5,310.95 |
— |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
— |
$6,645.10 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$4,619.40 |
— |
| Ht muscle image spect sing (78451) |
— |
$5,076.05 |
— |
| Hyperthermia ntrstl prb 5/< (77610) |
— |
$1,804.80 |
— |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
— |
$3,224.65 |
— |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
— |
$3,020.35 |
— |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
— |
$2,314.25 |
— |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
— |
$2,461.35 |
— |
| Liver and spleen imaging (78215) |
— |
$2,225.60 |
— |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
— |
$2,233.90 |
— |
| Liver imaging with flow (78202) |
— |
$2,947.75 |
— |
| Lung perfusion imaging (78580) |
— |
$3,320.20 |
— |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
— |
$3,287.75 |
— |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
— |
$4,777.45 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
— |
$1,941.25 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
— |
$1,779 |
— |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
— |
$4,777.45 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
— |
$2,502.30 |
— |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
— |
$2,321.05 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
— |
$2,499.20 |
— |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
— |
$4,208.15 |
— |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
— |
$5,301.80 |
— |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
— |
$5,045.50 |
— |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
— |
$1,706.50 |
— |
| Mammary ductogram single (77053) |
— |
$1,251.15 |
— |
| Mandible min 4v (70110) |
— |
$530.50 |
— |
| MRA head w/o contrast (70544) |
— |
$3,248.75 |
— |
| MRA neck w/ contrast (70548) |
— |
$3,701.15 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,248.75 |
— |
| MRI abdomen w/contrast (74182) |
— |
$1,867.90 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,746.20 |
— |
| MRI abdomen w/wo contrast (74183) |
— |
$4,410.35 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,915.75 |
— |
| MRI bone marrow (77084) |
— |
$3,534.65 |
— |
| MRI brain w/dye (70558) |
— |
$3,359.55 |
— |
| MRI brain w/o & w/dye (70559) |
— |
$4,410.35 |
— |
| MRI brain w/o dye (70557) |
— |
$3,177.25 |
— |
| MRI breast c- bilateral (77047) |
— |
$3,435.15 |
— |
| MRI breast without contrast material unilateral (77046) |
— |
$2,558.70 |
— |
| MRI c-spine w&w/o cont (72156) |
— |
$4,410.35 |
— |
| MRI cervical spine w/contrast (72142) |
— |
$3,280.25 |
— |
| MRI chest w/contrast (71551) |
— |
$1,909.15 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,705.80 |
— |
| MRI chest w/wo contrast (71552) |
— |
$2,604.70 |
— |
| MRI joint upr extr w/o&w/dye (73223) |
— |
$4,208.15 |
— |
| MRI joint upr extrem w/dye (73222) |
— |
$2,915.75 |
— |
| MRI joint upr extrem w/o dye (73221) |
— |
$2,757.15 |
— |
| MRI lumbar spine w/contrast (72149) |
— |
$3,359.55 |
— |
| MRI lumbar spine w/wo contrast (72158) |
— |
$4,410.35 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$4,666.90 |
— |
| MRI pelvis w & w/o contrast (72197) |
— |
$4,776.60 |
— |
| MRI pelvis w/contrast (72196) |
— |
$3,189.10 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,084.75 |
— |
| MRI spine cervical w/o contrast (72141) |
— |
$3,094.95 |
— |
| MRI t-spine w&w/o cont (72157) |
— |
$5,177.80 |
— |
| MRI thoracic spine w/contrast (72147) |
— |
$3,359.55 |
— |
| MRI thoracic spine w/o contrst (72146) |
— |
$3,284.80 |
— |
| MRI tmj (70336) |
— |
$1,325.55 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,360.35 |
— |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
— |
$8,821.75 |
— |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
— |
$9,822.60 |
— |
| Myocardial spect multiple studies (78452) |
— |
$8,731.05 |
— |
| Myocrd img PET metab eval single study (78459) |
— |
$9,239.05 |
— |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
— |
$4,996.60 |
— |
| Nm adrenal imaging (78075) |
— |
$13,881.15 |
— |
| Nm bone 3 phase (78315) |
— |
$5,483.25 |
— |
| Nm bone imaging whole body (78306) |
— |
$6,799.50 |
— |
| Nm csf cisternogram (78630) |
— |
$4,914.45 |
— |
| Nm gastric emptying (78264) |
— |
$4,979.50 |
— |
| Nm lymph system (78195) |
— |
$4,167.60 |
— |
| Nm myocard infarct spect (78469) |
— |
$6,414.60 |
— |
| Nuclear medicine study of bone and/or joint limited area (78300) |
— |
$2,428.95 |
— |
| Ob us limited fetus(s) (76815) |
— |
$1,395.30 |
— |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
— |
$862.85 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$3,849.90 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$2,270.15 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$9,989.95 |
— |
| PET imaging CT for attenuation limited area (78814) |
— |
$8,054.75 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$10,289.90 |
— |
| PET imaging whole body (78813) |
— |
$8,054.75 |
— |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
— |
$7,511 |
— |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
