| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,430.10 |
$10,215 |
1.1× |
| Abdomen 2 views (74019) |
$184.80 |
$1,320 |
1.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$390.46 |
$2,789 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,435.42 |
$10,253 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$1,078.56 |
$7,704 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$767.76 |
$5,484 |
0.3× |
| Angiography internal mammary rs&i (75756) |
$1,209.46 |
$8,639 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$721.28 |
$5,152 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$721.28 |
$5,152 |
0.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$816.06 |
$5,829 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$515.90 |
$3,685 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$721.42 |
$5,153 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$248.36 |
$1,774 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,547.42 |
$11,053 |
0.5× |
| Ankle 2 views (73600) |
$120.54 |
$861 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$320.74 |
$2,291 |
1.0× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,056.16 |
$7,544 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$721.42 |
$5,153 |
0.2× |
| Aortography abdominal serialography rs&i (75625) |
$1,098.72 |
$7,848 |
0.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,412.18 |
$10,087 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$721.28 |
$5,152 |
0.2× |
| Arthrogram elbow (73085) |
$301.28 |
$2,152 |
0.9× |
| Arthrogram hip (73525) |
$314.72 |
$2,248 |
1.0× |
| Arthrogram shoulder (73040) |
$329.14 |
$2,351 |
1.0× |
| Arthrogram wrist (73115) |
$222.32 |
$1,588 |
0.7× |
| Arthrography knee lt (73580) |
$240.52 |
$1,718 |
0.7× |
| Basic radiation dosimetry calculation (77300) |
$206.08 |
$1,472 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$259.28 |
$1,852 |
0.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$521.36 |
$3,724 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$549.78 |
$3,927 |
1.5× |
| Bone age studies (77072) |
$140 |
$1,000 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$637.14 |
$4,551 |
1.7× |
| Bone Marrow Imaging Limited Area (78102) |
$184.38 |
$1,317 |
0.5× |
| Bone survey complete (77075) |
$131.04 |
$936 |
1.3× |
| Brachytx isodose complex (77318) |
$156.38 |
$1,117 |
0.4× |
| Brachytx isodose intermed (77317) |
$156.38 |
$1,117 |
0.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$380.94 |
$2,721 |
1.1× |
| Brain image w/flow 4 + views (78606) |
$587.58 |
$4,197 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$668.22 |
$4,773 |
0.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$307.58 |
$2,197 |
0.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$171.08 |
$1,222 |
0.3× |
| Cervical spine 2 or 3 views (72040) |
$143.64 |
$1,026 |
1.8× |
| Chest 1 view (71045) |
$122.50 |
$875 |
1.5× |
| Chest 3 views (71047) |
$159.46 |
$1,139 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$243.18 |
$1,737 |
1.5× |
| Cineradiography/videoradiography (76120) |
$54.60 |
$390 |
0.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$340.48 |
$2,432 |
0.5× |
| Clavicle complete (73000) |
$117.18 |
$837 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$43.96 |
$314 |
0.4× |
| Continuing medical physics consltj pr wk (77336) |
$294 |
$2,100 |
2.3× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$184.80 |
$1,320 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,063.74 |
$14,741 |
6.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,714.72 |
$12,248 |
7.7× |
| CT abdomen w contrast (74160) |
$971.88 |
$6,942 |
5.9× |
| CT abdomen w wo contrast (74170) |
$1,087.10 |
$7,765 |
6.6× |
| CT abdomen w/o contrast (74150) |
$898.80 |
$6,420 |
9.2× |
| CT angio hrt w/3d image (75574) |
$135.94 |
$971 |
0.4× |
| CT angiography upper extremity lt (73206) |
$263.48 |
$1,882 |
1.6× |
| CT c-spine w/o contrast (72125) |
$811.72 |
$5,798 |
8.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,036 |
$7,400 |
6.3× |
| CT cervical spine with contrast (72126) |
$850.36 |
$6,074 |
2.6× |
| CT chest w/wo contrast (71270) |
$1,127.70 |
$8,055 |
6.8× |
