| 3-D radiotherapy plan dose-volume histograms (77295) |
$534.52 |
$1,909 |
0.4× |
| Abdomen 2 views (74019) |
$119.56 |
$427 |
1.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$437.64 |
$1,563 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$900.48 |
$3,216 |
0.3× |
| Angiography extremity bilateral rs&i (75716) |
$900.48 |
$3,216 |
0.3× |
| Angiography extremity unilateral rs&i (75710) |
$900.48 |
$3,216 |
0.3× |
| Angiography internal mammary rs&i (75756) |
$193.20 |
$690 |
0.1× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,500.24 |
$5,358 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$900.48 |
$3,216 |
0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$900.48 |
$3,216 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,500.24 |
$5,358 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,500.24 |
$5,358 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,139.32 |
$4,069 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$900.48 |
$3,216 |
0.3× |
| Ankle 2 views (73600) |
$170.52 |
$609 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$113.68 |
$406 |
0.4× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,500.24 |
$5,358 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$900.48 |
$3,216 |
0.3× |
| Aortography abdominal serialography rs&i (75625) |
$900.48 |
$3,216 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$194.88 |
$696 |
0.1× |
| Artery X-Rays Adrenal Gland (75731) |
$900.48 |
$3,216 |
0.3× |
| Arthrogram elbow (73085) |
$113.68 |
$406 |
0.4× |
| Arthrogram hip (73525) |
$188.16 |
$672 |
0.6× |
| Arthrogram shoulder (73040) |
$113.68 |
$406 |
0.4× |
| Arthrogram wrist (73115) |
$125.72 |
$449 |
0.4× |
| Arthrography knee lt (73580) |
$179.20 |
$640 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$54.88 |
$196 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$231.84 |
$828 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$340.48 |
$1,216 |
0.9× |
| Bone age studies (77072) |
$113.68 |
$406 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$437.64 |
$1,563 |
1.2× |
| Bone Marrow Imaging Limited Area (78102) |
$224.28 |
$801 |
0.6× |
| Bone survey complete (77075) |
$113.68 |
$406 |
1.2× |
| Brachytx isodose intermed (77317) |
$188.44 |
$673 |
0.6× |
| Brain image w/flow 4 + views (78606) |
$465.08 |
$1,661 |
0.9× |
| Brain imaging < 4 static views w vascular flow (78601) |
$301.56 |
$1,077 |
0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,117.92 |
$7,564 |
1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$355.04 |
$1,268 |
1.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$688.24 |
$2,458 |
2.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$348.04 |
$1,243 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$119.56 |
$427 |
1.5× |
| Chest 1 view (71045) |
$113.68 |
$406 |
1.4× |
| Chest 3 views (71047) |
$125.72 |
$449 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$113.68 |
$406 |
0.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$255.92 |
$914 |
0.4× |
| Clavicle complete (73000) |
$170.52 |
$609 |
2.2× |
Complete single session course of cranial lesion surgery using radiation (77371)
unusually low: confirm this is the full procedure |
$2,780.12 |
$9,929 |
0.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$278.88 |
$996 |
2.9× |
| Continuing medical physics consltj pr wk (77336) |
$78.96 |
$282 |
0.6× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$113.68 |
$406 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$858.76 |
$3,067 |
2.7× |
| CT abdomen and pelvis without contrast (74176) |
$485.24 |
$1,733 |
2.2× |
| CT abdomen w contrast (74160) |
$458.08 |
$1,636 |
2.9× |
| CT abdomen w wo contrast (74170) |
$590.24 |
$2,108 |
3.7× |
| CT abdomen w/o contrast (74150) |
$321.44 |
$1,148 |
3.4× |
| CT angio hrt w/3d image (75574) |
$476 |
$1,700 |
1.5× |
| CT angiography upper extremity lt (73206) |
$602.56 |
$2,152 |
3.8× |
| CT c-spine w/o contrast (72125) |
$343.84 |
$1,228 |
3.6× |
| CT cervical spine w&w/o contrast (72127) |
$534.80 |
$1,910 |
3.4× |
| CT cervical spine with contrast (72126) |
$425.60 |
$1,520 |
1.3× |
| CT chest w/wo contrast (71270) |
$535.36 |
$1,912 |
3.4× |
| CT chest with contrast (71260) |
$424.20 |
$1,515 |
2.7× |
| CT head/brain with contrast (70460) |
$341.88 |
$1,221 |
2.2× |
| CT head/brain without and with contrast (70470) |
$421.12 |
$1,504 |
2.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$388.36 |
