| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$1,373.43 |
— |
1.0× |
| Acute gi blood loss imaging (78278) |
$403.35 |
$1,251 |
1.0× |
| Angio adrenal bilat select (75733) |
$3,159.40 |
— |
1.0× |
| Angio adrenal unilat select (75731) |
$3,159.40 |
— |
1.0× |
| Angio extremity unilateral (75710) |
$3,159.40 |
— |
1.0× |
| Angio pulmonary unilateral (75741) |
$3,159.40 |
— |
1.0× |
| Angiogram extremity bilateral (75716) |
$3,159.40 |
— |
1.0× |
| Angiogram pelvic (75736) |
$5,426.13 |
— |
0.9× |
| Angiography internal mammary rs&i (75756) |
$3,159.40 |
— |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,159.40 |
— |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,426.13 |
— |
0.9× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$3,159.40 |
— |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,159.40 |
— |
1.0× |
| Ankle 2 views (73600) |
$88.38 |
$174 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,159.40 |
— |
1.0× |
| Arthrography knee lt (73580) |
$358.48 |
$1,090 |
1.0× |
| Arthrography wrist lt (73115) |
$315.49 |
$545 |
0.9× |
| Barium enema (74270) |
$178.69 |
$462 |
1.0× |
| Basic dosimetry (77300) |
$133.27 |
— |
0.9× |
| Bilat selctv renal venogram (75833) |
$3,159.40 |
— |
1.0× |
| Bone age studies (77072) |
$96.87 |
$174 |
0.9× |
| Bone imaging limited area (78300) |
$403.35 |
$1,105 |
1.0× |
| Bone marrow imaging whole body (78104) |
$403.35 |
— |
1.0× |
| Bone survey complete (77075) |
$106.74 |
$1,024 |
1.0× |
| Bowel imaging (78290) |
$403.35 |
$944 |
1.0× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$367.45 |
— |
0.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$540.30 |
$1,171 |
1.0× |
| Brain image w/flow 4 + views (78606) |
$496.15 |
$904 |
0.9× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$403.35 |
— |
1.0× |
| Card MRI w/stress img & dye (75563) |
$793.05 |
— |
1.0× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$540.30 |
— |
1.0× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$510.40 |
$961 |
0.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$403.35 |
— |
1.0× |
| Cardiac MRI w/stress img (75559) |
$550.37 |
— |
1.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$358.48 |
— |
1.0× |
| Cardiac shunt detection (78428) |
$403.35 |
— |
1.0× |
| Cephalogram, orthodontic Other Diagnostic Radiology FS (70350) |
$88.38 |
— |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$540.30 |
— |
1.0× |
| Cerebrospinal fluid leakage (78650) |
$1,310.41 |
— |
1.0× |
| Chg hyperthermia generated by intracavitary probes (77620) |
$580.66 |
— |
1.0× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$174.60 |
$341 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$178.69 |
$419 |
1.0× |
| Cineradiography/videoradiography (76120) |
$106.74 |
$279 |
1.0× |
| Cisternogram (78630) |
$540.30 |
— |
1.0× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$793.05 |
— |
1.0× |
| Clavicle complete (73000) |
$88.38 |
$267.50 |
1.0× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$242.63 |
— |
1.0× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$88.38 |
— |
1.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$178.69 |
$1,142 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$133.27 |
— |
0.9× |
| Contrast exam abdominl aorta (75625) |
$3,159.40 |
— |
1.0× |
| Contrast exam thoracic aorta (75605) |
$5,426.13 |
— |
0.9× |
| Corpora cavernosography (74445) |
$106.74 |
— |
1.0× |
| Csf shunt evaluation (78645) |
$540.30 |
— |
1.0× |
| CT - st neck w&wo contr (70492) |
$178.69 |
$1,428 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$358.48 |
$3,255 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$242.63 |
$2,940 |
1.0× |
| CT abdomen w wo contrast (74170) |
$178.69 |
$482 |
1.0× |
| CT abdomen w/contrast (74160) |
$178.69 |
$1,760 |
1.0× |
| CT abdomen w/o contrast (74150) |
$106.74 |
$1,760 |
1.0× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$358.48 |
$1,775 |
1.0× |
| CT angio abdom w/o & w/dye (74175) |
$178.69 |
$1,911 |
1.0× |
| CT angio abdominal arteries (75635) |
$178.69 |
$1,490 |
1.0× |
| CT angio hrt w/3d image (75574) |
$358.48 |
— |
1.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$178.69 |
$1,223 |
1.0× |
| CT cervical spine w/contrast (72126) |
$358.48 |
$1,145 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$106.74 |
$1,203 |
1.0× |
| CT chest w/contrast (71260) |
$178.69 |
$1,790 |
1.0× |
| CT colonography diag w cont (74262) |
$178.69 |
— |
1.0× |
| CT colonography w/o cntrst (74261) |
$106.74 |
— |
