| 3-D radiotherapy plan dose-volume histograms (77295) |
$999.90 |
$6,666 |
0.8× |
| Abdomen 2 views (74019) |
$69.90 |
$466 |
0.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$227.10 |
$1,514 |
0.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,228.20 |
$8,188 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$1,229.85 |
$8,199 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$853.95 |
$5,693 |
0.3× |
| Angiography internal mammary rs&i (75756) |
$935.85 |
$6,239 |
0.3× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,169.70 |
$7,798 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,169.70 |
$7,798 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,169.70 |
$7,798 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,228.20 |
$8,188 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,169.70 |
$7,798 |
0.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$296.40 |
$1,976 |
0.1× |
| Ankle 2 views (73600) |
$40.42 |
$269.50 |
0.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$213.90 |
$1,426 |
0.7× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$996 |
$6,640 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,169.70 |
$7,798 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,169.70 |
$7,798 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$671.55 |
$4,477 |
0.2× |
| Arthrogram hip (73525) |
$189.30 |
$1,262 |
0.6× |
| Arthrogram shoulder (73040) |
$187.95 |
$1,253 |
0.6× |
| Arthrogram wrist (73115) |
$189.30 |
$1,262 |
0.6× |
| Arthrography knee lt (73580) |
$232.65 |
$1,551 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$113.85 |
$759 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$207.30 |
$1,382 |
0.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$187.80 |
$1,252 |
0.5× |
| Bone &/joint imaging whole body (78306) |
$296.85 |
$1,979 |
0.8× |
| Bone age studies (77072) |
$44.40 |
$296 |
0.5× |
| Bone Imaging 3 Phase (78315) |
$359.70 |
$2,398 |
1.0× |
| Bone survey complete (77075) |
$142.95 |
$953 |
1.5× |
| Brachytx isodose complex (77318) |
$363.82 |
$2,425.50 |
1.0× |
| Brachytx isodose intermed (77317) |
$304.50 |
$2,030 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$213.60 |
$1,424 |
0.6× |
| Brain image w/flow 4 + views (78606) |
$335.85 |
$2,239 |
0.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$220.80 |
$1,472 |
0.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,642.65 |
$10,951 |
1.2× |
| Brain Imaging Vascular Flow Only (78610) |
$245.85 |
$1,639 |
0.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$642.15 |
$4,281 |
2.0× |
| Cardiac shunt detection (78428) |
$141 |
$940 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$72.90 |
$486 |
0.9× |
| Chest 1 view (71045) |
$60 |
$400 |
0.7× |
| Chest 3 views (71047) |
$71.10 |
$474 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$64.80 |
$432 |
0.4× |
| Clavicle complete (73000) |
$37.50 |
$250 |
0.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$33.30 |
$222 |
0.3× |
| Continuing medical physics consltj pr wk (77336) |
$178.95 |
$1,193 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,607.10 |
$10,714 |
5.0× |
| CT abdomen and pelvis without contrast (74176) |
$918.60 |
$6,124 |
4.2× |
| CT abdomen w contrast (74160) |
$538.50 |
$3,590 |
3.3× |
| CT abdomen w wo contrast (74170) |
$612.30 |
$4,082 |
3.8× |
| CT abdomen w/o contrast (74150) |
$459.90 |
$3,066 |
4.7× |
| CT angio hrt w/3d image (75574) |
$741.90 |
$4,946 |
2.3× |
| CT angiography upper extremity lt (73206) |
$556.95 |
$3,713 |
3.4× |
| CT c-spine w/o contrast (72125) |
$657.90 |
$4,386 |
6.8× |
| CT cervical spine w&w/o contrast (72127) |
$562.05 |
$3,747 |
3.5× |
| CT cervical spine with contrast (72126) |
$539.40 |
$3,596 |
1.7× |
| CT chest w/wo contrast (71270) |
$656.85 |
$4,379 |
4.0× |
| CT chest with contrast (71260) |
$548.85 |
$3,659 |
3.4× |
| CT head/brain with contrast (70460) |
$485.40 |
$3,236 |
3.0× |
| CT head/brain without and with contrast (70470) |
$777.30 |
$5,182 |
4.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$625.35 |
$4,169 |
