| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$4,367.35 |
$6,719 |
3.0× |
| Acute gi blood loss imaging (78278) |
$1,291.55 |
$1,987 |
3.1× |
| Angio adrenal bilat select (75733) |
$5,883.15 |
$9,051 |
1.8× |
| Angio adrenal unilat select (75731) |
$5,883.15 |
$9,051 |
1.8× |
| Angio extremity unilateral (75710) |
$5,883.15 |
$9,051 |
1.8× |
| Angio pulmonary unilateral (75741) |
$6,858.80 |
$10,552 |
2.1× |
| Angiogram extremity bilateral (75716) |
$5,883.15 |
$9,051 |
1.8× |
| Angiogram pelvic (75736) |
$4,306.90 |
$6,626 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$5,883.15 |
$9,051 |
1.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,579.30 |
$10,122 |
2.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,348.20 |
$8,228 |
0.9× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,979.90 |
$3,046 |
0.6× |
| Ankle 2 views (73600) |
$371.15 |
$571 |
4.1× |
| Arthrography knee lt (73580) |
$1,092.65 |
$1,681 |
3.0× |
| Arthrography wrist lt (73115) |
$1,129.70 |
$1,738 |
3.1× |
| Barium enema (74270) |
$1,119.95 |
$1,723 |
6.1× |
| Basic dosimetry (77300) |
$1,214.20 |
$1,868 |
8.7× |
| Bilat selctv renal venogram (75833) |
$5,883.15 |
$9,051 |
1.8× |
| Bone age studies (77072) |
$373.10 |
$574 |
3.4× |
| Bone imaging limited area (78300) |
$1,630.85 |
$2,509 |
3.9× |
| Bone marrow imaging whole body (78104) |
$1,022.45 |
$1,573 |
2.4× |
| Bone survey complete (77075) |
$1,106.30 |
$1,702 |
10.1× |
| Bowel imaging (78290) |
$1,549.60 |
$2,384 |
3.7× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,195.35 |
$1,839 |
3.1× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,333.15 |
$2,051 |
2.4× |
| Brain image w/flow 4 + views (78606) |
$1,600.95 |
$2,463 |
2.8× |
| Card MRI w/stress img & dye (75563) |
$1,911.65 |
$2,941 |
2.3× |
| Cardiac MRI w/stress img (75559) |
$1,456 |
$2,240 |
2.6× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,911.65 |
$2,941 |
5.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$786.50 |
$1,210 |
4.3× |
| Cisternogram (78630) |
$1,507.35 |
$2,319 |
2.7× |
| Clavicle complete (73000) |
$504.40 |
$776 |
5.6× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$902.85 |
$1,389 |
3.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,500.90 |
$5,386 |
19.1× |
| Continuing medical physics consltj pr wk (77336) |
$705.25 |
$1,085 |
5.0× |
| Contrast exam abdominl aorta (75625) |
$5,395 |
$8,300 |
1.6× |
| Contrast exam thoracic aorta (75605) |
$4,017 |
$6,180 |
0.7× |
| Csf shunt evaluation (78645) |
$965.90 |
$1,486 |
1.7× |
| CT - st neck w&wo contr (70492) |
$3,491.15 |
$5,371 |
19.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,280.25 |
$6,585 |
11.7× |
| CT abdomen and pelvis without contrast (74176) |
$3,325.40 |
$5,116 |
13.3× |
| CT abdomen w wo contrast (74170) |
$2,904.85 |
$4,469 |
15.9× |
| CT abdomen w/contrast (74160) |
$2,507.70 |
$3,858 |
13.7× |
| CT abdomen w/o contrast (74150) |
$2,261.35 |
$3,479 |
20.7× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$3,801.85 |
$5,849 |
10.4× |
| CT angio abdom w/o & w/dye (74175) |
$1,835.60 |
$2,824 |
10.0× |
| CT angio abdominal arteries (75635) |
$2,273.05 |
$3,497 |
12.4× |
| CT angio hrt w/3d image (75574) |
$1,681.55 |
$2,587 |
4.6× |
| CT angiograph pelv w/o&w/dye (72191) |
$1,842.75 |
$2,835 |
10.1× |
| CT cervical spine w/contrast (72126) |
$2,951 |
$4,540 |
8.1× |
| CT cervical spine w/o contrast (72125) |
$2,192.45 |
$3,373 |
20.1× |
| CT chest w/contrast (71260) |
$3,272.75 |
$5,035 |
17.9× |
| CT colonography diag w cont (74262) |
$1,069.25 |
$1,645 |
5.8× |
| CT colonography w/o cntrst (74261) |
$701.35 |
$1,079 |
6.4× |
| CT extremity upper w & w/o contrast (73202) |
$1,710.80 |
$2,632 |
9.3× |
| CT head/brain with contrast (70460) |
