| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,698.53 |
— |
1.2× |
| Abdomen 2 views (74019) |
$128.29 |
$450 |
1.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$490.58 |
$1,600 |
1.2× |
| Acute venous thrombus image (78456) |
$1,588.72 |
— |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,874.69 |
$5,500 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$3,874.69 |
$7,700 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,874.69 |
$6,700 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$3,874.69 |
$4,200 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,828.43 |
$9,500 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,874.69 |
$7,000 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,874.69 |
— |
1.2× |
| Angiography Spinal Selective Rs&I (75705) |
$6,828.43 |
$9,000 |
1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,828.43 |
$9,000 |
1.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,874.69 |
$2,100 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,874.69 |
— |
1.2× |
| Ankle 2 views (73600) |
$106.79 |
$750 |
1.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$428.12 |
$1,400 |
1.1× |
| Aortogram thoracic (75605) |
$6,828.43 |
$10,500 |
1.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,874.69 |
$7,300 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,874.69 |
$6,500 |
1.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,874.69 |
$7,000 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$3,874.69 |
$6,000 |
1.2× |
| Arthrogram elbow (73085) |
$428.12 |
$1,300 |
1.1× |
| Arthrogram hip (73525) |
$428.12 |
$1,400 |
1.1× |
| Arthrogram shoulder (73040) |
$428.12 |
$1,500 |
1.1× |
| Arthrogram wrist (73115) |
$428.12 |
$1,200 |
1.1× |
| Arthrography knee lt (73580) |
$428.12 |
$1,400 |
1.1× |
| Basic radiation dosimetry calculation (77300) |
$164.94 |
$350 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$490.58 |
$900 |
1.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$490.58 |
— |
1.2× |
| Bone &/joint imaging whole body (78306) |
$490.58 |
$1,350 |
1.2× |
| Bone age studies (77072) |
$128.29 |
$430 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$490.58 |
$1,100 |
1.2× |
| Bone Marrow Imaging Limited Area (78102) |
$490.58 |
$1,350 |
1.2× |
| Bone survey complete (77075) |
$128.29 |
$600 |
1.1× |
| Brachytx isodose complex (77318) |
$459.48 |
— |
1.1× |
| Brachytx isodose intermed (77317) |
$459.48 |
— |
1.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$459.48 |
— |
1.1× |
| Brain image w/flow 4 + views (78606) |
$666.30 |
$2,400 |
1.2× |
| Brain imaging < 4 static views (78600) |
$490.58 |
— |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$490.58 |
— |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$666.30 |
$1,700 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,754.75 |
$7,000 |
1.1× |
| Brain Imaging Vascular Flow Only (78610) |
$666.30 |
— |
1.2× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$12.72 |
— |
1.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$490.58 |
$900 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$428.12 |
$1,700 |
1.1× |
| Cardiac shunt detection (78428) |
$490.58 |
— |
1.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$666.30 |
— |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$106.79 |
$700 |
1.2× |
| Chest 1 view (71045) |
$106.79 |
$480 |
1.2× |
| Chest 3 views (71047) |
$106.79 |
$500 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$215.24 |
$700 |
1.1× |
| Cineradiography/videoradiography (76120) |
$128.29 |
— |
1.1× |
| Cisternography Positive Contrast Rs&I (70015) |
$961.98 |
— |
1.1× |
| Clavicle complete (73000) |
$106.79 |
$650 |
1.2× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$9,038.28 |
— |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$128.29 |
$1,700 |
1.1× |
| Continuing medical physics consltj pr wk (77336) |
$164.94 |
— |
1.1× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$215.24 |
— |
1.1× |
| Corpora cavernosography (74445) |
$128.29 |
— |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$428.12 |
$7,000 |
1.1× |
| CT abdomen and pelvis without contrast (74176) |
$292.80 |
$6,200 |
1.1× |
| CT abdomen w contrast (74160) |
$215.24 |
$5,000 |
1.1× |
| CT abdomen w wo contrast (74170) |
$215.24 |
$6,000 |
1.1× |
| CT abdomen w/o contrast (74150) |
$128.29 |
$4,500 |
1.1× |
| CT angio hrt w/3d image (75574) |
$428.12 |
$1,200 |
1.1× |
| CT angiography upper extremity lt (73206) |
$215.24 |
$3,000 |
1.1× |
| CT c-spine w/o contrast (72125) |
$128.29 |
$5,000 |
1.1× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$215.24 |
— |
1.1× |
| CT cervical spine w&w/o contrast (72127) |
