| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,288 |
$1,840 |
1.0× |
| Abdomen 1 View (74018) |
$172.20 |
$246 |
2.2× |
| Abdomen 2 views (74019) |
$216.30 |
$309 |
2.3× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$614.60 |
$878 |
1.7× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$604.80 |
$864 |
0.5× |
| Adrenal Cortex & Medulla Img (78075) |
$800.10 |
$1,143 |
0.7× |
| Angio internal mammary (75756) |
$542.50 |
$775 |
0.2× |
| Angio pulmonary bilat (75743) |
$563.50 |
$805 |
0.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$612.50 |
$875 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$591.50 |
$845 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$532 |
$760 |
0.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$511 |
$730 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$514.50 |
$735 |
0.2× |
| Ankle 2 views (73600) |
$105 |
$150 |
1.3× |
Aortography thoracic serialography rs&i (75605)
likely a partial charge, not the full procedure |
$511 |
$730 |
0.1× |
| Aortography thoracic w/o serialography rs&i (75600) |
$588 |
$840 |
0.2× |
Artery X-Rays Abdomen (75726)
likely a partial charge, not the full procedure |
$528.50 |
$755 |
0.1× |
| Artery X-Rays Adrenal Gland (75731) |
$542.50 |
$775 |
0.2× |
Artery X-Rays Pelvis (75736)
likely a partial charge, not the full procedure |
$532 |
$760 |
0.1× |
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure |
$633.50 |
$905 |
0.1× |
| Arthrogram ankle (73615) |
$182 |
$260 |
0.6× |
| Arthrogram hip (73525) |
$178.50 |
$255 |
0.6× |
| Arthrogram Wrist (73115) |
$189 |
$270 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$136.50 |
$195 |
1.1× |
| Bone age studies (77072) |
$91 |
$130 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$739.90 |
$1,057 |
2.0× |
| Bone Imaging Limited Area (78300) |
$386.40 |
$552 |
1.1× |
| Bone Imaging Multiple Areas (78305) |
$406 |
$580 |
1.1× |
| Bone Imaging Whole Body (78306) |
$618.80 |
$884 |
1.7× |
| Bone marrow imaging limited area (78102) |
$294 |
$420 |
0.8× |
| Bone marrow imaging; multiple areas (78103) |
$392 |
$560 |
1.1× |
| Bone marrow imaging; whole body (78104) |
$448 |
$640 |
1.2× |
| Bone survey infant (77076) |
$175 |
$250 |
1.8× |
| Brain Flow Imaging Only (78610) |
$311.50 |
$445 |
0.6× |
| Brain Image W/Flow < 4 Views (78601) |
$371 |
$530 |
1.0× |
| Brain imaging < 4 static views (78600) |
$311.50 |
$445 |
0.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$539 |
$770 |
1.1× |
| Brain Imaging Minimum 4 Static Views (78605) |
$350 |
$500 |
0.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$154 |
$220 |
0.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$521.50 |
$745 |
1.4× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$598.50 |
$855 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,242.50 |
$1,775 |
3.9× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,295 |
$1,850 |
1.8× |
| Cardiac Shunt Detection (78428) |
$357 |
$510 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$308 |
$440 |
3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$395.50 |
$565 |
0.8× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$521.50 |
$745 |
1.1× |
| Cerebrospinal Fluid Scan (78630) |
$574 |
$820 |
1.2× |
| Chest 1 view (71045) |
$89.60 |
$128 |
1.1× |
| Chest 2 views (71046) |
$115.50 |
$165 |
1.5× |
| Chest 3 views (71047) |
$125.30 |
$179 |
1.6× |
| Chest 4 or more views (71048) |
$160.30 |
$229 |
1.7× |
| Cholecystography Oral Contrast (74290) |
$119 |
$170 |
0.7× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$143.50 |
$205 |
1.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$269.50 |
$385 |
0.4× |
| Clavicle complete (73000) |
$133 |
$190 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$115.50 |
$165 |
0.9× |
| Contrast Exam Abdominl Aorta (75625) |
$504 |
$720 |
0.2× |
| Contrast X-Ray Bladder (74430) |
$246.40 |
$352 |
0.8× |
| Contrast X-Ray Of Elbow (73085) |
$178.50 |
$255 |
0.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$220.50 |
$315 |
0.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$143.50 |
$205 |
0.9× |
| Corpora cavernosography (74445) |
$119 |
