| 3-D radiotherapy plan dose-volume histograms (77295) |
$273 |
$909 |
0.2× |
| Abdomen 2 views (74019) |
$68 |
$226 |
0.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$277 |
$923.50 |
0.7× |
| Acute venous thrombus image (78456) |
$183 |
$611 |
0.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$100 |
$334 |
0.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,073 |
$10,242 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,871 |
$9,570 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$92 |
$306 |
0.0× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$83 |
$276 |
0.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$88 |
$294 |
0.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$78 |
$260 |
0.0× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$140 |
$467 |
0.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,126 |
$8,710.50 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$940 |
$3,132 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$80 |
$267 |
0.0× |
| Ankle 2 views (73600) |
$154 |
$512 |
1.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$155.50 |
$519 |
0.4× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,620 |
$8,733 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,846.50 |
$8,733 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$3,073 |
$5,248 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$117 |
$389 |
0.0× |
| Artery X-Rays Adrenal Gland (75731) |
$89 |
$298 |
0.0× |
| Arthrogram elbow (73085) |
$353 |
$1,175 |
1.0× |
| Arthrogram hip (73525) |
$353 |
$1,175 |
1.0× |
| Arthrogram shoulder (73040) |
$353 |
$1,175 |
1.0× |
| Arthrogram wrist (73115) |
$79 |
$262 |
0.2× |
| Arthrography knee lt (73580) |
$353 |
$1,175 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$38 |
$125 |
0.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$195 |
$649.50 |
0.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$160 |
$533 |
0.4× |
| Bone &/joint imaging whole body (78306) |
$263 |
$877 |
0.7× |
| Bone age studies (77072) |
$65.50 |
$217.50 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$276.50 |
$921.50 |
0.7× |
| Bone Marrow Imaging Limited Area (78102) |
$268 |
$892.50 |
0.7× |
| Bone survey complete (77075) |
$88.50 |
$294.50 |
0.8× |
| Brachytx isodose complex (77318) |
$246 |
$821 |
0.7× |
| Brachytx isodose intermed (77317) |
$173 |
$577 |
0.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$131 |
$438 |
0.3× |
| Brain image w/flow 4 + views (78606) |
$515.50 |
$1,718.50 |
0.9× |
| Brain imaging < 4 static views (78600) |
$105 |
$351 |
0.3× |
| Brain imaging < 4 static views w vascular flow (78601) |
$124 |
$413 |
0.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$114 |
$381 |
0.2× |
| Brain Imaging Vascular Flow Only (78610) |
$100 |
$334 |
0.2× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$7 |
$23 |
0.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$133 |
$442 |
0.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$238 |
$794 |
0.7× |
| Cardiac shunt detection (78428) |
$108 |
$359 |
0.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$475.50 |
$1,584.50 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$55 |
$183 |
0.6× |
| Chest 1 view (71045) |
$63 |
$210 |
0.7× |
| Chest 3 views (71047) |
$24 |
$80 |
0.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$131 |
$437.50 |
0.7× |
| Cineradiography/videoradiography (76120) |
$66 |
$221 |
0.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$97 |
$323 |
0.1× |
| Clavicle complete (73000) |
$164 |
$548 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$84.50 |
$281 |
0.8× |
| Continuing medical physics consltj pr wk (77336) |
$46 |
$153 |
0.3× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$56 |
$188 |
0.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,316.50 |
$4,388.50 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,033 |
$3,443 |
4.3× |
| CT abdomen w contrast (74160) |
$715 |
$2,384 |
4.1× |
| CT abdomen w wo contrast (74170) |
$802.50 |
$2,675 |
4.6× |
| CT abdomen w/o contrast (74150) |
$480.50 |
$1,601 |
4.6× |
| CT angio hrt w/3d image (75574) |
$274 |
$913 |
0.8× |
| CT angiography upper extremity lt (73206) |
$354 |
$1,179 |
2.0× |
| CT c-spine w/o contrast (72125) |
$534.50 |
$1,781.50 |
5.1× |
| CT cervical spine w&w/o contrast (72127) |
$739.50 |
$2,465 |
4.2× |
| CT cervical spine with contrast (72126) |
$645.50 |
$2,151.50 |
1.8× |
| CT chest w/wo contrast (71270) |
$1,421 |
$4,737 |
8.1× |
