| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,593.14 |
$13,317 |
3.9× |
| Abdomen 2 views (74019) |
$254.52 |
$606 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$766.50 |
$1,825 |
1.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,134.04 |
$7,462 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$2,081.10 |
$4,955 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,934.10 |
$4,605 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$2,233.56 |
$5,318 |
0.7× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,058 |
$4,900 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,818.18 |
$4,329 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,342.95 |
$3,197.50 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,006.76 |
$4,778 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,780 |
$9,000 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,367.52 |
$3,256 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$978.18 |
$2,329 |
0.3× |
| Ankle 2 views (73600) |
$167.58 |
$399 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$485.94 |
$1,157 |
1.3× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,841.49 |
$4,384.50 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,660.89 |
$3,954.50 |
0.5× |
| Aortography abdominal serialography rs&i (75625) |
$1,627.50 |
$3,875 |
0.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,914.36 |
$4,558 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$1,641.78 |
$3,909 |
0.5× |
| Arthrogram elbow (73085) |
$229.74 |
$547 |
0.6× |
| Arthrogram hip (73525) |
$471.24 |
$1,122 |
1.3× |
| Arthrogram shoulder (73040) |
$504.42 |
$1,201 |
1.4× |
| Arthrogram wrist (73115) |
$395.22 |
$941 |
1.1× |
| Arthrography knee lt (73580) |
$326.34 |
$777 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$468.30 |
$1,115 |
3.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$489.30 |
$1,165 |
1.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$645.96 |
$1,538 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$978.18 |
$2,329 |
2.4× |
| Bone age studies (77072) |
$90.30 |
$215 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,076.04 |
$2,562 |
2.6× |
| Bone Marrow Imaging Limited Area (78102) |
$268.80 |
$640 |
0.6× |
| Bone survey complete (77075) |
$522.48 |
$1,244 |
4.8× |
| Brachytx isodose complex (77318) |
$1,705.20 |
$4,060 |
4.4× |
| Brachytx isodose intermed (77317) |
$1,461.60 |
$3,480 |
3.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,380.96 |
$3,288 |
3.6× |
| Brain image w/flow 4 + views (78606) |
$640.08 |
$1,524 |
1.1× |
| Brain imaging < 4 static views (78600) |
$428.82 |
$1,021 |
1.0× |
| Brain imaging < 4 static views w vascular flow (78601) |
$620.76 |
$1,478 |
1.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$659.40 |
$1,570 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,374.89 |
$5,654.50 |
1.6× |
| Brain Imaging Vascular Flow Only (78610) |
$356.58 |
$849 |
0.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$511.56 |
$1,218 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,419.18 |
$3,379 |
3.9× |
| Cardiac shunt detection (78428) |
$344.40 |
$820 |
0.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$451.08 |
$1,074 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$211.68 |
$504 |
2.3× |
| Chest 1 view (71045) |
$140.70 |
$335 |
1.6× |
| Chest 3 views (71047) |
$226.80 |
$540 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$317.94 |
$757 |
1.7× |
| Clavicle complete (73000) |
$166.32 |
$396 |
1.8× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$8,909.88 |
$21,214 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$99.96 |
$238 |
0.9× |
| Continuing medical physics consltj pr wk (77336) |
$610.68 |
$1,454 |
4.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,933.70 |
$6,985 |
8.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,559.04 |
$3,712 |
6.3× |
| CT abdomen w contrast (74160) |
$1,257.90 |
$2,995 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,396.08 |
$3,324 |
7.7× |
| CT abdomen w/o contrast (74150) |
$943.32 |
$2,246 |
8.7× |
| CT angio hrt w/3d image (75574) |
$1,309.56 |
$3,118 |
3.6× |
| CT angiography upper extremity lt (73206) |
$1,288.56 |
$3,068 |
7.1× |
| CT c-spine w/o contrast (72125) |
$915.18 |
$2,179 |
8.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,217.16 |
$2,898 |
6.7× |
| CT cervical spine with contrast (72126) |
$1,153.32 |
$2,746 |
3.2× |
| CT chest w/wo contrast (71270) |
$1,265.04 |
$3,012 |
6.9× |
| CT chest with contrast (71260) |
$1,110.06 |
$2,643 |
6.1× |
| CT colonography screening (74263) |
$1,062.18 |
$2,529 |
4.3× |
| CT colonography w/dye (74262) |
$1,285.20 |
$3,060 |
7.1× |
| CT colonography w/o cntrst (74261) |
$1,223.88 |
$2,914 |
11.3× |
| CT head/brain with contrast (70460) |
$916.02 |
$2,181 |
5.0× |
| CT head/brain without and with contrast (70470) |
