| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,746 |
$5,746 |
4.1× |
| Abdomen 2 views (74019) |
$100 |
$100 |
0.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,885 |
$1,885 |
4.6× |
| Acute venous thrombus image (78456) |
$915 |
$915 |
0.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$528 |
$528 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$549 |
$549 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,725 |
$3,725 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$489 |
$489 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$444 |
$444 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$481 |
$481 |
0.1× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$626 |
$626 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$459 |
$459 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$212 |
$212 |
0.1× |
| Ankle 2 views (73600) |
$200 |
$200 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$989 |
$989 |
2.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$468 |
$468 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$6,153 |
$6,153 |
1.9× |
| Artery X-Rays Adrenal Gland (75731) |
$425 |
$425 |
0.1× |
| Arthrogram elbow (73085) |
$470 |
$470 |
1.3× |
| Arthrogram hip (73525) |
$828 |
$828 |
2.3× |
| Arthrogram shoulder (73040) |
$1,335 |
$1,335 |
3.7× |
| Arthrogram wrist (73115) |
$643 |
$643 |
1.8× |
| Arthrography knee lt (73580) |
$795 |
$795 |
2.2× |
| Basic radiation dosimetry calculation (77300) |
$168 |
$168 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$2,519 |
$2,519 |
6.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$855 |
$855 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$2,442 |
$2,442 |
6.0× |
| Bone age studies (77072) |
$145 |
$145 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$2,694 |
$2,694 |
6.6× |
| Bone Marrow Imaging Limited Area (78102) |
$438 |
$438 |
1.1× |
| Bone survey complete (77075) |
$1,020 |
$1,020 |
9.5× |
| Brachytx isodose complex (77318) |
$2,759 |
$2,759 |
7.2× |
| Brachytx isodose intermed (77317) |
$2,286 |
$2,286 |
6.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,664 |
$1,664 |
4.3× |
| Brain image w/flow 4 + views (78606) |
$857 |
$857 |
1.5× |
| Brain imaging < 4 static views (78600) |
$473 |
$473 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$558 |
$558 |
1.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$510 |
$510 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,659 |
$4,659 |
3.2× |
| Brain Imaging Vascular Flow Only (78610) |
$456 |
$456 |
0.8× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$593 |
$593 |
1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,142 |
$2,142 |
6.0× |
| Cardiac shunt detection (78428) |
$475 |
$475 |
1.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$830 |
$830 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$231.50 |
$231.50 |
2.6× |
| Chest 1 view (71045) |
$82 |
$82 |
0.9× |
| Chest 3 views (71047) |
$248.50 |
$248.50 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$800 |
$800 |
4.5× |
| Cineradiography/videoradiography (76120) |
$194 |
$194 |
1.8× |
| Clavicle complete (73000) |
$85 |
$85 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,051 |
$1,051 |
9.8× |
| Continuing medical physics consltj pr wk (77336) |
$952 |
$952 |
6.9× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$201 |
$201 |
1.1× |
| Corpora cavernosography (74445) |
$141 |
$141 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,500 |
$4,500 |
12.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,849 |
$2,849 |
11.7× |
| CT abdomen w contrast (74160) |
$2,262 |
$2,262 |
12.6× |
| CT abdomen w wo contrast (74170) |
$2,603 |
$2,603 |
14.5× |
| CT abdomen w/o contrast (74150) |
$1,727 |
$1,727 |
16.2× |
| CT angio hrt w/3d image (75574) |
$2,683 |
$2,683 |
7.5× |
| CT angiography upper extremity lt (73206) |
$2,504 |
$2,504 |
14.0× |
| CT c-spine w/o contrast (72125) |
$1,843 |
$1,843 |
17.3× |
| CT cervical spine w&w/o contrast (72127) |
$798 |
$798 |
4.5× |
| CT cervical spine with contrast (72126) |
$2,193 |
$2,193 |
6.2× |
| CT chest w/wo contrast (71270) |
$3,018 |
$3,018 |
16.8× |
| CT chest with contrast (71260) |
