| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,262.22 |
$5,412 |
1.5× |
| Abdomen 2 views (74019) |
$137.98 |
$539 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$476.03 |
$1,943 |
1.1× |
| Acute venous thrombus image (78456) |
$517.19 |
$2,111 |
0.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,082.55 |
$4,262 |
0.3× |
| Angiography extremity bilateral rs&i (75716) |
$2,136.90 |
$8,413 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$2,062.23 |
$8,119 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$755.65 |
$2,975 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,527.05 |
$6,012 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,424.94 |
$5,610 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,268.22 |
$4,993 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,484.63 |
$5,845 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$1,963.93 |
$7,732 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$550.67 |
$2,168 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,250.44 |
$4,923 |
0.4× |
| Ankle 2 views (73600) |
$86.78 |
$339 |
0.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$346.37 |
$1,353 |
0.9× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,292.61 |
$5,089 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,471.17 |
$5,792 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,250.44 |
$4,923 |
0.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,603.25 |
$6,312 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$1,002.03 |
$3,945 |
0.3× |
| Arthrogram elbow (73085) |
$345.98 |
$1,101 |
0.9× |
| Arthrogram hip (73525) |
$389.66 |
$1,240 |
1.0× |
| Arthrogram shoulder (73040) |
$345.98 |
$1,101 |
0.9× |
| Arthrogram wrist (73115) |
$342.52 |
$1,090 |
0.9× |
| Arthrography knee lt (73580) |
$345.98 |
$1,101 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$235.33 |
$563 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$444.92 |
$1,816 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$653.66 |
$2,668 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$888.12 |
$3,625 |
2.1× |
| Bone age studies (77072) |
$85.25 |
$333 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,021.40 |
$4,169 |
2.4× |
| Bone Marrow Imaging Limited Area (78102) |
$389.55 |
$1,590 |
0.9× |
| Bone survey complete (77075) |
$140.54 |
$549 |
1.3× |
| Brachytx isodose complex (77318) |
$888.25 |
$2,125 |
2.2× |
| Brachytx isodose intermed (77317) |
$657.10 |
$1,572 |
1.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$425.94 |
$1,019 |
1.1× |
| Brain image w/flow 4 + views (78606) |
$566.93 |
$2,314 |
1.0× |
| Brain imaging < 4 static views w vascular flow (78601) |
$299.39 |
$1,222 |
0.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$272.20 |
$1,111 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,180.70 |
$4,704 |
0.8× |
| Brain Imaging Vascular Flow Only (78610) |
$323.89 |
$1,322 |
0.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$307.23 |
$1,254 |
0.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$534.57 |
$2,595 |
1.4× |
| Cardiac shunt detection (78428) |
$285.92 |
$1,167 |
0.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$369.95 |
$1,510 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$94.72 |
$370 |
1.0× |
| Chest 1 view (71045) |
$60.93 |
$272 |
0.7× |
| Chest 3 views (71047) |
$81.98 |
$366 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$158.46 |
$619 |
0.8× |
| Cineradiography/videoradiography (76120) |
$579.58 |
$2,264 |
5.2× |
| Cisternography Positive Contrast Rs&I (70015) |
$375.81 |
$1,468 |
0.4× |
| Clavicle complete (73000) |
$81.92 |
$320 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$90.13 |
$467 |
0.8× |
| Continuing medical physics consltj pr wk (77336) |
$315.59 |
$755 |
2.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$131.33 |
$513 |
0.7× |
| Corpora cavernosography (74445) |
$209.41 |
$818 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$733.40 |
$3,800 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$488.87 |
$2,533 |
1.9× |
| CT abdomen w contrast (74160) |
$429.42 |
$2,225 |
2.3× |
| CT abdomen w wo contrast (74170) |
$515.31 |
$2,670 |
2.8× |
| CT abdomen w/o contrast (74150) |
$343.54 |
$1,780 |
3.1× |
| CT angio hrt w/3d image (75574) |