$170 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,369.90 |
$1,957 |
4.3× |
| CT abdomen w contrast (74160) |
$968.80 |
$1,384 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,210.30 |
$1,729 |
7.6× |
| CT abdomen w/o contrast (74150) |
$968.80 |
$1,384 |
10.2× |
| CT Angio Chest (71275) |
$1,843.10 |
$2,633 |
11.6× |
| CT Angio Head (70496) |
$1,687.70 |
$2,411 |
10.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,669.50 |
$2,385 |
10.5× |
| CT Angio Neck (70498) |
$1,651.30 |
$2,359 |
10.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,624 |
$2,320 |
10.2× |
| CT bone density (77078) |
$157.50 |
$225 |
2.0× |
| CT cervical spine w/ contrast (72126) |
$792.40 |
$1,132 |
2.5× |
| CT cervical spine w/o contrast (72125) |
$968.80 |
$1,384 |
10.2× |
| CT cervical spine w/wo cont (72127) |
$880.60 |
$1,258 |
5.5× |
| CT chest w contrast (71260) |
$968.80 |
$1,384 |
6.1× |
| CT chest w/wo contrast (71270) |
$1,197 |
$1,710 |
7.5× |
| CT head/brain with contrast (70460) |
$880.60 |
$1,258 |
5.5× |
| CT head/brain without and with contrast (70470) |
$968.80 |
$1,384 |
6.1× |
| CT iac w contrast (70481) |
$792.40 |
$1,132 |
5.0× |
| CT l-spine w&w/o contrast (72133) |
$1,365 |
$1,950 |
8.6× |
| CT lower ext w/o (73700) |
$880.60 |
$1,258 |
9.3× |
| CT lower extremity w/contrast material (73701) |
$880.60 |
$1,258 |
5.5× |
| CT lumbar spine w contrast (72132) |
$1,189.30 |
$1,699 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$968.80 |
$1,384 |
10.2× |
| CT maxillofacial w contrast (70487) |
$1,139.60 |
$1,628 |
7.2× |
| CT maxillofacial wo contrast (70486) |
$879.20 |
$1,256 |
9.3× |
| CT neck tissue combo (70492) |
$792.40 |
$1,132 |
5.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$880.60 |
$1,258 |
5.5× |
| CT orbits w/o contrast (70480) |
$968.80 |
$1,384 |
10.2× |
| CT pelvis w&w/o contrast (72194) |
$1,088.50 |
$1,555 |
6.9× |
| CT pelvis w/o contrast (72192) |
$968.80 |
$1,384 |
10.2× |
| CT scan of leg combo (73702) |
$880.60 |
$1,258 |
5.5× |
| CT scans face/jaw combo (70488) |
$968.80 |
$1,384 |
6.1× |
| CT soft tissue neck w contrast (70491) |
$968.80 |
$1,384 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$968.80 |
$1,384 |
10.2× |
| CT thoracic spine w contrast (72129) |
$792.40 |
$1,132 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$968.80 |
$1,384 |
10.2× |
| CT thoracic spine w/wo cont (72130) |
$880.60 |
$1,258 |
5.5× |
| CT thorax w/o contrast (71250) |
$968.80 |
$1,384 |
10.2× |
| CT upper ext wo (73200) |
$968.80 |
$1,384 |
10.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,458.40 |
$3,512 |
15.5× |
| CT upper extremity with contrast (73201) |
$880.60 |
$1,258 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,995.70 |
$2,851 |
12.6× |
| Cta Abdomen (74175) |
$1,868.30 |
$2,669 |
11.8× |
| CTA pelvis (72191) |
$1,775.20 |
$2,536 |
11.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$31.50 |
$45 |
0.1× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$45.50 |
$65 |
0.1× |
| Dilation ureters/urethra rs&i (74485) |
$220.50 |
$315 |
0.1× |
| Discography Cerv/Thor Spine (72285) |
$336 |
$480 |
0.2× |
| Diskography lumbar (72295) |
$297.50 |
$425 |
0.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$56 |
$80 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$136.50 |
$195 |
1.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$182 |
$260 |
1.9× |
| Dxa Bone Density Axial (77080) |
$180.60 |
$258 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$280.70 |
$401 |
3.6× |
| Echo exam of fetal heart (76825) |
$388.50 |
$555 |
0.8× |
| Echo exam uterus (76831) |
$224 |
$320 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$374.50 |
$535 |
1.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$213.50 |
$305 |
1.0× |
| Echograp Trans R Pros Study (76873) |
$336 |
$480 |
3.5× |
| Esophageal Motility Study (78258) |
$395.50 |
$565 |
1.1× |
| Esophagram (74220) |
$212.80 |
$304 |
1.3× |
| Fetal Biophys Profile W/Nst (76818) |
$227.50 |
$325 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$178.50 |
$255 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$191.10 |
$273 |
0.9× |