$1,387 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$80.08 |
$286 |
1.0× |
| CT hrt w/3d image congen (75573) |
$476.56 |
$1,702 |
1.5× |
| CT iac w contrast (70481) |
$493.92 |
$1,764 |
3.1× |
| CT limited/localized follow up study (76380) |
$194.32 |
$694 |
2.5× |
| CT lower ext w/o (73700) |
$495.60 |
$1,770 |
5.2× |
| CT lower extremity w wo contrast (73702) |
$819.42 |
$2,926.50 |
5.2× |
| CT lower extremity with contrast (73701) |
$616.98 |
$2,203.50 |
3.9× |
| CT lumbar spine w & w/o contrast (72133) |
$535.36 |
$1,912 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$341.88 |
$1,221 |
3.6× |
| CT lumbar spine with contrast (72132) |
$424.20 |
$1,515 |
1.3× |
| CT maxillofacial w contrast (70487) |
$422.24 |
$1,508 |
2.7× |
| CT maxillofacial w/o contrast (70486) |
$344.96 |
$1,232 |
3.6× |
| CT maxillofacial w/wo contrast (70488) |
$527.80 |
$1,885 |
3.3× |
| CT neck soft tissue w contrast (70491) |
$406.28 |
$1,451 |
2.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$573.72 |
$2,049 |
3.6× |
| CT orbits w/o contrast (70480) |
$345.52 |
$1,234 |
3.6× |
| CT pelvis w & w/o contrast (72194) |
$537.32 |
$1,919 |
3.4× |
| CT pelvis w/o contrast (72192) |
$324.52 |
$1,159 |
3.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$511 |
$1,825 |
3.2× |
| CT soft tissue neck w/o contrast (70490) |
$327.04 |
$1,168 |
3.5× |
| CT thoracic spine w/contrast (72129) |
$425.60 |
$1,520 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$342.44 |
$1,223 |
3.6× |
| CT thoracic spine w/wo contrast (72130) |
$536.76 |
$1,917 |
3.4× |
| CT thorax w/o contrast (71250) |
$342.44 |
$1,223 |
3.6× |
| CT unlisted procedure (76497) |
$340.76 |
$1,217 |
4.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$817.32 |
$2,919 |
5.1× |
| CT upper extremity w/o contrast rt (73200) |
$494.34 |
$1,765.50 |
5.2× |
| CT upper extremity with contrast (73201) |
$611.52 |
$2,184 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$603.12 |
$2,154 |
3.8× |
| Cta Abdomen (74175) |
$602.56 |
$2,152 |
3.8× |
| CTA abdomen pelvis (74174) |
$856.52 |
$3,059 |
2.7× |
| CTA chest (71275) |
$602.56 |
$2,152 |
3.8× |
| Cta Head (70496) |
$602.56 |
$2,152 |
3.8× |
| CTA lwr ext w&w/o contrast (73706) |
$903.84 |
$3,228 |
5.7× |
| Cta Neck (70498) |
$602.56 |
$2,152 |
3.8× |
| Cta Pelvis (72191) |
$602.56 |
$2,152 |
3.8× |
| Cystography minimum 3 views rs&i (74430) |
$113.68 |
$406 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$37.80 |
$135 |
0.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$66.64 |
$238 |
0.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$95.76 |
$342 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$113.68 |
$406 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$113.68 |
$406 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$113.68 |
$406 |
1.2× |
| Echo exam of eye (76529) |
$98.70 |
$352.50 |
1.3× |
| Echo exam of fetal heart (76825) |
$216.72 |
$774 |
0.4× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$132.44 |
$473 |
0.6× |
| Echoencephalography real time imaging (76506) |
$110.60 |
$395 |
1.2× |
| Esophageal motility (78258) |
$310.52 |
$1,109 |
0.9× |
| Esophagus (74220) |
$113.68 |
$406 |
0.7× |
| Fetal biophysical profile non-stress testing (76818) |
$115.08 |
$411 |
1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$89.60 |
$320 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$113.68 |
$406 |
0.5× |
| Foot 2 views (73620) |
$170.52 |
$609 |
2.2× |
| Forearm 2 views (73090) |
$170.52 |
$609 |
2.2× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$113.68 |
$406 |
0.5× |
| Functional MRI brain by tech (70554) |
$653.24 |
$2,333 |
3.0× |
| Gated Heart Planar Single (78472) |
$338.52 |
$1,209 |
0.9× |
| Hand 2 views (73120) |
$170.52 |
$609 |
1.8× |
| Hand 3 views (73130) |
$179.34 |
$640.50 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$602 |
$2,150 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$950.04 |
$3,393 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$900.48 |
$3,216 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$759.36 |
$2,712 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$550.48 |
$1,966 |
1.5× |
| Ht muscle image spect sing (78451) |
$467.32 |
$1,669 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$113.68 |
$406 |
1.4× |
| Hysterosalpingogram (74740) |
$113.68 |
$406 |
0.5× |
| Interstitial radiation source applic complex (77778) |
$373.52 |
$1,334 |
0.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$113.68 |
