| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,649 |
$11,298 |
4.4× |
| Abdomen 1 View (74018) |
$320 |
$640 |
4.0× |
| Abdomen 2 views (74019) |
$383 |
$766 |
3.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,890.50 |
$3,781 |
5.1× |
| Adrenal Cortex & Medulla Img (78075) |
$2,324.50 |
$4,649 |
1.9× |
| Angio pulmonary bilat (75743) |
$7,925.50 |
$15,851 |
2.7× |
| 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 pulmonary unilateral slctv rs&i (75741) |
$5,857 |
$11,714 |
2.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,896.50 |
$3,793 |
0.6× |
| Ankle 2 views (73600) |
$241 |
$482 |
3.0× |
| Aortography thoracic serialography rs&i (75605) |
$4,429 |
$8,858 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$10,190.50 |
$20,381 |
2.0× |
| Artery X-Rays Pelvis (75736) |
$4,169.50 |
$8,339 |
0.8× |
| Arthrogram hip (73525) |
$1,370 |
$2,740 |
4.2× |
| Arthrogram Wrist (73115) |
$1,233 |
$2,466 |
3.8× |
| Basic radiation dosimetry calculation (77300) |
$684 |
$1,368 |
5.5× |
| Bone age studies (77072) |
$210.50 |
$421 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$2,018.50 |
$4,037 |
5.4× |
| Bone Imaging Limited Area (78300) |
$570.50 |
$1,141 |
1.5× |
| Bone Imaging Whole Body (78306) |
$1,666 |
$3,332 |
4.5× |
| Bone survey infant (77076) |
$337 |
$674 |
3.5× |
| Brachytx isodose complex (77318) |
$2,855.50 |
$5,711 |
8.2× |
| Brachytx isodose intermed (77317) |
$1,595.50 |
$3,191 |
4.6× |
| Brachytx Isodose Plan Simple (77316) |
$617.50 |
$1,235 |
1.8× |
| Brain Flow Imaging Only (78610) |
$1,001.50 |
$2,003 |
2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,895.50 |
$5,791 |
5.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,753.50 |
$11,507 |
4.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,793 |
$7,586 |
11.7× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$4,216.50 |
$8,433 |
5.8× |
| Cat Scan Follow-Up Study (76380) |
$731 |
$1,462 |
9.0× |
| Cerebrospinal Fluid Scan (78630) |
$2,102 |
$4,204 |
4.2× |
| Chest 1 view (71045) |
$207 |
$414 |
2.6× |
| Chest 2 views (71046) |
$248 |
$496 |
3.1× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.6× |
| Chest 4 or more views (71048) |
$344.50 |
$689 |
3.5× |
| Cholecystography Oral Contrast (74290) |
$217.50 |
$435 |
1.3× |
| Cineradiograpy/vidradiograpy xcpt where spec (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× |
| Contrast Exam Abdominl Aorta (75625) |
$4,429 |
$8,858 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$634.50 |
$1,269 |
2.0× |
| Contrast X-Ray Of Elbow (73085) |
$1,370 |
$2,740 |
4.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,233 |
$2,466 |
3.8× |
| 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 Abdomen and Pelvis (74174) |
$5,754 |
$11,508 |
17.7× |
| CT Angio Chest (71275) |
$2,466 |
$4,932 |
15.1× |
| CT Angio Head (70496) |
$2,715.50 |
$5,431 |
16.6× |
| CT angio hrt w/3d image (75574) |
$809.50 |
$1,619 |
2.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,466 |
$4,932 |
15.1× |
| CT Angio Neck (70498) |
$2,514.50 |
$5,029 |
15.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,466 |
$4,932 |
15.1× |
| CT cervical spine w/ contrast (72126) |
$2,284.50 |
$4,569 |
7.0× |
| CT cervical spine w/o contrast (72125) |
$2,209.50 |
$4,419 |
22.7× |
| CT cervical spine w/wo cont (72127) |
$2,284.50 |
$4,569 |
14.0× |
| CT chest w contrast (71260) |
$2,194 |
$4,388 |
13.4× |
| CT chest w/wo contrast (71270) |
$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 l-spine w&w/o contrast (72133) |
$2,279.50 |
$4,559 |
14.0× |
| CT lower ext w/o (73700) |
$1,715 |
$3,430 |
17.6× |
| CT lower extremity w/contrast material (73701) |
$1,793 |
$3,586 |
11.0× |
| CT lumbar spine w contrast (72132) |
$2,551 |
$5,102 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$2,170 |
