| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,430.25 |
$9,845 |
3.0× |
| Abdomen 2 views (74019) |
$341.55 |
$759 |
3.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,338.30 |
$2,974 |
3.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$6,873.75 |
$15,275 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$4,724.10 |
$10,498 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,094.20 |
$6,876 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$3,788.10 |
$8,418 |
1.1× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,927.20 |
$17,616 |
1.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,778.15 |
$19,507 |
2.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,582.35 |
$10,183 |
1.4× |
| Angiography Spinal Selective Rs&I (75705) |
$7,643.70 |
$16,986 |
1.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,790.30 |
$19,534 |
1.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,273.10 |
$11,718 |
1.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,348.25 |
$11,885 |
1.6× |
| Ankle 2 views (73600) |
$202.05 |
$449 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$745.65 |
$1,657 |
2.0× |
| Aortogram thoracic (75605) |
$4,968.45 |
$11,041 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,465 |
$7,700 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,956.85 |
$8,793 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$4,582.35 |
$10,183 |
1.4× |
| Arthrogram elbow (73085) |
$888.75 |
$1,975 |
2.4× |
| Arthrogram hip (73525) |
$589.50 |
$1,310 |
1.6× |
| Arthrogram shoulder (73040) |
$1,021.95 |
$2,271 |
2.8× |
| Arthrogram wrist (73115) |
$611.55 |
$1,359 |
1.7× |
| Arthrography knee lt (73580) |
$888.75 |
$1,975 |
2.4× |
| Basic radiation dosimetry calculation (77300) |
$789.30 |
$1,754 |
5.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,222.65 |
$2,717 |
2.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,440.45 |
$3,201 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$1,597.05 |
$3,549 |
3.8× |
| Bone age studies (77072) |
$310.50 |
$690 |
2.8× |
| Bone Imaging 3 Phase (78315) |
$1,797.30 |
$3,994 |
4.3× |
| Bone Marrow Imaging Limited Area (78102) |
$1,815.30 |
$4,034 |
4.3× |
| Bone survey complete (77075) |
$245.70 |
$546 |
2.2× |
| Brachytx isodose complex (77318) |
$2,556.45 |
$5,681 |
6.5× |
| Brachytx isodose intermed (77317) |
$2,258.10 |
$5,018 |
5.7× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,091.60 |
$4,648 |
5.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,211.65 |
$7,137 |
2.1× |
| Brain Imaging Vascular Flow Only (78610) |
$1,574.10 |
$3,498 |
2.7× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$135.90 |
$302 |
12.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,912.05 |
$4,249 |
4.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,826.55 |
$4,059 |
5.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,400.85 |
$3,113 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$288.45 |
$641 |
3.1× |
| Chest 1 view (71045) |
$282.15 |
$627 |
3.1× |
| Chest 3 views (71047) |
$341.55 |
$759 |
3.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$563.85 |
$1,253 |
3.0× |
| Clavicle complete (73000) |
$310.50 |
$690 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$429.75 |
$955 |
3.9× |
| Continuing medical physics consltj pr wk (77336) |
$787.05 |
$1,749 |
5.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,328.55 |
$9,619 |
11.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,612.25 |
$5,805 |
10.4× |
| CT abdomen w contrast (74160) |
$1,299.60 |
$2,888 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,465.65 |
$3,257 |
7.9× |
| CT abdomen w/o contrast (74150) |
$1,147.05 |
$2,549 |
10.4× |
| CT angio hrt w/3d image (75574) |
$1,357.65 |
$3,017 |
3.7× |
| CT angiography upper extremity lt (73206) |
$2,236.50 |
$4,970 |
12.1× |
| CT c-spine w/o contrast (72125) |
$1,739.70 |
$3,866 |
15.8× |
| CT cervical spine w&w/o contrast (72127) |
$2,009.25 |
$4,465 |
10.9× |
| CT cervical spine with contrast (72126) |
$1,899 |
$4,220 |
5.2× |
| CT chest w/wo contrast (71270) |
$1,730.25 |
$3,845 |
9.4× |
| CT chest with contrast (71260) |
$1,413.90 |
$3,142 |
7.6× |
| CT head/brain with contrast (70460) |
$1,941.30 |
$4,314 |
10.5× |
| CT head/brain without and with contrast (70470) |
$2,057.85 |
$4,573 |
11.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$840.60 |
$1,868 |
2.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$271.80 |
$604 |
3.0× |
| CT hrt w/3d image congen (75573) |
$1,292.85 |
$2,873 |
3.5× |
| CT iac w contrast (70481) |
$1,941.30 |
$4,314 |
10.5× |
| CT limited/localized follow up study (76380) |
$552.15 |
$1,227 |
6.0× |
| CT lower ext w/o (73700) |