$3,117.40 |
$4,796 |
17.0× |
| CT head/brain without and with contrast (70470) |
$3,943.55 |
$6,067 |
21.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,375.40 |
$2,116 |
3.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,071.85 |
$1,649 |
11.8× |
| CT hrt w/3d image congen (75573) |
$1,318.20 |
$2,028 |
3.6× |
| CT limited/localized follow up study (76380) |
$1,115.40 |
$1,716 |
12.3× |
| CT lower ext w/wo contrast (73702) |
$2,252.90 |
$3,466 |
12.3× |
| CT lower extremity w contrast (73701) |
$2,186.60 |
$3,364 |
11.9× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,102.10 |
$3,234 |
19.3× |
| CT lumbar spine w/contrast (72132) |
$3,296.80 |
$5,072 |
9.0× |
| CT lumbar spine w/o contrast (72131) |
$2,984.80 |
$4,592 |
27.3× |
| CT lumbar spine w/o then w/ con (72133) |
$3,879.85 |
$5,969 |
21.2× |
| CT maxillofacial area w/o contrast (70486) |
$2,714.40 |
$4,176 |
24.9× |
| CT maxillofacial w/contrast (70487) |
$3,201.90 |
$4,926 |
17.5× |
| CT maxillofacial w/o then w/ con (70488) |
$3,354 |
$5,160 |
18.3× |
| CT orbit sella ear w/o con (70480) |
$3,235.70 |
$4,978 |
29.6× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$4,299.10 |
$6,614 |
23.5× |
| CT pelvis w & w/o contrast (72194) |
$3,361.80 |
$5,172 |
18.4× |
| CT pelvis w/o contrast (72192) |
$2,769 |
$4,260 |
25.4× |
| CT soft tissue neck w/contrast (70491) |
$3,259.10 |
$5,014 |
17.8× |
| CT soft tissue neck w/o contrast (70490) |
$2,840.50 |
$4,370 |
26.0× |
| CT spine cervical w/wo contrast (72127) |
$3,783 |
$5,820 |
20.7× |
| CT thoracic spine w/contrast (72129) |
$2,822.30 |
$4,342 |
15.4× |
| CT thoracic spine w/o contrast (72128) |
$1,960.40 |
$3,016 |
18.0× |
| CT thoracic spine w/o then w/ con (72130) |
$3,222.05 |
$4,957 |
17.6× |
| CT thorax lung cancer scr c- (71271) |
$388.05 |
$597 |
3.6× |
| CT thorax w/o contrast (71250) |
$2,051.40 |
$3,156 |
18.8× |
| CT thorax w/o then w/ contrast (71270) |
$3,441.75 |
$5,295 |
18.8× |
| CT upper extremity w/dye (73201) |
$2,190.50 |
$3,370 |
6.0× |
| CT upper extremity w/o contrast rt (73200) |
$2,109.25 |
$3,245 |
19.3× |
| CTA chest w/wo contrast (71275) |
$2,904.85 |
$4,469 |
15.9× |
| CTA head w contrast (70496) |
$2,365.35 |
$3,639 |
12.9× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,556.10 |
$2,394 |
8.5× |
| Cta Neck (70498) |
$3,283.15 |
$5,051 |
17.9× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,171 |
$3,340 |
11.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) |
$761.15 |
$1,171 |
3.1× |
| Dilation ureters/urethra rs&i (74485) |
$3,100.50 |
$4,770 |
1.4× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$4,941.30 |
$7,602 |
2.4× |
| Diskography lumbar (72295) |
$4,941.30 |
$7,602 |
2.4× |
| Doppler echo fetal spectral display complete (76827) |
$332.80 |
$512 |
3.0× |
| Dxa bone density study axial skeleton (77085) |
$800.80 |
$1,232 |
7.3× |
| Esophogram (74220) |
$738.40 |
$1,136 |
4.0× |
| Fetal biophysical profile w/o nst (76819) |
$657.15 |
$1,011 |
6.0× |
| Fetal echo complete (76825) |
$951.60 |
$1,464 |
1.7× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$771.88 |
$1,187.50 |
3.1× |
| Functional MRI brain by phys/psych (70555) |
$2,809.30 |
$4,322 |
11.3× |
| Functional MRI brain by tech (70554) |
$2,783.95 |
$4,283 |
11.2× |
| Gastric emptying study (78264) |
$1,752.40 |
$2,696 |
4.2× |
| Gated heart planar single (78472) |
$1,937.65 |
$2,981 |
4.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$5,731.05 |
$8,817 |
7.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$7,146.10 |
$10,994 |
9.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,124.20 |
$3,268 |
2.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,369.65 |
$8,261 |
1.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$5,394.35 |
