| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,527.50 |
$9,055 |
3.4× |
| Abdomen 2 views (74019) |
$202.25 |
$404.50 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$910 |
$1,820 |
2.3× |
| Acute venous thrombus image (78456) |
$1,301.52 |
$2,603.04 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,576.25 |
$5,152.50 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,969.75 |
$5,939.50 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,811 |
$5,622 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$2,029.50 |
$4,059 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,811 |
$5,622 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,532.25 |
$5,064.50 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,917 |
$3,834 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$2,811 |
$5,622 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,969.75 |
$5,939.50 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,045.50 |
$4,091 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,637 |
$3,274 |
0.5× |
| Ankle 2 views (73600) |
$157.50 |
$315 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$288.50 |
$577 |
0.9× |
| Aortogram thoracic (75605) |
$4,982.50 |
$9,965 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,963.25 |
$3,926.50 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,854.75 |
$3,709.50 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$2,089.50 |
$4,179 |
0.7× |
| Arthrogram elbow (73085) |
$544.25 |
$1,088.50 |
1.6× |
| Arthrogram hip (73525) |
$544.25 |
$1,088.50 |
1.6× |
| Arthrogram shoulder (73040) |
$526 |
$1,052 |
1.6× |
| Arthrogram wrist (73115) |
$544.25 |
$1,088.50 |
1.6× |
| Arthrography knee lt (73580) |
$544.25 |
$1,088.50 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$434.50 |
$869 |
3.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$431 |
$862 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$1,102 |
$2,204 |
2.8× |
| Bone age studies (77072) |
$112.75 |
$225.50 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$1,242.50 |
$2,485 |
3.2× |
| Bone Marrow Imaging Limited Area (78102) |
$823 |
$1,646 |
2.1× |
| Bone survey complete (77075) |
$291.75 |
$583.50 |
2.9× |
| Brachytx isodose complex (77318) |
$1,484.50 |
$2,969 |
4.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,156.50 |
$2,313 |
3.2× |
| Brain image w/flow 4 + views (78606) |
$1,014.50 |
$2,029 |
1.9× |
| Brain imaging < 4 static views (78600) |
$450 |
$900 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$946.50 |
$1,893 |
2.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$728 |
$1,456 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,525 |
$7,050 |
2.5× |
| Brain Imaging Vascular Flow Only (78610) |
$1,091.50 |
$2,183 |
2.1× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$20.50 |
$41 |
1.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$770 |
$1,540 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,517 |
$3,034 |
4.5× |
| Cardiac shunt detection (78428) |
$816.50 |
$1,633 |
2.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,014.50 |
$2,029 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$243.75 |
$487.50 |
2.9× |
| Chest 1 view (71045) |
$170.75 |
$341.50 |
2.0× |
| Chest 3 views (71047) |
$243.75 |
$487.50 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$333.50 |
$667 |
2.0× |
| Cineradiography/videoradiography (76120) |
$224.50 |
$449 |
2.2× |
| Clavicle complete (73000) |
$170.75 |
$341.50 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$183 |
$366 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$555 |
$1,110 |
4.2× |
| Corpora cavernosography (74445) |
$362 |
$724 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,908.75 |
$5,817.50 |
8.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,052.75 |
$4,105.50 |
8.9× |
| CT abdomen w contrast (74160) |
$1,439.75 |
$2,879.50 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,655 |
$3,310 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,114 |
$2,228 |
11.0× |
| CT angio hrt w/3d image (75574) |
$937.75 |
$1,875.50 |
2.8× |
| CT angiography upper extremity lt (73206) |
$1,416.75 |
$2,833.50 |
8.3× |
| CT c-spine w/o contrast (72125) |
$1,040 |
$2,080 |
10.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,713.25 |
$3,426.50 |
10.1× |
| CT cervical spine with contrast (72126) |
$1,439.75 |
$2,879.50 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,568.50 |
$3,137 |
9.2× |
