| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$5,064 |
— |
| Abdomen 1 View (74018) |
— |
$786 |
— |
| Abdomen 2 views (74019) |
— |
$956 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$8,172 |
— |
| Angio internal mammary (75756) |
— |
$7,739 |
— |
| Angio pulmonary bilat (75743) |
— |
$11,876 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$19,326 |
— |
Angiography extremity unilateral rs&i (75710)
range across 3 matching MRF lines |
— |
$7,547–$9,664 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$10,562 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$16,225 |
— |
| Ankle 2 views (73600) |
— |
$798 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$10,139 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$13,233 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$11,862 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$12,282 |
— |
| Artery X-Rays Spine (75705) |
— |
$9,734 |
— |
| Arthrogram ankle (73615) |
— |
$2,757 |
— |
Arthrogram hip (73525)
range across 3 matching MRF lines |
— |
$2,407–$2,648 |
— |
| Arthrogram Wrist (73115) |
— |
$2,281 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$656 |
— |
| Bone age studies (77072) |
— |
$854 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$8,124 |
— |
| Bone Imaging Limited Area (78300) |
— |
$4,217 |
— |
| Bone Imaging Multiple Areas (78305) |
— |
$5,391 |
— |
| Bone Imaging Whole Body (78306) |
— |
$5,891 |
— |
| Bone marrow imaging; whole body (78104) |
— |
$4,683 |
— |
| Bone survey infant (77076) |
— |
$1,355 |
— |
| Brachytx isodose complex (77318) |
— |
$6,923 |
— |
| Brachytx isodose intermed (77317) |
— |
$6,287 |
— |
| Brachytx Isodose Plan Simple (77316) |
— |
$4,121 |
— |
| Brain Flow Imaging Only (78610) |
— |
$4,220 |
— |
| Brain imaging < 4 static views (78600) |
— |
$4,270 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$1,163 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$7,947 |
— |
| Chest 1 view (71045) |
— |
$735 |
— |
| Chest 2 views (71046) |
— |
$901 |
— |
| Chest 3 views (71047) |
— |
$1,060 |
— |
| Chest 4 or more views (71048) |
— |
$1,321 |
— |
| Cholecystography Oral Contrast (74290) |
— |
$1,914 |
— |
| Cisternography Positive Contrast Rs&I (70015) |
— |
$5,131 |
— |
| Clavicle complete (73000) |
— |
$906 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$1,163 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$796 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$10,242 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$1,864 |
— |
| Contrast X-Ray Of Elbow (73085) |
— |
$2,325 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$2,438 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$7,199 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,301 |
— |
| CT abdomen w contrast (74160) |
— |
$3,763 |
— |
| CT abdomen w wo contrast (74170) |
— |
$3,763 |
— |
| CT abdomen w/o contrast (74150) |
— |
$2,099 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$7,199 |
— |
| CT Angio Chest (71275) |
— |
$983 |
— |
| CT Angio Head (70496) |
— |
$3,763 |
— |
| CT angio hrt w/3d image (75574) |
— |
$3,763 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$3,763 |
— |
| CT Angio Neck (70498) |
— |
$3,763 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$3,763 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$4,960 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,099 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,763 |
— |
| CT chest w contrast (71260) |
— |
$3,763 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,763 |
— |
| CT colonography screening (74263) |
— |
$1,253 |
— |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
— |
$3,013 |
— |
| CT head/brain with contrast (70460) |
— |
$3,763 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,763 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$936 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$878 |
— |
| CT hrt w/3d image congen (75573) |
— |
$2,073 |
— |
| CT iac w contrast (70481) |
— |
$3,763 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$3,763 |
— |
| CT lower ext w/o (73700) |
— |
$2,099 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$3,763 |
— |
| CT lumbar spine w contrast (72132) |
— |
$4,647 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$2,099 |
— |
| CT maxillofacial w contrast (70487) |
— |
$3,763 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$2,099 |
— |
| CT neck tissue combo (70492) |
— |
$3,763 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$3,763 |
— |
| CT orbits w/o contrast (70480) |
— |
$2,099 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$3,763 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,099 |
— |
| CT scan of leg combo (73702) |
— |
$3,763 |
— |
| CT scans face/jaw combo (70488) |
— |
$3,763 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$3,763 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$2,099 |
— |
| CT thoracic spine w contrast (72129) |
— |
$3,763 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,099 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$3,763 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,099 |
— |
| CT upper ext wo (73200) |
— |
$2,099 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$3,763 |
— |
| CT upper extremity with contrast (73201) |
— |