$406 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$311.64 |
$1,113 |
0.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$175 |
$625 |
0.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$474.60 |
$1,695 |
1.0× |
| Knee 3 views (73562) |
$179.34 |
$640.50 |
2.3× |
| Liver & spleen imaging static only (78215) |
$269.08 |
$961 |
0.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$174.44 |
$623 |
0.5× |
| Liver imaging static only (78201) |
$259.28 |
$926 |
0.5× |
| Liver imaging w/vascular flow (78202) |
$356.72 |
$1,274 |
0.7× |
| Lung perfusion differential (78597) |
$304.64 |
$1,088 |
0.8× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$440.44 |
$1,573 |
0.8× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,139.32 |
$4,069 |
0.4× |
| Lymphoscintigraphy (78195) |
$457.52 |
$1,634 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$113.68 |
$406 |
0.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$113.68 |
$406 |
1.4× |
| Meckels Diverticulum (78290) |
$437.64 |
$1,563 |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$371 |
$1,325 |
1.1× |
| MRA head w & w/o contrast (70546) |
$789.60 |
$2,820 |
2.5× |
| MRA head w/o contrast (70544) |
$515.48 |
$1,841 |
2.4× |
| MRA head with contrast (70545) |
$625.52 |
$2,234 |
2.0× |
| MRA neck w contrast (70548) |
$625.52 |
$2,234 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$789.60 |
$2,820 |
2.5× |
| MRA neck w/o contrast (70547) |
$515.48 |
$1,841 |
2.4× |
| MRI abdomen w contrast (74182) |
$625.52 |
$2,234 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$789.60 |
$2,820 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$515.48 |
$1,841 |
2.4× |
| MRI any jnt lwr ext with con lt (73722) |
$937.44 |
$3,348 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$624.96 |
$2,232 |
0.9× |
| MRI breast w/o contrast bilateral (77047) |
$662.20 |
$2,365 |
3.1× |
| MRI breast w/o contrast unilat (77046) |
$381.08 |
$1,361 |
1.8× |
| MRI c-spine with contrast (72142) |
$624.96 |
$2,232 |
2.0× |
| MRI cardiac w/o contrast (75557) |
$475.44 |
$1,698 |
2.2× |
| MRI cervical spine w/o contrast (72141) |
$515.48 |
$1,841 |
2.4× |
| MRI chest w/o & w/contrast material (71552) |
$789.60 |
$2,820 |
2.5× |
| MRI chest w/o contrast (71550) |
$515.48 |
$1,841 |
2.4× |
| MRI chest with contrast (71551) |
$625.52 |
$2,234 |
0.9× |
| MRI fetal sngl/1st gestation (74712) |
$258.72 |
$924 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$624.96 |
$2,232 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$937.44 |
$3,348 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$773.22 |
$2,761.50 |
3.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$515.48 |
$1,841 |
2.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$789.60 |
$2,820 |
2.5× |
| MRI orbit/face/neck w/contrast (70542) |
$624.96 |
$2,232 |
2.0× |
| MRI pelvis w contrast (72196) |
$624.96 |
$2,232 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$789.60 |
$2,820 |
2.5× |
| MRI pelvis w/o contrast (72195) |
$515.48 |
$1,841 |
2.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,184.40 |
$4,230 |
3.7× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$789.60 |
$2,820 |
1.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,184.40 |
$4,230 |
3.7× |
| MRI spectroscopy (76390) |
$546.28 |
$1,951 |
6.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$789.60 |
$2,820 |
2.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$624.96 |
$2,232 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$789.60 |
$2,820 |
2.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$615.44 |
$2,198 |
1.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$789.60 |
$2,820 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$515.48 |
$1,841 |
2.4× |
| MRI tmj (70336) |
$515.48 |
$1,841 |
2.4× |
| MRI upper ext joint w/o contrast (73221) |
$773.22 |
$2,761.50 |
3.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$789.60 |
$2,820 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$515.48 |
$1,841 |
2.4× |
| Myelogram Lumbar (72265) |
$225.12 |
$804 |
0.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,719.64 |
$9,713 |
2.3× |
| Myocardial infarct spect (78469) |
$341.04 |
$1,218 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$467.32 |
$1,669 |
0.4× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$3,315.20 |
$11,840 |
2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,315.20 |
$11,840 |
