| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,754.60 |
$9,591 |
4.3× |
| Abdomen 1 View (74018) |
$249 |
$415 |
3.0× |
| Abdomen 2 views (74019) |
$295.80 |
$493 |
3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,036.20 |
$1,727 |
2.7× |
| Angio internal mammary (75756) |
$629.40 |
$1,049 |
0.2× |
| Angio pulmonary bilat (75743) |
$712.80 |
$1,188 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$4,462.80 |
$7,438 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$2,187.60 |
$3,646 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,546.80 |
$2,578 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,276.20 |
$2,127 |
0.4× |
| Ankle 2 views (73600) |
$262.20 |
$437 |
3.2× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,364 |
$3,940 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$2,188.80 |
$3,648 |
0.7× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,420.40 |
$4,034 |
0.5× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$1,652.40 |
$2,754 |
0.3× |
| Arthrogram ankle (73615) |
$567.60 |
$946 |
1.7× |
| Arthrogram hip (73525) |
$549.60 |
$916 |
1.6× |
| Arthrogram Wrist (73115) |
$1,873.80 |
$3,123 |
5.6× |
| Basic radiation dosimetry calculation (77300) |
$554.40 |
$924 |
4.3× |
| Bone age studies (77072) |
$98.40 |
$164 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,707 |
$2,845 |
4.5× |
| Bone Imaging Limited Area (78300) |
$1,365.60 |
$2,276 |
3.6× |
| Bone Imaging Multiple Areas (78305) |
$631.80 |
$1,053 |
1.7× |
| Bone Imaging Whole Body (78306) |
$1,707 |
$2,845 |
4.5× |
| Bone marrow imaging limited area (78102) |
$697.20 |
$1,162 |
1.8× |
| Bone marrow imaging; multiple areas (78103) |
$527.40 |
$879 |
1.4× |
| Bone marrow imaging; whole body (78104) |
$956.40 |
$1,594 |
2.5× |
| Bone survey infant (77076) |
$148.80 |
$248 |
1.5× |
| Brachytx isodose complex (77318) |
$1,831.20 |
$3,052 |
5.1× |
| Brain Image W/Flow < 4 Views (78601) |
$527.40 |
$879 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,044.80 |
$3,408 |
1.5× |
| Cat Scan Follow-Up Study (76380) |
$720 |
$1,200 |
8.7× |
| Cerebrospinal Fluid Scan (78630) |
$629.40 |
$1,049 |
1.2× |
| Chest 1 view (71045) |
$267.60 |
$446 |
3.2× |
| Chest 2 views (71046) |
$334.80 |
$558 |
4.0× |
| Chest 3 views (71047) |
$369.60 |
$616 |
4.4× |
| Chest 4 or more views (71048) |
$452.40 |
$754 |
4.5× |
| Cholecystography Oral Contrast (74290) |
$271.80 |
$453 |
1.6× |
| Clavicle complete (73000) |
$297.60 |
$496 |
3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$176.40 |
$294 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$780.60 |
$1,301 |
6.1× |
| Contrast Exam Abdominl Aorta (75625) |
$2,982 |
$4,970 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$609.60 |
$1,016 |
1.8× |
| Contrast X-Ray Of Elbow (73085) |
$730.20 |
$1,217 |
2.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$583.20 |
$972 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,702.40 |
$9,504 |
17.1× |
| CT abdomen and pelvis without contrast (74176) |
$4,300.80 |
$7,168 |
18.9× |
| CT abdomen w contrast (74160) |
$2,109 |
$3,515 |
12.6× |
| CT abdomen w wo contrast (74170) |
$2,812.20 |
$4,687 |
16.8× |
| CT abdomen w/o contrast (74150) |
$1,800 |
$3,000 |
18.0× |
| CT Angio Abdomen and Pelvis (74174) |
$4,503 |
$7,505 |
13.5× |
| CT Angio Chest (71275) |
$3,037.20 |
$5,062 |
18.1× |
CT Angio Head (70496)
range across 2 matching MRF lines |
$2,838.60–$3,118.80 |
$4,731–$5,198 |
varies |
| CT angio hrt w/3d image (75574) |
$1,836.60 |
$3,061 |
5.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,266.20 |
$3,777 |
13.5× |
| CT Angio Neck (70498) |
$3,012.60 |
$5,021 |
18.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,784.40 |
$2,974 |
10.6× |
| CT cervical spine w/ contrast (72126) |
$2,110.80 |
$3,518 |
6.3× |
| CT cervical spine w/o contrast (72125) |
$1,936.20 |
$3,227 |
19.4× |
