| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,769.40 |
$7,949 |
3.8× |
| Abdomen 2 views (74019) |
$122.57 |
$204.28 |
1.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$595.20 |
$992 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,102 |
$5,170 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$2,259.90 |
$3,766.50 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,495.80 |
$2,493 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,102 |
$5,170 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,102 |
$5,170 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,495.80 |
$2,493 |
0.5× |
| Angiography Spinal Selective Rs&I (75705) |
$2,559 |
$4,265 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,102 |
$5,170 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$589.80 |
$983 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,417.80 |
$2,363 |
0.5× |
| Ankle 2 views (73600) |
$100.34 |
$167.22 |
1.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$403.20 |
$672 |
1.3× |
| Aortogram thoracic (75605) |
$3,102 |
$5,170 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,102 |
$5,170 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$3,102 |
$5,170 |
1.1× |
| Arthrogram elbow (73085) |
$684.60 |
$1,141 |
2.2× |
| Arthrogram hip (73525) |
$684.60 |
$1,141 |
2.2× |
| Arthrogram shoulder (73040) |
$684.60 |
$1,141 |
2.2× |
| Arthrogram wrist (73115) |
$379.20 |
$632 |
1.2× |
| Arthrography knee lt (73580) |
$726 |
$1,210 |
2.3× |
| Basic radiation dosimetry calculation (77300) |
$319.80 |
$533 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$647.40 |
$1,079 |
1.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$610.20 |
$1,017 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$610.20 |
$1,017 |
1.7× |
| Bone age studies (77072) |
$171.60 |
$286 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$763.20 |
$1,272 |
2.1× |
| Bone Marrow Imaging Limited Area (78102) |
$647.40 |
$1,079 |
1.8× |
| Bone survey complete (77075) |
$184.80 |
$308 |
1.9× |
| Brachytx isodose complex (77318) |
$1,124.40 |
$1,874 |
3.3× |
| Brachytx isodose intermed (77317) |
$771.60 |
$1,286 |
2.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$517.80 |
$863 |
1.5× |
| Brain image w/flow 4 + views (78606) |
$1,187.40 |
$1,979 |
2.4× |
| Brain imaging < 4 static views (78600) |
$514.80 |
$858 |
1.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$514.80 |
$858 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$679.80 |
$1,133 |
1.4× |
| Brain Imaging Vascular Flow Only (78610) |
$1,187.40 |
$1,979 |
2.4× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$838.80 |
$1,398 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,050 |
$1,750 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$92.70 |
$154.50 |
1.2× |
| Chest 1 view (71045) |
$32.48 |
$54.14 |
0.4× |
| Chest 3 views (71047) |
$133.80 |
$223 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$278.40 |
$464 |
1.7× |
| Clavicle complete (73000) |
$93.80 |
$156.33 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$173.40 |
$289 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$565.20 |
$942 |
4.6× |
| Corpora cavernosography (74445) |
$403.20 |
$672 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$309.60 |
$516 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$157.20 |
$262 |
0.7× |
| CT abdomen w contrast (74160) |
$586.20 |
$977 |
3.7× |
| CT abdomen w wo contrast (74170) |
$712.80 |
$1,188 |
4.5× |
| CT abdomen w/o contrast (74150) |
$385.80 |
$643 |
4.1× |
| CT angio hrt w/3d image (75574) |
$97.20 |
$162 |
0.3× |
| CT angiography upper extremity lt (73206) |
$654 |
$1,090 |
4.1× |
| CT c-spine w/o contrast (72125) |
$170.40 |
$284 |
1.8× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$268.80 |
$448 |
1.7× |
| CT cervical spine w&w/o contrast (72127) |
$551.70 |
$919.50 |
3.5× |
| CT cervical spine with contrast (72126) |
$465.60 |
$776 |
1.5× |
| CT chest w/wo contrast (71270) |
$280.80 |
$468 |
1.8× |
| CT chest with contrast (71260) |
$229.20 |
$382 |
1.4× |
| CT head/brain with contrast (70460) |
$449.10 |
$748.50 |
2.8× |
| CT head/brain without and with contrast (70470) |
$631.20 |
$1,052 |
4.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$51 |
$85 |