2.6× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$5,169.64 |
$18,463 |
2.6× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$6,318.20 |
$22,565 |
3.2× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$6,318.20 |
$22,565 |
4.6× |
| Neck soft tissue (70360) |
$113.68 |
$406 |
1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$145.04 |
$518 |
0.4× |
| Nm cisternogram (78630) |
$483 |
$1,725 |
1.0× |
| Nm csf leak detection (78650) |
$467.32 |
$1,669 |
0.4× |
| Nm gastric emptying study (78264) |
$395.36 |
$1,412 |
1.1× |
| Nm gastroesophageal reflux study (78262) |
$341.04 |
$1,218 |
0.9× |
| Nm peritoneal-venous shunt patency (78291) |
$332.08 |
$1,186 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,590.28 |
$9,251 |
2.1× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,525.04 |
$9,018 |
2.0× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$467.32 |
$1,669 |
0.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$356.72 |
$1,274 |
1.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$591.36 |
$2,112 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$145.04 |
$518 |
0.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$110.60 |
$395 |
1.2× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$177.24 |
$633 |
1.5× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$67.76 |
$242 |
0.7× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$120.12 |
$429 |
1.3× |
| Orthopantogram (70355) |
$113.68 |
$406 |
1.4× |
| Osseous survey infant (77076) |
$113.68 |
$406 |
1.2× |
| Osseous survey limited (77074) |
$82.32 |
$294 |
0.9× |
| Parathyrd planar w/spect&CT (78072) |
$797.72 |
$2,849 |
1.6× |
| Parathyrd planar w/wo subtrj (78071) |
$576.24 |
$2,058 |
1.6× |
| Parathyroid imaging (78070) |
$211.40 |
$755 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$113.68 |
$406 |
1.2× |
| Peritoneogram rs&i (74190) |
$336.56 |
$1,202 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,184.40 |
$4,230 |
3.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$900.48 |
$3,216 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$900.48 |
$3,216 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$283.64 |
$1,013 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$509.88 |
$1,821 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$152.04 |
$543 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$113.68 |
$406 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$119.56 |
$427 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$170.52 |
$609 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$119.56 |
$427 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$82.32 |
$294 |
0.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$309.40 |
$1,105 |
0.6× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$200.20 |
$715 |
2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$119.56 |
$427 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$113.68 |
$406 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$125.72 |
$449 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$119.56 |
$427 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$113.68 |
$406 |
0.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$230.44 |
$823 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$119.56 |
$427 |
0.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$113.68 |
$406 |
0.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$179.34 |
$640.50 |
2.3× |
| Radiological examination surgical specimen (76098) |
$152.04 |
$543 |
0.3× |
| Review by radiologist of adrenal gland vein image (75840) |
$900.48 |
$3,216 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$900.48 |
$3,216 |
0.3× |
| Ribs bilateral 3 views (71110) |
$170.52 |
$609 |
1.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$467.32 |
$1,669 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$467.32 |
$1,669 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,383.68 |
$15,656 |
3.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,972.80 |
$17,760 |
3.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,383.68 |
$15,656 |
3.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$145.04 |
$518 |
0.7× |
| Rp Therapy Intravenous Administration (79101) |
$145.04 |
$518 |
0.7× |
| Sacroiliac Joints < 3 Views (72200) |
$113.68 |
$406 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$98.84 |
$353 |
0.5× |
| Salivary gland function study (78232) |
$169.96 |
$607 |
0.5× |
| Scanogram (77073) |
$113.68 |
$406 |
1.2× |