| CT chest with contrast (71260) |
$1,250 |
$4,167 |
7.1× |
| CT colonography w/dye (74262) |
$303 |
$1,010 |
1.7× |
| CT colonography w/o cntrst (74261) |
$269 |
$896 |
2.6× |
| CT head/brain with contrast (70460) |
$665.50 |
$2,219 |
3.8× |
| CT head/brain without and with contrast (70470) |
$681.50 |
$2,271.50 |
3.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$305 |
$1,015 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$61 |
$203 |
0.7× |
| CT hrt w/3d image congen (75573) |
$258.50 |
$860.50 |
0.7× |
| CT iac w contrast (70481) |
$454 |
$1,514 |
2.6× |
| CT limited/localized follow up study (76380) |
$111.50 |
$371 |
1.3× |
| CT lower ext w/o (73700) |
$272 |
$908 |
2.6× |
| CT lower extremity w wo contrast (73702) |
$482 |
$1,606.50 |
2.7× |
| CT lower extremity with contrast (73701) |
$494 |
$1,646 |
2.8× |
| CT lumbar spine w & w/o contrast (72133) |
$773.50 |
$2,578.50 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$534.50 |
$1,781 |
5.1× |
| CT lumbar spine with contrast (72132) |
$645.50 |
$2,151 |
1.8× |
| CT maxillofacial w contrast (70487) |
$464 |
$1,546 |
2.6× |
| CT maxillofacial w/o contrast (70486) |
$409 |
$1,363 |
3.9× |
| CT maxillofacial w/wo contrast (70488) |
$525 |
$1,749 |
3.0× |
| CT neck soft tissue w contrast (70491) |
$632.50 |
$2,108.50 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$542 |
$1,808 |
3.1× |
| CT orbits w/o contrast (70480) |
$394 |
$1,314 |
3.8× |
| CT pelvis w & w/o contrast (72194) |
$858.50 |
$2,863 |
4.9× |
| CT pelvis w/o contrast (72192) |
$512.50 |
$1,707 |
4.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$65 |
$217 |
0.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$873.50 |
$2,911.50 |
5.0× |
| CT soft tissue neck w/o contrast (70490) |
$564.50 |
$1,883 |
5.4× |
| CT thoracic spine w/contrast (72129) |
$617.50 |
$2,058.50 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$534.50 |
$1,781 |
5.1× |
| CT thoracic spine w/wo contrast (72130) |
$739.50 |
$2,466 |
4.2× |
| CT thorax w/o contrast (71250) |
$1,011 |
$3,369 |
9.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$458 |
$1,528 |
2.6× |
| CT upper extremity w/o contrast rt (73200) |
$350 |
$1,167 |
3.3× |
| CT upper extremity with contrast (73201) |
$399 |
$1,329 |
1.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$912.50 |
$3,041.50 |
5.2× |
| Cta Abdomen (74175) |
$785.50 |
$2,618 |
4.5× |
| CTA abdomen pelvis (74174) |
$844.50 |
$2,815 |
2.4× |
| CTA chest (71275) |
$1,452 |
$4,840 |
8.2× |
| Cta Head (70496) |
$156 |
$521 |
0.9× |
| CTA lwr ext w&w/o contrast (73706) |
$432.50 |
$1,441 |
2.5× |
| Cta Neck (70498) |
$845 |
$2,816.50 |
4.8× |
| Cta Pelvis (72191) |
$427 |
$1,423.50 |
2.4× |
| Cystography minimum 3 views rs&i (74430) |
$136.50 |
$454.50 |
0.4× |
| Diskogram cervical (72285) |
$2,008 |
$3,467 |
1.0× |
| Diskography lumbar (72295) |
$2,008 |
$3,454 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$30 |
$100 |
0.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$43 |
$143 |
0.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$82 |
$274 |
0.8× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$44 |
$147 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$67 |
$223.50 |
0.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$39.50 |
$132 |
0.5× |
| Dxa bone density study axial skeleton (77085) |
$61 |
$204.50 |
0.6× |
| Echo exam of eye (76529) |
$49 |
$164 |
0.6× |
| Echo exam of fetal heart (76825) |
$161 |
$537 |
0.3× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$96 |
$321 |
0.4× |
| Echoencephalography real time imaging (76506) |
$73 |
$244 |
0.7× |
| Esophageal motility (78258) |
$123 |
$409 |
0.3× |
| Esophagus (74220) |
$124 |
$412 |
0.7× |
| Fetal biophysical profile non-stress testing (76818) |
$98 |
$326.50 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$89 |
$296 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$122 |
$406.50 |
0.5× |
| Foot 2 views (73620) |
$142 |
$472 |
1.6× |
| Forearm 2 views (73090) |
$175 |
$582 |
2.0× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$32 |
$106 |
0.1× |
| Functional MRI brain by tech (70554) |
$242 |
$805 |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$250 |
$834 |
0.5× |
| Gastric mucosa imaging (78261) |
$118 |
$393 |
0.3× |
| Gated Heart Planar Single (78472) |
$270 |
$900 |
0.7× |
| Hand 2 views (73120) |
$170 |
$566 |
1.6× |
| Hand 3 views (73130) |
$182 |
$606 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$197 |
$656 |
