| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,619.64 |
$7,362 |
1.3× |
| Abdomen 2 views (74019) |
$177.32 |
$806 |
1.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$608.74 |
$2,767 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,356.86 |
$10,713 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,356.86 |
$10,713 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,410.42 |
$6,411 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,356.86 |
$10,713 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,356.86 |
$10,713 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,343.54 |
$6,107 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,343.54 |
$6,107 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,356.86 |
$10,713 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$647.68 |
$2,944 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,343.54 |
$6,107 |
0.5× |
| Ankle 2 views (73600) |
$121 |
$550 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$408.10 |
$1,855 |
1.3× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,356.86 |
$10,713 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,356.86 |
$10,713 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,356.86 |
$10,713 |
0.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,356.86 |
$10,713 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$1,914.66 |
$8,703 |
0.7× |
| Arthrogram elbow (73085) |
$450.78 |
$2,049 |
1.4× |
| Arthrogram hip (73525) |
$450.78 |
$2,049 |
1.4× |
| Arthrogram shoulder (73040) |
$450.78 |
$2,049 |
1.4× |
| Arthrogram wrist (73115) |
$450.78 |
$2,049 |
1.4× |
| Basic radiation dosimetry calculation (77300) |
$181.72 |
$826 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$608.74 |
$2,767 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$608.74 |
$2,767 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$625.02 |
$2,841 |
1.7× |
| Bone age studies (77072) |
$211.20 |
$960 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$728.86 |
$3,313 |
2.0× |
| Bone Marrow Imaging Limited Area (78102) |
$609.40 |
$2,770 |
1.6× |
| Bone survey complete (77075) |
$211.20 |
$960 |
2.2× |
| Brachytx isodose complex (77318) |
$416.02 |
$1,891 |
1.2× |
| Brachytx isodose intermed (77317) |
$416.02 |
$1,891 |
1.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$226.60 |
$1,030 |
0.7× |
| Brain image w/flow 4 + views (78606) |
$728.86 |
$3,313 |
1.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$608.74 |
$2,767 |
1.6× |
| Brain Imaging Minimum 4 Static Views (78605) |
$356.84 |
$1,622 |
0.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,150.82 |
$5,231 |
0.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$293.26 |
$1,333 |
0.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,500.40 |
$6,820 |
4.6× |
| Cervical spine 2 or 3 views (72040) |
$121 |
$550 |
1.5× |
| Chest 1 view (71045) |
$96.36 |
$438 |
1.2× |
| Chest 3 views (71047) |
$96.36 |
$438 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$258.72 |
$1,176 |
1.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,185.14 |
$5,387 |
1.6× |
| Clavicle complete (73000) |
$121 |
$550 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$191.18 |
$869 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$181.72 |
$826 |
1.5× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$105.82 |
$481 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,268.64 |
$10,312 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,408.44 |
$6,402 |
6.4× |
| CT abdomen w contrast (74160) |
$975.04 |
$4,432 |
6.0× |
| CT abdomen w wo contrast (74170) |
$1,134.76 |
$5,158 |
7.0× |
| CT abdomen w/o contrast (74150) |
$704.44 |
$3,202 |
7.3× |
| CT angio hrt w/3d image (75574) |
$707.23 |
$3,214.67 |
2.2× |
| CT angiography upper extremity lt (73206) |
$1,134.76 |
$5,158 |
7.0× |
| CT c-spine w/o contrast (72125) |
$704.44 |
$3,202 |
7.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,134.76 |
$5,158 |
7.0× |
| CT cervical spine with contrast (72126) |
$975.04 |
$4,432 |
3.0× |
| CT chest w/wo contrast (71270) |
$1,134.76 |
$5,158 |
7.0× |
| CT chest with contrast (71260) |
$2,939.97 |
$13,363.50 |
18.1× |
| CT head/brain with contrast (70460) |
$975.04 |
$4,432 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,134.76 |
$5,158 |
7.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$677.82 |
$3,081 |
2.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$21.78 |
$99 |
0.3× |
| CT hrt w/3d image congen (75573) |
$112.64 |
$512 |
0.3× |
| CT iac w contrast (70481) |
$975.04 |
$4,432 |
6.0× |
| CT limited/localized follow up study (76380) |
$342.98 |
$1,559 |
4.3× |
| CT lower ext w/o (73700) |
$704.44 |
