| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,550 |
$3,100 |
1.2× |
| Abdomen 2 views (74019) |
$294.50 |
$589 |
2.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$646.50 |
$1,293 |
1.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,662.50 |
$7,325 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$3,837.50 |
$7,675 |
1.3× |
| Angiography extremity unilateral rs&i (75710) |
$3,837.50 |
$7,675 |
1.3× |
| Angiography internal mammary rs&i (75756) |
$1,622.50 |
$3,245 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,716 |
$5,432 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,578 |
$9,156 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,578 |
$9,156 |
1.5× |
| Angiography Spinal Selective Rs&I (75705) |
$2,851.50 |
$5,703 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,980 |
$15,960 |
1.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,513.50 |
$3,027 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,268.50 |
$4,537 |
0.8× |
| Ankle 2 views (73600) |
$230.25 |
$460.50 |
2.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$464.50 |
$929 |
1.4× |
| Aortogram thoracic (75605) |
$2,851.50 |
$5,703 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,248 |
$4,496 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,044 |
$4,088 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,746.50 |
$5,493 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,615.50 |
$5,231 |
0.9× |
| Arthrogram elbow (73085) |
$746 |
$1,492 |
2.2× |
| Arthrogram hip (73525) |
$672 |
$1,344 |
2.0× |
| Arthrogram shoulder (73040) |
$672 |
$1,344 |
2.0× |
| Arthrogram wrist (73115) |
$388 |
$776 |
1.2× |
| Arthrography knee lt (73580) |
$798 |
$1,596 |
2.4× |
| Basic radiation dosimetry calculation (77300) |
$135.50 |
$271 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$537.50 |
$1,075 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$740 |
$1,480 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,003 |
$2,006 |
2.6× |
| Bone age studies (77072) |
$163.50 |
$327 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$958 |
$1,916 |
2.5× |
| Bone Marrow Imaging Limited Area (78102) |
$868 |
$1,736 |
2.3× |
| Bone survey complete (77075) |
$724 |
$1,448 |
7.2× |
| Brachytx isodose complex (77318) |
$2,544.50 |
$5,089 |
7.1× |
| Brachytx isodose intermed (77317) |
$2,105 |
$4,210 |
5.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,664 |
$3,328 |
4.6× |
| Brain image w/flow 4 + views (78606) |
$4,544.50 |
$9,089 |
8.8× |
| Brain imaging < 4 static views w vascular flow (78601) |
$2,412 |
$4,824 |
6.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$2,412 |
$4,824 |
4.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,500 |
$5,000 |
1.8× |
| Brain Imaging Vascular Flow Only (78610) |
$467 |
$934 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,459.50 |
$4,919 |
7.4× |
| Cardiac shunt detection (78428) |
$717 |
$1,434 |
1.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$796.50 |
$1,593 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$297.25 |
$594.50 |
3.6× |
| Chest 1 view (71045) |
$167.25 |
$334.50 |
2.0× |
| Chest 3 views (71047) |
$301.75 |
$603.50 |
3.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$391 |
$782 |
2.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,062.50 |
$2,125 |
1.4× |
| Clavicle complete (73000) |
$231 |
$462 |
2.8× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$14,869 |
$29,738 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$373 |
$746 |
3.7× |
| Continuing medical physics consltj pr wk (77336) |
$199 |
$398 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,224.50 |
$4,449 |
6.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,880 |
$3,760 |
8.2× |
| CT abdomen w contrast (74160) |
$1,600 |
$3,200 |
9.5× |
| CT abdomen w wo contrast (74170) |
$1,897 |
$3,794 |
11.3× |
| CT abdomen w/o contrast (74150) |
$1,378 |
$2,756 |
13.8× |
| CT angio hrt w/3d image (75574) |
$375 |
$750 |
1.1× |
| CT angiography upper extremity lt (73206) |
$1,848.50 |
$3,697 |
11.0× |
| CT c-spine w/o contrast (72125) |
$1,365.50 |
$2,731 |
13.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,555 |
$3,110 |
9.3× |
| CT cervical spine with contrast (72126) |
$1,514 |
$3,028 |
