| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$2,354 |
$5,885 |
1.6× |
| Acute gi blood loss imaging (78278) |
$1,575.40 |
$3,938.50 |
3.7× |
| Angio adrenal bilat select (75733) |
$1,742.80 |
$4,357 |
0.5× |
| Angio adrenal unilat select (75731) |
$2,057.40 |
$5,143.50 |
0.6× |
| Angio extremity unilateral (75710) |
$3,101.60 |
$7,754 |
0.9× |
| Angio pulmonary unilateral (75741) |
$3,385.80 |
$8,464.50 |
1.0× |
| Angiogram extremity bilateral (75716) |
$3,034.60 |
$7,586.50 |
0.9× |
| Angiogram pelvic (75736) |
$4,873.80 |
$12,184.50 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,496.60 |
$6,241.50 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,639.60 |
$11,599 |
1.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,297.20 |
$8,243 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,680.40 |
$4,201 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,171.60 |
$5,429 |
0.6× |
| Ankle 2 views (73600) |
$318.40 |
$796 |
3.4× |
| Arthrography knee lt (73580) |
$895.20 |
$2,238 |
2.4× |
| Arthrography wrist lt (73115) |
$466 |
$1,165 |
1.3× |
| Barium enema (74270) |
$407.60 |
$1,019 |
2.2× |
| Basic dosimetry (77300) |
$422.80 |
$1,057 |
3.0× |
| Bilat selctv renal venogram (75833) |
$2,979 |
$7,447.50 |
0.9× |
| Bone age studies (77072) |
$214.80 |
$537 |
1.9× |
| Bone imaging limited area (78300) |
$1,045.60 |
$2,614 |
2.5× |
| Bone marrow imaging whole body (78104) |
$872.40 |
$2,181 |
2.0× |
| Bone survey complete (77075) |
$1,903.20 |
$4,758 |
17.1× |
| Bowel imaging (78290) |
$2,134.40 |
$5,336 |
5.0× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,134 |
$2,835 |
2.8× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$924 |
$2,310 |
1.6× |
| Brain image w/flow 4 + views (78606) |
$1,106.80 |
$2,767 |
1.9× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$367.60 |
$919 |
0.9× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,013.20 |
$2,533 |
1.8× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,808.40 |
$4,521 |
4.2× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$4,440 |
$11,100 |
12.0× |
| Cardiac shunt detection (78428) |
$694 |
$1,735 |
1.6× |
| Cerebrospinal fluid leakage (78650) |
$1,097.20 |
$2,743 |
0.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$546 |
$1,365 |
2.9× |
| Cineradiography/videoradiography (76120) |
$493.20 |
$1,233 |
4.4× |
| Cisternogram (78630) |
$2,670.80 |
$6,677 |
4.6× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$1,066.80 |
$2,667 |
1.3× |
| Clavicle complete (73000) |
$301.60 |
$754 |
3.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,148.20 |
$5,370.50 |
11.5× |
| Continuing medical physics consltj pr wk (77336) |
$593.60 |
$1,484 |
4.1× |
| Contrast exam abdominl aorta (75625) |
$3,070.40 |
$7,676 |
0.9× |
| Contrast exam thoracic aorta (75605) |
$4,873.80 |
$12,184.50 |
0.8× |
| Corpora cavernosography (74445) |
$579.20 |
$1,448 |
5.2× |
| Csf shunt evaluation (78645) |
$1,084 |
$2,710 |
1.9× |
| CT - st neck w&wo contr (70492) |
$2,114.80 |
$5,287 |
11.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,702.40 |
$14,256 |
15.4× |
| CT abdomen and pelvis without contrast (74176) |
$4,624.60 |
$11,561.50 |
18.2× |
| CT abdomen w wo contrast (74170) |
$3,121.80 |
$7,804.50 |
16.7× |
| CT abdomen w/contrast (74160) |
$2,868.60 |
$7,171.50 |
15.4× |
| CT abdomen w/o contrast (74150) |
$2,618.40 |
$6,546 |
23.5× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$612.80 |
$1,532 |
1.6× |
| CT angio abdom w/o & w/dye (74175) |
$3,121.80 |
$7,804.50 |
16.7× |
| CT angio abdominal arteries (75635) |
$3,025.20 |
$7,563 |
16.2× |
| CT angio hrt w/3d image (75574) |
$2,091.80 |
$5,229.50 |
5.6× |
| CT angiograph pelv w/o&w/dye (72191) |
$2,709.60 |
