| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,451 |
$4,085 |
1.9× |
| Abdomen 2 views (74019) |
$122.40 |
$204 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$624 |
$1,040 |
1.7× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,622 |
$4,370 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$2,857.80 |
$4,763 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,857.80 |
$4,763 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$2,622 |
$4,370 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,370.40 |
$7,284 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,857.80 |
$4,763 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,857.80 |
$4,763 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$4,758.60 |
$7,931 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,752.40 |
$11,254 |
1.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,538.60 |
$4,231 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,622 |
$4,370 |
0.9× |
| Ankle 2 views (73600) |
$112.20 |
$187 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$354 |
$590 |
1.1× |
| Aortogram thoracic (75605) |
$4,370.40 |
$7,284 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,622 |
$4,370 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,739.90 |
$4,566.50 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,622 |
$4,370 |
0.9× |
| Arthrogram elbow (73085) |
$375 |
$625 |
1.1× |
| Arthrogram hip (73525) |
$608.70 |
$1,014.50 |
1.9× |
| Arthrogram shoulder (73040) |
$530.40 |
$884 |
1.6× |
| Arthrogram wrist (73115) |
$375 |
$625 |
1.1× |
| Arthrography knee lt (73580) |
$354 |
$590 |
1.1× |
| Basic radiation dosimetry calculation (77300) |
$216.30 |
$360.50 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$345.60 |
$576 |
0.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$345.60 |
$576 |
0.9× |
| Bone &/joint imaging whole body (78306) |
$1,041.60 |
$1,736 |
2.8× |
| Bone Imaging 3 Phase (78315) |
$1,140.30 |
$1,900.50 |
3.0× |
| Bone Marrow Imaging Limited Area (78102) |
$345.60 |
$576 |
0.9× |
| Bone survey complete (77075) |
$240.60 |
$401 |
2.4× |
| Brachytx isodose complex (77318) |
$310.20 |
$517 |
0.9× |
| Brachytx isodose intermed (77317) |
$310.20 |
$517 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$310.20 |
$517 |
0.9× |
| Brain image w/flow 4 + views (78606) |
$448.20 |
$747 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,789.80 |
$2,983 |
1.3× |
| Brain Imaging Vascular Flow Only (78610) |
$475.20 |
$792 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,102.20 |
$1,837 |
3.4× |
| Cardiac shunt detection (78428) |
$345.60 |
$576 |
0.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$448.20 |
$747 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$81 |
$135 |
1.0× |
| Chest 1 view (71045) |
$81 |
$135 |
1.0× |
| Chest 3 views (71047) |
$78.90 |
$131.50 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$178.80 |
$298 |
1.1× |
| Clavicle complete (73000) |
$120.90 |
$201.50 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$102.60 |
$171 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$289.80 |
$483 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,415.40 |
$2,359 |
4.3× |
| CT abdomen and pelvis without contrast (74176) |
$829.80 |
$1,383 |
3.7× |
| CT abdomen w contrast (74160) |
$1,032.60 |
$1,721 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,084.20 |
$1,807 |
6.6× |
| CT abdomen w/o contrast (74150) |
$929.40 |
$1,549 |
9.5× |
| CT angio hrt w/3d image (75574) |
$691.80 |
$1,153 |
2.1× |
| CT angiography upper extremity lt (73206) |
$844.20 |
$1,407 |
5.1× |
| CT c-spine w/o contrast (72125) |
$631.20 |
$1,052 |
6.4× |
| CT cervical spine w&w/o contrast (72127) |
$699 |
$1,165 |
4.2× |
| CT cervical spine with contrast (72126) |
$663.60 |
$1,106 |
2.0× |
| CT chest w/wo contrast (71270) |
$672 |
$1,120 |
4.1× |
| CT chest with contrast (71260) |
$666 |
$1,110 |
4.0× |
| CT colonography w/dye (74262) |
$756.60 |
$1,261 |
4.6× |
| CT colonography w/o cntrst (74261) |
$687 |
$1,145 |
7.0× |
| CT head/brain with contrast (70460) |
$625.80 |
$1,043 |
3.8× |
| CT head/brain without and with contrast (70470) |
$724.80 |
$1,208 |
4.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$634.80 |
$1,058 |
1.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$102 |