$215.24 |
$1,200 |
1.1× |
| CT cervical spine with contrast (72126) |
$428.12 |
$4,800 |
1.1× |
| CT chest w/wo contrast (71270) |
$215.24 |
$3,500 |
1.1× |
| CT chest with contrast (71260) |
$215.24 |
$3,200 |
1.1× |
| CT colonography screening (74263) |
$292.80 |
— |
1.1× |
| CT colonography w/dye (74262) |
$215.24 |
$8,500 |
1.1× |
| CT colonography w/o cntrst (74261) |
$128.29 |
$700 |
1.1× |
| CT head/brain with contrast (70460) |
$215.24 |
$4,000 |
1.1× |
| CT head/brain without and with contrast (70470) |
$215.24 |
$5,000 |
1.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$428.12 |
$750 |
1.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$106.79 |
$500 |
1.2× |
| CT hrt w/3d image congen (75573) |
$428.12 |
$850 |
1.1× |
| CT iac w contrast (70481) |
$215.24 |
$3,000 |
1.1× |
| CT limited/localized follow up study (76380) |
$106.79 |
— |
1.2× |
| CT lower ext w/o (73700) |
$128.29 |
$3,000 |
1.1× |
| CT lower extremity w wo contrast (73702) |
$215.24 |
$4,000 |
1.1× |
| CT lower extremity with contrast (73701) |
$215.24 |
$3,400 |
1.1× |
| CT lumbar spine w & w/o contrast (72133) |
$215.24 |
$7,500 |
1.1× |
| CT lumbar spine w/o contrast (72131) |
$128.29 |
$5,800 |
1.1× |
| CT lumbar spine with contrast (72132) |
$428.12 |
$6,000 |
1.1× |
| CT maxillofacial w contrast (70487) |
$215.24 |
$4,000 |
1.1× |
| CT maxillofacial w/o contrast (70486) |
$128.29 |
$2,500 |
1.1× |
| CT maxillofacial w/wo contrast (70488) |
$215.24 |
$3,000 |
1.1× |
| CT neck soft tissue w contrast (70491) |
$215.24 |
$4,000 |
1.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$215.24 |
$3,000 |
1.1× |
| CT orbits w/o contrast (70480) |
$128.29 |
$3,000 |
1.1× |
| CT pelvis w & w/o contrast (72194) |
$215.24 |
$4,600 |
1.1× |
| CT pelvis w/o contrast (72192) |
$128.29 |
$3,500 |
1.1× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$106.79 |
— |
1.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$215.24 |
$3,500 |
1.1× |
| CT soft tissue neck w/o contrast (70490) |
$128.29 |
$2,400 |
1.1× |
| CT thoracic spine w/contrast (72129) |
$215.24 |
$5,500 |
1.1× |
| CT thoracic spine w/o contrast (72128) |
$128.29 |
$5,000 |
1.1× |
| CT thoracic spine w/wo contrast (72130) |
$215.24 |
$1,200 |
1.1× |
| CT thorax w/o contrast (71250) |
$128.29 |
$2,700 |
1.1× |
| CT unlisted procedure (76497) |
$106.79 |
— |
1.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$215.24 |
$3,700 |
1.1× |
| CT upper extremity w/o contrast rt (73200) |
$128.29 |
$2,700 |
1.1× |
| CT upper extremity with contrast (73201) |
$428.12 |
$3,400 |
1.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$215.24 |
$6,500 |
1.1× |
| Cta Abdomen (74175) |
$215.24 |
$6,500 |
1.1× |
| CTA abdomen pelvis (74174) |
$428.12 |
$6,500 |
1.1× |
| CTA chest (71275) |
$215.24 |
$4,000 |
1.1× |
| Cta Head (70496) |
$215.24 |
$3,820 |
1.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$428.12 |
— |
1.1× |
| CTA lwr ext w&w/o contrast (73706) |
$215.24 |
$3,200 |
1.1× |
| Cta Neck (70498) |
$215.24 |
$4,000 |
1.1× |
| Cta Pelvis (72191) |
$215.24 |
$4,500 |
1.1× |
| Cystography minimum 3 views rs&i (74430) |
$428.12 |
$1,100 |
1.1× |
| Dacryocystography (70170) |
$292.80 |
— |
1.1× |
| Diskogram cervical (72285) |
$2,396.28 |
$5,500 |
1.2× |
| Diskography lumbar (72295) |
$2,396.28 |
$5,500 |
1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$128.29 |
$380 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$128.29 |
$800 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$128.29 |
$400 |
1.1× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$128.29 |
$330 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$128.29 |
$750 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$106.79 |
$350 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$128.29 |
$480 |
1.1× |
| Echo exam of eye (76529) |
$106.79 |
$350 |
1.2× |
| Echo exam of fetal heart (76825) |
$670.53 |
$130 |
1.1× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$292.80 |
$900 |
1.1× |
| Echoencephalography real time imaging (76506) |
$128.29 |
$630 |
1.1× |
| Esophageal motility (78258) |
$490.58 |
$1,300 |
1.2× |
| Esophagus (74220) |
$215.24 |
$900 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$128.29 |
$500 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$128.29 |
$500 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$292.80 |
$900 |
1.1× |
| Foot 2 views (73620) |
$106.79 |
$600 |
1.2× |
| Forearm 2 views (73090) |
$106.79 |
$650 |
1.2× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$292.80 |
— |
1.1× |
| Functional MRI brain by phys/psych (70555) |
$292.80 |
$1,300 |
1.1× |
| Functional MRI brain by tech (70554) |
