| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,648.66 |
$6,341 |
1.1× |
| Abdomen 2 views (74019) |
$132.08 |
$508 |
1.2× |
| Acute gi blood loss imaging (78278) |
$592.02 |
$2,277 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$2,041.52 |
$7,852 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$2,041.52 |
$7,852 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$1,280.76 |
$4,926 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,367.30 |
$9,105 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,367.30 |
$9,105 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,367.30 |
$9,105 |
0.7× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,367.30 |
$9,105 |
0.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,367.30 |
$9,105 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,098.76 |
$4,226 |
0.3× |
| Ankle 2 views (73600) |
$132.08 |
$508 |
1.4× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,367.30 |
$9,105 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,041.52 |
$7,852 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$2,367.30 |
$9,105 |
0.7× |
| Arthrogram ankle (73615) |
$345.02 |
$1,327 |
0.9× |
| Basic dosimetry (77300) |
$202.80 |
$780 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$592.02 |
$2,277 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$592.02 |
$2,277 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$592.02 |
$2,277 |
1.4× |
| Bone age studies (77072) |
$132.08 |
$508 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$592.02 |
$2,277 |
1.4× |
| Bone Marrow Imaging Limited Area (78102) |
$395.20 |
$1,520 |
0.9× |
| Bone survey complete (77075) |
$216.84 |
$834 |
2.0× |
| Bone survey infant (77076) |
$216.84 |
$834 |
2.0× |
| Bowel imaging (78290) |
$592.02 |
$2,277 |
1.4× |
| Brachytx isodose intermed (77317) |
$719.94 |
$2,769 |
1.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$397.02 |
$1,527 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$532.48 |
$2,048 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,446.60 |
$9,410 |
1.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$670.80 |
$2,580 |
1.6× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,034.02 |
$3,977 |
1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$954.72 |
$3,672 |
2.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$305.50 |
$1,175 |
0.5× |
| Cervical spine 2 or 3 views (72040) |
$132.08 |
$508 |
1.4× |
| Chest 1 view (71045) |
$132.08 |
$508 |
1.4× |
| Chest xray 3 views (71047) |
$132.08 |
$508 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$292.50 |
$1,125 |
1.6× |
| Clavicle complete (73000) |
$132.08 |
$508 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$37.96 |
$146 |
0.3× |
| Continuing medical physics consltj pr wk (77336) |
$257.92 |
$992 |
1.8× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$177.84 |
$684 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$513.24 |
$1,974 |
1.4× |
| CT abdomen and pelvis without contrast (74176) |
$307.58 |
$1,183 |
1.2× |
| CT abdomen w contrast (74160) |
$584.74 |
$2,249 |
3.2× |
| CT abdomen w wo contrast (74170) |
$649.74 |
$2,499 |
3.5× |
| CT abdomen w/o contrast (74150) |
$427.70 |
$1,645 |
3.9× |
| CT angio hrt w/3d image (75574) |
$124.02 |
$477 |
0.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$615.68 |
$2,368 |
3.4× |
| CT angiography upper extremity lt (73206) |
$615.68 |
$2,368 |
3.4× |
| CT c-spine w/contrast (72126) |
$649.74 |
$2,499 |
1.8× |
| CT c-spine w/o contrast (72125) |
$427.70 |
$1,645 |
3.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$112.32 |
$432 |
0.6× |
| CT cervical spine w&w/o contrast (72127) |
$649.74 |
$2,499 |
3.5× |
| CT chest w contrast (71260) |
$584.74 |
$2,249 |
3.2× |
| CT chest w/wo contrast (71270) |
$649.74 |
$2,499 |
3.5× |
| CT head/brain with contrast (70460) |
$584.74 |
$2,249 |
3.2× |
| CT head/brain without and with contrast (70470) |
$584.74 |
$2,249 |
3.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$126.10 |
$485 |
0.3× |
| CT iac w contrast (70481) |
$649.74 |
$2,499 |
3.5× |
| CT limited/localized follow up study (76380) |
$277.16 |
$1,066 |
3.0× |
| CT lower ext w/o (73700) |
$427.70 |
$1,645 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$649.74 |
$2,499 |
3.5× |
| CT lower extremity w/contrast material (73701) |
$649.74 |
$2,499 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$649.74 |
$2,499 |
3.5× |
| CT lumbar spine w/contrast (72132) |
$649.74 |
$2,499 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$427.70 |
$1,645 |
3.9× |
| CT maxillofacial w contrast (70487) |
$584.74 |
$2,249 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$649.74 |
$2,499 |
3.5× |
| CT maxillofacial wo contrast (70486) |
$427.70 |
$1,645 |
3.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$584.74 |
$2,249 |
3.2× |
| CT orbits w/o contrast (70480) |
$427.70 |
$1,645 |
3.9× |
| CT pelvis w/o contrast (72192) |
$427.70 |
$1,645 |
3.9× |
| CT pelvis w/wo contrast (72194) |
$649.74 |
$2,499 |
3.5× |
| CT scan of arm combo (73202) |
$649.74 |
$2,499 |
3.5× |
| CT soft tissue neck w contrast (70491) |
$584.74 |
$2,249 |
3.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$649.74 |
$2,499 |
3.5× |
| CT soft tissue neck w/o contrast (70490) |
$385.06 |
$1,481 |
3.5× |
| CT thoracic spine w/contrast (72129) |
$649.74 |
$2,499 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$427.70 |