0.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$18 |
$30 |
0.2× |
| CT iac w contrast (70481) |
$259.80 |
$433 |
1.6× |
| CT limited/localized follow up study (76380) |
$259.80 |
$433 |
3.3× |
| CT lower ext w/o (73700) |
$169.80 |
$283 |
1.8× |
| CT lower extremity w wo contrast (73702) |
$282.60 |
$471 |
1.8× |
| CT lower extremity with contrast (73701) |
$229.20 |
$382 |
1.4× |
| CT lumbar spine w & w/o contrast (72133) |
$552.30 |
$920.50 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$169.20 |
$282 |
1.8× |
| CT lumbar spine with contrast (72132) |
$466.20 |
$777 |
1.5× |
| CT maxillofacial w contrast (70487) |
$202.20 |
$337 |
1.3× |
| CT maxillofacial w/o contrast (70486) |
$179.40 |
$299 |
1.9× |
| CT maxillofacial w/wo contrast (70488) |
$254.40 |
$424 |
1.6× |
| CT neck soft tissue w contrast (70491) |
$561.30 |
$935.50 |
3.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$307.20 |
$512 |
1.9× |
| CT orbits w/o contrast (70480) |
$201.60 |
$336 |
2.1× |
| CT pelvis w & w/o contrast (72194) |
$609 |
$1,015 |
3.8× |
| CT pelvis w/o contrast (72192) |
$484.80 |
$808 |
5.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$663.30 |
$1,105.50 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$334.50 |
$557.50 |
3.5× |
| CT thoracic spine w/contrast (72129) |
$466.80 |
$778 |
2.9× |
| CT thoracic spine w/o contrast (72128) |
$357.60 |
$596 |
3.8× |
| CT thoracic spine w/wo contrast (72130) |
$553.80 |
$923 |
3.5× |
| CT thorax w/o contrast (71250) |
$168.60 |
$281 |
1.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$385.80 |
$643 |
2.4× |
| CT upper extremity w/o contrast rt (73200) |
$232.20 |
$387 |
2.4× |
| CT upper extremity with contrast (73201) |
$296.40 |
$494 |
0.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$611.40 |
$1,019 |
3.8× |
| Cta Abdomen (74175) |
$249.60 |
$416 |
1.6× |
| CTA abdomen pelvis (74174) |
$60 |
$100 |
0.2× |
| CTA chest (71275) |
$226.20 |
$377 |
1.4× |
| Cta Head (70496) |
$397.20 |
$662 |
2.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$558.33 |
$930.55 |
1.8× |
| CTA lwr ext w&w/o contrast (73706) |
$797.70 |
$1,329.50 |
5.0× |
| Cta Neck (70498) |
$708 |
$1,180 |
4.4× |
| Cta Pelvis (72191) |
$661.50 |
$1,102.50 |
4.1× |
| Cystography minimum 3 views rs&i (74430) |
$403.20 |
$672 |
1.3× |
| Diskogram cervical (72285) |
$2,415.60 |
$4,026 |
1.4× |
| Diskography lumbar (72295) |
$2,415.60 |
$4,026 |
1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$171 |
$285 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$420.60 |
$701 |
4.4× |
| Echoencephalography real time imaging (76506) |
$182.40 |
$304 |
1.9× |
| Esophagus (74220) |
$379.20 |
$632 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$242.40 |
$404 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$296.40 |
$494 |
1.4× |
| Foot 2 views (73620) |
$98.84 |
$164.74 |
1.2× |
| Forearm 2 views (73090) |
$106.04 |
$176.74 |
1.3× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$88.20 |
$147 |
0.4× |
| Gated Heart Planar Single (78472) |
$60 |
$100 |
0.2× |
| Hand 2 views (73120) |
$106.97 |
$178.28 |
1.1× |
| Hand 3 views (73130) |
$112.34 |
$187.22 |
1.4× |
| Heart Infarct Image (78466) |
$838.80 |
$1,398 |
2.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,495.80 |
$2,493 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$874.80 |
$1,458 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$699.60 |
$1,166 |
1.9× |
| Ht muscle image spect sing (78451) |
$1,804.20 |
$3,007 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$110.99 |
$184.98 |
1.4× |
| Hyperthermia ntrstl prb 5/< (77610) |
$508.80 |
$848 |
1.0× |
| Hysterosalpingogram (74740) |
$348.60 |
$581 |
1.6× |
| Image fusion (77399) |
$606 |
$1,010 |
5.0× |
| Interstitial radiation source applic complex (77778) |
$930.60 |
$1,551 |
1.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,003.80 |
$1,673 |
1.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$942.60 |
$1,571 |
1.9× |
| Intracavitary radiation source applic simple (77761) |
$754.20 |
$1,257 |
1.5× |
| Kidney imaging morphology (78700) |
$786 |
$1,310 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$786 |
$1,310 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$786 |
$1,310 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$786 |
