| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,412.50 |
$8,550 |
4.6× |
| Abdomen 2 views (74019) |
$516.75 |
$689 |
4.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,725 |
$2,300 |
4.3× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$4,399.50 |
$5,866 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$4,599 |
$6,132 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,609 |
$4,812 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$3,664.50 |
$4,886 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$8,525.25 |
$11,367 |
1.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,421 |
$7,228 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,125.50 |
$6,834 |
1.6× |
| Angiography Spinal Selective Rs&I (75705) |
$4,614 |
$6,152 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,292 |
$7,056 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,338.75 |
$1,785 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,317.25 |
$4,423 |
1.0× |
| Ankle 2 views (73600) |
$399.75 |
$533 |
4.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$1,081.50 |
$1,442 |
3.1× |
| Aortogram thoracic (75605) |
$4,917 |
$6,556 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,303.50 |
$5,738 |
1.4× |
| Aortography abdominal serialography rs&i (75625) |
$4,406.25 |
$5,875 |
1.4× |
| Artery X-Rays Adrenal Gland (75731) |
$3,033 |
$4,044 |
1.0× |
| Arthrogram shoulder (73040) |
$1,630.50 |
$2,174 |
4.7× |
| Basic radiation dosimetry calculation (77300) |
$413.25 |
$551 |
3.1× |
| Bone &/joint imaging whole body (78306) |
$2,351.25 |
$3,135 |
5.9× |
| Bone age studies (77072) |
$647.25 |
$863 |
6.2× |
| Bone Imaging 3 Phase (78315) |
$2,472.75 |
$3,297 |
6.2× |
| Bone Marrow Imaging Limited Area (78102) |
$805.50 |
$1,074 |
2.0× |
| Bone survey complete (77075) |
$1,021.50 |
$1,362 |
9.7× |
| Brain image w/flow 4 + views (78606) |
$2,516.25 |
$3,355 |
4.6× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,350.75 |
$1,801 |
3.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,896.75 |
$2,529 |
3.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,030.75 |
$8,041 |
4.2× |
| Brain Imaging Vascular Flow Only (78610) |
$2,633.25 |
$3,511 |
4.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$4,288.50 |
$5,718 |
12.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$502.50 |
$670 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$531 |
$708 |
6.1× |
| Chest 1 view (71045) |
$513.75 |
$685 |
5.9× |
| Chest 3 views (71047) |
$683.25 |
$911 |
7.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$888 |
$1,184 |
5.0× |
| Clavicle complete (73000) |
$482.25 |
$643 |
5.5× |
| Continuing medical physics consltj pr wk (77336) |
$816.75 |
$1,089 |
6.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,709.25 |
$6,279 |
13.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,532.50 |
$4,710 |
14.7× |
| CT abdomen w contrast (74160) |
$3,413.25 |
$4,551 |
19.4× |
| CT abdomen w wo contrast (74170) |
$4,662.75 |
$6,217 |
26.5× |
| CT abdomen w/o contrast (74150) |
$2,872.50 |
$3,830 |
27.4× |
| CT angio hrt w/3d image (75574) |
$852.75 |
$1,137 |
2.4× |
| CT angiography upper extremity lt (73206) |
$3,652.50 |
$4,870 |
20.7× |
| CT c-spine w/o contrast (72125) |
$3,483.75 |
$4,645 |
33.2× |
| CT cervical spine w&w/o contrast (72127) |
$626.25 |
$835 |
3.6× |
| CT cervical spine with contrast (72126) |
$3,807 |
$5,076 |
10.9× |
| CT chest w/wo contrast (71270) |
$3,429.75 |
$4,573 |
19.5× |
| CT chest with contrast (71260) |
$2,710.50 |
$3,614 |
15.4× |
| CT head/brain with contrast (70460) |
$3,045 |
$4,060 |
17.3× |
| CT head/brain without and with contrast (70470) |
$3,177.75 |
$4,237 |
18.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,845 |
$2,460 |
5.3× |
| CT hrt w/3d image congen (75573) |
$2,127.75 |
$2,837 |
6.1× |
| CT iac w contrast (70481) |
$3,510 |
$4,680 |
19.9× |
| CT limited/localized follow up study (76380) |
$321 |
$428 |
3.7× |
| CT lower ext w/o (73700) |
$3,311.25 |
$4,415 |
31.5× |
| CT lower extremity w wo contrast (73702) |
$731.25 |
$975 |
4.2× |
| CT lower extremity with contrast (73701) |
