| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,373.43 |
— |
1.0× |
| Abdomen 2 views (74019) |
$106.74 |
$261 |
1.0× |
| Acute gi blood loss imaging (78278) |
$403.35 |
$1,251 |
1.0× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$1,310.41 |
— |
1.0× |
| Angio Adrenal Bilat Select (75733) |
$3,159.40 |
— |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,159.40 |
— |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,159.40 |
— |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,159.40 |
— |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,426.13 |
— |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,159.40 |
— |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,159.40 |
— |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$5,426.13 |
— |
0.9× |
| 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× |
| Aortogram thoracic (75605) |
$5,426.13 |
— |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,159.40 |
— |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,159.40 |
— |
1.0× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,159.40 |
— |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,159.40 |
— |
1.0× |
| Arthrogram ankle (73615) |
$358.48 |
$1,996 |
1.0× |
| Arthrogram elbow (73085) |
$282.74 |
$414 |
0.8× |
| Arthrogram hip (73525) |
$358.48 |
— |
1.0× |
| Arthrogram knee (73580) |
$358.48 |
$1,090 |
1.0× |
| Arthrogram shoulder (73040) |
$358.48 |
— |
1.0× |
| Arthrogram wrist (73115) |
$315.49 |
$545 |
0.9× |
| Basic dosimetry (77300) |
$133.27 |
— |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$403.35 |
$1,105 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$403.35 |
— |
1.0× |
| Bone &/joint imaging whole body (78306) |
$403.35 |
$1,091 |
1.0× |
| Bone age studies (77072) |
$96.87 |
$174 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$403.35 |
$1,293 |
1.0× |
| Bone Marrow Imaging Limited Area (78102) |
$403.35 |
— |
1.0× |
| Bone survey complete (77075) |
$106.74 |
$1,024 |
1.0× |
| Bone survey infant (77076) |
$106.74 |
$739 |
1.0× |
| Bowel imaging (78290) |
$403.35 |
$944 |
1.0× |
| Brachytx isodose complex (77318) |
$367.45 |
— |
0.9× |
| Brachytx isodose intermed (77317) |
$367.45 |
— |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$367.45 |
— |
0.9× |
| Brain imaging < 4 static views (78600) |
$403.35 |
— |
1.0× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$403.35 |
— |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$496.15 |
$904 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,464.10 |
— |
1.0× |
| Brain Imaging Vascular Flow Only (78610) |
$540.30 |
$1,171 |
1.0× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$493.90 |
$895 |
0.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$403.35 |
— |
1.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$403.35 |
— |
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 magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$793.05 |
— |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$358.48 |
— |
1.0× |
| Cardiac shunt detection (78428) |
$403.35 |
— |
1.0× |
| Cardiovasc nucl exam unlisted (78499) |
$403.35 |
— |
1.0× |
| Cephalogram, orthodontic Non-Facility (70350) |
$88.38 |
— |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$540.30 |
— |
1.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$540.30 |
— |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$88.38 |
$191 |
1.0× |
| Chest 1 view (71045) |
$88.38 |
$247 |
1.0× |
| Chest xray 3 views (71047) |
$88.38 |
$217 |
1.0× |
| Cholecystography, oral contrast Non-Facility (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× |
| Cisternography Positive Contrast Rs&I (70015) |
$793.05 |
— |
1.0× |
| Clavicle complete (73000) |
$88.38 |
$267.50 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$106.74 |
$261 |
1.0× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$88.38 |
— |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$133.27 |
— |
0.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$178.69 |
— |
1.0× |
| Corpora cavernosography (74445) |
$106.74 |
— |
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 contrast (74160) |
$178.69 |
$1,760 |
1.0× |
| CT abdomen w wo contrast (74170) |
$178.69 |
$482 |
1.0× |
| CT abdomen w/o contrast (74150) |
$106.74 |
$1,760 |
1.0× |
| CT angio hrt w/3d image (75574) |
$358.48 |
— |
1.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$178.69 |
$672 |
1.0× |
| CT angiography upper extremity lt (73206) |
$178.69 |
$1,008 |
1.0× |
| CT c-spine w/contrast (72126) |
$358.48 |
$1,145 |
1.0× |
| CT c-spine w/o contrast (72125) |
$106.74 |
$1,203 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$178.69 |
$1,087 |
1.0× |
| CT chest w contrast (71260) |
$178.69 |
$1,790 |
1.0× |
| CT chest w/wo contrast (71270) |
$178.69 |
$1,087 |
1.0× |
| CT colonography screening (74263) |
$242.63 |
— |
1.0× |
| CT colonography w/dye (74262) |
$178.69 |
— |
1.0× |
| CT colonography w/o cntrst (74261) |
$106.74 |
— |
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 iac w contrast (70481) |
$178.69 |
$1,142 |
1.0× |
| CT limited/localized follow up study (76380) |
$88.38 |
— |
