| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,214.10 |
$4,700 |
1.6× |
| Abdomen 2 views (74019) |
$238.84 |
$507 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$471.09 |
$1,000 |
1.2× |
| Acute venous thrombus image (78456) |
$1,061.35 |
$2,253 |
0.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,882.45 |
$3,996 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,783.16 |
$5,908 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$1,987.98 |
$4,220 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$1,596.03 |
$3,388 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,596.03 |
$3,388 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,764.68 |
$3,746 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,517.83 |
$3,222 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,596.03 |
$3,388 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,175 |
$4,617 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$581.32 |
$1,234 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,517.83 |
$3,222 |
0.5× |
| Ankle 2 views (73600) |
$310.92 |
$660 |
3.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$373.10 |
$792 |
1.1× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,596.03 |
$3,388 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,989.39 |
$4,223 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$2,583.42 |
$5,484 |
0.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,596.03 |
$3,388 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$1,710.98 |
$3,632 |
0.6× |
| Arthrogram elbow (73085) |
$539.40 |
$1,145 |
1.6× |
| Arthrogram hip (73525) |
$495.58 |
$1,052 |
1.5× |
| Arthrogram shoulder (73040) |
$522.91 |
$1,110 |
1.5× |
| Arthrogram wrist (73115) |
$440.47 |
$935 |
1.3× |
| Arthrography knee lt (73580) |
$611.47 |
$1,298 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$266.17 |
$565 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$865.86 |
$1,838 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$752.80 |
$1,598 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,881.51 |
$3,994 |
4.8× |
| Bone age studies (77072) |
$130.02 |
$276 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,204.09 |
$2,556 |
3.1× |
| Bone Marrow Imaging Limited Area (78102) |
$602.52 |
$1,279 |
1.5× |
| Bone survey complete (77075) |
$660.93 |
$1,403 |
6.5× |
| Brachytx isodose complex (77318) |
$540.34 |
$1,147 |
1.5× |
| Brachytx isodose intermed (77317) |
$540.34 |
$1,147 |
1.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$202.57 |
$430 |
0.6× |
| Brain image w/flow 4 + views (78606) |
$720.29 |
$1,529 |
1.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$590.74 |
$1,254 |
1.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$461.20 |
$979 |
0.9× |
| Brain Imaging Vascular Flow Only (78610) |
$710.40 |
$1,508 |
1.3× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$351.90 |
$747 |
31.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$945 |
$2,006 |
2.8× |
| Cardiac shunt detection (78428) |
$424.92 |
$902 |
1.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$544.11 |
$1,155 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$348.61 |
$740 |
4.1× |
| Chest 1 view (71045) |
$207.52 |
$440.50 |
2.4× |
| Chest 3 views (71047) |
$178.07 |
$378 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$432.46 |
$918 |
2.5× |
| Cineradiography/videoradiography (76120) |
$758.45 |
$1,610 |
7.4× |
| Clavicle complete (73000) |
$282.18 |
$599 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$868.21 |
$1,843 |
8.5× |
| Continuing medical physics consltj pr wk (77336) |
$267.11 |
$567 |
2.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$231.31 |
$491 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,884.34 |
$4,000 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,677.06 |
$3,560 |
7.2× |
| CT abdomen w contrast (74160) |
$1,000.11 |
$2,123 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,342.59 |
$2,850 |
7.8× |
| CT abdomen w/o contrast (74150) |
$870.57 |
$1,848 |
8.5× |
| CT angio hrt w/3d image (75574) |
$1,045.81 |
$2,220 |
3.1× |
| CT angiography upper extremity lt (73206) |
$839 |
$1,781 |
4.9× |
| CT c-spine w/o contrast (72125) |
$1,602.63 |
$3,402 |
15.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,715.22 |
$3,641 |
10.0× |
| CT cervical spine with contrast (72126) |
$1,699.20 |
$3,607 |
5.0× |
| CT chest w/wo contrast (71270) |
$1,241.78 |
$2,636 |
7.2× |
| CT chest with contrast (71260) |
$1,120.71 |
$2,379 |
6.5× |
| CT colonography w/dye (74262) |