$1,045.80 |
$2,324 |
9.5× |
| CT lower extremity w wo contrast (73702) |
$2,129.85 |
$4,733 |
11.5× |
| CT lower extremity with contrast (73701) |
$1,941.30 |
$4,314 |
10.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,129.85 |
$4,733 |
11.5× |
| CT lumbar spine w/o contrast (72131) |
$1,498.95 |
$3,331 |
13.6× |
| CT lumbar spine with contrast (72132) |
$1,807.20 |
$4,016 |
4.9× |
| CT maxillofacial w contrast (70487) |
$1,941.30 |
$4,314 |
10.5× |
| CT maxillofacial w/o contrast (70486) |
$1,377 |
$3,060 |
12.5× |
| CT maxillofacial w/wo contrast (70488) |
$2,057.85 |
$4,573 |
11.1× |
| CT neck soft tissue w contrast (70491) |
$1,554.75 |
$3,455 |
8.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,009.25 |
$4,465 |
10.9× |
| CT orbits w/o contrast (70480) |
$1,609.20 |
$3,576 |
14.6× |
| CT pelvis w & w/o contrast (72194) |
$1,889.10 |
$4,198 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,453.05 |
$3,229 |
13.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,890.45 |
$4,201 |
10.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,121.85 |
$2,493 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$1,234.35 |
$2,743 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$1,194.75 |
$2,655 |
10.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,009.25 |
$4,465 |
10.9× |
| CT thorax w/o contrast (71250) |
$1,256.40 |
$2,792 |
11.4× |
| CT unlisted procedure (76497) |
$794.23 |
$1,764.95 |
8.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,129.85 |
$4,733 |
11.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,609.20 |
$3,576 |
14.6× |
| CT upper extremity with contrast (73201) |
$1,941.30 |
$4,314 |
5.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,534.50 |
$3,410 |
8.3× |
| Cta Abdomen (74175) |
$1,654.20 |
$3,676 |
8.9× |
| CTA abdomen pelvis (74174) |
$4,545 |
$10,100 |
12.3× |
| CTA chest (71275) |
$2,799.90 |
$6,222 |
15.1× |
| Cta Head (70496) |
$2,545.20 |
$5,656 |
13.8× |
| CTA lwr ext w&w/o contrast (73706) |
$2,236.50 |
$4,970 |
12.1× |
| Cta Neck (70498) |
$2,110.05 |
$4,689 |
11.4× |
| Cta Pelvis (72191) |
$1,983.60 |
$4,408 |
10.7× |
| Cystography minimum 3 views rs&i (74430) |
$782.55 |
$1,739 |
2.1× |
| Diskogram cervical (72285) |
$2,811.15 |
$6,247 |
1.4× |
| Diskography lumbar (72295) |
$2,490.75 |
$5,535 |
1.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$189 |
$420 |
1.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$304.65 |
$677 |
2.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$422.10 |
$938 |
3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$199.80 |
$444 |
2.2× |
| Echoencephalography real time imaging (76506) |
$673.20 |
$1,496 |
6.1× |
| Esophageal motility (78258) |
$993.60 |
$2,208 |
2.4× |
| Esophagus (74220) |
$279 |
$620 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$279 |
$620 |
2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$242.10 |
$538 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$622.35 |
$1,383 |
2.5× |
| Foot 2 views (73620) |
$310.50 |
$690 |
3.4× |
| Forearm 2 views (73090) |
$283.05 |
$629 |
3.1× |
| Gated Heart Planar Single (78472) |
$2,117.25 |
$4,705 |
5.0× |
| Hand 2 views (73120) |
$310.50 |
$690 |
2.8× |
| Hand 3 views (73130) |
$315 |
$700 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,597.95 |
$3,551 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,804.90 |
$15,122 |
9.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$7,317 |
$16,260 |
10.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,585.50 |
$10,190 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,657.70 |
$5,906 |
4.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,696.95 |
$3,771 |
4.0× |
| Ht muscle image spect sing (78451) |
$2,421 |
$5,380 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$301.95 |
$671 |
3.3× |
| Hysterosalpingogram (74740) |
$636.30 |
$1,414 |
2.5× |
| Image fusion (77399) |
$481.84 |
$1,070.74 |
3.4× |
| Interstitial radiation source applic complex (77778) |
$7,521.75 |
$16,715 |
10.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$7,521.75 |
$16,715 |
10.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$6,354 |
$14,120 |
10.9× |
| Intracavitary radiation source applic simple (77761) |
$5,186.70 |
$11,526 |
8.9× |
| Kidney imaging morphology (78700) |
$1,323 |
$2,940 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,880.10 |
$4,178 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,794.60 |
$3,988 |
3.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,965.60 |
$4,368 |
3.4× |
| Knee 3 views (73562) |
$335.25 |
$745 |
3.7× |
| Liver & spleen imaging static only (78215) |
$1,621.80 |
$3,604 |
