| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$4,261.40 |
$6,556 |
2.9× |
| Acute gi blood loss imaging (78278) |
$1,766.70 |
$2,718 |
4.2× |
| Angio adrenal unilat select (75731) |
$2,860 |
$4,400 |
0.9× |
| Angio extremity unilateral (75710) |
$35,566.78 |
— |
10.8× |
| Angio pulmonary unilateral (75741) |
$3,069.30 |
$4,722 |
0.9× |
| Angiogram extremity bilateral (75716) |
$11,434.15 |
$17,591 |
3.5× |
| Angiogram pelvic (75736) |
$8,562.45 |
$13,173 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$3,303.95 |
$5,083 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,603.95 |
$7,083 |
1.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,706.40 |
$11,856 |
1.3× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,925 |
$4,500 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,795 |
$4,300 |
0.8× |
| Ankle 2 views (73600) |
$653.25 |
— |
7.2× |
| Arthrography knee lt (73580) |
$1,149.85 |
$1,769 |
3.2× |
| Arthrography wrist lt (73115) |
$967.20 |
$1,488 |
2.7× |
| Barium enema (74270) |
$1,119.30 |
$1,722 |
6.1× |
| Basic dosimetry (77300) |
$1,112.15 |
$1,711 |
7.9× |
| Bone age studies (77072) |
$343.20 |
$528 |
3.1× |
| Bone imaging limited area (78300) |
$1,014 |
$1,560 |
2.4× |
| Bone marrow imaging whole body (78104) |
$1,144 |
$1,760 |
2.7× |
| Bone survey complete (77075) |
$542.75 |
$835 |
5.0× |
| Bowel imaging (78290) |
$1,163.50 |
$1,790 |
2.8× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,151.80 |
$1,772 |
2.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,313 |
$2,020 |
2.3× |
| Brain image w/flow 4 + views (78606) |
$1,501.50 |
$2,310 |
2.6× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,085.50 |
$1,670 |
2.6× |
| Card MRI w/stress img & dye (75563) |
$1,909.05 |
$2,937 |
2.3× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,157 |
$1,780 |
2.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$654.55 |
$1,007 |
1.8× |
| Cerebrospinal fluid leakage (78650) |
$2,366 |
$3,640 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$787.15 |
$1,211 |
4.3× |
| Cisternogram (78630) |
$1,550.25 |
$2,385 |
2.7× |
| Clavicle complete (73000) |
$1,044.55 |
— |
11.5× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$634.40 |
$976 |
2.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,630.90 |
— |
19.8× |
| Continuing medical physics consltj pr wk (77336) |
$654.55 |
$1,007 |
4.7× |
| Contrast exam abdominl aorta (75625) |
$7,746.70 |
$11,918 |
2.3× |
| Contrast exam thoracic aorta (75605) |
$5,693.35 |
$8,759 |
1.0× |
| Csf shunt evaluation (78645) |
$1,319.50 |
$2,030 |
2.3× |
| CT - st neck w&wo contr (70492) |
$3,337.75 |
$5,135 |
18.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$7,086.30 |
$10,902 |
19.5× |
| CT abdomen and pelvis without contrast (74176) |
$5,712.20 |
— |
22.9× |
| CT abdomen w wo contrast (74170) |
$4,194.45 |
$6,453 |
22.9× |
| CT abdomen w/contrast (74160) |
$3,497 |
$5,380 |
19.1× |
| CT abdomen w/o contrast (74150) |
$3,268.20 |
$5,028 |
29.9× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$4,323.15 |
$6,651 |
11.9× |
| CT angio abdom w/o & w/dye (74175) |
$3,376.10 |
$5,194 |
18.4× |
| CT angio abdominal arteries (75635) |
$3,390.40 |
$5,216 |
18.5× |
| CT angio hrt w/3d image (75574) |
$2,111.85 |
— |
5.8× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,615.30 |
$5,562 |
19.7× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$2,980.90 |
$4,586 |
16.3× |
| CT cervical spine w/contrast (72126) |
$3,300.05 |
$5,077 |
9.1× |
| CT cervical spine w/o contrast (72125) |
$3,212.30 |
$4,942 |
29.4× |
| CT chest w/contrast (71260) |
$10,836.80 |
— |
59.2× |
| CT colonography w/o cntrst (74261) |
