| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,305.71 |
$3,605 |
0.9× |
| Abdomen 2 views (74019) |
$103.60 |
$287 |
1.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$388.66 |
$2,355 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,003.66 |
$4,131 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,003.66 |
$3,690 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$3,003.66 |
$3,914 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,178.43 |
$6,274 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,003.66 |
$4,954 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,003.66 |
$4,131 |
0.9× |
| Angiography Spinal Selective Rs&I (75705) |
$5,178.43 |
$6,274 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,178.43 |
$6,274 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,446 |
$1,446 |
0.5× |
| Ankle 2 views (73600) |
$85.63 |
$288 |
1.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$362.40 |
$816 |
1.0× |
| Aortogram thoracic (75605) |
$5,178.43 |
$6,274 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,003.66 |
$4,131 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$3,003.66 |
$3,690 |
0.9× |
| Arthrogram elbow (73085) |
$362.40 |
$1,115 |
1.0× |
| Arthrogram shoulder (73040) |
$362.40 |
$1,134 |
1.0× |
| Arthrogram wrist (73115) |
$362.40 |
$909 |
1.0× |
| Arthrography knee lt (73580) |
$362.40 |
$1,290 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$127.86 |
$439 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$388.66 |
$1,096 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$388.66 |
$1,266 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$388.66 |
$1,452 |
1.0× |
| Bone age studies (77072) |
$103.60 |
$216 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$388.66 |
$1,548 |
1.0× |
| Bone survey complete (77075) |
$103.60 |
$441 |
1.0× |
| Brachytx isodose complex (77318) |
$348.18 |
$1,041 |
0.9× |
| Brachytx isodose intermed (77317) |
$348.18 |
$809 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$348.18 |
$540 |
0.9× |
| Brain image w/flow 4 + views (78606) |
$509.34 |
$1,394 |
0.9× |
| Brain imaging < 4 static views w vascular flow (78601) |
$388.66 |
$1,053 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$509.34 |
$1,218 |
0.9× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$279 |
$279 |
25.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$362.40 |
$3,429 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$509.34 |
$1,240 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$85.63 |
$467 |
1.0× |
| Chest 1 view (71045) |
$85.63 |
$251 |
1.0× |
| Chest 3 views (71047) |
$85.63 |
$429 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$173.14 |
$663 |
1.0× |
| Clavicle complete (73000) |
$85.63 |
$348 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$103.60 |
$122 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$127.86 |
$599 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$362.40 |
$6,226 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$230.91 |
$4,511 |
1.0× |
| CT abdomen w contrast (74160) |
$173.14 |
$2,876 |
1.0× |
| CT abdomen w wo contrast (74170) |
$173.14 |
$3,447 |
1.0× |
| CT abdomen w/o contrast (74150) |
$103.60 |
$2,498 |
1.0× |
| CT angio hrt w/3d image (75574) |
$173.14 |
$323 |
0.5× |
| CT angiography upper extremity lt (73206) |
$173.14 |
$2,741 |
1.0× |
| CT c-spine w/o contrast (72125) |
$103.60 |
$2,407 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$173.14 |
$3,324 |
1.0× |
| CT cervical spine with contrast (72126) |
$362.40 |
$2,765 |
1.0× |
| CT chest w/wo contrast (71270) |
$173.14 |
$2,669 |
1.0× |
| CT chest with contrast (71260) |
$173.14 |
$2,221 |
1.0× |
| CT colonography screening (74263) |
$702 |
$702 |
2.9× |
| CT colonography w/dye (74262) |
$173.14 |
$403 |
1.0× |
| CT colonography w/o cntrst (74261) |
$103.60 |
$355 |
1.0× |
| CT head/brain with contrast (70460) |
$173.14 |
$2,137 |
1.0× |
| CT head/brain without and with contrast (70470) |
$173.14 |
$2,565 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$173.14 |
$323 |
0.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$85.63 |
$113 |
1.0× |
| CT hrt w/3d image congen (75573) |
$173.14 |
$323 |
0.5× |
| CT iac w contrast (70481) |
$173.14 |
$2,325 |
1.0× |
| CT limited/localized follow up study (76380) |
$85.63 |
$556 |
1.0× |
| CT lower ext w/o (73700) |
$103.60 |
$1,498 |
1.0× |
| CT lower extremity w wo contrast (73702) |
$173.14 |
$2,070 |
1.0× |
| CT lower extremity with contrast (73701) |
$173.14 |
