| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,372 |
$5,959.60 |
1.0× |
| Abdomen 1 View (74018) |
$86 |
$403 |
1.0× |
| Abdomen 2 views (74019) |
$103 |
$540 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$396 |
$1,716.55 |
1.0× |
| Angio internal mammary (75756) |
$3,130 |
$3,623.69 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,130 |
$8,505.98 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,130 |
$2,628.78 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,130 |
$13,266.30 |
1.0× |
Angiography extremity unilateral rs&i (75710)
range across 3 matching MRF lines |
$3,130 |
$2,850.35–$13,266.30 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,130 |
$3,623.69 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,130 |
$3,623.69 |
1.0× |
| Ankle 2 views (73600) |
$86 |
$475.10 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$5,517 |
$4,370 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,130 |
$6,690.70 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$5,517 |
$11,284 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,130 |
$8,505.98 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$5,517 |
$4,645 |
1.0× |
| Arthrogram ankle (73615) |
$345 |
$520 |
1.0× |
| Arthrogram hip (73525) |
$345 |
$399 |
1.0× |
| Arthrogram Wrist (73115) |
$345 |
$399 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$133 |
$618.85 |
1.0× |
| Bone age studies (77072) |
$103 |
$457.56 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$396 |
$2,208 |
1.0× |
| Bone Imaging Limited Area (78300) |
$396 |
$2,199.50 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$396 |
$2,326.17 |
1.0× |
| Bone Imaging Whole Body (78306) |
$396 |
$1,716.55 |
1.0× |
| Bone survey infant (77076) |
$103 |
$910.50 |
1.0× |
| Brachytx isodose complex (77318) |
$371 |
$1,167.08 |
1.0× |
| Brachytx isodose intermed (77317) |
$371 |
$1,609.10 |
1.0× |
| Brachytx Isodose Plan Simple (77316) |
$371 |
$429.60 |
1.0× |
| Brain Flow Imaging Only (78610) |
$538 |
$2,154.11 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$396 |
$3,900.75 |
1.0× |
| Brain imaging < 4 static views (78600) |
$396 |
$1,239.42 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$538 |
$2,060 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$538 |
$2,154.11 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,417 |
$7,401.70 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$396 |
$2,614.92 |
1.0× |
| Cardiac Shunt Detection (78428) |
$396 |
$2,614.92 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$86 |
$748.50 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$538 |
$3,900.75 |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$538 |
$3,900.75 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$538 |
$1,458.66 |
1.0× |
Chest 1 view (71045)
range across 3 matching MRF lines |
$86 |
$378.18–$440.71 |
1.0× |
| Chest 2 views (71046) |
$86 |
$437 |
1.0× |
| Chest 3 views (71047) |
$86 |
$378.18 |
1.0× |
| Chest 4 or more views (71048) |
$103 |
$648.03 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$173 |
$612.08 |
1.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$103 |
$1,116.71 |
1.0× |
| Clavicle complete (73000) |
$86 |
$435 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$103 |
$457.56 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$133 |
$618.85 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,130 |
$13,266.30 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$345 |
$1,600.58 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$345 |
$4,364.86 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$345 |
$1,454.95 |
1.0× |
| Corpora cavernosography (74445) |
$103 |
$1,856.75 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$345 |
$6,511 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$236 |
$4,502 |
1.0× |
| CT abdomen w contrast (74160) |
$173 |
$3,382.99 |
1.0× |
| CT abdomen w wo contrast (74170) |
$173 |
$3,347 |
1.0× |
| CT abdomen w/o contrast (74150) |
$103 |
$2,829 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$345 |
$1,877.85 |
1.0× |
| CT Angio Chest (71275) |
$173 |
$3,620 |
1.0× |
| CT Angio Head (70496) |
$173 |
$3,054 |
1.0× |
| CT angio hrt w/3d image (75574) |
$345 |
$3,801 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$173 |
$3,243 |
1.0× |
| CT Angio Neck (70498) |
$173 |
$3,297 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$173 |
$1,409.70 |
1.0× |
| CT bone density (77078) |
$86 |
$415.59 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$345 |
$3,448.87 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$103 |
$2,756.85 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$173 |
$2,248.50 |
1.0× |
| CT chest w contrast (71260) |
$173 |
$3,000 |
1.0× |
| CT chest w/wo contrast (71270) |
$173 |
$3,605 |
1.0× |
| CT colonography screening (74263) |
$236 |
$1,040.14 |
1.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$103 |
$840.14 |
1.0× |
| CT head/brain with contrast (70460) |
$173 |
$1,204.60 |
1.0× |
| CT head/brain without and with contrast (70470) |
$173 |
$3,152 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$86 |
$637 |
1.0× |
| CT iac w contrast (70481) |
$173 |
$2,481 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$173 |
$2,126.74 |
1.0× |
| CT lower ext w/o (73700) |
$103 |
$2,316 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$173 |
$2,499 |
1.0× |
| CT lumbar spine w contrast (72132) |
