| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,109.70 |
$6,849.50 |
3.1× |
| Abdomen 2 views (74019) |
$275.78 |
$459.63 |
2.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$968.94 |
$1,614.90 |
2.5× |
| Angiography extremity bilateral rs&i (75716) |
$2,309.44 |
$3,849.06 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$5,799.52 |
$9,665.86 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$5,799.52 |
$9,665.86 |
1.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$9,998.14 |
$16,663.56 |
1.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,616.97 |
$4,361.61 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,297.34 |
$3,828.90 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$9,159.62 |
$15,266.04 |
1.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,998.14 |
$16,663.56 |
1.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$6,936.50 |
$11,560.84 |
2.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,799.52 |
$9,665.86 |
1.9× |
| Ankle 2 views (73600) |
$306.14 |
$510.24 |
3.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$462.92 |
$771.54 |
1.4× |
| Aortogram thoracic (75605) |
$9,998.14 |
$16,663.56 |
1.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,799.52 |
$9,665.86 |
1.9× |
| Aortography abdominal serialography rs&i (75625) |
$5,799.52 |
$9,665.86 |
1.9× |
| Arthrogram elbow (73085) |
$892.26 |
$1,487.10 |
2.7× |
| Arthrogram hip (73525) |
$844.78 |
$1,407.96 |
2.5× |
| Arthrogram shoulder (73040) |
$941.12 |
$1,568.52 |
2.8× |
| Arthrogram wrist (73115) |
$777.20 |
$1,295.32 |
2.3× |
| Arthrography knee lt (73580) |
$942.52 |
$1,570.86 |
2.8× |
| Basic radiation dosimetry calculation (77300) |
$339.90 |
$566.50 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$799.75 |
$1,332.91 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$1,198.73 |
$1,997.88 |
3.1× |
| Bone age studies (77072) |
$227.56 |
$379.26 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,261.11 |
$2,101.85 |
3.3× |
| Bone survey complete (77075) |
$547.92 |
$913.20 |
5.5× |
| Brachytx isodose complex (77318) |
$951.07 |
$1,585.11 |
2.6× |
| Brachytx isodose intermed (77317) |
$509.71 |
$849.52 |
1.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$543.59 |
$905.99 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,240 |
$5,400 |
2.4× |
| Brain Imaging Vascular Flow Only (78610) |
$1,047.92 |
$1,746.53 |
2.0× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$185 |
$308.34 |
16.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$491.25 |
$818.75 |
1.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$786.83 |
$1,311.38 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$260.41 |
$434.02 |
3.1× |
| Chest 1 view (71045) |
$192.11 |
$320.19 |
2.3× |
| Chest 3 views (71047) |
$239.99 |
$399.99 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$409.12 |
$681.86 |
2.4× |
| Clavicle complete (73000) |
$330.65 |
$551.08 |
4.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$97.45 |
$162.41 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$599.60 |
$999.34 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,040 |
$3,400 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,800 |
$3,000 |
7.9× |
| CT abdomen w contrast (74160) |
$1,020 |
$1,700 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,200 |
$2,000 |
7.1× |
| CT abdomen w/o contrast (74150) |
$780 |
$1,300 |
7.8× |
| CT angio hrt w/3d image (75574) |
$630 |
$1,050 |
1.9× |
| CT angiography upper extremity lt (73206) |
$1,020 |
$1,700 |
6.1× |
| CT c-spine w/o contrast (72125) |
$960 |
$1,600 |
9.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,200 |
$2,000 |
7.1× |
| CT cervical spine with contrast (72126) |
$1,020 |
$1,700 |
3.0× |
| CT chest w/wo contrast (71270) |
$1,200 |
$2,000 |
7.1× |
| CT chest with contrast (71260) |
$660 |
$1,100 |
3.9× |
| CT head/brain with contrast (70460) |
$960 |
$1,600 |
5.7× |
| CT head/brain without and with contrast (70470) |
$1,080 |
$1,800 |
6.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$66.17 |
$110.28 |
0.8× |
| CT hrt w/3d image congen (75573) |
$240.61 |
$401.02 |
0.7× |
| CT iac w contrast (70481) |
$960 |
$1,600 |
5.7× |
| CT lower ext w/o (73700) |
$990 |
$1,650 |
9.9× |
| CT lower extremity w wo contrast (73702) |
$1,530 |
$2,550 |
9.1× |
| CT lower extremity with contrast (73701) |
$1,170 |
$1,950 |
7.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,200 |
$2,000 |
7.1× |
| CT lumbar spine w/o contrast (72131) |
$960 |
$1,600 |
9.6× |
| CT lumbar spine with contrast (72132) |
$1,080 |
$1,800 |
3.2× |
| CT maxillofacial w contrast (70487) |
$960 |
$1,600 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$480 |
$800 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,020 |
$1,700 |
6.1× |
| CT neck soft tissue w contrast (70491) |
$960 |
$1,600 |