| Follow-Up Angiography (75898) |
$171.50 |
$245 |
0.1× |
| Foot 2 views (73620) |
$100.10 |
$143 |
1.3× |
| Forearm 2 views (73090) |
$90.30 |
$129 |
1.1× |
| Gastric emptying imaging study (78264) |
$515.20 |
$736 |
1.4× |
| Gastric Mucosa Imaging (78261) |
$434 |
$620 |
1.2× |
| Gastroesophageal Reflux Exam (78262) |
$578.20 |
$826 |
1.6× |
| Gastrointestinal Protein Loss (78282) |
$38.50 |
$55 |
0.1× |
| Gated Heart Planar Single (78472) |
$546.70 |
$781 |
1.5× |
| Gated Heart, Multiple (78473) |
$654.50 |
$935 |
1.8× |
| GI Endoscopic US S&I (76975) |
$84 |
$120 |
0.4× |
| Hand 2 views (73120) |
$119.70 |
$171 |
1.3× |
| Heart first pass single,planar (78481) |
$423.50 |
$605 |
0.9× |
| Heart Image (Pet) Multiple (78492) |
$203 |
$290 |
0.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$493.50 |
$705 |
0.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$493.50 |
$705 |
0.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$402.50 |
$575 |
0.8× |
| Hyperthermia external generated superficial (77600) |
$679 |
$970 |
1.9× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$1,120 |
$1,600 |
2.2× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$1,582 |
$2,260 |
3.2× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$714 |
$1,020 |
1.4× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$1,204 |
$1,720 |
1.9× |
| Hysterosalpingogram (74740) |
$143.50 |
$205 |
0.7× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$189 |
$270 |
2.4× |
| Infant hip ultrasound, limited static exam (76886) |
$175 |
$250 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$1,578.50 |
$2,255 |
2.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$854 |
$1,220 |
1.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$570.50 |
$815 |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$378 |
$540 |
0.8× |
| Joint Survey Single View (77077) |
$80.50 |
$115 |
0.9× |
| K Flow/Funct Image Multiple (78709) |
$814.10 |
$1,163 |
1.7× |
| K Flow/Funct Image W/Drug (78708) |
$725.90 |
$1,037 |
1.5× |
| K Flow/Funct Image W/O Drug (78707) |
$725.90 |
$1,037 |
1.5× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$182 |
$260 |
0.5× |
| Kidney Imaging Morphol (78700) |
$311.50 |
$445 |
0.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$257.60 |
$368 |
0.7× |
| Knee 3 Views (73562) |
$106.40 |
$152 |
1.4× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$273 |
$390 |
0.8× |
| Leveen/Shunt Patency Exam (78291) |
$434 |
$620 |
1.2× |
| Liver & Spleen Imaging Static Only (78215) |
$481.60 |
$688 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$255.50 |
$365 |
0.7× |
| Liver imaging static only (78201) |
$311.50 |
$445 |
0.6× |
| Liver imaging w/vascular flow (78202) |
$357 |
$510 |
0.7× |
| Lymph System Imaging (78195) |
$598.50 |
$855 |
1.2× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$122.50 |
$175 |
0.1× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$84 |
$120 |
0.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$122.50 |
$175 |
0.0× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$84 |
$120 |
0.0× |
| Magnetic Image Jaw Joint (70336) |
$777 |
$1,110 |
3.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$322 |
$460 |
2.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$294 |
$420 |
0.6× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$329 |
$470 |
2.1× |
| Mammary ductogram or galactogram multiple (77054) |
$192.50 |
$275 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$143.50 |
$205 |
0.7× |
| Meckels Divert Exam (78290) |
$422.80 |
$604 |
1.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,151.50 |
$1,645 |
3.6× |
| MRA head w/o contrast (70544) |
$1,495.90 |
$2,137 |
6.9× |
| MRA head with contrast (70545) |
$892.50 |
$1,275 |
2.8× |
| MRA neck w contrast (70548) |
$892.50 |
$1,275 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,495.90 |
$2,137 |
4.7× |
| MRA neck w/o contrast (70547) |
$749 |
$1,070 |
3.5× |
| MRI abdomen w contrast (74182) |
$1,495.90 |
$2,137 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,495.90 |
$2,137 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$167.30 |
$239 |
