| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,904.50 |
$3,809 |
1.5× |
| Abdomen 2 views (74019) |
$242 |
$484 |
2.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$522 |
$1,044 |
1.4× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,912 |
$3,824 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$1,912 |
$3,824 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$1,912 |
$3,824 |
0.7× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,912 |
$3,824 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,912 |
$3,824 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,912 |
$3,824 |
0.7× |
| Angiography Spinal Selective Rs&I (75705) |
$2,665.50 |
$5,331 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,887 |
$5,774 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$648.50 |
$1,297 |
0.2× |
| Ankle 2 views (73600) |
$118 |
$236 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$753 |
$1,506 |
2.4× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,912 |
$3,824 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,912 |
$3,824 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,912 |
$3,824 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,912 |
$3,824 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$1,912 |
$3,824 |
0.7× |
| Arthrogram elbow (73085) |
$438.50 |
$877 |
1.4× |
| Arthrogram hip (73525) |
$438.50 |
$877 |
1.4× |
| Arthrogram shoulder (73040) |
$438.50 |
$877 |
1.4× |
| Arthrogram wrist (73115) |
$438.50 |
$877 |
1.4× |
| Arthrography knee lt (73580) |
$438.50 |
$877 |
1.4× |
| Basic radiation dosimetry calculation (77300) |
$179.50 |
$359 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$376.50 |
$753 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$582 |
$1,164 |
1.6× |
| Bone age studies (77072) |
$108 |
$216 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$660.50 |
$1,321 |
1.8× |
| Bone Marrow Imaging Limited Area (78102) |
$376.50 |
$753 |
1.0× |
| Bone survey complete (77075) |
$307 |
$614 |
3.3× |
| Brachytx isodose complex (77318) |
$358.50 |
$717 |
1.1× |
| Brachytx isodose intermed (77317) |
$313.50 |
$627 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$213 |
$426 |
0.6× |
| Brain image w/flow 4 + views (78606) |
$571.50 |
$1,143 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$537 |
$1,074 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,911.50 |
$3,823 |
1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,371.50 |
$4,743 |
7.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$485.50 |
$971 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$118 |
$236 |
1.5× |
| Chest 1 view (71045) |
$150 |
$300 |
1.9× |
| Chest 3 views (71047) |
$204 |
$408 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$346 |
$692 |
2.2× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,632 |
$3,264 |
2.3× |
| Clavicle complete (73000) |
$153 |
$306 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$240.50 |
$481 |
2.5× |
| Continuing medical physics consltj pr wk (77336) |
$221.50 |
$443 |
1.8× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$323.50 |
$647 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,634 |
$5,268 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,631.50 |
$3,263 |
7.6× |
| CT abdomen w contrast (74160) |
$2,346.50 |
$4,693 |
14.8× |
| CT abdomen w wo contrast (74170) |
$2,521 |
$5,042 |
15.9× |
| CT abdomen w/o contrast (74150) |
$1,067.50 |
$2,135 |
11.3× |
| CT angio hrt w/3d image (75574) |
$1,490 |
$2,980 |
4.7× |
| CT angiography upper extremity lt (73206) |
$1,904 |
$3,808 |
12.0× |
| CT c-spine w/o contrast (72125) |
$818 |
$1,636 |
8.7× |
| CT cervical spine w&w/o contrast (72127) |
$983 |
$1,966 |
6.2× |
| CT cervical spine with contrast (72126) |
$951.50 |
$1,903 |
3.0× |
| CT chest w/wo contrast (71270) |
$1,295.50 |
$2,591 |
8.2× |
| CT chest with contrast (71260) |
$1,165.50 |
$2,331 |
7.4× |
| CT head/brain with contrast (70460) |
$984.50 |
$1,969 |
6.2× |
| CT head/brain without and with contrast (70470) |
$1,046 |
$2,092 |
6.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$915 |
$1,830 |
2.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$59.50 |
$119 |
0.8× |
| CT hrt w/3d image congen (75573) |
$827.50 |
$1,655 |
2.6× |
| CT iac w contrast (70481) |
$845 |
$1,690 |
5.3× |
| CT limited/localized follow up study (76380) |
$745.50 |
$1,491 |
9.5× |
| CT lower ext w/o (73700) |
$805 |
$1,610 |
8.5× |
| CT lower extremity w wo contrast (73702) |
$2,006 |
$4,012 |
12.7× |
| CT lower extremity with contrast (73701) |
$1,989.50 |