| Scapula complete (73010) |
$170.52 |
$609 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$24.64 |
$88 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$113.68 |
$406 |
1.2× |
| Small bowel series (74250) |
$113.68 |
$406 |
0.7× |
| Spec medical radj physics consltj (77370) |
$331.80 |
$1,185 |
2.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$91.56 |
$327 |
0.3× |
| Special dosimetry (77331) |
$91.56 |
$327 |
0.8× |
| Special treatment procedure (77470) |
$165.76 |
$592 |
0.3× |
| Speech evaluation complex (70371) |
$82.32 |
$294 |
0.4× |
| Spine thoracic 3 views (72072) |
$119.56 |
$427 |
1.3× |
| Stereotactic body radiation delivery (77373) |
$2,200.52 |
$7,859 |
1.4× |
| Superior sagittal sinus venogram (75870) |
$900.48 |
$3,216 |
0.3× |
| Tbs Technical Calculation Only (77091) |
$100.52 |
$359 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$93.80 |
$335 |
0.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$47.60 |
$170 |
0.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$608.44 |
$2,173 |
1.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$211.96 |
$757 |
1.7× |
| Therapeutic Enema (74283) |
$148.96 |
$532 |
0.9× |
| Thoracolumbar 2 views (72080) |
$131.88 |
$471 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$447.72 |
$1,599 |
0.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$362.32 |
$1,294 |
1.0× |
| Thyroid uptake measurement (78012) |
$145.04 |
$518 |
0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$413.28 |
$1,476 |
1.1× |
| Tmj unilateral (70328) |
$113.68 |
$406 |
1.4× |
| Treatment device intermediate (77333) |
$29.96 |
$107 |
0.2× |
| Treatment devices simple (77332) |
$71.40 |
$255 |
0.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$859.60 |
$3,070 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$250.32 |
$894 |
0.7× |
| Tx devices design & construction complex (77334) |
$130.48 |
$466 |
0.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$7 |
$25 |
0.3× |
| Ultrasound scan to determine eye length and lens power (76519) |
$75.60 |
$270 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$125.16 |
$447 |
1.3× |
| Umbilical-artery Doppler (OB) (76820) |
$40.88 |
$146 |
0.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$75.18 |
$268.50 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$137.20 |
$490 |
1.7× |
| Unlisted magnetic resonance procedure (76498) |
$363.72 |
$1,299 |
4.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$316.96 |
$1,132 |
0.9× |
| Unlisted Ultrasound Procedure (76999) |
$57.68 |
$206 |
0.7× |
| Upper Extremity Infant (73092) |
$170.52 |
$609 |
1.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$302.12 |
$1,079 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$162.96 |
$582 |
0.8× |
| Urethrocystography voiding (74455) |
$113.68 |
$406 |
0.5× |
| Us abdl aorta screen aaa (76706) |
$120.68 |
$431 |
1.3× |
| Us breast unilateral complete (76641) |
$165.06 |
$589.50 |
1.7× |
| Us breast unilateral limited (76642) |
$165.06 |
$589.50 |
2.1× |
| Us chest (76604) |
$98.56 |
$352 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$162.96 |
$582 |
1.7× |
| Us elastography parenchyma (76981) |
$387.80 |
$1,385 |
4.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$114.52 |
$409 |
1.2× |
| Us guided compression repair (76936) |
$192.36 |
$687 |
1.0× |
| Us infant hips dynamic (76885) |
$110.60 |
$395 |
1.4× |
| Us infant hips limited static (76886) |
$110.60 |
$395 |
1.4× |
| Us kidney transplant (76776) |
$182.84 |
$653 |
1.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$129.92 |
$464 |
1.4× |
| Us ob detailed single fetus (76811) |
$168 |
$600 |
0.8× |
| Us ob transvaginal (76817) |
$108.64 |
$388 |
1.1× |
| Us pelvic non ob complete (76856) |
$145.88 |
$521 |
1.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$110.60 |
$395 |
1.2× |
| Us pregnancy ltd (76815) |
$97.72 |
$349 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$134.12 |
$479 |
1.4× |
| Us retroperitoneal complete (76770) |
$157.36 |
$562 |
1.7× |
| Us retroperitoneal limited (76775) |
$136.08 |
$486 |
1.4× |
| Us scrotum and contents (76870) |
$147.56 |
$527 |
1.6× |
| Us soft tissue head/neck (76536) |
$143.08 |
$511 |
1.5× |
| Us spinal canal and contents (76800) |
$120.12 |
$429 |
1.3× |
| Us transrectal (76872) |
$172.48 |
$616 |
1.8× |
| Us xtr non-vasc lmtd (76882) |
$46.76 |
$167 |
0.5× |
| Us, eye b-scan (76512) |
$100.80 |
$360 |
1.1× |
| Venogram extremity bilateral (75822) |
$442.40 |