$486.75 |
$2,509 |
1.3× |
| CT angiography upper extremity lt (73206) |
$523.61 |
$2,713 |
2.8× |
| CT c-spine w/o contrast (72125) |
$509.91 |
$2,642 |
4.6× |
| CT cervical spine w&w/o contrast (72127) |
$764.86 |
$3,963 |
4.1× |
| CT cervical spine with contrast (72126) |
$637.48 |
$3,303 |
1.7× |
| CT chest w/wo contrast (71270) |
$679.55 |
$3,521 |
3.6× |
| CT chest with contrast (71260) |
$566.26 |
$2,934 |
3.0× |
| CT head/brain with contrast (70460) |
$396.44 |
$2,033 |
2.1× |
| CT head/brain without and with contrast (70470) |
$475.60 |
$2,439 |
2.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$442.90 |
$2,283 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$502.07 |
$2,588 |
5.4× |
| CT iac w contrast (70481) |
$464.49 |
$2,382 |
2.5× |
| CT limited/localized follow up study (76380) |
$113.68 |
$586 |
1.2× |
| CT lower ext w/o (73700) |
$314.98 |
$1,632 |
2.8× |
| CT lower extremity w wo contrast (73702) |
$472.46 |
$2,448 |
2.5× |
| CT lower extremity with contrast (73701) |
$393.72 |
$2,040 |
2.1× |
| CT lumbar spine w & w/o contrast (72133) |
$750.77 |
$3,890 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$500.45 |
$2,593 |
4.5× |
| CT lumbar spine with contrast (72132) |
$625.71 |
$3,242 |
1.7× |
| CT maxillofacial w contrast (70487) |
$371.28 |
$1,904 |
2.0× |
| CT maxillofacial w/o contrast (70486) |
$296.98 |
$1,523 |
2.7× |
| CT maxillofacial w/wo contrast (70488) |
$445.58 |
$2,285 |
2.4× |
| CT neck soft tissue w contrast (70491) |
$362.12 |
$1,857 |
1.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$557.31 |
$2,858 |
3.0× |
| CT orbits w/o contrast (70480) |
$371.48 |
$1,905 |
3.3× |
| CT pelvis w & w/o contrast (72194) |
$566.65 |
$2,936 |
3.0× |
| CT pelvis w/o contrast (72192) |
$377.70 |
$1,957 |
3.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$69.29 |
$359 |
0.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$434.46 |
$2,228 |
2.3× |
| CT soft tissue neck w/o contrast (70490) |
$289.58 |
$1,485 |
2.6× |
| CT thoracic spine w/contrast (72129) |
$634.78 |
$3,289 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$507.78 |
$2,631 |
4.6× |
| CT thoracic spine w/wo contrast (72130) |
$761.77 |
$3,947 |
4.1× |
| CT thorax w/o contrast (71250) |
$452.97 |
$2,347 |
4.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$498.52 |
$2,583 |
2.7× |
| CT upper extremity w/o contrast rt (73200) |
$332.35 |
$1,722 |
3.0× |
| CT upper extremity with contrast (73201) |
$415.53 |
$2,153 |
1.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$474.52 |
$2,446 |
2.5× |
| Cta Abdomen (74175) |
$541.17 |
$2,804 |
2.9× |
| CTA abdomen pelvis (74174) |
$770.07 |
$3,990 |
2.1× |
| CTA chest (71275) |
$713.71 |
$3,698 |
3.8× |
| Cta Head (70496) |
$499.40 |
$2,561 |
2.7× |
| CTA lwr ext w&w/o contrast (73706) |
$496.20 |
$2,571 |
2.7× |
| Cta Neck (70498) |
$456.30 |
$2,340 |
2.4× |
| Cta Pelvis (72191) |
$595.02 |
$3,083 |
3.2× |
| Cystography minimum 3 views rs&i (74430) |
$260.61 |
$1,018 |
0.7× |
| Diskogram cervical (72285) |
$909.82 |
$3,554 |
0.4× |
| Diskography lumbar (72295) |
$919.55 |
$3,592 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$249.64 |
$603 |
2.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$317.95 |
$768 |
2.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$165.19 |
$399 |
1.5× |
| Echo exam of fetal heart (76825) |
$598.23 |
$1,445 |
1.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$284.83 |
$688 |
1.1× |
| Echoencephalography real time imaging (76506) |
$307.19 |
$742 |
2.8× |
| Esophagus (74220) |
$136.70 |
$534 |
0.7× |
| Fetal biophysical profile non-stress testing (76818) |
$402.82 |
$973 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$263.30 |
$636 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$176.13 |
$688 |
0.7× |
| Foot 2 views (73620) |
$79.87 |
$312 |
0.9× |
| Forearm 2 views (73090) |
$83.20 |
$325 |
0.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$214.62 |
$876 |
0.4× |
| Gastric mucosa imaging (78261) |
$418.95 |
$1,710 |
1.0× |
| Gated Heart Planar Single (78472) |
$643.37 |
$2,626 |
1.5× |
| Hand 2 views (73120) |
$83.46 |
$326 |
0.7× |
| Hand 3 views (73130) |
$92.16 |
$360 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,053.36 |
