| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$5,602 |
$14,005 |
3.9× |
| Acute gi blood loss imaging (78278) |
$2,522 |
$6,305 |
6.0× |
| Angio adrenal unilat select (75731) |
$2,369.60 |
$5,924 |
0.7× |
| Angio extremity unilateral (75710) |
$2,178.80 |
$5,447 |
0.7× |
| Angio pulmonary unilateral (75741) |
$2,793.20 |
$6,983 |
0.8× |
| Angiogram extremity bilateral (75716) |
$2,796 |
$6,990 |
0.8× |
| Angiogram pelvic (75736) |
$6,362 |
$15,905 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$1,384.80 |
$3,462 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,811.20 |
$7,028 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,362 |
$15,905 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,306 |
$5,765 |
0.7× |
| Ankle 2 views (73600) |
$162.40 |
$406 |
1.8× |
| Arthrography knee lt (73580) |
$518 |
$1,295 |
1.4× |
| Arthrography wrist lt (73115) |
$592.40 |
$1,481 |
1.6× |
| Barium enema (74270) |
$643.60 |
$1,609 |
3.5× |
| Basic dosimetry (77300) |
$548 |
$1,370 |
3.9× |
| Bilat selctv renal venogram (75833) |
$1,918.40 |
$4,796 |
0.6× |
| Bone age studies (77072) |
$279.60 |
$699 |
2.6× |
| Bone imaging limited area (78300) |
$1,708.80 |
$4,272 |
4.1× |
| Bone marrow imaging whole body (78104) |
$1,641.20 |
$4,103 |
3.9× |
| Bone survey complete (77075) |
$225.60 |
$564 |
2.1× |
| Bowel imaging (78290) |
$1,364.80 |
$3,412 |
3.3× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,083.20 |
$2,708 |
2.8× |
| Brain image w/flow 4 + views (78606) |
$1,186.40 |
$2,966 |
2.1× |
| Cardiac MRI w/stress img (75559) |
$563.20 |
$1,408 |
1.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,386 |
$3,465 |
3.8× |
| Cerebrospinal fluid leakage (78650) |
$529.60 |
$1,324 |
0.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$376.40 |
$941 |
2.1× |
| Cisternogram (78630) |
$1,429.60 |
$3,574 |
2.5× |
| Clavicle complete (73000) |
$368 |
$920 |
4.0× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$1,012 |
$2,530 |
4.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,728.80 |
$4,322 |
9.4× |
| Continuing medical physics consltj pr wk (77336) |
$452.80 |
$1,132 |
3.2× |
| Contrast exam abdominl aorta (75625) |
$2,166.80 |
$5,417 |
0.7× |
| Contrast exam thoracic aorta (75605) |
$6,988.60 |
$17,471.50 |
1.2× |
| Csf shunt evaluation (78645) |
$929.20 |
$2,323 |
1.6× |
| CT - st neck w&wo contr (70492) |
$1,422 |
$3,555 |
7.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,754.60 |
$4,386.50 |
4.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,754.60 |
$4,386.50 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,655.20 |
$4,138 |
9.0× |
| CT abdomen w/contrast (74160) |
$1,653.60 |
$4,134 |
9.0× |
| CT abdomen w/o contrast (74150) |
$1,164.60 |
$2,911.50 |
10.7× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$1,754.60 |
$4,386.50 |
4.8× |
| CT angio abdom w/o & w/dye (74175) |
$1,754.60 |
$4,386.50 |
9.6× |
| CT angio abdominal arteries (75635) |
$1,754.60 |
$4,386.50 |
9.6× |
| CT angio hrt w/3d image (75574) |
$631.20 |
$1,578 |
1.7× |
| CT angiograph pelv w/o&w/dye (72191) |
$1,819.20 |
$4,548 |
9.9× |
| CT cervical spine w/contrast (72126) |
$899.60 |
$2,249 |
2.5× |
| CT cervical spine w/o contrast (72125) |
$877.20 |
$2,193 |
8.0× |
| CT chest w/contrast (71260) |
$1,400 |
$3,500 |
7.6× |
| CT colonography diag w cont (74262) |
$764.80 |
$1,912 |
4.2× |
| CT colonography w/o cntrst (74261) |
$402.80 |
$1,007 |
3.7× |
| CT extremity upper w & w/o contrast (73202) |
$1,730.80 |
$4,327 |
9.4× |
| CT head/brain with contrast (70460) |
$1,103.20 |
$2,758 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,192.80 |