$3,207.75 |
$4,277 |
18.2× |
| CT lumbar spine w & w/o contrast (72133) |
$731.25 |
$975 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$3,165.75 |
$4,221 |
30.1× |
| CT lumbar spine with contrast (72132) |
$3,816.75 |
$5,089 |
10.9× |
| CT maxillofacial w contrast (70487) |
$3,097.50 |
$4,130 |
17.6× |
| CT maxillofacial w/o contrast (70486) |
$2,544.75 |
$3,393 |
24.2× |
| CT maxillofacial w/wo contrast (70488) |
$731.25 |
$975 |
4.2× |
| CT neck soft tissue w contrast (70491) |
$2,531.25 |
$3,375 |
14.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$731.25 |
$975 |
4.2× |
| CT orbits w/o contrast (70480) |
$2,976.75 |
$3,969 |
28.3× |
| CT pelvis w & w/o contrast (72194) |
$3,495.75 |
$4,661 |
19.8× |
| CT pelvis w/o contrast (72192) |
$2,805.75 |
$3,741 |
26.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$731.25 |
$975 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$2,454 |
$3,272 |
23.4× |
| CT thoracic spine w/contrast (72129) |
$852.75 |
$1,137 |
4.8× |
| CT thoracic spine w/o contrast (72128) |
$3,174.75 |
$4,233 |
30.2× |
| CT thoracic spine w/wo contrast (72130) |
$731.25 |
$975 |
4.2× |
| CT thorax w/o contrast (71250) |
$2,274 |
$3,032 |
21.7× |
| CT unlisted procedure (76497) |
$702 |
$936 |
8.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$731.25 |
$975 |
4.2× |
| CT upper extremity w/o contrast rt (73200) |
$2,081.25 |
$2,775 |
19.8× |
| CT upper extremity with contrast (73201) |
$3,371.25 |
$4,495 |
9.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$731.25 |
$975 |
4.2× |
| Cta Abdomen (74175) |
$3,936.75 |
$5,249 |
22.3× |
| CTA abdomen pelvis (74174) |
$1,630.50 |
$2,174 |
4.7× |
| CTA chest (71275) |
$3,429.75 |
$4,573 |
19.5× |
| Cta Head (70496) |
$3,809.25 |
$5,079 |
21.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,069.50 |
$1,426 |
3.1× |
| CTA lwr ext w&w/o contrast (73706) |
$5,946.75 |
$7,929 |
33.8× |
| Cta Neck (70498) |
$3,640.50 |
$4,854 |
20.7× |
| Cta Pelvis (72191) |
$4,336.50 |
$5,782 |
24.6× |
| Cystography minimum 3 views rs&i (74430) |
$800.25 |
$1,067 |
2.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$555 |
$740 |
5.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,086.75 |
$1,449 |
10.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$363.75 |
$485 |
3.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$690 |
$920 |
6.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$577.50 |
$770 |
6.6× |
| Echo exam of fetal heart (76825) |
$4,340.25 |
$5,787 |
7.9× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$3,681 |
$4,908 |
15.4× |
| Echoencephalography real time imaging (76506) |
$757.50 |
$1,010 |
7.2× |
| Esophagus (74220) |
$987.75 |
$1,317 |
5.6× |
| Fluoroscopy up to 1 hr (76000) |
$908.25 |
$1,211 |
3.8× |
| Foot 2 views (73620) |
$351 |
$468 |
4.0× |
| Forearm 2 views (73090) |
$629.25 |
$839 |
7.2× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$1,002 |
$1,336 |
4.2× |
| Functional MRI brain by phys/psych (70555) |
$3,675 |
$4,900 |
15.3× |
| Functional MRI brain by tech (70554) |
$3,562.50 |
$4,750 |
14.9× |
| Gated Heart Planar Single (78472) |
$2,536.50 |
$3,382 |
6.3× |
| Hand 2 views (73120) |
$312 |
$416 |
3.0× |
| Hand 3 views (73130) |
$504.75 |
$673 |
5.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,855 |
$5,140 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,917.50 |
$3,890 |
5.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,917.50 |
$3,890 |
7.3× |
| Ht muscle image spect sing (78451) |
$3,581.25 |
$4,775 |
2.8× |
| Humerus Min 2 Views Left (73060) |
$399.75 |
$533 |
4.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$342.75 |
$457 |
3.3× |
| Kidney funcj study non-img radioisotopic study (78725) |
$2,752.50 |
$3,670 |
6.9× |
| Kidney imaging morphology (78700) |
$2,643.75 |
$3,525 |
6.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$3,176.25 |
$4,235 |
5.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,025.50 |
$4,034 |
5.5× |
| Knee 3 views (73562) |
$568.50 |
$758 |
6.5× |
| Liver & spleen imaging static only (78215) |
$2,970 |
$3,960 |
7.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,491.75 |
