| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,901.72 |
$7,316 |
3.5× |
| Abdomen 2 views (74019) |
$348.40 |
$520 |
3.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,185.90 |
$1,770 |
3.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,003.97 |
$2,991 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,216.02 |
$3,307.50 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,292.74 |
$3,422 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,176.52 |
$1,756 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,444.16 |
$3,648 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,046.85 |
$3,055 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,046.85 |
$3,055 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$3,298.41 |
$4,923 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,759.01 |
$7,103 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,360.77 |
$2,031 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,054.89 |
$3,067 |
0.6× |
| Ankle 2 views (73600) |
$367.83 |
$549 |
4.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$905.17 |
$1,351 |
2.6× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,267.95 |
$3,385 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,945.01 |
$2,903 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,789.57 |
$2,671 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$1,731.95 |
$2,585 |
0.5× |
| Arthrogram elbow (73085) |
$613.72 |
$916 |
1.8× |
| Arthrogram hip (73525) |
$832.81 |
$1,243 |
2.4× |
| Arthrogram shoulder (73040) |
$818.07 |
$1,221 |
2.3× |
| Arthrogram wrist (73115) |
$708.86 |
$1,058 |
2.0× |
| Arthrography knee lt (73580) |
$716.23 |
$1,069 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$625.11 |
$933 |
4.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,067.31 |
$1,593 |
2.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$968.15 |
$1,445 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,589.24 |
$2,372 |
4.0× |
| Bone age studies (77072) |
$322.94 |
$482 |
3.1× |
| Bone Imaging 3 Phase (78315) |
$2,765.09 |
$4,127 |
6.9× |
| Bone Marrow Imaging Limited Area (78102) |
$615.06 |
$918 |
1.5× |
| Bone survey complete (77075) |
$843.53 |
$1,259 |
8.0× |
| Brain image w/flow 4 + views (78606) |
$1,154.41 |
$1,723 |
2.1× |
| Brain imaging < 4 static views w vascular flow (78601) |
$836.83 |
$1,249 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$8,276.51 |
$12,353 |
5.8× |
| Brain Imaging Vascular Flow Only (78610) |
$1,088.08 |
$1,624 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,690.05 |
$4,015 |
7.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$696.13 |
$1,039 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$553.42 |
$826 |
6.3× |
| Chest 1 view (71045) |
$348.40 |
$520 |
4.0× |
| Chest 3 views (71047) |
$373.19 |
$557 |
4.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$620.42 |
$926 |
3.5× |
| Cineradiography/videoradiography (76120) |
$1,154.41 |
$1,723 |
11.0× |
| Clavicle complete (73000) |
$415.40 |
$620 |
4.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$176.21 |
$263 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$594.29 |
$887 |
4.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,073.91 |
$7,573 |
14.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,980.47 |
$5,941 |
16.6× |
| CT abdomen w contrast (74160) |
$2,802.61 |
$4,183 |
15.9× |
| CT abdomen w wo contrast (74170) |
$3,404.27 |
$5,081 |
19.3× |
| CT abdomen w/o contrast (74150) |
$2,286.71 |
$3,413 |
21.8× |
| CT angio hrt w/3d image (75574) |
$3,461.22 |
$5,166 |
9.9× |
| CT angiography upper extremity lt (73206) |
$2,726.90 |
$4,070 |
15.5× |
| CT c-spine w/o contrast (72125) |
$2,730.25 |
$4,075 |
26.0× |
| CT cervical spine w&w/o contrast (72127) |
$2,876.98 |
$4,294 |
16.3× |
| CT cervical spine with contrast (72126) |
$2,885.02 |
$4,306 |
8.2× |
| CT chest w/wo contrast (71270) |
$2,759.06 |
$4,118 |
15.7× |
| CT chest with contrast (71260) |
$2,614.34 |
$3,902 |
14.8× |
| CT head/brain with contrast (70460) |
$2,373.14 |
$3,542 |
13.5× |
| CT head/brain without and with contrast (70470) |