1.0× |
| CT extremity upper w & w/o contrast (73202) |
$178.69 |
$672 |
1.0× |
| CT head/brain with contrast (70460) |
$178.69 |
$1,668 |
1.0× |
| CT head/brain without and with contrast (70470) |
$178.69 |
$940 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$358.48 |
— |
1.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$88.38 |
— |
1.0× |
| CT hrt w/3d image congen (75573) |
$358.48 |
— |
1.0× |
| CT limited/localized follow up study (76380) |
$88.38 |
— |
1.0× |
| CT lower ext w/wo contrast (73702) |
$178.69 |
$672 |
1.0× |
| CT lower extremity w contrast (73701) |
$178.69 |
$1,008 |
1.0× |
| CT lower extremity w/o contrast unilateral (73700) |
$106.74 |
$320 |
1.0× |
| CT lumbar spine w/contrast (72132) |
$358.48 |
$1,203 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$106.74 |
$906 |
1.0× |
| CT lumbar spine w/o then w/ con (72133) |
$178.69 |
$1,775 |
1.0× |
| CT maxillofacial area w/o contrast (70486) |
$106.74 |
$940 |
1.0× |
| CT maxillofacial w/contrast (70487) |
$178.69 |
$1,172 |
1.0× |
| CT maxillofacial w/o then w/ con (70488) |
$178.69 |
$1,142 |
1.0× |
| CT orbit sella ear w/o con (70480) |
$106.74 |
$1,024 |
1.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$178.69 |
$940 |
1.0× |
| CT pelvis w & w/o contrast (72194) |
$178.69 |
$862 |
1.0× |
| CT pelvis w/o contrast (72192) |
$106.74 |
$1,329 |
1.0× |
| CT soft tissue neck w/contrast (70491) |
$178.69 |
$1,428 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$106.74 |
$1,318 |
1.0× |
| CT spine cervical w/wo contrast (72127) |
$178.69 |
$1,087 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$178.69 |
$1,145 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$106.74 |
$1,203 |
1.0× |
| CT thoracic spine w/o then w/ con (72130) |
$178.69 |
— |
1.0× |
| CT thorax lung cancer scr c- (71271) |
$106.74 |
$261 |
1.0× |
| CT thorax w/o contrast (71250) |
$106.74 |
$1,747 |
1.0× |
| CT thorax w/o then w/ contrast (71270) |
$178.69 |
$1,087 |
1.0× |
| CT upper extremity w/dye (73201) |
$339.24 |
$320 |
0.9× |
| CT upper extremity w/o contrast rt (73200) |
$106.74 |
$320 |
1.0× |
| CTA chest w/wo contrast (71275) |
$178.69 |
$1,293 |
1.0× |
| CTA head w contrast (70496) |
$178.69 |
$1,584 |
1.0× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$178.69 |
$672 |
1.0× |
| Cta Neck (70498) |
$178.69 |
$2,218 |
1.0× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$178.69 |
$1,008 |
1.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) |
$242.63 |
— |
1.0× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$540.30 |
— |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,056.25 |
— |
0.9× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$1,960.15 |
— |
1.0× |
| Diskography lumbar (72295) |
$1,960.15 |
— |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$106.74 |
— |
1.0× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$106.74 |
— |
1.0× |
| Doppler fetal mid cerebral artery (76821) |
$106.74 |
$261 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$106.74 |
— |
1.0× |
| Echo exam of eye (76529) |
$88.38 |
$220 |
1.0× |
| Echo exam of eye (76516) |
$106.74 |
— |
1.0× |
| Echo exam of eye thickness (76514) |
$24.58 |
— |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$242.63 |
— |
1.0× |
| Esophageal motility (78258) |
$403.35 |
— |
1.0× |
| Esophogram (74220) |
$178.69 |
$390 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$106.74 |
$375 |
1.0× |
| Fetal biophysical profile w/o nst (76819) |
$106.74 |
$336 |
1.0× |
| Fetal echo complete (76825) |
$550.37 |
— |
1.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$240.82 |
$478 |
1.0× |
| Full mouth X-ray of teeth (70320) |
$242.63 |
— |
1.0× |
| Functional MRI brain by phys/psych (70555) |
$242.63 |
— |
1.0× |
| Functional MRI brain by tech (70554) |
$242.63 |
— |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$540.30 |
— |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$403.35 |
— |
1.0× |
| Gastric emptying study (78264) |
$403.35 |
$1,016 |
1.0× |
| Gastric mucosa imaging (78261) |
$403.35 |
— |
1.0× |
| Gastroesophageal reflux study (78262) |
$403.35 |
— |
1.0× |
| Gated heart planar single (78472) |
$201.68 |
$0.01 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$696.43 |
— |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$696.43 |
— |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$696.43 |
— |
1.0× |
| Heart infarct image (78466) |
$403.35 |
— |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,159.40 |
— |
