| 3-D radiotherapy plan dose-volume histograms (77295) |
$9,520.90 |
$18,032 |
7.5× |
| Abdomen 2 views (74019) |
$288.82 |
$547 |
3.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,947.26 |
$3,688 |
5.3× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,790.45 |
$3,391 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,339.60 |
$6,325 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$2,707.58 |
$5,128 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$1,508.50 |
$2,857 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,326.37 |
$4,406 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,392.34 |
$2,637 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,227.60 |
$2,325 |
0.4× |
| Angiography Spinal Selective Rs&I (75705) |
$2,947.82 |
$5,583 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,829.55 |
$5,359 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,160.02 |
$2,197 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,289.90 |
$2,443 |
0.4× |
| Ankle 2 views (73600) |
$151.01 |
$286 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$956.74 |
$1,812 |
3.0× |
| Aortogram thoracic (75605) |
$2,594.06 |
$4,913 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,542.88 |
$6,710 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$2,874.43 |
$5,444 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$1,167.41 |
$2,211 |
0.4× |
| Arthrogram elbow (73085) |
$387.55 |
$734 |
1.2× |
| Arthrogram hip (73525) |
$380.69 |
$721 |
1.2× |
| Arthrogram shoulder (73040) |
$693.26 |
$1,313 |
2.2× |
| Arthrogram wrist (73115) |
$221.23 |
$419 |
0.7× |
| Arthrography knee lt (73580) |
$221.23 |
$419 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$529.06 |
$1,002 |
4.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,588.22 |
$3,008 |
4.3× |
| Bone &/joint imaging whole body (78306) |
$2,006.40 |
$3,800 |
5.4× |
| Bone age studies (77072) |
$161.04 |
$305 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$2,323.20 |
$4,400 |
6.3× |
| Bone survey complete (77075) |
$580.80 |
$1,100 |
6.0× |
| Brachytx isodose complex (77318) |
$2,126.78 |
$4,028 |
6.2× |
| Brachytx isodose intermed (77317) |
$1,770.38 |
$3,353 |
5.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,416.62 |
$2,683 |
4.1× |
| Brain image w/flow 4 + views (78606) |
$970.99 |
$1,839 |
1.9× |
| Brain imaging < 4 static views w vascular flow (78601) |
$452.50 |
$857 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,071.44 |
$9,605 |
3.8× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$503.71 |
$954 |
45.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$898.66 |
$1,702 |
2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,008.48 |
$1,910 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$219.12 |
$415 |
2.7× |
| Chest 1 view (71045) |
$297.79 |
$564 |
3.7× |
| Chest 3 views (71047) |
$297.79 |
$564 |
3.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$557.57 |
$1,056 |
3.4× |
| Cisternography Positive Contrast Rs&I (70015) |
$724.42 |
$1,372 |
1.0× |
| Clavicle complete (73000) |
$162.62 |
$308 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$197.47 |
$374 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$589.25 |
$1,116 |
4.8× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$432.43 |
$819 |
2.7× |
| Corpora cavernosography (74445) |
$497.90 |
$943 |
5.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,535.46 |
$4,802 |
7.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,231.86 |
$4,227 |
10.1× |
| CT abdomen w contrast (74160) |
$2,606.74 |
$4,937 |
16.1× |
| CT abdomen w wo contrast (74170) |
$3,018.05 |
$5,716 |
18.6× |
| CT abdomen w/o contrast (74150) |
$2,225.52 |
$4,215 |
23.1× |
| CT angio hrt w/3d image (75574) |
$1,429.30 |
$2,707 |
4.4× |
| CT angiography upper extremity lt (73206) |
$1,128.34 |
$2,137 |
7.0× |
| CT c-spine w/o contrast (72125) |
$1,382.83 |
$2,619 |
14.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,736.59 |
$3,289 |
10.7× |
| CT cervical spine with contrast (72126) |
$1,620.96 |
$3,070 |
5.0× |
| CT chest w/wo contrast (71270) |
$1,698.05 |
$3,216 |
10.5× |
| CT chest with contrast (71260) |
$1,466.78 |
$2,778 |
9.1× |
| CT colonography screening (74263) |
$1,051.78 |
$1,992 |
4.8× |
| CT head/brain with contrast (70460) |
$886.51 |