$1,989 |
3.7× |
| Lung perf&ventilat diferentl (78598) |
$771 |
$1,028 |
1.4× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$11,049.75 |
$14,733 |
3.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$2,715 |
$3,620 |
4.3× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$2,715 |
$3,620 |
1.7× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,359 |
$5,812 |
1.4× |
| Lymphoscintigraphy (78195) |
$2,719.50 |
$3,626 |
5.0× |
| Meckels Diverticulum (78290) |
$3,750 |
$5,000 |
9.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,135 |
$4,180 |
8.3× |
| Mr elastography (76391) |
$2,412 |
$3,216 |
10.1× |
| Mr safety determination physician/other qhp (76016) |
$277.50 |
$370 |
3.2× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$187.50 |
$250 |
3.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$77.25 |
$103 |
2.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$288.75 |
$385 |
3.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$761.25 |
$1,015 |
3.2× |
| MRA head w & w/o contrast (70546) |
$4,926.75 |
$6,569 |
14.1× |
| MRA head w/o contrast (70544) |
$2,641.50 |
$3,522 |
11.0× |
| MRA head with contrast (70545) |
$4,152 |
$5,536 |
11.8× |
| MRA neck w contrast (70548) |
$4,578 |
$6,104 |
13.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,956 |
$6,608 |
14.1× |
| MRA neck w/o contrast (70547) |
$3,372.75 |
$4,497 |
14.1× |
| MRI abdomen w contrast (74182) |
$3,548.25 |
$4,731 |
10.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,288.50 |
$5,718 |
12.2× |
| MRI abdomen w/o contrast (74181) |
$2,748.75 |
$3,665 |
11.5× |
| MRI any jnt lwr ext with con lt (73722) |
$4,070.25 |
$5,427 |
5.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,549.75 |
$4,733 |
4.5× |
| MRI c-spine with contrast (72142) |
$3,606 |
$4,808 |
10.3× |
| MRI cardiac w/o cont stress (75559) |
$3,329.25 |
$4,439 |
6.1× |
| MRI cardiac w/o contrast (75557) |
$2,641.50 |
$3,522 |
11.0× |
| MRI cervical spine w/o contrast (72141) |
$3,384 |
$4,512 |
14.1× |
| MRI chest w/o & w/contrast material (71552) |
$4,288.50 |
$5,718 |
12.2× |
| MRI chest w/o contrast (71550) |
$2,641.50 |
$3,522 |
11.0× |
| MRI chest with contrast (71551) |
$3,042.75 |
$4,057 |
3.9× |
| MRI fetal sngl/1st gestation (74712) |
$1,003.50 |
$1,338 |
4.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$4,462.50 |
$5,950 |
12.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,948 |
$5,264 |
11.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,279.75 |
$4,373 |
13.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,172.50 |
$4,230 |
13.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,288.50 |
$5,718 |
12.2× |
| MRI orbit/face/neck w/contrast (70542) |
$3,399.75 |
$4,533 |
9.7× |
| MRI pelvis w contrast (72196) |
$3,387.75 |
$4,517 |
9.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,847.50 |
$5,130 |
11.0× |
| MRI pelvis w/o contrast (72195) |
$2,641.50 |
$3,522 |
11.0× |
| MRI scan of arm joint before and after contrast (73223) |
$3,781.50 |
$5,042 |
10.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$5,265.75 |
$7,021 |
6.7× |
| MRI scan of leg joint before and after contrast (73723) |
$4,432.50 |
$5,910 |
12.6× |
| MRI spectroscopy (76390) |
$3,192.75 |
$4,257 |
36.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,104.50 |
$6,806 |
14.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,407.25 |
$4,543 |
9.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,485.75 |
$5,981 |
12.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,616.50 |
$4,822 |
10.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,731.75 |
$6,309 |
13.5× |
| MRI thoracic spine w/o contrast (72146) |
$3,433.50 |
$4,578 |
14.3× |
| MRI tmj (70336) |
$2,589 |
$3,452 |
10.8× |
| MRI upper ext joint w/o contrast (73221) |
$3,525 |
$4,700 |
14.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,288.50 |
$5,718 |
12.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,372.75 |
$4,497 |
14.1× |
| Myelogram Cervical (72240) |
$2,041.50 |
$2,722 |
2.6× |
| Myelogram Lumbar (72265) |
$2,348.25 |
$3,131 |
3.0× |
| Myelogram thoracic (72255) |
$2,759.25 |
