| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,878.75 |
$11,515 |
1.7× |
| Abdomen 1 View (74018) |
$303.50 |
$1,214 |
2.8× |
| Abdomen 2 views (74019) |
$376.25 |
$1,505 |
2.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$354 |
$1,416 |
0.7× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$422.75 |
$1,691 |
0.3× |
| Angio internal mammary (75756) |
$1,311 |
$5,244 |
0.3× |
| Angio pulmonary bilat (75743) |
$4,178.75 |
$16,715 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,298 |
$13,192 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$1,857.25 |
$7,429 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,298 |
$13,192 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,311 |
$5,244 |
0.3× |
| Ankle 2 views (73600) |
$21.50 |
$86 |
0.2× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,196.25 |
$8,785 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,909.75 |
$7,639 |
0.5× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,484 |
$9,936 |
0.4× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,484 |
$9,936 |
0.4× |
| Arthrogram ankle (73615) |
$145.25 |
$581 |
0.3× |
| Arthrogram hip (73525) |
$383.75 |
$1,535 |
0.9× |
| Arthrogram Wrist (73115) |
$172 |
$688 |
0.4× |
| Basic radiation dosimetry calculation (77300) |
$289.50 |
$1,158 |
1.7× |
| Bone age studies (77072) |
$83.50 |
$334 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$593.75 |
$2,375 |
1.2× |
| Bone Imaging Limited Area (78300) |
$522.50 |
$2,090 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$546.25 |
$2,185 |
1.1× |
| Bone Imaging Whole Body (78306) |
$570 |
$2,280 |
1.1× |
| Bone marrow imaging limited area (78102) |
$221.75 |
$887 |
0.4× |
| Bone marrow imaging; whole body (78104) |
$259.75 |
$1,039 |
0.5× |
| Bone survey infant (77076) |
$85.75 |
$343 |
0.7× |
| Brachytx isodose complex (77318) |
$662.75 |
$2,651 |
1.4× |
| Brachytx isodose intermed (77317) |
$404 |
$1,616 |
0.9× |
| Brachytx Isodose Plan Simple (77316) |
$312.25 |
$1,249 |
0.7× |
| Brain Flow Imaging Only (78610) |
$263.50 |
$1,054 |
0.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$389.25 |
$1,557 |
0.6× |
| Brain Imaging Minimum 4 Static Views (78605) |
$263.50 |
$1,054 |
0.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,382.25 |
$5,529 |
0.8× |
| Cat Scan Follow-Up Study (76380) |
$282 |
$1,128 |
2.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$434.25 |
$1,737 |
0.6× |
| Cerebrospinal Fluid Scan (78630) |
$401.75 |
$1,607 |
0.6× |
| Chest 1 view (71045) |
$86.25 |
$345 |
0.8× |
| Chest 2 views (71046) |
$125.50 |
$502 |
1.2× |
| Chest 3 views (71047) |
$137.75 |
$551 |
1.3× |
| Chest 4 or more views (71048) |
$148 |
$592 |
1.1× |
| Cholecystography Oral Contrast (74290) |
$344.25 |
$1,377 |
1.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$346.75 |
$1,387 |
0.4× |
| Clavicle complete (73000) |
$50 |
$200 |
0.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$462.50 |
$1,850 |
3.5× |
| Continuing medical physics consltj pr wk (77336) |
$307 |
$1,228 |
1.8× |
| Contrast Exam Abdominl Aorta (75625) |
$2,484 |
$9,936 |
0.6× |
| Contrast X-Ray Bladder (74430) |
$547.50 |
$2,190 |
1.3× |
| Contrast X-Ray Of Elbow (73085) |
$366.25 |
$1,465 |
0.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$172 |
$688 |
0.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$747.25 |
$2,989 |
1.7× |
| CT abdomen and pelvis without contrast (74176) |
$478.25 |
$1,913 |
1.6× |
| CT abdomen w contrast (74160) |
$670.50 |
$2,682 |
3.1× |
| CT abdomen w wo contrast (74170) |
$824.25 |
$3,297 |
3.8× |
| CT abdomen w/o contrast (74150) |
$465.50 |
$1,862 |
3.6× |
| CT Angio Abdomen and Pelvis (74174) |
$884.50 |
$3,538 |
2.0× |
| CT Angio Chest (71275) |
$1,067.75 |
$4,271 |
4.9× |
| CT Angio Head (70496) |
$381 |
$1,524 |
1.7× |
| CT angio hrt w/3d image (75574) |
$1,823.75 |
$7,295 |
4.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$837.75 |
$3,351 |
3.8× |
| CT Angio Neck (70498) |
$381 |
$1,524 |
1.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$837.75 |
$3,351 |
3.8× |
| CT cervical spine w/ contrast (72126) |