3.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,431 |
$3,180 |
3.4× |
| Lung perf&ventilat diferentl (78598) |
$1,524.15 |
$3,387 |
2.7× |
| Lung Ventilation Imaging (78579) |
$841.05 |
$1,869 |
2.0× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$7,107.30 |
$15,794 |
2.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$5,273.10 |
$11,718 |
1.6× |
| Lymphoscintigraphy (78195) |
$1,682.10 |
$3,738 |
2.9× |
| Mammary ductogram or galactogram multiple (77054) |
$569.70 |
$1,266 |
2.3× |
| Mammary ductogram or galactogram single (77053) |
$495.45 |
$1,101 |
2.0× |
| Meckels Diverticulum (78290) |
$1,072.80 |
$2,384 |
2.5× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$562.95 |
$1,251 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,521.45 |
$3,381 |
3.9× |
| Mr elastography (76391) |
$561.60 |
$1,248 |
2.2× |
| Mr safety determination physician/other qhp (76016) |
$119.70 |
$266 |
1.3× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$93.15 |
$207 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$33.30 |
$74 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$143.10 |
$318 |
1.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$377.10 |
$838 |
1.5× |
| MRA head w & w/o contrast (70546) |
$1,946.70 |
$4,326 |
5.3× |
| MRA head w/o contrast (70544) |
$1,566.45 |
$3,481 |
6.2× |
| MRA head with contrast (70545) |
$1,685.25 |
$3,745 |
4.6× |
| MRA neck w contrast (70548) |
$1,632.60 |
$3,628 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,380.50 |
$5,290 |
6.5× |
| MRA neck w/o contrast (70547) |
$1,480.95 |
$3,291 |
5.9× |
| MRI abdomen w contrast (74182) |
$1,512.90 |
$3,362 |
4.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,604.70 |
$3,566 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$1,276.20 |
$2,836 |
5.1× |
| MRI any jnt lwr ext with con lt (73722) |
$2,159.10 |
$4,798 |
2.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,507.95 |
$3,351 |
1.8× |
| MRI bone marrow blood supply (77084) |
$1,694.70 |
$3,766 |
6.7× |
| MRI breast w/o contrast bilateral (77047) |
$627.75 |
$1,395 |
2.5× |
| MRI breast w/o contrast unilat (77046) |
$511.20 |
$1,136 |
2.0× |
| MRI c-spine with contrast (72142) |
$2,043.45 |
$4,541 |
5.6× |
| MRI cardiac w/o contrast (75557) |
$1,632.60 |
$3,628 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$1,548 |
$3,440 |
6.2× |
| MRI chest w/o & w/contrast material (71552) |
$2,324.25 |
$5,165 |
6.3× |
| MRI chest w/o contrast (71550) |
$1,854 |
$4,120 |
7.4× |
| MRI chest with contrast (71551) |
$2,200.05 |
$4,889 |
2.7× |
| MRI fetal sngl/1st gestation (74712) |
$2,331 |
$5,180 |
9.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,061.90 |
$4,582 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,758.60 |
$3,908 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,227.15 |
$2,727 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,604.60 |
$5,788 |
7.1× |
| MRI orbit/face/neck w/contrast (70542) |
$2,043.45 |
$4,541 |
5.6× |
| MRI pelvis w contrast (72196) |
$1,385.55 |
$3,079 |
3.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,702.35 |
$3,783 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,178.10 |
$2,618 |
4.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,821.60 |
$4,048 |
4.9× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,904.85 |
$4,233 |
2.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,880 |
$6,400 |
7.8× |
| MRI spectroscopy (76390) |
$2,171.70 |
$4,826 |
23.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,135.70 |
$4,746 |
5.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,043.45 |
$4,541 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,128.95 |
$4,731 |
5.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,043.45 |
$4,541 |
5.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,118.15 |
$4,707 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,662.75 |
$3,695 |
6.6× |
| MRI tmj (70336) |
$1,629.45 |
$3,621 |
6.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,178.10 |
$2,618 |
4.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,627.65 |
$3,617 |
4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,178.10 |
$2,618 |
4.7× |
| Myelogram Cervical (72240) |
$2,009.70 |
$4,466 |
2.4× |
| Myelogram Lumbar (72265) |
$1,895.85 |
$4,213 |
2.3× |
| Myelogram thoracic (72255) |
$1,318.05 |
$2,929 |
1.6× |
| Myelography 2 or more regions (72270) |
$3,091.95 |
$6,871 |
3.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,791.25 |
$8,425 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$4,150.35 |
$9,223 |
3.0× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$4,024.35 |
$8,943 |
2.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$4,135.50 |
$9,190 |
