| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,247 |
$14,980 |
1.6× |
| Abdomen 2 views (74019) |
$92.70 |
$618 |
0.8× |
| Acute gi blood loss imaging (78278) |
$497.85 |
$3,319 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$1,346.10 |
$8,974 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$1,864.20 |
$12,428 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$635.10 |
$4,234 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,300.95 |
$8,673 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,183.35 |
$7,889 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$767.85 |
$5,119 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,140.75 |
$7,605 |
0.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$649.35 |
$4,329 |
0.2× |
| Ankle 2 views (73600) |
$124.50 |
$830 |
1.4× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$942.30 |
$6,282 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,291.05 |
$8,607 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,608.30 |
$10,722 |
0.5× |
| Arthrogram ankle (73615) |
$196.72 |
$1,311.50 |
0.5× |
| Arthrogram elbow (73085) |
$203.25 |
$1,355 |
0.6× |
| Arthrogram hip (73525) |
$404.10 |
$2,694 |
1.1× |
| Arthrogram knee (73580) |
$334.12 |
$2,227.50 |
0.9× |
| Arthrogram shoulder (73040) |
$229.95 |
$1,533 |
0.6× |
| Arthrogram wrist (73115) |
$277.72 |
$1,851.50 |
0.8× |
| Basic dosimetry (77300) |
$208.65 |
$1,391 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$713.85 |
$4,759 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,151.25 |
$7,675 |
2.8× |
| Bone age studies (77072) |
$106.05 |
$707 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,271.55 |
$8,477 |
3.0× |
| Bone Marrow Imaging Limited Area (78102) |
$309.60 |
$2,064 |
0.7× |
| Bone survey complete (77075) |
$94.65 |
$631 |
0.9× |
| Bone survey infant (77076) |
$81.60 |
$544 |
0.7× |
| Bowel imaging (78290) |
$378.15 |
$2,521 |
0.9× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$378.75 |
$2,525 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,170.60 |
$7,804 |
0.8× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$620.10 |
$4,134 |
1.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$856.80 |
$5,712 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$817.80 |
$5,452 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$159 |
$1,060 |
1.7× |
| Chest 1 view (71045) |
$67.28 |
$448.50 |
0.7× |
| Chest xray 3 views (71047) |
$192 |
$1,280 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$243.30 |
$1,622 |
1.3× |
| Clavicle complete (73000) |
$98.10 |
$654 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$188.40 |
$1,256 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$136.50 |
$910 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,400 |
$16,000 |
6.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,800 |
$12,000 |
7.2× |
| CT abdomen w contrast (74160) |
$915 |
$6,100 |
5.0× |
| CT abdomen w wo contrast (74170) |
$960 |
$6,400 |
5.2× |
| CT abdomen w/o contrast (74150) |
$870 |
$5,800 |
8.0× |
| CT angio hrt w/3d image (75574) |
$1,650 |
$11,000 |
4.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$956.25 |
$6,375 |
5.2× |
| CT angiography upper extremity lt (73206) |
$1,200 |
$8,000 |
6.6× |
| CT c-spine w/contrast (72126) |
$630 |
$4,200 |
1.7× |
| CT c-spine w/o contrast (72125) |
$1,200 |
$8,000 |
11.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,350 |
$9,000 |
7.4× |
| CT chest w contrast (71260) |
$855 |
$5,700 |
4.7× |
| CT chest w/wo contrast (71270) |
$960 |
$6,400 |
5.2× |
| CT head/brain with contrast (70460) |
$915 |
$6,100 |
5.0× |
| CT head/brain without and with contrast (70470) |
$960 |
$6,400 |
5.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$733.20 |
$4,888 |
2.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$38.85 |
$259 |
0.4× |
| CT hrt w/3d image congen (75573) |
$412.05 |
$2,747 |
1.1× |
| CT iac w contrast (70481) |
$915 |
$6,100 |
5.0× |
| CT limited/localized follow up study (76380) |
$119.70 |
$798 |
1.3× |
| CT lower ext w/o (73700) |
$843.75 |
$5,625 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$956.25 |
$6,375 |
5.2× |
| CT lower extremity w/contrast material (73701) |
$900 |
$6,000 |
4.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,350 |
$9,000 |
7.4× |
| CT lumbar spine w/contrast (72132) |
