| 3-D radiotherapy plan dose-volume histograms (77295) |
$996.90 |
$3,323 |
0.7× |
| Abdomen 2 views (74019) |
$139.80 |
$466 |
1.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$615 |
$2,050 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$1,821 |
$6,070 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$726.30 |
$2,421 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,401.30 |
$4,671 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$874.50 |
$2,915 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,275.90 |
$4,253 |
0.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,064.40 |
$3,548 |
0.3× |
| Ankle 2 views (73600) |
$126.30 |
$421 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$78.60 |
$262 |
0.2× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$561 |
$1,870 |
0.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$558.90 |
$1,863 |
0.2× |
| Aortography abdominal serialography rs&i (75625) |
$558.90 |
$1,863 |
0.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,344.90 |
$4,483 |
0.4× |
| Arthrogram elbow (73085) |
$449.10 |
$1,497 |
1.3× |
| Arthrogram hip (73525) |
$15.90 |
$53 |
0.0× |
| Arthrogram shoulder (73040) |
$55.50 |
$185 |
0.2× |
| Arthrogram wrist (73115) |
$221.40 |
$738 |
0.6× |
| Arthrography knee lt (73580) |
$66 |
$220 |
0.2× |
| Basic radiation dosimetry calculation (77300) |
$116.10 |
$387 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$764.40 |
$2,548 |
1.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$923.10 |
$3,077 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$999.60 |
$3,332 |
2.5× |
| Bone age studies (77072) |
$92.10 |
$307 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,135.50 |
$3,785 |
2.8× |
| Bone Marrow Imaging Limited Area (78102) |
$327 |
$1,090 |
0.8× |
| Bone survey complete (77075) |
$405.90 |
$1,353 |
3.9× |
| Brachytx isodose complex (77318) |
$756.30 |
$2,521 |
2.0× |
| Brachytx isodose intermed (77317) |
$557.70 |
$1,859 |
1.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$248.40 |
$828 |
0.7× |
| Brain image w/flow 4 + views (78606) |
$816 |
$2,720 |
1.5× |
| Brain imaging < 4 static views w vascular flow (78601) |
$615 |
$2,050 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,157 |
$7,190 |
1.5× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$20.70 |
$69 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,104.30 |
$3,681 |
3.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$478.80 |
$1,596 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$145.50 |
$485 |
1.7× |
| Chest 1 view (71045) |
$89.70 |
$299 |
1.0× |
| Chest 3 views (71047) |
$135.90 |
$453 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$417.90 |
$1,393 |
2.4× |
| Clavicle complete (73000) |
$129 |
$430 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$186.30 |
$621 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$277.80 |
$926 |
2.1× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$308.10 |
$1,027 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,044.30 |
$3,481 |
3.0× |
| CT abdomen and pelvis without contrast (74176) |
$465.90 |
$1,553 |
2.0× |
| CT abdomen w contrast (74160) |
$691.50 |
$2,305 |
3.9× |
| CT abdomen w wo contrast (74170) |
$797.10 |
$2,657 |
4.5× |
| CT abdomen w/o contrast (74150) |
$423.60 |
$1,412 |
4.1× |
| CT angio hrt w/3d image (75574) |
$1,245.90 |
$4,153 |
3.6× |
| CT angiography upper extremity lt (73206) |
$979.80 |
$3,266 |
5.6× |
| CT c-spine w/o contrast (72125) |
$540.90 |
$1,803 |
5.2× |
| CT cervical spine w&w/o contrast (72127) |
$857.40 |
$2,858 |
4.9× |
| CT cervical spine with contrast (72126) |
$696 |
$2,320 |
2.0× |
| CT chest w/wo contrast (71270) |
$853.80 |
$2,846 |
4.9× |
| CT chest with contrast (71260) |
$691.50 |
$2,305 |
3.9× |
| CT head/brain with contrast (70460) |
$435.30 |
$1,451 |
2.5× |
| CT head/brain without and with contrast (70470) |
$529.50 |
$1,765 |
3.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$818.70 |
$2,729 |
2.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$17.70 |
$59 |
0.2× |
| CT iac w contrast (70481) |
$855.90 |
$2,853 |
4.9× |
| CT limited/localized follow up study (76380) |
$423.90 |
$1,413 |
4.9× |
| CT lower ext w/o (73700) |
$533.70 |
$1,779 |
5.1× |
| CT lower extremity w wo contrast (73702) |
$883.50 |
$2,945 |
5.0× |
| CT lower extremity with contrast (73701) |
$694.50 |
$2,315 |
4.0× |
| CT lumbar spine w & w/o contrast (72133) |
$857.40 |
$2,858 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$533.70 |
$1,779 |
5.1× |
| CT lumbar spine with contrast (72132) |
$692.40 |
$2,308 |
2.0× |
| CT maxillofacial w contrast (70487) |
$462 |
$1,540 |
2.6× |
| CT maxillofacial w/o contrast (70486) |
$422.10 |
$1,407 |
4.0× |
| CT maxillofacial w/wo contrast (70488) |
$586.50 |
$1,955 |
3.3× |
| CT neck soft tissue w contrast (70491) |
$688.50 |
$2,295 |
3.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$949.80 |
$3,166 |
5.4× |
| CT orbits w/o contrast (70480) |