$281.75 |
$1,127 |
0.6× |
| CT cervical spine w/o contrast (72125) |
$217.25 |
$869 |
1.7× |
| CT cervical spine w/wo cont (72127) |
$805 |
$3,220 |
3.7× |
| CT chest w contrast (71260) |
$897.25 |
$3,589 |
4.1× |
| CT chest w/wo contrast (71270) |
$930.25 |
$3,721 |
4.2× |
| CT head/brain with contrast (70460) |
$426.75 |
$1,707 |
1.9× |
| CT head/brain without and with contrast (70470) |
$457 |
$1,828 |
2.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$120.75 |
$483 |
1.1× |
| CT iac w contrast (70481) |
$333.75 |
$1,335 |
1.5× |
| CT l-spine w&w/o contrast (72133) |
$777.50 |
$3,110 |
3.6× |
| CT lower ext w/o (73700) |
$478.25 |
$1,913 |
3.7× |
| CT lower extremity w/contrast material (73701) |
$606.50 |
$2,426 |
2.8× |
| CT lumbar spine w contrast (72132) |
$619.50 |
$2,478 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$478.25 |
$1,913 |
3.7× |
| CT maxillofacial w contrast (70487) |
$283.75 |
$1,135 |
1.3× |
| CT maxillofacial wo contrast (70486) |
$217.25 |
$869 |
1.7× |
| CT neck tissue combo (70492) |
$340 |
$1,360 |
1.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$374.75 |
$1,499 |
1.7× |
| CT orbits w/o contrast (70480) |
$217.25 |
$869 |
1.7× |
| CT pelvis w&w/o contrast (72194) |
$785.50 |
$3,142 |
3.6× |
| CT pelvis w/o contrast (72192) |
$470.50 |
$1,882 |
3.6× |
| CT scan of leg combo (73702) |
$803 |
$3,212 |
3.7× |
| CT scans face/jaw combo (70488) |
$353.50 |
$1,414 |
1.6× |
| CT soft tissue neck w contrast (70491) |
$272 |
$1,088 |
1.2× |
| CT soft tissue neck w/o contrast (70490) |
$217.25 |
$869 |
1.7× |
| CT thoracic spine w contrast (72129) |
$619.50 |
$2,478 |
2.8× |
| CT thoracic spine w/o contrast (72128) |
$478.25 |
$1,913 |
3.7× |
| CT thoracic spine w/wo cont (72130) |
$741 |
$2,964 |
3.4× |
| CT thorax w/o contrast (71250) |
$833 |
$3,332 |
6.4× |
| CT unlisted procedure (76497) |
$1,823.75 |
$7,295 |
16.8× |
| CT upper ext wo (73200) |
$478.25 |
$1,913 |
3.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,944.25 |
$7,777 |
8.9× |
| CT upper extremity with contrast (73201) |
$597.75 |
$2,391 |
1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$837.75 |
$3,351 |
3.8× |
| Cta Abdomen (74175) |
$837.75 |
$3,351 |
3.8× |
| CTA pelvis (72191) |
$698.25 |
$2,793 |
3.2× |
| Dilation ureters/urethra rs&i (74485) |
$495.50 |
$1,982 |
0.2× |
| Discography Cerv/Thor Spine (72285) |
$474 |
$1,896 |
0.2× |
| Diskography lumbar (72295) |
$686.75 |
$2,747 |
0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$320 |
$1,280 |
2.5× |
| Dxa Bone Density Axial (77080) |
$127.25 |
$509 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$128 |
$512 |
1.2× |
| Echo exam uterus (76831) |
$202.75 |
$811 |
0.7× |
| Esophagram (74220) |
$349.75 |
$1,399 |
1.6× |
| Fetal Biophys Profile W/Nst (76818) |
$157.50 |
$630 |
1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$122.50 |
$490 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$480.50 |
$1,922 |
1.6× |
| Follow-Up Angiography (75898) |
$2,170.50 |
$8,682 |
0.6× |
| Foot 2 views (73620) |
$43.75 |
$175 |
0.4× |
| Forearm 2 views (73090) |
$54.50 |
$218 |
0.5× |
| Gastric emptying imaging study (78264) |
$372.75 |
$1,491 |
0.7× |
| Gastroesophageal Reflux Exam (78262) |
$266.50 |
$1,066 |
0.5× |
| Gated Heart Planar Single (78472) |
$728.25 |
$2,913 |
1.5× |
| Gated Heart, Multiple (78473) |
$837.50 |
$3,350 |
1.7× |
| Hand 2 views (73120) |
$21.50 |
$86 |
0.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,339.50 |
$13,358 |
3.8× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,903.75 |
$11,615 |
3.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,525 |
$10,100 |
2.9× |
| Heart Image (Pet) Multiple (78492) |
$1,470 |
$5,880 |
0.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,857.25 |
$7,429 |
0.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,465.50 |
$5,862 |
0.4× |
| Hepatobil Syst Image W/Drug (78227) |
$527.25 |
$2,109 |
0.8× |
| Hepatobiliary System Imaging (78226) |
$479 |
$1,916 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,438.50 |
$5,754 |
0.9× |
