| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$4,453.19 |
— |
| Abdomen 1 View (74018) |
— |
$246.16 |
— |
| Abdomen 2 views (74019) |
— |
$233.50 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$872 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$4,791.47 |
— |
| Angio pulmonary bilat (75743) |
— |
$1,267.16 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$1,205.38 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$7,595 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$3,038 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$2,978.97 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$1,140.61 |
— |
Ankle 2 views (73600)
range across 2 matching MRF lines |
— |
$237.94–$356.90 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$5,236 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$6,225 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$1,074.65 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$1,045.86 |
— |
| Artery X-Rays Spine (75705) |
— |
$991.90 |
— |
Arthrogram hip (73525)
range across 2 matching MRF lines |
— |
$492–$738 |
— |
Arthrogram Wrist (73115)
range across 2 matching MRF lines |
— |
$304.36–$456.55 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$507.44 |
— |
| Bone age studies (77072) |
— |
$711 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,210.81 |
— |
| Bone Imaging Limited Area (78300) |
— |
$745.60 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,278.29 |
— |
| Bone marrow imaging limited area (78102) |
— |
$1,594.04 |
— |
| Bone survey infant (77076) |
— |
$399.61 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$854.29 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$589.70 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,024.90 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,953.98 |
— |
| Chest 1 view (71045) |
— |
$247.80 |
— |
| Chest 2 views (71046) |
— |
$213.74 |
— |
| Chest 3 views (71047) |
— |
$229.62 |
— |
| Chest 4 or more views (71048) |
— |
$231.40 |
— |
| Clavicle complete (73000) |
— |
$830 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$662.07 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$773.75 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$3,038 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$962.62 |
— |
Contrast X-Ray Of Elbow (73085)
range across 2 matching MRF lines |
— |
$328.39–$492.59 |
— |
Contrast X-Ray Of Knee Joint (73580)
range across 2 matching MRF lines |
— |
$323.84–$485.76 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$2,154.72 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$1,275 |
— |
| CT abdomen w contrast (74160) |
— |
$1,689.45 |
— |
| CT abdomen w wo contrast (74170) |
— |
$1,906.91 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,128.19 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$2,035.79 |
— |
| CT Angio Chest (71275) |
— |
$2,055.22 |
— |
| CT Angio Head (70496) |
— |
$1,158.38 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,040.57 |
— |
| CT Angio Neck (70498) |
— |
$1,156.53 |
— |
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines |
— |
$4,072–$6,108 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,420 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$3,672 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$5,010 |
— |
| CT chest w contrast (71260) |
— |
$4,839 |
— |
| CT chest w/wo contrast (71270) |
— |
$1,954.29 |
— |
| CT head/brain with contrast (70460) |
— |
$1,755.11 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,959.79 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$132.50 |
— |
| CT iac w contrast (70481) |
— |
$1,782.51 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$1,995.90 |
— |
| CT lower ext w/o (73700) |
— |
$2,775 |
— |
CT lower extremity w/contrast material (73701)
range across 2 matching MRF lines |
— |
$1,811.97–$2,717.96 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,673.99 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$3,291 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,792.44 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,775 |
— |
| CT neck tissue combo (70492) |
— |
$1,892.28 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$1,949.06 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,116.96 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,906.08 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,155.48 |
— |
CT scan of leg combo (73702)
range across 3 matching MRF lines |
— |
$1,415.90–$2,123.85 |
— |
| CT scans face/jaw combo (70488) |
— |
$1,978.37 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,730.92 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,141.27 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,737.57 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,613 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,320.58 |
— |
| CT thorax w/o contrast (71250) |
— |
$1,115.66 |
— |
| CT upper ext wo (73200) |
— |
$2,965 |
— |
CT upper extremity w/o & w/contrast material (73202)
range across 2 matching MRF lines |
— |
$1,384.72–$2,077.07 |
— |
CT upper extremity with contrast (73201)
range across 2 matching MRF lines |
— |
$1,732.78–$2,599.19 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,003.44 |
— |
| Cta Abdomen (74175) |
— |
$2,001.32 |
— |
| CTA pelvis (72191) |
— |
$2,009.20 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$247.08 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$551.73 |
— |
| Diskography lumbar (72295) |
— |
$649.48 |
— |
| Dxa Bone Density Axial (77080) |
— |
$630.37 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$166.72 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$995.75 |
— |
| Esophagram (74220) |
— |
$454.85 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$500.43 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$290.77 |
— |
| Follow-Up Angiography (75898) |
— |
$688.33 |
— |
Foot 2 views (73620)
range across 2 matching MRF lines |
— |
$781–$1,172 |
— |
Forearm 2 views (73090)
range across 2 matching MRF lines |
— |
$953–$1,430 |
— |
| Gastric emptying imaging study (78264) |
— |
$931.14 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,549.48 |
— |
| Hand 2 views (73120) |
— |
$645 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$3,384.41 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$3,384.41 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$3,384.41 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$1,051.86 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$1,096.24 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,028.41 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,028.41 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$2,939.16 |
— |
| Hysterosalpingogram (74740) |
— |
$1,732 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,531 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$1,414.07 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,159.69 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,155.79 |