$1,310 |
1.6× |
| Knee 3 views (73562) |
$110.79 |
$184.65 |
1.4× |
| Liver & spleen imaging static only (78215) |
$699.60 |
$1,166 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$699.60 |
$1,166 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$699.60 |
$1,166 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$795.60 |
$1,326 |
1.6× |
| Lung perfusion differential (78597) |
$795.60 |
$1,326 |
2.2× |
| Lung Ventilation Imaging (78579) |
$509.40 |
$849 |
1.4× |
| Lymphoscintigraphy (78195) |
$647.40 |
$1,079 |
1.3× |
| Mammary ductogram or galactogram multiple (77054) |
$520.80 |
$868 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$348.60 |
$581 |
1.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$112.20 |
$187 |
1.4× |
| Meckels Diverticulum (78290) |
$595.20 |
$992 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$502.80 |
$838 |
1.5× |
| MRA head w & w/o contrast (70546) |
$1,338.60 |
$2,231 |
4.2× |
| MRA head w/o contrast (70544) |
$1,101 |
$1,835 |
5.1× |
| MRA head with contrast (70545) |
$754.45 |
$1,257.42 |
2.4× |
| MRA neck w contrast (70548) |
$1,020 |
$1,700 |
3.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,338.60 |
$2,231 |
4.2× |
| MRA neck w/o contrast (70547) |
$855 |
$1,425 |
3.9× |
| MRI abdomen w contrast (74182) |
$1,050 |
$1,750 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,673.40 |
$2,789 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$680.42 |
$1,134.04 |
3.1× |
| MRI any jnt lwr ext with con lt (73722) |
$480.58 |
$800.96 |
0.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$477.22 |
$795.36 |
0.7× |
| MRI bone marrow blood supply (77084) |
$772.20 |
$1,287 |
3.6× |
| MRI breast w/o contrast bilateral (77047) |
$1,050 |
$1,750 |
4.8× |
| MRI breast w/o contrast unilat (77046) |
$880.80 |
$1,468 |
4.1× |
| MRI c-spine with contrast (72142) |
$1,322.40 |
$2,204 |
4.2× |
| MRI cardiac w/o cont stress (75559) |
$880.80 |
$1,468 |
1.8× |
| MRI cardiac w/o contrast (75557) |
$880.80 |
$1,468 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,101 |
$1,835 |
5.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,338.60 |
$2,231 |
4.2× |
| MRI chest w/o contrast (71550) |
$880.80 |
$1,468 |
4.1× |
| MRI chest with contrast (71551) |
$1,020 |
$1,700 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$516.62 |
$861.04 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$380.42 |
$634.04 |
1.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$324.60 |
$541 |
1.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$934.20 |
$1,557 |
4.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$911.58 |
$1,519.30 |
2.9× |
| MRI orbit/face/neck w/contrast (70542) |
$389.76 |
$649.60 |
1.2× |
| MRI pelvis w contrast (72196) |
$1,050 |
$1,750 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,338.60 |
$2,231 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$855.60 |
$1,426 |
3.9× |
| MRI scan of arm joint before and after contrast (73223) |
$576.70 |
$961.16 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$574.70 |
$957.84 |
1.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,673.40 |
$2,789 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,322.40 |
$2,204 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,673.40 |
$2,789 |
5.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$855.76 |
$1,426.26 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,673.40 |
$2,789 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,101 |
$1,835 |
5.1× |
| MRI tmj (70336) |
$582.65 |
$971.08 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$285.62 |
$476.04 |
1.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$625.18 |
$1,041.96 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$483.24 |
$805.40 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,855.80 |
$75 |
1.6× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,577.54 |
$2,629.22 |
2.0× |
| Neck soft tissue (70360) |
$104.50 |
$174.16 |
1.3× |
| Nm adrenal scan (78075) |
$1,804.20 |
$3,007 |
1.5× |
| Nm bone marrow wb (78104) |
$647.40 |
$1,079 |
1.8× |
| Nm cisternogram (78630) |
$1,187.40 |
$1,979 |
2.4× |
| Nm gastric emptying study (78264) |
$595.20 |
$992 |
1.6× |
| Nm gastroesophageal reflux study (78262) |
$595.20 |
$992 |
