| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$3,060 |
$3,825 |
2.1× |
| Acute gi blood loss imaging (78278) |
$1,288 |
$1,610 |
3.1× |
| Angio adrenal bilat select (75733) |
$2,312 |
$2,890 |
0.7× |
| Angio adrenal unilat select (75731) |
$1,432 |
$1,790 |
0.4× |
| Angio extremity unilateral (75710) |
$5,784.80 |
$7,231 |
1.8× |
| Angio pulmonary unilateral (75741) |
$2,336 |
$2,920 |
0.7× |
| Angiogram extremity bilateral (75716) |
$4,284 |
$5,355 |
1.3× |
| Angiogram pelvic (75736) |
$5,620 |
$7,025 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$1,124 |
$1,405 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,096 |
$3,870 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,850.40 |
$4,813 |
0.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$920 |
$1,150 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,368 |
$2,960 |
0.7× |
| Ankle 2 views (73600) |
$545.26 |
$681.58 |
6.0× |
| Arthrography knee lt (73580) |
$592 |
$740 |
1.6× |
| Arthrography wrist lt (73115) |
$668 |
$835 |
1.8× |
| Barium enema (74270) |
$1,184 |
$1,480 |
6.5× |
| Basic dosimetry (77300) |
$648 |
$810 |
4.6× |
| Bilat selctv renal venogram (75833) |
$1,948 |
$2,435 |
0.6× |
| Bone age studies (77072) |
$236.80 |
$296 |
2.2× |
| Bone imaging limited area (78300) |
$1,072 |
$1,340 |
2.6× |
| Bone marrow imaging whole body (78104) |
$848 |
$1,060 |
2.0× |
| Bone survey complete (77075) |
$1,440 |
$1,800 |
13.2× |
| Bowel imaging (78290) |
$1,324 |
$1,655 |
3.2× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,088 |
$1,360 |
2.8× |
| Brain image w/flow 4 + views (78606) |
$1,380 |
$1,725 |
2.4× |
| Card MRI w/stress img & dye (75563) |
$2,480 |
$3,100 |
3.0× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,172 |
$1,465 |
2.1× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,320 |
$1,650 |
3.2× |
| Cardiac MRI w/stress img (75559) |
$2,156 |
$2,695 |
3.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,852 |
$3,565 |
7.8× |
| Cerebrospinal fluid leakage (78650) |
$1,488 |
$1,860 |
1.1× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$340 |
$425 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$836 |
$1,045 |
4.6× |
| Cisternogram (78630) |
$1,984 |
$2,480 |
3.5× |
| Clavicle complete (73000) |
$544 |
$680 |
6.0× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$2,820 |
$3,525 |
11.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,980 |
$2,475 |
10.8× |
| Continuing medical physics consltj pr wk (77336) |
$451.60 |
$564.50 |
3.2× |
| Contrast exam abdominl aorta (75625) |
$4,584 |
$5,730 |
1.4× |
| Contrast exam thoracic aorta (75605) |
$4,592 |
$5,740 |
0.8× |
| Corpora cavernosography (74445) |
$373.60 |
$467 |
3.4× |
| Csf shunt evaluation (78645) |
$900 |
$1,125 |
1.6× |
| CT - st neck w&wo contr (70492) |
$2,952 |
$3,690 |
16.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$7,872 |
$9,840 |
21.6× |
| CT abdomen and pelvis without contrast (74176) |
$5,697.60 |
$7,122 |
22.9× |
| CT abdomen w wo contrast (74170) |
$3,592 |
$4,490 |
19.6× |
| CT abdomen w/contrast (74160) |
$3,296 |
$4,120 |
18.0× |
| CT abdomen w/o contrast (74150) |
$2,152 |
$2,690 |
19.7× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$5,964 |
$7,455 |
16.4× |
| CT angio abdom w/o & w/dye (74175) |
$4,620 |
$5,775 |
25.2× |
| CT angio abdominal arteries (75635) |
$3,904.80 |
$4,881 |
21.3× |
| CT angio hrt w/3d image (75574) |
$1,710.40 |
$2,138 |
4.7× |
| CT angiograph pelv w/o&w/dye (72191) |
$1,576 |
$1,970 |