$3,979 |
12.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,045.50 |
$2,091 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$892 |
$1,784 |
9.5× |
| CT lumbar spine with contrast (72132) |
$951.50 |
$1,903 |
3.0× |
| CT maxillofacial w contrast (70487) |
$845 |
$1,690 |
5.3× |
| CT maxillofacial w/o contrast (70486) |
$782.50 |
$1,565 |
8.3× |
| CT maxillofacial w/wo contrast (70488) |
$983 |
$1,966 |
6.2× |
| CT neck soft tissue w contrast (70491) |
$906 |
$1,812 |
5.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$988 |
$1,976 |
6.2× |
| CT orbits w/o contrast (70480) |
$782.50 |
$1,565 |
8.3× |
| CT pelvis w & w/o contrast (72194) |
$1,337 |
$2,674 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,087.50 |
$2,175 |
11.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$986.50 |
$1,973 |
6.2× |
| CT soft tissue neck w/o contrast (70490) |
$824 |
$1,648 |
8.7× |
| CT thoracic spine w/contrast (72129) |
$951.50 |
$1,903 |
6.0× |
| CT thoracic spine w/o contrast (72128) |
$818 |
$1,636 |
8.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,148.50 |
$2,297 |
7.3× |
| CT thorax w/o contrast (71250) |
$849.50 |
$1,699 |
9.0× |
| CT unlisted procedure (76497) |
$486 |
$972 |
6.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,116 |
$4,232 |
13.4× |
| CT upper extremity w/o contrast rt (73200) |
$805 |
$1,610 |
8.5× |
| CT upper extremity with contrast (73201) |
$3,227 |
$6,454 |
10.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,524 |
$3,048 |
9.6× |
| Cta Abdomen (74175) |
$1,381 |
$2,762 |
8.7× |
| CTA abdomen pelvis (74174) |
$2,696.50 |
$5,393 |
8.6× |
| CTA chest (71275) |
$1,847 |
$3,694 |
11.7× |
| Cta Head (70496) |
$2,761 |
$5,522 |
17.4× |
| CTA lwr ext w&w/o contrast (73706) |
$2,328 |
$4,656 |
14.7× |
| Cta Neck (70498) |
$1,904 |
$3,808 |
12.0× |
| Cta Pelvis (72191) |
$1,061.50 |
$2,123 |
6.7× |
| Cystography minimum 3 views rs&i (74430) |
$711.50 |
$1,423 |
2.3× |
| Diskogram cervical (72285) |
$1,668.50 |
$3,337 |
0.9× |
| Diskography lumbar (72295) |
$1,668.50 |
$3,337 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$343 |
$686 |
3.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$393.50 |
$787 |
4.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$139 |
$278 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$449.50 |
$899 |
4.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$450 |
$900 |
5.7× |
| Dxa bone density study axial skeleton (77085) |
$225.50 |
$451 |
2.4× |
| Echo exam of fetal heart (76825) |
$466.50 |
$933 |
0.9× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$393.50 |
$787 |
1.8× |
| Echoencephalography real time imaging (76506) |
$311.50 |
$623 |
3.3× |
| Esophagus (74220) |
$316 |
$632 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$437 |
$874 |
4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$180.50 |
$361 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$165 |
$330 |
0.8× |
| Foot 2 views (73620) |
$118 |
$236 |
1.5× |
| Forearm 2 views (73090) |
$118 |
$236 |
1.5× |
| Functional MRI brain by phys/psych (70555) |
$2,407 |
$4,814 |
11.2× |
| Gated Heart Planar Single (78472) |
$735 |
$1,470 |
2.0× |
| Hand 2 views (73120) |
$118 |
$236 |
1.3× |
| Hand 3 views (73130) |
$118 |
$236 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$908.50 |
$1,817 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$908.50 |
$1,817 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$908.50 |
$1,817 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,912 |
$3,824 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$515 |
$1,030 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$515 |
$1,030 |
1.4× |
| Ht muscle image spect sing (78451) |
$1,437.50 |
$2,875 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$118 |
$236 |
1.5× |
| Hysterosalpingogram (74740) |
$753 |
$1,506 |
3.5× |
| Interstitial radiation source applic complex (77778) |
$1,584.50 |
$3,169 |
2.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,199 |
$2,398 |
1.9× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,199 |
$2,398 |
2.4× |
| Intracavitary radiation source applic simple (77761) |
$1,199 |
$2,398 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$70 |
$140 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$620 |
$1,240 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$651.50 |
$1,303 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$677.50 |
$1,355 |
1.4× |
| Knee 3 views (73562) |
$118 |
$236 |
1.5× |
| Liver & spleen imaging static only (78215) |
$376.50 |
$753 |
1.0× |
