| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,305.15 |
$23,729 |
6.0× |
| Abdomen 1 View (74018) |
$456.40 |
$1,304 |
5.2× |
| Abdomen 2 views (74019) |
$552.30 |
$1,578 |
5.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$805.70 |
$2,302 |
2.0× |
| Angio internal mammary (75756) |
$2,628.15 |
$7,509 |
0.8× |
| Angio pulmonary bilat (75743) |
$2,331.70 |
$6,662 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$3,127.95 |
$8,937 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,522.45 |
$7,207 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,538.95 |
$4,397 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,168.25 |
$6,195 |
0.7× |
| Ankle 2 views (73600) |
$260.75 |
$745 |
3.0× |
| Aortography thoracic serialography rs&i (75605) |
$4,982.25 |
$14,235 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$5,453.35 |
$15,581 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$2,628.15 |
$7,509 |
0.8× |
| Artery X-Rays Pelvis (75736) |
$5,244.40 |
$14,984 |
0.9× |
| Artery X-Rays Spine (75705) |
$4,306.40 |
$12,304 |
0.8× |
| Arthrogram ankle (73615) |
$410.20 |
$1,172 |
1.2× |
| Arthrogram hip (73525) |
$1,040.55 |
$2,973 |
3.0× |
| Arthrogram Wrist (73115) |
$366.80 |
$1,048 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$1,705.90 |
$4,874 |
12.6× |
| Bone age studies (77072) |
$210.70 |
$602 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$2,308.60 |
$6,596 |
5.7× |
| Bone Imaging Limited Area (78300) |
$1,506.40 |
$4,304 |
3.8× |
| Bone Imaging Multiple Areas (78305) |
$1,819.30 |
$5,198 |
4.5× |
| Bone Imaging Whole Body (78306) |
$1,956.15 |
$5,589 |
4.9× |
| Bone marrow imaging limited area (78102) |
$340.20 |
$972 |
0.8× |
| Bone marrow imaging; multiple areas (78103) |
$340.20 |
$972 |
0.8× |
| Bone marrow imaging; whole body (78104) |
$759.15 |
$2,169 |
1.9× |
| Bone survey infant (77076) |
$1,272.60 |
$3,636 |
12.1× |
| Brachytx isodose complex (77318) |
$2,342.20 |
$6,692 |
6.2× |
| Brachytx isodose intermed (77317) |
$1,649.20 |
$4,712 |
4.4× |
| Brachytx Isodose Plan Simple (77316) |
$1,253.70 |
$3,582 |
3.3× |
| Brain Flow Imaging Only (78610) |
$232.75 |
$665 |
0.4× |
| Brain Image W/Flow < 4 Views (78601) |
$336.35 |
$961 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,168.65 |
$3,339 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,805.25 |
$8,015 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,453.20 |
$4,152 |
4.1× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,453.20 |
$4,152 |
1.8× |
| Cat Scan Follow-Up Study (76380) |
$562.80 |
$1,608 |
6.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$397.25 |
$1,135 |
0.7× |
| Cerebrospinal Fluid Scan (78630) |
$773.15 |
$2,209 |
1.4× |
| Chest 1 view (71045) |
$436.80 |
$1,248 |
5.0× |
| Chest 2 views (71046) |
$572.25 |
$1,635 |
6.5× |
| Chest 3 views (71047) |
$721 |
$2,060 |
8.2× |
| Chest 4 or more views (71048) |
$777.70 |
$2,222 |
7.4× |
| Cisternography Positive Contrast Rs&I (70015) |
$727.65 |
$2,079 |
0.9× |
| Clavicle complete (73000) |
$377.65 |
$1,079 |
4.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$127.05 |
$363 |
1.2× |
| Continuing medical physics consltj pr wk (77336) |
$741.65 |
$2,119 |
5.5× |
| Contrast Exam Abdominl Aorta (75625) |
$3,124.10 |
$8,926 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$480.90 |
$1,374 |
1.4× |
| Contrast X-Ray Of Elbow (73085) |
$410.20 |
$1,172 |
1.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$603.40 |
$1,724 |
1.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$271.95 |
$777 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$7,343 |
