| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,649 |
$11,298 |
4.4× |
| Abdomen 2 views (74019) |
$383 |
$766 |
3.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,890.50 |
$3,781 |
5.1× |
| Angiography extremity bilateral rs&i (75716) |
$4,429 |
$8,858 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,429 |
$8,858 |
1.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,169.50 |
$8,339 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,925.50 |
$15,851 |
2.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,857 |
$11,714 |
2.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$10,190.50 |
$20,381 |
2.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,289 |
$2,578 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,896.50 |
$3,793 |
0.6× |
| Ankle 2 views (73600) |
$241 |
$482 |
3.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$604 |
$1,208 |
1.9× |
| Aortogram thoracic (75605) |
$4,429 |
$8,858 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,429 |
$8,858 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$4,429 |
$8,858 |
1.5× |
| Arthrogram elbow (73085) |
$1,370 |
$2,740 |
4.2× |
| Arthrogram hip (73525) |
$1,370 |
$2,740 |
4.2× |
| Arthrogram shoulder (73040) |
$2,740.50 |
$5,481 |
8.4× |
| Arthrogram wrist (73115) |
$1,233 |
$2,466 |
3.8× |
| Arthrography knee lt (73580) |
$1,233 |
$2,466 |
3.8× |
| Basic radiation dosimetry calculation (77300) |
$684 |
$1,368 |
5.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$570.50 |
$1,141 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,666 |
$3,332 |
4.5× |
| Bone age studies (77072) |
$210.50 |
$421 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$2,018.50 |
$4,037 |
5.4× |
| Bone survey complete (77075) |
$1,629 |
$3,258 |
16.8× |
| Brachytx isodose complex (77318) |
$2,855.50 |
$5,711 |
8.2× |
| Brachytx isodose intermed (77317) |
$1,595.50 |
$3,191 |
4.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$617.50 |
$1,235 |
1.8× |
| Brain image w/flow 4 + views (78606) |
$2,895.50 |
$5,791 |
5.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,753.50 |
$11,507 |
4.3× |
| Brain Imaging Vascular Flow Only (78610) |
$1,001.50 |
$2,003 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,793 |
$7,586 |
11.7× |
| Cervical spine 2 or 3 views (72040) |
$343.50 |
$687 |
4.2× |
| 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) |
$1,106.50 |
$2,213 |
6.8× |
| Cineradiography/videoradiography (76120) |
$96.50 |
$193 |
1.0× |
| Clavicle complete (73000) |
$337 |
$674 |
4.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$36 |
$72 |
0.4× |
| Continuing medical physics consltj pr wk (77336) |
$1,383 |
$2,766 |
11.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,415.50 |
$10,831 |
16.7× |
| CT abdomen and pelvis without contrast (74176) |
$3,208 |
$6,416 |
14.5× |
| CT abdomen w contrast (74160) |
$2,333 |
$4,666 |
14.3× |
| CT abdomen w wo contrast (74170) |
$3,308.50 |
$6,617 |
20.3× |
| CT abdomen w/o contrast (74150) |
$1,724.50 |
$3,449 |
17.7× |
| CT angio hrt w/3d image (75574) |
$809.50 |
$1,619 |
2.5× |
| CT angiography upper extremity lt (73206) |
$2,466 |
$4,932 |
15.1× |
| CT c-spine w/o contrast (72125) |
$2,209.50 |
$4,419 |
22.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,284.50 |
$4,569 |
14.0× |
| CT cervical spine with contrast (72126) |
$2,284.50 |
$4,569 |
7.0× |
| CT chest w/wo contrast (71270) |
$2,194 |
$4,388 |
13.4× |
| CT chest with contrast (71260) |
$2,194 |
$4,388 |
13.4× |
| CT head/brain with contrast (70460) |
$1,942 |
$3,884 |
11.9× |
| CT head/brain without and with contrast (70470) |
$2,440.50 |
$4,881 |
15.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$499.50 |
$999 |
1.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$2,198 |
$4,396 |
6.8× |
| CT iac w contrast (70481) |
$1,976.50 |
$3,953 |
12.1× |
| CT limited/localized follow up study (76380) |
$731 |
$1,462 |
9.0× |
| CT lower ext w/o (73700) |