$4,417.35 |
$9,377 |
25.8× |
| CT head/brain with contrast (70460) |
$791.42 |
$1,680 |
4.6× |
| CT head/brain without and with contrast (70470) |
$1,162.17 |
$2,467 |
6.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$251.09 |
$533 |
0.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$638.32 |
$1,355 |
7.5× |
| CT iac w contrast (70481) |
$744.32 |
$1,580 |
4.3× |
| CT limited/localized follow up study (76380) |
$626.07 |
$1,329 |
7.4× |
| CT lower ext w/o (73700) |
$975.14 |
$2,070 |
9.6× |
| CT lower extremity w wo contrast (73702) |
$1,249.32 |
$2,652 |
7.3× |
| CT lower extremity with contrast (73701) |
$954.89 |
$2,027 |
5.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,832.52 |
$3,890 |
10.7× |
| CT lumbar spine w/o contrast (72131) |
$1,553.17 |
$3,297 |
15.2× |
| CT lumbar spine with contrast (72132) |
$1,754.79 |
$3,725 |
5.2× |
| CT maxillofacial w contrast (70487) |
$922.39 |
$1,958 |
5.4× |
| CT maxillofacial w/o contrast (70486) |
$960.54 |
$2,039 |
9.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,047.22 |
$2,223 |
6.1× |
| CT neck soft tissue w contrast (70491) |
$1,530.55 |
$3,249 |
8.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$969.02 |
$2,057 |
5.7× |
| CT orbits w/o contrast (70480) |
$702.39 |
$1,491 |
6.9× |
| CT pelvis w & w/o contrast (72194) |
$1,166.41 |
$2,476 |
6.8× |
| CT pelvis w/o contrast (72192) |
$831.94 |
$1,766 |
8.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,683.66 |
$3,574 |
9.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,239.90 |
$2,632 |
12.1× |
| CT thoracic spine w/contrast (72129) |
$1,395.82 |
$2,963 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$1,516.89 |
$3,220 |
14.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,623.36 |
$3,446 |
9.5× |
| CT thorax w/o contrast (71250) |
$933.69 |
$1,982 |
9.1× |
| CT unlisted procedure (76497) |
$388.65 |
$825 |
4.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,100.45 |
$2,336 |
6.4× |
| CT upper extremity w/o contrast rt (73200) |
$963.14 |
$2,044.50 |
9.4× |
| CT upper extremity with contrast (73201) |
$867.74 |
$1,842 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,329.40 |
$2,822 |
7.8× |
| Cta Abdomen (74175) |
$1,300.67 |
$2,761 |
7.6× |
| CTA abdomen pelvis (74174) |
$1,000.59 |
$2,124 |
2.9× |
| CTA chest (71275) |
$1,352.48 |
$2,871 |
7.9× |
| Cta Head (70496) |
$1,315.27 |
$2,792 |
7.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,002.94 |
$2,129 |
5.9× |
| Cta Neck (70498) |
$1,265.33 |
$2,686 |
7.4× |
| Cta Pelvis (72191) |
$997.76 |
$2,118 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$355.20 |
$754 |
1.0× |
| Diskography lumbar (72295) |
$1,596.03 |
$3,388 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$146.98 |
$312 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$284.54 |
$604 |
2.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$351.43 |
$746 |
3.4× |
| Echo exam of fetal heart (76825) |
$515.37 |
$1,094 |
1.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$268.52 |
$570 |
1.2× |
| Echoencephalography real time imaging (76506) |
$468.73 |
$995 |
4.6× |
| Esophagus (74220) |
$446.59 |
$948 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$278.42 |
$591 |
2.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$190.79 |
$405 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$301.03 |
$639 |
1.3× |
| Foot 2 views (73620) |
$343.42 |
$729 |
4.0× |
| Forearm 2 views (73090) |
$325.05 |
$690 |
3.8× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$249.21 |
$529 |
1.1× |
| Gated Heart Planar Single (78472) |
$889.88 |
$1,889 |
2.3× |
| Hand 2 views (73120) |
$268.52 |
$570 |
2.6× |
| Hand 3 views (73130) |
$304.80 |
$647 |
3.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,820.27 |
$3,864 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,132.96 |
$2,405 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$691.08 |
$1,467 |
1.8× |
| Ht muscle image spect sing (78451) |
$1,587.08 |
$3,369 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$399.72 |
$848.50 |
4.7× |
| Hysterosalpingogram (74740) |
$439.05 |
$932 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$2,095.38 |
$4,448 |
3.1× |
| Intracavitary Radiation Source Applic Complex (77763) |
$708.04 |
$1,503 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$708.04 |
$1,503 |
1.3× |
| Intracavitary radiation source applic simple (77761) |
$708.04 |
$1,503 |
1.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$129.55 |