8.6× |
| CT cervical spine w/contrast (72126) |
$3,784.80 |
$4,731 |
10.4× |
| CT cervical spine w/o contrast (72125) |
$3,350.80 |
$4,188.50 |
30.7× |
| CT chest w/contrast (71260) |
$3,695.20 |
$4,619 |
20.2× |
| CT colonography diag w cont (74262) |
$2,396 |
$2,995 |
13.1× |
| CT colonography w/o cntrst (74261) |
$2,396 |
$2,995 |
21.9× |
| CT extremity upper w & w/o contrast (73202) |
$2,912 |
$3,640 |
15.9× |
| CT head/brain with contrast (70460) |
$3,049.60 |
$3,812 |
16.6× |
| CT head/brain without and with contrast (70470) |
$3,268.40 |
$4,085.50 |
17.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,855.20 |
$2,319 |
5.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,072 |
$1,340 |
11.8× |
| CT hrt w/3d image congen (75573) |
$1,044 |
$1,305 |
2.9× |
| CT lower ext w/wo contrast (73702) |
$2,816 |
$3,520 |
15.4× |
| CT lower extremity w contrast (73701) |
$2,639.20 |
$3,299 |
14.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,454.40 |
$3,068 |
22.5× |
| CT lumbar spine w/contrast (72132) |
$2,885.60 |
$3,607 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$3,331.20 |
$4,164 |
30.5× |
| CT lumbar spine w/o then w/ con (72133) |
$2,720 |
$3,400 |
14.8× |
| CT maxillofacial area w/o contrast (70486) |
$2,679.48 |
$3,349.34 |
24.5× |
| CT maxillofacial w/contrast (70487) |
$3,291.47 |
$4,114.34 |
18.0× |
| CT maxillofacial w/o then w/ con (70488) |
$1,940 |
$2,425 |
10.6× |
| CT orbit sella ear w/o con (70480) |
$2,140 |
$2,675 |
19.6× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$1,164 |
$1,455 |
6.4× |
| CT pelvis w & w/o contrast (72194) |
$4,285.60 |
$5,357 |
23.4× |
| CT pelvis w/o contrast (72192) |
$3,332 |
$4,165 |
30.5× |
| CT soft tissue neck w/contrast (70491) |
$2,892 |
$3,615 |
15.8× |
| CT soft tissue neck w/o contrast (70490) |
$2,503.20 |
$3,129 |
22.9× |
| CT spine cervical w/wo contrast (72127) |
$2,856 |
$3,570 |
15.6× |
| CT thoracic spine w/contrast (72129) |
$3,188 |
$3,985 |
17.4× |
| CT thoracic spine w/o contrast (72128) |
$3,380.80 |
$4,226 |
31.0× |
| CT thoracic spine w/o then w/ con (72130) |
$2,556 |
$3,195 |
14.0× |
| CT thorax w/o contrast (71250) |
$2,601.60 |
$3,252 |
23.8× |
| CT thorax w/o then w/ contrast (71270) |
$2,544 |
$3,180 |
13.9× |
| CT upper extremity w/dye (73201) |
$2,284 |
$2,855 |
6.3× |
| CT upper extremity w/o contrast rt (73200) |
$2,263.20 |
$2,829 |
20.7× |
| CTA chest w/wo contrast (71275) |
$4,728.80 |
$5,911 |
25.8× |
| CTA head w contrast (70496) |
$4,652 |
$5,815 |
25.4× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,340 |
$2,925 |
12.8× |
| Cta Neck (70498) |
$4,496 |
$5,620 |
24.5× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$4,296 |
$5,370 |
23.5× |
| Dilation ureters/urethra rs&i (74485) |
$1,068 |
$1,335 |
0.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$2,864 |
$3,580 |
1.4× |
| Diskography lumbar (72295) |
$2,100 |
$2,625 |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$422 |
$527.50 |
3.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$122 |
$152.50 |
1.1× |
| Doppler fetal mid cerebral artery (76821) |
$732 |
$915 |
6.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$282 |
$352.50 |
1.1× |
| Esophageal motility (78258) |
$1,056 |
$1,320 |
2.5× |
| Esophogram (74220) |
$811.20 |
$1,014 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$1,276 |
$1,595 |
11.7× |
| Fetal biophysical profile w/o nst (76819) |
$372 |
$465 |
3.4× |
| Fetal echo complete (76825) |
$812 |
$1,015 |