$2,982 |
6.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$631.20 |
$1,578 |
1.7× |
| CT limited/localized follow up study (76380) |
$499.20 |
$1,248 |
5.5× |
| CT lower ext w/wo contrast (73702) |
$900.40 |
$2,251 |
4.9× |
| CT lower extremity w contrast (73701) |
$886.80 |
$2,217 |
4.8× |
| CT lower extremity w/o contrast unilateral (73700) |
$895.60 |
$2,239 |
8.2× |
| CT lumbar spine w/contrast (72132) |
$973.20 |
$2,433 |
2.7× |
| CT lumbar spine w/o contrast (72131) |
$882.80 |
$2,207 |
8.1× |
| CT lumbar spine w/o then w/ con (72133) |
$1,158 |
$2,895 |
6.3× |
| CT maxillofacial area w/o contrast (70486) |
$1,629.20 |
$4,073 |
14.9× |
| CT maxillofacial w/contrast (70487) |
$1,728.80 |
$4,322 |
9.4× |
| CT maxillofacial w/o then w/ con (70488) |
$2,230.40 |
$5,576 |
12.2× |
| CT orbit sella ear w/o con (70480) |
$1,728.80 |
$4,322 |
15.8× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,308.40 |
$5,771 |
12.6× |
| CT pelvis w & w/o contrast (72194) |
$1,266.80 |
$3,167 |
6.9× |
| CT pelvis w/o contrast (72192) |
$974 |
$2,435 |
8.9× |
| CT soft tissue neck w/contrast (70491) |
$1,296.40 |
$3,241 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,376 |
$3,440 |
12.6× |
| CT spine cervical w/wo contrast (72127) |
$1,070.80 |
$2,677 |
5.8× |
| CT thoracic spine w/contrast (72129) |
$987.20 |
$2,468 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$884 |
$2,210 |
8.1× |
| CT thoracic spine w/o then w/ con (72130) |
$1,175.20 |
$2,938 |
6.4× |
| CT thorax lung cancer scr c- (71271) |
$1,260 |
$3,150 |
11.5× |
| CT thorax w/o contrast (71250) |
$1,241.60 |
$3,104 |
11.4× |
| CT thorax w/o then w/ contrast (71270) |
$1,754.40 |
$4,386 |
9.6× |
| CT upper extremity w/dye (73201) |
$1,454.80 |
$3,637 |
4.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,449.20 |
$3,623 |
13.3× |
| CTA chest w/wo contrast (71275) |
$1,728.80 |
$4,322 |
9.4× |
| CTA head w contrast (70496) |
$1,728.80 |
$4,322 |
9.4× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,598.80 |
$3,997 |
8.7× |
| Cta Neck (70498) |
$1,728.80 |
$4,322 |
9.4× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$1,728.80 |
$4,322 |
9.4× |
| Dilation ureters/urethra rs&i (74485) |
$1,062.40 |
$2,656 |
0.5× |
| Diskography lumbar (72295) |
$1,821.20 |
$4,553 |
0.9× |
| Doppler echo fetal spectral display complete (76827) |
$353.20 |
$883 |
3.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$144 |
$360 |
1.3× |
| Doppler fetal mid cerebral artery (76821) |
$357.60 |
$894 |
3.3× |
| Dxa bone density study axial skeleton (77085) |
$324.40 |
$811 |
3.0× |
| Echo exam of eye thickness (76514) |
$8.74 |
$21.86 |
0.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$187.60 |
$469 |
0.8× |
| Esophogram (74220) |
$726.80 |
$1,817 |
4.0× |
| Fetal biophysical profile non-stress testing (76818) |
$283.20 |
$708 |
2.6× |
| Fetal biophysical profile w/o nst (76819) |
$236.80 |
$592 |
2.2× |
| Fetal echo complete (76825) |
$355.60 |
$889 |
0.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$367.20 |
$918 |
1.5× |
| Gastric emptying study (78264) |
$2,508.40 |
$6,271 |
6.0× |
| Gastroesophageal reflux study (78262) |
$2,522 |
$6,305 |
6.0× |
| Gated heart planar single (78472) |
$1,050.40 |
$2,626 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,445.60 |
$6,114 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,445.60 |
$6,114 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,445.60 |
$6,114 |
3.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,918.40 |
$4,796 |
0.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$1,965.20 |