$1,679 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,025.38 |
$1,942 |
6.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$581.33 |
$1,101 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$140.98 |
$267 |
1.8× |
| CT iac w contrast (70481) |
$1,274.59 |
$2,414 |
7.9× |
| CT limited/localized follow up study (76380) |
$381.74 |
$723 |
4.8× |
| CT lower ext w/o (73700) |
$646.27 |
$1,224 |
6.7× |
| CT lower extremity w wo contrast (73702) |
$875.95 |
$1,659 |
5.4× |
| CT lower extremity with contrast (73701) |
$758.74 |
$1,437 |
4.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,274.06 |
$2,413 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$928.75 |
$1,759 |
9.6× |
| CT lumbar spine with contrast (72132) |
$1,087.68 |
$2,060 |
3.4× |
| CT maxillofacial w contrast (70487) |
$1,274.59 |
$2,414 |
7.9× |
| CT maxillofacial w/o contrast (70486) |
$1,086.10 |
$2,057 |
11.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,474.70 |
$2,793 |
9.1× |
| CT neck soft tissue w contrast (70491) |
$1,119.89 |
$2,121 |
6.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,474.70 |
$2,793 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,086.10 |
$2,057 |
11.3× |
| CT pelvis w & w/o contrast (72194) |
$1,226.02 |
$2,322 |
7.6× |
| CT pelvis w/o contrast (72192) |
$902.88 |
$1,710 |
9.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,295.18 |
$2,453 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$954.62 |
$1,808 |
9.9× |
| CT thoracic spine w/contrast (72129) |
$868.03 |
$1,644 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$739.73 |
$1,401 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,018.51 |
$1,929 |
6.3× |
| CT thorax w/o contrast (71250) |
$1,250.83 |
$2,369 |
13.0× |
| CT upper extremity w/o contrast rt (73200) |
$835.30 |
$1,582 |
8.7× |
| CT upper extremity with contrast (73201) |
$878.06 |
$1,663 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,666.40 |
$5,050 |
16.5× |
| Cta Abdomen (74175) |
$2,315.81 |
$4,386 |
14.3× |
| CTA abdomen pelvis (74174) |
$4,491.17 |
$8,506 |
14.0× |
| CTA chest (71275) |
$1,448.83 |
$2,744 |
9.0× |
| Cta Head (70496) |
$1,612.51 |
$3,054 |
10.0× |
| CTA lwr ext w&w/o contrast (73706) |
$974.16 |
$1,845 |
6.0× |
| Cta Neck (70498) |
$1,134.14 |
$2,148 |
7.0× |
| Cta Pelvis (72191) |
$956.74 |
$1,812 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$771.94 |
$1,462 |
2.4× |
| Diskography lumbar (72295) |
$1,079.23 |
$2,044 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$219.12 |
$415 |
2.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$314.16 |
$595 |
3.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$256.61 |
$486 |
2.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$283.54 |
$537 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$68.11 |
$129 |
0.8× |
| Echo exam of fetal heart (76825) |
$409.20 |
$775 |
0.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$399.17 |
$756 |
1.8× |
| Echoencephalography real time imaging (76506) |
$299.38 |
$567 |
3.1× |
| Esophagus (74220) |
$432.43 |
$819 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$459.89 |
$871 |
4.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$189.02 |
$358 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$226.51 |
$429 |
1.0× |
| Foot 2 views (73620) |
$148.37 |
$281 |
1.8× |
| Forearm 2 views (73090) |
$153.65 |
$291 |
1.9× |
| Gated Heart Planar Single (78472) |
$1,105.10 |
$2,093 |
3.0× |
| Hand 2 views (73120) |
$131.47 |
$249 |
1.4× |
| Hand 3 views (73130) |
$144.14 |
$273 |
1.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,226.05 |
$4,216 |
3.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,547.07 |
$4,824 |
4.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,753.52 |
$5,215 |
4.3× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$486.82 |
$922 |
1.4× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$486.82 |
$922 |
1.4× |
| Heart Infarct Image (78466) |
$376.99 |
$714 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,441.97 |
$2,731 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,258.26 |
$4,277 |
4.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,258.26 |
$4,277 |
6.1× |
| Ht muscle image spect sing (78451) |
$6,698.21 |
$12,686 |
5.6× |
| Humerus Min 2 Views Left (73060) |
$166.32 |
$315 |
2.1× |
| Hysterosalpingogram (74740) |
