| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,879.48 |
$5,878 |
2.7× |
| Abdomen 2 views (74019) |
$257.40 |
$390 |
2.4× |
| Acute gi blood loss imaging (78278) |
$1,469.82 |
$2,227 |
3.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,863.64 |
$5,854 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,522.42 |
$5,337 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$2,206.38 |
$3,343 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,159.32 |
$6,302 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,329.70 |
$5,045 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,544.30 |
$3,855 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$4,409.46 |
$6,681 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,008.84 |
$6,074 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,122.66 |
$1,701 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,848.66 |
$2,801 |
0.6× |
| Ankle 2 views (73600) |
$205.26 |
$311 |
2.3× |
| Aortogram thoracic (75605) |
$4,066.92 |
$6,162 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,322.44 |
$5,034 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,746.16 |
$5,676 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$2,410.32 |
$3,652 |
0.7× |
| Arthrogram elbow (73085) |
$382.80 |
$580 |
1.1× |
| Arthrogram hip (73525) |
$663.96 |
$1,006 |
1.8× |
| Arthrogram shoulder (73040) |
$527.34 |
$799 |
1.5× |
| Arthrogram wrist (73115) |
$326.04 |
$494 |
0.9× |
| Basic dosimetry (77300) |
$335.28 |
$508 |
2.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$704.22 |
$1,067 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,110.12 |
$1,682 |
2.7× |
| Bone age studies (77072) |
$198.66 |
$301 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,294.92 |
$1,962 |
3.1× |
| Bone survey complete (77075) |
$651.42 |
$987 |
6.0× |
| Bone survey infant (77076) |
$257.40 |
$390 |
2.4× |
| Bowel imaging (78290) |
$1,002.54 |
$1,519 |
2.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$687.72 |
$1,042 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,152.36 |
$1,746 |
2.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,787.28 |
$2,708 |
5.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$421.74 |
$639 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$240.24 |
$364 |
2.7× |
| Chest 1 view (71045) |
$201.96 |
$306 |
2.2× |
| Chest xray 3 views (71047) |
$184.80 |
$280 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$413.82 |
$627 |
2.3× |
| Cineradiography/videoradiography (76120) |
$192.72 |
$292 |
1.8× |
| Clavicle complete (73000) |
$195.36 |
$296 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$838.86 |
$1,271 |
7.8× |
| Continuing medical physics consltj pr wk (77336) |
$480.48 |
$728 |
3.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,664.42 |
$4,037 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,962.18 |
$2,973 |
8.0× |
| CT abdomen w contrast (74160) |
$1,350.36 |
$2,046 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,643.40 |
$2,490 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,093.62 |
$1,657 |
10.1× |
| CT angio hrt w/3d image (75574) |
$2,073.72 |
$3,142 |
5.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,661.22 |
$2,517 |
9.2× |
| CT angiography upper extremity lt (73206) |
$1,472.46 |
$2,231 |
8.1× |
| CT c-spine w/contrast (72126) |
$1,527.90 |
$2,315 |
4.2× |
| CT c-spine w/o contrast (72125) |
$1,514.70 |
$2,295 |
14.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,567.50 |
$2,375 |
8.7× |
| CT chest w contrast (71260) |
$1,410.42 |
$2,137 |
7.8× |
| CT chest w/wo contrast (71270) |
$1,494.24 |
$2,264 |
8.3× |
| CT colonography screening (74263) |
$925.98 |
$1,403 |
3.8× |
| CT colonography w/o cntrst (74261) |
$955.68 |
$1,448 |
8.9× |
| CT head/brain with contrast (70460) |
$1,213.08 |
$1,838 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,459.92 |
$2,212 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,246.08 |
$1,888 |
3.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$33 |
$50 |
0.4× |
| CT hrt w/3d image congen (75573) |
$1,473.78 |
$2,233 |
4.1× |
| CT iac w contrast (70481) |
$1,330.56 |
$2,016 |
7.3× |
| CT limited/localized follow up study (76380) |
$592.68 |
$898 |
6.6× |
| CT lower ext w/o (73700) |
$1,322.64 |
$2,004 |
12.3× |
| CT lower extremity w wo contrast (73702) |
$1,457.28 |
$2,208 |
8.0× |
| CT lower extremity w/contrast material (73701) |
$1,376.10 |
$2,085 |
7.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,389.30 |
$2,105 |
7.7× |
| CT lumbar spine w/contrast (72132) |
$1,381.38 |
$2,093 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,333.20 |
$2,020 |
12.4× |
| CT maxillofacial w contrast (70487) |
$1,291.62 |
$1,957 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,386 |
$2,100 |
7.7× |
| CT maxillofacial wo contrast (70486) |
$1,257.96 |
$1,906 |
11.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,230.24 |
$1,864 |
6.8× |
| CT orbits w/o contrast (70480) |
$1,158.30 |
$1,755 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,245.42 |
$1,887 |
11.5× |
| CT pelvis w/wo contrast (72194) |
$1,513.38 |
$2,293 |
8.4× |
| CT scan of arm combo (73202) |
$1,362.90 |
$2,065 |
7.5× |
| CT soft tissue neck w contrast (70491) |
$1,314.72 |
$1,992 |