$4,913 |
0.6× |
| Hepatobil syst image w/drug (78227) |
$2,621.20 |
$6,553 |
4.6× |
| Hepatobiliary system imaging (78226) |
$2,621.20 |
$6,553 |
6.3× |
| Humerus min 2 views (73060) |
$251.60 |
$629 |
2.8× |
| Hysterosalpingography (74740) |
$825.60 |
$2,064 |
3.3× |
| Imrt planning (77301) |
$4,031.60 |
$10,079 |
2.8× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$772.40 |
$1,931 |
1.1× |
| Intracavitary radiation source applic complex (77763) |
$2,384.80 |
$5,962 |
3.3× |
| Intracavitary radiation source applic intermed (77762) |
$2,384.80 |
$5,962 |
4.1× |
| Intracavitary radiation source applic simple (77761) |
$2,384.80 |
$5,962 |
4.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,144.80 |
$2,862 |
2.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$412.80 |
$1,032 |
1.1× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$390.80 |
$977 |
1.0× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$390.80 |
$977 |
1.0× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,789.20 |
$6,973 |
4.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,187.20 |
$7,968 |
5.6× |
| Liver & spleen; static only (78215) |
$2,086 |
$5,215 |
5.0× |
| Lung perfusion differential (78597) |
$687.20 |
$1,718 |
1.6× |
| Lung ventilat&perfus imaging (78582) |
$1,546 |
$3,865 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,631.60 |
$4,079 |
4.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,406.80 |
$3,517 |
3.9× |
| Mammary ductogram multiple ducts (77054) |
$308.40 |
$771 |
1.2× |
| Mammary ductogram single (77053) |
$286 |
$715 |
1.1× |
| Mlc device(s) for imrt (77338) |
$756.40 |
$1,891 |
1.9× |
| Mr safety determination physician/other qhp (76016) |
$116.40 |
$291 |
1.3× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$78.40 |
$196 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$32.40 |
$81 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$121.60 |
$304 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$319.60 |
$799 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,631.60 |
$4,079 |
4.5× |
| MRA head w/contrast (70545) |
$1,400 |
$3,500 |
3.8× |
| MRA head w/o contrast (70544) |
$1,084 |
$2,710 |
4.4× |
| MRA neck w/contrast (70548) |
$1,400 |
$3,500 |
3.8× |
| MRA neck w/o contrast (70547) |
$1,084.40 |
$2,711 |
4.4× |
| MRA neck w/wo contrast (70549) |
$1,631.60 |
$4,079 |
4.5× |
| MRI abdomen w/contrast (74182) |
$1,420.80 |
$3,552 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,484.40 |
$3,711 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,488.40 |
$3,721 |
6.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,499.20 |
$3,748 |
1.8× |
| MRI breast without contrast bilateral (77047) |
$1,631.60 |
$4,079 |
6.5× |
| MRI breast without contrast material unilateral (77046) |
$1,170.40 |
$2,926 |
4.7× |
| MRI cardiac w/o contrast (75557) |
$1,162.80 |
$2,907 |
4.7× |
| MRI cervical spine w/o contrast (72141) |
$978.80 |
$2,447 |
3.9× |
| MRI cervical spine with contrast (72142) |
$1,368.80 |
$3,422 |
3.8× |
| MRI chest w & w/o contrast (71552) |
$1,612.80 |
$4,032 |
4.4× |
| MRI chest w/contrast (71551) |
$1,612.80 |
$4,032 |
2.0× |
| MRI chest w/o contrast (71550) |
$1,612.80 |
$4,032 |
6.5× |
| MRI fetal sngl/1st gestation (74712) |
$298 |
$745 |
1.2× |
| MRI joint upper ext w/contrast (73222) |
$1,563.60 |
$3,909 |
1.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,631.60 |
$4,079 |
4.5× |
| MRI joint upr extrem w/o dye (73221) |
$1,467.60 |
$3,669 |
5.9× |
| Mri Lower Extremity W/O Dye (73718) |
$1,404.40 |
$3,511 |
5.6× |
| MRI lumbar spine with contrast (72149) |
$1,492 |