0.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$343 |
$1,143 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$513 |
$1,709 |
0.7× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$207 |
$691 |
0.5× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$141 |
$469 |
0.4× |
| Heart Infarct Image (78466) |
$115 |
$383 |
0.3× |
| Heart infarct image w ef (78468) |
$115 |
$383 |
0.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$74 |
$248 |
0.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$355 |
$1,182.50 |
0.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$295 |
$983.50 |
0.7× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$75 |
$249 |
0.1× |
| Ht muscle image spect sing (78451) |
$560 |
$1,866 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$187 |
$624 |
2.1× |
| Hyperthermia ntrstl prb 5/< (77610) |
$407 |
$1,355 |
0.7× |
| Hysterosalpingogram (74740) |
$184 |
$613.50 |
0.8× |
| Interstitial radiation source applic complex (77778) |
$499 |
$1,664 |
0.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$426 |
$1,421 |
0.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$303 |
$1,010 |
0.5× |
| Intracavitary radiation source applic simple (77761) |
$231 |
$770 |
0.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$56 |
$188 |
0.5× |
| Kidney funcj study non-img radioisotopic study (78725) |
$65 |
$216 |
0.2× |
| Kidney imaging morphology (78700) |
$257.50 |
$857.50 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$329 |
$1,095.50 |
0.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$315 |
$1,050 |
0.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$212 |
$705 |
0.4× |
| Knee 3 views (73562) |
$204 |
$679 |
2.3× |
| Liver & spleen imaging static only (78215) |
$112 |
$374 |
0.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$238 |
$793.50 |
0.6× |
| Liver imaging static only (78201) |
$110 |
$365 |
0.2× |
| Liver imaging w/vascular flow (78202) |
$121 |
$402 |
0.2× |
| Lung perf&ventilat diferentl (78598) |
$294 |
$979.50 |
0.5× |
| Lung perfusion differential (78597) |
$190 |
$633.50 |
0.5× |
| Lung Ventilation Imaging (78579) |
$222 |
$740.50 |
0.6× |
| Lymphoscintigraphy (78195) |
$268.50 |
$895.50 |
0.5× |
| Mammary ductogram or galactogram multiple (77054) |
$151.50 |
$504 |
0.6× |
| Mammary ductogram or galactogram single (77053) |
$144.50 |
$480.50 |
0.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$56 |
$188 |
0.6× |
| Meckels Diverticulum (78290) |
$271.50 |
$906 |
0.7× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$471 |
$1,571 |
1.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$267 |
$890 |
0.7× |
| Mr elastography (76391) |
$131 |
$435 |
0.5× |
| MRA head w & w/o contrast (70546) |
$668 |
$2,225.50 |
1.9× |
| MRA head w/o contrast (70544) |
$491 |
$1,636 |
2.0× |
| MRA head with contrast (70545) |
$555 |
$1,849 |
1.6× |
| MRA neck w contrast (70548) |
$584 |
$1,947 |
1.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$672.50 |
$2,241.50 |
1.9× |
| MRA neck w/o contrast (70547) |
$491 |
$1,636.50 |
2.0× |
| MRI abdomen w contrast (74182) |
$592 |
$1,974 |
1.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$769 |
$2,562.50 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$540.50 |
$1,801.50 |
2.3× |
| MRI any jnt lwr ext with con lt (73722) |
$751 |
$2,502 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$698 |
$2,326 |
0.9× |
| MRI bone marrow blood supply (77084) |
$207 |
$689 |
0.9× |
| MRI breast w/o contrast bilateral (77047) |
$140 |
$466 |
0.6× |
| MRI breast w/o contrast unilat (77046) |
$136 |
$453 |
0.6× |
| MRI c-spine with contrast (72142) |
$473.50 |
$1,577.50 |
1.4× |
| MRI cardiac w/o cont stress (75559) |
$251 |
$835 |
0.5× |
| MRI cardiac w/o contrast (75557) |
$181 |
$602 |
0.8× |
| MRI cervical spine w/o contrast (72141) |
$384 |
$1,280.50 |
1.6× |
| MRI chest w/o & w/contrast material (71552) |
$634.50 |
$2,115 |
1.8× |
| MRI chest w/o contrast (71550) |
$454 |
$1,513 |
1.9× |
| MRI chest with contrast (71551) |
$533 |
$1,777.50 |
0.7× |
| MRI fetal sngl/1st gestation (74712) |
$262 |
$874 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$647 |
$2,158 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,002 |
$3,341 |
2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$669 |
$2,230 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$510.50 |
$1,700 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$687.50 |
$2,291 |
2.0× |
| MRI orbit/face/neck w/contrast (70542) |