$6,774 |
14.5× |
| CT cervical spine w/contrast (72126) |
$2,494 |
$6,235 |
6.7× |
| CT cervical spine w/o contrast (72125) |
$1,985.20 |
$4,963 |
17.8× |
| CT chest w/contrast (71260) |
$2,603.80 |
$6,509.50 |
13.9× |
| CT extremity upper w & w/o contrast (73202) |
$1,460.40 |
$3,651 |
7.8× |
| CT head/brain with contrast (70460) |
$2,094 |
$5,235 |
11.2× |
| CT head/brain without and with contrast (70470) |
$2,432.60 |
$6,081.50 |
13.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,656 |
$6,640 |
7.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$501 |
$1,252.50 |
5.4× |
| CT hrt w/3d image congen (75573) |
$3,883.20 |
$9,708 |
10.5× |
| CT limited/localized follow up study (76380) |
$880.40 |
$2,201 |
9.5× |
| CT lower ext w/wo contrast (73702) |
$1,402.40 |
$3,506 |
7.5× |
| CT lower extremity w contrast (73701) |
$1,682.40 |
$4,206 |
9.0× |
| CT lower extremity w/o contrast unilateral (73700) |
$1,499.80 |
$3,749.50 |
13.5× |
| CT lumbar spine w/contrast (72132) |
$2,478 |
$6,195 |
6.7× |
| CT lumbar spine w/o contrast (72131) |
$2,084.40 |
$5,211 |
18.7× |
| CT lumbar spine w/o then w/ con (72133) |
$3,088 |
$7,720 |
16.5× |
| CT maxillofacial area w/o contrast (70486) |
$1,605 |
$4,012.50 |
14.4× |
| CT maxillofacial w/contrast (70487) |
$1,734.60 |
$4,336.50 |
9.3× |
| CT maxillofacial w/o then w/ con (70488) |
$2,539.20 |
$6,348 |
13.6× |
| CT orbit sella ear w/o con (70480) |
$1,785.20 |
$4,463 |
16.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$3,004.40 |
$7,511 |
16.1× |
| CT pelvis w & w/o contrast (72194) |
$2,709.60 |
$6,774 |
14.5× |
| CT pelvis w/o contrast (72192) |
$1,970.80 |
$4,927 |
17.7× |
| CT soft tissue neck w/contrast (70491) |
$1,720 |
$4,300 |
9.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,540.80 |
$3,852 |
13.8× |
| CT spine cervical w/wo contrast (72127) |
$2,348 |
$5,870 |
12.6× |
| CT thoracic spine w/contrast (72129) |
$2,344 |
$5,860 |
12.6× |
| CT thoracic spine w/o contrast (72128) |
$2,005.20 |
$5,013 |
18.0× |
| CT thoracic spine w/o then w/ con (72130) |
$2,842 |
$7,105 |
15.2× |
| CT thorax lung cancer scr c- (71271) |
$384.40 |
$961 |
3.5× |
| CT thorax w/o contrast (71250) |
$2,202.80 |
$5,507 |
19.8× |
| CT thorax w/o then w/ contrast (71270) |
$3,230.80 |
$8,077 |
17.3× |
| CT upper extremity w/dye (73201) |
$1,587.20 |
$3,968 |
4.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,416.40 |
$3,541 |
12.7× |
| CTA chest w/wo contrast (71275) |
$2,496.40 |
$6,241 |
13.4× |
| CTA head w contrast (70496) |
$3,466 |
$8,665 |
18.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,424.80 |
$3,562 |
7.6× |
| Cta Neck (70498) |
$3,047.60 |
$7,619 |
16.3× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$1,424.80 |
$3,562 |
7.6× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$1,699.60 |
$4,249 |
0.8× |
| Diskography lumbar (72295) |
$1,426.40 |
$3,566 |
0.7× |
| Doppler echo fetal spectral display complete (76827) |
$199.20 |
$498 |
1.8× |
| Doppler fetal mid cerebral artery (76821) |
$456.40 |
$1,141 |
4.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$955.20 |
$2,388 |
3.8× |
| Esophogram (74220) |
$422.80 |
$1,057 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$548.80 |
$1,372 |
4.9× |
| Fetal biophysical profile w/o nst (76819) |
$471.60 |
$1,179 |
4.2× |
| Fetal echo complete (76825) |
$955.20 |
$2,388 |
1.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$602.80 |
$1,507 |
2.4× |
| Functional MRI brain by phys/psych (70555) |
$2,978.20 |
$7,445.50 |
11.7× |
| Gastric emptying study (78264) |
$2,060 |
$5,150 |
4.8× |
| Gastroesophageal reflux study (78262) |
$961.60 |
$2,404 |
2.3× |
| Gated heart planar single (78472) |
$1,916.80 |