$1,104.60 |
$2,630 |
6.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,257.48 |
$2,994 |
3.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$109.20 |
$260 |
1.2× |
| CT hrt w/3d image congen (75573) |
$1,204.98 |
$2,869 |
3.3× |
| CT iac w contrast (70481) |
$1,152.48 |
$2,744 |
6.3× |
| CT limited/localized follow up study (76380) |
$437.22 |
$1,041 |
4.8× |
| CT lower ext w/o (73700) |
$805.98 |
$1,919 |
7.4× |
| CT lower extremity w wo contrast (73702) |
$1,168.86 |
$2,783 |
6.4× |
| CT lower extremity with contrast (73701) |
$1,039.92 |
$2,476 |
5.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,150.38 |
$2,739 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$935.34 |
$2,227 |
8.6× |
| CT lumbar spine with contrast (72132) |
$1,094.10 |
$2,605 |
3.0× |
| CT maxillofacial w contrast (70487) |
$1,034.46 |
$2,463 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$808.50 |
$1,925 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,050.84 |
$2,502 |
5.8× |
| CT neck soft tissue w contrast (70491) |
$1,128.54 |
$2,687 |
6.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,368.36 |
$3,258 |
7.5× |
| CT orbits w/o contrast (70480) |
$1,029 |
$2,450 |
9.5× |
| CT pelvis w & w/o contrast (72194) |
$699.72 |
$1,666 |
3.8× |
| CT pelvis w/o contrast (72192) |
$847.98 |
$2,019 |
7.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,388.10 |
$3,305 |
7.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,071.84 |
$2,552 |
9.9× |
| CT thoracic spine w/contrast (72129) |
$1,102.50 |
$2,625 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$958.44 |
$2,282 |
8.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,112.16 |
$2,648 |
6.1× |
| CT thorax w/o contrast (71250) |
$754.74 |
$1,797 |
7.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,259.58 |
$2,999 |
6.9× |
| CT upper extremity w/o contrast rt (73200) |
$893.34 |
$2,127 |
8.2× |
| CT upper extremity with contrast (73201) |
$1,045.38 |
$2,489 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,529.22 |
$3,641 |
8.4× |
| Cta Abdomen (74175) |
$1,661.52 |
$3,956 |
9.1× |
| CTA abdomen pelvis (74174) |
$1,408.26 |
$3,353 |
3.9× |
| CTA chest (71275) |
$1,197.84 |
$2,852 |
6.6× |
| Cta Head (70496) |
$1,198.68 |
$2,854 |
6.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,132.32 |
$2,696 |
6.2× |
| Cta Neck (70498) |
$1,260.42 |
$3,001 |
6.9× |
| Cta Pelvis (72191) |
$660.24 |
$1,572 |
3.6× |
| Cystography minimum 3 views rs&i (74430) |
$352.38 |
$839 |
1.0× |
| Diskography lumbar (72295) |
$2,306.22 |
$5,491 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$80.22 |
$191 |
0.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$138.60 |
$330 |
1.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$168 |
$400 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$280.14 |
$667 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$57.96 |
$138 |
0.6× |
| Dxa bone density study axial skeleton (77085) |
$106.68 |
$254 |
1.0× |
| Echo exam of fetal heart (76825) |
$437.64 |
$1,042 |
0.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$416.64 |
$992 |
1.7× |
| Echoencephalography real time imaging (76506) |
$385.14 |
$917 |
3.5× |
| Esophagus (74220) |
$358.68 |
$854 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$334.32 |
$796 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$254.52 |
$606 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$266.70 |
$635 |
1.1× |
| Foot 2 views (73620) |
$157.08 |
$374 |
1.7× |
| Forearm 2 views (73090) |
$194.46 |
$463 |
2.2× |
| Functional MRI brain by phys/psych (70555) |
$1,186.08 |
$2,824 |
4.8× |
| Functional MRI brain by tech (70554) |
$1,138.62 |
$2,711 |
4.6× |
| Gated Heart Planar Single (78472) |
$924.84 |
$2,202 |
2.2× |
| Hand 2 views (73120) |
$171.78 |
$409 |
1.6× |
| Hand 3 views (73130) |
$223.02 |
$531 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,244.90 |
$5,345 |
3.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,693.88 |
$6,414 |
3.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,152.96 |
$9,888 |
5.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,843.38 |
$4,389 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$951.72 |
$2,266 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$857.64 |
$2,042 |
2.1× |
| Ht muscle image spect sing (78451) |
$736.68 |
$1,754 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$204.12 |
$486 |
2.3× |
| Hysterosalpingogram (74740) |
$592.62 |
$1,411 |
2.4× |
| Interstitial radiation source applic complex (77778) |
$3,240.30 |
$7,715 |
4.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,247.82 |
$2,971 |
1.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,129.80 |
$2,690 |
2.0× |
| Intracavitary radiation source applic simple (77761) |
$837.06 |
$1,993 |
1.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$88.20 |
$210 |
0.8× |
