| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,748.80 |
$12,496 |
3.1× |
| Abdomen 2 views (74019) |
$213.30 |
$711 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,443.30 |
$4,811 |
4.1× |
| Angiography extremity bilateral rs&i (75716) |
$1,678.20 |
$5,594 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,480.80 |
$4,936 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$1,456.80 |
$4,856 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,738.20 |
$5,794 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,718.30 |
$9,061 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$1,630.20 |
$5,434 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,020.20 |
$6,734 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,086.30 |
$3,621 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$383.70 |
$1,279 |
0.1× |
| Ankle 2 views (73600) |
$202.80 |
$676 |
2.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$1,506.90 |
$5,023 |
4.9× |
| Aortogram thoracic (75605) |
$907.20 |
$3,024 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,563.30 |
$5,211 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,587.60 |
$5,292 |
0.6× |
| Arthrogram elbow (73085) |
$105 |
$350 |
0.3× |
| Arthrogram hip (73525) |
$296.10 |
$987 |
1.0× |
| Arthrogram shoulder (73040) |
$297.30 |
$991 |
1.0× |
| Arthrogram wrist (73115) |
$99.60 |
$332 |
0.3× |
| Arthrography knee lt (73580) |
$312.30 |
$1,041 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$361.20 |
$1,204 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$776.40 |
$2,588 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$2,106 |
$7,020 |
6.0× |
| Bone &/joint imaging whole body (78306) |
$638.10 |
$2,127 |
1.8× |
| Bone age studies (77072) |
$133.20 |
$444 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,113.30 |
$3,711 |
3.2× |
| Bone survey complete (77075) |
$362.40 |
$1,208 |
4.0× |
| Brachytx isodose complex (77318) |
$1,365.60 |
$4,552 |
4.2× |
| Brachytx isodose intermed (77317) |
$1,092 |
$3,640 |
3.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$865.50 |
$2,885 |
2.6× |
| Brain imaging < 4 static views w vascular flow (78601) |
$910.50 |
$3,035 |
2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,595.90 |
$18,653 |
4.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$955.50 |
$3,185 |
3.1× |
| Cardiac shunt detection (78428) |
$865.50 |
$2,885 |
2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$975 |
$3,250 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$225.90 |
$753 |
3.0× |
| Chest 1 view (71045) |
$168.90 |
$563 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$226.20 |
$754 |
1.5× |
| Clavicle complete (73000) |
$176.40 |
$588 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$91.20 |
$304 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$432.30 |
$1,441 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,653 |
$5,510 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,282.50 |
$4,275 |
6.1× |
| CT abdomen w contrast (74160) |
$862.20 |
$2,874 |
5.6× |
| CT abdomen w wo contrast (74170) |
$957.90 |
$3,193 |
6.2× |
| CT abdomen w/o contrast (74150) |
$852 |
$2,840 |
9.3× |
| CT angio hrt w/3d image (75574) |
$1,347.60 |
$4,492 |
4.4× |
| CT angiography upper extremity lt (73206) |
$912 |
$3,040 |
5.9× |
| CT c-spine w/o contrast (72125) |
$465.30 |
$1,551 |
5.1× |
| CT cervical spine w&w/o contrast (72127) |
$272.40 |
$908 |
1.8× |
| CT cervical spine with contrast (72126) |
$598.50 |
$1,995 |
2.0× |
| CT chest w/wo contrast (71270) |
$889.20 |
$2,964 |
5.8× |
| CT chest with contrast (71260) |
$735.60 |
$2,452 |
4.8× |
| CT head/brain with contrast (70460) |
$612.90 |
$2,043 |
4.0× |
| CT head/brain without and with contrast (70470) |
$726.60 |
$2,422 |
4.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$882 |
$2,940 |
2.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$174.60 |
$582 |
2.3× |
| CT iac w contrast (70481) |
$803.10 |
$2,677 |
5.2× |
| CT limited/localized follow up study (76380) |
$920.70 |
$3,069 |
12.1× |
| CT lower ext w/o (73700) |
$384.60 |
$1,282 |
4.2× |
| CT lower extremity w wo contrast (73702) |
$855 |
$2,850 |
5.6× |
| CT lower extremity with contrast (73701) |
$662.40 |
$2,208 |
4.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,083 |
$3,610 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$451.50 |
$1,505 |
4.9× |
| CT lumbar spine with contrast (72132) |
$583.20 |
$1,944 |
1.9× |
| CT maxillofacial w contrast (70487) |
$767.40 |
$2,558 |
5.0× |
| CT maxillofacial w/o contrast (70486) |
$565.20 |
$1,884 |
6.2× |
| CT maxillofacial w/wo contrast (70488) |
$792 |
$2,640 |
5.2× |
| CT neck soft tissue w contrast (70491) |
$824.10 |
$2,747 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$926.40 |
$3,088 |
6.0× |
| CT orbits w/o contrast (70480) |
$540.60 |
$1,802 |
5.9× |
