| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,398.22 |
$5,449 |
1.1× |
| Abdomen 2 views (74019) |
$139.60 |
$544 |
1.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$381.06 |
$1,485 |
1.0× |
| Acute venous thrombus image (78456) |
$655.62 |
$2,555 |
0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,177.03 |
$4,587 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$1,411.05 |
$5,499 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,213.47 |
$4,729 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,527.03 |
$5,951 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,288.39 |
$5,021 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$811.63 |
$3,163 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,456.69 |
$9,574 |
0.5× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,130.81 |
$8,304 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$264.56 |
$1,031 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$811.63 |
$3,163 |
0.3× |
| Ankle 2 views (73600) |
$95.20 |
$371 |
1.1× |
| Antegrade urography radiological supvj & interpj (74425) |
$168.33 |
$656 |
0.5× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,725 |
$6,722.50 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,120.06 |
$4,365 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$918.12 |
$3,578 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$1,012.29 |
$3,945 |
0.3× |
| Arthrogram elbow (73085) |
$205.28 |
$800 |
0.6× |
| Arthrogram hip (73525) |
$183.47 |
$715 |
0.5× |
| Arthrogram shoulder (73040) |
$212.47 |
$828 |
0.6× |
| Arthrogram wrist (73115) |
$188.35 |
$734 |
0.6× |
| Arthrography knee lt (73580) |
$228.38 |
$890 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$145.50 |
$567 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$377.98 |
$1,473 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$640.48 |
$2,496 |
1.7× |
| Bone age studies (77072) |
$101.36 |
$395 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$672.55 |
$2,621 |
1.8× |
| Bone Marrow Imaging Limited Area (78102) |
$347.44 |
$1,354 |
0.9× |
| Bone survey complete (77075) |
$170.90 |
$666 |
1.7× |
| Brachytx isodose complex (77318) |
$214.39 |
$835.50 |
0.6× |
| Brachytx isodose intermed (77317) |
$200.54 |
$781.50 |
0.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$113.68 |
$443 |
0.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,758.48 |
$6,853 |
1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$993.30 |
$3,871 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$120.61 |
$470 |
1.4× |
| Chest 1 view (71045) |
$95.59 |
$372.50 |
1.1× |
| Chest 3 views (71047) |
$135.23 |
$527 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$134.72 |
$525 |
0.8× |
| Clavicle complete (73000) |
$103.93 |
$405 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$73.39 |
$286 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$129.46 |
$504.50 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,712.30 |
$6,673 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,496.50 |
$5,832 |
6.6× |
| CT abdomen w contrast (74160) |
$847.04 |
$3,301 |
5.0× |
| CT abdomen w wo contrast (74170) |
$923.51 |
$3,599 |
5.5× |
| CT abdomen w/o contrast (74150) |
$796.23 |
$3,103 |
8.0× |
| CT angio hrt w/3d image (75574) |
$292.53 |
$1,140 |
0.9× |
| CT angiography upper extremity lt (73206) |
$787 |
$3,067 |
4.7× |
| CT c-spine w/o contrast (72125) |
$705.91 |
$2,751 |
7.1× |
| CT cervical spine w&w/o contrast (72127) |
$826 |
$3,219 |
4.9× |
| CT cervical spine with contrast (72126) |
$741.32 |
$2,889 |
2.2× |
| CT chest w/wo contrast (71270) |
$851.66 |
$3,319 |
5.1× |
| CT chest with contrast (71260) |
$734.14 |
$2,861 |
4.4× |
| CT colonography w/dye (74262) |
$643.81 |
$2,509 |
3.8× |
| CT colonography w/o cntrst (74261) |
$573.25 |
$2,234 |
5.7× |
| CT head/brain with contrast (70460) |
$798.54 |
$3,112 |
4.8× |
| CT head/brain without and with contrast (70470) |
$1,011.01 |
$3,940 |
6.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$584.80 |
$2,279 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$58.51 |
$228 |
0.7× |
| CT hrt w/3d image congen (75573) |
$368.48 |
$1,436 |
1.1× |
| CT iac w contrast (70481) |
$636.63 |
$2,481 |
3.8× |
| CT limited/localized follow up study (76380) |
$317.68 |
$1,238 |
3.8× |
| CT lower ext w/o (73700) |
$585.44 |
$2,281.50 |
5.9× |
| CT lower extremity w wo contrast (73702) |
$744.14 |
$2,900 |
4.4× |
| CT lower extremity with contrast (73701) |
$646.89 |
$2,521 |
3.9× |
| CT lumbar spine w & w/o contrast (72133) |
$850.63 |
$3,315 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$727.21 |
$2,834 |
7.3× |
| CT lumbar spine with contrast (72132) |
$763.39 |
$2,975 |
2.3× |
| CT maxillofacial w contrast (70487) |
$836.78 |
$3,261 |
5.0× |
| CT maxillofacial w/o contrast (70486) |
$767.50 |
$2,991 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$905.80 |
$3,530 |
5.4× |
| CT neck soft tissue w contrast (70491) |
$743.89 |
$2,899 |