1.0× |
| CT lower ext w/o (73700) |
$106.74 |
$320 |
1.0× |
| CT lower extremity w wo contrast (73702) |
$178.69 |
$672 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$178.69 |
$1,008 |
1.0× |
| CT lumbar spine w & w/o contrast (72133) |
$178.69 |
$1,775 |
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 maxillofacial w contrast (70487) |
$178.69 |
$1,172 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$178.69 |
$1,142 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$106.74 |
$940 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$178.69 |
$940 |
1.0× |
| CT orbits w/o contrast (70480) |
$106.74 |
$1,024 |
1.0× |
| CT pelvis w/o contrast (72192) |
$106.74 |
$1,329 |
1.0× |
| CT pelvis w/wo contrast (72194) |
$178.69 |
$862 |
1.0× |
| CT scan of arm combo (73202) |
$178.69 |
$672 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$178.69 |
$1,428 |
1.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$178.69 |
$1,428 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$106.74 |
$1,318 |
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/wo contrast (72130) |
$178.69 |
— |
1.0× |
| CT thorax w/o contrast (71250) |
$106.74 |
$1,747 |
1.0× |
| CT unlisted procedure (76497) |
$88.38 |
— |
1.0× |
| CT upper ext wo (73200) |
$106.74 |
$320 |
1.0× |
| CT upper extremity with contrast (73201) |
$339.24 |
$320 |
0.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$178.69 |
$1,490 |
1.0× |
| Cta Abdomen (74175) |
$178.69 |
$1,911 |
1.0× |
| CTA abdomen pelvis (74174) |
$358.48 |
$1,775 |
1.0× |
| CTA chest (71275) |
$178.69 |
$1,293 |
1.0× |
| Cta Head (70496) |
$178.69 |
$1,584 |
1.0× |
| Cta Neck (70498) |
$178.69 |
$2,218 |
1.0× |
| Cta Pelvis (72191) |
$178.69 |
$1,223 |
1.0× |
| Cystography minimum 3 views rs&i (74430) |
$358.48 |
$786 |
1.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (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 of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,056.25 |
— |
0.9× |
| Diskogram cervical (72285) |
$1,960.15 |
— |
1.0× |
| Diskography lumbar (72295) |
$1,960.15 |
— |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$106.74 |
— |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$106.74 |
— |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$106.74 |
$261 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$106.74 |
$406 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$88.38 |
$271 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$106.74 |
— |
1.0× |
| Echo exam of eye (76529) |
$88.38 |
$220 |
1.0× |
| 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× |
| Esophagus (74220) |
$178.69 |
$390 |
1.0× |
| Facial bones min 3 views (70150) |
$106.74 |
$348 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$106.74 |
$375 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$106.74 |
$336 |
1.0× |
| Fetal Echo (76825) |
$550.37 |
— |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$240.82 |
$478 |
1.0× |
| Foot 2 views (73620) |
$88.38 |
$173 |
1.0× |
| Forearm 2 views (73090) |
$88.38 |
$173 |
1.0× |
| Functional MRI brain by phys/psych (70555) |
$242.63 |
— |
1.0× |
| Functional MRI brain by tech (70554) |
$242.63 |
— |
1.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$403.35 |
— |
1.0× |
| Gastric mucosa imaging (78261) |
$403.35 |
— |
1.0× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$242.63 |
— |
1.0× |
| Gastrointestinal protein loss Facility (78282) |
$403.35 |
— |
1.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$540.30 |
— |
1.0× |
| Hand 2 views (73120) |
$106.74 |
$286 |
1.0× |
| 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 first pass single,planar (78481) |
$510.40 |
$961 |
0.9× |
| Heart Infarct Image (78466) |
$403.35 |
— |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,159.40 |
— |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,159.40 |
— |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$540.30 |
$1,251 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$403.35 |
$904 |
1.0× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$580.66 |
— |
1.0× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$580.66 |
— |
1.0× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$580.66 |
— |
1.0× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$580.66 |
— |
1.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$696.43 |
— |
1.0× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$263.97 |
— |
0.7× |
| Hysterosalpingogram (74740) |
$212.32 |
$364 |
0.9× |
| Image fusion (77399) |
$133.27 |
— |
0.9× |
| Interstitial radiation source applic complex (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× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$7,673.39 |
— |
1.0× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$7,673.39 |
— |
1.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$106.74 |
— |
1.0× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$403.35 |
— |
1.0× |
| Kidney imaging morphology (78700) |
$403.35 |
$895 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$493.90 |
$895 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$496.15 |