$1,275 |
$8,500 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$1,200 |
$8,000 |
11.0× |
| CT maxillofacial w contrast (70487) |
$960 |
$6,400 |
5.2× |
| CT maxillofacial w/wo contrast (70488) |
$990 |
$6,600 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$903.75 |
$6,025 |
8.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$960 |
$6,400 |
5.2× |
| CT orbits w/o contrast (70480) |
$870 |
$5,800 |
8.0× |
| CT pelvis w/o contrast (72192) |
$870 |
$5,800 |
8.0× |
| CT pelvis w/wo contrast (72194) |
$1,210.05 |
$8,067 |
6.6× |
| CT scan of arm combo (73202) |
$1,200 |
$8,000 |
6.6× |
| CT soft tissue neck w contrast (70491) |
$675 |
$4,500 |
3.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$960 |
$6,400 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$630 |
$4,200 |
5.8× |
| CT thoracic spine w/contrast (72129) |
$1,275 |
$8,500 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$1,200 |
$8,000 |
11.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,350 |
$9,000 |
7.4× |
| CT thorax w/o contrast (71250) |
$825 |
$5,500 |
7.6× |
| CT upper ext wo (73200) |
$1,087.50 |
$7,250 |
10.0× |
| CT upper extremity with contrast (73201) |
$1,143.75 |
$7,625 |
3.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,341.60 |
$8,944 |
7.3× |
| Cta Abdomen (74175) |
$960 |
$6,400 |
5.2× |
| CTA abdomen pelvis (74174) |
$1,350 |
$9,000 |
3.7× |
| CTA chest (71275) |
$1,425 |
$9,500 |
7.8× |
| Cta Head (70496) |
$1,275 |
$8,500 |
7.0× |
| Cta Neck (70498) |
$1,275 |
$8,500 |
7.0× |
| Cta Pelvis (72191) |
$577.50 |
$3,850 |
3.2× |
| Cystography minimum 3 views rs&i (74430) |
$229.95 |
$1,533 |
0.6× |
| Diskography lumbar (72295) |
$1,021.05 |
$6,807 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$90.45 |
$603 |
0.8× |
| Esophagus (74220) |
$451.20 |
$3,008 |
2.5× |
| Facial bones min 3 views (70150) |
$100.58 |
$670.50 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$262.95 |
$1,753 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$50.85 |
$339 |
0.5× |
| Fluoroscopy up to 1 hr (76000) |
$232.20 |
$1,548 |
0.9× |
| Foot 2 views (73620) |
$162.22 |
$1,081.50 |
1.8× |
| Forearm 2 views (73090) |
$289.65 |
$1,931 |
3.2× |
| Hand 2 views (73120) |
$150.45 |
$1,003 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$686.70 |
$4,578 |
0.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,103.40 |
$7,356 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$780.15 |
$5,201 |
1.9× |
| Hysterosalpingogram (74740) |
$340.50 |
$2,270 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$100.80 |
$672 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$430.35 |
$2,869 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$631.50 |
$4,210 |
1.1× |
| Knee 3 views (73562) |
$134.25 |
$895 |
1.5× |
| Liver & spleen imaging static only (78215) |
$406.20 |
$2,708 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$374.70 |
$2,498 |
0.7× |
| Lymphoscintigraphy (78195) |
$841.95 |
$5,613 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,698.30 |
$11,322 |
2.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,132.20 |
$7,548 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,178.10 |
$7,854 |
3.2× |
| Mammary ductogram or galactogram multiple (77054) |
$458.55 |
$3,057 |
1.8× |
| Mammary ductogram or galactogram single (77053) |
$316.65 |
$2,111 |
1.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$204.90 |
$1,366 |
0.5× |
| MRA head w & w/o contrast (70546) |
$900.90 |
$6,006 |
2.5× |
| MRA head w/o contrast (70544) |
$657.45 |
$4,383 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$703.80 |
$4,692 |
1.9× |
| MRA neck w/o contrast (70547) |
$673.20 |
$4,488 |
2.7× |
| MRI abdomen w contrast (74182) |
$765.45 |
$5,103 |
2.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$780.30 |
$5,202 |
2.1× |
| MRI abdomen w/o contrast (74181) |
$649.65 |
$4,331 |
2.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$849.15 |
$5,661 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,147.50 |
$7,650 |
3.1× |
| MRI breast w/o contrast bilateral (77047) |
$459 |
$3,060 |
1.8× |
| MRI c-spine with contrast (72142) |
$1,071 |
$7,140 |
2.9× |
| MRI cardiac w/o contrast (75557) |
$849.90 |
$5,666 |
3.4× |
| MRI cervical spine w/o contrast (72141) |
$918 |
$6,120 |
3.7× |
| MRI chest w/o & w/contrast material (71552) |