— |
$7,853.40 |
— |
| Proton treatment complex (77525) |
— |
$4,815.30 |
— |
| Proton treatment delivery; simple, without compensation (77520) |
— |
$1,804.80 |
— |
| Proton trmt intermediate (77523) |
— |
$4,377.55 |
— |
| Proton trmt simple w/comp (77522) |
— |
$3,979.60 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$3,286.40 |
— |
| Pulmonary ventilation & perfusion imaging (78582) |
— |
$5,208 |
— |
| Quant differential pulm perfusion w/wo imaging (78597) |
— |
$2,401.80 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$816.75 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
— |
$476 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$780.40 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
— |
$834.10 |
— |
| Radex hip unilateral with pelvis 1 view (73501) |
— |
$530.60 |
— |
| Radex hip unilateral with pelvis 2-3 views (73502) |
— |
$540.70 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$663.60 |
— |
| Radex spine cervical 2 or 3 views (72040) |
— |
$376.95 |
— |
| Radex spine cervical 4 or 5 views (72050) |
— |
$508.20 |
— |
| Radex spine cervical 6 or more views (72052) |
— |
$804.35 |
— |
| Radex spine thoracolumbar junction min 2 views (72080) |
— |
$516.55 |
— |
| Radiologic exam abdomen 3+ views (74021) |
— |
$537.40 |
— |
| Radiologic exam chest 3 views (71047) |
— |
$566.80 |
— |
| Radiologic exam chest 4+ views (71048) |
— |
$582.40 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,890.60 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$2,088.90 |
— |
| Radiologic exam esophagus single contrast study (74220) |
— |
$904.55 |
— |
| Radiologic exam small int single contrast study (74250) |
— |
$1,567.65 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$920.15 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,566.95 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$1,488.60 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$372.75 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$376.95 |
— |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
— |
$361.05 |
— |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
— |
$452.30 |
— |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
— |
$739.70 |
— |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
— |
$359.60 |
— |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
— |
$461.95 |
— |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
— |
$406 |
— |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
— |
$479.70 |
— |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
— |
$461.95 |
— |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
— |
$430.55 |
— |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
— |
$672.80 |
— |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
— |
$459.05 |
— |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
— |
$762.60 |
— |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
— |
$486.30 |
— |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
— |
$445.80 |
— |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
— |
$2,159.65 |
— |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
— |
$806 |
— |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
— |
$741.05 |
— |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
— |
$278.98 |
— |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
— |
$1,450.10 |
— |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
— |
$376.95 |
— |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
— |
$419.25 |
— |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
— |
$891.10 |
— |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
— |
$557.15 |
— |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
— |
$564.95 |
— |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
— |
$621.20 |
— |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
— |
$593.15 |
— |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
— |
$461.95 |
— |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
— |
$337.15 |
— |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
— |
$376.95 |
— |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
— |
$433.25 |
— |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
— |
$585.05 |
— |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
— |
$500.35 |
— |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
— |
$325.40 |
— |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
— |
$374.35 |
— |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
— |
$3,596.15 |
— |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
— |
$1,939.75 |
— |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
— |
$967.25 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,687.85 |
— |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
— |
$22,543.05 |
— |
| Rp loclzj tum spect 2 areas (78831) |
— |
$6,769.10 |
— |
| Rp loclzj tum spect w/CT 1 (78830) |
— |
$6,546.80 |
— |
| Rp loclzj tum spect w/CT 2 (78832) |
— |
$7,450.90 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$1,569.55 |
— |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
— |
$2,243.55 |
— |
| Scapula complete (73010) |
