| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,288 |
$1,840 |
1.0× |
| Abdomen 2 views (74019) |
$216.30 |
$309 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$614.60 |
$878 |
1.7× |
| Acute venous thrombus image (78456) |
$604.80 |
$864 |
0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$612.50 |
$875 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$591.50 |
$845 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$532 |
$760 |
0.2× |
| Angiography internal mammary rs&i (75756) |
$542.50 |
$775 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$532 |
$760 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$563.50 |
$805 |
0.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$511 |
$730 |
0.2× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$633.50 |
$905 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$528.50 |
$755 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$171.50 |
$245 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$514.50 |
$735 |
0.2× |
| Ankle 2 views (73600) |
$105 |
$150 |
1.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$38.50 |
$55 |
0.1× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$511 |
$730 |
0.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$588 |
$840 |
0.2× |
| Aortography abdominal serialography rs&i (75625) |
$504 |
$720 |
0.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$588 |
$840 |
0.2× |
| Artery X-Rays Adrenal Gland (75731) |
$542.50 |
$775 |
0.2× |
| Arthrogram elbow (73085) |
$178.50 |
$255 |
0.6× |
| Arthrogram hip (73525) |
$178.50 |
$255 |
0.6× |
| Arthrogram shoulder (73040) |
$393.40 |
$562 |
1.2× |
| Arthrogram wrist (73115) |
$189 |
$270 |
0.6× |
| Arthrography knee lt (73580) |
$220.50 |
$315 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$136.50 |
$195 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$386.40 |
$552 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$406 |
$580 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$618.80 |
$884 |
1.7× |
| Bone age studies (77072) |
$91 |
$130 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$739.90 |
$1,057 |
2.0× |
| Bone Marrow Imaging Limited Area (78102) |
$294 |
$420 |
0.8× |
| Bone survey complete (77075) |
$281.40 |
$402 |
3.0× |
| Brain image w/flow 4 + views (78606) |
$539 |
$770 |
1.1× |
| Brain imaging < 4 static views (78600) |
$311.50 |
$445 |
0.9× |
| Brain imaging < 4 static views w vascular flow (78601) |
$371 |
$530 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$350 |
$500 |
0.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$154 |
$220 |
0.1× |
| Brain Imaging Vascular Flow Only (78610) |
$311.50 |
$445 |
0.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$521.50 |
$745 |
1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,242.50 |
$1,775 |
3.9× |
| Cardiac shunt detection (78428) |
$357 |
$510 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$395.50 |
$565 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$115.50 |
$165 |
1.5× |
| Chest 1 view (71045) |
$89.60 |
$128 |
1.1× |
| Chest 3 views (71047) |
$125.30 |
$179 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$371.70 |
$531 |
2.3× |
| Cineradiography/videoradiography (76120) |
$143.50 |
$205 |
1.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$269.50 |
$385 |
0.4× |
| Clavicle complete (73000) |
$133 |
$190 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$115.50 |
$165 |
0.9× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$143.50 |
$205 |
0.9× |
| Corpora cavernosography (74445) |
$119 |
$170 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,369.90 |
$1,957 |
4.3× |
| CT abdomen w contrast (74160) |
$968.80 |
$1,384 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,210.30 |
$1,729 |
7.6× |
| CT abdomen w/o contrast (74150) |
$968.80 |
$1,384 |
10.2× |
| CT angiography upper extremity lt (73206) |
$1,624 |
$2,320 |
10.2× |
| CT c-spine w/o contrast (72125) |
$968.80 |
$1,384 |
10.2× |
| CT cervical spine w&w/o contrast (72127) |
$880.60 |
$1,258 |
5.5× |
| CT cervical spine with contrast (72126) |
$792.40 |
$1,132 |
2.5× |
| CT chest w/wo contrast (71270) |
$1,197 |
$1,710 |
