| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,244.80 |
$10,612 |
3.1× |
| Abdomen 2 views (74019) |
$152.40 |
$381 |
1.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$621 |
$1,552.50 |
1.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,006.40 |
$7,516 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$1,788.80 |
$4,472 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,727.20 |
$4,318 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$750 |
$1,875 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,578 |
$6,445 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,342.80 |
$5,857 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,006.40 |
$7,516 |
0.9× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,223.20 |
$5,558 |
0.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,485.40 |
$6,213.50 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$346.40 |
$866 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,131.60 |
$7,829 |
1.0× |
| Ankle 2 views (73600) |
$169.60 |
$424 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$269.60 |
$674 |
0.8× |
| Aortogram thoracic (75605) |
$5,647.60 |
$14,119 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,928.20 |
$7,320.50 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$1,680.40 |
$4,201 |
0.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,059.20 |
$5,148 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$793.60 |
$1,984 |
0.3× |
| Arthrogram elbow (73085) |
$257.80 |
$644.50 |
0.7× |
| Arthrogram hip (73525) |
$277.40 |
$693.50 |
0.8× |
| Arthrogram shoulder (73040) |
$276.20 |
$690.50 |
0.8× |
| Arthrogram wrist (73115) |
$233.20 |
$583 |
0.7× |
| Arthrography knee lt (73580) |
$279.20 |
$698 |
0.8× |
| Basic radiation dosimetry calculation (77300) |
$326 |
$815 |
2.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$522.60 |
$1,306.50 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$672.80 |
$1,682 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,065.20 |
$2,663 |
2.7× |
| Bone age studies (77072) |
$95.20 |
$238 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$911.80 |
$2,279.50 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$496 |
$1,240 |
1.2× |
| Bone survey complete (77075) |
$310 |
$775 |
3.0× |
| Brachytx isodose complex (77318) |
$1,052.80 |
$2,632 |
2.8× |
| Brachytx isodose intermed (77317) |
$672.80 |
$1,682 |
1.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$347.20 |
$868 |
0.9× |
| Brain image w/flow 4 + views (78606) |
$656.40 |
$1,641 |
1.2× |
| Brain Imaging Vascular Flow Only (78610) |
$481.40 |
$1,203.50 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,769.20 |
$4,423 |
5.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$638 |
$1,595 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$264 |
$660 |
3.0× |
| Chest 1 view (71045) |
$208.80 |
$522 |
2.4× |
| Chest 3 views (71047) |
$190 |
$475 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$213.40 |
$533.50 |
1.2× |
| Clavicle complete (73000) |
$178 |
$445 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$101 |
$252.50 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$281.60 |
$704 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,398.40 |
$3,496 |
4.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,796 |
$4,490 |
7.5× |
| CT abdomen w contrast (74160) |
$1,716.80 |
$4,292 |
9.8× |
| CT abdomen w wo contrast (74170) |
$1,456.20 |
$3,640.50 |
8.3× |
| CT abdomen w/o contrast (74150) |
$1,354.40 |
$3,386 |
12.9× |
| CT angio hrt w/3d image (75574) |
$971.60 |
$2,429 |
2.8× |
| CT angiography upper extremity lt (73206) |
$1,338 |
$3,345 |
7.6× |
| CT c-spine w/o contrast (72125) |
$815.80 |
$2,039.50 |
7.8× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$140.80 |
$352 |
0.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,016 |
$2,540 |
5.8× |
| CT cervical spine with contrast (72126) |
$890 |
$2,225 |
2.5× |
| CT chest w/wo contrast (71270) |
$1,166.80 |
$2,917 |
6.6× |
| CT chest with contrast (71260) |
$960 |
$2,400 |
5.5× |
| CT head/brain with contrast (70460) |
$881.20 |
$2,203 |
5.0× |
| CT head/brain without and with contrast (70470) |
$1,076.60 |
$2,691.50 |
6.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$732.80 |
$1,832 |
2.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$88.60 |
$221.50 |
1.0× |
| CT hrt w/3d image congen (75573) |
$724.40 |
$1,811 |
2.1× |
| CT iac w contrast (70481) |
$1,487.60 |
$3,719 |
8.5× |
| CT limited/localized follow up study (76380) |
$477.20 |
$1,193 |
5.5× |
| CT lower ext w/o (73700) |
$1,171 |
$2,927.50 |
11.2× |
| CT lower extremity w wo contrast (73702) |
$1,343.60 |
$3,359 |
7.6× |
| CT lower extremity with contrast (73701) |
$1,140.40 |
$2,851 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,016.80 |
$2,542 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$815.80 |
$2,039.50 |
7.8× |
| CT lumbar spine with contrast (72132) |
$1,103.20 |
$2,758 |
3.2× |
| CT maxillofacial w contrast (70487) |
$974.60 |
$2,436.50 |
5.5× |
| CT maxillofacial w/o contrast (70486) |
$742.60 |