$2,498 |
$2,498 |
13.9× |
| CT colonography screening (74263) |
$777.50 |
$777.50 |
3.2× |
| CT colonography w/dye (74262) |
$1,140 |
$1,140 |
6.4× |
| CT colonography w/o cntrst (74261) |
$1,358 |
$1,358 |
12.7× |
| CT head/brain with contrast (70460) |
$1,944 |
$1,944 |
10.8× |
| CT head/brain without and with contrast (70470) |
$2,310 |
$2,310 |
12.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,872 |
$1,872 |
5.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$299 |
$299 |
3.4× |
| CT hrt w/3d image congen (75573) |
$2,429 |
$2,429 |
6.8× |
| CT iac w contrast (70481) |
$2,111 |
$2,111 |
11.8× |
| CT limited/localized follow up study (76380) |
$614 |
$614 |
6.9× |
| CT lower ext w/o (73700) |
$1,445 |
$1,445 |
13.5× |
| CT lower extremity w wo contrast (73702) |
$2,490 |
$2,490 |
13.9× |
| CT lower extremity with contrast (73701) |
$1,800 |
$1,800 |
10.0× |
| CT lumbar spine w & w/o contrast (72133) |
$798 |
$798 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$1,866 |
$1,866 |
17.5× |
| CT lumbar spine with contrast (72132) |
$2,231 |
$2,231 |
6.3× |
| CT maxillofacial w contrast (70487) |
$2,235 |
$2,235 |
12.5× |
| CT maxillofacial w/o contrast (70486) |
$1,785 |
$1,785 |
16.7× |
| CT maxillofacial w/wo contrast (70488) |
$3,025 |
$3,025 |
16.9× |
| CT neck soft tissue w contrast (70491) |
$1,885 |
$1,885 |
10.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$904 |
$904 |
5.0× |
| CT orbits w/o contrast (70480) |
$1,765 |
$1,765 |
16.5× |
| CT pelvis w & w/o contrast (72194) |
$2,773 |
$2,773 |
15.5× |
| CT pelvis w/o contrast (72192) |
$1,878 |
$1,878 |
17.6× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$335 |
$335 |
3.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,210 |
$2,210 |
12.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,790 |
$1,790 |
16.8× |
| CT thoracic spine w/contrast (72129) |
$2,377 |
$2,377 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$1,796 |
$1,796 |
16.8× |
| CT thoracic spine w/wo contrast (72130) |
$802 |
$802 |
4.5× |
| CT thorax w/o contrast (71250) |
$1,990 |
$1,990 |
18.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,606.50 |
$2,606.50 |
14.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,824 |
$1,824 |
17.1× |
| CT upper extremity with contrast (73201) |
$2,285 |
$2,285 |
6.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,478 |
$3,478 |
19.4× |
| Cta Abdomen (74175) |
$2,300 |
$2,300 |
12.8× |
| CTA abdomen pelvis (74174) |
$3,355 |
$3,355 |
9.4× |
| CTA chest (71275) |
$2,715 |
$2,715 |
15.2× |
| Cta Head (70496) |
$2,365 |
$2,365 |
13.2× |
| CTA lwr ext w&w/o contrast (73706) |
$2,444 |
$2,444 |
13.6× |
| Cta Neck (70498) |
$2,635 |
$2,635 |
14.7× |
| Cta Pelvis (72191) |
$2,322 |
$2,322 |
13.0× |
| Cystography minimum 3 views rs&i (74430) |
$427.50 |
$427.50 |
1.2× |
| Dacryocystography (70170) |
$38 |
$38 |
0.2× |
| Diskogram cervical (72285) |
$299 |
$299 |
0.1× |
| Diskography lumbar (72295) |
$1,663.50 |
$1,663.50 |
0.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$544.50 |
$544.50 |
5.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$291.50 |
$291.50 |
2.7× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$250 |
$250 |
2.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$482 |
$482 |
4.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$309 |
$309 |
3.5× |
| Echo exam of fetal heart (76825) |
$940 |
$940 |
1.7× |
| Echoencephalography real time imaging (76506) |
$301 |
$301 |
2.8× |
| Esophageal motility (78258) |
$579 |
$579 |
1.4× |
| Esophagus (74220) |
$761 |
$761 |
4.2× |
| Fetal biophysical profile non-stress testing (76818) |
$572 |
$572 |
5.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$280 |
$280 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$200 |
$200 |
0.8× |
| Foot 2 views (73620) |
$193 |
$193 |
2.2× |
| Forearm 2 views (73090) |
$223 |
$223 |
2.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$140 |
$140 |
0.6× |
| Functional MRI brain by phys/psych (70555) |
$320 |
$320 |
1.3× |
| Functional MRI brain by tech (70554) |
$1,246 |
$1,246 |
5.1× |
| Gastric mucosa imaging (78261) |
$652 |
$652 |
1.6× |
