| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,399.69 |
$14,593.75 |
3.7× |
| Abdomen 2 views (74019) |
$174.46 |
$471.50 |
1.6× |
| Acute gi blood loss imaging (78278) |
$1,550.95 |
$4,191.75 |
3.7× |
| Angiography extremity bilateral rs&i (75716) |
$1,990.79 |
$5,380.50 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,729.01 |
$4,673 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$1,745.20 |
$4,716.75 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,832.61 |
$4,953 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,192.25 |
$5,925 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$907.06 |
$2,451.50 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$401.91 |
$1,086.25 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,320.35 |
$3,568.50 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,712.50 |
$4,628.38 |
0.5× |
| Ankle 2 views (73600) |
$191.48 |
$517.50 |
2.1× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,767.68 |
$4,777.50 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,235.43 |
$3,339 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,281.31 |
$3,463 |
0.4× |
| Basic dosimetry (77300) |
$750.73 |
$2,029 |
5.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,436.06 |
$3,881.25 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$1,665.83 |
$4,502.25 |
4.0× |
| Bone age studies (77072) |
$165.02 |
$446 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,550.95 |
$4,191.75 |
3.7× |
| Bone Marrow Imaging Limited Area (78102) |
$1,550.95 |
$4,191.75 |
3.7× |
| Bone survey complete (77075) |
$551.58 |
$1,490.75 |
5.1× |
| Bone survey infant (77076) |
$610.87 |
$1,651 |
5.6× |
| Bowel imaging (78290) |
$1,550.95 |
$4,191.75 |
3.7× |
| Brachytx isodose complex (77318) |
$4,042.44 |
$10,925.50 |
10.3× |
| Brachytx isodose intermed (77317) |
$3,537.11 |
$9,559.75 |
9.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,938.82 |
$7,942.75 |
7.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,550.95 |
$4,191.75 |
2.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$999 |
$2,700 |
2.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,274.98 |
$3,445.88 |
3.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$761.46 |
$2,058 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$234.77 |
$634.50 |
2.6× |
| Chest 1 view (71045) |
$130.98 |
$354 |
1.4× |
| Chest xray 3 views (71047) |
$156.60 |
$423.25 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$216.82 |
$586 |
1.2× |
| Clavicle complete (73000) |
$179.64 |
$485.50 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$647.32 |
$1,749.50 |
5.9× |
| Continuing medical physics consltj pr wk (77336) |
$707.81 |
$1,913 |
5.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$738.98 |
$1,997.25 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$647.32 |
$1,749.50 |
2.6× |
| CT abdomen w contrast (74160) |
$647.32 |
$1,749.50 |
3.5× |
| CT abdomen w wo contrast (74170) |
$693.10 |
$1,873.25 |
3.8× |
| CT abdomen w/o contrast (74150) |
$601.44 |
$1,625.50 |
5.5× |
| CT angio hrt w/3d image (75574) |
$647.32 |
$1,749.50 |
1.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$647.32 |
$1,749.50 |
3.5× |
| CT angiography upper extremity lt (73206) |
$647.32 |
$1,749.50 |
3.5× |
| CT c-spine w/contrast (72126) |
$693.10 |
$1,873.25 |
1.9× |
| CT c-spine w/o contrast (72125) |
$647.32 |
$1,749.50 |
5.9× |
| CT cervical spine w&w/o contrast (72127) |
$785.70 |
$2,123.50 |
4.3× |
| CT chest w contrast (71260) |
$693.10 |
$1,873.25 |
3.8× |
| CT chest w/wo contrast (71270) |
$738.98 |
$1,997.25 |
4.0× |
| CT head/brain with contrast (70460) |
$722.43 |
$1,952.50 |
3.9× |
| CT head/brain without and with contrast (70470) |
$768.31 |
$2,076.50 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$647.32 |
$1,749.50 |
1.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$38.85 |
$105 |
0.4× |
| CT iac w contrast (70481) |
$624.28 |
$1,687.25 |
3.4× |
| CT lower ext w/o (73700) |
$555.56 |
$1,501.50 |
5.1× |
| CT lower extremity w wo contrast (73702) |
$647.32 |
$1,749.50 |
3.5× |
| CT lower extremity w/contrast material (73701) |
$601.44 |
$1,625.50 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$693.10 |
$1,873.25 |
3.8× |
| CT lumbar spine w/contrast (72132) |
$647.32 |
$1,749.50 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$601.44 |
$1,625.50 |
5.5× |
| CT maxillofacial w contrast (70487) |
$647.32 |
$1,749.50 |
3.5× |
| CT maxillofacial w/wo contrast (70488) |