$275 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,283.24 |
$2,724 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,394.88 |
$2,961 |
2.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$879.05 |
$1,866 |
1.7× |
| Knee 3 views (73562) |
$371.69 |
$789 |
4.4× |
| Liver & spleen imaging static only (78215) |
$516.78 |
$1,097 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$823.93 |
$1,749 |
2.1× |
| Lung perf&ventilat diferentl (78598) |
$666.12 |
$1,414 |
1.3× |
| Lung perfusion differential (78597) |
$512.54 |
$1,088 |
1.3× |
| Lung Ventilation Imaging (78579) |
$550.70 |
$1,169 |
1.4× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,600.27 |
$3,397 |
0.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$726.89 |
$1,543 |
1.2× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$349.55 |
$742 |
0.2× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$888.94 |
$1,887 |
0.3× |
| Lymphoscintigraphy (78195) |
$544.11 |
$1,155 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$156.40 |
$332 |
0.7× |
| Mammary ductogram or galactogram single (77053) |
$159.23 |
$338 |
0.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$92.34 |
$196 |
1.1× |
| Meckels Diverticulum (78290) |
$631.26 |
$1,340 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,902.82 |
$6,162 |
7.9× |
| Mr safety determination physician/other qhp (76016) |
$105.06 |
$223 |
1.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$29.21 |
$62 |
1.0× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$109.77 |
$233 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$288.31 |
$612 |
1.2× |
| MRA head w & w/o contrast (70546) |
$1,839.58 |
$3,905 |
5.4× |
| MRA head w/o contrast (70544) |
$1,149.92 |
$2,441 |
4.9× |
| MRA head with contrast (70545) |
$1,314.33 |
$2,790 |
3.9× |
| MRA neck w contrast (70548) |
$896.48 |
$1,903 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,104.22 |
$2,344 |
3.2× |
| MRA neck w/o contrast (70547) |
$1,182.42 |
$2,510 |
5.1× |
| MRI abdomen w contrast (74182) |
$1,151.33 |
$2,444 |
3.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,232.83 |
$2,617 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$812.62 |
$1,725 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,064.18 |
$2,259 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,158.40 |
$2,459 |
1.5× |
| MRI breast w/o contrast bilateral (77047) |
$783.42 |
$1,663 |
3.4× |
| MRI breast w/o contrast unilat (77046) |
$490.87 |
$1,042 |
2.1× |
| MRI c-spine with contrast (72142) |
$1,165.94 |
$2,475 |
3.4× |
| MRI cardiac w/o contrast (75557) |
$647.27 |
$1,374 |
2.8× |
| MRI cervical spine w/o contrast (72141) |
$1,092.92 |
$2,320 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$937.93 |
$1,991 |
2.8× |
| MRI chest w/o contrast (71550) |
$741.02 |
$1,573 |
3.2× |
| MRI chest with contrast (71551) |
$815.92 |
$1,732 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,223.41 |
$2,597 |
3.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,340.24 |
$2,845 |
3.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,089.62 |
$2,313 |
4.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,207.86 |
$2,564 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,219.17 |
$2,588 |
3.6× |
| MRI orbit/face/neck w/contrast (70542) |
$1,207.86 |
$2,564 |
3.5× |
| MRI pelvis w contrast (72196) |
$1,039.69 |
$2,207 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,284.18 |
$2,726 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$953.95 |
$2,025 |
4.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,201.27 |
$2,550 |
3.5× |
| MRI scan of leg joint before and after contrast (73723) |
$1,154.16 |
$2,450 |
3.4× |
| MRI spectroscopy (76390) |
$463.55 |
$984 |
5.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,551.28 |
$3,293 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,031.21 |
$2,189 |
3.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,449.06 |
$3,076 |
4.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,190.43 |
$2,527 |
3.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,553.64 |
$3,298 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,101.87 |
$2,339 |
4.7× |
| MRI tmj (70336) |
$658.11 |
$1,397 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,346.12 |
$2,857.50 |
5.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,152.75 |
$2,447 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,070.31 |
$2,272 |
4.6× |
| Myelogram Cervical (72240) |
$784.83 |
$1,666 |
1.0× |
| Myelogram Lumbar (72265) |
$687.79 |
$1,460 |
