| 3-D radiotherapy plan dose-volume histograms (77295) |
$996.12 |
$1,532.50 |
0.8× |
| Abdomen 2 views (74019) |
$81.90 |
$126 |
0.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$513.50 |
$790 |
1.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography extremity unilateral rs&i (75710) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography internal mammary rs&i (75756) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,805.50 |
$10,470 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,948.75 |
$6,075 |
1.3× |
| Angiography Spinal Selective Rs&I (75705) |
$3,687.12 |
$5,672.50 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,805.50 |
$10,470 |
1.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,948.75 |
$5,900 |
1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,721.25 |
$5,725 |
1.3× |
| Ankle 2 views (73600) |
$113.75 |
$175 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$245.38 |
$377.50 |
0.8× |
| Aortogram thoracic (75605) |
$6,805.50 |
$10,470 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,948.75 |
$5,397.50 |
1.3× |
| Aortography abdominal serialography rs&i (75625) |
$3,948.75 |
$6,075 |
1.3× |
| Artery X-Rays Adrenal Gland (75731) |
$3,948.75 |
$6,075 |
1.3× |
| Arthrogram elbow (73085) |
$438.75 |
$675 |
1.3× |
| Arthrogram hip (73525) |
$438.75 |
$675 |
1.3× |
| Arthrogram shoulder (73040) |
$438.75 |
$675 |
1.3× |
| Arthrogram wrist (73115) |
$438.75 |
$675 |
1.3× |
| Arthrography knee lt (73580) |
$438.75 |
$675 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$165.75 |
$255 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$513.50 |
$790 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$513.50 |
$790 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$513.50 |
$790 |
1.4× |
| Bone age studies (77072) |
$75.72 |
$116.50 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$513.50 |
$790 |
1.4× |
| Bone survey complete (77075) |
$136.50 |
$210 |
1.4× |
| Brachytx isodose complex (77318) |
$533 |
$820 |
1.5× |
| Brachytx isodose intermed (77317) |
$286 |
$440 |
0.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$269.75 |
$415 |
0.8× |
| Brain image w/flow 4 + views (78606) |
$669.50 |
$1,030 |
1.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$669.50 |
$1,030 |
1.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$669.50 |
$1,030 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$72.80 |
$112 |
0.9× |
| Chest 1 view (71045) |
$62.72 |
$96.50 |
0.8× |
| Chest 3 views (71047) |
$71.50 |
$110 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$227.50 |
$350 |
1.4× |
| Clavicle complete (73000) |
$113.75 |
$175 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$165.75 |
$255 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$159.25 |
$245 |
1.3× |
| Corpora cavernosography (74445) |
$136.50 |
$210 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$477.75 |
$735 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$207.02 |
$318.50 |
0.9× |
| CT abdomen w contrast (74160) |
$227.50 |
$350 |
1.4× |
| CT abdomen w wo contrast (74170) |
$227.50 |
$350 |
1.4× |
| CT abdomen w/o contrast (74150) |
$136.50 |
$210 |
1.4× |
| CT angio hrt w/3d image (75574) |
$180.38 |
$277.50 |
0.6× |
| CT angiography upper extremity lt (73206) |
$167.38 |
$257.50 |
1.0× |
| CT c-spine w/o contrast (72125) |
$136.50 |
$210 |
1.4× |
| CT cervical spine w&w/o contrast (72127) |
$227.50 |
$350 |
1.4× |
| CT cervical spine with contrast (72126) |
$477.75 |
$735 |
1.5× |
| CT chest w/wo contrast (71270) |
$227.50 |
$350 |
1.4× |
| CT chest with contrast (71260) |
$179.72 |
$276.50 |
1.1× |
| CT head/brain with contrast (70460) |
$227.50 |
$350 |
1.4× |
| CT head/brain without and with contrast (70470) |
$227.50 |
$350 |
1.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$227.50 |
$350 |
0.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$48.75 |
$75 |
0.6× |
| CT iac w contrast (70481) |
$227.50 |
$350 |
1.4× |
| CT limited/localized follow up study (76380) |
$78 |
$120 |
1.0× |
| CT lower ext w/o (73700) |
$136.50 |
$210 |
1.4× |
| CT lower extremity w wo contrast (73702) |
$227.50 |
$350 |
1.4× |
| CT lower extremity with contrast (73701) |
$227.50 |
$350 |
1.4× |
| CT lumbar spine w & w/o contrast (72133) |
$227.50 |
$350 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$136.50 |
$210 |
1.4× |
| CT lumbar spine with contrast (72132) |
$477.75 |
$735 |
1.5× |
| CT maxillofacial w contrast (70487) |
$227.50 |
$350 |
1.4× |
| CT maxillofacial w/o contrast (70486) |
$115.70 |
$178 |
1.2× |
| CT maxillofacial w/wo contrast (70488) |
$227.50 |
$350 |
1.4× |
| CT neck soft tissue w contrast (70491) |
$179.72 |
$276.50 |
1.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$227.50 |
$350 |
1.4× |
| CT orbits w/o contrast (70480) |