$345 |
$2,965 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$103 |
$2,549 |
1.0× |
| CT maxillofacial w contrast (70487) |
$173 |
$2,887.76 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$103 |
$2,408 |
1.0× |
| CT neck tissue combo (70492) |
$173 |
$1,348.55 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$173 |
$2,126.74 |
1.0× |
| CT orbits w/o contrast (70480) |
$103 |
$2,251 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$173 |
$2,689 |
1.0× |
| CT pelvis w/o contrast (72192) |
$103 |
$600.10 |
1.0× |
| CT scan of leg combo (73702) |
$173 |
$2,872 |
1.0× |
| CT scans face/jaw combo (70488) |
$173 |
$2,857 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$173 |
$2,914.25 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$103 |
$2,188 |
1.0× |
| CT thoracic spine w contrast (72129) |
$173 |
$3,144.70 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$103 |
$2,738.41 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$173 |
$2,126.74 |
1.0× |
| CT thorax w/o contrast (71250) |
$103 |
$2,462 |
1.0× |
| CT upper ext wo (73200) |
$103 |
$2,268 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$173 |
$2,126.74 |
1.0× |
| CT upper extremity with contrast (73201) |
$345 |
$2,729 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$173 |
$3,513 |
1.0× |
| Cta Abdomen (74175) |
$173 |
$3,278 |
1.0× |
| CTA pelvis (72191) |
$173 |
$1,409.70 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,072 |
$944.93 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$103 |
$641.83 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$103 |
$641.83 |
1.0× |
| Dxa Bone Density Axial (77080) |
$103 |
$564 |
1.0× |
| Dxa bone density study (77085) |
$103 |
$665.14 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86 |
$415.59 |
1.0× |
| Echo exam uterus (76831) |
$236 |
$215 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$214 |
$1,197 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$103 |
$614.32 |
1.0× |
| Esophageal Motility Study (78258) |
$396 |
$2,288.65 |
1.0× |
| Esophagram (74220) |
$173 |
$1,008.70 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$103 |
$1,070 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$103 |
$803.75 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$236 |
$1,152.80 |
1.0× |
| Follow-Up Angiography (75898) |
$3,130 |
$4,137.60 |
1.0× |
| Foot 2 views (73620) |
$86 |
$401 |
1.0× |
| Forearm 2 views (73090) |
$86 |
$432 |
1.0× |
| Gastric emptying imaging study (78264) |
$396 |
$2,107 |
1.0× |
| Gastric Mucosa Imaging (78261) |
$396 |
$2,288.65 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$396 |
$2,288.65 |
1.0× |
| Gastrointestinal Protein Loss (78282) |
$396 |
$2,288.65 |
1.0× |
| Gated Heart Planar Single (78472) |
$396 |
$2,037 |
1.0× |
| GI Endoscopic US S&I (76975) |
$236 |
$1,327.34 |
1.0× |
| Hand 2 views (73120) |
$103 |
$562.55 |
1.0× |
| Heart first pass single,planar (78481) |
$538 |
$1,751.19 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,130 |
$14,997.50 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,130 |
$14,997.50 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$538 |
$2,420.50 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$396 |
$2,135.12 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,283 |
$5,702.70 |
1.0× |
| Hysterosalpingogram (74740) |
$236 |
$1,152.80 |
1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$86 |
$641.83 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$86 |
$472.60 |
1.0× |
| Infusion Ivp (74410) |
$173 |
$419 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$690 |
$2,784.84 |
1.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$690 |
$2,784.84 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$547 |
$2,599.25 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$547 |
$2,022.04 |
1.0× |
| Joint Survey Single View (77077) |
$103 |
$665.14 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$538 |
$1,728.51 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$538 |
$2,249.58 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$538 |
$1,915 |
1.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$396 |
$1,961.89 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$396 |
$2,944.62 |
1.0× |
| Knee 3 Views (73562) |
$86 |
$493 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$396 |
$1,627 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$396 |
$1,282.65 |
1.0× |
| Liver imaging static only (78201) |
$538 |
$2,611.35 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$538 |
$2,611.35 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$538 |
$3,082.38 |
1.0× |
| Lung perfusion differential (78597) |
$396 |
$2,252.18 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$538 |
$2,281.25 |
1.0× |
| Lung Ventilation Imaging (78579) |
$396 |
$1,542 |
1.0× |
| Lymph System Imaging (78195) |
$538 |
$1,848 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$236 |
$2,409 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$236 |
$2,359.21 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$236 |
$592 |
1.0× |
| Meckels Divert Exam (78290) |
$396 |
$1,570.31 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$371 |
$1,609.10 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$345 |
$4,330.31 |
1.0× |
| MRA head w/o contrast (70544) |
$236 |
$3,164.38 |
1.0× |
| MRA head with contrast (70545) |
$345 |
$2,678 |
1.0× |
| MRA neck w contrast (70548) |
