| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,505 |
$7,129.87 |
1.0× |
| Abdomen 1 View (74018) |
$94 |
$458.82 |
1.0× |
| Abdomen 2 views (74019) |
$113 |
$554.13 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$434 |
$2,093.90 |
1.0× |
| Angio internal mammary (75756) |
$3,434 |
$3,280.26 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,434 |
$8,833.28 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,434 |
$16,401.30 |
1.0× |
Angiography extremity unilateral rs&i (75710)
range across 2 matching MRF lines |
$3,434 |
$14,894.90–$16,401.30 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,434 |
$8,162.30 |
1.0× |
| Ankle 2 views (73600) |
$94 |
$458.82 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$6,052 |
$7,932.03 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$6,052 |
$28,168.60 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$6,052 |
$28,168.60 |
1.0× |
| Artery X-Rays Spine (75705) |
$6,052 |
$8,531.49 |
1.0× |
| Arthrogram ankle (73615) |
$379 |
$1,763.36 |
1.0× |
| Arthrogram hip (73525) |
$379 |
$1,975.59 |
1.0× |
| Arthrogram Wrist (73115) |
$379 |
$1,632.44 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$146 |
$830.22 |
1.0× |
| Bone age studies (77072) |
$113 |
$545.25 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$434 |
$2,026.01 |
1.0× |
| Bone Imaging Limited Area (78300) |
$434 |
$777.65 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$434 |
$2,026.01 |
1.0× |
| Bone Imaging Whole Body (78306) |
$434 |
$2,093.90 |
1.0× |
| Bone survey infant (77076) |
$113 |
$579.43 |
1.0× |
| Brachytx isodose complex (77318) |
$407 |
$1,899.32 |
1.0× |
| Brachytx isodose intermed (77317) |
$407 |
$1,994.08 |
1.0× |
| Brachytx Isodose Plan Simple (77316) |
$407 |
$1,657.37 |
1.0× |
| Brain Flow Imaging Only (78610) |
$590 |
$2,574.95 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$434 |
$1,632.55 |
1.0× |
| Brain imaging < 4 static views (78600) |
$434 |
$1,632.55 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$590 |
$2,273.21 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,555 |
$10,410.20 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$379 |
$2,099.14 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$94 |
$475.86 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$590 |
$1,879.75 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$590 |
$1,633.89 |
1.0× |
| Chest 1 view (71045) |
$94 |
$458.82 |
1.0× |
| Chest 2 views (71046) |
$94 |
$458.82 |
1.0× |
| Chest 3 views (71047) |
$94 |
$458.82 |
1.0× |
| Chest 4 or more views (71048) |
$113 |
$845.63 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$190 |
$742.63 |
1.0× |
| Clavicle complete (73000) |
$94 |
$458.82 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$113 |
$608.73 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$146 |
$691.85 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,434 |
$16,401.30 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$379 |
$1,860.97 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$379 |
$1,583.11 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$379 |
$1,856.51 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$379 |
$4,151.93 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$259 |
$2,561 |
1.0× |
| CT abdomen w contrast (74160) |
$190 |
$2,957.13 |
1.0× |
| CT abdomen w wo contrast (74170) |
$190 |
$3,231.11 |
1.0× |
| CT abdomen w/o contrast (74150) |
$113 |
$2,240.25 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$379 |
$3,212.38 |
1.0× |
| CT Angio Chest (71275) |
$190 |
$4,830.70 |
1.0× |
| CT Angio Head (70496) |
$190 |
$1,306.04 |
1.0× |
| CT angio hrt w/3d image (75574) |
$379 |
$2,237.16 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$190 |
$1,889.02 |
1.0× |
| CT Angio Neck (70498) |
$190 |
$1,306.04 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$190 |
$1,306.04 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$379 |
$4,151.93 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$113 |
$2,637.83 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$190 |
$3,077.64 |
1.0× |
| CT chest w contrast (71260) |
$190 |
$2,870.61 |
1.0× |
| CT chest w/wo contrast (71270) |
$190 |
$3,224.93 |
1.0× |
| CT head/brain with contrast (70460) |
$190 |
$2,448.31 |
1.0× |
| CT head/brain without and with contrast (70470) |
$190 |
$3,104.42 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$379 |
$1,860.97 |
1.0× |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$94 |
$458.82–$1,170.08 |
1.0× |
| CT iac w contrast (70481) |
$190 |
$2,331.92 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$190 |
$3,077.64 |
1.0× |
| CT lower ext w/o (73700) |
$113 |
$1,889.02 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$190 |
$1,748.94 |
1.0× |
| CT lumbar spine w contrast (72132) |
$379 |
$4,284.80 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$113 |
$2,563.67 |
1.0× |
| CT maxillofacial w contrast (70487) |
$190 |
$2,331.92 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$113 |