$8,299 |
1.6× |
| Hepatobil syst image w/drug (78227) |
$1,813.50 |
$2,790 |
3.2× |
| Hepatobiliary system imaging (78226) |
$1,813.50 |
$2,790 |
4.3× |
| Humerus min 2 views (73060) |
$520.65 |
$801 |
5.7× |
| Hysterosalpingography (74740) |
$1,008.15 |
$1,551 |
4.0× |
| Imrt planning (77301) |
$5,141.50 |
$7,910 |
3.6× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$719.55 |
$1,107 |
1.7× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$8,628.75 |
$13,275 |
11.9× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$711.10 |
$1,094 |
1.8× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$506.35 |
$779 |
1.3× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$2,085.85 |
$3,209 |
5.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$1,843.40 |
$2,836 |
4.7× |
| Ivp w tomography (74415) |
$1,270.10 |
$1,954 |
6.9× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$2,568.15 |
$3,951 |
4.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,716 |
$2,640 |
3.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,987.70 |
$3,058 |
3.5× |
| Liver & spleen; static only (78215) |
$1,034.15 |
$1,591 |
2.5× |
| Liver imaging w/vascular flow (78202) |
$3,598.40 |
$5,536 |
6.3× |
| Lung perf&ventilat diferentl (78598) |
$2,356.90 |
$3,626 |
4.2× |
| Lung perfusion differential (78597) |
$3,412.50 |
$5,250 |
8.2× |
| Lung ventilat&perfus imaging (78582) |
$3,412.50 |
$5,250 |
6.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,814.15 |
$2,791 |
2.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,199.95 |
$4,923 |
1.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,110.30 |
$7,862 |
14.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,211 |
$4,940 |
8.8× |
| Mammary ductogram multiple ducts (77054) |
$739.05 |
$1,137 |
3.0× |
| Mammary ductogram single (77053) |
$739.05 |
$1,137 |
3.0× |
| Mlc device(s) for imrt (77338) |
$2,034.50 |
$3,130 |
5.2× |
| MRA head w & w/o contrast (70546) |
$3,806.40 |
$5,856 |
10.4× |
| MRA head w/contrast (70545) |
$3,043.95 |
$4,683 |
8.4× |
| MRA head w/o contrast (70544) |
$2,533.70 |
$3,898 |
10.2× |
| MRA neck w/contrast (70548) |
$1,983.80 |
$3,052 |
5.4× |
| MRA neck w/o contrast (70547) |
$1,655.55 |
$2,547 |
6.6× |
| MRA neck w/wo contrast (70549) |
$2,479.75 |
$3,815 |
6.8× |
| MRI abdomen w/contrast (74182) |
$3,546.72 |
$5,456.50 |
9.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,546.72 |
$5,456.50 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$3,223.02 |
$4,958.50 |
12.9× |
| MRI any jnt lwr ext with con lt (73722) |
$3,970.85 |
$6,109 |
4.9× |
| MRI bone marrow (77084) |
$800.80 |
$1,232 |
3.2× |
| MRI brain w/dye (70558) |
$983.45 |
$1,513 |
5.4× |
| MRI brain w/o & w/dye (70559) |
$5,883.15 |
$9,051 |
32.1× |
| MRI brain w/o dye (70557) |
$647.40 |
$996 |
1.1× |
| MRI breast without contrast bilateral (77047) |
$3,209.05 |
$4,937 |
12.9× |
| MRI breast without contrast material unilateral (77046) |
$1,572.35 |
$2,419 |
6.3× |
| MRI cardiac w/o contrast (75557) |
$1,249.30 |
$1,922 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$3,417.70 |
$5,258 |
13.7× |
| MRI cervical spine with contrast (72142) |
$3,542.50 |
$5,450 |
9.7× |
| MRI chest w & w/o contrast (71552) |
$4,080.70 |
$6,278 |
11.2× |
| MRI chest w/contrast (71551) |
$3,278.60 |
$5,044 |
4.0× |
| MRI chest w/o contrast (71550) |
$3,224 |
$4,960 |
12.9× |
| MRI joint upper ext w/contrast (73222) |
$3,445 |
$5,300 |
4.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,020.90 |
$6,186 |
11.0× |
| MRI joint upr extrem w/o dye (73221) |
$2,964 |
$4,560 |
11.9× |
| Mri Lower Extremity W/O Dye (73718) |
$2,652.65 |
$4,081 |
10.6× |
| MRI lumbar spine with contrast (72149) |
$3,612.70 |
$5,558 |
9.9× |
| MRI lumbar w/wo contrast (72158) |