$292.80 |
$1,100 |
1.1× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$666.30 |
— |
1.2× |
| Gastric mucosa imaging (78261) |
$490.58 |
$1,300 |
1.2× |
| Gastrointestinal Protein Loss (78282) |
$490.58 |
— |
1.2× |
| Gated Heart Planar Single (78472) |
$490.58 |
$950 |
1.2× |
| Hand 2 views (73120) |
$128.29 |
$630 |
1.1× |
| Hand 3 views (73130) |
$106.79 |
$850 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$854.68 |
— |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$854.68 |
— |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$854.68 |
— |
1.2× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$473.30 |
— |
1.1× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$473.30 |
— |
1.1× |
| Heart Infarct Image (78466) |
$490.58 |
$900 |
1.2× |
| Heart infarct image w ef (78468) |
$666.30 |
$1,000 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,874.69 |
$5,500 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$666.30 |
$2,500 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$490.58 |
$2,000 |
1.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$678.05 |
— |
1.1× |
| Ht muscle image spect sing (78451) |
$1,588.72 |
$4,500 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$106.79 |
$700 |
1.2× |
| Hyperthermia ntrstl prb 5/< (77610) |
$678.05 |
— |
1.1× |
| Hysterosalpingogram (74740) |
$292.80 |
$1,400 |
1.1× |
| Image fusion (77399) |
$164.94 |
— |
1.1× |
| Interstitial radiation source applic complex (77778) |
$854.68 |
$2,300 |
1.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$854.68 |
— |
1.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$678.05 |
— |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$678.05 |
— |
1.1× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$9,038.28 |
— |
1.2× |
| Io rad tx deliver by elctrns (77425) |
$9,038.28 |
— |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$128.29 |
$330 |
1.1× |
| Kidney funcj study non-img radioisotopic study (78725) |
$490.58 |
— |
1.2× |
| Kidney imaging morphology (78700) |
$490.58 |
— |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$666.30 |
$1,250 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$666.30 |
$1,400 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$666.30 |
— |
1.2× |
| Knee 3 views (73562) |
$106.79 |
$700 |
1.2× |
| Liver & spleen imaging static only (78215) |
$490.58 |
$1,400 |
1.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$490.58 |
$1,400 |
1.2× |
| Liver imaging static only (78201) |
$666.30 |
$4,200 |
1.2× |
| Liver imaging w/vascular flow (78202) |
$666.30 |
$4,200 |
1.2× |
| Lung perf&ventilat diferentl (78598) |
$666.30 |
$1,400 |
1.2× |
| Lung perfusion differential (78597) |
$490.58 |
— |
1.2× |
| Lung Ventilation Imaging (78579) |
$490.58 |
$1,000 |
1.2× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$3,874.69 |
$6,000 |
1.2× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$769.79 |
$1,800 |
1.2× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$1,931.72 |
— |
1.2× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,874.69 |
— |
1.2× |
| Lymphoscintigraphy (78195) |
$666.30 |
$1,350 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$292.80 |
— |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$292.80 |
— |
1.1× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$106.79 |
— |
1.2× |
| Meckels Diverticulum (78290) |
$490.58 |
$1,400 |
1.2× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$457.92 |
— |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$459.48 |
— |
1.1× |
| Mr elastography (76391) |
$292.80 |
$800 |
1.1× |
| Mr safety determination physician/other qhp (76016) |
$106.79 |
$180 |
1.2× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$72.39 |
$1,300 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$35.49 |
$300 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$116.67 |
$1,300 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$292.80 |
$1,500 |
1.1× |
| MRA head w & w/o contrast (70546) |
$428.12 |
$4,200 |
1.1× |
| MRA head w/o contrast (70544) |
$292.80 |
$3,200 |
1.1× |
| MRA head with contrast (70545) |
$428.12 |
$2,700 |
1.1× |
| MRA neck w contrast (70548) |
$428.12 |
$2,700 |
1.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$428.12 |
$3,500 |
1.1× |
| MRA neck w/o contrast (70547) |
$292.80 |
$2,900 |
1.1× |
| MRI abdomen w contrast (74182) |
$428.12 |
$3,000 |
1.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$428.12 |
$5,300 |
1.1× |
| MRI abdomen w/o contrast (74181) |
$292.80 |
$3,300 |
1.1× |
| MRI any jnt lwr ext with con lt (73722) |
$961.98 |
$2,700 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$961.98 |
$3,000 |
1.1× |