| CT chest with contrast (71260) |
$987.70 |
$7,055 |
6.0× |
| CT colonography screening (74263) |
$70.84 |
$506 |
0.3× |
| CT colonography w/dye (74262) |
$264.18 |
$1,887 |
1.6× |
| CT colonography w/o cntrst (74261) |
$115.78 |
$827 |
1.2× |
| CT head/brain with contrast (70460) |
$797.02 |
$5,693 |
4.8× |
| CT head/brain without and with contrast (70470) |
$914.20 |
$6,530 |
5.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$920.50 |
$6,575 |
2.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$39.76 |
$284 |
0.5× |
| CT hrt w/3d image congen (75573) |
$920.50 |
$6,575 |
2.8× |
| CT iac w contrast (70481) |
$735.98 |
$5,257 |
4.5× |
| CT limited/localized follow up study (76380) |
$75.04 |
$536 |
0.9× |
| CT lower ext w/o (73700) |
$788.48 |
$5,632 |
8.0× |
| CT lower extremity w wo contrast (73702) |
$1,084.16 |
$7,744 |
6.6× |
| CT lower extremity with contrast (73701) |
$988.96 |
$7,064 |
6.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,036 |
$7,400 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$824.18 |
$5,887 |
8.4× |
| CT lumbar spine with contrast (72132) |
$880.74 |
$6,291 |
2.7× |
| CT maxillofacial w contrast (70487) |
$795.20 |
$5,680 |
4.8× |
| CT maxillofacial w/o contrast (70486) |
$665 |
$4,750 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$876.68 |
$6,262 |
5.3× |
| CT neck soft tissue w contrast (70491) |
$831.18 |
$5,937 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$874.72 |
$6,248 |
5.3× |
| CT orbits w/o contrast (70480) |
$607.18 |
$4,337 |
6.2× |
| CT pelvis w & w/o contrast (72194) |
$977.06 |
$6,979 |
5.9× |
| CT pelvis w/o contrast (72192) |
$816.20 |
$5,830 |
8.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$920.08 |
$6,572 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$772.38 |
$5,517 |
7.9× |
| CT thoracic spine w/contrast (72129) |
$735.98 |
$5,257 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$862.40 |
$6,160 |
8.8× |
| CT thoracic spine w/wo contrast (72130) |
$905.94 |
$6,471 |
5.5× |
| CT thorax w/o contrast (71250) |
$779.66 |
$5,569 |
7.9× |
| CT unlisted procedure (76497) |
$128.87 |
$920.50 |
1.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,073.10 |
$7,665 |
6.5× |
| CT upper extremity w/o contrast rt (73200) |
$780.92 |
$5,578 |
8.0× |
| CT upper extremity with contrast (73201) |
$910.14 |
$6,501 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$201.60 |
$1,440 |
1.2× |
| Cta Abdomen (74175) |
$201.60 |
$1,440 |
1.2× |
| CTA abdomen pelvis (74174) |
$466.13 |
$3,329.50 |
1.4× |
| CTA chest (71275) |
$201.60 |
$1,440 |
1.2× |
| Cta Head (70496) |
$263.48 |
$1,882 |
1.6× |
| CTA lwr ext w&w/o contrast (73706) |
$263.48 |
$1,882 |
1.6× |
| Cta Neck (70498) |
$263.48 |
$1,882 |
1.6× |
| Cta Pelvis (72191) |
$188.58 |
$1,347 |
1.1× |
| Cystography minimum 3 views rs&i (74430) |
$227.92 |
$1,628 |
0.7× |
| Diskogram cervical (72285) |
$762.30 |
$5,445 |
0.4× |
| Diskography lumbar (72295) |
$1,555.82 |
$11,113 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$200.48 |
$1,432 |
2.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$87.36 |
$624 |
0.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$107.94 |
$771 |
1.1× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$116.48 |
$832 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$92.82 |
$663 |
0.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$58.66 |
$419 |
0.7× |
| Dxa bone density study axial skeleton (77085) |
$60.06 |
$429 |
0.6× |
| Echo exam of fetal heart (76825) |
$208.18 |
$1,487 |
0.4× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$220.50 |
$1,575 |
1.0× |
| Echoencephalography real time imaging (76506) |
$296.94 |
$2,121 |
3.0× |
| Esophagus (74220) |
$256.62 |
$1,833 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$173.74 |
$1,241 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$173.74 |
$1,241 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$170.66 |
$1,219 |
0.8× |
| Foot 2 views (73620) |
$109.06 |
$779 |
1.3× |
| Forearm 2 views (73090) |
$126.84 |
$906 |
1.6× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$195.30 |
$1,395 |
0.4× |
| Gated Heart Planar Single (78472) |
$445.20 |
$3,180 |
