| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,048.60 |
$5,081 |
2.4× |
| Abdomen 2 views (74019) |
$219.03 |
$365.05 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$668.71 |
$1,114.51 |
1.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$5,625 |
$9,375 |
2.0× |
| Angiography extremity bilateral rs&i (75716) |
$4,770.22 |
$7,950.36 |
1.7× |
| Angiography extremity unilateral rs&i (75710) |
$4,770.22 |
$7,950.36 |
1.7× |
| Angiography internal mammary rs&i (75756) |
$4,770.22 |
$7,950.36 |
1.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$8,161.63 |
$13,602.72 |
1.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,770.22 |
$7,950.36 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,770.22 |
$7,950.36 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$9,720 |
$16,200 |
1.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,161.63 |
$13,602.72 |
1.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,881.05 |
$3,135.09 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,881.05 |
$3,135.09 |
0.7× |
| Ankle 2 views (73600) |
$118.88 |
$198.14 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$580.20 |
$967 |
1.8× |
| Aortogram thoracic (75605) |
$8,161.63 |
$13,602.72 |
1.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,770.22 |
$7,950.36 |
1.7× |
| Aortography abdominal serialography rs&i (75625) |
$4,770.22 |
$7,950.36 |
1.7× |
| Artery X-Rays Adrenal Gland (75731) |
$5,790 |
$9,650 |
2.0× |
| Arthrogram elbow (73085) |
$873.33 |
$1,455.55 |
2.8× |
| Arthrogram hip (73525) |
$873.33 |
$1,455.55 |
2.8× |
| Arthrogram shoulder (73040) |
$873.33 |
$1,455.55 |
2.8× |
| Arthrogram wrist (73115) |
$483.65 |
$806.09 |
1.5× |
| Arthrography knee lt (73580) |
$873.33 |
$1,455.55 |
2.8× |
| Basic radiation dosimetry calculation (77300) |
$280.80 |
$468 |
2.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,251.60 |
$2,086 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$1,251.60 |
$2,086 |
3.4× |
| Bone age studies (77072) |
$219.03 |
$365.05 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,251.60 |
$2,086 |
3.4× |
| Bone Marrow Imaging Limited Area (78102) |
$720 |
$1,200 |
2.0× |
| Bone survey complete (77075) |
$492 |
$820 |
5.2× |
| Brachytx isodose complex (77318) |
$888.60 |
$1,481 |
2.6× |
| Brachytx isodose intermed (77317) |
$774 |
$1,290 |
2.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$774 |
$1,290 |
2.3× |
| Brain image w/flow 4 + views (78606) |
$867.03 |
$1,445.05 |
1.8× |
| Brain Imaging Vascular Flow Only (78610) |
$1,005 |
$1,675 |
2.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$573.60 |
$956 |
1.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$750 |
$1,250 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$297.60 |
$496 |
3.8× |
| Chest 1 view (71045) |
$186 |
$310 |
2.4× |
| Chest 3 views (71047) |
$118.88 |
$198.14 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$247.20 |
$412 |
1.6× |
| Clavicle complete (73000) |
$260.10 |
$433.50 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$195 |
$325 |
2.1× |
| Continuing medical physics consltj pr wk (77336) |
$260.40 |
$434 |
2.1× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$483.65 |
$806.09 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,293.40 |
$5,489 |
10.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,662.80 |
$4,438 |
12.3× |
| CT abdomen w contrast (74160) |
$1,735.80 |
$2,893 |
10.9× |
| CT abdomen w wo contrast (74170) |
$1,915.80 |
$3,193 |
12.0× |
| CT abdomen w/o contrast (74150) |
$1,386.60 |
$2,311 |
14.6× |
| CT angio hrt w/3d image (75574) |
$754.80 |
$1,258 |
2.4× |
| CT angiography upper extremity lt (73206) |
$729 |
$1,215 |
4.6× |
| CT c-spine w/o contrast (72125) |
$1,191 |
$1,985 |
12.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,560.60 |
$2,601 |
9.8× |
| CT cervical spine with contrast (72126) |
$1,371 |
$2,285 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,139.40 |
$1,899 |
7.2× |
| CT chest with contrast (71260) |
$1,139.40 |
$1,899 |
7.2× |
| CT head/brain with contrast (70460) |
$1,203 |
$2,005 |
7.6× |
| CT head/brain without and with contrast (70470) |
$1,203 |
$2,005 |
7.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$537 |
$895 |
1.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$118.80 |