$136.50 |
$210 |
1.4× |
| CT pelvis w & w/o contrast (72194) |
$227.50 |
$350 |
1.4× |
| CT pelvis w/o contrast (72192) |
$136.50 |
$210 |
1.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$227.50 |
$350 |
1.4× |
| CT soft tissue neck w/o contrast (70490) |
$136.50 |
$210 |
1.4× |
| CT thoracic spine w/contrast (72129) |
$227.50 |
$350 |
1.4× |
| CT thoracic spine w/o contrast (72128) |
$136.50 |
$210 |
1.4× |
| CT thoracic spine w/wo contrast (72130) |
$227.50 |
$350 |
1.4× |
| CT thorax w/o contrast (71250) |
$119.60 |
$184 |
1.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$227.50 |
$350 |
1.4× |
| CT upper extremity w/o contrast rt (73200) |
$136.50 |
$210 |
1.4× |
| CT upper extremity with contrast (73201) |
$477.75 |
$735 |
1.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$185.25 |
$285 |
1.1× |
| Cta Abdomen (74175) |
$170.62 |
$262.50 |
1.0× |
| CTA abdomen pelvis (74174) |
$300.62 |
$462.50 |
0.9× |
| CTA chest (71275) |
$227.50 |
$350 |
1.4× |
| Cta Head (70496) |
$390 |
$600 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$227.50 |
$350 |
1.4× |
| Cta Neck (70498) |
$167.38 |
$257.50 |
1.0× |
| Cta Pelvis (72191) |
$227.50 |
$350 |
1.4× |
| Cystography minimum 3 views rs&i (74430) |
$242.12 |
$372.50 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$149.50 |
$230 |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$45.50 |
$70 |
0.6× |
| Dxa bone density study axial skeleton (77085) |
$100.75 |
$155 |
1.0× |
| Echoencephalography real time imaging (76506) |
$136.50 |
$210 |
1.4× |
| Esophagus (74220) |
$227.50 |
$350 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$149.50 |
$230 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$136.50 |
$210 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$299 |
$455 |
1.3× |
| Foot 2 views (73620) |
$113.75 |
$175 |
1.4× |
| Forearm 2 views (73090) |
$113.75 |
$175 |
1.4× |
| Gated Heart Planar Single (78472) |
$282.75 |
$435 |
0.8× |
| Hand 2 views (73120) |
$136.50 |
$210 |
1.4× |
| Hand 3 views (73130) |
$113.75 |
$175 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$536.25 |
$825 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$604.50 |
$930 |
0.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,222 |
$1,880 |
1.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,948.75 |
$6,075 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$669.50 |
$1,030 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$513.50 |
$790 |
1.4× |
| Ht muscle image spect sing (78451) |
$1,482 |
$2,280 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$113.75 |
$175 |
1.4× |
| Hysterosalpingogram (74740) |
$295.75 |
$455 |
1.3× |
| Interstitial radiation source applic complex (77778) |
$1,313 |
$2,020 |
2.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,066 |
$1,640 |
1.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$796.25 |
$1,225 |
1.5× |
| Intracavitary radiation source applic simple (77761) |
$705.25 |
$1,085 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$23.40 |
$36 |
0.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$669.50 |
$1,030 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$669.50 |
$1,030 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$669.50 |
$1,030 |
1.3× |
| Knee 3 views (73562) |
$113.75 |
$175 |
1.4× |
| Liver & spleen imaging static only (78215) |
$513.50 |
$790 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$669.50 |
$1,030 |
1.3× |
| Lung Ventilation Imaging (78579) |
$513.50 |
$790 |
1.4× |
| Lymphoscintigraphy (78195) |
$669.50 |
$1,030 |
1.3× |
| Mammary ductogram or galactogram multiple (77054) |
$302.25 |
$465 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$302.25 |
$465 |
1.4× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$113.75 |
$175 |
1.4× |
| Meckels Diverticulum (78290) |
$513.50 |
$790 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$698.75 |
$1,075 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$32.50 |
$50 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$120.25 |
$185 |
1.3× |
| MRA head w/o contrast (70544) |
$302.25 |
$465 |
1.4× |
| MRA head with contrast (70545) |
$497.25 |
$765 |
1.5× |
| MRA neck w contrast (70548) |
$477.75 |
$735 |
1.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$477.75 |
$735 |
1.5× |
| MRA neck w/o contrast (70547) |
$302.25 |
$465 |
1.4× |
| MRI abdomen w contrast (74182) |
$477.75 |
$735 |
1.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$477.75 |
$735 |
1.5× |
| MRI abdomen w/o contrast (74181) |
$302.25 |
$465 |
1.4× |
| MRI any jnt lwr ext with con lt (73722) |
$991.25 |
$1,525 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$991.25 |
$1,525 |
1.3× |
| MRI breast w/o contrast bilateral (77047) |
$302.25 |
$465 |
1.4× |
