| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,497.80 |
$3,744.50 |
1.1× |
| Abdomen 2 views (74019) |
$519.60 |
$1,299 |
4.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$902.80 |
$2,257 |
2.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,528 |
$6,320 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$3,028.40 |
$7,571 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,200.40 |
$5,501 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$2,318 |
$5,795 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,960 |
$7,400 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,462 |
$11,155 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,968 |
$4,920 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$3,348 |
$8,370 |
0.6× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,526 |
$6,315 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,837.20 |
$12,093 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,654.80 |
$4,137 |
0.5× |
| Ankle 2 views (73600) |
$328.80 |
$822 |
3.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$434 |
$1,085 |
1.2× |
| Aortogram thoracic (75605) |
$2,849.60 |
$7,124 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,536 |
$6,340 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,542.80 |
$6,357 |
0.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,048 |
$7,620 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$4,462 |
$11,155 |
1.4× |
| Arthrogram elbow (73085) |
$617.60 |
$1,544 |
1.8× |
| Arthrogram hip (73525) |
$682 |
$1,705 |
1.9× |
| Arthrogram shoulder (73040) |
$676.80 |
$1,692 |
1.9× |
| Arthrogram wrist (73115) |
$337.60 |
$844 |
1.0× |
| Arthrography knee lt (73580) |
$784 |
$1,960 |
2.2× |
| Basic radiation dosimetry calculation (77300) |
$272.80 |
$682 |
2.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$694.80 |
$1,737 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$765.60 |
$1,914 |
1.9× |
| Bone age studies (77072) |
$202 |
$505 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,052.40 |
$2,631 |
2.6× |
| Bone Marrow Imaging Limited Area (78102) |
$568.80 |
$1,422 |
1.4× |
| Bone survey complete (77075) |
$748 |
$1,870 |
7.1× |
| Brachytx isodose complex (77318) |
$329.20 |
$823 |
0.9× |
| Brachytx isodose intermed (77317) |
$329.20 |
$823 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$118 |
$295 |
0.3× |
| Brain image w/flow 4 + views (78606) |
$1,711.60 |
$4,279 |
3.1× |
| Brain imaging < 4 static views w vascular flow (78601) |
$534.80 |
$1,337 |
1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,544 |
$8,860 |
2.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,274 |
$3,185 |
3.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,320.40 |
$3,301 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$313.60 |
$784 |
3.6× |
| Chest 1 view (71045) |
$271.60 |
$679 |
3.1× |
| Chest 3 views (71047) |
$271.60 |
$679 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$422.40 |
$1,056 |
2.4× |
| Clavicle complete (73000) |
$373 |
$932.50 |
4.3× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$10,210.40 |
$25,526 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$292.40 |
$731 |
2.8× |
| Continuing medical physics consltj pr wk (77336) |
$86.80 |
$217 |
0.6× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$457.60 |
$1,144 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,150.80 |
$5,377 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,521.60 |
$3,804 |
6.3× |
| CT abdomen w contrast (74160) |
$1,955 |
$4,887.50 |
11.1× |
| CT abdomen w wo contrast (74170) |
$1,322.80 |
$3,307 |
7.5× |
| CT abdomen w/o contrast (74150) |
$2,227.20 |
$5,568 |
21.2× |
| CT angio hrt w/3d image (75574) |
$1,098.80 |
$2,747 |
3.1× |
| CT angiography upper extremity lt (73206) |
$1,207.60 |
$3,019 |
6.9× |
| CT c-spine w/o contrast (72125) |
$2,199.20 |
$5,498 |
20.9× |
| CT cervical spine w&w/o contrast (72127) |
$3,113.60 |
$7,784 |
17.7× |
| CT cervical spine with contrast (72126) |
$2,551.20 |
$6,378 |
7.3× |
| CT chest w/wo contrast (71270) |
$2,437.60 |
$6,094 |
13.8× |
| CT chest with contrast (71260) |
$1,971.20 |
$4,928 |
11.2× |
