| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,649.50 |
$7,299 |
2.8× |
| Abdomen 2 views (74019) |
$197 |
$394 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$729.50 |
$1,459 |
2.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,234.50 |
$4,469 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,439.50 |
$4,879 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,439.50 |
$4,879 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,513 |
$3,026 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,531 |
$5,062 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,120.50 |
$4,241 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,410.50 |
$2,821 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$523 |
$1,046 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,679.50 |
$3,359 |
0.6× |
| Ankle 2 views (73600) |
$178 |
$356 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$236 |
$472 |
0.7× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,954 |
$3,908 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,954 |
$3,908 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$1,679.50 |
$3,359 |
0.6× |
| Arthrogram elbow (73085) |
$662.50 |
$1,325 |
2.0× |
| Arthrogram hip (73525) |
$679 |
$1,358 |
2.1× |
| Arthrogram shoulder (73040) |
$794 |
$1,588 |
2.4× |
| Arthrogram wrist (73115) |
$918.50 |
$1,837 |
2.8× |
| Arthrography knee lt (73580) |
$940 |
$1,880 |
2.9× |
| Basic radiation dosimetry calculation (77300) |
$389 |
$778 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$565 |
$1,130 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,033 |
$2,066 |
2.8× |
| Bone age studies (77072) |
$178 |
$356 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,033 |
$2,066 |
2.8× |
| Bone survey complete (77075) |
$185.50 |
$371 |
1.9× |
| Brachytx isodose complex (77318) |
$937.50 |
$1,875 |
2.7× |
| Brachytx isodose intermed (77317) |
$638 |
$1,276 |
1.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$488.50 |
$977 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$447 |
$894 |
0.9× |
| Brain imaging < 4 static views (78600) |
$366 |
$732 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,340 |
$6,680 |
2.5× |
| Brain Imaging Vascular Flow Only (78610) |
$549.50 |
$1,099 |
1.1× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$85 |
$170 |
7.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$477 |
$954 |
1.5× |
| Cardiac shunt detection (78428) |
$323.50 |
$647 |
0.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$679 |
$1,358 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$197.50 |
$395 |
2.4× |
| Chest 1 view (71045) |
$207 |
$414 |
2.6× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$272.50 |
$545 |
1.7× |
| Cineradiography/videoradiography (76120) |
$78.50 |
$157 |
0.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$505 |
$1,010 |
0.7× |
| Clavicle complete (73000) |
$175 |
$350 |
2.2× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$29,123 |
$58,246 |
4.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$64 |
$128 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$482 |
$964 |
3.9× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$184.50 |
$369 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,790.50 |
$5,581 |
8.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,565.50 |
$3,131 |
7.1× |
| CT abdomen w contrast (74160) |
$1,042 |
$2,084 |
6.4× |
| CT abdomen w wo contrast (74170) |
$1,442 |
$2,884 |
8.8× |
| CT abdomen w/o contrast (74150) |
$739.50 |
$1,479 |
7.6× |
| CT angio hrt w/3d image (75574) |
$1,576.50 |
$3,153 |
4.9× |
| CT angiography upper extremity lt (73206) |
$996 |
$1,992 |
6.1× |
| CT c-spine w/o contrast (72125) |
$652 |
$1,304 |
6.7× |
| CT cervical spine w&w/o contrast (72127) |
$734.50 |
$1,469 |
4.5× |
| CT cervical spine with contrast (72126) |
$705.50 |
$1,411 |
2.2× |
| CT chest w/wo contrast (71270) |
$1,162 |
$2,324 |
7.1× |
| CT chest with contrast (71260) |
$954 |
$1,908 |
5.8× |
| CT colonography w/dye (74262) |
$229 |
$458 |
1.4× |
| CT colonography w/o cntrst (74261) |
$151 |
$302 |
1.6× |
| CT head/brain with contrast (70460) |
$685.50 |
$1,371 |
4.2× |
| CT head/brain without and with contrast (70470) |
$908.50 |
$1,817 |
5.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,444.50 |
$2,889 |
4.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$1,444.50 |
$2,889 |
4.5× |
| CT iac w contrast (70481) |
$972 |
$1,944 |
6.0× |
| CT limited/localized follow up study (76380) |
$453 |
$906 |
5.6× |
| CT lower ext w/o (73700) |
$699.50 |
$1,399 |
7.2× |
| CT lower extremity w wo contrast (73702) |
$1,105 |
$2,210 |
6.8× |
| CT lower extremity with contrast (73701) |
$868.50 |
$1,737 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,267.50 |
$2,535 |
7.8× |
| CT lumbar spine w/o contrast (72131) |
$937 |
$1,874 |
9.6× |
| CT lumbar spine with contrast (72132) |
$1,014 |
$2,028 |
3.1× |