$3,730 |
4.1× |
| MRI lumbar w/wo contrast (72158) |
$1,631.60 |
$4,079 |
4.5× |
| MRI lwr ext w/o jnts with con rt (73719) |
$1,499.20 |
$3,748 |
4.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,085.60 |
$2,714 |
3.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,430.40 |
$3,576 |
3.9× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,085.60 |
$2,714 |
4.4× |
| MRI pelvis w/ contrast (72196) |
$1,797.20 |
$4,493 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,090 |
$2,725 |
4.4× |
| MRI pelvis w/wo contrast (72197) |
$1,631.60 |
$4,079 |
4.5× |
| MRI spectroscopy (76390) |
$870 |
$2,175 |
9.6× |
| MRI spine cervical wo/w contrast (72156) |
$1,631.60 |
$4,079 |
4.5× |
| MRI spine thoracic w/contrast (72147) |
$1,567.60 |
$3,919 |
4.3× |
| MRI thoracic spine w wo contrast (72157) |
$1,631.60 |
$4,079 |
4.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,012.60 |
$2,531.50 |
4.1× |
| MRI tmj (70336) |
$1,241.60 |
$3,104 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,470.40 |
$3,676 |
5.9× |
| Mri Upper Extremity W/Dye (73219) |
$1,565.20 |
$3,913 |
4.3× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$1,470 |
$3,675 |
4.0× |
| Myelogram thoracic (72255) |
$1,755.60 |
$4,389 |
2.1× |
| Myelography lumbosacral (72265) |
$1,662.40 |
$4,156 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,913.20 |
$7,283 |
2.2× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$5,002.40 |
$12,506 |
3.3× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$4,322.80 |
$10,807 |
2.9× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$5,496.40 |
$13,741 |
2.4× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$5,607.20 |
$14,018 |
2.4× |
| Nm bone 3 phase (78315) |
$3,040.40 |
$7,601 |
7.3× |
| Nm bone imaging whole body (78306) |
$2,826.40 |
$7,066 |
6.8× |
| Nm bone marrow scan limited (78102) |
$1,388 |
$3,470 |
3.3× |
| Nm heart perfusion spect stress rest (78452) |
$5,966 |
$14,915 |
4.4× |
| Nm lymph system (78195) |
$2,867.60 |
$7,169 |
5.1× |
| Nm thyroid imaging only (78013) |
$1,396 |
$3,490 |
3.3× |
| Nose to rectum for fb child (76010) |
$237.60 |
$594 |
2.6× |
| Nuclear rx IV admin (79101) |
$1,912 |
$4,780 |
7.8× |
| Ob us < 14 wks single fetus (76801) |
$496.80 |
$1,242 |
4.6× |
| Ob us nuchal meas 1 gest (76813) |
$509.60 |
$1,274 |
4.7× |
| Oral radiopharm rx (79005) |
$1,659.20 |
$4,148 |
6.8× |
| Orthopantogram (70355) |
$170 |
$425 |
1.9× |
| Parathyroid imaging (78070) |
$3,016.80 |
$7,542 |
7.2× |
| Peritoneogram rs&i (74190) |
$1,246.80 |
$3,117 |
2.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,472.80 |
$3,682 |
0.4× |
| Pulmonary perfusion imaging particulate (78580) |
$695.20 |
$1,738 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$431.60 |
$1,079 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$176.80 |
$442 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$296.80 |
$742 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$558 |
$1,395 |
5.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$558 |
$1,395 |
5.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$179.60 |
$449 |
2.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$179.60 |
$449 |
2.0× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$292.80 |
$732 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$296.80 |
$742 |
2.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$439.80 |
$1,099.50 |
4.0× |
| Radex spine cervical 2 or 3 views (72040) |
$145.60 |
$364 |
1.6× |
| Radex spine cervical 4 or 5 views (72050) |
$372 |
$930 |
3.4× |
| Radex spine cervical 6 or more views (72052) |
$396 |
$990 |