4.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$732.60 |
$2,855 |
4.4× |
| CT orbits w/o contrast (70480) |
$600.45 |
$2,340 |
6.0× |
| CT pelvis w & w/o contrast (72194) |
$737.73 |
$2,875 |
4.4× |
| CT pelvis w/o contrast (72192) |
$550.41 |
$2,145 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$862.95 |
$3,363 |
5.1× |
| CT soft tissue neck w/o contrast (70490) |
$691.80 |
$2,696 |
6.9× |
| CT thoracic spine w/contrast (72129) |
$763.39 |
$2,975 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$727.21 |
$2,834 |
7.3× |
| CT thoracic spine w/wo contrast (72130) |
$850.63 |
$3,315 |
5.1× |
| CT thorax w/o contrast (71250) |
$601.99 |
$2,346 |
6.0× |
| CT unlisted procedure (76497) |
$526.03 |
$2,050 |
6.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$692.70 |
$2,699.50 |
4.1× |
| CT upper extremity w/o contrast rt (73200) |
$567.86 |
$2,213 |
5.7× |
| CT upper extremity with contrast (73201) |
$661.39 |
$2,577.50 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$628.42 |
$2,449 |
3.7× |
| Cta Abdomen (74175) |
$658.70 |
$2,567 |
3.9× |
| CTA abdomen pelvis (74174) |
$983.04 |
$3,831 |
2.9× |
| CTA chest (71275) |
$692.57 |
$2,699 |
4.1× |
| Cta Head (70496) |
$686.67 |
$2,676 |
4.1× |
| CTA lwr ext w&w/o contrast (73706) |
$804.45 |
$3,135 |
4.8× |
| Cta Neck (70498) |
$835.49 |
$3,256 |
5.0× |
| Cta Pelvis (72191) |
$847.81 |
$3,304 |
5.1× |
| Cystography minimum 3 views rs&i (74430) |
$171.16 |
$667 |
0.5× |
| Diskogram cervical (72285) |
$1,211.42 |
$4,721 |
0.6× |
| Diskography lumbar (72295) |
$944.55 |
$3,681 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$109.57 |
$427 |
1.1× |
| Echoencephalography real time imaging (76506) |
$163.97 |
$639 |
1.6× |
| Esophagus (74220) |
$148.06 |
$577 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$126.25 |
$492 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$230.43 |
$898 |
1.0× |
| Foot 2 views (73620) |
$85.71 |
$334 |
1.0× |
| Forearm 2 views (73090) |
$121.12 |
$472 |
1.5× |
| Functional MRI brain by phys/psych (70555) |
$235.05 |
$916 |
1.0× |
| Functional MRI brain by tech (70554) |
$235.05 |
$916 |
1.0× |
| Gated Heart Planar Single (78472) |
$289.71 |
$1,129 |
0.8× |
| Hand 2 views (73120) |
$109.32 |
$426 |
1.1× |
| Hand 3 views (73130) |
$125.74 |
$490 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$519.62 |
$2,025 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$519.62 |
$2,025 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$519.62 |
$2,025 |
0.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$865.52 |
$3,373 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$659.72 |
$2,571 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$602.25 |
$2,347 |
1.6× |
| Ht muscle image spect sing (78451) |
$1,231.04 |
$4,797.50 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$125.23 |
$488 |
1.5× |
| Hysterosalpingogram (74740) |
$261.99 |
$1,021 |
1.1× |
| Image fusion (77399) |
$71.08 |
$277 |
0.6× |
| Interstitial radiation source applic complex (77778) |
$1,649.30 |
$6,427.50 |
2.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$791.49 |
$3,084.50 |
1.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$615.72 |
$2,399.50 |
1.2× |
| Intracavitary radiation source applic simple (77761) |
$590.18 |
$2,300 |
1.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$419.03 |
$1,633 |
0.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$586.59 |
$2,286 |
1.1× |
| Knee 3 views (73562) |
$119.32 |
$465 |
1.4× |
| Liver & spleen imaging static only (78215) |
$296.12 |
$1,154 |
0.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$290.48 |
$1,132 |
0.8× |
| Liver imaging w/vascular flow (78202) |
$439.82 |
$1,714 |
0.8× |
| Lung perf&ventilat diferentl (78598) |
$459.32 |
$1,790 |
0.9× |
| Lung perfusion differential (78597) |
$431.09 |
$1,680 |
1.1× |
| Lung Ventilation Imaging (78579) |
$338.46 |
$1,319 |
0.9× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$865.52 |
$3,373 |
0.3× |
| Lymphoscintigraphy (78195) |
$432.89 |
$1,687 |
0.8× |
| Meckels Diverticulum (78290) |
$332.82 |
$1,297 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$217.60 |
$848 |
0.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$18.74 |
$73 |
0.7× |
| MRA head w & w/o contrast (70546) |
$1,249.39 |
$4,869 |
3.7× |
| MRA head w/o contrast (70544) |
$939.42 |
$3,661 |
4.1× |
| MRA head with contrast (70545) |
$1,249.39 |
$4,869 |
3.7× |
| MRA neck w contrast (70548) |
$844.99 |
$3,293 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$956.35 |
$3,727 |
2.9× |
| MRA neck w/o contrast (70547) |
$655.10 |
$2,553 |
2.9× |
| MRI abdomen w contrast (74182) |
$1,203.97 |
$4,692 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,252.21 |
$4,880 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$1,203.97 |
$4,692 |
5.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,159.32 |
$4,518 |
1.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,203.72 |
$4,691 |
1.6× |