$510.50 |
$1,700 |
1.5× |
| MRI pelvis w contrast (72196) |
$592 |
$1,973.50 |
1.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$707 |
$2,357 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$516.50 |
$1,721.50 |
2.2× |
| MRI scan of arm joint before and after contrast (73223) |
$792 |
$2,640 |
2.3× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$282 |
$940 |
0.4× |
| MRI scan of leg joint before and after contrast (73723) |
$901 |
$3,003 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$892 |
$2,973 |
2.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$505.50 |
$1,684.50 |
1.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$566 |
$1,888 |
1.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$443.50 |
$1,479.50 |
1.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$959 |
$3,196 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$361.50 |
$1,204 |
1.5× |
| MRI tmj (70336) |
$378 |
$1,261 |
1.6× |
| MRI upper ext joint w/o contrast (73221) |
$544 |
$1,814 |
2.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$792 |
$2,640 |
2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$566 |
$1,888 |
2.4× |
| Myelogram Cervical (72240) |
$340.50 |
$1,134.50 |
0.4× |
| Myelogram Lumbar (72265) |
$338.50 |
$1,128 |
0.4× |
| Myelogram thoracic (72255) |
$341.50 |
$1,137 |
0.4× |
| Myelography 2 or more regions (72270) |
$353.50 |
$1,177 |
0.4× |
| Myocardial infarct spect (78469) |
$128 |
$426 |
0.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,112 |
$3,706.50 |
0.9× |
| Neck soft tissue (70360) |
$83 |
$276.50 |
0.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$217 |
$723 |
0.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$23 |
$77 |
0.1× |
| Nm adrenal scan (78075) |
$257 |
$858 |
0.2× |
| Nm bone marrow multiple (78103) |
$124 |
$412 |
0.3× |
| Nm bone marrow wb (78104) |
$143 |
$475 |
0.4× |
| Nm cisternogram (78630) |
$497.50 |
$1,658 |
0.9× |
| Nm csf leak detection (78650) |
$160 |
$533 |
0.1× |
| Nm gastric emptying study (78264) |
$272 |
$907.50 |
0.7× |
| Nm gastroesophageal reflux study (78262) |
$140 |
$468 |
0.3× |
| Nm peritoneal-venous shunt patency (78291) |
$231 |
$769.50 |
0.6× |
| Nm red cell sequestration (78140) |
$64 |
$214 |
0.2× |
| Nm whole blood volume (78122) |
$56 |
$186 |
0.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,079 |
$3,598 |
0.8× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$700.50 |
$2,334.50 |
0.5× |
| Nuclear medicine of heart pumping function (78473) |
$168 |
$559 |
0.4× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$141 |
$470 |
0.3× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$172 |
$574 |
0.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$127 |
$424 |
0.3× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$131 |
$435 |
0.3× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$225 |
$751 |
0.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,053 |
$3,511 |
2.6× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$1,326 |
$4,421 |
2.4× |
| Nuclear Rx Oral Admin (79005) |
$316 |
$1,053 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$72.50 |
$242 |
0.7× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$41 |
$136 |
0.3× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$26 |
$88 |
0.2× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$33 |
$109 |
0.3× |
| Orthopantogram (70355) |
$34.50 |
$114.50 |
0.4× |
| Osseous survey infant (77076) |
$85.50 |
$284.50 |
0.8× |
| Osseous survey limited (77074) |
$68.50 |
$229 |
0.7× |
| Parathyrd planar w/spect&CT (78072) |
$255 |
$850 |
0.5× |
| Parathyrd planar w/wo subtrj (78071) |
$203 |
$675 |
0.5× |
| Parathyroid imaging (78070) |
$261.50 |
$872.50 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$63 |
$210 |
0.6× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$43 |
$143 |
0.0× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$40 |
$134 |
0.0× |
| Platelet survival study (78191) |
$72 |
$241 |
0.2× |
| Pr csf ventriculography (78635) |
$194 |
$647 |
0.4× |
| Pr heart first pass single,planar (78481) |
$389 |
$1,295 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,169 |
$3,896 |
3.3× |
| Pr red cell survival study (78130) |
$72 |
$241 |
0.2× |
| Pr sono bone density measure,peripheral (76977) |
$4 |
$13 |
0.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$81 |
$269 |
0.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$82 |
$273 |
0.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$244.50 |