$4,350 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$3,763 |
— |
| Cta Abdomen (74175) |
— |
$3,763 |
— |
| CTA pelvis (72191) |
— |
$3,763 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$5,265 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$10,832 |
— |
| Diskography lumbar (72295) |
— |
$7,668 |
— |
| Dxa Bone Density Axial (77080) |
— |
$1,307 |
— |
| Echo Guide For Artery Repair (76936) |
— |
$2,463 |
— |
| Esophagram (74220) |
— |
$1,569 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$2,149 |
— |
Fluoroscopy up to 1 hr (76000)
range across 3 matching MRF lines |
— |
$1,373–$1,656 |
— |
| Follow-Up Angiography (75898) |
— |
$4,004 |
— |
| Foot 2 views (73620) |
— |
$856 |
— |
| Forearm 2 views (73090) |
— |
$890 |
— |
| Gastric emptying imaging study (78264) |
— |
$6,770 |
— |
| Gastroesophageal Reflux Exam (78262) |
— |
$5,687 |
— |
| Gated Heart Planar Single (78472) |
— |
$5,377 |
— |
| Hand 2 views (73120) |
— |
$798 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
— |
$28,526 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
— |
$9,295 |
— |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
— |
$4,995 |
— |
| Heart first pass single,planar (78481) |
— |
$4,228 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$15,324 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$11,306 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$7,092 |
— |
| Hysterosalpingogram (74740) |
— |
$2,367 |
— |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
— |
$1,390 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$8,036 |
— |
| Intracavitary Radiation Source Applic Complex (77763) |
— |
$8,737 |
— |
| Intracavitary Radiation Source Applic Intermed (77762) |
— |
$6,156 |
— |
| Intracavitary radiation source applic simple (77761) |
— |
$4,652 |
— |
| Joint Survey Single View (77077) |
— |
$679 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$4,201 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$5,422 |
— |
| Kidney Imaging Morphol (78700) |
— |
$4,058 |
— |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
— |
$5,097 |
— |
| Knee 3 Views (73562) |
— |
$1,011 |
— |
| Leveen/Shunt Patency Exam (78291) |
— |
$5,857 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$4,537 |
— |
| Liver imaging static only (78201) |
— |
$4,361 |
— |
| Lung Perf&Ventilat Diferentl (78598) |
— |
$8,061 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$11,423 |
— |
| Lung Ventilation Imaging (78579) |
— |
$6,518 |
— |
| Lymph System Imaging (78195) |
— |
$8,325 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$5,144 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,803 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,402 |
— |
| Meckels Divert Exam (78290) |
— |
$7,786 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$5,239 |
— |
| Mr safety determination physician/other qhp (76016) |
— |
$458 |
— |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
— |
$128 |
— |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
— |
$477 |
— |
| Mr safety implt pos&/immoblj (76019) |
— |
$309 |
— |
| Mr safety med physics xm customization plng&mntr (76017) |
— |
$1,256 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$8,610 |
— |
| MRA head w/o contrast (70544) |
— |
$5,144 |
— |
| MRA head with contrast (70545) |
— |
$7,463 |
— |
| MRA neck w contrast (70548) |
— |
$6,855 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$8,200 |
— |
| MRA neck w/o contrast (70547) |
— |
$5,144 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,144 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$7,581 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$8,610 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$7,476 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$10,286 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$5,144 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$5,144 |
— |
| MRI cervical spine w contrast (72142) |
— |
$8,277 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$5,144 |
— |
| MRI chest w/o contrast (71550) |
— |
$5,144 |
— |
| MRI chest with contrast (71551) |
— |
$9,423 |
— |
| MRI chest wo w contrast (71552) |
— |
$8,610 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$7,130 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$8,494 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$5,144 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$8,133 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$8,610 |
— |
MRI orbit face &/neck w/o contrast (70540)
range across 8 matching MRF lines |
— |
$4,618–$5,144 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$8,023 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$8,610 |
— |
| MRI pelvis w contrast (72196) |
— |
$8,030 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$8,610 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$5,144 |
— |
| MRI spectroscopy (76390) |
— |
$5,201 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$5,144 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$8,073 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$5,144 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$8,604 |
— |
| MRI, abdomen, combo (74183) |
— |
$8,427 |
— |
| MRI, dorsal spine combo (72157) |
— |
$8,610 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$8,243 |