| CT colonography screening (74263) |
$636.40 |
$1,591 |
2.7× |
| CT colonography w/dye (74262) |
$966.80 |
$2,417 |
5.5× |
| CT colonography w/o cntrst (74261) |
$636.40 |
$1,591 |
6.1× |
| CT head/brain with contrast (70460) |
$1,748.40 |
$4,371 |
9.9× |
| CT head/brain without and with contrast (70470) |
$2,095.20 |
$5,238 |
11.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$877.60 |
$2,194 |
2.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$146.40 |
$366 |
1.7× |
| CT hrt w/3d image congen (75573) |
$877.60 |
$2,194 |
2.5× |
| CT iac w contrast (70481) |
$2,162 |
$5,405 |
12.3× |
| CT limited/localized follow up study (76380) |
$934.80 |
$2,337 |
10.7× |
| CT lower ext w/o (73700) |
$2,425 |
$6,062.50 |
23.1× |
| CT lower extremity w wo contrast (73702) |
$3,812 |
$9,530 |
21.6× |
| CT lower extremity with contrast (73701) |
$2,952.80 |
$7,382 |
16.8× |
| CT lumbar spine w & w/o contrast (72133) |
$3,355.20 |
$8,388 |
19.0× |
| CT lumbar spine w/o contrast (72131) |
$2,356.40 |
$5,891 |
22.4× |
| CT lumbar spine with contrast (72132) |
$2,740.80 |
$6,852 |
7.8× |
| CT maxillofacial w contrast (70487) |
$1,483.60 |
$3,709 |
8.4× |
| CT maxillofacial w/o contrast (70486) |
$1,533.20 |
$3,833 |
14.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,715.20 |
$4,288 |
9.7× |
| CT neck soft tissue w contrast (70491) |
$2,069.60 |
$5,174 |
11.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,453.20 |
$6,133 |
13.9× |
| CT orbits w/o contrast (70480) |
$1,860.80 |
$4,652 |
17.7× |
| CT pelvis w & w/o contrast (72194) |
$2,860 |
$7,150 |
16.2× |
| CT pelvis w/o contrast (72192) |
$1,809.60 |
$4,524 |
17.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,518 |
$6,295 |
14.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,542.80 |
$3,857 |
14.7× |
| CT thoracic spine w/contrast (72129) |
$2,792 |
$6,980 |
15.8× |
| CT thoracic spine w/o contrast (72128) |
$2,416.40 |
$6,041 |
23.0× |
| CT thoracic spine w/wo contrast (72130) |
$3,416 |
$8,540 |
19.4× |
| CT thorax w/o contrast (71250) |
$1,630 |
$4,075 |
15.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,564.40 |
$6,411 |
14.6× |
| CT upper extremity w/o contrast rt (73200) |
$2,446.80 |
$6,117 |
23.3× |
| CT upper extremity with contrast (73201) |
$2,965.40 |
$7,413.50 |
8.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,429.20 |
$3,573 |
8.1× |
| Cta Abdomen (74175) |
$1,335.60 |
$3,339 |
7.6× |
| CTA abdomen pelvis (74174) |
$1,922.40 |
$4,806 |
5.5× |
| CTA chest (71275) |
$1,360.80 |
$3,402 |
7.7× |
| Cta Head (70496) |
$1,288 |
$3,220 |
7.3× |
| CTA lwr ext w&w/o contrast (73706) |
$2,697.80 |
$6,744.50 |
15.3× |
| Cta Neck (70498) |
$1,295.60 |
$3,239 |
7.4× |
| Cta Pelvis (72191) |
$1,307.60 |
$3,269 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$501.60 |
$1,254 |
1.4× |
| Diskography lumbar (72295) |
$1,726.40 |
$4,316 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$485.60 |
$1,214 |
4.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$668 |
$1,670 |
6.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$501.60 |
$1,254 |
4.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$425.60 |
$1,064 |
4.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$425.60 |
$1,064 |
4.9× |
| Echo exam of fetal heart (76825) |
$782.80 |
$1,957 |
1.4× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$455.60 |
$1,139 |
1.9× |
| Echoencephalography real time imaging (76506) |
$325.20 |
$813 |
3.1× |
| Esophageal motility (78258) |
$1,278 |
$3,195 |
3.2× |
| Esophagus (74220) |
$398 |
$995 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$380 |
$950 |
3.6× |
| Fluoroscopy up to 1 hr (76000) |
$407.20 |
$1,018 |
1.7× |
| Foot 2 views (73620) |
$352 |
$880 |
4.0× |
| Forearm 2 views (73090) |
$394.20 |
$985.50 |
4.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$423.20 |
$1,058 |
1.8× |
| Functional MRI brain by phys/psych (70555) |
$1,062.40 |
$2,656 |
4.4× |
| Functional MRI brain by tech (70554) |
$830.80 |
$2,077 |
3.5× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,244.40 |
$3,111 |
2.3× |
| Gated Heart Planar Single (78472) |
$1,380.40 |
$3,451 |
3.4× |