| Liver imaging static only (78201) |
$1,285.50 |
$2,571 |
2.6× |
| Liver imaging w/vascular flow (78202) |
$1,285.50 |
$2,571 |
2.6× |
| Lung perf&ventilat diferentl (78598) |
$736.50 |
$1,473 |
1.5× |
| Lung Ventilation Imaging (78579) |
$298.50 |
$597 |
0.8× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$2,540.50 |
$5,081 |
0.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$736.50 |
$1,473 |
1.3× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$785 |
$1,570 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$785 |
$1,570 |
0.3× |
| Lymphoscintigraphy (78195) |
$603 |
$1,206 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$521.50 |
$1,043 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$417 |
$834 |
1.9× |
| Meckels Diverticulum (78290) |
$426.50 |
$853 |
1.2× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$102 |
$204 |
0.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$748 |
$1,496 |
2.2× |
| Mr elastography (76391) |
$278.50 |
$557 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$28.50 |
$57 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$80.50 |
$161 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,680 |
$3,360 |
5.3× |
| MRA head w/o contrast (70544) |
$675 |
$1,350 |
3.1× |
| MRA head with contrast (70545) |
$1,275.50 |
$2,551 |
4.0× |
| MRA neck w contrast (70548) |
$1,275.50 |
$2,551 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,775 |
$3,550 |
5.6× |
| MRA neck w/o contrast (70547) |
$1,217.50 |
$2,435 |
5.7× |
| MRI abdomen w contrast (74182) |
$1,380 |
$2,760 |
4.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,468.50 |
$2,937 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,150.50 |
$2,301 |
5.3× |
| MRI any jnt lwr ext with con lt (73722) |
$2,817 |
$5,634 |
4.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,083.50 |
$8,167 |
5.8× |
| MRI bone marrow blood supply (77084) |
$1,292 |
$2,584 |
6.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,606 |
$3,212 |
7.5× |
| MRI breast w/o contrast unilat (77046) |
$1,285 |
$2,570 |
6.0× |
| MRI c-spine with contrast (72142) |
$1,566.50 |
$3,133 |
5.0× |
| MRI cardiac w/o contrast (75557) |
$2,047.50 |
$4,095 |
9.5× |
| MRI cervical spine w/o contrast (72141) |
$1,233.50 |
$2,467 |
5.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,468.50 |
$2,937 |
4.7× |
| MRI chest w/o contrast (71550) |
$912 |
$1,824 |
4.2× |
| MRI chest with contrast (71551) |
$1,150.50 |
$2,301 |
1.6× |
| MRI fetal sngl/1st gestation (74712) |
$288.50 |
$577 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,842 |
$5,684 |
9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,468.50 |
$2,937 |
4.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$912 |
$1,824 |
4.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,083 |
$2,166 |
5.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,382 |
$2,764 |
4.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,260 |
$2,520 |
4.0× |
| MRI pelvis w contrast (72196) |
$1,831 |
$3,662 |
5.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,584.50 |
$5,169 |
8.2× |
| MRI pelvis w/o contrast (72195) |
$1,468.50 |
$2,937 |
6.8× |
| MRI scan of arm joint before and after contrast (73223) |
$2,481.50 |
$4,963 |
7.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,967 |
$3,934 |
6.2× |
| MRI spectroscopy (76390) |
$1,118 |
$2,236 |
14.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,335 |
$4,670 |
7.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,664.50 |
$3,329 |
5.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,481 |
$4,962 |
7.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,664.50 |
$3,329 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,481 |
$4,962 |
7.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,310.50 |
$2,621 |
6.1× |
| MRI tmj (70336) |
$1,076 |
$2,152 |
5.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,468.50 |
$2,937 |
6.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,396.50 |
$4,793 |
7.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,468.50 |
$2,937 |
6.8× |
| Myelogram Cervical (72240) |
$1,038.50 |
$2,077 |
1.5× |
| Myelogram Lumbar (72265) |
$1,038.50 |
$2,077 |
1.5× |
| Myelogram thoracic (72255) |
$961.50 |
$1,923 |
1.4× |
| Myelography 2 or more regions (72270) |
$1,549 |
$3,098 |
2.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,602 |
$3,204 |
1.4× |
| Myocardial infarct spect (78469) |
$985.50 |
$1,971 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,993 |
$3,986 |
1.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,491.50 |
$2,983 |
