| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,461.80 |
$12,748 |
3.0× |
| Abdomen 1 View (74018) |
$289.10 |
$826 |
3.1× |
| Abdomen 2 views (74019) |
$302.40 |
$864 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$998.90 |
$2,854 |
2.3× |
| Adrenal Cortex & Medulla Img (78075) |
$943.95 |
$2,697 |
0.7× |
| Angio internal mammary (75756) |
$1,613.15 |
$4,609 |
0.5× |
| Angio pulmonary bilat (75743) |
$3,548.65 |
$10,139 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,739.40 |
$10,684 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,596.95 |
$10,277 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$2,446.85 |
$6,991 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,604 |
$7,440 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,442 |
$4,120 |
0.4× |
| Ankle 2 views (73600) |
$226.80 |
$648 |
2.4× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,582.30 |
$7,378 |
0.4× |
| Artery X-Rays Abdomen (75726) |
$3,184.65 |
$9,099 |
0.5× |
| Artery X-Rays Adrenal Gland (75731) |
$3,479.35 |
$9,941 |
1.0× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,874.90 |
$8,214 |
0.5× |
| Artery X-Rays Spine (75705) |
$3,184.65 |
$9,099 |
0.5× |
| Arthrogram ankle (73615) |
$523.60 |
$1,496 |
1.4× |
| Arthrogram hip (73525) |
$759.85 |
$2,171 |
2.0× |
| Arthrogram Wrist (73115) |
$669.90 |
$1,914 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$500.85 |
$1,431 |
3.5× |
| Bone age studies (77072) |
$145.25 |
$415 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,421.35 |
$4,061 |
3.3× |
| Bone Imaging Limited Area (78300) |
$667.80 |
$1,908 |
1.6× |
| Bone Imaging Multiple Areas (78305) |
$934.15 |
$2,669 |
2.2× |
| Bone Imaging Whole Body (78306) |
$1,191.40 |
$3,404 |
2.8× |
| Bone marrow imaging limited area (78102) |
$1,354.50 |
$3,870 |
3.2× |
| Bone survey infant (77076) |
$776.30 |
$2,218 |
7.0× |
| Brachytx isodose complex (77318) |
$2,068.15 |
$5,909 |
5.2× |
| Brachytx isodose intermed (77317) |
$1,412.95 |
$4,037 |
3.5× |
| Brachytx Isodose Plan Simple (77316) |
$1,155.70 |
$3,302 |
2.9× |
| Brain Flow Imaging Only (78610) |
$808.85 |
$2,311 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$976.15 |
$2,789 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,176.60 |
$9,076 |
2.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,079.35 |
$5,941 |
4.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,738.45 |
$4,967 |
4.7× |
| Cardiac Shunt Detection (78428) |
$1,107.05 |
$3,163 |
2.6× |
| Cardiovasc nucl exam unlisted (78499) |
$419.04 |
$1,197.24 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$633.85 |
$1,811 |
6.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,398.95 |
$3,997 |
2.4× |
| Cerebrospinal Fluid Scan (78630) |
$1,461.95 |
$4,177 |
2.5× |
| Chest 1 view (71045) |
$244.65 |
$699 |
2.6× |
| Chest 2 views (71046) |
$255.85 |
$731 |
2.8× |
| Chest 3 views (71047) |
$267.05 |
$763 |
2.9× |
| Chest 4 or more views (71048) |
$285.60 |
$816 |
2.6× |
| Clavicle complete (73000) |
$225.05 |
$643 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,196.30 |
$3,418 |
10.7× |
| Continuing medical physics consltj pr wk (77336) |
$629.65 |
$1,799 |
4.4× |
| Contrast Exam Abdominl Aorta (75625) |
$3,336.90 |
$9,534 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$668.15 |
$1,909 |
1.8× |
| Contrast X-Ray Of Elbow (73085) |
$805.70 |
$2,302 |
2.2× |
| Contrast X-Ray Of Knee Joint (73580) |
$839.30 |
$2,398 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,155.15 |
$14,729 |
13.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,890.25 |
$11,115 |
15.3× |
| CT abdomen w contrast (74160) |
$2,619.75 |
$7,485 |
14.0× |
| CT abdomen w wo contrast (74170) |
$2,844.80 |
$8,128 |
15.2× |
| CT abdomen w/o contrast (74150) |
$1,822.10 |
$5,206 |
16.3× |
| CT Angio Abdomen and Pelvis (74174) |
$5,412.75 |
$15,465 |
14.5× |
| CT Angio Chest (71275) |
$2,697.10 |
$7,706 |
14.4× |
| CT Angio Head (70496) |
$2,710.40 |
$7,744 |
14.5× |
| CT angio hrt w/3d image (75574) |
$1,109.15 |
$3,169 |
3.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,485.35 |
$7,101 |
13.3× |
| CT Angio Neck (70498) |
$2,353.05 |
$6,723 |