$2,520 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,880.58 |
$4,499 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,379.95 |
$8,086 |
4.5× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$1,949.13 |
$4,663 |
4.7× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$1,297.89 |
$3,105 |
3.2× |
| Heart Infarct Image (78466) |
$415.76 |
$1,697 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,271.81 |
$4,968 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$441.74 |
$1,803 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$359.66 |
$1,468 |
0.8× |
| Ht muscle image spect sing (78451) |
$872.44 |
$3,561 |
0.6× |
| Humerus Min 2 Views Left (73060) |
$90.11 |
$352 |
1.0× |
| Hysterosalpingogram (74740) |
$176.13 |
$688 |
0.7× |
| Interstitial radiation source applic complex (77778) |
$1,759.78 |
$4,210 |
2.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,273.23 |
$3,046 |
1.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$898.70 |
$2,150 |
1.5× |
| Intracavitary radiation source applic simple (77761) |
$680.92 |
$1,629 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$91.39 |
$357 |
0.8× |
| Kidney imaging morphology (78700) |
$412.82 |
$1,685 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$564.24 |
$2,303 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$427.52 |
$1,745 |
0.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$666.89 |
$2,722 |
1.2× |
| Knee 3 views (73562) |
$102.40 |
$400 |
1.1× |
| Liver & spleen imaging static only (78215) |
$358.68 |
$1,464 |
0.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$315.56 |
$1,288 |
0.7× |
| Liver imaging static only (78201) |
$391.51 |
$1,598 |
0.7× |
| Liver imaging w/vascular flow (78202) |
$422.87 |
$1,726 |
0.7× |
| Lung perf&ventilat diferentl (78598) |
$451.29 |
$1,842 |
0.8× |
| Lung perfusion differential (78597) |
$389.55 |
$1,590 |
0.9× |
| Lung Ventilation Imaging (78579) |
$301.84 |
$1,232 |
0.7× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$696.32 |
$2,720 |
0.2× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$604.16 |
$2,360 |
0.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$480.51 |
$1,877 |
0.1× |
| Lymphoscintigraphy (78195) |
$527.73 |
$2,154 |
0.9× |
| Mammary ductogram or galactogram multiple (77054) |
$265.98 |
$1,039 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$204.54 |
$799 |
0.8× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$80.64 |
$315 |
0.9× |
| Meckels Diverticulum (78290) |
$434.88 |
$1,775 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$661.69 |
$1,583 |
1.7× |
| Mr safety determination physician/other qhp (76016) |
$34.56 |
$135 |
0.4× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$74.24 |
$290 |
1.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$10.24 |
$40 |
0.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$52.99 |
$207 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$139.26 |
$544 |
0.5× |
| MRA head w & w/o contrast (70546) |
$625.54 |
$3,258 |
1.7× |
| MRA head w/o contrast (70544) |
$417.02 |
$2,172 |
1.6× |
| MRA head with contrast (70545) |
$521.28 |
$2,715 |
1.4× |
| MRA neck w contrast (70548) |
$429.89 |
$2,239 |
1.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$515.90 |
$2,687 |
1.4× |
| MRA neck w/o contrast (70547) |
$343.87 |
$1,791 |
1.4× |
| MRI abdomen w contrast (74182) |
$543.43 |
$2,638 |
1.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$651.99 |
$3,165 |
1.8× |
| MRI abdomen w/o contrast (74181) |
$434.66 |
$2,110 |
1.7× |
| MRI any jnt lwr ext with con lt (73722) |
$612.64 |
$2,974 |
0.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$627.27 |
$3,045 |
0.7× |
| MRI bone marrow blood supply (77084) |
$374.51 |
$1,818 |
1.5× |
| MRI breast w/o contrast bilateral (77047) |
$600.70 |
$2,916 |
2.4× |
| MRI breast w/o contrast unilat (77046) |
$400.46 |
$1,944 |
1.6× |
| MRI c-spine with contrast (72142) |
$524.26 |
$3,013 |
1.4× |
| MRI cardiac w/o cont stress (75559) |
$499.34 |
$2,424 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$356.38 |
$1,730 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$419.34 |
$2,410 |
1.6× |
| MRI chest w/o & w/contrast material (71552) |
$527.77 |
$2,562 |
1.4× |
| MRI chest w/o contrast (71550) |
$351.85 |
$1,708 |
1.4× |