— |
Knee 3 Views (73562)
range across 2 matching MRF lines |
— |
$867–$1,301 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$882.33 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$1,109.05 |
— |
| Lung perfusion differential (78597) |
— |
$709.37 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$1,109.05 |
— |
| Lung Ventilation Imaging (78579) |
— |
$709.37 |
— |
| Lymph System Imaging (78195) |
— |
$1,146.07 |
— |
| Lymphangiography extremity only unilateral rs&i (75801) |
— |
$1,010.18 |
— |
Lymphangiography, pelvic/abdominal, unilateral (75805)
range across 2 matching MRF lines |
— |
$5,033–$5,334.98 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,788.04 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$906.96 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$906.96 |
— |
| Meckels Divert Exam (78290) |
— |
$732.75 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$1,610.96 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$2,825.80 |
— |
| MRA head w/o contrast (70544) |
— |
$2,093.57 |
— |
| MRA head with contrast (70545) |
— |
$3,261.41 |
— |
| MRA neck w contrast (70548) |
— |
$1,469.24 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,039.87 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,060.16 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,078.87 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$3,765 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$5,602 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$4,115 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$4,722 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$1,436.27 |
— |
| MRI cervical spine w contrast (72142) |
— |
$2,787.82 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,015.11 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,363.02 |
— |
| MRI chest with contrast (71551) |
— |
$2,203.35 |
— |
| MRI chest wo w contrast (71552) |
— |
$2,850.57 |
— |
MRI lower extrem oth/thn jt w/contrast matrl (73719)
range across 2 matching MRF lines |
— |
$1,104.63–$1,656.95 |
— |
MRI lower extrem oth/thn jt w/o & w/contr matr (73720)
range across 2 matching MRF lines |
— |
$2,966.45–$4,449.69 |
— |
MRI lower extrem oth/thn jt w/o contr matrl (73718)
range across 2 matching MRF lines |
— |
$2,040.17–$3,060.25 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$2,646.99 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$2,981.21 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$1,988.01 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,101.13 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$2,899.35 |
— |
| MRI pelvis w contrast (72196) |
— |
$1,945.17 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$2,908.79 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,029.78 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,020.24 |
— |
MRI upper extremity oth than jt w/contr matrl (73219)
range across 2 matching MRF lines |
— |
$2,794.03–$4,191.05 |
— |
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 2 matching MRF lines |
— |
$2,025.28–$3,037.92 |
— |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines |
— |
$2,942.90–$4,414.41 |
— |
| MRI, abdomen, combo (74183) |
— |
$2,922.42 |
— |
| MRI, dorsal spine combo (72157) |
— |
$3,017.10 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$2,410.84 |
— |
| MRI, joint upper extrem (73221) |
— |
$3,895 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$5,138 |
— |
| MRI, lumbar spine combo (72158) |
— |
$2,973.19 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$2,939.16 |
— |
| Neck soft tissue (70360) |
— |
$237.51 |
— |
| Nm csf leak detection (78650) |
— |
$640.42 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$4,485.33 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$829.75 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$437.08 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$473 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$923.97 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$632 |
— |
| Peritoneogram Rs&I (74190) |
— |
$503.13 |
— |
| PET image w/CT, full body (78816) |
— |
$6,554.44 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$6,470.26 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$732.13 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$407.39 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$442.95 |
— |
Radex Ankle Complete Minimum 3 Views (73610)
range across 2 matching MRF lines |
— |
$243.79–$365.69 |
— |
Radex Calcaneus Minimum 2 Views (73650)
range across 2 matching MRF lines |
— |
$913–$1,370 |
— |
Radex elbow complete minimum 3 views (73080)
range across 2 matching MRF lines |
— |
$896–$1,344 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$237.75 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$505 |
— |
Radex foot complete minimum 3 views (73630)
range across 2 matching MRF lines |
— |
$241.58–$362.38 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$975 |
— |
Radex lower extremity infant minimum 2 views (73592)
range across 2 matching MRF lines |
— |
$226.18–$339.26 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$242.11 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$297 |
— |
Radex shoulder complete minimum 2 views (73030)
range across 2 matching MRF lines |
— |
$975–$1,463 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$866 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$602 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$238.30 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$942 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$770 |
— |
Radex upper extremity infant minimum 2 views (73092)
range across 2 matching MRF lines |
— |
$245.58–$368.38 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$1,205 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$1,032.72 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$18,263.65 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$421.47 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$421.47 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$729.45 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$910 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$242.40 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$802.63 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$467.69 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$683.66 |
— |
Radiologic exam knee complete 4/more views (73564)
range across 2 matching MRF lines |
— |
$692–$1,038 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$234.32 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$478.58 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$468.06 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,199 |
— |
Radiologic examination femur 1 view (73551)
range across 2 matching MRF lines |
— |
$308.52–$462.79 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$304.70 |
— |
Radiologic examination knee 1/2 views (73560)
