| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,355.80 |
$5,593 |
2.6× |
| Abdomen 2 views (74019) |
$237.60 |
$396 |
2.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,307.70 |
$2,179.50 |
3.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,000.40 |
$3,334 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$2,374.20 |
$3,957 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,374.20 |
$3,957 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,351.80 |
$2,253 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,741.80 |
$2,903 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,744.20 |
$2,907 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,134.20 |
$3,557 |
0.7× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$802.20 |
$1,337 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$1,793.40 |
$2,989 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$569.40 |
$949 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,869 |
$3,115 |
0.6× |
| Ankle 2 views (73600) |
$179.70 |
$299.50 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$327.30 |
$545.50 |
1.0× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,449.80 |
$4,083 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,372.40 |
$3,954 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,449.80 |
$4,083 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,203.80 |
$3,673 |
0.8× |
| Arthrogram elbow (73085) |
$456.60 |
$761 |
1.4× |
| Arthrogram hip (73525) |
$949.80 |
$1,583 |
2.9× |
| Arthrogram shoulder (73040) |
$751.80 |
$1,253 |
2.3× |
| Arthrogram wrist (73115) |
$484.80 |
$808 |
1.5× |
| Arthrography knee lt (73580) |
$974.40 |
$1,624 |
3.0× |
| Basic radiation dosimetry calculation (77300) |
$441 |
$735 |
3.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$838.80 |
$1,398 |
2.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$405.90 |
$676.50 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$1,442.40 |
$2,404 |
3.9× |
| Bone age studies (77072) |
$101.70 |
$169.50 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,448.70 |
$2,414.50 |
3.9× |
| Bone survey complete (77075) |
$263.10 |
$438.50 |
2.7× |
| Brain image w/flow 4 + views (78606) |
$777 |
$1,295 |
1.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$748.20 |
$1,247 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,176.60 |
$6,961 |
3.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,533 |
$2,555 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$309.30 |
$515.50 |
3.8× |
| Chest 1 view (71045) |
$201.60 |
$336 |
2.5× |
| Chest 3 views (71047) |
$270.60 |
$451 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$310.20 |
$517 |
1.9× |
| Clavicle complete (73000) |
$222.60 |
$371 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$942.60 |
$1,571 |
9.7× |
| Continuing medical physics consltj pr wk (77336) |
$404.40 |
$674 |
3.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,958 |
$4,930 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,563.80 |
$4,273 |
11.6× |
| CT abdomen w contrast (74160) |
$1,587.30 |
$2,645.50 |
9.7× |
| CT abdomen w wo contrast (74170) |
$1,766.40 |
$2,944 |
10.8× |
| CT abdomen w/o contrast (74150) |
$1,366.50 |
$2,277.50 |
14.1× |
| CT angio hrt w/3d image (75574) |
$425.40 |
$709 |
1.3× |
| CT angiography upper extremity lt (73206) |
$879 |
$1,465 |
5.4× |
| CT c-spine w/o contrast (72125) |
$1,375.80 |
$2,293 |
14.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,405.50 |
$2,342.50 |
8.6× |
| CT cervical spine with contrast (72126) |
$1,714.80 |
$2,858 |
5.3× |
| CT chest w/wo contrast (71270) |
$1,752.30 |
$2,920.50 |
10.7× |
| CT chest with contrast (71260) |
$1,593.30 |
$2,655.50 |
9.8× |
| CT colonography screening (74263) |
$496.20 |
$827 |
2.2× |
| CT colonography w/o cntrst (74261) |
$496.20 |
$827 |
5.1× |
| CT head/brain with contrast (70460) |
$1,101.30 |
$1,835.50 |
6.8× |
| CT head/brain without and with contrast (70470) |
$1,269.90 |
$2,116.50 |
7.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$147.60 |
$246 |
0.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$85.20 |
$142 |
1.1× |
| CT iac w contrast (70481) |
$1,163.40 |
$1,939 |
7.1× |