$4,792 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,918.40 |
$4,796 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,302 |
$5,755 |
3.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,766 |
$4,415 |
2.4× |
| Heart infarct image (78466) |
$624.40 |
$1,561 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,030.80 |
$7,577 |
0.9× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$2,566.40 |
$6,416 |
0.8× |
| Hepatobil syst image w/drug (78227) |
$1,142.60 |
$2,856.50 |
2.0× |
| Hepatobiliary system imaging (78226) |
$1,142.60 |
$2,856.50 |
2.7× |
| Humerus min 2 views (73060) |
$363.20 |
$908 |
3.9× |
| Hysterosalpingography (74740) |
$658.80 |
$1,647 |
2.6× |
| Image fusion (77399) |
$819.20 |
$2,048 |
5.7× |
| Imrt planning (77301) |
$9,313.60 |
$23,284 |
6.3× |
| Infusion of radioelement (77750) |
$484.80 |
$1,212 |
1.2× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,809.80 |
$4,524.50 |
2.4× |
| Intracavitary radiation source applic complex (77763) |
$1,778.80 |
$4,447 |
2.4× |
| Intracavitary radiation source applic intermed (77762) |
$1,410.40 |
$3,526 |
2.4× |
| Intracavitary radiation source applic simple (77761) |
$903.60 |
$2,259 |
1.5× |
| Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425) |
$17,322.80 |
$43,307 |
2.2× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$17,322.80 |
$43,307 |
2.2× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$832 |
$2,080 |
2.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$700.40 |
$1,751 |
1.8× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,429.20 |
$3,573 |
3.6× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$510.80 |
$1,277 |
1.3× |
| Ivp (74400) |
$682.80 |
$1,707 |
3.7× |
| Ivp w tomography (74415) |
$942 |
$2,355 |
5.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,646 |
$4,115 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,347.20 |
$3,368 |
2.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,321.20 |
$3,303 |
2.3× |
| Kidney w vascular flow (78701) |
$696.40 |
$1,741 |
1.6× |
| Liver & spleen; static only (78215) |
$1,339.20 |
$3,348 |
3.1× |
| Liver & spleen; w vasc flow (78216) |
$2,072.40 |
$5,181 |
4.9× |
| Liver imaging w/vascular flow (78202) |
$1,503.60 |
$3,759 |
2.6× |
| Lung perf&ventilat diferentl (78598) |
$2,728 |
$6,820 |
4.7× |
| Lung ventilat&perfus imaging (78582) |
$2,963.60 |
$7,409 |
5.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,190.60 |
$2,976.50 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,029.60 |
$2,574 |
1.5× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$1,535.40 |
$3,838.50 |
0.5× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,139.20 |
$2,848 |
0.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,121.60 |
$12,804 |
13.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,122 |
$7,805 |
8.4× |
| Mammary ductogram multiple ducts (77054) |
$928.80 |
$2,322 |
3.7× |
| Mammary ductogram single (77053) |
$275.20 |
$688 |
1.1× |
| Mlc device(s) for imrt (77338) |
$6,492.40 |
$16,231 |
16.3× |
| Mr safety determination physician/other qhp (76016) |
$40 |
$100 |
0.4× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$40 |
$100 |
0.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$40 |
$100 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$40 |
$100 |
0.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$40 |
$100 |
0.2× |
| MRA head w & w/o contrast (70546) |
$5,318 |
$13,295 |
14.3× |
| MRA head w/contrast (70545) |
$2,796.80 |
$6,992 |
7.5× |
| MRA head w/o contrast (70544) |
$2,925.20 |
$7,313 |
11.5× |
| MRA neck w/contrast (70548) |
$2,796.80 |
$6,992 |
7.5× |
| MRA neck w/o contrast (70547) |
$2,925.20 |
$7,313 |
11.5× |
| MRA neck w/wo contrast (70549) |
$3,722 |
$9,305 |