| CT cervical spine w/wo cont (72127) |
$1,839.60 |
$3,066 |
11.0× |
| CT chest w contrast (71260) |
$2,293.80 |
$3,823 |
13.7× |
| CT chest w/wo contrast (71270) |
$3,007.20 |
$5,012 |
17.9× |
| CT head/brain with contrast (70460) |
$1,930.80 |
$3,218 |
11.5× |
| CT head/brain without and with contrast (70470) |
$2,925 |
$4,875 |
17.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$257.40 |
$429 |
0.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$110.40 |
$184 |
1.3× |
| CT iac w contrast (70481) |
$1,764.60 |
$2,941 |
10.5× |
| CT l-spine w&w/o contrast (72133) |
$2,082 |
$3,470 |
12.4× |
| CT lower ext w/o (73700) |
$1,791.60 |
$2,986 |
17.9× |
| CT lower extremity w/contrast material (73701) |
$2,310.60 |
$3,851 |
13.8× |
| CT lumbar spine w contrast (72132) |
$2,120.40 |
$3,534 |
6.4× |
| CT lumbar spine w/o contrast (72131) |
$1,927.80 |
$3,213 |
19.3× |
| CT maxillofacial w contrast (70487) |
$1,842.60 |
$3,071 |
11.0× |
| CT maxillofacial wo contrast (70486) |
$1,486.20 |
$2,477 |
14.9× |
| CT neck tissue combo (70492) |
$3,222 |
$5,370 |
19.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,233.20 |
$3,722 |
13.3× |
| CT orbits w/o contrast (70480) |
$1,561.80 |
$2,603 |
15.6× |
| CT pelvis w&w/o contrast (72194) |
$2,268.60 |
$3,781 |
13.5× |
| CT pelvis w/o contrast (72192) |
$1,502.40 |
$2,504 |
15.0× |
| CT scan of leg combo (73702) |
$2,077.80 |
$3,463 |
12.4× |
| CT scans face/jaw combo (70488) |
$2,674.80 |
$4,458 |
16.0× |
| CT soft tissue neck w contrast (70491) |
$2,285.40 |
$3,809 |
13.6× |
| CT soft tissue neck w/o contrast (70490) |
$2,170.80 |
$3,618 |
21.7× |
| CT thoracic spine w contrast (72129) |
$1,978.80 |
$3,298 |
11.8× |
| CT thoracic spine w/o contrast (72128) |
$1,866.60 |
$3,111 |
18.7× |
| CT thoracic spine w/wo cont (72130) |
$2,034.60 |
$3,391 |
12.1× |
| CT thorax w/o contrast (71250) |
$1,927.80 |
$3,213 |
19.3× |
| CT upper ext wo (73200) |
$1,796.40 |
$2,994 |
18.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,383 |
$2,305 |
8.2× |
| CT upper extremity with contrast (73201) |
$1,850.40 |
$3,084 |
5.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,513.40 |
$4,189 |
15.0× |
| Cta Abdomen (74175) |
$3,332.40 |
$5,554 |
19.9× |
| CTA pelvis (72191) |
$2,233.20 |
$3,722 |
13.3× |
| Discography Cerv/Thor Spine (72285) |
$1,726.80 |
$2,878 |
0.9× |
| Diskography lumbar (72295) |
$1,726.80 |
$2,878 |
0.9× |
| Dxa Bone Density Axial (77080) |
$493.80 |
$823 |
4.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$172.80 |
$288 |
2.1× |
| Echograp Trans R Pros Study (76873) |
$243.60 |
$406 |
2.4× |
| Esophagram (74220) |
$448.80 |
$748 |
2.7× |
| Fetal Biophys Profile W/Nst (76818) |
$545.40 |
$909 |
5.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$510 |
$850 |
5.1× |
| Fluoroscopy up to 1 hr (76000) |
$756 |
$1,260 |
3.3× |
| Follow-Up Angiography (75898) |
$4,006.80 |
$6,678 |
1.3× |
| Foot 2 views (73620) |
$225.60 |
$376 |
2.7× |
| Forearm 2 views (73090) |
$240.60 |
$401 |
2.9× |
| Gastric emptying imaging study (78264) |
$1,483.80 |
$2,473 |
3.9× |
| Gastroesophageal Reflux Exam (78262) |
$527.40 |
$879 |
1.4× |
| Gated Heart Planar Single (78472) |
$1,536 |
$2,560 |
4.0× |
| Hand 2 views (73120) |
$246.60 |
$411 |
2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,199.60 |
$3,666 |
0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,006.80 |
$6,678 |
1.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,813.80 |
$3,023 |
3.5× |
| Hepatobiliary System Imaging (78226) |
$1,813.80 |
$3,023 |
4.7× |
| Ht Muscle Image Spect Sing (78451) |
$3,245.40 |
$5,409 |
2.6× |
| Hysterosalpingogram (74740) |
$374.40 |
$624 |
1.6× |
| Image fusion (77399) |
$455.40 |
$759 |
3.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$484.20 |
$807 |
5.8× |
| Infant hip ultrasound, limited static exam (76886) |
$111.60 |
$186 |
1.3× |