4.5× |
| CT chest w/wo contrast (71270) |
$1,846 |
$3,692 |
11.0× |
| CT chest with contrast (71260) |
$1,699.50 |
$3,399 |
10.1× |
| CT colonography screening (74263) |
$567.50 |
$1,135 |
2.5× |
| CT colonography w/dye (74262) |
$612.50 |
$1,225 |
3.7× |
| CT colonography w/o cntrst (74261) |
$567.50 |
$1,135 |
5.7× |
| CT head/brain with contrast (70460) |
$1,322 |
$2,644 |
7.9× |
| CT head/brain without and with contrast (70470) |
$1,455 |
$2,910 |
8.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,400.50 |
$2,801 |
4.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$169 |
$338 |
2.0× |
| CT hrt w/3d image congen (75573) |
$1,400.50 |
$2,801 |
4.2× |
| CT iac w contrast (70481) |
$1,333.50 |
$2,667 |
8.0× |
| CT limited/localized follow up study (76380) |
$904.50 |
$1,809 |
10.9× |
| CT lower ext w/o (73700) |
$1,495.50 |
$2,991 |
15.0× |
| CT lower extremity w wo contrast (73702) |
$2,624.50 |
$5,249 |
15.7× |
| CT lower extremity with contrast (73701) |
$2,511 |
$5,022 |
15.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,374 |
$4,748 |
14.2× |
| CT lumbar spine w/o contrast (72131) |
$1,327 |
$2,654 |
13.3× |
| CT lumbar spine with contrast (72132) |
$2,192.50 |
$4,385 |
6.6× |
| CT maxillofacial w contrast (70487) |
$1,476 |
$2,952 |
8.8× |
| CT maxillofacial w/o contrast (70486) |
$1,229.50 |
$2,459 |
12.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,530 |
$3,060 |
9.1× |
| CT neck soft tissue w contrast (70491) |
$1,397.50 |
$2,795 |
8.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,530 |
$3,060 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,041 |
$2,082 |
10.4× |
| CT pelvis w & w/o contrast (72194) |
$1,927.50 |
$3,855 |
11.5× |
| CT pelvis w/o contrast (72192) |
$1,418.50 |
$2,837 |
14.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,549.50 |
$3,099 |
9.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,220.50 |
$2,441 |
12.2× |
| CT thoracic spine w/contrast (72129) |
$2,130 |
$4,260 |
12.7× |
| CT thoracic spine w/o contrast (72128) |
$1,569.50 |
$3,139 |
15.7× |
| CT thoracic spine w/wo contrast (72130) |
$2,282 |
$4,564 |
13.6× |
| CT thorax w/o contrast (71250) |
$1,090.50 |
$2,181 |
10.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,511 |
$5,022 |
15.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,411 |
$2,822 |
14.1× |
| CT upper extremity with contrast (73201) |
$2,406 |
$4,812 |
7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,151.50 |
$2,303 |
6.9× |
| Cta Abdomen (74175) |
$1,979.50 |
$3,959 |
11.8× |
| CTA abdomen pelvis (74174) |
$1,634 |
$3,268 |
4.9× |
| CTA chest (71275) |
$1,528.50 |
$3,057 |
9.1× |
| Cta Head (70496) |
$1,503.50 |
$3,007 |
9.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,979.50 |
$3,959 |
11.8× |
| Cta Neck (70498) |
$1,503.50 |
$3,007 |
9.0× |
| Cta Pelvis (72191) |
$1,979.50 |
$3,959 |
11.8× |
| Cystography minimum 3 views rs&i (74430) |
$301.50 |
$603 |
0.9× |
| Dacryocystography (70170) |
$320.50 |
$641 |
1.4× |
| Diskogram cervical (72285) |
$2,008.50 |
$4,017 |
1.1× |
| Diskography lumbar (72295) |
$2,108.50 |
$4,217 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$142 |
$284 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$142 |
$284 |
1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$346 |
$692 |
3.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$458.50 |
$917 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$226 |
$452 |
2.7× |
| Dxa bone density study axial skeleton (77085) |
$179 |
$358 |
1.8× |
| Echo exam of eye (76529) |
$251 |
$502 |
3.0× |
| Echo exam of fetal heart (76825) |
$1,039.75 |
$2,079.50 |
2.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$299.50 |
$599 |
1.3× |
| Echoencephalography real time imaging (76506) |
$782.50 |
$1,565 |
7.8× |
| Esophagus (74220) |
$354.50 |
$709 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$374.50 |
$749 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$334.75 |
$669.50 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$443.50 |
$887 |
1.9× |
| Foot 2 views (73620) |
$208.25 |
$416.50 |
2.5× |
| Forearm 2 views (73090) |
$240.50 |
$481 |
2.9× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$167 |
$334 |
0.7× |
| Functional MRI brain by phys/psych (70555) |