$170 |
1.2× |
| CT hrt w/3d image congen (75573) |
$691.80 |
$1,153 |
2.1× |
| CT iac w contrast (70481) |
$838.20 |
$1,397 |
5.1× |
| CT limited/localized follow up study (76380) |
$118.80 |
$198 |
1.5× |
| CT lower ext w/o (73700) |
$180.30 |
$300.50 |
1.8× |
| CT lower extremity w wo contrast (73702) |
$275.40 |
$459 |
1.7× |
| CT lower extremity with contrast (73701) |
$249 |
$415 |
1.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,023.60 |
$1,706 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$965.40 |
$1,609 |
9.8× |
| CT lumbar spine with contrast (72132) |
$973.80 |
$1,623 |
3.0× |
| CT maxillofacial w contrast (70487) |
$760.80 |
$1,268 |
4.6× |
| CT maxillofacial w/o contrast (70486) |
$630 |
$1,050 |
6.4× |
| CT maxillofacial w/wo contrast (70488) |
$807.60 |
$1,346 |
4.9× |
| CT neck soft tissue w contrast (70491) |
$832.20 |
$1,387 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$924.60 |
$1,541 |
5.6× |
| CT orbits w/o contrast (70480) |
$798.60 |
$1,331 |
8.1× |
| CT pelvis w & w/o contrast (72194) |
$794.40 |
$1,324 |
4.8× |
| CT pelvis w/o contrast (72192) |
$583.20 |
$972 |
5.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$269.40 |
$449 |
3.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$851.40 |
$1,419 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$455.70 |
$759.50 |
4.6× |
| CT thoracic spine w/contrast (72129) |
$748.80 |
$1,248 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$711.60 |
$1,186 |
7.2× |
| CT thoracic spine w/wo contrast (72130) |
$766.20 |
$1,277 |
4.6× |
| CT thorax w/o contrast (71250) |
$632.40 |
$1,054 |
6.4× |
| CT unlisted procedure (76497) |
$74.40 |
$124 |
0.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$885.60 |
$1,476 |
5.4× |
| CT upper extremity w/o contrast rt (73200) |
$842.40 |
$1,404 |
8.6× |
| CT upper extremity with contrast (73201) |
$817.80 |
$1,363 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$982.80 |
$1,638 |
6.0× |
| Cta Abdomen (74175) |
$1,096.80 |
$1,828 |
6.7× |
| CTA abdomen pelvis (74174) |
$1,264.80 |
$2,108 |
3.9× |
| CTA chest (71275) |
$712.71 |
$1,187.85 |
4.3× |
| Cta Head (70496) |
$1,239.60 |
$2,066 |
7.5× |
| CTA lwr ext w&w/o contrast (73706) |
$260.70 |
$434.50 |
1.6× |
| Cta Neck (70498) |
$1,139.40 |
$1,899 |
6.9× |
| Cta Pelvis (72191) |
$945.60 |
$1,576 |
5.7× |
| Cystography minimum 3 views rs&i (74430) |
$369.90 |
$616.50 |
1.1× |
| Diskogram cervical (72285) |
$1,607.40 |
$2,679 |
0.9× |
| Diskography lumbar (72295) |
$1,607.40 |
$2,679 |
0.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$174.60 |
$291 |
1.8× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$232.80 |
$388 |
2.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$213.30 |
$355.50 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$96.60 |
$161 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$261.30 |
$435.50 |
2.7× |
| Echo exam of eye (76529) |
$247.80 |
$413 |
3.0× |
| Echo exam of fetal heart (76825) |
$456.60 |
$761 |
0.9× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$211.80 |
$353 |
0.9× |
| Echoencephalography real time imaging (76506) |
$241.50 |
$402.50 |
2.5× |
| Esophagus (74220) |
$193.80 |
$323 |
1.2× |
| Fetal biophysical profile non-stress testing (76818) |
$309.60 |
$516 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$157.80 |
$263 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$273.60 |
$456 |
1.2× |
| Foot 2 views (73620) |
$82.20 |
$137 |
1.0× |
| Forearm 2 views (73090) |
$77.70 |
$129.50 |
1.0× |
| Functional MRI brain by phys/psych (70555) |
$1,590 |
$2,650 |
7.1× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$448.20 |
$747 |
0.9× |
| Gastric mucosa imaging (78261) |
$351.60 |
$586 |
0.9× |
| Gated Heart Planar Single (78472) |
$523 |
$871.67 |
1.4× |
| Hand 2 views (73120) |
$107.70 |
$179.50 |
1.1× |
| Hand 3 views (73130) |
$74.40 |
$124 |
0.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$649.20 |
$1,082 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$649.20 |
$1,082 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$649.20 |
$1,082 |
1.0× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$221.40 |
$369 |
0.6× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$221.40 |
$369 |
0.6× |