$700.20 |
$2,334 |
6.7× |
| CT pelvis w & w/o contrast (72194) |
$826.50 |
$2,755 |
4.7× |
| CT pelvis w/o contrast (72192) |
$423.30 |
$1,411 |
4.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$850.50 |
$2,835 |
4.9× |
| CT soft tissue neck w/o contrast (70490) |
$532.50 |
$1,775 |
5.1× |
| CT thoracic spine w/contrast (72129) |
$697.20 |
$2,324 |
4.0× |
| CT thoracic spine w/o contrast (72128) |
$538.80 |
$1,796 |
5.2× |
| CT thoracic spine w/wo contrast (72130) |
$824.70 |
$2,749 |
4.7× |
| CT thorax w/o contrast (71250) |
$533.70 |
$1,779 |
5.1× |
| CT unlisted procedure (76497) |
$109.80 |
$366 |
1.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$899.10 |
$2,997 |
5.1× |
| CT upper extremity w/o contrast rt (73200) |
$533.70 |
$1,779 |
5.1× |
| CT upper extremity with contrast (73201) |
$681 |
$2,270 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,077.60 |
$3,592 |
6.1× |
| Cta Abdomen (74175) |
$894.90 |
$2,983 |
5.1× |
| CTA abdomen pelvis (74174) |
$1,156.20 |
$3,854 |
3.3× |
| CTA chest (71275) |
$864 |
$2,880 |
4.9× |
| Cta Head (70496) |
$859.50 |
$2,865 |
4.9× |
| CTA lwr ext w&w/o contrast (73706) |
$1,064.70 |
$3,549 |
6.1× |
| Cta Neck (70498) |
$853.80 |
$2,846 |
4.9× |
| Cta Pelvis (72191) |
$848.10 |
$2,827 |
4.8× |
| Cystography minimum 3 views rs&i (74430) |
$16.50 |
$55 |
0.0× |
| Diskogram cervical (72285) |
$813.60 |
$2,712 |
0.4× |
| Diskography lumbar (72295) |
$813.60 |
$2,712 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$211.20 |
$704 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$116.40 |
$388 |
1.3× |
| Echoencephalography real time imaging (76506) |
$464.40 |
$1,548 |
4.4× |
| Esophagus (74220) |
$293.70 |
$979 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$360 |
$1,200 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$346.20 |
$1,154 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$259.80 |
$866 |
1.1× |
| Foot 2 views (73620) |
$121.80 |
$406 |
1.4× |
| Forearm 2 views (73090) |
$116.40 |
$388 |
1.3× |
| Gated Heart Planar Single (78472) |
$615 |
$2,050 |
1.5× |
| Hand 2 views (73120) |
$118.50 |
$395 |
1.1× |
| Hand 3 views (73130) |
$145.50 |
$485 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,561.50 |
$5,205 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,748.70 |
$5,829 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,748.70 |
$5,829 |
2.5× |
| Heart Infarct Image (78466) |
$596.40 |
$1,988 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,244.70 |
$4,149 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$657.30 |
$2,191 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$615 |
$2,050 |
1.5× |
| Ht muscle image spect sing (78451) |
$2,049.60 |
$6,832 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$118.50 |
$395 |
1.4× |
| Hysterosalpingogram (74740) |
$42.60 |
$142 |
0.2× |
| Interstitial radiation source applic complex (77778) |
$911.70 |
$3,039 |
1.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$140.70 |
$469 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$816 |
$2,720 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$871.80 |
$2,906 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$323.10 |
$1,077 |
0.6× |
| Knee 3 views (73562) |
$165.30 |
$551 |
1.9× |
| Liver & spleen imaging static only (78215) |
$615 |
$2,050 |
1.5× |
| Liver imaging static only (78201) |
$637.20 |
$2,124 |
1.2× |
| Liver imaging w/vascular flow (78202) |
$637.20 |
$2,124 |
1.2× |
| Lung perf&ventilat diferentl (78598) |
$816 |
$2,720 |
1.5× |
| Lung perfusion differential (78597) |
$294.60 |
$982 |
0.7× |
| Lung Ventilation Imaging (78579) |
$497.40 |
$1,658 |
1.2× |
| Lymphoscintigraphy (78195) |
$657.30 |
$2,191 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$30.30 |
$101 |
0.1× |
| Meckels Diverticulum (78290) |
$657.30 |
$2,191 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,059.90 |
$3,533 |
2.8× |
| Mr safety determination physician/other qhp (76016) |
$112.80 |
$376 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$35.70 |
$119 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$117.60 |
$392 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$193.80 |
$646 |
0.8× |
| MRA head w & w/o contrast (70546) |
$1,623.60 |
$5,412 |
4.7× |
| MRA head w/o contrast (70544) |
$1,017.60 |
$3,392 |
4.3× |
| MRA head with contrast (70545) |
$1,048.80 |
$3,496 |
3.0× |
| MRA neck w contrast (70548) |
$1,324.20 |
$4,414 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,919.10 |
$6,397 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,251.90 |
$4,173 |
5.2× |
| MRI abdomen w contrast (74182) |
$1,157.10 |
$3,857 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,471.80 |
$4,906 |
4.2× |
| MRI abdomen w/o contrast (74181) |
$971.10 |
$3,237 |
4.1× |
| MRI any jnt lwr ext with con lt (73722) |
$1,121.10 |
$3,737 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,110.60 |
$3,702 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,064.10 |
