| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,006 |
$15,030 |
2.3× |
| Abdomen 2 views (74019) |
$244.80 |
$1,224 |
2.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$439.80 |
$2,199 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,264.40 |
$6,322 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$3,447.20 |
$17,236 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$1,723.60 |
$8,618 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$1,184.60 |
$5,923 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,325.20 |
$11,626 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,253.70 |
$6,268.50 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,168.60 |
$5,843 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,554.80 |
$7,774 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,702.20 |
$13,511 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$707.60 |
$3,538 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$864.40 |
$4,322 |
0.3× |
| Ankle 2 views (73600) |
$113.20 |
$566 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$446.88 |
$2,234.40 |
1.4× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,473.80 |
$12,369 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,939.60 |
$9,698 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,322.80 |
$11,614 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$1,580.40 |
$7,902 |
0.5× |
| Arthrogram elbow (73085) |
$268.80 |
$1,344 |
0.8× |
| Arthrogram hip (73525) |
$309.60 |
$1,548 |
1.0× |
| Arthrogram shoulder (73040) |
$466.40 |
$2,332 |
1.4× |
| Arthrogram wrist (73115) |
$310.60 |
$1,553 |
1.0× |
| Arthrography knee lt (73580) |
$325.60 |
$1,628 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$356.20 |
$1,781 |
2.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$277.20 |
$1,386 |
0.7× |
| Bone &/joint imaging whole body (78306) |
$759.40 |
$3,797 |
2.0× |
| Bone age studies (77072) |
$60 |
$300 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$728.20 |
$3,641 |
2.0× |
| Bone survey complete (77075) |
$605.20 |
$3,026 |
6.2× |
| Brachytx isodose complex (77318) |
$957 |
$4,785 |
2.7× |
| Brachytx isodose intermed (77317) |
$358.20 |
$1,791 |
1.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$225 |
$1,125 |
0.6× |
| Brain imaging < 4 static views (78600) |
$231.60 |
$1,158 |
0.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$821.20 |
$4,106 |
0.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$543.60 |
$2,718 |
1.7× |
| Cardiac shunt detection (78428) |
$244.20 |
$1,221 |
0.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$322.20 |
$1,611 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$213.80 |
$1,069 |
2.6× |
| Chest 1 view (71045) |
$127.20 |
$636 |
1.6× |
| Chest 3 views (71047) |
$320.60 |
$1,603 |
3.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$308.20 |
$1,541 |
1.9× |
| Clavicle complete (73000) |
$153.80 |
$769 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$203.30 |
$344.50 |
2.1× |
| Continuing medical physics consltj pr wk (77336) |
$520.20 |
$2,601 |
4.1× |
| Corpora cavernosography (74445) |
$136.40 |
$682 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,090.60 |
$10,453 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,742.20 |
$8,711 |
7.8× |
| CT abdomen w contrast (74160) |
$963.20 |
$4,816 |
5.9× |
| CT abdomen w wo contrast (74170) |
$1,155.80 |
$5,779 |
7.1× |
| CT abdomen w/o contrast (74150) |
$963.20 |
$4,816 |
9.9× |
| CT angio hrt w/3d image (75574) |
$486.40 |
$2,432 |
1.5× |
| CT angiography upper extremity lt (73206) |
$875.40 |
$4,377 |
5.3× |
| CT c-spine w/o contrast (72125) |
$1,202.20 |
$6,011 |
12.3× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$780.80 |
$3,904 |
4.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,442.60 |
$7,213 |
8.8× |
| CT cervical spine with contrast (72126) |
$1,202.20 |
$6,011 |
3.7× |
| CT chest w/wo contrast (71270) |
$1,217.60 |
$6,088 |
7.4× |
| CT chest with contrast (71260) |
$1,014.60 |
$5,073 |
6.2× |
| CT colonography screening (74263) |
$247.80 |
$1,239 |
1.1× |
| CT colonography w/dye (74262) |
$405.40 |
$2,027 |
2.5× |
| CT colonography w/o cntrst (74261) |
$356.60 |
$1,783 |
3.7× |
| CT head/brain with contrast (70460) |
$911.60 |
$4,558 |
5.6× |
| CT head/brain without and with contrast (70470) |
$1,094 |
$5,470 |
6.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$391.20 |
$1,956 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$21 |
$35 |
0.3× |
| CT hrt w/3d image congen (75573) |
$268.80 |
$1,344 |
0.8× |
| CT iac w contrast (70481) |
$831.20 |
$4,156 |
5.1× |
| CT limited/localized follow up study (76380) |
$720.20 |
$3,601 |
8.9× |