| Kidney imaging morphology (78700) |
$382.62 |
$911 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$861 |
$2,050 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,063.02 |
$2,531 |
1.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,126.86 |
$2,683 |
2.0× |
| Knee 3 views (73562) |
$264.18 |
$629 |
2.9× |
| Liver & spleen imaging static only (78215) |
$580.86 |
$1,383 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$480.06 |
$1,143 |
1.2× |
| Liver imaging static only (78201) |
$357.42 |
$851 |
0.6× |
| Lung perf&ventilat diferentl (78598) |
$1,231.02 |
$2,931 |
2.2× |
| Lung perfusion differential (78597) |
$591.78 |
$1,409 |
1.4× |
| Lung Ventilation Imaging (78579) |
$456.96 |
$1,088 |
1.1× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$2,097.90 |
$4,995 |
0.6× |
| Lymphoscintigraphy (78195) |
$956.34 |
$2,277 |
1.7× |
| Mammary ductogram or galactogram multiple (77054) |
$537.18 |
$1,279 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$564.48 |
$1,344 |
2.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$73.50 |
$175 |
0.8× |
| Meckels Diverticulum (78290) |
$527.94 |
$1,257 |
1.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,918.58 |
$6,949 |
7.5× |
| Mr elastography (76391) |
$194.04 |
$462 |
0.8× |
| Mr safety determination physician/other qhp (76016) |
$63 |
$150 |
0.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$42.42 |
$101 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$18.06 |
$43 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$65.52 |
$156 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$172.62 |
$411 |
0.7× |
| MRA head w & w/o contrast (70546) |
$2,120.58 |
$5,049 |
5.9× |
| MRA head w/o contrast (70544) |
$1,452.36 |
$3,458 |
5.9× |
| MRA head with contrast (70545) |
$1,496.04 |
$3,562 |
4.1× |
| MRA neck w contrast (70548) |
$1,434.72 |
$3,416 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,839.18 |
$4,379 |
5.1× |
| MRA neck w/o contrast (70547) |
$1,195.74 |
$2,847 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,604.82 |
$3,821 |
4.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,803.06 |
$4,293 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,406.58 |
$3,349 |
5.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,546.86 |
$3,683 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,396.50 |
$3,325 |
1.7× |
| MRI breast w/o contrast bilateral (77047) |
$201.60 |
$480 |
0.8× |
| MRI breast w/o contrast unilat (77046) |
$201.60 |
$480 |
0.8× |
| MRI c-spine with contrast (72142) |
$1,880.76 |
$4,478 |
5.2× |
| MRI cardiac w/o cont stress (75559) |
$1,092.84 |
$2,602 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$610.26 |
$1,453 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$1,424.64 |
$3,392 |
5.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,089.92 |
$4,976 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,755.60 |
$4,180 |
7.1× |
| MRI chest with contrast (71551) |
$1,922.76 |
$4,578 |
2.4× |
| MRI fetal sngl/1st gestation (74712) |
$230.58 |
$549 |
0.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,291.92 |
$3,076 |
3.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,242.36 |
$2,958 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,150.38 |
$2,739 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,872.78 |
$4,459 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,058 |
$4,900 |
5.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,934.52 |
$4,606 |
5.3× |
| MRI pelvis w contrast (72196) |
$1,620.78 |
$3,859 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,687.98 |
$4,019 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$1,435.14 |
$3,417 |
5.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,490.16 |
$3,548 |
4.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,533 |
$3,650 |
1.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,647.66 |
$3,923 |
4.5× |
| MRI spectroscopy (76390) |
$578.76 |
$1,378 |
6.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,094.12 |
$4,986 |
5.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,695.54 |
$4,037 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,966.02 |
$4,681 |
5.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,577.10 |
$3,755 |
4.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,748.88 |
$4,164 |
4.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,561.56 |
$3,718 |
6.3× |
| MRI tmj (70336) |
$1,209.18 |
$2,879 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,173.48 |
$2,794 |
4.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,435.56 |
$3,418 |
4.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,191.54 |
$2,837 |
4.8× |
| Myelogram Cervical (72240) |
$727.86 |
$1,733 |
0.9× |
| Myelogram Lumbar (72265) |
$727.86 |
$1,733 |
0.9× |
| Myelogram thoracic (72255) |
$727.86 |
$1,733 |
0.9× |
| Myelography 2 or more regions (72270) |
