| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$9,493 |
— |
| Abdomen 1 View (74018) |
— |
$563 |
— |
| Abdomen 2 views (74019) |
— |
$673 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$2,219 |
— |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
— |
$1,640 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$2,622 |
— |
| Angio internal mammary (75756) |
— |
$6,406 |
— |
| Angio pulmonary bilat (75743) |
— |
$6,664 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$7,013 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$6,785 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$5,274 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$4,443 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,490 |
— |
Ankle 2 views (73600)
range across 7 matching MRF lines |
— |
$520–$780 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$11,053 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$6,197 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$6,036 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$4,675 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$11,053 |
— |
| Artery X-Rays Spine (75705) |
— |
$11,053 |
— |
Arthrogram ankle (73615)
range across 3 matching MRF lines |
— |
$650–$975 |
— |
Arthrogram hip (73525)
range across 3 matching MRF lines |
— |
$779–$1,168 |
— |
Arthrogram Wrist (73115)
range across 3 matching MRF lines |
— |
$984–$1,477 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$930 |
— |
| Bone age studies (77072) |
— |
$404 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$3,011 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,582 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$1,819 |
— |
| Bone Imaging Whole Body (78306) |
— |
$2,744 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,029 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$1,286 |
— |
| Bone survey infant (77076) |
— |
$362 |
— |
| Brachytx isodose complex (77318) |
— |
$2,361 |
— |
| Brachytx isodose intermed (77317) |
— |
$2,094 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$1,343 |
— |
| Brain Flow Imaging Only (78610) |
— |
$1,823 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$2,924 |
— |
| Brain Imaging Minimum 4 Static Views (78605) |
— |
$1,640 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$8,841 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$4,808 |
— |
| Cardiac MRI w/w/o contrast w/stress (75563) |
— |
$5,058 |
— |
| Cardiac Shunt Detection (78428) |
— |
$812 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,557 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,714 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$2,532 |
— |
| Chest 1 view (71045) |
— |
$511 |
— |
| Chest 2 views (71046) |
— |
$563 |
— |
| Chest 3 views (71047) |
— |
$588 |
— |
| Chest 4 or more views (71048) |
— |
$681 |
— |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
— |
$422 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$1,431 |
— |
Clavicle complete (73000)
range across 3 matching MRF lines |
— |
$592–$888 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$386 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$998 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$4,410 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,083 |
— |
Contrast X-Ray Of Elbow (73085)
range across 3 matching MRF lines |
— |
$650–$975 |
— |
Contrast X-Ray Of Knee Joint (73580)
range across 3 matching MRF lines |
— |
$763–$1,144 |
— |
| Corpora cavernosography (74445) |
— |
$514 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,707 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,629 |
— |
| CT abdomen w contrast (74160) |
— |
$3,122 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,680 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,543 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$4,049 |
— |
| CT Angio Chest (71275) |
— |
$3,215 |
— |
| CT Angio Head (70496) |
— |
$3,052 |
— |
| CT angio hrt w/3d image (75574) |
— |
$5,075 |
— |
Ct Angio Lwr Extr W/O&W/Dye (73706)
range across 2 matching MRF lines |
— |
$1,960–$2,940 |
— |
| CT Angio Neck (70498) |
— |
$3,028 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,075 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$3,018 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,671 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,320 |
— |
| CT chest w contrast (71260) |
— |
$3,068 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,386 |
— |
| CT colonography screening (74263) |
— |
$2,013 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$1,925 |
— |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
— |
$2,106 |
— |
| CT head/brain with contrast (70460) |
— |
$2,683 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,532 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,792 |
— |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
— |
$257.58–$522 |
— |
| CT hrt w/3d image congen (75573) |
— |
$3,792 |
— |
| CT iac w contrast (70481) |
— |
$2,891 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,307 |
— |
CT lower ext w/o (73700)
range across 4 matching MRF lines |
— |
$2,209–$3,314 |
— |
CT lower extremity w/contrast material (73701)
range across 3 matching MRF lines |
— |
$2,470–$3,705 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,234 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,785 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,763 |
— |
CT maxillofacial wo contrast (70486)
range across 7 matching MRF lines |
— |
$2,196–$2,312 |
— |
| CT neck tissue combo (70492) |
— |
$3,120 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,129 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,155 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,710 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,395 |