| Gastrointestinal Protein Loss (78282) |
$47 |
$47 |
0.1× |
| Gated Heart Planar Single (78472) |
$4,171 |
$4,171 |
10.2× |
| Hand 2 views (73120) |
$205.50 |
$205.50 |
1.9× |
| Hand 3 views (73130) |
$385 |
$385 |
4.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$6,172 |
$6,172 |
8.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$8,080 |
$8,080 |
11.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$5,723 |
$5,723 |
8.0× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$2,406 |
$2,406 |
6.1× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$1,395 |
$1,395 |
3.5× |
| Heart Infarct Image (78466) |
$507 |
$507 |
1.2× |
| Heart infarct image w ef (78468) |
$516 |
$516 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,594 |
$2,594 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,304 |
$2,304 |
5.6× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$721 |
$721 |
1.3× |
| Ht muscle image spect sing (78451) |
$2,552.50 |
$2,552.50 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$218 |
$218 |
2.5× |
| Hysterosalpingogram (74740) |
$649 |
$649 |
2.7× |
| Interstitial radiation source applic complex (77778) |
$5,700 |
$5,700 |
8.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,040 |
$3,040 |
4.3× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,130 |
$2,130 |
3.8× |
| Intracavitary radiation source applic simple (77761) |
$1,610 |
$1,610 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$619 |
$619 |
5.8× |
| Kidney funcj study non-img radioisotopic study (78725) |
$286 |
$286 |
0.7× |
| Kidney imaging morphology (78700) |
$457 |
$457 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,078 |
$2,078 |
3.7× |
| Knee 3 views (73562) |
$272 |
$272 |
3.1× |
| Liver & spleen imaging static only (78215) |
$1,355 |
$1,355 |
3.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$318 |
$318 |
0.8× |
| Liver imaging static only (78201) |
$481 |
$481 |
0.9× |
| Liver imaging w/vascular flow (78202) |
$568 |
$568 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$911 |
$911 |
1.6× |
| Lung perfusion differential (78597) |
$611 |
$611 |
1.5× |
| Lung Ventilation Imaging (78579) |
$785 |
$785 |
1.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$115 |
$115 |
0.2× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$147 |
$147 |
0.1× |
| Lymphoscintigraphy (78195) |
$1,810 |
$1,810 |
3.3× |
| Mammary ductogram or galactogram multiple (77054) |
$630 |
$630 |
2.6× |
| Mammary ductogram or galactogram single (77053) |
$477 |
$477 |
2.0× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$132 |
$132 |
1.5× |
| Meckels Diverticulum (78290) |
$981 |
$981 |
2.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,258 |
$1,258 |
3.3× |
| Mr safety determination physician/other qhp (76016) |
$236 |
$236 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$65 |
$65 |
2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$246 |
$246 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$647 |
$647 |
2.7× |
| MRA head w & w/o contrast (70546) |
$3,163 |
$3,163 |
8.9× |
| MRA head w/o contrast (70544) |
$2,299 |
$2,299 |
9.4× |
| MRA head with contrast (70545) |
$2,650 |
$2,650 |
7.4× |
| MRA neck w contrast (70548) |
$2,950 |
$2,950 |
8.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,509 |
$3,509 |
9.8× |
| MRA neck w/o contrast (70547) |
$2,489 |
$2,489 |
10.2× |
| MRI abdomen w contrast (74182) |
$3,156 |
$3,156 |
8.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,075 |
$3,075 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$2,505 |
$2,505 |
10.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,556 |
$1,556 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,423 |
$2,423 |
3.0× |
| MRI bone marrow blood supply (77084) |
$1,423.50 |
$1,423.50 |
5.8× |
| MRI breast w/o contrast bilateral (77047) |
$2,194 |
$2,194 |
9.0× |
| MRI c-spine with contrast (72142) |
$3,000 |
$3,000 |
8.4× |
| MRI cardiac w/o cont stress (75559) |
$2,137 |
$2,137 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$2,114 |
$2,114 |
8.7× |
| MRI cervical spine w/o contrast (72141) |
$2,521 |
$2,521 |
10.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,529 |
$3,529 |