| Hand 2 views (73120) |
$371.80 |
$929.50 |
3.5× |
| Hand 3 views (73130) |
$427.40 |
$1,068.50 |
4.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$516.80 |
$1,292 |
0.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$516.80 |
$1,292 |
0.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$516.80 |
$1,292 |
0.7× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$144 |
$360 |
0.4× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$144 |
$360 |
0.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,968 |
$4,920 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,077.20 |
$2,693 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$836.80 |
$2,092 |
2.1× |
| Ht muscle image spect sing (78451) |
$2,526 |
$6,315 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$286 |
$715 |
3.3× |
| Hysterosalpingogram (74740) |
$570.80 |
$1,427 |
2.4× |
| Image fusion (77399) |
$211.60 |
$529 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$1,724.20 |
$4,310.50 |
2.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$278 |
$695 |
0.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$278 |
$695 |
0.5× |
| Intracavitary radiation source applic simple (77761) |
$278 |
$695 |
0.5× |
| Kidney imaging morphology (78700) |
$784 |
$1,960 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,059.60 |
$2,649 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$786.40 |
$1,966 |
1.4× |
| Knee 3 views (73562) |
$423 |
$1,057.50 |
4.8× |
| Liver & spleen imaging static only (78215) |
$650.40 |
$1,626 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$510.40 |
$1,276 |
1.3× |
| Liver imaging static only (78201) |
$1,770 |
$4,425 |
3.2× |
| Liver imaging w/vascular flow (78202) |
$4,614 |
$11,535 |
8.5× |
| Lung perf&ventilat diferentl (78598) |
$902.40 |
$2,256 |
1.7× |
| Lung perfusion differential (78597) |
$1,221.20 |
$3,053 |
3.0× |
| Lung Ventilation Imaging (78579) |
$742.80 |
$1,857 |
1.8× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,582.80 |
$3,957 |
0.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$933.60 |
$2,334 |
1.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,796.40 |
$11,991 |
1.5× |
| Lymphoscintigraphy (78195) |
$1,278.40 |
$3,196 |
2.3× |
| Mammary ductogram or galactogram multiple (77054) |
$1,003.60 |
$2,509 |
4.2× |
| Mammary ductogram or galactogram single (77053) |
$420.40 |
$1,051 |
1.8× |
| Meckels Diverticulum (78290) |
$556 |
$1,390 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$725.60 |
$1,814 |
1.9× |
| Mr elastography (76391) |
$892.40 |
$2,231 |
3.7× |
| MRA head w & w/o contrast (70546) |
$1,870 |
$4,675 |
5.3× |
| MRA head w/o contrast (70544) |
$1,328 |
$3,320 |
5.5× |
| MRA head with contrast (70545) |
$1,399.60 |
$3,499 |
4.0× |
| MRA neck w contrast (70548) |
$646.40 |
$1,616 |
1.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,335 |
$3,337.50 |
3.8× |
| MRA neck w/o contrast (70547) |
$923.20 |
$2,308 |
3.9× |
| MRI abdomen w contrast (74182) |
$2,285.20 |
$5,713 |
6.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,096.80 |
$10,242 |
11.7× |
| MRI abdomen w/o contrast (74181) |
$1,844.80 |
$4,612 |
7.7× |
| MRI any jnt lwr ext with con lt (73722) |
$3,870 |
$9,675 |
4.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,148.60 |
$10,371.50 |
5.3× |
| MRI bone marrow blood supply (77084) |
$2,110.80 |
$5,277 |
8.8× |
| MRI breast w/o contrast bilateral (77047) |
$892.40 |
$2,231 |
3.7× |
| MRI breast w/o contrast unilat (77046) |
$892.40 |
$2,231 |
3.7× |
| MRI c-spine with contrast (72142) |
$2,780.40 |
$6,951 |
7.9× |
| MRI cardiac w/o cont stress (75559) |
$1,716.80 |
$4,292 |
3.1× |
| MRI cardiac w/o contrast (75557) |
$1,189.20 |
$2,973 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$2,805.20 |
$7,013 |
11.7× |
| MRI chest w/o & w/contrast material (71552) |
$2,668.40 |
$6,671 |
7.6× |
| MRI chest w/o contrast (71550) |
$1,900 |
$4,750 |
7.9× |
| MRI chest with contrast (71551) |
$2,193.20 |
$5,483 |
2.8× |
| MRI fetal sngl/1st gestation (74712) |
$771.60 |
$1,929 |
3.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,239.20 |
$5,598 |
6.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,147.20 |