$816 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$323.50 |
$1,078.50 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$236 |
$787 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$43 |
$143 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$75 |
$250 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$136 |
$452 |
1.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$45.50 |
$153 |
0.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$126.50 |
$420 |
1.2× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$601 |
$2,004 |
0.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$67.50 |
$225 |
0.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$63 |
$210 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$98 |
$326.50 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$19 |
$63 |
0.2× |
| Radiologic exam colon single contrast study (74270) |
$103.50 |
$344.50 |
0.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$65 |
$215 |
0.4× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$22 |
$74 |
0.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$297 |
$990.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$225 |
$749.50 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$74 |
$247 |
0.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$21 |
$71 |
0.2× |
| Radiological examination surgical specimen (76098) |
$425 |
$1,418 |
0.8× |
| Radiopharm Dacryocystography (78660) |
$109 |
$362 |
0.3× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$70 |
$232 |
0.3× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$78 |
$259 |
0.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$41 |
$137 |
0.1× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$45 |
$150 |
0.1× |
| Review by radiologist of adrenal gland vein image (75840) |
$77 |
$256 |
0.0× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$74 |
$246 |
0.0× |
| Ribs bilateral 3 views (71110) |
$160.50 |
$534 |
1.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$263 |
$876.50 |
0.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$410.50 |
$1,369.50 |
0.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$772 |
$2,572 |
1.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$865 |
$2,882 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$532 |
$1,773 |
0.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$283 |
$942 |
0.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$106 |
$353 |
0.5× |
| Rp Therapy Intravenous Administration (79101) |
$84 |
$279 |
0.4× |
| Sacroiliac Joints < 3 Views (72200) |
$65 |
$216.50 |
0.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$71 |
$236 |
0.3× |
| Salivary gland function study (78232) |
$60 |
$200 |
0.1× |
| Salivary gland imaging (78230) |
$101 |
$335 |
0.3× |
| Salivary gland imaging serial images (78231) |
$61 |
$203 |
0.2× |
| Scanogram (77073) |
$41 |
$136.50 |
0.4× |
| Scapula complete (73010) |
$59 |
$195 |
0.6× |
| Screening digital breast tomosynthesis (77063) |
$30 |
$99 |
1.3× |
| Sella turcica (70240) |
$37.50 |
$125.50 |
0.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$83.50 |
$278 |
0.8× |
| Sialogram (70390) |
$182.50 |
$609 |
0.8× |
| Simulation intermediate (77285) |
$268 |
$892 |
0.7× |
| Small bowel series (74250) |
$187 |
$622 |
1.1× |
| Spec medical radj physics consltj (77370) |
$72 |
$240 |
0.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$53 |
$177 |
0.1× |
| Special dosimetry (77331) |
$36 |
$121 |
0.3× |
| Special treatment procedure (77470) |
$74 |
$246 |
0.1× |
| Speech evaluation complex (70371) |
$63 |
$210 |
0.3× |
| Spine thoracic 3 views (72072) |
$153.50 |
$512 |
1.5× |
| Spleen imaging only (78185) |
$99 |
$330 |
0.2× |
| Stereotactic body radiation delivery (77373) |
$656 |
$2,187 |
0.4× |
| Superior sagittal sinus venogram (75870) |
$97 |
$324 |
0.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$74 |
$246 |
0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$162 |
$540 |
0.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$83 |
$278 |
0.2× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$201 |
$669 |
0.8× |
| Testicular Imaging With Vascular Flow (78761) |
$121 |
$404 |
0.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$281 |
$935 |
0.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$162 |
$539 |
1.2× |
| Therapeutic Enema (74283) |
$132 |
$440.50 |
0.7× |
| Thoracolumbar 2 views (72080) |
$39.50 |
$130.50 |
0.5× |
| Thyroid carcinoma metastases img addl study (78016) |