| Hysterosalpingogram (74740) |
$568.50 |
$2,274 |
1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$176.25 |
$705 |
1.6× |
| Infant hip ultrasound, limited static exam (76886) |
$176.25 |
$705 |
1.6× |
| Infusion Ivp (74410) |
$436.50 |
$1,746 |
2.0× |
| Interstitial radiation source applic complex (77778) |
$3,991.25 |
$15,965 |
4.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,857 |
$15,428 |
4.4× |
| K Flow/Funct Image W/Drug (78708) |
$774.50 |
$3,098 |
1.1× |
| K Flow/Funct Image W/O Drug (78707) |
$774.50 |
$3,098 |
1.1× |
| Kidney Imaging Morphol (78700) |
$774.50 |
$3,098 |
1.6× |
| Knee 3 Views (73562) |
$68.75 |
$275 |
0.6× |
| Leveen/Shunt Patency Exam (78291) |
$456 |
$1,824 |
0.9× |
| Liver & Spleen Imaging Static Only (78215) |
$466.25 |
$1,865 |
0.9× |
| Liver imaging static only (78201) |
$231.75 |
$927 |
0.3× |
| Liver imaging w/vascular flow (78202) |
$231.75 |
$927 |
0.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$474 |
$1,896 |
0.7× |
| Lung Ventilat&Perfus Imaging (78582) |
$297 |
$1,188 |
0.4× |
| Lung Ventilation Imaging (78579) |
$282.50 |
$1,130 |
0.6× |
| Lymph System Imaging (78195) |
$466.25 |
$1,865 |
0.7× |
| Magnetic Image Jaw Joint (70336) |
$890 |
$3,560 |
3.0× |
| Mammary ductogram or galactogram multiple (77054) |
$265.50 |
$1,062 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$245 |
$980 |
0.8× |
| Meckels Divert Exam (78290) |
$341 |
$1,364 |
0.7× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$67.50 |
$270 |
0.1× |
| Mlc imrt design & construction per imrt plan (77338) |
$540.50 |
$2,162 |
1.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,260.75 |
$5,043 |
2.9× |
| MRA head w/o contrast (70544) |
$813.25 |
$3,253 |
2.7× |
| MRA head with contrast (70545) |
$1,055.75 |
$4,223 |
2.4× |
| MRA neck w contrast (70548) |
$1,057.25 |
$4,229 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,260.75 |
$5,043 |
2.9× |
| MRA neck w/o contrast (70547) |
$813.25 |
$3,253 |
2.7× |
| MRI abdomen w contrast (74182) |
$1,157 |
$4,628 |
2.7× |
| MRI abdomen w/o contrast (74181) |
$890 |
$3,560 |
3.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,157 |
$4,628 |
1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,379.75 |
$5,519 |
3.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,157 |
$4,628 |
1.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,720.25 |
$6,881 |
5.8× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,720.25 |
$6,881 |
5.8× |
| MRI cervical spine w contrast (72142) |
$1,057.25 |
$4,229 |
2.4× |
| MRI cervical spine w/o cont (72141) |
$813.25 |
$3,253 |
2.7× |
| MRI chest w/o contrast (71550) |
$890 |
$3,560 |
3.0× |
| MRI chest with contrast (71551) |
$942.50 |
$3,770 |
1.0× |
| MRI chest wo w contrast (71552) |
$1,379.75 |
$5,519 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,157 |
$4,628 |
2.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,379.75 |
$5,519 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$890 |
$3,560 |
3.0× |
| MRI lumbar spine w contrast (72149) |
$1,157 |
$4,628 |
2.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,260.75 |
$5,043 |
2.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,240.25 |
$4,961 |
4.2× |
| MRI orbit face neck w contrast (70542) |
$1,343.50 |
$5,374 |
3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,378 |
$5,512 |
3.2× |
| MRI pelvis w contrast (72196) |
$1,772 |
$7,088 |
4.1× |
| MRI pelvis w/o & w contrast (72197) |
$1,809.50 |
$7,238 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,734.25 |
$6,937 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$890 |
$3,560 |
3.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,102.25 |
$4,409 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$890 |
$3,560 |
3.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,379.75 |
$5,519 |
3.2× |
| MRI, abdomen, combo (74183) |
$1,288 |
$5,152 |
3.0× |
| MRI, dorsal spine combo (72157) |
$1,379.75 |
$5,519 |
3.2× |
| MRI, dorsal spine contrast (72147) |
$1,112.50 |
$4,450 |
2.6× |
| MRI, joint upper extrem (73221) |
$890 |
$3,560 |
3.0× |
| MRI, joint upper extrem combo (73223) |