$2,309 |
$4,618 |
10.1× |
| Functional MRI brain by tech (70554) |
$2,866 |
$5,732 |
12.6× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,313.50 |
$2,627 |
2.5× |
| Gated Heart Planar Single (78472) |
$1,127 |
$2,254 |
2.9× |
| Hand 2 views (73120) |
$169.75 |
$339.50 |
1.7× |
| Hand 3 views (73130) |
$239.75 |
$479.50 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,374 |
$4,748 |
3.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,729 |
$5,458 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,957 |
$5,914 |
4.4× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$2,729 |
$5,458 |
7.4× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$2,374 |
$4,748 |
6.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,746.50 |
$5,493 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$708.50 |
$1,417 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$708.50 |
$1,417 |
1.9× |
| Ht muscle image spect sing (78451) |
$1,702.25 |
$3,404.50 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$254.75 |
$509.50 |
3.1× |
| Hysterosalpingogram (74740) |
$636 |
$1,272 |
2.8× |
| Interstitial radiation source applic complex (77778) |
$2,957 |
$5,914 |
4.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,813.50 |
$3,627 |
2.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,592 |
$3,184 |
3.0× |
| Intracavitary radiation source applic simple (77761) |
$1,376 |
$2,752 |
2.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$3,906.50 |
$7,813 |
0.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$390 |
$780 |
3.9× |
| Kidney imaging morphology (78700) |
$914 |
$1,828 |
2.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,383 |
$2,766 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,590.50 |
$3,181 |
3.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,969.50 |
$3,939 |
3.8× |
| Knee 3 views (73562) |
$276 |
$552 |
3.3× |
| Liver & spleen imaging static only (78215) |
$532 |
$1,064 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$621.50 |
$1,243 |
1.6× |
| Liver imaging static only (78201) |
$1,223 |
$2,446 |
2.4× |
| Liver imaging w/vascular flow (78202) |
$1,223 |
$2,446 |
2.4× |
| Lung perf&ventilat diferentl (78598) |
$1,357 |
$2,714 |
2.6× |
| Lung perfusion differential (78597) |
$1,357 |
$2,714 |
3.6× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,666 |
$3,332 |
0.6× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$1,024.50 |
$2,049 |
1.7× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,666 |
$3,332 |
0.6× |
| Lymphoscintigraphy (78195) |
$888.50 |
$1,777 |
1.7× |
| Mammary ductogram or galactogram multiple (77054) |
$715 |
$1,430 |
3.1× |
| Mammary ductogram or galactogram single (77053) |
$452.50 |
$905 |
2.0× |
| Meckels Diverticulum (78290) |
$508 |
$1,016 |
1.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,487.50 |
$2,975 |
4.2× |
| Mr elastography (76391) |
$1,207 |
$2,414 |
5.3× |
| MRA head w & w/o contrast (70546) |
$3,814.50 |
$7,629 |
11.4× |
| MRA head w/o contrast (70544) |
$1,798.50 |
$3,597 |
7.9× |
| MRA head with contrast (70545) |
$3,319 |
$6,638 |
10.0× |
| MRA neck w contrast (70548) |
$2,429 |
$4,858 |
7.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,722.50 |
$7,445 |
11.2× |
| MRA neck w/o contrast (70547) |
$1,698.50 |
$3,397 |
7.4× |
| MRI abdomen w contrast (74182) |
$1,832 |
$3,664 |
5.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,224.50 |
$4,449 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,410.50 |
$2,821 |
6.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,960 |
$3,920 |
2.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,904 |
$3,808 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$3,520.50 |
$7,041 |
15.4× |
| MRI breast w/o contrast unilat (77046) |
$3,151.50 |
$6,303 |
13.8× |
| MRI c-spine with contrast (72142) |
$1,798.50 |
$3,597 |
5.4× |
| MRI cardiac w/o contrast (75557) |
$1,742.50 |
$3,485 |
7.6× |
| MRI cervical spine w/o contrast (72141) |
$1,410.50 |
$2,821 |
6.2× |
| MRI chest w/o & w/contrast material (71552) |
$2,394.50 |
$4,789 |
7.2× |
| MRI chest w/o contrast (71550) |
$1,525 |
$3,050 |
6.7× |
| MRI chest with contrast (71551) |
$1,832 |
$3,664 |
2.4× |
| MRI fetal sngl/1st gestation (74712) |
$575.50 |