$960.96 |
$1,820 |
4.4× |
| Interstitial radiation source applic complex (77778) |
$3,647.95 |
$6,909 |
5.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,471.01 |
$2,786 |
2.3× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,471.01 |
$2,786 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$100.32 |
$190 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,340.10 |
$4,432 |
4.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,340.10 |
$4,432 |
4.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$3,670.13 |
$6,951 |
7.3× |
| Knee 3 views (73562) |
$203.81 |
$386 |
2.5× |
| Liver & spleen imaging static only (78215) |
$2,329.01 |
$4,411 |
6.3× |
| Lung perfusion differential (78597) |
$1,563.94 |
$2,962 |
4.2× |
| Lymphoscintigraphy (78195) |
$1,833.74 |
$3,473 |
3.7× |
| Mammary ductogram or galactogram multiple (77054) |
$736.56 |
$1,395 |
3.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$123.55 |
$234 |
1.5× |
| Meckels Diverticulum (78290) |
$2,030.16 |
$3,845 |
5.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$859.58 |
$1,628 |
2.5× |
| MRA head w & w/o contrast (70546) |
$1,994.78 |
$3,778 |
6.2× |
| MRA head w/o contrast (70544) |
$1,049.66 |
$1,988 |
4.8× |
| MRA head with contrast (70545) |
$1,552.32 |
$2,940 |
4.8× |
| MRA neck w contrast (70548) |
$1,560.24 |
$2,955 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,734.48 |
$3,285 |
5.4× |
| MRA neck w/o contrast (70547) |
$1,049.66 |
$1,988 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,522.22 |
$2,883 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,205.46 |
$4,177 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,256.11 |
$2,379 |
5.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,607.76 |
$3,045 |
2.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,717.06 |
$3,252 |
2.4× |
| MRI breast w/o contrast bilateral (77047) |
$185.33 |
$351 |
0.8× |
| MRI breast w/o contrast unilat (77046) |
$185.33 |
$351 |
0.8× |
| MRI c-spine with contrast (72142) |
$2,040.19 |
$3,864 |
6.3× |
| MRI cardiac w/o contrast (75557) |
$898.66 |
$1,702 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,492.66 |
$2,827 |
6.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,203.34 |
$4,173 |
6.8× |
| MRI chest w/o contrast (71550) |
$627.26 |
$1,188 |
2.8× |
| MRI fetal sngl/1st gestation (74712) |
$204.86 |
$388 |
0.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,607.76 |
$3,045 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,143.12 |
$2,165 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,470.48 |
$2,785 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,290.46 |
$4,338 |
7.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,767.22 |
$3,347 |
5.5× |
| MRI pelvis w contrast (72196) |
$1,127.28 |
$2,135 |
3.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,206.48 |
$2,285 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$764.54 |
$1,448 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,740.82 |
$3,297 |
5.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,791.50 |
$3,393 |
5.6× |
| MRI spectroscopy (76390) |
$595.06 |
$1,127 |
7.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,699.14 |
$5,112 |
8.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,854.86 |
$3,513 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,456.26 |
$4,652 |
7.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,066.59 |
$3,914 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,270.40 |
$4,300 |
7.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,673.76 |
$3,170 |
7.6× |
| MRI tmj (70336) |
$388.08 |
$735 |
1.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,569.74 |
$2,973 |
7.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,740.82 |
$3,297 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,058.11 |
$2,004 |
4.8× |
| Myelogram thoracic (72255) |
$483.12 |
$915 |
0.7× |
| Myocardial infarct spect (78469) |
$805.73 |
$1,526 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$7,352.93 |
$13,926 |
6.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,566.08 |
$4,860 |
1.9× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$3,564.53 |
$6,751 |
1.8× |
| Neck soft tissue (70360) |
$237.60 |
$450 |
3.0× |
| Nm bone marrow multiple (78103) |
$1,148.40 |
$2,175 |
3.1× |
| Nm cisternogram (78630) |