$198 |
1.5× |
| CT hrt w/3d image congen (75573) |
$537 |
$895 |
1.7× |
| CT iac w contrast (70481) |
$1,233.60 |
$2,056 |
7.7× |
| CT limited/localized follow up study (76380) |
$127.87 |
$213.12 |
1.6× |
| CT lower ext w/o (73700) |
$1,057.20 |
$1,762 |
11.1× |
| CT lower extremity w wo contrast (73702) |
$1,059 |
$1,765 |
6.6× |
| CT lower extremity with contrast (73701) |
$1,059 |
$1,765 |
6.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,560.60 |
$2,601 |
9.8× |
| CT lumbar spine w/o contrast (72131) |
$1,171.20 |
$1,952 |
12.3× |
| CT lumbar spine with contrast (72132) |
$1,824 |
$3,040 |
5.8× |
| CT maxillofacial w contrast (70487) |
$1,122 |
$1,870 |
7.0× |
| CT maxillofacial w/o contrast (70486) |
$1,077.60 |
$1,796 |
11.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,236 |
$2,060 |
7.8× |
| CT neck soft tissue w contrast (70491) |
$1,125.60 |
$1,876 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,099.20 |
$1,832 |
6.9× |
| CT orbits w/o contrast (70480) |
$1,099.20 |
$1,832 |
11.6× |
| CT pelvis w & w/o contrast (72194) |
$1,407.60 |
$2,346 |
8.8× |
| CT pelvis w/o contrast (72192) |
$1,246.20 |
$2,077 |
13.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,125.60 |
$1,876 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,125.60 |
$1,876 |
11.9× |
| CT thoracic spine w/contrast (72129) |
$1,824 |
$3,040 |
11.5× |
| CT thoracic spine w/o contrast (72128) |
$1,171.20 |
$1,952 |
12.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,560.60 |
$2,601 |
9.8× |
| CT thorax w/o contrast (71250) |
$1,139.40 |
$1,899 |
12.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,059 |
$1,765 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,059 |
$1,765 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,096.20 |
$1,827 |
3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,430.40 |
$2,384 |
9.0× |
| Cta Abdomen (74175) |
$1,567.20 |
$2,612 |
9.8× |
| CTA abdomen pelvis (74174) |
$1,712.40 |
$2,854 |
5.4× |
| CTA chest (71275) |
$2,082 |
$3,470 |
13.1× |
| Cta Head (70496) |
$808.20 |
$1,347 |
5.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$729.60 |
$1,216 |
2.3× |
| CTA lwr ext w&w/o contrast (73706) |
$736.20 |
$1,227 |
4.6× |
| Cta Neck (70498) |
$1,048.80 |
$1,748 |
6.6× |
| Cta Pelvis (72191) |
$801 |
$1,335 |
5.0× |
| Cystography minimum 3 views rs&i (74430) |
$483.65 |
$806.09 |
1.5× |
| Diskogram cervical (72285) |
$3,081.92 |
$5,136.53 |
1.7× |
| Diskography lumbar (72295) |
$3,081.92 |
$5,136.53 |
1.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$225 |
$375 |
2.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$219.03 |
$365.05 |
2.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$309 |
$515 |
3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$153 |
$255 |
1.9× |
| Dxa bone density study axial skeleton (77085) |
$219.03 |
$365.05 |
2.3× |
| Echoencephalography real time imaging (76506) |
$219.03 |
$365.05 |
2.3× |
| Esophagus (74220) |
$483.65 |
$806.09 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$255 |
$425 |
2.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$255 |
$425 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$444.55 |
$740.92 |
2.1× |
| Foot 2 views (73620) |
$201.30 |
$335.50 |
2.5× |
| Forearm 2 views (73090) |
$247.50 |
$412.50 |
3.1× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$867.03 |
$1,445.05 |
1.8× |
| Gated Heart Planar Single (78472) |
$1,134.60 |
$1,891 |
3.1× |
| Hand 2 views (73120) |
$328.50 |
$547.50 |
3.5× |
| Hand 3 views (73130) |
$265.50 |
$442.50 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,366.55 |
$2,277.59 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,366.55 |
$2,277.59 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,366.55 |
$2,277.59 |
2.2× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$420.67 |
$701.12 |
1.2× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$555.60 |
$926 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$867.03 |
$1,445.05 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$668.71 |
$1,114.51 |
1.8× |
| Ht muscle image spect sing (78451) |
$2,301.50 |
$3,835.83 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$261.90 |
$436.50 |
3.3× |
| Hysterosalpingogram (74740) |
$444.55 |
$740.92 |
2.1× |