$10,368 |
11.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,556.80 |
$6,392 |
10.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,219.60 |
$5,549 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,037.20 |
$7,593 |
8.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,530 |
$3,825 |
4.4× |
| MRI pelvis w contrast (72196) |
$1,838.60 |
$4,596.50 |
5.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,031.20 |
$7,578 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,555.60 |
$6,389 |
10.7× |
| MRI scan of arm joint before and after contrast (73223) |
$5,223 |
$13,057.50 |
14.9× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,561.60 |
$3,904 |
2.0× |
| MRI scan of leg joint before and after contrast (73723) |
$4,803.40 |
$12,008.50 |
13.7× |
| MRI spectroscopy (76390) |
$960.40 |
$2,401 |
11.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,184.80 |
$10,462 |
11.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,558.80 |
$8,897 |
10.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,124.40 |
$10,311 |
11.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,931.20 |
$7,328 |
8.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,887.20 |
$9,718 |
11.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,658.80 |
$6,647 |
11.1× |
| MRI tmj (70336) |
$1,929.20 |
$4,823 |
8.0× |
| MRI upper ext joint w/o contrast (73221) |
$3,860.20 |
$9,650.50 |
16.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$5,089.40 |
$12,723.50 |
14.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,784.80 |
$9,462 |
15.8× |
| Myelogram Cervical (72240) |
$1,260 |
$3,150 |
1.6× |
| Myelogram Lumbar (72265) |
$1,353.60 |
$3,384 |
1.7× |
| Myelogram thoracic (72255) |
$1,199.60 |
$2,999 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,992.40 |
$4,981 |
2.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,397.60 |
$8,494 |
2.6× |
| Myocardial infarct spect (78469) |
$1,014.80 |
$2,537 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,526 |
$6,315 |
1.9× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$5,233.20 |
$13,083 |
3.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$5,233.20 |
$13,083 |
3.6× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$8,162.80 |
$20,407 |
3.7× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$9,974.80 |
$24,937 |
4.5× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$9,974.80 |
$24,937 |
6.5× |
| Neck soft tissue (70360) |
$258 |
$645 |
3.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$129.20 |
$323 |
0.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,366.80 |
$3,417 |
3.4× |
| Nm adrenal scan (78075) |
$2,378.40 |
$5,946 |
1.8× |
| Nm bone marrow multiple (78103) |
$748 |
$1,870 |
1.9× |
| Nm bone marrow wb (78104) |
$842 |
$2,105 |
2.1× |
| Nm cisternogram (78630) |
$1,365.60 |
$3,414 |
2.5× |
| Nm csf leak detection (78650) |
$1,363.60 |
$3,409 |
1.0× |
| Nm gastric emptying study (78264) |
$1,202 |
$3,005 |
3.0× |
| Nm peritoneal-venous shunt patency (78291) |
$784 |
$1,960 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,897.20 |
$4,743 |
1.4× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$3,957.60 |
$9,894 |
2.8× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$4,672.80 |
$11,682 |
3.3× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$3,150.80 |
$7,877 |
2.2× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,644.40 |
$4,111 |
1.3× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$783.20 |
$1,958 |
2.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$938.40 |
$2,346 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$928.80 |
$2,322 |
4.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$302.40 |
$756 |
2.9× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$358.80 |
$897 |
2.7× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$163.20 |
$408 |
1.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$217.60 |
$544 |
2.1× |
| Orthopantogram (70355) |
$275.20 |
$688 |
3.1× |
| Osseous survey infant (77076) |
$607.20 |
$1,518 |
5.8× |
| Osseous survey limited (77074) |
$502.80 |
$1,257 |