$1,977.89 |
$3,746 |
3.9× |
| Nm gastric emptying study (78264) |
$2,023.30 |
$3,832 |
5.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,604.72 |
$10,615 |
4.4× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$4,040.78 |
$7,653 |
3.4× |
| Nuclear medicine of heart pumping function (78473) |
$1,105.10 |
$2,093 |
3.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$3,512.78 |
$6,653 |
2.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$2,772 |
$5,250 |
7.5× |
| Nuclear Rx Oral Admin (79005) |
$966.77 |
$1,831 |
4.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$277.20 |
$525 |
2.9× |
| Orthopantogram (70355) |
$76.56 |
$145 |
1.0× |
| Osseous survey limited (77074) |
$580.80 |
$1,100 |
6.0× |
| Parathyrd planar w/spect&CT (78072) |
$1,152.62 |
$2,183 |
2.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,056 |
$2,000 |
2.9× |
| Parathyroid imaging (78070) |
$1,003.20 |
$1,900 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$161.04 |
$305 |
1.7× |
| Peritoneogram rs&i (74190) |
$276.14 |
$523 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$2,690.16 |
$5,095 |
2.0× |
| PET imaging for CT attenuation whole body (78816) |
$2,690.16 |
$5,095 |
2.0× |
| PET imaging limited area chest head/neck (78811) |
$2,696.50 |
$5,107 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,791.50 |
$3,393 |
5.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,498.46 |
$2,838 |
0.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,428.77 |
$2,706 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,755.07 |
$3,324 |
4.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,326.37 |
$4,406 |
4.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$945.12 |
$1,790 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$176.88 |
$335 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$190.61 |
$361 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$170.54 |
$323 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$111.41 |
$211 |
1.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$9,071.57 |
$17,181 |
1.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$752.40 |
$1,425 |
1.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$499.49 |
$946 |
5.3× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$581.86 |
$1,102 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$155.23 |
$294 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$254.50 |
$482 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$288.82 |
$547 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$297.79 |
$564 |
3.7× |
| Radiologic exam colon single contrast study (74270) |
$696.96 |
$1,320 |
4.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$578.16 |
$1,095 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$925.06 |
$1,752 |
5.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$925.06 |
$1,752 |
5.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$110.88 |
$210 |
1.4× |
| Radiological examination surgical specimen (76098) |
$275.62 |
$522 |
0.5× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,790.45 |
$3,391 |
0.6× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,450.94 |
$2,748 |
0.5× |
| Ribs bilateral 3 views (71110) |
$178.99 |
$339 |
1.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,372.80 |
$2,600 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,584 |
$3,000 |
3.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,244 |
$4,250 |
1.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$442.46 |
$838 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$901.82 |
$1,708 |
4.2× |
| Sacroiliac Joints < 3 Views (72200) |
$211.73 |
$401 |
2.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$430.85 |
$816 |
2.0× |
| Scanogram (77073) |
$123.55 |
$234 |
1.3× |
| Scapula complete (73010) |
$171.07 |
$324 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$13.20 |
$25 |
0.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$451.44 |
$855 |
4.7× |
| Sialogram (70390) |
$376.46 |
$713 |
1.7× |
| Simulation intermediate (77285) |
$1,773.55 |
$3,359 |
5.1× |
| Small bowel series (74250) |
$643.63 |
$1,219 |
4.0× |
| Spec medical radj physics consltj (77370) |
$691.15 |
$1,309 |
5.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,466.26 |
$2,777 |
4.2× |
| Special dosimetry (77331) |
$514.80 |
$975 |
4.2× |