| MRI bone marrow blood supply (77084) |
$292.80 |
— |
1.1× |
| MRI breast w/o contrast bilateral (77047) |
$292.80 |
$1,400 |
1.1× |
| MRI breast w/o contrast unilat (77046) |
$292.80 |
$1,400 |
1.1× |
| MRI c-spine with contrast (72142) |
$428.12 |
$6,500 |
1.1× |
| MRI cardiac w/o cont stress (75559) |
$670.53 |
$1,100 |
1.1× |
| MRI cardiac w/o contrast (75557) |
$292.80 |
$900 |
1.1× |
| MRI cervical spine w/o contrast (72141) |
$292.80 |
$5,500 |
1.1× |
| MRI chest w/o & w/contrast material (71552) |
$428.12 |
$2,700 |
1.1× |
| MRI chest w/o contrast (71550) |
$292.80 |
$2,200 |
1.1× |
| MRI chest with contrast (71551) |
$961.98 |
$1,800 |
1.1× |
| MRI fetal sngl/1st gestation (74712) |
$292.80 |
$1,100 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$428.12 |
$4,000 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$428.12 |
— |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$292.80 |
$3,200 |
1.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$292.80 |
$3,200 |
1.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$428.12 |
$4,800 |
1.1× |
| MRI orbit/face/neck w/contrast (70542) |
$428.12 |
— |
1.1× |
| MRI pelvis w contrast (72196) |
$428.12 |
— |
1.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$428.12 |
$5,500 |
1.1× |
| MRI pelvis w/o contrast (72195) |
$292.80 |
$3,200 |
1.1× |
| MRI scan of arm joint before and after contrast (73223) |
$428.12 |
$4,200 |
1.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$961.98 |
$2,700 |
1.1× |
| MRI scan of leg joint before and after contrast (73723) |
$428.12 |
$5,800 |
1.1× |
| MRI spectroscopy (76390) |
$106.79 |
$2,100 |
1.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$428.12 |
$10,000 |
1.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$428.12 |
$3,700 |
1.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$428.12 |
$6,400 |
1.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$428.12 |
$7,500 |
1.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$428.12 |
$7,000 |
1.1× |
| MRI thoracic spine w/o contrast (72146) |
$292.80 |
$5,200 |
1.1× |
| MRI tmj (70336) |
$292.80 |
$1,100 |
1.1× |
| MRI upper ext joint w/o contrast (73221) |
$292.80 |
$2,400 |
1.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$428.12 |
$5,000 |
1.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$292.80 |
$3,500 |
1.1× |
| Myelogram Cervical (72240) |
$961.98 |
$2,000 |
1.1× |
| Myelogram Lumbar (72265) |
$961.98 |
$2,100 |
1.1× |
| Myelogram thoracic (72255) |
$961.98 |
$2,000 |
1.1× |
| Myelography 2 or more regions (72270) |
$961.98 |
$1,800 |
1.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,588.72 |
— |
1.1× |
| Myocardial infarct spect (78469) |
$666.30 |
— |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,588.72 |
$5,500 |
1.1× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,754.75 |
— |
1.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,754.75 |
— |
1.1× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,703.14 |
— |
1.1× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,703.14 |
— |
1.1× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$1,862.35 |
— |
1.1× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,053.80 |
— |
1.1× |
| Neck soft tissue (70360) |
$106.79 |
$500 |
1.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$473.30 |
— |
1.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$490.58 |
$1,100 |
1.2× |
| Nm adrenal scan (78075) |
$1,588.72 |
$3,500 |
1.1× |
| Nm bone marrow multiple (78103) |
$490.58 |
$900 |
1.2× |
| Nm bone marrow wb (78104) |
$490.58 |
$950 |
1.2× |
| Nm cisternogram (78630) |
$666.30 |
$1,500 |
1.2× |
| Nm csf leak detection (78650) |
$1,588.72 |
$3,000 |
1.1× |
| Nm gastric emptying study (78264) |
$490.58 |
$1,900 |
1.2× |
| Nm gastroesophageal reflux study (78262) |
$490.58 |
$1,400 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$490.58 |
$1,300 |
1.2× |
| Nm red cell sequestration (78140) |
$490.58 |
— |
1.2× |
| Nm whole blood volume (78122) |
$666.30 |
— |
1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,698.53 |
— |
1.2× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$1,754.75 |
— |
1.1× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,588.72 |
— |
1.1× |
| Nuclear medicine of heart pumping function (78473) |
$490.58 |
$900 |
1.2× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$666.30 |
— |
1.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,754.75 |
$7,000 |
1.1× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$1,754.75 |
— |
1.1× |
| Nuclear medicine study of digestive tracts (78299) |
$490.58 |
— |
1.2× |
| Nuclear medicine study of endocrine organs (78099) |
$490.58 |
— |