$2,637.12 |
$3,936 |
15.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,501.78 |
$3,734 |
7.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$3,309.13 |
$4,939 |
37.9× |
| CT hrt w/3d image congen (75573) |
$2,197.60 |
$3,280 |
6.3× |
| CT iac w contrast (70481) |
$2,704.79 |
$4,037 |
15.4× |
| CT limited/localized follow up study (76380) |
$746.38 |
$1,114 |
8.5× |
| CT lower ext w/o (73700) |
$2,149.36 |
$3,208 |
20.5× |
| CT lower extremity w wo contrast (73702) |
$2,061.59 |
$3,077 |
11.7× |
| CT lower extremity with contrast (73701) |
$1,910.84 |
$2,852 |
10.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,876.98 |
$4,294 |
16.3× |
| CT lumbar spine w/o contrast (72131) |
$2,694.74 |
$4,022 |
25.7× |
| CT lumbar spine with contrast (72132) |
$2,935.94 |
$4,382 |
8.4× |
| CT maxillofacial w contrast (70487) |
$2,945.99 |
$4,397 |
16.7× |
| CT maxillofacial w/o contrast (70486) |
$2,599.60 |
$3,880 |
24.8× |
| CT maxillofacial w/wo contrast (70488) |
$3,255.53 |
$4,859 |
18.5× |
| CT neck soft tissue w contrast (70491) |
$2,547.34 |
$3,802 |
14.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,891.72 |
$4,316 |
16.4× |
| CT orbits w/o contrast (70480) |
$2,324.90 |
$3,470 |
22.1× |
| CT pelvis w & w/o contrast (72194) |
$2,852.86 |
$4,258 |
16.2× |
| CT pelvis w/o contrast (72192) |
$2,259.91 |
$3,373 |
21.5× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$582.23 |
$869 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,140.29 |
$4,687 |
17.8× |
| CT soft tissue neck w/o contrast (70490) |
$2,202.96 |
$3,288 |
21.0× |
| CT thoracic spine w/contrast (72129) |
$2,838.12 |
$4,236 |
16.1× |
| CT thoracic spine w/o contrast (72128) |
$2,436.79 |
$3,637 |
23.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,955.37 |
$4,411 |
16.8× |
| CT thorax w/o contrast (71250) |
$2,168.12 |
$3,236 |
20.6× |
| CT unlisted procedure (76497) |
$2,577.49 |
$3,847 |
29.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,671.65 |
$2,495 |
9.5× |
| CT upper extremity w/o contrast rt (73200) |
$2,042.16 |
$3,048 |
19.4× |
| CT upper extremity with contrast (73201) |
$1,690.41 |
$2,523 |
4.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,510.49 |
$3,747 |
14.2× |
| Cta Abdomen (74175) |
$3,055.20 |
$4,560 |
17.3× |
| CTA abdomen pelvis (74174) |
$5,609.24 |
$8,372 |
16.0× |
| CTA chest (71275) |
$2,594.91 |
$3,873 |
14.7× |
| Cta Head (70496) |
$2,840.80 |
$4,240 |
16.1× |
| CTA lwr ext w&w/o contrast (73706) |
$2,615.01 |
$3,903 |
14.8× |
| Cta Neck (70498) |
$2,556.72 |
$3,816 |
14.5× |
| Cta Pelvis (72191) |
$2,682.01 |
$4,003 |
15.2× |
| Cystography minimum 3 views rs&i (74430) |
$861.62 |
$1,286 |
2.5× |
| Diskography lumbar (72295) |
$1,680.36 |
$2,508 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$244.55 |
$365 |
2.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$481.73 |
$719 |
4.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$507.19 |
$757 |
4.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$548.73 |
$819 |
5.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$185.59 |
$277 |
2.1× |
| Dxa bone density study axial skeleton (77085) |
$230.48 |
$344 |
2.2× |
| Echo exam of eye (76529) |
$176.21 |
$263 |
2.0× |
| Echo exam of fetal heart (76825) |
$2,024.07 |
$3,021 |
3.7× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$1,252.23 |
$1,869 |
5.2× |
| Echoencephalography real time imaging (76506) |
$461.63 |
$689 |
4.4× |
| Esophageal motility (78258) |
$678.71 |
$1,013 |
1.7× |
| Esophagus (74220) |
$778.54 |
$1,162 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$667.32 |
$996 |
6.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$750.40 |
$1,120 |
7.1× |
| Fluoroscopy up to 1 hr (76000) |
$522.60 |
$780 |
2.2× |
| Foot 2 views (73620) |
$361.13 |
$539 |
4.1× |
| Forearm 2 views (73090) |
$447.56 |
$668 |
5.1× |
| Functional MRI brain by phys/psych (70555) |
$2,952.69 |
$4,407 |
12.3× |
| Functional MRI brain by tech (70554) |
$3,234.76 |
$4,828 |
13.5× |
| Gastric mucosa imaging (78261) |
$1,365.46 |
$2,038 |
3.4× |