$163 |
$544 |
0.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$273 |
$910 |
0.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$233.50 |
$779 |
0.6× |
| Thyroid uptake measurement (78012) |
$97 |
$323.50 |
0.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$245.50 |
$819 |
0.6× |
| Tmj unilateral (70328) |
$20 |
$66 |
0.2× |
| Tomogram (76100) |
$54 |
$179 |
0.5× |
| Treatment device intermediate (77333) |
$75 |
$251 |
0.6× |
| Treatment devices simple (77332) |
$23 |
$77 |
0.2× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$864 |
$2,879.50 |
1.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$256.50 |
$854.50 |
0.6× |
| Tx devices design & construction complex (77334) |
$72 |
$239 |
0.2× |
| Ultrasound elastography first target lesion (76982) |
$57 |
$190 |
0.5× |
| Ultrasound scan of cornea to determine thickness (76514) |
$7 |
$22 |
0.2× |
| Ultrasound scan to determine eye length and lens power (76519) |
$38 |
$127 |
0.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$181 |
$604 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$198.50 |
$662 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$69 |
$230.50 |
0.7× |
| Unlisted Ultrasound Procedure (76999) |
$79 |
$264 |
0.9× |
| Upper Extremity Infant (73092) |
$56 |
$188 |
0.5× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$59 |
$195 |
0.6× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$273 |
$909 |
0.7× |
| Urethrocystography retrograde rs&i (74450) |
$231 |
$770 |
1.0× |
| Urethrocystography voiding (74455) |
$152.50 |
$507.50 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$160.50 |
$534.50 |
0.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$92 |
$305 |
0.5× |
| Us abdl aorta screen aaa (76706) |
$98.50 |
$328 |
0.9× |
| Us breast unilateral complete (76641) |
$116 |
$387 |
1.1× |
| Us breast unilateral limited (76642) |
$97 |
$322 |
1.1× |
| Us chest (76604) |
$116 |
$386 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$79.50 |
$264.50 |
0.8× |
| Us elastography parenchyma (76981) |
$61 |
$204 |
0.6× |
| Us fetal nuchal translucency 1st gestation (76813) |
$71 |
$238 |
0.7× |
| Us guided compression repair (76936) |
$141 |
$470 |
0.7× |
| Us infant hips dynamic (76885) |
$82.50 |
$275 |
0.9× |
| Us infant hips limited static (76886) |
$60 |
$199 |
0.7× |
| Us kidney transplant (76776) |
$105 |
$350 |
1.0× |
| Us ob detailed single fetus (76811) |
$147 |
$490 |
0.6× |
| Us ob transvaginal (76817) |
$116 |
$386 |
1.1× |
| Us pelvic non ob complete (76856) |
$128 |
$425 |
1.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$116 |
$386 |
1.1× |
| Us pregnancy ltd (76815) |
$82.50 |
$274 |
0.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$128 |
$425 |
1.2× |
| Us retroperitoneal complete (76770) |
$109 |
$362.50 |
1.0× |
| Us retroperitoneal limited (76775) |
$128 |
$425 |
1.2× |
| Us scrotum and contents (76870) |
$94 |
$312.50 |
0.9× |
| Us soft tissue head/neck (76536) |
$128 |
$425 |
1.2× |
| Us spinal canal and contents (76800) |
$105 |
$349.50 |
1.0× |
| Us transrectal (76872) |
$111 |
$371 |
1.1× |
| Us transrectal prostate volume (76873) |
$102 |
$340 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$57.50 |
$192.50 |
0.5× |
| Us, eye b-scan (76512) |
$28 |
$92 |
0.3× |
| Use of body cavity probe generated heat to increase temperature of cancer cell (77620) |
$371 |
$1,236 |
0.7× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$279 |
$929 |
0.7× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$589 |
$1,962 |
0.8× |
| Use of interstitial probe generated heat to increase temperature of cancer cell, more than 5 probes (77615) |
$634 |
$2,112 |
1.1× |
| Vascular flow imaging (78445) |
$118 |
$394 |
0.3× |
| Vasogram (74440) |
$59 |
$195 |
0.2× |
| Venogram extremity bilateral (75822) |
$609 |
$2,030.50 |
0.4× |
| Venogram orbital (75880) |
$65 |
$217 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$2,612 |
$7,659 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$378.50 |
$1,261 |
0.2× |
| Venography epidural rs&i (75872) |
$77 |
$256 |
0.1× |
| Venography extremity unilateral rs&i (75820) |
$1,084 |
$3,614 |
0.7× |
| Venography Renal Bilateral (75833) |
$86 |
$285 |
0.0× |
| Venography renal unilateral selective rs&i (75831) |
$71 |
$238 |
0.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,088 |
$5,272.50 |
1.0× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$63 |
$210 |
0.0× |
| Vertebral fracture assessment via dxa (77086) |