$1,151 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,978.50 |
$3,957 |
5.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,960 |
$3,920 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,501.50 |
$3,003 |
6.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,480.50 |
$2,961 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,814 |
$3,628 |
5.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,511.50 |
$3,023 |
4.5× |
| MRI pelvis w contrast (72196) |
$1,832 |
$3,664 |
5.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,224.50 |
$4,449 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,410.50 |
$2,821 |
6.2× |
| MRI scan of arm joint before and after contrast (73223) |
$1,960 |
$3,920 |
5.9× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$2,798 |
$5,596 |
3.7× |
| MRI scan of leg joint before and after contrast (73723) |
$2,015 |
$4,030 |
6.0× |
| MRI spectroscopy (76390) |
$2,199 |
$4,398 |
26.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,861.50 |
$3,723 |
5.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,798.50 |
$3,597 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,861.50 |
$3,723 |
5.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,778.50 |
$3,557 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,861.50 |
$3,723 |
5.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,410.50 |
$2,821 |
6.2× |
| MRI tmj (70336) |
$1,778.50 |
$3,557 |
7.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,501.50 |
$3,003 |
6.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,527.50 |
$5,055 |
7.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,960 |
$3,920 |
8.6× |
| Myelogram Cervical (72240) |
$1,160.50 |
$2,321 |
1.5× |
| Myelogram Lumbar (72265) |
$1,438.50 |
$2,877 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,754.25 |
$5,508.50 |
2.2× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,263 |
$4,526 |
1.1× |
| Neck soft tissue (70360) |
$264.50 |
$529 |
3.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$931 |
$1,862 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$395.50 |
$791 |
1.0× |
| Nm adrenal scan (78075) |
$1,350 |
$2,700 |
1.1× |
| Nm bone marrow multiple (78103) |
$999.50 |
$1,999 |
2.6× |
| Nm bone marrow wb (78104) |
$1,247 |
$2,494 |
3.3× |
| Nm cisternogram (78630) |
$1,164.50 |
$2,329 |
2.2× |
| Nm gastric emptying study (78264) |
$650.50 |
$1,301 |
1.7× |
| Nm gastroesophageal reflux study (78262) |
$696.50 |
$1,393 |
1.8× |
| Nm peritoneal-venous shunt patency (78291) |
$696.50 |
$1,393 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,074 |
$4,148 |
1.6× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,811.50 |
$3,623 |
1.5× |
| Nuclear medicine of heart pumping function (78473) |
$1,220 |
$2,440 |
3.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$5,425.50 |
$10,851 |
4.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,449 |
$2,898 |
1.2× |
| Nuclear medicine study of kidney and blood flow (78701) |
$986 |
$1,972 |
2.6× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$813 |
$1,626 |
2.1× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$1,098.50 |
$2,197 |
2.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$978 |
$1,956 |
2.6× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$852.50 |
$1,705 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$425 |
$850 |
1.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$198.25 |
$396.50 |
2.0× |
| Orthopantogram (70355) |
$379 |
$758 |
4.6× |
| Osseous survey infant (77076) |
$360.50 |
$721 |
3.6× |
| Osseous survey limited (77074) |
$578 |
$1,156 |
5.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,682 |
$3,364 |
3.2× |
| Parathyrd planar w/wo subtrj (78071) |
$1,367.50 |
$2,735 |
3.6× |
| Parathyroid imaging (78070) |
$632.50 |
$1,265 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$240.25 |
$480.50 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$4,409 |
$8,818 |
3.2× |
| PET imaging CT for attenuation limited area (78814) |
$4,409 |
$8,818 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,409 |
$8,818 |
3.2× |
| PET imaging limited area chest head/neck (78811) |
$5,425.50 |
$10,851 |
4.4× |
| PET whole body (78813) |
$5,425.50 |
$10,851 |