| Heart Infarct Image (78466) |
$345.60 |
$576 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,779.20 |
$4,632 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$566.64 |
$944.40 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$476.40 |
$794 |
1.3× |
| Ht muscle image spect sing (78451) |
$2,130 |
$3,550 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$77.70 |
$129.50 |
1.0× |
| Hyperthermia ntrstl prb 5/< (77610) |
$496.80 |
$828 |
1.0× |
| Hysterosalpingogram (74740) |
$238.50 |
$397.50 |
1.1× |
| Image fusion (77399) |
$207 |
$345 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$649.20 |
$1,082 |
1.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$649.20 |
$1,082 |
1.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$496.80 |
$828 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$496.80 |
$828 |
1.0× |
| Kidney imaging morphology (78700) |
$345 |
$575 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$495.90 |
$826.50 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$867 |
$1,445 |
1.7× |
| Knee 3 views (73562) |
$68.10 |
$113.50 |
0.8× |
| Liver & spleen imaging static only (78215) |
$345.60 |
$576 |
0.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$345.60 |
$576 |
0.9× |
| Liver imaging static only (78201) |
$1,128 |
$1,880 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,128 |
$1,880 |
2.2× |
| Lung perf&ventilat diferentl (78598) |
$574.80 |
$958 |
1.1× |
| Lung perfusion differential (78597) |
$345.60 |
$576 |
0.9× |
| Lung Ventilation Imaging (78579) |
$345.60 |
$576 |
0.9× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$2,622 |
$4,370 |
0.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$568.80 |
$948 |
1.0× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$1,288.20 |
$2,147 |
0.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,622 |
$4,370 |
0.9× |
| Lymphoscintigraphy (78195) |
$872.40 |
$1,454 |
1.7× |
| Mammary ductogram or galactogram multiple (77054) |
$211.80 |
$353 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$211.80 |
$353 |
0.9× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$136.80 |
$228 |
1.7× |
| Meckels Diverticulum (78290) |
$356.10 |
$593.50 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$530.40 |
$884 |
1.5× |
| Mr elastography (76391) |
$237 |
$395 |
1.1× |
| Mr safety determination physician/other qhp (76016) |
$55.80 |
$93 |
0.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$37.20 |
$62 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$15.60 |
$26 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$58.20 |
$97 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$152.40 |
$254 |
0.7× |
| MRA head w & w/o contrast (70546) |
$1,410 |
$2,350 |
4.3× |
| MRA head w/o contrast (70544) |
$1,353.60 |
$2,256 |
6.0× |
| MRA head with contrast (70545) |
$1,464.60 |
$2,441 |
4.5× |
| MRA neck w contrast (70548) |
$931.20 |
$1,552 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,205.70 |
$2,009.50 |
3.7× |
| MRA neck w/o contrast (70547) |
$929.70 |
$1,549.50 |
4.1× |
| MRI abdomen w contrast (74182) |
$1,260 |
$2,100 |
3.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,381.20 |
$2,302 |
4.2× |
| MRI abdomen w/o contrast (74181) |
$1,091.70 |
$1,819.50 |
4.9× |
| MRI any jnt lwr ext with con lt (73722) |
$823.80 |
$1,373 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,283.40 |
$2,139 |
1.7× |
| MRI bone marrow blood supply (77084) |
$913.50 |
$1,522.50 |
4.1× |
| MRI breast w/o contrast bilateral (77047) |
$224.40 |
$374 |
1.0× |
| MRI breast w/o contrast unilat (77046) |
$237 |
$395 |
1.1× |
| MRI c-spine with contrast (72142) |
$1,049.40 |
$1,749 |
3.2× |
| MRI cardiac w/o cont stress (75559) |
$1,071.60 |
$1,786 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$994.20 |
$1,657 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,044.60 |
$1,741 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$837 |
$1,395 |
2.6× |
| MRI chest w/o contrast (71550) |
$817.80 |
$1,363 |
3.6× |
| MRI chest with contrast (71551) |
$850.80 |
$1,418 |
1.2× |
| MRI fetal sngl/1st gestation (74712) |
$211.80 |
$353 |
0.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,242 |
$2,070 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,144.20 |
$1,907 |