$20,980 |
21.0× |
| CT abdomen and pelvis without contrast (74176) |
$5,658.80 |
$16,168 |
23.6× |
| CT abdomen w contrast (74160) |
$2,346.75 |
$6,705 |
13.3× |
| CT abdomen w wo contrast (74170) |
$2,636.55 |
$7,533 |
15.0× |
| CT abdomen w/o contrast (74150) |
$1,371.30 |
$3,918 |
13.1× |
| CT Angio Abdomen and Pelvis (74174) |
$4,027.10 |
$11,506 |
11.5× |
| CT Angio Chest (71275) |
$3,421.25 |
$9,775 |
19.4× |
| CT Angio Head (70496) |
$3,731 |
$10,660 |
21.2× |
| CT angio hrt w/3d image (75574) |
$1,514.10 |
$4,326 |
4.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$3,600.80 |
$10,288 |
20.4× |
| CT Angio Neck (70498) |
$3,731 |
$10,660 |
21.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$3,546.90 |
$10,134 |
20.1× |
| CT cervical spine w/ contrast (72126) |
$3,706.50 |
$10,590 |
10.6× |
| CT cervical spine w/o contrast (72125) |
$2,851.10 |
$8,146 |
27.1× |
| CT cervical spine w/wo cont (72127) |
$4,333.70 |
$12,382 |
24.6× |
| CT chest w contrast (71260) |
$3,540.25 |
$10,115 |
20.1× |
| CT chest w/wo contrast (71270) |
$4,177.60 |
$11,936 |
23.7× |
| CT colonography screening (74263) |
$962.50 |
$2,750 |
4.0× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$471.45 |
$1,347 |
2.7× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$409.85 |
$1,171 |
3.9× |
| CT head/brain with contrast (70460) |
$3,358.95 |
$9,597 |
19.1× |
| CT head/brain without and with contrast (70470) |
$3,935.05 |
$11,243 |
22.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,075.20 |
$3,072 |
3.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$469.70 |
$1,342 |
5.4× |
| CT hrt w/3d image congen (75573) |
$1,423.45 |
$4,067 |
4.1× |
| CT iac w contrast (70481) |
$1,344.70 |
$3,842 |
7.6× |
| CT l-spine w&w/o contrast (72133) |
$5,346.60 |
$15,276 |
30.3× |
| CT lower ext w/o (73700) |
$1,767.50 |
$5,050 |
16.8× |
| CT lower extremity w/contrast material (73701) |
$2,280.25 |
$6,515 |
12.9× |
| CT lumbar spine w contrast (72132) |
$4,547.90 |
$12,994 |
13.0× |
| CT lumbar spine w/o contrast (72131) |
$3,471.65 |
$9,919 |
33.1× |
| CT maxillofacial w contrast (70487) |
$2,300.90 |
$6,574 |
13.1× |
| CT maxillofacial wo contrast (70486) |
$2,256.80 |
$6,448 |
21.5× |
| CT neck tissue combo (70492) |
$2,943.50 |
$8,410 |
16.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,569.05 |
$4,483 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,179.50 |
$3,370 |
11.2× |
| CT pelvis w&w/o contrast (72194) |
$3,005.80 |
$8,588 |
17.1× |
| CT pelvis w/o contrast (72192) |
$1,573.60 |
$4,496 |
15.0× |
| CT scan of leg combo (73702) |
$2,669.10 |
$7,626 |
15.1× |
| CT scans face/jaw combo (70488) |
$1,822.80 |
$5,208 |
10.3× |
| CT soft tissue neck w contrast (70491) |
$2,452.80 |
$7,008 |
13.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,986.95 |
$5,677 |
18.9× |
| CT thoracic spine w contrast (72129) |
$4,334.05 |
$12,383 |
24.6× |
| CT thoracic spine w/o contrast (72128) |
$3,308.20 |
$9,452 |
31.5× |
| CT thoracic spine w/wo cont (72130) |
$5,094.95 |
$14,557 |
28.9× |
| CT thorax w/o contrast (71250) |
$2,796.85 |
$7,991 |
26.6× |
| CT unlisted procedure (76497) |
$63.70 |
$182 |
0.7× |
| CT upper ext wo (73200) |
$1,572.55 |
$4,493 |
15.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,437.75 |
$6,965 |
13.8× |
| CT upper extremity with contrast (73201) |
$1,965.95 |
$5,617 |
5.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$4,274.55 |
$12,213 |
24.3× |
| Cta Abdomen (74175) |
$3,101 |
$8,860 |
17.6× |
| CTA pelvis (72191) |
$1,253 |
$3,580 |
7.1× |
| Dilation ureters/urethra rs&i (74485) |
$1,679.30 |