$640.90 |
$986 |
5.9× |
| CT extremity upper w & w/o contrast (73202) |
$2,198.30 |
$3,382 |
12.0× |
| CT head/brain with contrast (70460) |
$2,895.75 |
$4,455 |
15.8× |
| CT head/brain without and with contrast (70470) |
$3,329.95 |
$5,123 |
18.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,552.85 |
$2,389 |
4.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$540.80 |
$832 |
6.0× |
| CT lower ext w/wo contrast (73702) |
$2,198.30 |
$3,382 |
12.0× |
| CT lower extremity w contrast (73701) |
$2,178.80 |
$3,352 |
11.9× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,050.10 |
$3,154 |
18.8× |
| CT lumbar spine w/contrast (72132) |
$3,300.05 |
$5,077 |
9.1× |
| CT lumbar spine w/o contrast (72131) |
$3,212.30 |
$4,942 |
29.4× |
| CT lumbar spine w/o then w/ con (72133) |
$3,480.75 |
$5,355 |
19.0× |
| CT maxillofacial area w/o contrast (70486) |
$2,538.90 |
$3,906 |
23.3× |
| CT maxillofacial w/contrast (70487) |
$2,978.95 |
$4,583 |
16.3× |
| CT maxillofacial w/o then w/ con (70488) |
$3,010.15 |
$4,631 |
16.4× |
| CT orbit sella ear w/o con (70480) |
$2,661.10 |
— |
24.4× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$4,143.10 |
$6,374 |
22.6× |
| CT pelvis w & w/o contrast (72194) |
$3,894.80 |
$5,992 |
21.3× |
| CT pelvis w/o contrast (72192) |
$3,145.35 |
$4,839 |
28.8× |
| CT soft tissue neck w/contrast (70491) |
$3,301.35 |
— |
18.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,791.75 |
$4,295 |
25.6× |
| CT spine cervical w/wo contrast (72127) |
$3,480.75 |
$5,355 |
19.0× |
| CT thoracic spine w/contrast (72129) |
$3,300.05 |
$5,077 |
18.0× |
| CT thoracic spine w/o contrast (72128) |
$2,859.35 |
$4,399 |
26.2× |
| CT thoracic spine w/o then w/ con (72130) |
$3,480.75 |
$5,355 |
19.0× |
| CT thorax lung cancer scr c- (71271) |
$1,554.15 |
$2,391 |
14.2× |
| CT thorax w/o contrast (71250) |
$3,046.55 |
$4,687 |
27.9× |
| CT thorax w/o then w/ contrast (71270) |
$3,706.95 |
$5,703 |
20.2× |
| CT upper extremity w/dye (73201) |
$2,178.80 |
$3,352 |
6.0× |
| CT upper extremity w/o contrast rt (73200) |
$2,050.10 |
$3,154 |
18.8× |
| CTA chest w/wo contrast (71275) |
$3,046.55 |
$4,687 |
16.6× |
| CTA head w contrast (70496) |
$5,937.10 |
— |
32.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,980.90 |
$4,586 |
8.2× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$3,680.95 |
$5,663 |
20.1× |
| Cta Neck (70498) |
$5,937.10 |
— |
32.4× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$3,680.95 |
$5,663 |
20.1× |
| Dilation ureters/urethra rs&i (74485) |
$1,836.25 |
$2,825 |
0.8× |
| Diskography lumbar (72295) |
$3,766.75 |
$5,795 |
1.8× |
| Doppler echo fetal spectral display complete (76827) |
$223.60 |
$344 |
2.0× |
| Dxa bone density study axial skeleton (77085) |
$308.10 |
$474 |
2.8× |
| Esophogram (74220) |
$1,537.90 |
— |
8.4× |
| Fetal biophysical profile non-stress testing (76818) |
$682.50 |
$1,050 |
6.3× |
| Fetal biophysical profile w/o nst (76819) |
$650 |
$1,000 |
6.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,866.15 |
— |
7.5× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,194.05 |
$1,837 |
2.1× |
| Gastric emptying study (78264) |
$1,592.50 |
$2,450 |
3.8× |
| Gated heart planar single (78472) |
$1,118 |
$1,720 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$865.80 |
$1,332 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,539.20 |
$2,368 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$7,176.65 |
$11,041 |
9.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,547.05 |
$5,457 |
1.1× |
| Hepatobil syst image w/drug (78227) |
$2,401.10 |
$3,694 |
4.2× |
| Hepatobiliary system imaging (78226) |