9.9× |
| MRI chest w/o contrast (71550) |
$2,483 |
$2,483 |
10.2× |
| MRI chest with contrast (71551) |
$2,700 |
$2,700 |
3.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,570 |
$2,570 |
7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,450 |
$2,450 |
6.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,175 |
$2,175 |
8.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,025 |
$2,025 |
8.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,922 |
$2,922 |
8.2× |
| MRI orbit/face/neck w/contrast (70542) |
$2,300 |
$2,300 |
6.5× |
| MRI pelvis w contrast (72196) |
$3,000 |
$3,000 |
8.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,444 |
$3,444 |
9.7× |
| MRI pelvis w/o contrast (72195) |
$2,594 |
$2,594 |
10.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,905 |
$2,905 |
8.2× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$3,756.50 |
$3,756.50 |
4.7× |
| MRI scan of leg joint before and after contrast (73723) |
$2,720 |
$2,720 |
7.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,565 |
$3,565 |
10.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,000 |
$3,000 |
8.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,564 |
$3,564 |
10.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,950 |
$2,950 |
8.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,504 |
$3,504 |
9.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,426 |
$2,426 |
10.0× |
| MRI tmj (70336) |
$1,977 |
$1,977 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,297 |
$1,297 |
5.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,039 |
$3,039 |
8.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,422.50 |
$1,422.50 |
5.8× |
| Myelogram Lumbar (72265) |
$323 |
$323 |
0.4× |
| Myelogram thoracic (72255) |
$314 |
$314 |
0.4× |
| Myelography 2 or more regions (72270) |
$503 |
$503 |
0.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$177 |
$177 |
0.1× |
| Myocardial infarct spect (78469) |
$586 |
$586 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,032 |
$3,032 |
2.3× |
| Neck soft tissue (70360) |
$217 |
$217 |
2.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$907 |
$907 |
2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$115 |
$115 |
0.3× |
| Nm adrenal scan (78075) |
$1,105 |
$1,105 |
0.8× |
| Nm bone marrow multiple (78103) |
$559 |
$559 |
1.4× |
| Nm bone marrow wb (78104) |
$640 |
$640 |
1.6× |
| Nm cisternogram (78630) |
$2,441 |
$2,441 |
4.4× |
| Nm csf leak detection (78650) |
$861 |
$861 |
0.7× |
| Nm gastric emptying study (78264) |
$2,159 |
$2,159 |
5.3× |
| Nm gastroesophageal reflux study (78262) |
$646 |
$646 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$660 |
$660 |
1.6× |
| Nm red cell sequestration (78140) |
$348 |
$348 |
0.9× |
| Nm whole blood volume (78122) |
$253 |
$253 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,988 |
$4,988 |
3.5× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$224 |
$224 |
0.2× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,127 |
$1,127 |
0.9× |
| Nuclear medicine of heart pumping function (78473) |
$758 |
$758 |
1.9× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$628 |
$628 |
1.1× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$235 |
$235 |
0.2× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$181 |
$181 |
0.1× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$784 |
$784 |
0.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$551 |
$551 |
1.3× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$483 |
$483 |
1.2× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$526 |
$526 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$2,102 |
$2,102 |
8.8× |
| Nuclr Rx Interstit Colloid (79300) |
$201 |
$201 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$420 |
$420 |
3.9× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$461 |
$461 |
3.4× |
| Orthopantogram (70355) |
$54 |
$54 |
0.6× |
| Osseous survey infant (77076) |
$270 |
$270 |
2.5× |
| Osseous survey limited (77074) |
$450 |
$450 |
4.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,755 |
$1,755 |
3.2× |
| Parathyrd planar w/wo subtrj (78071) |
$1,722 |
$1,722 |
4.2× |
| Parathyroid imaging (78070) |