| MRI chest with contrast (71551) |
$439.81 |
$2,135 |
0.5× |
| MRI fetal sngl/1st gestation (74712) |
$169.54 |
$823 |
0.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$426.01 |
$2,068 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$537.45 |
$2,609 |
1.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$429.92 |
$2,087 |
1.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$402.73 |
$2,034 |
1.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$604.10 |
$3,051 |
1.6× |
| MRI orbit/face/neck w/contrast (70542) |
$503.51 |
$2,543 |
1.4× |
| MRI pelvis w contrast (72196) |
$511.50 |
$2,483 |
1.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$613.67 |
$2,979 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$409.12 |
$1,986 |
1.6× |
| MRI scan of arm joint before and after contrast (73223) |
$752.72 |
$3,654 |
2.0× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$749.02 |
$3,636 |
0.9× |
| MRI scan of leg joint before and after contrast (73723) |
$735.21 |
$3,569 |
2.0× |
| MRI spectroscopy (76390) |
$428.89 |
$2,082 |
4.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$629.01 |
$3,615 |
1.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$525.83 |
$3,022 |
1.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$630.92 |
$3,626 |
1.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$522.87 |
$3,005 |
1.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$627.44 |
$3,606 |
1.7× |
| MRI thoracic spine w/o contrast (72146) |
$418.30 |
$2,404 |
1.6× |
| MRI tmj (70336) |
$340.93 |
$1,655 |
1.3× |
| MRI upper ext joint w/o contrast (73221) |
$501.82 |
$2,436 |
2.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$511.09 |
$2,481 |
1.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$340.72 |
$1,654 |
1.3× |
| Myelogram Cervical (72240) |
$547.58 |
$2,139 |
0.7× |
| Myelogram Lumbar (72265) |
$547.58 |
$2,139 |
0.7× |
| Myelogram thoracic (72255) |
$548.10 |
$2,141 |
0.7× |
| Myelography 2 or more regions (72270) |
$691.97 |
$2,703 |
0.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,000.24 |
$3,985 |
0.7× |
| Myocardial infarct spect (78469) |
$462.07 |
$1,886 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,051.30 |
$4,291 |
0.8× |
| Neck soft tissue (70360) |
$79.10 |
$309 |
0.9× |
| Nm adrenal scan (78075) |
$605.15 |
$2,470 |
0.4× |
| Nm bone marrow multiple (78103) |
$523.56 |
$2,137 |
1.2× |
| Nm bone marrow wb (78104) |
$605.88 |
$2,473 |
1.4× |
| Nm cisternogram (78630) |
$406.46 |
$1,659 |
0.7× |
| Nm csf leak detection (78650) |
$517.19 |
$2,111 |
0.4× |
| Nm gastric emptying study (78264) |
$457.66 |
$1,868 |
1.1× |
| Nm gastroesophageal reflux study (78262) |
$476.52 |
$1,945 |
1.1× |
| Nm peritoneal-venous shunt patency (78291) |
$302.58 |
$1,235 |
0.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,960.28 |
$7,082 |
2.0× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,051.30 |
$4,291 |
0.8× |
| Nuclear medicine of heart pumping function (78473) |
$809.97 |
$3,306 |
1.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,353.89 |
$5,394 |
0.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$872.44 |
$3,561 |
0.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$662.72 |
$2,705 |
1.6× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$365.05 |
$1,490 |
0.9× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$185.22 |
$756 |
0.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$493.18 |
$2,013 |
1.2× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$421.64 |
$1,721 |
0.7× |
| Nuclear Rx Oral Admin (79005) |
$782.18 |
$1,794 |
3.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$210.31 |
$508 |
1.9× |
| Osseous survey infant (77076) |
$269.57 |
$1,053 |
2.4× |
| Osseous survey limited (77074) |
$105.73 |
$413 |
0.9× |
| Parathyrd planar w/spect&CT (78072) |
$666.64 |
$2,721 |
1.2× |
| Parathyrd planar w/wo subtrj (78071) |
$543.66 |
$2,219 |
1.3× |
| Parathyroid imaging (78070) |
$476.03 |
$1,943 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$91.14 |
$356 |
0.8× |
| Peritoneogram rs&i (74190) |
$211.71 |
$827 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$1,707.80 |
$6,804 |
1.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,604.64 |
$6,393 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,836.07 |