$1,379.75 |
$5,519 |
3.2× |
| MRI, lumbar spine combo (72158) |
$1,379.75 |
$5,519 |
3.2× |
| Myelogram cervical (72240) |
$826 |
$3,304 |
0.8× |
| Myelogram Lumbar (72265) |
$783 |
$3,132 |
0.8× |
| Myelography thoracic (72255) |
$783 |
$3,132 |
0.8× |
| Myelograpy 2/more regions rs&i (72270) |
$960.50 |
$3,842 |
1.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$740.50 |
$2,962 |
0.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,438.50 |
$5,754 |
0.9× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$1,235 |
$4,940 |
0.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,470 |
$5,880 |
0.8× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$1,470 |
$5,880 |
0.5× |
| Neck soft tissue (70360) |
$234.50 |
$938 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$3,605.25 |
$14,421 |
7.5× |
| Nm csf leak detection (78650) |
$732.75 |
$2,931 |
0.5× |
| Nonvascular Shunt X-Ray (75809) |
$242.50 |
$970 |
1.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,757.25 |
$15,029 |
2.2× |
| Nuclear Rx Intra-Arterial (79445) |
$166 |
$664 |
0.6× |
| Nuclear Rx Oral Admin (79005) |
$831.25 |
$3,325 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$146.50 |
$586 |
1.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$570 |
$2,280 |
0.8× |
| Parathyroid Planar Imaging (78070) |
$386.25 |
$1,545 |
0.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$498.75 |
$1,995 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$31.50 |
$126 |
0.2× |
| Peritoneogram Rs&I (74190) |
$318.25 |
$1,273 |
0.5× |
| Pet Image Skull-Thigh (78812) |
$1,730.25 |
$6,921 |
1.0× |
| Pet Image W/Ct Lmtd (78814) |
$2,042.50 |
$8,170 |
1.1× |
| PET image w/CT, full body (78816) |
$2,042.50 |
$8,170 |
1.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,042.50 |
$8,170 |
1.1× |
| Pet Myocardial Sngl Study (78491) |
$1,470 |
$5,880 |
0.8× |
| PET whole body (78813) |
$1,730.25 |
$6,921 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,768.50 |
$7,074 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$297 |
$1,188 |
0.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$384.75 |
$1,539 |
2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$346.75 |
$1,387 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$49.50 |
$198 |
0.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$50 |
$200 |
0.5× |
| Radex elbow complete minimum 3 views (73080) |
$62.50 |
$250 |
0.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$122.25 |
$489 |
0.9× |
| Radex fingr minimum 2 views (73140) |
$41.75 |
$167 |
0.4× |
| Radex foot complete minimum 3 views (73630) |
$47.75 |
$191 |
0.4× |
| Radex Hand Minimum 3 Views (73130) |
$51.50 |
$206 |
0.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$43.75 |
$175 |
0.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$93.25 |
$373 |
0.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$58.25 |
$233 |
0.5× |
| Radex shoulder complete minimum 2 views (73030) |
$75.75 |
$303 |
0.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$31.50 |
$126 |
0.3× |
| Radex Spine 1 View Specify Level (72020) |
$44.25 |
$177 |
0.4× |
| Radex Sternum Minimum 2 Views (71120) |
$54.50 |
$218 |
0.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$241.75 |
$967 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$41.75 |
$167 |
0.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$62.50 |
$250 |
0.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$50 |
$200 |
0.5× |
Radiation Delivery Stereotactic Cranial Linear (77372)
unusually low: confirm this is the full procedure |
$3,795.25 |
$15,181 |
0.4× |
| Radiation treatment delivery level 1 (77402) |
$347 |
$1,388 |
2.7× |
| Radiation treatment delivery level 2 (77407) |
$349 |
$1,396 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$639.75 |
$2,559 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$88.75 |
$355 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$429.75 |
$1,719 |
3.3× |
| Radiologic exam colon double contrast study (74280) |
$593.25 |
$2,373 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$510.50 |