$1,645 |
3.9× |
| CT thoracic spine w/wo contrast (72130) |
$649.74 |
$2,499 |
3.5× |
| CT thorax w/o contrast (71250) |
$427.70 |
$1,645 |
3.9× |
| CT unlisted procedure (76497) |
$184.86 |
$711 |
2.0× |
| CT upper ext wo (73200) |
$427.70 |
$1,645 |
3.9× |
| CT upper extremity with contrast (73201) |
$649.74 |
$2,499 |
1.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$615.68 |
$2,368 |
3.4× |
| Cta Abdomen (74175) |
$615.68 |
$2,368 |
3.4× |
| CTA abdomen pelvis (74174) |
$513.24 |
$1,974 |
1.4× |
| CTA chest (71275) |
$615.68 |
$2,368 |
3.4× |
| Cta Head (70496) |
$615.68 |
$2,368 |
3.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$223.60 |
$860 |
0.6× |
| Cta Neck (70498) |
$615.68 |
$2,368 |
3.4× |
| Cta Pelvis (72191) |
$554.32 |
$2,132 |
3.0× |
| Cystography minimum 3 views rs&i (74430) |
$207.22 |
$797 |
0.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,262.82 |
$4,857 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$124.54 |
$479 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$40.30 |
$155 |
0.4× |
| Esophagus (74220) |
$177.84 |
$684 |
1.0× |
| Facial bones min 3 views (70150) |
$216.84 |
$834 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$197.86 |
$761 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$183.30 |
$705 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$158.08 |
$608 |
0.6× |
| Foot 2 views (73620) |
$132.08 |
$508 |
1.4× |
| Forearm 2 views (73090) |
$132.08 |
$508 |
1.4× |
| Functional MRI brain by tech (70554) |
$752.70 |
$2,895 |
3.0× |
| Hand 2 views (73120) |
$132.08 |
$508 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,404.26 |
$5,401 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,404.26 |
$5,401 |
1.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,367.30 |
$9,105 |
0.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,367.30 |
$9,105 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$512.72 |
$1,972 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$512.72 |
$1,972 |
1.2× |
| Hysterosalpingogram (74740) |
$216.84 |
$834 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$132.08 |
$508 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$670.80 |
$2,580 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$670.80 |
$2,580 |
1.2× |
| Knee 3 views (73562) |
$132.08 |
$508 |
1.4× |
| Lung perfusion differential (78597) |
$395.20 |
$1,520 |
0.9× |
| Lymphoscintigraphy (78195) |
$395.20 |
$1,520 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$752.70 |
$2,895 |
0.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$752.70 |
$2,895 |
2.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,060.28 |
$4,078 |
2.9× |
| Magnetic Resonance Elastography (76391) |
$752.70 |
$2,895 |
3.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$277.16 |
$1,066 |
0.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$367.12 |
$1,412 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,060.28 |
$4,078 |
2.9× |
| MRA head w/o contrast (70544) |
$752.70 |
$2,895 |
3.0× |
| MRA head with contrast (70545) |
$677.56 |
$2,606 |
1.9× |
| MRA neck w contrast (70548) |
$752.70 |
$2,895 |
2.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,060.28 |
$4,078 |
2.9× |
| MRA neck w/o contrast (70547) |
$752.70 |
$2,895 |
3.0× |
| MRI abdomen w contrast (74182) |
$752.70 |
$2,895 |
2.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,060.28 |
$4,078 |
2.9× |
| MRI abdomen w/o contrast (74181) |
$752.70 |
$2,895 |
3.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$752.70 |
$2,895 |
0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,060.28 |
$4,078 |
2.9× |
| MRI breast w/o contrast bilateral (77047) |
$752.70 |
$2,895 |
3.0× |
| MRI c-spine with contrast (72142) |
$752.70 |
$2,895 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$677.56 |
$2,606 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$752.70 |
$2,895 |
3.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,060.28 |
$4,078 |
2.9× |
| MRI chest w/o contrast (71550) |
$752.70 |
$2,895 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$752.70 |
$2,895 |
2.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,060.28 |
$4,078 |
2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$752.70 |
$2,895 |
3.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$752.70 |
$2,895 |
3.0× |
| MRI orbit face neck w contrast (70542) |
$752.70 |
$2,895 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,060.28 |
$4,078 |
2.9× |
| MRI pelvis w/contrast (72196) |
$998.92 |
$3,842 |
2.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,060.28 |
$4,078 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$752.70 |
$2,895 |
3.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,060.28 |
$4,078 |
2.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$752.70 |
$2,895 |
2.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,060.28 |
$4,078 |
2.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$752.70 |
$2,895 |
2.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,060.28 |
$4,078 |
2.9× |
| MRI temporomandibular joint (70336) |
$752.70 |
$2,895 |
3.0× |
| MRI thoracic spine w/o contrast (72146) |
$752.70 |
$2,895 |
3.0× |
| MRI up ext w/o contrast (73218) |
$752.70 |
$2,895 |
3.0× |
| MRI upper ext joint w/o contrast (73221) |
$752.70 |
$2,895 |
3.0× |
| MRI, joint upper extrem combo (73223) |
$1,060.28 |
