| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$5,257 |
— |
| Abdomen 1 View (74018) |
— |
$399 |
— |
Abdomen 2 views (74019)
range across 2 matching MRF lines |
— |
$560–$669 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$1,676 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$2,879.61 |
— |
| Angio internal mammary (75756) |
— |
$5,141.71 |
— |
| Angio pulmonary bilat (75743) |
— |
$5,470.61 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$7,596 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$8,641.86 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$3,920.73 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$2,174.81 |
— |
| Ankle 2 views (73600) |
— |
$319 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$3,878 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$4,256 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$5,058 |
— |
| Artery X-Rays Spine (75705) |
— |
$3,705 |
— |
| Arthrogram hip (73525) |
— |
$1,909 |
— |
| Arthrogram Wrist (73115) |
— |
$1,909 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,070.36 |
— |
| Bone age studies (77072) |
— |
$560 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,472 |
— |
| Bone Imaging Limited Area (78300) |
— |
$1,178 |
— |
| Bone Imaging Whole Body (78306) |
— |
$1,733 |
— |
| Bone survey infant (77076) |
— |
$560 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$1,115.10 |
— |
| Brain Image W/Flow < 4 Views (78601) |
— |
$1,472 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$1,781.20 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$5,790.80 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$2,920 |
— |
| Cardiac MRI w/w/o contrast w/stress (75563) |
— |
$2,920 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$743 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$1,784.21 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$1,815 |
— |
Chest 1 view (71045)
range across 2 matching MRF lines |
— |
$399–$549 |
— |
| Chest 2 views (71046) |
— |
$478 |
— |
| Chest 3 views (71047) |
— |
$574 |
— |
| Chest 4 or more views (71048) |
— |
$689 |
— |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
— |
$1,228.70 |
— |
| Clavicle complete (73000) |
— |
$399 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$569.29 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,083.46 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$4,474 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,909 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$545.73 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,909 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$5,367 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,089 |
— |
| CT abdomen w contrast (74160) |
— |
$1,978 |
— |
| CT abdomen w wo contrast (74170) |
— |
$2,627 |
— |
| CT abdomen w/o contrast (74150) |
— |
$1,594.50 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$3,982.90 |
— |
| CT Angio Chest (71275) |
— |
$2,798 |
— |
| CT Angio Head (70496) |
— |
$2,655.50 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,331.10 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,592.43 |
— |
| CT Angio Neck (70498) |
— |
$2,655.50 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$1,639 |
— |
| CT bone density (77078) |
— |
$555 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$3,436 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,685 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$4,123 |
— |
| CT chest w contrast (71260) |
— |
$2,423 |
— |
| CT chest w/wo contrast (71270) |
— |
$2,907 |
— |
| CT head/brain with contrast (70460) |
— |
$1,976 |
— |
| CT head/brain without and with contrast (70470) |
— |
$2,448 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$2,966 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$100 |
— |
| CT iac w contrast (70481) |
— |
$2,102.50 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$4,123 |
— |
| CT lower ext w/o (73700) |
— |
$1,872.50 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$1,639 |
— |
| CT lumbar spine w contrast (72132) |
— |
$3,436 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,631 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,056 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,846 |
— |
| CT neck tissue combo (70492) |
— |
$2,423 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,655.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,140 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$1,967 |
— |
| CT pelvis w/o contrast (72192) |
— |
$1,552 |
— |
| CT scan of leg combo (73702) |
— |
$2,775 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,473 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,016 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,671 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,966.56 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,682.50 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$1,967 |
— |
CT thorax w/o contrast (71250)
range across 2 matching MRF lines |
— |
$1,830–$3,637 |
— |
| CT upper ext wo (73200) |
— |
$1,500 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$4,123 |
— |
| CT upper extremity with contrast (73201) |
— |
$3,436 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,900 |
— |
| Cta Abdomen (74175) |
— |
$2,177 |
— |
| CTA pelvis (72191) |
— |
$2,395.75 |
— |
| Diskography lumbar (72295) |
— |
$2,988 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$271 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$743 |
— |
| Doppler Fetal Mid Cerebral Artery (76821) |
— |
$362.96 |
— |
| Echo exam of fetal heart (76825) |
— |
$1,224 |
— |
| Echo exam uterus (76831) |
— |
$946.41 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$1,977 |
— |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
— |
$798 |
— |
| Echograp Trans R Pros Study (76873) |
— |
$1,196 |
— |
| Esophagram (74220) |
— |
$911 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$784 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$627 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,165 |
— |
| Follow-Up Angiography (75898) |
— |
$4,667.90 |
— |
| Foot 2 views (73620) |
— |
$319 |
— |
| Forearm 2 views (73090) |
— |
$399 |
— |
| Gastric emptying imaging study (78264) |
— |
$1,797.50 |
— |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
— |
$1,507.25 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$1,405.86 |
— |
Gated Heart Planar Single (78472)
range across 2 matching MRF lines |
— |
$2,635.70–$3,826.95 |
— |
| Hand 2 views (73120) |
— |
$560 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$1,887 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$1,584.35 |
— |
| Ht Musc Image Planar Mult (78454) |
— |
$2,730.42 |
— |
Ht Muscle Image Spect Sing (78451)
range across 2 matching MRF lines |
— |
$4,071–$6,095 |
— |
| Hysterosalpingogram (74740) |