$2,042 |
2.3× |
| Radiologic exam knee complete 4/more views (73564) |
$86.25 |
$345 |
0.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$83.75 |
$335 |
0.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$484.25 |
$1,937 |
2.2× |
| Radiologic exam swallow function contrast study (74230) |
$533.25 |
$2,133 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$573.25 |
$2,293 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$74.25 |
$297 |
0.7× |
| Radiologic examination knee 1/2 views (73560) |
$60.25 |
$241 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$54.50 |
$218 |
0.5× |
| Radiopharm Dacryocystography (78660) |
$96.25 |
$385 |
0.2× |
| Renal Cyst Study (74470) |
$519.50 |
$2,078 |
0.8× |
| Ribs bilateral 3 views (71110) |
$107.25 |
$429 |
0.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$860.75 |
$3,443 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$860.75 |
$3,443 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$860.75 |
$3,443 |
1.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$860.75 |
$3,443 |
1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$860.75 |
$3,443 |
0.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$564.75 |
$2,259 |
1.9× |
| Rp Therapy Intravenous Administration (79101) |
$410 |
$1,640 |
1.4× |
| Salivary Gland Imaging (78230) |
$139.75 |
$559 |
0.3× |
| Salivary Gland Imaging Serial Images (78231) |
$139.75 |
$559 |
0.3× |
| Scapula (73010) |
$64.75 |
$259 |
0.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30.75 |
$123 |
1.3× |
| Shoulder 1 view (73020) |
$34.50 |
$138 |
0.3× |
| Shoulder Arthrography (73040) |
$383.75 |
$1,535 |
0.9× |
| Skull less than 4 views (70250) |
$65 |
$260 |
0.5× |
| Special dosimetry (77331) |
$285.25 |
$1,141 |
1.7× |
| Special Physics Consult (77370) |
$358.75 |
$1,435 |
2.1× |
| Special teletherapy port plan (77321) |
$515.25 |
$2,061 |
1.1× |
| Special treatment procedure (77470) |
$1,149.50 |
$4,598 |
1.7× |
| Speech evaluation, complex (70371) |
$732.50 |
$2,930 |
2.5× |
| Stereotactic Body Radiation Delivery (77373) |
$3,400.25 |
$13,601 |
1.5× |
| Sternoclavicular joints (71130) |
$74 |
$296 |
0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$534.75 |
$2,139 |
1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$333.75 |
$1,335 |
0.7× |
| Testicular Imaging W/Flow (78761) |
$319.75 |
$1,279 |
0.6× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$886 |
$3,544 |
1.9× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$574.50 |
$2,298 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$431.25 |
$1,725 |
2.6× |
| Thoracic spine 2 views (72070) |
$88.75 |
$355 |
0.7× |
| Thoracic spine 3 views (72072) |
$100.50 |
$402 |
0.8× |
| Thyroid Met Imaging Body (78018) |
$405.75 |
$1,623 |
0.6× |
| Thyroid Uptake Measurement (78012) |
$254.50 |
$1,018 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$267.50 |
$1,070 |
0.5× |
| Tx Devices Design & Construction Complex (77334) |
$478.50 |
$1,914 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$284.75 |
$1,139 |
1.7× |
| Tx devices design & construction simple (77332) |
$233.75 |
$935 |
1.4× |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
$222.50–$460 |
$890–$1,840 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$84 |
$336 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$335.25 |
$1,341 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$320 |
$1,280 |
2.5× |
Unlisted Dx Radiographic Procedure (76499)
range across 3 matching MRF lines |
$58–$524.75 |
$232–$2,099 |
varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$209.75 |
$839 |
0.4× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$179.75 |
$719 |
0.4× |
| Unlisted us procedure (76999) |
$133.50 |
$534 |
1.2× |
| Upper gi w/o kub (74240) |
$489.50 |
$1,958 |
2.2× |
| Ureteral Reflux Study (78740) |
$376.25 |
$1,505 |
0.8× |
| Urethrocystogram voiding (74455) |
$473 |
$1,892 |
1.6× |
| Urethrocystography retrograde (74450) |
$551.25 |
$2,205 |
1.9× |
| Us breast unilateral complete (76641) |
$222.50 |
$890 |
1.7× |
| Us chest (76604) |
$126.50 |
$506 |