$4,798 |
0.8× |
| Diskography lumbar (72295) |
$1,321.60 |
$3,776 |
0.7× |
| Dxa Bone Density Axial (77080) |
$416.50 |
$1,190 |
4.0× |
| Dxa bone density study (77085) |
$191.45 |
$547 |
1.8× |
| Echo exam uterus (76831) |
$450.45 |
$1,287 |
1.9× |
| Echo Guide For Artery Repair (76936) |
$215.60 |
$616 |
1.0× |
| Esophagram (74220) |
$1,021.30 |
$2,918 |
5.8× |
| Fetal Biophys Profile W/Nst (76818) |
$492.45 |
$1,407 |
4.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$413.70 |
$1,182 |
3.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,187.55 |
$3,393 |
5.0× |
| Fluoroscopy up to 1 hr (76000) |
$573.30 |
$1,638 |
2.4× |
| Follow-Up Angiography (75898) |
$1,670.20 |
$4,772 |
0.5× |
| Foot 2 views (73620) |
$380.45 |
$1,087 |
4.4× |
| Forearm 2 views (73090) |
$410.20 |
$1,172 |
4.7× |
| Gastric emptying imaging study (78264) |
$1,282.40 |
$3,664 |
3.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,270.50 |
$3,630 |
3.2× |
| Gastroesophageal Reflux Exam (78262) |
$1,093.40 |
$3,124 |
2.7× |
| Gated Heart Planar Single (78472) |
$607.60 |
$1,736 |
1.5× |
| Hand 2 views (73120) |
$329 |
$940 |
3.1× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$9,692.55 |
$27,693 |
13.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$6,486.55 |
$18,533 |
9.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$3,727.85 |
$10,651 |
5.3× |
| Heart first pass single,planar (78481) |
$839.65 |
$2,399 |
1.5× |
| Heart Image (Pet) Multiple (78492) |
$3,055.50 |
$8,730 |
2.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,116.75 |
$8,905 |
1.0× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,148.25 |
$8,995 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$2,172.80 |
$6,208 |
4.0× |
| Hepatobiliary System Imaging (78226) |
$1,521.10 |
$4,346 |
3.8× |
| Ht Musc Image Planar Mult (78454) |
$4,876.90 |
$13,934 |
3.7× |
| Ht Muscle Image Spect Sing (78451) |
$4,048.10 |
$11,566 |
3.1× |
| Hysterosalpingogram (74740) |
$530.60 |
$1,516 |
2.2× |
| Image fusion (77399) |
$1,106 |
$3,160 |
8.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$105.35 |
$301 |
1.2× |
| Interstitial radiation source applic complex (77778) |
$673.40 |
$1,924 |
1.0× |
| Joint Survey Single View (77077) |
$124.25 |
$355 |
1.2× |
| K Flow/Funct Image Multiple (78709) |
$2,572.15 |
$7,349 |
4.7× |
| K Flow/Funct Image W/Drug (78708) |
$1,325.80 |
$3,788 |
2.4× |
| K Flow/Funct Image W/O Drug (78707) |
$1,631 |
$4,660 |
3.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$315.70 |
$902 |
0.8× |
| Kidney Imaging Morphol (78700) |
$1,206.80 |
$3,448 |
3.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,577.80 |
$4,508 |
3.9× |
| Knee 3 Views (73562) |
$504.35 |
$1,441 |
5.8× |
| Liver & Spleen Imaging Static Only (78215) |
$444.50 |
$1,270 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$954.80 |
$2,728 |
2.4× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,538.60 |
$4,396 |
2.8× |
| Lung perfusion differential (78597) |
$998.90 |
$2,854 |
2.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,027.95 |
$2,937 |
1.9× |
| Lung Ventilation Imaging (78579) |
$412.65 |
$1,179 |
1.0× |
| Lymph System Imaging (78195) |
$1,491.70 |
$4,262 |
2.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,792.55 |
$13,693 |
1.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,310.30 |
$9,458 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$673.75 |
$1,925 |
2.8× |
| Magnetic Resonance Elastography (76391) |
$1,811.95 |
$5,177 |
7.6× |
| Mammary ductogram or galactogram multiple (77054) |
$707.35 |
$2,021 |
3.0× |
| Mammary ductogram or galactogram single (77053) |