0.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,660 |
$3,800 |
8.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$934.50 |
$1,335 |
1.3× |
| MRI bone marrow blood supply (77084) |
$791 |
$1,130 |
3.7× |
| MRI brain functional w/o physician admnistration (70554) |
$1,134 |
$1,620 |
5.2× |
| MRI brain functional w/physician admnistration (70555) |
$262.50 |
$375 |
1.2× |
| MRI cardiac w/o cont stress (75559) |
$938 |
$1,340 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$875 |
$1,250 |
4.0× |
| MRI cervical spine w contrast (72142) |
$1,495.90 |
$2,137 |
4.7× |
| MRI cervical spine w/o cont (72141) |
$1,495.90 |
$2,137 |
6.9× |
| MRI chest w/o contrast (71550) |
$1,495.90 |
$2,137 |
6.9× |
| MRI chest with contrast (71551) |
$945 |
$1,350 |
1.3× |
| MRI chest wo w contrast (71552) |
$1,197 |
$1,710 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$934.50 |
$1,335 |
3.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,660 |
$3,800 |
8.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,495.90 |
$2,137 |
6.9× |
| MRI lumbar spine w contrast (72149) |
$1,495.90 |
$2,137 |
4.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,894.90 |
$2,707 |
6.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,495.90 |
$2,137 |
6.9× |
| MRI orbit face neck w contrast (70542) |
$934.50 |
$1,335 |
3.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,894.90 |
$2,707 |
6.0× |
| MRI pelvis w contrast (72196) |
$1,495.90 |
$2,137 |
4.7× |
| MRI pelvis w/o & w contrast (72197) |
$1,894.90 |
$2,707 |
6.0× |
| MRI pelvis w/o contrast (72195) |
$1,495.90 |
$2,137 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,495.90 |
$2,137 |
6.9× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$934.50 |
$1,335 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,495.90 |
$2,137 |
6.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,495.90 |
$2,137 |
4.7× |
| MRI, abdomen, combo (74183) |
$1,495.90 |
$2,137 |
4.7× |
| MRI, dorsal spine combo (72157) |
$1,894.90 |
$2,707 |
6.0× |
| MRI, dorsal spine contrast (72147) |
$1,495.90 |
$2,137 |
4.7× |
| MRI, joint upper extrem (73221) |
$1,495.90 |
$2,137 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$1,894.90 |
$2,707 |
6.0× |
| MRI, lumbar spine combo (72158) |
$1,894.90 |
$2,707 |
6.0× |
| Myelogram cervical (72240) |
$294 |
$420 |
0.4× |
| Myelogram Lumbar (72265) |
$273 |
$390 |
0.4× |
| Myelography thoracic (72255) |
$269.50 |
$385 |
0.4× |
| Myelograpy 2/more regions rs&i (72270) |
$427 |
$610 |
0.6× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$329 |
$470 |
0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$157.50 |
$225 |
0.1× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$413 |
$590 |
0.8× |
| Neck soft tissue (70360) |
$96.60 |
$138 |
1.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$658 |
$940 |
1.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$84 |
$120 |
0.2× |
| Nm csf leak detection (78650) |
$560 |
$800 |
0.5× |
| Nm myocard infarct spect (78469) |
$472.50 |
$675 |
1.0× |
| Nm red cell survival study (78130) |
$280 |
$400 |
0.8× |
| Nm whole blood volume (78122) |
$469.70 |
$671 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$161 |
$230 |
1.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,948 |
$5,640 |
3.2× |
| Nuclear Rx Intra-Arterial (79445) |
$245 |
$350 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$182 |
$260 |
0.9× |
| Ob us nuchal meas 1 gest (76813) |
$241.50 |
$345 |
2.6× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$328.30 |
$469 |
3.5× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$157.50 |
$225 |
1.7× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$161 |
$230 |
1.3× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$126 |
$180 |
1.3× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$129.50 |
$185 |
1.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$98 |
$140 |
1.0× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$21 |
$30 |
0.8× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$98 |
$140 |
1.0× |
| Optic foramina (70190) |
$66.50 |
$95 |
0.8× |
| Panoramic X-ray of jaws (70355) |
$45.50 |
$65 |
0.6× |
