| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$11,618.40 |
— |
| Abdomen 1 View (74018) |
— |
$380.55 |
— |
| Abdomen 2 views (74019) |
— |
$529.90 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$5,654.25 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$14,014.60 |
— |
| Angio internal mammary (75756) |
— |
$7,672.55 |
— |
| Angio pulmonary bilat (75743) |
— |
$9,911.60 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$7,672.55 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$9,911.60 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$6,607.75 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,607.75 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,318 |
— |
| Ankle 2 views (73600) |
— |
$380.55 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$12,754.85 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$11,780.25 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$3,318 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$12,117.15 |
— |
| Artery X-Rays Spine (75705) |
— |
$12,754.85 |
— |
| Arthrogram ankle (73615) |
— |
$796.20 |
— |
| Arthrogram hip (73525) |
— |
$796.20 |
— |
| Arthrogram Wrist (73115) |
— |
$835.75 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,768.45 |
— |
| Bone age studies (77072) |
— |
$722.35 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$5,536 |
— |
| Bone Imaging Limited Area (78300) |
— |
$3,948.65 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$4,005 |
— |
| Bone Imaging Whole Body (78306) |
— |
$6,864.90 |
— |
| Bone marrow imaging limited area (78102) |
— |
$2,521.50 |
— |
| Bone marrow imaging; multiple areas (78103) |
— |
$3,102.45 |
— |
| Bone survey infant (77076) |
— |
$1,275.50 |
— |
| Brachytx isodose complex (77318) |
— |
$6,378.75 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$2,237.15 |
— |
| Brain Flow Imaging Only (78610) |
— |
$2,029.10 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$3,427 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$2,627.80 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$9,469.15 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$1,743.50 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$3,900.65 |
— |
| Cardiac MRI w/w/o contrast w/stress (75563) |
— |
$3,945.65 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$975.70 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$5,326.95 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$5,604.50 |
— |
| Chest 1 view (71045) |
— |
$421.90 |
— |
| Chest 2 views (71046) |
— |
$563.05 |
— |
| Chest 3 views (71047) |
— |
$572.25 |
— |
| Chest 4 or more views (71048) |
— |
$510.95 |
— |
| Clavicle complete (73000) |
— |
$461.70 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,232.45 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,995.50 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$7,672.55 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$744.95 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$835.75 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,118.05 |
— |
| Corpora cavernosography (74445) |
— |
$638.25 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,505 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,349.45 |
— |
| CT abdomen w contrast (74160) |
— |
$3,926.65 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,708.50 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,411.95 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$6,888.40 |
— |
| CT Angio Chest (71275) |
— |
$3,790.70 |
— |
| CT Angio Head (70496) |
— |
$3,221.90 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,373.15 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,091.70 |
— |
| CT Angio Neck (70498) |
— |
$3,221.90 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,091.70 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,933.15 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,513.35 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,091.70 |
— |
| CT chest w contrast (71260) |
— |
$3,221.35 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,284.95 |
— |
| CT colonography screening (74263) |
— |
$2,006 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$3,381.20 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$2,298.95 |
— |
| CT head/brain with contrast (70460) |
— |
$2,933.15 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,415.20 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,092.35 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$1,015.45 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,933.15 |
— |
| CT iac w contrast (70481) |
— |
$2,933.15 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,091.70 |
— |
| CT lower ext w/o (73700) |
— |
$1,158.50 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,933.15 |
— |
| CT lumbar spine w contrast (72132) |
— |
$2,749.80 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,351.05 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,373.15 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,813.45 |
— |
| CT neck tissue combo (70492) |
— |
$4,830.80 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,091.70 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,035.70 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,091.70 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,492.15 |
— |
| CT scan of leg combo (73702) |
— |
$3,091.70 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,400.90 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,159.75 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,140.40 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,449.05 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,413.45 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,091.70 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,803.80 |
— |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
— |
$1,658.15–$7,267.70 |
— |
| CT upper ext wo (73200) |
— |
$2,461.45 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,091.70 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,933.15 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,473.35 |
— |
| Cta Abdomen (74175) |
— |
$3,927.75 |
— |
| CTA pelvis (72191) |
— |
$3,091.70 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$5,345.55 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$4,827.40 |
— |
| Diskography lumbar (72295) |
— |
$5,081.50 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$2,048.55 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,285.20 |
— |
| Dxa bone density study (77085) |
— |
$1,515.35 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$298.45 |
— |
| Echo exam of fetal heart (76825) |
— |
$3,288.55 |
— |
| Echo exam uterus (76831) |
— |
$2,265.10 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,698.80 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,743.65 |
— |
| Esophagram (74220) |
— |
$913.25 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$2,085.20 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,694.35 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$2,541.80 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,805.45 |
— |
| Follow-Up Angiography (75898) |
— |
$3,364.15 |
— |
| Foot 2 views (73620) |
— |
$376.30 |
— |
| Forearm 2 views (73090) |
— |
$380.55 |
— |
| Gastric emptying imaging study (78264) |
— |
$6,094.65 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$2,827.40 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,908.20 |
— |
| Hand 2 views (73120) |
— |
$363.05 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$17,816.15 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$13,815.15 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$8,919.80 |
— |
| Heart Image (Pet) Multiple (78492) |
— |
$9,917.05 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$7,672.55 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$7,288.90 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$5,740.15 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$3,754.10 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,893.55 |
— |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
— |
$1,822.15 |
— |
| Hysterosalpingogram (74740) |
— |
$734.30 |
— |
| Image fusion (77399) |
— |
$1,286.70 |
— |
| Infusion Ivp (74410) |
— |