$318.15 |
$909 |
1.3× |
| Meckels Divert Exam (78290) |
$501.55 |
$1,433 |
1.2× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$442.05 |
$1,263 |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$7,167.30 |
$20,478 |
19.1× |
| Mr safety determination physician/other qhp (76016) |
$77 |
$220 |
0.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$21.35 |
$61 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$80.50 |
$230 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$52.15 |
$149 |
0.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$211.40 |
$604 |
0.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,251.55 |
$6,433 |
6.4× |
| MRA head w/o contrast (70544) |
$1,471.40 |
$4,204 |
6.1× |
| MRA head with contrast (70545) |
$1,545.25 |
$4,415 |
4.4× |
| MRA neck w contrast (70548) |
$3,743.60 |
$10,696 |
10.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$5,254.20 |
$15,012 |
15.0× |
| MRA neck w/o contrast (70547) |
$3,283.70 |
$9,382 |
13.7× |
| MRI abdomen w contrast (74182) |
$4,442.55 |
$12,693 |
12.7× |
| MRI abdomen w/o contrast (74181) |
$2,863 |
$8,180 |
11.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,225.20 |
$12,072 |
5.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,206.60 |
$14,876 |
14.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,775.15 |
$7,929 |
3.5× |
| MRI bone marrow blood supply (77084) |
$1,301.65 |
$3,719 |
5.4× |
| MRI brain functional w/o physician admnistration (70554) |
$992.95 |
$2,837 |
4.1× |
| MRI brain functional w/physician admnistration (70555) |
$753.55 |
$2,153 |
3.1× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,163.05 |
$3,323 |
4.9× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,206.80 |
$3,448 |
5.0× |
| MRI cardiac w/o cont stress (75559) |
$1,264.55 |
$3,613 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$1,264.55 |
$3,613 |
5.3× |
| MRI cervical spine w contrast (72142) |
$4,278.05 |
$12,223 |
12.2× |
| MRI cervical spine w/o cont (72141) |
$2,950.15 |
$8,429 |
12.3× |
| MRI chest w/o contrast (71550) |
$1,548.40 |
$4,424 |
6.5× |
| MRI chest with contrast (71551) |
$1,414 |
$4,040 |
1.8× |
| MRI chest wo w contrast (71552) |
$2,150.40 |
$6,144 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,427.20 |
$9,792 |
9.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,385.50 |
$12,530 |
12.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,904.30 |
$8,298 |
12.1× |
| MRI lumbar spine w contrast (72149) |
$5,010.95 |
$14,317 |
14.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,956.35 |
$14,161 |
14.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,555.75 |
$4,445 |
6.5× |
| MRI orbit face neck w contrast (70542) |
$1,069.60 |
$3,056 |
3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,321.90 |
$6,634 |
6.6× |
| MRI pelvis w contrast (72196) |
$3,949.05 |
$11,283 |
11.3× |
| MRI pelvis w/o & w contrast (72197) |
$4,936.05 |
$14,103 |
14.1× |
| MRI pelvis w/o contrast (72195) |
$3,356.85 |
$9,591 |
14.0× |
| MRI spectroscopy (76390) |
$273.70 |
$782 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,760.85 |
$5,031 |
7.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,136.75 |
$6,105 |
6.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,951.95 |
$5,577 |
8.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,637.60 |
$7,536 |
7.5× |
| MRI, abdomen, combo (74183) |
$4,936.05 |
$14,103 |
14.1× |
| MRI, dorsal spine combo (72157) |
$2,984.45 |
$8,527 |
8.5× |
| MRI, dorsal spine contrast (72147) |
$2,536.80 |
$7,248 |
7.2× |
| MRI, joint upper extrem (73221) |
$1,790.25 |