| CT pelvis w & w/o contrast (72194) |
$930.90 |
$3,103 |
6.1× |
| CT pelvis w/o contrast (72192) |
$441.60 |
$1,472 |
4.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$936.90 |
$3,123 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$587.40 |
$1,958 |
6.4× |
| CT thoracic spine w/contrast (72129) |
$583.50 |
$1,945 |
3.8× |
| CT thoracic spine w/o contrast (72128) |
$463.80 |
$1,546 |
5.1× |
| CT thoracic spine w/wo contrast (72130) |
$254.70 |
$849 |
1.7× |
| CT thorax w/o contrast (71250) |
$445.20 |
$1,484 |
4.9× |
| CT unlisted procedure (76497) |
$445.20 |
$1,484 |
5.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$997.50 |
$3,325 |
6.5× |
| CT upper extremity w/o contrast rt (73200) |
$391.80 |
$1,306 |
4.3× |
| CT upper extremity with contrast (73201) |
$562.50 |
$1,875 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,469.10 |
$4,897 |
9.6× |
| Cta Abdomen (74175) |
$912 |
$3,040 |
5.9× |
| CTA abdomen pelvis (74174) |
$1,596 |
$5,320 |
5.2× |
| CTA chest (71275) |
$1,223.10 |
$4,077 |
8.0× |
| Cta Head (70496) |
$975.90 |
$3,253 |
6.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,048.20 |
$3,494 |
6.8× |
| Cta Neck (70498) |
$975.90 |
$3,253 |
6.3× |
| Cta Pelvis (72191) |
$1,356.30 |
$4,521 |
8.8× |
| Cystography minimum 3 views rs&i (74430) |
$394.80 |
$1,316 |
1.3× |
| Diskogram cervical (72285) |
$1,215.60 |
$4,052 |
0.7× |
| Diskography lumbar (72295) |
$1,823.40 |
$6,078 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$80.70 |
$269 |
0.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$170.10 |
$567 |
1.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$84.90 |
$283 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$68.40 |
$228 |
0.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$66.30 |
$221 |
0.9× |
| Echo exam of fetal heart (76825) |
$472.50 |
$1,575 |
1.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$179.70 |
$599 |
0.9× |
| Echoencephalography real time imaging (76506) |
$249 |
$830 |
2.7× |
| Esophagus (74220) |
$166.80 |
$556 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$80.70 |
$269 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$275.70 |
$919 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$638.10 |
$2,127 |
3.1× |
| Foot 2 views (73620) |
$207 |
$690 |
2.7× |
| Forearm 2 views (73090) |
$186.30 |
$621 |
2.4× |
| Functional MRI brain by tech (70554) |
$654 |
$2,180 |
3.1× |
| Gated Heart Planar Single (78472) |
$878.70 |
$2,929 |
2.5× |
| Hand 2 views (73120) |
$178.20 |
$594 |
1.9× |
| Hand 3 views (73130) |
$201.90 |
$673 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$973.50 |
$3,245 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,374 |
$4,580 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,811.40 |
$6,038 |
3.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,087.20 |
$3,624 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,244.10 |
$4,147 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,244.10 |
$4,147 |
3.6× |
| Ht muscle image spect sing (78451) |
$2,842.50 |
$4,834 |
2.5× |
| Humerus Min 2 Views Left (73060) |
$200.10 |
$667 |
2.6× |
| Hysterosalpingogram (74740) |
$245.10 |
$817 |
1.2× |
| Interstitial radiation source applic complex (77778) |
$756.60 |
$2,522 |
1.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$646.20 |
$2,154 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,479.90 |
$4,933 |
3.1× |
| Intracavitary radiation source applic simple (77761) |
$1,426.80 |
$4,756 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$230.10 |
$767 |
2.5× |
| Kidney imaging morphology (78700) |
$1,435.80 |
$4,786 |
4.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$963.60 |
$3,212 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$924.30 |
$3,081 |
1.9× |
| Knee 3 views (73562) |
$174 |
$580 |
2.3× |
| Liver & spleen imaging static only (78215) |
$549.90 |
$1,833 |
1.6× |
| Liver imaging static only (78201) |
$374.70 |
$1,249 |
0.8× |
| Lung perf&ventilat diferentl (78598) |
$652.50 |
$2,175 |
1.4× |
| Lung Ventilation Imaging (78579) |
$488.40 |
$1,628 |
1.4× |
| Lymphoscintigraphy (78195) |
$896.40 |
$2,988 |
1.9× |
| Mammary ductogram or galactogram multiple (77054) |
$238.50 |
$795 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$266.40 |
$888 |
1.3× |
| Meckels Diverticulum (78290) |
$1,521.60 |
$5,072 |
4.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$978.30 |
$3,261 |
3.0× |
| MRA head w & w/o contrast (70546) |
$1,199.40 |
$3,998 |
3.9× |
| MRA head w/o contrast (70544) |
$576.30 |
$1,921 |
2.8× |
| MRA head with contrast (70545) |
$769.80 |
$2,566 |
2.5× |
| MRA neck w contrast (70548) |
$1,150.80 |
$3,836 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,196.40 |
$3,988 |
3.9× |
| MRA neck w/o contrast (70547) |
$560.70 |
$1,869 |
2.7× |
| MRI abdomen w contrast (74182) |
$1,137 |