$3,202 |
7.3× |
| CT lower extremity w wo contrast (73702) |
$1,134.76 |
$5,158 |
7.0× |
| CT lower extremity with contrast (73701) |
$975.04 |
$4,432 |
6.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,134.76 |
$5,158 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$704.44 |
$3,202 |
7.3× |
| CT lumbar spine with contrast (72132) |
$975.04 |
$4,432 |
3.0× |
| CT maxillofacial w contrast (70487) |
$975.04 |
$4,432 |
6.0× |
| CT maxillofacial w/o contrast (70486) |
$704.44 |
$3,202 |
7.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,134.76 |
$5,158 |
7.0× |
| CT neck soft tissue w contrast (70491) |
$975.04 |
$4,432 |
6.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,134.76 |
$5,158 |
7.0× |
| CT orbits w/o contrast (70480) |
$704.44 |
$3,202 |
7.3× |
| CT pelvis w & w/o contrast (72194) |
$1,134.76 |
$5,158 |
7.0× |
| CT pelvis w/o contrast (72192) |
$704.44 |
$3,202 |
7.3× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$54.56 |
$248 |
0.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,134.76 |
$5,158 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$704.44 |
$3,202 |
7.3× |
| CT thoracic spine w/contrast (72129) |
$975.04 |
$4,432 |
6.0× |
| CT thoracic spine w/o contrast (72128) |
$704.44 |
$3,202 |
7.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,134.76 |
$5,158 |
7.0× |
| CT thorax w/o contrast (71250) |
$704.44 |
$3,202 |
7.3× |
| CT unlisted procedure (76497) |
$211.20 |
$960 |
2.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,134.76 |
$5,158 |
7.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,056.77 |
$4,803.50 |
10.9× |
| CT upper extremity with contrast (73201) |
$975.04 |
$4,432 |
3.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,134.76 |
$5,158 |
7.0× |
| Cta Abdomen (74175) |
$1,134.76 |
$5,158 |
7.0× |
| CTA abdomen pelvis (74174) |
$1,239.04 |
$5,632 |
3.8× |
| CTA chest (71275) |
$1,134.76 |
$5,158 |
7.0× |
| Cta Head (70496) |
$1,134.76 |
$5,158 |
7.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,701.92 |
$7,736 |
10.5× |
| Cta Neck (70498) |
$1,134.76 |
$5,158 |
7.0× |
| Cta Pelvis (72191) |
$1,134.76 |
$5,158 |
7.0× |
| Cystography minimum 3 views rs&i (74430) |
$408.10 |
$1,855 |
1.3× |
| Diskogram cervical (72285) |
$1,159.62 |
$5,271 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$361.46 |
$1,643 |
3.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$669.02 |
$3,041 |
6.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$311.96 |
$1,418 |
3.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$254.32 |
$1,156 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86.68 |
$394 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$79.20 |
$360 |
0.8× |
| Echo exam of fetal heart (76825) |
$669.02 |
$3,041 |
1.3× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$361.46 |
$1,643 |
1.6× |
| Echoencephalography real time imaging (76506) |
$267.74 |
$1,217 |
2.8× |
| Esophagus (74220) |
$258.72 |
$1,176 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$267.74 |
$1,217 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$267.74 |
$1,217 |
2.8× |
| Fluoroscopy up to 1 hr (76000) |
$238.26 |
$1,083 |
1.1× |
| Foot 2 views (73620) |
$121 |
$550 |
1.5× |
| Forearm 2 views (73090) |
$181.39 |
$824.50 |
2.2× |
| Functional MRI brain by phys/psych (70555) |
$1,164.68 |
$5,294 |
5.3× |
| Functional MRI brain by tech (70554) |
$1,108.80 |
$5,040 |
5.0× |
| Gated Heart Planar Single (78472) |
$939.40 |
$4,270 |
2.5× |
| Hand 2 views (73120) |
$121 |
$550 |
1.2× |
| Hand 3 views (73130) |
$181.39 |
$824.50 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,967.26 |
$18,033 |
6.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,967.26 |
$18,033 |
6.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$430.76 |
$1,958 |
0.7× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$177.54 |
$807 |
0.5× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$177.54 |
$807 |
0.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,343.54 |
$6,107 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$625.90 |
$2,845 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$644.60 |
$2,930 |
1.7× |
| Ht muscle image spect sing (78451) |
$1,879.02 |
$8,541 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$121 |
$550 |
1.5× |
| Hysterosalpingogram (74740) |
$647.68 |
$2,944 |
2.9× |
| Image fusion (77399) |
$181.72 |
$826 |
1.5× |
| Interstitial radiation source applic complex (77778) |
$573.76 |
$2,608 |
0.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$353.54 |
$1,607 |
0.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$353.54 |
$1,607 |
0.7× |
| Intracavitary radiation source applic simple (77761) |