0.9× |
| Myelogram thoracic (72255) |
$670.83 |
$1,424 |
0.9× |
| Myelography 2 or more regions (72270) |
$1,096.22 |
$2,327 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,735.58 |
$5,807 |
2.2× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,173 |
$2,490 |
1.4× |
| Neck soft tissue (70360) |
$187.50 |
$398 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$272.76 |
$579 |
0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$302.91 |
$643 |
0.8× |
| Nm cisternogram (78630) |
$710.40 |
$1,508 |
1.3× |
| Nm csf leak detection (78650) |
$458.84 |
$974 |
0.4× |
| Nm gastric emptying study (78264) |
$1,585.67 |
$3,366 |
4.1× |
| Nm peritoneal-venous shunt patency (78291) |
$424.92 |
$902 |
1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,214.10 |
$4,700 |
1.6× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,368.03 |
$2,904 |
1.1× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,723.70 |
$3,659 |
1.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,018.49 |
$2,162 |
2.6× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$576.61 |
$1,224 |
1.1× |
| Nuclear Rx Oral Admin (79005) |
$603.93 |
$1,282 |
2.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$220.47 |
$468 |
2.2× |
| Orthopantogram (70355) |
$335.89 |
$713 |
4.0× |
| Osseous survey infant (77076) |
$224.71 |
$477 |
2.2× |
| Osseous survey limited (77074) |
$304.32 |
$646 |
3.0× |
| Parathyrd planar w/wo subtrj (78071) |
$464.96 |
$987 |
1.2× |
| Parathyroid imaging (78070) |
$781.06 |
$1,658 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$227.54 |
$483 |
2.2× |
| Perineogram (74775) |
$256.75 |
$545 |
1.1× |
| Peritoneogram rs&i (74190) |
$653.87 |
$1,388 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,176.77 |
$2,498 |
3.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,822.15 |
$3,868 |
0.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,440.11 |
$3,057 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$550.70 |
$1,169 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$776.82 |
$1,649 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$206.81 |
$439 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$178.55 |
$379 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$171.48 |
$364 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$186.55 |
$396 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$141.33 |
$300 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$185.14 |
$393 |
1.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,495.08 |
$9,542 |
0.6× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$371.22 |
$788 |
0.7× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$189.38 |
$402 |
1.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$285.95 |
$607 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$412.20 |
$875 |
4.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$217.17 |
$461 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$234.60 |
$498 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$297.73 |
$632 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$610.06 |
$1,295 |
3.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$259.57 |
$551 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$355.20 |
$754 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$611.47 |
$1,298 |
3.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$446.60 |
$948 |
5.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$92.34 |
$196 |
1.1× |
| Radiological examination surgical specimen (76098) |
$309.98 |
$658 |
0.6× |
| Radiopharm Dacryocystography (78660) |
$538.45 |
$1,143 |
1.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,596.03 |
$3,388 |
0.5× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,596.03 |
$3,388 |
0.5× |
| Ribs bilateral 3 views (71110) |
$368.86 |
$783 |
3.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,458.95 |
$3,097 |
3.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,254.61 |
$4,786 |
4.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$884.23 |
$1,877 |
1.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,325.27 |
$4,936 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$362.74 |
$770 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$205.87 |
$437 |
2.0× |
| Scanogram (77073) |
$163.47 |
$347 |
1.6× |
| Scapula complete (73010) |
$279.36 |
$593 |
2.7× |
| Screening digital breast tomosynthesis (77063) |
$41.93 |
$89 |
1.8× |
| Sella turcica (70240) |
$92.34 |
$196 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$183.73 |