| CT chest with contrast (71260) |
$1,282.75 |
$2,565.50 |
7.5× |
| CT colonography screening (74263) |
$1,066.75 |
$2,133.50 |
4.6× |
| CT colonography w/o cntrst (74261) |
$1,070.50 |
$2,141 |
10.5× |
| CT head/brain with contrast (70460) |
$1,142 |
$2,284 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,171.50 |
$2,343 |
6.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$442.75 |
$885.50 |
1.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$125 |
$250 |
1.5× |
| CT hrt w/3d image congen (75573) |
$479 |
$958 |
1.4× |
| CT iac w contrast (70481) |
$1,282.75 |
$2,565.50 |
7.5× |
| CT limited/localized follow up study (76380) |
$443.25 |
$886.50 |
5.2× |
| CT lower ext w/o (73700) |
$931 |
$1,862 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,508.75 |
$3,017.50 |
8.9× |
| CT lower extremity with contrast (73701) |
$1,363.75 |
$2,727.50 |
8.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,914.50 |
$3,829 |
11.2× |
| CT lumbar spine w/o contrast (72131) |
$1,239.50 |
$2,479 |
12.2× |
| CT lumbar spine with contrast (72132) |
$1,535.50 |
$3,071 |
4.5× |
| CT maxillofacial w contrast (70487) |
$979.50 |
$1,959 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$908.75 |
$1,817.50 |
8.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,542.50 |
$3,085 |
9.0× |
| CT neck soft tissue w contrast (70491) |
$1,333 |
$2,666 |
7.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,392.25 |
$2,784.50 |
8.2× |
| CT orbits w/o contrast (70480) |
$1,135.75 |
$2,271.50 |
11.2× |
| CT pelvis w & w/o contrast (72194) |
$1,342.75 |
$2,685.50 |
7.9× |
| CT pelvis w/o contrast (72192) |
$1,038.25 |
$2,076.50 |
10.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$232 |
$464 |
2.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,472.25 |
$2,944.50 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,083.50 |
$2,167 |
10.7× |
| CT thoracic spine w/contrast (72129) |
$1,149 |
$2,298 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$1,000 |
$2,000 |
9.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,432.75 |
$2,865.50 |
8.4× |
| CT thorax w/o contrast (71250) |
$870.75 |
$1,741.50 |
8.6× |
| CT unlisted procedure (76497) |
$363 |
$726 |
4.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,461.50 |
$2,923 |
8.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,194.75 |
$2,389.50 |
11.8× |
| CT upper extremity with contrast (73201) |
$1,342.25 |
$2,684.50 |
4.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,619 |
$3,238 |
9.5× |
| Cta Abdomen (74175) |
$1,232.75 |
$2,465.50 |
7.2× |
| CTA abdomen pelvis (74174) |
$2,386.25 |
$4,772.50 |
7.0× |
| CTA chest (71275) |
$1,550.50 |
$3,101 |
9.1× |
| Cta Head (70496) |
$1,543.50 |
$3,087 |
9.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,415.50 |
$2,831 |
8.3× |
| Cta Neck (70498) |
$1,632.50 |
$3,265 |
9.6× |
| Cta Pelvis (72191) |
$1,597.50 |
$3,195 |
9.4× |
| Cystography minimum 3 views rs&i (74430) |
$243.75 |
$487.50 |
0.7× |
| Dacryocystography (70170) |
$341.25 |
$682.50 |
1.5× |
| Diskogram cervical (72285) |
$1,811.75 |
$3,623.50 |
1.0× |
| Diskography lumbar (72295) |
$2,418 |
$4,836 |
1.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$189.25 |
$378.50 |
1.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$383 |
$766 |
3.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$193.50 |
$387 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$194.50 |
$389 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$197.25 |
$394.50 |
2.3× |
| Dxa bone density study axial skeleton (77085) |
$128.50 |
$257 |
1.3× |
| Echo exam of fetal heart (76825) |
$1,139.75 |
$2,279.50 |
2.1× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$553 |
$1,106 |
2.4× |
| Echoencephalography real time imaging (76506) |
$273.25 |
$546.50 |
2.7× |
| Esophagus (74220) |
$250.50 |
$501 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$411.50 |
$823 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$354 |
$708 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$414.75 |
$829.50 |
1.8× |
| Foot 2 views (73620) |
$157.50 |
$315 |
1.9× |
| Forearm 2 views (73090) |
$130.75 |
$261.50 |
1.5× |
| Functional MRI brain by phys/psych (70555) |
$761 |
$1,522 |
3.3× |
| Functional MRI brain by tech (70554) |
$761 |
$1,522 |
3.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$3,016.50 |
$6,033 |
5.7× |
| Gated Heart Planar Single (78472) |
$1,276.50 |
$2,553 |
3.3× |