4.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,978.50 |
$3,957 |
5.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,662.50 |
$7,325 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,513.50 |
$3,027 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$528.50 |
$1,057 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$755.50 |
$1,511 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$410 |
$820 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$162.50 |
$325 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$203 |
$406 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$285.50 |
$571 |
2.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$259 |
$518 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$323.75 |
$647.50 |
3.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,508.50 |
$21,017 |
1.5× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$352 |
$704 |
0.7× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$175 |
$350 |
1.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$185.50 |
$371 |
0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$338 |
$676 |
3.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$220.75 |
$441.50 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$350.75 |
$701.50 |
3.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$208.75 |
$417.50 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$375.50 |
$751 |
2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$272.50 |
$545 |
1.6× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$167 |
$334 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$744 |
$1,488 |
4.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$744 |
$1,488 |
4.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$306.25 |
$612.50 |
3.7× |
| Radiological examination surgical specimen (76098) |
$1,073.50 |
$2,147 |
2.1× |
| Review by radiologist of adrenal gland vein image (75840) |
$3,662.50 |
$7,325 |
1.2× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,662.50 |
$7,325 |
1.2× |
| Ribs bilateral 3 views (71110) |
$448.25 |
$896.50 |
4.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,791 |
$3,582 |
4.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,914.50 |
$5,829 |
5.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,121 |
$8,242 |
3.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,634.50 |
$9,269 |
3.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,543 |
$7,086 |
2.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$874.50 |
$1,749 |
3.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$935.50 |
$1,871 |
4.2× |
| Rp Therapy Intravenous Administration (79101) |
$658 |
$1,316 |
3.0× |
| Sacroiliac Joints < 3 Views (72200) |
$245.50 |
$491 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$604.25 |
$1,208.50 |
2.6× |
| Salivary gland imaging serial images (78231) |
$696.50 |
$1,393 |
1.8× |
| Scanogram (77073) |
$280.50 |
$561 |
2.8× |
| Scapula complete (73010) |
$289.75 |
$579.50 |
2.9× |
| Screening digital breast tomosynthesis (77063) |
$18.50 |
$37 |
0.8× |
| Sella turcica (70240) |
$160 |
$320 |
1.9× |
| Sialogram (70390) |
$548.50 |
$1,097 |
2.4× |
| Simulation intermediate (77285) |
$409 |
$818 |
1.1× |
| Small bowel series (74250) |
$313.50 |
$627 |
1.9× |
| Spec medical radj physics consltj (77370) |
$404 |
$808 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$270 |
$540 |
0.8× |
| Special dosimetry (77331) |
$154 |
$308 |
1.2× |
| Special treatment procedure (77470) |
$667.50 |
$1,335 |
1.3× |
| Spine thoracic 3 views (72072) |
$338.50 |
$677 |
3.4× |
| Spleen imaging only (78185) |
$726.50 |
$1,453 |
1.9× |
| Splenoportograpy rs&i (75810) |
$2,615.50 |
$5,231 |
0.9× |
| Stereotactic body radiation delivery (77373) |
$10,508.50 |
$21,017 |
6.1× |
| Superior sagittal sinus venogram (75870) |
$1,513.50 |
$3,027 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$246 |
$492 |
2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$455 |
$910 |
1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$406 |
$812 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$828 |
$1,656 |
2.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$519 |
$1,038 |
1.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$198 |
$396 |
1.5× |