| CT maxillofacial w contrast (70487) |
$939.50 |
$1,879 |
5.8× |
| CT maxillofacial w/o contrast (70486) |
$783 |
$1,566 |
8.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,241.50 |
$2,483 |
7.6× |
| CT neck soft tissue w contrast (70491) |
$970 |
$1,940 |
5.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,127 |
$2,254 |
6.9× |
| CT orbits w/o contrast (70480) |
$811 |
$1,622 |
8.3× |
| CT pelvis w & w/o contrast (72194) |
$1,349 |
$2,698 |
8.3× |
| CT pelvis w/o contrast (72192) |
$827.50 |
$1,655 |
8.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,293.50 |
$2,587 |
7.9× |
| CT soft tissue neck w/o contrast (70490) |
$839 |
$1,678 |
8.6× |
| CT thoracic spine w/contrast (72129) |
$1,009 |
$2,018 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$932 |
$1,864 |
9.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,052.50 |
$2,105 |
6.5× |
| CT thorax w/o contrast (71250) |
$898 |
$1,796 |
9.2× |
| CT unlisted procedure (76497) |
$315.50 |
$631 |
3.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$927 |
$1,854 |
5.7× |
| CT upper extremity w/o contrast rt (73200) |
$709 |
$1,418 |
7.3× |
| CT upper extremity with contrast (73201) |
$877.50 |
$1,755 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$307 |
$614 |
1.9× |
| Cta Abdomen (74175) |
$1,087 |
$2,174 |
6.7× |
| CTA abdomen pelvis (74174) |
$406.50 |
$813 |
1.3× |
| CTA chest (71275) |
$1,314 |
$2,628 |
8.1× |
| Cta Head (70496) |
$1,353.50 |
$2,707 |
8.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,077 |
$2,154 |
6.6× |
| Cta Neck (70498) |
$840.50 |
$1,681 |
5.2× |
| Cta Pelvis (72191) |
$926 |
$1,852 |
5.7× |
| Cystography minimum 3 views rs&i (74430) |
$236 |
$472 |
0.7× |
| Dacryocystography (70170) |
$164 |
$328 |
0.7× |
| Diskogram cervical (72285) |
$1,506 |
$3,012 |
0.8× |
| Diskography lumbar (72295) |
$1,506 |
$3,012 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$319 |
$638 |
3.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$417.50 |
$835 |
4.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$261.50 |
$523 |
2.7× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$209.50 |
$419 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$221 |
$442 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$61 |
$122 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$351 |
$702 |
3.6× |
| Echo exam of fetal heart (76825) |
$367.50 |
$735 |
0.7× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$268.50 |
$537 |
1.2× |
| Echoencephalography real time imaging (76506) |
$364.50 |
$729 |
3.7× |
| Esophagus (74220) |
$272.50 |
$545 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$334 |
$668 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$225 |
$450 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$407 |
$814 |
1.8× |
| Foot 2 views (73620) |
$173 |
$346 |
2.1× |
| Forearm 2 views (73090) |
$178 |
$356 |
2.2× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$157.50 |
$315 |
0.7× |
| Functional MRI brain by phys/psych (70555) |
$224 |
$448 |
1.0× |
| Functional MRI brain by tech (70554) |
$224 |
$448 |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$912 |
$1,824 |
1.8× |
| Gated Heart Planar Single (78472) |
$875.50 |
$1,751 |
2.4× |
| Hand 2 views (73120) |
$163 |
$326 |
1.7× |
| Hand 3 views (73130) |
$178 |
$356 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,475.50 |
$2,951 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,541 |
$3,082 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,607.50 |
$3,215 |
2.5× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$1,724 |
$3,448 |
4.8× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$1,610.50 |
$3,221 |
4.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,428 |
$2,856 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$466.50 |
$933 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$466.50 |
$933 |
1.3× |
| Ht muscle image spect sing (78451) |
$842.50 |
$1,685 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$180 |
$360 |
2.2× |
| Hysterosalpingogram (74740) |
$319 |
$638 |
1.4× |
| Interstitial radiation source applic complex (77778) |
$1,937.50 |
$3,875 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$739 |
$1,478 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$678.50 |
$1,357 |
1.3× |
| Intracavitary radiation source applic simple (77761) |
$633.50 |
$1,267 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$102 |
$204 |
1.0× |
| Kidney imaging morphology (78700) |
$321.50 |
$643 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$826 |
$1,652 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$826 |
$1,652 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,030.50 |
$2,061 |
2.0× |
| Knee 3 views (73562) |
$191.50 |
$383 |
2.4× |
| Liver & spleen imaging static only (78215) |
$931.50 |
$1,863 |
2.5× |
| Lung perf&ventilat diferentl (78598) |
$504 |
$1,008 |
1.0× |
| Lung perfusion differential (78597) |
$322.50 |
$645 |