$3,547 |
4.5× |
| MRI breast w/o contrast unilat (77046) |
$919.20 |
$3,064 |
3.9× |
| MRI c-spine with contrast (72142) |
$874.20 |
$2,914 |
2.5× |
| MRI cardiac w/o contrast (75557) |
$751.50 |
$2,505 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$614.40 |
$2,048 |
2.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,845.90 |
$6,153 |
5.3× |
| MRI chest w/o contrast (71550) |
$1,351.80 |
$4,506 |
5.7× |
| MRI chest with contrast (71551) |
$1,473.90 |
$4,913 |
1.9× |
| MRI fetal sngl/1st gestation (74712) |
$414.90 |
$1,383 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,157.10 |
$3,857 |
3.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,029.60 |
$3,432 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$942.30 |
$3,141 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,089.90 |
$3,633 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,439.10 |
$4,797 |
4.1× |
| MRI orbit/face/neck w/contrast (70542) |
$488.40 |
$1,628 |
1.4× |
| MRI pelvis w contrast (72196) |
$1,157.10 |
$3,857 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,467 |
$4,890 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,132.20 |
$3,774 |
4.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,350.60 |
$4,502 |
3.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,358.70 |
$4,529 |
3.9× |
| MRI spectroscopy (76390) |
$1,407.30 |
$4,691 |
16.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$989.40 |
$3,298 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$859.20 |
$2,864 |
2.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$982.20 |
$3,274 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$865.80 |
$2,886 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$990.30 |
$3,301 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$614.40 |
$2,048 |
2.6× |
| MRI tmj (70336) |
$922.20 |
$3,074 |
3.9× |
| MRI upper ext joint w/o contrast (73221) |
$612.30 |
$2,041 |
2.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,464.90 |
$4,883 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,110.60 |
$3,702 |
4.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,070.40 |
$3,568 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,049.60 |
$6,832 |
1.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,213.20 |
$4,044 |
0.8× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,213.20 |
$4,044 |
0.8× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,892.40 |
$6,308 |
0.9× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,313.30 |
$7,711 |
1.1× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$2,313.30 |
$7,711 |
1.5× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,313.10 |
$4,377 |
1.5× |
| Neck soft tissue (70360) |
$131.10 |
$437 |
1.5× |
| Nm cisternogram (78630) |
$712.50 |
$2,375 |
1.3× |
| Nm csf leak detection (78650) |
$260.70 |
$869 |
0.2× |
| Nm gastric emptying study (78264) |
$657.30 |
$2,191 |
1.6× |
| Nm gastroesophageal reflux study (78262) |
$657.30 |
$2,191 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$615 |
$2,050 |
1.5× |
| Nm whole blood volume (78122) |
$816 |
$2,720 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,708.10 |
$19,027 |
4.1× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$2,592.60 |
$8,642 |
1.8× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$615 |
$2,050 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$493.20 |
$1,644 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$420.30 |
$1,401 |
4.0× |
| Orthopantogram (70355) |
$60.60 |
$202 |
0.7× |
| Osseous survey infant (77076) |
$405.90 |
$1,353 |
3.9× |
| Osseous survey limited (77074) |
$278.40 |
$928 |
2.7× |
| Parathyrd planar w/spect&CT (78072) |
$871.80 |
$2,906 |
1.6× |
| Parathyrd planar w/wo subtrj (78071) |
$657.30 |
$2,191 |
1.6× |
| Parathyroid imaging (78070) |
$657.30 |
$2,191 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$124.20 |
$414 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$2,635.50 |
$8,785 |
1.8× |
| PET imaging CT for attenuation limited area (78814) |
$3,541.50 |
$11,805 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,964.60 |
$9,882 |
2.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,264.50 |
$4,215 |
3.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$615 |
$2,050 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$816 |
$2,720 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$21.60 |
$72 |
0.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$145.50 |
$485 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$147.60 |
$492 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$172.20 |
$574 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$99.30 |
$331 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$145.50 |
$485 |
1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$15,762.60 |
$52,542 |
2.1× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$484.80 |
$1,616 |
0.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$302.10 |