1.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$40.35 |
$269 |
0.5× |
| CT iac w contrast (70481) |
$606.90 |
$4,046 |
3.7× |
| CT limited/localized follow up study (76380) |
$223.65 |
$1,491 |
2.8× |
| CT lower ext w/o (73700) |
$463.65 |
$3,091 |
4.8× |
| CT lower extremity w wo contrast (73702) |
$530.70 |
$3,538 |
3.3× |
| CT lower extremity with contrast (73701) |
$512.55 |
$3,417 |
3.2× |
| CT lumbar spine w & w/o contrast (72133) |
$562.05 |
$3,747 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$526.65 |
$3,511 |
5.4× |
| CT lumbar spine with contrast (72132) |
$539.40 |
$3,596 |
1.7× |
| CT maxillofacial w contrast (70487) |
$529.28 |
$3,528.50 |
3.3× |
| CT maxillofacial w/o contrast (70486) |
$568.50 |
$3,790 |
5.9× |
| CT maxillofacial w/wo contrast (70488) |
$714.75 |
$4,765 |
4.4× |
| CT neck soft tissue w contrast (70491) |
$462.75 |
$3,085 |
2.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$547.20 |
$3,648 |
3.4× |
| CT orbits w/o contrast (70480) |
$431.10 |
$2,874 |
4.5× |
| CT pelvis w & w/o contrast (72194) |
$642.45 |
$4,283 |
4.0× |
| CT pelvis w/o contrast (72192) |
$438.15 |
$2,921 |
4.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$492.90 |
$3,286 |
3.0× |
| CT soft tissue neck w/o contrast (70490) |
$446.10 |
$2,974 |
4.6× |
| CT thoracic spine w/contrast (72129) |
$566.25 |
$3,775 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$526.65 |
$3,511 |
5.4× |
| CT thoracic spine w/wo contrast (72130) |
$590.25 |
$3,935 |
3.6× |
| CT thorax w/o contrast (71250) |
$248.70 |
$1,658 |
2.6× |
| CT unlisted procedure (76497) |
$178.65 |
$1,191 |
2.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$529.80 |
$3,532 |
3.3× |
| CT upper extremity w/o contrast rt (73200) |
$463.65 |
$3,091 |
4.8× |
| CT upper extremity with contrast (73201) |
$512.55 |
$3,417 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$642.45 |
$4,283 |
4.0× |
| Cta Abdomen (74175) |
$642.45 |
$4,283 |
4.0× |
| CTA abdomen pelvis (74174) |
$1,286.10 |
$8,574 |
4.0× |
| CTA chest (71275) |
$656.85 |
$4,379 |
4.0× |
| Cta Head (70496) |
$621.45 |
$4,143 |
3.8× |
| CTA lwr ext w&w/o contrast (73706) |
$556.95 |
$3,713 |
3.4× |
| Cta Neck (70498) |
$517.50 |
$3,450 |
3.2× |
| Cta Pelvis (72191) |
$612.30 |
$4,082 |
3.8× |
| Cystography minimum 3 views rs&i (74430) |
$102.15 |
$681 |
0.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$103.95 |
$693 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$84.60 |
$564 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$177.90 |
$1,186 |
1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$72.60 |
$484 |
0.9× |
| Dxa bone density study axial skeleton (77085) |
$36.15 |
$241 |
0.4× |
| Echoencephalography real time imaging (76506) |
$115.35 |
$769 |
1.2× |
| Esophagus (74220) |
$84.90 |
$566 |
0.5× |
| Fetal biophysical profile non-stress testing (76818) |
$176.25 |
$1,175 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$185.40 |
$1,236 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$97.65 |
$651 |
0.4× |
| Foot 2 views (73620) |
$35.18 |
$234.50 |
0.4× |
| Forearm 2 views (73090) |
$42.08 |
$280.50 |
0.5× |
| Functional MRI brain by phys/psych (70555) |
$561.60 |
$3,744 |
2.5× |
| Functional MRI brain by tech (70554) |
$589.80 |
$3,932 |
2.7× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$545.85 |
$3,639 |
1.1× |
| Gated Heart Planar Single (78472) |
$285.75 |
$1,905 |
0.8× |
| Hand 2 views (73120) |
$36.22 |
$241.50 |
0.4× |
| Hand 3 views (73130) |
$75.60 |
$504 |
0.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,496.70 |
$9,978 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,617.60 |
$10,784 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,676.85 |
$11,179 |
2.6× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$76.35 |
$509 |
0.2× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$76.35 |
$509 |
0.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,228.20 |
$8,188 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$319.50 |
$2,130 |
0.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$286.50 |