| Hand 2 views (73120) |
$132.50 |
$265 |
1.3× |
| Hand 3 views (73130) |
$243.75 |
$487.50 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,092.50 |
$6,185 |
4.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,398.50 |
$8,797 |
6.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,630.75 |
$7,261.50 |
5.4× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$3,122.50 |
$6,245 |
8.3× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$3,122.50 |
$6,245 |
8.3× |
| Heart Infarct Image (78466) |
$615.50 |
$1,231 |
1.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,998.75 |
$5,997.50 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,620 |
$3,240 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,591 |
$3,182 |
4.1× |
| Ht muscle image spect sing (78451) |
$1,906 |
$3,812 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$130.75 |
$261.50 |
1.5× |
| Hysterosalpingogram (74740) |
$519 |
$1,038 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$5,657 |
$11,314 |
8.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$153.50 |
$307 |
1.5× |
| Kidney imaging morphology (78700) |
$612 |
$1,224 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,049.50 |
$2,099 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,172 |
$2,344 |
2.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,697 |
$3,394 |
3.2× |
| Knee 3 views (73562) |
$243.75 |
$487.50 |
2.9× |
| Liver & spleen imaging static only (78215) |
$699.50 |
$1,399 |
1.8× |
| Liver imaging w/vascular flow (78202) |
$783 |
$1,566 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$1,294 |
$2,588 |
2.5× |
| Lung perfusion differential (78597) |
$987 |
$1,974 |
2.5× |
| Lung Ventilation Imaging (78579) |
$1,112.50 |
$2,225 |
2.9× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,672 |
$3,344 |
0.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$579 |
$1,158 |
0.9× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$808 |
$1,616 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,637 |
$3,274 |
0.5× |
| Lymphoscintigraphy (78195) |
$1,248.50 |
$2,497 |
2.4× |
| Mammary ductogram or galactogram multiple (77054) |
$402.50 |
$805 |
1.7× |
| Mammary ductogram or galactogram single (77053) |
$251 |
$502 |
1.1× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$124.50 |
$249 |
1.5× |
| Meckels Diverticulum (78290) |
$699.50 |
$1,399 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$5,053.50 |
$10,107 |
13.9× |
| Mr elastography (76391) |
$255.50 |
$511 |
1.1× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$121 |
$242 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$50 |
$100 |
1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$186.75 |
$373.50 |
2.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$492.50 |
$985 |
2.1× |
| MRA head w & w/o contrast (70546) |
$2,137.25 |
$4,274.50 |
6.3× |
| MRA head w/o contrast (70544) |
$1,589 |
$3,178 |
6.9× |
| MRA head with contrast (70545) |
$2,143.50 |
$4,287 |
6.3× |
| MRA neck w contrast (70548) |
$2,068.50 |
$4,137 |
6.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,064.75 |
$4,129.50 |
6.1× |
| MRA neck w/o contrast (70547) |
$1,414.50 |
$2,829 |
6.1× |
| MRI abdomen w contrast (74182) |
$1,969 |
$3,938 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,406.25 |
$4,812.50 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$1,583.50 |
$3,167 |
6.8× |
| MRI any jnt lwr ext with con lt (73722) |
$1,470 |
$2,940 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,739 |
$3,478 |
2.3× |
| MRI bone marrow blood supply (77084) |
$275.50 |
$551 |
1.2× |
| MRI breast w/o contrast bilateral (77047) |
$2,300 |
$4,600 |
9.9× |
| MRI breast w/o contrast unilat (77046) |
$1,800 |
$3,600 |
7.8× |
| MRI c-spine with contrast (72142) |
$1,913 |
$3,826 |
5.6× |
| MRI cardiac w/o cont stress (75559) |
$1,189 |
$2,378 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$898.50 |
$1,797 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$1,755.75 |
$3,511.50 |
7.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,032.50 |
$4,065 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,438.25 |
$2,876.50 |
6.2× |
| MRI chest with contrast (71551) |
$1,684.50 |
$3,369 |
2.2× |
| MRI fetal sngl/1st gestation (74712) |
$465 |
$930 |
2.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,865 |
$3,730 |
5.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,622.50 |
$3,245 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,263.25 |