$663.10 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,950.10 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$6,409.60 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$5,473 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$3,404.30 |
— |
| Kidney Imaging Morphol (78700) |
— |
$3,132.05 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$3,271.25 |
— |
| Knee 3 Views (73562) |
— |
$484.30 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$3,461.35 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$2,960.05 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$3,020.65 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$3,235.95 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$11,105.85 |
— |
| Lung perfusion differential (78597) |
— |
$2,424.90 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$7,427.45 |
— |
| Lung Ventilation Imaging (78579) |
— |
$3,259.85 |
— |
| Lymph System Imaging (78195) |
— |
$3,225.60 |
— |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
— |
$2,223.60 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$1,914.45 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$7,672.55 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$3,319.40 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,079.65 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
— |
$3,391.85 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
— |
$3,207.80 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
— |
$4,452.80 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,853.85 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,153.40 |
— |
| Meckels Divert Exam (78290) |
— |
$3,461.35 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$5,036.60 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$5,094 |
— |
| MRA head w/o contrast (70544) |
— |
$3,280 |
— |
| MRA head with contrast (70545) |
— |
$3,679.75 |
— |
| MRA neck w contrast (70548) |
— |
$3,679.75 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,094 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,280 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,391.85 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,643.80 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,943.80 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,823.40 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,943.80 |
— |
| MRI brain functional w/o physician admnistration (70554) |
— |
$2,298.95 |
— |
| MRI brain functional w/physician admnistration (70555) |
— |
$2,298.95 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$6,232.90 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$3,448.40 |
— |
| MRI cardiac w/o cont stress (75559) |
— |
$3,838.55 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$2,933.15 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,311.75 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,124.70 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,298.95 |
— |
| MRI chest with contrast (71551) |
— |
$2,943.80 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,391.85 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$2,943.80 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,823.40 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,643.80 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,391.85 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,452.80 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,592.10 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,679.75 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,711.75 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,219.80 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,822.50 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,114.40 |
— |
| MRI spectroscopy (76390) |
— |
$4,120.25 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,316.35 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,943.80 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,383.05 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,248.65 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,452.80 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,227.55 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,391.85 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,783.65 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,248.65 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,452.80 |
— |
| Myelogram cervical (72240) |
— |
$2,910.15 |
— |
| Myelogram Lumbar (72265) |
— |
$1,461.55 |
— |
| Myelography thoracic (72255) |
— |
$2,677.10 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,940 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$2,686.65 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$9,482.30 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$12,348.90 |
— |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
— |
$7,892.70 |
— |
| N-invas est c ffr sw aly CTA (75580) |
— |
$5,044.65 |
— |
| Neck soft tissue (70360) |
— |
$562.15 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$1,762.50 |
— |
| Nm csf leak detection (78650) |
— |
$4,670.40 |
— |
| Nm myocard infarct spect (78469) |
— |
$6,476.30 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$366.40 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$10,276.10 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$1,584.65 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$7,781.05 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$2,472.55 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$900.70 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$6,108.75 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,718.90 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$5,333 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$512.60 |
— |
| Peritoneogram Rs&I (74190) |
— |
$1,461.55 |
— |
| Pet Image Skull-Thigh (78812) |
— |
$7,928.90 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$7,367.80 |
— |
| PET image w/CT, full body (78816) |
— |
$12,627.50 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$12,193.90 |
— |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
— |
$7,583.25 |
— |
| PET whole body (78813) |
— |
$13,070.75 |
— |
| Proton trmt simple w/comp (77522) |
— |
$4,017.90 |
— |
| Proton tx delivery complex (77525) |
— |
$4,861.60 |
— |
| Proton tx delivery intermediate (77523) |
— |
$4,419.65 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$1,822.15 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$7,672.55 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,334.30 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$746.85 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,370.20 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$456.60 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$399.35 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$466.40 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$838.50 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$380.55 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$484.30 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$466.40 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$538.40 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$759.25 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$590.40 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$741.35 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$380.55 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$512.55 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$362.25 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$621 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$591.40 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$423.95 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$538.40 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$466.40 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$611.50 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$29,843.90 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$1,324.20 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$2,432.45 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$3,329.60 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$819.70 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$542.60 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,427.95 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,163 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$768.65 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$962.25 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,582.70 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$929 |