| Gastrointestinal Protein Loss (78282) |
$646.55 |
$965 |
1.6× |
| Gated Heart Planar Single (78472) |
$1,069.32 |
$1,596 |
2.7× |
| Hand 2 views (73120) |
$339.69 |
$507 |
3.2× |
| Hand 3 views (73130) |
$416.74 |
$622 |
4.8× |
| Heart Infarct Image (78466) |
$367.16 |
$548 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,883.37 |
$2,811 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,643.15 |
$3,945 |
4.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,150.70 |
$3,210 |
5.4× |
| Ht muscle image spect sing (78451) |
$1,504.82 |
$2,246 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$393.29 |
$587 |
4.5× |
| Hysterosalpingogram (74740) |
$1,143.02 |
$1,706 |
4.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$273.36 |
$408 |
2.6× |
| Kidney funcj study non-img radioisotopic study (78725) |
$1,019.07 |
$1,521 |
2.5× |
| Kidney imaging morphology (78700) |
$1,737.98 |
$2,594 |
4.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,225.43 |
$1,829 |
2.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,951.04 |
$2,912 |
3.6× |
| Knee 3 views (73562) |
$447.56 |
$668 |
5.1× |
| Liver & spleen imaging static only (78215) |
$1,408.34 |
$2,102 |
3.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$858.94 |
$1,282 |
2.1× |
| Liver imaging w/vascular flow (78202) |
$925.27 |
$1,381 |
1.7× |
| Lung perf&ventilat diferentl (78598) |
$1,453.23 |
$2,169 |
2.7× |
| Lung perfusion differential (78597) |
$1,366.80 |
$2,040 |
3.4× |
| Lung Ventilation Imaging (78579) |
$680.72 |
$1,016 |
1.7× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$637.84 |
$952 |
0.2× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$432.15 |
$645 |
0.7× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$565.48 |
$844 |
0.4× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$276.71 |
$413 |
0.1× |
| Lymphoscintigraphy (78195) |
$1,663.61 |
$2,483 |
3.1× |
| Meckels Diverticulum (78290) |
$410.04 |
$612 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,187.91 |
$1,773 |
3.2× |
| Mr elastography (76391) |
$2,273.31 |
$3,393 |
9.5× |
| MRA head w & w/o contrast (70546) |
$4,879.61 |
$7,283 |
13.9× |
| MRA head w/o contrast (70544) |
$2,776.48 |
$4,144 |
11.6× |
| MRA head with contrast (70545) |
$2,848.84 |
$4,252 |
8.1× |
| MRA neck w contrast (70548) |
$2,897.08 |
$4,324 |
8.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,512.14 |
$5,242 |
10.0× |
| MRA neck w/o contrast (70547) |
$2,448.18 |
$3,654 |
10.2× |
| MRI abdomen w contrast (74182) |
$3,888.01 |
$5,803 |
11.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,600.22 |
$6,866 |
13.1× |
| MRI abdomen w/o contrast (74181) |
$3,227.39 |
$4,817 |
13.5× |
| MRI any jnt lwr ext with con lt (73722) |
$4,045.46 |
$6,038 |
5.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,356.70 |
$5,010 |
4.3× |
| MRI breast w/o contrast bilateral (77047) |
$2,247.85 |
$3,355 |
9.4× |
| MRI breast w/o contrast unilat (77046) |
$2,062.93 |
$3,079 |
8.6× |
| MRI c-spine with contrast (72142) |
$3,646.81 |
$5,443 |
10.4× |
| MRI cardiac w/o cont stress (75559) |
$3,520.85 |
$5,255 |
6.4× |
| MRI cardiac w/o contrast (75557) |
$2,490.39 |
$3,717 |
10.4× |
| MRI cervical spine w/o contrast (72141) |
$3,706.44 |
$5,532 |
15.5× |
| MRI chest w/o & w/contrast material (71552) |
$4,044.12 |
$6,036 |
11.5× |
| MRI chest w/o contrast (71550) |
$2,878.32 |
$4,296 |
12.0× |
| MRI chest with contrast (71551) |
$2,499.77 |
$3,731 |
3.2× |
| MRI fetal sngl/1st gestation (74712) |
$2,375.82 |
$3,546 |
9.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,138.28 |
$4,684 |
9.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,749.01 |
$4,103 |
7.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,859.56 |
$4,268 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,768.44 |
$4,132 |
11.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,295.37 |
$6,411 |
12.3× |
| MRI orbit/face/neck w/contrast (70542) |
$2,680.67 |
$4,001 |
7.6× |
| MRI pelvis w contrast (72196) |
$3,168.43 |
$4,729 |
9.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,285.99 |
$6,397 |