$1,724 |
1.0× |
| CT lumbar spine w & w/o contrast (72133) |
$173.14 |
$3,324 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$103.60 |
$2,407 |
1.0× |
| CT lumbar spine with contrast (72132) |
$362.40 |
$2,765 |
1.0× |
| CT maxillofacial w contrast (70487) |
$173.14 |
$2,261 |
1.0× |
| CT maxillofacial w/o contrast (70486) |
$103.60 |
$1,965 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$173.14 |
$2,711 |
1.0× |
| CT neck soft tissue w contrast (70491) |
$173.14 |
$2,325 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$173.14 |
$2,787 |
1.0× |
| CT orbits w/o contrast (70480) |
$103.60 |
$2,020 |
1.0× |
| CT pelvis w & w/o contrast (72194) |
$173.14 |
$2,779 |
1.0× |
| CT pelvis w/o contrast (72192) |
$103.60 |
$2,013 |
1.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$173.14 |
$2,787 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$103.60 |
$2,020 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$173.14 |
$2,765 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$103.60 |
$2,407 |
1.0× |
| CT thoracic spine w/wo contrast (72130) |
$173.14 |
$3,324 |
1.0× |
| CT thorax w/o contrast (71250) |
$103.60 |
$1,932 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$173.14 |
$2,039 |
1.0× |
| CT upper extremity w/o contrast rt (73200) |
$103.60 |
$1,476 |
1.0× |
| CT upper extremity with contrast (73201) |
$362.40 |
$1,698 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$173.14 |
$7,230 |
1.0× |
| Cta Abdomen (74175) |
$173.14 |
$846 |
1.0× |
| CTA abdomen pelvis (74174) |
$362.40 |
$871 |
1.0× |
| CTA chest (71275) |
$173.14 |
$3,468 |
1.0× |
| Cta Head (70496) |
$173.14 |
$3,302 |
1.0× |
| CTA lwr ext w&w/o contrast (73706) |
$173.14 |
$2,785 |
1.0× |
| Cta Neck (70498) |
$173.14 |
$3,522 |
1.0× |
| Cta Pelvis (72191) |
$173.14 |
$3,743 |
1.0× |
| Cystography minimum 3 views rs&i (74430) |
$362.40 |
$666 |
1.0× |
| Dacryocystography (70170) |
$230.91 |
$472 |
1.0× |
| Diskography lumbar (72295) |
$1,819.43 |
$2,042 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$103.60 |
$166 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$103.60 |
$619 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$103.60 |
$746 |
1.0× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$103.60 |
$200 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$103.60 |
$564 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$66 |
$66 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$103.60 |
$140 |
1.0× |
| Echo exam of fetal heart (76825) |
$518 |
$518 |
0.9× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$230.91 |
$581 |
1.0× |
| Echoencephalography real time imaging (76506) |
$103.60 |
$718 |
1.0× |
| Esophageal motility (78258) |
$388.66 |
$1,960 |
1.0× |
| Esophagus (74220) |
$173.14 |
$545 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$103.60 |
$766 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$103.60 |
$228 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$230.91 |
$328 |
1.0× |
| Foot 2 views (73620) |
$85.63 |
$299 |
1.0× |
| Forearm 2 views (73090) |
$85.63 |
$281 |
1.0× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$230.91 |
$342 |
1.0× |
| Gated Heart Planar Single (78472) |
$388.66 |
$1,461 |
1.0× |
| Hand 2 views (73120) |
$103.60 |
$264 |
1.0× |
| Hand 3 views (73130) |
$85.63 |
$292 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$675.63 |
$1,050 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$675.63 |
$1,050 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$675.63 |
$1,050 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,003.66 |
$3,441 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$509.34 |
$2,007 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$388.66 |
$2,007 |
1.0× |
| Ht muscle image spect sing (78451) |
$1,338.07 |
$2,271 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$85.63 |
$325 |
1.0× |
| Hysterosalpingogram (74740) |
$230.91 |
$849 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$554.71 |
$891 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$554.71 |
$884 |
1.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$103.60 |
$202 |
1.0× |
| Kidney funcj study non-img radioisotopic study (78725) |
$388.66 |
$1,042 |
1.0× |
| Kidney imaging morphology (78700) |
$388.66 |
$926 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$509.34 |
$1,450 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$484 |
$484 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$509.34 |
$1,852 |
0.9× |
| Knee 3 views (73562) |