| Interstitial radiation source applic complex (77778) |
$2,418.60 |
$4,031 |
3.8× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,914 |
$3,190 |
3.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,333.20 |
$2,222 |
2.7× |
| Intracavitary radiation source applic simple (77761) |
$1,222.80 |
$2,038 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$228.60 |
$381 |
2.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,257 |
$2,095 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,721.40 |
$2,869 |
3.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$867.03 |
$1,445.05 |
1.8× |
| Knee 3 views (73562) |
$244.50 |
$407.50 |
3.1× |
| Liver & spleen imaging static only (78215) |
$668.71 |
$1,114.51 |
1.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$668.71 |
$1,114.51 |
1.8× |
| Liver imaging static only (78201) |
$2,301.50 |
$3,835.83 |
4.7× |
| Lung perfusion differential (78597) |
$668.71 |
$1,114.51 |
1.8× |
| Lung Ventilation Imaging (78579) |
$668.71 |
$1,114.51 |
1.8× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$5,310 |
$8,850 |
1.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$1,172.24 |
$1,953.74 |
2.1× |
| Lymphoscintigraphy (78195) |
$945 |
$1,575 |
1.9× |
| Mammary ductogram or galactogram multiple (77054) |
$444.60 |
$741 |
2.1× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$168.60 |
$281 |
2.1× |
| Meckels Diverticulum (78290) |
$668.71 |
$1,114.51 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$774 |
$1,290 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$51 |
$85 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,667 |
$4,445 |
8.4× |
| MRA head w/o contrast (70544) |
$1,675.80 |
$2,793 |
7.7× |
| MRA head with contrast (70545) |
$1,768.20 |
$2,947 |
5.6× |
| MRA neck w contrast (70548) |
$1,779 |
$2,965 |
5.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,824.20 |
$4,707 |
8.9× |
| MRA neck w/o contrast (70547) |
$1,496.40 |
$2,494 |
6.9× |
| MRI abdomen w contrast (74182) |
$1,275 |
$2,125 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,449 |
$2,415 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,116 |
$1,860 |
5.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,759.20 |
$2,932 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,759.20 |
$2,932 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$498 |
$830 |
2.3× |
| MRI breast w/o contrast unilat (77046) |
$498 |
$830 |
2.3× |
| MRI c-spine with contrast (72142) |
$2,079 |
$3,465 |
6.6× |
| MRI cardiac w/o contrast (75557) |
$465 |
$775 |
2.1× |
| MRI cervical spine w/o contrast (72141) |
$1,823.40 |
$3,039 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,402.40 |
$4,004 |
7.6× |
| MRI chest w/o contrast (71550) |
$1,398 |
$2,330 |
6.5× |
| MRI fetal sngl/1st gestation (74712) |
$451.20 |
$752 |
2.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,811.40 |
$3,019 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,660.20 |
$2,767 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,456.20 |
$2,427 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,137.20 |
$3,562 |
9.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,776.20 |
$4,627 |
8.8× |
| MRI orbit/face/neck w/contrast (70542) |
$2,443.20 |
$4,072 |
7.7× |
| MRI pelvis w contrast (72196) |
$1,398 |
$2,330 |
4.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,896 |
$3,160 |
6.0× |
| MRI pelvis w/o contrast (72195) |
$1,457.40 |
$2,429 |
6.7× |
| MRI scan of arm joint before and after contrast (73223) |
$2,006.40 |
$3,344 |
6.3× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,118.40 |
$1,864 |
1.6× |
| MRI scan of leg joint before and after contrast (73723) |
$2,006.40 |
$3,344 |
6.3× |
| MRI spectroscopy (76390) |
$939 |
$1,565 |
11.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,370.60 |
$3,951 |
7.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,961.40 |
$3,269 |
6.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,274.60 |
$3,791 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,782 |
$2,970 |
5.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,266.20 |
$3,777 |
7.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,562.40 |
$2,604 |
7.2× |
| MRI tmj (70336) |
$969 |
$1,615 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,543.20 |
$2,572 |