$2,614.14 |
1.0× |
| CT neck tissue combo (70492) |
$190 |
$3,663.71 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$190 |
$2,718.17 |
1.0× |
| CT orbits w/o contrast (70480) |
$113 |
$1,945.67 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$190 |
$3,077.64 |
1.0× |
| CT pelvis w/o contrast (72192) |
$113 |
$2,148.58 |
1.0× |
| CT scan of leg combo (73702) |
$190 |
$3,989.19 |
1.0× |
| CT scans face/jaw combo (70488) |
$190 |
$972.52 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$190 |
$2,448.31 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$113 |
$1,804.56 |
1.0× |
| CT thoracic spine w contrast (72129) |
$190 |
$1,926.10 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$113 |
$3,197.12 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$190 |
$3,077.64 |
1.0× |
| CT thorax w/o contrast (71250) |
$113 |
$2,255.70 |
1.0× |
| CT unlisted procedure (76497) |
$94 |
$633.45 |
1.0× |
| CT upper ext wo (73200) |
$113 |
$1,885.93 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$190 |
$3,989.19 |
1.0× |
| CT upper extremity with contrast (73201) |
$379 |
$2,331.92 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$190 |
$1,474.96 |
1.0× |
| Cta Abdomen (74175) |
$190 |
$4,601.01 |
1.0× |
| CTA pelvis (72191) |
$190 |
$1,306.04 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,273 |
$3,316.70 |
1.0× |
| Discography Cerv/Thor Spine (72285) |
$2,124 |
$6,201.63 |
1.0× |
| Diskography lumbar (72295) |
$2,124 |
$4,443.42 |
1.0× |
| Dxa Bone Density Axial (77080) |
$113 |
$579.43 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$94 |
$320.85 |
1.0× |
| Echo exam uterus (76831) |
$259 |
$1,689.20 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$234 |
$1,182.44 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$113 |
$472.77 |
1.0× |
| Esophagram (74220) |
$190 |
$986.74 |
1.0× |
| Fetal Biophys Profile W/Nst (76818) |
$113 |
$565.47 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$113 |
$818.85 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$259 |
$1,259.58 |
1.0× |
| Follow-Up Angiography (75898) |
$3,434 |
$3,280.26 |
1.0× |
| Foot 2 views (73620) |
$94 |
$458.82 |
1.0× |
| Forearm 2 views (73090) |
$94 |
$458.82 |
1.0× |
| Gastric emptying imaging study (78264) |
$434 |
$2,093.90 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$434 |
$3,126.05 |
1.0× |
| Gated Heart Planar Single (78472) |
$434 |
$2,779.97 |
1.0× |
| Hand 2 views (73120) |
$113 |
$579.43 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$757 |
$6,274.60 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$757 |
$5,647.49 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$757 |
$3,764.65 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,434 |
$7,663.20 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,434 |
$3,978.89 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$590 |
$2,804.87 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$434 |
$2,093.90 |
1.0× |
| Ht Musc Image Planar Mult (78454) |
$1,408 |
$4,130.30 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,408 |
$2,082.25 |
1.0× |
| Hysterosalpingogram (74740) |
$259 |
$1,330.76 |
1.0× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$94 |
$779.71 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$94 |
$173.66 |
1.0× |
| Infusion Ivp (74410) |
$190 |
$1,186.56 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$757 |
$6,853.62 |
1.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$757 |
$2,005.41 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$601 |
$2,005.41 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$601 |
$2,005.41 |
1.0× |
| Joint Survey Single View (77077) |
$113 |
$475.89 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$590 |
$2,804.87 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$590 |
$2,695.51 |
1.0× |
| Kidney Imaging Morphol (78700) |
$434 |
$885.80 |
1.0× |
| Knee 3 Views (73562) |
$94 |
$628.66 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$434 |
$921.85 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$434 |
$2,507.02 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$434 |
$2,113.56 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$590 |
$1,063.99 |
1.0× |
| Lung perfusion differential (78597) |
$434 |
$1,330.76 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$590 |
$2,804.87 |
1.0× |
| Lung Ventilation Imaging (78579) |
$434 |
$1,330.76 |
1.0× |
| Lymph System Imaging (78195) |
$590 |
$1,848.85 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$259 |
$3,922.24 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$259 |
$431.57 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$259 |
$630.36 |
1.0× |
| Meckels Divert Exam (78290) |
$434 |
$1,911.68 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$407 |
$2,666.67 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$379 |
$2,524.53 |
1.0× |
| MRA head w/o contrast (70544) |
$259 |
$3,922.24 |
1.0× |
| MRA head with contrast (70545) |
$379 |
$3,922.24 |
1.0× |
| MRA neck w contrast (70548) |