| MRI breast w/o contrast unilat (77046) |
$302.25 |
$465 |
1.4× |
| MRI c-spine with contrast (72142) |
$477.75 |
$735 |
1.5× |
| MRI cardiac w/o contrast (75557) |
$302.25 |
$465 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$302.25 |
$465 |
1.4× |
| MRI chest w/o & w/contrast material (71552) |
$477.75 |
$735 |
1.5× |
| MRI chest w/o contrast (71550) |
$302.25 |
$465 |
1.4× |
| MRI chest with contrast (71551) |
$991.25 |
$1,525 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$477.75 |
$735 |
1.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$477.75 |
$735 |
1.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$302.25 |
$465 |
1.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$302.25 |
$465 |
1.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$477.75 |
$735 |
1.5× |
| MRI orbit/face/neck w/contrast (70542) |
$477.75 |
$735 |
1.5× |
| MRI pelvis w contrast (72196) |
$477.75 |
$735 |
1.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$487.50 |
$750 |
1.5× |
| MRI pelvis w/o contrast (72195) |
$302.25 |
$465 |
1.4× |
| MRI scan of arm joint before and after contrast (73223) |
$477.75 |
$735 |
1.5× |
| MRI scan of leg joint before and after contrast (73723) |
$477.75 |
$735 |
1.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$477.75 |
$735 |
1.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$477.75 |
$735 |
1.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$477.75 |
$735 |
1.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$477.75 |
$735 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$477.75 |
$735 |
1.5× |
| MRI thoracic spine w/o contrast (72146) |
$302.25 |
$465 |
1.4× |
| MRI tmj (70336) |
$302.25 |
$465 |
1.4× |
| MRI upper ext joint w/o contrast (73221) |
$302.25 |
$465 |
1.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$477.75 |
$735 |
1.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$302.25 |
$465 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,761.50 |
$2,710 |
1.5× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$97.50 |
$150 |
0.0× |
| Neck soft tissue (70360) |
$67.92 |
$104.50 |
0.8× |
| Nm cisternogram (78630) |
$669.50 |
$1,030 |
1.3× |
| Nm csf leak detection (78650) |
$1,761.50 |
$2,710 |
1.5× |
| Nm gastric emptying study (78264) |
$513.50 |
$790 |
1.4× |
| Nm gastroesophageal reflux study (78262) |
$513.50 |
$790 |
1.4× |
| Nm peritoneal-venous shunt patency (78291) |
$490.75 |
$755 |
1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,330.88 |
$2,047.50 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$250.25 |
$385 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$128.38 |
$197.50 |
1.3× |
| Osseous survey infant (77076) |
$113.75 |
$175 |
1.2× |
| Osseous survey limited (77074) |
$139.75 |
$215 |
1.4× |
| Parathyrd planar w/spect&CT (78072) |
$669.50 |
$1,030 |
1.3× |
| Parathyrd planar w/wo subtrj (78071) |
$513.50 |
$790 |
1.4× |
| Parathyroid imaging (78070) |
$513.50 |
$790 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$79.95 |
$123 |
0.8× |
| Peritoneogram rs&i (74190) |
$682.50 |
$1,050 |
1.3× |
| PET whole body (78813) |
$1,618.50 |
$2,490 |
1.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,758.25 |
$2,705 |
1.4× |
| Pr heart first pass single,planar (78481) |
$669.50 |
$1,030 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$477.75 |
$735 |
1.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,948.75 |
$6,075 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,948.75 |
$6,075 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$513.50 |
$790 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$669.50 |
$1,030 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$682.50 |
$1,050 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$65.98 |
$101.50 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$84.18 |
$129.50 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$84.18 |
$129.50 |
0.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$136.50 |
$210 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$91 |
$140 |
0.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,722.75 |
$18,035 |
1.7× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$315.25 |
$485 |
0.6× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$156 |
$240 |
1.6× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$315.25 |
$485 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$81.90 |
$126 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$68.25 |
$105 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$91 |
$140 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$67.28 |
$103.50 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$227.50 |
$350 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$227.50 |
$350 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$227.50 |