$5,115 |
7.5× |
| MRI, joint upper extrem combo (73223) |
$3,419.50 |
$9,770 |
9.8× |
| MRI, lumbar spine combo (72158) |
$5,892.95 |
$16,837 |
16.8× |
| Myelogram cervical (72240) |
$982.45 |
$2,807 |
1.2× |
| Myelogram Lumbar (72265) |
$971.60 |
$2,776 |
1.2× |
| Myelography thoracic (72255) |
$516.60 |
$1,476 |
0.7× |
| Myelograpy 2/more regions rs&i (72270) |
$1,224.30 |
$3,498 |
1.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$738.15 |
$2,109 |
1.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,523.85 |
$7,211 |
1.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,048.10 |
$11,566 |
3.1× |
| Myocardial Spect Multiple Studies (78452) |
$4,876.90 |
$13,934 |
3.7× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$3,314.15 |
$9,469 |
2.3× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,167.15 |
$9,049 |
2.2× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$3,682.35 |
$10,521 |
1.7× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$4,308.50 |
$12,310 |
1.9× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$3,940.30 |
$11,258 |
2.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,774.50 |
$5,070 |
2.1× |
| Neck soft tissue (70360) |
$251.30 |
$718 |
2.9× |
| Nm csf leak detection (78650) |
$564.55 |
$1,613 |
0.4× |
| Nm myocard infarct spect (78469) |
$911.05 |
$2,603 |
1.7× |
| Nm whole blood volume (78122) |
$361.20 |
$1,032 |
0.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$9,115.75 |
$26,045 |
6.6× |
| Nuclear Rx Intra-Arterial (79445) |
$468.65 |
$1,339 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$1,329.65 |
$3,799 |
5.7× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,641.50 |
$4,690 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$430.85 |
$1,231 |
1.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$859.25 |
$2,455 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$457.45 |
$1,307 |
4.4× |
| Peritoneogram Rs&I (74190) |
$679.70 |
$1,942 |
1.2× |
| Pet Image Skull-Thigh (78812) |
$2,108.75 |
$6,025 |
1.5× |
| Pet Image W/Ct Lmtd (78814) |
$3,694.25 |
$10,555 |
2.6× |
| PET image w/CT, full body (78816) |
$4,186.70 |
$11,962 |
2.9× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,104.45 |
$11,727 |
2.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,243.15 |
$6,409 |
1.7× |
| Pet Myocardial Sngl Study (78491) |
$1,526.70 |
$4,362 |
1.1× |
| PET whole body (78813) |
$2,550.45 |
$7,287 |
1.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,288.25 |
$9,395 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$724.15 |
$2,069 |
1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$552.30 |
$1,578 |
5.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$662.20 |
$1,892 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$542.85 |
$1,551 |
6.2× |
Radex Calcaneus Minimum 2 Views (73650)
range across 2 matching MRF lines |
$309.05–$401.10 |
$883–$1,146 |
varies |
| Radex elbow complete minimum 3 views (73080) |
$491.75 |
$1,405 |
5.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$467.60 |
$1,336 |
4.5× |
| Radex fingr minimum 2 views (73140) |
$275.10 |
$786 |
3.1× |
| Radex foot complete minimum 3 views (73630) |
$513.80 |
$1,468 |
5.9× |
| Radex Hand Minimum 3 Views (73130) |
$505.75 |
$1,445 |
5.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$177.45 |
$507 |
2.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$106.40 |
$304 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$291.55 |
$833 |
3.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$393.75 |
$1,125 |
4.5× |
| Radex shoulder complete minimum 2 views (73030) |
$558.60 |
$1,596 |