1.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$816 |
$1,020 |
3.3× |
| Full mouth X-ray of teeth (70320) |
$208.80 |
$261 |
0.8× |
| Gastric emptying study (78264) |
$2,502.40 |
$3,128 |
6.0× |
| Gastroesophageal reflux study (78262) |
$564 |
$705 |
1.4× |
| Gated heart planar single (78472) |
$1,896 |
$2,370 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,500 |
$3,125 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,527.60 |
$3,159.50 |
3.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,926 |
$2,407.50 |
2.6× |
| Heart infarct image (78466) |
$640 |
$800 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,988 |
$2,485 |
0.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$5,244 |
$6,555 |
1.6× |
| Hepatobil syst image w/drug (78227) |
$3,044 |
$3,805 |
5.4× |
| Hepatobiliary system imaging (78226) |
$2,144.80 |
$2,681 |
5.1× |
| Humerus min 2 views (73060) |
$528.80 |
$661 |
5.8× |
| Hysterosalpingography (74740) |
$1,600 |
$2,000 |
6.4× |
| Imrt planning (77301) |
$6,418 |
$8,022.50 |
4.4× |
| Infusion of radioelement (77750) |
$181.60 |
$227 |
0.5× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$552 |
$690 |
1.3× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,420 |
$1,775 |
2.0× |
| Intracavitary radiation source applic complex (77763) |
$710 |
$887.50 |
1.0× |
| Intracavitary radiation source applic intermed (77762) |
$596 |
$745 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$636 |
$795 |
1.1× |
Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425)
likely a partial charge, not the full procedure |
$496 |
$620 |
0.1× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$7,140 |
$8,925 |
0.9× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$405.20 |
$506.50 |
1.0× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$252 |
$315 |
0.6× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,675.20 |
$2,094 |
4.3× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$298 |
$372.50 |
0.8× |
| Ivp w tomography (74415) |
$1,100 |
$1,375 |
6.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,488 |
$1,860 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,588 |
$1,985 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,532 |
$1,915 |
2.7× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$828 |
$1,035 |
2.0× |
| Liver & spleen; static only (78215) |
$1,184 |
$1,480 |
2.8× |
| Lung perf&ventilat diferentl (78598) |
$2,240 |
$2,800 |
4.0× |
| Lung perfusion differential (78597) |
$1,128 |
$1,410 |
2.7× |
| Lung ventilat&perfus imaging (78582) |
$3,240 |
$4,050 |
5.7× |
| Lung ventilation imaging (78579) |
$832 |
$1,040 |
2.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$772 |
$965 |
0.5× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$1,016 |
$1,270 |
0.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,652 |
$5,815 |
12.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,736 |
$5,920 |
13.0× |
| Mlc device(s) for imrt (77338) |
$1,027.60 |
$1,284.50 |
2.6× |
| MRA head w & w/o contrast (70546) |
$4,001.60 |
$5,002 |
11.0× |
| MRA head w/contrast (70545) |
$3,628 |
$4,535 |
10.0× |
| MRA head w/o contrast (70544) |
$3,159.20 |
$3,949 |
12.7× |
| MRA neck w/contrast (70548) |
$2,580 |
$3,225 |
7.1× |
| MRA neck w/o contrast (70547) |
$3,357.60 |
$4,197 |
13.5× |
| MRA neck w/wo contrast (70549) |
$5,560 |
$6,950 |
15.3× |
| MRI abdomen w/contrast (74182) |
$2,992 |
$3,740 |
8.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,973.60 |
$4,967 |
10.9× |