$390 |
1.8× |
| Sialogram (70390) |
$190.79 |
$405 |
0.8× |
| Simulation intermediate (77285) |
$643.50 |
$1,366 |
1.8× |
| Small bowel series (74250) |
$686.37 |
$1,457 |
4.0× |
| Spec medical radj physics consltj (77370) |
$261.93 |
$556 |
2.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$613.36 |
$1,302 |
1.7× |
| Special dosimetry (77331) |
$233.66 |
$496 |
1.8× |
| Special treatment procedure (77470) |
$941.70 |
$1,999 |
1.7× |
| Speech evaluation complex (70371) |
$207.75 |
$441 |
0.9× |
| Spine thoracic 3 views (72072) |
$357.09 |
$758 |
3.5× |
| Spleen imaging only (78185) |
$317.99 |
$675 |
0.8× |
| Stereotactic body radiation delivery (77373) |
$1,587.55 |
$3,370 |
0.9× |
| Superior sagittal sinus venogram (75870) |
$862.09 |
$1,830 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$578.49 |
$1,228 |
1.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$225.65 |
$479 |
0.6× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$490.40 |
$1,041 |
2.1× |
| Testicular Imaging With Vascular Flow (78761) |
$424.92 |
$902 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$677.42 |
$1,438 |
1.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$270.88 |
$575 |
2.1× |
| Therapeutic Enema (74283) |
$354.26 |
$752 |
2.1× |
| Thoracolumbar 2 views (72080) |
$208.22 |
$442 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,471.20 |
$3,123 |
2.8× |
| Thyroid uptake measurement (78012) |
$586.97 |
$1,246 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$424.92 |
$902 |
1.1× |
| Tmj unilateral (70328) |
$156.88 |
$333 |
1.8× |
| Tomogram (76100) |
$568.60 |
$1,207 |
5.6× |
| Treatment device intermediate (77333) |
$435.29 |
$924 |
3.3× |
| Treatment devices simple (77332) |
$474.39 |
$1,007 |
3.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,387.45 |
$5,068 |
4.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$981.74 |
$2,084 |
2.5× |
| Tx devices design & construction complex (77334) |
$488.99 |
$1,038 |
1.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$170.07 |
$361 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$864.91 |
$1,836 |
8.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$529.03 |
$1,123 |
6.2× |
| Unlisted Ultrasound Procedure (76999) |
$195.50 |
$415 |
2.3× |
| Upper Extremity Infant (73092) |
$163 |
$346 |
1.6× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$243.08 |
$516 |
2.6× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$442.82 |
$940 |
1.1× |
| Urethrocystography retrograde rs&i (74450) |
$462.61 |
$982 |
2.0× |
| Urethrocystography voiding (74455) |
$462.61 |
$982 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$622.31 |
$1,321 |
3.6× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$734.42 |
$1,559 |
4.3× |
| Us abdl aorta screen aaa (76706) |
$190.32 |
$404 |
1.9× |
| Us breast unilateral complete (76641) |
$373.58 |
$793 |
3.7× |
| Us breast unilateral limited (76642) |
$332.12 |
$705 |
3.9× |
| Us chest (76604) |
$406.55 |
$863 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$662.82 |
$1,407 |
6.5× |
| Us elastography parenchyma (76981) |
$114.48 |
$243 |
1.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$244.50 |
$519 |
2.4× |
| Us guided compression repair (76936) |
$440 |
$934 |
2.1× |
| Us infant hips dynamic (76885) |
$180.43 |
$383 |
2.1× |
| Us infant hips limited static (76886) |
$146.04 |
$310 |
1.7× |
| Us kidney transplant (76776) |
$410.79 |
$872 |
4.0× |
| Us ob transvaginal (76817) |
$367.45 |
$780 |
3.6× |
| Us pelvic non ob complete (76856) |
$773.05 |
$1,641 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$247.32 |
$525 |
2.4× |
| Us pregnancy ltd (76815) |
$338.24 |
$718 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$263.34 |
$559 |
2.6× |
| Us retroperitoneal complete (76770) |
$2,813.31 |
$5,972 |
27.6× |
| Us retroperitoneal limited (76775) |
$514.43 |
$1,092 |
5.0× |
| Us scrotum and contents (76870) |
$658.58 |
$1,398 |
6.5× |
| Us soft tissue head/neck (76536) |
$570.02 |
$1,210 |
5.6× |
| Us spinal canal and contents (76800) |
$269.94 |
$573 |
2.6× |
| Us transrectal (76872) |
$1,902.24 |
$4,038 |
18.6× |
| Us xtr non-vasc lmtd (76882) |
$344.13 |
$730.50 |
3.4× |
| Venogram extremity bilateral (75822) |
$1,063.24 |
$2,257 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$1,894.23 |
$4,021 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,972.90 |
$4,188 |
1.3× |
| Venography extremity unilateral rs&i (75820) |
$1,118.83 |
$2,375 |
0.7× |
| Venography Renal Bilateral (75833) |
$1,596.03 |