0.9× |
| Lung Ventilation Imaging (78579) |
$322.50 |
$645 |
0.9× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,259 |
$2,518 |
0.4× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$795.50 |
$1,591 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$639.50 |
$1,279 |
0.2× |
| Lymphoscintigraphy (78195) |
$709 |
$1,418 |
1.4× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Diverticulum (78290) |
$571 |
$1,142 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,357.50 |
$2,715 |
3.9× |
| Mr elastography (76391) |
$264 |
$528 |
1.2× |
| MRA head w & w/o contrast (70546) |
$1,091.50 |
$2,183 |
3.4× |
| MRA head w/o contrast (70544) |
$595.50 |
$1,191 |
2.7× |
| MRA head with contrast (70545) |
$708 |
$1,416 |
2.2× |
| MRA neck w contrast (70548) |
$611.50 |
$1,223 |
1.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$672 |
$1,344 |
2.1× |
| MRA neck w/o contrast (70547) |
$556 |
$1,112 |
2.5× |
| MRI abdomen w contrast (74182) |
$771 |
$1,542 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,475 |
$2,950 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$650 |
$1,300 |
2.9× |
| MRI any jnt lwr ext with con lt (73722) |
$957 |
$1,914 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$928 |
$1,856 |
1.3× |
| MRI breast w/o contrast bilateral (77047) |
$849 |
$1,698 |
3.8× |
| MRI breast w/o contrast unilat (77046) |
$636.50 |
$1,273 |
2.9× |
| MRI c-spine with contrast (72142) |
$724.50 |
$1,449 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$312.50 |
$625 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$644 |
$1,288 |
2.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,555 |
$3,110 |
4.8× |
| MRI chest w/o contrast (71550) |
$717 |
$1,434 |
3.2× |
| MRI chest with contrast (71551) |
$912 |
$1,824 |
1.3× |
| MRI fetal sngl/1st gestation (74712) |
$221 |
$442 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$908 |
$1,816 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$848.50 |
$1,697 |
2.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$718.50 |
$1,437 |
3.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$668 |
$1,336 |
3.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$808 |
$1,616 |
2.5× |
| MRI orbit/face/neck w/contrast (70542) |
$734.50 |
$1,469 |
2.3× |
| MRI pelvis w contrast (72196) |
$778 |
$1,556 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,783 |
$3,566 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$579 |
$1,158 |
2.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,658 |
$3,316 |
5.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$461.50 |
$923 |
0.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,658 |
$3,316 |
5.1× |
| MRI spectroscopy (76390) |
$1,033.50 |
$2,067 |
12.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$920 |
$1,840 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$935 |
$1,870 |
2.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,187 |
$2,374 |
3.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$935 |
$1,870 |
2.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,187 |
$2,374 |
3.7× |
| MRI thoracic spine w/o contrast (72146) |
$830.50 |
$1,661 |
3.7× |
| MRI tmj (70336) |
$1,236.50 |
$2,473 |
5.6× |
| MRI upper ext joint w/o contrast (73221) |
$809 |
$1,618 |
3.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,543.50 |
$3,087 |
4.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$798.50 |
$1,597 |
3.6× |
| Myelogram Cervical (72240) |
$1,432.50 |
$2,865 |
2.0× |
| Myelogram Lumbar (72265) |
$1,404 |
$2,808 |
1.9× |
| Myelogram thoracic (72255) |
$1,139.50 |
$2,279 |
1.6× |
| Myelography 2 or more regions (72270) |
$1,879 |
$3,758 |
2.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,879.50 |
$5,759 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,556 |
$3,112 |
1.3× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,463.50 |
$2,927 |
1.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,463.50 |
$2,927 |
1.1× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,282 |
$4,564 |
1.1× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,788.50 |
$5,577 |
1.4× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$2,788.50 |
$5,577 |
2.0× |
| Neck soft tissue (70360) |
$131.50 |
$263 |
1.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$167.50 |
$335 |
0.5× |
| Nm adrenal scan (78075) |
$1,416 |
$2,832 |
1.2× |
| Nm bone marrow wb (78104) |
$354.50 |
$709 |
1.0× |
| Nm cisternogram (78630) |
$872.50 |
$1,745 |
1.7× |
| Nm gastric emptying study (78264) |
$861.50 |
$1,723 |
2.3× |
| Nm gastroesophageal reflux study (78262) |
$637.50 |
$1,275 |
1.7× |
| Nm peritoneal-venous shunt patency (78291) |
$613 |
$1,226 |
1.6× |
| Nm red cell sequestration (78140) |
$920 |
$1,840 |
2.5× |
| Nm whole blood volume (78122) |
$1,532 |
$3,064 |
3.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,047 |
$10,094 |
3.9× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$3,109.50 |
$6,219 |