— |
| Radiologic exam teeth complete full mouth (70320) |
— |
$260.10 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,332.95 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$376.30 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$380.55 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$413.20 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$1,330.10 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$380.55 |
— |
| Radiologic examination, teeth; single view Non-Facility (70300) |
— |
$247.35 |
— |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
— |
$1,584.65 |
— |
| Renal Cyst Study (74470) |
— |
$734.30 |
— |
| Ribs bilateral 3 views (71110) |
— |
$950.75 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$2,147.65 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$3,081.85 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$22,759.80 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$3,630.75 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$6,834.20 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$7,522.55 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$6,940.20 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$5,962.45 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$7,642.70 |
— |
| Salivary Gland Function Study (78232) |
— |
$2,373.50 |
— |
| Scapula (73010) |
— |
$624.80 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$63.90 |
— |
| Sella turcica (70240) |
— |
$591.15 |
— |
| Shoulder 1 view (73020) |
— |
$372.85 |
— |
| Shoulder Arthrography (73040) |
— |
$1,065 |
— |
Sialogram (70390)
range across 2 matching MRF lines |
— |
$912.45–$1,368.45 |
— |
| Skull less than 4 views (70250) |
— |
$818.95 |
— |
| Special dosimetry (77331) |
— |
$971.80 |
— |
| Special Physics Consult (77370) |
— |
$2,659.80 |
— |
| Special teletherapy port plan (77321) |
— |
$3,750.50 |
— |
| Special treatment procedure (77470) |
— |
$5,902 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$13,947.60 |
— |
| Sternoclavicular joints (71130) |
— |
$669 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$3,318 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$4,601.55 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$2,208.75 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$3,108.10 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$7,321.55 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$2,953.60 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$2,153.10 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$509 |
— |
| Thoracic spine 2 views (72070) |
— |
$512.60 |
— |
| Thoracic spine 3 views (72072) |
— |
$736.55 |
— |
| Thoracolumbar 2 views (72080) |
— |
$521.50 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$4,654.45 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$5,077.75 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$4,397.65 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$4,951.10 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$3,741.35 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$2,052.35 |
— |
| Tx devices design & construction simple (77332) |
— |
$1,559.35 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$812.40–$840 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$561.70 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$1,145.70 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,938.15 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,482.85 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$2,150.05 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,744.80 |
— |
Unlisted magnetic resonance procedure (76498)
range across 4 matching MRF lines |
— |
$2,057.35–$5,512.50 |
— |
| Upper gi w/o kub (74240) |
— |
$1,067 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,743.50 |
— |
| Urethrocystogram voiding (74455) |
— |
$976.55 |
— |
| Urethrocystography retrograde (74450) |
— |
$914.30 |
— |
| Us breast unilateral complete (76641) |
— |
$1,795 |
— |
| Us chest (76604) |
— |
$824.40 |
— |
| Us complete joint (76881) |
— |
$771.35 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,458.25 |
— |
| Us head (76506) |
— |
$2,008.90 |
— |
| Us kidney transplant (76776) |
— |
$2,817.95 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$951.25 |
— |
| Us ob detailed single fetus (76811) |
— |
$3,697.20 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,408.75 |
— |
| Us ob transvaginal (76817) |
— |
$1,482.85 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,977.05 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,482.85 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$926.80 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,544.65 |
— |
| Us retroperitoneal limited (76775) |
— |
$948.10 |
— |
| Us scrotum and contents (76870) |
— |
$1,482.85 |
— |
| Us spinal canal and contents (76800) |
— |
$2,779.60 |
— |
| Us thyroid (76536) |
— |
$1,482.85 |
— |
| Us transrectal (76872) |
— |
$871.15 |
— |
| Vascular Flow Imaging (78445) |
— |
$3,052.60 |
— |
| Vasogram (74440) |
— |
$571.25 |
— |
| Vein X-Ray Chest (75827) |
— |
$2,223.60 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$3,318 |
— |
| Vein X-Ray Spleen/Liver (75810) |
— |
$5,000.15 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$7,193 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$7,672.55 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$7,672.55 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,872.50 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,915 |
— |
| Venography Renal Bilateral (75833) |
— |
$9,911.60 |
— |
| Venography Renal Unilateral (75831) |
— |
$6,607.75 |
— |
| Venous sampling by catheter (75893) |
— |
$12,754.85 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$543.70 |
— |
| Wrist 2 views (73100) |
— |
$363.05 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$340.35 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,461.55 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$8,056.15 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$570.35 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$363.05 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,896.65 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$281.25 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$539.70 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$551.65 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$535.70 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$545.90 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$566.50 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$670 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$787.50 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$841.15 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$728.25 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$380.55 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$852 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$768.90 |
— |
| X-ray eye for foreign body (70030) |
— |
$667.45 |
— |
| X-ray humerus (73060) |
— |
$380.55 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,046.35 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$729.35 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$482 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$434.70 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$562.50 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$566.90 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,007.55 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$644.75 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$585.82 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$540.95 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$729.85 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$996.10 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$995.95 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,267.20 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$1,405.05 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,836.45 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$513.10 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$786.25 |
— |
| Xr orbits complete 4 views (70200) |
— |
$749.80 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$1,118.05 |
— |