7.5× |
| CT chest with contrast (71260) |
$968.80 |
$1,384 |
6.1× |
| CT head/brain with contrast (70460) |
$880.60 |
$1,258 |
5.5× |
| CT head/brain without and with contrast (70470) |
$968.80 |
$1,384 |
6.1× |
| CT iac w contrast (70481) |
$792.40 |
$1,132 |
5.0× |
| CT limited/localized follow up study (76380) |
$308 |
$440 |
3.9× |
| CT lower ext w/o (73700) |
$880.60 |
$1,258 |
9.3× |
| CT lower extremity w wo contrast (73702) |
$880.60 |
$1,258 |
5.5× |
| CT lower extremity with contrast (73701) |
$880.60 |
$1,258 |
5.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,365 |
$1,950 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$968.80 |
$1,384 |
10.2× |
| CT lumbar spine with contrast (72132) |
$1,189.30 |
$1,699 |
3.8× |
| CT maxillofacial w contrast (70487) |
$1,139.60 |
$1,628 |
7.2× |
| CT maxillofacial w/o contrast (70486) |
$879.20 |
$1,256 |
9.3× |
| CT maxillofacial w/wo contrast (70488) |
$968.80 |
$1,384 |
6.1× |
| CT neck soft tissue w contrast (70491) |
$968.80 |
$1,384 |
6.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$880.60 |
$1,258 |
5.5× |
| CT orbits w/o contrast (70480) |
$968.80 |
$1,384 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,088.50 |
$1,555 |
6.9× |
| CT pelvis w/o contrast (72192) |
$968.80 |
$1,384 |
10.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$157.50 |
$225 |
2.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$792.40 |
$1,132 |
5.0× |
| CT soft tissue neck w/o contrast (70490) |
$968.80 |
$1,384 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$792.40 |
$1,132 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$968.80 |
$1,384 |
10.2× |
| CT thoracic spine w/wo contrast (72130) |
$880.60 |
$1,258 |
5.5× |
| CT thorax w/o contrast (71250) |
$968.80 |
$1,384 |
10.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,458.40 |
$3,512 |
15.5× |
| CT upper extremity w/o contrast rt (73200) |
$968.80 |
$1,384 |
10.2× |
| CT upper extremity with contrast (73201) |
$880.60 |
$1,258 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,995.70 |
$2,851 |
12.6× |
| Cta Abdomen (74175) |
$1,868.30 |
$2,669 |
11.8× |
| CTA chest (71275) |
$1,843.10 |
$2,633 |
11.6× |
| Cta Head (70496) |
$1,687.70 |
$2,411 |
10.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,669.50 |
$2,385 |
10.5× |
| Cta Neck (70498) |
$1,651.30 |
$2,359 |
10.4× |
| Cta Pelvis (72191) |
$1,775.20 |
$2,536 |
11.2× |
| Cystography minimum 3 views rs&i (74430) |
$246.40 |
$352 |
0.8× |
| Dacryocystography (70170) |
$31.50 |
$45 |
0.1× |
| Diskogram cervical (72285) |
$336 |
$480 |
0.2× |
| Diskography lumbar (72295) |
$297.50 |
$425 |
0.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$56 |
$80 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$136.50 |
$195 |
1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$182 |
$260 |
1.9× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$157.50 |
$225 |
1.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$180.60 |
$258 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$280.70 |
$401 |
3.6× |
| Echo exam of eye (76529) |
$129.50 |
$185 |
1.6× |
| Echo exam of fetal heart (76825) |
$388.50 |
$555 |
0.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$213.50 |
$305 |
1.0× |
| Echoencephalography real time imaging (76506) |
$178.50 |
$255 |
1.9× |
| Esophageal motility (78258) |
$395.50 |
$565 |
1.1× |
| Esophagus (74220) |
$212.80 |
$304 |
1.3× |
| Fetal biophysical profile non-stress testing (76818) |
$227.50 |
$325 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$178.50 |
$255 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$191.10 |
$273 |
0.9× |
| Foot 2 views (73620) |
$100.10 |
$143 |
1.3× |
| Forearm 2 views (73090) |
$90.30 |
$129 |
1.1× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$80.50 |
$115 |
0.4× |
| Functional MRI brain by phys/psych (70555) |
$262.50 |
$375 |
1.2× |
| Functional MRI brain by tech (70554) |
$1,134 |
$1,620 |
5.2× |
| Gastric mucosa imaging (78261) |
$434 |
$620 |
1.2× |
| Gastrointestinal Protein Loss (78282) |
$38.50 |
$55 |
0.1× |
| Gated Heart Planar Single (78472) |
$546.70 |
$781 |
1.5× |
| Hand 2 views (73120) |
$119.70 |