2.3× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,361 |
$2,722 |
1.1× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,239 |
$2,478 |
0.9× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,879.50 |
$5,759 |
2.2× |
| Nuclear medicine study of endocrine organs (78099) |
$249.50 |
$499 |
0.7× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,361 |
$2,722 |
1.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$446.50 |
$893 |
1.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$861.50 |
$1,723 |
2.3× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$354.50 |
$709 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$717 |
$1,434 |
3.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$282 |
$564 |
2.9× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$126.50 |
$253 |
1.0× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$304 |
$608 |
3.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$185.50 |
$371 |
1.9× |
| Orthopantogram (70355) |
$83.50 |
$167 |
1.0× |
| Osseous survey infant (77076) |
$163 |
$326 |
1.7× |
| Osseous survey limited (77074) |
$185.50 |
$371 |
1.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,016 |
$2,032 |
2.0× |
| Parathyrd planar w/wo subtrj (78071) |
$805 |
$1,610 |
2.2× |
| Parathyroid imaging (78070) |
$733 |
$1,466 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$146.50 |
$293 |
1.5× |
| Perineogram (74775) |
$236 |
$472 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$981.50 |
$1,963 |
0.7× |
| PET imaging CT for attenuation limited area (78814) |
$846.50 |
$1,693 |
0.6× |
| PET imaging for CT attenuation whole body (78816) |
$981.50 |
$1,963 |
0.7× |
| PET imaging limited area chest head/neck (78811) |
$1,128 |
$2,256 |
0.9× |
| PET whole body (78813) |
$1,239 |
$2,478 |
0.9× |
| Pr gi endoscopic ultrasound (76975) |
$280 |
$560 |
1.3× |
| Pr MRI brain w/o dye (70557) |
$207.50 |
$415 |
0.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,492 |
$2,984 |
4.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,439.50 |
$4,879 |
0.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,674 |
$3,348 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$569.50 |
$1,139 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$504 |
$1,008 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$240 |
$480 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$187.50 |
$375 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$476 |
$952 |
4.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$246 |
$492 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$102 |
$204 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$476 |
$952 |
4.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,861 |
$15,722 |
1.1× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$661 |
$1,322 |
1.3× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$373 |
$746 |
3.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$488.50 |
$977 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$231 |
$462 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$124 |
$248 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$243.50 |
$487 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$248 |
$496 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$347.50 |
$695 |
2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$272.50 |
$545 |
1.7× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$245.50 |
$491 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$352.75 |
$705.50 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$350.25 |
$700.50 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$120 |
$240 |
1.5× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$71.50 |
$143 |
0.9× |
| Radiological examination surgical specimen (76098) |
$496 |
$992 |
1.0× |
| Radiopharm Dacryocystography (78660) |
$354.50 |
$709 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$234.50 |
$469 |
1.1× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,556 |
$5,112 |
0.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,229 |
$4,458 |
0.8× |
| Ribs bilateral 3 views (71110) |
$192.50 |
$385 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$668 |
$1,336 |
1.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$807 |
$1,614 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$991.50 |
$1,983 |
2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,161.50 |
$2,323 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,316.50 |
$2,633 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,161.50 |
$2,323 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$398.50 |
$797 |
1.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$396.50 |
$793 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$658.50 |
$1,317 |
3.0× |
| Sacroiliac Joints < 3 Views (72200) |
$164.50 |
$329 |
1.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$331.50 |
$663 |
1.5× |
| Salivary gland function study (78232) |