| Special treatment procedure (77470) |
$1,760.35 |
$3,334 |
3.5× |
| Spine thoracic 3 views (72072) |
$115.63 |
$219 |
1.2× |
| Splenoportograpy rs&i (75810) |
$1,215.46 |
$2,302 |
0.4× |
| Stereotactic body radiation delivery (77373) |
$4,765.20 |
$9,025 |
2.9× |
| Superior sagittal sinus venogram (75870) |
$1,225.49 |
$2,321 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,387.58 |
$2,628 |
4.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$759.79 |
$1,439 |
2.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,198.59 |
$4,164 |
6.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,130.98 |
$2,142 |
9.1× |
| Therapeutic Enema (74283) |
$729.70 |
$1,382 |
4.5× |
| Thoracolumbar 2 views (72080) |
$112.99 |
$214 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,082.43 |
$3,944 |
4.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$797.28 |
$1,510 |
2.2× |
| Thyroid uptake measurement (78012) |
$425.04 |
$805 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$879.12 |
$1,665 |
2.4× |
| Treatment device intermediate (77333) |
$871.20 |
$1,650 |
7.0× |
| Treatment devices simple (77332) |
$778.80 |
$1,475 |
6.3× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,531.20 |
$2,900 |
3.1× |
| Tx devices design & construction complex (77334) |
$1,069.73 |
$2,026 |
3.1× |
| Ultrasound elastography first target lesion (76982) |
$182.16 |
$345 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$505.30 |
$957 |
5.2× |
| Umbilical-artery Doppler (OB) (76820) |
$256.61 |
$486 |
2.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$930.34 |
$1,762 |
11.6× |
| Unlisted fluoroscopic procedure (76496) |
$96.10 |
$182 |
1.2× |
| Unlisted magnetic resonance procedure (76498) |
$179.52 |
$340 |
2.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,525.39 |
$2,889 |
16.2× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$343.20 |
$650 |
0.9× |
| Unlisted Ultrasound Procedure (76999) |
$353.23 |
$669 |
4.4× |
| Upper Extremity Infant (73092) |
$64.42 |
$122 |
0.7× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,191.70 |
$2,257 |
3.2× |
| Urethrocystography retrograde rs&i (74450) |
$719.66 |
$1,363 |
3.3× |
| Urethrocystography voiding (74455) |
$905.52 |
$1,715 |
4.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$789.36 |
$1,495 |
4.9× |
| Us abdl aorta screen aaa (76706) |
$145.20 |
$275 |
1.5× |
| Us breast unilateral complete (76641) |
$393.36 |
$745 |
4.1× |
| Us breast unilateral limited (76642) |
$393.36 |
$745 |
4.9× |
| Us chest (76604) |
$183.74 |
$348 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$372.24 |
$705 |
3.9× |
| Us elastography parenchyma (76981) |
$182.16 |
$345 |
1.9× |
| Us fetal nuchal translucency 1st gestation (76813) |
$346.37 |
$656 |
3.6× |
| Us guided compression repair (76936) |
$722.83 |
$1,369 |
3.6× |
| Us infant hips dynamic (76885) |
$507.41 |
$961 |
6.3× |
| Us infant hips limited static (76886) |
$450.91 |
$854 |
5.6× |
| Us kidney transplant (76776) |
$349.01 |
$661 |
3.6× |
| Us ob detailed single fetus (76811) |
$312.05 |
$591 |
1.4× |
| Us ob transvaginal (76817) |
$393.89 |
$746 |
4.1× |
| Us pelvic non ob complete (76856) |
$755.57 |
$1,431 |
7.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$79.73 |
$151 |
0.8× |
| Us pregnancy ltd (76815) |
$277.20 |
$525 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$439.82 |
$833 |
4.6× |
| Us retroperitoneal complete (76770) |
$779.33 |
$1,476 |
8.1× |
| Us retroperitoneal limited (76775) |
$372.24 |
$705 |
3.9× |
| Us scrotum and contents (76870) |
$571.82 |
$1,083 |
5.9× |
| Us soft tissue head/neck (76536) |
$577.10 |
$1,093 |
6.0× |
| Us spinal canal and contents (76800) |
$487.34 |
$923 |
5.1× |
| Us transrectal (76872) |
$312.05 |
$591 |
3.2× |
| Us xtr non-vasc lmtd (76882) |
$119.86 |
$227 |
1.2× |
| Us, eye b-scan (76512) |
$221.23 |
$419 |
2.3× |
| Venogram extremity bilateral (75822) |
$837.41 |
$1,586 |
0.6× |
| Venogram orbital (75880) |
$784.61 |
$1,486 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,611.98 |
$3,053 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,477.87 |
$2,799 |
1.0× |
| Venography epidural rs&i (75872) |
$681.12 |
$1,290 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$769.82 |
$1,458 |
0.5× |
| Venography Renal Bilateral (75833) |
$1,340.59 |