$3,790 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,740.30 |
$5,801 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,011.60 |
$3,372 |
4.8× |
| MRI any jnt lwr ext with con lt (73722) |
$1,488.60 |
$4,962 |
2.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,179.90 |
$3,933 |
1.7× |
| MRI breast w/o contrast bilateral (77047) |
$1,855.50 |
$6,185 |
8.9× |
| MRI breast w/o contrast unilat (77046) |
$927.90 |
$3,093 |
4.4× |
| MRI c-spine with contrast (72142) |
$1,170.60 |
$3,902 |
3.8× |
| MRI cardiac w/o cont stress (75559) |
$964.20 |
$3,214 |
2.0× |
| MRI cardiac w/o contrast (75557) |
$683.10 |
$2,277 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$654 |
$2,180 |
3.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,773.60 |
$5,912 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,008.60 |
$3,362 |
4.8× |
| MRI chest with contrast (71551) |
$449.40 |
$1,498 |
0.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$464.40 |
$1,548 |
1.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$464.40 |
$1,548 |
1.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$824.10 |
$2,747 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$902.70 |
$3,009 |
4.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,835.10 |
$6,117 |
6.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,053.60 |
$3,512 |
3.4× |
| MRI pelvis w contrast (72196) |
$1,435.50 |
$4,785 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,752.30 |
$5,841 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$861.60 |
$2,872 |
4.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,470 |
$4,900 |
4.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,153.20 |
$3,844 |
1.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,613.70 |
$5,379 |
5.3× |
| MRI spectroscopy (76390) |
$1,528.80 |
$5,096 |
20.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,561.80 |
$5,206 |
5.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,090.20 |
$3,634 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,320.30 |
$4,401 |
4.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,448.70 |
$4,829 |
4.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,561.80 |
$5,206 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$718.50 |
$2,395 |
3.4× |
| MRI tmj (70336) |
$1,325.10 |
$4,417 |
6.3× |
| MRI upper ext joint w/o contrast (73221) |
$803.10 |
$2,677 |
3.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,161 |
$3,870 |
3.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$647.70 |
$2,159 |
3.1× |
| Myelogram Cervical (72240) |
$1,576.20 |
$5,254 |
2.3× |
| Myelogram Lumbar (72265) |
$1,567.50 |
$5,225 |
2.3× |
| Myelogram thoracic (72255) |
$1,588.80 |
$5,296 |
2.3× |
| Myelography 2 or more regions (72270) |
$1,706.10 |
$5,687 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,458.75 |
$4,862.50 |
1.3× |
| Neck soft tissue (70360) |
$134.70 |
$449 |
1.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$621.60 |
$2,072 |
1.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,127.10 |
$3,757 |
3.2× |
| Nm adrenal scan (78075) |
$7,602 |
$25,340 |
6.7× |
| Nm cisternogram (78630) |
$4,321.80 |
$14,406 |
9.1× |
| Nm csf leak detection (78650) |
$625.20 |
$2,084 |
0.6× |
| Nm gastric emptying study (78264) |
$1,137.90 |
$3,793 |
3.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,905.40 |
$13,018 |
3.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,321.50 |
$4,405 |
1.1× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,115.40 |
$3,718 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$1,040.40 |
$3,468 |
5.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$214.80 |
$716 |
2.3× |
| Orthopantogram (70355) |
$182.10 |
$607 |
2.4× |
| Parathyroid imaging (78070) |
$1,107.60 |
$3,692 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$204.60 |
$682 |
2.2× |
| Peritoneogram rs&i (74190) |
$574.50 |
$1,915 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$2,866.20 |
$9,554 |
2.3× |
| PET imaging CT for attenuation limited area (78814) |
$2,722.20 |
$9,074 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$3,024.90 |
$10,083 |
2.4× |
| PET imaging limited area chest head/neck (78811) |
$1,746 |
$5,820 |
1.5× |
| PET whole body (78813) |
$1,321.50 |
$4,405 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,527 |
$5,090 |
5.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,899.20 |
$9,664 |
1.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$422.70 |
$1,409 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$383.10 |
$1,277 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$806.40 |
$2,688 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$246.60 |
$822 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$238.80 |
$796 |
2.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$314.70 |
$1,049 |
3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,437.10 |