$85.63 |
$350 |
1.0× |
| Liver & spleen imaging static only (78215) |
$388.66 |
$2,138 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$388.66 |
$2,495 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$509.34 |
$1,769 |
0.9× |
| Lung perf&ventilat diferentl (78598) |
$509.34 |
$836 |
0.9× |
| Lung Ventilation Imaging (78579) |
$388.66 |
$654 |
1.0× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$3,003.66 |
$3,473 |
0.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$591.98 |
$1,613 |
0.9× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$1,509.18 |
$1,945 |
1.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,006 |
$1,006 |
0.3× |
| Lymphoscintigraphy (78195) |
$509.34 |
$2,153 |
0.9× |
| Mammary ductogram or galactogram multiple (77054) |
$230.91 |
$724 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$230.91 |
$613 |
1.0× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$85.63 |
$113 |
1.0× |
| Meckels Diverticulum (78290) |
$388.66 |
$1,788 |
1.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$191 |
$191 |
0.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$348.18 |
$395 |
0.9× |
| Mr elastography (76391) |
$230.91 |
$353 |
1.0× |
| MRA head w & w/o contrast (70546) |
$362.40 |
$4,928 |
1.0× |
| MRA head w/o contrast (70544) |
$230.91 |
$3,493 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$362.40 |
$4,928 |
1.0× |
| MRA neck w/o contrast (70547) |
$230.91 |
$3,493 |
1.0× |
| MRI abdomen w contrast (74182) |
$362.40 |
$5,387 |
1.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$362.40 |
$6,466 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$230.91 |
$2,543 |
1.0× |
| MRI any jnt lwr ext with con lt (73722) |
$701 |
$701 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$754.50 |
$3,462 |
1.0× |
| MRI bone marrow blood supply (77084) |
$230.91 |
$3,030 |
1.0× |
| MRI c-spine with contrast (72142) |
$362.40 |
$4,729 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$230.91 |
$3,371 |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$230.91 |
$2,256.50 |
1.0× |
| MRI chest w/o & w/contrast material (71552) |
$362.40 |
$5,751 |
1.0× |
| MRI chest w/o contrast (71550) |
$230.91 |
$2,284.50 |
1.0× |
| MRI chest with contrast (71551) |
$754.50 |
$4,792 |
1.0× |
| MRI fetal sngl/1st gestation (74712) |
$230.91 |
$402 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$362.40 |
$3,086 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$362.40 |
$3,604 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$230.91 |
$3,132 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$230.91 |
$4,313 |
1.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$362.40 |
$5,709 |
1.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$362.40 |
$5,804 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$230.91 |
$2,303.50 |
1.0× |
| MRI scan of arm joint before and after contrast (73223) |
$362.40 |
$4,157 |
1.0× |
| MRI scan of leg joint before and after contrast (73723) |
$362.40 |
$885 |
1.0× |
| MRI spectroscopy (76390) |
$85.63 |
$1,581 |
1.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$362.40 |
$5,674 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$362.40 |
$4,898 |
1.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$362.40 |
$5,879 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$362.40 |
$5,156 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$362.40 |
$6,187 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$230.91 |
$4,483 |
1.0× |
| MRI tmj (70336) |
$230.91 |
$5,730 |
1.0× |
| MRI upper ext joint w/o contrast (73221) |
$230.91 |
$3,009 |
1.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$362.40 |
$3,702 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$230.91 |
$1,512.50 |
1.0× |
| Myelogram Cervical (72240) |
$754.50 |
$1,375 |
1.0× |
| Myelogram Lumbar (72265) |
$754.50 |
$1,348 |
1.0× |
| Myelogram thoracic (72255) |
$754.50 |
$1,278 |
1.0× |
| Myelography 2 or more regions (72270) |
$754.50 |
$1,810 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,338.07 |
$3,479 |
1.0× |
| Neck soft tissue (70360) |
$85.63 |
$348 |
1.0× |
| Nm adrenal scan (78075) |
$1,338.07 |
$1,769 |
1.0× |
| Nm bone marrow wb (78104) |
$388.66 |
$2,333 |
1.0× |
| Nm cisternogram (78630) |
$509.34 |
$1,579 |
0.9× |
| Nm csf leak detection (78650) |
$1,338.07 |
$1,736 |
1.0× |
| Nm gastric emptying study (78264) |
$388.66 |
$2,075 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$388.66 |
$2,021 |
1.0× |
| Nm peritoneal-venous shunt patency (78291) |