— |
$423.70 |
— |
| Screening digital breast tomosynthesis bi (77063) |
— |
$38.65 |
— |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
— |
$5,837.90 |
— |
| Thyroid met imaging body (78018) |
— |
$4,756.80 |
— |
| Thyroid uptake single/multiple quant measurement (78012) |
— |
$914.95 |
— |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
— |
$1,897.85 |
— |
| Ultrasound breast limited (76642) |
— |
$745.28 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,468.75 |
— |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
— |
$942.20 |
— |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
— |
$1,958.20 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
— |
$2,718.95 |
— |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
— |
$1,468.75 |
— |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
— |
$2,306.95 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$790.80 |
— |
| Unlisted CT procedure (76497) |
— |
$4,420.40 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,029.25 |
— |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
— |
$5,107.35 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$905.60 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
— |
$1,036.35 |
— |
| Urography antegrade rs&i (74425) |
— |
$1,687.50 |
— |
| Us abdominal aorta real time screen study aaa (76706) |
— |
$539.30 |
— |
| Us breast uni real time with image complete (76641) |
— |
$1,131.92 |
— |
| Us chest (76604) |
— |
$1,153.55 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$858.75 |
— |
| Us encephalogram (76506) |
— |
$2,254.70 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,444.35 |
— |
| US OB Follow-Up/Repeat (76816) |
— |
$1,292.50 |
— |
| Us ob transvaginal (76817) |
— |
$1,468.75 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,529.95 |
— |
| Us retroperitoneal ltd (76775) |
— |
$1,444.35 |
— |
| Us scrotum (76870) |
— |
$1,468.75 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,468.75 |
— |
| Us spinal canal (76800) |
— |
$2,395.65 |
— |
| Venogram sinus/jugular (75860) |
— |
$7,124.50 |
— |
| Venography adrenal unilateral selective rs&i (75840) |
— |
$7,599.45 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$6,544.80 |
— |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
— |
$6,950.70 |
— |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
— |
$2,425.75 |
— |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
— |
$1,944.65 |
— |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
— |
$1,778.20 |
— |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
— |
$3,286.40 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$12,633.40 |
— |
| X-ray exam hips bi 3-4 views (73522) |
— |
$750.75 |
— |
| X-ray exam of finger(s) (73140) |
— |
$376.95 |
— |
| X-ray exam of knee 1 or 2 (73560) |
— |
$409.25 |
— |
| X-ray exam ribs bil 3 views (71110) |
— |
$780 |
— |
| X-ray exam ribs uni 2 views (71100) |
— |
$657.50 |
— |
| X-ray heel (73650) |
— |
$378 |
— |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
— |
$464.20 |
— |
| X-ray retrograde pyelogram (74420) |
— |
$1,656.40 |
— |
| Xr abdomen 1 view (74018) |
— |
$376.95 |
— |
| Xr abdomen 2 views (74019) |
— |
$524.90 |
— |
| Xr arthrogram hip (73525) |
— |
$1,396.30 |
— |
| Xr arthrogram knee (73580) |
— |
$1,816.30 |
— |
| Xr arthrogram wrist (73115) |
— |
$1,516.45 |
— |
| Xr bone age studies (77072) |
— |
$693 |
— |
| Xr bone length study (77073) |
— |
$1,271.50 |
— |
| Xr bone survey infant (77076) |
— |
$3,232.95 |
— |
| Xr bone survey ltd (77074) |
— |
$2,088.90 |
— |
| Xr chest 1 view (71045) |
— |
$417.85 |
— |
| Xr chest 2 views (71046) |
— |
$557.70 |
— |
| Xr eye foreign body (70030) |
— |
$383.90 |
— |
| Xr facial bones 3+ views (70150) |
— |
$571.80 |
— |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
— |
$372.75 |
— |
| Xr forearm 2 views (73090) |
— |
$376.95 |
— |
| Xr hand 2v (73120) |
— |
$359.60 |
— |
| Xr hysterosalpingogram (74740) |
— |
$798.75 |
— |
| Xr myelogram t-spine (72255) |
— |
$2,066.30 |
— |
| Xr neck soft tissue (70360) |
— |
$361.05 |
— |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
— |
$479.70 |
— |
| Xr osseous survey complete (77075) |
— |
$3,092.95 |
— |
| Xr pelvis 1-2 views (72170) |
— |
$507.70 |
— |
| Xr pelvis min 3 view (72190) |
— |
$661.80 |
— |
| Xr peritoneogram (74190) |
— |
$607.40 |
— |
| Xr sacrum/coccyx 2+ views (72220) |
— |
$387.60 |
— |
| Xr shoulder 1 view (73020) |
— |
$369.30 |
— |
| Xr sialogram (70390) |
— |
$1,978.42 |
— |
| Xr sinuses 3+ views (70220) |
— |
$526.15 |
— |
| Xr skull min 4 view (70260) |
— |
$814.90 |
— |
| Xr spine 1 view (72020) |
— |
$358.80 |
— |
| Xr spine thoracic 3v (72072) |
— |
$547.75 |
— |
| Xr sternum 2+ views (71120) |
— |
$423.70 |
— |
| Xr surgical specimen (76098) |
— |
$1,878.55 |
— |
| Xr t-spine 2 views (72070) |
— |
$507.70 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$376.95 |
— |
| Xr tmj bilateral (70330) |
— |
$650.65 |
— |
| Xr tmj unilateral (70328) |
— |
$415.55 |
— |
| Xr venogram renal bilat (75833) |
— |
$9,817.20 |
— |
| Xr wrist 2 views (73100) |
— |
$359.60 |
— |