$2,526.50 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,464.25 |
$2,928.50 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,018.75 |
$4,037.50 |
6.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,595.25 |
$3,190.50 |
4.7× |
| MRI pelvis w contrast (72196) |
$1,765 |
$3,530 |
5.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,213.25 |
$4,426.50 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,464.25 |
$2,928.50 |
6.3× |
| MRI scan of arm joint before and after contrast (73223) |
$2,187.25 |
$4,374.50 |
6.5× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,853 |
$3,706 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,847.25 |
$3,694.50 |
5.4× |
| MRI spectroscopy (76390) |
$378.50 |
$757 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,230.25 |
$4,460.50 |
6.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,913 |
$3,826 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,230.25 |
$4,460.50 |
6.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,930.75 |
$3,861.50 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,230.25 |
$4,460.50 |
6.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,755.75 |
$3,511.50 |
7.6× |
| MRI tmj (70336) |
$1,543 |
$3,086 |
6.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,516.75 |
$3,033.50 |
6.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,844.25 |
$3,688.50 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,332.50 |
$2,665 |
5.7× |
| Myelogram Cervical (72240) |
$686 |
$1,372 |
0.9× |
| Myelogram Lumbar (72265) |
$997.25 |
$1,994.50 |
1.3× |
| Myelogram thoracic (72255) |
$2,569.50 |
$5,139 |
3.4× |
| Myelography 2 or more regions (72270) |
$978.75 |
$1,957.50 |
1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,825 |
$5,650 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,165 |
$6,330 |
2.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,896.50 |
$3,793 |
1.4× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,925.50 |
$5,851 |
1.4× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$2,464.50 |
$4,929 |
3.0× |
| Neck soft tissue (70360) |
$170.75 |
$341.50 |
2.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$266.30 |
$532.60 |
0.7× |
| Nm bone marrow multiple (78103) |
$823 |
$1,646 |
2.1× |
| Nm bone marrow wb (78104) |
$435 |
$870 |
1.1× |
| Nm cisternogram (78630) |
$1,014.50 |
$2,029 |
1.9× |
| Nm csf leak detection (78650) |
$1,301.52 |
$2,603.04 |
1.0× |
| Nm gastric emptying study (78264) |
$1,321.50 |
$2,643 |
3.4× |
| Nm gastroesophageal reflux study (78262) |
$483.50 |
$967 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$629.50 |
$1,259 |
1.6× |
| Nm whole blood volume (78122) |
$1,102 |
$2,204 |
2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,727 |
$9,454 |
3.5× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,478 |
$4,956 |
1.8× |
| Nuclear medicine of heart pumping function (78473) |
$770 |
$1,540 |
2.0× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,478 |
$4,956 |
1.8× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,453 |
$2,906 |
3.7× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$787.50 |
$1,575 |
2.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$928 |
$1,856 |
2.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$450 |
$900 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$764.50 |
$1,529 |
3.4× |
| Nuclr Rx Interstit Colloid (79300) |
$463.50 |
$927 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$240.50 |
$481 |
2.4× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$266.50 |
$533 |
2.6× |
| Orthopantogram (70355) |
$246.25 |
$492.50 |
2.9× |
| Osseous survey infant (77076) |
$202.25 |
$404.50 |
2.0× |
| Osseous survey limited (77074) |
$157.50 |
$315 |
1.6× |
| Parathyrd planar w/spect&CT (78072) |
$2,773.50 |
$5,547 |
5.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,012 |
$2,024 |
2.6× |
| Parathyroid imaging (78070) |
$804.50 |
$1,609 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$202.25 |
$404.50 |
2.0× |
| Perineogram (74775) |
$1,759 |
$3,518 |
7.6× |
| Peritoneogram rs&i (74190) |
$302.50 |
$605 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$5,261.50 |
$10,523 |
3.8× |
| PET imaging CT for attenuation limited area (78814) |
$3,525 |
$7,050 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,135.25 |
$10,270.50 |
3.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,860 |
$3,720 |