— |
CT scan of leg combo (73702)
range across 3 matching MRF lines |
— |
$2,757–$4,136 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,510 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,011 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,556 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,853 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,599 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,319 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,435 |
— |
CT upper ext wo (73200)
range across 3 matching MRF lines |
— |
$2,455–$3,683 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 3 matching MRF lines |
— |
$2,813–$4,219 |
— |
CT upper extremity with contrast (73201)
range across 3 matching MRF lines |
— |
$2,669–$4,004 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,990 |
— |
| Cta Abdomen (74175) |
— |
$2,444 |
— |
| CTA pelvis (72191) |
— |
$2,601 |
— |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
— |
$605 |
— |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
— |
$1,640 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$3,989 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$2,599 |
— |
| Diskography lumbar (72295) |
— |
$2,137 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$725 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$1,005 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$496 |
— |
| Dxa Bone Density Axial (77080) |
— |
$794 |
— |
| Dxa bone density study (77085) |
— |
$347 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$365 |
— |
| Echo exam of fetal heart (76825) |
— |
$1,409 |
— |
| Echo exam uterus (76831) |
— |
$1,329 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,843 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$1,005 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,019 |
— |
| Esophagram (74220) |
— |
$834 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$1,020 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$799 |
— |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
— |
$627 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,048 |
— |
| Follow-Up Angiography (75898) |
— |
$6,406 |
— |
Foot 2 views (73620)
range across 13 matching MRF lines |
— |
$438–$657 |
— |
Forearm 2 views (73090)
range across 3 matching MRF lines |
— |
$622–$932 |
— |
| Gastric emptying imaging study (78264) |
— |
$3,067 |
— |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
— |
$1,047 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$1,640 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,898 |
— |
| Gated Heart, Multiple (78473) |
— |
$3,148 |
— |
| GI Endoscopic US S&I (76975) |
— |
$1,411 |
— |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
— |
$1,389 |
— |
Hand 2 views (73120)
range across 3 matching MRF lines |
— |
$493–$740 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$5,847 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$5,209 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$5,209 |
— |
| Heart Image (Pet) Multiple (78492) |
— |
$4,630 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$4,056 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$3,979 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$2,342 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$2,121 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$4,892 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$3,989 |
— |
| Hyperthermia external generated superficial (77600) |
— |
$1,500 |
— |
| Hysterosalpingogram (74740) |
— |
$1,291 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$653 |
— |
| Infant hip ultrasound, limited static exam (76886) |
— |
$605 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$5,939 |
— |
| Intracavitary Radiation Source Applic Complex (77763) |
— |
$5,511 |
— |
| Intracavitary Radiation Source Applic Intermed (77762) |
— |
$2,123 |
— |
| Intracavitary radiation source applic simple (77761) |
— |
$1,326 |
— |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
— |
$11,300 |
— |
| Intraop radiaj tx deliver xray single tx session (77424) |
— |
$11,300 |
— |
| Joint Survey Single View (77077) |
— |
$330 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$3,562 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,375 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,270 |
— |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
— |
$1,393 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$1,626 |
— |
Knee 3 Views (73562)
range across 10 matching MRF lines |
— |
$542–$813 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$1,885 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$812 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$1,640 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$2,181 |
— |
| Lung perfusion differential (78597) |
— |
$1,578 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,287 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,393 |
— |
| Lymph System Imaging (78195) |
— |
$2,601 |
— |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
— |
$1,871 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$1,247 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$6,406 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$6,406 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$3,770 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$963 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$587 |
— |
| Meckels Divert Exam (78290) |
— |
$1,898 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$1,677 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$177 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$74 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$119 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$484 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,502 |