$1,856.50 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$951.20 |
$2,378 |
5.4× |
| CT neck soft tissue w contrast (70491) |
$1,387.60 |
$3,469 |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,674 |
$4,185 |
9.5× |
| CT orbits w/o contrast (70480) |
$867 |
$2,167.50 |
8.3× |
| CT pelvis w & w/o contrast (72194) |
$1,695.60 |
$4,239 |
9.6× |
| CT pelvis w/o contrast (72192) |
$739.60 |
$1,849 |
7.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,488 |
$3,720 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$958 |
$2,395 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$792.20 |
$1,980.50 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$869.40 |
$2,173.50 |
8.3× |
| CT thoracic spine w/wo contrast (72130) |
$976 |
$2,440 |
5.5× |
| CT thorax w/o contrast (71250) |
$878 |
$2,195 |
8.4× |
| CT unlisted procedure (76497) |
$642 |
$1,605 |
7.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$921.60 |
$2,304 |
5.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,059.60 |
$2,649 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,105.60 |
$2,764 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$964.80 |
$2,412 |
5.5× |
| Cta Abdomen (74175) |
$1,589.60 |
$3,974 |
9.0× |
| CTA abdomen pelvis (74174) |
$1,350 |
$3,375 |
3.9× |
| CTA chest (71275) |
$1,244.20 |
$3,110.50 |
7.1× |
| Cta Head (70496) |
$1,132.80 |
$2,832 |
6.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$350 |
$875 |
1.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,730.40 |
$4,326 |
9.8× |
| Cta Neck (70498) |
$1,138.40 |
$2,846 |
6.5× |
| Cta Pelvis (72191) |
$1,029.80 |
$2,574.50 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$288.40 |
$721 |
0.8× |
| Dacryocystography (70170) |
$146.80 |
$367 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$348.80 |
$872 |
3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$83 |
$207.50 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$327.60 |
$819 |
3.1× |
| Echo exam of eye (76529) |
$147.60 |
$369 |
1.7× |
| Echoencephalography real time imaging (76506) |
$280.40 |
$701 |
2.7× |
| Esophagus (74220) |
$298.80 |
$747 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$320.80 |
$802 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$100 |
$250 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$373.60 |
$934 |
1.6× |
| Foot 2 views (73620) |
$148 |
$370 |
1.7× |
| Forearm 2 views (73090) |
$250 |
$625 |
2.9× |
| Gated Heart Planar Single (78472) |
$845.20 |
$2,113 |
2.1× |
| Hand 3 views (73130) |
$226.80 |
$567 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,390.80 |
$3,477 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,762.60 |
$4,406.50 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,776.80 |
$4,442 |
2.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,313.60 |
$3,284 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$610 |
$1,525 |
1.5× |
| Ht muscle image spect sing (78451) |
$1,469.80 |
$3,674.50 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$134.80 |
$337 |
1.5× |
| Hysterosalpingogram (74740) |
$428 |
$1,070 |
1.8× |
| Interstitial radiation source applic complex (77778) |
$2,262.80 |
$5,657 |
3.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$628 |
$1,570 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$923.80 |
$2,309.50 |
1.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$963.60 |
$2,409 |
1.8× |
| Knee 3 views (73562) |
$240 |
$600 |
2.7× |
| Liver & spleen imaging static only (78215) |
$582.60 |
$1,456.50 |
1.5× |
| Liver imaging static only (78201) |
$535.60 |
$1,339 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$535.60 |
$1,339 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$683.60 |
$1,709 |
1.3× |
| Lung perfusion differential (78597) |
$1,403.20 |
$3,508 |
3.5× |
| Lung Ventilation Imaging (78579) |
$452 |
$1,130 |
1.1× |
| Lymphoscintigraphy (78195) |
$1,200 |
$3,000 |
2.2× |
| Mammary ductogram or galactogram multiple (77054) |
$115.60 |
$289 |
0.5× |
| Mammary ductogram or galactogram single (77053) |
$263.60 |
$659 |
1.1× |
| Meckels Diverticulum (78290) |
$590.40 |
$1,476 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,633.20 |
$4,083 |
4.3× |
| Mr safety determination physician/other qhp (76016) |
$87.60 |
$219 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$24.40 |
$61 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$91.20 |
$228 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$240.40 |
$601 |
1.0× |
| MRA head w & w/o contrast (70546) |
$2,084.80 |
$5,212 |
6.0× |
| MRA head w/o contrast (70544) |
$1,712.40 |
$4,281 |
7.2× |
| MRA head with contrast (70545) |
$1,908.20 |
$4,770.50 |
5.5× |
| MRA neck w contrast (70548) |
$1,737.20 |
$4,343 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,890.40 |
$4,726 |
5.4× |
| MRA neck w/o contrast (70547) |
$1,668 |
$4,170 |
7.0× |
| MRI abdomen w contrast (74182) |
$2,510 |
$6,275 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,674.20 |
$6,685.50 |
7.6× |
| MRI abdomen w/o contrast (74181) |
$2,351.80 |
$5,879.50 |
9.8× |
| MRI any jnt lwr ext with con lt (73722) |