1.2× |
| Hand 2 views (73120) |
$105.42 |
$753 |
1.1× |
| Hand 3 views (73130) |
$126.84 |
$906 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$302.82 |
$2,163 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$338.80 |
$2,420 |
0.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$592.20 |
$4,230 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$721.56 |
$5,154 |
0.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$465.08 |
$3,322 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$377.58 |
$2,697 |
1.0× |
| Ht muscle image spect sing (78451) |
$234.08 |
$1,672 |
0.2× |
| Humerus Min 2 Views Left (73060) |
$170.94 |
$1,221 |
2.1× |
| Hysterosalpingogram (74740) |
$329.84 |
$2,356 |
1.5× |
| Interstitial radiation source applic complex (77778) |
$1,690.50 |
$12,075 |
2.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$158.20 |
$1,130 |
0.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$158.20 |
$1,130 |
0.3× |
| Intracavitary radiation source applic simple (77761) |
$158.20 |
$1,130 |
0.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$53.76 |
$384 |
0.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$459.62 |
$3,283 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$358.12 |
$2,558 |
0.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$919.66 |
$6,569 |
1.8× |
| Knee 3 views (73562) |
$158.48 |
$1,132 |
1.9× |
| Liver & spleen imaging static only (78215) |
$326.48 |
$2,332 |
0.9× |
| Liver imaging static only (78201) |
$379.26 |
$2,709 |
0.7× |
| Liver imaging w/vascular flow (78202) |
$521.64 |
$3,726 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$173.32 |
$1,238 |
0.3× |
| Lung perfusion differential (78597) |
$481.04 |
$3,436 |
1.3× |
| Lung Ventilation Imaging (78579) |
$91.14 |
$651 |
0.2× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,256.22 |
$8,973 |
0.4× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$123.90 |
$885 |
0.2× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$760.48 |
$5,432 |
0.5× |
| Lymphoscintigraphy (78195) |
$486.64 |
$3,476 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$90.16 |
$644 |
0.4× |
| Mammary ductogram or galactogram single (77053) |
$91.70 |
$655 |
0.4× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$34.30 |
$245 |
0.4× |
| Meckels Diverticulum (78290) |
$319.90 |
$2,285 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$118.72 |
$848 |
0.3× |
| Mr elastography (76391) |
$113.40 |
$810 |
0.5× |
| Mr safety determination physician/other qhp (76016) |
$42.56 |
$304 |
0.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$28.70 |
$205 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$11.76 |
$84 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$44.38 |
$317 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$116.76 |
$834 |
0.5× |
| MRA head w & w/o contrast (70546) |
$1,355.20 |
$9,680 |
4.1× |
| MRA head w/o contrast (70544) |
$1,080.24 |
$7,716 |
4.8× |
| MRA head with contrast (70545) |
$1,080.24 |
$7,716 |
3.3× |
| MRA neck w contrast (70548) |
$1,080.24 |
$7,716 |
3.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,080.24 |
$7,716 |
3.3× |
| MRA neck w/o contrast (70547) |
$1,080.24 |
$7,716 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,080.24 |
$7,716 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,355.20 |
$9,680 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,080.24 |
$7,716 |
4.8× |
| MRI any jnt lwr ext with con lt (73722) |
$1,241.10 |
$8,865 |
1.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,241.10 |
$8,865 |
1.7× |
| MRI bone marrow blood supply (77084) |
$1,344.56 |
$9,604 |
6.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,080.24 |
$7,716 |
4.8× |
| MRI breast w/o contrast unilat (77046) |
$1,080.24 |
$7,716 |
4.8× |
| MRI c-spine with contrast (72142) |
$1,485.82 |
$10,613 |
4.5× |
| MRI cardiac w/o contrast (75557) |
$1,094.80 |
$7,820 |
4.9× |
| MRI cervical spine w/o contrast (72141) |
$1,259.72 |
$8,998 |
5.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,355.20 |
$9,680 |
4.1× |
| MRI chest w/o contrast (71550) |
$1,425.06 |
$10,179 |
6.4× |
| MRI chest with contrast (71551) |
$232.96 |
$1,664 |
0.3× |