$693.10 |
$1,873.25 |
3.8× |
| CT maxillofacial wo contrast (70486) |
$601.44 |
$1,625.50 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$670.16 |
$1,811.25 |
3.7× |
| CT orbits w/o contrast (70480) |
$578.40 |
$1,563.25 |
5.3× |
| CT pelvis w/o contrast (72192) |
$624.28 |
$1,687.25 |
5.7× |
| CT pelvis w/wo contrast (72194) |
$716.04 |
$1,935.25 |
3.9× |
| CT scan of arm combo (73202) |
$693.10 |
$1,873.25 |
3.8× |
| CT soft tissue neck w contrast (70491) |
$647.32 |
$1,749.50 |
3.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$693.10 |
$1,873.25 |
3.8× |
| CT soft tissue neck w/o contrast (70490) |
$601.44 |
$1,625.50 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$624.28 |
$1,687.25 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$578.40 |
$1,563.25 |
5.3× |
| CT thoracic spine w/wo contrast (72130) |
$670.16 |
$1,811.25 |
3.7× |
| CT thorax w/o contrast (71250) |
$647.32 |
$1,749.50 |
5.9× |
| CT upper ext wo (73200) |
$601.44 |
$1,625.50 |
5.5× |
| CT upper extremity with contrast (73201) |
$647.32 |
$1,749.50 |
1.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Abdomen (74175) |
$647.32 |
$1,749.50 |
3.5× |
| CTA abdomen pelvis (74174) |
$647.32 |
$1,749.50 |
1.8× |
| CTA chest (71275) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Head (70496) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Neck (70498) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Pelvis (72191) |
$647.32 |
$1,749.50 |
3.5× |
| Cystography minimum 3 views rs&i (74430) |
$366.02 |
$989.25 |
1.0× |
| Diskography lumbar (72295) |
$2,805.80 |
$7,583.25 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$250.40 |
$676.75 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$145.88 |
$394.25 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$245.68 |
$664 |
2.3× |
| Esophagus (74220) |
$419.77 |
$1,134.50 |
2.3× |
| Facial bones min 3 views (70150) |
$163.26 |
$441.25 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$531.23 |
$1,435.75 |
4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$640.38 |
$1,730.75 |
5.9× |
| Fluoroscopy up to 1 hr (76000) |
$248.27 |
$671 |
1.0× |
| Foot 2 views (73620) |
$194.90 |
$526.75 |
2.1× |
| Forearm 2 views (73090) |
$185.37 |
$501 |
2.0× |
| Hand 2 views (73120) |
$189.53 |
$512.25 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$6,587.85 |
$17,805 |
9.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,901.89 |
$18,653.75 |
9.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$7,228.51 |
$19,536.50 |
9.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,359.25 |
$11,781.75 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,148.57 |
$3,104.25 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,550.95 |
$4,191.75 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,550.95 |
$4,191.75 |
3.7× |
| Hysterosalpingogram (74740) |
$665.50 |
$1,798.62 |
2.7× |
| Interstitial radiation source applic complex (77778) |
$4,118.29 |
$11,130.50 |
5.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,550.95 |
$4,191.75 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,550.95 |
$4,191.75 |
2.7× |
| Knee 3 views (73562) |
$235.51 |
$636.50 |
2.6× |
| Liver & spleen imaging static only (78215) |
$1,550.95 |
$4,191.75 |
3.7× |
| Lung perfusion differential (78597) |
$1,550.95 |
$4,191.75 |
3.7× |
| Lymphoscintigraphy (78195) |
$1,550.95 |
$4,191.75 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$622.25 |
$1,681.75 |
0.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,101.40 |
$2,976.75 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$622.25 |
$1,681.75 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$916.68 |
$2,477.50 |
2.3× |
| Mr safety determination physician/other qhp (76016) |
$156.42 |
$422.75 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$135.88 |
$367.25 |
1.4× |
| MRA head w & w/o contrast (70546) |
$638.34 |
$1,725.25 |
1.8× |
| MRA head w/o contrast (70544) |
$574.06 |
$1,551.50 |
2.3× |
| MRA neck w contrast (70548) |
$590.15 |
$1,595 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$622.25 |
$1,681.75 |
1.7× |
| MRA neck w/o contrast (70547) |
$558.05 |
$1,508.25 |
2.2× |
| MRI abdomen w contrast (74182) |
$590.15 |
$1,595 |
1.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$622.25 |
$1,681.75 |
1.7× |
| MRI abdomen w/o contrast (74181) |
$558.05 |
$1,508.25 |
2.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$622.25 |
$1,681.75 |