7.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,893.60 |
$3,156 |
6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,456.20 |
$2,427 |
6.7× |
| Myelogram Lumbar (72265) |
$1,304.88 |
$2,174.80 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,759.40 |
$4,599 |
2.3× |
| Neck soft tissue (70360) |
$155.40 |
$259 |
2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$705 |
$1,175 |
1.9× |
| Nm cisternogram (78630) |
$867.03 |
$1,445.05 |
1.8× |
| Nm gastric emptying study (78264) |
$1,206.60 |
$2,011 |
3.3× |
| Nm peritoneal-venous shunt patency (78291) |
$676.20 |
$1,127 |
1.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,393.80 |
$7,323 |
3.5× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$2,301.50 |
$3,835.83 |
2.0× |
| Nuclear medicine of heart pumping function (78473) |
$672 |
$1,120 |
1.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$2,301.50 |
$3,835.83 |
2.0× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$668.71 |
$1,114.51 |
1.8× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$668.71 |
$1,114.51 |
1.8× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$735 |
$1,225 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$456.37 |
$760.62 |
2.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$294 |
$490 |
3.1× |
| Osseous survey limited (77074) |
$464.40 |
$774 |
4.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,230 |
$2,050 |
2.5× |
| Parathyrd planar w/wo subtrj (78071) |
$1,242 |
$2,070 |
3.4× |
| Parathyroid imaging (78070) |
$832.80 |
$1,388 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$219.03 |
$365.05 |
2.3× |
| Perineogram (74775) |
$316.80 |
$528 |
1.5× |
| Peritoneogram rs&i (74190) |
$931.35 |
$1,552.25 |
1.9× |
| Pr MRI brain w/o dye (70557) |
$930 |
$1,550 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,893.60 |
$3,156 |
6.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,652.80 |
$11,088 |
2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$710.40 |
$1,184 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,137.60 |
$1,896 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$444.55 |
$740.92 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$118.88 |
$198.14 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$219.03 |
$365.05 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$219.03 |
$365.05 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$227.40 |
$379 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$316.80 |
$528 |
3.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$14,520 |
$24,200 |
2.2× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$555.60 |
$926 |
1.1× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$238.69 |
$397.81 |
2.6× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$555.60 |
$926 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$256.20 |
$427 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$118.88 |
$198.14 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$225 |
$375 |
2.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$180 |
$300 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$483.65 |
$806.09 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$315 |
$525 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$465 |
$775 |
2.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$118.88 |
$198.14 |
1.5× |
| Radiological examination surgical specimen (76098) |
$931.35 |
$1,552.25 |
1.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$4,770.22 |
$7,950.36 |
1.7× |
| Ribs bilateral 3 views (71110) |
$219.03 |
$365.05 |
2.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,301.50 |
$3,835.83 |
4.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,400 |
$4,000 |
4.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,400 |
$4,000 |
2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,730 |
$4,550 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,400 |
$4,000 |
2.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$456.37 |
$760.62 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$219.03 |
$365.05 |
2.3× |
| Scanogram (77073) |
$219.03 |
$365.05 |
2.3× |
| Scapula complete (73010) |
$249.60 |
$416 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$42 |
$70 |
1.8× |
| Sella turcica (70240) |
$118.88 |
$198.14 |
1.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$219.03 |