$3,679 |
3.5× |
| Myelography 2 or more regions (72270) |
$2,486.25 |
$3,315 |
3.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,616.50 |
$4,822 |
2.8× |
| Neck soft tissue (70360) |
$289.50 |
$386 |
3.3× |
| Nm adrenal scan (78075) |
$5,112.75 |
$6,817 |
3.9× |
| Nm bone marrow wb (78104) |
$1,479 |
$1,972 |
3.7× |
| Nm cisternogram (78630) |
$4,569 |
$6,092 |
8.4× |
| Nm csf leak detection (78650) |
$5,112.75 |
$6,817 |
3.9× |
| Nm gastric emptying study (78264) |
$2,410.50 |
$3,214 |
6.0× |
| Nm gastroesophageal reflux study (78262) |
$2,362.50 |
$3,150 |
5.9× |
| Nm peritoneal-venous shunt patency (78291) |
$3,136.50 |
$4,182 |
7.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,225.50 |
$5,634 |
3.0× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$1,896.75 |
$2,529 |
3.5× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,479 |
$1,972 |
3.7× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$1,479 |
$1,972 |
3.7× |
| Nuclear Rx Oral Admin (79005) |
$1,591.50 |
$2,122 |
6.8× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$417.75 |
$557 |
4.0× |
| Orthopantogram (70355) |
$389.25 |
$519 |
4.5× |
| Osseous survey infant (77076) |
$417.75 |
$557 |
4.0× |
| Parathyrd planar w/spect&CT (78072) |
$1,822.50 |
$2,430 |
3.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,404 |
$1,872 |
3.5× |
| Parathyroid imaging (78070) |
$2,063.25 |
$2,751 |
5.1× |
| Pelvis 1 or 2 views (72170) |
$389.25 |
$519 |
3.7× |
| Perineogram (74775) |
$923.25 |
$1,231 |
3.9× |
| Peritoneogram rs&i (74190) |
$1,994.25 |
$2,659 |
3.6× |
| PET image w/CT, skull-thigh (78815) |
$6,230.25 |
$8,307 |
4.3× |
| PET imaging CT for attenuation limited area (78814) |
$2,929.50 |
$3,906 |
2.0× |
| PET imaging for CT attenuation whole body (78816) |
$6,891.75 |
$9,189 |
4.8× |
| Pr csf ventriculography (78635) |
$1,903.50 |
$2,538 |
3.5× |
| Pr heart first pass single,planar (78481) |
$1,896.75 |
$2,529 |
3.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,292.25 |
$5,723 |
12.2× |
| Pr sono bone density measure,peripheral (76977) |
$371.25 |
$495 |
3.5× |
| Proton trmt simple w/comp (77522) |
$4,971 |
$6,628 |
4.0× |
| Proton tx delivery complex (77525) |
$4,971 |
$6,628 |
4.0× |
| Proton tx delivery intermediate (77523) |
$4,971 |
$6,628 |
4.0× |
| Proton tx delivery simple w/o compensation (77520) |
$2,078.25 |
$2,771 |
3.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,397.75 |
$7,197 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,033 |
$4,044 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$3,815.25 |
$5,087 |
9.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$699 |
$932 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$312 |
$416 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$524.25 |
$699 |
5.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$849.75 |
$1,133 |
8.1× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$2,122.50 |
$2,830 |
3.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$445.50 |
$594 |
4.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$495 |
$660 |
5.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$629.25 |
$839 |
6.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$516.75 |
$689 |
5.9× |
| Radiologic exam colon single contrast study (74270) |
$1,299.75 |
$1,733 |
7.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$683.25 |
$911 |
3.9× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$1,991.25 |
$2,655 |
8.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,403.25 |
$1,871 |
8.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$447.75 |
$597 |
5.1× |
| Radiopharm Dacryocystography (78660) |
$1,479 |
$1,972 |
3.7× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,872.50 |
$3,830 |
0.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$5,413.50 |
$7,218 |
1.7× |
| Ribs bilateral 3 views (71110) |
$798.75 |
$1,065 |
7.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,635.50 |
$3,514 |
4.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,270.25 |
$3,027 |
4.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$5,112.75 |
$6,817 |