3.6× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$348.40 |
$871 |
3.8× |
Radiation delivery stereotactic cranial linear (77372)
unusually low: confirm this is the full procedure |
$3,441.20 |
$8,603 |
0.4× |
| Radiation tx delivery lvl 1 (77402) |
$368 |
$920 |
3.5× |
| Radiation tx delivery lvl 2 (77407) |
$383.60 |
$959 |
1.0× |
| Radiation tx delivery lvl 3 (77412) |
$736.80 |
$1,842 |
1.3× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$380 |
$950 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$936.40 |
$2,341 |
5.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$398.80 |
$997 |
2.2× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$179.60 |
$449 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$179.60 |
$449 |
2.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$362 |
$905 |
3.3× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$416.40 |
$1,041 |
3.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$3,877.60 |
$9,694 |
15.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$3,447.20 |
$8,618 |
8.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$5,454.80 |
$13,637 |
9.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,447.20 |
$8,618 |
6.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$860 |
$2,150 |
1.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$813.20 |
$2,033 |
3.3× |
| Saline infused sonohysterogram (76831) |
$327.40 |
$818.50 |
1.3× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$78.80 |
$197 |
3.4× |
Selective spinal angiogram (75705)
likely a partial charge, not the full procedure |
$1,596.40 |
$3,991 |
0.3× |
| Shoulder arthrogram (73040) |
$996.80 |
$2,492 |
2.7× |
| Simulation complex (77290) |
$1,588.80 |
$3,972 |
4.1× |
| Simulation intermediate (77285) |
$1,283.60 |
$3,209 |
3.3× |
| Simulation simple (77280) |
$811.20 |
$2,028 |
5.8× |
| Small bowel series (74250) |
$514.80 |
$1,287 |
2.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$964 |
$2,410 |
2.5× |
| Special dosimetry (77331) |
$512 |
$1,280 |
3.6× |
| Special physics consult (77370) |
$824 |
$2,060 |
5.9× |
| Special treatment procedure (77470) |
$1,445.60 |
$3,614 |
2.5× |
| Splenoportography (75810) |
$3,566 |
$8,915 |
1.1× |
| Stereotactic body radiation delivery (77373) |
$3,590.80 |
$8,977 |
1.9× |
| Superior sagittal sinus venogram (75870) |
$1,518 |
$3,795 |
0.5× |
| Tbs technical calculation only (77091) |
$158.80 |
$397 |
1.7× |
| Therapeutic enema barium or air (74283) |
$1,096.80 |
$2,742 |
6.0× |
| Thyroid met imaging body (78018) |
$3,200.80 |
$8,002 |
5.6× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,146.40 |
$2,866 |
2.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,608 |
$4,020 |
3.9× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$158.80 |
$397 |
1.7× |
| Treatment device intermediate (77333) |
$756.40 |
$1,891 |
5.4× |
| Treatment devices complex (77334) |
$1,223.20 |
$3,058 |
3.1× |
| Treatment devices simple (77332) |
$754.40 |
$1,886 |
5.4× |
| Ultrasound breast limited (76642) |
$370.40 |
$926 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$929.60 |
$2,324 |
8.5× |
| Ultrasound, elastography; first target lesion (76982) |
$406 |
$1,015 |
3.7× |
| Umbilical-artery Doppler (OB) (76820) |
$309.60 |
$774 |
2.8× |
| Unlisted diagnostic radiographic procedure (76499) |
$284 |
$710 |
3.1× |
| Unlisted fluoroscopic procedure (76496) |
$95.80 |
$239.49 |
1.1× |
| Unlisted procedure, clinical brachytherapy (77799) |
$307.20 |
$768 |
2.9× |
| Ureteral reflux study (78740) |
$734.40 |
$1,836 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$503.20 |
$1,258 |