| MRI abdomen w/o contrast (74181) |
$3,456.80 |
$4,321 |
13.9× |
| MRI any jnt lwr ext with con lt (73722) |
$3,784 |
$4,730 |
4.6× |
| MRI bone marrow (77084) |
$1,764 |
$2,205 |
7.1× |
| MRI cardiac w/o contrast (75557) |
$2,416 |
$3,020 |
9.7× |
| MRI cervical spine w/o contrast (72141) |
$4,104 |
$5,130 |
16.5× |
| MRI cervical spine with contrast (72142) |
$3,988 |
$4,985 |
10.9× |
| MRI chest w & w/o contrast (71552) |
$2,932 |
$3,665 |
8.0× |
| MRI chest w/contrast (71551) |
$2,200 |
$2,750 |
2.7× |
| MRI chest w/o contrast (71550) |
$1,836 |
$2,295 |
7.4× |
| MRI joint upper ext w/contrast (73222) |
$3,420 |
$4,275 |
4.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,500 |
$5,625 |
12.4× |
| MRI joint upr extrem w/o dye (73221) |
$3,748 |
$4,685 |
15.0× |
| Mri Lower Extremity W/O Dye (73718) |
$3,604 |
$4,505 |
14.5× |
| MRI lumbar spine with contrast (72149) |
$3,680 |
$4,600 |
10.1× |
| MRI lumbar w/wo contrast (72158) |
$4,972.80 |
$6,216 |
13.6× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,672 |
$3,340 |
7.3× |
| MRI orbit/face/neck w/contrast (70542) |
$2,204 |
$2,755 |
6.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$3,660 |
$4,575 |
10.0× |
| MRI orbit/face/neck w/o contrast (70540) |
$2,084 |
$2,605 |
8.4× |
| MRI pelvis w/ contrast (72196) |
$2,200 |
$2,750 |
6.0× |
| MRI pelvis w/o contrast (72195) |
$3,336 |
$4,170 |
13.4× |
| MRI pelvis w/wo contrast (72197) |
$4,795.20 |
$5,994 |
13.2× |
| MRI spectroscopy (76390) |
$2,054.40 |
$2,568 |
22.6× |
| MRI spine cervical wo/w contrast (72156) |
$4,484 |
$5,605 |
12.3× |
| MRI spine thoracic w/contrast (72147) |
$4,160 |
$5,200 |
11.4× |
| MRI thoracic spine w wo contrast (72157) |
$4,444.80 |
$5,556 |
12.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,660 |
$4,575 |
14.7× |
| MRI tmj (70336) |
$1,440 |
$1,800 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,850.40 |
$4,813 |
15.5× |
| Mri Upper Extremity W/Dye (73219) |
$2,676 |
$3,345 |
7.3× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$4,344 |
$5,430 |
11.9× |
| Myelogram thoracic (72255) |
$1,576 |
$1,970 |
1.9× |
| Myelography 2 or more regions (72270) |
$1,924 |
$2,405 |
2.4× |
| Myelography lumbosacral (72265) |
$1,692 |
$2,115 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,448 |
$5,560 |
3.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,736 |
$5,920 |
3.2× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$1,420 |
$1,775 |
1.1× |
| Myocardial perfusion planar multiple studies (78454) |
$2,864 |
$3,580 |
2.1× |
| Myocardial spect single study at rest or stress (78451) |
$3,910.40 |
$4,888 |
2.9× |
| Myocrd img PET metab eval single study (78459) |
$4,696 |
$5,870 |
3.5× |
| Nm bone 3 phase (78315) |
$2,080 |
$2,600 |
5.0× |
| Nm bone imaging whole body (78306) |
$3,220 |
$4,025 |
7.7× |
| Nm bone marrow scan limited (78102) |
$696 |
$870 |
1.7× |
| Nm bone marrow scan multiple (78103) |
$828 |
$1,035 |
2.0× |
| Nm heart perfusion spect stress rest (78452) |
$7,584 |
$9,480 |
5.6× |
| Nm kidney function (78725) |
$576 |
$720 |
1.4× |
| Nm kidney imaging morphology (78700) |
$792 |
$990 |
1.9× |
| Nm liver image static only (78201) |
$1,084 |
$1,355 |
1.9× |
| Nm lymph system (78195) |
$2,620 |
$3,275 |
4.6× |
| Nm myocard infarct spect (78469) |
$1,320 |
$1,650 |
2.3× |
| Nose to rectum for fb child (76010) |
$404 |
$505 |
4.4× |
| Nuclear medicine study of red blood cell survival (78130) |
$728 |
$910 |
1.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$588 |