$1,091.58 |
$2,599 |
1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,070.18 |
$4,929 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,107.35 |
$5,017.50 |
1.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,167.18 |
$2,779 |
0.8× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$1,358.28 |
$3,234 |
0.6× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$847.56 |
$2,018 |
1.0× |
| Neck soft tissue (70360) |
$186.48 |
$444 |
2.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$2,288.16 |
$5,448 |
5.7× |
| Nm adrenal scan (78075) |
$1,204.14 |
$2,867 |
0.9× |
| Nm bone marrow multiple (78103) |
$320.04 |
$762 |
0.8× |
| Nm bone marrow wb (78104) |
$191.10 |
$455 |
0.5× |
| Nm cisternogram (78630) |
$425.88 |
$1,014 |
0.8× |
| Nm csf leak detection (78650) |
$438.48 |
$1,044 |
0.3× |
| Nm gastric emptying study (78264) |
$912.24 |
$2,172 |
2.2× |
| Nm gastroesophageal reflux study (78262) |
$672 |
$1,600 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$530.04 |
$1,262 |
1.3× |
| Nm whole blood volume (78122) |
$481.74 |
$1,147 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,414.22 |
$12,891 |
3.8× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,677.08 |
$6,374 |
1.8× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,779.96 |
$4,238 |
1.3× |
| Nuclear medicine of heart pumping function (78473) |
$286.86 |
$683 |
0.7× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,679.18 |
$6,379 |
1.8× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$614.04 |
$1,462 |
0.5× |
| Nuclear medicine study of kidney and blood flow (78701) |
$260.82 |
$621 |
0.6× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$393.12 |
$936 |
0.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$628.74 |
$1,497 |
1.5× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$566.16 |
$1,348 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$501.90 |
$1,195 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$251.16 |
$598 |
2.3× |
| Osseous survey infant (77076) |
$245.70 |
$585 |
2.3× |
| Osseous survey limited (77074) |
$177.66 |
$423 |
1.6× |
| Parathyrd planar w/spect&CT (78072) |
$276.78 |
$659 |
0.5× |
| Parathyrd planar w/wo subtrj (78071) |
$503.58 |
$1,199 |
1.2× |
| Parathyroid imaging (78070) |
$754.74 |
$1,797 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$168.42 |
$401 |
1.6× |
| Peritoneogram rs&i (74190) |
$647.22 |
$1,541 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$3,220.98 |
$7,669 |
2.2× |
| PET imaging CT for attenuation limited area (78814) |
$2,802.24 |
$6,672 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$3,092.04 |
$7,362 |
2.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$909.30 |
$2,165 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,425.48 |
$3,394 |
3.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,791.30 |
$4,265 |
0.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,727.67 |
$4,113.50 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$614.04 |
$1,462 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$714 |
$1,700 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$636.30 |
$1,515 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$57.54 |
$137 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$301.98 |
$719 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$108.78 |
$259 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$178.50 |
$425 |
1.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,449.18 |
$24,879 |
1.4× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$757.89 |
$1,804.50 |
1.3× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$385.56 |
$918 |
3.6× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$472.08 |
$1,124 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$218.40 |
$520 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$205.38 |
$489 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$71.82 |
$171 |
0.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$145.32 |
$346 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$417.48 |
$994 |
2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$171.78 |
$409 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$423.36 |
$1,008 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$302.40 |
$720 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$65.52 |
$156 |
0.7× |
| Radiological examination surgical specimen (76098) |
$277.20 |
$660 |
0.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$346.08 |
$824 |
0.6× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,631.70 |
$3,885 |
0.5× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,417.92 |
$3,376 |
0.4× |
| Ribs bilateral 3 views (71110) |
$235.62 |
$561 |
2.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$935.76 |
$2,228 |
2.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,216.32 |
$2,896 |