0.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$654.35 |
$1,768.50 |
1.8× |
| MRI breast w/o contrast bilateral (77047) |
$566.01 |
$1,529.75 |
2.3× |
| MRI c-spine with contrast (72142) |
$574.06 |
$1,551.50 |
1.6× |
| MRI cardiac w/o contrast (75557) |
$388.59 |
$1,050.25 |
1.6× |
| MRI cervical spine w/o contrast (72141) |
$558.05 |
$1,508.25 |
2.2× |
| MRI chest w/o & w/contrast material (71552) |
$654.35 |
$1,768.50 |
1.8× |
| MRI chest w/o contrast (71550) |
$590.15 |
$1,595 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$622.25 |
$1,681.75 |
1.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$654.35 |
$1,768.50 |
1.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$590.15 |
$1,595 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$525.86 |
$1,421.25 |
2.1× |
| MRI orbit face neck w contrast (70542) |
$558.05 |
$1,508.25 |
1.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$590.15 |
$1,595 |
1.6× |
| MRI pelvis w/contrast (72196) |
$720.02 |
$1,946 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$590.15 |
$1,595 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$525.86 |
$1,421.25 |
2.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$606.15 |
$1,638.25 |
1.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$622.25 |
$1,681.75 |
1.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$654.35 |
$1,768.50 |
1.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$590.15 |
$1,595 |
1.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$622.25 |
$1,681.75 |
1.7× |
| MRI temporomandibular joint (70336) |
$675.80 |
$1,826.50 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$558.05 |
$1,508.25 |
2.2× |
| MRI up ext w/o contrast (73218) |
$558.05 |
$1,508.25 |
2.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,136.27 |
$3,071 |
4.6× |
| MRI, joint upper extrem combo (73223) |
$654.35 |
$1,768.50 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,036 |
$2,800 |
0.8× |
| Myocardial spect single study at rest or stress (78451) |
$962 |
$2,600 |
0.7× |
| N-invas est c ffr sw aly CTA (75580) |
$1,210.55 |
$3,271.76 |
1.3× |
| Neck soft tissue (70360) |
$159.38 |
$430.75 |
1.8× |
| Nm cisternogram (78630) |
$1,550.95 |
$4,191.75 |
2.7× |
| Nm gastric emptying study (78264) |
$1,550.95 |
$4,191.75 |
3.7× |
| Nm peritoneal-venous shunt patency (78291) |
$752.49 |
$2,033.75 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$199.25 |
$538.50 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,017.96 |
$16,264.75 |
4.2× |
| Nuclear Rx Oral Admin (79005) |
$1,550.95 |
$4,191.75 |
6.4× |
| Orthopantogram (70355) |
$145.13 |
$392.25 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$1,550.95 |
$4,191.75 |
3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,723.28 |
$4,657.50 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$150.50 |
$406.75 |
1.4× |
| Peritoneogram after injection (74190) |
$466.11 |
$1,259.75 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$1,998 |
$5,400 |
1.3× |
| PET imaging CT for attenuation limited area (78814) |
$1,979.50 |
$5,350 |
1.3× |
| PET imaging for CT attenuation whole body (78816) |
$2,016.50 |
$5,450 |
1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,453.01 |
$6,629.75 |
0.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$975.97 |
$2,637.75 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,550.95 |
$4,191.75 |
3.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,550.95 |
$4,191.75 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$507.55 |
$1,371.75 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$206.83 |
$559 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$181.12 |
$489.50 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$145.50 |
$393.25 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$130.98 |
$354 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$186.57 |
$504.25 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$156.60 |
$423.25 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$197.03 |
$532.50 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$199.15 |
$538.25 |
2.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$159.47 |
$431 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$191.48 |
$517.50 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$203.41 |
$549.75 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$222.83 |
$602.25 |
2.0× |
| Radex Humerus Minimum 2 Views (73060) |
$157.53 |
$425.75 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$210.62 |