$430.76 |
$1,958 |
0.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$110.44 |
$502 |
1.1× |
| Kidney funcj study non-img radioisotopic study (78725) |
$608.74 |
$2,767 |
1.6× |
| Kidney imaging morphology (78700) |
$243.98 |
$1,109 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$728.86 |
$3,313 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$728.86 |
$3,313 |
1.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$728.86 |
$3,313 |
1.4× |
| Knee 3 views (73562) |
$121 |
$550 |
1.5× |
| Liver & spleen imaging static only (78215) |
$608.74 |
$2,767 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$432.52 |
$1,966 |
0.9× |
| Lung perfusion differential (78597) |
$432.52 |
$1,966 |
1.2× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$415.36 |
$1,888 |
0.7× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$673.64 |
$3,062 |
0.2× |
| Lymphoscintigraphy (78195) |
$608.74 |
$2,767 |
1.2× |
| Meckels Diverticulum (78290) |
$608.74 |
$2,767 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$245.96 |
$1,118 |
0.7× |
| Mr elastography (76391) |
$193.60 |
$880 |
0.9× |
| Mr safety determination physician/other qhp (76016) |
$53.02 |
$241 |
0.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$35.86 |
$163 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$14.74 |
$67 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$55.22 |
$251 |
0.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$145.64 |
$662 |
0.7× |
| MRA head w & w/o contrast (70546) |
$1,858.78 |
$8,449 |
5.8× |
| MRA head w/o contrast (70544) |
$1,364.44 |
$6,202 |
6.2× |
| MRA head with contrast (70545) |
$1,551.44 |
$7,052 |
4.8× |
| MRA neck w contrast (70548) |
$1,551.44 |
$7,052 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,858.78 |
$8,449 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,364.44 |
$6,202 |
6.2× |
| MRI abdomen w contrast (74182) |
$1,551.44 |
$7,052 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,858.78 |
$8,449 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,364.44 |
$6,202 |
6.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,551.88 |
$7,054 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,551.88 |
$7,054 |
2.1× |
| MRI bone marrow blood supply (77084) |
$147.18 |
$669 |
0.7× |
| MRI breast w/o contrast bilateral (77047) |
$1,364.44 |
$6,202 |
6.2× |
| MRI c-spine with contrast (72142) |
$1,551.44 |
$7,052 |
4.8× |
| MRI cardiac w/o contrast (75557) |
$981.20 |
$4,460 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,364.44 |
$6,202 |
6.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,858.78 |
$8,449 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,364.44 |
$6,202 |
6.2× |
| MRI chest with contrast (71551) |
$1,551.44 |
$7,052 |
2.1× |
| MRI fetal sngl/1st gestation (74712) |
$464.20 |
$2,110 |
2.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,551.88 |
$7,054 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,551.88 |
$7,054 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,364.22 |
$6,201 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,364.44 |
$6,202 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,858.78 |
$8,449 |
5.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,551.44 |
$7,052 |
4.8× |
| MRI pelvis w contrast (72196) |
$1,551.44 |
$7,052 |
4.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,858.78 |
$8,449 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$1,364.44 |
$6,202 |
6.2× |
| MRI scan of arm joint before and after contrast (73223) |
$1,858.78 |
$8,449 |
5.8× |
| MRI scan of leg joint before and after contrast (73723) |
$1,858.78 |
$8,449 |
5.8× |
| MRI spectroscopy (76390) |
$1,170.62 |
$5,321 |
14.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,858.78 |
$8,449 |
5.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,551.44 |
$7,052 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,858.78 |
$8,449 |
5.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,551.44 |
$7,052 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,858.78 |
$8,449 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,364.44 |
$6,202 |
6.2× |
| MRI tmj (70336) |
$1,169.74 |
$5,317 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,364.22 |
$6,201 |
6.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,858.78 |
$8,449 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,364.22 |
$6,201 |
6.2× |
| Myelogram Cervical (72240) |
$911.68 |
$4,144 |
1.3× |
| Myelogram Lumbar (72265) |
$542.96 |
$2,468 |
0.7× |
| Myelogram thoracic (72255) |
$542.96 |
$2,468 |
0.7× |
| Myelography 2 or more regions (72270) |
$911.68 |
$4,144 |
1.3× |
| Myocardial infarct spect (78469) |
$728.86 |