range across 2 matching MRF lines |
— |
$234.58–$351.87 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$375.13 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 2 matching MRF lines |
— |
$1,016–$1,524 |
— |
| Renal Cyst Study (74470) |
— |
$349.02 |
— |
| Ribs bilateral 3 views (71110) |
— |
$234.05 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$1,381.35 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$1,232.14 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$725.73 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$797.02 |
— |
Scapula (73010)
range across 2 matching MRF lines |
— |
$822–$1,233 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$240 |
— |
Shoulder 1 view (73020)
range across 2 matching MRF lines |
— |
$241.62–$362.42 |
— |
Shoulder Arthrography (73040)
range across 2 matching MRF lines |
— |
$1,542.41–$2,313.62 |
— |
Sialogram (70390)
range across 2 matching MRF lines |
— |
$380.86–$571.29 |
— |
| Skull less than 4 views (70250) |
— |
$239.80 |
— |
| Special dosimetry (77331) |
— |
$444.09 |
— |
| Special Physics Consult (77370) |
— |
$477.98 |
— |
| Special teletherapy port plan (77321) |
— |
$1,120.96 |
— |
| Special treatment procedure (77470) |
— |
$2,413.95 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$12,755.47 |
— |
| Sternoclavicular joints (71130) |
— |
$204.52 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$991.90 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$418.40 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$429.94 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$421.11 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$1,217.75 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$662.83 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$462.56 |
— |
| Thoracic spine 2 views (72070) |
— |
$681 |
— |
| Thoracic spine 3 views (72072) |
— |
$938 |
— |
| Thoracolumbar 2 views (72080) |
— |
$297.11 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,652 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$962.97 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,390 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$940.43 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$910.95 |
— |
| Tx devices design & construction simple (77332) |
— |
$883.53 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$775–$1,163 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$395.87 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$514.20 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$110.28 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$559 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$2,164.59 |
— |
| Unlisted us procedure (76999) |
— |
$321.38 |
— |
| Upper gi w/o kub (74240) |
— |
$473.84 |
— |
| Ureteral Reflux Study (78740) |
— |
$759.63 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,412 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,466 |
— |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
— |
$875–$1,313 |
— |
| Us chest (76604) |
— |
$330.73 |
— |
Us complete joint (76881)
range across 2 matching MRF lines |
— |
$502.39–$753.58 |
— |
| Us exam, pelvic, limited (76857) |
— |
$318.92 |
— |
| Us head (76506) |
— |
$331.90 |
— |
| Us kidney transplant (76776) |
— |
$530.10 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$698 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$339.67 |
— |
| Us ob transvaginal (76817) |
— |
$1,672 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,711 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$865 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$331.90 |
— |
| Us retroperitoneal complete (76770) |
— |
$513.27 |
— |
| Us retroperitoneal limited (76775) |
— |
$440.58 |
— |
| Us scrotum and contents (76870) |
— |
$516.82 |
— |
| Us spinal canal and contents (76800) |
— |
$528.59 |
— |
| Us thyroid (76536) |
— |
$495.30 |
— |
| Us transrectal (76872) |
— |
$1,954 |
— |
| Vein X-Ray Chest (75827) |
— |
$1,526 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$2,974.47 |
— |
| Vein X-Ray Skull Epidural (75872) |
— |
$991.90 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$1,074.65 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$1,020.67 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$3,038 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$3,460.30 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,348.25 |
— |
| Venography Orbital Rs&I (75880) |
— |
$462.97 |
— |
| Venography Renal Unilateral (75831) |
— |
$1,211.38 |
— |
| Venous sampling by catheter (75893) |
— |
$1,033.87 |
— |
| Wrist 2 views (73100) |
— |
$1,205 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$225.55 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$386.45 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$1,165.81 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$327.30 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$855 |
— |
X-Ray Exam Breast Specimen (76098)
range across 2 matching MRF lines |
— |
$526–$789 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$308.52 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$1,156 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,032.72 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$296.54 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$299.32 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$506.91 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$873 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$485.65 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$999.71 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$378.05 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$1,139 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,540 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,057 |
— |
X-ray humerus (73060)
range across 2 matching MRF lines |
— |
$1,035–$1,450 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$938.51 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$225.55 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$226.39 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$949 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$248.02 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$395.50 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$225.97 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$235.43 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,050 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,175 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$1,342 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$186.70 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$971.17 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$226.39 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$383.29 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,364 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$962 |
— |
| Xr orbits complete 4 views (70200) |
— |
$232.56 |
— |