| Parathyroid Planar Imaging (78070) |
$738.50 |
$1,055 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$100.10 |
$143 |
1.1× |
| Perineogram (74775) |
$63 |
$90 |
0.3× |
| Peritoneogram Rs&I (74190) |
$52.50 |
$75 |
0.1× |
| Pet Image Skull-Thigh (78812) |
$199.50 |
$285 |
0.2× |
| Pet Image W/Ct Lmtd (78814) |
$224 |
$320 |
0.2× |
| PET image w/CT, full body (78816) |
$255.50 |
$365 |
0.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$252 |
$360 |
0.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$161 |
$230 |
0.1× |
| Pet Myocardial Sngl Study (78491) |
$161 |
$230 |
0.1× |
| PET whole body (78813) |
$206.50 |
$295 |
0.2× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$178.50 |
$255 |
0.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$143.50 |
$205 |
0.1× |
| Platelet survival study Non-Facility (78191) |
$364 |
$520 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$525 |
$750 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$425.60 |
$608 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$317.10 |
$453 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$302.40 |
$432 |
0.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$214.20 |
$306 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$89.60 |
$128 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$119 |
$170 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$143.50 |
$205 |
1.5× |
| Radex fingr minimum 2 views (73140) |
$79.80 |
$114 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$116.20 |
$166 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$105 |
$150 |
1.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$56 |
$80 |
0.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$136.50 |
$195 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$95.90 |
$137 |
1.2× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$136.50 |
$195 |
1.7× |
| Radex Ribs Unilateral 2 Views (71100) |
$147 |
$210 |
1.9× |
| Radex shoulder complete minimum 2 views (73030) |
$109.90 |
$157 |
1.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$102.20 |
$146 |
1.3× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$329 |
$470 |
2.1× |
| Radex Spine 1 View Specify Level (72020) |
$79.80 |
$114 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$117.60 |
$168 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$149.80 |
$214 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$87.50 |
$125 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$56 |
$80 |
0.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$109.90 |
$157 |
1.4× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$1,456 |
$2,080 |
0.2× |
| Radiation treatment delivery level 1 (77402) |
$245 |
$350 |
2.7× |
| Radiation treatment delivery level 2 (77407) |
$385 |
$550 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$371 |
$530 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$137.90 |
$197 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$355.60 |
$508 |
3.8× |
| Radiologic exam colon double contrast study (74280) |
$329.70 |
$471 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$248.50 |
$355 |
1.6× |
| Radiologic exam knee complete 4/more views (73564) |
$18.20 |
$26 |
0.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$119.70 |
$171 |
1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$210.70 |
$301 |
1.3× |
| Radiologic exam swallow function contrast study (74230) |
$371.70 |
$531 |
2.3× |
| Radiologic exam teeth complete full mouth (70320) |
$80.50 |
$115 |
0.4× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$63 |
$90 |
0.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$279.30 |
$399 |
1.8× |
| Radiologic examination knee 1/2 views (73560) |
$107.10 |
$153 |
1.4× |
| Radiologic Examination Osseous Survey Limited (77074) |
$129.50 |
$185 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$70 |
$100 |
0.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$115.50 |
$165 |
1.5× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$87.50 |
$125 |
0.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$28 |
$40 |
0.4× |
| Radiopharm Dacryocystography (78660) |
$294 |
$420 |