$345 |
$3,517 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$345 |
$2,415.40 |
1.0× |
| MRA neck w/o contrast (70547) |
$236 |
$1,152.80 |
1.0× |
| MRI abdomen w contrast (74182) |
$345 |
$3,545 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$236 |
$3,461.11 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$777 |
$3,796 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$345 |
$2,673 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$777 |
$2,171 |
1.0× |
| MRI bone marrow blood supply (77084) |
$236 |
$2,004.87 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$236 |
$2,721.10 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$236 |
$2,721.10 |
1.0× |
| MRI cervical spine w contrast (72142) |
$345 |
$3,612.50 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$236 |
$3,604.09 |
1.0× |
| MRI chest w/o contrast (71550) |
$236 |
$2,444.40 |
1.0× |
| MRI chest with contrast (71551) |
$777 |
$3,458.75 |
1.0× |
| MRI chest wo w contrast (71552) |
$345 |
$3,543.82 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$345 |
$2,597 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$345 |
$4,183 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$236 |
$1,045 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$345 |
$2,135.20 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$345 |
$5,197.98 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$236 |
$3,517 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$345 |
$3,512.50 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$345 |
$4,740.14 |
1.0× |
| MRI pelvis w contrast (72196) |
$345 |
$2,597 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$345 |
$4,504.50 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$236 |
$3,447.46 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$236 |
$3,544.46 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$345 |
$1,080 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$236 |
$1,152.80 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$345 |
$1,929.40 |
1.0× |
| MRI, abdomen, combo (74183) |
$345 |
$4,733.77 |
1.0× |
| MRI, dorsal spine combo (72157) |
$345 |
$5,125.75 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$345 |
$2,028 |
1.0× |
| MRI, joint upper extrem (73221) |
$236 |
$1,687 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$345 |
$1,998 |
1.0× |
| MRI, lumbar spine combo (72158) |
$345 |
$4,934 |
1.0× |
| Musculoskeletal Nuclear Exam (78399) |
$396 |
$2,326.17 |
1.0× |
| Myelogram cervical (72240) |
$777 |
$1,994 |
1.0× |
| Myelogram Lumbar (72265) |
$777 |
$1,914 |
1.0× |
| Myelography thoracic (72255) |
$777 |
$1,596.50 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$777 |
$2,210.50 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$396 |
$1,751.19 |
1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$538 |
$2,614.92 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,283 |
$5,909.87 |
1.0× |
| Neck soft tissue (70360) |
$86 |
$390.95 |
1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$382 |
$1,352.68 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$396 |
$1,961.89 |
1.0× |
| Nm csf leak detection (78650) |
$1,283 |
$1,777 |
1.0× |
| Nm myocard infarct spect (78469) |
$538 |
$1,751.19 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$103 |
$571 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,372 |
$5,959.60 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$231 |
$1,614.55 |
1.0× |
| Ob us nuchal meas 1 gest (76813) |
$103 |
$710.50 |
1.0× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$103 |
$641.83 |
1.0× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$103 |
$943.95 |
1.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$103 |
$641.83 |
1.0× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$86 |
$781 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$28 |
$204.68 |
1.0× |
| Panoramic X-ray of jaws (70355) |
$86 |
$113 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$538 |
$1,886.65 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$396 |
$1,716.55 |
1.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$396 |
$1,886.65 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$103 |
$562.55 |
1.0× |
| Peritoneogram Rs&I (74190) |
$541 |
$1,685.15 |
1.0× |
| Pet Image Skull-Thigh (78812) |
$1,417 |
$9,003.61 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$1,417 |
$9,003.61 |
1.0× |
| PET image w/CT, full body (78816) |
$1,417 |
$9,003.61 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,417 |
$9,003.61 |
1.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,283 |
$9,003.61 |
1.0× |
| PET whole body (78813) |
$1,417 |
$9,003.61 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$396 |
$1,716.55 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$103 |
$619 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$541 |
$1,685.15 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$86 |
$475.10 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86 |
$378.18 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$86 |
$476.38 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$103 |
$552 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$86 |
$378.18 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$86 |
$452 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$86 |
$465.28 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$86 |