$1,715 |
$3,430 |
17.6× |
| CT lower extremity w wo contrast (73702) |
$1,793 |
$3,586 |
11.0× |
| CT lower extremity with contrast (73701) |
$1,793 |
$3,586 |
11.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,279.50 |
$4,559 |
14.0× |
| CT lumbar spine w/o contrast (72131) |
$2,170 |
$4,340 |
22.3× |
| CT lumbar spine with contrast (72132) |
$2,551 |
$5,102 |
7.9× |
| CT maxillofacial w contrast (70487) |
$1,766 |
$3,532 |
10.8× |
| CT maxillofacial w/o contrast (70486) |
$1,525.50 |
$3,051 |
15.7× |
| CT maxillofacial w/wo contrast (70488) |
$3,063.50 |
$6,127 |
18.8× |
| CT neck soft tissue w contrast (70491) |
$1,789.50 |
$3,579 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,976.50 |
$3,953 |
12.1× |
| CT orbits w/o contrast (70480) |
$1,779 |
$3,558 |
18.3× |
| CT pelvis w & w/o contrast (72194) |
$2,111.50 |
$4,223 |
12.9× |
| CT pelvis w/o contrast (72192) |
$1,483 |
$2,966 |
15.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,065 |
$6,130 |
18.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,567.50 |
$3,135 |
16.1× |
| CT thoracic spine w/contrast (72129) |
$2,016.50 |
$4,033 |
12.4× |
| CT thoracic spine w/o contrast (72128) |
$1,971.50 |
$3,943 |
20.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,016.50 |
$4,033 |
12.4× |
| CT thorax w/o contrast (71250) |
$1,945 |
$3,890 |
20.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,983.50 |
$3,967 |
12.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,529 |
$3,058 |
15.7× |
| CT upper extremity with contrast (73201) |
$1,575 |
$3,150 |
4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,288 |
$6,576 |
20.2× |
| Cta Abdomen (74175) |
$3,288 |
$6,576 |
20.2× |
| CTA abdomen pelvis (74174) |
$5,754 |
$11,508 |
17.7× |
| CTA chest (71275) |
$2,466 |
$4,932 |
15.1× |
| Cta Head (70496) |
$2,715.50 |
$5,431 |
16.6× |
| CTA lwr ext w&w/o contrast (73706) |
$2,466 |
$4,932 |
15.1× |
| Cta Neck (70498) |
$2,514.50 |
$5,029 |
15.4× |
| Cta Pelvis (72191) |
$2,466 |
$4,932 |
15.1× |
| Cystography minimum 3 views rs&i (74430) |
$634.50 |
$1,269 |
2.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$156 |
$312 |
1.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$156 |
$312 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$450.50 |
$901 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$272.50 |
$545 |
3.4× |
| Echo exam of fetal heart (76825) |
$847.50 |
$1,695 |
1.7× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$847.50 |
$1,695 |
3.8× |
| Echoencephalography real time imaging (76506) |
$973 |
$1,946 |
10.0× |
| Esophagus (74220) |
$603.50 |
$1,207 |
3.7× |
| Fetal biophysical profile non-stress testing (76818) |
$1,481 |
$2,962 |
15.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,481 |
$2,962 |
15.2× |
| Fluoroscopy up to 1 hr (76000) |
$651 |
$1,302 |
2.9× |
| Foot 2 views (73620) |
$292.50 |
$585 |
3.6× |
| Forearm 2 views (73090) |
$359 |
$718 |
4.4× |
| Gated Heart Planar Single (78472) |
$1,024 |
$2,048 |
2.8× |
| Hand 2 views (73120) |
$409 |
$818 |
4.2× |
| Hand 3 views (73130) |
$327.50 |
$655 |
4.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$10,190.50 |
$20,381 |
3.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,890.50 |
$3,781 |
3.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,890.50 |
$3,781 |
5.1× |
| Ht muscle image spect sing (78451) |
$3,169.50 |
$6,339 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$327.50 |
$655 |
4.0× |
| Hysterosalpingogram (74740) |
$814.50 |
$1,629 |
3.7× |
| Image fusion (77399) |
$394.50 |
$789 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$21,845 |
$43,690 |
33.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$241.50 |
$483 |
2.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,299.50 |
$2,599 |
2.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,919.50 |
$3,839 |
3.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,940.50 |
$3,881 |
3.8× |