$3,388 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,596.03 |
$3,388 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,596.03 |
$3,388 |
0.5× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,596.03 |
$3,388 |
0.3× |
| Wrist 2 views (73100) |
$195.50 |
$415 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$349.55 |
$742 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$176.19 |
$374 |
2.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$317.51 |
$674 |
3.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$835.71 |
$1,774 |
4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$308.56 |
$655 |
3.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$326.23 |
$692.50 |
3.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$310.92 |
$660 |
3.0× |
| X-ray exam hip uni 1 view (73501) |
$184.20 |
$391 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$230.36 |
$489 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$336.36 |
$714 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$389.12 |
$826 |
3.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$631.73 |
$1,341 |
3.7× |
| X-ray eye for foreign body (70030) |
$177.13 |
$376 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$358.97 |
$762 |
3.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$307.15 |
$652 |
3.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$309.51 |
$657 |
3.6× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$884.23 |
$1,877 |
0.4× |
| X-ray head for orthodontia (70350) |
$129.55 |
$275 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$179.96 |
$382 |
2.1× |
| X-ray IV pyelogram+drip infusn (74410) |
$310.92 |
$660 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$325.99 |
$692 |
3.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$269.94 |
$573 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$262.87 |
$558 |
3.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$195.50 |
$415 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$384.41 |
$816 |
3.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$645.86 |
$1,371 |
6.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$423.04 |
$898 |
4.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$384.41 |
$816 |
4.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$155.46 |
$330 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$196.92 |
$418 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$232.25 |
$493 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$479.10 |
$1,017 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$87.63 |
$186 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$323.64 |
$687 |
3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$456.01 |
$968 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$309.04 |
$656 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$244.03 |
$518 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$349.08 |
$741 |
4.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$462.61 |
$982 |
5.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$111.18 |
$236 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$514.90 |
$1,093 |
5.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$312.33 |
$663 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$259.10 |
$550 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$124.84 |
$265 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$337.30 |
$716 |
4.0× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$196.45 |
$417 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$333.53 |
$708 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$497 |
$1,055 |
4.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$225.18 |
$478 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$287.37 |
$610 |
3.4× |
| Xr arthrogram ankle (73615) |
$267.11 |
$567 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$449.42 |
$954 |
4.4× |
| Xr chest 4+ views (71048) |
$423.51 |
$899 |
4.1× |
| Xr Cholecystography Oral Contrast (74290) |
$238.37 |
$506 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$238.37 |
$506 |
2.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$220 |
$467 |
2.2× |
| Xr optic foramina (70190) |
$110.24 |
$234 |
1.3× |
| Xr shoulder 1 view (73020) |
$289.72 |
$615 |
3.4× |
| Xr spine cervical 4 or 5 views (72050) |
$508.77 |
$1,080 |
5.0× |
| Xr tibia/fibula 2 views (73590) |
$397.13 |
$843 |
4.7× |
| Xr tmj bilateral (70330) |
$227.54 |
$483 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$350.49 |
$744 |
4.1× |