10.0× |
| MRI abdomen w/contrast (74182) |
$2,796.80 |
$6,992 |
7.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,730.80 |
$11,827 |
12.7× |
| MRI abdomen w/o contrast (74181) |
$2,720.80 |
$6,802 |
10.7× |
| MRI any jnt lwr ext with con lt (73722) |
$2,775.20 |
$6,938 |
3.3× |
| MRI bone marrow (77084) |
$2,450 |
$6,125 |
9.6× |
| MRI brain w/o & w/dye (70559) |
$267.60 |
$669 |
1.4× |
| MRI brain w/o dye (70557) |
$928.40 |
$2,321 |
1.6× |
| MRI breast without contrast bilateral (77047) |
$4,746.80 |
$11,867 |
18.7× |
| MRI breast without contrast material unilateral (77046) |
$3,240 |
$8,100 |
12.8× |
| MRI cardiac w/o contrast (75557) |
$2,260.60 |
$5,651.50 |
8.9× |
| MRI cervical spine w/o contrast (72141) |
$2,899.60 |
$7,249 |
11.4× |
| MRI cervical spine with contrast (72142) |
$2,863.20 |
$7,158 |
7.7× |
| MRI chest w & w/o contrast (71552) |
$5,444.40 |
$13,611 |
14.7× |
| MRI chest w/contrast (71551) |
$2,796.80 |
$6,992 |
3.4× |
| MRI chest w/o contrast (71550) |
$2,597.20 |
$6,493 |
10.2× |
| MRI fetal sngl/1st gestation (74712) |
$628 |
$1,570 |
2.5× |
| MRI joint upper ext w/contrast (73222) |
$2,756 |
$6,890 |
3.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,073.60 |
$12,684 |
13.7× |
| MRI joint upr extrem w/o dye (73221) |
$2,741.20 |
$6,853 |
10.8× |
| Mri Lower Extremity W/O Dye (73718) |
$2,724.60 |
$6,811.50 |
10.7× |
| MRI lumbar spine with contrast (72149) |
$2,929.60 |
$7,324 |
7.9× |
| MRI lumbar w/wo contrast (72158) |
$5,673.80 |
$14,184.50 |
15.3× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,929.60 |
$7,324 |
7.9× |
| MRI orbit/face/neck w/contrast (70542) |
$2,605.20 |
$6,513 |
7.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$2,923.20 |
$7,308 |
7.9× |
| MRI orbit/face/neck w/o contrast (70540) |
$2,861 |
$7,152.50 |
11.3× |
| MRI pelvis w/ contrast (72196) |
$2,498.40 |
$6,246 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$2,617.60 |
$6,544 |
10.3× |
| MRI pelvis w/wo contrast (72197) |
$5,570.80 |
$13,927 |
15.0× |
| MRI spectroscopy (76390) |
$2,683.60 |
$6,709 |
29.0× |
| MRI spine cervical wo/w contrast (72156) |
$5,684.60 |
$14,211.50 |
15.3× |
| MRI spine thoracic w/contrast (72147) |
$2,965.20 |
$7,413 |
8.0× |
| MRI thoracic spine w wo contrast (72157) |
$5,673.80 |
$14,184.50 |
15.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,653 |
$6,632.50 |
10.4× |
| MRI tmj (70336) |
$2,221.20 |
$5,553 |
8.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,947.60 |
$4,869 |
7.7× |
| Mri Upper Extremity W/Dye (73219) |
$2,929.60 |
$7,324 |
7.9× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,821.20 |
$7,053 |
7.6× |
| Myelogram thoracic (72255) |
$1,190.80 |
$2,977 |
1.4× |
| Myelography 2 or more regions (72270) |
$2,498.80 |
$6,247 |
3.0× |
| Myelography lumbosacral (72265) |
$1,310 |
$3,275 |
1.6× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$2,321.60 |
$5,804 |
1.7× |
| Myocardial perfusion planar multiple studies (78454) |
$2,653.60 |
$6,634 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,852 |
$4,630 |
1.3× |
| Myocrd img PET metab eval single study (78459) |
$8,134.40 |
$20,336 |
5.9× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,428 |
$3,570 |
1.6× |
| Nm adrenal imaging (78075) |
$2,002.40 |
$5,006 |
1.5× |
| Nm bone 3 phase (78315) |
$2,816.80 |
$7,042 |
6.6× |
| Nm bone imaging whole body (78306) |
$2,317.20 |
$5,793 |
5.4× |
| Nm bone marrow scan limited (78102) |
$512.80 |
$1,282 |
1.2× |
| Nm heart perfusion spect stress rest (78452) |
$4,205.20 |
$10,513 |
3.1× |
| Nm kidney function (78725) |
$313.20 |
$783 |
0.7× |
| Nm liver image static only (78201) |
$1,939.20 |
$4,848 |
3.4× |
| Nm lymph system (78195) |
$2,431.60 |
$6,079 |