1.0× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$3,159.40 |
— |
1.0× |
| Hepatobil syst image w/drug (78227) |
$540.30 |
$1,251 |
1.0× |
| Hepatobiliary system imaging (78226) |
$403.35 |
$904 |
1.0× |
| High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with… (77423) |
$580.66 |
— |
1.0× |
| Humerus min 2 views (73060) |
$88.38 |
$173 |
1.0× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators (77615) |
$580.66 |
— |
1.0× |
| Hyperthermia ntrstl prb 5/< (77610) |
$580.66 |
— |
1.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) (77605) |
$696.43 |
— |
1.0× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) (77600) |
$263.97 |
— |
0.7× |
| Hysterosalpingography (74740) |
$212.32 |
$364 |
0.9× |
| Image fusion (77399) |
$133.27 |
— |
0.9× |
| Imrt planning (77301) |
$1,373.43 |
— |
1.0× |
| Infusion of radioelement (77750) |
$263.97 |
— |
0.7× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$403.35 |
— |
1.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$696.43 |
— |
1.0× |
| Intracavitary radiation source applic complex (77763) |
$696.43 |
— |
1.0× |
| Intracavitary radiation source applic intermed (77762) |
$580.66 |
— |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$580.66 |
— |
1.0× |
| Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425) |
$7,673.39 |
— |
1.0× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$7,673.39 |
— |
1.0× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$367.45 |
— |
0.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$367.45 |
— |
0.9× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$367.45 |
— |
0.9× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$367.45 |
— |
0.9× |
| Ivp (74400) |
$178.69 |
$534 |
1.0× |
| Ivp w tomography (74415) |
$178.69 |
— |
1.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$540.30 |
— |
1.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$493.90 |
$895 |
0.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$496.15 |
$904 |
0.9× |
| Kidney w vascular flow (78701) |
$403.35 |
$895 |
1.0× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$403.35 |
— |
1.0× |
| Liver & spleen; static only (78215) |
$403.35 |
$895 |
1.0× |
| Liver & spleen; w vasc flow (78216) |
$403.35 |
$904 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$540.30 |
$3,461 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$540.30 |
— |
1.0× |
| Lung perfusion differential (78597) |
$403.35 |
— |
1.0× |
| Lung ventilat&perfus imaging (78582) |
$540.30 |
$1,314 |
1.0× |
| Lung ventilation imaging (78579) |
$403.35 |
$895 |
1.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,559.31 |
— |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$620.60 |
— |
0.9× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$3,159.40 |
— |
1.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,159.40 |
— |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$358.48 |
$2,272 |
1.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$358.48 |
$2,203.50 |
1.0× |
| Mammary ductogram multiple ducts (77054) |
$121.32 |
$0.01 |
0.5× |
| Mammary ductogram single (77053) |
$121.32 |
$0.01 |
0.5× |
| Med physic dos eval rad exps (76145) |
$532.61 |
— |
1.4× |
| Mlc device(s) for imrt (77338) |
$367.45 |
— |
0.9× |
| Mr safety determination physician/other qhp (76016) |
$88.38 |
— |
1.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$59.62 |
— |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$24.58 |
— |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$92.14 |
— |
0.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$242.63 |
— |
1.0× |
| MRA head w & w/o contrast (70546) |
$358.48 |
$4,568 |
1.0× |
| MRA head w/contrast (70545) |
$358.48 |
$3,130 |
1.0× |
| MRA head w/o contrast (70544) |
$242.63 |
$2,931 |
1.0× |
| MRA neck w/contrast (70548) |
$358.48 |
$3,130 |
1.0× |
| MRA neck w/o contrast (70547) |
$242.63 |
$2,931 |
1.0× |
| MRA neck w/wo contrast (70549) |
$358.48 |
$4,568 |
1.0× |
| MRI abdomen w/contrast (74182) |
$358.48 |
$2,688 |
1.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$358.48 |
$3,472 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$242.63 |
$2,688 |
1.0× |
| MRI any jnt lwr ext with con lt (73722) |
$793.05 |
$1,289 |
1.0× |
| MRI bone marrow (77084) |
$242.63 |
— |
1.0× |
| MRI brain w/dye (70558) |
$178.69 |
— |
1.0× |
| MRI brain w/o & w/dye (70559) |
$178.69 |
— |
1.0× |
| MRI brain w/o dye (70557) |
$550.37 |
— |
1.0× |
| MRI breast without contrast bilateral (77047) |
$242.63 |
— |
1.0× |