4.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,190.80 |
$2,977 |
2.2× |
| Parathyrd planar w/wo subtrj (78071) |
$1,190.80 |
$2,977 |
3.0× |
| Parathyroid imaging (78070) |
$864 |
$2,160 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$253.20 |
$633 |
2.4× |
| Peritoneogram rs&i (74190) |
$492.40 |
$1,231 |
0.9× |
| PET image w/CT, skull-thigh (78815) |
$5,580.40 |
$13,951 |
3.9× |
| PET imaging CT for attenuation limited area (78814) |
$3,581.20 |
$8,953 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,738.40 |
$14,346 |
4.0× |
| PET imaging limited area chest head/neck (78811) |
$2,564.40 |
$6,411 |
2.0× |
| PET whole body (78813) |
$3,294.40 |
$8,236 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$5,276.60 |
$13,191.50 |
15.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,969.60 |
$4,924 |
0.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,445.20 |
$3,613 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$607.20 |
$1,518 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$902.40 |
$2,256 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$465.60 |
$1,164 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$170.80 |
$427 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$284.80 |
$712 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$284.80 |
$712 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$541.60 |
$1,354 |
5.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$5,539.20 |
$13,848 |
0.7× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$226.40 |
$566 |
0.4× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$146 |
$365 |
1.4× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$238.40 |
$596 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$314 |
$785 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$271.60 |
$679 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$519.60 |
$1,299 |
4.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$271.60 |
$679 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$653.60 |
$1,634 |
3.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$661.20 |
$1,653 |
3.8× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$313.60 |
$784 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$661.20 |
$1,653 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$648.40 |
$1,621 |
3.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$256.40 |
$641 |
2.9× |
| Radiological examination surgical specimen (76098) |
$374.80 |
$937 |
0.7× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,968 |
$4,920 |
0.6× |
| Ribs bilateral 3 views (71110) |
$424.80 |
$1,062 |
4.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,064.40 |
$5,161 |
5.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,723.60 |
$6,809 |
5.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,943.20 |
$7,358 |
5.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,614 |
$11,535 |
3.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,233.20 |
$13,083 |
3.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,614 |
$11,535 |
3.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$581.20 |
$1,453 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$938.80 |
$2,347 |
4.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$579.60 |
$1,449 |
2.4× |
| Salivary gland imaging (78230) |
$671.20 |
$1,678 |
1.7× |
| Scanogram (77073) |
$264.80 |
$662 |
2.5× |
| Scapula complete (73010) |
$394.20 |
$985.50 |
3.8× |
| Screening digital breast tomosynthesis (77063) |
$46 |
$115 |
2.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$463.60 |
$1,159 |
4.4× |
| Simulation intermediate (77285) |
$278 |
$695 |
0.7× |
| Small bowel series (74250) |
$448.40 |
$1,121 |
2.5× |
| Spec medical radj physics consltj (77370) |
$289.20 |
$723 |
2.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$222.80 |
$557 |
0.6× |
| Special dosimetry (77331) |
$86.80 |
$217 |
0.6× |
| Special treatment procedure (77470) |
$1,140.60 |
$2,851.50 |
2.1× |
| Speech evaluation complex (70371) |
$488.80 |
$1,222 |
2.0× |
| Splenoportograpy rs&i (75810) |
$4,462 |
$11,155 |
1.4× |
| Stereotactic body radiation delivery (77373) |
$1,610.40 |
$4,026 |
0.9× |