$735 |
1.4× |
| Nuclear rx IV admin (79101) |
$292 |
$365 |
1.2× |
| Ob us < 14 wks single fetus (76801) |
$1,339.20 |
$1,674 |
12.3× |
| Ob us nuchal meas 1 gest (76813) |
$388 |
$485 |
3.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$0.01 |
$0.01 |
0.0× |
| Oral radiopharm rx (79005) |
$2,500 |
$3,125 |
10.3× |
| Orthopantogram (70355) |
$212 |
$265 |
2.3× |
| Parathyroid imaging (78070) |
$1,044 |
$1,305 |
2.5× |
| Peritoneal-venous shunt patency test (78291) |
$1,292 |
$1,615 |
3.1× |
| Peritoneogram rs&i (74190) |
$560 |
$700 |
1.0× |
| PET brain metabolic eval (78608) |
$6,332 |
$7,915 |
4.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,564 |
$6,955 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$6,888 |
$8,610 |
4.6× |
| PET imaging for CT attenuation whole body (78816) |
$6,888 |
$8,610 |
4.6× |
| PET imaging limited area chest head/neck (78811) |
$6,332 |
$7,915 |
4.7× |
| PET imaging whole body (78813) |
$5,740 |
$7,175 |
3.8× |
| Plasma volume multiple (78111) |
$900 |
$1,125 |
0.7× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$6,920 |
$8,650 |
4.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,028 |
$2,535 |
0.6× |
| Pulmonary perfusion imaging particulate (78580) |
$2,032 |
$2,540 |
4.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$444 |
$555 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$364 |
$455 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$309.60 |
$387 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$333.60 |
$417 |
3.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$464 |
$580 |
5.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$572 |
$715 |
6.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$576 |
$720 |
5.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$584 |
$730 |
5.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$588 |
$735 |
5.4× |
| Radex spine cervical 2 or 3 views (72040) |
$584 |
$730 |
6.4× |
| Radex spine cervical 4 or 5 views (72050) |
$833.60 |
$1,042 |
7.6× |
| Radex spine cervical 6 or more views (72052) |
$616 |
$770 |
5.6× |
| Radiation delivery stereotactic cranial linear (77372) |
$8,336 |
$10,420 |
1.1× |
| Radiation tx delivery lvl 1 (77402) |
$301.60 |
$377 |
2.8× |
| Radiation tx delivery lvl 2 (77407) |
$448 |
$560 |
1.1× |
| Radiation tx delivery lvl 3 (77412) |
$1,288.80 |
$1,611 |
2.2× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$336.80 |
$421 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$404 |
$505 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,088 |
$1,360 |
5.9× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$352.80 |
$441 |
3.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$452 |
$565 |
5.0× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$253.60 |
$317 |
2.3× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$232 |
$290 |
2.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$326.40 |
$408 |
3.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$316 |
$395 |
2.9× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$221.60 |
$277 |
0.9× |
| Radiologic examination, teeth; single view Other Diagnostic Radiology FS (70300) |
$210.40 |
$263 |
2.3× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$680 |
$850 |
2.8× |
| Red cell mass multiple (78121) |
$1,076 |
$1,345 |
1.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$400 |
$500 |
1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$602 |
$752.50 |
1.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$3,132 |