| Knee 3 views (73562) |
$486.50 |
$973 |
6.0× |
| Liver & spleen imaging static only (78215) |
$1,411 |
$2,822 |
3.8× |
| Lung perf&ventilat diferentl (78598) |
$4,556.50 |
$9,113 |
9.0× |
| Lung perfusion differential (78597) |
$3,764 |
$7,528 |
10.1× |
| Lymphoscintigraphy (78195) |
$1,604 |
$3,208 |
3.2× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Diverticulum (78290) |
$1,811 |
$3,622 |
4.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$4,319 |
$8,638 |
12.4× |
| MRA head w/o contrast (70544) |
$1,343.50 |
$2,687 |
6.1× |
| MRA neck w contrast (70548) |
$1,631 |
$3,262 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,695 |
$5,390 |
8.3× |
| MRA neck w/o contrast (70547) |
$1,343.50 |
$2,687 |
6.1× |
| MRI abdomen w contrast (74182) |
$4,575 |
$9,150 |
14.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,705.50 |
$9,411 |
14.5× |
| MRI abdomen w/o contrast (74181) |
$4,278.50 |
$8,557 |
19.3× |
| MRI any jnt lwr ext with con lt (73722) |
$4,247 |
$8,494 |
5.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,705.50 |
$9,411 |
6.5× |
| MRI breast w/o contrast bilateral (77047) |
$3,759.50 |
$7,519 |
16.9× |
| MRI c-spine with contrast (72142) |
$3,116.50 |
$6,233 |
9.6× |
| MRI cardiac w/o contrast (75557) |
$3,414 |
$6,828 |
15.4× |
| MRI cervical spine w/o contrast (72141) |
$2,974 |
$5,948 |
13.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,979 |
$7,958 |
12.3× |
| MRI chest w/o contrast (71550) |
$3,789.50 |
$7,579 |
17.1× |
| MRI chest with contrast (71551) |
$3,848.50 |
$7,697 |
5.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$4,278.50 |
$8,557 |
13.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,409 |
$8,818 |
13.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,278.50 |
$8,557 |
19.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,875.50 |
$5,751 |
13.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,185 |
$6,370 |
9.8× |
| MRI orbit/face/neck w/contrast (70542) |
$997 |
$1,994 |
3.1× |
| MRI pelvis w contrast (72196) |
$4,705.50 |
$9,411 |
14.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$5,122 |
$10,244 |
15.8× |
| MRI pelvis w/o contrast (72195) |
$4,409 |
$8,818 |
19.9× |
| MRI scan of arm joint before and after contrast (73223) |
$4,409 |
$8,818 |
13.6× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$4,216.50 |
$8,433 |
5.8× |
| MRI scan of leg joint before and after contrast (73723) |
$3,927 |
$7,854 |
12.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,210 |
$6,420 |
9.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,319.50 |
$8,639 |
13.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,449 |
$8,898 |
13.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$5,253 |
$10,506 |
16.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,692 |
$11,384 |
17.5× |
| MRI thoracic spine w/o contrast (72146) |
$4,953.50 |
$9,907 |
22.3× |
| MRI tmj (70336) |
$4,703.50 |
$9,407 |
21.2× |
| MRI upper ext joint w/o contrast (73221) |
$4,319.50 |
$8,639 |
19.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,278.50 |
$8,557 |
13.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,981 |
$7,962 |
17.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,753.50 |
$11,507 |
4.8× |
| Myocardial Spect Multiple Studies (78452) |
$5,615 |
$11,230 |
4.7× |
| Neck soft tissue (70360) |
$479 |
$958 |
5.9× |
| Nm adrenal scan (78075) |
$2,324.50 |
$4,649 |
1.9× |
| Nm cisternogram (78630) |
$2,102 |
$4,204 |
4.2× |
| Nm gastric emptying study (78264) |
$1,307.50 |
$2,615 |
3.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,222.50 |
$12,445 |
4.8× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$2,716.50 |
$5,433 |
2.3× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,299.50 |
$2,599 |
3.5× |
| Nuclear Rx Oral Admin (79005) |
$1,892.50 |
$3,785 |
8.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$973 |
$1,946 |
10.0× |
| Orthopantogram (70355) |
$371.50 |
$743 |