1.2× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,898.50 |
$3,797 |
1.0× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$1,630.50 |
$3,261 |
0.8× |
| Neck soft tissue (70360) |
$173 |
$346 |
2.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$342 |
$684 |
0.9× |
| Nm cisternogram (78630) |
$570 |
$1,140 |
1.2× |
| Nm csf leak detection (78650) |
$1,285.50 |
$2,571 |
1.1× |
| Nm gastric emptying study (78264) |
$556.50 |
$1,113 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,006.50 |
$4,013 |
1.6× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$2,598.50 |
$5,197 |
2.0× |
| Nuclear medicine study of digestive tracts (78299) |
$515 |
$1,030 |
1.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$353 |
$706 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$567 |
$1,134 |
2.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$229 |
$458 |
2.4× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$449.50 |
$899 |
4.8× |
| Orthopantogram (70355) |
$122 |
$244 |
1.6× |
| Osseous survey infant (77076) |
$122 |
$244 |
1.3× |
| Osseous survey limited (77074) |
$175 |
$350 |
1.9× |
| Parathyrd planar w/wo subtrj (78071) |
$383.50 |
$767 |
1.1× |
| Parathyroid imaging (78070) |
$376.50 |
$753 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$118 |
$236 |
1.3× |
| Peritoneogram rs&i (74190) |
$701 |
$1,402 |
1.4× |
| PET image w/CT, skull-thigh (78815) |
$2,548.50 |
$5,097 |
2.0× |
| PET imaging CT for attenuation limited area (78814) |
$2,548.50 |
$5,097 |
2.0× |
| PET imaging for CT attenuation whole body (78816) |
$2,977.50 |
$5,955 |
2.3× |
| PET imaging limited area chest head/neck (78811) |
$1,750.50 |
$3,501 |
1.5× |
| PET whole body (78813) |
$2,598.50 |
$5,197 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,681.50 |
$3,363 |
5.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,912 |
$3,824 |
0.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,440.50 |
$2,881 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$372.50 |
$745 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$596.50 |
$1,193 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$710 |
$1,420 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$56.50 |
$113 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$179.50 |
$359 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$153 |
$306 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$202.50 |
$405 |
2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$290 |
$580 |
3.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$8,502 |
$17,004 |
1.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$771.50 |
$1,543 |
1.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$709 |
$1,418 |
7.7× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$741 |
$1,482 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$158.50 |
$317 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$164.50 |
$329 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$242 |
$484 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$204 |
$408 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$468.50 |
$937 |
3.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$316 |
$632 |
2.0× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$81 |
$162 |
0.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$939.50 |
$1,879 |
5.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,118 |
$2,236 |
7.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$118 |
$236 |
1.5× |
| Radiological examination surgical specimen (76098) |
$451.50 |
$903 |
0.9× |
| Radiopharm Dacryocystography (78660) |
$420 |
$840 |
1.2× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,912 |
$3,824 |
0.7× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,916 |
$3,832 |
0.7× |
| Ribs bilateral 3 views (71110) |
$176 |
$352 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$919 |
$1,838 |
2.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,039 |
$2,078 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,437.50 |
$2,875 |
2.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,715 |
$3,430 |
1.3× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,636.50 |
$3,273 |
1.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$479 |
$958 |
2.3× |
| Rp Therapy Intravenous Administration (79101) |
$783.50 |
$1,567 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$106 |
$212 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$364.50 |
$729 |
1.7× |
| Scanogram (77073) |
$153.50 |
$307 |
1.6× |
| Scapula complete (73010) |
$153 |