$4,340 |
22.3× |
| CT maxillofacial w contrast (70487) |
$1,766 |
$3,532 |
10.8× |
| CT maxillofacial wo contrast (70486) |
$1,525.50 |
$3,051 |
15.7× |
| CT neck tissue combo (70492) |
$3,065 |
$6,130 |
18.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (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 scan of leg combo (73702) |
$1,793 |
$3,586 |
11.0× |
| CT scans face/jaw combo (70488) |
$3,063.50 |
$6,127 |
18.8× |
| CT soft tissue neck w contrast (70491) |
$1,789.50 |
$3,579 |
11.0× |
| 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 cont (72130) |
$2,016.50 |
$4,033 |
12.4× |
| CT thorax w/o contrast (71250) |
$1,945 |
$3,890 |
20.0× |
| CT upper ext wo (73200) |
$1,529 |
$3,058 |
15.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,983.50 |
$3,967 |
12.2× |
| 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 pelvis (72191) |
$2,466 |
$4,932 |
15.1× |
| Dilation ureters/urethra rs&i (74485) |
$6,639.50 |
$13,279 |
3.4× |
| 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 Axial (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 exam uterus (76831) |
$683 |
$1,366 |
3.1× |
| Echo Guide For Artery Repair (76936) |
$1,005 |
$2,010 |
5.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$847.50 |
$1,695 |
3.8× |
| Esophagram (74220) |
$603.50 |
$1,207 |
3.7× |
| Fetal Biophys Profile W/Nst (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× |
| Follow-Up Angiography (75898) |
$1,289 |
$2,578 |
0.4× |
| Foot 2 views (73620) |
$292.50 |
$585 |
3.6× |
| Forearm 2 views (73090) |
$359 |
$718 |
4.4× |
| Gastric emptying imaging study (78264) |
$1,307.50 |
$2,615 |
3.5× |
| Gated Heart Planar Single (78472) |
$1,024 |
$2,048 |
2.8× |
| GI Endoscopic US S&I (76975) |
$483 |
$966 |
2.2× |
| Hand 2 views (73120) |
$409 |
$818 |
4.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$10,190.50 |
$20,381 |
3.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$10,190.50 |
$20,381 |
3.5× |
| Hepatobil Syst Image W/Drug (78227) |
$1,890.50 |
$3,781 |
3.7× |
| Hepatobiliary System Imaging (78226) |
$1,890.50 |
$3,781 |
5.1× |
| Ht Musc Image Planar Mult (78454) |
$2,716.50 |
$5,433 |
2.3× |
| Ht Muscle Image Spect Sing (78451) |
$3,169.50 |
$6,339 |
2.6× |
| Hysterosalpingogram (74740) |
$814.50 |
$1,629 |
3.7× |
| Image fusion (77399) |
$394.50 |
$789 |
3.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$846.50 |
$1,693 |
10.5× |
| Infant hip ultrasound, limited static exam (76886) |
$260 |
$520 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$21,845 |
$43,690 |
33.7× |
| Joint Survey Single View (77077) |
$241.50 |
$483 |
2.5× |
| K Flow/Funct Image Multiple (78709) |
$1,940.50 |
$3,881 |
3.8× |
| K Flow/Funct Image W/Drug (78708) |
$1,919.50 |
$3,839 |
3.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,299.50 |
$2,599 |
2.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,299.50 |
$2,599 |
3.5× |
| 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× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,214 |
$4,428 |
4.4× |
| Lymph System Imaging (78195) |
$1,604 |
$3,208 |
3.2× |
| Magnetic Image Jaw Joint (70336) |
$4,703.50 |
$9,407 |
21.2× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Divert Exam (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 contrast (74181) |
$4,278.50 |
$8,557 |
19.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,247 |
$8,494 |
5.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,927 |
$7,854 |
12.1× |
| 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 cardiac w/o contrast (75557) |
$3,414 |
$6,828 |
15.4× |
| MRI cervical spine w contrast (72142) |
$3,116.50 |
$6,233 |
9.6× |
| MRI cervical spine w/o cont (72141) |
$2,974 |
$5,948 |
13.4× |
| 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 chest wo w contrast (71552) |