4.6× |
| Osseous survey infant (77076) |
$337 |
$674 |
3.5× |
| Osseous survey limited (77074) |
$276.50 |
$553 |
2.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,505.50 |
$3,011 |
3.0× |
| Parathyrd planar w/wo subtrj (78071) |
$1,505.50 |
$3,011 |
4.0× |
| Parathyroid imaging (78070) |
$838.50 |
$1,677 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$421.50 |
$843 |
4.3× |
| Perineogram (74775) |
$647 |
$1,294 |
2.9× |
| Peritoneogram rs&i (74190) |
$1,731.50 |
$3,463 |
3.4× |
| PET image w/CT, skull-thigh (78815) |
$6,982 |
$13,964 |
5.2× |
| PET imaging CT for attenuation limited area (78814) |
$6,982 |
$13,964 |
5.2× |
| PET imaging for CT attenuation whole body (78816) |
$6,982 |
$13,964 |
5.2× |
| Pr gi endoscopic ultrasound (76975) |
$483 |
$966 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,409 |
$8,818 |
13.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,422 |
$2,844 |
3.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,214 |
$4,428 |
4.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$863.50 |
$1,727 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$1,519.50 |
$3,039 |
18.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,519.50 |
$3,039 |
15.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$579.50 |
$1,159 |
6.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$3,039.50 |
$6,079 |
31.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$944.50 |
$1,889 |
1.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$543.50 |
$1,087 |
5.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$520 |
$1,040 |
5.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$320 |
$640 |
4.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$446 |
$892 |
4.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$248 |
$496 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$1,142 |
$2,284 |
7.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$603.50 |
$1,207 |
3.7× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$202.50 |
$405 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,040 |
$2,080 |
6.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,040 |
$2,080 |
6.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$327.50 |
$655 |
4.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$79.50 |
$159 |
1.0× |
| Radiological examination surgical specimen (76098) |
$496 |
$992 |
1.0× |
| Review by radiologist of adrenal gland vein image (75840) |
$10,190.50 |
$20,381 |
3.5× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$10,190.50 |
$20,381 |
3.5× |
| Ribs bilateral 3 views (71110) |
$475 |
$950 |
4.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,044 |
$4,088 |
5.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,636.50 |
$5,273 |
5.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,808 |
$3,616 |
3.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,840.50 |
$5,681 |
2.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,840.50 |
$5,681 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,840.50 |
$5,681 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$3,009 |
$6,018 |
13.9× |
| Sacroiliac Joints < 3 Views (72200) |
$348.50 |
$697 |
3.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$683 |
$1,366 |
3.1× |
| Salivary gland imaging serial images (78231) |
$368 |
$736 |
1.0× |
| Scanogram (77073) |
$457 |
$914 |
4.7× |
| Scapula complete (73010) |
$359 |
$718 |
3.7× |
| Screening digital breast tomosynthesis (77063) |
$358 |
$716 |
15.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$271.50 |
$543 |
2.8× |
| Sialogram (70390) |
$1,130.50 |
$2,261 |
5.1× |
| Simulation intermediate (77285) |
$864 |
$1,728 |
2.5× |
| Small bowel series (74250) |
$809.50 |
$1,619 |
5.0× |
| Spec medical radj physics consltj (77370) |
$1,007.50 |
$2,015 |
8.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,636.50 |
$3,273 |
4.7× |
| Special dosimetry (77331) |
$649.50 |
$1,299 |
5.2× |