$388.66 |
$1,555 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,305.71 |
$3,940 |
0.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,338.07 |
$1,434 |
1.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$388.66 |
$555 |
1.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$388.66 |
$489 |
1.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$388.66 |
$1,418 |
1.0× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$509.34 |
$1,769 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$234.44 |
$919 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$103.60 |
$471 |
1.0× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$103.60 |
$238 |
1.0× |
| Orthopantogram (70355) |
$85.63 |
$331 |
1.0× |
| Osseous survey limited (77074) |
$103.60 |
$331 |
1.0× |
| Parathyrd planar w/spect&CT (78072) |
$509.34 |
$725 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$388.66 |
$725 |
1.0× |
| Parathyroid imaging (78070) |
$388.66 |
$725 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$103.60 |
$226 |
1.0× |
| Perineogram (74775) |
$230.91 |
$1,012 |
1.0× |
| Peritoneogram rs&i (74190) |
$519.86 |
$716 |
0.9× |
| PET image w/CT, skull-thigh (78815) |
$1,474.23 |
$1,888 |
1.0× |
| PET imaging CT for attenuation limited area (78814) |
$1,474.23 |
$1,888 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$1,474.23 |
$1,888 |
1.0× |
| Pr csf ventriculography (78635) |
$509.34 |
$1,240 |
0.9× |
| Pr gi endoscopic ultrasound (76975) |
$230.91 |
$1,078 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$362.40 |
$4,323 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,003.66 |
$3,570 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,446 |
$1,446 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$388.66 |
$992 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$509.34 |
$1,935 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$379 |
$379 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$85.63 |
$89 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$103.60 |
$148 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$103.60 |
$148 |
1.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$103.60 |
$475 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$103.60 |
$282 |
1.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,338.17 |
$11,130 |
1.0× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$253.25 |
$649 |
0.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$113 |
$395 |
1.1× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$253.25 |
$512 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$103.60 |
$424 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$85.63 |
$229 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$103.60 |
$319 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$85.63 |
$292 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$173.14 |
$856 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$173.14 |
$268 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$173.14 |
$783 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$173.14 |
$731 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$85.63 |
$89 |
1.0× |
| Radiological examination surgical specimen (76098) |
$519.86 |
$625 |
0.9× |
| Review by radiologist of adrenal gland vein image (75840) |
$3,003.66 |
$3,667 |
0.9× |
| Ribs bilateral 3 views (71110) |
$103.60 |
$404 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$388.66 |
$1,379 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,338.07 |
$1,741 |
2.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,338.07 |
$1,980 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,338.07 |
$1,664 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,474.23 |
$1,980 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,196 |
$1,196 |
0.9× |
| Rp Therapy Intravenous Administration (79101) |
$234.44 |
$690 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$103.60 |
$168 |
1.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$230.91 |
$953 |
1.0× |
| Salivary gland imaging serial images (78231) |
$388.66 |
$1,367 |
1.0× |
| Scanogram (77073) |
$103.60 |
$253 |
1.0× |
| Scapula complete (73010) |
$103.60 |
$364 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$23.36 |
$39 |
1.0× |
| Sella turcica (70240) |
$85.63 |
$310 |
1.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$103.60 |
$564 |
1.0× |
| Sialogram (70390) |
$230.91 |
$920 |
1.0× |
| Simulation intermediate (77285) |
$348.18 |
$2,237 |
0.9× |