2.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,309.77 |
$3,118.50 |
2.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$770.70 |
$1,835 |
3.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$240.03 |
$571.50 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$521.22 |
$1,241 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$205.38 |
$489 |
1.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$163.80 |
$390 |
0.7× |
| Scanogram (77073) |
$153.30 |
$365 |
1.4× |
| Scapula complete (73010) |
$203.70 |
$485 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$42 |
$100 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$276.78 |
$659 |
2.5× |
| Sialogram (70390) |
$297.36 |
$708 |
1.2× |
| Simulation intermediate (77285) |
$1,196.58 |
$2,849 |
3.1× |
| Small bowel series (74250) |
$402.36 |
$958 |
2.2× |
| Spec medical radj physics consltj (77370) |
$702.24 |
$1,672 |
5.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,107.12 |
$2,636 |
2.8× |
| Special dosimetry (77331) |
$362.46 |
$863 |
2.6× |
| Special treatment procedure (77470) |
$1,855.14 |
$4,417 |
3.2× |
| Speech evaluation complex (70371) |
$240.66 |
$573 |
1.0× |
| Spine thoracic 3 views (72072) |
$230.16 |
$548 |
2.1× |
| Splenoportograpy rs&i (75810) |
$970.20 |
$2,310 |
0.3× |
| Stereotactic body radiation delivery (77373) |
$6,487.32 |
$15,446 |
3.5× |
| Superior sagittal sinus venogram (75870) |
$2,040.78 |
$4,859 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$396.48 |
$944 |
3.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,922.34 |
$4,577 |
4.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,191.96 |
$2,838 |
3.1× |
| Testicular Imaging With Vascular Flow (78761) |
$732.06 |
$1,743 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,534.26 |
$3,653 |
3.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$798 |
$1,900 |
5.7× |
| Thoracolumbar 2 views (72080) |
$197.82 |
$471 |
2.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$943.53 |
$2,246.50 |
1.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$228.48 |
$544 |
0.6× |
| Thyroid uptake measurement (78012) |
$343.14 |
$817 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$438.90 |
$1,045 |
1.1× |
| Tomogram (76100) |
$119.28 |
$284 |
1.1× |
| Treatment device intermediate (77333) |
$615.72 |
$1,466 |
4.4× |
| Treatment devices simple (77332) |
$248.22 |
$591 |
1.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,418.76 |
$3,378 |
2.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$763.98 |
$1,819 |
1.8× |
| Tx devices design & construction complex (77334) |
$918.96 |
$2,188 |
2.4× |
| Ultrasound elastography first target lesion (76982) |
$113.82 |
$271 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$320.04 |
$762 |
2.9× |
| Umbilical-artery Doppler (OB) (76820) |
$143.64 |
$342 |
1.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$34.02 |
$81 |
0.4× |
| Unlisted fluoroscopic procedure (76496) |
$285.60 |
$680 |
3.2× |
| Unlisted magnetic resonance procedure (76498) |
$67.20 |
$160 |
0.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,706.46 |
$4,063 |
16.1× |
| Unlisted Ultrasound Procedure (76999) |
$163.59 |
$389.50 |
1.8× |
| Upper Extremity Infant (73092) |
$81.06 |
$193 |
0.7× |
| Urethrocystography retrograde rs&i (74450) |
$476.70 |
$1,135 |
1.9× |
| Urethrocystography voiding (74455) |
$471.66 |
$1,123 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$338.52 |
$806 |
1.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$757.68 |
$1,804 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$199.50 |
$475 |
1.8× |
| Us breast unilateral complete (76641) |
$139.02 |
$331 |
1.3× |
| Us breast unilateral limited (76642) |
$139.02 |
$331 |
1.5× |
| Us chest (76604) |
$171.78 |
$409 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$380.10 |
$905 |
3.5× |
| Us elastography parenchyma (76981) |
$119.70 |
$285 |
1.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$149.52 |
$356 |
1.4× |
| Us guided compression repair (76936) |
$456.54 |
$1,087 |
2.0× |
| Us infant hips dynamic (76885) |
$314.58 |
$749 |
3.5× |
| Us infant hips limited static (76886) |
$292.74 |
$697 |
3.2× |
| Us kidney transplant (76776) |
$60.48 |
$144 |
0.6× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$402.36 |
$958 |
3.7× |
| Us ob detailed single fetus (76811) |
$490.98 |
$1,169 |
2.0× |
| Us ob transvaginal (76817) |
$398.58 |
$949 |
3.7× |
| Us pelvic non ob complete (76856) |
$471.66 |
$1,123 |
4.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$231.42 |
$551 |
2.1× |
| Us pregnancy ltd (76815) |
$251.16 |
$598 |
2.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$444.36 |
$1,058 |
4.1× |
| Us retroperitoneal complete (76770) |
$488.04 |
$1,162 |
4.5× |
| Us retroperitoneal limited (76775) |
$317.52 |
$756 |
2.9× |
| Us scrotum and contents (76870) |
$416.22 |
$991 |
3.8× |