| CT lower ext w/o (73700) |
$942.40 |
$4,712 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$1,130.80 |
$5,654 |
6.9× |
| CT lower extremity with contrast (73701) |
$942.40 |
$4,712 |
5.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,433.60 |
$7,168 |
8.8× |
| CT lumbar spine w/o contrast (72131) |
$1,194.60 |
$5,973 |
12.2× |
| CT lumbar spine with contrast (72132) |
$1,194.60 |
$5,973 |
3.7× |
| CT maxillofacial w contrast (70487) |
$1,023.80 |
$5,119 |
6.3× |
| CT maxillofacial w/o contrast (70486) |
$1,023.80 |
$5,119 |
10.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,228.60 |
$6,143 |
7.5× |
| CT neck soft tissue w contrast (70491) |
$881.60 |
$4,408 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$997.40 |
$4,987 |
6.1× |
| CT orbits w/o contrast (70480) |
$831.20 |
$4,156 |
8.5× |
| CT pelvis w & w/o contrast (72194) |
$956.40 |
$4,782 |
5.8× |
| CT pelvis w/o contrast (72192) |
$797 |
$3,985 |
8.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,058 |
$5,290 |
6.5× |
| CT soft tissue neck w/o contrast (70490) |
$881.60 |
$4,408 |
9.0× |
| CT thoracic spine w/contrast (72129) |
$1,249.40 |
$6,247 |
7.6× |
| CT thoracic spine w/o contrast (72128) |
$1,249.40 |
$6,247 |
12.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,499.20 |
$7,496 |
9.2× |
| CT thorax w/o contrast (71250) |
$1,014.60 |
$5,073 |
10.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$795.60 |
$3,978 |
4.9× |
| CT upper extremity w/o contrast rt (73200) |
$663 |
$3,315 |
6.8× |
| CT upper extremity with contrast (73201) |
$663 |
$3,315 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,329.40 |
$6,647 |
8.1× |
| Cta Abdomen (74175) |
$1,058.80 |
$5,294 |
6.5× |
| CTA abdomen pelvis (74174) |
$2,702.80 |
$13,514 |
8.3× |
| CTA chest (71275) |
$1,463.40 |
$7,317 |
8.9× |
| Cta Head (70496) |
$1,642.20 |
$8,211 |
10.0× |
| CTA lwr ext w&w/o contrast (73706) |
$821 |
$4,105 |
5.0× |
| Cta Neck (70498) |
$1,485.20 |
$7,426 |
9.1× |
| Cta Pelvis (72191) |
$955.80 |
$4,779 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$505.72 |
$2,528.60 |
1.6× |
| Diskogram cervical (72285) |
$1,158.60 |
$5,793 |
0.6× |
| Diskography lumbar (72295) |
$1,014.60 |
$5,073 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$119.20 |
$596 |
1.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$137.80 |
$689 |
1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$68.60 |
$343 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$270 |
$1,350 |
2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$36.50 |
$182.50 |
0.4× |
| Echo exam of fetal heart (76825) |
$412.80 |
$2,064 |
0.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$304 |
$1,520 |
1.4× |
| Echoencephalography real time imaging (76506) |
$80 |
$400 |
0.8× |
| Esophageal motility (78258) |
$219 |
$1,095 |
0.6× |
| Esophagus (74220) |
$181.10 |
$905.50 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$163.70 |
$818.50 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$123.40 |
$617 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$226.80 |
$1,134 |
1.0× |
| Foot 2 views (73620) |
$157.20 |
$786 |
1.9× |
| Forearm 2 views (73090) |
$152.60 |
$763 |
1.9× |
| Functional MRI brain by phys/psych (70555) |
$515.20 |
$2,576 |
2.3× |
| Functional MRI brain by tech (70554) |
$515.20 |
$2,576 |
2.3× |
| Gated Heart Planar Single (78472) |
$521.80 |
$2,609 |
1.4× |
| Hand 2 views (73120) |
$110.40 |
$552 |
1.1× |
| Hand 3 views (73130) |
$219 |
$1,095 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$946.60 |
$4,733 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$981.60 |
$4,908 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$884.80 |
$4,424 |
1.4× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$720.20 |
$3,601 |
2.0× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$643.60 |
$3,218 |
1.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,649 |
$8,245 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$666.40 |
$3,332 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$500 |
$2,500 |
1.3× |
| Ht muscle image spect sing (78451) |
$1,116.10 |
$5,580.50 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$145 |
$725 |
1.8× |
| Hysterosalpingogram (74740) |
$187.90 |
$939.50 |
0.8× |
| Interstitial radiation source applic complex (77778) |
$857.60 |
$4,288 |
1.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$522.20 |
$2,611 |
0.8× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$3,967.20 |
$19,836 |
0.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$71.90 |
$359.50 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$304 |
$1,520 |
0.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$483.20 |