$171 |
1.3× |
| Hand 3 views (73130) |
$105 |
$150 |
1.3× |
| Heart Infarct Image (78466) |
$329 |
$470 |
0.9× |
| Heart infarct image w ef (78468) |
$413 |
$590 |
0.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$493.50 |
$705 |
0.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$402.50 |
$575 |
0.8× |
| Humerus Min 2 Views Left (73060) |
$102.20 |
$146 |
1.3× |
| Hyperthermia ntrstl prb 5/< (77610) |
$1,120 |
$1,600 |
2.2× |
| Hysterosalpingogram (74740) |
$143.50 |
$205 |
0.7× |
| Interstitial radiation source applic complex (77778) |
$1,578.50 |
$2,255 |
2.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$854 |
$1,220 |
1.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$570.50 |
$815 |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$378 |
$540 |
0.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$80.50 |
$115 |
0.9× |
| Kidney funcj study non-img radioisotopic study (78725) |
$182 |
$260 |
0.5× |
| Kidney imaging morphology (78700) |
$311.50 |
$445 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$725.90 |
$1,037 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$725.90 |
$1,037 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$814.10 |
$1,163 |
1.7× |
| Knee 3 views (73562) |
$106.40 |
$152 |
1.4× |
| Liver & spleen imaging static only (78215) |
$481.60 |
$688 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$255.50 |
$365 |
0.7× |
| Liver imaging static only (78201) |
$311.50 |
$445 |
0.6× |
| Liver imaging w/vascular flow (78202) |
$357 |
$510 |
0.7× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$122.50 |
$175 |
0.0× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$84 |
$120 |
0.1× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$122.50 |
$175 |
0.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$84 |
$120 |
0.0× |
| Lymphoscintigraphy (78195) |
$598.50 |
$855 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$192.50 |
$275 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$143.50 |
$205 |
0.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$77 |
$110 |
1.0× |
| Meckels Diverticulum (78290) |
$422.80 |
$604 |
1.2× |
| MRA head w & w/o contrast (70546) |
$1,151.50 |
$1,645 |
3.6× |
| MRA head w/o contrast (70544) |
$1,495.90 |
$2,137 |
6.9× |
| MRA head with contrast (70545) |
$892.50 |
$1,275 |
2.8× |
| MRA neck w contrast (70548) |
$892.50 |
$1,275 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,495.90 |
$2,137 |
4.7× |
| MRA neck w/o contrast (70547) |
$749 |
$1,070 |
3.5× |
| MRI abdomen w contrast (74182) |
$1,495.90 |
$2,137 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,495.90 |
$2,137 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,495.90 |
$2,137 |
6.9× |
| MRI any jnt lwr ext with con lt (73722) |
$167.30 |
$239 |
0.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$934.50 |
$1,335 |
1.3× |
| MRI bone marrow blood supply (77084) |
$791 |
$1,130 |
3.7× |
| MRI c-spine with contrast (72142) |
$1,495.90 |
$2,137 |
4.7× |
| MRI cardiac w/o cont stress (75559) |
$938 |
$1,340 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$875 |
$1,250 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,495.90 |
$2,137 |
6.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,197 |
$1,710 |
3.8× |
| MRI chest w/o contrast (71550) |
$1,495.90 |
$2,137 |
6.9× |
| MRI chest with contrast (71551) |
$945 |
$1,350 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$934.50 |
$1,335 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$934.50 |
$1,335 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,495.90 |
$2,137 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,495.90 |
$2,137 |
6.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,894.90 |
$2,707 |
6.0× |
| MRI orbit/face/neck w/contrast (70542) |
$934.50 |
$1,335 |
3.0× |
| MRI pelvis w contrast (72196) |
$1,495.90 |
$2,137 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,894.90 |
$2,707 |
6.0× |
| MRI pelvis w/o contrast (72195) |
$1,495.90 |
$2,137 |
6.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,894.90 |
$2,707 |
6.0× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,295 |