1.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,651.80 |
$2,753 |
1.3× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,804.20 |
$3,007 |
1.5× |
| Nuclear medicine of heart pumping function (78473) |
$838.80 |
$1,398 |
2.3× |
| Nuclear medicine study of kidney and blood flow (78701) |
$786 |
$1,310 |
2.2× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$694.20 |
$1,157 |
1.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$500.40 |
$834 |
1.4× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$469.20 |
$782 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$534 |
$890 |
2.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$171.60 |
$286 |
1.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$183 |
$305 |
1.5× |
| Osseous survey infant (77076) |
$171.60 |
$286 |
1.8× |
| Osseous survey limited (77074) |
$184.80 |
$308 |
1.9× |
| Parathyrd planar w/wo subtrj (78071) |
$514.80 |
$858 |
1.4× |
| Parathyroid imaging (78070) |
$564 |
$940 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$111.62 |
$186.03 |
1.2× |
| Peritoneogram rs&i (74190) |
$585.30 |
$975.50 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$1,800 |
$3,000 |
1.4× |
| PET imaging CT for attenuation limited area (78814) |
$1,800 |
$3,000 |
1.4× |
| PET imaging for CT attenuation whole body (78816) |
$1,800 |
$3,000 |
1.4× |
| Pr gi endoscopic ultrasound (76975) |
$184.80 |
$308 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$479.90 |
$799.84 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$509.40 |
$849 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$795.60 |
$1,326 |
1.6× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,425.75 |
$2,376.25 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$348.60 |
$581 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$184.80 |
$308 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$184.80 |
$308 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$135.35 |
$225.58 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$112.20 |
$187 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$182.40 |
$304 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$62.42 |
$104.03 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$117.84 |
$196.40 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$122.40 |
$204 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$379.20 |
$632 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$379.20 |
$632 |
2.4× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$88.20 |
$147 |
0.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$273.33 |
$455.55 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$273.33 |
$455.55 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$105.62 |
$176.02 |
1.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$112.20 |
$187 |
1.4× |
| Radiological examination surgical specimen (76098) |
$730.20 |
$1,217 |
1.5× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,102 |
$5,170 |
1.1× |
| Ribs bilateral 3 views (71110) |
$171.60 |
$286 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$694.20 |
$1,157 |
1.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,804.20 |
$3,007 |
3.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,908.29 |
$3,180.48 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$171.60 |
$286 |
1.8× |
| Scanogram (77073) |
$182.40 |
$304 |
1.9× |
| Scapula complete (73010) |
$130.14 |
$216.89 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$49.20 |
$82 |
2.1× |
| Sella turcica (70240) |
$112.20 |
$187 |
1.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$228.60 |
$381 |
2.4× |
| Sialogram (70390) |
$348.60 |
$581 |
1.6× |
| Simulation intermediate (77285) |
$1,057.20 |
$1,762 |
3.1× |
| Small bowel series (74250) |
$222.60 |
$371 |
1.4× |
| Spec medical radj physics consltj (77370) |
$667.80 |
$1,113 |
5.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$765.60 |
$1,276 |
2.2× |
| Special dosimetry (77331) |
$504 |
$840 |
4.1× |
| Special treatment procedure (77470) |
$2,115.60 |
$3,526 |
4.2× |
| Speech evaluation complex (70371) |
$348.60 |
$581 |
1.6× |
| Spine thoracic 3 views (72072) |
$85.92 |
$143.20 |
0.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$717 |
$1,195 |
2.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$401.40 |