6.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$89.60 |
$256 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$298.90 |
$854 |
3.4× |
| Radex Sternum Minimum 2 Views (71120) |
$336.70 |
$962 |
3.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$493.15 |
$1,409 |
5.6× |
| Radex Toe Minimum 2 Views (73660) |
$258.65 |
$739 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$110.60 |
$316 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$462.35 |
$1,321 |
5.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$3,060.40 |
$8,744 |
29.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$23,033.50 |
$65,810 |
3.1× |
| Radiation treatment delivery level 1 (77402) |
$235.20 |
$672 |
2.3× |
| Radiation treatment delivery level 2 (77407) |
$421.40 |
$1,204 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$1,178.80 |
$3,368 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$679.35 |
$1,941 |
6.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$552.30 |
$1,578 |
5.3× |
| Radiologic exam colon double contrast study (74280) |
$2,032.10 |
$5,806 |
11.5× |
| Radiologic exam colon single contrast study (74270) |
$1,031.80 |
$2,948 |
5.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$818.30 |
$2,338 |
4.6× |
| Radiologic exam knee complete 4/more views (73564) |
$579.60 |
$1,656 |
5.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$690.90 |
$1,974 |
6.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$676.20 |
$1,932 |
3.8× |
| Radiologic exam swallow function contrast study (74230) |
$1,078.70 |
$3,082 |
6.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,152.55 |
$3,293 |
6.5× |
| Radiologic examination femur 1 view (73551) |
$82.25 |
$235 |
0.9× |
| Radiologic examination femur minimum 2 views (73552) |
$456.05 |
$1,303 |
5.2× |
| Radiologic examination knee 1/2 views (73560) |
$417.55 |
$1,193 |
4.8× |
| Radiologic Examination Osseous Survey Limited (77074) |
$777.70 |
$2,222 |
7.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$484.75 |
$1,385 |
5.5× |
| Radiopharm Dacryocystography (78660) |
$356.65 |
$1,019 |
0.9× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$345.10 |
$986 |
0.6× |
| Ribs bilateral 3 views (71110) |
$470.75 |
$1,345 |
4.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,425.55 |
$4,073 |
3.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,531.95 |
$4,377 |
3.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,595.90 |
$10,274 |
6.6× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,723.40 |
$4,924 |
3.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,127.65 |
$6,079 |
3.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,978.80 |
$11,368 |
3.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,042.80 |
$14,408 |
3.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,659.65 |
$7,599 |
2.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$786.45 |
$2,247 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$1,314.95 |
$3,757 |
5.6× |
| Rp Therapy Unlisted Procedure (79999) |
$89.95 |
$257 |
0.4× |
| Scapula (73010) |
$374.50 |
$1,070 |
3.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$64.75 |
$185 |
2.8× |
| Sella turcica (70240) |
$86.45 |
$247 |
1.0× |
| Shoulder 1 view (73020) |
$329.70 |
$942 |
3.8× |
| Shoulder Arthrography (73040) |
$745.50 |
$2,130 |
2.1× |
| Sialogram (70390) |
$348.25 |
$995 |
1.5× |
| Skull less than 4 views (70250) |
$407.05 |
$1,163 |
3.9× |
| Special dosimetry (77331) |
$112 |
$320 |
0.8× |
| Special Physics Consult (77370) |
$2,781.10 |
$7,946 |
20.6× |
| Special teletherapy port plan (77321) |
$1,542.45 |