$4,345.90 |
$6,686 |
11.9× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,089.10 |
$3,214 |
5.7× |
| MRI orbit/face/neck w/contrast (70542) |
$3,438.50 |
$5,290 |
9.4× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$3,818.75 |
$5,875 |
10.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$3,059.55 |
$4,707 |
12.3× |
| MRI pelvis w/ contrast (72196) |
$3,070.60 |
$4,724 |
8.4× |
| MRI pelvis w/o contrast (72195) |
$2,913.30 |
$4,482 |
11.7× |
| MRI pelvis w/wo contrast (72197) |
$3,232.45 |
$4,973 |
8.9× |
| MRI spectroscopy (76390) |
$1,708.85 |
$2,629 |
18.8× |
| MRI spine cervical wo/w contrast (72156) |
$4,284.80 |
$6,592 |
11.8× |
| MRI spine thoracic w/contrast (72147) |
$3,697.20 |
$5,688 |
10.1× |
| MRI thoracic spine w wo contrast (72157) |
$4,332.25 |
$6,665 |
11.9× |
| MRI thoracic spine w/o contrast (72146) |
$3,385.20 |
$5,208 |
13.6× |
| MRI tmj (70336) |
$3,357.25 |
$5,165 |
13.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,487.55 |
$3,827 |
10.0× |
| Mri Upper Extremity W/Dye (73219) |
$2,503.15 |
$3,851 |
6.9× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$3,324.75 |
$5,115 |
9.1× |
| Myocardial spect single study at rest or stress (78451) |
$3,837.60 |
$5,904 |
2.8× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$4,244.50 |
$6,530 |
4.7× |
| Nm bone 3 phase (78315) |
$2,436.85 |
$3,749 |
5.8× |
| Nm bone imaging whole body (78306) |
$2,258.75 |
$3,475 |
5.4× |
| Nm bone marrow scan limited (78102) |
$819 |
$1,260 |
2.0× |
| Nm bone multi (78305) |
$1,034.15 |
$1,591 |
2.5× |
| Nm heart perfusion spect stress rest (78452) |
$5,848.05 |
$8,997 |
4.3× |
| Nm kidney imaging morphology (78700) |
$1,077.70 |
$1,658 |
2.6× |
| Nm lymph system (78195) |
$1,592.50 |
$2,450 |
2.8× |
| Nm thyroid imaging only (78013) |
$1,034.15 |
$1,591 |
2.5× |
| Nose to rectum for fb child (76010) |
$297.70 |
$458 |
3.3× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$1,034.15 |
$1,591 |
2.5× |
| Nuclear rx IV admin (79101) |
$2,675.40 |
$4,116 |
11.0× |
| Ob us < 14 wks single fetus (76801) |
$669.50 |
$1,030 |
6.1× |
| Oral radiopharm rx (79005) |
$2,900.95 |
$4,463 |
11.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,161.90 |
$3,326 |
3.8× |
| Parathyroid imaging (78070) |
$1,775.80 |
$2,732 |
4.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,508.65 |
$2,321 |
3.6× |
| Peritoneal-venous shunt patency test (78291) |
$1,034.15 |
$1,591 |
2.5× |
| Peritoneogram rs&i (74190) |
$1,456 |
$2,240 |
2.6× |
| PET brain metabolic eval (78608) |
$5,235.75 |
$8,055 |
3.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,918.55 |
$7,567 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$3,966.30 |
$6,102 |
2.7× |
| PET imaging for CT attenuation whole body (78816) |
$5,541.25 |
$8,525 |
3.7× |
| PET imaging limited area chest head/neck (78811) |
$3,371.55 |
$5,187 |
2.5× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$4,024.80 |
$6,192 |
2.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,467.75 |
$5,335 |
1.1× |
| Pulmonary perfusion imaging particulate (78580) |
$1,855.10 |
$2,854 |
4.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,156.35 |
$1,779 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$235.30 |
$362 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$388.05 |
$597 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$741 |
$1,140 |
6.8× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$741 |
$1,140 |
6.8× |
| Radex hip unilateral with pelvis 1 view (73501) |
$371.80 |
$572 |
4.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$598.65 |
$921 |
6.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$742.30 |
$1,142 |
6.8× |
| Radex spine cervical 2 or 3 views (72040) |
$594.10 |
$914 |
6.5× |