— |
| MRA head w/o contrast (70544) |
— |
$3,450 |
— |
| MRA head with contrast (70545) |
— |
$3,737 |
— |
| MRA neck w contrast (70548) |
— |
$3,272 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,358 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,043 |
— |
| MRI abdomen w contrast (74182) |
— |
$4,222 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$3,893 |
— |
MRI any jt lower extrem w/contrast material (73722)
range across 3 matching MRF lines |
— |
$4,566–$6,849 |
— |
MRI any jt lower extrem w/o & w/contrast matrl (73723)
range across 3 matching MRF lines |
— |
$5,031–$7,547 |
— |
MRI any jt upper extremity w/contrast matrl (73222)
range across 3 matching MRF lines |
— |
$5,469–$8,204 |
— |
| MRI bone marrow blood supply (77084) |
— |
$2,602 |
— |
| MRI brain functional w/o physician admnistration (70554) |
— |
$3,466 |
— |
| MRI brain functional w/physician admnistration (70555) |
— |
$3,812 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$4,374 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$2,945 |
— |
| MRI cardiac w/o cont stress (75559) |
— |
$4,696 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$4,674 |
— |
| MRI cervical spine w contrast (72142) |
— |
$4,729 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,971 |
— |
| MRI chest w/o contrast (71550) |
— |
$3,119 |
— |
| MRI chest with contrast (71551) |
— |
$3,715 |
— |
| MRI chest wo w contrast (71552) |
— |
$4,345 |
— |
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 4 matching MRF lines |
— |
$4,033–$6,050 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 3 matching MRF lines |
— |
$4,432–$6,648 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 3 matching MRF lines |
— |
$3,767–$5,651 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$4,903 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$5,231 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$3,241 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,578 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,907 |
— |
| MRI pelvis w contrast (72196) |
— |
$4,129 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$5,434 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,722 |
— |
| MRI spectroscopy (76390) |
— |
$2,082 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,916 |
— |
MRI upper extremity oth than jt w/contr matrl (73219)
range across 3 matching MRF lines |
— |
$4,080–$6,121 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 4 matching MRF lines |
— |
$3,654–$5,481 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines |
— |
$4,469–$6,704 |
— |
| MRI, abdomen, combo (74183) |
— |
$5,517 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,324 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$4,748 |
— |
MRI, joint upper extrem (73221)
range across 3 matching MRF lines |
— |
$4,113–$6,170 |
— |
MRI, joint upper extrem combo (73223)
range across 3 matching MRF lines |
— |
$5,622–$8,433 |
— |
| MRI, lumbar spine combo (72158) |
— |
$5,274 |
— |
| Myelogram cervical (72240) |
— |
$2,053 |
— |
| Myelogram Lumbar (72265) |
— |
$1,808 |
— |
| Myelography thoracic (72255) |
— |
$1,893 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$2,402 |
— |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
— |
$1,640 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$5,220 |
— |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
— |
$3,366 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$6,649 |
— |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
— |
$3,228 |
— |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
— |
$18,225 |
— |
| N-invas est c ffr sw aly CTA (75580) |
— |
$2,753 |
— |
| Neck soft tissue (70360) |
— |
$589 |
— |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
— |
$1,528 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$603 |
— |
| Nm csf leak detection (78650) |
— |
$1,640 |
— |
| Nm myocard infarct spect (78469) |
— |
$2,595 |
— |
| Nm red cell survival study (78130) |
— |
$1,640 |
— |
| Nm whole blood volume (78122) |
— |
$1,640 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$9,078 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$1,655 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,655 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$605 |
— |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
— |
$747 |
— |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
— |
$812 |
— |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
— |
$695 |
— |
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 3 matching MRF lines |
— |
$614–$921 |
— |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
— |
$65 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$596 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$549 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$4,251 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$2,204 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$2,454 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$603 |
— |
| Perineogram (74775) |
— |
$828 |
— |
| Peritoneogram Rs&I (74190) |
— |
$1,592 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$7,793 |
— |
| PET image w/CT, full body (78816) |
— |
$11,048 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$11,610 |
— |
Pet Imaging Limited Area Chest Head/Neck (78811)
range across 2 matching MRF lines |
— |
$8,198–$9,020 |
— |
| Pet Myocardial Sngl Study (78491) |
— |
$3,568 |
— |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
— |
$1,640 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$4,808 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,443 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$905 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,290 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 16 matching MRF lines |