$1,248 |
$3,120 |
1.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,834.20 |
$4,585.50 |
2.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,794.80 |
$4,487 |
7.5× |
| MRI breast w/o contrast unilat (77046) |
$1,549.20 |
$3,873 |
6.5× |
| MRI c-spine with contrast (72142) |
$1,945.60 |
$4,864 |
5.6× |
| MRI cardiac w/o cont stress (75559) |
$1,769.20 |
$4,423 |
3.2× |
| MRI cardiac w/o contrast (75557) |
$1,359.20 |
$3,398 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,795.20 |
$4,488 |
7.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,765.60 |
$4,414 |
5.0× |
| MRI chest w/o contrast (71550) |
$1,678.60 |
$4,196.50 |
7.0× |
| MRI chest with contrast (71551) |
$1,746 |
$4,365 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,248.20 |
$3,120.50 |
3.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,360.40 |
$3,401 |
3.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,626.40 |
$4,066 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,462.40 |
$3,656 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,574.20 |
$6,435.50 |
7.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,465.20 |
$3,663 |
4.2× |
| MRI pelvis w contrast (72196) |
$1,732 |
$4,330 |
4.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,538 |
$6,345 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$1,550.40 |
$3,876 |
6.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,371.20 |
$5,928 |
6.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,946 |
$4,865 |
2.5× |
| MRI scan of leg joint before and after contrast (73723) |
$2,773 |
$6,932.50 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,744.40 |
$6,861 |
7.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,729.20 |
$4,323 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,245.60 |
$5,614 |
6.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,729.20 |
$4,323 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,725.60 |
$6,814 |
7.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,648.80 |
$4,122 |
6.9× |
| MRI tmj (70336) |
$1,718.40 |
$4,296 |
7.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,962.40 |
$4,906 |
8.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,288.40 |
$5,721 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,600 |
$4,000 |
6.7× |
| Myelogram Cervical (72240) |
$786 |
$1,965 |
1.0× |
| Myelogram Lumbar (72265) |
$692.80 |
$1,732 |
0.9× |
| Myelogram thoracic (72255) |
$652.60 |
$1,631.50 |
0.8× |
| Myelography 2 or more regions (72270) |
$786 |
$1,965 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,037.60 |
$5,094 |
1.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$2,564.40 |
$6,411 |
1.8× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,564.40 |
$6,411 |
1.8× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,773.60 |
$6,934 |
1.3× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$1,780 |
$4,450 |
1.2× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$887.40 |
$2,218.50 |
1.0× |
| Neck soft tissue (70360) |
$134.80 |
$337 |
1.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$254.80 |
$637 |
0.7× |
| Nm adrenal scan (78075) |
$754.80 |
$1,887 |
0.6× |
| Nm cisternogram (78630) |
$670 |
$1,675 |
1.2× |
| Nm gastric emptying study (78264) |
$959.40 |
$2,398.50 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$638 |
$1,595 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$630.80 |
$1,577 |
1.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,650 |
$4,125 |
1.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,670 |
$4,175 |
1.2× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$525.60 |
$1,314 |
1.3× |
| Nuclear Rx Oral Admin (79005) |
$919.60 |
$2,299 |
3.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$179 |
$447.50 |
1.7× |
| Orthopantogram (70355) |
$119 |
$297.50 |
1.4× |
| Osseous survey limited (77074) |
$281.80 |
$704.50 |
2.7× |
| Parathyrd planar w/wo subtrj (78071) |
$917.20 |
$2,293 |
2.3× |
| Parathyroid imaging (78070) |
$563.80 |
$1,409.50 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$102 |
$255 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$2,911.20 |
$7,278 |
2.0× |
| PET imaging CT for attenuation limited area (78814) |
$1,434.40 |
$3,586 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$3,337.20 |
$8,343 |
2.3× |
| PET imaging limited area chest head/neck (78811) |
$1,298.40 |
$3,246 |
1.0× |
| PET whole body (78813) |
$1,434.40 |
$3,586 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,660.60 |
$6,651.50 |
7.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$564.20 |
$1,410.50 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$718 |
$1,795 |
1.3× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$2,360 |
$5,900 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$377.40 |
$943.50 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$174 |
$435 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$224 |
$560 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$155.80 |
$389.50 |
1.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$124 |
$310 |