| Interstitial radiation source applic complex (77778) |
$4,995.60 |
$8,326 |
7.5× |
| K Flow/Funct Image Multiple (78709) |
$1,255.20 |
$2,092 |
2.4× |
| K Flow/Funct Image W/Drug (78708) |
$1,960.80 |
$3,268 |
3.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,999.80 |
$3,333 |
3.9× |
| Knee 3 Views (73562) |
$371.40 |
$619 |
4.5× |
| Liver & Spleen Imaging Static Only (78215) |
$1,012.80 |
$1,688 |
2.7× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,533.60 |
$2,556 |
3.0× |
| Lung perfusion differential (78597) |
$1,090.80 |
$1,818 |
2.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,384.80 |
$2,308 |
2.7× |
| Lung Ventilation Imaging (78579) |
$817.20 |
$1,362 |
2.1× |
| Lymph System Imaging (78195) |
$1,204.80 |
$2,008 |
2.3× |
| Magnetic Image Jaw Joint (70336) |
$1,931.40 |
$3,219 |
8.5× |
| Mammary ductogram or galactogram single (77053) |
$390.60 |
$651 |
1.7× |
| Meckels Divert Exam (78290) |
$1,407.60 |
$2,346 |
3.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,723.40 |
$4,539 |
7.6× |
| Mr safety determination physician/other qhp (76016) |
$123.60 |
$206 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$34.80 |
$58 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$129 |
$215 |
1.4× |
| Mr safety implt pos&/immoblj (76019) |
$83.40 |
$139 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$339 |
$565 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,705 |
$6,175 |
11.1× |
| MRA head w/o contrast (70544) |
$2,503.20 |
$4,172 |
11.0× |
| MRA head with contrast (70545) |
$3,404.40 |
$5,674 |
10.2× |
| MRA neck w contrast (70548) |
$2,303.40 |
$3,839 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,916 |
$4,860 |
8.7× |
| MRA neck w/o contrast (70547) |
$2,041.20 |
$3,402 |
9.0× |
| MRI abdomen w contrast (74182) |
$3,393.60 |
$5,656 |
10.2× |
| MRI abdomen w/o contrast (74181) |
$2,794.80 |
$4,658 |
12.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,528.60 |
$5,881 |
4.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,822.60 |
$6,371 |
11.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,297.60 |
$5,496 |
4.4× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,558.40 |
$4,264 |
11.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,704 |
$2,840 |
7.5× |
| MRI cervical spine w contrast (72142) |
$3,300 |
$5,500 |
9.9× |
| MRI cervical spine w/o cont (72141) |
$2,973 |
$4,955 |
13.0× |
| MRI chest w/o contrast (71550) |
$1,983.60 |
$3,306 |
8.7× |
| MRI chest with contrast (71551) |
$1,001.40 |
$1,669 |
1.3× |
| MRI chest wo w contrast (71552) |
$2,953.80 |
$4,923 |
8.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$645.60 |
$1,076 |
1.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,397.20 |
$5,662 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,276.40 |
$3,794 |
10.0× |
| MRI lumbar spine w contrast (72149) |
$3,508.20 |
$5,847 |
10.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,864.60 |
$6,441 |
11.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,408.40 |
$4,014 |
10.6× |
| MRI orbit face neck w contrast (70542) |
$541.80 |
$903 |
1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,010.20 |
$5,017 |
9.0× |
| MRI pelvis w contrast (72196) |
$618.60 |
$1,031 |
1.9× |
| MRI pelvis w/o & w contrast (72197) |
$3,435.60 |
$5,726 |
10.3× |
| MRI pelvis w/o contrast (72195) |
$2,199 |
$3,665 |
9.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,973 |
$4,955 |
13.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$594 |
$990 |
1.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,210.40 |
$3,684 |
9.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,298.80 |
$5,498 |
9.9× |
| MRI, abdomen, combo (74183) |
$3,992.40 |
$6,654 |
12.0× |
| MRI, dorsal spine combo (72157) |
$3,924 |
$6,540 |
11.8× |
| MRI, dorsal spine contrast (72147) |
$3,567.60 |
$5,946 |
10.7× |
| MRI, joint upper extrem (73221) |