12.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,681.40 |
$4,804 |
9.0× |
| CT cervical spine w/ contrast (72126) |
$2,235.80 |
$6,388 |
6.0× |
| CT cervical spine w/o contrast (72125) |
$1,996.05 |
$5,703 |
17.9× |
| CT cervical spine w/wo cont (72127) |
$2,441.25 |
$6,975 |
13.0× |
| CT chest w contrast (71260) |
$1,470.70 |
$4,202 |
7.9× |
| CT chest w/wo contrast (71270) |
$1,886.15 |
$5,389 |
10.1× |
| CT head/brain with contrast (70460) |
$2,065.35 |
$5,901 |
11.0× |
| CT head/brain without and with contrast (70470) |
$2,359.35 |
$6,741 |
12.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$626.85 |
$1,791 |
1.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$212.10 |
$606 |
2.3× |
| CT hrt w/3d image congen (75573) |
$694.05 |
$1,983 |
1.9× |
| CT iac w contrast (70481) |
$1,732.50 |
$4,950 |
9.3× |
| CT l-spine w&w/o contrast (72133) |
$2,114.35 |
$6,041 |
11.3× |
| CT lower ext w/o (73700) |
$947.45 |
$2,707 |
8.5× |
| CT lower extremity w/contrast material (73701) |
$1,192.45 |
$3,407 |
6.4× |
| CT lumbar spine w contrast (72132) |
$1,770.30 |
$5,058 |
4.8× |
| CT lumbar spine w/o contrast (72131) |
$1,307.25 |
$3,735 |
11.7× |
| CT maxillofacial w contrast (70487) |
$1,536.15 |
$4,389 |
8.2× |
| CT maxillofacial wo contrast (70486) |
$1,359.40 |
$3,884 |
12.2× |
| CT neck tissue combo (70492) |
$1,524.95 |
$4,357 |
8.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,047.85 |
$5,851 |
10.9× |
| CT orbits w/o contrast (70480) |
$1,330.35 |
$3,801 |
11.9× |
| CT pelvis w&w/o contrast (72194) |
$1,872.15 |
$5,349 |
10.0× |
| CT pelvis w/o contrast (72192) |
$1,139.25 |
$3,255 |
10.2× |
| CT scan of leg combo (73702) |
$1,469.65 |
$4,199 |
7.9× |
| CT scans face/jaw combo (70488) |
$1,930.60 |
$5,516 |
10.3× |
| CT soft tissue neck w contrast (70491) |
$1,075.20 |
$3,072 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$668.85 |
$1,911 |
6.0× |
| CT thoracic spine w contrast (72129) |
$2,087.40 |
$5,964 |
11.2× |
| CT thoracic spine w/o contrast (72128) |
$1,930.60 |
$5,516 |
17.3× |
| CT thoracic spine w/wo cont (72130) |
$2,325.75 |
$6,645 |
12.4× |
| CT thorax w/o contrast (71250) |
$1,254.05 |
$3,583 |
11.2× |
| CT unlisted procedure (76497) |
$628.04 |
$1,794.40 |
6.8× |
| CT upper ext wo (73200) |
$1,001.70 |
$2,862 |
9.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,281.70 |
$3,662 |
6.9× |
| CT upper extremity with contrast (73201) |
$1,129.80 |
$3,228 |
3.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,600.15 |
$7,429 |
13.9× |
| Cta Abdomen (74175) |
$2,986.90 |
$8,534 |
16.0× |
| CTA pelvis (72191) |
$1,965.60 |
$5,616 |
10.5× |
| Dilation ureters/urethra rs&i (74485) |
$1,885.80 |
$5,388 |
0.8× |
| Discography Cerv/Thor Spine (72285) |
$3,371.55 |
$9,633 |
1.6× |
| Diskography lumbar (72295) |
$2,863 |
$8,180 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$121.10 |
$346 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$139.65 |
$399 |
1.3× |
| Dxa Bone Density Axial (77080) |
$329.35 |
$941 |
3.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$137.20 |
$392 |
1.5× |
| Echo exam uterus (76831) |
$390.95 |
$1,117 |
1.5× |
| Echo Guide For Artery Repair (76936) |
$1,001.70 |
$2,862 |
4.3× |
| Echograp Trans R Pros Study (76873) |
$312.55 |
$893 |
2.8× |
| Esophageal Motility Study (78258) |
$982.80 |
$2,808 |
2.3× |
| Esophagram (74220) |
$525 |
$1,500 |
2.8× |
| Fetal Biophys Profile W/Nst (76818) |
$327.95 |
$937 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$207.90 |
$594 |
1.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,300.25 |
$3,715 |
5.1× |
| Fluoroscopy up to 1 hr (76000) |
$565.95 |
$1,617 |
2.2× |
| Follow-Up Angiography (75898) |
$1,357.65 |
$3,879 |
0.4× |
| Foot 2 views (73620) |
$242.20 |
$692 |
2.6× |
| Forearm 2 views (73090) |
$256.55 |
$733 |
2.8× |
| Gastric emptying imaging study (78264) |
$1,631 |
$4,660 |
3.8× |
| Gastroesophageal Reflux Exam (78262) |
$872.90 |
$2,494 |
2.0× |
| Gated Heart Planar Single (78472) |
$1,264.20 |
$3,612 |
3.0× |
| Hand 2 views (73120) |
$212.10 |
$606 |
1.9× |
| Heart Image (Pet) Multiple (78492) |
$4,907.70 |
$14,022 |