3.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,801.25 |
$7,735 |
4.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$5,112.75 |
$6,817 |
3.9× |
| Rp Therapy Intravenous Administration (79101) |
$1,354.50 |
$1,806 |
5.8× |
| Salivary gland imaging serial images (78231) |
$1,443 |
$1,924 |
3.6× |
| Scanogram (77073) |
$708 |
$944 |
6.7× |
| Scapula complete (73010) |
$441.75 |
$589 |
4.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$2,175 |
$2,900 |
20.7× |
| Sialogram (70390) |
$835.50 |
$1,114 |
3.5× |
| Simulation intermediate (77285) |
$2,695.50 |
$3,594 |
7.2× |
| Small bowel series (74250) |
$1,041 |
$1,388 |
5.9× |
| Spec medical radj physics consltj (77370) |
$621 |
$828 |
4.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$645 |
$860 |
1.7× |
| Special treatment procedure (77470) |
$3,279.75 |
$4,373 |
5.9× |
| Speech evaluation complex (70371) |
$762 |
$1,016 |
3.2× |
| Splenoportograpy rs&i (75810) |
$9,863.25 |
$13,151 |
3.1× |
| Stereotactic body radiation delivery (77373) |
$7,136.25 |
$9,515 |
4.0× |
| Superior sagittal sinus venogram (75870) |
$5,710.50 |
$7,614 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,431.75 |
$1,909 |
3.8× |
| Testicular Imaging With Vascular Flow (78761) |
$1,479 |
$1,972 |
3.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,189.75 |
$4,253 |
8.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,691.25 |
$2,255 |
12.5× |
| Therapeutic Enema (74283) |
$2,907 |
$3,876 |
16.5× |
| Thoracolumbar 2 views (72080) |
$681 |
$908 |
7.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$3,462.75 |
$4,617 |
6.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,702.50 |
$2,270 |
4.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,702.50 |
$2,270 |
4.2× |
| Tmj unilateral (70328) |
$504.75 |
$673 |
5.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$5,329.50 |
$7,106 |
9.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,284.75 |
$1,713 |
3.2× |
| Tx devices design & construction complex (77334) |
$1,398.75 |
$1,865 |
3.7× |
| Ultrasound elastography first target lesion (76982) |
$1,326 |
$1,768 |
12.6× |
| Ultrasound scan to determine eye length and lens power (76519) |
$474.75 |
$633 |
4.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$895.50 |
$1,194 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$924.75 |
$1,233 |
8.8× |
| Umbilical-artery Doppler (OB) (76820) |
$363.75 |
$485 |
3.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$705 |
$940 |
8.1× |
| Unlisted magnetic resonance procedure (76498) |
$2,235.75 |
$2,981 |
25.6× |
| Upper Extremity Infant (73092) |
$371.25 |
$495 |
3.5× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$2,994 |
$3,992 |
7.5× |
| Urethrocystography retrograde rs&i (74450) |
$1,002 |
$1,336 |
4.2× |
| Urethrocystography voiding (74455) |
$1,324.50 |
$1,766 |
5.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$941.25 |
$1,255 |
5.3× |
| Us breast unilateral limited (76642) |
$674.25 |
$899 |
7.7× |
| Us chest (76604) |
$504.75 |
$673 |
4.8× |
| Us compl joint r-t w/image documentation (76881) |
$1,149.75 |
$1,533 |
10.9× |
| Us elastography parenchyma (76981) |
$1,326 |
$1,768 |
12.6× |
| Us infant hips dynamic (76885) |
$877.50 |
$1,170 |
10.0× |
| Us infant hips limited static (76886) |
$835.50 |
$1,114 |
9.6× |
| Us kidney transplant (76776) |
$1,199.25 |
$1,599 |
11.4× |
| Us pelvic non ob complete (76856) |
$1,092.75 |
$1,457 |
10.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$395.25 |
$527 |
3.8× |
| Us pregnancy ltd (76815) |
$346.50 |
$462 |
3.3× |
| Us retroperitoneal complete (76770) |
$823.50 |
$1,098 |
7.8× |
| Us retroperitoneal limited (76775) |
$450.75 |
$601 |
4.3× |
| Us scrotum and contents (76870) |
$1,021.50 |
$1,362 |
9.7× |
| Us soft tissue head/neck (76536) |
$872.25 |
$1,163 |
8.3× |
| Us spinal canal and contents (76800) |
$1,369.50 |
$1,826 |
13.0× |
| Us transrectal (76872) |
$417.75 |
$557 |
4.0× |
| Us xtr non-vasc lmtd (76882) |
$580.50 |
$774 |
5.5× |
| Us, eye b-scan (76512) |
$416.25 |
$555 |
4.0× |
| Venogram extremity bilateral (75822) |
$2,206.50 |
$2,942 |
1.4× |
| Venogram orbital (75880) |