— |
| MRI, joint upper extrem (73221) |
— |
$5,144 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$8,610 |
— |
| MRI, lumbar spine combo (72158) |
— |
$8,610 |
— |
| Myelogram cervical (72240) |
— |
$4,753 |
— |
| Myelogram Lumbar (72265) |
— |
$4,922 |
— |
| Myelography thoracic (72255) |
— |
$5,911 |
— |
| Myelograpy 2/more regions rs&i (72270) |
— |
$5,564 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$11,049 |
— |
| Neck soft tissue (70360) |
— |
$829 |
— |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
— |
$7,659 |
— |
| Nm csf leak detection (78650) |
— |
$8,103 |
— |
| Nonvascular Shunt X-Ray (75809) |
— |
$1,468 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$20,091 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$2,547 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$824 |
— |
| Optic foramina (70190) |
— |
$727 |
— |
| Parathyroid Planar Imaging (78070) |
— |
$7,028 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$888 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$5,576 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$1,372 |
— |
Radex abscess/fistula/sinus tract rs&i (76080)
range across 3 matching MRF lines |
— |
$2,129–$2,849 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$970 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$798 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$990 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$1,182 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$702 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$970 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$871 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$720 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$1,062 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$891 |
— |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
— |
$948 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$986 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$996 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$824 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$846 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$904 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$1,712 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$703 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$779 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$976 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$14,833 |
— |
| Radiation treatment delivery level 1 (77402) |
— |
$828 |
— |
| Radiation treatment delivery level 2 (77407) |
— |
$906 |
— |
| Radiation treatment delivery level 3 (77412) |
— |
$1,511 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$1,261 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,220 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,712 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$2,267 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$1,216 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,826 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$1,603 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$2,127 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$782 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$1,007 |
— |
Radiologic examination knee 1/2 views (73560)
range across 8 matching MRF lines |
— |
$851–$1,390 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$900 |
— |
Radiologic examination tibia & fibula 2 views (73590)
range across 6 matching MRF lines |
— |
$891–$1,390 |
— |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
— |
$4,857 |
— |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
— |
$3,649 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
— |
$11,020 |
— |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
— |
$7,031 |
— |
| Ribs bilateral 3 views (71110) |
— |
$1,249 |
— |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
— |
$4,613 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$5,840 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$13,334 |
— |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
— |
$8,448 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$9,293 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$14,953 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$4,467 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$3,205 |
— |
| Salivary Gland Imaging (78230) |
— |
$4,186 |
— |
| Scapula (73010) |
— |
$887 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$272 |
— |
| Sella turcica (70240) |
— |
$486 |
— |
| Shoulder 1 view (73020) |
— |
$822 |
— |
| Shoulder Arthrography (73040) |
— |
$2,391 |
— |
| Sialogram (70390) |
— |
$2,228 |
— |
| Skull less than 4 views (70250) |
— |
$955 |
— |
| Special dosimetry (77331) |
— |
$663 |
— |
| Special Physics Consult (77370) |
— |
$1,211 |
— |
| Special teletherapy port plan (77321) |
— |
$851 |
— |
| Special treatment procedure (77470) |
— |
$1,614 |
— |
| Spleen Imaging (78185) |
— |
$4,908 |
— |
| Stereotactic Body Radiation Delivery (77373) |
— |
$18,856 |
— |
| Sternoclavicular joints (71130) |
— |
$901 |
— |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
— |
$1,956 |
— |
| Tbs technical calculation only (77091) |
— |
$1,956 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$2,952 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$1,508 |