5.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,020 |
$1,700 |
6.1× |
| CT orbits w/o contrast (70480) |
$660 |
$1,100 |
6.6× |
| CT pelvis w & w/o contrast (72194) |
$1,200 |
$2,000 |
7.1× |
| CT pelvis w/o contrast (72192) |
$660 |
$1,100 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,080 |
$1,800 |
6.4× |
| CT soft tissue neck w/o contrast (70490) |
$660 |
$1,100 |
6.6× |
| CT thoracic spine w/contrast (72129) |
$1,020 |
$1,700 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$900 |
$1,500 |
9.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,140 |
$1,900 |
6.8× |
| CT thorax w/o contrast (71250) |
$480 |
$800 |
4.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,530 |
$2,550 |
9.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,491.36 |
$2,485.60 |
14.9× |
| CT upper extremity with contrast (73201) |
$1,350 |
$2,250 |
4.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,200 |
$2,000 |
7.1× |
| Cta Abdomen (74175) |
$1,140 |
$1,900 |
6.8× |
| CTA abdomen pelvis (74174) |
$2,040 |
$3,400 |
6.1× |
| CTA chest (71275) |
$1,200 |
$2,000 |
7.1× |
| Cta Head (70496) |
$1,080 |
$1,800 |
6.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,620 |
$2,700 |
9.6× |
| Cta Neck (70498) |
$1,080 |
$1,800 |
6.4× |
| Cta Pelvis (72191) |
$1,080 |
$1,800 |
6.4× |
| Cystography minimum 3 views rs&i (74430) |
$453.37 |
$755.61 |
1.4× |
| Diskography lumbar (72295) |
$1,674.72 |
$2,791.20 |
0.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$191.41 |
$319.02 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$358.47 |
$597.45 |
3.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$137.49 |
$229.15 |
1.6× |
| Echoencephalography real time imaging (76506) |
$422.03 |
$703.38 |
4.2× |
| Esophagus (74220) |
$375.46 |
$625.77 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$207.20 |
$345.33 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$413.41 |
$689.01 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$368.65 |
$614.41 |
1.6× |
| Foot 2 views (73620) |
$304.78 |
$507.98 |
3.7× |
| Forearm 2 views (73090) |
$335.30 |
$558.84 |
4.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,174.82 |
$1,958.03 |
2.3× |
| Gated Heart Planar Single (78472) |
$1,176.59 |
$1,960.98 |
3.1× |
| Hand 2 views (73120) |
$304.19 |
$506.99 |
3.0× |
| Hand 3 views (73130) |
$369.66 |
$616.10 |
4.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,935.50 |
$4,892.50 |
4.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,414.32 |
$5,690.53 |
5.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$5,121.47 |
$8,535.79 |
7.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,166.81 |
$1,944.68 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,075.36 |
$1,792.27 |
2.8× |
| Ht muscle image spect sing (78451) |
$1,627.70 |
$2,712.84 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$227.10 |
$378.50 |
2.7× |
| Hysterosalpingogram (74740) |
$535.57 |
$892.61 |
2.3× |
| Image fusion (77399) |
$279.56 |
$465.94 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$3,590.98 |
$5,984.96 |
5.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$4,386.27 |
$7,310.45 |
6.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$220.79 |
$367.99 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,094.94 |
$1,824.90 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,116.39 |
$1,860.65 |
2.1× |
| Knee 3 views (73562) |
$398.53 |
$664.22 |
4.8× |
| Liver & spleen imaging static only (78215) |
$974.46 |
$1,624.10 |
2.5× |
| Lymphoscintigraphy (78195) |
$1,055.84 |
$1,759.74 |
2.0× |
| Meckels Diverticulum (78290) |
$850.60 |
$1,417.67 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,163 |
$3,605 |
6.0× |
| Mr elastography (76391) |
$270 |
$450 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$163.15 |
$271.92 |
2.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$110 |
$183.34 |
1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$45.11 |
$75.19 |
1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$169.95 |
$283.25 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$448.05 |
$746.75 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,380 |
$2,300 |
4.1× |
| MRA head w/o contrast (70544) |
$1,140 |
$1,900 |
5.0× |
| MRA head with contrast (70545) |
$1,200 |
$2,000 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,338.89 |
$3,898.15 |
7.0× |
| MRA neck w/o contrast (70547) |
$1,080 |
$1,800 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,440 |
$2,400 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$1,200 |
$2,000 |
5.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,800 |
$3,000 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,980 |
$3,300 |
2.6× |
| MRI breast w/o contrast bilateral (77047) |
$660 |
$1,100 |
2.9× |
| MRI breast w/o contrast unilat (77046) |
$300 |
$500 |
1.3× |
