| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$17,569 |
$17,569 |
12.2× |
| Acute gi blood loss imaging (78278) |
$4,032 |
$4,032 |
9.7× |
| Angio adrenal bilat select (75733) |
$6,772 |
$6,772 |
2.1× |
| Angio adrenal unilat select (75731) |
$5,260 |
$5,260 |
1.6× |
| Angio extremity unilateral (75710) |
$3,020 |
$3,020 |
0.9× |
| Angio pulmonary unilateral (75741) |
$5,093 |
$5,093 |
1.5× |
| Angiogram extremity bilateral (75716) |
$8,444 |
$8,444 |
2.6× |
| Angiogram pelvic (75736) |
$7,231 |
$7,231 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$4,072 |
$4,072 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,269 |
$7,269 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,353 |
$7,353 |
1.3× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,184 |
$1,184 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,516 |
$6,516 |
2.0× |
| Ankle 2 views (73600) |
$745 |
$745 |
8.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,944 |
$4,944 |
1.5× |
| Arthrography knee lt (73580) |
$3,260 |
$3,260 |
8.9× |
| Arthrography wrist lt (73115) |
$1,411 |
$1,411 |
3.9× |
| Barium enema (74270) |
$1,873 |
$1,873 |
10.2× |
| Basic dosimetry (77300) |
$1,717 |
$1,717 |
12.2× |
| Bilat selctv renal venogram (75833) |
$10,913 |
$10,913 |
3.3× |
| Bone age studies (77072) |
$659 |
$659 |
6.0× |
| Bone imaging limited area (78300) |
$3,367 |
$3,367 |
8.1× |
| Bone survey complete (77075) |
$2,891 |
$2,891 |
26.5× |
| Bowel imaging (78290) |
$4,010 |
$4,010 |
9.6× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$9,331 |
$9,331 |
23.9× |
| Brain image w/flow 4 + views (78606) |
$4,261 |
$4,261 |
7.5× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$3,282 |
$3,282 |
7.9× |
| Card MRI w/stress img & dye (75563) |
$7,450 |
$7,450 |
9.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$5,548 |
$5,548 |
9.8× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$5,548 |
$5,548 |
9.8× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$4,274 |
$4,274 |
10.2× |
| Cardiac MRI w/stress img (75559) |
$9,687 |
$9,687 |
17.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$7,448.50 |
$7,448.50 |
20.4× |
| Cerebrospinal fluid leakage (78650) |
$4,656 |
$4,656 |
3.4× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$1,506 |
$1,506 |
8.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,783 |
$1,783 |
9.7× |
| Cineradiography/videoradiography (76120) |
$1,281 |
$1,281 |
11.7× |
| Cisternogram (78630) |
$5,498 |
$5,498 |
9.7× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$14,343 |
$14,343 |
17.5× |
| Clavicle complete (73000) |
$724 |
$724 |
8.0× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$3,543.50 |
$3,543.50 |
14.2× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$1,621 |
$1,621 |
17.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$6,335 |
$6,335 |
34.6× |
| Continuing medical physics consltj pr wk (77336) |
$1,646 |
$1,646 |
11.7× |
| Contrast exam abdominl aorta (75625) |
$7,103 |
$7,103 |
2.2× |
| Contrast exam thoracic aorta (75605) |
$7,807 |
$7,807 |
1.3× |
| Corpora cavernosography (74445) |
$2,183 |
$2,183 |
20.0× |
| Csf shunt evaluation (78645) |
$3,868 |
$3,868 |
6.8× |
| CT - st neck w&wo contr (70492) |
$8,325.50 |
$8,325.50 |
45.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$16,101 |
$16,101 |
44.2× |
| CT abdomen and pelvis without contrast (74176) |
$7,961.50 |
$7,961.50 |
32.0× |
| CT abdomen w wo contrast (74170) |
$9,007.50 |
$9,007.50 |
49.2× |
| CT abdomen w/contrast (74160) |
$7,770 |
$7,770 |
42.4× |
| CT abdomen w/o contrast (74150) |
$5,106.50 |
$5,106.50 |
46.8× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$14,948 |
$14,948 |
41.0× |
| CT angio abdom w/o & w/dye (74175) |
$13,462.50 |
$13,462.50 |
73.5× |
| CT angio abdominal arteries (75635) |
$10,211 |
$10,211 |