| MRI breast without contrast material unilateral (77046) |
$242.63 |
— |
1.0× |
| MRI cardiac w/o contrast (75557) |
$242.63 |
— |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$242.63 |
$3,038 |
1.0× |
| MRI cervical spine with contrast (72142) |
$358.48 |
$3,118 |
1.0× |
| MRI chest w & w/o contrast (71552) |
$358.48 |
$881 |
1.0× |
| MRI chest w/contrast (71551) |
$793.05 |
$1,711 |
1.0× |
| MRI chest w/o contrast (71550) |
$242.63 |
$2,688 |
1.0× |
| MRI elastography (76391) |
$242.63 |
— |
1.0× |
| MRI fetal sngl/1st gestation (74712) |
$242.63 |
— |
1.0× |
| MRI joint upper ext w/contrast (73222) |
$793.05 |
$0.01 |
1.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$358.48 |
$2,272 |
1.0× |
| MRI joint upr extrem w/o dye (73221) |
$242.63 |
$1,947.50 |
1.0× |
| Mri Lower Extremity W/O Dye (73718) |
$242.63 |
$2,422 |
1.0× |
| MRI lumbar spine with contrast (72149) |
$358.48 |
$3,118 |
1.0× |
| MRI lumbar w/wo contrast (72158) |
$358.48 |
$3,326 |
1.0× |
| MRI lwr ext w/o jnts with con rt (73719) |
$358.48 |
$1,988.50 |
1.0× |
| MRI orbit/face/neck w/contrast (70542) |
$358.48 |
$1,682 |
1.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$358.48 |
$2,732 |
1.0× |
| MRI orbit/face/neck w/o contrast (70540) |
$242.63 |
$1,682 |
1.0× |
| MRI pelvis w/ contrast (72196) |
$358.48 |
$2,688 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$242.63 |
$2,422 |
1.0× |
| MRI pelvis w/wo contrast (72197) |
$358.48 |
$3,472 |
1.0× |
| MRI spectroscopy (76390) |
$88.38 |
— |
1.0× |
| MRI spine cervical wo/w contrast (72156) |
$358.48 |
$3,326 |
1.0× |
| MRI spine thoracic w/contrast (72147) |
$358.48 |
$3,118 |
1.0× |
| MRI thoracic spine w wo contrast (72157) |
$358.48 |
$3,326 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$242.63 |
$3,038 |
1.0× |
| MRI tmj (70336) |
$242.63 |
$1,570 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$242.63 |
$1,599.50 |
1.0× |
| Mri Upper Extremity W/Dye (73219) |
$358.48 |
$2,578 |
1.0× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$358.48 |
$1,988.50 |
1.0× |
| Myelogram Cpa (70010) |
$358.48 |
— |
1.0× |
| Myelogram thoracic (72255) |
$777.02 |
$1,522 |
0.9× |
| Myelography 2 or more regions (72270) |
$720.28 |
$1,295 |
0.9× |
| Myelography lumbosacral (72265) |
$750 |
$750 |
0.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$1,464.10 |
— |
1.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$1,464.10 |
— |
1.0× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$1,310.41 |
$3,461 |
1.0× |
| Myocardial perfusion planar multiple studies (78454) |
$1,006.20 |
$1,404 |
0.7× |
| Myocardial spect single study at rest or stress (78451) |
$1,310.41 |
$3,461 |
1.0× |
| Myocrd img PET metab eval single study (78459) |
$1,310.41 |
— |
1.0× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,464.10 |
— |
1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,464.10 |
— |
1.0× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,259.01 |
— |
1.0× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$1,957.87 |
— |
0.9× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$1,857.49 |
— |
1.2× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,021.24 |
— |
1.1× |
| Nm adrenal imaging (78075) |
$1,310.41 |
— |
1.0× |
| Nm bone 3 phase (78315) |
$403.35 |
$1,293 |
1.0× |
| Nm bone imaging whole body (78306) |
$403.35 |
$1,091 |
1.0× |
| Nm bone marrow scan limited (78102) |
$403.35 |
— |
1.0× |
| Nm bone marrow scan multiple (78103) |
$403.35 |
— |
1.0× |
| Nm bone multi (78305) |
$403.35 |
— |
1.0× |
| Nm heart perfusion spect stress rest (78452) |
$1,310.41 |
$3,517 |
1.0× |
| Nm kidney function (78725) |
$403.35 |
— |
1.0× |
| Nm kidney imaging morphology (78700) |
$403.35 |
$895 |
1.0× |
| Nm liver image static only (78201) |
$540.30 |
$3,461 |
1.0× |
| Nm lymph system (78195) |
$540.30 |
$1,106 |
1.0× |
| Nm myocard infarct spect (78469) |
$540.30 |
— |
1.0× |
| Nm thyroid ca mets limited (78015) |
$403.35 |
— |
1.0× |
| Nm thyroid imaging only (78013) |
$355.92 |
$617 |
0.9× |
| Nose to rectum for fb child (76010) |
$81.94 |
$151 |
0.9× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$493.90 |
$895 |
0.9× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$403.35 |
— |
1.0× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$540.30 |
— |
1.0× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$403.35 |
— |
1.0× |
| Nuclear medicine study of red blood cell survival (78130) |
$403.35 |
— |
1.0× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$403.35 |