$379 |
$4,327.03 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$379 |
$2,547.19 |
1.0× |
| MRA neck w/o contrast (70547) |
$259 |
$3,922.24 |
1.0× |
| MRI abdomen w contrast (74182) |
$379 |
$3,480.37 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$259 |
$2,851.04 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$852 |
$4,623.67 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$379 |
$8,977.48 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$852 |
$4,854.39 |
1.0× |
| MRI bone marrow blood supply (77084) |
$259 |
$4,522.73 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$259 |
$2,802.73 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$259 |
$2,802.73 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$259 |
$1,348.27 |
1.0× |
| MRI cervical spine w contrast (72142) |
$379 |
$4,706.07 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$259 |
$4,117.94 |
1.0× |
| MRI chest w/o contrast (71550) |
$259 |
$3,872.80 |
1.0× |
| MRI chest with contrast (71551) |
$852 |
$5,958.55 |
1.0× |
| MRI chest wo w contrast (71552) |
$379 |
$8,494.41 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$379 |
$1,829.28 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$379 |
$5,360.68 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$259 |
$1,507.92 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$379 |
$3,529.81 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$379 |
$7,390.25 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$259 |
$5,349.82 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$379 |
$4,923.40 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$379 |
$8,550.03 |
1.0× |
| MRI pelvis w contrast (72196) |
$379 |
$2,422.56 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$379 |
$5,560.97 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$259 |
$3,297.03 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$259 |
$4,569.08 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$379 |
$5,958.55 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$259 |
$4,044.81 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$379 |
$6,412.78 |
1.0× |
| MRI, abdomen, combo (74183) |
$379 |
$9,006.32 |
1.0× |
| MRI, dorsal spine combo (72157) |
$379 |
$7,650.84 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$379 |
$3,529.81 |
1.0× |
| MRI, joint upper extrem (73221) |
$259 |
$4,044.81 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$379 |
$6,412.78 |
1.0× |
| MRI, lumbar spine combo (72158) |
$379 |
$7,555.05 |
1.0× |
| Myelogram cervical (72240) |
$852 |
$1,454.36 |
1.0× |
| Myelogram Lumbar (72265) |
$852 |
$1,577.96 |
1.0× |
| Myelography thoracic (72255) |
$852 |
$1,184.50 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$852 |
$1,944.64 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$434 |
$2,206.26 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,408 |
$1,616.07 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,408 |
$8,163.27 |
1.0× |
| Neck soft tissue (70360) |
$94 |
$458.82 |
1.0× |
| Nm csf leak detection (78650) |
$1,408 |
$2,337.07 |
1.0× |
| Nm myocard infarct spect (78469) |
$590 |
$798.46 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$113 |
$2,145.49 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,505 |
$7,129.87 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$253 |
$1,694.35 |
1.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$113 |
$796.04 |
1.0× |
| Optic foramina (70190) |
$94 |
$368.74 |
1.0× |
| Panoramic X-ray of jaws (70355) |
$94 |
$458.82 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$434 |
$2,093.90 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$113 |
$579.43 |
1.0× |
| Peritoneogram Rs&I (74190) |
$594 |
$1,409.04 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$1,555 |
$7,243.99 |
1.0× |
| PET image w/CT, full body (78816) |
$1,555 |
$9,564.58 |
1.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,555 |
$9,564.58 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,434 |
$5,553.25 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$434 |
$1,330.76 |
1.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$113 |
$787.95 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$594 |
$2,857.14 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$94 |
$458.82 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$94 |
$454.23 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$94 |
$557.23 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$113 |
$705.55 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$94 |
$458.82 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$94 |
$458.82 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$94 |
$458.82 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$94 |
$320.85 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$113 |
$1,182.44 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$94 |
$529.42 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$94 |
$432.90 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$94 |