7.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,399.20 |
$2,120 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,079.76 |
$1,636 |
10.0× |
| CT thoracic spine w/contrast (72129) |
$1,286.34 |
$1,949 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$1,281.06 |
$1,941 |
11.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,486.98 |
$2,253 |
8.2× |
| CT thorax w/o contrast (71250) |
$1,244.76 |
$1,886 |
11.5× |
| CT unlisted procedure (76497) |
$5,016 |
$7,600 |
55.8× |
| CT upper ext wo (73200) |
$1,153.02 |
$1,747 |
10.7× |
| CT upper extremity with contrast (73201) |
$1,357.62 |
$2,057 |
3.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,047.98 |
$3,103 |
11.3× |
| Cta Abdomen (74175) |
$1,814.34 |
$2,749 |
10.0× |
| CTA abdomen pelvis (74174) |
$2,534.40 |
$3,840 |
7.0× |
| CTA chest (71275) |
$1,805.76 |
$2,736 |
10.0× |
| Cta Head (70496) |
$1,759.56 |
$2,666 |
9.7× |
| Cta Neck (70498) |
$1,757.58 |
$2,663 |
9.7× |
| Cta Pelvis (72191) |
$1,343.10 |
$2,035 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$502.26 |
$761 |
1.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,211.76 |
$1,836 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$624.36 |
$946 |
5.8× |
| Esophagus (74220) |
$411.18 |
$623 |
2.3× |
| Facial bones min 3 views (70150) |
$255.42 |
$387 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$442.86 |
$671 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$417.78 |
$633 |
1.7× |
| Foot 2 views (73620) |
$191.40 |
$290 |
2.1× |
| Forearm 2 views (73090) |
$198 |
$300 |
2.2× |
| Hand 2 views (73120) |
$194.70 |
$295 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,111.90 |
$4,715 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,547.60 |
$3,860 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,380.06 |
$2,091 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,221 |
$1,850 |
3.0× |
| Image fusion (77399) |
$529.98 |
$803 |
3.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,063.26 |
$1,611 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,169.52 |
$1,772 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$411.18 |
$623 |
0.7× |
| Knee 3 views (73562) |
$223.74 |
$339 |
2.5× |
| Liver & spleen imaging static only (78215) |
$803.22 |
$1,217 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$803.22 |
$1,217 |
1.9× |
| Lung perfusion differential (78597) |
$883.08 |
$1,338 |
2.1× |
| Lung ventilation imaging (78579) |
$353.76 |
$536 |
0.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,457.18 |
$3,723 |
0.8× |
| Lymphoscintigraphy (78195) |
$1,457.28 |
$2,208 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,065.80 |
$3,130 |
2.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,320.56 |
$3,516 |
6.4× |
| Magnetic Resonance Elastography (76391) |
$1,410.42 |
$2,137 |
5.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,186.02 |
$1,797 |
3.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$33 |
$50 |
1.1× |
| MRA head w & w/o contrast (70546) |
$2,290.86 |
$3,471 |
6.4× |
| MRA head w/o contrast (70544) |
$1,956.24 |
$2,964 |
7.9× |
| MRA head with contrast (70545) |
$1,626.90 |
$2,465 |
4.5× |
| MRA neck w contrast (70548) |
$1,805.10 |
$2,735 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,469.72 |
$3,742 |
6.9× |
| MRA neck w/o contrast (70547) |
$1,627.56 |
$2,466 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,633.40 |
$3,990 |
7.3× |
| MRI abdomen w/o contrast (74181) |
$1,947 |
$2,950 |
7.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,151.60 |
$3,260 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,293.50 |
$3,475 |
6.4× |
| MRI c-spine with contrast (72142) |
$1,774.74 |
$2,689 |
4.9× |
| MRI cardiac w/o contrast (75557) |
$1,398.54 |
$2,119 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,940.40 |
$2,940 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,136.42 |
$3,237 |
5.9× |
| MRI chest w/o contrast (71550) |
$1,615.68 |
$2,448 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,409 |
$3,650 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,888.92 |
$2,862 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,719.30 |
$2,605 |
7.0× |
| MRI orbit face neck w contrast (70542) |
$485.10 |
$735 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,463.78 |
$3,733 |
6.8× |
| MRI pelvis w/contrast (72196) |
$2,008.38 |
$3,043 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,525.16 |
$3,826 |
7.0× |
| MRI pelvis w/o contrast (72195) |
$1,913.34 |
$2,899 |
7.8× |
| MRI spectroscopy (76390) |
$1,146.42 |
$1,737 |
12.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,488.20 |
$3,770 |
6.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,741.08 |
$2,638 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,605.68 |
$3,948 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,935.12 |
$2,932 |
5.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,470.38 |
$3,743 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,900.14 |
$2,879 |
7.7× |
| MRI up ext w/o contrast (73218) |
$1,907.40 |
$2,890 |
7.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,918.62 |
$2,907 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$2,331.78 |
$3,533 |
6.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,574 |