$2,152.15 |
$3,311 |
5.2× |
| Humerus min 2 views (73060) |
$406.25 |
— |
4.5× |
| Hysterosalpingography (74740) |
$1,242.15 |
$1,911 |
5.0× |
| Imrt planning (77301) |
$5,937.10 |
$9,134 |
4.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$1,539.20 |
$2,368 |
2.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$811.85 |
$1,249 |
2.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$789.10 |
$1,214 |
2.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$923 |
$1,420 |
2.4× |
| Ivp (74400) |
$1,030.90 |
$1,586 |
5.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,560 |
$2,400 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,495 |
$2,300 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,480.05 |
$2,277 |
2.6× |
| Kidney w vascular flow (78701) |
$1,072.50 |
$1,650 |
2.6× |
| Liver & spleen; static only (78215) |
$1,027 |
$1,580 |
2.5× |
| Liver & spleen; w vasc flow (78216) |
$975 |
$1,500 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$1,932.45 |
$2,973 |
3.4× |
| Lung perfusion differential (78597) |
$1,053 |
$1,620 |
2.5× |
| Lung ventilat&perfus imaging (78582) |
$2,133.30 |
$3,282 |
3.8× |
| Lung ventilation imaging (78579) |
$1,040 |
$1,600 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,315 |
$5,100 |
9.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,260.40 |
$5,016 |
8.9× |
| Mlc device(s) for imrt (77338) |
$1,389.05 |
$2,137 |
3.6× |
| MRA head w & w/o contrast (70546) |
$3,848.39 |
— |
10.6× |
| MRA head w/contrast (70545) |
$2,678 |
$4,120 |
7.4× |
| MRA head w/o contrast (70544) |
$4,572.68 |
— |
18.4× |
| MRA neck w/contrast (70548) |
$2,670.20 |
$4,108 |
7.3× |
| MRA neck w/o contrast (70547) |
$1,767.35 |
$2,719 |
7.1× |
| MRA neck w/wo contrast (70549) |
$3,051.10 |
$4,694 |
8.4× |
| MRI abdomen w/contrast (74182) |
$2,467.40 |
$3,796 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,614 |
$5,560 |
9.9× |
| MRI abdomen w/o contrast (74181) |
$1,542.45 |
$2,373 |
6.2× |
| MRI any jnt lwr ext with con lt (73722) |
$2,936.70 |
$4,518 |
3.6× |
| MRI breast without contrast bilateral (77047) |
$2,696.85 |
$4,149 |
10.8× |
| MRI breast without contrast material unilateral (77046) |
$1,797.90 |
$2,766 |
7.2× |
| MRI cardiac w/o contrast (75557) |
$475.15 |
$731 |
1.9× |
| MRI cervical spine w/o contrast (72141) |
$3,151.20 |
$4,848 |
12.6× |
| MRI cervical spine with contrast (72142) |
$3,456.70 |
$5,318 |
9.5× |
| MRI chest w & w/o contrast (71552) |
$2,544.10 |
$3,914 |
7.0× |
| MRI chest w/o contrast (71550) |
$2,282.15 |
$3,511 |
9.2× |
| MRI joint upper ext w/contrast (73222) |
$2,936.70 |
$4,518 |
3.6× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,315 |
$5,100 |
9.1× |
| MRI joint upr extrem w/o dye (73221) |
$2,774.20 |
— |
11.1× |
| Mri Lower Extremity W/O Dye (73718) |
$2,678 |
$4,120 |
10.7× |
| MRI lumbar spine with contrast (72149) |
$3,456.70 |
$5,318 |
9.5× |
| MRI lumbar w/wo contrast (72158) |
$5,649.15 |
$8,691 |
15.5× |
| MRI lwr ext w/o jnts with con rt (73719) |
$3,129.75 |
$4,815 |
8.6× |
| MRI orbit/face/neck w/contrast (70542) |
$2,650.05 |
$4,077 |
7.3× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$2,755.35 |
$4,239 |
7.6× |
| MRI orbit/face/neck w/o contrast (70540) |
$2,440.10 |
$3,754 |
9.8× |
| MRI pelvis w/ contrast (72196) |
$3,116.10 |
$4,794 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,724.15 |
$4,191 |
10.9× |
| MRI pelvis w/wo contrast (72197) |
$3,463.20 |
$5,328 |
9.5× |
| MRI spectroscopy (76390) |
$609.70 |
$938 |
6.7× |
| MRI spine cervical wo/w contrast (72156) |
$5,422.30 |
$8,342 |
14.9× |
| MRI spine thoracic w/contrast (72147) |
$3,456.70 |