$2,416 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$568.60 |
$2,843 |
1.1× |
| Knee 3 views (73562) |
$223 |
$1,115 |
2.7× |
| Liver & spleen imaging static only (78215) |
$328.60 |
$1,643 |
0.9× |
| Liver imaging static only (78201) |
$405.20 |
$2,026 |
0.8× |
| Lung perf&ventilat diferentl (78598) |
$618.40 |
$3,092 |
1.2× |
| Lung perfusion differential (78597) |
$440.40 |
$2,202 |
1.2× |
| Lung Ventilation Imaging (78579) |
$225.20 |
$1,126 |
0.6× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$534.40 |
$2,672 |
0.2× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$183.80 |
$919 |
0.3× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$832.60 |
$4,163 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$267.20 |
$1,336 |
0.1× |
| Lymphoscintigraphy (78195) |
$625 |
$3,125 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$433.60 |
$2,168 |
1.9× |
| Mammary ductogram or galactogram single (77053) |
$301.40 |
$1,507 |
1.4× |
| Meckels Diverticulum (78290) |
$274.20 |
$1,371 |
0.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$480.20 |
$2,401 |
1.4× |
| Mr elastography (76391) |
$698.80 |
$3,494 |
3.1× |
| Mr safety determination physician/other qhp (76016) |
$71.20 |
$356 |
0.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$195.60 |
$978 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,072 |
$5,360 |
3.3× |
| MRA head w/o contrast (70544) |
$893.40 |
$4,467 |
4.0× |
| MRA head with contrast (70545) |
$893.40 |
$4,467 |
2.7× |
| MRA neck w contrast (70548) |
$468.80 |
$2,344 |
1.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$562.60 |
$2,813 |
1.7× |
| MRA neck w/o contrast (70547) |
$468.80 |
$2,344 |
2.1× |
| MRI abdomen w contrast (74182) |
$1,005 |
$5,025 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,206 |
$6,030 |
3.7× |
| MRI abdomen w/o contrast (74181) |
$778.70 |
$3,893.50 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,011 |
$5,055 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,041.20 |
$5,206 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$572 |
$2,860 |
2.6× |
| MRI breast w/o contrast unilat (77046) |
$286 |
$1,430 |
1.3× |
| MRI c-spine with contrast (72142) |
$1,258.40 |
$6,292 |
3.9× |
| MRI cardiac w/o cont stress (75559) |
$453 |
$2,265 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$453 |
$2,265 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$1,006.70 |
$5,033.50 |
4.5× |
| MRI chest w/o & w/contrast material (71552) |
$647.20 |
$3,236 |
2.0× |
| MRI chest w/o contrast (71550) |
$539.40 |
$2,697 |
2.4× |
| MRI chest with contrast (71551) |
$539.40 |
$2,697 |
0.7× |
| MRI fetal sngl/1st gestation (74712) |
$605 |
$3,025 |
2.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$805.60 |
$4,028 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$805.60 |
$4,028 |
2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$805.60 |
$4,028 |
3.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$762.20 |
$3,811 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$914.60 |
$4,573 |
2.8× |
| MRI orbit/face/neck w/contrast (70542) |
$762.20 |
$3,811 |
2.3× |
| MRI pelvis w contrast (72196) |
$588.40 |
$2,942 |
1.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$706.10 |
$3,530.50 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$735.40 |
$3,677 |
3.3× |
| MRI scan of arm joint before and after contrast (73223) |
$1,249.40 |
$6,247 |
3.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$543.60 |
$2,718 |
0.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,213.20 |
$6,066 |
3.7× |
| MRI spectroscopy (76390) |
$309.80 |
$1,549 |
3.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,510 |
$7,550 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,305.20 |
$6,526 |
4.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,566.20 |
$7,831 |
4.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,345.60 |
$6,728 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,614.80 |
$8,074 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,076.50 |
$5,382.50 |
4.8× |
| MRI tmj (70336) |
$306.20 |
$1,531 |
1.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,041.20 |
$5,206 |
4.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$966.80 |
$4,834 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$805.60 |
$4,028 |
3.6× |
| Myelogram Cervical (72240) |
$552.80 |
$2,764 |
0.8× |
| Myelogram Lumbar (72265) |
$552.80 |
$2,764 |
0.8× |
| Myelogram thoracic (72255) |
$542.40 |
$2,712 |
0.7× |
| Myelography 2 or more regions (72270) |
$597.20 |
$2,986 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,469.80 |
$7,349 |
1.2× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$998.20 |