$5,717.25 |
$7,623 |
9.1× |
| Venography caval inferior serialography rs&i (75825) |
$4,338 |
$5,784 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$2,796 |
$3,728 |
1.8× |
| Venography epidural rs&i (75872) |
$2,534.25 |
$3,379 |
4.0× |
| Venography extremity unilateral rs&i (75820) |
$2,031.75 |
$2,709 |
1.3× |
| Venography Renal Bilateral (75833) |
$3,528 |
$4,704 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$3,204 |
$4,272 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,074.25 |
$4,099 |
1.0× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$5,118.75 |
$6,825 |
0.9× |
| Wrist 2 views (73100) |
$460.50 |
$614 |
5.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,144.50 |
$1,526 |
10.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$423.75 |
$565 |
4.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$552.75 |
$737 |
6.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$466.50 |
$622 |
5.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$582.75 |
$777 |
6.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$739.50 |
$986 |
7.0× |
| X-ray exam hip uni 1 view (73501) |
$353.25 |
$471 |
4.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$405.75 |
$541 |
4.6× |
| X-ray exam hip uni 4/> views (73503) |
$450.75 |
$601 |
4.3× |
| X-ray exam of femur 1 (73551) |
$223.50 |
$298 |
2.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$447.75 |
$597 |
4.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$405.75 |
$541 |
4.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$418.50 |
$558 |
4.8× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,973.25 |
$2,631 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$353.25 |
$471 |
4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$393.75 |
$525 |
4.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$659.25 |
$879 |
6.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$661.50 |
$882 |
7.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$310.50 |
$414 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$550.50 |
$734 |
5.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,008.75 |
$1,345 |
9.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$605.25 |
$807 |
5.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$557.25 |
$743 |
5.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$567 |
$756 |
5.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$1,002 |
$1,336 |
1.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,359 |
$1,812 |
3.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$508.50 |
$678 |
5.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$562.50 |
$750 |
5.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$492.75 |
$657 |
5.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$466.50 |
$622 |
5.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$713.25 |
$951 |
8.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$492.75 |
$657 |
5.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$877.50 |
$1,170 |
8.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$375.75 |
$501 |
3.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$536.25 |
$715 |
6.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$533.25 |
$711 |
6.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$576 |
$768 |
6.6× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$265.50 |
$354 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$486 |
$648 |
4.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$371.25 |
$495 |
3.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$365.25 |
$487 |
4.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$515.25 |
$687 |
5.9× |
| Xr c-spine 6 or more views (72052) |
$937.50 |
$1,250 |
8.9× |
| Xr chest 4+ views (71048) |
$683.25 |
$911 |
6.5× |
| Xr finger(s) 2+ views (73140) |
$413.25 |
$551 |
4.7× |
| Xr shoulder 1 view (73020) |
$433.50 |
$578 |
5.0× |
| Xr spine cervical 4 or 5 views (72050) |
$597 |
$796 |
5.7× |
| Xr tibia/fibula 2 views (73590) |
$513.75 |
$685 |
5.9× |
| Xr tmj bilateral (70330) |
$540.75 |
$721 |
6.2× |
| Xray knee 1 or 2 views rt (73560) |
$536.25 |
$715 |
6.1× |