3.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$740.40 |
$1,234 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$970.80 |
$1,618 |
4.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,300.80 |
$2,168 |
4.0× |
| MRI orbit/face/neck w/contrast (70542) |
$964.20 |
$1,607 |
2.9× |
| MRI pelvis w contrast (72196) |
$951 |
$1,585 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,042.20 |
$1,737 |
3.2× |
| MRI pelvis w/o contrast (72195) |
$939.60 |
$1,566 |
4.2× |
| MRI scan of arm joint before and after contrast (73223) |
$1,519.80 |
$2,533 |
4.6× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,227 |
$2,045 |
1.7× |
| MRI scan of leg joint before and after contrast (73723) |
$861.60 |
$1,436 |
2.6× |
| MRI spectroscopy (76390) |
$705.30 |
$1,175.50 |
8.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,198.80 |
$1,998 |
3.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$763.80 |
$1,273 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$936.60 |
$1,561 |
2.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,049.40 |
$1,749 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,635 |
$2,725 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,001.40 |
$1,669 |
4.5× |
| MRI tmj (70336) |
$211.80 |
$353 |
0.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,504.20 |
$2,507 |
6.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,081.20 |
$1,802 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,069.50 |
$1,782.50 |
4.8× |
| Myelogram Cervical (72240) |
$714 |
$1,190 |
1.0× |
| Myelogram Lumbar (72265) |
$714 |
$1,190 |
1.0× |
| Myelogram thoracic (72255) |
$714 |
$1,190 |
1.0× |
| Myelography 2 or more regions (72270) |
$684.60 |
$1,141 |
0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,196.40 |
$1,994 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,015.70 |
$3,359.50 |
1.7× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$1,356 |
$2,260 |
1.0× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,396.80 |
$2,328 |
1.0× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,158.20 |
$3,597 |
1.0× |
| Neck soft tissue (70360) |
$89.10 |
$148.50 |
1.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$221.40 |
$369 |
0.6× |
| Nm adrenal scan (78075) |
$1,196.40 |
$1,994 |
1.0× |
| Nm bone marrow multiple (78103) |
$345.60 |
$576 |
0.9× |
| Nm bone marrow wb (78104) |
$394.80 |
$658 |
1.1× |
| Nm cisternogram (78630) |
$448.20 |
$747 |
0.9× |
| Nm csf leak detection (78650) |
$1,196.40 |
$1,994 |
1.0× |
| Nm gastric emptying study (78264) |
$666 |
$1,110 |
1.8× |
| Nm gastroesophageal reflux study (78262) |
$351.60 |
$586 |
0.9× |
| Nm peritoneal-venous shunt patency (78291) |
$345.60 |
$576 |
0.9× |
| Nm red cell sequestration (78140) |
$345.60 |
$576 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,073.80 |
$5,123 |
2.4× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$1,356 |
$2,260 |
1.0× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,196.40 |
$1,994 |
1.0× |
| Nuclear medicine of heart pumping function (78473) |
$345.60 |
$576 |
0.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,356 |
$2,260 |
1.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,196.40 |
$1,994 |
1.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$345 |
$575 |
0.9× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$345.60 |
$576 |
0.9× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$345.60 |
$576 |
0.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$345.60 |
$576 |
0.9× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$1,128 |
$1,880 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$297 |
$495 |
1.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$208.20 |
$347 |
2.1× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$128.10 |
$213.50 |
1.0× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$189.60 |
$316 |
1.9× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$255 |
$425 |
2.6× |
| Osseous survey infant (77076) |
$180 |
$300 |
1.8× |
| Osseous survey limited (77074) |
$161.40 |
$269 |
1.6× |
| Parathyrd planar w/spect&CT (78072) |
$468.30 |
$780.50 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$345.60 |
$576 |
0.9× |
| Parathyroid imaging (78070) |
$564 |
$940 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$112.20 |
$187 |
1.1× |