— |
$1,165 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$721.14 |
— |
Infant hip ultrasound, limited static exam (76886)
range across 2 matching MRF lines |
— |
$424–$2,200.97 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$1,164 |
— |
| Joint Survey Single View (77077) |
— |
$76.50 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$2,331.90 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$1,911.50 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$1,887 |
— |
| Kidney Imaging Morphol (78700) |
— |
$1,472 |
— |
| Knee 3 Views (73562) |
— |
$478 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$1,293.36 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$1,472 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$5,731.79 |
— |
| Lung perfusion differential (78597) |
— |
$1,466.85 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$2,360 |
— |
| Lung Ventilation Imaging (78579) |
— |
$1,472 |
— |
| Lymph System Imaging (78195) |
— |
$1,887 |
— |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
— |
$3,504 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$2,519.20 |
— |
| Meckels Divert Exam (78290) |
— |
$1,472 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$906 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$4,123 |
— |
| MRA head w/o contrast (70544) |
— |
$2,675 |
— |
| MRA head with contrast (70545) |
— |
$4,186 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$4,123 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,202.55 |
— |
| MRI abdomen w contrast (74182) |
— |
$3,436 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$2,705.07 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,749 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$3,436 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$3,095.60 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$4,387.32 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,639 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,436 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$2,222 |
— |
| MRI chest w/o contrast (71550) |
— |
$2,612.25 |
— |
| MRI chest wo w contrast (71552) |
— |
$3,845 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$3,232 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$3,436 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$2,168 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,436 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,123 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,382 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$3,436 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,123 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,436 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,123 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$2,097 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$2,460.30 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,920 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,097 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$3,714.20 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,123 |
— |
| MRI, dorsal spine combo (72157) |
— |
$4,240 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,436 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,097 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$3,436 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,123 |
— |
| Myelogram Lumbar (72265) |
— |
$4,228.37 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$965.56 |
— |
Myocardial Spect Multiple Studies (78452)
range across 2 matching MRF lines |
— |
$5,088–$6,923 |
— |
| Neck soft tissue (70360) |
— |
$399 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$693 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$10,646 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$1,343.53 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,366 |
— |
| Ob us nuchal meas 1 gest (76813) |
— |
$865.33 |
— |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
— |
$986.74 |
— |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
— |
$350.28 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$542.94 |
— |
| Panoramic X-ray of jaws (70355) |
— |
$548.84 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$4,953.25 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$1,472 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$448 |
— |
| Peritoneogram Rs&I (74190) |
— |
$1,353.57 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$4,621.42 |
— |
| PET image w/CT, full body (78816) |
— |
$6,226.80 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$5,790.80 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$1,517.47 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$1,472 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$560 |
— |
Radex abscess/fistula/sinus tract rs&i (76080)
range across 2 matching MRF lines |
— |
$596–$986.96 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$399 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$399 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$399 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$560 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$399 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$399 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$672 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$1,009.65 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$399 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$399 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$478 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$399 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$399 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$399 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$399 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$399 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$560 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$399 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,746 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$560 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$875 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$1,737 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,510.46 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$1,069 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$560 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$972.41 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$959.70 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$911 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,177.24 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$399 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$478 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$399 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$959.30 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$399 |