12.2× |
| MRI pelvis w/o contrast (72195) |
$3,169.10 |
$4,730 |
13.2× |
| MRI scan of arm joint before and after contrast (73223) |
$4,177.45 |
$6,235 |
11.9× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$3,697.06 |
$5,518 |
4.7× |
| MRI scan of leg joint before and after contrast (73723) |
$3,881.98 |
$5,794 |
11.1× |
| MRI spectroscopy (76390) |
$2,182.19 |
$3,257 |
25.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,007.58 |
$7,474 |
14.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,831.06 |
$5,718 |
10.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,990.16 |
$7,448 |
14.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,137.61 |
$4,683 |
9.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,684.64 |
$6,992 |
13.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,678.66 |
$3,998 |
11.2× |
| MRI tmj (70336) |
$2,824.05 |
$4,215 |
11.8× |
| MRI upper ext joint w/o contrast (73221) |
$3,312.48 |
$4,944 |
13.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,062.21 |
$6,063 |
11.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,035.77 |
$4,531 |
12.7× |
| Myelogram Cervical (72240) |
$1,281.71 |
$1,913 |
1.6× |
| Myelogram Lumbar (72265) |
$2,001.96 |
$2,988 |
2.5× |
| Myelogram thoracic (72255) |
$1,581.87 |
$2,361 |
2.0× |
| Myelography 2 or more regions (72270) |
$1,445.19 |
$2,157 |
1.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,735.92 |
$5,576 |
2.9× |
| Myocardial infarct spect (78469) |
$531.98 |
$794 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,092.72 |
$4,616 |
2.4× |
| Neck soft tissue (70360) |
$440.86 |
$658 |
5.0× |
| Nm bone marrow multiple (78103) |
$812.71 |
$1,213 |
2.0× |
| Nm bone marrow wb (78104) |
$1,002.99 |
$1,497 |
2.5× |
| Nm cisternogram (78630) |
$896.46 |
$1,338 |
1.6× |
| Nm csf leak detection (78650) |
$661.29 |
$987 |
0.5× |
| Nm gastric emptying study (78264) |
$2,293.41 |
$3,423 |
5.7× |
| Nm gastroesophageal reflux study (78262) |
$541.36 |
$808 |
1.3× |
| Nm peritoneal-venous shunt patency (78291) |
$604.34 |
$902 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,756.95 |
$10,085 |
4.9× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$3,599.91 |
$5,373 |
2.5× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$676.03 |
$1,009 |
0.5× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$4,947.95 |
$7,385 |
3.4× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$3,221.36 |
$4,808 |
2.2× |
| Nuclear medicine study of digestive tracts (78299) |
$729.63 |
$1,089 |
1.8× |
| Nuclear medicine study of endocrine organs (78099) |
$864.97 |
$1,291 |
2.2× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$459.62 |
$686 |
0.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$981.55 |
$1,465 |
2.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$941.35 |
$1,405 |
2.3× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$714.22 |
$1,066 |
1.3× |
| Nuclear Rx Oral Admin (79005) |
$1,746.02 |
$2,606 |
7.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$657.94 |
$982 |
6.3× |
| Orthopantogram (70355) |
$201 |
$300 |
2.3× |
| Osseous survey infant (77076) |
$507.86 |
$758 |
4.8× |
| Osseous survey limited (77074) |
$756.43 |
$1,129 |
7.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,900.12 |
$2,836 |
3.5× |
| Parathyrd planar w/wo subtrj (78071) |
$1,395.61 |
$2,083 |
3.5× |
| Parathyroid imaging (78070) |
$1,763.44 |
$2,632 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$481.73 |
$719 |
4.6× |
| Perineogram (74775) |
$703.50 |
$1,050 |
2.9× |
| Peritoneogram rs&i (74190) |
$324.95 |
$485 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$6,850.75 |
$10,225 |
4.8× |
| PET imaging CT for attenuation limited area (78814) |
$4,860.18 |
$7,254 |
3.4× |
| PET imaging for CT attenuation whole body (78816) |
$6,514.41 |
$9,723 |
4.5× |
| PET imaging limited area chest head/neck (78811) |
$3,660.21 |
$5,463 |
2.8× |
| PET whole body (78813) |
$4,334.90 |
$6,470 |
3.0× |
| Pr csf ventriculography (78635) |
$601.66 |
$898 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,164.05 |
$6,215 |
11.9× |