3.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,333.10 |
$6,666 |
0.7× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$1,840.65 |
$5,259 |
0.5× |
| Hepatobil Syst Image W/Drug (78227) |
$2,101.75 |
$6,005 |
3.6× |
| Hepatobiliary System Imaging (78226) |
$1,890.35 |
$5,401 |
4.4× |
| Ht Muscle Image Spect Sing (78451) |
$2,964.85 |
$8,471 |
2.1× |
| Hysterosalpingogram (74740) |
$619.50 |
$1,770 |
2.4× |
| Image fusion (77399) |
$359.46 |
$1,027.01 |
2.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$396.90 |
$1,134 |
4.3× |
| Infant hip ultrasound, limited static exam (76886) |
$264.60 |
$756 |
2.9× |
| Interstitial radiation source applic complex (77778) |
$2,772.70 |
$7,922 |
3.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,318.10 |
$3,766 |
1.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$955.85 |
$2,731 |
1.6× |
| Intracavitary radiation source applic simple (77761) |
$645.05 |
$1,843 |
1.1× |
| K Flow/Funct Image Multiple (78709) |
$1,841.70 |
$5,262 |
3.2× |
| K Flow/Funct Image W/Drug (78708) |
$1,813.35 |
$5,181 |
3.1× |
| K Flow/Funct Image W/O Drug (78707) |
$1,824.90 |
$5,214 |
3.2× |
| Kidney Imaging Morphol (78700) |
$987 |
$2,820 |
2.3× |
| Knee 3 Views (73562) |
$385.35 |
$1,101 |
4.2× |
| Liver & Spleen Imaging Static Only (78215) |
$833.35 |
$2,381 |
2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$638.75 |
$1,825 |
1.5× |
| Liver imaging static only (78201) |
$756.35 |
$2,161 |
1.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,136.80 |
$3,248 |
2.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,307.60 |
$3,736 |
2.3× |
| Lung Ventilation Imaging (78579) |
$627.20 |
$1,792 |
1.5× |
| Lymph System Imaging (78195) |
$1,394.05 |
$3,983 |
2.4× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$588.35 |
$1,681 |
0.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,131.45 |
$8,947 |
0.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,982.35 |
$8,521 |
0.9× |
| Magnetic Image Jaw Joint (70336) |
$2,003.40 |
$5,724 |
7.9× |
| Mammary ductogram or galactogram multiple (77054) |
$801.85 |
$2,291 |
3.2× |
| Mammary ductogram or galactogram single (77053) |
$530.95 |
$1,517 |
2.1× |
| Meckels Divert Exam (78290) |
$617.75 |
$1,765 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,135.05 |
$3,243 |
2.8× |
| Mr safety determination physician/other qhp (76016) |
$101.15 |
$289 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$25.90 |
$74 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$111.30 |
$318 |
1.1× |
| Mr safety implt pos&/immoblj (76019) |
$72.45 |
$207 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$293.30 |
$838 |
1.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,470.25 |
$9,915 |
9.3× |
| MRA head w/o contrast (70544) |
$2,312.45 |
$6,607 |
9.1× |
| MRA head with contrast (70545) |
$2,487.80 |
$7,108 |
6.7× |
| MRA neck w contrast (70548) |
$1,707.65 |
$4,879 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,922.55 |
$5,493 |
5.2× |
| MRA neck w/o contrast (70547) |
$1,389.15 |
$3,969 |
5.5× |
| MRI abdomen w contrast (74182) |
$2,518.25 |
$7,195 |
6.8× |
| MRI abdomen w/o contrast (74181) |
$2,300.55 |
$6,573 |
9.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,532.25 |
$7,235 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,210.20 |
$9,172 |
8.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,291.45 |
$6,547 |
2.7× |
| MRI bone marrow blood supply (77084) |
$1,318.10 |
$3,766 |
5.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$633.50 |
$1,810 |
2.5× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$616 |
$1,760 |
2.4× |
| MRI cardiac w/o contrast (75557) |
$1,374.45 |
$3,927 |
5.4× |
| MRI cervical spine w contrast (72142) |
$2,608.55 |
$7,453 |
7.0× |
| MRI cervical spine w/o cont (72141) |
$2,319.10 |
$6,626 |
9.1× |
| MRI chest w/o contrast (71550) |
$1,616.30 |
$4,618 |
6.4× |
| MRI chest with contrast (71551) |
$1,773.45 |
$5,067 |
2.1× |
| MRI chest wo w contrast (71552) |
$2,010.05 |
$5,743 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,324.35 |
$6,641 |
6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,455.20 |
$9,872 |