1.2× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,588.72 |
— |
1.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$490.58 |
— |
1.2× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$490.58 |
$2,000 |
1.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$490.58 |
— |
1.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$490.58 |
— |
1.2× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$666.30 |
— |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$286.34 |
$1,100 |
1.2× |
| Nuclr Rx Interstit Colloid (79300) |
$286.34 |
— |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$128.29 |
$430 |
1.1× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$163.27 |
— |
1.2× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$128.29 |
$280 |
1.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$128.29 |
$390 |
1.1× |
| Orthopantogram (70355) |
$106.79 |
$360 |
1.2× |
| Osseous survey infant (77076) |
$128.29 |
— |
1.1× |
| Osseous survey limited (77074) |
$128.29 |
$350 |
1.1× |
| Parathyrd planar w/spect&CT (78072) |
$666.30 |
$900 |
1.2× |
| Parathyrd planar w/wo subtrj (78071) |
$490.58 |
— |
1.2× |
| Parathyroid imaging (78070) |
$490.58 |
$1,500 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$128.29 |
$700 |
1.1× |
| Perineogram (74775) |
$292.80 |
— |
1.1× |
| Peritoneogram rs&i (74190) |
$670.53 |
— |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$1,754.75 |
$7,500 |
1.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,754.75 |
$7,400 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,754.75 |
$8,000 |
1.1× |
| PET imaging limited area chest head/neck (78811) |
$1,588.72 |
$5,500 |
1.1× |
| PET whole body (78813) |
$1,754.75 |
$6,800 |
1.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,588.72 |
— |
1.1× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$1,588.72 |
— |
1.1× |
| Platelet survival study (78191) |
$490.58 |
— |
1.2× |
| Pr csf ventriculography (78635) |
$666.30 |
— |
1.2× |
| Pr gi endoscopic ultrasound (76975) |
$292.80 |
— |
1.1× |
| Pr heart first pass single,planar (78481) |
$666.30 |
— |
1.2× |
| Pr MRI brain w/ dye (70558) |
$215.24 |
— |
1.1× |
| Pr MRI brain w/o & w/ dye (70559) |
$215.24 |
— |
1.1× |
| Pr MRI brain w/o dye (70557) |
$670.53 |
— |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$428.12 |
$5,000 |
1.1× |
| Pr non-imaging heart function (78414) |
$666.30 |
— |
1.2× |
| Pr red cell survival study (78130) |
$490.58 |
— |
1.2× |
| Pr sono bone density measure,peripheral (76977) |
$128.29 |
— |
1.1× |
| Proton trmt simple w/comp (77522) |
$1,533.61 |
— |
1.1× |
| Proton tx delivery complex (77525) |
$1,533.61 |
— |
1.1× |
| Proton tx delivery intermediate (77523) |
$1,533.61 |
— |
1.1× |
| Proton tx delivery simple w/o compensation (77520) |
$678.05 |
— |
1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,874.69 |
$5,500 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,874.69 |
$2,800 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$490.58 |
$1,500 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$666.30 |
$1,500 |
1.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,141.67 |
— |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$670.53 |
$1,400 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$106.79 |
$750 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$128.29 |
$850 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$128.29 |
$680 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$128.29 |
$280 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$128.29 |
— |
1.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$9,038.28 |
— |
1.2× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$678.05 |
— |
1.1× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$125.21 |
— |
1.2× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$473.30 |
— |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128.29 |
$530 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$106.79 |
$380 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$128.29 |
$530 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$106.79 |
$500 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$215.24 |
$1,300 |
1.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$215.24 |
— |
1.1× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$292.80 |
— |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$215.24 |
$550 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$215.24 |
$700 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$106.79 |
$500 |
1.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$106.79 |
— |
1.2× |
| Radiological examination surgical specimen (76098) |
$670.53 |