| CT limited/localized follow up study (76380) |
$321.30 |
$535.50 |
4.0× |
| CT lower ext w/o (73700) |
$762.60 |
$1,271 |
7.8× |
| CT lower extremity w wo contrast (73702) |
$933 |
$1,555 |
5.7× |
| CT lower extremity with contrast (73701) |
$685.20 |
$1,142 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,521.90 |
$2,536.50 |
9.3× |
| CT lumbar spine w/o contrast (72131) |
$1,409.70 |
$2,349.50 |
14.5× |
| CT lumbar spine with contrast (72132) |
$1,938.60 |
$3,231 |
6.0× |
| CT maxillofacial w contrast (70487) |
$1,170.90 |
$1,951.50 |
7.2× |
| CT maxillofacial w/o contrast (70486) |
$1,244.40 |
$2,074 |
12.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,262.70 |
$2,104.50 |
7.7× |
| CT neck soft tissue w contrast (70491) |
$1,385.70 |
$2,309.50 |
8.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,247.40 |
$2,079 |
7.6× |
| CT orbits w/o contrast (70480) |
$1,159.80 |
$1,933 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$1,480.80 |
$2,468 |
9.1× |
| CT pelvis w/o contrast (72192) |
$1,229.70 |
$2,049.50 |
12.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,573.80 |
$2,623 |
9.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,203.60 |
$2,006 |
12.4× |
| CT thoracic spine w/contrast (72129) |
$1,260.30 |
$2,100.50 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,114.50 |
$1,857.50 |
11.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,831.20 |
$3,052 |
11.2× |
| CT thorax w/o contrast (71250) |
$1,574.40 |
$2,624 |
16.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$781.20 |
$1,302 |
4.8× |
| CT upper extremity w/o contrast rt (73200) |
$777 |
$1,295 |
8.0× |
| CT upper extremity with contrast (73201) |
$712.20 |
$1,187 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,500 |
$2,500 |
9.2× |
| Cta Abdomen (74175) |
$1,791 |
$2,985 |
11.0× |
| CTA abdomen pelvis (74174) |
$3,592.80 |
$5,988 |
11.1× |
| CTA chest (71275) |
$1,472.10 |
$2,453.50 |
9.0× |
| Cta Head (70496) |
$2,490.60 |
$4,151 |
15.3× |
| CTA lwr ext w&w/o contrast (73706) |
$2,611.80 |
$4,353 |
16.0× |
| Cta Neck (70498) |
$2,034.60 |
$3,391 |
12.5× |
| Cta Pelvis (72191) |
$1,804.20 |
$3,007 |
11.1× |
| Cystography minimum 3 views rs&i (74430) |
$308.40 |
$514 |
1.0× |
| Diskogram cervical (72285) |
$751.80 |
$1,253 |
0.4× |
| Diskography lumbar (72295) |
$289.20 |
$482 |
0.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$289.20 |
$482 |
3.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$120.90 |
$201.50 |
1.5× |
| Echoencephalography real time imaging (76506) |
$431.40 |
$719 |
4.4× |
| Esophagus (74220) |
$361.20 |
$602 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$313.80 |
$523 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$355.20 |
$592 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$400.20 |
$667 |
1.8× |
| Foot 2 views (73620) |
$255 |
$425 |
3.2× |
| Forearm 2 views (73090) |
$229.80 |
$383 |
2.8× |
| Gated Heart Planar Single (78472) |
$1,418.10 |
$2,363.50 |
3.8× |
| Hand 2 views (73120) |
$139.80 |
$233 |
1.4× |
| Hand 3 views (73130) |
$282.60 |
$471 |
3.5× |
| Heart Infarct Image (78466) |
$624 |
$1,040 |
1.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,583.40 |
$2,639 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,199.10 |
$1,998.50 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,199.10 |
$1,998.50 |
3.2× |
| Ht muscle image spect sing (78451) |
$1,621.20 |
$2,702 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$232.20 |
$387 |
2.9× |
| Hysterosalpingogram (74740) |
$714.60 |
$1,191 |
3.2× |
| Kidney imaging morphology (78700) |
$768.30 |
$1,280.50 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$461.40 |
$769 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$418.80 |
$698 |
0.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$626.70 |
$1,044.50 |
1.2× |
| Knee 3 views (73562) |
$138.90 |
$231.50 |
1.7× |
| Liver & spleen imaging static only (78215) |
$700.50 |
$1,167.50 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$990 |
$1,650 |
2.0× |
| Lung perfusion differential (78597) |
$829.20 |
$1,382 |
2.2× |
| Lymphoscintigraphy (78195) |
$842.40 |
$1,404 |
1.7× |
| Mammary ductogram or galactogram multiple (77054) |
$238.20 |