0.8× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$168 |
$240 |
0.8× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$203 |
$290 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$336 |
$480 |
1.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$161 |
$230 |
0.4× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$192.50 |
$275 |
0.4× |
| Renal Cyst Study (74470) |
$56 |
$80 |
0.1× |
| Ribs bilateral 3 views (71110) |
$154 |
$220 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$332.50 |
$475 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$444.50 |
$635 |
1.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,008 |
$1,440 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$593.60 |
$848 |
1.2× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$640.50 |
$915 |
1.3× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$231 |
$330 |
1.1× |
| Rp Therapy Intravenous Administration (79101) |
$332.50 |
$475 |
1.6× |
| Salivary Gland Function Study (78232) |
$248.50 |
$355 |
0.7× |
| Salivary Gland Imaging (78230) |
$710.50 |
$1,015 |
2.0× |
| Scapula (73010) |
$105 |
$150 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$102.20 |
$146 |
4.4× |
| Sella turcica (70240) |
$85.40 |
$122 |
1.1× |
| Shoulder 1 view (73020) |
$85.40 |
$122 |
1.1× |
| Shoulder Arthrography (73040) |
$393.40 |
$562 |
1.2× |
| Sialogram (70390) |
$182 |
$260 |
0.8× |
| Skull less than 4 views (70250) |
$130.90 |
$187 |
1.4× |
| Special dosimetry (77331) |
$87.50 |
$125 |
0.7× |
| Special Physics Consult (77370) |
$213.50 |
$305 |
1.8× |
| Special teletherapy port plan (77321) |
$234.50 |
$335 |
0.7× |
| Special treatment procedure (77470) |
$490 |
$700 |
1.0× |
| Speech evaluation, complex (70371) |
$185.50 |
$265 |
0.9× |
| Spleen Imaging (78185) |
$336 |
$480 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$2,691.50 |
$3,845 |
1.7× |
| Sternoclavicular joints (71130) |
$175 |
$250 |
2.2× |
| Superior sagittal sinus venogram (75870) |
$500.50 |
$715 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$115.50 |
$165 |
1.3× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$157.50 |
$225 |
0.7× |
| Testicular Imaging W/Flow (78761) |
$482.30 |
$689 |
1.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$899.50 |
$1,285 |
2.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$581 |
$830 |
1.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$339.50 |
$485 |
2.8× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$206.50 |
$295 |
1.3× |
| Thoracic spine 2 views (72070) |
$125.30 |
$179 |
1.3× |
| Thoracic spine 3 views (72072) |
$73.50 |
$105 |
0.8× |
| Thoracolumbar 2 views (72080) |
$108.50 |
$155 |
1.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$560 |
$800 |
1.5× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$371 |
$530 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$563.50 |
$805 |
1.1× |
| Tx Devices Design & Construction Complex (77334) |
$301 |
$430 |
0.9× |
| Tx devices design & construction intermediate (77333) |
$87.50 |
$125 |
0.7× |
| Tx devices design & construction simple (77332) |
$147 |
$210 |
1.2× |
| Ultrasound Breast Limited (76642) |
$122.50 |
$175 |
1.6× |
| Ultrasound Exam Aaa Screen (76706) |
$344.40 |
$492 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$244.30 |
$349 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$105 |
$150 |
1.1× |
| Upper gi w/o kub (74240) |
$262.50 |
$375 |
1.7× |
| Ureteral Reflux Study (78740) |
$496.30 |
$709 |
1.4× |
| Urethrocystogram voiding (74455) |
$246.40 |
$352 |
1.1× |
| Urethrocystography retrograde (74450) |
$35 |
$50 |
0.2× |
| Us bone density measurement (76977) |
$28 |
$40 |
0.3× |
| Us breast unilateral complete (76641) |
$122.50 |
$175 |
1.3× |
| Us chest (76604) |
$268.10 |
$383 |
2.8× |
| Us exam, pelvic, limited (76857) |
$154 |
$220 |
1.6× |
| Us head (76506) |
$178.50 |
$255 |
1.9× |
| Us kidney transplant (76776) |
$171.50 |
$245 |
1.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$244.30 |
$349 |
2.6× |
| Us ob detailed single fetus (76811) |
$392 |
$560 |
1.8× |
| Us ob limited 1 or more fetuses (76815) |
$246.40 |
$352 |
2.6× |
| Us ob transvaginal (76817) |