$4,078 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$859.30 |
$3,305 |
0.6× |
| Myocardial spect single study at rest or stress (78451) |
$444.60 |
$1,710 |
0.3× |
| Neck soft tissue (70360) |
$132.08 |
$508 |
1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$227.50 |
$875 |
0.5× |
| Nm cisternogram (78630) |
$532.48 |
$2,048 |
0.9× |
| Nm gastric emptying study (78264) |
$592.02 |
$2,277 |
1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,870.70 |
$7,195 |
1.3× |
| Nuclear Rx Oral Admin (79005) |
$592.02 |
$2,277 |
2.4× |
| Orthopantogram (70355) |
$158.08 |
$608 |
1.7× |
| Osseous survey limited (77074) |
$216.84 |
$834 |
2.0× |
| Parathyrd planar w/spect&CT (78072) |
$227.50 |
$875 |
0.4× |
| Parathyroid Planar Imaging (78070) |
$473.46 |
$1,821 |
1.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$193.18 |
$743 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$132.08 |
$508 |
1.2× |
| Peritoneogram after injection (74190) |
$216.84 |
$834 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$2,446.60 |
$9,410 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$2,446.60 |
$9,410 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,446.60 |
$9,410 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$395.20 |
$1,520 |
0.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$631.28 |
$2,428 |
1.1× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$370.50 |
$1,425 |
0.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$216.84 |
$834 |
0.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$132.08 |
$508 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$132.08 |
$508 |
1.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$132.08 |
$508 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$132.08 |
$508 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$216.84 |
$834 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$132.08 |
$508 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$132.08 |
$508 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$132.08 |
$508 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$132.08 |
$508 |
1.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$51.48 |
$198 |
0.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$216.84 |
$834 |
2.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$84.24 |
$324 |
0.8× |
| Radex Humerus Minimum 2 Views (73060) |
$132.08 |
$508 |
1.4× |
| Radex Kne 1/2 Views (73560) |
$132.08 |
$508 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$216.84 |
$834 |
2.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$216.84 |
$834 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$132.08 |
$508 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$132.08 |
$508 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$132.08 |
$508 |
1.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$132.08 |
$508 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$216.84 |
$834 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$132.08 |
$508 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$132.08 |
$508 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$132.08 |
$508 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$132.08 |
$508 |
1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,837.22 |
$26,297 |
0.9× |
| Radiation treatment delivery level 1 (77402) |
$197.34 |
$759 |
1.8× |
| Radiation treatment delivery level 2 (77407) |
$221.52 |
$852 |
0.5× |
| Radiation treatment delivery level 3 (77412) |
$257.14 |
$989 |
0.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$132.08 |
$508 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$132.08 |
$508 |
1.2× |
| Radiologic exam chest 2 views (71046) |
$132.08 |
$508 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$286 |
$1,100 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$286 |
$1,100 |
1.6× |
| Radiologic examination femur 1 view (73551) |
$132.08 |
$508 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$132.08 |
$508 |
1.4× |
| Radiological examination surgical specimen (76098) |
$227.50 |
$875 |
0.4× |
| Ribs bilateral 3 views (71110) |
$216.84 |
$834 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$241.80 |
$930 |
0.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$836.42 |
$3,217 |
1.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$836.42 |
$3,217 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$633.88 |
$2,438 |
1.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$949.26 |
$3,651 |
0.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$836.42 |
$3,217 |
0.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$372.32 |
$1,432 |
1.5× |
| Rp Therapy Intravenous Administration (79101) |
$592.02 |
$2,277 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$132.08 |
$508 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$395.20 |
$1,520 |
1.6× |
| Scapula (73010) |
$132.08 |
$508 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$31.20 |
$120 |
1.3× |
| Shoulder 1 view (73020) |
$132.08 |
$508 |
1.4× |
| Small bowel series (74250) |
$177.84 |
$684 |
1.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$441.22 |
$1,697 |
1.1× |
| Special dosimetry (77331) |
$203.06 |
$781 |
1.4× |
| Special Physics Consult (77370) |
$441.22 |
$1,697 |
3.1× |
| Spine thoracic 3 views (72072) |
$216.84 |
$834 |
2.0× |
| Splenoportograpy rs&i (75810) |
$2,276.04 |
$8,754 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$4,994.60 |