$1,850 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$2,660 |
$3,800 |
8.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,894.90 |
$2,707 |
6.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,495.90 |
$2,137 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,894.90 |
$2,707 |
6.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,495.90 |
$2,137 |
4.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,894.90 |
$2,707 |
6.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,495.90 |
$2,137 |
6.9× |
| MRI tmj (70336) |
$777 |
$1,110 |
3.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,495.90 |
$2,137 |
6.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,495.90 |
$2,137 |
4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,495.90 |
$2,137 |
6.9× |
| Myelogram Cervical (72240) |
$294 |
$420 |
0.4× |
| Myelogram Lumbar (72265) |
$273 |
$390 |
0.4× |
| Myelogram thoracic (72255) |
$269.50 |
$385 |
0.4× |
| Myelography 2 or more regions (72270) |
$427 |
$610 |
0.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$157.50 |
$225 |
0.1× |
| Myocardial infarct spect (78469) |
$472.50 |
$675 |
1.0× |
| Neck soft tissue (70360) |
$96.60 |
$138 |
1.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$658 |
$940 |
1.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$84 |
$120 |
0.2× |
| Nm adrenal scan (78075) |
$800.10 |
$1,143 |
0.7× |
| Nm bone marrow multiple (78103) |
$392 |
$560 |
1.1× |
| Nm bone marrow wb (78104) |
$448 |
$640 |
1.2× |
| Nm cisternogram (78630) |
$574 |
$820 |
1.2× |
| Nm csf leak detection (78650) |
$560 |
$800 |
0.5× |
| Nm gastric emptying study (78264) |
$515.20 |
$736 |
1.4× |
| Nm gastroesophageal reflux study (78262) |
$578.20 |
$826 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$434 |
$620 |
1.2× |
| Nm red cell sequestration (78140) |
$273 |
$390 |
0.8× |
| Nm whole blood volume (78122) |
$469.70 |
$671 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,948 |
$5,640 |
3.2× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$203 |
$290 |
0.2× |
| Nuclear medicine of heart pumping function (78473) |
$654.50 |
$935 |
1.8× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$598.50 |
$855 |
1.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$199.50 |
$285 |
0.2× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$161 |
$230 |
0.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$257.60 |
$368 |
0.7× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$371 |
$530 |
1.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$308.70 |
$441 |
0.9× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$343 |
$490 |
0.7× |
| Nuclear Rx Oral Admin (79005) |
$182 |
$260 |
0.9× |
| Nuclr Rx Interstit Colloid (79300) |
$168 |
$240 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$199.50 |
$285 |
2.1× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$161 |
$230 |
1.3× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$126 |
$180 |
1.3× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$98 |
$140 |
1.0× |
| Orthopantogram (70355) |
$45.50 |
$65 |
0.6× |
| Osseous survey infant (77076) |
$175 |
$250 |
1.8× |
| Osseous survey limited (77074) |
$129.50 |
$185 |
1.4× |
| Parathyroid imaging (78070) |
$738.50 |
$1,055 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$100.10 |
$143 |
1.1× |
| Perineogram (74775) |
$63 |
$90 |
0.3× |
| Peritoneogram rs&i (74190) |
$52.50 |
$75 |
0.1× |
| PET image w/CT, skull-thigh (78815) |
$252 |
$360 |
0.2× |
| PET imaging CT for attenuation limited area (78814) |
$224 |
$320 |
0.2× |
| PET imaging for CT attenuation whole body (78816) |
$255.50 |
$365 |
0.2× |
| PET imaging limited area chest head/neck (78811) |
$161 |
$230 |
0.1× |
| PET whole body (78813) |
$206.50 |
$295 |
0.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$178.50 |
$255 |
0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$143.50 |
$205 |
0.1× |
| Platelet survival study (78191) |
$364 |
$520 |
1.0× |
| Pr csf ventriculography (78635) |
$521.50 |
$745 |
1.1× |
| Pr gi endoscopic ultrasound (76975) |
$84 |
$120 |
0.4× |
| Pr heart first pass single,planar (78481) |
$423.50 |
$605 |
0.9× |
| Pr MRI brain w/ dye (70558) |
$322 |
$460 |