$716.10 |
$4,774 |
2.0× |
| MRI chest w/o contrast (71550) |
$527.85 |
$3,519 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$849.15 |
$5,661 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,178.10 |
$7,854 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,018.50 |
$6,790 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$636.45 |
$4,243 |
2.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$791.85 |
$5,279 |
2.2× |
| MRI pelvis w/contrast (72196) |
$994.50 |
$6,630 |
2.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,071 |
$7,140 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$975.45 |
$6,503 |
3.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,224 |
$8,160 |
3.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,224 |
$8,160 |
3.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,224 |
$8,160 |
3.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,071 |
$7,140 |
2.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,224 |
$8,160 |
3.4× |
| MRI temporomandibular joint (70336) |
$676.80 |
$4,512 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$918 |
$6,120 |
3.7× |
| MRI up ext w/o contrast (73218) |
$1,357.88 |
$9,052.50 |
5.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,357.88 |
$9,052.50 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$1,472.62 |
$9,817.50 |
4.0× |
| Myelography 2 or more regions (72270) |
$652.35 |
$4,349 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,887.50 |
$19,250 |
2.1× |
| Myocardial spect single study at rest or stress (78451) |
$1,402.50 |
$9,350 |
1.0× |
| Neck soft tissue (70360) |
$183.60 |
$1,224 |
2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$230.25 |
$1,535 |
0.6× |
| Nm adrenal scan (78075) |
$994.65 |
$6,631 |
0.7× |
| Nm cisternogram (78630) |
$437.10 |
$2,914 |
0.8× |
| Nm csf leak detection (78650) |
$647.25 |
$4,315 |
0.5× |
| Nm gastric emptying study (78264) |
$921.90 |
$6,146 |
2.2× |
| Nm kidney scan w/flow (78701) |
$208.35 |
$1,389 |
0.5× |
| Nm peritoneal-venous shunt patency (78291) |
$298.65 |
$1,991 |
0.7× |
| Nonvascular shunt X-ray (75809) |
$137.10 |
$914 |
1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,444.50 |
$9,630 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$398.55 |
$2,657 |
1.6× |
| Osseous survey limited (77074) |
$152.85 |
$1,019 |
1.4× |
| Parathyrd planar w/spect&CT (78072) |
$825.90 |
$5,506 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$754.65 |
$5,031 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$66.45 |
$443 |
0.6× |
| Peritoneogram after injection (74190) |
$118.05 |
$787 |
0.2× |
| PET image w/CT, skull-thigh (78815) |
$2,520 |
$16,800 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$3,150 |
$21,000 |
2.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$820.80 |
$5,472 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$441.75 |
$2,945 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$625.05 |
$4,167 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$220.50 |
$1,470 |
0.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$129.15 |
$861 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$131.70 |
$878 |
1.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$222.90 |
$1,486 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$84.30 |
$562 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$121.65 |
$811 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$149.70 |
$998 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$144.75 |
$965 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$193.35 |
$1,289 |
2.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$73.05 |
$487 |
0.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$175.80 |
$1,172 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$22.80 |
$152 |
0.2× |
| Radex Humerus Minimum 2 Views (73060) |
$223.35 |
$1,489 |
2.5× |
| Radex Kne 1/2 Views (73560) |
$119.40 |
$796 |
1.3× |
| Radex Kne Compl 4/More Views (73564) |
$175.50 |
$1,170 |
1.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$87.68 |
$584.50 |
0.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$129.90 |
$866 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$162.90 |
$1,086 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$188.70 |
$1,258 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$78.82 |
$525.50 |