2.7× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$4,846.95 |
$10,771 |
2.1× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$6,624.90 |
$14,722 |
2.9× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$5,333.40 |
$11,852 |
3.3× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,555.20 |
$3,456 |
1.7× |
| Neck soft tissue (70360) |
$310.50 |
$690 |
3.4× |
| Nm bone marrow wb (78104) |
$2,549.25 |
$5,665 |
6.0× |
| Nm cisternogram (78630) |
$1,809.90 |
$4,022 |
3.2× |
| Nm csf leak detection (78650) |
$2,294.55 |
$5,099 |
1.7× |
| Nm gastric emptying study (78264) |
$1,856.25 |
$4,125 |
4.4× |
| Nm gastroesophageal reflux study (78262) |
$993.60 |
$2,208 |
2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,151.85 |
$15,893 |
4.9× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$5,585.85 |
$12,413 |
3.7× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$3,720.60 |
$8,268 |
2.5× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,889.55 |
$4,199 |
1.4× |
| Nuclear Rx Oral Admin (79005) |
$1,229.40 |
$2,732 |
5.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$255.60 |
$568 |
2.3× |
| Orthopantogram (70355) |
$310.50 |
$690 |
3.4× |
| Osseous survey infant (77076) |
$295.65 |
$657 |
2.7× |
| Osseous survey limited (77074) |
$221.85 |
$493 |
2.0× |
| Parathyrd planar w/spect&CT (78072) |
$879.75 |
$1,955 |
1.5× |
| Parathyrd planar w/wo subtrj (78071) |
$2,388.15 |
$5,307 |
5.7× |
| Parathyroid imaging (78070) |
$1,139.85 |
$2,533 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$282.15 |
$627 |
2.6× |
| Perineogram (74775) |
$767.25 |
$1,705 |
3.0× |
| Peritoneogram rs&i (74190) |
$961.20 |
$2,136 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$4,921.20 |
$10,936 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$3,211.65 |
$7,137 |
2.1× |
| PET imaging for CT attenuation whole body (78816) |
$4,950.45 |
$11,001 |
3.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,600.10 |
$5,778 |
7.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,585.50 |
$10,190 |
1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,585.50 |
$10,190 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,147.50 |
$2,550 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,524.15 |
$3,387 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$744.30 |
$1,654 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$310.50 |
$690 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$326.25 |
$725 |
3.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$233.10 |
$518 |
2.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$357.30 |
$794 |
3.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$357.30 |
$794 |
3.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,269.80 |
$25,044 |
1.5× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$1,302.30 |
$2,894 |
2.2× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$561.15 |
$1,247 |
5.2× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$862.65 |
$1,917 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$357.30 |
$794 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$328.95 |
$731 |
3.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$357.30 |
$794 |
3.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$310.50 |
$690 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$357.30 |
$794 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$461.25 |
$1,025 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$493.65 |
$1,097 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$359.10 |
$798 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$252 |
$560 |
2.7× |
| Radiological examination surgical specimen (76098) |
$503.10 |
$1,118 |
0.9× |
| Review by radiologist of adrenal gland vein image (75840) |
$4,582.35 |
$10,183 |
1.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,370.50 |
$7,490 |
1.0× |
| Ribs bilateral 3 views (71110) |
$341.10 |
$758 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,630.80 |
$3,624 |
3.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,294.55 |
$5,099 |
4.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,333.25 |
$5,185 |
4.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,895.75 |
$6,435 |
2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,132.45 |
$6,961 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,757.60 |
$6,128 |
2.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,427.40 |
$3,172 |
5.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$645.75 |
$1,435 |
2.6× |
| Rp Therapy Intravenous Administration (79101) |
$1,204.20 |
$2,676 |
4.9× |
| Sacroiliac Joints < 3 Views (72200) |
$315.90 |
$702 |
2.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$536.85 |