| MRI fetal sngl/1st gestation (74712) |
$154.70 |
$1,105 |
0.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,241.10 |
$8,865 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,241.10 |
$8,865 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,355.20 |
$9,680 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,034.32 |
$7,388 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,355.20 |
$9,680 |
4.1× |
| MRI orbit/face/neck w/contrast (70542) |
$232.96 |
$1,664 |
0.7× |
| MRI pelvis w contrast (72196) |
$1,671.60 |
$11,940 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,671.60 |
$11,940 |
5.1× |
| MRI pelvis w/o contrast (72195) |
$1,386.56 |
$9,904 |
6.2× |
| MRI scan of arm joint before and after contrast (73223) |
$1,355.20 |
$9,680 |
4.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$352.94 |
$2,521 |
0.5× |
| MRI scan of leg joint before and after contrast (73723) |
$1,355.20 |
$9,680 |
4.1× |
| MRI spectroscopy (76390) |
$1,013.18 |
$7,237 |
12.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,799.56 |
$12,854 |
5.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,485.82 |
$10,613 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,394.40 |
$9,960 |
4.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,485.82 |
$10,613 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,400.42 |
$10,003 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,263.50 |
$9,025 |
5.6× |
| MRI tmj (70336) |
$1,388.80 |
$9,920 |
6.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,080.24 |
$7,716 |
4.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,355.20 |
$9,680 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,241.10 |
$8,865 |
5.5× |
| Myelogram Cervical (72240) |
$771.96 |
$5,514 |
1.0× |
| Myelogram Lumbar (72265) |
$718.76 |
$5,134 |
1.0× |
| Myelogram thoracic (72255) |
$771.96 |
$5,514 |
1.0× |
| Myelography 2 or more regions (72270) |
$606.06 |
$4,329 |
0.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$701.96 |
$5,014 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$234.08 |
$1,672 |
0.2× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$730.10 |
$5,215 |
0.5× |
| Neck soft tissue (70360) |
$124.18 |
$887 |
1.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$167.58 |
$1,197 |
0.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$95.62 |
$683 |
0.3× |
| Nm adrenal scan (78075) |
$454.44 |
$3,246 |
0.4× |
| Nm bone marrow wb (78104) |
$377.02 |
$2,693 |
1.0× |
| Nm cisternogram (78630) |
$496.72 |
$3,548 |
1.0× |
| Nm csf leak detection (78650) |
$644.70 |
$4,605 |
0.5× |
| Nm gastric emptying study (78264) |
$441.42 |
$3,153 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$293.16 |
$2,094 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,128.12 |
$8,058 |
0.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$730.10 |
$5,215 |
0.5× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$730.10 |
$5,215 |
0.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$317.66 |
$2,269 |
0.8× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$152.74 |
$1,091 |
0.3× |
| Nuclear Rx Oral Admin (79005) |
$469.14 |
$3,351 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$135.38 |
$967 |
1.4× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$143.36 |
$1,024 |
1.5× |
| Osseous survey infant (77076) |
$248.50 |
$1,775 |
2.5× |
| Osseous survey limited (77074) |
$53.76 |
$384 |
0.5× |
| Parathyrd planar w/wo subtrj (78071) |
$547.96 |
$3,914 |
1.5× |
| Parathyroid imaging (78070) |
$352.24 |
$2,516 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$191.52 |
$1,368 |
2.0× |
| Peritoneogram rs&i (74190) |
$247.94 |
$1,771 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$1,947.68 |
$13,912 |
1.5× |
| PET imaging CT for attenuation limited area (78814) |
$652.68 |
$4,662 |
0.5× |
| PET imaging for CT attenuation whole body (78816) |
$1,947.68 |
$13,912 |
1.5× |
| PET imaging limited area chest head/neck (78811) |
$644.70 |
$4,605 |
0.5× |
| PET whole body (78813) |
$1,947.68 |
$13,912 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,355.20 |
$9,680 |
4.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$717.78 |
$5,127 |