$2,223 |
$2,223 |
5.4× |
| Pelvis 1 or 2 views (72170) |
$220.50 |
$220.50 |
2.1× |
| Perineogram (74775) |
$78 |
$78 |
0.3× |
| Peritoneogram rs&i (74190) |
$605 |
$605 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$3,931.50 |
$3,931.50 |
2.7× |
| PET imaging CT for attenuation limited area (78814) |
$271 |
$271 |
0.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,351.50 |
$4,351.50 |
3.0× |
| PET imaging limited area chest head/neck (78811) |
$195 |
$195 |
0.1× |
| PET whole body (78813) |
$245 |
$245 |
0.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$218 |
$218 |
0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$238 |
$238 |
0.2× |
| Platelet survival study (78191) |
$415 |
$415 |
1.0× |
| Pr csf ventriculography (78635) |
$873 |
$873 |
1.6× |
| Pr gi endoscopic ultrasound (76975) |
$110 |
$110 |
0.5× |
| Pr heart first pass single,planar (78481) |
$470 |
$470 |
0.8× |
| Pr MRI brain w/ dye (70558) |
$403 |
$403 |
2.2× |
| Pr MRI brain w/o & w/ dye (70559) |
$404 |
$404 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,952 |
$2,952 |
8.3× |
| Pr non-imaging heart function (78414) |
$57 |
$57 |
0.1× |
| Pr red cell survival study (78130) |
$414 |
$414 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,795 |
$1,795 |
4.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,923.50 |
$1,923.50 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$148 |
$148 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$355 |
$355 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$526 |
$526 |
4.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$363 |
$363 |
3.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$171 |
$171 |
1.6× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$1,963 |
$1,963 |
0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$291.50 |
$291.50 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196.50 |
$196.50 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$274.50 |
$274.50 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$120 |
$120 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$920 |
$920 |
5.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$798 |
$798 |
4.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,279 |
$1,279 |
7.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$920 |
$920 |
5.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$198.50 |
$198.50 |
2.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$102 |
$102 |
1.1× |
| Radiological examination surgical specimen (76098) |
$605 |
$605 |
1.1× |
| Radiopharm Dacryocystography (78660) |
$488 |
$488 |
1.2× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$358 |
$358 |
1.5× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$392 |
$392 |
1.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$235 |
$235 |
0.6× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$199 |
$199 |
0.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$413 |
$413 |
0.1× |
| Ribs bilateral 3 views (71110) |
$337.50 |
$337.50 |
3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,835 |
$1,835 |
4.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,945 |
$1,945 |
3.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$477 |
$477 |
2.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$286 |
$286 |
1.2× |
| Rp Therapy Intravenous Administration (79101) |
$1,150 |
$1,150 |
4.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$386.50 |
$386.50 |
1.6× |
| Salivary gland function study (78232) |
$250 |
$250 |
0.6× |
| Salivary gland imaging (78230) |
$447 |
$447 |
1.1× |
| Salivary gland imaging serial images (78231) |
$332 |
$332 |
0.8× |
| Scanogram (77073) |
$585 |
$585 |
5.5× |
| Scapula complete (73010) |
$242 |
$242 |
2.3× |
| Screening digital breast tomosynthesis (77063) |
$81 |
$81 |
3.5× |
| Sella turcica (70240) |
$100 |
$100 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$266 |
$266 |
2.5× |
| Sialogram (70390) |
$480 |
$480 |
2.0× |
| Small bowel series (74250) |
$840 |
$840 |
4.7× |
| Spec medical radj physics consltj (77370) |
$1,531 |
$1,531 |
11.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$228 |
$228 |
0.6× |