$378.18 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$103 |
$562.55 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86 |
$428 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$86 |
$483.18 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$86 |
$475.10 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$86 |
$378.18 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$173 |
$1,297 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$86 |
$378.18 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$86 |
$427 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$86 |
$337.50 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$86 |
$378.18 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$103 |
$457.56 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$86 |
$480 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$103 |
$1,343.79 |
1.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,302 |
$29,201 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$101 |
$441.36 |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$382 |
$441.36 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$547 |
$1,122.30 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$103 |
$701 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$103 |
$667.70 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$173 |
$956.06 |
1.0× |
Radiologic exam colon single contrast study (74270)
range across 2 matching MRF lines |
$173 |
$1,068.57–$2,014.65 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$173 |
$911.10 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$103 |
$537 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$103 |
$374 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$173 |
$920.76 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$173 |
$764.69 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$173 |
$764.69 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$86 |
$425.60 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$86 |
$469.40 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$86 |
$413 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$103 |
$812 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$86 |
$303.94 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$86 |
$434 |
1.0× |
| Radiopharm Dacryocystography (78660) |
$396 |
$1,239.42 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$231 |
$1,938.51 |
1.0× |
| Renal Cyst Study (74470) |
$541 |
$707.28 |
1.0× |
| Ribs bilateral 3 views (71110) |
$103 |
$562.55 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$396 |
$1,724.52 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$396 |
$1,231.80 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$538 |
$3,250 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$538 |
$5,909.87 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$538 |
$5,909.87 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$231 |
$1,938.51 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$231 |
$1,614.55 |
1.0× |
| Rp Therapy Unlisted Procedure (79999) |
$231 |
$1,938.51 |
1.0× |
| Salivary Gland Function Study (78232) |
$396 |
$2,288.65 |
1.0× |
| Scapula (73010) |
$103 |
$562.55 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$21 |
$139.94 |
0.9× |
| Sella turcica (70240) |
$86 |
$303.94 |
1.0× |
| Shoulder 1 view (73020) |
$86 |
$383.38 |
1.0× |
| Shoulder Arthrography (73040) |
$345 |
$399 |
1.0× |
| Sialogram (70390) |
$236 |
$1,152.80 |
1.0× |
| Skull less than 4 views (70250) |
$103 |
$562.55 |
1.0× |
| Special dosimetry (77331) |
$133 |
$564.70 |
1.0× |
| Special Physics Consult (77370) |
$133 |
$668.45 |
1.0× |
| Special teletherapy port plan (77321) |
$371 |
$1,609.10 |
1.0× |
| Special treatment procedure (77470) |
$547 |
$2,599.25 |
1.0× |
| Speech evaluation, complex (70371) |
$236 |
$167 |
1.0× |
| Spleen Imaging (78185) |
$396 |
$2,587.20 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$1,772 |
$8,452.85 |
1.0× |
| Sternoclavicular joints (71130) |
$86 |
$434.20 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$3,130 |
$2,628.78 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$371 |
$1,609.10 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$371 |
$668.45 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$396 |
$1,087.80 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$371 |
$1,609.10 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$371 |
$1,609.10 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$133 |
$668.45 |
1.0× |
| Thoracic spine 2 views (72070) |
$103 |
$517 |
1.0× |
| Thoracic spine 3 views (72072) |
$103 |
$562.55 |
1.0× |
| Thoracolumbar 2 views (72080) |
$86 |
$378.18 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$396 |
$2,641.31 |
1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$396 |
$1,724.52 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$396 |
$590 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$538 |
$1,760 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$396 |
$981 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$396 |
$1,716.55 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$371 |
$1,609.10 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$133 |
$668.45 |
1.0× |
| Tx devices design & construction simple (77332) |
$133 |
$618.85 |
1.0× |
| Ultrasound Breast Limited (76642) |
$86 |
$1,284 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$103 |
$622 |
1.0× |