$5,318 |
9.5× |
| MRI thoracic spine w wo contrast (72157) |
$5,422.30 |
$8,342 |
14.9× |
| MRI thoracic spine w/o contrast (72146) |
$3,151.20 |
$4,848 |
12.6× |
| MRI tmj (70336) |
$1,471.60 |
$2,264 |
5.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,678 |
— |
10.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$3,260.40 |
$5,016 |
8.9× |
| Myelogram thoracic (72255) |
$1,752.40 |
$2,696 |
2.1× |
| Myelography 2 or more regions (72270) |
$8,898.79 |
— |
10.9× |
| Myelography lumbosacral (72265) |
$1,550.25 |
$2,385 |
1.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,250 |
$5,000 |
2.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,380 |
$5,200 |
2.3× |
| Myocardial perfusion planar multiple studies (78454) |
$2,392 |
$3,680 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,366 |
$3,640 |
1.8× |
| Myocrd img PET metab eval single study (78459) |
$3,185 |
$4,900 |
2.4× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$3,250 |
$5,000 |
2.2× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$6,101.55 |
$9,387 |
2.7× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,286.70 |
$3,518 |
2.5× |
| Nm bone 3 phase (78315) |
$2,144.74 |
— |
5.1× |
| Nm bone imaging whole body (78306) |
$1,863.55 |
$2,867 |
4.5× |
| Nm bone marrow scan limited (78102) |
$988 |
$1,520 |
2.4× |
| Nm bone multi (78305) |
$1,079 |
$1,660 |
2.6× |
| Nm heart perfusion spect stress rest (78452) |
$3,809 |
$5,860 |
2.8× |
| Nm lymph system (78195) |
$42,935.65 |
— |
75.7× |
| Nm myocard infarct spect (78469) |
$2,340 |
$3,600 |
4.1× |
| Nm thyroid imaging only (78013) |
$1,059.50 |
$1,630 |
2.5× |
| Nose to rectum for fb child (76010) |
$477.10 |
$734 |
5.2× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$766.35 |
$1,179 |
1.8× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$963.30 |
$1,482 |
2.3× |
| Ob us < 14 wks single fetus (76801) |
$746.85 |
$1,149 |
6.8× |
| Oral radiopharm rx (79005) |
$1,170 |
$1,800 |
4.8× |
| Parathyrd planar w/spect&CT (78072) |
$2,275 |
$3,500 |
4.0× |
| Parathyroid imaging (78070) |
$1,267.50 |
$1,950 |
3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,300 |
$2,000 |
3.1× |
| Peritoneal-venous shunt patency test (78291) |
$1,131 |
$1,740 |
2.7× |
| Peritoneogram rs&i (74190) |
$1,795.95 |
$2,763 |
3.1× |
| PET brain metabolic eval (78608) |
$4,967.95 |
$7,643 |
3.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,597.95 |
— |
5.1× |
| PET imaging CT for attenuation limited area (78814) |
$4,312.10 |
$6,634 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$5,792.15 |
$8,911 |
3.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,332.50 |
$2,050 |
0.4× |
| Pulmonary perfusion imaging particulate (78580) |
$1,105 |
$1,700 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$774.15 |
$1,191 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$234 |
$360 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$720.85 |
$1,109 |
6.6× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$747.50 |
$1,150 |
6.8× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$780 |
$1,200 |
7.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$55,462.70 |
— |
610.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$488.48 |
— |
5.4× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$235.30 |
$362 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$219.70 |
$338 |
2.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$366.60 |
$564 |
3.4× |
| Radex spine cervical 2 or 3 views (72040) |
$1,218.75 |
— |
13.4× |
| Radex spine cervical 4 or 5 views (72050) |
$662.35 |
$1,019 |
6.1× |
| Radex spine cervical 6 or more views (72052) |
$686.40 |