1.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,797.20 |
$31,993 |
1.7× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$996.80 |
$2,492 |
1.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$608.40 |
$1,521 |
5.9× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$857.60 |
$2,144 |
2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$137.60 |
$344 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$132.20 |
$330.50 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$139.60 |
$349 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$171.60 |
$429 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$403.20 |
$1,008 |
2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$352.80 |
$882 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$304.80 |
$762 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$451.60 |
$1,129 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$131.60 |
$329 |
1.5× |
| Radiological examination surgical specimen (76098) |
$362.80 |
$907 |
0.7× |
| Ribs bilateral 3 views (71110) |
$256.40 |
$641 |
2.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$430.60 |
$1,076.50 |
1.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$821.60 |
$2,054 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$956.80 |
$2,392 |
1.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$942.40 |
$2,356 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,102.40 |
$2,756 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$874.80 |
$2,187 |
0.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$334.40 |
$836 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$473.20 |
$1,183 |
2.0× |
| Sacroiliac Joints < 3 Views (72200) |
$112.80 |
$282 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$255.20 |
$638 |
1.1× |
| Scanogram (77073) |
$129.60 |
$324 |
1.2× |
| Scapula complete (73010) |
$182.40 |
$456 |
1.7× |
| Screening digital breast tomosynthesis (77063) |
$22.80 |
$57 |
1.0× |
| Sella turcica (70240) |
$70.40 |
$176 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$179 |
$447.50 |
1.7× |
| Sialogram (70390) |
$446.80 |
$1,117 |
1.9× |
| Simulation intermediate (77285) |
$641.60 |
$1,604 |
1.7× |
| Small bowel series (74250) |
$267.40 |
$668.50 |
1.5× |
| Spec medical radj physics consltj (77370) |
$427.20 |
$1,068 |
3.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$663.60 |
$1,659 |
1.8× |
| Special dosimetry (77331) |
$285.20 |
$713 |
2.1× |
| Special treatment procedure (77470) |
$908.20 |
$2,270.50 |
1.6× |
| Spine thoracic 3 views (72072) |
$175.80 |
$439.50 |
1.7× |
| Stereotactic body radiation delivery (77373) |
$4,690.20 |
$11,725.50 |
2.6× |
| Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction 2nd-5th Sessions (77438) |
$210.40 |
$526 |
2.1× |
| Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting 2nd-5th… (77436) |
$210.40 |
$526 |
5.6× |
| Surface radiation therapy; superficial, delivery, </=150 kV, per fraction (eg, electronic brachytherapy) 2nd-5th… (77437) |
$210.40 |
$526 |
2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,102.80 |
$2,757 |
2.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$390.20 |
$975.50 |
1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$266 |
$665 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,402.80 |
$3,507 |
3.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$682.80 |
$1,707 |
5.1× |
| Thoracolumbar 2 views (72080) |
$91.20 |
$228 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,090.80 |
$2,727 |
2.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$364.80 |
$912 |
0.9× |
| Thyroid uptake measurement (78012) |
$400.80 |
$1,002 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$911.60 |
$2,279 |
2.3× |
| Tmj unilateral (70328) |
$119.60 |
$299 |
1.4× |
| Tomogram (76100) |
$178.40 |
$446 |
1.7× |
| Treatment device intermediate (77333) |
$452.80 |
$1,132 |
3.4× |
| Treatment devices simple (77332) |
$453.80 |
$1,134.50 |
3.4× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,227.80 |
$3,069.50 |
2.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$400 |
$1,000 |
1.0× |
| Tx devices design & construction complex (77334) |
$790.40 |
$1,976 |
2.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$350 |
$875 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$174 |
$435 |
1.7× |
| Umbilical-artery Doppler (OB) (76820) |
$118.60 |
$296.50 |
1.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$82.60 |
$206.50 |
0.9× |
| Unlisted magnetic resonance procedure (76498) |
$1,075.20 |
$2,688 |
12.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$2,193.60 |
$5,484 |
5.5× |
| Upper Extremity Infant (73092) |
$78.80 |
$197 |
0.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$796 |
$1,990 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$270 |
$675 |
1.1× |
| Urethrocystography voiding (74455) |
$227.60 |
$569 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$340 |
$850 |
1.9× |
| Us abdl aorta screen aaa (76706) |
$159.40 |
$398.50 |
1.5× |
| Us breast unilateral complete (76641) |
$368.40 |
$921 |
3.5× |
| Us breast unilateral limited (76642) |
$374.60 |
$936.50 |