$3,900 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,528.56 |
$2,316 |
1.1× |
| Neck soft tissue (70360) |
$184.80 |
$280 |
2.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$180.84 |
$274 |
0.5× |
| Nm gastric emptying study (78264) |
$1,199.22 |
$1,817 |
2.9× |
| Nm kidney scan w/flow (78701) |
$725.34 |
$1,099 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$330.66 |
$501 |
3.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,046.46 |
$6,131 |
2.8× |
| Nuclear Rx Oral Admin (79005) |
$611.82 |
$927 |
2.5× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$335.28 |
$508 |
2.4× |
| Orthopantogram (70355) |
$219.78 |
$333 |
2.4× |
| Parathyroid Planar Imaging (78070) |
$1,155 |
$1,750 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$209.88 |
$318 |
1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,058.44 |
$4,634 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,260.60 |
$1,910 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$912.12 |
$1,382 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$944.46 |
$1,431 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$552.42 |
$837 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$216.48 |
$328 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$178.86 |
$271 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$226.38 |
$343 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$305.58 |
$463 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$369.60 |
$560 |
3.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$386.10 |
$585 |
3.6× |
| Radex fingr minimum 2 views (73140) |
$209.88 |
$318 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$213.84 |
$324 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$221.10 |
$335 |
2.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$254.76 |
$386 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$213.84 |
$324 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$338.58 |
$513 |
3.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$384.12 |
$582 |
3.6× |
| Radex Humerus Minimum 2 Views (73060) |
$213.18 |
$323 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$216.48 |
$328 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$265.98 |
$403 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$236.28 |
$358 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$205.92 |
$312 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$252.12 |
$382 |
2.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$221.10 |
$335 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$147.84 |
$224 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$219.12 |
$332 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$227.70 |
$345 |
2.5× |
| Radex Toe Minimum 2 Views (73660) |
$180.18 |
$273 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$217.14 |
$329 |
2.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$25,179 |
$38,150 |
3.3× |
| Radiation treatment delivery level 1 (77402) |
$372.90 |
$565 |
3.5× |
| Radiation treatment delivery level 2 (77407) |
$447.48 |
$678 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$672.54 |
$1,019 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$199.32 |
$302 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$297 |
$450 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$215.82 |
$327 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$539.22 |
$817 |
3.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$356.40 |
$540 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$211.86 |
$321 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$438.24 |
$664 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$165 |
$250 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$210.54 |
$319 |
2.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$213.84 |
$324 |
2.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$213.84 |
$324 |
2.0× |
| Radiological examination surgical specimen (76098) |
$380.16 |
$576 |
0.7× |
| Renal Cyst Study (74470) |
$367.62 |
$557 |
0.7× |
| Ribs bilateral 3 views (71110) |
$237.60 |
$360 |
2.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$324.06 |
$491 |
0.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,486.88 |
$3,768 |
4.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,617.66 |
$2,451 |
2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,124.64 |
$1,704 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,207.80 |
$1,830 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,124.64 |
$1,704 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$452.10 |
$685 |
1.9× |
| Sacroiliac Joints < 3 Views (72200) |
$178.20 |
$270 |
1.7× |
| Scapula (73010) |
$225.72 |
$342 |
2.1× |
| Sella turcica (70240) |
$189.42 |
$287 |
2.1× |
| Shoulder 1 view (73020) |
$200.64 |
$304 |
2.2× |
| Simulation intermediate (77285) |
$910.80 |
$1,380 |
2.4× |
| Small bowel series (74250) |
$656.70 |
$995 |
3.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$837.54 |
$1,269 |
2.2× |
| Special dosimetry (77331) |
$105.60 |
$160 |
0.8× |
| Special Physics Consult (77370) |
$703.56 |
$1,066 |
5.1× |
| Special treatment procedure (77470) |
$1,788.60 |
$2,710 |
3.1× |
| Spine thoracic 3 views (72072) |
$277.20 |
$420 |