$904 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$540.30 |
— |
1.0× |
| Knee 3 views (73562) |
$88.38 |
$183 |
1.0× |
| Liver & spleen imaging static only (78215) |
$403.35 |
$895 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$403.35 |
$904 |
1.0× |
| Liver imaging static only (78201) |
$540.30 |
$3,461 |
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 ventilation imaging (78579) |
$403.35 |
$895 |
1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,159.40 |
— |
1.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,159.40 |
— |
1.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,559.31 |
— |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$620.60 |
— |
0.9× |
| Lymphoscintigraphy (78195) |
$540.30 |
$1,106 |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$793.05 |
$2,578 |
1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$178.69 |
— |
1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$550.37 |
— |
1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$178.69 |
— |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$358.48 |
$2,578 |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$358.48 |
$1,988.50 |
1.0× |
| Magnetic Resonance Elastography (76391) |
$242.63 |
— |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$242.63 |
— |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$242.63 |
— |
1.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$88.38 |
— |
1.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$532.61 |
— |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$367.45 |
— |
0.9× |
| Mr safety determination physician/other qhp (76016) |
$88.38 |
— |
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 implt pos&/immoblj (76019) |
$59.62 |
— |
1.0× |
| 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/o contrast (70544) |
$242.63 |
$2,931 |
1.0× |
| MRA head with contrast (70545) |
$358.48 |
$3,130 |
1.0× |
| MRA neck w contrast (70548) |
$358.48 |
$3,130 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$358.48 |
$4,568 |
1.0× |
| MRA neck w/o contrast (70547) |
$242.63 |
$2,931 |
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 jt lower extrem w/contrast material (73722) |
$793.05 |
$1,289 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$358.48 |
$2,272 |
1.0× |
| MRI bone marrow blood supply (77084) |
$242.63 |
— |
1.0× |
| MRI breast w/o contrast bilateral (77047) |
$242.63 |
— |
1.0× |
| MRI breast wo contrast unilateral (77046) |
$242.63 |
— |
1.0× |
| MRI c-spine with contrast (72142) |
$358.48 |
$3,118 |
1.0× |
| MRI cardiac w/o cont stress (75559) |
$550.37 |
— |
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 chest w/o & w/contrast material (71552) |
$358.48 |
$881 |
1.0× |
| MRI chest w/o contrast (71550) |
$242.63 |
$2,688 |
1.0× |
| MRI chest with contrast (71551) |
$793.05 |
$1,711 |
1.0× |
| MRI fetal sngl/1st gestation (74712) |
$242.63 |
— |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$358.48 |
$1,988.50 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$358.48 |
$2,203.50 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$242.63 |
$2,422 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$242.63 |
$1,682 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$358.48 |
$1,682 |
1.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$358.48 |
$2,732 |
1.0× |
| MRI pelvis w/contrast (72196) |
$358.48 |
$2,688 |
1.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$358.48 |
$3,472 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$242.63 |
$2,422 |
1.0× |
| MRI spectroscopy (76390) |
$88.38 |
— |
1.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$358.48 |
$3,326 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$358.48 |
$3,118 |
1.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$358.48 |
$3,326 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$358.48 |
$3,118 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$358.48 |
$3,326 |
1.0× |
| MRI temporomandibular joint (70336) |
$242.63 |
$1,570 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$242.63 |
$3,038 |
1.0× |
| MRI up ext w/o contrast (73218) |
$242.63 |
$1,599.50 |
1.0× |
| MRI upper ext joint w/o contrast (73221) |
$242.63 |
$1,947.50 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$358.48 |
$2,272 |
1.0× |
| Musculoskeletal Nuclear Exam (78399) |
$403.35 |
— |
1.0× |
| Myelogram Cervical (72240) |
$718 |
$718 |
0.9× |
| Myelogram Lumbar (72265) |
$750 |
$750 |
0.9× |
| Myelogram thoracic (72255) |
$777.02 |
$1,522 |
0.9× |
| Myelography 2 or more regions (72270) |
$720.28 |
$1,295 |
0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,310.41 |
— |
1.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$540.30 |
— |
1.0× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$1,957.87 |
— |
0.9× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$1,464.10 |
— |
1.0× |
| 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… (78431) |
$2,259.01 |
— |
1.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$1,464.10 |
— |
1.0× |
| Myocardial infarct spect (78469) |
$540.30 |
— |
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 Multiple Studies (78452) |