| Peritoneogram rs&i (74190) |
$538.20 |
$897 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$1,789.80 |
$2,983 |
1.3× |
| PET imaging CT for attenuation limited area (78814) |
$1,356 |
$2,260 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$1,789.80 |
$2,983 |
1.3× |
| PET imaging limited area chest head/neck (78811) |
$1,196.40 |
$1,994 |
1.0× |
| PET whole body (78813) |
$1,437.60 |
$2,396 |
1.1× |
| Pr heart first pass single,planar (78481) |
$448.20 |
$747 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,810.80 |
$3,018 |
5.5× |
| Proton tx delivery intermediate (77523) |
$1,257 |
$2,095 |
1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,779.20 |
$4,632 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,700.60 |
$4,501 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$345.60 |
$576 |
0.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$468.30 |
$780.50 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$477 |
$795 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$77.70 |
$129.50 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$107.70 |
$179.50 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$112.20 |
$187 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$103.20 |
$172 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$174.60 |
$291 |
1.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$24,799.80 |
$41,333 |
3.6× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$41.40 |
$69 |
0.1× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$207 |
$345 |
2.2× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$221.40 |
$369 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$107.70 |
$179.50 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$129.60 |
$216 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$153.60 |
$256 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$81 |
$135 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$193.80 |
$323 |
1.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$167.40 |
$279 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$193.80 |
$323 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$202.20 |
$337 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$81.90 |
$136.50 |
1.0× |
| Radiological examination surgical specimen (76098) |
$456.60 |
$761 |
0.9× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,622 |
$4,370 |
0.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,779.20 |
$4,632 |
0.9× |
| Ribs bilateral 3 views (71110) |
$107.70 |
$179.50 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$366.60 |
$611 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,196.40 |
$1,994 |
2.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,250.10 |
$2,083.50 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,196.40 |
$1,994 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,356 |
$2,260 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,339.80 |
$2,233 |
1.1× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$228.60 |
$381 |
1.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,264.80 |
$2,108 |
5.8× |
| Rp Therapy Intravenous Administration (79101) |
$297 |
$495 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$112.20 |
$187 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$252 |
$420 |
1.1× |
| Salivary gland imaging (78230) |
$351.60 |
$586 |
0.9× |
| Scanogram (77073) |
$136.20 |
$227 |
1.4× |
| Scapula complete (73010) |
$144.60 |
$241 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$108 |
$180 |
4.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$286.80 |
$478 |
2.9× |
| Simulation intermediate (77285) |
$431.40 |
$719 |
1.2× |
| Small bowel series (74250) |
$171.30 |
$285.50 |
1.0× |
| Spec medical radj physics consltj (77370) |
$255.60 |
$426 |
2.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$310.20 |
$517 |
0.9× |
| Special dosimetry (77331) |
$207 |
$345 |
1.6× |
| Special treatment procedure (77470) |
$1,007.40 |
$1,679 |
1.9× |
| Speech evaluation complex (70371) |
$211.80 |
$353 |
0.9× |
| Spine thoracic 3 views (72072) |
$112.20 |
$187 |
1.1× |
| Splenoportograpy rs&i (75810) |
$2,622 |
$4,370 |
0.9× |
| Stereotactic body radiation delivery (77373) |
$5,505.60 |
$9,176 |
3.3× |
| Superior sagittal sinus venogram (75870) |
$2,700.60 |