0.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$139.80 |
$932 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$154.95 |
$1,033 |
1.7× |
| Radex Toe Minimum 2 Views (73660) |
$181.50 |
$1,210 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$33.15 |
$221 |
0.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$233.40 |
$1,556 |
2.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,255 |
$41,700 |
0.8× |
| Radiation treatment delivery level 1 (77402) |
$109.65 |
$731 |
1.0× |
| Radiation treatment delivery level 2 (77407) |
$199.05 |
$1,327 |
0.5× |
| Radiation treatment delivery level 3 (77412) |
$561.75 |
$3,745 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$73.88 |
$492.50 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$164.62 |
$1,097.50 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$95.62 |
$637.50 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$283.95 |
$1,893 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$344.55 |
$2,297 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$230.10 |
$1,534 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$165.90 |
$1,106 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$227.40 |
$1,516 |
2.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$138.30 |
$922 |
1.3× |
| Radiological examination surgical specimen (76098) |
$123.15 |
$821 |
0.2× |
| Ribs bilateral 3 views (71110) |
$213.45 |
$1,423 |
2.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$440.10 |
$2,934 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$478.50 |
$3,190 |
1.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$630.15 |
$4,201 |
1.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$776.40 |
$5,176 |
1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$763.65 |
$5,091 |
0.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$906.30 |
$6,042 |
0.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$896.40 |
$5,976 |
0.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$195.60 |
$1,304 |
0.8× |
| Rp Therapy Intravenous Administration (79101) |
$178.05 |
$1,187 |
0.7× |
| Salivary gland function study (78232) |
$341.40 |
$2,276 |
0.8× |
| Scapula (73010) |
$89.10 |
$594 |
0.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$86.25 |
$575 |
3.7× |
| Shoulder 1 view (73020) |
$154.35 |
$1,029 |
1.7× |
| Simulation intermediate (77285) |
$463.50 |
$3,090 |
1.2× |
| Small bowel series (74250) |
$250.50 |
$1,670 |
1.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$325.05 |
$2,167 |
0.8× |
| Special dosimetry (77331) |
$227.55 |
$1,517 |
1.6× |
| Special Physics Consult (77370) |
$216.75 |
$1,445 |
1.5× |
| Special treatment procedure (77470) |
$394.95 |
$2,633 |
0.7× |
| Spine thoracic 3 views (72072) |
$284.25 |
$1,895 |
2.6× |
| Stereotactic Body Radiation Delivery (77373) |
$978.15 |
$6,521 |
0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$277.50 |
$1,850 |
0.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$153 |
$1,020 |
0.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$513.60 |
$3,424 |
1.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$229.05 |
$1,527 |
1.6× |
| Thoracolumbar 2 views (72080) |
$81.75 |
$545 |
0.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$702.60 |
$4,684 |
1.2× |
| Thyroid imaging w/blood flow (78013) |
$349.65 |
$2,331 |
0.8× |
| Thyroid uptake measurement (78012) |
$273.75 |
$1,825 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$493.05 |
$3,287 |
1.2× |
| Treatment device complex (77334) |
$401.25 |
$2,675 |
1.0× |
| Treatment device intermediate (77333) |
$288.90 |
$1,926 |
2.1× |
| Treatment devices simple (77332) |
$240.75 |
$1,605 |
1.7× |
| Ultrasound breast complete (76641) |
$331.12 |
$2,207.50 |
3.0× |
| Ultrasound elastography first target lesion (76982) |
$48 |
$320 |
0.4× |
| Ultrasound Exam Aaa Screen (76706) |
$112.95 |
$753 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$470.40 |
$3,136 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$18.75 |
$125 |
0.2× |
| Unlisted fluoroscopic procedure (76496) |
$94.80 |
$632 |
1.0× |
| Unlisted ultrasound procedure (76999) |
$200.10 |
$1,334 |
2.2× |
| Urethrocystogram voiding (74455) |
$277.80 |
$1,852 |
1.1× |
| Urethrocystography retrograde rs&i (74450) |
$485.10 |
$3,234 |
1.9× |
| Us breast unilateral limited (76642) |
$249.45 |