$1,310.41 |
$3,517 |
1.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,310.41 |
$3,461 |
1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,464.10 |
— |
1.0× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$1,857.49 |
— |
1.2× |
| N-invas est c ffr sw aly CTA (75580) |
$1,021.24 |
— |
1.1× |
| Neck soft tissue (70360) |
$88.38 |
$206 |
1.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$263.97 |
— |
0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$403.35 |
— |
1.0× |
| Nm adrenal scan (78075) |
$1,310.41 |
— |
1.0× |
| Nm bone marrow multi (78103) |
$403.35 |
— |
1.0× |
| Nm bone marrow wb (78104) |
$403.35 |
— |
1.0× |
| Nm cardiac blood pool multiple (78473) |
$403.35 |
— |
1.0× |
| Nm cisternogram (78630) |
$540.30 |
— |
1.0× |
| Nm csf leak detection (78650) |
$1,310.41 |
— |
1.0× |
| Nm gastric emptying study (78264) |
$403.35 |
$1,016 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$403.35 |
— |
1.0× |
| Nm kidney scan w/flow (78701) |
$403.35 |
$895 |
1.0× |
| Nm peritoneal-venous shunt patency (78291) |
$403.35 |
— |
1.0× |
| Nm red cell sequestration (78140) |
$403.35 |
— |
1.0× |
| Noncardiac Vascular Flow Imaging (78445) |
$377.18 |
$702 |
0.9× |
| Nonvascular shunt X-ray (75809) |
$106.74 |
— |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,373.43 |
— |
1.0× |
| Nuclear medicine study of endocrine organs (78099) |
$403.35 |
— |
1.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$403.35 |
— |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$224.98 |
— |
0.9× |
| Ob us nuchal meas 1 gest (76813) |
$106.74 |
— |
1.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$106.74 |
— |
1.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (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 and quantitative A-scan performed during the same patient encounter… (76510) |
$129.39 |
— |
0.9× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$24.58 |
— |
0.8× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$106.74 |
— |
1.0× |
| Orthopantogram (70355) |
$88.38 |
— |
1.0× |
| Osseous survey limited (77074) |
$106.74 |
$739 |
1.0× |
| Parathyrd planar w/spect&CT (78072) |
$540.30 |
— |
1.0× |
| Parathyroid Planar Imaging (78070) |
$341.92 |
$561 |
0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$403.35 |
— |
1.0× |
| Pelvis 1 or 2 views (72170) |
$96.87 |
$174 |
0.9× |
| Perineogram (74775) |
$242.63 |
— |
1.0× |
| Peritoneogram after injection (74190) |
$550.37 |
— |
1.0× |
| PET image w/CT, skull-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 whole body (78813) |
$1,464.10 |
— |
1.0× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,310.41 |
— |
1.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$1,310.41 |
— |
1.0× |
| Platelet survival study Non-Facility (78191) |
$403.35 |
— |
1.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$1,464.10 |
— |
1.0× |
| Proton trmt simple w/comp (77522) |
$1,280.33 |
— |
1.0× |
| Proton tx delivery complex (77525) |
$1,280.33 |
— |
1.0× |
| Proton tx delivery intermediate (77523) |
$1,280.33 |
— |
1.0× |
| Proton tx delivery simple w/o compensation (77520) |
$580.66 |
— |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,159.40 |
— |
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× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$540.30 |
$1,314 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$468.94 |
$775 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$88.38 |
$192.50 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$87.44 |
$173 |
1.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$88.38 |
$173 |
1.0× |
| 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 fingr minimum 2 views (73140) |
$87.44 |
$173 |
1.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$88.38 |
$178 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$87.44 |
$173 |
1.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$88.38 |
$339 |
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 Humerus Minimum 2 Views (73060) |
$88.38 |
$173 |
1.0× |
| Radex Kne 1/2 Views (73560) |
$87.69 |
$174 |
1.0× |
| Radex Kne Compl 4/More Views (73564) |
$106.74 |
$213 |
1.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$106.74 |
$247 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$88.38 |
$235 |
1.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$106.74 |
$240 |
1.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$88.38 |
$173 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$88.38 |
$318 |
1.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$106.74 |
$261 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$88.38 |
$318 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$87.69 |
$174 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$106.74 |
$286 |
1.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$88.38 |
$173 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$106.74 |
— |
1.0× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$7,673.39 |
— |
1.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,673.39 |
— |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$109.91 |