55.7× |
| CT angio hrt w/3d image (75574) |
$11,191.50 |
$11,191.50 |
30.7× |
| CT angiograph pelv w/o&w/dye (72191) |
$11,197 |
$11,197 |
61.1× |
| CT cervical spine w/contrast (72126) |
$5,659 |
$5,659 |
15.5× |
| CT cervical spine w/o contrast (72125) |
$5,271 |
$5,271 |
48.3× |
| CT chest w/contrast (71260) |
$7,597 |
$7,597 |
41.5× |
| CT colonography diag w cont (74262) |
$11,904.50 |
$11,904.50 |
65.0× |
| CT colonography w/o cntrst (74261) |
$7,044 |
$7,044 |
64.5× |
| CT extremity upper w & w/o contrast (73202) |
$5,138.50 |
$5,138.50 |
28.1× |
| CT head/brain with contrast (70460) |
$6,126 |
$6,126 |
33.4× |
| CT head/brain without and with contrast (70470) |
$7,338 |
$7,338 |
40.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$7,260.50 |
$7,260.50 |
19.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$8,713 |
$8,713 |
95.9× |
| CT hrt w/3d image congen (75573) |
$8,487 |
$8,487 |
23.3× |
| CT limited/localized follow up study (76380) |
$1,990.50 |
$1,990.50 |
21.9× |
| CT lower ext w/wo contrast (73702) |
$5,138.50 |
$5,138.50 |
28.1× |
| CT lower extremity w contrast (73701) |
$4,258.50 |
$4,258.50 |
23.2× |
| CT lower extremity w/o contrast unilateral (73700) |
$3,058.50 |
$3,058.50 |
28.0× |
| CT lumbar spine w/contrast (72132) |
$5,656.50 |
$5,656.50 |
15.5× |
| CT lumbar spine w/o contrast (72131) |
$5,266.50 |
$5,266.50 |
48.2× |
| CT lumbar spine w/o then w/ con (72133) |
$5,713.50 |
$5,713.50 |
31.2× |
| CT maxillofacial area w/o contrast (70486) |
$3,723 |
$3,723 |
34.1× |
| CT maxillofacial w/contrast (70487) |
$5,944 |
$5,944 |
32.5× |
| CT maxillofacial w/o then w/ con (70488) |
$6,228.50 |
$6,228.50 |
34.0× |
| CT orbit sella ear w/o con (70480) |
$6,138.50 |
$6,138.50 |
56.2× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$7,838 |
$7,838 |
42.8× |
| CT pelvis w & w/o contrast (72194) |
$8,123.50 |
$8,123.50 |
44.3× |
| CT pelvis w/o contrast (72192) |
$4,799 |
$4,799 |
44.0× |
| CT soft tissue neck w/contrast (70491) |
$8,325.50 |
$8,325.50 |
45.5× |
| CT soft tissue neck w/o contrast (70490) |
$4,934 |
$4,934 |
45.2× |
| CT spine cervical w/wo contrast (72127) |
$5,713.50 |
$5,713.50 |
31.2× |
| CT thoracic spine w/contrast (72129) |
$5,657 |
$5,657 |
30.9× |
| CT thoracic spine w/o contrast (72128) |
$5,266.50 |
$5,266.50 |
48.2× |
| CT thoracic spine w/o then w/ con (72130) |
$5,713.50 |
$5,713.50 |
31.2× |
| CT thorax lung cancer scr c- (71271) |
$986 |
$986 |
9.0× |
| CT thorax w/o contrast (71250) |
$4,805.50 |
$4,805.50 |
44.0× |
| CT thorax w/o then w/ contrast (71270) |
$8,146.50 |
$8,146.50 |
44.5× |
| CT upper extremity w/dye (73201) |
$4,145.50 |
$4,145.50 |
11.4× |
| CT upper extremity w/o contrast rt (73200) |
$3,058.50 |
$3,058.50 |
28.0× |
| CTA chest w/wo contrast (71275) |
$10,465 |
$10,465 |
57.1× |
| CTA head w contrast (70496) |
$10,371.50 |
$10,371.50 |
56.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$8,063 |
$8,063 |
44.0× |
| Cta Neck (70498) |
$12,301 |
$12,301 |
67.2× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$8,063 |
$8,063 |
44.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) |
$4,613 |
$4,613 |
18.5× |
| Dilation ureters/urethra rs&i (74485) |
$2,311 |
$2,311 |
1.1× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$12,758 |
$12,758 |
6.3× |
| Diskography lumbar (72295) |
$2,024 |
$2,024 |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$1,532 |
$1,532 |
14.0× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$1,150 |
$1,150 |
10.5× |
| Doppler fetal mid cerebral artery (76821) |
$2,183 |
$2,183 |
20.0× |
| Dxa bone density study axial skeleton (77085) |
$3,419 |
$3,419 |
31.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,339 |
$1,339 |
5.4× |
| Esophageal motility (78258) |
$2,778 |
$2,778 |
6.7× |
| Esophogram (74220) |
$1,175 |
$1,175 |