4.3× |
| Us chest (76604) |
$172.60 |
$431.50 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$259.80 |
$649.50 |
2.5× |
| Us guided compression repair (76936) |
$368.40 |
$921 |
1.7× |
| Us infant hips dynamic (76885) |
$183.20 |
$458 |
2.1× |
| Us kidney transplant (76776) |
$308.80 |
$772 |
2.9× |
| Us ob detailed single fetus (76811) |
$344 |
$860 |
1.4× |
| Us ob transvaginal (76817) |
$361.20 |
$903 |
3.4× |
| Us pelvic non ob complete (76856) |
$583.60 |
$1,459 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$327.20 |
$818 |
3.1× |
| Us pregnancy ltd (76815) |
$341.60 |
$854 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$482.40 |
$1,206 |
4.6× |
| Us retroperitoneal complete (76770) |
$292.60 |
$731.50 |
2.8× |
| Us retroperitoneal limited (76775) |
$278.20 |
$695.50 |
2.7× |
| Us scrotum and contents (76870) |
$547.60 |
$1,369 |
5.2× |
| Us soft tissue head/neck (76536) |
$608.40 |
$1,521 |
5.8× |
| Us spinal canal and contents (76800) |
$242 |
$605 |
2.3× |
| Us transrectal (76872) |
$320.40 |
$801 |
3.1× |
| Us transrectal prostate volume (76873) |
$375.60 |
$939 |
3.6× |
| Us xtr non-vasc lmtd (76882) |
$428.40 |
$1,071 |
4.1× |
| Venogram extremity bilateral (75822) |
$621.80 |
$1,554.50 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,268.20 |
$5,670.50 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,435.60 |
$3,589 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$746.80 |
$1,867 |
0.5× |
| Venography Renal Bilateral (75833) |
$2,582.80 |
$6,457 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$1,999.20 |
$4,998 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,132 |
$7,830 |
1.0× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$5,378.40 |
$13,446 |
1.0× |
| Wrist 2 views (73100) |
$166.40 |
$416 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$205.40 |
$513.50 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$121.40 |
$303.50 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$295 |
$737.50 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$369.40 |
$923.50 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$180.40 |
$451 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$278 |
$695 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$109.40 |
$273.50 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$158 |
$395 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$182.40 |
$456 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$281 |
$702.50 |
2.7× |
| X-ray eye for foreign body (70030) |
$90.60 |
$226.50 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$233.60 |
$584 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$150.60 |
$376.50 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$255.60 |
$639 |
2.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$190 |
$475 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$84.80 |
$212 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$228.40 |
$571 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$225.60 |
$564 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$144.80 |
$362 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$224.80 |
$562 |
2.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$309.20 |
$773 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$220.80 |
$552 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$233.20 |
$583 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$292.40 |
$731 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$189.60 |
$474 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$165.40 |
$413.50 |
1.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$207.20 |
$518 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$301.20 |
$753 |
3.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$158.40 |
$396 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$264 |
$660 |
2.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$168.20 |
$420.50 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$93.60 |
$234 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$165.20 |
$413 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$195.20 |
$488 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$170.40 |
$426 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$158 |
$395 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$280 |
$700 |
3.2× |
| Xr arthrogram ankle (73615) |
$269.20 |
$673 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$282.40 |
$706 |
2.7× |
| Xr chest 4+ views (71048) |
$215 |
$537.50 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$168.40 |
$421 |
1.9× |
| Xr internal auditory meati complete (70134) |
$99 |
$247.50 |
0.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$144.80 |
$362 |
1.4× |
| Xr optic foramina (70190) |
$96 |
$240 |
1.1× |
| Xr shoulder 1 view (73020) |
$173 |
$432.50 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$293.40 |
$733.50 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$175.20 |
$438 |
2.0× |
| Xr tmj bilateral (70330) |
$219.60 |
$549 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$186.80 |
$467 |
2.1× |