| MRI bone marrow blood supply (77084) |
$926.84 |
$3,612 |
4.1× |
| MRI c-spine with contrast (72142) |
$1,210.64 |
$4,718 |
3.6× |
| MRI cardiac w/o cont stress (75559) |
$774.94 |
$3,020 |
1.5× |
| MRI cardiac w/o contrast (75557) |
$715.41 |
$2,788 |
3.1× |
| MRI cervical spine w/o contrast (72141) |
$1,052.58 |
$4,102 |
4.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,260.68 |
$4,913 |
3.8× |
| MRI chest w/o contrast (71550) |
$794.44 |
$3,096 |
3.5× |
| MRI chest with contrast (71551) |
$970.98 |
$3,784 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$995.10 |
$3,878 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,104.67 |
$4,305 |
3.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,017.68 |
$3,966 |
4.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$575.05 |
$2,241 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,064.89 |
$4,150 |
3.2× |
| MRI orbit/face/neck w/contrast (70542) |
$873.21 |
$3,403 |
2.6× |
| MRI pelvis w contrast (72196) |
$1,014.86 |
$3,955 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,252.73 |
$4,882 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$939.67 |
$3,662 |
4.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,256.06 |
$4,895 |
3.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$814.71 |
$3,175 |
1.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,284.80 |
$5,007 |
3.9× |
| MRI spectroscopy (76390) |
$580.18 |
$2,261 |
7.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,442.10 |
$5,620 |
4.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,175.23 |
$4,580 |
3.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,400.01 |
$5,456 |
4.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,175.23 |
$4,580 |
3.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,400.01 |
$5,456 |
4.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,022.04 |
$3,983 |
4.5× |
| MRI tmj (70336) |
$926.84 |
$3,612 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,046.68 |
$4,079 |
4.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,178.31 |
$4,592 |
3.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$872.70 |
$3,401 |
3.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,540.12 |
$6,002 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,984.55 |
$7,734 |
1.6× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,647.12 |
$6,419 |
0.8× |
| Neck soft tissue (70360) |
$63.13 |
$246 |
0.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$171.16 |
$667 |
0.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$302.54 |
$1,179 |
0.8× |
| Nm cisternogram (78630) |
$777.50 |
$3,030 |
1.5× |
| Nm csf leak detection (78650) |
$622.26 |
$2,425 |
0.5× |
| Nm gastric emptying study (78264) |
$589.93 |
$2,299 |
1.5× |
| Nm gastroesophageal reflux study (78262) |
$364.89 |
$1,422 |
1.0× |
| Nm peritoneal-venous shunt patency (78291) |
$318.96 |
$1,243 |
0.8× |
| Nm whole blood volume (78122) |
$419.80 |
$1,636 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$766.21 |
$2,986 |
0.6× |
| Nuclear Rx Oral Admin (79005) |
$331.79 |
$1,293 |
1.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$124.97 |
$487 |
1.2× |
| Osseous survey limited (77074) |
$131.64 |
$513 |
1.3× |
| Parathyrd planar w/spect&CT (78072) |
$444.18 |
$1,731 |
0.9× |
| Parathyroid imaging (78070) |
$446.49 |
$1,740 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$88.02 |
$343 |
0.9× |
| Peritoneogram rs&i (74190) |
$312.29 |
$1,217 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$1,700.49 |
$6,627 |
1.2× |
| PET imaging CT for attenuation limited area (78814) |
$1,360.50 |
$5,302 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$1,360.50 |
$5,302 |
1.0× |
| PET imaging limited area chest head/neck (78811) |
$1,412.84 |
$5,506 |
1.1× |
| PET whole body (78813) |
$1,412.59 |
$5,505 |
1.0× |
| Platelet survival study (78191) |
$713.35 |
$2,780 |
1.9× |
| Pr gi endoscopic ultrasound (76975) |
$177.06 |
$690 |
0.8× |
| Pr heart first pass single,planar (78481) |
$492.42 |
$1,919 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,240.92 |
$4,836 |
3.7× |
| Pr sono bone density measure,peripheral (76977) |
$56.71 |
$221 |
0.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$865.52 |
$3,373 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,425.16 |
$5,554 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$419.80 |
$1,636 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$676.92 |
$2,638 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$216.83 |
$845 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$241.98 |
$943 |
2.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$184.76 |
$720 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$107.78 |
$420 |
1.1× |
Radiation Delivery Stereotactic Cranial Linear (77372)
unusually low: confirm this is the full procedure |
$2,360.47 |
$9,199 |
0.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$339.23 |
$1,322 |
0.6× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$181.68 |
$708 |