— |
$582–$873 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 7 matching MRF lines |
— |
$574–$862 |
— |
Radex elbow complete minimum 3 views (73080)
range across 10 matching MRF lines |
— |
$622–$932 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$671 |
— |
Radex fingr minimum 2 views (73140)
range across 19 matching MRF lines |
— |
$358–$537 |
— |
Radex foot complete minimum 3 views (73630)
range across 13 matching MRF lines |
— |
$647–$971 |
— |
Radex Hand Minimum 3 Views (73130)
range across 3 matching MRF lines |
— |
$574–$861 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 3 matching MRF lines |
— |
$616–$925 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$599 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$640 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$612 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 13 matching MRF lines |
— |
$733–$1,101 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$455 |
— |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
— |
$609 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$542 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$491 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$758 |
— |
Radex Toe Minimum 2 Views (73660)
range across 14 matching MRF lines |
— |
$373–$560 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 3 matching MRF lines |
— |
$310–$466 |
— |
Radex Wrist Complete Minimum 3 Views (73110)
range across 13 matching MRF lines |
— |
$635–$953 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$963 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$23,678 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$938 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$1,018 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,336 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$654 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$714 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,574 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,336 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$422 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 10 matching MRF lines |
— |
$799–$1,199 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$844 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,022 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$872 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,221 |
— |
Radiologic examination femur 1 view (73551)
range across 9 matching MRF lines |
— |
$318–$479 |
— |
Radiologic examination femur minimum 2 views (73552)
range across 10 matching MRF lines |
— |
$384–$576 |
— |
Radiologic examination knee 1/2 views (73560)
range across 13 matching MRF lines |
— |
$442–$663 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$711 |
— |
| Radiologic Examination Salivary Gland Calculus (70380) |
— |
$144 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 3 matching MRF lines |
— |
$645–$968 |
— |
| Radiopharm Dacryocystography (78660) |
— |
$1,640 |
— |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
— |
$1,655 |
— |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
— |
$1,821 |
— |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
— |
$1,640 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
— |
$585 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
— |
$509 |
— |
| Renal Cyst Study (74470) |
— |
$1,225 |
— |
| Ribs bilateral 3 views (71110) |
— |
$800 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,431 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$1,942 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$3,640 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$3,578 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$3,483 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$3,557 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$4,034 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$3,557 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$2,013 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$1,655 |
— |
| Salivary Gland Imaging Serial Images (78231) |
— |
$1,640 |
— |
Scapula (73010)
range across 3 matching MRF lines |
— |
$663–$995 |
— |
Screening Digital Breast Tomosynthesis Bi (77063)
range across 2 matching MRF lines |
— |
$197–$296 |
— |
| Sella turcica (70240) |
— |
$144 |
— |
Shoulder 1 view (73020)
range across 3 matching MRF lines |
— |
$343–$515 |
— |
Shoulder Arthrography (73040)
range across 3 matching MRF lines |
— |
$1,262–$1,893 |
— |
| Sialogram (70390) |
— |
$1,223 |
— |
| Skull less than 4 views (70250) |
— |
$548 |
— |
| Special dosimetry (77331) |
— |
$1,236 |
— |
| Special Physics Consult (77370) |
— |
$1,192 |
— |
| Special teletherapy port plan (77321) |
— |
$1,523 |
— |
| Special treatment procedure (77470) |
— |
$2,886 |
— |
| Spleen Imaging (78185) |
— |
$1,640 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$9,337 |
— |
| Sternoclavicular joints (71130) |
— |
$493 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$6,406 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$608 |
— |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
— |
$187 |
— |
| Tbs technical calculation only (77091) |
— |
$187 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$2,327 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$1,326 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$1,393 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$3,021 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$2,156 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$1,554 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$904 |
— |
| Thoracic spine 2 views (72070) |
— |
$655 |
— |