— |
1.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$403.35 |
— |
1.0× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$1,310.41 |
— |
1.0× |
| Nuclear medicine study to assess protein loss into the digestive tract (78282) |
$403.35 |
— |
1.0× |
| Nuclear rx IV admin (79101) |
$224.98 |
— |
0.9× |
| Ob us < 14 wks single fetus (76801) |
$106.74 |
$231 |
1.0× |
| Ob us nuchal meas 1 gest (76813) |
$106.74 |
— |
1.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$106.74 |
— |
1.0× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$106.74 |
— |
1.0× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$106.74 |
— |
1.0× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$129.39 |
— |
0.9× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$106.74 |
— |
1.0× |
| Oral radiopharm rx (79005) |
$224.98 |
— |
0.9× |
| Orthopantogram (70355) |
$88.38 |
— |
1.0× |
| Parathyrd planar w/spect&CT (78072) |
$540.30 |
— |
1.0× |
| Parathyroid imaging (78070) |
$341.92 |
$561 |
0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$403.35 |
— |
1.0× |
| Peritoneal-venous shunt patency test (78291) |
$403.35 |
— |
1.0× |
| Peritoneogram rs&i (74190) |
$550.37 |
— |
1.0× |
| PET brain metabolic eval (78608) |
$1,464.10 |
— |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,464.10 |
— |
1.0× |
| PET imaging CT for attenuation limited area (78814) |
$1,464.10 |
— |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$1,464.10 |
— |
1.0× |
| PET imaging limited area chest head/neck (78811) |
$1,310.41 |
— |
1.0× |
| PET imaging whole body (78813) |
$1,464.10 |
— |
1.0× |
| Plasma volume multiple (78111) |
$1,310.41 |
— |
1.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$1,310.41 |
— |
1.0× |
| Platelet survival study (78191) |
$403.35 |
— |
1.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$1,464.10 |
— |
1.0× |
| Proton treatment complex (77525) |
$1,280.33 |
— |
1.0× |
| Proton trmt intermediate (77523) |
$1,280.33 |
— |
1.0× |
| Proton trmt simple w/comp (77522) |
$1,280.33 |
— |
1.0× |
| Proton trmt simple w/o comp (77520) |
$580.66 |
— |
1.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,159.40 |
— |
1.0× |
| Pulmonary perfusion imaging particulate (78580) |
$403.35 |
$895 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$468.94 |
$775 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$88.38 |
$281 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$106.74 |
$261 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$106.74 |
— |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$106.74 |
— |
1.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$88.38 |
$339 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$88.38 |
$211 |
1.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$106.74 |
— |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$106.74 |
$414 |
1.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$106.74 |
— |
1.0× |
| Radex spine cervical 2 or 3 views (72040) |
$88.38 |
$191 |
1.0× |
| Radex spine cervical 4 or 5 views (72050) |
$106.74 |
$378 |
1.0× |
| Radex spine cervical 6 or more views (72052) |
$106.74 |
$414 |
1.0× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$88.38 |
— |
1.0× |
| Radiation delivery stereotactic cranial linear (77372) |
$7,673.39 |
— |
1.0× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$7,673.39 |
— |
1.0× |
| Radiation tx delivery lvl 1 (77402) |
$109.91 |
— |
1.0× |
| Radiation tx delivery lvl 2 (77407) |
$263.97 |
— |
0.7× |
| Radiation tx delivery lvl 3 (77412) |
$263.97 |
— |
0.5× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$106.74 |
$235 |
1.0× |
| Radiologic exam esophagus double contrast study (74221) |
$178.69 |
— |
1.0× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$178.69 |
— |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$178.69 |
$505 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$178.69 |
$483 |
1.0× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$87.69 |
$174 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$88.38 |
$173 |
1.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$106.74 |
$490 |
1.0× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$106.74 |
— |
1.0× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$88.38 |
— |
1.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$106.74 |
$326 |
1.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$106.74 |
$334 |
1.0× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$242.63 |
— |
1.0× |