| Thoracolumbar 2 views (72080) |
$355.50 |
$711 |
4.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,869.50 |
$3,739 |
3.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$613.50 |
$1,227 |
1.6× |
| Thyroid uptake measurement (78012) |
$270.50 |
$541 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$741.50 |
$1,483 |
1.9× |
| Tmj unilateral (70328) |
$274.25 |
$548.50 |
3.3× |
| Tomogram (76100) |
$135 |
$270 |
1.4× |
| Treatment device intermediate (77333) |
$359 |
$718 |
2.8× |
| Treatment devices simple (77332) |
$305 |
$610 |
2.4× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,619.50 |
$5,239 |
5.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,206.50 |
$2,413 |
3.2× |
| Tx devices design & construction complex (77334) |
$868 |
$1,736 |
2.4× |
| Ultrasound elastography first target lesion (76982) |
$336.50 |
$673 |
3.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$412 |
$824 |
4.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$687.50 |
$1,375 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$320.50 |
$641 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$389.50 |
$779 |
3.9× |
| Unlisted magnetic resonance procedure (76498) |
$1,331.50 |
$2,663 |
16.0× |
| Unlisted Ultrasound Procedure (76999) |
$121 |
$242 |
1.5× |
| Upper Extremity Infant (73092) |
$121.50 |
$243 |
1.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$914 |
$1,828 |
2.4× |
| Urethrocystography retrograde rs&i (74450) |
$371 |
$742 |
1.6× |
| Urethrocystography voiding (74455) |
$448 |
$896 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,046 |
$2,092 |
6.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$1,178 |
$2,356 |
7.0× |
| Us abdl aorta screen aaa (76706) |
$424 |
$848 |
4.2× |
| Us breast unilateral complete (76641) |
$519.75 |
$1,039.50 |
5.2× |
| Us breast unilateral limited (76642) |
$466 |
$932 |
5.6× |
| Us chest (76604) |
$579 |
$1,158 |
5.8× |
| Us compl joint r-t w/image documentation (76881) |
$551 |
$1,102 |
5.5× |
| Us elastography parenchyma (76981) |
$336.50 |
$673 |
3.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$481.50 |
$963 |
4.8× |
| Us guided compression repair (76936) |
$472.50 |
$945 |
2.3× |
| Us infant hips dynamic (76885) |
$273 |
$546 |
3.3× |
| Us infant hips limited static (76886) |
$165.50 |
$331 |
2.0× |
| Us kidney transplant (76776) |
$581.50 |
$1,163 |
5.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$404 |
$808 |
4.0× |
| Us ob detailed single fetus (76811) |
$658.50 |
$1,317 |
2.9× |
| Us ob transvaginal (76817) |
$214.50 |
$429 |
2.1× |
| Us pelvic non ob complete (76856) |
$578.75 |
$1,157.50 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$174 |
$348 |
1.7× |
| Us pregnancy ltd (76815) |
$214.50 |
$429 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$344.25 |
$688.50 |
3.4× |
| Us retroperitoneal complete (76770) |
$619 |
$1,238 |
6.2× |
| Us retroperitoneal limited (76775) |
$434.50 |
$869 |
4.3× |
| Us scrotum and contents (76870) |
$522 |
$1,044 |
5.2× |
| Us soft tissue head/neck (76536) |
$407.75 |
$815.50 |
4.1× |
| Us spinal canal and contents (76800) |
$553.50 |
$1,107 |
5.5× |
| Us transrectal (76872) |
$506.75 |
$1,013.50 |
5.1× |
| Us transrectal prostate volume (76873) |
$588.50 |
$1,177 |
5.9× |
| Us xtr non-vasc lmtd (76882) |
$138.50 |
$277 |
1.4× |
| Us, eye b-scan (76512) |
$322 |
$644 |
3.2× |
| Vascular flow imaging (78445) |
$468.50 |
$937 |
1.2× |
| Vasogram (74440) |
$526.50 |
$1,053 |
2.3× |
| Venogram extremity bilateral (75822) |
$1,627 |
$3,254 |
1.1× |
| Venogram orbital (75880) |
$2,268.50 |
$4,537 |
3.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,837.50 |
$7,675 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$1,200.50 |
$2,401 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,241.50 |
$2,483 |
0.8× |
| Venography Renal Bilateral (75833) |
$3,654.50 |
$7,309 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,654.50 |
$7,309 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,666 |
$3,332 |
0.6× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,654.50 |
$7,309 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$112.50 |
$225 |
1.4× |
| Wrist 2 views (73100) |
$200.50 |
$401 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$394.25 |