6.4× |
| Fetal biophysical profile non-stress testing (76818) |
$2,183 |
$2,183 |
20.0× |
| Fetal biophysical profile w/o nst (76819) |
$952 |
$952 |
8.7× |
| Fetal echo complete (76825) |
$4,785 |
$4,785 |
8.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,097 |
$1,097 |
4.4× |
| Full mouth X-ray of teeth (70320) |
$399 |
$399 |
1.6× |
| Functional MRI brain by phys/psych (70555) |
$7,173 |
$7,173 |
28.8× |
| Functional MRI brain by tech (70554) |
$7,173 |
$7,173 |
28.8× |
| Gastric emptying study (78264) |
$4,505 |
$4,505 |
10.8× |
| Gastroesophageal reflux study (78262) |
$4,160 |
$4,160 |
10.0× |
| Gated heart planar single (78472) |
$4,274 |
$4,274 |
10.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$13,472 |
$13,472 |
18.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$16,988 |
$16,988 |
23.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$18,484 |
$18,484 |
25.4× |
| Heart infarct image (78466) |
$3,041 |
$3,041 |
7.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$10,815 |
$10,815 |
3.3× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$10,815 |
$10,815 |
3.3× |
| Hepatobil syst image w/drug (78227) |
$4,327 |
$4,327 |
7.6× |
| Hepatobiliary system imaging (78226) |
$3,212 |
$3,212 |
7.7× |
| Humerus min 2 views (73060) |
$723 |
$723 |
8.0× |
| Hysterosalpingography (74740) |
$852 |
$852 |
3.4× |
| Imrt planning (77301) |
$33,520 |
$33,520 |
23.2× |
| Infusion of radioelement (77750) |
$1,900 |
$1,900 |
4.7× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$1,326 |
$1,326 |
3.2× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$12,930 |
$12,930 |
17.8× |
| Intracavitary radiation source applic complex (77763) |
$38,442 |
$38,442 |
52.9× |
| Intracavitary radiation source applic intermed (77762) |
$33,921 |
$33,921 |
58.8× |
| Intracavitary radiation source applic simple (77761) |
$29,398 |
$29,398 |
50.9× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$16,497 |
$16,497 |
2.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$6,750 |
$6,750 |
17.3× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$4,288 |
$4,288 |
11.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$7,112 |
$7,112 |
18.2× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$3,773 |
$3,773 |
9.6× |
| Ivp (74400) |
$3,774 |
$3,774 |
20.6× |
| Ivp w tomography (74415) |
$3,130 |
$3,130 |
17.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$4,818 |
$4,818 |
8.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$4,818 |
$4,818 |
8.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$4,818 |
$4,818 |
8.5× |
| Kidney w vascular flow (78701) |
$7,557 |
$7,557 |
18.1× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$2,294 |
$2,294 |
5.5× |
| Liver & spleen; static only (78215) |
$3,875 |
$3,875 |
9.3× |
| Liver & spleen; w vasc flow (78216) |
$7,557 |
$7,557 |
18.1× |
| Liver imaging w/vascular flow (78202) |
$9,811 |
$9,811 |
17.3× |
| Lung perf&ventilat diferentl (78598) |
$6,638 |
$6,638 |
11.7× |
| Lung perfusion differential (78597) |
$3,317 |
$3,317 |
7.9× |
| Lung ventilat&perfus imaging (78582) |
$7,061 |
$7,061 |
12.5× |
| Lung ventilation imaging (78579) |
$3,530 |
$3,530 |
8.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$6,362 |
$6,362 |
3.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$4,106 |
$4,106 |
6.3× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$19,837 |
$19,837 |
6.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$21,142 |
$21,142 |
6.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$10,978.50 |
$10,978.50 |
30.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$12,336 |
$12,336 |
33.9× |
| Mammary ductogram multiple ducts (77054) |
$1,658 |
$1,658 |
6.7× |
| Mammary ductogram single (77053) |
$1,041 |
$1,041 |
4.2× |
| Mlc device(s) for imrt (77338) |
$11,887 |
$11,887 |