$3,915 |
7.5× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,452 |
$4,315 |
6.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,880 |
$2,350 |
3.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,580 |
$1,975 |
2.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,932 |
$3,665 |
2.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$720 |
$900 |
3.0× |
Selective spinal angiogram (75705)
unusually low: confirm this is the full procedure |
$1,776 |
$2,220 |
0.3× |
| Shoulder arthrogram (73040) |
$528 |
$660 |
1.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$375.20 |
$469 |
3.4× |
| Simulation complex (77290) |
$1,747.60 |
$2,184.50 |
4.5× |
| Simulation intermediate (77285) |
$432 |
$540 |
1.1× |
| Simulation simple (77280) |
$900 |
$1,125 |
6.4× |
| Small bowel series (74250) |
$1,172 |
$1,465 |
6.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$216 |
$270 |
0.6× |
| Special dosimetry (77331) |
$0.01 |
$0.01 |
0.0× |
| Special physics consult (77370) |
$1,035.32 |
$1,294.15 |
7.4× |
| Special treatment procedure (77470) |
$1,900 |
$2,375 |
3.3× |
| Spleen imaging only (78185) |
$696 |
$870 |
1.7× |
| Splenoportography (75810) |
$1,584 |
$1,980 |
0.5× |
| Stereotactic body radiation delivery (77373) |
$15,115.20 |
$18,894 |
8.1× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$123.60 |
$154.50 |
1.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$408 |
$510 |
1.6× |
| Testicular imaging w/flow (78761) |
$800 |
$1,000 |
1.9× |
| Therapeutic enema barium or air (74283) |
$700 |
$875 |
3.8× |
| Thyroid met imaging body (78018) |
$1,684 |
$2,105 |
3.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,068 |
$1,335 |
2.6× |
| Treatment device intermediate (77333) |
$250 |
$312.50 |
1.8× |
| Treatment devices complex (77334) |
$1,156.80 |
$1,446 |
3.0× |
| Treatment devices simple (77332) |
$680 |
$850 |
4.8× |
| Ultrasound breast limited (76642) |
$376 |
$470 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$1,236 |
$1,545 |
11.3× |
| Umbilical-artery Doppler (OB) (76820) |
$476 |
$595 |
4.4× |
| Unlisted CT procedure (76497) |
$668 |
$835 |
7.4× |
| Unlisted diagnostic radiographic procedure (76499) |
$270 |
$337.50 |
3.0× |
| Unlisted endocrine procedure, diagnostic nuclear medicine UNSCHEDULED (78099) |
$828 |
$1,035 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$379.60 |
$474.50 |
4.2× |
| Unlisted magnetic resonance procedure (76498) |
$3,148 |
$3,935 |
34.6× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine UNSCHEDULED (78999) |
$1,284 |
$1,605 |
3.1× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$1,652 |
$2,065 |
4.0× |
| Unlisted procedure, clinical brachytherapy (77799) |
$0.01 |
$0.01 |
0.0× |
| Ureteral reflux study (78740) |
$1,132 |
$1,415 |
2.7× |
| Urethrocystography retrograde rs&i (74450) |
$420 |
$525 |
1.7× |
| Urethrocystography voiding (74455) |
$376.80 |
$471 |
1.5× |
| Urography antegrade (74425) |
$668 |
$835 |
1.8× |
| Urography retrograde w/wo kub (74420) |
$1,288 |
$1,610 |
3.5× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$868 |
$1,085 |
4.7× |
| Us breast uni real time with image complete (76641) |
$285.60 |
$357 |
2.6× |
| Us chest (76604) |
$672 |
$840 |
6.2× |
| Us compl joint r-t w/image documentation (76881) |
$568 |
$710 |
5.2× |
| Us encephalogram (76506) |
$792 |
$990 |
7.3× |
| Us guided compression repair (76936) |
$780 |
$975 |
3.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$440 |
$550 |
4.8× |