| Special treatment procedure (77470) |
$3,035.50 |
$6,071 |
5.9× |
| Spine thoracic 3 views (72072) |
$501.50 |
$1,003 |
5.2× |
| Stereotactic body radiation delivery (77373) |
$2,577.50 |
$5,155 |
1.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,104.50 |
$4,209 |
6.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,558.50 |
$3,117 |
4.5× |
| Testicular Imaging With Vascular Flow (78761) |
$1,504 |
$3,008 |
4.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,892.50 |
$3,785 |
5.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$548.50 |
$1,097 |
4.4× |
| Thoracolumbar 2 views (72080) |
$483 |
$966 |
6.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,782.50 |
$3,565 |
3.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$929 |
$1,858 |
2.5× |
| Thyroid uptake measurement (78012) |
$836 |
$1,672 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,085 |
$2,170 |
2.9× |
| Tmj unilateral (70328) |
$49.50 |
$99 |
0.6× |
| Tomogram (76100) |
$543.50 |
$1,087 |
5.6× |
| Treatment device intermediate (77333) |
$915 |
$1,830 |
7.3× |
| Treatment devices simple (77332) |
$881.50 |
$1,763 |
7.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,840.50 |
$5,681 |
5.6× |
| Tx devices design & construction complex (77334) |
$1,658 |
$3,316 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$973 |
$1,946 |
10.0× |
| Umbilical-artery Doppler (OB) (76820) |
$320 |
$640 |
3.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$455.50 |
$911 |
1.2× |
| Upper Extremity Infant (73092) |
$327.50 |
$655 |
3.4× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$77 |
$154 |
0.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,504 |
$3,008 |
4.0× |
| Urethrocystography retrograde rs&i (74450) |
$604 |
$1,208 |
2.7× |
| Urethrocystography voiding (74455) |
$997.50 |
$1,995 |
4.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$493.50 |
$987 |
3.0× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$941 |
$1,882 |
5.8× |
| Us abdl aorta screen aaa (76706) |
$819 |
$1,638 |
8.4× |
| Us breast unilateral complete (76641) |
$625 |
$1,250 |
6.4× |
| Us breast unilateral limited (76642) |
$625 |
$1,250 |
7.7× |
| Us chest (76604) |
$803.50 |
$1,607 |
8.3× |
| Us compl joint r-t w/image documentation (76881) |
$710.50 |
$1,421 |
7.3× |
| Us elastography parenchyma (76981) |
$92.50 |
$185 |
1.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$5,026.50 |
$10,053 |
51.7× |
| Us guided compression repair (76936) |
$1,005 |
$2,010 |
5.0× |
| Us infant hips dynamic (76885) |
$846.50 |
$1,693 |
10.5× |
| Us infant hips limited static (76886) |
$260 |
$520 |
3.2× |
| Us kidney transplant (76776) |
$405 |
$810 |
4.2× |
| Us ob detailed single fetus (76811) |
$816.50 |
$1,633 |
3.7× |
| Us ob transvaginal (76817) |
$679.50 |
$1,359 |
7.0× |
| Us pelvic non ob complete (76856) |
$832.50 |
$1,665 |
8.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$622 |
$1,244 |
6.4× |
| Us pregnancy ltd (76815) |
$890 |
$1,780 |
9.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$979 |
$1,958 |
10.1× |
| Us retroperitoneal complete (76770) |
$973 |
$1,946 |
10.0× |
| Us retroperitoneal limited (76775) |
$819 |
$1,638 |
8.4× |
| Us scrotum and contents (76870) |
$1,149.50 |
$2,299 |
11.8× |
| Us soft tissue head/neck (76536) |
$1,047.50 |
$2,095 |
10.8× |
| Us spinal canal and contents (76800) |
$994 |
$1,988 |
10.2× |
| Us xtr non-vasc lmtd (76882) |
$355.50 |
$711 |
3.7× |
| Venogram extremity bilateral (75822) |
$3,220.50 |
$6,441 |
2.2× |
| Venography caval inferior serialography rs&i (75825) |
$5,644 |
$11,288 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$1,829.50 |
$3,659 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$2,380 |
$4,760 |
1.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,380 |
$4,760 |
0.8× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$10,190.50 |
$20,381 |
2.0× |
| Wrist 2 views (73100) |
$285 |