30.4× |
| Mr safety determination physician/other qhp (76016) |
$352 |
$352 |
3.9× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$238 |
$238 |
3.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$98 |
$98 |
3.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$367 |
$367 |
3.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$967 |
$967 |
3.9× |
| MRA head w & w/o contrast (70546) |
$6,233 |
$6,233 |
17.1× |
| MRA head w/contrast (70545) |
$4,799 |
$4,799 |
13.2× |
| MRA head w/o contrast (70544) |
$3,866.50 |
$3,866.50 |
15.5× |
| MRA neck w/contrast (70548) |
$4,799 |
$4,799 |
13.2× |
| MRA neck w/o contrast (70547) |
$3,866.50 |
$3,866.50 |
15.5× |
| MRA neck w/wo contrast (70549) |
$6,233 |
$6,233 |
17.1× |
| MRI abdomen w/contrast (74182) |
$6,550.50 |
$6,550.50 |
18.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$6,935.50 |
$6,935.50 |
19.0× |
| MRI abdomen w/o contrast (74181) |
$6,171.50 |
$6,171.50 |
24.8× |
| MRI any jnt lwr ext with con lt (73722) |
$8,398 |
$8,398 |
10.3× |
| MRI breast without contrast bilateral (77047) |
$3,857 |
$3,857 |
15.5× |
| MRI breast without contrast material unilateral (77046) |
$5,364.50 |
$5,364.50 |
21.5× |
| MRI cardiac w/o contrast (75557) |
$5,816.50 |
$5,816.50 |
23.3× |
| MRI cervical spine w/o contrast (72141) |
$7,772 |
$7,772 |
31.2× |
| MRI cervical spine with contrast (72142) |
$8,884 |
$8,884 |
24.4× |
| MRI chest w & w/o contrast (71552) |
$6,295 |
$6,295 |
17.3× |
| MRI chest w/contrast (71551) |
$5,849 |
$5,849 |
7.1× |
| MRI chest w/o contrast (71550) |
$5,406.50 |
$5,406.50 |
21.7× |
| MRI elastography (76391) |
$6,957 |
$6,957 |
27.9× |
| MRI fetal sngl/1st gestation (74712) |
$5,464 |
$5,464 |
21.9× |
| MRI joint upper ext w/contrast (73222) |
$8,109.50 |
$8,109.50 |
9.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$10,535 |
$10,535 |
28.9× |
| MRI joint upr extrem w/o dye (73221) |
$7,175.50 |
$7,175.50 |
28.8× |
| Mri Lower Extremity W/O Dye (73718) |
$7,818.50 |
$7,818.50 |
31.4× |
| MRI lumbar spine with contrast (72149) |
$11,633 |
$11,633 |
31.9× |
| MRI lumbar w/wo contrast (72158) |
$11,633 |
$11,633 |
31.9× |
| MRI lwr ext w/o jnts with con rt (73719) |
$12,336 |
$12,336 |
33.9× |
| MRI orbit/face/neck w/contrast (70542) |
$8,142 |
$8,142 |
22.3× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$8,396 |
$8,396 |
23.0× |
| MRI orbit/face/neck w/o contrast (70540) |
$7,700.50 |
$7,700.50 |
30.9× |
| MRI pelvis w/ contrast (72196) |
$8,706 |
$8,706 |
23.9× |
| MRI pelvis w/o contrast (72195) |
$5,518 |
$5,518 |
22.1× |
| MRI pelvis w/wo contrast (72197) |
$8,706 |
$8,706 |
23.9× |
| MRI spectroscopy (76390) |
$4,312.50 |
$4,312.50 |
47.5× |
| MRI spine cervical wo/w contrast (72156) |
$9,991.50 |
$9,991.50 |
27.4× |
| MRI spine thoracic w/contrast (72147) |
$10,987 |
$10,987 |
30.2× |
| MRI thoracic spine w wo contrast (72157) |
$10,987 |
$10,987 |
30.2× |
| MRI thoracic spine w/o contrast (72146) |
$6,963.50 |
$6,963.50 |
27.9× |
| MRI tmj (70336) |
$4,888 |
$4,888 |
19.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$7,090 |
$7,090 |
28.5× |
| Mri Upper Extremity W/Dye (73219) |
$11,185 |
$11,185 |
30.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$11,185 |
$11,185 |
30.7× |
| Myelogram thoracic (72255) |
$14,343 |
$14,343 |
17.5× |
| Myelography 2 or more regions (72270) |
$14,343 |
$14,343 |
17.5× |
| Myelography lumbosacral (72265) |
$14,343 |
$14,343 |
17.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$6,951 |
$6,951 |
4.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$6,951 |
$6,951 |
4.7× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$6,238 |
$6,238 |
4.6× |
| Myocardial perfusion planar multiple studies (78454) |
$6,238 |
$6,238 |
4.6× |
| Myocardial spect single study at rest or stress (78451) |
$6,238 |