4.2× |
| Nm myocard infarct spect (78469) |
$888.40 |
$2,221 |
1.5× |
| Nm thyroid imaging only (78013) |
$788.40 |
$1,971 |
1.9× |
| Nose to rectum for fb child (76010) |
$422 |
$1,055 |
4.6× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$811.20 |
$2,028 |
1.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,065.20 |
$2,663 |
2.5× |
| Nuclear rx IV admin (79101) |
$629.20 |
$1,573 |
2.5× |
| Ob us < 14 wks single fetus (76801) |
$910.80 |
$2,277 |
8.2× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$282.40 |
$706 |
2.5× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$365.60 |
$914 |
3.3× |
| Oral radiopharm rx (79005) |
$2,181.60 |
$5,454 |
8.8× |
| Orthopantogram (70355) |
$458 |
$1,145 |
4.9× |
| Parathyrd planar w/spect&CT (78072) |
$3,215.20 |
$8,038 |
5.6× |
| Parathyroid imaging (78070) |
$2,304.80 |
$5,762 |
5.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,215.20 |
$8,038 |
7.6× |
| Peritoneal-venous shunt patency test (78291) |
$783.60 |
$1,959 |
1.8× |
| Peritoneogram rs&i (74190) |
$260.40 |
$651 |
0.4× |
| PET brain metabolic eval (78608) |
$4,892.40 |
$12,231 |
3.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,598 |
$18,995 |
5.0× |
| PET imaging CT for attenuation limited area (78814) |
$5,285.20 |
$13,213 |
3.5× |
| PET imaging for CT attenuation whole body (78816) |
$8,258.40 |
$20,646 |
5.4× |
| PET imaging limited area chest head/neck (78811) |
$2,321.60 |
$5,804 |
1.7× |
| PET imaging whole body (78813) |
$4,813.20 |
$12,033 |
3.2× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$2,895.60 |
$7,239 |
1.9× |
| Proton trmt simple w/o comp (77520) |
$785.60 |
$1,964 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,492 |
$3,730 |
0.4× |
| Pulmonary perfusion imaging particulate (78580) |
$1,389.40 |
$3,473.50 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$389.40 |
$973.50 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$272.40 |
$681 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$477.60 |
$1,194 |
4.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$752 |
$1,880 |
6.8× |
| Radex hip unilateral with pelvis 1 view (73501) |
$167.60 |
$419 |
1.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$396.60 |
$991.50 |
4.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$160.80 |
$402 |
1.4× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$439.20 |
$1,098 |
3.9× |
| Radex spine cervical 2 or 3 views (72040) |
$435.60 |
$1,089 |
4.7× |
| Radex spine cervical 4 or 5 views (72050) |
$561.20 |
$1,403 |
5.0× |
| Radex spine cervical 6 or more views (72052) |
$650 |
$1,625 |
5.8× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$196.40 |
$491 |
2.1× |
| Radiation delivery stereotactic cranial linear (77372) |
$19,176 |
$47,940 |
2.4× |
| Radiation tx delivery lvl 1 (77402) |
$944 |
$2,360 |
8.7× |
| Radiation tx delivery lvl 2 (77407) |
$985.60 |
$2,464 |
2.4× |
| Radiation tx delivery lvl 3 (77412) |
$1,358 |
$3,395 |
2.3× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$541.80 |
$1,354.50 |
4.9× |
| Radiologic exam esophagus double contrast study (74221) |
$422.80 |
$1,057 |
2.3× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$330.80 |
$827 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,048 |
$2,620 |
5.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,048 |
$2,620 |
5.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$394.80 |
$987 |
4.3× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$641.60 |
$1,604 |
5.8× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$174 |
$435 |
1.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$489.60 |
$1,224 |
4.4× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$256.40 |
$641 |