$3,313 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,933.80 |
$8,790 |
1.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,150.82 |
$5,231 |
0.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,150.82 |
$5,231 |
0.9× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,489.62 |
$6,771 |
0.7× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$1,291.18 |
$5,869 |
0.6× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$588.06 |
$2,673 |
0.7× |
| Neck soft tissue (70360) |
$121 |
$550 |
1.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$85.80 |
$390 |
0.2× |
| Nm bone marrow multiple (78103) |
$609.40 |
$2,770 |
1.6× |
| Nm bone marrow wb (78104) |
$609.40 |
$2,770 |
1.6× |
| Nm cisternogram (78630) |
$728.86 |
$3,313 |
1.4× |
| Nm gastric emptying study (78264) |
$630.74 |
$2,867 |
1.7× |
| Nm gastroesophageal reflux study (78262) |
$608.74 |
$2,767 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$608.74 |
$2,767 |
1.6× |
| Nm red cell sequestration (78140) |
$247.72 |
$1,126 |
0.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,908.06 |
$8,673 |
1.5× |
| Nuclear medicine of heart pumping function (78473) |
$939.40 |
$4,270 |
2.5× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,150.82 |
$5,231 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$871.64 |
$3,962 |
4.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$163.46 |
$743 |
1.7× |
| Orthopantogram (70355) |
$121 |
$550 |
1.5× |
| Osseous survey infant (77076) |
$211.20 |
$960 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$466.62 |
$2,121 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$466.62 |
$2,121 |
1.3× |
| Parathyroid imaging (78070) |
$608.74 |
$2,767 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$121 |
$550 |
1.2× |
| Perineogram (74775) |
$408.10 |
$1,855 |
1.8× |
| Peritoneogram rs&i (74190) |
$383.90 |
$1,745 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$1,150.82 |
$5,231 |
0.9× |
| PET imaging CT for attenuation limited area (78814) |
$1,150.82 |
$5,231 |
0.9× |
| PET imaging for CT attenuation whole body (78816) |
$1,150.82 |
$5,231 |
0.9× |
| PET imaging limited area chest head/neck (78811) |
$1,014.42 |
$4,611 |
0.8× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$951.94 |
$4,327 |
0.8× |
| Pr gi endoscopic ultrasound (76975) |
$150.48 |
$684 |
0.7× |
| Pr MRI brain w/o & w/ dye (70559) |
$1,858.78 |
$8,449 |
11.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,858.78 |
$8,449 |
5.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,343.54 |
$6,107 |
0.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,449.36 |
$6,588 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$608.74 |
$2,767 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$689.26 |
$3,133 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$279.84 |
$1,272 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$103.40 |
$470 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$171.16 |
$778 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$177.32 |
$806 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$121 |
$550 |
1.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$326.04 |
$1,482 |
3.4× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$230.78 |
$1,049 |
0.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$230.78 |
$1,049 |
2.4× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$230.78 |
$1,049 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$121 |
$550 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$96.36 |
$438 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$177.32 |
$806 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$96.36 |
$438 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$258.72 |
$1,176 |
1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$246.18 |
$1,119 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$258.72 |
$1,176 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$258.72 |
$1,176 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$103.40 |
$470 |
1.3× |
| Radiological examination surgical specimen (76098) |
$352 |
$1,600 |
0.7× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$356.84 |
$1,622 |
0.7× |
| Review by radiologist of adrenal gland vein image (75840) |
$707.52 |
$3,216 |
0.2× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,343.54 |
$6,107 |
0.5× |
| Ribs bilateral 3 views (71110) |
$121 |
$550 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$728.86 |
$3,313 |
2.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$728.86 |
$3,313 |
1.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$728.86 |
$3,313 |
1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,014.42 |