$2,771.40 |
$4,619 |
12.2× |
| MRI, joint upper extrem combo (73223) |
$3,796.80 |
$6,328 |
11.4× |
| MRI, lumbar spine combo (72158) |
$3,924 |
$6,540 |
11.8× |
| Myelogram cervical (72240) |
$1,001.40 |
$1,669 |
1.3× |
| Myelogram Lumbar (72265) |
$1,001.40 |
$1,669 |
1.3× |
| Myelography thoracic (72255) |
$1,001.40 |
$1,669 |
1.3× |
| Myelograpy 2/more regions rs&i (72270) |
$1,001.40 |
$1,669 |
1.3× |
| Myocardial Spect Multiple Studies (78452) |
$4,327.20 |
$7,212 |
3.5× |
| Neck soft tissue (70360) |
$237.60 |
$396 |
2.9× |
| Nm csf leak detection (78650) |
$1,190.40 |
$1,984 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,680.40 |
$11,134 |
5.0× |
| Nuclear Rx Oral Admin (79005) |
$808.20 |
$1,347 |
3.6× |
| Parathyroid Planar Imaging (78070) |
$796.80 |
$1,328 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$178.80 |
$298 |
1.8× |
| PET image w/CT, full body (78816) |
$4,951.80 |
$8,253 |
3.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,951.80 |
$8,253 |
3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,006.80 |
$6,678 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,066.20 |
$1,777 |
2.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$582 |
$970 |
5.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$457.20 |
$762 |
0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$391.80 |
$653 |
4.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$229.80 |
$383 |
2.8× |
| Radex elbow complete minimum 3 views (73080) |
$343.20 |
$572 |
4.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$398.40 |
$664 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$323.40 |
$539 |
3.9× |
| Radex foot complete minimum 3 views (73630) |
$363.60 |
$606 |
4.4× |
| Radex Hand Minimum 3 Views (73130) |
$403.80 |
$673 |
4.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$127.20 |
$212 |
1.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$240.60 |
$401 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$241.80 |
$403 |
2.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$404.40 |
$674 |
4.9× |
| Radex shoulder complete minimum 2 views (73030) |
$415.80 |
$693 |
5.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$172.80 |
$288 |
2.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$277.80 |
$463 |
1.7× |
| Radex Spine 1 View Specify Level (72020) |
$208.20 |
$347 |
2.5× |
| Radex Sternum Minimum 2 Views (71120) |
$210 |
$350 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$292.20 |
$487 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$295.20 |
$492 |
3.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$157.80 |
$263 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$402 |
$670 |
4.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$423.60 |
$706 |
4.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,179.20 |
$18,632 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$548.40 |
$914 |
5.6× |
| Radiation treatment delivery level 2 (77407) |
$383.40 |
$639 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$582 |
$970 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$353.40 |
$589 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$330.60 |
$551 |
3.3× |
| Radiologic exam colon double contrast study (74280) |
$819 |
$1,365 |
4.9× |
| Radiologic exam colon single contrast study (74270) |
$514.80 |
$858 |
3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$366.60 |
$611 |
2.2× |
| Radiologic exam knee complete 4/more views (73564) |
$453.60 |
$756 |
4.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$235.80 |
$393 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$478.80 |
$798 |
2.9× |
| Radiologic exam swallow function contrast study (74230) |
$397.20 |
$662 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$780 |
$1,300 |
4.7× |
| Radiologic examination femur 1 view (73551) |
$189 |