2.0× |
| Pr MRI brain w/o & w/ dye (70559) |
$329 |
$470 |
2.1× |
| Pr MRI brain w/o dye (70557) |
$294 |
$420 |
0.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,660 |
$3,800 |
8.4× |
| Pr non-imaging heart function (78414) |
$45.50 |
$65 |
0.1× |
| Pr red cell survival study (78130) |
$280 |
$400 |
0.8× |
| Pr sono bone density measure,peripheral (76977) |
$28 |
$40 |
0.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$525 |
$750 |
0.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$528.50 |
$755 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$425.60 |
$608 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$302.40 |
$432 |
0.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$136.50 |
$195 |
1.4× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$1,456 |
$2,080 |
0.2× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$371 |
$530 |
0.7× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$245 |
$350 |
2.7× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$385 |
$550 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$137.90 |
$197 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$172.20 |
$246 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$355.60 |
$508 |
3.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$115.50 |
$165 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$248.50 |
$355 |
1.6× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$63 |
$90 |
0.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$279.30 |
$399 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$262.50 |
$375 |
1.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$70 |
$100 |
0.9× |
| Radiological examination surgical specimen (76098) |
$271.60 |
$388 |
0.5× |
| Radiopharm Dacryocystography (78660) |
$294 |
$420 |
0.8× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$203 |
$290 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$336 |
$480 |
1.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$161 |
$230 |
0.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$192.50 |
$275 |
0.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$490 |
$700 |
0.2× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$493.50 |
$705 |
0.2× |
| Ribs bilateral 3 views (71110) |
$154 |
$220 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$444.50 |
$635 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$593.60 |
$848 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$640.50 |
$915 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$231 |
$330 |
1.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$245 |
$350 |
1.2× |
| Rp Therapy Intravenous Administration (79101) |
$332.50 |
$475 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$56 |
$80 |
0.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$224 |
$320 |
1.0× |
| Salivary gland function study (78232) |
$248.50 |
$355 |
0.7× |
| Salivary gland imaging (78230) |
$710.50 |
$1,015 |
2.0× |
| Scanogram (77073) |
$73.50 |
$105 |
0.8× |
| Scapula complete (73010) |
$105 |
$150 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$102.20 |
$146 |
4.4× |
| Sella turcica (70240) |
$85.40 |
$122 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$161 |
$230 |
1.7× |
| Sialogram (70390) |
$182 |
$260 |
0.8× |
| Simulation intermediate (77285) |
$581 |
$830 |
1.7× |
| Small bowel series (74250) |
$210.70 |
$301 |
1.3× |
| Spec medical radj physics consltj (77370) |
$213.50 |
$305 |
1.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$234.50 |
$335 |
0.7× |
| Special dosimetry (77331) |
$87.50 |
$125 |
0.7× |
| Special treatment procedure (77470) |
$490 |
$700 |
1.0× |
| Speech evaluation complex (70371) |
$185.50 |
$265 |
0.9× |
| Spine thoracic 3 views (72072) |
$73.50 |
$105 |
0.8× |
| Spleen imaging only (78185) |
$336 |
$480 |
0.9× |
| Splenoportograpy rs&i (75810) |
$119 |
$170 |
0.0× |
| Stereotactic body radiation delivery (77373) |
$2,691.50 |
$3,845 |
1.7× |
| Superior sagittal sinus venogram (75870) |
$500.50 |
$715 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$115.50 |
$165 |
1.3× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$157.50 |
$225 |
0.7× |