$1,056 |
6.3× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$344.50 |
$530 |
3.8× |
| Radiation tx delivery lvl 1 (77402) |
$230.10 |
$354 |
2.2× |
| Radiation tx delivery lvl 2 (77407) |
$871 |
$1,340 |
2.2× |
| Radiation tx delivery lvl 3 (77412) |
$1,247.35 |
$1,919 |
2.2× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$370.50 |
$570 |
3.4× |
| Radiologic exam esophagus double contrast study (74221) |
$472.94 |
— |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$824.85 |
$1,269 |
4.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$771.55 |
$1,187 |
4.2× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$131.95 |
$203 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$447.52 |
— |
4.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$655.20 |
$1,008 |
6.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$744.90 |
$1,146 |
6.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$752.70 |
$1,158 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,066 |
$1,640 |
2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,641.25 |
$2,525 |
3.9× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,815.50 |
$5,870 |
6.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,353 |
$3,620 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,699.10 |
$2,614 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,187.25 |
$3,365 |
1.6× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$2,828.80 |
$4,352 |
1.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,809.60 |
$2,784 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$499.20 |
$768 |
2.0× |
| Saline infused sonohysterogram (76831) |
$830.05 |
$1,277 |
3.3× |
| Salivary gland funct study (78232) |
$963.30 |
$1,482 |
2.3× |
| Salivary gland imaging (78230) |
$1,001 |
$1,540 |
2.4× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$649.35 |
— |
27.8× |
| Selective spinal angiogram (75705) |
$8,992.10 |
$13,834 |
1.5× |
| Shoulder arthrogram (73040) |
$1,049.75 |
$1,615 |
2.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$501.15 |
$771 |
4.6× |
| Simulation complex (77290) |
$1,953.90 |
$3,006 |
5.0× |
| Simulation simple (77280) |
$986.05 |
$1,517 |
7.0× |
| Small bowel series (74250) |
$965.25 |
$1,485 |
5.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,259.05 |
$1,937 |
3.2× |
| Special dosimetry (77331) |
$331.50 |
$510 |
2.4× |
| Special physics consult (77370) |
$979.55 |
$1,507 |
7.0× |
| Special treatment procedure (77470) |
$2,795 |
$4,300 |
4.8× |
| Stereotactic body radiation delivery (77373) |
$10,908.30 |
$16,782 |
5.8× |
| Superior sagittal sinus venogram (75870) |
$3,494.40 |
$5,376 |
1.1× |
| Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction 2nd-5th Sessions (77438) |
$230.10 |
$354 |
2.2× |
| Surface radiation therapy; superficial, delivery, </=150 kV, per fraction (eg, electronic brachytherapy) 2nd-5th… (77437) |
$230.10 |
$354 |
2.2× |
| Therapeutic enema barium or air (74283) |
$555.75 |
$855 |
3.0× |
| Thyroid met imaging body (78018) |
$2,076.75 |
$3,195 |
3.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$503.10 |
$774 |
1.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,537.25 |
$2,365 |
3.7× |
| Treatment devices complex (77334) |
$1,252.55 |
$1,927 |
3.2× |
| Treatment devices simple (77332) |
$786.50 |
$1,210 |
5.6× |
| Ultrasound breast limited (76642) |
$388.70 |
$598 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$291.85 |
— |
2.7× |
| Umbilical-artery Doppler (OB) (76820) |
$195 |
$300 |
1.8× |
| Unlisted diagnostic radiographic procedure (76499) |
$206.70 |
$318 |
2.3× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$29.90 |