| MRI c-spine with contrast (72142) |
$1,380 |
$2,300 |
4.1× |
| MRI cardiac w/o cont stress (75559) |
$644.31 |
$1,073.85 |
1.2× |
| MRI cardiac w/o contrast (75557) |
$307.45 |
$512.41 |
1.3× |
| MRI cervical spine w/o contrast (72141) |
$1,200 |
$2,000 |
5.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,440 |
$2,400 |
4.3× |
| MRI chest w/o contrast (71550) |
$1,200 |
$2,000 |
5.2× |
| MRI chest with contrast (71551) |
$491.25 |
$818.75 |
0.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,800 |
$3,000 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,530 |
$2,550 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,200 |
$2,000 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,440 |
$2,400 |
4.3× |
| MRI orbit/face/neck w/contrast (70542) |
$955.09 |
$1,591.82 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,440 |
$2,400 |
4.3× |
| MRI pelvis w/o contrast (72195) |
$1,200 |
$2,000 |
5.2× |
| MRI scan of arm joint before and after contrast (73223) |
$2,160 |
$3,600 |
6.5× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$954.43 |
$1,590.71 |
1.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,160 |
$3,600 |
6.5× |
| MRI spectroscopy (76390) |
$660 |
$1,100 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,800 |
$3,000 |
5.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,380 |
$2,300 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,800 |
$3,000 |
5.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,320 |
$2,200 |
3.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,440 |
$2,400 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,200 |
$2,000 |
5.2× |
| MRI tmj (70336) |
$1,140 |
$1,900 |
5.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,800 |
$3,000 |
7.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,160 |
$3,600 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,530 |
$2,550 |
6.7× |
| Myelogram Cervical (72240) |
$1,118.76 |
$1,864.60 |
1.5× |
| Myelogram Lumbar (72265) |
$994.96 |
$1,658.26 |
1.3× |
| Myelogram thoracic (72255) |
$994.96 |
$1,658.26 |
1.3× |
| Myelography 2 or more regions (72270) |
$1,239.01 |
$2,065.01 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,362.11 |
$3,936.85 |
1.9× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,800 |
$3,000 |
2.2× |
| Neck soft tissue (70360) |
$209.42 |
$349.04 |
2.5× |
| Nm cisternogram (78630) |
$1,166.14 |
$1,943.56 |
2.2× |
| Nm gastric emptying study (78264) |
$1,061.45 |
$1,769.09 |
2.8× |
| Nm whole blood volume (78122) |
$1,142.33 |
$1,903.88 |
2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,376.60 |
$8,961 |
4.0× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,440 |
$2,400 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$1,583.19 |
$2,638.65 |
7.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$317.35 |
$528.91 |
3.2× |
| Orthopantogram (70355) |
$211.37 |
$352.28 |
2.5× |
| Osseous survey infant (77076) |
$267.46 |
$445.77 |
2.7× |
| Osseous survey limited (77074) |
$356.58 |
$594.30 |
3.6× |
| Parathyroid imaging (78070) |
$832.46 |
$1,387.44 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$214.27 |
$357.11 |
2.1× |
| PET image w/CT, skull-thigh (78815) |
$2,160 |
$3,600 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$2,160 |
$3,600 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,160 |
$3,600 |
1.6× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$2,472.96 |
$4,121.60 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,160 |
$3,600 |
6.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,731.55 |
$9,552.58 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$849.55 |
$1,415.92 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,169.80 |
$1,949.66 |
2.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,722 |
$2,870 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$232.45 |
$387.41 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$367.34 |
$612.24 |
3.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$322.97 |
$538.29 |
3.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,205.50 |
$20,342.50 |
1.7× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$1,854 |
$3,090 |
3.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$1,200 |
$2,000 |
12.3× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$1,650 |
$2,750 |
4.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$312.38 |
$520.64 |
3.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$207.44 |
$345.74 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$245.83 |
$409.71 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$234.27 |
$390.45 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$542.61 |
$904.35 |
3.2× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$445.58 |
$742.63 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$534.08 |
$890.13 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$309.01 |