$306 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$45.50 |
$91 |
1.9× |
| Sella turcica (70240) |
$23.50 |
$47 |
0.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$689 |
$1,378 |
7.3× |
| Sialogram (70390) |
$430.50 |
$861 |
2.0× |
| Simulation intermediate (77285) |
$418.50 |
$837 |
1.2× |
| Small bowel series (74250) |
$389.50 |
$779 |
2.5× |
| Spec medical radj physics consltj (77370) |
$299 |
$598 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$401 |
$802 |
1.2× |
| Special dosimetry (77331) |
$112.50 |
$225 |
0.9× |
| Special treatment procedure (77470) |
$716.50 |
$1,433 |
1.4× |
| Spine thoracic 3 views (72072) |
$129.50 |
$259 |
1.4× |
| Splenoportograpy rs&i (75810) |
$1,912 |
$3,824 |
0.7× |
| Stereotactic body radiation delivery (77373) |
$2,486.50 |
$4,973 |
1.5× |
| Superior sagittal sinus venogram (75870) |
$1,023.50 |
$2,047 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$347 |
$694 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$223.50 |
$447 |
0.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$478 |
$956 |
1.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$299 |
$598 |
2.5× |
| Therapeutic Enema (74283) |
$489 |
$978 |
3.1× |
| Thoracolumbar 2 views (72080) |
$118 |
$236 |
1.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$707 |
$1,414 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$376.50 |
$753 |
1.0× |
| Thyroid uptake measurement (78012) |
$376.50 |
$753 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$376.50 |
$753 |
1.0× |
| Tmj unilateral (70328) |
$100.50 |
$201 |
1.3× |
| Tomogram (76100) |
$242 |
$484 |
2.6× |
| Treatment device intermediate (77333) |
$234 |
$468 |
1.9× |
| Treatment devices simple (77332) |
$197 |
$394 |
1.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,285.50 |
$2,571 |
2.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$670 |
$1,340 |
1.9× |
| Tx devices design & construction complex (77334) |
$514 |
$1,028 |
1.5× |
| Ultrasound elastography first target lesion (76982) |
$175.50 |
$351 |
1.9× |
| Ultrasound scan of cornea to determine thickness (76514) |
$89 |
$178 |
3.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$278.50 |
$557 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$347.50 |
$695 |
3.7× |
| Umbilical-artery Doppler (OB) (76820) |
$139 |
$278 |
1.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$147 |
$294 |
1.9× |
| Unlisted magnetic resonance procedure (76498) |
$489.50 |
$979 |
6.2× |
| Unlisted Ultrasound Procedure (76999) |
$488 |
$976 |
6.2× |
| Upper Extremity Infant (73092) |
$118 |
$236 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$820.50 |
$1,641 |
3.8× |
| Urethrocystography voiding (74455) |
$711.50 |
$1,423 |
3.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$767 |
$1,534 |
4.8× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$756 |
$1,512 |
4.8× |
| Us abdl aorta screen aaa (76706) |
$404.50 |
$809 |
4.3× |
| Us breast unilateral complete (76641) |
$337 |
$674 |
3.6× |
| Us breast unilateral limited (76642) |
$337 |
$674 |
4.3× |
| Us chest (76604) |
$337 |
$674 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$311.50 |
$623 |
3.3× |
| Us elastography parenchyma (76981) |
$416 |
$832 |
4.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$145 |
$290 |
1.5× |
| Us guided compression repair (76936) |
$549 |
$1,098 |
2.8× |
| Us infant hips dynamic (76885) |
$443 |
$886 |
5.6× |
| Us kidney transplant (76776) |
$419 |
$838 |
4.4× |
| Us ob detailed single fetus (76811) |
$470 |
$940 |
2.2× |
| Us ob transvaginal (76817) |
$311.50 |
$623 |
3.3× |
| Us pelvic non ob complete (76856) |
$405.50 |
$811 |
4.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$311.50 |
$623 |
3.3× |
| Us pregnancy ltd (76815) |
$337 |
$674 |
3.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$377 |
$754 |
4.0× |
| Us retroperitoneal complete (76770) |
$441.50 |
$883 |
4.7× |
| Us retroperitoneal limited (76775) |
$404.50 |
$809 |
4.3× |
| Us scrotum and contents (76870) |
$486.50 |
$973 |
5.2× |
| Us soft tissue head/neck (76536) |
$311.50 |
$623 |
3.3× |
| Us spinal canal and contents (76800) |
$96.50 |
$193 |
1.0× |
| Us transrectal (76872) |
$386 |
$772 |
4.1× |
| Us transrectal prostate volume (76873) |
$389.50 |
$779 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$311.50 |
$623 |
3.3× |
| Us, eye b-scan (76512) |
$312 |
$624 |
3.3× |
| Venogram extremity bilateral (75822) |
$1,261.50 |
$2,523 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$2,329 |
$4,658 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$1,912 |
$3,824 |