$397 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$201.60 |
$336 |
0.9× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$52.20 |
$87 |
0.6× |
| Meckels Diverticulum (78290) |
$990.30 |
$1,650.50 |
2.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$750.60 |
$1,251 |
2.2× |
| MRA head w & w/o contrast (70546) |
$3,249 |
$5,415 |
10.0× |
| MRA head w/o contrast (70544) |
$2,286.60 |
$3,811 |
10.3× |
| MRA head with contrast (70545) |
$2,539.80 |
$4,233 |
7.8× |
| MRA neck w contrast (70548) |
$1,837.50 |
$3,062.50 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,249 |
$5,415 |
10.0× |
| MRA neck w/o contrast (70547) |
$2,286.60 |
$3,811 |
10.3× |
| MRI abdomen w contrast (74182) |
$1,086.30 |
$1,810.50 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,419 |
$2,365 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$1,320 |
$2,200 |
5.9× |
| MRI any jnt lwr ext with con lt (73722) |
$2,097 |
$3,495 |
2.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,156.10 |
$3,593.50 |
3.0× |
| MRI bone marrow blood supply (77084) |
$1,496.40 |
$2,494 |
6.7× |
| MRI breast w/o contrast unilat (77046) |
$394.20 |
$657 |
1.8× |
| MRI c-spine with contrast (72142) |
$2,067.30 |
$3,445.50 |
6.4× |
| MRI cardiac w/o contrast (75557) |
$1,671 |
$2,785 |
7.5× |
| MRI cervical spine w/o contrast (72141) |
$1,669.20 |
$2,782 |
7.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,622.40 |
$2,704 |
5.0× |
| MRI chest w/o contrast (71550) |
$1,463.40 |
$2,439 |
6.6× |
| MRI chest with contrast (71551) |
$1,271.40 |
$2,119 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,156.10 |
$3,593.50 |
6.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,094.60 |
$3,491 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,653.30 |
$2,755.50 |
7.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,804.50 |
$3,007.50 |
8.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,096.40 |
$3,494 |
6.5× |
| MRI orbit/face/neck w/contrast (70542) |
$2,196.60 |
$3,661 |
6.8× |
| MRI pelvis w contrast (72196) |
$2,006.10 |
$3,343.50 |
6.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,268.30 |
$3,780.50 |
7.0× |
| MRI pelvis w/o contrast (72195) |
$1,511.10 |
$2,518.50 |
6.8× |
| MRI scan of arm joint before and after contrast (73223) |
$2,359.50 |
$3,932.50 |
7.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,217.30 |
$3,695.50 |
6.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,808.90 |
$4,681.50 |
8.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,790.10 |
$2,983.50 |
5.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,328.60 |
$3,881 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,458.50 |
$4,097.50 |
7.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,591.70 |
$4,319.50 |
8.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,989.60 |
$3,316 |
9.0× |
| MRI tmj (70336) |
$1,317 |
$2,195 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,750.80 |
$2,918 |
7.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,731.20 |
$4,552 |
8.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,637.40 |
$2,729 |
7.4× |
| Myelogram Cervical (72240) |
$1,179 |
$1,965 |
1.6× |
| Myelogram Lumbar (72265) |
$1,179 |
$1,965 |
1.6× |
| Myelogram thoracic (72255) |
$967.50 |
$1,612.50 |
1.3× |
| Myelography 2 or more regions (72270) |
$1,224.60 |
$2,041 |
1.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,797.40 |
$6,329 |
3.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,007 |
$3,345 |
1.7× |
| Neck soft tissue (70360) |
$129.30 |
$215.50 |
1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$363 |
$605 |
1.0× |
| Nm adrenal scan (78075) |
$327.60 |
$546 |
0.3× |
| Nm cisternogram (78630) |
$1,326.60 |
$2,211 |
2.6× |
| Nm csf leak detection (78650) |
$660.60 |
$1,101 |
0.5× |
| Nm gastric emptying study (78264) |
$1,417.20 |
$2,362 |
3.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,228.20 |
$7,047 |
3.3× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$3,797.40 |
$6,329 |
2.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$3,873 |
$6,455 |
2.9× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$3,797.40 |
$6,329 |
2.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$522.60 |
$871 |