| Small bowel series (74250) |
$173.14 |
$608 |
1.0× |
| Spec medical radj physics consltj (77370) |
$127.86 |
$934 |
0.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$348.18 |
$1,064 |
0.9× |
| Special dosimetry (77331) |
$127.86 |
$194 |
0.9× |
| Special treatment procedure (77470) |
$554.71 |
$694 |
1.0× |
| Spine thoracic 3 views (72072) |
$103.60 |
$483 |
1.0× |
| Spleen imaging only (78185) |
$388.66 |
$979 |
1.0× |
| Splenoportograpy rs&i (75810) |
$3,003.66 |
$3,310 |
0.9× |
| Stereotactic body radiation delivery (77373) |
$1,681.45 |
$2,399 |
0.9× |
| Superior sagittal sinus venogram (75870) |
$901 |
$901 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$348.18 |
$621 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$348.18 |
$606 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$230.91 |
$1,134 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$388.66 |
$1,108 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$348.18 |
$2,865 |
0.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$127.86 |
$1,524 |
0.9× |
| Thoracolumbar 2 views (72080) |
$85.63 |
$470 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$509.34 |
$2,612 |
0.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$388.66 |
$725 |
1.0× |
| Thyroid uptake measurement (78012) |
$388.66 |
$461 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$388.66 |
$653 |
1.0× |
| Treatment device intermediate (77333) |
$127.86 |
$479 |
0.9× |
| Treatment devices simple (77332) |
$127.86 |
$408 |
0.9× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,338.07 |
$1,752 |
2.5× |
| Tx devices design & construction complex (77334) |
$348.18 |
$1,017 |
0.9× |
| Ultrasound scan of cornea to determine thickness (76514) |
$3.70 |
$14.65 |
0.1× |
| Ultrasound scan to determine eye length and lens power (76519) |
$37.12 |
$81.87 |
0.4× |
| Ultrasound, abdomen limited (76705) |
$103.60 |
$618 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$103.60 |
$576 |
1.0× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$388.66 |
$408 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$85.63 |
$91 |
1.0× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$367 |
$367 |
0.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$113 |
$811 |
1.1× |
| Upper Extremity Infant (73092) |
$103.60 |
$297 |
1.0× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$186.20 |
$278 |
2.0× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$388.66 |
$830 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$230.91 |
$885 |
1.0× |
| Urethrocystography voiding (74455) |
$230.91 |
$970 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$173.14 |
$981 |
1.0× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$173.14 |
$776 |
1.0× |
| Us abdl aorta screen aaa (76706) |
$103.60 |
$163 |
1.0× |
| Us breast unilateral complete (76641) |
$103.60 |
$614 |
1.0× |
| Us breast unilateral limited (76642) |
$85.63 |
$135 |
1.0× |
| Us chest (76604) |
$30.30 |
$43 |
0.3× |
| Us compl joint r-t w/image documentation (76881) |
$103.60 |
$153 |
1.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$103.60 |
$160 |
1.0× |
| Us guided compression repair (76936) |
$295.78 |
$366 |
1.4× |
| Us infant hips limited static (76886) |
$85.63 |
$600 |
1.0× |
| Us kidney transplant (76776) |
$103.60 |
$854 |
1.0× |
| Us ob detailed single fetus (76811) |
$230.91 |
$919 |
1.0× |
| Us ob transvaginal (76817) |
$103.60 |
$723 |
1.0× |
| Us pelvic non ob complete (76856) |
$103.60 |
$721 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$103.60 |
$660 |
1.0× |
| Us pregnancy ltd (76815) |
$103.60 |
$535 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$103.60 |
$774 |
1.0× |
| Us retroperitoneal complete (76770) |
$103.60 |
$787 |
1.0× |
| Us retroperitoneal limited (76775) |
$103.60 |
$198 |
1.0× |
| Us scrotum and contents (76870) |
$103.60 |
$618 |
1.0× |
| Us soft tissue head/neck (76536) |
$103.60 |
$655 |
1.0× |
| Us spinal canal and contents (76800) |
$103.60 |
$898 |
1.0× |
| Us transrectal (76872) |
$103.60 |
$882 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$103.60 |
$168 |
1.0× |
| Us, eye b-scan (76512) |
$17.33 |
$54 |
0.2× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$253.25 |
$1,040 |
0.7× |
| Vascular flow imaging (78445) |
$388.66 |
$1,091 |
1.0× |
| Venogram extremity bilateral (75822) |
$1,446 |
$1,446 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,003.66 |
$3,309 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,509.18 |
$3,309 |
1.0× |
| Venography epidural rs&i (75872) |