$350 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$227.50 |
$350 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$113.75 |
$175 |
1.4× |
| Radiological examination surgical specimen (76098) |
$682.50 |
$1,050 |
1.3× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$388.38 |
$165 |
0.8× |
| Review by radiologist of adrenal gland vein image (75840) |
$3,948.75 |
$6,075 |
1.3× |
| Ribs bilateral 3 views (71110) |
$86.45 |
$133 |
0.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,761.50 |
$2,710 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,761.50 |
$2,710 |
3.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,940.25 |
$2,985 |
1.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$81.25 |
$125 |
0.1× |
| Rp Therapy Intravenous Administration (79101) |
$308.75 |
$475 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$35.75 |
$55 |
0.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$214.50 |
$330 |
1.0× |
| Scanogram (77073) |
$95.22 |
$146.50 |
1.0× |
| Scapula complete (73010) |
$136.50 |
$210 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$42.25 |
$65 |
1.8× |
| Sella turcica (70240) |
$113.75 |
$175 |
1.4× |
| Sialogram (70390) |
$302.25 |
$465 |
1.4× |
| Simulation intermediate (77285) |
$624 |
$960 |
1.8× |
| Small bowel series (74250) |
$227.50 |
$350 |
1.4× |
| Spec medical radj physics consltj (77370) |
$167.38 |
$257.50 |
1.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$258.38 |
$397.50 |
0.7× |
| Special dosimetry (77331) |
$165.75 |
$255 |
1.3× |
| Special treatment procedure (77470) |
$432.25 |
$665 |
0.8× |
| Spine thoracic 3 views (72072) |
$80.92 |
$124.50 |
0.8× |
| Spleen imaging only (78185) |
$432.25 |
$665 |
1.2× |
| Stereotactic body radiation delivery (77373) |
$6,214 |
$9,560 |
3.7× |
| Superior sagittal sinus venogram (75870) |
$4,091.75 |
$6,295 |
1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$438.75 |
$675 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$438.75 |
$675 |
1.2× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$302.25 |
$465 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$513.50 |
$790 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$411.12 |
$632.50 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$216.12 |
$332.50 |
1.7× |
| Therapeutic Enema (74283) |
$227.50 |
$350 |
1.4× |
| Thoracolumbar 2 views (72080) |
$80.28 |
$123.50 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$669.50 |
$1,030 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$513.50 |
$790 |
1.4× |
| Thyroid uptake measurement (78012) |
$513.50 |
$790 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$513.50 |
$790 |
1.4× |
| Tmj unilateral (70328) |
$113.75 |
$175 |
1.4× |
| Treatment device intermediate (77333) |
$165.75 |
$255 |
1.3× |
| Treatment devices simple (77332) |
$104 |
$160 |
0.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,725.75 |
$2,655 |
3.4× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$513.50 |
$790 |
1.4× |
| Tx devices design & construction complex (77334) |
$442 |
$680 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$138.12 |
$212.50 |
1.4× |
| Umbilical-artery Doppler (OB) (76820) |
$100.75 |
$155 |
1.0× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$156 |
$240 |
1.6× |
| Unlisted Ultrasound Procedure (76999) |
$121.88 |
$187.50 |
1.5× |
| Upper Extremity Infant (73092) |
$136.50 |
$210 |
1.4× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$432.25 |
$665 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$302.25 |
$465 |
1.4× |
| Urethrocystography voiding (74455) |
$302.25 |
$465 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$227.50 |
$350 |
1.4× |
| Us abdl aorta screen aaa (76706) |
$136.50 |
$210 |
1.4× |
| Us breast unilateral complete (76641) |
$136.50 |
$210 |
1.4× |
| Us breast unilateral limited (76642) |
$113.75 |
$175 |
1.4× |
| Us chest (76604) |
$100.75 |
$155 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$136.50 |
$210 |
1.4× |
| Us guided compression repair (76936) |
$396.50 |
$610 |
2.0× |
| Us infant hips limited static (76886) |
$113.75 |
$175 |
1.4× |
| Us kidney transplant (76776) |
$136.50 |
$210 |
1.4× |
| Us ob transvaginal (76817) |
$136.50 |
$210 |
1.4× |
| Us pelvic non ob complete (76856) |
$105.95 |
$163 |
1.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$139.75 |
$215 |
1.4× |
| Us pregnancy ltd (76815) |
$136.50 |
$210 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$136.50 |
$210 |
1.4× |
| Us retroperitoneal complete (76770) |
$136.50 |
$210 |
1.4× |
| Us retroperitoneal limited (76775) |
$136.50 |
$210 |
1.4× |
| Us scrotum and contents (76870) |
$86.12 |
$132.50 |
0.9× |
| Us soft tissue head/neck (76536) |
$136.50 |
$210 |
1.4× |
| Us spinal canal and contents (76800) |