$1,910 |
0.8× |
| Ht muscle image spect sing (78451) |
$939.15 |
$6,261 |
0.8× |
| Humerus Min 2 Views Left (73060) |
$46.58 |
$310.50 |
0.6× |
| Hysterosalpingogram (74740) |
$117.90 |
$786 |
0.5× |
| Image fusion (77399) |
$86.85 |
$579 |
0.7× |
| Interstitial radiation source applic complex (77778) |
$2,044.65 |
$13,631 |
3.2× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$4,016.40 |
$26,776 |
0.6× |
| Io rad tx deliver by elctrns (77425) |
$4,016.40 |
$26,776 |
0.6× |
| Kidney imaging morphology (78700) |
$209.10 |
$1,394 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$298.80 |
$1,992 |
0.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$406.05 |
$2,707 |
0.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$478.95 |
$3,193 |
1.0× |
| Knee 3 views (73562) |
$53.55 |
$357 |
0.7× |
| Liver & spleen imaging static only (78215) |
$152.55 |
$1,017 |
0.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$215.25 |
$1,435 |
0.6× |
| Liver imaging w/vascular flow (78202) |
$238.80 |
$1,592 |
0.5× |
| Lung perf&ventilat diferentl (78598) |
$479.85 |
$3,199 |
1.0× |
| Lung perfusion differential (78597) |
$313.80 |
$2,092 |
0.8× |
| Lung Ventilation Imaging (78579) |
$166.35 |
$1,109 |
0.4× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$863.25 |
$5,755 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$863.25 |
$5,755 |
0.3× |
| Lymphoscintigraphy (78195) |
$279.90 |
$1,866 |
0.6× |
| Mammary ductogram or galactogram multiple (77054) |
$151.95 |
$1,013 |
0.7× |
| Mammary ductogram or galactogram single (77053) |
$97.05 |
$647 |
0.4× |
| Meckels Diverticulum (78290) |
$237.60 |
$1,584 |
0.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$507.30 |
$3,382 |
1.5× |
| Mr elastography (76391) |
$80.85 |
$539 |
0.4× |
| Mr safety determination physician/other qhp (76016) |
$36.45 |
$243 |
0.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$24.60 |
$164 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$10.20 |
$68 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$38.10 |
$254 |
0.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$100.20 |
$668 |
0.5× |
| MRA head w & w/o contrast (70546) |
$950.55 |
$6,337 |
2.9× |
| MRA head w/o contrast (70544) |
$561.60 |
$3,744 |
2.5× |
| MRA head with contrast (70545) |
$660.60 |
$4,404 |
2.0× |
| MRA neck w contrast (70548) |
$660.60 |
$4,404 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$950.55 |
$6,337 |
2.9× |
| MRA neck w/o contrast (70547) |
$561.60 |
$3,744 |
2.5× |
| MRI abdomen w contrast (74182) |
$643.80 |
$4,292 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$905.70 |
$6,038 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$561.60 |
$3,744 |
2.5× |
| MRI any jnt lwr ext with con lt (73722) |
$643.80 |
$4,292 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$643.80 |
$4,292 |
0.9× |
| MRI breast w/o contrast bilateral (77047) |
$660.60 |
$4,404 |
3.0× |
| MRI breast w/o contrast unilat (77046) |
$517.05 |
$3,447 |
2.3× |
| MRI c-spine with contrast (72142) |
$612.75 |
$4,085 |
1.9× |
| MRI cardiac w/o cont stress (75559) |
$559.05 |
$3,727 |
1.1× |
| MRI cardiac w/o contrast (75557) |
$532.65 |
$3,551 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$411.38 |
$2,742.50 |
1.9× |
| MRI chest w/o & w/contrast material (71552) |
$710.55 |
$4,737 |
2.2× |
| MRI chest w/o contrast (71550) |
$561.60 |
$3,744 |
2.5× |
| MRI chest with contrast (71551) |
$612.75 |
$4,085 |
0.8× |
| MRI fetal sngl/1st gestation (74712) |
$215.10 |
$1,434 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$643.80 |
$4,292 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$643.80 |
$4,292 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$561.60 |
$3,744 |
2.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$419.18 |
$2,794.50 |
1.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$774.75 |
$5,165 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$643.80 |
$4,292 |
2.0× |
| MRI pelvis w contrast (72196) |
$643.80 |
$4,292 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$905.70 |