— |
| Temporomandble Jt Arthrography Rs&I (70332) |
— |
$3,892 |
— |
| Testicular Imaging W/Flow (78761) |
— |
$5,104 |
— |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
— |
$5,291 |
— |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
— |
$8,892 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$2,810 |
— |
| Thoracic spine 2 views (72070) |
— |
$1,113 |
— |
| Thoracic spine 3 views (72072) |
— |
$1,284 |
— |
| Thoracolumbar 2 views (72080) |
— |
$1,108 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$4,443 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$7,283 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$5,632 |
— |
| Tx Devices Design & Construction Complex (77334) |
— |
$1,578 |
— |
| Tx devices design & construction intermediate (77333) |
— |
$717 |
— |
| Tx devices design & construction simple (77332) |
— |
$856 |
— |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
— |
$1,203–$2,405 |
— |
| Ultrasound Elastography Parenchyma (76981) |
— |
$550 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$616 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,828 |
— |
| Unlisted Dx Radiographic Procedure (76499) |
— |
$1,390 |
— |
| Unlisted us procedure (76999) |
— |
$1,390 |
— |
| Upper gi w/o kub (74240) |
— |
$1,817 |
— |
| Ureteral Reflux Study (78740) |
— |
$5,128 |
— |
| Urethrocystogram voiding (74455) |
— |
$2,228 |
— |
| Urethrocystography retrograde (74450) |
— |
$1,838 |
— |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
— |
$1,462–$2,923 |
— |
Us chest (76604)
range across 4 matching MRF lines |
— |
$685–$1,361 |
— |
| Us complete joint (76881) |
— |
$1,981 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,614 |
— |
| Us head (76506) |
— |
$1,731 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$1,261 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,311 |
— |
| Us ob transvaginal (76817) |
— |
$1,557 |
— |
Us pelvic non ob complete (76856)
range across 3 matching MRF lines |
— |
$2,197–$2,416 |
— |
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801)
range across 5 matching MRF lines |
— |
$1,736–$1,910 |
— |
| Us retroperitoneal complete (76770) |
— |
$2,092 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,623 |
— |
Us scrotum and contents (76870)
range across 2 matching MRF lines |
— |
$1,614–$1,775 |
— |
| Us spinal canal and contents (76800) |
— |
$1,602 |
— |
| Us thyroid (76536) |
— |
$1,742 |
— |
| Us transrectal (76872) |
— |
$1,980 |
— |
| Vein X-Ray Chest (75827) |
— |
$6,014 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$6,424 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$10,769 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$4,809 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$3,561 |
— |
| Venography Renal Bilateral (75833) |
— |
$13,114 |
— |
| Venography Renal Unilateral (75831) |
— |
$8,764 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$513 |
— |
| Wrist 2 views (73100) |
— |
$814 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$937 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$2,519 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$11,491 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$815 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,106 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$996 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$1,363 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$778 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$577 |
— |
| X-Ray Exam Hip Uni 4/> Views (73503) |
— |
$720 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$1,153 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,291 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,761 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$1,071 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$1,066 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$1,761 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$1,207 |
— |
X-ray eye for foreign body (70030)
range across 2 matching MRF lines |
— |
$735–$809 |
— |
| X-ray humerus (73060) |
— |
$837 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$2,578 |
— |
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100)
range across 3 matching MRF lines |
— |
$720–$791 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$947 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$1,149 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$2,413 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$992 |
— |
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200)
range across 2 matching MRF lines |
— |
$491–$747 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$1,018 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$1,215 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,558 |
— |
X-Ray Tmj Unilat (70328)
range across 3 matching MRF lines |
— |
$779–$856 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$2,343 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$992 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$2,217 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$1,512 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$904 |
— |
| Xr orbits complete 4 views (70200) |
— |
$1,222 |
— |
| Xr Tomogram Single Plane (76100) |
— |
$1,957 |
— |