| Proton trmt simple w/comp (77522) |
$3,153.69 |
$4,707 |
2.5× |
| Proton tx delivery complex (77525) |
$3,689.02 |
$5,506 |
2.9× |
| Proton tx delivery intermediate (77523) |
$3,884.66 |
$5,798 |
3.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,777.82 |
$4,146 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,390.56 |
$3,568 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,367.47 |
$2,041 |
3.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,992.58 |
$2,974 |
3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$836.83 |
$1,249 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$392.62 |
$586 |
4.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$668.66 |
$998 |
6.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$352.42 |
$526 |
3.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$186.26 |
$278 |
1.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$568.83 |
$849 |
5.4× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$1,057.93 |
$1,579 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$324.28 |
$484 |
3.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$323.61 |
$483 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$495.80 |
$740 |
4.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$361.80 |
$540 |
4.1× |
| Radiologic exam colon single contrast study (74270) |
$1,052.57 |
$1,571 |
6.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$548.73 |
$819 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$344.38 |
$514 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$911.20 |
$1,360 |
5.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$453.59 |
$677 |
5.2× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$276.04 |
$412 |
1.2× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$485.08 |
$724 |
2.1× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,488.74 |
$2,222 |
0.5× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,912.49 |
$4,347 |
0.9× |
| Ribs bilateral 3 views (71110) |
$404.68 |
$604 |
3.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,650.21 |
$2,463 |
4.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,840.44 |
$5,732 |
7.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,178.48 |
$4,744 |
5.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,985.88 |
$2,964 |
1.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,270.32 |
$1,896 |
5.4× |
| Rp Therapy Intravenous Administration (79101) |
$1,285.73 |
$1,919 |
5.5× |
| Sacroiliac Joints < 3 Views (72200) |
$150.75 |
$225 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$888.42 |
$1,326 |
3.7× |
| Salivary gland function study (78232) |
$435.50 |
$650 |
1.1× |
| Salivary gland imaging (78230) |
$688.76 |
$1,028 |
1.7× |
| Salivary gland imaging serial images (78231) |
$715.56 |
$1,068 |
1.8× |
| Scanogram (77073) |
$519.25 |
$775 |
4.9× |
| Scapula complete (73010) |
$232.49 |
$347 |
2.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$486.42 |
$726 |
4.6× |
| Sialogram (70390) |
$368.50 |
$550 |
1.5× |
| Small bowel series (74250) |
$449.57 |
$671 |
2.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,083.39 |
$1,617 |
2.9× |
| Special treatment procedure (77470) |
$2,596.25 |
$3,875 |
4.7× |
| Speech evaluation complex (70371) |
$322.27 |
$481 |
1.3× |
| Spleen imaging only (78185) |
$687.42 |
$1,026 |
1.7× |
| Splenoportograpy rs&i (75810) |
$1,829.77 |
$2,731 |
0.6× |
| Superior sagittal sinus venogram (75870) |
$1,016.39 |
$1,517 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,154.05 |
$3,215 |
5.7× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$453.59 |
$677 |
1.9× |
| Testicular Imaging With Vascular Flow (78761) |
$663.97 |
$991 |
1.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,946.35 |
$2,905 |
5.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$856.93 |
$1,279 |
6.3× |
| Therapeutic Enema (74283) |
$644.54 |
$962 |
3.7× |
| Thoracolumbar 2 views (72080) |
$471.68 |
$704 |
5.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,727.26 |
$2,578 |
3.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$785.91 |
$1,173 |