$1,663 |
2.7× |
| Us chest (76604) |
$137.40 |
$916 |
1.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$190.20 |
$1,268 |
0.8× |
| Us compl joint r-t w/image documentation (76881) |
$246.45 |
$1,643 |
2.3× |
| Us elastography parenchyma (76981) |
$94.65 |
$631 |
0.9× |
| Us encephalogram (76506) |
$178.65 |
$1,191 |
1.6× |
| Us infant hips w manipulation (76885) |
$268.20 |
$1,788 |
3.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$126.52 |
$843.50 |
1.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$18 |
$120 |
0.2× |
| Us ob detailed single fetus (76811) |
$101.40 |
$676 |
0.4× |
| Us ob limited (76815) |
$217.80 |
$1,452 |
2.0× |
| Us ob transvaginal (76817) |
$64.20 |
$428 |
0.6× |
| Us pelvic non ob complete (76856) |
$332.40 |
$2,216 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$171.30 |
$1,142 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$151.20 |
$1,008 |
1.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$48.15 |
$321 |
0.4× |
| Us retroperitoneal complete (76770) |
$335.55 |
$2,237 |
3.1× |
| Us retroperitoneal limited (76775) |
$453.60 |
$3,024 |
4.2× |
| Us scrotum and contents (76870) |
$410.55 |
$2,737 |
3.8× |
| Us soft tissue head/neck (76536) |
$200.40 |
$1,336 |
1.8× |
| Us spinal canal and contents (76800) |
$186.75 |
$1,245 |
1.7× |
| Us transrectal (76872) |
$18.75 |
$125 |
0.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$426 |
$2,840 |
3.9× |
| Venogram extremity bilateral (75822) |
$670.20 |
$4,468 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$605.85 |
$4,039 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,224.60 |
$8,164 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$986.85 |
$6,579 |
0.6× |
| Venography Renal Bilateral (75833) |
$1,069.95 |
$7,133 |
0.3× |
| Venography renal unilateral selective rs&i (75831) |
$713.10 |
$4,754 |
0.2× |
| Wrist 2 views (73100) |
$211.95 |
$1,413 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$141.22 |
$941.50 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$156.75 |
$1,045 |
1.7× |
| X-ray b.e. reductn intuss (74283) |
$291.15 |
$1,941 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$520.50 |
$3,470 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$169.95 |
$1,133 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$69.38 |
$462.50 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$168.60 |
$1,124 |
1.5× |
| X-ray exam of femur 2/> (73552) |
$182.55 |
$1,217 |
2.0× |
| X-ray eye for foreign body (70030) |
$107.70 |
$718 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$124.95 |
$833 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$280.95 |
$1,873 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$41.55 |
$277 |
0.5× |
| X-ray leg, infant (73592) |
$38.85 |
$259 |
0.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$121.95 |
$813 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$202.80 |
$1,352 |
1.9× |
| X-ray nose-rectum child f.b. (76010) |
$58.95 |
$393 |
0.6× |
| X-ray optic foramen (70190) |
$58.95 |
$393 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$119.70 |
$798 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$331.65 |
$2,211 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$334.35 |
$2,229 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$237 |
$1,580 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$88.95 |
$593 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$153.75 |
$1,025 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$90.82 |
$605.50 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$256.20 |
$1,708 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$145.50 |
$970 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$219.45 |
$1,463 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$137.25 |
$915 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$179.40 |
$1,196 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$159.90 |
$1,066 |
1.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$298.35 |
$1,989 |
2.7× |
| Xr bone length studies (77073) |
$125.85 |
$839 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$329.10 |
$2,194 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$387.90 |
$2,586 |
3.6× |
| Xr chest 4+ views (71048) |
$207.45 |
$1,383 |
1.9× |
| Xr urogram antegrade (74425) |
$239.55 |
$1,597 |
0.7× |