| Testicular Imaging With Vascular Flow (78761) |
$482.30 |
$689 |
1.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$899.50 |
$1,285 |
2.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$339.50 |
$485 |
2.8× |
| Therapeutic Enema (74283) |
$206.50 |
$295 |
1.3× |
| Thoracolumbar 2 views (72080) |
$108.50 |
$155 |
1.4× |
| Thyroid carcinoma metastases img addl study (78016) |
$560 |
$800 |
1.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$563.50 |
$805 |
1.1× |
| Tmj unilateral (70328) |
$52.50 |
$75 |
0.7× |
| Tomogram (76100) |
$196 |
$280 |
2.1× |
| Treatment device intermediate (77333) |
$87.50 |
$125 |
0.7× |
| Treatment devices simple (77332) |
$147 |
$210 |
1.2× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,008 |
$1,440 |
2.1× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$332.50 |
$475 |
0.9× |
| Tx devices design & construction complex (77334) |
$301 |
$430 |
0.9× |
| Ultrasound scan of cornea to determine thickness (76514) |
$21 |
$30 |
0.8× |
| Ultrasound scan to determine eye length and lens power (76519) |
$328.30 |
$469 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$244.30 |
$349 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$105 |
$150 |
1.1× |
| Upper Extremity Infant (73092) |
$56 |
$80 |
0.6× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$496.30 |
$709 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$35 |
$50 |
0.2× |
| Urethrocystography voiding (74455) |
$246.40 |
$352 |
1.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$305.90 |
$437 |
1.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$269.50 |
$385 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$344.40 |
$492 |
3.6× |
| Us breast unilateral complete (76641) |
$122.50 |
$175 |
1.3× |
| Us breast unilateral limited (76642) |
$122.50 |
$175 |
1.6× |
| Us chest (76604) |
$268.10 |
$383 |
2.8× |
| Us fetal nuchal translucency 1st gestation (76813) |
$241.50 |
$345 |
2.6× |
| Us guided compression repair (76936) |
$374.50 |
$535 |
1.9× |
| Us infant hips dynamic (76885) |
$189 |
$270 |
2.4× |
| Us infant hips limited static (76886) |
$175 |
$250 |
2.2× |
| Us kidney transplant (76776) |
$171.50 |
$245 |
1.8× |
| Us ob detailed single fetus (76811) |
$392 |
$560 |
1.8× |
| Us ob transvaginal (76817) |
$189 |
$270 |
2.0× |
| Us pelvic non ob complete (76856) |
$254.80 |
$364 |
2.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$154 |
$220 |
1.6× |
| Us pregnancy ltd (76815) |
$246.40 |
$352 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$245 |
$350 |
2.6× |
| Us retroperitoneal complete (76770) |
$244.30 |
$349 |
2.6× |
| Us retroperitoneal limited (76775) |
$244.30 |
$349 |
2.6× |
| Us scrotum and contents (76870) |
$244.30 |
$349 |
2.6× |
| Us soft tissue head/neck (76536) |
$213.50 |
$305 |
2.3× |
| Us spinal canal and contents (76800) |
$365.40 |
$522 |
3.9× |
| Us transrectal (76872) |
$252.70 |
$361 |
2.7× |
| Us transrectal prostate volume (76873) |
$336 |
$480 |
3.5× |
| Us xtr non-vasc lmtd (76882) |
$244.30 |
$349 |
2.6× |
| Us, eye b-scan (76512) |
$98 |
$140 |
1.0× |
| Use of body cavity probe generated heat to increase temperature of cancer cell (77620) |
$714 |
$1,020 |
1.4× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$679 |
$970 |
1.9× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$1,204 |
$1,720 |
1.9× |
| Use of interstitial probe generated heat to increase temperature of cancer cell, more than 5 probes (77615) |
$1,582 |
$2,260 |
3.2× |
| Vascular flow imaging (78445) |
$297.50 |
$425 |
0.8× |
| Vasogram (74440) |
$154 |
$220 |
0.7× |
| Venogram extremity bilateral (75822) |
$273 |
$390 |
0.2× |
| Venogram orbital (75880) |
$224 |
$320 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$486.50 |
$695 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$486.50 |
$695 |
0.3× |
| Venography epidural rs&i (75872) |
$542.50 |
$775 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$998.90 |
$1,427 |
0.7× |
| Venography Renal Bilateral (75833) |
$549.50 |
$785 |
0.2× |
| Venography renal unilateral selective rs&i (75831) |
$493.50 |
$705 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$500.50 |
$715 |