$591.98 |
$3,460 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,243 |
$1,243 |
0.8× |
| Venography Renal Bilateral (75833) |
$3,003.66 |
$3,853 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$3,003.66 |
$3,223 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,003.66 |
$3,667 |
0.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$5,178.43 |
$6,274 |
0.9× |
| Wrist 2 views (73100) |
$85.63 |
$258 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$103.60 |
$442 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$85.63 |
$348 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$85.63 |
$311 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$173.14 |
$1,123 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$85.63 |
$292 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$85.63 |
$325 |
1.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$103.60 |
$282 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$85.63 |
$91 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$85.63 |
$89 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$103.60 |
$148 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$103.60 |
$282 |
1.0× |
| X-ray exam of femur 1 (73551) |
$85.63 |
$89 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$173.14 |
$711 |
1.0× |
| X-ray eye for foreign body (70030) |
$74 |
$74 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$103.60 |
$446 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$85.63 |
$364 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$85.63 |
$311 |
1.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,719 |
$1,719 |
0.8× |
| X-ray head for orthodontia (70350) |
$85.63 |
$91 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$85.63 |
$267 |
1.0× |
| X-ray IV pyelogram+drip infusn (74410) |
$173.14 |
$1,046 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$103.60 |
$392 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$85.63 |
$295 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$85.63 |
$321 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$103.60 |
$424 |
1.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$103.60 |
$605 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$85.63 |
$281 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$103.60 |
$453 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$103.60 |
$285 |
1.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$362.40 |
$654 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$85.63 |
$333 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$103.60 |
$383 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$103.60 |
$478 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$103.60 |
$282 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$85.63 |
$243 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$85.63 |
$392 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$85.63 |
$504 |
1.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$85.63 |
$310 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$103.60 |
$504 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$103.60 |
$364 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$85.63 |
$326 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$85.63 |
$354 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$85.63 |
$292 |
1.0× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$8.24 |
$107 |
0.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$103.60 |
$448 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$85.63 |
$236 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$85.63 |
$292 |
1.0× |
| Xr arthrogram ankle (73615) |
$362.40 |
$1,070 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$103.60 |
$704 |
1.0× |
| Xr chest 4+ views (71048) |
$103.60 |
$478 |
1.0× |
| Xr Cholecystography Oral Contrast (74290) |
$173.14 |
$441 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$85.63 |
$222 |
1.0× |
| Xr internal auditory meati complete (70134) |
$519.86 |
$549 |
0.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$103.60 |
$251 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$362.40 |
$1,331 |
1.0× |
| Xr optic foramina (70190) |
$85.63 |
$358 |
1.0× |
| Xr shoulder 1 view (73020) |
$85.63 |
$308 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$103.60 |
$595 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$85.63 |
$321 |
1.0× |
| Xr tmj bilateral (70330) |
$85.63 |
$671 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$85.63 |
$295 |
1.0× |