$569.25 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$275.74 |
$745.25 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$206.46 |
$558 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$215.62 |
$582.75 |
2.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$148.37 |
$401 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$210.90 |
$570 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$169.09 |
$457 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$448.16 |
$1,211.25 |
4.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$148.46 |
$401.25 |
1.6× |
| Radex Toe Minimum 2 Views (73660) |
$130.98 |
$354 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$109.80 |
$296.75 |
1.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$220.24 |
$595.25 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$299.79 |
$810.25 |
2.7× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$41,814.81 |
$113,013 |
5.4× |
| Radiation treatment delivery level 1 (77402) |
$622.53 |
$1,682.50 |
5.8× |
| Radiation treatment delivery level 2 (77407) |
$663.60 |
$1,793.50 |
1.6× |
| Radiation treatment delivery level 3 (77412) |
$759.33 |
$2,052.25 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$162.99 |
$440.50 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$185.93 |
$502.50 |
1.7× |
| Radiologic exam chest 2 views (71046) |
$141.90 |
$383.50 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$538.17 |
$1,454.50 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$581.27 |
$1,571 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$114.89 |
$310.50 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$215.53 |
$582.50 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$173.72 |
$469.50 |
1.6× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$227.83 |
$615.75 |
2.1× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$2,260.89 |
$6,110.50 |
9.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$883.10 |
$2,386.75 |
2.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$588.49 |
$1,590.50 |
1.5× |
| Ribs bilateral 3 views (71110) |
$240.87 |
$651 |
2.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$765.62 |
$2,069.25 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,493.51 |
$4,036.50 |
3.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,608.39 |
$4,347 |
2.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,608.39 |
$4,347 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,227.76 |
$3,318.25 |
2.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,064.53 |
$8,282.50 |
2.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$403.39 |
$1,090.25 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$141.62 |
$382.75 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$460.93 |
$1,245.75 |
1.8× |
| Scapula (73010) |
$221.72 |
$599.25 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$76.04 |
$205.50 |
3.3× |
| Shoulder 1 view (73020) |
$110.08 |
$297.50 |
1.2× |
| Simulation intermediate (77285) |
$1,330.71 |
$3,596.50 |
3.4× |
| Small bowel series (74250) |
$480.17 |
$1,297.75 |
2.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,705.52 |
$4,609.50 |
4.4× |
| Special dosimetry (77331) |
$750.73 |
$2,029 |
5.3× |
| Special Physics Consult (77370) |
$707.81 |
$1,913 |
5.0× |
| Special treatment procedure (77470) |
$2,882.21 |
$7,789.75 |
5.0× |
| Spine thoracic 3 views (72072) |
$143.56 |
$388 |
1.3× |
| Stereotactic Body Radiation Delivery (77373) |
$3,575.50 |
$9,663.50 |
1.9× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$150.82 |
$407.62 |
1.7× |
| Tbs technical calculation only (77091) |
$150.82 |
$407.62 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,404.45 |
$6,498.50 |
6.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,469.46 |
$3,971.50 |
3.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,530.32 |
$4,136 |
3.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$673.77 |
$1,821 |
4.8× |
| Thoracolumbar 2 views (72080) |
$158.27 |
$427.75 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,665.83 |
$4,502.25 |
2.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,550.95 |
$4,191.75 |
3.7× |
| Treatment device complex (77334) |
$1,151.53 |
$3,112.25 |
2.9× |
| Treatment device intermediate (77333) |
$1,071.06 |
$2,894.75 |
7.6× |
| Treatment devices simple (77332) |
$1,001.22 |
$2,706 |
7.1× |
| Ultrasound breast complete (76641) |
$377.40 |
$1,020 |
3.5× |