$6,038 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$405.08 |
$2,700.50 |
1.8× |
| MRI scan of arm joint before and after contrast (73223) |
$704.40 |
$4,696 |
2.2× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$642.15 |
$4,281 |
0.9× |
| MRI scan of leg joint before and after contrast (73723) |
$924.30 |
$6,162 |
2.9× |
| MRI spectroscopy (76390) |
$80.25 |
$535 |
1.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$905.25 |
$6,035 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$643.80 |
$4,292 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$905.70 |
$6,038 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$643.80 |
$4,292 |
2.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$905.70 |
$6,038 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$405.08 |
$2,700.50 |
1.8× |
| MRI tmj (70336) |
$594 |
$3,960 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$561.60 |
$3,744 |
2.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$737.40 |
$4,916 |
2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$561.60 |
$3,744 |
2.5× |
| Myelogram Cervical (72240) |
$297.75 |
$1,985 |
0.4× |
| Myelogram Lumbar (72265) |
$297.75 |
$1,985 |
0.4× |
| Myelogram thoracic (72255) |
$297.75 |
$1,985 |
0.4× |
| Myelography 2 or more regions (72270) |
$373.20 |
$2,488 |
0.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,725 |
$11,500 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,490.40 |
$9,936 |
1.2× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$726.90 |
$4,846 |
0.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$726.90 |
$4,846 |
0.5× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,134 |
$7,560 |
0.6× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$1,385.85 |
$9,239 |
0.7× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$1,385.85 |
$9,239 |
1.0× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$420.60 |
$2,804 |
0.5× |
| Neck soft tissue (70360) |
$53.40 |
$356 |
0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$103.95 |
$693 |
0.3× |
| Nm cisternogram (78630) |
$357.90 |
$2,386 |
0.7× |
| Nm gastric emptying study (78264) |
$486.90 |
$3,246 |
1.3× |
| Nm gastroesophageal reflux study (78262) |
$149.85 |
$999 |
0.4× |
| Nm peritoneal-venous shunt patency (78291) |
$131.55 |
$877 |
0.4× |
| Nm whole blood volume (78122) |
$235.35 |
$1,569 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$986.85 |
$6,579 |
0.8× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,024.95 |
$6,833 |
0.9× |
| Nuclear medicine of heart pumping function (78473) |
$260.70 |
$1,738 |
0.7× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,642.65 |
$10,951 |
1.2× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$850.35 |
$5,669 |
0.7× |
| Nuclear medicine study of kidney and blood flow (78701) |
$345.30 |
$2,302 |
0.9× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$372.30 |
$2,482 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$98.25 |
$655 |
0.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$112.80 |
$752 |
1.2× |
| Orthopantogram (70355) |
$64.95 |
$433 |
0.8× |
| Osseous survey infant (77076) |
$55.50 |
$370 |
0.6× |
| Osseous survey limited (77074) |
$118.50 |
$790 |
1.2× |
| Parathyrd planar w/spect&CT (78072) |
$270.15 |
$1,801 |
0.5× |
| Parathyrd planar w/wo subtrj (78071) |
$280.35 |
$1,869 |
0.8× |
| Parathyroid imaging (78070) |
$280.35 |
$1,869 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$57.45 |
$383 |
0.6× |
| Peritoneogram rs&i (74190) |
$171.30 |
$1,142 |
0.3× |
| PET image w/CT, skull-thigh (78815) |
$2,025 |
$13,500 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,025 |
$13,500 |
1.5× |
| PET imaging limited area chest head/neck (78811) |
$1,642.65 |
$10,951 |
1.4× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$603.90 |
$4,026 |
0.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$924.30 |
$6,162 |
2.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,169.70 |
$7,798 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,228.20 |