2.0× |
| Thyroid uptake measurement (78012) |
$1,191.93 |
$1,779 |
3.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,109.16 |
$3,148 |
5.3× |
| Treatment device intermediate (77333) |
$880.38 |
$1,314 |
6.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$940.68 |
$1,404 |
2.3× |
| Tx devices design & construction complex (77334) |
$1,283.72 |
$1,916 |
3.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$158.12 |
$236 |
5.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$1,507.50 |
$2,250 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$749.06 |
$1,118 |
7.1× |
| Umbilical-artery Doppler (OB) (76820) |
$499.82 |
$746 |
4.8× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$2,667.94 |
$3,982 |
6.6× |
| Unlisted fluoroscopic procedure (76496) |
$439.52 |
$656 |
5.0× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$672.01 |
$1,003 |
1.7× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$811.37 |
$1,211 |
2.0× |
| Unlisted magnetic resonance procedure (76498) |
$3,174.46 |
$4,738 |
36.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$842.86 |
$1,258 |
2.1× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$520.59 |
$777 |
1.3× |
| Unlisted nervous system procedure, diagnostic nuclear medicine UNSCHEDULED (78699) |
$1,502.81 |
$2,243 |
3.7× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$1,189.25 |
$1,775 |
3.0× |
| Unlisted Ultrasound Procedure (76999) |
$372.52 |
$556 |
4.3× |
| Upper Extremity Infant (73092) |
$178.22 |
$266 |
1.7× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,086.74 |
$1,622 |
2.7× |
| Urethrocystography retrograde rs&i (74450) |
$812.04 |
$1,212 |
3.4× |
| Urethrocystography voiding (74455) |
$942.69 |
$1,407 |
3.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$397.31 |
$593 |
2.3× |
| Us breast unilateral complete (76641) |
$570.84 |
$852 |
5.4× |
| Us breast unilateral limited (76642) |
$479.05 |
$715 |
5.5× |
| Us chest (76604) |
$443.20 |
$661.50 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$610.37 |
$911 |
5.8× |
| Us elastography parenchyma (76981) |
$956.76 |
$1,428 |
9.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$529.97 |
$791 |
5.0× |
| Us guided compression repair (76936) |
$890.43 |
$1,329 |
4.1× |
| Us infant hips dynamic (76885) |
$462.97 |
$691 |
5.3× |
| Us infant hips limited static (76886) |
$418.08 |
$624 |
4.8× |
| Us kidney transplant (76776) |
$905.17 |
$1,351 |
8.6× |
| Us ob detailed single fetus (76811) |
$685.41 |
$1,023 |
2.9× |
| Us ob transvaginal (76817) |
$799.98 |
$1,194 |
7.6× |
| Us pelvic non ob complete (76856) |
$1,015.05 |
$1,515 |
9.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$443.54 |
$662 |
4.2× |
| Us pregnancy ltd (76815) |
$747.05 |
$1,115 |
7.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$988.92 |
$1,476 |
9.4× |
| Us retroperitoneal complete (76770) |
$886.41 |
$1,323 |
8.4× |
| Us retroperitoneal limited (76775) |
$572.18 |
$854 |
5.4× |
| Us scrotum and contents (76870) |
$737 |
$1,100 |
7.0× |
| Us soft tissue head/neck (76536) |
$722.93 |
$1,079 |
6.9× |
| Us spinal canal and contents (76800) |
$450.24 |
$672 |
4.3× |
| Us transrectal (76872) |
$1,467.97 |
$2,191 |
14.0× |
| Us xtr non-vasc lmtd (76882) |
$493.12 |
$736 |
4.7× |
| Us, eye b-scan (76512) |
$176.21 |
$263 |
1.7× |
| Vascular flow imaging (78445) |
$447.56 |
$668 |
1.1× |
| Venogram extremity bilateral (75822) |
$1,457.92 |
$2,176 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$2,959.39 |
$4,417 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$2,357.06 |
$3,518 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$1,453.90 |
$2,170 |
0.9× |
| Venography Renal Bilateral (75833) |
$2,046.18 |
$3,054 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$2,046.85 |
$3,055 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,024.43 |
$1,529 |
0.3× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,186.57 |
$1,771 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$210.38 |
$314 |
2.4× |
| Wrist 2 views (73100) |
$373.86 |
$558 |
4.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$420.09 |