$246.50 |
$493 |
0.7× |
| Salivary gland imaging serial images (78231) |
$364.50 |
$729 |
1.0× |
| Scanogram (77073) |
$166 |
$332 |
1.7× |
| Scapula complete (73010) |
$177.50 |
$355 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$358 |
$716 |
15.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$255 |
$510 |
2.6× |
| Sialogram (70390) |
$164 |
$328 |
0.7× |
| Simulation intermediate (77285) |
$845.50 |
$1,691 |
2.4× |
| Small bowel series (74250) |
$304.50 |
$609 |
1.9× |
| Spec medical radj physics consltj (77370) |
$1,138.50 |
$2,277 |
9.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$852 |
$1,704 |
2.4× |
| Special dosimetry (77331) |
$345 |
$690 |
2.8× |
| Special treatment procedure (77470) |
$1,682.50 |
$3,365 |
3.3× |
| Spine thoracic 3 views (72072) |
$231 |
$462 |
2.4× |
| Splenoportograpy rs&i (75810) |
$1,123 |
$2,246 |
0.4× |
| Stereotactic body radiation delivery (77373) |
$2,621.50 |
$5,243 |
1.6× |
| Superior sagittal sinus venogram (75870) |
$1,291 |
$2,582 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$244.50 |
$489 |
2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$324 |
$648 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$324 |
$648 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,462 |
$2,924 |
4.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$646 |
$1,292 |
5.2× |
| Therapeutic Enema (74283) |
$717 |
$1,434 |
4.4× |
| Thoracolumbar 2 views (72080) |
$187.50 |
$375 |
2.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,112 |
$2,224 |
2.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$637.50 |
$1,275 |
1.7× |
| Thyroid uptake measurement (78012) |
$554.50 |
$1,109 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,056.50 |
$2,113 |
2.8× |
| Tmj unilateral (70328) |
$60 |
$120 |
0.7× |
| Tomogram (76100) |
$128 |
$256 |
1.3× |
| Treatment device intermediate (77333) |
$508 |
$1,016 |
4.1× |
| Treatment devices simple (77332) |
$346.50 |
$693 |
2.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$856 |
$1,712 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$363.50 |
$727 |
1.0× |
| Tx devices design & construction complex (77334) |
$980 |
$1,960 |
2.8× |
| Ultrasound elastography first target lesion (76982) |
$112 |
$224 |
1.2× |
| Ultrasound scan of cornea to determine thickness (76514) |
$92 |
$184 |
3.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$304 |
$608 |
3.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$200 |
$400 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$420 |
$840 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$261.50 |
$523 |
2.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$346.50 |
$693 |
4.3× |
| Unlisted fluoroscopic procedure (76496) |
$1,290 |
$2,580 |
15.9× |
| Unlisted magnetic resonance procedure (76498) |
$448 |
$896 |
5.5× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$249.50 |
$499 |
0.7× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$405 |
$810 |
1.1× |
| Upper Extremity Infant (73092) |
$73 |
$146 |
0.8× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$85 |
$170 |
0.9× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$821 |
$1,642 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$286 |
$572 |
1.3× |
| Urethrocystography voiding (74455) |
$280 |
$560 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$399.50 |
$799 |
2.4× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$439 |
$878 |
2.7× |
| Us abdl aorta screen aaa (76706) |
$114 |
$228 |
1.2× |
| Us breast unilateral complete (76641) |
$448 |
$896 |
4.6× |
| Us breast unilateral limited (76642) |
$424 |
$848 |
5.2× |
| Us chest (76604) |
$294 |
$588 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$126.50 |
$253 |
1.3× |
| Us elastography parenchyma (76981) |
$112 |
$224 |
1.2× |
| Us fetal nuchal translucency 1st gestation (76813) |
$172.50 |
$345 |
1.8× |
| Us guided compression repair (76936) |
$123 |
$246 |
0.6× |
| Us infant hips dynamic (76885) |
$177 |
$354 |
2.2× |
| Us infant hips limited static (76886) |
$154 |
$308 |
1.9× |
| Us kidney transplant (76776) |
$233 |
$466 |
2.4× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$120.50 |
$241 |
1.2× |
| Us ob detailed single fetus (76811) |
$298.50 |
$597 |
1.3× |
| Us ob transvaginal (76817) |
$202.50 |
$405 |
2.1× |
| Us pelvic non ob complete (76856) |
$373 |
$746 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$218 |
$436 |
2.2× |
| Us pregnancy ltd (76815) |
$231 |
$462 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$202.50 |
$405 |
2.1× |
| Us retroperitoneal complete (76770) |
$359.50 |
$719 |
3.7× |
| Us retroperitoneal limited (76775) |
$230 |
$460 |
2.4× |
| Us scrotum and contents (76870) |
$388 |
$776 |
4.0× |
| Us soft tissue head/neck (76536) |
$352.50 |
$705 |
3.6× |
| Us spinal canal and contents (76800) |
$263 |
$526 |
2.7× |
| Us transrectal (76872) |
$216 |
$432 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$82.50 |