$8,188 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$189.30 |
$1,262 |
0.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$479.85 |
$3,199 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$187.95 |
$1,253 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$59.55 |
$397 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$66 |
$440 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$74.70 |
$498 |
0.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$93.60 |
$624 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$109.20 |
$728 |
1.1× |
Radiation Delivery Stereotactic Cranial Linear (77372)
unusually low: confirm this is the full procedure |
$2,690.40 |
$17,936 |
0.4× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$174.45 |
$1,163 |
0.3× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$97.95 |
$653 |
1.0× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$121.95 |
$813 |
0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$70.20 |
$468 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$57.45 |
$383 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$73.20 |
$488 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$68.70 |
$458 |
0.9× |
| Radiologic exam colon single contrast study (74270) |
$96.90 |
$646 |
0.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$91.95 |
$613 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$202.05 |
$1,347 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$176.25 |
$1,175 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$63.90 |
$426 |
0.8× |
| Radiological examination surgical specimen (76098) |
$215.48 |
$1,436.50 |
0.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$226.35 |
$1,509 |
0.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,228.20 |
$8,188 |
0.4× |
| Ribs bilateral 3 views (71110) |
$73.35 |
$489 |
0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$384.90 |
$2,566 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$381.90 |
$2,546 |
0.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$624.60 |
$4,164 |
1.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$640.80 |
$4,272 |
0.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$640.80 |
$4,272 |
0.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$726.90 |
$4,846 |
0.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$599.40 |
$3,996 |
2.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$83.40 |
$556 |
0.4× |
| Rp Therapy Intravenous Administration (79101) |
$201.90 |
$1,346 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$28.65 |
$191 |
0.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$174.45 |
$1,163 |
0.8× |
| Scanogram (77073) |
$55.80 |
$372 |
0.6× |
| Scapula complete (73010) |
$43.88 |
$292.50 |
0.5× |
| Screening digital breast tomosynthesis (77063) |
$15.75 |
$105 |
0.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$194.10 |
$1,294 |
2.0× |
| Simulation intermediate (77285) |
$216.30 |
$1,442 |
0.6× |
| Small bowel series (74250) |
$89.10 |
$594 |
0.5× |
| Spec medical radj physics consltj (77370) |
$198.90 |
$1,326 |
1.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$192.30 |
$1,282 |
0.6× |
| Special dosimetry (77331) |
$62.10 |
$414 |
0.5× |
| Special treatment procedure (77470) |
$618 |
$4,120 |
1.2× |
| Speech evaluation complex (70371) |
$77.55 |
$517 |
0.4× |
| Spine thoracic 3 views (72072) |
$104.40 |
$696 |
1.1× |
| Stereotactic body radiation delivery (77373) |
$1,918.05 |
$12,787 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$410.85 |
$2,739 |
0.1× |
| Tbs Technical Calculation Only (77091) |
$37.95 |
$253 |
0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$310.50 |
$2,070 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$249.68 |
$1,664.50 |
0.7× |
| Testicular Imaging With Vascular Flow (78761) |
$210.45 |
$1,403 |
0.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$316.80 |
$2,112 |
0.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$161.10 |
$1,074 |
1.3× |
| Thoracolumbar 2 views (72080) |
$67.35 |
$449 |
0.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$283.20 |
$1,888 |