0.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$613.20 |
$1,022 |
1.6× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$479.70 |
$799.50 |
1.3× |
| Nuclear Rx Oral Admin (79005) |
$747.60 |
$1,246 |
3.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$205.80 |
$343 |
2.1× |
| Osseous survey infant (77076) |
$216 |
$360 |
2.2× |
| Osseous survey limited (77074) |
$190.80 |
$318 |
2.0× |
| Parathyrd planar w/spect&CT (78072) |
$924.60 |
$1,541 |
1.8× |
| Parathyrd planar w/wo subtrj (78071) |
$924.60 |
$1,541 |
2.5× |
| Parathyroid imaging (78070) |
$1,359.60 |
$2,266 |
3.7× |
| Pelvis 1 or 2 views (72170) |
$174.30 |
$290.50 |
1.8× |
| Peritoneogram rs&i (74190) |
$249.60 |
$416 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$3,873 |
$6,455 |
2.9× |
| PET imaging CT for attenuation limited area (78814) |
$3,873 |
$6,455 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$3,873 |
$6,455 |
2.9× |
| PET imaging limited area chest head/neck (78811) |
$4,936.20 |
$8,227 |
4.1× |
| PET whole body (78813) |
$3,873 |
$6,455 |
2.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,097 |
$3,495 |
6.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,903.80 |
$3,173 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$615.30 |
$1,025.50 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$241.20 |
$402 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$123 |
$205 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$274.20 |
$457 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$244.80 |
$408 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$211.80 |
$353 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$274.20 |
$457 |
2.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,865.20 |
$21,442 |
1.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$603.60 |
$1,006 |
1.2× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$383.70 |
$639.50 |
4.0× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$481.20 |
$802 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$289.20 |
$482 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$157.20 |
$262 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$359.70 |
$599.50 |
4.4× |
| Radiologic exam colon single contrast study (74270) |
$957 |
$1,595 |
5.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$502.80 |
$838 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$588.60 |
$981 |
3.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$148.20 |
$247 |
1.8× |
| Radiological examination surgical specimen (76098) |
$793.80 |
$1,323 |
1.6× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,741.80 |
$2,903 |
0.6× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,984.80 |
$3,308 |
0.7× |
| Ribs bilateral 3 views (71110) |
$127.20 |
$212 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$804.60 |
$1,341 |
2.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$948.60 |
$1,581 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$853.20 |
$1,422 |
1.7× |
| Rp Therapy Intravenous Administration (79101) |
$2,427.30 |
$4,045.50 |
11.2× |
| Sacroiliac Joints < 3 Views (72200) |
$72.90 |
$121.50 |
0.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$319.80 |
$533 |
1.4× |
| Salivary gland imaging serial images (78231) |
$807.60 |
$1,346 |
2.2× |
| Scanogram (77073) |
$138.60 |
$231 |
1.4× |
| Scapula complete (73010) |
$318.90 |
$531.50 |
3.3× |
| Screening digital breast tomosynthesis (77063) |
$30 |
$50 |
1.3× |
| Sella turcica (70240) |
$85.80 |
$143 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$295.80 |
$493 |
3.0× |
| Sialogram (70390) |
$488.40 |
$814 |
2.2× |
| Simulation intermediate (77285) |
$1,099.80 |
$1,833 |
3.2× |
| Small bowel series (74250) |
$365.40 |
$609 |
2.2× |
| Spec medical radj physics consltj (77370) |
$714 |
$1,190 |
5.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,120.20 |
$1,867 |
3.2× |
| Special dosimetry (77331) |
$441 |
$735 |
3.5× |
| Special treatment procedure (77470) |
$1,475.40 |
$2,459 |
2.9× |
| Speech evaluation complex (70371) |
$272.40 |
$454 |
1.2× |
| Spine thoracic 3 views (72072) |
$523.20 |
$872 |
5.4× |
| Splenoportograpy rs&i (75810) |
$1,128 |
$1,880 |
0.4× |