$4,991 |
0.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,032 |
$5,160 |
0.8× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$1,354.60 |
$6,773 |
0.7× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,120.40 |
$5,602 |
1.4× |
| Neck soft tissue (70360) |
$110.20 |
$551 |
1.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$256 |
$1,280 |
0.7× |
| Nm bone marrow wb (78104) |
$302.40 |
$1,512 |
0.8× |
| Nm cisternogram (78630) |
$518.80 |
$2,594 |
1.0× |
| Nm gastric emptying study (78264) |
$681.40 |
$3,407 |
1.8× |
| Nm peritoneal-venous shunt patency (78291) |
$232.40 |
$1,162 |
0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,093.40 |
$25,467 |
3.9× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$1,145.40 |
$5,727 |
0.9× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$842.80 |
$4,214 |
0.7× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$1,098 |
$5,490 |
0.8× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$574.40 |
$2,872 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$163.60 |
$818 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$232 |
$1,160 |
2.4× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$57.20 |
$286 |
0.6× |
| Orthopantogram (70355) |
$218.40 |
$1,092 |
2.7× |
| Osseous survey limited (77074) |
$89.20 |
$446 |
0.9× |
| Parathyrd planar w/spect&CT (78072) |
$602.20 |
$3,011 |
1.2× |
| Parathyrd planar w/wo subtrj (78071) |
$513.40 |
$2,567 |
1.4× |
| Parathyroid imaging (78070) |
$471.60 |
$2,358 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$121 |
$605 |
1.2× |
| Peritoneogram rs&i (74190) |
$357.20 |
$1,786 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$2,797.80 |
$13,989 |
2.1× |
| PET imaging CT for attenuation limited area (78814) |
$821.20 |
$4,106 |
0.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,948.40 |
$14,742 |
2.2× |
| Platelet survival study (78191) |
$218.80 |
$1,094 |
0.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,333.70 |
$6,668.50 |
4.1× |
| Proton trmt simple w/comp (77522) |
$960.20 |
$4,801 |
0.8× |
| Proton tx delivery complex (77525) |
$1,094 |
$5,470 |
0.9× |
| Proton tx delivery intermediate (77523) |
$960.20 |
$4,801 |
0.8× |
| Proton tx delivery simple w/o compensation (77520) |
$491.20 |
$2,456 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,565.40 |
$7,827 |
0.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$866.60 |
$4,333 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$316.80 |
$1,584 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$616 |
$3,080 |
1.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$760 |
$3,800 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$329 |
$1,645 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$66.20 |
$331 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$278.70 |
$1,393.50 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$390 |
$1,950 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$5,416 |
$27,080 |
0.8× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$520.60 |
$2,603 |
1.0× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$131.40 |
$657 |
1.4× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$205.60 |
$1,028 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$143.60 |
$718 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$162.60 |
$813 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$260.20 |
$1,301 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$262 |
$1,310 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$356.20 |
$1,781 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$322.60 |
$1,613 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$357 |
$1,785 |
2.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$182 |
$910 |
2.2× |
| Radiological examination surgical specimen (76098) |
$8,562.44 |
$42,812.19 |
16.8× |
| Radiopharm Dacryocystography (78660) |
$218.80 |
$1,094 |
0.6× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,649.60 |
$8,248 |
0.6× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$913.60 |
$4,568 |
0.3× |
| Ribs bilateral 3 views (71110) |
$306.40 |
$1,532 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$302.40 |
$1,512 |
0.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$795 |
$3,975 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$861.80 |
$4,309 |
1.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$943.20 |
$4,716 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,035.80 |
$5,179 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$884.80 |
$4,424 |
0.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$272.80 |
$1,364 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$124.80 |
$624 |