$315 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$236.40 |
$394 |
2.8× |
| Radiologic examination knee 1/2 views (73560) |
$249 |
$415 |
3.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$256.20 |
$427 |
3.1× |
| Radiopharm Dacryocystography (78660) |
$583.80 |
$973 |
1.5× |
| Ribs bilateral 3 views (71110) |
$450 |
$750 |
4.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$831.60 |
$1,386 |
2.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$831.60 |
$1,386 |
2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,648.80 |
$2,748 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,261.20 |
$2,102 |
2.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,385.40 |
$2,309 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,385.40 |
$2,309 |
1.1× |
| Rp Therapy Intravenous Administration (79101) |
$896.40 |
$1,494 |
4.0× |
| Scapula (73010) |
$236.40 |
$394 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$64.20 |
$107 |
2.7× |
| Shoulder 1 view (73020) |
$274.20 |
$457 |
3.3× |
| Shoulder Arthrography (73040) |
$670.20 |
$1,117 |
2.0× |
| Sialogram (70390) |
$372.60 |
$621 |
1.6× |
| Skull less than 4 views (70250) |
$256.80 |
$428 |
2.6× |
| Special dosimetry (77331) |
$515.40 |
$859 |
4.0× |
| Special Physics Consult (77370) |
$928.80 |
$1,548 |
7.2× |
| Special teletherapy port plan (77321) |
$1,236.60 |
$2,061 |
3.5× |
| Special treatment procedure (77470) |
$2,482.20 |
$4,137 |
4.7× |
| Stereotactic Body Radiation Delivery (77373) |
$2,569.20 |
$4,282 |
1.5× |
| Sternoclavicular joints (71130) |
$189 |
$315 |
2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$3,751.80 |
$6,253 |
10.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,575.60 |
$2,626 |
4.4× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$2,011.80 |
$3,353 |
5.6× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,549.20 |
$2,582 |
4.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,126.20 |
$1,877 |
8.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$250.20 |
$417 |
1.5× |
| Thoracic spine 2 views (72070) |
$354 |
$590 |
3.5× |
| Thoracic spine 3 views (72072) |
$428.40 |
$714 |
4.3× |
| Thoracolumbar 2 views (72080) |
$384 |
$640 |
4.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$741 |
$1,235 |
1.9× |
| Thyroid Met Imaging Body (78018) |
$1,023.60 |
$1,706 |
2.0× |
| Thyroid Uptake Measurement (78012) |
$527.40 |
$879 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,453.20 |
$2,422 |
3.8× |
| Tx Devices Design & Construction Complex (77334) |
$1,504.80 |
$2,508 |
4.2× |
| Tx devices design & construction simple (77332) |
$677.40 |
$1,129 |
5.3× |
| Ultrasound Breast Limited (76642) |
$435 |
$725 |
5.2× |
| Ultrasound Elastography Parenchyma (76981) |
$152.40 |
$254 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$133.20 |
$222 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$745.80 |
$1,243 |
7.5× |
| Unlisted fluoroscopic procedure (76496) |
$113.40 |
$189 |
1.4× |
| Unlisted us procedure (76999) |
$363 |
$605 |
4.4× |
| Upper gi w/o kub (74240) |
$623.40 |
$1,039 |
3.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$26.40 |
$44 |
2.4× |
| Ureteral Reflux Study (78740) |
$527.40 |
$879 |
1.4× |
| Urethrocystogram voiding (74455) |
$609.60 |
$1,016 |
2.7× |
| Urethrocystography retrograde (74450) |
$322.20 |
$537 |
1.4× |
| Us breast unilateral complete (76641) |
$652.20 |
$1,087 |
6.5× |
| Us chest (76604) |
$337.80 |
$563 |
3.4× |
| Us complete joint (76881) |
$492.60 |
$821 |
4.9× |
| Us exam, pelvic, limited (76857) |
$450 |
$750 |
4.5× |
| Us head (76506) |
$504.60 |
$841 |
5.0× |
| Us kidney transplant (76776) |
$152.40 |
$254 |
1.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$421.20 |
$702 |
4.2× |
| Us ob detailed single fetus (76811) |
$318.60 |
$531 |
1.4× |
| Us ob limited 1 or more fetuses (76815) |
$512.40 |
$854 |
5.1× |
| Us ob transvaginal (76817) |