$19,210 |
2.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$680.68 |
$2,618 |
1.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$470.34 |
$1,809 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$480.22 |
$1,847 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$248.56 |
$956 |
1.8× |
| Thoracolumbar 2 views (72080) |
$132.08 |
$508 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$631.28 |
$2,428 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$473.46 |
$1,821 |
1.1× |
| Treatment device complex (77334) |
$385.84 |
$1,484 |
1.0× |
| Treatment devices simple (77332) |
$348.14 |
$1,339 |
2.5× |
| Ultrasound breast complete (76641) |
$180.70 |
$695 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$197.86 |
$761 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$116.48 |
$448 |
1.1× |
| Umbilical-artery Doppler (OB) (76820) |
$187.46 |
$721 |
1.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$11.70 |
$45 |
0.1× |
| Unlisted fluoroscopic procedure (76496) |
$495.56 |
$1,906 |
5.4× |
| Unlisted magnetic resonance procedure (76498) |
$56.68 |
$218 |
0.6× |
| Urethrocystogram voiding (74455) |
$207.22 |
$797 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$207.22 |
$797 |
0.8× |
| Us breast unilateral limited (76642) |
$109.46 |
$421 |
1.2× |
| Us chest (76604) |
$143.39 |
$551.50 |
1.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$305.50 |
$1,175 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$197.86 |
$761 |
1.8× |
| Us encephalogram (76506) |
$187.46 |
$721 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$113.62 |
$437 |
1.0× |
| Us ob detailed single fetus (76811) |
$108.68 |
$418 |
0.4× |
| Us ob limited (76815) |
$101.40 |
$390 |
0.9× |
| Us ob transvaginal (76817) |
$123.37 |
$474.50 |
1.1× |
| Us pelvic non ob complete (76856) |
$197.86 |
$761 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$124.15 |
$477.50 |
1.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$128.57 |
$494.50 |
1.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$141.18 |
$543 |
1.3× |
| Us retroperitoneal complete (76770) |
$197.86 |
$761 |
1.8× |
| Us retroperitoneal limited (76775) |
$115.83 |
$445.50 |
1.1× |
| Us scrotum and contents (76870) |
$197.86 |
$761 |
1.8× |
| Us soft tissue head/neck (76536) |
$167.57 |
$644.50 |
1.5× |
| Us spinal canal and contents (76800) |
$319.93 |
$1,230.50 |
2.9× |
| Us transrectal (76872) |
$116.48 |
$448 |
1.1× |
| Us, eye b-scan (76512) |
$122.07 |
$469.50 |
1.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$197.86 |
$761 |
1.8× |
| Venogram extremity bilateral (75822) |
$710.32 |
$2,732 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$710.32 |
$2,732 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,367.30 |
$9,105 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$710.32 |
$2,732 |
0.4× |
| Venography Renal Bilateral (75833) |
$2,367.30 |
$9,105 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,367.30 |
$9,105 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,280.76 |
$4,926 |
0.4× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,367.30 |
$9,105 |
0.4× |
| Wrist 2 views (73100) |
$132.08 |
$508 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$132.08 |
$508 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$286 |
$1,100 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$132.08 |
$508 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$132.08 |
$508 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$216.84 |
$834 |
2.0× |
| X-ray exam of femur 2/> (73552) |
$132.08 |
$508 |
1.4× |
| X-ray eye for foreign body (70030) |
$132.08 |
$508 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$132.08 |
$508 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$132.08 |
$508 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$132.08 |
$508 |
1.4× |
| X-ray leg, infant (73592) |
$132.08 |
$508 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$132.08 |
$508 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$216.84 |
$834 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$132.08 |
$508 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$216.84 |
$834 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$150.28 |
$578 |
0.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$132.08 |
$508 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$216.84 |
$834 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$216.84 |
$834 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$132.08 |
$508 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$132.08 |
$508 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$216.84 |
$834 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$216.84 |
$834 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$132.08 |
$508 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$132.08 |
$508 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$132.08 |
$508 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$132.08 |
$508 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$132.08 |
$508 |
1.2× |
| Xr bone length studies (77073) |
$216.84 |
$834 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$216.84 |
$834 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$216.84 |
$834 |
2.0× |
| Xr chest 4+ views (71048) |
$216.84 |
$834 |
2.0× |
| Xr urogram antegrade (74425) |
$207.22 |
$797 |
0.6× |