$4,407 |
4.1× |
| Special treatment procedure (77470) |
$3,141.95 |
$8,977 |
5.7× |
| Spleen Imaging (78185) |
$539.70 |
$1,542 |
1.3× |
| Srs Multisource (77371) |
$42,976.15 |
$122,789 |
5.8× |
| Stereotactic Body Radiation Delivery (77373) |
$14,014 |
$40,040 |
7.8× |
| Sternoclavicular joints (71130) |
$414.40 |
$1,184 |
4.7× |
| Superior sagittal sinus venogram (75870) |
$3,573.15 |
$10,209 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,987.25 |
$8,535 |
7.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$3,902.50 |
$11,150 |
10.4× |
| Testicular Imaging W/Flow (78761) |
$913.85 |
$2,611 |
2.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$4,662 |
$13,320 |
12.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$4,615.45 |
$13,187 |
12.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$2,797.20 |
$7,992 |
20.7× |
| Thoracic spine 2 views (72070) |
$405.65 |
$1,159 |
3.9× |
| Thoracic spine 3 views (72072) |
$709.45 |
$2,027 |
6.8× |
| Thoracolumbar 2 views (72080) |
$361.55 |
$1,033 |
4.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$838.25 |
$2,395 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$568.75 |
$1,625 |
1.4× |
| Thyroid Met Imaging Body (78018) |
$1,269.80 |
$3,628 |
2.3× |
| Thyroid Uptake Measurement (78012) |
$370.30 |
$1,058 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,353.80 |
$3,868 |
3.4× |
| Tx Devices Design & Construction Complex (77334) |
$3,342.50 |
$9,550 |
8.9× |
| Tx devices design & construction intermediate (77333) |
$3,643.50 |
$10,410 |
27.0× |
| Tx devices design & construction simple (77332) |
$1,036.35 |
$2,961 |
7.7× |
| Ultrasound Breast Limited (76642) |
$754.95 |
$2,157 |
8.6× |
| Ultrasound elastography first target lesion (76982) |
$108.15 |
$309 |
1.0× |
| Ultrasound Elastography Parenchyma (76981) |
$899.85 |
$2,571 |
8.6× |
| Ultrasound Exam Aaa Screen (76706) |
$698.25 |
$1,995 |
6.6× |
| Ultrasound, abdomen limited (76705) |
$1,069.25 |
$3,055 |
10.2× |
Unlisted Dx Radiographic Procedure (76499)
range across 2 matching MRF lines |
$64.05–$92.75 |
$183–$265 |
varies |
| Unlisted magnetic resonance procedure (76498) |
$1,262.80 |
$3,608 |
14.4× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$670.60 |
$1,916 |
1.7× |
| Unlisted us procedure (76999) |
$113.05 |
$323 |
1.3× |
| Upper gi w/o kub (74240) |
$801.15 |
$2,289 |
4.5× |
| Urethrocystogram voiding (74455) |
$463.75 |
$1,325 |
1.9× |
| Urethrocystography retrograde (74450) |
$463.75 |
$1,325 |
1.9× |
| Us breast unilateral complete (76641) |
$980.35 |
$2,801 |
9.3× |
| Us chest (76604) |
$612.15 |
$1,749 |
5.8× |
| Us complete joint (76881) |
$616 |
$1,760 |
5.9× |
| Us exam, pelvic, limited (76857) |
$435.40 |
$1,244 |
4.1× |
| Us head (76506) |
$198.10 |
$566 |
1.9× |
| Us kidney transplant (76776) |
$750.05 |
$2,143 |
7.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$1,044.05 |
$2,983 |
9.9× |
| Us ob detailed single fetus (76811) |
$329.35 |
$941 |
1.4× |
| Us ob limited 1 or more fetuses (76815) |
$618.45 |
$1,767 |
5.9× |
| Us ob transvaginal (76817) |
$710.85 |
$2,031 |
6.8× |
| Us pelvic non ob complete (76856) |
$989.80 |
$2,828 |
9.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$938.35 |
$2,681 |
8.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$845.95 |
$2,417 |
8.1× |
| Us retroperitoneal complete (76770) |
$1,124.20 |
$3,212 |
10.7× |
| Us retroperitoneal limited (76775) |
$877.10 |
$2,506 |
8.4× |
| Us scrotum and contents (76870) |
$908.25 |
$2,595 |
8.6× |
| Us spinal canal and contents (76800) |
$212.80 |
$608 |
2.0× |
| Us thyroid (76536) |
$1,158.15 |