$1,193 |
2.1× |
| Scanogram (77073) |
$211.50 |
$470 |
1.9× |
| Scapula complete (73010) |
$233.10 |
$518 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$80.10 |
$178 |
3.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$320.40 |
$712 |
2.9× |
| Sialogram (70390) |
$1,517.85 |
$3,373 |
6.0× |
| Simulation intermediate (77285) |
$1,407.15 |
$3,127 |
3.6× |
| Small bowel series (74250) |
$539.55 |
$1,199 |
2.9× |
| Spec medical radj physics consltj (77370) |
$463.05 |
$1,029 |
3.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,627.65 |
$3,617 |
4.1× |
| Special dosimetry (77331) |
$863.55 |
$1,919 |
6.1× |
| Special treatment procedure (77470) |
$2,327.40 |
$5,172 |
4.0× |
| Spine thoracic 3 views (72072) |
$263.25 |
$585 |
2.4× |
| Stereotactic body radiation delivery (77373) |
$8,852.85 |
$19,673 |
4.7× |
| Superior sagittal sinus venogram (75870) |
$4,585.50 |
$10,190 |
1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,351.25 |
$5,225 |
6.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$2,218.05 |
$4,929 |
5.6× |
| Testicular Imaging With Vascular Flow (78761) |
$1,247.85 |
$2,773 |
3.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,878.75 |
$4,175 |
4.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,061.55 |
$2,359 |
7.5× |
| Therapeutic Enema (74283) |
$607.05 |
$1,349 |
3.3× |
| Thoracolumbar 2 views (72080) |
$226.35 |
$503 |
2.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,247.75 |
$4,995 |
3.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$698.85 |
$1,553 |
1.7× |
| Thyroid uptake measurement (78012) |
$617.40 |
$1,372 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$828 |
$1,840 |
2.0× |
| Tmj unilateral (70328) |
$310.50 |
$690 |
3.4× |
| Tomogram (76100) |
$380.70 |
$846 |
3.5× |
| Treatment device intermediate (77333) |
$930.15 |
$2,067 |
6.6× |
| Treatment devices simple (77332) |
$517.50 |
$1,150 |
3.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,741.85 |
$6,093 |
4.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,365.75 |
$3,035 |
3.2× |
| Tx devices design & construction complex (77334) |
$1,449 |
$3,220 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$460.80 |
$1,024 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$198 |
$440 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$502.26 |
$1,116.13 |
5.5× |
| Unlisted fluoroscopic procedure (76496) |
$247.25 |
$549.44 |
2.7× |
| Unlisted magnetic resonance procedure (76498) |
$561.62 |
$1,248.04 |
6.1× |
| Unlisted Ultrasound Procedure (76999) |
$339.33 |
$754.05 |
3.7× |
| Upper Extremity Infant (73092) |
$310.50 |
$690 |
2.8× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$430.65 |
$957 |
4.6× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,247.85 |
$2,773 |
3.0× |
| Urethrocystography retrograde rs&i (74450) |
$767.25 |
$1,705 |
3.0× |
| Urethrocystography voiding (74455) |
$992.70 |
$2,206 |
3.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$914.85 |
$2,033 |
4.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$914.85 |
$2,033 |
4.9× |
| Us abdl aorta screen aaa (76706) |
$347.85 |
$773 |
3.2× |
| Us breast unilateral complete (76641) |
$230.40 |
$512 |
2.1× |
| Us breast unilateral limited (76642) |
$197.10 |
$438 |
2.1× |
| Us chest (76604) |
$328.05 |
$729 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$350.55 |
$779 |
3.2× |
| Us elastography parenchyma (76981) |
$191.70 |
$426 |
1.7× |
| Us fetal nuchal translucency 1st gestation (76813) |
$205.20 |
$456 |
1.9× |
| Us guided compression repair (76936) |
$610.20 |
$1,356 |
2.7× |
| Us infant hips dynamic (76885) |
$531.90 |
$1,182 |
5.8× |
| Us infant hips limited static (76886) |
$334.35 |
$743 |
3.6× |
| Us kidney transplant (76776) |
$531 |
$1,180 |
4.8× |
| Us ob detailed single fetus (76811) |
$551.70 |
$1,226 |
2.2× |
| Us ob transvaginal (76817) |
$390.15 |
$867 |
3.5× |
| Us pelvic non ob complete (76856) |
$688.95 |
$1,531 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$481.95 |
$1,071 |
4.4× |
| Us pregnancy ltd (76815) |
$323.10 |
$718 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$545.85 |
$1,213 |
4.9× |
| Us retroperitoneal complete (76770) |
$667.35 |
$1,483 |
6.1× |
| Us retroperitoneal limited (76775) |
$618.75 |
$1,375 |
5.6× |
| Us scrotum and contents (76870) |
$537.75 |
$1,195 |
4.9× |
| Us soft tissue head/neck (76536) |
$310.95 |
$691 |
2.8× |
| Us spinal canal and contents (76800) |
$511.65 |
$1,137 |
4.6× |
| Us transrectal (76872) |
$301.05 |
$669 |
2.7× |
| Us transrectal prostate volume (76873) |
$531.90 |
$1,182 |
4.8× |
| Us xtr non-vasc lmtd (76882) |
$297.45 |
$661 |
2.7× |
| Us, eye b-scan (76512) |