5.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,090 |
$4,180 |
0.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,045.50 |
$4,091 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$629.50 |
$1,259 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,276.50 |
$2,553 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$351.50 |
$703 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$151.50 |
$303 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$195 |
$390 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$202.25 |
$404.50 |
2.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$243.75 |
$487.50 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$295 |
$590 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,267.50 |
$24,535 |
1.7× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$777.50 |
$1,555 |
1.4× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$485 |
$970 |
4.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$643 |
$1,286 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$259 |
$518 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$170.75 |
$341.50 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$243.75 |
$487.50 |
2.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$232.50 |
$465 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$456 |
$912 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$250.50 |
$501 |
1.5× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$146 |
$292 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$304.75 |
$609.50 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$282.50 |
$565 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$202.25 |
$404.50 |
2.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$56.75 |
$113.50 |
0.7× |
| Radiological examination surgical specimen (76098) |
$393 |
$786 |
0.7× |
| Radiopharm Dacryocystography (78660) |
$378.04 |
$756.07 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$571.50 |
$1,143 |
2.5× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,463.50 |
$4,927 |
0.8× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,297.25 |
$4,594.50 |
0.7× |
| Ribs bilateral 3 views (71110) |
$243.75 |
$487.50 |
2.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$768.50 |
$1,537 |
2.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,407 |
$2,814 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,301.52 |
$2,603.04 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,231.17 |
$2,462.33 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,356.45 |
$2,712.89 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,231.17 |
$2,462.33 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$831 |
$1,662 |
3.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$844.50 |
$1,689 |
3.7× |
| Rp Therapy Intravenous Administration (79101) |
$764.50 |
$1,529 |
3.4× |
| Sacroiliac Joints < 3 Views (72200) |
$207.50 |
$415 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$359 |
$718 |
1.5× |
| Salivary gland imaging (78230) |
$408.69 |
$817.38 |
1.1× |
| Salivary gland imaging serial images (78231) |
$423.50 |
$847 |
1.1× |
| Scanogram (77073) |
$164 |
$328 |
1.6× |
| Scapula complete (73010) |
$243.75 |
$487.50 |
2.4× |
| Screening digital breast tomosynthesis (77063) |
$76 |
$152 |
3.3× |
| Sella turcica (70240) |
$114.50 |
$229 |
1.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$164 |
$328 |
1.6× |
| Sialogram (70390) |
$291 |
$582 |
1.3× |
| Small bowel series (74250) |
$304.75 |
$609.50 |
1.8× |
| Spec medical radj physics consltj (77370) |
$637 |
$1,274 |
4.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$637 |
$1,274 |
1.8× |
| Special dosimetry (77331) |
$378.50 |
$757 |
2.9× |
| Special treatment procedure (77470) |
$1,803.50 |
$3,607 |
3.4× |
| Spine thoracic 3 views (72072) |
$243.75 |
$487.50 |
2.4× |
| Spleen imaging only (78185) |
$746 |
$1,492 |
1.9× |
| Splenoportograpy rs&i (75810) |
$2,532.25 |
$5,064.50 |
0.8× |
| Stereotactic body radiation delivery (77373) |
$4,925.50 |
$9,851 |
2.8× |
| Superior sagittal sinus venogram (75870) |
$2,045.50 |
$4,091 |
0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,404.50 |
$4,809 |
6.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,096 |
$2,192 |
3.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$467 |
$934 |
2.0× |
| Testicular Imaging With Vascular Flow (78761) |
$837 |
$1,674 |
2.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,837.50 |
$3,675 |