| Radex spine cervical 4 or 5 views (72050) |
$787.80 |
$1,212 |
7.2× |
| Radex spine cervical 6 or more views (72052) |
$891.80 |
$1,372 |
8.2× |
| Radiation delivery stereotactic cranial linear (77372) |
$22,369.10 |
$34,414 |
2.9× |
| Radiation tx delivery lvl 1 (77402) |
$616.20 |
$948 |
5.8× |
| Radiation tx delivery lvl 2 (77407) |
$830.70 |
$1,278 |
2.1× |
| Radiation tx delivery lvl 3 (77412) |
$1,234.35 |
$1,899 |
2.1× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$810.55 |
$1,247 |
7.4× |
| Radiologic exam esophagus double contrast study (74221) |
$794.30 |
$1,222 |
4.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,142.05 |
$1,757 |
6.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,057.55 |
$1,627 |
5.8× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$452.40 |
$696 |
5.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$563.55 |
$867 |
6.2× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$329.55 |
$507 |
3.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$936.65 |
$1,441 |
8.6× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$329.55 |
$507 |
3.0× |
| Radiologic examination, teeth; single view Other Diagnostic Radiology FS (70300) |
$174.85 |
$269 |
1.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$1,368.25 |
$2,105 |
5.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$695.50 |
$1,070 |
1.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$695.50 |
$1,070 |
1.7× |
| Renal cyst study (74470) |
$3,352.05 |
$5,157 |
5.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,370.20 |
$2,108 |
3.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,442.70 |
$3,758 |
5.9× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,598.40 |
$5,536 |
6.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,598.40 |
$5,536 |
6.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,722.55 |
$5,727 |
6.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,722.55 |
$5,727 |
2.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,270.75 |
$1,955 |
5.2× |
| Saline infused sonohysterogram (76831) |
$467.35 |
$719 |
1.9× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$145.60 |
$224 |
6.2× |
| Selective spinal angiogram (75705) |
$7,289.75 |
$11,215 |
1.3× |
| Shoulder arthrogram (73040) |
$1,034.80 |
$1,592 |
2.8× |
| Simulation complex (77290) |
$3,203.20 |
$4,928 |
8.2× |
| Simulation intermediate (77285) |
$2,577.90 |
$3,966 |
6.6× |
| Simulation simple (77280) |
$1,940.90 |
$2,986 |
13.8× |
| Small bowel series (74250) |
$924.95 |
$1,423 |
5.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$759.20 |
$1,168 |
1.9× |
| Special dosimetry (77331) |
$1,123.20 |
$1,728 |
8.0× |
| Special physics consult (77370) |
$1,095.90 |
$1,686 |
7.8× |
| Special treatment procedure (77470) |
$2,569.45 |
$3,953 |
4.5× |
| Splenoportography (75810) |
$5,883.15 |
$9,051 |
1.8× |
| Stereotactic body radiation delivery (77373) |
$6,427.20 |
$9,888 |
3.4× |
| Superior sagittal sinus venogram (75870) |
$1,626.30 |
$2,502 |
0.5× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$436.80 |
$672 |
4.1× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$679.90 |
$1,046 |
2.7× |
| Thyroid met imaging body (78018) |
$1,741.02 |
$2,678.50 |
3.1× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,034.15 |
$1,591 |
2.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,682.20 |
$2,588 |
4.0× |
| Treatment device intermediate (77333) |
$1,071.85 |
$1,649 |
7.6× |
| Treatment devices complex (77334) |
$1,110.85 |
$1,709 |
2.8× |
| Treatment devices simple (77332) |
$858 |
$1,320 |
6.1× |
| Ultrasound breast limited (76642) |
$513.50 |
$790 |
5.7× |
| Ultrasound, abdomen limited (76705) |
$1,046.50 |
$1,610 |
9.6× |
| Ultrasound, elastography; first target lesion (76982) |