2.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$211.20 |
$528 |
2.3× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$3,233.60 |
$8,084 |
13.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$526 |
$1,315 |
1.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$526 |
$1,315 |
1.3× |
| Renal cyst study (74470) |
$787 |
$1,967.50 |
1.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$600.40 |
$1,501 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$778 |
$1,945 |
1.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,616 |
$4,040 |
2.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,616 |
$4,040 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,116 |
$5,290 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,067.60 |
$2,669 |
0.8× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$1,067.60 |
$2,669 |
0.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,175.60 |
$2,939 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$656.60 |
$1,641.50 |
2.6× |
| Saline infused sonohysterogram (76831) |
$981.20 |
$2,453 |
3.9× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$66.80 |
$167 |
2.9× |
| Selective spinal angiogram (75705) |
$4,127.80 |
$10,319.50 |
0.7× |
| Shoulder arthrogram (73040) |
$846.80 |
$2,117 |
2.3× |
| Simulation complex (77290) |
$669.20 |
$1,673 |
1.7× |
| Simulation intermediate (77285) |
$1,454.20 |
$3,635.50 |
3.6× |
| Simulation simple (77280) |
$945 |
$2,362.50 |
6.6× |
| Small bowel series (74250) |
$329.40 |
$823.50 |
1.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$3,291.60 |
$8,229 |
8.3× |
| Special dosimetry (77331) |
$1,176 |
$2,940 |
8.2× |
| Special physics consult (77370) |
$673 |
$1,682.50 |
4.7× |
| Special treatment procedure (77470) |
$2,076.80 |
$5,192 |
3.5× |
| Speech evaluation complex (70371) |
$850.80 |
$2,127 |
3.3× |
| Splenoportography (75810) |
$3,623.60 |
$9,059 |
1.1× |
| Stereotactic body radiation delivery (77373) |
$6,544.40 |
$16,361 |
3.4× |
| Superior sagittal sinus venogram (75870) |
$2,084.40 |
$5,211 |
0.6× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$174.40 |
$436 |
1.6× |
| Testicular imaging w/flow (78761) |
$900.80 |
$2,252 |
2.1× |
| Thyroid met imaging body (78018) |
$2,147.60 |
$5,369 |
3.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$268 |
$670 |
0.6× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$679.80 |
$1,699.50 |
1.6× |
| Treatment device intermediate (77333) |
$616.40 |
$1,541 |
4.3× |
| Treatment devices complex (77334) |
$1,083.20 |
$2,708 |
2.7× |
| Treatment devices simple (77332) |
$403.20 |
$1,008 |
2.8× |
| Ultrasound breast limited (76642) |
$673.20 |
$1,683 |
7.3× |
| Ultrasound, abdomen limited (76705) |
$633.60 |
$1,584 |
5.7× |
| Ultrasound, elastography; first target lesion (76982) |
$211.60 |
$529 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$547.60 |
$1,369 |
4.9× |
| Unlisted CT procedure (76497) |
$1,141.20 |
$2,853 |
12.3× |
| Unlisted diagnostic radiographic procedure (76499) |
$132.40 |
$331 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$2,290.80 |
$5,727 |
24.7× |
| Unlisted procedure, clinical brachytherapy (77799) |
$229.20 |
$573 |
2.1× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$2,425.20 |
$6,063 |
16.9× |
| Ureteral reflux study (78740) |
$1,422.80 |
$3,557 |
3.3× |
| Urethrocystography retrograde rs&i (74450) |
$405.20 |
$1,013 |
1.6× |
| Urethrocystography voiding (74455) |
$436.60 |
$1,091.50 |
1.7× |
| Urography antegrade (74425) |
$1,421.60 |
$3,554 |
3.8× |
| Urography retrograde w/wo kub (74420) |
$1,075.60 |
$2,689 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$545.20 |
$1,363 |
2.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$234 |
$585 |
2.1× |