$461.40 |
$769 |
4.6× |
| Us pelvic non ob complete (76856) |
$817.80 |
$1,363 |
8.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$441.60 |
$736 |
4.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$373.80 |
$623 |
3.7× |
| Us retroperitoneal complete (76770) |
$622.20 |
$1,037 |
6.2× |
| Us retroperitoneal limited (76775) |
$591 |
$985 |
5.9× |
| Us scrotum and contents (76870) |
$638.40 |
$1,064 |
6.4× |
| Us spinal canal and contents (76800) |
$288.60 |
$481 |
2.9× |
| Us thyroid (76536) |
$627 |
$1,045 |
6.3× |
| Vein X-Ray Chest (75827) |
$1,968 |
$3,280 |
1.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$4,006.80 |
$6,678 |
1.3× |
| Venogram Sinus/Jugular (75860) |
$1,305 |
$2,175 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,130.60 |
$3,551 |
0.7× |
| Venography extremity bilateral rs&i (75822) |
$2,064 |
$3,440 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$1,002 |
$1,670 |
0.7× |
| Venography Renal Bilateral (75833) |
$4,006.80 |
$6,678 |
1.3× |
| Venography Renal Unilateral (75831) |
$1,959 |
$3,265 |
0.6× |
| Wrist 2 views (73100) |
$257.40 |
$429 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$353.40 |
$589 |
4.2× |
| X-ray antegrade pyelogram tube (74425) |
$242.40 |
$404 |
0.7× |
| X-Ray Aorta Leg Arteries (75630) |
$2,355.60 |
$3,926 |
0.8× |
| X-Ray Bend Only L-S Spine (72120) |
$430.20 |
$717 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$274.80 |
$458 |
3.3× |
| X-Ray Exam Breast Specimen (76098) |
$199.20 |
$332 |
0.4× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$213 |
$355 |
2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$266.40 |
$444 |
2.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$351.60 |
$586 |
3.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$183.60 |
$306 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$229.80 |
$383 |
2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$276 |
$460 |
2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$273.60 |
$456 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$328.80 |
$548 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$395.40 |
$659 |
4.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$613.80 |
$1,023 |
6.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$462 |
$770 |
5.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$799.80 |
$1,333 |
8.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$417 |
$695 |
4.2× |
| X-ray eye for foreign body (70030) |
$164.40 |
$274 |
2.0× |
| X-ray humerus (73060) |
$285 |
$475 |
3.4× |
| X-ray IV pyelogram (ivp) (74400) |
$446.40 |
$744 |
2.7× |
| X-ray IV pyelogram+tomography (74415) |
$250.20 |
$417 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$134.40 |
$224 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$208.20 |
$347 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$391.20 |
$652 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$156 |
$260 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$533.40 |
$889 |
5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$346.80 |
$578 |
3.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$220.20 |
$367 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$333.60 |
$556 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$442.80 |
$738 |
5.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$606.60 |
$1,011 |
6.1× |
| X-ray thoracic spine 4 vw (72074) |
$460.80 |
$768 |
4.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$515.40 |
$859 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$286.20 |
$477 |
2.9× |
| X-Rays Bone Survey Complete (77075) |
$596.40 |
$994 |
6.0× |
| Xr c-spine 4 or 5 views (72050) |
$517.80 |
$863 |
5.2× |
| Xr facial bones less than 3 views (70140) |
$203.40 |
$339 |
2.4× |
| Xr orbits complete 4 views (70200) |
$292.20 |
$487 |
2.9× |
| Xr Tomogram Single Plane (76100) |
$444 |
$740 |
4.4× |