$3,979 |
$7,958 |
12.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,409 |
$8,818 |
13.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$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 lumbar spine w contrast (72149) |
$4,319.50 |
$8,639 |
13.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,210 |
$6,420 |
9.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,875.50 |
$5,751 |
13.0× |
| MRI orbit face neck w contrast (70542) |
$997 |
$1,994 |
3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,185 |
$6,370 |
9.8× |
| MRI pelvis w contrast (72196) |
$4,705.50 |
$9,411 |
14.5× |
| MRI pelvis w/o & w contrast (72197) |
$5,122 |
$10,244 |
15.8× |
| MRI pelvis w/o contrast (72195) |
$4,409 |
$8,818 |
19.9× |
| MRI thoracic spine w/o contrast (72146) |
$4,953.50 |
$9,907 |
22.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$4,278.50 |
$8,557 |
13.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,981 |
$7,962 |
17.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$4,278.50 |
$8,557 |
13.2× |
| MRI, abdomen, combo (74183) |
$4,705.50 |
$9,411 |
14.5× |
| MRI, dorsal spine combo (72157) |
$5,692 |
$11,384 |
17.5× |
| MRI, dorsal spine contrast (72147) |
$5,253 |
$10,506 |
16.2× |
| MRI, joint upper extrem (73221) |
$4,319.50 |
$8,639 |
19.5× |
| MRI, joint upper extrem combo (73223) |
$4,409 |
$8,818 |
13.6× |
| MRI, lumbar spine combo (72158) |
$4,449 |
$8,898 |
13.7× |
| 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× |
| Nonvascular Shunt X-Ray (75809) |
$271.50 |
$543 |
2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,222.50 |
$12,445 |
4.8× |
| Nuclear Rx Oral Admin (79005) |
$1,892.50 |
$3,785 |
8.7× |
| Ob us nuchal meas 1 gest (76813) |
$5,026.50 |
$10,053 |
51.7× |
| Panoramic X-ray of jaws (70355) |
$371.50 |
$743 |
4.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,505.50 |
$3,011 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$838.50 |
$1,677 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,505.50 |
$3,011 |
4.0× |
| 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 Lmtd (78814) |
$6,982 |
$13,964 |
5.2× |
| PET image w/CT, full body (78816) |
$6,982 |
$13,964 |
5.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,982 |
$13,964 |
5.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,422 |
$2,844 |
3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$819 |
$1,638 |
8.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$863.50 |
$1,727 |
1.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$359 |
$718 |
4.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$254 |
$508 |
3.1× |
| Radex elbow complete minimum 3 views (73080) |
$359 |
$718 |
4.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$571.50 |
$1,143 |
5.9× |
| Radex fingr minimum 2 views (73140) |
$253 |
$506 |
3.1× |
| Radex foot complete minimum 3 views (73630) |
$683.50 |
$1,367 |
8.4× |
| Radex Hand Minimum 3 Views (73130) |
$327.50 |
$655 |
4.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$327.50 |
$655 |
4.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$331.50 |
$663 |
4.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$265 |
$530 |
3.3× |
| Radex shoulder complete minimum 2 views (73030) |
$683.50 |
$1,367 |
8.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$304.50 |
$609 |
3.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,003 |
$2,006 |
6.1× |
| Radex Spine 1 View Specify Level (72020) |
$164.50 |
$329 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$401.50 |
$803 |
5.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$493.50 |
$987 |
6.1× |
| Radex Toe Minimum 2 Views (73660) |
$253 |
$506 |
3.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$327.50 |
$655 |
3.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$398.50 |
$797 |