| Us kidney transplanted (76776) |
$996 |
$1,245 |
9.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$564 |
$705 |
5.2× |
| Us ob detailed single fetus (76811) |
$592 |
$740 |
2.4× |
| Us ob followup per fetus (76816) |
$320 |
$400 |
2.9× |
| Us ob limited 1 or more fetuses (76815) |
$752 |
$940 |
6.9× |
| Us obstetric transvaginal (76817) |
$852.80 |
$1,066 |
7.8× |
| Us pelvic limited or f/u non-ob (76857) |
$628 |
$785 |
5.8× |
| Us pelvis complete (76856) |
$1,146.40 |
$1,433 |
10.5× |
| Us retroperitoneal complete (76770) |
$864 |
$1,080 |
7.9× |
| Us retroperitoneal limited (76775) |
$713.65 |
$892.06 |
6.5× |
| Us scrotum (76870) |
$444.80 |
$556 |
4.1× |
| Us soft tissue head/neck (76536) |
$644 |
$805 |
5.9× |
| Us spinal canal (76800) |
$716 |
$895 |
6.6× |
| Us transrectal (76872) |
$374.40 |
$468 |
3.4× |
| Us transrectal prostate volume (76873) |
$152 |
$190 |
1.4× |
| Us unlstd proc (76999) |
$460 |
$575 |
5.1× |
| Vascular flow imaging (78445) |
$1,232 |
$1,540 |
3.0× |
| Vein X-ray liver w/hemodynam (75885) |
$3,072 |
$3,840 |
0.9× |
| Venogram epidural (75872) |
$1,280 |
$1,600 |
2.0× |
| Venogram extremity bilateral (75822) |
$1,708 |
$2,135 |
1.0× |
| Venogram ivc w serialography (75825) |
$2,268 |
$2,835 |
0.7× |
| Venogram svc w serialography (75827) |
$1,836 |
$2,295 |
1.1× |
| Venography adrenal unilateral selective rs&i (75840) |
$3,032 |
$3,790 |
0.9× |
| Venography ext unilateral (75820) |
$2,164 |
$2,705 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$2,488 |
$3,110 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,306.80 |
$1,633.50 |
0.4× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$1,280 |
$1,600 |
2.0× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,076 |
$2,595 |
0.4× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$748 |
$935 |
1.3× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,076 |
$1,345 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$269.60 |
$337 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$572 |
$715 |
6.3× |
| X-ray aorta leg arteries (75630) |
$3,710.40 |
$4,638 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$964 |
$1,205 |
5.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$592.80 |
$741 |
6.5× |
| X-ray exam hips bi 3-4 views (73522) |
$568 |
$710 |
5.2× |
| X-ray exam of finger(s) (73140) |
$353.60 |
$442 |
3.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$532 |
$665 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$285.60 |
$357 |
3.1× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$446.76 |
$558.45 |
4.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$512 |
$640 |
5.6× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$526.70 |
$658.38 |
4.8× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$564.80 |
$706 |
6.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$416 |
$520 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$440 |
$550 |
4.8× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$528 |
$660 |
5.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$544 |
$680 |
5.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$127.20 |
$159 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$668 |
$835 |
6.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$588 |
$735 |
5.4× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$440 |
$550 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$560 |
$700 |
6.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$492 |