$4,501 |
0.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$110.40 |
$184 |
1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$310.20 |
$517 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$310.20 |
$517 |
0.9× |
| Testicular Imaging With Vascular Flow (78761) |
$345.60 |
$576 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$646.20 |
$1,077 |
1.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$394.20 |
$657 |
3.1× |
| Thoracolumbar 2 views (72080) |
$119.40 |
$199 |
1.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$957.84 |
$1,596.40 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$345.60 |
$576 |
0.9× |
| Thyroid uptake measurement (78012) |
$345.60 |
$576 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$435.60 |
$726 |
1.2× |
| Tmj unilateral (70328) |
$85.20 |
$142 |
1.0× |
| Treatment device intermediate (77333) |
$207 |
$345 |
1.6× |
| Treatment devices simple (77332) |
$207 |
$345 |
1.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,196.40 |
$1,994 |
2.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$345.60 |
$576 |
0.9× |
| Tx devices design & construction complex (77334) |
$339.30 |
$565.50 |
1.0× |
| Ultrasound elastography first target lesion (76982) |
$103.20 |
$172 |
1.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$23.40 |
$39 |
0.9× |
| Ultrasound scan to determine eye length and lens power (76519) |
$242.40 |
$404 |
2.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$185.40 |
$309 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$144.60 |
$241 |
1.5× |
| Umbilical-artery Doppler (OB) (76820) |
$141.60 |
$236 |
1.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$74.40 |
$124 |
0.9× |
| Unlisted fluoroscopic procedure (76496) |
$74.40 |
$124 |
0.9× |
| Unlisted magnetic resonance procedure (76498) |
$74.40 |
$124 |
0.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$207 |
$345 |
2.2× |
| Unlisted Ultrasound Procedure (76999) |
$119.40 |
$199 |
1.5× |
| Upper Extremity Infant (73092) |
$103.20 |
$172 |
1.1× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$345.60 |
$576 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$247.80 |
$413 |
1.1× |
| Urethrocystography voiding (74455) |
$231 |
$385 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$273 |
$455 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$103.20 |
$172 |
1.1× |
| Us breast unilateral complete (76641) |
$145.80 |
$243 |
1.5× |
| Us breast unilateral limited (76642) |
$108.60 |
$181 |
1.3× |
| Us chest (76604) |
$101.40 |
$169 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$115.80 |
$193 |
1.2× |
| Us elastography parenchyma (76981) |
$107.70 |
$179.50 |
1.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$103.20 |
$172 |
1.1× |
| Us guided compression repair (76936) |
$242.40 |
$404 |
1.2× |
| Us infant hips dynamic (76885) |
$74.40 |
$124 |
0.9× |
| Us infant hips limited static (76886) |
$74.40 |
$124 |
0.9× |
| Us kidney transplant (76776) |
$355.80 |
$593 |
3.6× |
| Us ob detailed single fetus (76811) |
$231 |
$385 |
1.0× |
| Us ob transvaginal (76817) |
$193.20 |
$322 |
2.0× |
| Us pelvic non ob complete (76856) |
$153 |
$255 |
1.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$112.20 |
$187 |
1.1× |
| Us pregnancy ltd (76815) |
$107.70 |
$179.50 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$146.10 |
$243.50 |
1.5× |
| Us retroperitoneal complete (76770) |
$187.80 |
$313 |
1.9× |
| Us retroperitoneal limited (76775) |
$154.80 |
$258 |
1.6× |
| Us scrotum and contents (76870) |
$271.80 |
$453 |
2.8× |
| Us soft tissue head/neck (76536) |
$398.40 |
$664 |
4.1× |
| Us spinal canal and contents (76800) |
$157.20 |
$262 |
1.6× |
| Us transrectal (76872) |
$273 |
$455 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$168.60 |
$281 |
1.7× |
| Us, eye b-scan (76512) |
$192 |
$320 |
2.0× |
| Use of body cavity probe generated heat to increase temperature of cancer cell (77620) |
$496.80 |
$828 |
1.0× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$221.40 |
$369 |
0.6× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths more than 4.0 cm (77605) |
$649.20 |
$1,082 |
1.0× |
| Use of interstitial probe generated heat to increase temperature of cancer cell, more than 5 probes (77615) |
$496.80 |
$828 |
1.0× |