| Us breast uni real time with image complete (76641) |
$716.80 |
$1,792 |
6.4× |
| Us chest (76604) |
$1,199.20 |
$2,998 |
10.8× |
| Us compl joint r-t w/image documentation (76881) |
$772.80 |
$1,932 |
6.9× |
| Us elastography parenchyma (76981) |
$272.40 |
$681 |
2.4× |
| Us encephalogram (76506) |
$969.20 |
$2,423 |
8.7× |
| Us guided compression repair (76936) |
$1,968 |
$4,920 |
8.6× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$936.80 |
$2,342 |
10.1× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$808.40 |
$2,021 |
8.7× |
| Us kidney transplanted (76776) |
$1,770.60 |
$4,426.50 |
15.9× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$165.20 |
$413 |
1.5× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$165.20 |
$413 |
1.5× |
| Us ob detailed single fetus (76811) |
$910.80 |
$2,277 |
3.6× |
| Us ob followup per fetus (76816) |
$392.40 |
$981 |
3.5× |
| Us ob limited 1 or more fetuses (76815) |
$606 |
$1,515 |
5.4× |
| Us obstetric transvaginal (76817) |
$672.40 |
$1,681 |
6.0× |
| Us pelvic limited or f/u non-ob (76857) |
$598.80 |
$1,497 |
5.4× |
| Us pelvis complete (76856) |
$632.40 |
$1,581 |
5.7× |
| Us retroperitoneal complete (76770) |
$1,131.60 |
$2,829 |
10.2× |
| Us retroperitoneal limited (76775) |
$533 |
$1,332.50 |
4.8× |
| Us scrotum (76870) |
$729.20 |
$1,823 |
6.6× |
| Us soft tissue head/neck (76536) |
$950 |
$2,375 |
8.5× |
| Us spinal canal (76800) |
$444.40 |
$1,111 |
4.0× |
| Us transrectal (76872) |
$883.60 |
$2,209 |
7.9× |
| Us transrectal prostate volume (76873) |
$1,015.60 |
$2,539 |
9.1× |
| Vascular flow imaging (78445) |
$408 |
$1,020 |
1.0× |
| Vein X-ray liver w/hemodynam (75885) |
$4,426 |
$11,065 |
1.3× |
| Venogram extremity bilateral (75822) |
$1,490.80 |
$3,727 |
0.9× |
| Venogram ivc w serialography (75825) |
$2,542.80 |
$6,357 |
0.8× |
| Venogram svc w serialography (75827) |
$2,406.80 |
$6,017 |
1.4× |
| Venography adrenal unilateral selective rs&i (75840) |
$2,428.80 |
$6,072 |
0.7× |
| Venography ext unilateral (75820) |
$854.80 |
$2,137 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$2,406.80 |
$6,017 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,688.40 |
$9,221 |
1.1× |
| Venous sampling by catheter (75893) |
$6,117.20 |
$15,293 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$170 |
$425 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$268.80 |
$672 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$375.20 |
$938 |
4.0× |
| X-ray aorta leg arteries (75630) |
$3,128 |
$7,820 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$792.80 |
$1,982 |
4.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$339.60 |
$849 |
3.7× |
| X-ray exam hips bi 3-4 views (73522) |
$444.40 |
$1,111 |
4.0× |
| X-ray exam of finger(s) (73140) |
$238.80 |
$597 |
2.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$260.40 |
$651 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$202 |
$505 |
2.2× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$318.40 |
$796 |
3.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$406.40 |
$1,016 |
4.4× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$361.60 |
$904 |
3.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$310.80 |
$777 |
3.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$339.60 |
$849 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$159.20 |
$398 |
1.7× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$522.40 |
$1,306 |
5.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$475.20 |
$1,188 |
4.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$313.60 |
$784 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$609.60 |
$1,524 |
5.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$339.20 |
$848 |