$515.02 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$513.50 |
$855.83 |
6.2× |
| Radiological examination surgical specimen (76098) |
$1,003.19 |
$1,671.98 |
1.9× |
| Ribs bilateral 3 views (71110) |
$313.95 |
$523.25 |
3.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,583.08 |
$4,305.13 |
5.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,664.06 |
$4,440.10 |
5.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,227.53 |
$2,045.88 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,615.88 |
$2,693.14 |
1.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,583.08 |
$4,305.13 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$886.19 |
$1,476.99 |
4.0× |
| Sacroiliac Joints < 3 Views (72200) |
$180.75 |
$301.25 |
1.8× |
| Scanogram (77073) |
$257.44 |
$429.07 |
2.6× |
| Scapula complete (73010) |
$340 |
$566.66 |
3.4× |
| Screening digital breast tomosynthesis (77063) |
$88.10 |
$146.83 |
3.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$526.36 |
$877.26 |
5.2× |
| Simulation intermediate (77285) |
$775.59 |
$1,292.65 |
2.2× |
| Small bowel series (74250) |
$469.53 |
$782.55 |
2.8× |
| Spec medical radj physics consltj (77370) |
$803.40 |
$1,339 |
6.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$927 |
$1,545 |
2.6× |
| Special dosimetry (77331) |
$278.10 |
$463.50 |
2.2× |
| Special treatment procedure (77470) |
$1,483.20 |
$2,472 |
2.8× |
| Spine thoracic 3 views (72072) |
$309.06 |
$515.10 |
3.1× |
| Stereotactic body radiation delivery (77373) |
$7,725 |
$12,875 |
4.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,236 |
$2,060 |
3.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$410.67 |
$684.45 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,081.50 |
$1,802.50 |
3.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$648.90 |
$1,081.50 |
5.0× |
| Therapeutic Enema (74283) |
$674.89 |
$1,124.81 |
4.0× |
| Thoracolumbar 2 views (72080) |
$165.20 |
$275.34 |
2.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,227.69 |
$2,046.15 |
2.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$541.45 |
$902.41 |
1.4× |
| Thyroid uptake measurement (78012) |
$441.05 |
$735.08 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$792.77 |
$1,321.28 |
2.1× |
| Treatment device intermediate (77333) |
$463.50 |
$772.50 |
3.6× |
| Treatment devices simple (77332) |
$370.80 |
$618 |
2.9× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,967.86 |
$3,279.76 |
3.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$343.72 |
$572.86 |
0.9× |
| Tx devices design & construction complex (77334) |
$865.20 |
$1,442 |
2.4× |
| Ultrasound elastography first target lesion (76982) |
$241.30 |
$402.16 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$439.55 |
$732.59 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$255.47 |
$425.79 |
2.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$307.75 |
$512.92 |
3.7× |
| Unlisted magnetic resonance procedure (76498) |
$124.88 |
$208.13 |
1.5× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$714.41 |
$1,190.68 |
1.9× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$279.56 |
$465.94 |
2.2× |
| Unlisted Ultrasound Procedure (76999) |
$129.04 |
$215.07 |
1.5× |
| Upper Extremity Infant (73092) |
$307.36 |
$512.26 |
3.1× |
| Urethrocystography retrograde rs&i (74450) |
$490.93 |
$818.21 |
2.1× |
| Urethrocystography voiding (74455) |
$523.41 |
$872.35 |
2.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$684.13 |
$1,140.22 |
4.1× |
| Us abdl aorta screen aaa (76706) |
$299.33 |
$498.89 |
3.0× |
| Us breast unilateral complete (76641) |
$498.40 |
$830.67 |
5.0× |
| Us breast unilateral limited (76642) |
$237.34 |
$395.58 |
2.8× |
| Us chest (76604) |
$368.11 |
$613.52 |
3.7× |
| Us compl joint r-t w/image documentation (76881) |
$292.17 |
$486.95 |
2.9× |
| Us elastography parenchyma (76981) |
$241.30 |
$402.16 |
2.4× |
| Us guided compression repair (76936) |
$880.82 |
$1,468.04 |
4.3× |
| Us infant hips dynamic (76885) |
$500.11 |
$833.51 |
6.0× |
| Us infant hips limited static (76886) |
$500.11 |
$833.51 |
6.0× |
| Us ob detailed single fetus (76811) |
$499.55 |
$832.58 |
2.2× |
| Us ob transvaginal (76817) |
$399.64 |
$666.06 |
4.0× |
| Us pelvic non ob complete (76856) |
$555.47 |
$925.78 |
5.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$338.39 |
$563.98 |
3.4× |
| Us pregnancy ltd (76815) |
$334.26 |
$557.10 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$446.86 |
$744.76 |
4.5× |
| Us retroperitoneal complete (76770) |
$349.46 |
$582.43 |
3.5× |
| Us retroperitoneal limited (76775) |
$446.72 |
$744.54 |
4.5× |
| Us scrotum and contents (76870) |
$495.80 |
$826.33 |
4.9× |
| Us soft tissue head/neck (76536) |
$473.79 |
$789.65 |
4.7× |
| Us spinal canal and contents (76800) |
$367.91 |
$613.18 |