— |
| Ribs bilateral 3 views (71110) |
— |
$560 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$1,593.19 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$5,088 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$5,088 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$4,457.41 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$4,292 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$3,301 |
— |
Rp Therapy Intravenous Administration (79101)
range across 2 matching MRF lines |
— |
$320–$1,503.31 |
— |
| Scapula (73010) |
— |
$560 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$116.66 |
— |
| Shoulder 1 view (73020) |
— |
$399 |
— |
| Shoulder Arthrography (73040) |
— |
$1,198 |
— |
| Skull less than 4 views (70250) |
— |
$560 |
— |
| Special dosimetry (77331) |
— |
$1,426.81 |
— |
| Special Physics Consult (77370) |
— |
$542 |
— |
| Special teletherapy port plan (77321) |
— |
$376.46 |
— |
| Special treatment procedure (77470) |
— |
$2,089 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$7,591 |
— |
| Sternoclavicular joints (71130) |
— |
$478 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$1,704 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$1,142 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$834 |
— |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
— |
$1,205.16 |
— |
| Thoracic spine 2 views (72070) |
— |
$560 |
— |
| Thoracic spine 3 views (72072) |
— |
$672 |
— |
| Thoracolumbar 2 views (72080) |
— |
$399 |
— |
Thyroid Imaging With Vascular Flow (78013)
range across 2 matching MRF lines |
— |
$1,472–$1,509.69 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$1,887 |
— |
Thyroid Uptake Measurement (78012)
range across 2 matching MRF lines |
— |
$353–$1,104 |
— |
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014)
range across 2 matching MRF lines |
— |
$1,472–$1,578 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$2,022 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$871 |
— |
| Tx devices design & construction simple (77332) |
— |
$304.03 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$558–$578 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$560 |
— |
Ultrasound, abdomen limited (76705)
range across 2 matching MRF lines |
— |
$784–$1,045 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$410 |
— |
| Unlisted magnetic resonance procedure (76498) |
— |
$4,830.72 |
— |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
— |
$725 |
— |
| Upper gi w/o kub (74240) |
— |
$1,020 |
— |
| Urethrocystogram voiding (74455) |
— |
$1,165 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,165 |
— |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
— |
$784–$870 |
— |
Us chest (76604)
range across 2 matching MRF lines |
— |
$711–$784 |
— |
Us complete joint (76881)
range across 2 matching MRF lines |
— |
$845–$1,049 |
— |
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines |
— |
$784–$1,220.59 |
— |
| Us head (76506) |
— |
$1,184.95 |
— |
| Us kidney transplant (76776) |
— |
$1,682 |
— |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines |
— |
$519–$784 |
— |
| Us ob detailed single fetus (76811) |
— |
$1,101.84 |
— |
Us ob limited 1 or more fetuses (76815)
range across 2 matching MRF lines |
— |
$665–$784 |
— |
Us ob transvaginal (76817)
range across 2 matching MRF lines |
— |
$784–$881 |
— |
Us pelvic non ob complete (76856)
range across 2 matching MRF lines |
— |
$941–$1,664.43 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$784 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$784 |
— |
Us retroperitoneal complete (76770)
range across 2 matching MRF lines |
— |
$941–$1,235 |
— |
Us retroperitoneal limited (76775)
range across 2 matching MRF lines |
— |
$784–$959 |
— |
| Us scrotum and contents (76870) |
— |
$784 |
— |
| Us spinal canal and contents (76800) |
— |
$460.97 |
— |
Us thyroid (76536)
range across 2 matching MRF lines |
— |
$711–$784 |
— |
| Us transrectal (76872) |
— |
$1,238 |
— |
| Vascular Flow Imaging (78445) |
— |
$797.53 |
— |
| Vein X-Ray Chest (75827) |
— |
$1,614 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$3,547 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$2,013 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$1,614 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,631 |
— |
| Venography Renal Bilateral (75833) |
— |
$1,508.60 |
— |
| Venography Renal Unilateral (75831) |
— |
$1,614 |
— |
| Venous sampling by catheter (75893) |
— |
$4,409.56 |
— |
| Wrist 2 views (73100) |
— |
$319 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$399 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$508.95 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$12,493.52 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$560 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$319 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$407 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$780.82 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$560 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$1,047 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$399 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$478 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$929.13 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$560 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$672 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$806 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$806 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$478 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$672 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$560 |
— |
| X-ray humerus (73060) |
— |
$399 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,167.50 |
— |
| X-ray IV pyelogram+tomography (74415) |
— |
$1,368.50 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$587.90 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$399 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$560 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$399 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$672 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$560 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$399 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$478 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$672 |
— |
| X-Ray Stress View (77071) |
— |
$835.15 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$850 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$548.84 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,909 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$560 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$940 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$560 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$399 |
— |