4.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$3,039.50 |
$6,079 |
31.3× |
| Radiation treatment delivery level 1 (77402) |
$543.50 |
$1,087 |
5.7× |
| Radiation treatment delivery level 3 (77412) |
$944.50 |
$1,889 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$520 |
$1,040 |
5.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$446 |
$892 |
4.6× |
| Radiologic exam colon double contrast study (74280) |
$1,714.50 |
$3,429 |
10.5× |
| 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 knee complete 4/more views (73564) |
$693.50 |
$1,387 |
7.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$431 |
$862 |
4.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$809.50 |
$1,619 |
5.0× |
| Radiologic exam swallow function contrast study (74230) |
$1,106.50 |
$2,213 |
6.8× |
| 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 examination femur 1 view (73551) |
$254 |
$508 |
3.1× |
| Radiologic examination femur minimum 2 views (73552) |
$327.50 |
$655 |
4.0× |
| Radiologic examination knee 1/2 views (73560) |
$327.50 |
$655 |
4.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$276.50 |
$553 |
2.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$79.50 |
$159 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$359 |
$718 |
4.4× |
| Renal Cyst Study (74470) |
$1,731.50 |
$3,463 |
3.4× |
| 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 2+ Days Imaging (78804) |
$2,840.50 |
$5,681 |
5.6× |
| 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/acquisj 1day img (78830) |
$2,840.50 |
$5,681 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$3,009 |
$6,018 |
13.9× |
| Salivary Gland Imaging Serial Images (78231) |
$368 |
$736 |
1.0× |
| Scapula (73010) |
$359 |
$718 |
3.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$358 |
$716 |
15.3× |
| Shoulder 1 view (73020) |
$244.50 |
$489 |
3.0× |
| Shoulder Arthrography (73040) |
$2,740.50 |
$5,481 |
8.4× |
| Sialogram (70390) |
$1,130.50 |
$2,261 |
5.1× |
| Skull less than 4 views (70250) |
$379.50 |
$759 |
3.9× |
| Special dosimetry (77331) |
$649.50 |
$1,299 |
5.2× |
| Special Physics Consult (77370) |
$1,007.50 |
$2,015 |
8.1× |
| Special teletherapy port plan (77321) |
$1,636.50 |
$3,273 |
4.7× |
| Special treatment procedure (77470) |
$3,035.50 |
$6,071 |
5.9× |
| Stereotactic Body Radiation Delivery (77373) |
$2,577.50 |
$5,155 |
1.5× |
| Sternoclavicular joints (71130) |
$341.50 |
$683 |
4.2× |
| 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 W/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 Intermed (77285) |
$864 |
$1,728 |
2.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$548.50 |
$1,097 |
4.4× |
| Thoracic spine 2 views (72070) |
$176.50 |
$353 |
1.8× |
| Thoracic spine 3 views (72072) |
$501.50 |
$1,003 |
5.2× |
| Thoracolumbar 2 views (72080) |
$483 |
$966 |
6.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$929 |
$1,858 |
2.5× |
| Thyroid Met Imaging Body (78018) |
$1,782.50 |
$3,565 |
3.5× |
| 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× |
| Tx Devices Design & Construction Complex (77334) |
$1,658 |
$3,316 |
4.8× |
| Tx devices design & construction intermediate (77333) |
$915 |
$1,830 |
7.3× |
| Tx devices design & construction simple (77332) |
$881.50 |
$1,763 |
7.1× |
| Ultrasound Breast Limited (76642) |
$625 |
$1,250 |
7.7× |
| Ultrasound Elastography Parenchyma (76981) |
$92.50 |
$185 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$819 |
$1,638 |
8.4× |
| 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 gi w/o kub (74240) |
$1,040 |
$2,080 |
6.4× |
| Urea breath test c-14 isotopic analysis (78268) |
$77 |
$154 |
0.8× |
| Ureteral Reflux Study (78740) |
$1,504 |
$3,008 |
4.0× |
| Urethrocystogram voiding (74455) |
$997.50 |
$1,995 |
4.5× |
| Urethrocystography retrograde (74450) |