— |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$263.97 |
— |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$263.97 |
— |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$87.69 |
$174 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$106.74 |
$190 |
1.0× |
| Radiologic exam chest 2 views (71046) |
$88.38 |
$247 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$178.69 |
$462 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$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 (73551) |
$87.69 |
$174 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$88.38 |
— |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$88.38 |
$174 |
1.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$550.37 |
— |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$106.74 |
$455 |
1.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$106.74 |
— |
1.0× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$242.63 |
— |
1.0× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$242.63 |
— |
1.0× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$88.38 |
— |
1.0× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$88.38 |
— |
1.0× |
| Radiological examination surgical specimen (76098) |
$483.94 |
$835 |
0.8× |
| Radiopharm Dacryocystography (78660) |
$403.35 |
— |
1.0× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$224.98 |
— |
0.9× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$224.98 |
— |
0.9× |
| Red cell survival study Non-Facility (78130) |
$403.35 |
— |
1.0× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$540.30 |
— |
1.0× |
| Red cell volume determination (separate procedure); single sampling Non-Facility (78120) |
$403.35 |
— |
1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$263.97 |
— |
0.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$263.97 |
— |
0.7× |
| Renal Cyst Study (74470) |
$550.37 |
— |
1.0× |
| Ribs bilateral 3 views (71110) |
$106.74 |
— |
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 1d img/1 ar img>2+d (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× |
| Rp Therapy Intravenous Administration (79101) |
$224.98 |
— |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$106.74 |
— |
1.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$240.06 |
$475 |
1.0× |
| Salivary gland function study (78232) |
$403.35 |
— |
1.0× |
| Salivary gland imaging (78230) |
$403.35 |
— |
1.0× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$403.35 |
— |
1.0× |
| Scapula (73010) |
$100.87 |
$181.50 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$51.51 |
$75 |
2.2× |
| Sella turcica (70240) |
$88.38 |
$252 |
1.0× |
| Shoulder 1 view (73020) |
$88.38 |
— |
1.0× |
| Sialogram (70390) |
$211.56 |
$361 |
0.8× |
| Simulation intermediate (77285) |
$367.45 |
— |
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× |
| Spine thoracic 3 views (72072) |
$106.74 |
— |
1.0× |
| Spleen imaging only (78185) |
$403.35 |
$904 |
1.0× |
| Splenoportograpy rs&i (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 Applic Low Dose Rate Radionuclide Source (77789) |
$109.91 |
— |
1.0× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$88.38 |
— |
1.0× |
| Tbs technical calculation only (77091) |
$88.38 |
— |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$367.45 |
— |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$367.45 |
— |
0.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$242.63 |
— |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$403.35 |
$842 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$367.45 |
— |
0.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$133.27 |
— |
0.9× |
| Thoracolumbar 2 views (72080) |
$88.38 |
— |
1.0× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$403.35 |
— |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$403.35 |
— |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$540.30 |
— |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$355.92 |
$617 |
0.9× |
| Thyroid uptake measurement (78012) |
$403.35 |
$831 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$403.35 |
$929 |
1.0× |
| Tmj unilateral (70328) |
$88.38 |
— |
1.0× |
| Tomogram (76100) |
$106.74 |
$326 |
1.0× |
| Treatment device complex (77334) |
$367.45 |
— |
0.9× |
| Treatment device intermediate (77333) |
$133.27 |
— |
0.9× |
| Treatment devices simple (77332) |
$133.27 |
— |
0.9× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
$106.74 |
— |
1.0× |
| Ultrasound breast complete (76641) |
$106.74 |
$293.50 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$106.74 |
— |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$106.74 |
$375 |
1.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$178.69 |
— |
0.5× |
| Ultrasound, abdomen limited (76705) |
$106.74 |
$411 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$106.74 |
$375 |
1.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$88.38 |
$194 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$88.38 |
— |
1.0× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$403.35 |
— |
1.0× |
| Unlisted genitourinary px dx nuclear medicine (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 px dx nuclear medicine (78999) |