$4,611 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,150.82 |
$5,231 |
0.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,014.42 |
$4,611 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$871.64 |
$3,962 |
4.0× |
| Rp Therapy Intravenous Administration (79101) |
$871.64 |
$3,962 |
4.0× |
| Sacroiliac Joints < 3 Views (72200) |
$121 |
$550 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$267.74 |
$1,217 |
1.2× |
| Salivary gland imaging serial images (78231) |
$608.74 |
$2,767 |
1.6× |
| Scanogram (77073) |
$121 |
$550 |
1.2× |
| Scapula complete (73010) |
$121 |
$550 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$40.04 |
$182 |
1.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$279.84 |
$1,272 |
2.9× |
| Small bowel series (74250) |
$258.72 |
$1,176 |
1.6× |
| Spec medical radj physics consltj (77370) |
$416.02 |
$1,891 |
3.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$416.02 |
$1,891 |
1.2× |
| Special dosimetry (77331) |
$181.72 |
$826 |
1.5× |
| Special treatment procedure (77470) |
$560.78 |
$2,549 |
1.1× |
| Spine thoracic 3 views (72072) |
$121 |
$550 |
1.2× |
| Stereotactic body radiation delivery (77373) |
$2,018.50 |
$9,175 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$707.52 |
$3,216 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$72.16 |
$328 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$416.02 |
$1,891 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$181.72 |
$826 |
0.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$147.18 |
$669 |
0.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$416.02 |
$1,891 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$181.72 |
$826 |
1.5× |
| Therapeutic Enema (74283) |
$258.72 |
$1,176 |
1.6× |
| Thoracolumbar 2 views (72080) |
$121 |
$550 |
1.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$728.42 |
$3,311 |
1.4× |
| Thyroid uptake measurement (78012) |
$137.72 |
$626 |
0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$280.50 |
$1,275 |
0.8× |
| Tmj unilateral (70328) |
$121 |
$550 |
1.5× |
| Treatment device intermediate (77333) |
$334.40 |
$1,520 |
2.7× |
| Treatment devices simple (77332) |
$334.40 |
$1,520 |
2.7× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,459.70 |
$6,635 |
2.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$608.74 |
$2,767 |
1.6× |
| Tx devices design & construction complex (77334) |
$334.40 |
$1,520 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$66 |
$300 |
0.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$169.40 |
$770 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$267.74 |
$1,217 |
2.8× |
| Umbilical-artery Doppler (OB) (76820) |
$311.96 |
$1,418 |
3.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$87.12 |
$396 |
1.1× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$3,967.26 |
$18,033 |
42.0× |
| Upper Extremity Infant (73092) |
$241.78 |
$1,099 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$408.10 |
$1,855 |
1.8× |
| Urethrocystography voiding (74455) |
$428.56 |
$1,948 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$408.10 |
$1,855 |
2.5× |
| Us abdl aorta screen aaa (76706) |
$182.38 |
$829 |
1.9× |
| Us breast unilateral complete (76641) |
$245.08 |
$1,114 |
2.5× |
| Us breast unilateral limited (76642) |
$245.19 |
$1,114.50 |
3.0× |
| Us chest (76604) |
$267.74 |
$1,217 |
2.8× |
| Us compl joint r-t w/image documentation (76881) |
$267.74 |
$1,217 |
2.8× |
| Us elastography parenchyma (76981) |
$94.38 |
$429 |
1.0× |
| Us guided compression repair (76936) |
$374.88 |
$1,704 |
1.9× |
| Us infant hips dynamic (76885) |
$267.74 |
$1,217 |
3.3× |
| Us infant hips limited static (76886) |
$267.74 |
$1,217 |
3.3× |
| Us kidney transplant (76776) |
$267.74 |
$1,217 |
2.8× |
| Us ob detailed single fetus (76811) |
$432.96 |
$1,968 |
2.0× |
| Us ob transvaginal (76817) |
$163.46 |
$743 |
1.7× |
| Us pelvic non ob complete (76856) |
$267.74 |
$1,217 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$163.46 |
$743 |
1.7× |
| Us pregnancy ltd (76815) |
$163.46 |
$743 |
1.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$172.26 |
$783 |
1.8× |
| Us retroperitoneal complete (76770) |
$267.74 |
$1,217 |
2.8× |
| Us retroperitoneal limited (76775) |
$267.74 |
$1,217 |
2.8× |
| Us scrotum and contents (76870) |
$267.74 |
$1,217 |
2.8× |
| Us soft tissue head/neck (76536) |
$267.74 |
$1,217 |
2.8× |
| Us spinal canal and contents (76800) |
$267.74 |
$1,217 |
2.8× |
| Us transrectal prostate volume (76873) |
$267.74 |
$1,217 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$225.50 |
$1,025 |
2.3× |
| Us, eye b-scan (76512) |
$82.28 |
$374 |
0.8× |
| Vasogram (74440) |