$604 |
$1,208 |
2.7× |
| Us breast unilateral complete (76641) |
$625 |
$1,250 |
6.4× |
| Us chest (76604) |
$803.50 |
$1,607 |
8.3× |
| Us complete joint (76881) |
$710.50 |
$1,421 |
7.3× |
| Us exam, pelvic, limited (76857) |
$622 |
$1,244 |
6.4× |
| Us head (76506) |
$973 |
$1,946 |
10.0× |
| Us kidney transplant (76776) |
$405 |
$810 |
4.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$355.50 |
$711 |
3.7× |
| Us ob detailed single fetus (76811) |
$816.50 |
$1,633 |
3.7× |
| Us ob limited 1 or more fetuses (76815) |
$890 |
$1,780 |
9.2× |
| Us ob transvaginal (76817) |
$679.50 |
$1,359 |
7.0× |
| Us pelvic non ob complete (76856) |
$832.50 |
$1,665 |
8.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$979 |
$1,958 |
10.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$973 |
$1,946 |
10.0× |
| 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 spinal canal and contents (76800) |
$994 |
$1,988 |
10.2× |
| Us thyroid (76536) |
$1,047.50 |
$2,095 |
10.8× |
| Vein X-Ray Chest (75827) |
$1,829.50 |
$3,659 |
1.2× |
| Venogram Sinus/Jugular (75860) |
$2,380 |
$4,760 |
0.8× |
| Venography Adrenal Unilateral (75840) |
$10,190.50 |
$20,381 |
3.5× |
| Venography caval inferior serialography rs&i (75825) |
$5,644 |
$11,288 |
1.9× |
| Venography extremity bilateral rs&i (75822) |
$3,220.50 |
$6,441 |
2.2× |
| Venography extremity unilateral rs&i (75820) |
$2,380 |
$4,760 |
1.6× |
| Venous sampling by catheter (75893) |
$10,190.50 |
$20,381 |
2.0× |
| Wrist 2 views (73100) |
$285 |
$570 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$293.50 |
$587 |
3.6× |
| X-ray antegrade pyelogram tube (74425) |
$604 |
$1,208 |
1.9× |
| X-Ray Aorta Leg Arteries (75630) |
$4,429 |
$8,858 |
1.5× |
| X-Ray Bend Only L-S Spine (72120) |
$534.50 |
$1,069 |
5.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$293.50 |
$587 |
3.6× |
| X-Ray Exam Breast Specimen (76098) |
$496 |
$992 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$1,519.50 |
$3,039 |
18.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$1,519.50 |
$3,039 |
15.6× |
| 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 2 Views (73521) |
$579.50 |
$1,159 |
6.0× |
| 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 L-S Spine Bending (72114) |
$706.50 |
$1,413 |
7.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$343.50 |
$687 |
4.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$882.50 |
$1,765 |
9.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$323.50 |
$647 |
3.3× |
| X-ray humerus (73060) |
$327.50 |
$655 |
4.0× |
| X-ray IV pyelogram (ivp) (74400) |
$493.50 |
$987 |
3.0× |
| X-ray IV pyelogram+tomography (74415) |
$941 |
$1,882 |
5.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$520 |
$1,040 |
6.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$244 |
$488 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$534.50 |
$1,069 |
5.5× |
| 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 Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$348.50 |
$697 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$347.50 |
$695 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$489 |
$978 |
6.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$496.50 |
$993 |
5.1× |
| X-ray thoracic spine 4 vw (72074) |
$687 |
$1,374 |
7.1× |
| X-Ray Tmj Unilat (70328) |
$49.50 |
$99 |
0.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,014.50 |
$2,029 |
3.1× |
| X-Rays Bone Length Studies (77073) |
$457 |
$914 |
4.7× |
| X-Rays Bone Survey Complete (77075) |
$1,629 |
$3,258 |
16.8× |
| Xr c-spine 4 or 5 views (72050) |
$654.50 |
$1,309 |
6.7× |
| Xr facial bones less than 3 views (70140) |
$520 |
$1,040 |
6.4× |
| Xr orbits complete 4 views (70200) |
$439.50 |
$879 |
4.5× |
| Xr Tomogram Single Plane (76100) |
$543.50 |
$1,087 |
5.6× |