$669 |
1.2× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$351.60 |
$586 |
1.6× |
| Testicular Imaging With Vascular Flow (78761) |
$786 |
$1,310 |
2.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,237.20 |
$2,062 |
3.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$657.60 |
$1,096 |
5.4× |
| Therapeutic Enema (74283) |
$379.20 |
$632 |
2.4× |
| Thoracolumbar 2 views (72080) |
$112.20 |
$187 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$694.20 |
$1,157 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$436.80 |
$728 |
1.2× |
| Thyroid uptake measurement (78012) |
$524.40 |
$874 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$655.80 |
$1,093 |
1.8× |
| Tmj unilateral (70328) |
$112.20 |
$187 |
1.4× |
| Tomogram (76100) |
$171.60 |
$286 |
1.8× |
| Treatment device intermediate (77333) |
$439.20 |
$732 |
3.6× |
| Treatment devices simple (77332) |
$301.80 |
$503 |
2.5× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,958.91 |
$3,264.85 |
4.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,249.20 |
$2,082 |
3.4× |
| Tx devices design & construction complex (77334) |
$700.20 |
$1,167 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$303 |
$505 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$171.60 |
$286 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$194.40 |
$324 |
2.5× |
| Unlisted fluoroscopic procedure (76496) |
$253.80 |
$423 |
3.2× |
| Unlisted Ultrasound Procedure (76999) |
$119.72 |
$199.53 |
1.5× |
| Upper Extremity Infant (73092) |
$171.60 |
$286 |
1.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$786 |
$1,310 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$403.20 |
$672 |
1.9× |
| Urethrocystography voiding (74455) |
$403.20 |
$672 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$504 |
$840 |
3.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$504 |
$840 |
3.2× |
| Us abdl aorta screen aaa (76706) |
$18 |
$30 |
0.2× |
| Us breast unilateral complete (76641) |
$171.60 |
$286 |
1.8× |
| Us breast unilateral limited (76642) |
$155.40 |
$259 |
2.0× |
| Us chest (76604) |
$171.60 |
$286 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$160.74 |
$267.90 |
1.7× |
| Us infant hips dynamic (76885) |
$153 |
$255 |
1.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$157.20 |
$262 |
1.7× |
| Us ob transvaginal (76817) |
$171.60 |
$286 |
1.8× |
| Us pelvic non ob complete (76856) |
$180 |
$300 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$171.60 |
$286 |
1.8× |
| Us pregnancy ltd (76815) |
$185.40 |
$309 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$257.40 |
$429 |
2.7× |
| Us retroperitoneal complete (76770) |
$196.50 |
$327.50 |
2.1× |
| Us retroperitoneal limited (76775) |
$18 |
$30 |
0.2× |
| Us scrotum and contents (76870) |
$149.70 |
$249.50 |
1.6× |
| Us soft tissue head/neck (76536) |
$303 |
$505 |
3.2× |
| Us spinal canal and contents (76800) |
$242.40 |
$404 |
2.5× |
| Us transrectal (76872) |
$185.61 |
$309.35 |
1.9× |
| Us transrectal prostate volume (76873) |
$268.80 |
$448 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$171.60 |
$286 |
1.8× |
| Us, eye b-scan (76512) |
$159.51 |
$265.85 |
1.7× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$508.80 |
$848 |
1.4× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$676.80 |
$1,128 |
1.1× |
| Use of interstitial probe generated heat to increase temperature of cancer cell, more than 5 probes (77615) |
$676.80 |
$1,128 |
1.3× |
| Vascular flow imaging (78445) |
$469.20 |
$782 |
1.3× |
| Venogram extremity bilateral (75822) |
$1,474.20 |
$2,457 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$1,495.80 |
$2,493 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,417.80 |
$2,363 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$987.90 |
$1,646.50 |
0.7× |
| Venography Renal Bilateral (75833) |
$1,495.80 |
$2,493 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,495.80 |
$2,493 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,495.80 |
$2,493 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,559 |
$4,265 |
0.5× |
| Wrist 2 views (73100) |
$106.04 |
$176.74 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$64.13 |
$106.88 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$112.20 |