$189 |
$270 |
2.0× |
| Us pelvic non ob complete (76856) |
$254.80 |
$364 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$245 |
$350 |
2.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$199.50 |
$285 |
2.1× |
| Us retroperitoneal complete (76770) |
$244.30 |
$349 |
2.6× |
| Us retroperitoneal limited (76775) |
$244.30 |
$349 |
2.6× |
| Us scrotum and contents (76870) |
$244.30 |
$349 |
2.6× |
| Us spinal canal and contents (76800) |
$365.40 |
$522 |
3.9× |
| Us thyroid (76536) |
$213.50 |
$305 |
2.3× |
| Us transrectal (76872) |
$252.70 |
$361 |
2.7× |
| Vascular Flow Imaging (78445) |
$297.50 |
$425 |
0.8× |
| Vasogram (74440) |
$154 |
$220 |
0.7× |
| Vein X-Ray Chest (75827) |
$486.50 |
$695 |
0.3× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$528.50 |
$755 |
0.2× |
| Vein X-Ray Skull Epidural (75872) |
$542.50 |
$775 |
1.0× |
| Vein X-Ray Spleen/Liver (75810) |
$119 |
$170 |
0.0× |
| Venogram Sinus/Jugular (75860) |
$500.50 |
$715 |
0.2× |
| Venography Adrenal Unilateral (75840) |
$490 |
$700 |
0.2× |
| Venography caval inferior serialography rs&i (75825) |
$486.50 |
$695 |
0.2× |
| Venography extremity bilateral rs&i (75822) |
$273 |
$390 |
0.2× |
| Venography extremity unilateral rs&i (75820) |
$998.90 |
$1,427 |
0.7× |
| Venography Orbital Rs&I (75880) |
$224 |
$320 |
0.4× |
| Venography Renal Bilateral (75833) |
$549.50 |
$785 |
0.2× |
| Venography Renal Unilateral (75831) |
$493.50 |
$705 |
0.2× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$430.50 |
$615 |
0.1× |
| Venous thrombosis imaging (78457) |
$343 |
$490 |
0.7× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$308.70 |
$441 |
0.9× |
| Wrist 2 views (73100) |
$82.60 |
$118 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$399 |
$570 |
5.1× |
| X-ray antegrade pyelogram tube (74425) |
$38.50 |
$55 |
0.1× |
| X-Ray Aorta Leg Arteries (75630) |
$588 |
$840 |
0.2× |
| X-Ray Bend Only L-S Spine (72120) |
$169.40 |
$242 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$93.80 |
$134 |
1.2× |
| X-Ray Exam Breast Specimen (76098) |
$271.60 |
$388 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116.20 |
$166 |
1.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$245.70 |
$351 |
2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$115.50 |
$165 |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$219.80 |
$314 |
2.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$147 |
$210 |
1.6× |
| X-ray eye for foreign body (70030) |
$56 |
$80 |
0.7× |
| X-ray head for orthodontia (70350) |
$38.50 |
$55 |
0.5× |
| X-ray humerus (73060) |
$102.20 |
$146 |
1.3× |
| X-ray IV pyelogram (ivp) (74400) |
$305.90 |
$437 |
1.9× |
| X-ray IV pyelogram+tomography (74415) |
$269.50 |
$385 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$93.80 |
$134 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$56 |
$80 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$126.70 |
$181 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$65.10 |
$93 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$154 |
$220 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$168 |
$240 |
1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$56 |
$80 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$141.40 |
$202 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$154 |
$220 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$158.20 |
$226 |
1.7× |
| X-Ray Stress View (77071) |
$77 |
$110 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$122.50 |
$175 |
1.3× |
| X-Ray Tmj Unilat (70328) |
$52.50 |
$75 |
0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$236.60 |
$338 |
0.7× |
| X-Rays Bone Length Studies (77073) |
$73.50 |
$105 |
0.8× |
| X-Rays Bone Survey Complete (77075) |
$281.40 |
$402 |
3.0× |
| Xr c-spine 4 or 5 views (72050) |
$190.40 |
$272 |
2.0× |
| Xr facial bones less than 3 views (70140) |
$105 |
$150 |
1.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$98 |
$140 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$322 |
$460 |
1.0× |
| Xr orbits complete 4 views (70200) |
$163.10 |
$233 |
1.7× |
| Xr Tomogram Single Plane (76100) |
$196 |
$280 |
2.1× |