| Superior sagittal sinus venogram (75870) |
$5,914.80 |
$14,787 |
1.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$78 |
$195 |
0.8× |
| Tbs Technical Calculation Only (77091) |
$286.40 |
$716 |
3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$118 |
$295 |
0.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$118 |
$295 |
0.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$446 |
$1,115 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$156.40 |
$391 |
1.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,148.40 |
$2,871 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$478.60 |
$1,196.50 |
1.2× |
| Thyroid uptake measurement (78012) |
$422 |
$1,055 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$861.20 |
$2,153 |
2.1× |
| Tmj unilateral (70328) |
$240 |
$600 |
2.7× |
| Tomogram (76100) |
$416 |
$1,040 |
4.0× |
| Treatment device intermediate (77333) |
$159.60 |
$399 |
1.2× |
| Treatment devices simple (77332) |
$159.60 |
$399 |
1.2× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$5,233.20 |
$13,083 |
9.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,513.20 |
$3,783 |
3.8× |
| Tx devices design & construction complex (77334) |
$159.60 |
$399 |
0.4× |
| Ultrasound elastography first target lesion (76982) |
$434.80 |
$1,087 |
4.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$34 |
$85 |
1.2× |
| Ultrasound scan to determine eye length and lens power (76519) |
$174.40 |
$436 |
1.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$780.40 |
$1,951 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$588.80 |
$1,472 |
5.6× |
| Umbilical-artery Doppler (OB) (76820) |
$226 |
$565 |
2.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$298.40 |
$746 |
3.4× |
| Unlisted fluoroscopic procedure (76496) |
$437.60 |
$1,094 |
5.0× |
| Unlisted magnetic resonance procedure (76498) |
$4,703.40 |
$11,758.50 |
53.8× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$588.40 |
$1,471 |
1.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$116.80 |
$292 |
1.1× |
| Upper Extremity Infant (73092) |
$410 |
$1,025 |
3.9× |
| Urethrocystography retrograde rs&i (74450) |
$546.80 |
$1,367 |
2.3× |
| Urethrocystography voiding (74455) |
$700 |
$1,750 |
2.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$540 |
$1,350 |
3.1× |
| Us abdl aorta screen aaa (76706) |
$413.20 |
$1,033 |
3.9× |
| Us breast unilateral complete (76641) |
$382.20 |
$955.50 |
3.6× |
| Us breast unilateral limited (76642) |
$382.20 |
$955.50 |
4.4× |
| Us chest (76604) |
$480.40 |
$1,201 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$365.20 |
$913 |
3.5× |
| Us elastography parenchyma (76981) |
$434.80 |
$1,087 |
4.1× |
| Us guided compression repair (76936) |
$956.40 |
$2,391 |
4.4× |
| Us infant hips dynamic (76885) |
$508 |
$1,270 |
5.8× |
| Us infant hips limited static (76886) |
$452 |
$1,130 |
5.2× |
| Us kidney transplant (76776) |
$606 |
$1,515 |
5.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$176.80 |
$442 |
1.7× |
| Us ob detailed single fetus (76811) |
$636.40 |
$1,591 |
2.7× |
| Us ob transvaginal (76817) |
$300.40 |
$751 |
2.9× |
| Us pelvic non ob complete (76856) |
$658.80 |
$1,647 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$536.40 |
$1,341 |
5.1× |
| Us pregnancy ltd (76815) |
$304.80 |
$762 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$302.40 |
$756 |
2.9× |
| Us retroperitoneal complete (76770) |
$559.60 |
$1,399 |
5.3× |
| Us retroperitoneal limited (76775) |
$456 |
$1,140 |
4.3× |
| Us scrotum and contents (76870) |
$502.80 |
$1,257 |
4.8× |
| Us soft tissue head/neck (76536) |
$558.40 |
$1,396 |
5.3× |
| Us spinal canal and contents (76800) |
$701.20 |
$1,753 |
6.7× |
| Us transrectal (76872) |
$678.40 |
$1,696 |
6.5× |
| Us transrectal prostate volume (76873) |
$535.20 |
$1,338 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$305.40 |
$763.50 |
2.9× |
| Us, eye b-scan (76512) |
$204.40 |
$511 |
1.9× |
| Vasogram (74440) |
$418.80 |
$1,047 |
1.7× |
| Venogram extremity bilateral (75822) |
$1,070 |
$2,675 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,326.80 |