$187 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$113.15 |
$188.58 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$474 |
$790 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$95.04 |
$158.39 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$111.92 |
$186.52 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$163.46 |
$272.43 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$112.20 |
$187 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$127.80 |
$213 |
1.6× |
| X-ray exam hip uni 4/> views (73503) |
$184.80 |
$308 |
1.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$64.09 |
$106.81 |
0.7× |
| X-ray exam of femur 1 (73551) |
$112.20 |
$187 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$353.40 |
$589 |
2.2× |
| X-ray eye for foreign body (70030) |
$112.20 |
$187 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$117.84 |
$196.40 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$112.20 |
$187 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$110.99 |
$184.98 |
1.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,543.40 |
$4,239 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$54 |
$90 |
0.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$504 |
$840 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$119.40 |
$199 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$172.20 |
$287 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$112.20 |
$187 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$112.20 |
$187 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$84.05 |
$140.08 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$124.44 |
$207.40 |
1.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$231 |
$385 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$112.20 |
$187 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$94.80 |
$158 |
1.2× |
| X-ray of voice box or throat (70370) |
$205.80 |
$343 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$171.60 |
$286 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$177.60 |
$296 |
1.9× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$348.60 |
$581 |
0.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$684.60 |
$1,141 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$102.14 |
$170.24 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$120.30 |
$200.50 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$184.80 |
$308 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$182.40 |
$304 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$140.40 |
$234 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$112.54 |
$187.56 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$112.20 |
$187 |
1.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$112.20 |
$187 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$184.80 |
$308 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$171.60 |
$286 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$88.24 |
$147.06 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$112.20 |
$187 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$112.20 |
$187 |
1.4× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$88.20 |
$147 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$101.10 |
$168.51 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$230.40 |
$384 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$98.09 |
$163.48 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$119.75 |
$199.58 |
1.5× |
| Xr arthrogram ankle (73615) |
$684.60 |
$1,141 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$78.24 |
$130.40 |
0.8× |
| Xr chest 4+ views (71048) |
$171.60 |
$286 |
1.8× |
| Xr Cholecystography Oral Contrast (74290) |
$379.20 |
$632 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$88.68 |
$147.80 |
1.1× |
| Xr internal auditory meati complete (70134) |
$348.60 |
$581 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$112.20 |
$187 |
1.2× |
| Xr optic foramina (70190) |
$112.20 |
$187 |
1.4× |
| Xr shoulder 1 view (73020) |
$78.35 |
$130.58 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$184.80 |
$308 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$108.20 |
$180.34 |
1.4× |
| Xr tmj bilateral (70330) |
$112.20 |
$187 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$98.94 |
$164.90 |
1.2× |