2.6× |
| Splenoportograpy rs&i (75810) |
$2,153.58 |
$3,263 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$17,820 |
$27,000 |
9.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,783.88 |
$4,218 |
7.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,287 |
$1,950 |
3.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,606.44 |
$2,434 |
4.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$782.10 |
$1,185 |
5.6× |
| Thoracolumbar 2 views (72080) |
$213.84 |
$324 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,248.72 |
$1,892 |
2.2× |
| Treatment device complex (77334) |
$813.78 |
$1,233 |
2.1× |
| Treatment device intermediate (77333) |
$545.82 |
$827 |
3.9× |
| Treatment devices simple (77332) |
$427.68 |
$648 |
3.1× |
| Ultrasound breast complete (76641) |
$264.66 |
$401 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$369.60 |
$560 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$479.82 |
$727 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$262.68 |
$398 |
2.4× |
| Unlisted magnetic resonance procedure (76498) |
$5,016 |
$7,600 |
55.8× |
| Urethrocystogram voiding (74455) |
$524.70 |
$795 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$576.84 |
$874 |
2.3× |
| Us breast unilateral limited (76642) |
$314.16 |
$476 |
3.5× |
| Us chest (76604) |
$338.58 |
$513 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$172.92 |
$262 |
1.6× |
| Us encephalogram (76506) |
$274.56 |
$416 |
2.5× |
| Us hips infant static (76886) |
$214.50 |
$325 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$122.10 |
$185 |
1.1× |
| Us ob limited (76815) |
$359.04 |
$544 |
3.3× |
| Us ob transvaginal (76817) |
$365.64 |
$554 |
3.4× |
| Us pelvic non ob complete (76856) |
$502.92 |
$762 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$337.92 |
$512 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$466.62 |
$707 |
4.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$417.12 |
$632 |
3.9× |
| Us retroperitoneal complete (76770) |
$481.14 |
$729 |
4.5× |
| Us retroperitoneal limited (76775) |
$423.72 |
$642 |
3.9× |
| Us scrotum and contents (76870) |
$440.88 |
$668 |
4.1× |
| Us soft tissue head/neck (76536) |
$417.12 |
$632 |
3.9× |
| Us spinal canal and contents (76800) |
$352.44 |
$534 |
3.3× |
| Us transrectal prostate volume (76873) |
$281.16 |
$426 |
2.6× |
| Us, eye b-scan (76512) |
$281.82 |
$427 |
2.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$495 |
$750 |
4.6× |
| Venogram adrenal unilat (75840) |
$2,458.50 |
$3,725 |
0.8× |
| Venogram extremity bilateral (75822) |
$1,460.58 |
$2,213 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,281.72 |
$1,942 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,196.38 |
$4,843 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,715.34 |
$2,599 |
1.1× |
| Venography Renal Bilateral (75833) |
$2,272.38 |
$3,443 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,714.58 |
$4,113 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,244 |
$3,400 |
0.7× |
| Venous sampling by catheter (75893) |
$5,053.62 |
$7,657 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$73.92 |
$112 |
0.8× |
| Wrist 2 views (73100) |
$197.34 |
$299 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$324.72 |
$492 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$176.22 |
$267 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$187.44 |
$284 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$246.84 |
$374 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$301.62 |
$457 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$227.04 |
$344 |
2.5× |
| X-ray eye for foreign body (70030) |
$222.42 |
$337 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$186.12 |
$282 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$202.62 |
$307 |
2.3× |
| X-ray leg, infant (73592) |
$144.54 |
$219 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$248.82 |
$377 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$131.34 |
$199 |
1.2× |
| X-ray nose-rectum child f.b. (76010) |
$161.70 |
$245 |
1.8× |
| X-ray optic foramen (70190) |
$104.28 |
$158 |
1.2× |
| X-ray retrograde pyelogram (74420) |
$640.86 |
$971 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$199.98 |
$303 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$291.06 |
$441 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$346.50 |
$525 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$94.38 |
$143 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$217.80 |
$330 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$205.92 |
$312 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$223.08 |
$338 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$201.30 |
$305 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$113.52 |
$172 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$217.14 |
$329 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$232.98 |
$353 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$102.30 |
$155 |
0.9× |
| Xr bone length studies (77073) |
$266.64 |
$404 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$310.86 |
$471 |
2.9× |
| Xr c-spine 6 or more views (72052) |
$322.08 |
$488 |
3.0× |
| Xr urogram antegrade (74425) |
$710.82 |
$1,077 |
2.0× |