$6,238 |
4.6× |
| Myocrd img PET metab eval single study (78459) |
$6,951 |
$6,951 |
5.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$7,699 |
$7,699 |
8.6× |
| Nm bone 3 phase (78315) |
$4,646 |
$4,646 |
11.1× |
| Nm bone imaging whole body (78306) |
$4,169 |
$4,169 |
10.0× |
| Nm bone marrow scan limited (78102) |
$3,132 |
$3,132 |
7.5× |
| Nm bone multi (78305) |
$3,880 |
$3,880 |
9.3× |
| Nm heart perfusion spect stress rest (78452) |
$6,238 |
$6,238 |
4.6× |
| Nm kidney function (78725) |
$1,687 |
$1,687 |
4.0× |
| Nm lymph system (78195) |
$4,212 |
$4,212 |
7.4× |
| Nm myocard infarct spect (78469) |
$3,973 |
$3,973 |
7.0× |
| Nm thyroid imaging only (78013) |
$7,557 |
$7,557 |
18.1× |
| Nose to rectum for fb child (76010) |
$696 |
$696 |
7.7× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$1,722 |
$1,722 |
4.1× |
| Nuclear rx IV admin (79101) |
$2,447 |
$2,447 |
10.0× |
| Ob us < 14 wks single fetus (76801) |
$1,763 |
$1,763 |
16.1× |
| Ob us nuchal meas 1 gest (76813) |
$517 |
$517 |
4.7× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$736 |
$736 |
6.7× |
| Oral radiopharm rx (79005) |
$2,390 |
$2,390 |
9.8× |
| Orthopantogram (70355) |
$1,147 |
$1,147 |
12.6× |
| Parathyrd planar w/spect&CT (78072) |
$3,047 |
$3,047 |
5.4× |
| Parathyroid imaging (78070) |
$2,347 |
$2,347 |
5.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,347 |
$2,347 |
5.6× |
| Peritoneal-venous shunt patency test (78291) |
$2,694 |
$2,694 |
6.5× |
| Peritoneogram rs&i (74190) |
$9,687 |
$9,687 |
17.0× |
| PET brain metabolic eval (78608) |
$6,951 |
$6,951 |
4.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,135 |
$7,135 |
4.8× |
| PET imaging CT for attenuation limited area (78814) |
$6,951 |
$6,951 |
4.7× |
| PET imaging for CT attenuation whole body (78816) |
$7,330 |
$7,330 |
4.9× |
| PET imaging limited area chest head/neck (78811) |
$6,951 |
$6,951 |
5.1× |
| PET imaging whole body (78813) |
$7,330 |
$7,330 |
4.9× |
| Plasma volume multiple (78111) |
$8,343 |
$8,343 |
6.2× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$7,135 |
$7,135 |
4.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$5,097 |
$5,097 |
1.5× |
| Pulmonary perfusion imaging particulate (78580) |
$4,195 |
$4,195 |
10.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,118 |
$1,118 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$751 |
$751 |
8.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$923 |
$923 |
8.5× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$923 |
$923 |
8.5× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$923 |
$923 |
8.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$832 |
$832 |
9.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$1,004 |
$1,004 |
11.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$1,757 |
$1,757 |
16.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$2,184 |
$2,184 |
20.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$2,184 |
$2,184 |
20.0× |
| Radex spine cervical 2 or 3 views (72040) |
$947 |
$947 |
10.4× |
| Radex spine cervical 4 or 5 views (72050) |
$1,165 |
$1,165 |
10.7× |
| Radex spine cervical 6 or more views (72052) |
$1,165 |
$1,165 |
10.7× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$585 |
$585 |
6.4× |
| Radiation delivery stereotactic cranial linear (77372) |
$35,795 |
$35,795 |
4.7× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$136,731 |
$136,731 |
17.8× |
| Radiation tx delivery lvl 1 (77402) |
$1,345 |
$1,345 |
12.6× |
| Radiation tx delivery lvl 2 (77407) |
$1,601 |
$1,601 |
4.0× |
| Radiation tx delivery lvl 3 (77412) |
$2,217 |
$2,217 |
3.8× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$957 |
$957 |
8.8× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$1,175 |
$1,175 |
6.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$2,461 |