$462.47 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$94 |
$320.85 |
1.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$190 |
$890.10 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$94 |
$458.82 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$94 |
$342.99 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$94 |
$342.99 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$94 |
$458.82 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$113 |
$451.23 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$94 |
$462.47 |
1.0× |
Radiation Delivery Stereotactic Cranial Linear (77372)
range across 2 matching MRF lines |
$8,011 |
$24,608.80–$96,592.80 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$110 |
$602.50 |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$419 |
$604.61 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$601 |
$1,370.36 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$113 |
$579.43 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$113 |
$579.43 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$190 |
$1,144.33 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$190 |
$927.64 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$113 |
$579.43 |
1.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$113 |
$664.35 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$190 |
$927.64 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$190 |
$927.64 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$190 |
$1,038.96 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$94 |
$458.82 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$94 |
$469.68 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$94 |
$458.82 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$113 |
$1,118.58 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$94 |
$458.82 |
1.0× |
| Renal Cyst Study (74470) |
$594 |
$2,241.28 |
1.0× |
| Ribs bilateral 3 views (71110) |
$113 |
$531.70 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$434 |
$1,943.25 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$434 |
$3,181.67 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$590 |
$4,138.54 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$590 |
$3,176.52 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$590 |
$3,253.77 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,408 |
$3,319.48 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,555 |
$4,382.60 |
1.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,408 |
$2,235.92 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$253 |
$3,519.51 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$253 |
$1,585.17 |
1.0× |
| Scapula (73010) |
$113 |
$579.43 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$23 |
$610.79 |
1.0× |
| Sella turcica (70240) |
$94 |
$311.06 |
1.0× |
| Shoulder 1 view (73020) |
$94 |
$458.82 |
1.0× |
| Shoulder Arthrography (73040) |
$379 |
$1,863.52 |
1.0× |
| Sialogram (70390) |
$259 |
$1,330.76 |
1.0× |
| Skull less than 4 views (70250) |
$113 |
$875.50 |
1.0× |
| Special dosimetry (77331) |
$146 |
$508.82 |
1.0× |
| Special Physics Consult (77370) |
$146 |
$691.85 |
1.0× |
| Special teletherapy port plan (77321) |
$407 |
$1,187.59 |
1.0× |
| Special treatment procedure (77470) |
$601 |
$3,014.35 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$1,944 |
$17,976.60 |
1.0× |
| Sternoclavicular joints (71130) |
$94 |
$590.19 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$407 |
$1,657.37 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$407 |
$683.30 |
1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$259 |
$1,748.94 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$434 |
$1,585.17 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$407 |
$2,289.06 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$407 |
$1,187.59 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$146 |
$830.22 |
1.0× |
| Thoracic spine 2 views (72070) |
$113 |
$554.13 |
1.0× |
| Thoracic spine 3 views (72072) |
$113 |
$609.76 |
1.0× |
| Thoracolumbar 2 views (72080) |
$94 |
$665.38 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$434 |
$6,162.29 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$590 |
$4,714.31 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$434 |
$1,916.83 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$434 |
$1,916.83 |
1.0× |
| Tx Devices Design & Construction Complex (77334) |
$407 |
$2,289.06 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$146 |
$867.26 |
1.0× |
| Tx devices design & construction simple (77332) |
$146 |
$910.52 |
1.0× |
| Ultrasound Breast Limited (76642) |
$94 |
$675.91 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$113 |
$567.24 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$113 |
$729.24 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$113 |
$779.71 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$113 |
$542.81 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$94 |
$2,973.61 |
1.0× |