1.0× |
| Us complete joint (76881) |
$191.50 |
$766 |
1.5× |
| Us exam, pelvic, limited (76857) |
$170.25 |
$681 |
1.3× |
| Us head (76506) |
$141.50 |
$566 |
1.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$191.50 |
$766 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$293.50 |
$1,174 |
2.2× |
| Us ob transvaginal (76817) |
$223.50 |
$894 |
1.7× |
| Us pelvic non ob complete (76856) |
$202.75 |
$811 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$183.75 |
$735 |
1.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$279 |
$1,116 |
2.1× |
| Us retroperitoneal complete (76770) |
$214.75 |
$859 |
1.6× |
| Us retroperitoneal limited (76775) |
$183.75 |
$735 |
1.4× |
| Us scrotum and contents (76870) |
$207 |
$828 |
1.6× |
| Us spinal canal and contents (76800) |
$176.25 |
$705 |
1.4× |
| Us thyroid (76536) |
$202.75 |
$811 |
1.6× |
| Us transrectal (76872) |
$155 |
$620 |
1.2× |
| Vascular Flow Imaging (78445) |
$183 |
$732 |
0.4× |
| Vein X-Ray Chest (75827) |
$1,465.50 |
$5,862 |
0.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,465.50 |
$5,862 |
0.4× |
| Vein X-Ray Spleen/Liver (75810) |
$1,311 |
$5,244 |
0.3× |
| Venogram Sinus/Jugular (75860) |
$1,396 |
$5,584 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,465.50 |
$5,862 |
0.4× |
| Venography extremity bilateral rs&i (75822) |
$995 |
$3,980 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$772.25 |
$3,089 |
0.4× |
| Venography Renal Bilateral (75833) |
$1,473.50 |
$5,894 |
0.4× |
| Venography Renal Unilateral (75831) |
$1,396 |
$5,584 |
0.4× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,396 |
$5,584 |
0.2× |
| Wrist 2 views (73100) |
$23.50 |
$94 |
0.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$80.25 |
$321 |
0.7× |
| X-ray antegrade pyelogram tube (74425) |
$917.50 |
$3,670 |
2.1× |
| X-Ray Aorta Leg Arteries (75630) |
$2,484 |
$9,936 |
0.6× |
| X-Ray Bend Only L-S Spine (72120) |
$70.25 |
$281 |
0.5× |
| X-Ray Exam Breast Specimen (76098) |
$54 |
$216 |
0.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$173.50 |
$694 |
1.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$173.50 |
$694 |
1.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$181.75 |
$727 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$181.69 |
$726.75 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$104.25 |
$417 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$161.50 |
$646 |
1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$291.75 |
$1,167 |
2.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$67 |
$268 |
0.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$87 |
$348 |
0.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$114.75 |
$459 |
0.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$195.50 |
$782 |
1.5× |
| X-ray eye for foreign body (70030) |
$377.25 |
$1,509 |
3.5× |
| X-ray humerus (73060) |
$58.25 |
$233 |
0.5× |
| X-ray IV pyelogram (ivp) (74400) |
$508.50 |
$2,034 |
2.3× |
| X-ray IV pyelogram+tomography (74415) |
$555.50 |
$2,222 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$50 |
$200 |
0.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$59.50 |
$238 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$47.75 |
$191 |
0.4× |
| X-ray nose-rectum child f.b. (76010) |
$64.25 |
$257 |
0.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$123 |
$492 |
0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$78.25 |
$313 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$82 |
$328 |
0.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$122.25 |
$489 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$127.25 |
$509 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$578.50 |
$2,314 |
1.3× |
| X-Rays Bone Length Studies (77073) |
$94.50 |
$378 |
0.7× |
| X-Rays Bone Survey Complete (77075) |
$133 |
$532 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$99.75 |
$399 |
0.8× |
| Xr facial bones less than 3 views (70140) |
$24.25 |
$97 |
0.2× |
| Xr orbits complete 4 views (70200) |
$122.25 |
$489 |
0.9× |
| Xr Tomogram Single Plane (76100) |
$644.50 |
$2,578 |
4.9× |