0.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$652.82 |
$4,663 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$613.20 |
$4,380 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$687.54 |
$4,911 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$156.94 |
$1,121 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$222.04 |
$1,586 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$230.02 |
$1,643 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$135.52 |
$968 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$33.04 |
$236 |
0.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$247.94 |
$1,771 |
2.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,240.74 |
$30,291 |
0.6× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$325.92 |
$2,328 |
0.6× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$238.14 |
$1,701 |
2.5× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$263.76 |
$1,884 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$95.06 |
$679 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$120.96 |
$864 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$190.54 |
$1,361 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$144.62 |
$1,033 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$304.22 |
$2,173 |
1.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$88.76 |
$634 |
0.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$308 |
$2,200 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$313.04 |
$2,236 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$141.54 |
$1,011 |
1.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$139.86 |
$999 |
1.7× |
| Radiological examination surgical specimen (76098) |
$177.80 |
$1,270 |
0.3× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$124.88 |
$892 |
0.6× |
| Review by radiologist of adrenal gland vein image (75840) |
$990.50 |
$7,075 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$685.44 |
$4,896 |
0.2× |
| Ribs bilateral 3 views (71110) |
$250.88 |
$1,792 |
2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$494.34 |
$3,531 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$509.88 |
$3,642 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$445.90 |
$3,185 |
0.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$498.68 |
$3,562 |
0.4× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$191.38 |
$1,367 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$105.56 |
$754 |
0.5× |
| Rp Therapy Intravenous Administration (79101) |
$1,664.60 |
$11,890 |
7.6× |
| Sacroiliac Joints < 3 Views (72200) |
$53.76 |
$384 |
0.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$399.28 |
$2,852 |
1.8× |
| Salivary gland imaging (78230) |
$189.84 |
$1,356 |
0.5× |
| Salivary gland imaging serial images (78231) |
$164.50 |
$1,175 |
0.4× |
| Scanogram (77073) |
$227.36 |
$1,624 |
2.3× |
| Scapula complete (73010) |
$138.18 |
$987 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$18.34 |
$131 |
0.8× |
| Sella turcica (70240) |
$34.30 |
$245 |
0.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$55.58 |
$397 |
0.6× |
| Sialogram (70390) |
$125.72 |
$898 |
0.6× |
| Simulation intermediate (77285) |
$146.30 |
$1,045 |
0.4× |
| Small bowel series (74250) |
$356.72 |
$2,548 |
2.2× |
| Spec medical radj physics consltj (77370) |
$370.58 |
$2,647 |
2.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$498.12 |
$3,558 |
1.4× |
| Special dosimetry (77331) |
$185.92 |
$1,328 |
1.5× |
| Special treatment procedure (77470) |
$669.20 |
$4,780 |
1.3× |
| Speech evaluation complex (70371) |
$113.54 |
$811 |
0.5× |
| Spine thoracic 3 views (72072) |
$214.76 |
$1,534 |
2.2× |
| Splenoportograpy rs&i (75810) |
$717.78 |
$5,127 |
0.2× |
| Stereotactic body radiation delivery (77373) |
$7,920.36 |
$56,574 |
4.7× |
| Superior sagittal sinus venogram (75870) |
$1,477.42 |
$10,553 |
0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$656.88 |
$4,692 |
1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$366.66 |
$2,619 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$152.74 |
$1,091 |
0.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$823.76 |
$5,884 |
2.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$55.30 |