$2,539 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,241.86 |
$2,352 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,520.64 |
$2,880 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,602.51 |
$4,929 |
0.5× |
| Wrist 2 views (73100) |
$135.70 |
$257 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$632.54 |
$1,198 |
6.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$96.62 |
$183 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$162.10 |
$307 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$929.81 |
$1,761 |
5.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$159.98 |
$303 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$159.98 |
$303 |
2.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$196.94 |
$373 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$77.09 |
$146 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$102.43 |
$194 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$128.30 |
$243 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$174.24 |
$330 |
1.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$181.63 |
$344 |
1.9× |
| X-ray exam of femur 1 (73551) |
$110.88 |
$210 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$855.89 |
$1,621 |
5.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$192.19 |
$364 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$192.19 |
$364 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$148.37 |
$281 |
1.8× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,090.32 |
$2,065 |
0.6× |
| X-ray head for orthodontia (70350) |
$79.20 |
$150 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$139.39 |
$264 |
1.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$711.74 |
$1,348 |
4.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$138.86 |
$263 |
1.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$209.09 |
$396 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$114.58 |
$217 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$60.19 |
$114 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$257.66 |
$488 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$359.57 |
$681 |
3.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$177.41 |
$336 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$160.51 |
$304 |
2.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$234.43 |
$444 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$92.93 |
$176 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$182.69 |
$346 |
1.9× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$397.06 |
$752 |
0.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,110.91 |
$2,104 |
3.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$153.12 |
$290 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$285.12 |
$540 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$310.46 |
$588 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$211.73 |
$401 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$220.18 |
$417 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$164.74 |
$312 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$265.58 |
$503 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$253.44 |
$480 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$193.25 |
$366 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$193.25 |
$366 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$190.61 |
$361 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$52.27 |
$99 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$130.94 |
$248 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$112.99 |
$214 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$115.63 |
$219 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$134.11 |
$254 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$170.54 |
$323 |
2.1× |
| Xr arthrogram ankle (73615) |
$281.95 |
$534 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$263.47 |
$499 |
2.7× |
| Xr chest 4+ views (71048) |
$380.16 |
$720 |
3.9× |
| Xr finger(s) 2+ views (73140) |
$134.11 |
$254 |
1.7× |
| Xr shoulder 1 view (73020) |
$148.37 |
$281 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$263.47 |
$499 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$154.18 |
$292 |
1.9× |
| Xr tmj bilateral (70330) |
$55.97 |
$106 |
0.7× |
| Xray knee 1 or 2 views rt (73560) |
$163.15 |
$309 |
2.0× |