| Special dosimetry (77331) |
$430.50 |
$430.50 |
3.1× |
| Special treatment procedure (77470) |
$2,288 |
$2,288 |
4.1× |
| Speech evaluation complex (70371) |
$235 |
$235 |
1.0× |
| Spine thoracic 3 views (72072) |
$291 |
$291 |
2.7× |
| Spleen imaging only (78185) |
$547 |
$547 |
1.3× |
| Splenoportograpy rs&i (75810) |
$142 |
$142 |
0.0× |
| Stereotactic body radiation delivery (77373) |
$3,173 |
$3,173 |
1.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$296 |
$296 |
2.8× |
| Testicular Imaging With Vascular Flow (78761) |
$557 |
$557 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,974 |
$2,974 |
7.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,578 |
$1,578 |
11.5× |
| Therapeutic Enema (74283) |
$880 |
$880 |
4.9× |
| Thoracolumbar 2 views (72080) |
$281.50 |
$281.50 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,368 |
$2,368 |
4.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$668 |
$668 |
1.6× |
| Thyroid uptake measurement (78012) |
$630 |
$630 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,933 |
$1,933 |
4.7× |
| Tomogram (76100) |
$310 |
$310 |
2.9× |
| Treatment devices simple (77332) |
$695 |
$695 |
5.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$4,711 |
$4,711 |
8.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$490 |
$490 |
1.2× |
| Tx devices design & construction complex (77334) |
$1,691 |
$1,691 |
4.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$39 |
$39 |
1.3× |
| Ultrasound scan to determine eye length and lens power (76519) |
$220 |
$220 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$601 |
$601 |
5.6× |
| Umbilical-artery Doppler (OB) (76820) |
$267 |
$267 |
2.5× |
| Unlisted magnetic resonance procedure (76498) |
$7,000 |
$7,000 |
78.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,081 |
$1,081 |
10.4× |
| Upper Extremity Infant (73092) |
$116 |
$116 |
1.1× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$520 |
$520 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$796 |
$796 |
3.3× |
| Urethrocystography voiding (74455) |
$738 |
$738 |
3.0× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$605 |
$605 |
3.4× |
| Us abdl aorta screen aaa (76706) |
$593 |
$593 |
5.6× |
| Us breast unilateral complete (76641) |
$623 |
$623 |
5.8× |
| Us breast unilateral limited (76642) |
$456.50 |
$456.50 |
5.1× |
| Us chest (76604) |
$559 |
$559 |
5.2× |
| Us compl joint r-t w/image documentation (76881) |
$588 |
$588 |
5.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$382.50 |
$382.50 |
3.6× |
| Us guided compression repair (76936) |
$722 |
$722 |
3.3× |
| Us infant hips dynamic (76885) |
$385 |
$385 |
4.3× |
| Us infant hips limited static (76886) |
$287.50 |
$287.50 |
3.2× |
| Us kidney transplant (76776) |
$779 |
$779 |
7.3× |
| Us ob detailed single fetus (76811) |
$845 |
$845 |
3.5× |
| Us ob transvaginal (76817) |
$300 |
$300 |
2.8× |
| Us pelvic non ob complete (76856) |
$594 |
$594 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$210 |
$210 |
2.0× |
| Us pregnancy ltd (76815) |
$320 |
$320 |
3.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$450 |
$450 |
4.2× |
| Us retroperitoneal complete (76770) |
$832 |
$832 |
7.8× |
| Us retroperitoneal limited (76775) |
$523 |
$523 |
4.9× |
| Us scrotum and contents (76870) |
$651 |
$651 |
6.1× |
| Us soft tissue head/neck (76536) |
$663 |
$663 |
6.2× |
| Us spinal canal and contents (76800) |
$385 |
$385 |
3.6× |
| Us transrectal (76872) |
$595 |
$595 |
5.6× |
| Us transrectal prostate volume (76873) |
$435 |
$435 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$445 |
$445 |
4.2× |
| Us, eye b-scan (76512) |
$241 |
$241 |
2.3× |
| Vascular flow imaging (78445) |
$505 |
$505 |
1.2× |
| Vasogram (74440) |
$216 |
$216 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,349.50 |
$1,349.50 |
0.8× |
| Venogram orbital (75880) |
$605 |
$605 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$4,403.50 |
$4,403.50 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$389 |
$389 |
0.2× |
| Venography extremity unilateral rs&i (75820) |
$1,683 |
$1,683 |
1.0× |
| Venography Renal Bilateral (75833) |
$475 |
$475 |
0.1× |