| Thoracic spine 3 views (72072) |
— |
$868 |
— |
| Thoracolumbar 2 views (72080) |
— |
$525 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,640 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$2,885 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$805 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,099 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$1,738 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$1,165 |
— |
| Tx devices design & construction simple (77332) |
— |
$1,073 |
— |
Ultrasound Breast Limited (76642)
range across 8 matching MRF lines |
— |
$639–$959 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$483 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$483 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$703 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$662 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,259 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$725 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$144 |
— |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
— |
$2,432–$4,139 |
— |
| Upper gi w/o kub (74240) |
— |
$1,168 |
— |
| Ureteral Reflux Study (78740) |
— |
$1,393 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,022 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,020 |
— |
Us breast unilateral complete (76641)
range across 5 matching MRF lines |
— |
$682–$1,023 |
— |
| Us chest (76604) |
— |
$662 |
— |
Us complete joint (76881)
range across 6 matching MRF lines |
— |
$1,269–$1,904 |
— |
| Us exam, pelvic, limited (76857) |
— |
$823 |
— |
| Us head (76506) |
— |
$695 |
— |
| Us kidney transplant (76776) |
— |
$1,343 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 9 matching MRF lines |
— |
$696–$1,043 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,261 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$619 |
— |
| Us ob transvaginal (76817) |
— |
$643 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,655 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$670 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$697 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,252 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,158 |
— |
| Us scrotum and contents (76870) |
— |
$1,228 |
— |
| Us spinal canal and contents (76800) |
— |
$556 |
— |
| Us thyroid (76536) |
— |
$1,471 |
— |
| Us transrectal (76872) |
— |
$1,372 |
— |
| Vascular Flow Imaging (78445) |
— |
$1,640 |
— |
| Vein X-Ray Chest (75827) |
— |
$3,141 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$4,724 |
— |
| Vein X-Ray Skull Epidural (75872) |
— |
$2,951 |
— |
| Vein X-Ray Spleen/Liver (75810) |
— |
$5,548 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$3,393 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$4,810 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$4,339 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$2,510 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,075 |
— |
| Venography Orbital Rs&I (75880) |
— |
$1,430 |
— |
| Venography Renal Bilateral (75833) |
— |
$5,390 |
— |
| Venography Renal Unilateral (75831) |
— |
$6,406 |
— |
| Venous sampling by catheter (75893) |
— |
$11,053 |
— |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
— |
$1,640 |
— |
Wrist 2 views (73100)
range across 7 matching MRF lines |
— |
$479–$719 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$615 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,324 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$5,119 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$682 |
— |
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070)
range across 3 matching MRF lines |
— |
$412–$618 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$730 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$352 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$608 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$875 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$360 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$385 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$459 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$500 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$596 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$875 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,044 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$621 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,155 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$783 |
— |
| X-ray eye for foreign body (70030) |
— |
$191 |
— |
X-ray humerus (73060)
range across 7 matching MRF lines |
— |
$621–$931 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,108 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$1,710 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$236 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$495 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$700 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$165 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$1,256 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$788 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$695 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$749 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,026 |
— |
| X-Ray Stress View (77071) |
— |
$306 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$912 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,136 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$639 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$1,460 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$979 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$447 |
— |
| Xr orbits complete 4 views (70200) |
— |
$716 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$1,094 |
— |