2.0× |
| Urethrocystography voiding (74455) |
$742.40 |
$1,856 |
3.0× |
| Urography antegrade (74425) |
$457.60 |
$1,144 |
1.3× |
| Urography retrograde w/wo kub (74420) |
$1,167.60 |
$2,919 |
3.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$382.40 |
$956 |
3.5× |
| Us breast uni real time with image complete (76641) |
$370.40 |
$926 |
3.4× |
| Us chest (76604) |
$245.20 |
$613 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$887.60 |
$2,219 |
8.1× |
| Us elastography parenchyma (76981) |
$502.40 |
$1,256 |
4.6× |
| Us encephalogram (76506) |
$637.60 |
$1,594 |
5.8× |
| Us guided compression repair (76936) |
$1,016 |
$2,540 |
4.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,158.80 |
$2,897 |
12.8× |
| Us kidney transplanted (76776) |
$1,319.60 |
$3,299 |
12.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$582.40 |
$1,456 |
5.3× |
| Us ob detailed single fetus (76811) |
$1,299.20 |
$3,248 |
5.2× |
| Us ob followup per fetus (76816) |
$348 |
$870 |
3.2× |
| Us ob limited 1 or more fetuses (76815) |
$483.20 |
$1,208 |
4.4× |
| Us obstetric transvaginal (76817) |
$336 |
$840 |
3.1× |
| Us pelvic limited or f/u non-ob (76857) |
$289.40 |
$723.50 |
2.7× |
| Us pelvis complete (76856) |
$1,339.20 |
$3,348 |
12.3× |
| Us retroperitoneal complete (76770) |
$926.40 |
$2,316 |
8.5× |
| Us retroperitoneal limited (76775) |
$1,493.60 |
$3,734 |
13.7× |
| Us scrotum (76870) |
$926.40 |
$2,316 |
8.5× |
| Us soft tissue head/neck (76536) |
$916.40 |
$2,291 |
8.4× |
| Us spinal canal (76800) |
$838.40 |
$2,096 |
7.7× |
| Us transrectal (76872) |
$974.40 |
$2,436 |
8.9× |
| Us transrectal prostate volume (76873) |
$462.80 |
$1,157 |
4.2× |
| Us trgt dyn mbubb 1st les (76978) |
$387.20 |
$968 |
1.1× |
| Vein X-ray liver w/hemodynam (75885) |
$1,918.40 |
$4,796 |
0.6× |
| Venogram extremity bilateral (75822) |
$1,425.20 |
$3,563 |
0.9× |
| Venogram ivc w serialography (75825) |
$1,741.60 |
$4,354 |
0.5× |
| Venogram svc w serialography (75827) |
$1,878.20 |
$4,695.50 |
1.1× |
| Venography adrenal unilateral selective rs&i (75840) |
$2,445.20 |
$6,113 |
0.7× |
| Venography ext unilateral (75820) |
$1,404.40 |
$3,511 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$599.60 |
$1,499 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,472.80 |
$3,682 |
0.4× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,384.80 |
$3,462 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$146.80 |
$367 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$202.80 |
$507 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$422.40 |
$1,056 |
4.6× |
| X-ray aorta leg arteries (75630) |
$2,813.20 |
$7,033 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,034.40 |
$2,586 |
5.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$406.80 |
$1,017 |
4.5× |
| X-ray exam hips bi 3-4 views (73522) |
$232.80 |
$582 |
2.1× |
| X-ray exam of finger(s) (73140) |
$349.60 |
$874 |
3.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$298.40 |
$746 |
3.3× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$336.80 |
$842 |
3.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$374.80 |
$937 |
4.1× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$349.60 |
$874 |
3.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$402.40 |
$1,006 |
4.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$197.80 |
$494.50 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$177.20 |
$443 |
1.9× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$407.60 |
$1,019 |
4.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$540.80 |
$1,352 |