$38.50 |
$128.50 |
0.4× |
| Wrist 2 views (73100) |
$166 |
$553 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$130.50 |
$435.50 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$37.50 |
$124.50 |
0.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$198 |
$660 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$160 |
$533 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$160 |
$533 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$234 |
$779 |
2.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$118.50 |
$394.50 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$69 |
$231 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$76 |
$252 |
0.9× |
| X-ray exam hip uni 4/> views (73503) |
$126 |
$420 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$142 |
$473 |
1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$192 |
$639 |
1.8× |
| X-ray exam of femur 1 (73551) |
$69 |
$231 |
0.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$233 |
$778 |
1.3× |
| X-ray eye for foreign body (70030) |
$18 |
$61 |
0.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$89.50 |
$299 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$38.50 |
$128 |
0.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$185 |
$618 |
2.1× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,536 |
$2,677.50 |
0.7× |
| X-ray head for orthodontia (70350) |
$32.50 |
$109.50 |
0.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$146 |
$485 |
1.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$82 |
$274 |
0.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$40.50 |
$134 |
0.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$237 |
$791 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$41 |
$135.50 |
0.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$56 |
$188 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$122 |
$405 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$185.50 |
$618.50 |
1.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$41 |
$136 |
0.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$91.50 |
$305.50 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$123 |
$410 |
1.4× |
| X-ray of voice box or throat (70370) |
$55 |
$184 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$69 |
$229.50 |
0.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$112 |
$373.50 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$137.50 |
$458.50 |
0.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$201 |
$670 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$263 |
$877 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$159.50 |
$530.50 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$66 |
$220.50 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$38.50 |
$128 |
0.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$193 |
$644 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$118.50 |
$394 |
1.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$135 |
$450 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$95.50 |
$318 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$65 |
$217 |
0.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$59 |
$195 |
0.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$39.50 |
$133 |
0.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$39 |
$129.50 |
0.4× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$7 |
$24 |
0.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$139.50 |
$465 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$68 |
$227 |
0.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$168 |
$561 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$182 |
$605 |
2.1× |
| Xr arthrogram ankle (73615) |
$78 |
$261 |
0.2× |
| Xr c-spine 6 or more views (72052) |
$83 |
$277 |
0.8× |
| Xr chest 4+ views (71048) |
$26 |
$85 |
0.2× |
| Xr Cholecystography Oral Contrast (74290) |
$50 |
$167 |
0.3× |
| Xr finger(s) 2+ views (73140) |
$146 |
$488 |
1.7× |
| Xr internal auditory meati complete (70134) |
$65 |
$217.50 |
0.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$22 |
$73 |
0.2× |
| Xr myelogram posterior fossa (70010) |
$324 |
$1,079 |
0.9× |
| Xr optic foramina (70190) |
$39 |
$130.50 |
0.4× |
| Xr shoulder 1 view (73020) |
$59 |
$195 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$78 |
$260 |
0.7× |
| Xr tibia/fibula 2 views (73590) |
$197 |
$658 |
2.3× |
| Xr tmj bilateral (70330) |
$45 |
$148.50 |
0.5× |
| Xray knee 1 or 2 views rt (73560) |
$191 |
$638 |
2.2× |