$136.50 |
$210 |
1.4× |
| Us transrectal (76872) |
$162.50 |
$250 |
1.7× |
| Us xtr non-vasc lmtd (76882) |
$136.50 |
$210 |
1.4× |
| Venogram extremity bilateral (75822) |
$2,018.25 |
$3,077.50 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$4,020.25 |
$6,185 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$2,000.38 |
$3,077.50 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$2,000.38 |
$3,077.50 |
1.4× |
| Venography Renal Bilateral (75833) |
$3,948.75 |
$6,075 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$4,020.25 |
$6,185 |
1.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,948.75 |
$6,075 |
1.3× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$6,503.25 |
$10,005 |
1.2× |
| Vertebral fracture assessment via dxa (77086) |
$73.12 |
$112.50 |
0.9× |
| Wrist 2 views (73100) |
$113.75 |
$175 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$87.75 |
$135 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$78.32 |
$120.50 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$84.18 |
$129.50 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$227.50 |
$350 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$113.75 |
$175 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$88.08 |
$135.50 |
1.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$94.58 |
$145.50 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$113.75 |
$175 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$113.75 |
$175 |
1.4× |
| X-ray exam hip uni 4/> views (73503) |
$136.50 |
$210 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$86.45 |
$133 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$113.10 |
$174 |
1.2× |
| X-ray exam of femur 1 (73551) |
$113.75 |
$175 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$84.18 |
$129.50 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$40.62 |
$62.50 |
0.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$113.75 |
$175 |
1.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,522 |
$3,880 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$113.75 |
$175 |
1.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$227.50 |
$350 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$71.18 |
$109.50 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$136.50 |
$210 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$78 |
$120 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$85.48 |
$131.50 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$108.55 |
$167 |
1.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$32.50 |
$50 |
0.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$70.85 |
$109 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$33.80 |
$52 |
0.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$82.88 |
$127.50 |
0.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$100.75 |
$155 |
1.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$682.50 |
$1,050 |
1.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$232.38 |
$357.50 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$113.75 |
$175 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$136.50 |
$210 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$34.45 |
$53 |
0.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$136.50 |
$210 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$69.88 |
$107.50 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$83.52 |
$128.50 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$74.75 |
$115 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$71.18 |
$109.50 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$100.75 |
$155 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$83.52 |
$128.50 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$113.75 |
$175 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$113.75 |
$175 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$71.82 |
$110.50 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$83.20 |
$128 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$91 |
$140 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$113.75 |
$175 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$113.75 |
$175 |
1.4× |
| Xr arthrogram ankle (73615) |
$438.75 |
$675 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$89.38 |
$137.50 |
0.9× |
| Xr chest 4+ views (71048) |
$82.55 |
$127 |
0.8× |
| Xr Cholecystography Oral Contrast (74290) |
$227.50 |
$350 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$113.75 |
$175 |
1.4× |
| Xr shoulder 1 view (73020) |
$113.75 |
$175 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$136.50 |
$210 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$113.75 |
$175 |
1.4× |
| Xr tmj bilateral (70330) |
$113.75 |
$175 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$113.75 |
$175 |
1.4× |