$900 |
1.1× |
| Radiopharm Dacryocystography (78660) |
$490.58 |
— |
1.2× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$286.34 |
— |
1.2× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$286.34 |
$680 |
1.2× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$286.34 |
— |
1.2× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$490.58 |
— |
1.2× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$666.30 |
— |
1.2× |
| Review by radiologist of adrenal gland vein image (75840) |
$3,874.69 |
$5,900 |
1.2× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,874.69 |
$6,400 |
1.2× |
| Ribs bilateral 3 views (71110) |
$128.29 |
$700 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$490.58 |
$3,000 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$666.30 |
$5,000 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$666.30 |
$3,500 |
1.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,588.72 |
$4,000 |
1.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,754.75 |
$3,900 |
1.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,588.72 |
— |
1.1× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$286.34 |
$930 |
1.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$286.34 |
$1,300 |
1.2× |
| Rp Therapy Intravenous Administration (79101) |
$286.34 |
$930 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$128.29 |
$350 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$292.80 |
$900 |
1.1× |
| Salivary gland function study (78232) |
$490.58 |
$850 |
1.2× |
| Salivary gland imaging (78230) |
$490.58 |
$850 |
1.2× |
| Salivary gland imaging serial images (78231) |
$490.58 |
$850 |
1.2× |
| Scanogram (77073) |
$128.29 |
$600 |
1.1× |
| Scapula complete (73010) |
$128.29 |
$750 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$76.18 |
$120 |
3.3× |
| Sella turcica (70240) |
$106.79 |
— |
1.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$128.29 |
$450 |
1.1× |
| Sialogram (70390) |
$292.80 |
$630 |
1.1× |
| Simulation intermediate (77285) |
$459.48 |
— |
1.1× |
| Small bowel series (74250) |
$215.24 |
$1,000 |
1.1× |
| Spec medical radj physics consltj (77370) |
$164.94 |
$490 |
1.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$459.48 |
— |
1.1× |
| Special dosimetry (77331) |
$164.94 |
— |
1.1× |
| Special treatment procedure (77470) |
$678.05 |
— |
1.1× |
| Speech evaluation complex (70371) |
$292.80 |
— |
1.1× |
| Spine thoracic 3 views (72072) |
$128.29 |
$430 |
1.1× |
| Spleen imaging only (78185) |
$490.58 |
$850 |
1.2× |
| Splenoportograpy rs&i (75810) |
$3,874.69 |
$5,500 |
1.2× |
| Stereotactic body radiation delivery (77373) |
$2,194.20 |
— |
1.2× |
| Superior sagittal sinus venogram (75870) |
$3,874.69 |
$1,900 |
1.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$125.21 |
— |
1.2× |
| Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction 2nd-5th Sessions (77438) |
$125.21 |
— |
1.2× |
| Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting 2nd-5th… (77436) |
$45.84 |
— |
1.2× |
| Surface radiation therapy; superficial, delivery, </=150 kV, per fraction (eg, electronic brachytherapy) 2nd-5th… (77437) |
$125.21 |
— |
1.2× |
| Tbs Technical Calculation Only (77091) |
$106.79 |
— |
1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$459.48 |
— |
1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$459.48 |
— |
1.1× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$292.80 |
— |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$490.58 |
$900 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$459.48 |
— |
1.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$164.94 |
— |
1.1× |
| Therapeutic Enema (74283) |
$215.24 |
$800 |
1.1× |
| Thoracolumbar 2 views (72080) |
$106.79 |
$700 |
1.2× |
| Thyroid carcinoma metastases img addl study (78016) |
$490.58 |
— |
1.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$666.30 |
$2,500 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$490.58 |
$1,200 |
1.2× |
| Thyroid uptake measurement (78012) |
$490.58 |
$1,500 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$490.58 |
$1,600 |
1.2× |
| Tmj unilateral (70328) |
$106.79 |
— |
1.2× |
| Tomogram (76100) |
$128.29 |
— |
1.1× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$106.79 |
— |
1.2× |
| Treatment device intermediate (77333) |
$164.94 |
— |
1.1× |
| Treatment devices simple (77332) |
$164.94 |
— |
1.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$666.30 |
$4,200 |
1.2× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$490.58 |
$2,000 |
1.2× |
| Tx devices design & construction complex (77334) |
$459.48 |
— |
1.1× |
| Ultrasound elastography first target lesion (76982) |
$128.29 |