$365.05 |
2.3× |
| Sialogram (70390) |
$444.55 |
$740.92 |
2.1× |
| Simulation intermediate (77285) |
$783.60 |
$1,306 |
2.3× |
| Small bowel series (74250) |
$474.60 |
$791 |
3.0× |
| Spec medical radj physics consltj (77370) |
$380.40 |
$634 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$774 |
$1,290 |
2.3× |
| Special dosimetry (77331) |
$280.80 |
$468 |
2.3× |
| Special treatment procedure (77470) |
$1,252.20 |
$2,087 |
2.5× |
| Spine thoracic 3 views (72072) |
$208.80 |
$348 |
2.2× |
| Stereotactic body radiation delivery (77373) |
$3,711.60 |
$6,186 |
2.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$238.69 |
$397.81 |
2.6× |
| Tbs Technical Calculation Only (77091) |
$180 |
$300 |
2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$774 |
$1,290 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$774 |
$1,290 |
2.3× |
| Testicular Imaging With Vascular Flow (78761) |
$668.71 |
$1,114.51 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$775.80 |
$1,293 |
2.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$396 |
$660 |
3.2× |
| Therapeutic Enema (74283) |
$789 |
$1,315 |
5.0× |
| Thoracolumbar 2 views (72080) |
$297.60 |
$496 |
3.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$995.40 |
$1,659 |
2.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$687 |
$1,145 |
1.9× |
| Thyroid uptake measurement (78012) |
$668.71 |
$1,114.51 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$892.80 |
$1,488 |
2.5× |
| Tmj unilateral (70328) |
$118.88 |
$198.14 |
1.5× |
| Tomogram (76100) |
$347.40 |
$579 |
3.7× |
| Treatment device intermediate (77333) |
$347.40 |
$579 |
2.8× |
| Treatment devices simple (77332) |
$280.80 |
$468 |
2.3× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,301.50 |
$3,835.83 |
4.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$735 |
$1,225 |
2.0× |
| Tx devices design & construction complex (77334) |
$680.40 |
$1,134 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$502.20 |
$837 |
5.3× |
| Umbilical-artery Doppler (OB) (76820) |
$219.03 |
$365.05 |
2.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$118.88 |
$198.14 |
1.5× |
| Unlisted fluoroscopic procedure (76496) |
$135 |
$225 |
1.7× |
| Unlisted Ultrasound Procedure (76999) |
$165 |
$275 |
2.1× |
| Upper Extremity Infant (73092) |
$219.03 |
$365.05 |
2.3× |
| Urethrocystography retrograde rs&i (74450) |
$444.55 |
$740.92 |
2.1× |
| Urethrocystography voiding (74455) |
$444.55 |
$740.92 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$483.65 |
$806.09 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$219.03 |
$365.05 |
2.3× |
| Us breast unilateral complete (76641) |
$382.50 |
$637.50 |
4.0× |
| Us breast unilateral limited (76642) |
$382.50 |
$637.50 |
4.8× |
| Us chest (76604) |
$219.03 |
$365.05 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$502.20 |
$837 |
5.3× |
| Us elastography parenchyma (76981) |
$216 |
$360 |
2.3× |
| Us fetal nuchal translucency 1st gestation (76813) |
$219.03 |
$365.05 |
2.3× |
| Us guided compression repair (76936) |
$476.18 |
$793.63 |
2.4× |
| Us infant hips dynamic (76885) |
$148.80 |
$248 |
1.9× |
| Us infant hips limited static (76886) |
$118.88 |
$198.14 |
1.5× |
| Us kidney transplant (76776) |
$358.20 |
$597 |
3.8× |
| Us ob detailed single fetus (76811) |
$450 |
$750 |
2.1× |
| Us ob transvaginal (76817) |
$277.20 |
$462 |
2.9× |
| Us pelvic non ob complete (76856) |
$479.40 |
$799 |
5.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$271.20 |
$452 |
2.9× |
| Us pregnancy ltd (76815) |
$310.80 |
$518 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$285 |
$475 |
3.0× |
| Us retroperitoneal complete (76770) |
$358.20 |
$597 |
3.8× |
| Us retroperitoneal limited (76775) |
$276 |
$460 |
2.9× |
| Us scrotum and contents (76870) |
$466.20 |
$777 |
4.9× |
| Us soft tissue head/neck (76536) |
$466.20 |
$777 |
4.9× |
| Us spinal canal and contents (76800) |
$466.20 |
$777 |
4.9× |
| Us transrectal (76872) |
$237 |
$395 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$753.30 |
$1,255.50 |
7.9× |
| Venogram extremity bilateral (75822) |
$1,881.05 |
$3,135.09 |
1.3× |
| Venography caval inferior serialography rs&i (75825) |
$4,770.22 |
$7,950.36 |
1.7× |
| Venography caval superior serialography rs&i (75827) |