| Vascular flow imaging (78445) |
$345.60 |
$576 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,404 |
$2,340 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$2,857.80 |
$4,763 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,404 |
$2,340 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,404 |
$2,340 |
0.9× |
| Venography Renal Bilateral (75833) |
$2,691 |
$4,485 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$2,656.50 |
$4,427.50 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,779.20 |
$4,632 |
0.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,370.40 |
$7,284 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$74.40 |
$124 |
0.9× |
| Wrist 2 views (73100) |
$130.50 |
$217.50 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$123 |
$205 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$147.60 |
$246 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$226.80 |
$378 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$77.70 |
$129.50 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$136.80 |
$228 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$123.30 |
$205.50 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$81 |
$135 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$98.40 |
$164 |
1.2× |
| X-ray exam hip uni 4/> views (73503) |
$115.80 |
$193 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$128.40 |
$214 |
1.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$124.50 |
$207.50 |
1.3× |
| X-ray exam of femur 1 (73551) |
$74.40 |
$124 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$107.70 |
$179.50 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$74.40 |
$124 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$100.65 |
$167.75 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$112.20 |
$187 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$74.40 |
$124 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$137.40 |
$229 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86.40 |
$144 |
1.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$78.60 |
$131 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$112.20 |
$187 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$220.20 |
$367 |
2.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$172.80 |
$288 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$81 |
$135 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$103.20 |
$172 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$137.40 |
$229 |
1.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$456.60 |
$761 |
0.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$174 |
$290 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$81 |
$135 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$107.70 |
$179.50 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$103.20 |
$172 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$127.80 |
$213 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$81 |
$135 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$80.40 |
$134 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$77.70 |
$129.50 |
1.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$74.40 |
$124 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$115.80 |
$193 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$107.70 |
$179.50 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$124.20 |
$207 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$74.40 |
$124 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$74.40 |
$124 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$112.20 |
$187 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$135.30 |
$225.50 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$131.40 |
$219 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$144 |
$240 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$162.60 |
$271 |
1.7× |
| Xr chest 4+ views (71048) |
$109.20 |
$182 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$81 |
$135 |
1.0× |
| Xr shoulder 1 view (73020) |
$81 |
$135 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$129.60 |
$216 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$81 |
$135 |
1.0× |
| Xr tmj bilateral (70330) |
$85.20 |
$142 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$77.70 |
$129.50 |
1.0× |