$339.30 |
$754 |
3.1× |
| Venogram extremity bilateral (75822) |
$2,591.10 |
$5,758 |
1.6× |
| Venography caval inferior serialography rs&i (75825) |
$2,980.35 |
$6,623 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$2,591.10 |
$5,758 |
1.6× |
| Venography extremity unilateral rs&i (75820) |
$2,253.15 |
$5,007 |
1.4× |
| Venography Renal Bilateral (75833) |
$7,240.50 |
$16,090 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$4,217.85 |
$9,373 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,585.50 |
$10,190 |
1.4× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$6,269.40 |
$13,932 |
1.1× |
| Wrist 2 views (73100) |
$288 |
$640 |
3.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$372.60 |
$828 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$202.05 |
$449 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$310.50 |
$690 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$493.65 |
$1,097 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$279.90 |
$622 |
3.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$310.50 |
$690 |
3.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$341.55 |
$759 |
3.1× |
| X-ray exam hip uni 1 view (73501) |
$202.05 |
$449 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$281.25 |
$625 |
3.1× |
| X-ray exam hip uni 4/> views (73503) |
$341.55 |
$759 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$304.20 |
$676 |
2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$357.30 |
$794 |
3.2× |
| X-ray exam of femur 1 (73551) |
$202.05 |
$449 |
2.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$563.85 |
$1,253 |
3.0× |
| X-ray eye for foreign body (70030) |
$310.50 |
$690 |
3.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$357.30 |
$794 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$209.25 |
$465 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$334.80 |
$744 |
3.6× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,873.25 |
$6,385 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$305.55 |
$679 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$310.50 |
$690 |
3.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$357.30 |
$794 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$310.50 |
$690 |
3.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$310.50 |
$690 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$229.05 |
$509 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$357.30 |
$794 |
3.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$236.70 |
$526 |
2.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$310.50 |
$690 |
3.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$310.50 |
$690 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$310.50 |
$690 |
2.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$357.30 |
$794 |
3.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$743.85 |
$1,653 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$310.50 |
$690 |
3.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$333.45 |
$741 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$357.30 |
$794 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$357.30 |
$794 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$303.30 |
$674 |
3.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$310.50 |
$690 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$357.30 |
$794 |
3.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$310.50 |
$690 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$357.30 |
$794 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$310.50 |
$690 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$279.45 |
$621 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$357.30 |
$794 |
3.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$310.50 |
$690 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$202.05 |
$449 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$302.85 |
$673 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$310.50 |
$690 |
3.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$310.50 |
$690 |
3.4× |
| Xr arthrogram ankle (73615) |
$888.75 |
$1,975 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$357.30 |
$794 |
3.2× |
| Xr chest 4+ views (71048) |
$357.30 |
$794 |
3.2× |
| Xr finger(s) 2+ views (73140) |
$222.75 |
$495 |
2.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$310.50 |
$690 |
2.8× |
| Xr shoulder 1 view (73020) |
$252 |
$560 |
2.7× |
| Xr spine cervical 4 or 5 views (72050) |
$307.35 |
$683 |
2.8× |
| Xr tibia/fibula 2 views (73590) |
$298.35 |
$663 |
3.3× |
| Xr tmj bilateral (70330) |
$357.30 |
$794 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$306.45 |
$681 |
3.3× |