0.6× |
| Rp Therapy Intravenous Administration (79101) |
$168.80 |
$844 |
0.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$182 |
$910 |
0.8× |
| Scanogram (77073) |
$80 |
$400 |
0.8× |
| Scapula complete (73010) |
$125.20 |
$626 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$11.40 |
$57 |
0.5× |
| Sella turcica (70240) |
$40.80 |
$204 |
0.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$94 |
$470 |
1.0× |
| Sialogram (70390) |
$189.80 |
$949 |
0.9× |
| Simulation intermediate (77285) |
$374 |
$1,870 |
1.1× |
| Small bowel series (74250) |
$315.70 |
$1,578.50 |
1.9× |
| Spec medical radj physics consltj (77370) |
$474.60 |
$2,373 |
3.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$351.80 |
$1,759 |
1.0× |
| Special dosimetry (77331) |
$186.20 |
$931 |
1.5× |
| Special treatment procedure (77470) |
$784.20 |
$3,921 |
1.5× |
| Spine thoracic 3 views (72072) |
$133.90 |
$669.50 |
1.4× |
| Spleen imaging only (78185) |
$252.60 |
$1,263 |
0.7× |
| Splenoportograpy rs&i (75810) |
$862.40 |
$4,312 |
0.3× |
| Stereotactic body radiation delivery (77373) |
$2,319 |
$11,595 |
1.4× |
| Superior sagittal sinus venogram (75870) |
$789 |
$3,945 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$984.40 |
$4,922 |
2.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$275.60 |
$1,378 |
0.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$939.80 |
$4,699 |
2.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$410 |
$2,050 |
3.3× |
| Therapeutic Enema (74283) |
$182.40 |
$912 |
1.1× |
| Thoracolumbar 2 views (72080) |
$258.60 |
$1,293 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$750 |
$3,750 |
1.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$302.40 |
$1,512 |
0.8× |
| Thyroid uptake measurement (78012) |
$202.20 |
$1,011 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$464.60 |
$2,323 |
1.2× |
| Treatment device intermediate (77333) |
$166.80 |
$834 |
1.3× |
| Treatment devices simple (77332) |
$200.80 |
$1,004 |
1.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$890.60 |
$4,453 |
1.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$302.40 |
$1,512 |
0.8× |
| Tx devices design & construction complex (77334) |
$657.80 |
$3,289 |
1.9× |
| Ultrasound scan of cornea to determine thickness (76514) |
$10.80 |
$54 |
0.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$46.40 |
$232 |
0.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$349.80 |
$1,749 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$316.80 |
$1,584 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$78.80 |
$394 |
0.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$113.70 |
$368.50 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$1,162.80 |
$5,814 |
14.3× |
| Unlisted magnetic resonance procedure (76498) |
$1,551.20 |
$7,756 |
19.1× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$130.20 |
$651 |
0.3× |
| Unlisted Ultrasound Procedure (76999) |
$103.20 |
$516 |
1.3× |
| Upper Extremity Infant (73092) |
$80 |
$400 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$301.26 |
$1,506.28 |
1.4× |
| Urethrocystography voiding (74455) |
$235.60 |
$1,178 |
1.1× |
| Us abdl aorta screen aaa (76706) |
$57.20 |
$286 |
0.6× |
| Us breast unilateral complete (76641) |
$171 |
$855 |
1.8× |
| Us breast unilateral limited (76642) |
$131.60 |
$658 |
1.6× |
| Us chest (76604) |
$73.60 |
$368 |
0.8× |
| Us compl joint r-t w/image documentation (76881) |
$300.20 |
$1,501 |
3.1× |
| Us elastography parenchyma (76981) |
$93.20 |
$466 |
1.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$82 |
$410 |
0.8× |
| Us guided compression repair (76936) |
$234.40 |
$1,172 |
1.2× |
| Us infant hips dynamic (76885) |
$99.80 |
$499 |
1.2× |
| Us infant hips limited static (76886) |
$66.20 |
$331 |
0.8× |
| Us kidney transplant (76776) |
$437.20 |
$2,186 |
4.5× |
| Us ob detailed single fetus (76811) |
$231 |
$1,155 |
1.0× |
| Us ob transvaginal (76817) |
$200.60 |
$1,003 |
2.1× |
| Us pelvic non ob complete (76856) |
$282.10 |
$1,410.50 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$123.60 |
$618 |
1.3× |
| Us pregnancy ltd (76815) |
$102.60 |
$513 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$244.80 |
$1,224 |
2.5× |
| Us retroperitoneal complete (76770) |
$448.40 |
$2,242 |
4.6× |
| Us retroperitoneal limited (76775) |
$224.20 |
$1,121 |
2.3× |
| Us scrotum and contents (76870) |
$391.40 |
$1,957 |
4.0× |
| Us soft tissue head/neck (76536) |
$547.80 |
$2,739 |
5.6× |
| Us spinal canal and contents (76800) |
$68.60 |
$343 |
0.7× |
| Us transrectal (76872) |
$2,832 |
$14,160.02 |
29.0× |
| Us transrectal prostate volume (76873) |
$206.80 |