| Venography renal unilateral selective rs&i (75831) |
$4,419.50 |
$4,419.50 |
1.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$395 |
$395 |
0.1× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$322 |
$322 |
0.1× |
| Wrist 2 views (73100) |
$350 |
$350 |
3.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$315 |
$315 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$299.50 |
$299.50 |
3.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$253.50 |
$253.50 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,013 |
$1,013 |
5.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$201 |
$201 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$252.50 |
$252.50 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$219 |
$219 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$282.50 |
$282.50 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$386 |
$386 |
3.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$900 |
$900 |
5.0× |
| X-ray eye for foreign body (70030) |
$161 |
$161 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$317.50 |
$317.50 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$192.50 |
$192.50 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$387 |
$387 |
4.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$250 |
$250 |
0.1× |
| X-ray head for orthodontia (70350) |
$56 |
$56 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$196.50 |
$196.50 |
2.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$395 |
$395 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$250.50 |
$250.50 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$496 |
$496 |
4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$191.50 |
$191.50 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$91.50 |
$91.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$269.50 |
$269.50 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$465.50 |
$465.50 |
4.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$203 |
$203 |
2.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$120 |
$120 |
1.3× |
| X-ray of voice box or throat (70370) |
$210 |
$210 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$354 |
$354 |
3.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$303.50 |
$303.50 |
2.8× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$66 |
$66 |
0.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,273 |
$1,273 |
3.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$250 |
$250 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$290 |
$290 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$400.50 |
$400.50 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$276.50 |
$276.50 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$254.50 |
$254.50 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$256 |
$256 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$303.50 |
$303.50 |
3.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$184 |
$184 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$370 |
$370 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$430 |
$430 |
4.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$190.50 |
$190.50 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$251.50 |
$251.50 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$239 |
$239 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$269 |
$269 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$186.50 |
$186.50 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$250 |
$250 |
2.8× |
| Xr arthrogram ankle (73615) |
$452 |
$452 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$424 |
$424 |
4.0× |
| Xr chest 4+ views (71048) |
$316.50 |
$316.50 |
3.0× |
| Xr Cholecystography Oral Contrast (74290) |
$180 |
$180 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$185 |
$185 |
2.1× |
| Xr internal auditory meati complete (70134) |
$119 |
$119 |
0.2× |
| Xr shoulder 1 view (73020) |
$172 |
$172 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$318.50 |
$318.50 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$213.50 |
$213.50 |
2.4× |
| Xr tmj bilateral (70330) |
$285 |
$285 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$90 |
$90 |
1.0× |