1.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$228.89 |
$892 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$130.61 |
$509 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$100.34 |
$391 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$128.30 |
$500 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$203.88 |
$794.50 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$277.26 |
$1,080.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$204.64 |
$797.50 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$123.17 |
$480 |
1.5× |
| Radiological examination surgical specimen (76098) |
$260.20 |
$1,014 |
0.5× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$1,067.72 |
$4,161 |
4.8× |
| Review by radiologist of adrenal gland vein image (75840) |
$865.52 |
$3,373 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$865.52 |
$3,373 |
0.3× |
| Ribs bilateral 3 views (71110) |
$91.35 |
$356 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$720.02 |
$2,806 |
1.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$991.90 |
$3,865.50 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$689.75 |
$2,688 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$986.63 |
$3,845 |
4.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$259.43 |
$1,011 |
1.2× |
| Rp Therapy Intravenous Administration (79101) |
$1,106.98 |
$4,314 |
5.0× |
| Sacroiliac Joints < 3 Views (72200) |
$56.46 |
$220 |
0.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$148.06 |
$577 |
0.6× |
| Scanogram (77073) |
$110.34 |
$430 |
1.1× |
| Scapula complete (73010) |
$75.45 |
$294 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$274.05 |
$1,068 |
2.7× |
| Simulation intermediate (77285) |
$268.02 |
$1,044.50 |
0.7× |
| Small bowel series (74250) |
$240.95 |
$939 |
1.4× |
| Spec medical radj physics consltj (77370) |
$317.30 |
$1,236.50 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$200.54 |
$781.50 |
0.6× |
| Special dosimetry (77331) |
$87.76 |
$342 |
0.7× |
| Special treatment procedure (77470) |
$525.01 |
$2,046 |
1.0× |
| Stereotactic body radiation delivery (77373) |
$1,247.59 |
$4,862 |
0.7× |
| Superior sagittal sinus venogram (75870) |
$746.71 |
$2,910 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$80.83 |
$315 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$230.94 |
$900 |
0.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$97 |
$378 |
0.3× |
| Testicular Imaging With Vascular Flow (78761) |
$349.75 |
$1,363 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$279.44 |
$1,089 |
0.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$199 |
$775.50 |
1.5× |
| Therapeutic Enema (74283) |
$223.25 |
$870 |
1.3× |
| Thoracolumbar 2 views (72080) |
$116.76 |
$455 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$616.61 |
$2,403 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$221.96 |
$865 |
0.6× |
| Thyroid uptake measurement (78012) |
$120.09 |
$468 |
0.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$426.73 |
$1,663 |
1.1× |
| Treatment device intermediate (77333) |
$169.62 |
$661 |
1.3× |
| Treatment devices simple (77332) |
$119.84 |
$467 |
0.9× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,356.90 |
$5,288 |
2.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$850.89 |
$3,316 |
2.2× |
| Tx devices design & construction complex (77334) |
$266.74 |
$1,039.50 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$251.47 |
$980 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$113.94 |
$444 |
1.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$79.55 |
$310 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$111.11 |
$433 |
1.3× |
| Unlisted magnetic resonance procedure (76498) |
$581.20 |
$2,265 |
7.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,819.81 |
$7,092 |
18.6× |
| Unlisted Ultrasound Procedure (76999) |
$100.85 |
$393 |
1.2× |
| Upper Extremity Infant (73092) |
$54.15 |
$211 |
0.5× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$349.75 |
$1,363 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$134.72 |
$525 |
0.6× |
| Urethrocystography voiding (74455) |
$192.45 |
$750 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$206.82 |
$806 |
1.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$328.45 |
$1,280 |
2.0× |
| Us breast unilateral complete (76641) |
$88.28 |
$344 |
0.9× |
| Us breast unilateral limited (76642) |
$88.28 |
$344 |
1.1× |
| Us chest (76604) |
$162.43 |
$633 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$155.50 |
$606 |
1.6× |
| Us guided compression repair (76936) |
$118.81 |
$463 |
0.6× |
| Us infant hips dynamic (76885) |
$132.15 |
$515 |
1.6× |
| Us infant hips limited static (76886) |
$115.47 |
$450 |
1.4× |
| Us kidney transplant (76776) |
$224.53 |
$875 |
2.2× |
| Us ob detailed single fetus (76811) |
$204.26 |
$796 |
0.9× |
| Us ob transvaginal (76817) |
$154.22 |
$601 |
1.5× |
| Us pelvic non ob complete (76856) |
$297.66 |
$1,160 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$80.58 |