$1,007 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$170.10 |
$567 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$135.90 |
$453 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$149.70 |
$499 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$114 |
$380 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$467.10 |
$1,557 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$308.10 |
$1,027 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$392.40 |
$1,308 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$338.40 |
$1,128 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$125.70 |
$419 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$180 |
$600 |
2.1× |
| Radiological examination surgical specimen (76098) |
$55.80 |
$186 |
0.1× |
| Ribs bilateral 3 views (71110) |
$158.10 |
$527 |
1.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$470.10 |
$1,567 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,070.40 |
$3,568 |
2.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,070.40 |
$3,568 |
2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,070.40 |
$3,568 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,213.50 |
$4,045 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,070.40 |
$3,568 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$164.40 |
$548 |
0.7× |
| Rp Therapy Intravenous Administration (79101) |
$518.10 |
$1,727 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$131.10 |
$437 |
1.3× |
| Salivary gland imaging (78230) |
$420.30 |
$1,401 |
1.1× |
| Scanogram (77073) |
$145.50 |
$485 |
1.4× |
| Scapula complete (73010) |
$138.60 |
$462 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$76.20 |
$254 |
3.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$289.80 |
$966 |
2.8× |
| Sialogram (70390) |
$57 |
$190 |
0.2× |
| Small bowel series (74250) |
$345 |
$1,150 |
2.0× |
| Spec medical radj physics consltj (77370) |
$248.40 |
$828 |
1.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$161.40 |
$538 |
0.4× |
| Special dosimetry (77331) |
$147 |
$490 |
1.1× |
| Special treatment procedure (77470) |
$178.20 |
$594 |
0.3× |
| Spine thoracic 3 views (72072) |
$158.10 |
$527 |
1.5× |
| Stereotactic body radiation delivery (77373) |
$3,490.50 |
$11,635 |
2.0× |
| Superior sagittal sinus venogram (75870) |
$681.60 |
$2,272 |
0.2× |
| Tbs Technical Calculation Only (77091) |
$52.80 |
$176 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$502.50 |
$1,675 |
1.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,608.60 |
$5,362 |
4.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$878.70 |
$2,929 |
6.5× |
| Therapeutic Enema (74283) |
$494.40 |
$1,648 |
2.8× |
| Thoracolumbar 2 views (72080) |
$145.50 |
$485 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$657.30 |
$2,191 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$657.30 |
$2,191 |
1.6× |
| Thyroid uptake measurement (78012) |
$657.30 |
$2,191 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$657.30 |
$2,191 |
1.6× |
| Tmj unilateral (70328) |
$145.50 |
$485 |
1.7× |
| Treatment device intermediate (77333) |
$34.80 |
$116 |
0.3× |
| Treatment devices simple (77332) |
$202.80 |
$676 |
1.5× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,070.40 |
$3,568 |
2.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$313.80 |
$1,046 |
0.8× |
| Tx devices design & construction complex (77334) |
$329.40 |
$1,098 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$333.30 |
$1,111 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$217.80 |
$726 |
2.1× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$543.90 |
$1,813 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$43.50 |
$145 |
0.5× |
| Unlisted Ultrasound Procedure (76999) |
$183.60 |
$612 |
2.1× |
| Upper Extremity Infant (73092) |
$129 |
$430 |
1.2× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$180.60 |
$602 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$39.30 |
$131 |
0.2× |
| Urethrocystography voiding (74455) |
$49.50 |
$165 |
0.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$576.30 |
$1,921 |
3.3× |
| Us abdl aorta screen aaa (76706) |
$346.20 |
$1,154 |
3.3× |
| Us breast unilateral complete (76641) |
$316.95 |
$1,056.50 |
3.0× |
| Us breast unilateral limited (76642) |
$210.30 |
$701 |
2.4× |
| Us chest (76604) |
$325.50 |
$1,085 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$454.80 |
$1,516 |
4.4× |
| Us elastography parenchyma (76981) |
$67.50 |
$225 |
0.6× |
| Us guided compression repair (76936) |
$926.70 |
$3,089 |
4.3× |
| Us infant hips limited static (76886) |
$402.90 |
$1,343 |
4.6× |
| Us ob detailed single fetus (76811) |
$447 |
$1,490 |
1.9× |
| Us ob transvaginal (76817) |
$315.90 |
$1,053 |
3.0× |
| Us pelvic non ob complete (76856) |
$405.30 |
$1,351 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$121.80 |
$406 |
1.2× |
| Us pregnancy ltd (76815) |
$276 |
$920 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$392.10 |