$5,817 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$2,318 |
$5,795 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$1,003.20 |
$2,508 |
0.6× |
| Venography Renal Bilateral (75833) |
$10,050 |
$25,125 |
3.2× |
| Venography renal unilateral selective rs&i (75831) |
$1,968 |
$4,920 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,622 |
$4,055 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,926.80 |
$7,317 |
0.5× |
| Wrist 2 views (73100) |
$393 |
$982.50 |
4.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$477.60 |
$1,194 |
4.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$239.20 |
$598 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$382.80 |
$957 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$904 |
$2,260 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$347.60 |
$869 |
4.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$462.60 |
$1,156.50 |
5.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$541.60 |
$1,354 |
5.2× |
| X-ray exam hip uni 1 view (73501) |
$170.80 |
$427 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$170.80 |
$427 |
2.0× |
| X-ray exam hip uni 4/> views (73503) |
$284.80 |
$712 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$284.80 |
$712 |
2.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$541.60 |
$1,354 |
5.2× |
| X-ray exam of femur 1 (73551) |
$256.40 |
$641 |
2.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$292.40 |
$731 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$417 |
$1,042.50 |
4.8× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,137.60 |
$2,844 |
0.5× |
| X-ray head for orthodontia (70350) |
$206.80 |
$517 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$306.60 |
$766.50 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240 |
$600 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$494.60 |
$1,236.50 |
4.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$374.80 |
$937 |
4.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$257.60 |
$644 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$360.40 |
$901 |
3.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$668.80 |
$1,672 |
6.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$400 |
$1,000 |
3.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$264 |
$660 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$133.60 |
$334 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$400 |
$1,000 |
3.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$556 |
$1,390 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$343.60 |
$859 |
3.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$266 |
$665 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$559.60 |
$1,399 |
5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$252.40 |
$631 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$252.40 |
$631 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$392.40 |
$981 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$370 |
$925 |
4.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$365.60 |
$914 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$278 |
$695 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$248 |
$620 |
2.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$424.80 |
$1,062 |
4.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$241.60 |
$604 |
2.8× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$113.20 |
$283 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$336 |
$840 |
3.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$325.20 |
$813 |
3.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$482.20 |
$1,205.50 |
5.5× |
| Xr arthrogram ankle (73615) |
$690.80 |
$1,727 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$553.20 |
$1,383 |
5.3× |
| Xr chest 4+ views (71048) |
$519.60 |
$1,299 |
4.9× |
| Xr finger(s) 2+ views (73140) |
$311 |
$777.50 |
3.6× |
| Xr shoulder 1 view (73020) |
$305.40 |
$763.50 |
3.5× |
| Xr spine cervical 4 or 5 views (72050) |
$440 |
$1,100 |
4.2× |
| Xr tibia/fibula 2 views (73590) |
$366.60 |
$916.50 |
4.2× |
| Xr tmj bilateral (70330) |
$365.20 |
$913 |
4.2× |
| Xray knee 1 or 2 views rt (73560) |
$339.80 |
$849.50 |
3.9× |