$314 |
0.8× |
| Us pregnancy ltd (76815) |
$109.32 |
$426 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$96.23 |
$375 |
1.0× |
| Us retroperitoneal complete (76770) |
$222.22 |
$866 |
2.2× |
| Us retroperitoneal limited (76775) |
$211.06 |
$822.50 |
2.1× |
| Us scrotum and contents (76870) |
$199.38 |
$777 |
2.0× |
| Us soft tissue head/neck (76536) |
$154.22 |
$601 |
1.5× |
| Us spinal canal and contents (76800) |
$83.91 |
$327 |
0.8× |
| Us transrectal (76872) |
$120.61 |
$470 |
1.2× |
| Us transrectal prostate volume (76873) |
$150.37 |
$586 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$136.77 |
$533 |
1.4× |
| Venogram extremity bilateral (75822) |
$457.78 |
$1,784 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,483.67 |
$5,782 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$726.95 |
$2,833 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$557.08 |
$2,171 |
0.4× |
| Venography Renal Bilateral (75833) |
$1,194.22 |
$4,654 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$865.52 |
$3,373 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$933.26 |
$3,637 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$2,456.69 |
$9,574 |
0.5× |
| Wrist 2 views (73100) |
$107.26 |
$418 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$204.77 |
$798 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$119.84 |
$467 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$136 |
$530 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$293.04 |
$1,142 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$82.63 |
$322 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$105.72 |
$412 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$90.32 |
$352 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$120.61 |
$470 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$160.51 |
$625.50 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$369.25 |
$1,439 |
3.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$404.92 |
$1,578 |
2.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$119.32 |
$465 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$53.63 |
$209 |
0.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$136 |
$530 |
1.6× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$496.78 |
$1,936 |
0.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$67.49 |
$263 |
0.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$38.24 |
$149 |
0.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$138.57 |
$540 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$77.75 |
$303 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$83.40 |
$325 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$119.84 |
$467 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$209.90 |
$818 |
2.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$131.90 |
$514 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$105.21 |
$410 |
1.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$62.10 |
$242 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$162.43 |
$633 |
1.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$114.45 |
$446 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$168.33 |
$656 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$71.85 |
$280 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$78.78 |
$307 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$163.97 |
$639 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$111.88 |
$436 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.44 |
$407 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$117.53 |
$458 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$126.25 |
$492 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$66.98 |
$261 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$138.57 |
$540 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$122.66 |
$478 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$100.59 |
$392 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$72.11 |
$281 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$111.88 |
$436 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$113.42 |
$442 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$90.84 |
$354 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$108.03 |
$421 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$120.61 |
$470 |
1.4× |
| Xr arthrogram ankle (73615) |
$273.54 |
$1,066 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$176.29 |
$687 |
1.8× |
| Xr finger(s) 2+ views (73140) |
$62.10 |
$242 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$31.82 |
$124 |
0.3× |
| Xr optic foramina (70190) |
$84.17 |
$328 |
1.0× |
| Xr shoulder 1 view (73020) |
$58.77 |
$229 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$176.29 |
$687 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$112.14 |
$437 |
1.3× |
| Xr tmj bilateral (70330) |
$120.35 |
$469 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$101.36 |
$395 |
1.2× |