$1,307 |
3.8× |
| Us retroperitoneal complete (76770) |
$409.50 |
$1,365 |
3.9× |
| Us retroperitoneal limited (76775) |
$153.90 |
$513 |
1.5× |
| Us scrotum and contents (76870) |
$188.70 |
$629 |
1.8× |
| Us soft tissue head/neck (76536) |
$474 |
$1,580 |
4.5× |
| Us spinal canal and contents (76800) |
$434.10 |
$1,447 |
4.2× |
| Us transrectal (76872) |
$321.90 |
$1,073 |
3.1× |
| Us transrectal prostate volume (76873) |
$341.70 |
$1,139 |
3.3× |
| Us xtr non-vasc lmtd (76882) |
$60.90 |
$203 |
0.6× |
| Venogram extremity bilateral (75822) |
$578.10 |
$1,927 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$543.90 |
$1,813 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$558.90 |
$1,863 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$547.20 |
$1,824 |
0.3× |
| Venography Renal Bilateral (75833) |
$2,316 |
$7,720 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$566.40 |
$1,888 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$945 |
$3,150 |
0.3× |
| Wrist 2 views (73100) |
$138.60 |
$462 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$189.60 |
$632 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$167.40 |
$558 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$150.60 |
$502 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$698.10 |
$2,327 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$129 |
$430 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$150.60 |
$502 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$145.50 |
$485 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$116.40 |
$388 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$119.40 |
$398 |
1.4× |
| X-ray exam hip uni 4/> views (73503) |
$149.40 |
$498 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$175.50 |
$585 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$179.70 |
$599 |
1.7× |
| X-ray exam of femur 1 (73551) |
$121.80 |
$406 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$516.90 |
$1,723 |
2.9× |
| X-ray eye for foreign body (70030) |
$104.40 |
$348 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$189.60 |
$632 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$120 |
$400 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$138.60 |
$462 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$126.30 |
$421 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$160.20 |
$534 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$189.60 |
$632 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$158.10 |
$527 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$129 |
$430 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$158.10 |
$527 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$308.10 |
$1,027 |
2.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$191.70 |
$639 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$160.20 |
$534 |
1.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$114 |
$380 |
1.3× |
| X-ray of voice box or throat (70370) |
$437.40 |
$1,458 |
5.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$189.60 |
$632 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$182.40 |
$608 |
1.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$699.60 |
$2,332 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$129 |
$430 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$153.30 |
$511 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$209.40 |
$698 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$158.10 |
$527 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$129 |
$430 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$129 |
$430 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$165.30 |
$551 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$140.70 |
$469 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$187.20 |
$624 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$155.70 |
$519 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$95.10 |
$317 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$165.30 |
$551 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$129 |
$430 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$133.80 |
$446 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$189.60 |
$632 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$143.40 |
$478 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$177.60 |
$592 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$252.60 |
$842 |
2.4× |
| Xr chest 4+ views (71048) |
$137.70 |
$459 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$162.60 |
$542 |
1.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$112.80 |
$376 |
1.1× |
| Xr shoulder 1 view (73020) |
$102.30 |
$341 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$193.80 |
$646 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$118.50 |
$395 |
1.4× |
| Xr tmj bilateral (70330) |
$230.70 |
$769 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$133.80 |
$446 |
1.5× |