$362.05 |
$557 |
3.3× |
| Unlisted CT procedure (76497) |
$430.30 |
$662 |
4.7× |
| Unlisted diagnostic radiographic procedure (76499) |
$182 |
$280 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$350.35 |
$539 |
3.9× |
| Unlisted procedure, clinical brachytherapy (77799) |
$352.30 |
$542 |
3.3× |
| Ureteral reflux study (78740) |
$1,276.60 |
$1,964 |
3.1× |
| Urethrocystography retrograde rs&i (74450) |
$990.60 |
$1,524 |
4.0× |
| Urethrocystography voiding (74455) |
$938.60 |
$1,444 |
3.8× |
| Urography antegrade (74425) |
$2,412.15 |
$3,711 |
6.6× |
| Urography retrograde w/wo kub (74420) |
$1,017.25 |
$1,565 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$705.90 |
$1,086 |
3.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$442.65 |
$681 |
4.1× |
| Us breast uni real time with image complete (76641) |
$430.30 |
$662 |
3.9× |
| Us chest (76604) |
$633.10 |
$974 |
5.8× |
| Us elastography parenchyma (76981) |
$362.05 |
$557 |
3.3× |
| Us encephalogram (76506) |
$839.80 |
$1,292 |
7.7× |
| Us guided compression repair (76936) |
$1,498.25 |
$2,305 |
6.6× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$925.60 |
$1,424 |
10.2× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$552.50 |
$850 |
6.1× |
| Us kidney transplanted (76776) |
$442.65 |
$681 |
4.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$226.20 |
$348 |
2.1× |
| Us ob limited 1 or more fetuses (76815) |
$527.80 |
$812 |
4.8× |
| Us obstetric transvaginal (76817) |
$974.35 |
$1,499 |
8.9× |
| Us pelvic limited or f/u non-ob (76857) |
$1,007.50 |
$1,550 |
9.2× |
| Us pelvis complete (76856) |
$1,134.25 |
$1,745 |
10.4× |
| Us retroperitoneal complete (76770) |
$1,168.05 |
$1,797 |
10.7× |
| Us retroperitoneal limited (76775) |
$1,045.20 |
$1,608 |
9.6× |
| Us scrotum (76870) |
$779.35 |
$1,199 |
7.1× |
| Us soft tissue head/neck (76536) |
$643.50 |
$990 |
5.9× |
| Us spinal canal (76800) |
$776.10 |
$1,194 |
7.1× |
| Us transrectal (76872) |
$1,165.45 |
$1,793 |
10.7× |
| Us transrectal prostate volume (76873) |
$458.25 |
$705 |
4.2× |
| Vein X-ray liver w/hemodynam (75885) |
$5,798 |
$8,920 |
1.8× |
| Venogram epidural (75872) |
$4,730.05 |
$7,277 |
7.2× |
| Venogram extremity bilateral (75822) |
$3,566.55 |
$5,487 |
2.2× |
| Venogram ivc w serialography (75825) |
$5,883.15 |
$9,051 |
1.8× |
| Venogram svc w serialography (75827) |
$1,599 |
$2,460 |
1.0× |
| Venography adrenal unilateral selective rs&i (75840) |
$5,883.15 |
$9,051 |
1.8× |
| Venography ext unilateral (75820) |
$2,478.45 |
$3,813 |
1.5× |
| Venography renal unilateral selective rs&i (75831) |
$5,883.15 |
$9,051 |
1.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,883.15 |
$9,051 |
1.8× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$5,883.15 |
$9,051 |
9.0× |
| Venous sampling by catheter (75893) |
$4,497.35 |
$6,919 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$182 |
$280 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$339.95 |
$523 |
3.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$537.55 |
$827 |
5.9× |
| X-ray aorta leg arteries (75630) |
$5,202.60 |
$8,004 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,525.55 |
$2,347 |
8.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$536.25 |
$825 |
5.9× |
| X-ray exam hips bi 3-4 views (73522) |
$1,197.30 |
$1,842 |
11.0× |
| X-ray exam of finger(s) (73140) |
$423.15 |
$651 |
4.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$449.80 |
$692 |
4.9× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$389.35 |
$599 |
4.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$538.20 |
$828 |
5.9× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$362.70 |
$558 |
3.3× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$520 |
$800 |