$408.10 |
$1,855 |
1.8× |
| Venogram extremity bilateral (75822) |
$752.62 |
$3,421 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,343.54 |
$6,107 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,343.54 |
$6,107 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$752.62 |
$3,421 |
0.5× |
| Venography Renal Bilateral (75833) |
$707.52 |
$3,216 |
0.2× |
| Venography renal unilateral selective rs&i (75831) |
$707.52 |
$3,216 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$707.52 |
$3,216 |
0.2× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$904.64 |
$4,112 |
0.2× |
| Wrist 2 views (73100) |
$121 |
$550 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$211.20 |
$960 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$121 |
$550 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$121 |
$550 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$374.22 |
$1,701 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$121 |
$550 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$121 |
$550 |
1.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$326.04 |
$1,482 |
3.4× |
| X-ray exam hip uni 1 view (73501) |
$103.40 |
$470 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$103.40 |
$470 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$177.32 |
$806 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$177.32 |
$806 |
1.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$177.32 |
$806 |
1.8× |
| X-ray exam of femur 1 (73551) |
$103.40 |
$470 |
1.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$392.70 |
$1,785 |
2.4× |
| X-ray eye for foreign body (70030) |
$54.56 |
$248 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$121 |
$550 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$121 |
$550 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$181.39 |
$824.50 |
2.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$588.94 |
$2,677 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$121 |
$550 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$121 |
$550 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$121 |
$550 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$121 |
$550 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$420.86 |
$1,913 |
5.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$121 |
$550 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$211.20 |
$960 |
2.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$121 |
$550 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$121 |
$550 |
1.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$121 |
$550 |
1.5× |
| X-ray of voice box or throat (70370) |
$54.56 |
$248 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$121 |
$550 |
1.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$121 |
$550 |
1.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$408.10 |
$1,855 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$121 |
$550 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$121 |
$550 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$211.20 |
$960 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$121 |
$550 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$121 |
$550 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$121 |
$550 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$121 |
$550 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$121 |
$550 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$211.20 |
$960 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$121 |
$550 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$121 |
$550 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$121 |
$550 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$121 |
$550 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$121 |
$550 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$121 |
$550 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$121 |
$550 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$121 |
$550 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$211.20 |
$960 |
2.2× |
| Xr chest 4+ views (71048) |
$177.32 |
$806 |
1.8× |
| Xr Cholecystography Oral Contrast (74290) |
$110.22 |
$501 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$121 |
$550 |
1.5× |
| Xr internal auditory meati complete (70134) |
$331.32 |
$1,506 |
0.7× |
| Xr myelogram posterior fossa (70010) |
$231 |
$1,050 |
0.7× |
| Xr shoulder 1 view (73020) |
$121 |
$550 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$211.20 |
$960 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$121 |
$550 |
1.5× |
| Xr tmj bilateral (70330) |
$53.02 |
$241 |
0.7× |
| Xray knee 1 or 2 views rt (73560) |
$181.39 |
$824.50 |
2.2× |