$1,297.24 |
$2,162.08 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,172.24 |
$1,953.74 |
0.8× |
| Venography Renal Bilateral (75833) |
$4,770.22 |
$7,950.36 |
1.7× |
| Venography renal unilateral selective rs&i (75831) |
$4,770.22 |
$7,950.36 |
1.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,770.22 |
$7,950.36 |
1.7× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$8,161.63 |
$13,602.72 |
1.6× |
| Vertebral fracture assessment via dxa (77086) |
$118.88 |
$198.14 |
1.5× |
| Wrist 2 views (73100) |
$195 |
$325 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$232.20 |
$387 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$151.20 |
$252 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$265.50 |
$442.50 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$529.80 |
$883 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$172.80 |
$288 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$263.70 |
$439.50 |
3.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$316.80 |
$528 |
3.3× |
| X-ray exam hip uni 1 view (73501) |
$118.88 |
$198.14 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$180 |
$300 |
2.3× |
| X-ray exam hip uni 4/> views (73503) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$316.80 |
$528 |
3.3× |
| X-ray exam of femur 1 (73551) |
$118.88 |
$198.14 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$315 |
$525 |
2.0× |
| X-ray eye for foreign body (70030) |
$118.88 |
$198.14 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$253.20 |
$422 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$214.80 |
$358 |
2.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$265.50 |
$442.50 |
3.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$3,244.94 |
$5,408.24 |
1.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$265.50 |
$442.50 |
3.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$483.65 |
$806.09 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$248.40 |
$414 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$328.50 |
$547.50 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$147 |
$245 |
1.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$118.88 |
$198.14 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$237.60 |
$396 |
2.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$164.40 |
$274 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$129.60 |
$216 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$256.20 |
$427 |
2.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$229.80 |
$383 |
2.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$873.33 |
$1,455.55 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$217.80 |
$363 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$249.60 |
$416 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$231.60 |
$386 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$282.60 |
$471 |
3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$256.20 |
$427 |
3.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$138.60 |
$231 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$295.20 |
$492 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$219.03 |
$365.05 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$121.80 |
$203 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$177.60 |
$296 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$231.60 |
$386 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$229.20 |
$382 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$297.60 |
$496 |
3.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$165 |
$275 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$265.50 |
$442.50 |
3.4× |
| Xr arthrogram ankle (73615) |
$873.33 |
$1,455.55 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$297.60 |
$496 |
3.1× |
| Xr chest 4+ views (71048) |
$219.03 |
$365.05 |
2.3× |
| Xr finger(s) 2+ views (73140) |
$177 |
$295 |
2.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$237 |
$395 |
2.5× |
| Xr shoulder 1 view (73020) |
$118.88 |
$198.14 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$219.03 |
$365.05 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$265.50 |
$442.50 |
3.4× |
| Xr tmj bilateral (70330) |
$256.80 |
$428 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$220.50 |
$367.50 |
2.8× |