$615 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$496 |
$620 |
4.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$397.60 |
$497 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$534.49 |
$668.11 |
5.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$612 |
$765 |
6.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$280 |
$350 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$784 |
$980 |
7.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$524.80 |
$656 |
4.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$224.80 |
$281 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$360 |
$450 |
4.0× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$440 |
$550 |
4.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$524 |
$655 |
5.8× |
| Xr abdomen 1 view (74018) |
$455.20 |
$569 |
5.0× |
| Xr abdomen 2 views (74019) |
$654.40 |
$818 |
6.0× |
| Xr abdomen 3 views (74021) |
$436 |
$545 |
4.0× |
| Xr arthrogram ankle (73615) |
$760 |
$950 |
2.1× |
| Xr arthrogram elbow (73085) |
$984 |
$1,230 |
2.7× |
| Xr arthrogram hip (73525) |
$596 |
$745 |
1.6× |
| Xr bone length study (77073) |
$256.80 |
$321 |
2.4× |
| Xr bone survey infant (77076) |
$315.20 |
$394 |
2.9× |
| Xr bone survey limited (77074) |
$440 |
$550 |
4.0× |
| Xr chest 1 view (71045) |
$483.66 |
$604.58 |
5.3× |
| Xr chest 2 views (71046) |
$715.60 |
$894.50 |
7.9× |
| Xr chest 3 views (71047) |
$335.20 |
$419 |
3.7× |
| Xr cystogram 3+ views (74430) |
$448 |
$560 |
1.2× |
| Xr eye foreign body (70030) |
$400 |
$500 |
4.4× |
| Xr facial bones 3 views (70150) |
$480 |
$600 |
4.4× |
| Xr joint survey 1 view (77077) |
$123.20 |
$154 |
1.1× |
| Xr lower extremity 2 views infant (73592) |
$247.20 |
$309 |
2.7× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$455.20 |
$569 |
4.2× |
| Xr mandible 4 views (70110) |
$588 |
$735 |
5.4× |
| Xr myelogram c-spine (72240) |
$1,692 |
$2,115 |
2.1× |
| Xr nasal bones (70160) |
$756 |
$945 |
8.3× |
| Xr pelvis 3 views (72190) |
$688 |
$860 |
6.3× |
| Xr sella turcica (70240) |
$186.40 |
$233 |
2.1× |
| Xr sialogram (70390) |
$476 |
$595 |
1.9× |
| Xr spine 1 view (72020) |
$472 |
$590 |
5.2× |
| Xr sternum 2 views (71120) |
$396 |
$495 |
4.4× |
| Xr stress view joint (77071) |
$111.20 |
$139 |
1.2× |
| Xr surgical specimen (76098) |
$273.60 |
$342 |
0.5× |
| Xr upper extremity 2 views infant (73092) |
$214.40 |
$268 |
2.0× |
| Xray elbow 2 views (73070) |
$444.46 |
$555.58 |
4.9× |
| Xray forearm 2 views (73090) |
$501.54 |
$626.92 |
5.5× |
| Xray internal auditory meati compl (70134) |
$480 |
$600 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$508 |
$635 |
5.6× |
| Xray neck soft tissue (70360) |
$466.40 |
$583 |
5.1× |
| Xray optic foramina (70190) |
$197.60 |
$247 |
2.2× |
| Xray orbits complete min 4 views (70200) |
$377.71 |
$472.14 |
3.5× |
| Xray pelvis 1 or 2 views (72170) |
$621.60 |
$777 |
5.7× |
| Xray ribs bilateral 3 views (71110) |
$404 |
$505 |
3.7× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$712 |
$890 |
6.5× |
| Xray scapula complete (73010) |
$556.80 |
$696 |
5.1× |
| Xray shoulder 1 view (73020) |
$588 |
$735 |
6.5× |
| Xray sinuses paranasal <3 views (70210) |
$216 |
$270 |
2.4× |
| Xray spine thoracic 2 views (72070) |
$577.60 |
$722 |
5.3× |
| Xray spine thoracic 3 views (72072) |
$612 |
$765 |
5.6× |
| Xray tibia-fibula 2 views bil (73590) |
$504 |
$630 |
5.5× |
| Xray tmj open - closed unilat (70328) |
$208.80 |
$261 |
2.3× |
| Xray tmj's bilateral open-clsc (70330) |
$328 |
$410 |
3.6× |