| Stereotactic body radiation delivery (77373) |
$1,439.40 |
$2,399 |
0.9× |
| Superior sagittal sinus venogram (75870) |
$1,145.40 |
$1,909 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,040.70 |
$1,734.50 |
3.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$568.20 |
$947 |
1.6× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$282 |
$470 |
1.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,047 |
$1,745 |
3.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$432 |
$720 |
3.5× |
| Therapeutic Enema (74283) |
$158.40 |
$264 |
1.0× |
| Thoracolumbar 2 views (72080) |
$309 |
$515 |
3.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,158.90 |
$1,931.50 |
2.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$846.30 |
$1,410.50 |
2.3× |
| Thyroid uptake measurement (78012) |
$176.70 |
$294.50 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,021.20 |
$1,702 |
2.7× |
| Tmj unilateral (70328) |
$122.40 |
$204 |
1.5× |
| Treatment device intermediate (77333) |
$603.60 |
$1,006 |
4.8× |
| Treatment devices simple (77332) |
$627.60 |
$1,046 |
5.0× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,153.80 |
$1,923 |
2.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$591 |
$985 |
1.6× |
| Tx devices design & construction complex (77334) |
$1,016.40 |
$1,694 |
2.9× |
| Ultrasound elastography first target lesion (76982) |
$192.60 |
$321 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$748.20 |
$1,247 |
7.7× |
| Umbilical-artery Doppler (OB) (76820) |
$167.40 |
$279 |
1.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$220.80 |
$368 |
2.7× |
| Unlisted fluoroscopic procedure (76496) |
$168.60 |
$281 |
2.1× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$277.20 |
$462 |
0.7× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$3,797.40 |
$6,329 |
10.2× |
| Unlisted Ultrasound Procedure (76999) |
$100.80 |
$168 |
1.2× |
| Upper Extremity Infant (73092) |
$87.60 |
$146 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$298.20 |
$497 |
1.3× |
| Urethrocystography voiding (74455) |
$478.80 |
$798 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,056 |
$1,760 |
6.5× |
| Us abdl aorta screen aaa (76706) |
$268.80 |
$448 |
2.8× |
| Us breast unilateral complete (76641) |
$378.90 |
$631.50 |
3.9× |
| Us breast unilateral limited (76642) |
$240 |
$400 |
3.0× |
| Us chest (76604) |
$148.50 |
$247.50 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$228.30 |
$380.50 |
2.3× |
| Us elastography parenchyma (76981) |
$192.60 |
$321 |
2.0× |
| Us infant hips dynamic (76885) |
$472.80 |
$788 |
5.8× |
| Us infant hips limited static (76886) |
$472.80 |
$788 |
5.8× |
| Us kidney transplant (76776) |
$409.20 |
$682 |
4.2× |
| Us ob detailed single fetus (76811) |
$413.40 |
$689 |
1.9× |
| Us ob transvaginal (76817) |
$297 |
$495 |
3.1× |
| Us pelvic non ob complete (76856) |
$533.10 |
$888.50 |
5.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$685.20 |
$1,142 |
7.0× |
| Us pregnancy ltd (76815) |
$251.10 |
$418.50 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$251.40 |
$419 |
2.6× |
| Us retroperitoneal complete (76770) |
$448.80 |
$748 |
4.6× |
| Us retroperitoneal limited (76775) |
$327.30 |
$545.50 |
3.4× |
| Us scrotum and contents (76870) |
$405 |
$675 |
4.2× |
| Us soft tissue head/neck (76536) |
$651 |
$1,085 |
6.7× |
| Us spinal canal and contents (76800) |
$298.20 |
$497 |
3.1× |
| Us transrectal (76872) |
$274.20 |
$457 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$148.50 |
$247.50 |
1.5× |
| Vascular flow imaging (78445) |
$748.20 |
$1,247 |
2.0× |
| Venogram extremity bilateral (75822) |
$871.20 |
$1,452 |
0.6× |
| Venogram orbital (75880) |
$1,014.60 |
$1,691 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$1,445.70 |
$2,409.50 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,069.80 |
$1,783 |
0.7× |
| Venography epidural rs&i (75872) |
$1,145.40 |
$1,909 |
2.0× |
| Venography extremity unilateral rs&i (75820) |
$787.20 |
$1,312 |
0.5× |
| Venography Renal Bilateral (75833) |
$1,425.60 |
$2,376 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,031.40 |
$1,719 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$660.60 |
$1,101 |