$3,309 |
11.0× |
| Us transrectal (76872) |
$512.75 |
$1,465 |
4.9× |
| Vein X-Ray Chest (75827) |
$1,691.55 |
$4,833 |
1.1× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,067.50 |
$3,050 |
0.3× |
| Venogram Sinus/Jugular (75860) |
$2,881.55 |
$8,233 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,316.95 |
$9,477 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,512.70 |
$4,322 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$957.60 |
$2,736 |
0.6× |
| Venography Renal Bilateral (75833) |
$4,055.45 |
$11,587 |
1.3× |
| Venography Renal Unilateral (75831) |
$3,288.25 |
$9,395 |
1.0× |
| Venous sampling by catheter (75893) |
$5,580.40 |
$15,944 |
1.0× |
| Venous thrombosis imaging (78457) |
$697.20 |
$1,992 |
1.3× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,361.85 |
$3,891 |
3.4× |
| Vertebral fracture assessment via dxa (77086) |
$108.85 |
$311 |
1.2× |
| Wrist 2 views (73100) |
$300.65 |
$859 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$270.20 |
$772 |
3.1× |
| X-ray antegrade pyelogram tube (74425) |
$1,771.70 |
$5,062 |
5.1× |
| X-Ray Aorta Leg Arteries (75630) |
$4,435.90 |
$12,674 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$314.65 |
$899 |
3.6× |
| X-Ray Exam Breast Specimen (76098) |
$642.95 |
$1,837 |
1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$503.65 |
$1,439 |
5.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$1,065.40 |
$3,044 |
10.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$2,237.90 |
$6,394 |
21.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$387.10 |
$1,106 |
4.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$560.70 |
$1,602 |
6.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$706.65 |
$2,019 |
6.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$487.90 |
$1,394 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$633.85 |
$1,811 |
6.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$729.05 |
$2,083 |
6.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$1,093.75 |
$3,125 |
10.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$520.80 |
$1,488 |
6.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$627.20 |
$1,792 |
6.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$452.55 |
$1,293 |
4.3× |
| X-ray humerus (73060) |
$360.85 |
$1,031 |
4.1× |
| X-ray IV pyelogram (ivp) (74400) |
$881.30 |
$2,518 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$455.35 |
$1,301 |
5.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$492.80 |
$1,408 |
5.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$713.65 |
$2,039 |
6.8× |
| X-ray nose-rectum child f.b. (76010) |
$96.60 |
$276 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$561.40 |
$1,604 |
5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$494.55 |
$1,413 |
4.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$420.35 |
$1,201 |
4.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$411.95 |
$1,177 |
4.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$744.45 |
$2,127 |
8.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$537.25 |
$1,535 |
5.1× |
| X-Ray Tmj Unilat (70328) |
$91 |
$260 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,771.70 |
$5,062 |
5.1× |
| X-Rays Bone Length Studies (77073) |
$339.50 |
$970 |
3.2× |
| X-Rays Bone Survey Complete (77075) |
$1,178.10 |
$3,366 |
11.2× |
| Xr c-spine 4 or 5 views (72050) |
$596.05 |
$1,703 |
5.7× |
| Xr facial bones less than 3 views (70140) |
$112.35 |
$321 |
1.3× |
| Xr orbits complete 4 views (70200) |
$474.25 |
$1,355 |
4.5× |
| Xr Tomogram Single Plane (76100) |
$105.35 |
$301 |
1.0× |