1.3× |
| Venography epidural rs&i (75872) |
$1,023.50 |
$2,047 |
1.8× |
| Venography extremity unilateral rs&i (75820) |
$1,202 |
$2,404 |
0.8× |
| Venography Renal Bilateral (75833) |
$1,912 |
$3,824 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,912 |
$3,824 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$816.50 |
$1,633 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$2,421.50 |
$4,843 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$99 |
$198 |
1.3× |
| Wrist 2 views (73100) |
$118 |
$236 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$287 |
$574 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$153 |
$306 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$118 |
$236 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$637 |
$1,274 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$118 |
$236 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$147 |
$294 |
1.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$203 |
$406 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$94.50 |
$189 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$118 |
$236 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$118 |
$236 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$164.50 |
$329 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$172 |
$344 |
1.8× |
| X-ray exam of femur 1 (73551) |
$118 |
$236 |
1.5× |
| X-ray eye for foreign body (70030) |
$203.50 |
$407 |
2.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$123 |
$246 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$96 |
$192 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$153 |
$306 |
1.9× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,943.50 |
$3,887 |
1.0× |
| X-ray head for orthodontia (70350) |
$98.50 |
$197 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$118 |
$236 |
1.5× |
| X-ray IV pyelogram+drip infusn (74410) |
$418 |
$836 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$104.50 |
$209 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$153 |
$306 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$153 |
$306 |
1.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$118 |
$236 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$118 |
$236 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$182.50 |
$365 |
1.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$142.50 |
$285 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$108 |
$216 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$173 |
$346 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$189 |
$378 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$132 |
$264 |
1.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$711.50 |
$1,423 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$118 |
$236 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$164.50 |
$329 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$190.50 |
$381 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$205.50 |
$411 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111.50 |
$223 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$118 |
$236 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$146 |
$292 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$122.50 |
$245 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$147 |
$294 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$116 |
$232 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$108 |
$216 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$102.50 |
$205 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$106 |
$212 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$118 |
$236 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$139 |
$278 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$118 |
$236 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$118 |
$236 |
1.5× |
| Xr arthrogram ankle (73615) |
$438.50 |
$877 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$175 |
$350 |
1.9× |
| Xr chest 4+ views (71048) |
$220.50 |
$441 |
2.3× |
| Xr finger(s) 2+ views (73140) |
$118 |
$236 |
1.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$91 |
$182 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$1,311.50 |
$2,623 |
4.2× |
| Xr optic foramina (70190) |
$126.50 |
$253 |
1.6× |
| Xr shoulder 1 view (73020) |
$118 |
$236 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$143 |
$286 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$118 |
$236 |
1.5× |
| Xr tmj bilateral (70330) |
$127 |
$254 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$118 |
$236 |
1.5× |