| Unlisted us procedure (76999) |
$94 |
$532.66 |
1.0× |
| Upper gi w/o kub (74240) |
$190 |
$1,187.38 |
1.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$11 |
$580.32 |
1.0× |
| Ureteral Reflux Study (78740) |
$434 |
$1,804.56 |
1.0× |
| Urethrocystogram voiding (74455) |
$259 |
$1,186.56 |
1.0× |
| Urethrocystography retrograde (74450) |
$259 |
$1,186.56 |
1.0× |
| Us breast unilateral complete (76641) |
$113 |
$1,337.97 |
1.0× |
| Us chest (76604) |
$113 |
$779.71 |
1.0× |
| Us complete joint (76881) |
$113 |
$807.40 |
1.0× |
| Us exam, pelvic, limited (76857) |
$113 |
$612.85 |
1.0× |
| Us head (76506) |
$113 |
$796.19 |
1.0× |
| Us kidney transplant (76776) |
$113 |
$779.71 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$113 |
$566.50 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$113 |
$936.27 |
1.0× |
| Us ob transvaginal (76817) |
$113 |
$554.13 |
1.0× |
| Us pelvic non ob complete (76856) |
$113 |
$1,073.26 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$113 |
$811.09 |
1.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$113 |
$582.98 |
1.0× |
| Us retroperitoneal complete (76770) |
$113 |
$1,481.14 |
1.0× |
| Us retroperitoneal limited (76775) |
$113 |
$825.65 |
1.0× |
| Us scrotum and contents (76870) |
$113 |
$929.88 |
1.0× |
| Us spinal canal and contents (76800) |
$113 |
$779.71 |
1.0× |
| Us thyroid (76536) |
$113 |
$1,014.55 |
1.0× |
| Us transrectal (76872) |
$113 |
$1,335.91 |
1.0× |
| Vascular Flow Imaging (78445) |
$434 |
$969.23 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,712 |
$2,624.44 |
1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,434 |
$6,023.44 |
1.0× |
| Vein X-Ray Spleen/Liver (75810) |
$3,434 |
$4,602.04 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$3,434 |
$15,737.50 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,434 |
$5,553.76 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,712 |
$2,816.02 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,712 |
$8,094.82 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,434 |
$5,553.25 |
1.0× |
| Venography Renal Unilateral (75831) |
$3,434 |
$9,192.34 |
1.0× |
| Venous sampling by catheter (75893) |
$6,052 |
$8,057.69 |
1.0× |
| Wrist 2 views (73100) |
$94 |
$458.82 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94 |
$342.99 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$379 |
$1,380.07 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,434 |
$16,401.30 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$113 |
$751.90 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$94 |
$458.82 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$594 |
$1,537.24 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$94 |
$440.25 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$113 |
$1,147.42 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$94 |
$458.82 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$94 |
$493.37 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$113 |
$554.13 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$113 |
$554.13 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$113 |
$988.65 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$113 |
$1,106.22 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$94 |
$458.82 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$113 |
$1,026.91 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$113 |
$554.13 |
1.0× |
| X-ray eye for foreign body (70030) |
$94 |
$591.22 |
1.0× |
| X-ray humerus (73060) |
$94 |
$458.82 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$190 |
$661.26 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$190 |
$1,353.42 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$94 |
$342.99 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$94 |
$342.99 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$113 |
$751.90 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$94 |
$196.73 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$113 |
$850.78 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$113 |
$778.68 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$113 |
$534.40 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$94 |
$631.39 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$94 |
$711.73 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$113 |
$909.49 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$113 |
$554.13 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$94 |
$257.50 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$379 |
$1,955.59 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$113 |
$608.73 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$113 |
$1,000.13 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$113 |
$593.28 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$94 |
$1,341.06 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$113 |
$342.99 |
1.0× |
| Xr orbits complete 4 views (70200) |
$113 |
$864.17 |
1.0× |
| Xr Tomogram Single Plane (76100) |
$113 |
$501.61 |
1.0× |