$395 |
0.4× |
| Thoracolumbar 2 views (72080) |
$177.38 |
$1,267 |
2.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$511.70 |
$3,655 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$316.12 |
$2,258 |
0.8× |
| Thyroid uptake measurement (78012) |
$182.28 |
$1,302 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$547.96 |
$3,914 |
1.5× |
| Tmj unilateral (70328) |
$39.90 |
$285 |
0.5× |
| Tomogram (76100) |
$57.54 |
$411 |
0.6× |
| Treatment device intermediate (77333) |
$322.56 |
$2,304 |
2.6× |
| Treatment devices simple (77332) |
$221.48 |
$1,582 |
1.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$303.10 |
$2,165 |
0.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$426.72 |
$3,048 |
1.1× |
| Tx devices design & construction complex (77334) |
$515.62 |
$3,683 |
1.5× |
| Ultrasound scan of cornea to determine thickness (76514) |
$43.26 |
$309 |
1.6× |
| Ultrasound scan to determine eye length and lens power (76519) |
$143.36 |
$1,024 |
1.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$78.40 |
$560 |
0.2× |
| Ultrasound, abdomen limited (76705) |
$317.66 |
$2,269 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$134.26 |
$959 |
1.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$26.60 |
$190 |
0.3× |
| Unlisted fluoroscopic procedure (76496) |
$38.08 |
$272 |
0.5× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$167.16 |
$1,194 |
0.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$158.20 |
$1,130 |
1.7× |
| Upper Extremity Infant (73092) |
$77.28 |
$552 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$278.32 |
$1,988 |
1.2× |
| Urethrocystography voiding (74455) |
$329.42 |
$2,353 |
1.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$115.78 |
$827 |
0.7× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$141.12 |
$1,008 |
0.9× |
| Us abdl aorta screen aaa (76706) |
$68.32 |
$488 |
0.7× |
| Us breast unilateral complete (76641) |
$167.30 |
$1,195 |
1.7× |
| Us breast unilateral limited (76642) |
$167.30 |
$1,195 |
2.0× |
| Us chest (76604) |
$296.66 |
$2,119 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$173.74 |
$1,241 |
1.8× |
| Us elastography parenchyma (76981) |
$145.88 |
$1,042 |
1.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$137.06 |
$979 |
1.4× |
| Us guided compression repair (76936) |
$392.28 |
$2,802 |
1.9× |
| Us infant hips dynamic (76885) |
$258.16 |
$1,844 |
3.2× |
| Us infant hips limited static (76886) |
$61.46 |
$439 |
0.8× |
| Us kidney transplant (76776) |
$410.34 |
$2,931 |
4.2× |
| Us ob detailed single fetus (76811) |
$265.44 |
$1,896 |
1.2× |
| Us ob transvaginal (76817) |
$135.38 |
$967 |
1.4× |
| Us pelvic non ob complete (76856) |
$344.82 |
$2,463 |
3.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$127.54 |
$911 |
1.3× |
| Us pregnancy ltd (76815) |
$135.38 |
$967 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$135.38 |
$967 |
1.4× |
| Us retroperitoneal complete (76770) |
$296.94 |
$2,121 |
3.0× |
| Us retroperitoneal limited (76775) |
$220.92 |
$1,578 |
2.3× |
| Us scrotum and contents (76870) |
$173.74 |
$1,241 |
1.8× |
| Us soft tissue head/neck (76536) |
$296.66 |
$2,119 |
3.0× |
| Us spinal canal and contents (76800) |
$300.30 |
$2,145 |
3.1× |
| Us transrectal (76872) |
$173.74 |
$1,241 |
1.8× |
| Us transrectal prostate volume (76873) |
$56.56 |
$404 |
0.6× |
| Us xtr non-vasc lmtd (76882) |
$173.74 |
$1,241 |
1.8× |
| Us, eye b-scan (76512) |
$110.32 |
$788 |
1.1× |
| Venogram extremity bilateral (75822) |
$439.18 |
$3,137 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$547.26 |
$3,909 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$547.26 |
$3,909 |
0.4× |
| Venography epidural rs&i (75872) |
$299.88 |
$2,142 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$338.10 |
$2,415 |
0.2× |
| Venography Renal Bilateral (75833) |
$1,980.86 |
$14,149 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,015.28 |
$7,252 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$344.68 |
$2,462 |
0.1× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,173.62 |
$8,383 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$68.74 |
$491 |
0.8× |
| Wrist 2 views (73100) |
$109.06 |