$403.35 |
— |
1.0× |
| Unlisted ns dx nm (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 px dx nuclear medicine (78599) |
$403.35 |
— |
1.0× |
| Unlisted ultrasound procedure (76999) |
$88.38 |
$400 |
1.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$11.06 |
— |
1.0× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$94.41 |
— |
1.0× |
| Ureteral reflux study (78740) |
$403.35 |
— |
1.0× |
| Urethrocystogram voiding (74455) |
$242.63 |
$604 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$242.63 |
$492 |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$178.69 |
— |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$178.69 |
— |
1.0× |
| Us breast unilateral limited (76642) |
$88.38 |
$256 |
1.0× |
| Us chest (76604) |
$106.74 |
$400 |
1.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$312.58 |
— |
1.4× |
| 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 hips infant static (76886) |
$88.38 |
— |
1.0× |
| Us infant hips w manipulation (76885) |
$88.38 |
$1,155 |
1.0× |
| Us lmtd joint/oth 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 limited (76815) |
$105.37 |
$208 |
1.0× |
| Us ob transvaginal (76817) |
$100.62 |
$189 |
0.9× |
| Us pelvic non ob complete (76856) |
$106.74 |
$545 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$106.74 |
$375 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$106.74 |
$231 |
1.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$106.74 |
$275 |
1.0× |
| Us retroperitoneal complete (76770) |
$106.74 |
$261 |
1.0× |
| Us retroperitoneal limited (76775) |
$106.74 |
$537 |
1.0× |
| Us scrotum and contents (76870) |
$106.74 |
$416 |
1.0× |
| Us soft tissue head/neck (76536) |
$106.74 |
$411 |
1.0× |
| Us spinal canal and contents (76800) |
$106.74 |
$313 |
1.0× |
| Us transrectal (76872) |
$106.74 |
$345 |
1.0× |
| Us transrectal prostate volume (76873) |
$106.74 |
— |
1.0× |
| Us, eye b-scan (76512) |
$106.74 |
— |
1.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$106.74 |
$261 |
1.0× |
| Vasogram (74440) |
$242.63 |
— |
1.0× |
| Venogram adrenal unilat (75840) |
$3,159.40 |
— |
1.0× |
| Venogram extremity bilateral (75822) |
$748 |
$748 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$1,292.16 |
$2,050 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,159.40 |
— |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,559.31 |
— |
0.9× |
| Venography Orbital Rs&I (75880) |
$620.60 |
— |
0.9× |
| Venography Renal Bilateral (75833) |
$3,159.40 |
— |
1.0× |
| 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, epidural, radiological supervision and interpretation Non-Facility (75872) |
$620.60 |
— |
0.9× |
| Venous sampling by catheter (75893) |
$5,426.13 |
— |
0.9× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (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× |
| Wrist 2 views (73100) |
$88.38 |
$173 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$106.74 |
$490 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$87.69 |
$174 |
1.0× |
| X-ray b.e. reductn intuss (74283) |
$178.69 |
$561 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$178.69 |
$689 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$88.38 |
$173 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$88.38 |
$211 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$106.74 |
— |
1.0× |
| X-ray exam of femur 2/> (73552) |
$88.38 |
$173 |
1.0× |
| X-ray eye for foreign body (70030) |
$87.44 |
$173 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$88.38 |
$348 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$178.69 |
$534 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$88.38 |
— |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$88.38 |
— |
1.0× |
| X-ray leg, infant (73592) |
$87.69 |
$174 |
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 nose-rectum child f.b. (76010) |
$81.94 |
$151 |
0.9× |
| X-ray optic foramen (70190) |
$88.38 |
$348 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$106.74 |
$348 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$320.49 |
$565 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$88.38 |
$242 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$106.74 |
$318 |
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 Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$88.38 |
$268 |
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 Small Bowel Enteroclysis (74251) |
$178.69 |
— |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$84.94 |
$163 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$88.38 |
$190 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$88.38 |
$318 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$106.74 |
$298 |
1.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$106.74 |
$334 |
1.0× |
| Xr bone length studies (77073) |
$106.74 |
$243.50 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$106.74 |
$378 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$106.74 |
$414 |
1.0× |
| Xr chest 4+ views (71048) |
$106.74 |
$235 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$358.48 |
— |
1.0× |
| Xr urogram antegrade (74425) |
$358.48 |
— |
1.0× |