$165 |
0.8× |
| Us, eye b-scan (76512) |
$209.50 |
$419 |
2.2× |
| Venogram extremity bilateral (75822) |
$1,084 |
$2,168 |
0.7× |
| Venogram orbital (75880) |
$849.50 |
$1,699 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,558 |
$3,116 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,611.50 |
$3,223 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$761 |
$1,522 |
0.5× |
| Venography Renal Bilateral (75833) |
$1,955 |
$3,910 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,550 |
$3,100 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,457.50 |
$2,915 |
0.5× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$2,084 |
$4,168 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$102.50 |
$205 |
1.3× |
| Wrist 2 views (73100) |
$139.50 |
$279 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$225 |
$450 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$146.50 |
$293 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$197.50 |
$395 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$420.50 |
$841 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$171.50 |
$343 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$252.50 |
$505 |
3.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$476 |
$952 |
4.9× |
| X-ray exam hip uni 1 view (73501) |
$161 |
$322 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.50 |
$367 |
2.3× |
| X-ray exam hip uni 4/> views (73503) |
$275 |
$550 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$306 |
$612 |
3.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$359 |
$718 |
3.7× |
| X-ray exam of femur 1 (73551) |
$61 |
$122 |
0.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$155 |
$310 |
1.0× |
| X-ray eye for foreign body (70030) |
$45.50 |
$91 |
0.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$188 |
$376 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$161 |
$322 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$199.50 |
$399 |
2.5× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$832 |
$1,664 |
0.4× |
| X-ray head for orthodontia (70350) |
$83.50 |
$167 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$175.50 |
$351 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$212.50 |
$425 |
2.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$221.50 |
$443 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$158 |
$316 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$97.50 |
$195 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$242.50 |
$485 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$294 |
$588 |
3.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$228 |
$456 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$178 |
$356 |
2.2× |
| X-ray of voice box or throat (70370) |
$175.50 |
$351 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$177.50 |
$355 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$212.50 |
$425 |
2.2× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$340 |
$680 |
0.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$236 |
$472 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$171.50 |
$343 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$216 |
$432 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$291 |
$582 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$197.50 |
$395 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180 |
$360 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$212.50 |
$425 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$221 |
$442 |
2.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$178 |
$356 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$221 |
$442 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$133 |
$266 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$117.50 |
$235 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$166 |
$332 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$142 |
$284 |
1.8× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$66.50 |
$133 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$187.50 |
$375 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$274 |
$548 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$135 |
$270 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$192.50 |
$385 |
2.4× |
| Xr arthrogram ankle (73615) |
$800 |
$1,600 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$411 |
$822 |
4.2× |
| Xr chest 4+ views (71048) |
$344.50 |
$689 |
3.5× |
| Xr Cholecystography Oral Contrast (74290) |
$98 |
$196 |
0.6× |
| Xr finger(s) 2+ views (73140) |
$137.50 |
$275 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$62.50 |
$125 |
0.6× |
| Xr shoulder 1 view (73020) |
$153 |
$306 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$294 |
$588 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$189 |
$378 |
2.3× |
| Xr tmj bilateral (70330) |
$122 |
$244 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$158 |
$316 |
2.0× |