$2,461 |
13.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$2,079 |
$2,079 |
11.4× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$773 |
$773 |
8.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$773 |
$773 |
8.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,091 |
$1,091 |
10.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$1,940 |
$1,940 |
17.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$1,368 |
$1,368 |
12.5× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$331 |
$331 |
1.3× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$12,930 |
$12,930 |
53.1× |
| Red cell mass multiple (78121) |
$3,171 |
$3,171 |
5.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$6,010 |
$6,010 |
14.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$10,187 |
$10,187 |
25.3× |
| Renal cyst study (74470) |
$962 |
$962 |
1.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,401 |
$1,401 |
3.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,401 |
$1,401 |
3.4× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,785 |
$4,785 |
8.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,785 |
$4,785 |
8.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,785 |
$4,785 |
8.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,785 |
$4,785 |
3.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,128 |
$1,128 |
4.6× |
| Saline infused sonohysterogram (76831) |
$1,460 |
$1,460 |
5.9× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$341 |
$341 |
14.6× |
| Selective spinal angiogram (75705) |
$3,965 |
$3,965 |
0.7× |
| Shoulder arthrogram (73040) |
$1,705 |
$1,705 |
4.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$2,183 |
$2,183 |
20.0× |
| Simulation complex (77290) |
$9,167 |
$9,167 |
23.4× |
| Simulation intermediate (77285) |
$8,218 |
$8,218 |
21.0× |
| Simulation simple (77280) |
$7,157 |
$7,157 |
51.0× |
| Small bowel series (74250) |
$1,608 |
$1,608 |
8.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$5,339 |
$5,339 |
13.7× |
| Special dosimetry (77331) |
$2,810 |
$2,810 |
20.0× |
| Special physics consult (77370) |
$2,567 |
$2,567 |
18.3× |
| Special treatment procedure (77470) |
$6,334 |
$6,334 |
11.0× |
| Speech evaluation complex (70371) |
$1,783 |
$1,783 |
7.2× |
| Splenoportography (75810) |
$57,389 |
$57,389 |
17.4× |
| Stereotactic body radiation delivery (77373) |
$48,664 |
$48,664 |
26.1× |
| Superior sagittal sinus venogram (75870) |
$5,445 |
$5,445 |
1.7× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$1,298 |
$1,298 |
12.2× |
| Tbs technical calculation only (77091) |
$281 |
$281 |
3.1× |
| Testicular imaging w/flow (78761) |
$2,444 |
$2,444 |
5.9× |
| Therapeutic enema barium or air (74283) |
$1,331 |
$1,331 |
7.3× |
| Thyroid met imaging body (78018) |
$5,291 |
$5,291 |
9.3× |
| Thyroid uptake single/multiple quant measurement (78012) |
$3,071 |
$3,071 |
7.4× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$2,907 |
$2,907 |
7.0× |
| Treatment device intermediate (77333) |
$2,350 |
$2,350 |
16.7× |
| Treatment devices complex (77334) |
$4,132 |
$4,132 |
10.6× |
| Treatment devices simple (77332) |
$1,533 |
$1,533 |
10.9× |
| Ultrasound breast limited (76642) |
$751 |
$751 |
8.3× |
| Ultrasound, abdomen limited (76705) |
$1,659 |
$1,659 |
15.2× |
| Umbilical-artery Doppler (OB) (76820) |
$1,257 |
$1,257 |
11.5× |
| Unlisted CT procedure (76497) |
$9,309 |
$9,309 |
102.4× |
| Unlisted fluoroscopic procedure (76496) |
$1,862 |
$1,862 |
20.5× |
| Unlisted magnetic resonance procedure (76498) |
$8,380 |
$8,380 |
92.2× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$2,039 |
$2,039 |
184.4× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$2,039 |
$2,039 |
21.6× |
| Ureteral reflux study (78740) |
$3,209 |
$3,209 |
7.7× |
| Urethrocystography retrograde rs&i (74450) |
$1,601 |
$1,601 |