| Us soft tissue head/neck (76536) |
$367.92 |
$876 |
3.4× |
| Us spinal canal and contents (76800) |
$290.64 |
$692 |
2.7× |
| Us transrectal (76872) |
$302.40 |
$720 |
2.8× |
| Us transrectal prostate volume (76873) |
$287.28 |
$684 |
2.6× |
| Us xtr non-vasc lmtd (76882) |
$316.68 |
$754 |
2.9× |
| Us, eye b-scan (76512) |
$27.30 |
$65 |
0.3× |
| Vascular flow imaging (78445) |
$487.62 |
$1,161 |
1.2× |
| Venogram extremity bilateral (75822) |
$1,308.72 |
$3,116 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$1,581.72 |
$3,766 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$913.50 |
$2,175 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$719.67 |
$1,713.50 |
0.4× |
| Venography Renal Bilateral (75833) |
$1,987.02 |
$4,731 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$1,352.40 |
$3,220 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,055.88 |
$2,514 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$1,953.21 |
$4,650.50 |
0.3× |
| Wrist 2 views (73100) |
$145.32 |
$346 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$348.60 |
$830 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$204.54 |
$487 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$229.32 |
$546 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$564.06 |
$1,343 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$164.64 |
$392 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$205.80 |
$490 |
2.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$178.50 |
$425 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$79.80 |
$190 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$65.52 |
$156 |
0.7× |
| X-ray exam hip uni 4/> views (73503) |
$108.78 |
$259 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$108.78 |
$259 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$207.48 |
$494 |
1.9× |
| X-ray exam of femur 1 (73551) |
$65.52 |
$156 |
0.7× |
| X-ray eye for foreign body (70030) |
$86.94 |
$207 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$259.56 |
$618 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$75.18 |
$179 |
0.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$189 |
$450 |
2.1× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$683.13 |
$1,626.50 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$145.32 |
$346 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$87.36 |
$208 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$268.80 |
$640 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$120.54 |
$287 |
1.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$105.84 |
$252 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$311.22 |
$741 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$429.24 |
$1,022 |
4.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$519.54 |
$1,237 |
4.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$204.96 |
$488 |
2.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$186.06 |
$443 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$247.38 |
$589 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$261.24 |
$622 |
2.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$810.18 |
$1,929 |
1.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$476.70 |
$1,135 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$169.26 |
$403 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$228.90 |
$545 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$322.56 |
$768 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$236.88 |
$564 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.06 |
$243 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$214.62 |
$511 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$242.76 |
$578 |
2.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$207.48 |
$494 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$243.18 |
$579 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$143.64 |
$342 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$170.94 |
$407 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$84 |
$200 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$110.46 |
$263 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$183.96 |
$438 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$146.58 |
$349 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$217.14 |
$517 |
2.4× |
| Xr arthrogram ankle (73615) |
$371.70 |
$885 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$472.08 |
$1,124 |
4.3× |
| Xr chest 4+ views (71048) |
$337.68 |
$804 |
3.1× |
| Xr finger(s) 2+ views (73140) |
$141.54 |
$337 |
1.6× |
| Xr shoulder 1 view (73020) |
$163.38 |
$389 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$338.52 |
$806 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$214.20 |
$510 |
2.4× |
| Xr tmj bilateral (70330) |
$209.16 |
$498 |
2.3× |
| Xray knee 1 or 2 views rt (73560) |
$231.84 |
$552 |
2.6× |