$788.50 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$232.75 |
$465.50 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$270.25 |
$540.50 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$529 |
$1,058 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$205.50 |
$411 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$311.25 |
$622.50 |
3.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$323.75 |
$647.50 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$156 |
$312 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$250.50 |
$501 |
3.0× |
| X-ray exam hip uni 4/> views (73503) |
$340.50 |
$681 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$315 |
$630 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$365.25 |
$730.50 |
3.7× |
| X-ray exam of femur 1 (73551) |
$239.25 |
$478.50 |
2.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$480.50 |
$961 |
2.9× |
| X-ray eye for foreign body (70030) |
$164 |
$328 |
2.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$406.75 |
$813.50 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$228.25 |
$456.50 |
2.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$261 |
$522 |
3.1× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,003.50 |
$4,007 |
1.0× |
| X-ray head for orthodontia (70350) |
$160 |
$320 |
1.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$217.25 |
$434.50 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$118 |
$236 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$314.25 |
$628.50 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$178.50 |
$357 |
2.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$115 |
$230 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$315.50 |
$631 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$638.25 |
$1,276.50 |
6.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$572.75 |
$1,145.50 |
5.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$236.75 |
$473.50 |
2.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$131.50 |
$263 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$409.25 |
$818.50 |
4.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$436 |
$872 |
4.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$330 |
$660 |
0.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$514 |
$1,028 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$263.75 |
$527.50 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$340.75 |
$681.50 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$502.25 |
$1,004.50 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$436.50 |
$873 |
4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$289.75 |
$579.50 |
3.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$244.50 |
$489 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$549.25 |
$1,098.50 |
6.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$379.75 |
$759.50 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$494.75 |
$989.50 |
5.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$378 |
$756 |
3.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$234 |
$468 |
2.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$283.25 |
$566.50 |
3.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$257.75 |
$515.50 |
3.1× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$74.50 |
$149 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$306.75 |
$613.50 |
3.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$464.75 |
$929.50 |
4.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$188.25 |
$376.50 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$255.25 |
$510.50 |
3.1× |
| Xr arthrogram ankle (73615) |
$798 |
$1,596 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$549.25 |
$1,098.50 |
5.5× |
| Xr chest 4+ views (71048) |
$376.25 |
$752.50 |
3.8× |
| Xr finger(s) 2+ views (73140) |
$160.25 |
$320.50 |
1.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$140 |
$280 |
1.4× |
| Xr shoulder 1 view (73020) |
$176.50 |
$353 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$416 |
$832 |
4.2× |
| Xr tibia/fibula 2 views (73590) |
$242 |
$484 |
2.9× |
| Xr tmj bilateral (70330) |
$354.75 |
$709.50 |
4.3× |
| Xray knee 1 or 2 views rt (73560) |
$182 |
$364 |
2.2× |