$1,580 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$900.48 |
$3,216 |
0.3× |
| Venography caval superior serialography rs&i (75827) |
$442.40 |
$1,580 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$442.40 |
$1,580 |
0.3× |
| Venography Renal Bilateral (75833) |
$900.48 |
$3,216 |
0.3× |
| Venography renal unilateral selective rs&i (75831) |
$900.48 |
$3,216 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$900.48 |
$3,216 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,500.24 |
$5,358 |
0.3× |
| Wrist 2 views (73100) |
$170.52 |
$609 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$132.16 |
$472 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$113.68 |
$406 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$179.34 |
$640.50 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$163.52 |
$584 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$170.52 |
$609 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$173.46 |
$619.50 |
2.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$125.72 |
$449 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$113.68 |
$406 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$119.56 |
$427 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$125.72 |
$449 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$179.20 |
$640 |
1.9× |
| X-ray exam of femur 1 (73551) |
$113.68 |
$406 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$353.36 |
$1,262 |
2.2× |
| X-ray eye for foreign body (70030) |
$170.52 |
$609 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$119.56 |
$427 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$113.68 |
$406 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$179.34 |
$640.50 |
2.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$170.52 |
$609 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$113.68 |
$406 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$188.58 |
$673.50 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$170.52 |
$609 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$170.52 |
$609 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$113.68 |
$406 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$131.88 |
$471 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$125.72 |
$449 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$125.72 |
$449 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$113.68 |
$406 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$119.56 |
$427 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$119.56 |
$427 |
1.3× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$336.56 |
$1,202 |
0.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$113.68 |
$406 |
0.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$113.68 |
$406 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$119.56 |
$427 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$179.20 |
$640 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$119.56 |
$427 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$125.72 |
$449 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$179.34 |
$640.50 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$119.56 |
$427 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$113.68 |
$406 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$119.56 |
$427 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$113.68 |
$406 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$113.68 |
$406 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$119.56 |
$427 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$113.68 |
$406 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$113.68 |
$406 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$125.72 |
$449 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$113.68 |
$406 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$179.34 |
$640.50 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$131.88 |
$471 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$113.68 |
$406 |
1.4× |
| Xr internal auditory meati complete (70134) |
$82.32 |
$294 |
0.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$113.68 |
$406 |
1.2× |
| Xr shoulder 1 view (73020) |
$170.52 |
$609 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$125.72 |
$449 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$170.52 |
$609 |
2.2× |
| Xr tmj bilateral (70330) |
$170.52 |
$609 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$170.52 |
$609 |
2.2× |