0.2× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$430.50 |
$615 |
0.1× |
| Wrist 2 views (73100) |
$82.60 |
$118 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$317.10 |
$453 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$399 |
$570 |
5.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$214.20 |
$306 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$329.70 |
$471 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$93.80 |
$134 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$119 |
$170 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116.20 |
$166 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$329 |
$470 |
2.1× |
| X-ray eye for foreign body (70030) |
$56 |
$80 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$143.50 |
$205 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$105 |
$150 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$116.20 |
$166 |
1.5× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$220.50 |
$315 |
0.1× |
| X-ray head for orthodontia (70350) |
$38.50 |
$55 |
0.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$89.60 |
$128 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$93.80 |
$134 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$18.20 |
$26 |
0.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$56 |
$80 |
0.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$56 |
$80 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$126.70 |
$181 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$245.70 |
$351 |
2.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$169.40 |
$242 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$95.90 |
$137 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$65.10 |
$93 |
0.8× |
| X-ray of voice box or throat (70370) |
$136.50 |
$195 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$163.10 |
$233 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$119.70 |
$171 |
1.3× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$56 |
$80 |
0.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$236.60 |
$338 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$147 |
$210 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$147 |
$210 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$154 |
$220 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$168 |
$240 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$141.40 |
$202 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$109.90 |
$157 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$154 |
$220 |
2.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$102.20 |
$146 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$158.20 |
$226 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$130.90 |
$187 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$79.80 |
$114 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$175 |
$250 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$117.60 |
$168 |
1.5× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$28 |
$40 |
0.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$125.30 |
$179 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$122.50 |
$175 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$87.50 |
$125 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$109.90 |
$157 |
1.4× |
| Xr arthrogram ankle (73615) |
$182 |
$260 |
0.6× |
| Xr c-spine 6 or more views (72052) |
$219.80 |
$314 |
2.3× |
| Xr chest 4+ views (71048) |
$160.30 |
$229 |
1.7× |
| Xr Cholecystography Oral Contrast (74290) |
$119 |
$170 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$79.80 |
$114 |
1.0× |
| Xr internal auditory meati complete (70134) |
$87.50 |
$125 |
0.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$98 |
$140 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$322 |
$460 |
1.0× |
| Xr optic foramina (70190) |
$66.50 |
$95 |
0.8× |
| Xr shoulder 1 view (73020) |
$85.40 |
$122 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$190.40 |
$272 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$115.50 |
$165 |
1.5× |
| Xr tmj bilateral (70330) |
$149.80 |
$214 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$107.10 |
$153 |
1.4× |