| Radiologic examination, teeth; single view Other Diagnostic Radiology FS (70300) |
$88.38 |
— |
1.0× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$88.38 |
— |
1.0× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$403.35 |
— |
1.0× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration UNSCHEDULED (79300) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$224.98 |
— |
0.9× |
| Red cell mass multiple (78121) |
$540.30 |
— |
1.0× |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
$403.35 |
— |
1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$263.97 |
— |
0.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$263.97 |
— |
0.7× |
| Renal cyst study (74470) |
$550.37 |
— |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$402.42 |
$803 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$403.35 |
— |
1.0× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,310.41 |
$2,835 |
2.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,209.46 |
$2,217 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,301.96 |
$2,587 |
2.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,310.41 |
— |
1.0× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$1,464.10 |
— |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,310.41 |
— |
1.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$224.98 |
— |
0.9× |
| Saline infused sonohysterogram (76831) |
$240.06 |
$475 |
1.0× |
| Salivary gland funct study (78232) |
$403.35 |
— |
1.0× |
| Salivary gland imaging (78230) |
$403.35 |
— |
1.0× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$51.51 |
$75 |
2.2× |
| Selective spinal angiogram (75705) |
$5,426.13 |
— |
0.9× |
| Shoulder arthrogram (73040) |
$358.48 |
— |
1.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$106.74 |
— |
1.0× |
| Simulation complex (77290) |
$367.45 |
— |
0.9× |
| Simulation intermediate (77285) |
$367.45 |
— |
0.9× |
| Simulation simple (77280) |
$133.27 |
— |
0.9× |
| Small bowel series (74250) |
$178.69 |
$378 |
1.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$367.45 |
— |
0.9× |
| Special dosimetry (77331) |
$133.27 |
— |
0.9× |
| Special physics consult (77370) |
$133.27 |
— |
0.9× |
| Special treatment procedure (77470) |
$580.66 |
— |
1.0× |
| Speech evaluation complex (70371) |
$242.63 |
— |
1.0× |
| Spleen imaging only (78185) |
$403.35 |
$904 |
1.0× |
| Splenoportography (75810) |
$3,159.40 |
— |
1.0× |
| Stereotactic body radiation delivery (77373) |
$1,762.55 |
— |
0.9× |
| Superior sagittal sinus venogram (75870) |
$3,159.40 |
— |
1.0× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$109.91 |
— |
1.0× |
| Tbs technical calculation only (77091) |
$88.38 |
— |
1.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$242.63 |
— |
1.0× |
| Testicular imaging w/flow (78761) |
$403.35 |
$842 |
1.0× |
| Therapeutic enema barium or air (74283) |
$178.69 |
$561 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Age Under 21 (78016) |
$403.35 |
— |
1.0× |
| Thyroid met imaging body (78018) |
$540.30 |
— |
1.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$403.35 |
$831 |
1.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$403.35 |
$929 |
1.0× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$88.38 |
— |
1.0× |
| Treatment device intermediate (77333) |
$133.27 |
— |
0.9× |
| Treatment devices complex (77334) |
$367.45 |
— |
0.9× |
| Treatment devices simple (77332) |
$133.27 |
— |
0.9× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Age Under 21 (76977) |
$106.74 |
— |
1.0× |
| Ultrasound breast limited (76642) |
$88.38 |
$256 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$106.74 |
$411 |
1.0× |
| Ultrasound, elastography; first target lesion (76982) |
$106.74 |
— |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$106.74 |
$375 |
1.0× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$403.35 |
— |
1.0× |
| Unlisted CT procedure (76497) |
$88.38 |
— |
1.0× |
| Unlisted diagnostic radiographic procedure (76499) |
$88.38 |
$194 |
1.0× |
| Unlisted endocrine procedure, diagnostic nuclear medicine UNSCHEDULED (78099) |
$403.35 |
— |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$88.38 |
— |
1.0× |
| Unlisted gastrointestinal procedure, diagnostic nuclear medicine UNSCHEDULED (78299) |
$403.35 |
— |
1.0× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$403.35 |
— |
1.0× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$403.35 |
— |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$88.38 |
— |
1.0× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine UNSCHEDULED (78999) |