$1,034 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$298.20 |
$1,491 |
3.1× |
| Us, eye b-scan (76512) |
$63.80 |
$319 |
0.7× |
| Vascular flow imaging (78445) |
$254.20 |
$1,271 |
0.7× |
| Vasogram (74440) |
$14,705.22 |
$73,526.09 |
66.0× |
| Venogram extremity bilateral (75822) |
$1,490 |
$7,450 |
1.0× |
| Venogram orbital (75880) |
$465.40 |
$2,327 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,117.80 |
$10,589 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,623 |
$8,115 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$745 |
$3,725 |
0.5× |
| Venography Renal Bilateral (75833) |
$3,261.60 |
$16,308 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$1,630.80 |
$8,154 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,319.10 |
$6,595.50 |
0.4× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$2,572.40 |
$12,862 |
0.5× |
| Wrist 2 views (73100) |
$79.40 |
$397 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$472 |
$2,360 |
4.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$93 |
$465 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$220.20 |
$1,101 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$267.60 |
$1,338 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$125.90 |
$629.50 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$194.60 |
$973 |
2.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$256.60 |
$1,283 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$46 |
$230 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$195 |
$975 |
2.4× |
| X-ray exam hip uni 4/> views (73503) |
$199.60 |
$998 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$226.20 |
$1,131 |
2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$233.40 |
$1,167 |
2.4× |
| X-ray exam of femur 1 (73551) |
$114.60 |
$573 |
1.4× |
| X-ray eye for foreign body (70030) |
$66.20 |
$331 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$132.20 |
$661 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$221.20 |
$1,106 |
2.7× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,084.80 |
$5,424 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$104.80 |
$524 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$66.20 |
$331 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$323.20 |
$1,616 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$125.80 |
$629 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$52.40 |
$262 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$160.80 |
$804 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$237.30 |
$1,186.50 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$186 |
$930 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$91 |
$455 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$127.40 |
$637 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$133 |
$665 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$215.80 |
$1,079 |
2.2× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$306.20 |
$1,531 |
0.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$5,129.60 |
$25,647.98 |
15.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$153.20 |
$766 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$238.80 |
$1,194 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$267.40 |
$1,337 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$98.70 |
$493.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111 |
$555 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$262.20 |
$1,311 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$200.40 |
$1,002 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$86.60 |
$433 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$160 |
$800 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$156 |
$780 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$131.20 |
$656 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$74.20 |
$371 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$85.70 |
$428.50 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$139.30 |
$696.50 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$111.60 |
$558 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$228.60 |
$1,143 |
2.8× |
| Xr arthrogram ankle (73615) |
$326.40 |
$1,632 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$399 |
$1,995 |
4.1× |
| Xr finger(s) 2+ views (73140) |
$159.40 |
$797 |
2.0× |
| Xr internal auditory meati complete (70134) |
$88.60 |
$443 |
0.2× |
| Xr shoulder 1 view (73020) |
$65.20 |
$326 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$382.40 |
$1,912 |
3.9× |
| Xr tibia/fibula 2 views (73590) |
$146.70 |
$733.50 |
1.8× |
| Xr tmj bilateral (70330) |
$84.20 |
$421 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$185.60 |
$928 |
2.3× |