0.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$220.80 |
$1,472 |
0.6× |
| Thyroid uptake measurement (78012) |
$190.65 |
$1,271 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$288.15 |
$1,921 |
0.8× |
| Tmj unilateral (70328) |
$25.95 |
$173 |
0.3× |
| Tomogram (76100) |
$96.75 |
$645 |
1.0× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$37.95 |
$253 |
0.5× |
| Treatment device intermediate (77333) |
$114.90 |
$766 |
0.9× |
| Treatment devices simple (77332) |
$100.80 |
$672 |
0.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$847.50 |
$5,650 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$237.15 |
$1,581 |
0.6× |
| Tx devices design & construction complex (77334) |
$316.80 |
$2,112 |
0.9× |
| Ultrasound elastography first target lesion (76982) |
$58.95 |
$393 |
0.6× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$71.25 |
$475 |
0.2× |
| Ultrasound, abdomen limited (76705) |
$133.35 |
$889 |
1.4× |
| Umbilical-artery Doppler (OB) (76820) |
$84.60 |
$564 |
0.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$47.70 |
$318 |
0.6× |
| Unlisted fluoroscopic procedure (76496) |
$53.10 |
$354 |
0.7× |
| Unlisted magnetic resonance procedure (76498) |
$292.58 |
$1,950.50 |
3.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$114.15 |
$761 |
0.3× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$1,573.65 |
$10,491 |
4.2× |
| Upper Extremity Infant (73092) |
$44.40 |
$296 |
0.5× |
| Urethrocystography retrograde rs&i (74450) |
$141.75 |
$945 |
0.6× |
| Urethrocystography voiding (74455) |
$93.60 |
$624 |
0.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$226.20 |
$1,508 |
1.4× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$275.70 |
$1,838 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$60 |
$400 |
0.6× |
| Us breast unilateral complete (76641) |
$58.05 |
$387 |
0.6× |
| Us breast unilateral limited (76642) |
$45.75 |
$305 |
0.6× |
| Us chest (76604) |
$74.10 |
$494 |
0.8× |
| Us compl joint r-t w/image documentation (76881) |
$144.60 |
$964 |
1.5× |
| Us elastography parenchyma (76981) |
$58.95 |
$393 |
0.6× |
| Us fetal nuchal translucency 1st gestation (76813) |
$95.70 |
$638 |
1.0× |
| Us guided compression repair (76936) |
$293.85 |
$1,959 |
1.5× |
| Us infant hips dynamic (76885) |
$123.30 |
$822 |
1.5× |
| Us infant hips limited static (76886) |
$88.80 |
$592 |
1.1× |
| Us kidney transplant (76776) |
$133.05 |
$887 |
1.4× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$46.80 |
$312 |
0.5× |
| Us ob detailed single fetus (76811) |
$305.40 |
$2,036 |
1.4× |
| Us ob transvaginal (76817) |
$117.90 |
$786 |
1.2× |
| Us pelvic non ob complete (76856) |
$205.80 |
$1,372 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$95.78 |
$638.50 |
1.0× |
| Us pregnancy ltd (76815) |
$111 |
$740 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$81.90 |
$546 |
0.8× |
| Us retroperitoneal complete (76770) |
$174.45 |
$1,163 |
1.8× |
| Us retroperitoneal limited (76775) |
$123.60 |
$824 |
1.3× |
| Us scrotum and contents (76870) |
$131.70 |
$878 |
1.4× |
| Us soft tissue head/neck (76536) |
$117.30 |
$782 |
1.2× |
| Us spinal canal and contents (76800) |
$77.55 |
$517 |
0.8× |
| Us transrectal (76872) |
$156.90 |
$1,046 |
1.6× |
| Us transrectal prostate volume (76873) |
$164.40 |
$1,096 |
1.7× |
| Us xtr non-vasc lmtd (76882) |
$84.30 |
$562 |
0.9× |
| Us, eye b-scan (76512) |
$46.95 |
$313 |
0.5× |
| Vascular flow imaging (78445) |
$120.15 |
$801 |
0.3× |
| Venogram extremity bilateral (75822) |
$378.90 |
$2,526 |
0.3× |
| Venogram orbital (75880) |
$935.85 |
$6,239 |
1.6× |
| Venography caval inferior serialography rs&i (75825) |
$1,242 |
$8,280 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$435.15 |
$2,901 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$378.90 |
$2,526 |
0.3× |
| Venography Renal Bilateral (75833) |
$1,169.70 |
$7,798 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,228.20 |
$8,188 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$889.35 |
$5,929 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,228.20 |