$46 |
2.7× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$237.90 |
$366 |
2.5× |
| Ureteral reflux study (78740) |
$58.50 |
$90 |
0.1× |
| Urethrocystography retrograde rs&i (74450) |
$1,354.60 |
$2,084 |
5.4× |
| Urethrocystography voiding (74455) |
$1,032.85 |
$1,589 |
4.1× |
| Urography antegrade (74425) |
$1,235 |
$1,900 |
3.4× |
| Urography retrograde w/wo kub (74420) |
$17,114.84 |
— |
47.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$404.95 |
$623 |
3.7× |
| Us breast uni real time with image complete (76641) |
$452.40 |
$696 |
4.1× |
| Us chest (76604) |
$798.85 |
$1,229 |
7.3× |
| Us compl joint r-t w/image documentation (76881) |
$718.90 |
$1,106 |
6.6× |
| Us encephalogram (76506) |
$877.50 |
$1,350 |
8.0× |
| Us guided compression repair (76936) |
$1,182.35 |
$1,819 |
5.2× |
| Us kidney transplanted (76776) |
$651.30 |
$1,002 |
6.0× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$646.42 |
— |
5.9× |
| Us ob detailed single fetus (76811) |
$822.90 |
$1,266 |
3.3× |
| Us ob followup per fetus (76816) |
$507 |
$780 |
4.6× |
| Us ob limited 1 or more fetuses (76815) |
$472.55 |
$727 |
4.3× |
| Us obstetric transvaginal (76817) |
$703.95 |
$1,083 |
6.4× |
| Us pelvic limited or f/u non-ob (76857) |
$536.90 |
$826 |
4.9× |
| Us pelvis complete (76856) |
$1,473.55 |
— |
13.5× |
| Us retroperitoneal complete (76770) |
$1,119.30 |
$1,722 |
10.3× |
| Us retroperitoneal limited (76775) |
$952.90 |
— |
8.7× |
| Us scrotum (76870) |
$890.50 |
$1,370 |
8.2× |
| Us soft tissue head/neck (76536) |
$851.50 |
$1,310 |
7.8× |
| Us spinal canal (76800) |
$612.95 |
$943 |
5.6× |
| Us transrectal (76872) |
$422.50 |
$650 |
3.9× |
| Us unlstd proc (76999) |
$507 |
$780 |
5.6× |
| Vascular flow imaging (78445) |
$1,014 |
$1,560 |
2.4× |
| Venogram extremity bilateral (75822) |
$3,493.75 |
$5,375 |
2.1× |
| Venogram ivc w serialography (75825) |
$3,529.50 |
$5,430 |
1.1× |
| Venogram svc w serialography (75827) |
$3,512.60 |
$5,404 |
2.1× |
| Venography ext unilateral (75820) |
$2,328.95 |
$3,583 |
1.4× |
| Venography renal unilateral selective rs&i (75831) |
$3,547.05 |
$5,457 |
1.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,564.60 |
$5,484 |
1.1× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$772.20 |
$1,188 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$167.70 |
$258 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$316.55 |
$487 |
3.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$447.52 |
— |
4.9× |
| X-ray aorta leg arteries (75630) |
$7,037.55 |
$10,827 |
2.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,354.60 |
$2,084 |
7.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$529.75 |
— |
5.8× |
| X-ray exam hips bi 3-4 views (73522) |
$235.30 |
$362 |
2.2× |
| X-ray exam of finger(s) (73140) |
$434.85 |
— |
4.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$94.90 |
$146 |
1.0× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$443.95 |
$683 |
4.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$447.52 |
— |
4.9× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$1,326.65 |
— |
12.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$988.98 |
— |
10.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$443.95 |
$683 |
4.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$111.80 |
$172 |
1.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$447.52 |
— |
4.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$524.88 |
— |
4.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$426.40 |
$656 |
4.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,042.60 |
— |
9.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$828.75 |