6.4× |
| Urethrocystography voiding (74455) |
$1,647 |
$1,647 |
6.6× |
| Urography antegrade (74425) |
$1,230 |
$1,230 |
3.4× |
| Urography retrograde w/wo kub (74420) |
$1,395 |
$1,395 |
3.8× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$2,082 |
$2,082 |
11.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$1,663 |
$1,663 |
15.2× |
| Us breast uni real time with image complete (76641) |
$789 |
$789 |
7.2× |
| Us chest (76604) |
$959 |
$959 |
8.8× |
| Us compl joint r-t w/image documentation (76881) |
$2,183 |
$2,183 |
20.0× |
| Us elastography parenchyma (76981) |
$710 |
$710 |
6.5× |
| Us encephalogram (76506) |
$1,267 |
$1,267 |
11.6× |
| Us guided compression repair (76936) |
$5,305 |
$5,305 |
23.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,014 |
$1,014 |
11.2× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$656 |
$656 |
7.2× |
| Us kidney transplanted (76776) |
$1,827 |
$1,827 |
16.7× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$1,102 |
$1,102 |
10.1× |
| Us ob detailed single fetus (76811) |
$1,511 |
$1,511 |
6.1× |
| Us ob followup per fetus (76816) |
$1,005 |
$1,005 |
9.2× |
| Us ob limited 1 or more fetuses (76815) |
$436 |
$436 |
4.0× |
| Us obstetric transvaginal (76817) |
$1,199 |
$1,199 |
11.0× |
| Us pelvic limited or f/u non-ob (76857) |
$597 |
$597 |
5.5× |
| Us pelvis complete (76856) |
$1,880 |
$1,880 |
17.2× |
| Us retroperitoneal complete (76770) |
$1,487 |
$1,487 |
13.6× |
| Us retroperitoneal limited (76775) |
$1,487 |
$1,487 |
13.6× |
| Us scrotum (76870) |
$1,438 |
$1,438 |
13.2× |
| Us soft tissue head/neck (76536) |
$1,126 |
$1,126 |
10.3× |
| Us spinal canal (76800) |
$865 |
$865 |
7.9× |
| Us transrectal (76872) |
$2,551 |
$2,551 |
23.4× |
| Us transrectal prostate volume (76873) |
$2,033 |
$2,033 |
18.6× |
| Vascular flow imaging (78445) |
$3,397 |
$3,397 |
8.1× |
| Vein X-ray liver w/hemodynam (75885) |
$9,198 |
$9,198 |
2.8× |
| Venogram epidural (75872) |
$4,930 |
$4,930 |
7.5× |
| Venogram extremity bilateral (75822) |
$4,155 |
$4,155 |
2.5× |
| Venogram ivc w serialography (75825) |
$8,780 |
$8,780 |
2.7× |
| Venogram svc w serialography (75827) |
$8,847 |
$8,847 |
5.4× |
| Venography adrenal unilateral selective rs&i (75840) |
$33,603 |
$33,603 |
10.2× |
| Venography ext unilateral (75820) |
$2,713 |
$2,713 |
1.7× |
| Venography renal unilateral selective rs&i (75831) |
$5,260 |
$5,260 |
1.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,445 |
$5,445 |
1.7× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$10,836 |
$10,836 |
16.5× |
| Venous sampling by catheter (75893) |
$14,801 |
$14,801 |
2.5× |
| Vertebral fracture assessment via dxa (77086) |
$1,749 |
$1,749 |
19.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$868 |
$868 |
9.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$935 |
$935 |
10.3× |
| X-ray aorta leg arteries (75630) |
$8,614 |
$8,614 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,125 |
$2,125 |
11.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$752 |
$752 |
8.3× |
| X-ray exam hips bi 3-4 views (73522) |
$758 |
$758 |
6.9× |
| X-ray exam of finger(s) (73140) |
$469 |
$469 |
5.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$751 |
$751 |
8.3× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$712 |
$712 |
7.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$743 |
$743 |
8.2× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$622 |
$622 |
5.7× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$751 |
$751 |
8.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$712 |
$712 |
7.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$1,134 |
$1,134 |
12.5× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$769 |
$769 |
8.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$946 |
$946 |