$41,457 |
1.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$547.80 |
$1,826 |
1.1× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$391.80 |
$1,306 |
4.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$191.10 |
$637 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$154.50 |
$515 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$178.80 |
$596 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$363.30 |
$1,211 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$195 |
$650 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$194.10 |
$647 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$195.90 |
$653 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$193.50 |
$645 |
2.5× |
| Radiological examination surgical specimen (76098) |
$151.50 |
$505 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$891 |
$2,970 |
0.3× |
| Ribs bilateral 3 views (71110) |
$208.50 |
$695 |
2.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,385.10 |
$4,617 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$973.50 |
$3,245 |
2.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,781.40 |
$5,938 |
8.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$4,499.70 |
$14,999 |
22.0× |
| Rp Therapy Intravenous Administration (79101) |
$322.20 |
$1,074 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$318 |
$1,060 |
1.5× |
| Scanogram (77073) |
$172.20 |
$574 |
1.9× |
| Scapula complete (73010) |
$187.80 |
$626 |
2.0× |
| Screening digital breast tomosynthesis (77063) |
$42.90 |
$143 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$249.90 |
$833 |
2.7× |
| Sialogram (70390) |
$408.30 |
$1,361 |
2.0× |
| Simulation intermediate (77285) |
$854.10 |
$2,847 |
2.6× |
| Small bowel series (74250) |
$1,037.70 |
$3,459 |
6.8× |
| Spec medical radj physics consltj (77370) |
$348.60 |
$1,162 |
3.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$755.40 |
$2,518 |
2.3× |
| Special dosimetry (77331) |
$273.90 |
$913 |
2.3× |
| Special treatment procedure (77470) |
$1,599 |
$5,330 |
3.3× |
| Spine thoracic 3 views (72072) |
$224.70 |
$749 |
2.5× |
| Stereotactic body radiation delivery (77373) |
$7,890.30 |
$26,301 |
5.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,217.10 |
$4,057 |
3.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$901.50 |
$3,005 |
2.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,166.70 |
$3,889 |
3.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$606.90 |
$2,023 |
5.2× |
| Therapeutic Enema (74283) |
$198.30 |
$661 |
1.3× |
| Thoracolumbar 2 views (72080) |
$241.80 |
$806 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,293 |
$4,310 |
2.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$432.90 |
$1,443 |
1.2× |
| Thyroid uptake measurement (78012) |
$2,116.50 |
$7,055 |
6.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$574.20 |
$1,914 |
1.6× |
| Tmj unilateral (70328) |
$243.60 |
$812 |
3.2× |
| Treatment device intermediate (77333) |
$530.10 |
$1,767 |
4.5× |
| Treatment devices simple (77332) |
$332.10 |
$1,107 |
2.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,626.30 |
$5,421 |
3.4× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$521.25 |
$1,737.50 |
1.5× |
| Tx devices design & construction complex (77334) |
$768.90 |
$2,563 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$222.60 |
$742 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$91.50 |
$305 |
1.0× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$1,429.50 |
$4,765 |
4.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$82.20 |
$274 |
1.1× |
| Unlisted magnetic resonance procedure (76498) |
$1,507.20 |
$5,024 |
19.8× |
| Upper Extremity Infant (73092) |
$159 |
$530 |
1.7× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$715.80 |
$2,386 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$246.60 |
$822 |
1.2× |
| Urethrocystography voiding (74455) |
$246.60 |
$822 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$425.40 |
$1,418 |
2.8× |
| Us abdl aorta screen aaa (76706) |
$215.70 |
$719 |
2.4× |
| Us breast unilateral complete (76641) |
$281.10 |
$937 |
3.1× |
| Us breast unilateral limited (76642) |
$259.80 |
$866 |
3.4× |
| Us chest (76604) |
$236.40 |
$788 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$283.20 |
$944 |
3.1× |
| Us elastography parenchyma (76981) |
$77.40 |
$258 |
0.8× |
| Us fetal nuchal translucency 1st gestation (76813) |
$80.70 |
$269 |
0.9× |
| Us guided compression repair (76936) |
$233.10 |
$777 |
1.2× |
| Us infant hips dynamic (76885) |
$326.40 |
$1,088 |
4.3× |
| Us kidney transplant (76776) |
$214.80 |
$716 |
2.3× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$55.20 |
$184 |
0.6× |
| Us ob detailed single fetus (76811) |
$179.70 |
$599 |
0.9× |
| Us ob transvaginal (76817) |
$235.50 |
$785 |
2.6× |
| Us pelvic non ob complete (76856) |