$8,188 |
0.2× |
| Wrist 2 views (73100) |
$42.45 |
$283 |
0.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$69.90 |
$466 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$58.05 |
$387 |
0.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$75.60 |
$504 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$184.65 |
$1,231 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$35.55 |
$237 |
0.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$55.50 |
$370 |
0.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$94.65 |
$631 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$39.45 |
$263 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$77.10 |
$514 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$85.35 |
$569 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$85.35 |
$569 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$98.85 |
$659 |
1.0× |
| X-ray exam of femur 1 (73551) |
$35.40 |
$236 |
0.4× |
| X-ray eye for foreign body (70030) |
$82.05 |
$547 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$65.25 |
$435 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$60.30 |
$402 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$53.55 |
$357 |
0.7× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$660.90 |
$4,406 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$30.30 |
$202 |
0.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$27.60 |
$184 |
0.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$67.50 |
$450 |
0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$44.40 |
$296 |
0.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$48.15 |
$321 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$72.90 |
$486 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$158.70 |
$1,058 |
1.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$65.85 |
$439 |
0.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$51 |
$340 |
0.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$66 |
$440 |
0.8× |
| X-ray of voice box or throat (70370) |
$84.90 |
$566 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$42.45 |
$283 |
0.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$57.90 |
$386 |
0.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$92.25 |
$615 |
0.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$49.50 |
$330 |
0.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$73.35 |
$489 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$80.55 |
$537 |
0.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$53.55 |
$357 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$53.55 |
$357 |
0.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$68.70 |
$458 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$64.95 |
$433 |
0.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$44.40 |
$296 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$82.05 |
$547 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$50.02 |
$333.50 |
0.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$39.98 |
$266.50 |
0.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$55.80 |
$372 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$48.15 |
$321 |
0.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$72.90 |
$486 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$104.40 |
$696 |
1.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$28.65 |
$191 |
0.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$57.90 |
$386 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$136.50 |
$910 |
1.4× |
| Xr chest 4+ views (71048) |
$77.10 |
$514 |
0.8× |
| Xr Cholecystography Oral Contrast (74290) |
$84.60 |
$564 |
0.5× |
| Xr finger(s) 2+ views (73140) |
$38.10 |
$254 |
0.5× |
| Xr optic foramina (70190) |
$38.10 |
$254 |
0.5× |
| Xr shoulder 1 view (73020) |
$44.40 |
$296 |
0.6× |
| Xr spine cervical 4 or 5 views (72050) |
$117.15 |
$781 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$62.70 |
$418 |
0.8× |
| Xr tmj bilateral (70330) |
$60.75 |
$405 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$44.40 |
$296 |
0.6× |