0.2× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,385.40 |
$2,309 |
0.3× |
| Wrist 2 views (73100) |
$190.80 |
$318 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$234.30 |
$390.50 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$258.60 |
$431 |
3.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$277.80 |
$463 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,211.40 |
$2,019 |
7.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$206.40 |
$344 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$87 |
$145 |
1.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$274.20 |
$457 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$148.20 |
$247 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$148.20 |
$247 |
1.8× |
| X-ray exam hip uni 4/> views (73503) |
$148.20 |
$247 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$296.40 |
$494 |
3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$296.40 |
$494 |
3.0× |
| X-ray exam of femur 1 (73551) |
$148.20 |
$247 |
1.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$243.60 |
$406 |
1.5× |
| X-ray eye for foreign body (70030) |
$113.70 |
$189.50 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$257.10 |
$428.50 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$78.60 |
$131 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$259.20 |
$432 |
3.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$351 |
$585 |
0.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$115.80 |
$193 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$177 |
$295 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$185.40 |
$309 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$77.10 |
$128.50 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$121.80 |
$203 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$347.70 |
$579.50 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$365.70 |
$609.50 |
3.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$240 |
$400 |
3.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$198.60 |
$331 |
2.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$206.40 |
$344 |
2.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$95.40 |
$159 |
1.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$542.70 |
$904.50 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$422.40 |
$704 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$228.30 |
$380.50 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$298.50 |
$497.50 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$564.60 |
$941 |
5.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$145.80 |
$243 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$264 |
$440 |
3.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$263.40 |
$439 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$153.90 |
$256.50 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$67.50 |
$112.50 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$305.40 |
$509 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$213.30 |
$355.50 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$246 |
$410 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$85.50 |
$142.50 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$101.70 |
$169.50 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$277.80 |
$463 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$222 |
$370 |
2.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$186 |
$310 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$163.50 |
$272.50 |
2.0× |
| Xr arthrogram ankle (73615) |
$399.60 |
$666 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$468 |
$780 |
4.8× |
| Xr chest 4+ views (71048) |
$192 |
$320 |
2.0× |
| Xr Cholecystography Oral Contrast (74290) |
$316.20 |
$527 |
1.9× |
| Xr finger(s) 2+ views (73140) |
$186.90 |
$311.50 |
2.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$184.80 |
$308 |
1.9× |
| Xr shoulder 1 view (73020) |
$193.50 |
$322.50 |
2.4× |
| Xr spine cervical 4 or 5 views (72050) |
$210.60 |
$351 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$247.50 |
$412.50 |
3.1× |
| Xr tmj bilateral (70330) |
$141 |
$235 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$233.10 |
$388.50 |
2.9× |