5.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$441.35 |
$679 |
4.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$200.20 |
$308 |
2.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$505.05 |
$777 |
5.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$593.45 |
$913 |
5.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$559.65 |
$861 |
6.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$620.10 |
$954 |
5.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,107.60 |
$1,704 |
10.1× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$329.55 |
$507 |
3.0× |
| X-ray perineogram (74775) |
$490.10 |
$754 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$686.40 |
$1,056 |
6.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$362.05 |
$557 |
3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$585 |
$900 |
6.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$577.85 |
$889 |
6.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$810.55 |
$1,247 |
8.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$815.75 |
$1,255 |
7.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$492.05 |
$757 |
4.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$283.40 |
$436 |
3.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$408.85 |
$629 |
4.5× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$393.25 |
$605 |
4.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$574.60 |
$884 |
6.3× |
| Xr abdomen 1 view (74018) |
$516.10 |
$794 |
5.7× |
| Xr abdomen 2 views (74019) |
$574.60 |
$884 |
5.3× |
| Xr abdomen 3 views (74021) |
$604.50 |
$930 |
5.5× |
| Xr arthrogram ankle (73615) |
$549.90 |
$846 |
1.5× |
| Xr arthrogram elbow (73085) |
$716.30 |
$1,102 |
2.0× |
| Xr arthrogram hip (73525) |
$949.65 |
$1,461 |
2.6× |
| Xr bone density appendicular (77081) |
$182 |
$280 |
2.0× |
| Xr bone density axial (77080) |
$488.80 |
$752 |
4.5× |
| Xr bone length study (77073) |
$566.15 |
$871 |
5.2× |
| Xr bone survey limited (77074) |
$733.85 |
$1,129 |
6.7× |
| Xr chest 1 view (71045) |
$375.05 |
$577 |
4.1× |
| Xr chest 2 views (71046) |
$445.90 |
$686 |
4.9× |
| Xr chest 3 views (71047) |
$611.65 |
$941 |
6.7× |
| Xr cystogram 3+ views (74430) |
$733.85 |
$1,129 |
2.0× |
| Xr facial bones 3 views (70150) |
$731.25 |
$1,125 |
6.7× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$408.85 |
$629 |
3.7× |
| Xr mandible 4 views (70110) |
$354.90 |
$546 |
3.3× |
| Xr nasal bones (70160) |
$577.85 |
$889 |
6.4× |
| Xr pelvis 3 views (72190) |
$752.70 |
$1,158 |
6.9× |
| Xr sialogram (70390) |
$743.60 |
$1,144 |
3.0× |
| Xr spine 1 view (72020) |
$434.20 |
$668 |
4.8× |
| Xr sternum 2 views (71120) |
$563.55 |
$867 |
6.2× |
| Xr stress view joint (77071) |
$408.20 |
$628 |
4.5× |
| Xr surgical specimen (76098) |
$575.90 |
$886 |
1.0× |
| Xray elbow 2 views (73070) |
$394.55 |
$607 |
4.3× |
| Xray forearm 2 views (73090) |
$502.45 |
$773 |
5.5× |
| Xray knee 1 or 2 views rt (73560) |
$413.40 |
$636 |
4.5× |
| Xray neck soft tissue (70360) |
$534.95 |
$823 |
5.9× |
| Xray orbits complete min 4 views (70200) |
$824.85 |
$1,269 |
7.6× |
| Xray pelvis 1 or 2 views (72170) |
$583.05 |
$897 |
5.3× |
| Xray ribs bilateral 3 views (71110) |
$813.15 |
$1,251 |
7.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$736.45 |
$1,133 |
6.7× |
| Xray scapula complete (73010) |
$549.25 |
$845 |
5.0× |
| Xray shoulder 1 view (73020) |
$394.55 |
$607 |
4.3× |
| Xray sinuses paranasal <3 views (70210) |
$334.75 |
$515 |
3.7× |
| Xray spine thoracic 3 views (72072) |
$663 |
$1,020 |
6.1× |
| Xray tibia-fibula 2 views bil (73590) |
$521.95 |
$803 |
5.7× |
| Xray tmj open - closed unilat (70328) |
$312.65 |
$481 |
3.4× |
| Xray tmj's bilateral open-clsc (70330) |
$722.80 |
$1,112 |
8.0× |