$779 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$190.54 |
$1,361 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$18.62 |
$133 |
0.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$134.68 |
$962 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$383.74 |
$2,741 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.48 |
$932 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$144.06 |
$1,029 |
1.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$241.36 |
$1,724 |
2.5× |
| X-ray exam hip uni 1 view (73501) |
$135.52 |
$968 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$142.24 |
$1,016 |
1.7× |
| X-ray exam hip uni 4/> views (73503) |
$148.96 |
$1,064 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$142.24 |
$1,016 |
1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$148.96 |
$1,064 |
1.5× |
| X-ray exam of femur 1 (73551) |
$135.52 |
$968 |
1.7× |
| X-ray eye for foreign body (70030) |
$18.62 |
$133 |
0.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$181.30 |
$1,295 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$158.90 |
$1,135 |
1.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$123.90 |
$885 |
1.5× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$883.26 |
$6,309 |
0.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$109.06 |
$779 |
1.3× |
| X-ray IV pyelogram+drip infusn (74410) |
$112.98 |
$807 |
0.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86.52 |
$618 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$180.18 |
$1,287 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$110.88 |
$792 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$49.28 |
$352 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$170.94 |
$1,221 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$232.54 |
$1,661 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$165.20 |
$1,180 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$127.96 |
$914 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$92.68 |
$662 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$158.90 |
$1,135 |
1.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$226.24 |
$1,616 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$494.48 |
$3,532 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$174.30 |
$1,245 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$89.74 |
$641 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$181.02 |
$1,293 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$143.64 |
$1,026 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$177.66 |
$1,269 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$174.30 |
$1,245 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$218.12 |
$1,558 |
2.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$163.52 |
$1,168 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$237.44 |
$1,696 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$187.18 |
$1,337 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$126.28 |
$902 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$141.68 |
$1,012 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$143.50 |
$1,025 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$197.54 |
$1,411 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$253.12 |
$1,808 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$136.64 |
$976 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$132.44 |
$946 |
1.6× |
| Xr arthrogram ankle (73615) |
$216.86 |
$1,549 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$244.02 |
$1,743 |
2.5× |
| Xr chest 4+ views (71048) |
$177.52 |
$1,268 |
1.8× |
| Xr Cholecystography Oral Contrast (74290) |
$217 |
$1,550 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$102.76 |
$734 |
1.3× |
| Xr internal auditory meati complete (70134) |
$144.20 |
$1,030 |
0.3× |
| Xr optic foramina (70190) |
$34.30 |
$245 |
0.4× |
| Xr shoulder 1 view (73020) |
$122.36 |
$874 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$203.56 |
$1,454 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$133.56 |
$954 |
1.6× |
| Xr tmj bilateral (70330) |
$218.12 |
$1,558 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$115.50 |
$825 |
1.4× |