$350 |
1.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$35.49 |
$60 |
1.2× |
| Ultrasound scan to determine eye length and lens power (76519) |
$128.29 |
$380 |
1.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$428.12 |
$550 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$128.29 |
$900 |
1.1× |
| Umbilical-artery Doppler (OB) (76820) |
$128.29 |
$300 |
1.1× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$490.58 |
— |
1.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$106.79 |
$180 |
1.2× |
| Unlisted fluoroscopic procedure (76496) |
$106.79 |
$250 |
1.2× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$490.58 |
— |
1.2× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$490.58 |
— |
1.2× |
| Unlisted magnetic resonance procedure (76498) |
$106.79 |
— |
1.2× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$490.58 |
— |
1.2× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$490.58 |
— |
1.2× |
| Unlisted nervous system procedure, diagnostic nuclear medicine UNSCHEDULED (78699) |
$490.58 |
— |
1.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$125.21 |
— |
1.2× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$164.94 |
— |
1.1× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$490.58 |
— |
1.2× |
| Unlisted Ultrasound Procedure (76999) |
$106.79 |
— |
1.2× |
| Upper Extremity Infant (73092) |
$128.29 |
$500 |
1.1× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$108.57 |
— |
1.1× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$490.58 |
— |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$292.80 |
$1,000 |
1.1× |
| Urethrocystography voiding (74455) |
$292.80 |
$1,100 |
1.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$215.24 |
$630 |
1.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$215.24 |
— |
1.1× |
| Us abdl aorta screen aaa (76706) |
$128.29 |
$1,100 |
1.1× |
| Us breast unilateral complete (76641) |
$128.29 |
$950 |
1.1× |
| Us breast unilateral limited (76642) |
$106.79 |
$800 |
1.2× |
| Us chest (76604) |
$128.29 |
$680 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$128.29 |
$900 |
1.1× |
| Us elastography parenchyma (76981) |
$128.29 |
$400 |
1.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$128.29 |
$500 |
1.1× |
| Us guided compression repair (76936) |
$264.97 |
— |
1.1× |
| Us infant hips dynamic (76885) |
$106.79 |
$550 |
1.2× |
| Us infant hips limited static (76886) |
$106.79 |
$480 |
1.2× |
| Us kidney transplant (76776) |
$128.29 |
— |
1.1× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$128.29 |
— |
1.1× |
| Us ob detailed single fetus (76811) |
$292.80 |
$800 |
1.1× |
| Us ob transvaginal (76817) |
$128.29 |
$950 |
1.1× |
| Us pelvic non ob complete (76856) |
$128.29 |
$1,800 |
1.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$128.29 |
$1,100 |
1.1× |
| Us pregnancy ltd (76815) |
$128.29 |
$530 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$128.29 |
$830 |
1.1× |
| Us retroperitoneal complete (76770) |
$128.29 |
$1,200 |
1.1× |
| Us retroperitoneal limited (76775) |
$128.29 |
$950 |
1.1× |
| Us scrotum and contents (76870) |
$128.29 |
$1,100 |
1.1× |
| Us soft tissue head/neck (76536) |
$128.29 |
$1,400 |
1.1× |
| Us spinal canal and contents (76800) |
$128.29 |
$450 |
1.1× |
| Us transrectal (76872) |
$128.29 |
$430 |
1.1× |
| Us transrectal prostate volume (76873) |
$128.29 |
— |
1.1× |
| Us xtr non-vasc lmtd (76882) |
$128.29 |
$550 |
1.1× |
| Us, eye b-scan (76512) |
$128.29 |
$330 |
1.1× |
| Use of body cavity probe generated heat to increase temperature of cancer cell (77620) |
$678.05 |
— |
1.1× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$473.30 |
— |
1.1× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$854.68 |
— |
1.2× |
| Use of interstitial probe generated heat to increase temperature of cancer cell, more than 5 probes (77615) |
$678.05 |
— |
1.1× |
| Vascular flow imaging (78445) |
$490.58 |
$900 |
1.2× |
| Vasogram (74440) |
$292.80 |
— |
1.1× |
| Venogram extremity bilateral (75822) |
$1,931.72 |
$2,700 |
1.2× |
| Venogram orbital (75880) |
$769.79 |
$5,000 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$3,874.69 |
$6,000 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$1,931.72 |
$2,300 |
1.2× |
| Venography epidural rs&i (75872) |
$769.79 |
$5,600 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$1,931.72 |
$2,500 |
1.2× |
| Venography Renal Bilateral (75833) |
$3,874.69 |
$7,000 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,874.69 |
$6,000 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,874.69 |
$6,000 |
1.2× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$6,828.43 |