8.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$850 |
$850 |
9.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,063 |
$1,063 |
9.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,368 |
$1,368 |
12.5× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$1,257 |
$1,257 |
11.5× |
| X-ray perineogram (74775) |
$1,873 |
$1,873 |
7.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$842 |
$842 |
9.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,271 |
$1,271 |
11.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$911 |
$911 |
8.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$536 |
$536 |
4.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$820 |
$820 |
9.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$792 |
$792 |
8.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,224 |
$1,224 |
13.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,370 |
$1,370 |
12.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$1,093 |
$1,093 |
10.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$878 |
$878 |
9.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$469 |
$469 |
5.2× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$709 |
$709 |
7.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$730 |
$730 |
8.0× |
| Xr abdomen 1 view (74018) |
$887 |
$887 |
9.8× |
| Xr abdomen 2 views (74019) |
$1,091 |
$1,091 |
10.0× |
| Xr abdomen 3 views (74021) |
$1,091 |
$1,091 |
10.0× |
| Xr arthrogram ankle (73615) |
$2,615 |
$2,615 |
7.2× |
| Xr arthrogram elbow (73085) |
$1,177 |
$1,177 |
3.2× |
| Xr arthrogram hip (73525) |
$2,252 |
$2,252 |
6.2× |
| Xr bone density appendicular (77081) |
$868 |
$868 |
9.6× |
| Xr bone density axial (77080) |
$1,749 |
$1,749 |
16.0× |
| Xr bone length study (77073) |
$1,400 |
$1,400 |
12.8× |
| Xr bone survey infant (77076) |
$871 |
$871 |
8.0× |
| Xr bone survey limited (77074) |
$1,199 |
$1,199 |
11.0× |
| Xr chest 1 view (71045) |
$777 |
$777 |
8.5× |
| Xr chest 2 views (71046) |
$777 |
$777 |
8.5× |
| Xr chest 3 views (71047) |
$777 |
$777 |
8.5× |
| Xr cystogram 3+ views (74430) |
$1,061 |
$1,061 |
2.9× |
| Xr eye foreign body (70030) |
$598 |
$598 |
6.6× |
| Xr facial bones 3 views (70150) |
$1,368 |
$1,368 |
12.5× |
| Xr lower extremity 2 views infant (73592) |
$743 |
$743 |
8.2× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$1,063 |
$1,063 |
9.7× |
| Xr mandible 4 views (70110) |
$1,147 |
$1,147 |
10.5× |
| Xr myelogram c-spine (72240) |
$14,343 |
$14,343 |
17.5× |
| Xr nasal bones (70160) |
$838 |
$838 |
9.2× |
| Xr pelvis 3 views (72190) |
$903 |
$903 |
8.3× |
| Xr spine 1 view (72020) |
$555 |
$555 |
6.1× |
| Xr sternum 2 views (71120) |
$865 |
$865 |
9.5× |
| Xr stress view joint (77071) |
$1,621 |
$1,621 |
17.8× |
| Xr surgical specimen (76098) |
$486 |
$486 |
0.9× |
| Xr upper extremity 2 views infant (73092) |
$723 |
$723 |
6.6× |
| Xray elbow 2 views (73070) |
$689 |
$689 |
7.6× |
| Xray forearm 2 views (73090) |
$696 |
$696 |
7.7× |
| Xray knee 1 or 2 views rt (73560) |
$769 |
$769 |
8.5× |
| Xray neck soft tissue (70360) |
$708 |
$708 |
7.8× |
| Xray orbits complete min 4 views (70200) |
$1,351 |
$1,351 |
12.4× |
| Xray pelvis 1 or 2 views (72170) |
$730 |
$730 |
6.7× |
| Xray ribs bilateral 3 views (71110) |
$1,219 |
$1,219 |
11.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$992 |
$992 |
9.1× |
| Xray scapula complete (73010) |
$723 |
$723 |
6.6× |
| Xray shoulder 1 view (73020) |
$687 |
$687 |
7.6× |
| Xray sinuses paranasal <3 views (70210) |
$693 |
$693 |
7.6× |
| Xray spine thoracic 2 views (72070) |
$709 |
$709 |
6.5× |
| Xray spine thoracic 3 views (72072) |
$849 |
$849 |
7.8× |
| Xray tibia-fibula 2 views bil (73590) |
$723 |
$723 |
8.0× |
| Xray tmj open - closed unilat (70328) |
$1,436 |
$1,436 |
15.8× |
| Xray tmj's bilateral open-clsc (70330) |
$1,436 |
$1,436 |
15.8× |