$1,275 |
7.6× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$223.60 |
$344 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$333.45 |
$513 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$817.05 |
$1,257 |
7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$369.85 |
$569 |
3.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$252.85 |
$389 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$540.80 |
$832 |
6.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$828.75 |
— |
9.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$234 |
$360 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$307.45 |
$473 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$278.20 |
— |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$249.60 |
$384 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$443.30 |
$682 |
4.9× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$445.90 |
$686 |
4.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$507.98 |
— |
5.6× |
| Xr abdomen 1 view (74018) |
$456.95 |
$703 |
5.0× |
| Xr abdomen 2 views (74019) |
$412.75 |
$635 |
3.8× |
| Xr abdomen 3 views (74021) |
$646.10 |
$994 |
5.9× |
| Xr arthrogram ankle (73615) |
$1,186.25 |
$1,825 |
3.3× |
| Xr arthrogram elbow (73085) |
$1,101.10 |
$1,694 |
3.0× |
| Xr arthrogram hip (73525) |
$1,174.55 |
$1,807 |
3.2× |
| Xr bone density appendicular (77081) |
$131.30 |
$202 |
1.4× |
| Xr bone density axial (77080) |
$835.90 |
$1,286 |
7.7× |
| Xr bone length study (77073) |
$293.80 |
$452 |
2.7× |
| Xr bone survey infant (77076) |
$542.75 |
$835 |
5.0× |
| Xr bone survey limited (77074) |
$536.25 |
$825 |
4.9× |
| Xr chest 1 view (71045) |
$4,996.65 |
— |
55.0× |
| Xr chest 2 views (71046) |
$359.45 |
— |
4.0× |
| Xr chest 3 views (71047) |
$365.30 |
$562 |
4.0× |
| Xr cystogram 3+ views (74430) |
$1,272.05 |
$1,957 |
3.5× |
| Xr eye foreign body (70030) |
$195.65 |
$301 |
2.2× |
| Xr facial bones 3 views (70150) |
$196.95 |
$303 |
1.8× |
| Xr joint survey 1 view (77077) |
$414.70 |
$638 |
3.8× |
| Xr lower extremity 2 views infant (73592) |
$165.10 |
$254 |
1.8× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$597.35 |
$919 |
5.5× |
| Xr mandible 4 views (70110) |
$222.30 |
$342 |
2.0× |
| Xr myelogram c-spine (72240) |
$1,752.40 |
$2,696 |
2.1× |
| Xr nasal bones (70160) |
$113.10 |
$174 |
1.2× |
| Xr pelvis 3 views (72190) |
$1,337.70 |
— |
12.3× |
| Xr spine 1 view (72020) |
$340.60 |
$524 |
3.7× |
| Xr sternum 2 views (71120) |
$487.50 |
$750 |
5.4× |
| Xr surgical specimen (76098) |
$26,195.62 |
— |
45.9× |
| Xr upper extremity 2 views infant (73092) |
$351 |
$540 |
3.2× |
| Xray elbow 2 views (73070) |
$453.05 |
$697 |
5.0× |
| Xray forearm 2 views (73090) |
$797.55 |
— |
8.8× |
| Xray knee 1 or 2 views rt (73560) |
$22,596.91 |
— |
248.6× |
| Xray neck soft tissue (70360) |
$278.20 |
$428 |
3.1× |
| Xray orbits complete min 4 views (70200) |
$278.20 |
$428 |
2.5× |
| Xray pelvis 1 or 2 views (72170) |
$694.20 |
— |
6.4× |
| Xray ribs bilateral 3 views (71110) |
$499.85 |
$769 |
4.6× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$536.90 |
$826 |
4.9× |
| Xray scapula complete (73010) |
$436.15 |
$671 |
4.0× |
| Xray shoulder 1 view (73020) |
$58,481.40 |
— |
643.5× |
| Xray sinuses paranasal <3 views (70210) |
$111.80 |
$172 |
1.2× |
| Xray spine thoracic 2 views (72070) |
$732.55 |
$1,127 |
6.7× |
| Xray spine thoracic 3 views (72072) |
$735.80 |
$1,132 |
6.7× |
| Xray tibia-fibula 2 views bil (73590) |
$570.70 |
— |
6.3× |
| Xray tmj open - closed unilat (70328) |
$343.20 |
$528 |
3.8× |
| Xray tmj's bilateral open-clsc (70330) |
$514.80 |
$792 |
5.7× |