$7,315 |
1.2× |
| PET imaging limited area chest head/neck (78811) |
$1,075.54 |
$4,285 |
0.8× |
| PET whole body (78813) |
$1,565.74 |
$6,238 |
1.0× |
| Pr heart first pass single,planar (78481) |
$352.06 |
$1,437 |
0.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$644.99 |
$3,131 |
1.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,260.29 |
$4,923 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$749.31 |
$2,927 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$382.44 |
$1,561 |
0.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$454.47 |
$1,855 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$271.87 |
$1,062 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$92.16 |
$360 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$151.04 |
$590 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$83.46 |
$326 |
0.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$214.02 |
$836 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$208.38 |
$814 |
1.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,260.66 |
$17,370 |
0.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$307.23 |
$735 |
0.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$181.41 |
$434 |
1.7× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$230.74 |
$552 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$99.58 |
$389 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$113.15 |
$442 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$159.23 |
$622 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$73.47 |
$328 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$240.13 |
$938 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$157.44 |
$615 |
0.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$155.14 |
$606 |
0.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$94.72 |
$370 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$60.16 |
$235 |
0.6× |
| Radiological examination surgical specimen (76098) |
$131.58 |
$514 |
0.2× |
| Review by radiologist of adrenal gland vein image (75840) |
$911.36 |
$3,560 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,260.29 |
$4,923 |
0.4× |
| Ribs bilateral 3 views (71110) |
$86.78 |
$339 |
0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$294.24 |
$1,201 |
0.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$402.04 |
$1,641 |
0.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$504.70 |
$2,060 |
0.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$923.90 |
$3,771 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,197.56 |
$4,888 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$625 |
$2,551 |
0.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,100.03 |
$2,523 |
4.4× |
| Rp Therapy Intravenous Administration (79101) |
$817.94 |
$1,876 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$83.46 |
$326 |
0.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$284.83 |
$688 |
1.1× |
| Salivary gland imaging (78230) |
$416.26 |
$1,699 |
1.0× |
| Salivary gland imaging serial images (78231) |
$250.64 |
$1,023 |
0.6× |
| Scanogram (77073) |
$98.05 |
$383 |
0.9× |
| Scapula complete (73010) |
$92.93 |
$363 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$83.46 |
$326 |
0.7× |
| Sialogram (70390) |
$176.13 |
$688 |
0.7× |
| Simulation intermediate (77285) |
$777.48 |
$1,860 |
1.9× |
| Small bowel series (74250) |
$140.54 |
$549 |
0.8× |
| Spec medical radj physics consltj (77370) |
$491.99 |
$1,177 |
3.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$770.79 |
$1,844 |
1.9× |
| Special dosimetry (77331) |
$250.80 |
$600 |
1.7× |
| Special treatment procedure (77470) |
$1,406.57 |
$3,365 |
2.4× |
| Speech evaluation complex (70371) |
$191.23 |
$747 |
0.8× |
| Spine thoracic 3 views (72072) |
$96.26 |
$376 |
0.9× |
| Spleen imaging only (78185) |
$249.66 |
$1,019 |
0.6× |
| Splenoportograpy rs&i (75810) |
$690.69 |
$2,698 |
0.2× |
| Stereotactic body radiation delivery (77373) |
$4,836.68 |
$11,571 |
2.5× |
| Superior sagittal sinus venogram (75870) |
$1,260.29 |
$4,923 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$222.79 |
$533 |
2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$502.44 |
$1,202 |
1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$326.46 |