3.7× |
| Us transrectal prostate volume (76873) |
$507.94 |
$846.56 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$308.80 |
$514.66 |
3.1× |
| Us, eye b-scan (76512) |
$361.52 |
$602.52 |
3.6× |
| Venogram extremity bilateral (75822) |
$1,199.33 |
$1,998.88 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,061.23 |
$3,435.39 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,745.42 |
$2,909.03 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$2,913.44 |
$4,855.74 |
1.9× |
| Venography Renal Bilateral (75833) |
$5,799.52 |
$9,665.86 |
1.9× |
| Venography renal unilateral selective rs&i (75831) |
$5,799.52 |
$9,665.86 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,799.52 |
$9,665.86 |
1.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$9,998.14 |
$16,663.56 |
1.9× |
| Vertebral fracture assessment via dxa (77086) |
$140.83 |
$234.72 |
1.7× |
| Wrist 2 views (73100) |
$299.70 |
$499.50 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$369.44 |
$615.73 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$231.67 |
$386.12 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$371.85 |
$619.74 |
4.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$703 |
$1,171.66 |
4.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$308.13 |
$513.56 |
3.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$370.60 |
$617.67 |
4.4× |
| X-ray exam hip uni 1 view (73501) |
$179.06 |
$298.43 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$239.82 |
$399.70 |
2.9× |
| X-ray exam hip uni 4/> views (73503) |
$385.89 |
$643.15 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$200.51 |
$334.18 |
2.0× |
| X-ray exam of femur 1 (73551) |
$200.60 |
$334.33 |
2.4× |
| X-ray eye for foreign body (70030) |
$278.65 |
$464.42 |
3.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$317.53 |
$529.22 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$238.79 |
$397.98 |
2.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$366.99 |
$611.66 |
4.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$3,705.30 |
$6,175.50 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$307.56 |
$512.60 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$208.30 |
$347.16 |
2.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$462.82 |
$771.36 |
4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$200.24 |
$333.74 |
2.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$332.60 |
$554.33 |
4.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$285.25 |
$475.42 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$445.10 |
$741.83 |
4.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$212.02 |
$353.37 |
2.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$240.86 |
$401.44 |
2.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$257.02 |
$428.37 |
3.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$299.85 |
$499.75 |
3.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$260.74 |
$434.56 |
2.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$591.28 |
$985.47 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$241.96 |
$403.26 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$300.64 |
$501.06 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$394.74 |
$657.90 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$244.36 |
$407.27 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$242.71 |
$404.51 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$385.74 |
$642.90 |
4.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$314.91 |
$524.85 |
3.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$194.61 |
$324.35 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$365.23 |
$608.72 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$245.26 |
$408.77 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$206.85 |
$344.75 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$218.12 |
$363.54 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$241 |
$401.67 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$251.39 |
$418.99 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$328.58 |
$547.64 |
3.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$280.20 |
$467 |
3.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$363.52 |
$605.86 |
4.4× |
| Xr arthrogram ankle (73615) |
$563.18 |
$938.64 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$422.30 |
$703.83 |
4.2× |
| Xr chest 4+ views (71048) |
$243.85 |
$406.42 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$186.68 |
$311.14 |
2.2× |
| Xr shoulder 1 view (73020) |
$236.54 |
$394.24 |
2.8× |
| Xr spine cervical 4 or 5 views (72050) |
$380.45 |
$634.08 |
3.8× |
| Xr tibia/fibula 2 views (73590) |
$354.12 |
$590.20 |
4.2× |
| Xr tmj bilateral (70330) |
$265.79 |
$442.99 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$329.03 |
$548.38 |
3.9× |