5.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,131.50 |
$2,263 |
8.7× |
| Therapeutic Enema (74283) |
$452.75 |
$905.50 |
2.7× |
| Thoracolumbar 2 views (72080) |
$202.25 |
$404.50 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,364 |
$2,728 |
2.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$595.50 |
$1,191 |
1.5× |
| Thyroid uptake measurement (78012) |
$420 |
$840 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$643 |
$1,286 |
1.7× |
| Tmj unilateral (70328) |
$170.75 |
$341.50 |
2.0× |
| Tomogram (76100) |
$191.25 |
$382.50 |
1.9× |
| Treatment device intermediate (77333) |
$703 |
$1,406 |
5.4× |
| Treatment devices simple (77332) |
$693.50 |
$1,387 |
5.3× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,767 |
$3,534 |
3.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$768.50 |
$1,537 |
2.0× |
| Tx devices design & construction complex (77334) |
$920 |
$1,840 |
2.5× |
| Ultrasound elastography first target lesion (76982) |
$140 |
$280 |
1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$638.75 |
$1,277.50 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$450.50 |
$901 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$206 |
$412 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$723 |
$1,446 |
8.5× |
| Unlisted magnetic resonance procedure (76498) |
$301.25 |
$602.50 |
3.6× |
| Unlisted Ultrasound Procedure (76999) |
$134.50 |
$269 |
1.6× |
| Upper Extremity Infant (73092) |
$202.25 |
$404.50 |
2.0× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$837 |
$1,674 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$323 |
$646 |
1.4× |
| Urethrocystography voiding (74455) |
$499 |
$998 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$317 |
$634 |
1.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$387.50 |
$775 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$266.75 |
$533.50 |
2.6× |
| Us breast unilateral complete (76641) |
$282.25 |
$564.50 |
2.8× |
| Us breast unilateral limited (76642) |
$282.25 |
$564.50 |
3.3× |
| Us chest (76604) |
$229.25 |
$458.50 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$338.50 |
$677 |
3.3× |
| Us elastography parenchyma (76981) |
$140 |
$280 |
1.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$290 |
$580 |
2.9× |
| Us guided compression repair (76936) |
$338.75 |
$677.50 |
1.6× |
| Us infant hips dynamic (76885) |
$248 |
$496 |
2.9× |
| Us infant hips limited static (76886) |
$219 |
$438 |
2.6× |
| Us kidney transplant (76776) |
$373 |
$746 |
3.7× |
| Us ob detailed single fetus (76811) |
$502.25 |
$1,004.50 |
2.2× |
| Us ob transvaginal (76817) |
$347.50 |
$695 |
3.4× |
| Us pelvic non ob complete (76856) |
$579.25 |
$1,158.50 |
5.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$233.50 |
$467 |
2.3× |
| Us pregnancy ltd (76815) |
$278.75 |
$557.50 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$362.75 |
$725.50 |
3.6× |
| Us retroperitoneal complete (76770) |
$505 |
$1,010 |
5.0× |
| Us retroperitoneal limited (76775) |
$310.25 |
$620.50 |
3.1× |
| Us scrotum and contents (76870) |
$463.25 |
$926.50 |
4.6× |
| Us soft tissue head/neck (76536) |
$410.25 |
$820.50 |
4.0× |
| Us spinal canal and contents (76800) |
$356.75 |
$713.50 |
3.5× |
| Us transrectal (76872) |
$514 |
$1,028 |
5.1× |
| Us transrectal prostate volume (76873) |
$937 |
$1,874 |
9.2× |
| Us xtr non-vasc lmtd (76882) |
$147.50 |
$295 |
1.5× |
| Vasogram (74440) |
$217 |
$434 |
0.9× |
| Venogram extremity bilateral (75822) |
$982.75 |
$1,965.50 |
0.6× |
| Venogram orbital (75880) |
$885.50 |
$1,771 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$2,031.75 |
$4,063.50 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,141.75 |
$2,283.50 |
0.7× |
| Venography epidural rs&i (75872) |
$927.75 |
$1,855.50 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$941.50 |
$1,883 |
0.6× |
| Venography Renal Bilateral (75833) |
$2,955.25 |
$5,910.50 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$2,688.50 |
$5,377 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,672 |
$3,344 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,285 |
$6,570 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$146 |
$292 |
1.7× |
| Wrist 2 views (73100) |
$99.50 |
$199 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$282.50 |
$565 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$243.75 |
$487.50 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$243.75 |