$215.10 |
$717 |
2.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$319.50 |
$1,065 |
3.5× |
| Us pregnancy ltd (76815) |
$179.40 |
$598 |
2.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$263.40 |
$878 |
2.9× |
| Us retroperitoneal complete (76770) |
$292.20 |
$974 |
3.2× |
| Us retroperitoneal limited (76775) |
$216.60 |
$722 |
2.4× |
| Us scrotum and contents (76870) |
$362.10 |
$1,207 |
4.0× |
| Us soft tissue head/neck (76536) |
$231.60 |
$772 |
2.5× |
| Us spinal canal and contents (76800) |
$327 |
$1,090 |
3.6× |
| Us transrectal (76872) |
$159.60 |
$532 |
1.7× |
| Us transrectal prostate volume (76873) |
$117.30 |
$391 |
1.3× |
| Us xtr non-vasc lmtd (76882) |
$204.30 |
$681 |
2.2× |
| Venogram extremity bilateral (75822) |
$1,308.30 |
$4,361 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$1,111.80 |
$3,706 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$1,143.60 |
$3,812 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$780 |
$2,600 |
0.6× |
| Venography Renal Bilateral (75833) |
$2,178.30 |
$7,261 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$2,041.50 |
$6,805 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$202.20 |
$674 |
0.1× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$869.40 |
$2,898 |
0.2× |
| Wrist 2 views (73100) |
$202.50 |
$675 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$253.50 |
$845 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.50 |
$435 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$196.50 |
$655 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$345.30 |
$1,151 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$206.70 |
$689 |
2.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$213.90 |
$713 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$210 |
$700 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$238.50 |
$795 |
3.1× |
| X-ray exam hip uni 4/> views (73503) |
$234.60 |
$782 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$352.80 |
$1,176 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$382.50 |
$1,275 |
4.2× |
| X-ray exam of femur 1 (73551) |
$183.90 |
$613 |
2.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$194.10 |
$647 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$195 |
$650 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$103.20 |
$344 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$241.05 |
$803.50 |
3.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$879.90 |
$2,933 |
0.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$210.30 |
$701 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$230.40 |
$768 |
3.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$214.80 |
$716 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$215.70 |
$719 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$202.20 |
$674 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$285 |
$950 |
3.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$222.30 |
$741 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$133.20 |
$444 |
1.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$139.20 |
$464 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$203.40 |
$678 |
2.2× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$2,538.60 |
$8,462 |
5.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$263.70 |
$879 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$211.50 |
$705 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$233.70 |
$779 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$212.40 |
$708 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$174.30 |
$581 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$214.80 |
$716 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$215.10 |
$717 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$234.60 |
$782 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$208.50 |
$695 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$198.60 |
$662 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$120.30 |
$401 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$44.40 |
$148 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$216.60 |
$722 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$270 |
$900 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$171.90 |
$573 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$175.80 |
$586 |
2.3× |
| Xr arthrogram ankle (73615) |
$217.20 |
$724 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$228.30 |
$761 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$164.40 |
$548 |
2.2× |
| Xr shoulder 1 view (73020) |
$116.70 |
$389 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$177.90 |
$593 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$201 |
$670 |
2.6× |
| Xr tmj bilateral (70330) |
$262.20 |
$874 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$220.80 |
$736 |
2.9× |