5.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$356.80 |
$892 |
3.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$209.20 |
$523 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$698 |
$1,745 |
6.4× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$301.60 |
$754 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$208.40 |
$521 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$859.60 |
$2,149 |
7.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$33.20 |
$83 |
0.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$408.80 |
$1,022 |
4.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$430.40 |
$1,076 |
4.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$432 |
$1,080 |
4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$634.80 |
$1,587 |
5.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$343.20 |
$858 |
3.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$231.40 |
$578.50 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$170.20 |
$425.50 |
1.9× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$389.60 |
$974 |
4.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$445.60 |
$1,114 |
4.9× |
| Xr abdomen 1 view (74018) |
$203.40 |
$508.50 |
2.2× |
| Xr abdomen 2 views (74019) |
$212.80 |
$532 |
1.9× |
| Xr abdomen 3 views (74021) |
$225.20 |
$563 |
2.1× |
| Xr arthrogram ankle (73615) |
$555.60 |
$1,389 |
1.5× |
| Xr arthrogram elbow (73085) |
$551.60 |
$1,379 |
1.5× |
| Xr arthrogram hip (73525) |
$766.40 |
$1,916 |
2.1× |
| Xr bone density appendicular (77081) |
$175.20 |
$438 |
1.9× |
| Xr bone density axial (77080) |
$338 |
$845 |
3.1× |
| Xr bone length study (77073) |
$284.60 |
$711.50 |
2.6× |
| Xr bone survey infant (77076) |
$362.40 |
$906 |
3.3× |
| Xr bone survey limited (77074) |
$242.40 |
$606 |
2.2× |
| Xr chest 1 view (71045) |
$178.40 |
$446 |
2.0× |
| Xr chest 2 views (71046) |
$205.60 |
$514 |
2.3× |
| Xr chest 3 views (71047) |
$351.20 |
$878 |
3.9× |
| Xr cystogram 3+ views (74430) |
$638 |
$1,595 |
1.8× |
| Xr facial bones 3 views (70150) |
$336 |
$840 |
3.1× |
| Xr joint survey 1 view (77077) |
$326 |
$815 |
3.0× |
| Xr mandible 4 views (70110) |
$445.60 |
$1,114 |
4.1× |
| Xr myelogram c-spine (72240) |
$1,889.60 |
$4,724 |
2.3× |
| Xr nasal bones (70160) |
$402 |
$1,005 |
4.4× |
| Xr pelvis 3 views (72190) |
$286.16 |
$715.42 |
2.6× |
| Xr sella turcica (70240) |
$405.20 |
$1,013 |
4.5× |
| Xr sialogram (70390) |
$481.20 |
$1,203 |
1.9× |
| Xr spine 1 view (72020) |
$528.80 |
$1,322 |
5.8× |
| Xr sternum 2 views (71120) |
$357.40 |
$893.50 |
3.9× |
| Xr surgical specimen (76098) |
$280.80 |
$702 |
0.5× |
| Xr upper extremity 2 views infant (73092) |
$135.20 |
$338 |
1.2× |
| Xray elbow 2 views (73070) |
$362 |
$905 |
4.0× |
| Xray forearm 2 views (73090) |
$378.40 |
$946 |
4.2× |
| Xray knee 1 or 2 views rt (73560) |
$391.20 |
$978 |
4.3× |
| Xray neck soft tissue (70360) |
$373.20 |
$933 |
4.1× |
| Xray optic foramina (70190) |
$550.80 |
$1,377 |
6.1× |
| Xray orbits complete min 4 views (70200) |
$516 |
$1,290 |
4.7× |
| Xray pelvis 1 or 2 views (72170) |
$27.60 |
$69 |
0.3× |
| Xray ribs bilateral 3 views (71110) |
$207.60 |
$519 |
1.9× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$584 |
$1,460 |
5.3× |
| Xray scapula complete (73010) |
$285.20 |
$713 |
2.6× |
| Xray shoulder 1 view (73020) |
$154.40 |
$386 |
1.7× |
| Xray sinuses paranasal <3 views (70210) |
$180.80 |
$452 |
2.0× |
| Xray spine thoracic 2 views (72070) |
$31.20 |
$78 |
0.3× |
| Xray tibia-fibula 2 views bil (73590) |
$273.20 |
$683 |
3.0× |
| Xray tmj's bilateral open-clsc (70330) |
$644.80 |
$1,612 |
7.1× |