$487.50 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$535.25 |
$1,070.50 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.75 |
$261.50 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$243.75 |
$487.50 |
2.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$215 |
$430 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$170.75 |
$341.50 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$222 |
$444 |
2.6× |
| X-ray exam hip uni 4/> views (73503) |
$259 |
$518 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$259 |
$518 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$280 |
$560 |
2.8× |
| X-ray exam of femur 1 (73551) |
$170.75 |
$341.50 |
2.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$434 |
$868 |
2.5× |
| X-ray eye for foreign body (70030) |
$170.75 |
$341.50 |
2.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$243.75 |
$487.50 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$202.25 |
$404.50 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$243.75 |
$487.50 |
2.9× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,530.25 |
$3,060.50 |
0.8× |
| X-ray head for orthodontia (70350) |
$120.25 |
$240.50 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$202.25 |
$404.50 |
2.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$380.25 |
$760.50 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$259 |
$518 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$259 |
$518 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$259 |
$518 |
3.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$202.25 |
$404.50 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$243.75 |
$487.50 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$338.75 |
$677.50 |
3.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$259 |
$518 |
2.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$243.75 |
$487.50 |
2.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$170.75 |
$341.50 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$259 |
$518 |
2.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$243.75 |
$487.50 |
2.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$537.75 |
$1,075.50 |
1.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$386.75 |
$773.50 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$178.75 |
$357.50 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$216.25 |
$432.50 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$251.25 |
$502.50 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$243.75 |
$487.50 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202.25 |
$404.50 |
2.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$202.25 |
$404.50 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$243.75 |
$487.50 |
2.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$158 |
$316 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$259 |
$518 |
2.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$243.75 |
$487.50 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$170.75 |
$341.50 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$243.75 |
$487.50 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$202.25 |
$404.50 |
2.4× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$47 |
$94 |
0.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$202.25 |
$404.50 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$259 |
$518 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$180.50 |
$361 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$243.75 |
$487.50 |
2.9× |
| Xr arthrogram ankle (73615) |
$468.25 |
$936.50 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$323.75 |
$647.50 |
3.2× |
| Xr chest 4+ views (71048) |
$259 |
$518 |
2.5× |
| Xr Cholecystography Oral Contrast (74290) |
$213.25 |
$426.50 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$184 |
$368 |
2.2× |
| Xr internal auditory meati complete (70134) |
$341.50 |
$683 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$202.25 |
$404.50 |
2.0× |
| Xr myelogram posterior fossa (70010) |
$612 |
$1,224 |
1.8× |
| Xr optic foramina (70190) |
$101 |
$202 |
1.2× |
| Xr shoulder 1 view (73020) |
$170.75 |
$341.50 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$259 |
$518 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$130.75 |
$261.50 |
1.5× |
| Xr tmj bilateral (70330) |
$187.75 |
$375.50 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$171.25 |
$342.50 |
2.0× |