$403.35 |
— |
1.0× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$403.35 |
— |
1.0× |
| Unlisted nervous system procedure, diagnostic nuclear medicine UNSCHEDULED (78699) |
$403.35 |
— |
1.0× |
| Unlisted procedure, clinical brachytherapy (77799) |
$109.91 |
— |
1.0× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$133.27 |
— |
0.9× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$403.35 |
— |
1.0× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$11.06 |
— |
1.0× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$94.41 |
— |
1.0× |
| Ureteral reflux study (78740) |
$403.35 |
— |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$242.63 |
$492 |
1.0× |
| Urethrocystography voiding (74455) |
$242.63 |
$604 |
1.0× |
| Urography antegrade (74425) |
$358.48 |
— |
1.0× |
| Urography retrograde w/wo kub (74420) |
$320.49 |
$565 |
0.9× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$178.69 |
— |
1.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$106.74 |
$375 |
1.0× |
| Us breast uni real time with image complete (76641) |
$106.74 |
$293.50 |
1.0× |
| Us chest (76604) |
$106.74 |
$400 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$106.74 |
$1,276 |
1.0× |
| Us elastography parenchyma (76981) |
$106.74 |
— |
1.0× |
| Us encephalogram (76506) |
$106.74 |
$789 |
1.0× |
| Us gi endoscopic (76975) |
$242.63 |
— |
1.0× |
| Us guided compression repair (76936) |
$312.58 |
— |
1.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$88.38 |
$1,155 |
1.0× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$88.38 |
— |
1.0× |
| Us kidney transplanted (76776) |
$106.74 |
$261 |
1.0× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$106.74 |
$861 |
1.0× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$106.74 |
— |
1.0× |
| Us ob detailed single fetus (76811) |
$242.63 |
— |
1.0× |
| Us ob followup per fetus (76816) |
$106.74 |
$275 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$105.37 |
$208 |
1.0× |
| Us obstetric transvaginal (76817) |
$100.62 |
$189 |
0.9× |
| Us pelvic limited or f/u non-ob (76857) |
$106.74 |
$375 |
1.0× |
| Us pelvis complete (76856) |
$106.74 |
$545 |
1.0× |
| Us retroperitoneal complete (76770) |
$106.74 |
$261 |
1.0× |
| Us retroperitoneal limited (76775) |
$106.74 |
$537 |
1.0× |
| Us scrotum (76870) |
$106.74 |
$416 |
1.0× |
| Us soft tissue head/neck (76536) |
$106.74 |
$411 |
1.0× |
| Us spinal canal (76800) |
$106.74 |
$313 |
1.0× |
| Us transrectal (76872) |
$106.74 |
$345 |
1.0× |
| Us transrectal prostate volume (76873) |
$106.74 |
— |
1.0× |
| Us trgt dyn mbubb 1st les (76978) |
$178.69 |
— |
0.5× |
| Us unlstd proc (76999) |
$88.38 |
$400 |
1.0× |
| Vascular flow imaging (78445) |
$377.18 |
$702 |
0.9× |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Other Diagnostic Radiology… (74440) |
$242.63 |
— |
1.0× |
| Vein X-ray liver w/hemodynam (75885) |
$3,159.40 |
— |
1.0× |
| Venogram epidural (75872) |
$620.60 |
— |
0.9× |
| Venogram extremity bilateral (75822) |
$748 |
$748 |
0.5× |
| Venogram ivc w serialography (75825) |
$3,159.40 |
— |
1.0× |
| Venogram svc w serialography (75827) |
$1,559.31 |
— |
0.9× |
| Venography adrenal unilateral selective rs&i (75840) |
$3,159.40 |
— |
1.0× |
| Venography ext unilateral (75820) |
$1,292.16 |
$2,050 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$3,159.40 |
— |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,159.40 |
— |
1.0× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$620.60 |
— |
0.9× |
| Venous sampling by catheter (75893) |
$5,426.13 |
— |
0.9× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$540.30 |
— |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$88.38 |
— |
1.0× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$540.30 |
— |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$87.69 |
$174 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$88.38 |
$192.50 |
1.0× |
| X-ray aorta leg arteries (75630) |
$3,159.40 |
— |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$178.69 |
$689 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$88.38 |
$173 |
1.0× |
| X-ray exam hips bi 3-4 views (73522) |
$53.38 |
$0.01 |
0.5× |
| X-ray exam of finger(s) (73140) |
$87.44 |
$173 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$178.69 |
— |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$88.38 |
$348 |
1.0× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$88.38 |
$173 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$88.38 |
$178 |