$10,500 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$106.79 |
— |
1.2× |
| Wrist 2 views (73100) |
$106.79 |
$700 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$128.29 |
$800 |
1.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$106.79 |
$500 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$106.79 |
$900 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$215.24 |
$1,300 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$106.79 |
$730 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$106.79 |
$850 |
1.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$128.29 |
— |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$106.79 |
$530 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106.79 |
$600 |
1.2× |
| X-ray exam hip uni 4/> views (73503) |
$128.29 |
— |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$128.29 |
$750 |
1.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$128.29 |
— |
1.1× |
| X-ray exam of femur 1 (73551) |
$106.79 |
$500 |
1.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$215.24 |
$1,100 |
1.1× |
| X-ray eye for foreign body (70030) |
$106.79 |
$350 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$128.29 |
$880 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$106.79 |
$850 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$106.79 |
$680 |
1.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,565.20 |
$3,800 |
1.1× |
| X-ray head for orthodontia (70350) |
$106.79 |
— |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$106.79 |
$600 |
1.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$215.24 |
$680 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$106.79 |
— |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$128.29 |
$700 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$106.79 |
$630 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$106.79 |
$650 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$128.29 |
$800 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$128.29 |
$1,200 |
1.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$128.29 |
$850 |
1.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$106.79 |
$550 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$106.79 |
$500 |
1.2× |
| X-ray of voice box or throat (70370) |
$106.79 |
— |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$128.29 |
$580 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$128.29 |
$750 |
1.1× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$670.53 |
— |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$428.12 |
$1,300 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$106.79 |
$350 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$128.29 |
$750 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$128.29 |
$850 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$128.29 |
$900 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$106.79 |
$600 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$106.79 |
$800 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$106.79 |
$950 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$106.79 |
$680 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$128.29 |
$1,000 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$128.29 |
$700 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$106.79 |
$600 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$106.79 |
$400 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$106.79 |
$380 |
1.2× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$106.79 |
— |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$128.29 |
$450 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$128.29 |
— |
1.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$106.79 |
$500 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$106.79 |
$880 |
1.2× |
| Xr arthrogram ankle (73615) |
$428.12 |
$1,400 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$128.29 |
$1,400 |
1.1× |
| Xr chest 4+ views (71048) |
$128.29 |
$500 |
1.1× |
| Xr Cholecystography Oral Contrast (74290) |
$215.24 |
— |
1.1× |
| Xr finger(s) 2+ views (73140) |
$106.79 |
$750 |
1.2× |
| Xr internal auditory meati complete (70134) |
$670.53 |
— |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$128.29 |
$330 |
1.1× |
| Xr myelogram posterior fossa (70010) |
$428.12 |
— |
1.1× |
| Xr optic foramina (70190) |
$106.79 |
$300 |
1.2× |
| Xr shoulder 1 view (73020) |
$106.79 |
$630 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$128.29 |
$1,250 |
1.1× |
| Xr tibia/fibula 2 views (73590) |
$106.79 |
$800 |
1.2× |
| Xr tmj bilateral (70330) |
$106.79 |
$680 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$106.79 |
$650 |
1.2× |