$781 |
0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$346.61 |
$1,103 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$361.38 |
$1,475 |
0.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$866.51 |
$2,073 |
2.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$485.30 |
$1,161 |
3.4× |
| Therapeutic Enema (74283) |
$343.55 |
$1,342 |
1.8× |
| Thoracolumbar 2 views (72080) |
$87.55 |
$342 |
0.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$633.57 |
$2,586 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$406.21 |
$1,658 |
1.0× |
| Tmj unilateral (70328) |
$81.92 |
$320 |
0.9× |
| Tomogram (76100) |
$205.57 |
$803 |
1.8× |
| Treatment device intermediate (77333) |
$432.21 |
$1,034 |
3.0× |
| Treatment devices simple (77332) |
$237.42 |
$568 |
1.7× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$855.30 |
$3,491 |
1.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$267.05 |
$1,090 |
0.6× |
| Tx devices design & construction complex (77334) |
$528.77 |
$1,265 |
1.3× |
| Ultrasound elastography first target lesion (76982) |
$135.38 |
$327 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$272.41 |
$658 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$161.46 |
$390 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$689.66 |
$2,694 |
7.4× |
| Upper Extremity Infant (73092) |
$133.89 |
$523 |
1.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$404 |
$1,649 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$271.87 |
$1,062 |
1.1× |
| Urethrocystography voiding (74455) |
$176.13 |
$688 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$387.84 |
$1,515 |
2.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$698.88 |
$2,730 |
3.7× |
| Us abdl aorta screen aaa (76706) |
$164.77 |
$398 |
1.5× |
| Us breast unilateral complete (76641) |
$173.88 |
$420 |
1.6× |
| Us breast unilateral limited (76642) |
$133.72 |
$323 |
1.4× |
| Us chest (76604) |
$182.57 |
$441 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$193.75 |
$468 |
1.7× |
| Us elastography parenchyma (76981) |
$162.70 |
$393 |
1.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$184.23 |
$445 |
1.7× |
| Us guided compression repair (76936) |
$259.16 |
$626 |
1.1× |
| Us infant hips dynamic (76885) |
$232.67 |
$562 |
2.5× |
| Us infant hips limited static (76886) |
$170.15 |
$411 |
1.8× |
| Us kidney transplant (76776) |
$231.01 |
$558 |
2.1× |
| Us ob detailed single fetus (76811) |
$361.42 |
$873 |
1.4× |
| Us ob transvaginal (76817) |
$237.64 |
$574 |
2.1× |
| Us pelvic non ob complete (76856) |
$320.44 |
$774 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$270.76 |
$654 |
2.4× |
| Us pregnancy ltd (76815) |
$209.07 |
$505 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$221.49 |
$535 |
2.0× |
| Us retroperitoneal complete (76770) |
$281.11 |
$679 |
2.5× |
| Us retroperitoneal limited (76775) |
$181.33 |
$438 |
1.6× |
| Us scrotum and contents (76870) |
$295.60 |
$714 |
2.6× |
| Us soft tissue head/neck (76536) |
$244.67 |
$591 |
2.2× |
| Us spinal canal and contents (76800) |
$324.58 |
$784 |
2.9× |
| Us transrectal (76872) |
$224.39 |
$542 |
2.0× |
| Us transrectal prostate volume (76873) |
$218.59 |
$528 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$139.52 |
$337 |
1.3× |
| Vascular flow imaging (78445) |
$221.72 |
$905 |
0.5× |
| Vasogram (74440) |
$179.71 |
$702 |
0.7× |
| Venogram extremity bilateral (75822) |
$584.19 |
$2,282 |
0.3× |
| Venogram orbital (75880) |
$591.36 |
$2,310 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$1,260.29 |
$4,923 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$328.19 |
$1,282 |
0.2× |
| Venography epidural rs&i (75872) |
$705.54 |
$2,756 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$499.20 |
$1,950 |
0.3× |
| Venography Renal Bilateral (75833) |
$1,124.61 |
$4,393 |
0.3× |
| Venography renal unilateral selective rs&i (75831) |
$936.96 |
$3,660 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,049.34 |
$4,099 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,192.45 |
$4,658 |
0.2× |
| Wrist 2 views (73100) |
$76.03 |
$297 |
0.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$184.06 |
$719 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$77.06 |