$570 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$819 |
$1,638 |
8.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$293.50 |
$587 |
3.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$359 |
$718 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,714.50 |
$3,429 |
10.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$293.50 |
$587 |
3.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$359 |
$718 |
4.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$3,039.50 |
$6,079 |
31.3× |
| X-ray exam hip uni 1 view (73501) |
$270.50 |
$541 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$435.50 |
$871 |
5.4× |
| X-ray exam hip uni 4/> views (73503) |
$654 |
$1,308 |
6.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$579.50 |
$1,159 |
6.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$1,159 |
$2,318 |
11.9× |
| X-ray exam of femur 1 (73551) |
$254 |
$508 |
3.1× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,003 |
$2,006 |
6.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$571.50 |
$1,143 |
5.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$520 |
$1,040 |
6.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$683.50 |
$1,367 |
8.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$6,639.50 |
$13,279 |
3.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$254 |
$508 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$520 |
$1,040 |
6.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$693.50 |
$1,387 |
7.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$244 |
$488 |
3.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$327.50 |
$655 |
4.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$534.50 |
$1,069 |
5.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$706.50 |
$1,413 |
7.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$534.50 |
$1,069 |
5.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$331.50 |
$663 |
4.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$439.50 |
$879 |
4.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$431 |
$862 |
4.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$1,731.50 |
$3,463 |
3.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,014.50 |
$2,029 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$265 |
$530 |
3.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$323.50 |
$647 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$534.50 |
$1,069 |
5.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$348.50 |
$697 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$347.50 |
$695 |
4.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$683.50 |
$1,367 |
8.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$489 |
$978 |
6.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$304.50 |
$609 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$496.50 |
$993 |
5.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$379.50 |
$759 |
3.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$164.50 |
$329 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$341.50 |
$683 |
4.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$401.50 |
$803 |
5.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$176.50 |
$353 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$687 |
$1,374 |
7.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$253 |
$506 |
3.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$398.50 |
$797 |
4.9× |
| Xr c-spine 6 or more views (72052) |
$882.50 |
$1,765 |
9.1× |
| Xr chest 4+ views (71048) |
$344.50 |
$689 |
3.5× |
| Xr Cholecystography Oral Contrast (74290) |
$217.50 |
$435 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$253 |
$506 |
3.1× |
| Xr shoulder 1 view (73020) |
$244.50 |
$489 |
3.0× |
| Xr spine cervical 4 or 5 views (72050) |
$654.50 |
$1,309 |
6.7× |
| Xr tibia/fibula 2 views (73590) |
$359 |
$718 |
4.4× |
| Xr tmj bilateral (70330) |
$493.50 |
$987 |
6.1× |
| Xray knee 1 or 2 views rt (73560) |
$327.50 |
$655 |
4.0× |