1.0× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$106.74 |
$286 |
1.0× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$87.44 |
$173 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$87.44 |
$173 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$88.38 |
— |
1.0× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$88.38 |
$183 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$106.74 |
$213 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$88.38 |
— |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$100.87 |
$190 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$106.74 |
$348 |
1.0× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$106.74 |
$455 |
1.0× |
| X-ray perineogram (74775) |
$242.63 |
— |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$88.38 |
$242 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$106.74 |
$261 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$106.74 |
$235 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$106.74 |
— |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$88.38 |
$268 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$88.38 |
$173 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$88.38 |
$360 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$106.74 |
$348 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$106.74 |
$311 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$88.38 |
$190 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$87.69 |
$174 |
1.0× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$88.38 |
$173 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$88.38 |
$173 |
1.0× |
| Xr abdomen 1 view (74018) |
$87.69 |
$174 |
1.0× |
| Xr abdomen 2 views (74019) |
$106.74 |
$261 |
1.0× |
| Xr abdomen 3 views (74021) |
$106.74 |
$190 |
1.0× |
| Xr arthrogram ankle (73615) |
$358.48 |
$1,996 |
1.0× |
| Xr arthrogram elbow (73085) |
$282.74 |
$414 |
0.8× |
| Xr arthrogram hip (73525) |
$358.48 |
— |
1.0× |
| Xr bone density appendicular (77081) |
$88.38 |
$271 |
1.0× |
| Xr bone density axial (77080) |
$106.74 |
$406 |
1.0× |
| Xr bone length study (77073) |
$106.74 |
$243.50 |
1.0× |
| Xr bone survey infant (77076) |
$106.74 |
$739 |
1.0× |
| Xr bone survey limited (77074) |
$106.74 |
$739 |
1.0× |
| Xr chest 1 view (71045) |
$88.38 |
$247 |
1.0× |
| Xr chest 2 views (71046) |
$88.38 |
$247 |
1.0× |
| Xr chest 3 views (71047) |
$88.38 |
$217 |
1.0× |
| Xr cystogram 3+ views (74430) |
$358.48 |
$786 |
1.0× |
| Xr eye foreign body (70030) |
$87.44 |
$173 |
1.0× |
| Xr facial bones 3 views (70150) |
$106.74 |
$348 |
1.0× |
| Xr joint survey 1 view (77077) |
$106.74 |
— |
1.0× |
| Xr lower extremity 2 views infant (73592) |
$87.69 |
$174 |
1.0× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$106.74 |
$261 |
1.0× |
| Xr mandible 4 views (70110) |
$106.74 |
$247 |
1.0× |
| Xr myelogram c-spine (72240) |
$718 |
$718 |
0.9× |
| Xr nasal bones (70160) |
$88.38 |
$235 |
1.0× |
| Xr pelvis 3 views (72190) |
$106.74 |
$240 |
1.0× |
| Xr sella turcica (70240) |
$88.38 |
$252 |
1.0× |
| Xr sialogram (70390) |
$211.56 |
$361 |
0.8× |
| Xr spine 1 view (72020) |
$84.94 |
$163 |
0.9× |
| Xr sternum 2 views (71120) |
$88.38 |
$318 |
1.0× |
| Xr stress view joint (77071) |
$88.38 |
— |
1.0× |
| Xr surgical specimen (76098) |
$483.94 |
$835 |
0.8× |
| Xr upper extremity 2 views infant (73092) |
$106.74 |
$286 |
1.0× |
| Xray elbow 2 views (73070) |
$88.38 |
$173 |
1.0× |
| Xray forearm 2 views (73090) |
$88.38 |
$173 |
1.0× |
| Xray internal auditory meati compl (70134) |
$550.37 |
— |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$87.69 |
$174 |
1.0× |
| Xray neck soft tissue (70360) |
$88.38 |
$206 |
1.0× |
| Xray optic foramina (70190) |
$88.38 |
$348 |
1.0× |
| Xray orbits complete min 4 views (70200) |
$106.74 |
$348 |
1.0× |
| Xray pelvis 1 or 2 views (72170) |
$96.87 |
$174 |
0.9× |
| Xray ribs bilateral 3 views (71110) |
$106.74 |
— |
1.0× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$106.74 |
$318 |
1.0× |
| Xray scapula complete (73010) |
$100.87 |
$181.50 |
0.9× |
| Xray shoulder 1 view (73020) |
$44.20 |
$0.01 |
0.5× |
| Xray sinuses paranasal <3 views (70210) |
$88.38 |
$318 |
1.0× |
| Xray spine thoracic 2 views (72070) |
$106.74 |
$298 |
1.0× |
| Xray spine thoracic 3 views (72072) |
$106.74 |
— |
1.0× |
| Xray tibia-fibula 2 views bil (73590) |
$88.38 |
$174 |
1.0× |
| Xray tmj open - closed unilat (70328) |
$88.38 |
— |
1.0× |
| Xray tmj's bilateral open-clsc (70330) |
$88.38 |
$318 |
1.0× |