| Ultrasound Elastography Parenchyma (76981) |
$103 |
$1,538.60 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$103 |
$562.55 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$103 |
$903 |
1.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$86 |
$554.50 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$86 |
$2,004.87 |
1.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$396 |
$424.80 |
1.0× |
| Unlisted us procedure (76999) |
$86 |
$641.83 |
1.0× |
| Upper gi w/o kub (74240) |
$173 |
$764.69 |
1.0× |
| Urethrocystogram voiding (74455) |
$236 |
$1,064.70 |
1.0× |
| Urethrocystography retrograde (74450) |
$236 |
$1,064.70 |
1.0× |
| Us bone density measurement (76977) |
$103 |
$366.59 |
1.0× |
| Us breast unilateral complete (76641) |
$103 |
$457.56 |
1.0× |
| Us chest (76604) |
$103 |
$651 |
1.0× |
| Us complete joint (76881) |
$103 |
$847.05 |
1.0× |
| Us exam, pelvic, limited (76857) |
$103 |
$608 |
1.0× |
| Us kidney transplant (76776) |
$103 |
$899 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$103 |
$661.64 |
1.0× |
| Us ob detailed single fetus (76811) |
$236 |
$1,327.34 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$103 |
$674.25 |
1.0× |
| Us ob transvaginal (76817) |
$103 |
$732 |
1.0× |
| Us pelvic non ob complete (76856) |
$103 |
$1,025 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$103 |
$851 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$103 |
$552 |
1.0× |
| Us retroperitoneal complete (76770) |
$103 |
$915 |
1.0× |
| Us retroperitoneal limited (76775) |
$103 |
$822.99 |
1.0× |
| Us scrotum and contents (76870) |
$103 |
$854 |
1.0× |
| Us spinal canal and contents (76800) |
$103 |
$472.60 |
1.0× |
| Us thyroid (76536) |
$103 |
$867 |
1.0× |
| Us transrectal (76872) |
$103 |
$894 |
1.0× |
| Vascular Flow Imaging (78445) |
$396 |
$867.72 |
1.0× |
| Vasogram (74440) |
$236 |
$1,856.75 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,560 |
$6,665.54 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$3,130 |
$2,628.78 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$3,130 |
$8,505.98 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,130 |
$13,266.30 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,560 |
$2,628.78 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,560 |
$3,100.05 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,130 |
$3,623.69 |
1.0× |
| Venography Renal Unilateral (75831) |
$3,130 |
$3,623.69 |
1.0× |
| Venous sampling by catheter (75893) |
$5,517 |
$774 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$86 |
$415.59 |
1.0× |
| Wrist 2 views (73100) |
$86 |
$382 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$378.18 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$345 |
$1,326.25 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,130 |
$13,266.30 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$103 |
$681.50 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$405 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$541 |
$301.50 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$86 |
$296.85 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$103 |
$703 |
1.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$103 |
$1,343.79 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$86 |
$785.06 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$459.60 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$103 |
$704.83 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$103 |
$574 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$103 |
$704.83 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$103 |
$1,343.79 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$103 |
$562.55 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$86 |
$504.91 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$103 |
$737 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$103 |
$532 |
1.0× |
| X-ray eye for foreign body (70030) |
$86 |
$296.85 |
1.0× |
| X-ray head for orthodontia (70350) |
$86 |
$415.59 |
1.0× |
| X-ray humerus (73060) |
$86 |
$435 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$173 |
$1,119 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86 |
$378.18 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86 |
$378.18 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$103 |
$544 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$86 |
$378.18 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$103 |
$710 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$103 |
$562.55 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$103 |
$562.55 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$425 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$558 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$103 |
$719 |
1.0× |
| X-Ray Stress View (77071) |
$86 |
$415.59 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$103 |
$665.14 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$86 |
$415.59 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$345 |
$1,600.58 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$103 |
$517.23 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$103 |
$834 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$103 |
$665 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$86 |
$399 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$103 |
$415.59 |
1.0× |
| Xr orbits complete 4 views (70200) |
$103 |
$562.55 |
1.0× |