$627 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$176.88 |
$264 |
2.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$452.92 |
$676 |
5.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$648.56 |
$968 |
3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$424.11 |
$633 |
4.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$452.92 |
$676 |
5.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$698.81 |
$1,043 |
6.7× |
| X-ray exam hip uni 1 view (73501) |
$292.12 |
$436 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$397.98 |
$594 |
4.6× |
| X-ray exam hip uni 4/> views (73503) |
$486.42 |
$726 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$446.89 |
$667 |
4.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$515.23 |
$769 |
4.9× |
| X-ray exam of femur 1 (73551) |
$278.05 |
$415 |
3.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$256.61 |
$383 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$132.66 |
$198 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$452.92 |
$676 |
5.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,604.65 |
$2,395 |
0.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$353.09 |
$527 |
4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$150.75 |
$225 |
1.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$487.09 |
$727 |
4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$216.41 |
$323 |
2.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$178.22 |
$266 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$484.08 |
$722.50 |
4.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$530.64 |
$792 |
5.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$432.82 |
$646 |
4.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$239.19 |
$357 |
2.7× |
| X-ray of voice box or throat (70370) |
$413.39 |
$617 |
4.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$229.14 |
$342 |
2.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$494.46 |
$738 |
4.7× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$909.19 |
$1,357 |
1.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$889.09 |
$1,327 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$276.71 |
$413 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$312.22 |
$466 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$468.33 |
$699 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$254.60 |
$380 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$317.58 |
$474 |
3.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$496.47 |
$741 |
5.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$481.73 |
$719 |
5.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$225.12 |
$336 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$616.40 |
$920 |
5.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$319.59 |
$477 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$428.13 |
$639 |
4.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$174.20 |
$260 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$196.98 |
$294 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$471.68 |
$704 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$367.83 |
$549 |
4.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$509.87 |
$761 |
5.8× |
| Xr arthrogram ankle (73615) |
$637.84 |
$952 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$604.34 |
$902 |
5.8× |
| Xr chest 4+ views (71048) |
$454.26 |
$678 |
4.3× |
| Xr Cholecystography Oral Contrast (74290) |
$191.62 |
$286 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$385.92 |
$576 |
4.4× |
| Xr internal auditory meati complete (70134) |
$138.02 |
$206 |
0.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$138.02 |
$206 |
1.3× |
| Xr optic foramina (70190) |
$186.26 |
$278 |
2.1× |
| Xr shoulder 1 view (73020) |
$395.97 |
$591 |
4.5× |
| Xr spine cervical 4 or 5 views (72050) |
$572.85 |
$855 |
5.5× |
| Xr tibia/fibula 2 views (73590) |
$469.67 |
$701 |
5.4× |
| Xr tmj bilateral (70330) |
$252.59 |
$377 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$422.77 |
$631 |
4.8× |