$301 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$95.49 |
$373 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$267.26 |
$1,044 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86.78 |
$339 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$94.21 |
$368 |
1.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$175.10 |
$684 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$66.82 |
$261 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$81.15 |
$317 |
0.9× |
| X-ray exam hip uni 4/> views (73503) |
$100.61 |
$393 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$96.51 |
$377 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$113.66 |
$444 |
1.0× |
| X-ray exam of femur 1 (73551) |
$61.95 |
$242 |
0.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$505.86 |
$1,976 |
2.7× |
| X-ray eye for foreign body (70030) |
$61.95 |
$242 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$89.86 |
$351 |
0.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$81.41 |
$318 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$94.21 |
$368 |
1.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$655.87 |
$2,562 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$73.47 |
$287 |
0.8× |
| X-ray IV pyelogram+drip infusn (74410) |
$598.78 |
$2,339 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$87.55 |
$342 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$114.69 |
$448 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$101.38 |
$396 |
1.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$120.58 |
$471 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$112.90 |
$441 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$152.58 |
$596 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$94.46 |
$369 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$77.06 |
$301 |
0.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$86.53 |
$338 |
0.9× |
| X-ray of voice box or throat (70370) |
$135.17 |
$528 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$110.85 |
$433 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$112.90 |
$441 |
1.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$358.91 |
$1,402 |
0.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$281.86 |
$1,101 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$73.98 |
$289 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$84.74 |
$331 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$118.27 |
$462 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$92.67 |
$362 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$92.93 |
$363 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$99.33 |
$388 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86.78 |
$339 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$72.96 |
$285 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$110.08 |
$430 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$86.53 |
$338 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$62.21 |
$243 |
0.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$108.29 |
$423 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$84.99 |
$332 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$83.46 |
$326 |
0.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$103.17 |
$403 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$64.26 |
$251 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$90.62 |
$354 |
1.0× |
| Xr arthrogram ankle (73615) |
$345.98 |
$1,101 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$137.22 |
$536 |
1.2× |
| Xr chest 4+ views (71048) |
$99.23 |
$443 |
0.9× |
| Xr Cholecystography Oral Contrast (74290) |
$188.67 |
$737 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$66.56 |
$260 |
0.7× |
| Xr internal auditory meati complete (70134) |
$145.15 |
$567 |
0.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$131.33 |
$513 |
1.2× |
| Xr myelogram posterior fossa (70010) |
$139.26 |
$544 |
0.4× |
| Xr optic foramina (70190) |
$107.01 |
$418 |
1.2× |
| Xr shoulder 1 view (73020) |
$71.42 |
$279 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$102.91 |
$402 |
0.9× |
| Xr tibia/fibula 2 views (73590) |
$80.90 |
$316 |
0.9× |
| Xr tmj bilateral (70330) |
$100.61 |
$393 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$87.04 |
$340 |
0.9× |