3.0× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$429.60 |
$1,074 |
3.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$410.20 |
$1,025.50 |
4.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$595.60 |
$1,489 |
5.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$242 |
$605 |
2.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$170.40 |
$426 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$412 |
$1,030 |
4.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$463.60 |
$1,159 |
5.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$650 |
$1,625 |
7.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$588.40 |
$1,471 |
5.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$447.80 |
$1,119.50 |
4.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$159.20 |
$398 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$219.60 |
$549 |
2.4× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$312.40 |
$781 |
3.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$339.60 |
$849 |
3.7× |
| Xr abdomen 1 view (74018) |
$315.60 |
$789 |
3.4× |
| Xr abdomen 2 views (74019) |
$367.60 |
$919 |
3.3× |
| Xr abdomen 3 views (74021) |
$350.40 |
$876 |
3.1× |
| Xr arthrogram ankle (73615) |
$466 |
$1,165 |
1.3× |
| Xr arthrogram elbow (73085) |
$466 |
$1,165 |
1.3× |
| Xr arthrogram hip (73525) |
$603.20 |
$1,508 |
1.6× |
| Xr bone density appendicular (77081) |
$206 |
$515 |
2.2× |
| Xr bone density axial (77080) |
$382.60 |
$956.50 |
3.4× |
| Xr bone length study (77073) |
$466 |
$1,165 |
4.2× |
| Xr bone survey infant (77076) |
$230.20 |
$575.50 |
2.1× |
| Xr bone survey limited (77074) |
$438.40 |
$1,096 |
3.9× |
| Xr chest 1 view (71045) |
$240.80 |
$602 |
2.6× |
| Xr chest 2 views (71046) |
$391.60 |
$979 |
4.2× |
| Xr chest 3 views (71047) |
$207.60 |
$519 |
2.2× |
| Xr cystogram 3+ views (74430) |
$1,073.20 |
$2,683 |
2.9× |
| Xr eye foreign body (70030) |
$118.80 |
$297 |
1.3× |
| Xr facial bones 3 views (70150) |
$594.80 |
$1,487 |
5.3× |
| Xr lower extremity 2 views infant (73592) |
$256.40 |
$641 |
2.8× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$328.80 |
$822 |
3.0× |
| Xr mandible 4 views (70110) |
$604.80 |
$1,512 |
5.4× |
| Xr myelogram c-spine (72240) |
$949.60 |
$2,374 |
1.1× |
| Xr nasal bones (70160) |
$334.40 |
$836 |
3.6× |
| Xr pelvis 3 views (72190) |
$449.20 |
$1,123 |
4.0× |
| Xr sella turcica (70240) |
$168 |
$420 |
1.8× |
| Xr sialogram (70390) |
$376.40 |
$941 |
1.5× |
| Xr spine 1 view (72020) |
$384 |
$960 |
4.1× |
| Xr sternum 2 views (71120) |
$275.20 |
$688 |
3.0× |
| Xr surgical specimen (76098) |
$136 |
$340 |
0.2× |
| Xr upper extremity 2 views infant (73092) |
$296.40 |
$741 |
2.7× |
| Xray elbow 2 views (73070) |
$318.40 |
$796 |
3.4× |
| Xray forearm 2 views (73090) |
$339.60 |
$849 |
3.7× |
| Xray knee 1 or 2 views rt (73560) |
$382.40 |
$956 |
4.1× |
| Xray neck soft tissue (70360) |
$244.80 |
$612 |
2.6× |
| Xray orbits complete min 4 views (70200) |
$555.20 |
$1,388 |
5.0× |
| Xray pelvis 1 or 2 views (72170) |
$391 |
$977.50 |
3.5× |
| Xray ribs bilateral 3 views (71110) |
$510.80 |
$1,277 |
4.6× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$221.60 |
$554 |
2.0× |
| Xray scapula complete (73010) |
$267.60 |
$669 |
2.4× |
| Xray shoulder 1 view (73020) |
$155.20 |
$388 |
1.7× |
| Xray sinuses paranasal <3 views (70210) |
$193 |
$482.50 |
2.1× |
| Xray spine thoracic 2 views (72070) |
$454.20 |
$1,135.50 |
4.1× |
| Xray spine thoracic 3 views (72072) |
$328.40 |
$821 |
3.0× |
| Xray tibia-fibula 2 views bil (73590) |
$367.60 |
$919 |
4.0× |
| Xray tmj open - closed unilat (70328) |
$458.40 |
$1,146 |
4.9× |
| Xray tmj's bilateral open-clsc (70330) |
$522.40 |
$1,306 |
5.6× |