| Ultrasound Exam Aaa Screen (76706) |
$173.62 |
$469.25 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$875.70 |
$2,366.75 |
8.0× |
| Umbilical-artery Doppler (OB) (76820) |
$452.33 |
$1,222.50 |
4.1× |
| Unlisted magnetic resonance procedure (76498) |
$590.15 |
$1,595 |
6.5× |
| Urethrocystogram voiding (74455) |
$432.81 |
$1,169.75 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$370 |
$1,000 |
1.5× |
| Us breast unilateral limited (76642) |
$333 |
$900 |
3.7× |
| Us chest (76604) |
$444.56 |
$1,201.50 |
4.1× |
| Us compl joint r-t w/image documentation (76881) |
$693.29 |
$1,873.75 |
6.4× |
| Us encephalogram (76506) |
$659.80 |
$1,783.25 |
6.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$684.22 |
$1,849.25 |
6.3× |
| Us ob limited (76815) |
$294.02 |
$794.62 |
2.7× |
| Us ob transvaginal (76817) |
$473.65 |
$1,280.12 |
4.3× |
| Us pelvic non ob complete (76856) |
$762.76 |
$2,061.50 |
7.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$429.66 |
$1,161.25 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$467.68 |
$1,264 |
4.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$247.07 |
$667.75 |
2.3× |
| Us retroperitoneal complete (76770) |
$565.36 |
$1,528 |
5.2× |
| Us retroperitoneal limited (76775) |
$444.56 |
$1,201.50 |
4.1× |
| Us scrotum and contents (76870) |
$632.61 |
$1,709.75 |
5.8× |
| Us soft tissue head/neck (76536) |
$656.01 |
$1,773 |
6.0× |
| Us transrectal (76872) |
$750.36 |
$2,028 |
6.9× |
| Us transrectal prostate volume (76873) |
$1,963.78 |
$5,307.50 |
18.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$513.93 |
$1,389 |
4.7× |
| Venogram extremity bilateral (75822) |
$590.24 |
$1,595.25 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$581.83 |
$1,572.50 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,115.09 |
$3,013.75 |
0.3× |
| Venography caval superior serialography rs&i (75827) |
$1,312.11 |
$3,546.25 |
0.8× |
| Venography Renal Bilateral (75833) |
$4,043.45 |
$10,928.25 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$4,043.45 |
$10,928.25 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,854.36 |
$7,714.50 |
0.9× |
| Venous sampling by catheter (75893) |
$3,420.70 |
$9,245.12 |
0.6× |
| Wrist 2 views (73100) |
$210.62 |
$569.25 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$230.33 |
$622.50 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$948.87 |
$2,564.50 |
5.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.24 |
$352 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$175.38 |
$474 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$212.57 |
$574.50 |
1.9× |
| X-ray exam of femur 2/> (73552) |
$227.83 |
$615.75 |
2.5× |
| X-ray eye for foreign body (70030) |
$130.98 |
$354 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$743.33 |
$2,009 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$149.57 |
$404.25 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$189.16 |
$511.25 |
2.1× |
| X-ray leg, infant (73592) |
$110.08 |
$297.50 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$261.78 |
$707.50 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$474.43 |
$1,282.25 |
4.3× |
| X-ray nose-rectum child f.b. (76010) |
$159.75 |
$431.75 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$144.49 |
$390.50 |
1.3× |
| X-ray retrograde pyelogram (74420) |
$555.83 |
$1,502.25 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$267.23 |
$722.25 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$272.04 |
$735.25 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$396.83 |
$1,072.50 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$166.04 |
$448.75 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$210.72 |
$569.50 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$213.68 |
$577.50 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$241.80 |
$653.50 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$245.59 |
$663.75 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$207.29 |
$560.25 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$124.51 |
$336.50 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$148.83 |
$402.25 |
1.4× |
| Xr bone length studies (77073) |
$218.86 |
$591.50 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$352.33 |
$952.25 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$382.95 |
$1,035 |
3.5× |
| Xr chest 4+ views (71048) |
$171.40 |
$463.25 |
1.6× |
| Xr urogram antegrade (74425) |
$588.49 |
$1,590.50 |
1.6× |