9.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,213.75 |
$6,325 |
8.7× |
| MRI lumbar spine w contrast (72149) |
$2,497.25 |
$7,135 |
6.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,031.35 |
$8,661 |
8.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,415.75 |
$4,045 |
5.6× |
| MRI orbit face neck w contrast (70542) |
$1,557.50 |
$4,450 |
4.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,807.40 |
$5,164 |
4.9× |
| MRI pelvis w contrast (72196) |
$2,708.65 |
$7,739 |
7.3× |
| MRI pelvis w/o & w contrast (72197) |
$3,359.65 |
$9,599 |
9.0× |
| MRI pelvis w/o contrast (72195) |
$2,391.90 |
$6,834 |
9.4× |
| MRI spectroscopy (76390) |
$1,183 |
$3,380 |
12.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,147.25 |
$6,135 |
8.4× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,535.80 |
$4,388 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,436.75 |
$4,105 |
5.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,785.70 |
$5,102 |
4.8× |
| MRI, abdomen, combo (74183) |
$2,954.70 |
$8,442 |
7.9× |
| MRI, dorsal spine combo (72157) |
$3,365.25 |
$9,615 |
9.0× |
| MRI, dorsal spine contrast (72147) |
$2,479.75 |
$7,085 |
6.7× |
| MRI, joint upper extrem (73221) |
$1,981.35 |
$5,661 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$2,768.50 |
$7,910 |
7.4× |
| MRI, lumbar spine combo (72158) |
$2,877 |
$8,220 |
7.7× |
| Musculoskeletal Nuclear Exam (78399) |
$415.16 |
$1,186.17 |
1.0× |
| Myelogram cervical (72240) |
$827.75 |
$2,365 |
1.0× |
| Myelogram Lumbar (72265) |
$831.95 |
$2,377 |
1.0× |
| Myelography thoracic (72255) |
$771.05 |
$2,203 |
0.9× |
| Myelograpy 2/more regions rs&i (72270) |
$1,051.05 |
$3,003 |
1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,653.40 |
$4,724 |
1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,320.85 |
$6,631 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,150.65 |
$11,859 |
3.0× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$3,130.05 |
$8,943 |
2.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,599.40 |
$10,284 |
2.4× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$3,944.50 |
$11,270 |
1.7× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$5,152.70 |
$14,722 |
2.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$4,148.20 |
$11,852 |
2.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,080.10 |
$3,086 |
1.2× |
| Neck soft tissue (70360) |
$257.60 |
$736 |
2.8× |
| Nm csf leak detection (78650) |
$1,491.70 |
$4,262 |
1.1× |
| Nm unlisted gi procedure (78299) |
$413.93 |
$1,182.63 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$572.95 |
$1,637 |
5.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,335.40 |
$15,244 |
3.6× |
| Nuclear medicine study of endocrine organs (78099) |
$477.94 |
$1,365.52 |
1.1× |
| Nuclear Rx Intra-Arterial (79445) |
$505.05 |
$1,443 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$1,354.85 |
$3,871 |
5.4× |
| Ob us nuchal meas 1 gest (76813) |
$297.85 |
$851 |
2.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$186.55 |
$533 |
1.7× |
| Panoramic X-ray of jaws (70355) |
$185.15 |
$529 |
2.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$782.60 |
$2,236 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$1,150.10 |
$3,286 |
2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,257.20 |
$3,592 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$184.45 |
$527 |
1.7× |
| Perineogram (74775) |
$525.70 |
$1,502 |
2.1× |
| Peritoneogram Rs&I (74190) |
$410.90 |
$1,174 |
0.7× |
| Pet Image W/Ct Lmtd (78814) |
$3,064.60 |
$8,756 |
2.0× |
| PET image w/CT, full body (78816) |
$4,066.30 |
$11,618 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,880.45 |
$11,087 |
2.5× |
| Pet Myocardial Sngl Study (78491) |
$2,689.75 |
$7,685 |
1.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,843.45 |
$5,267 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,253 |
$3,580 |
2.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$366.80 |
$1,048 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$610.75 |
$1,745 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$389.55 |
$1,113 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$219.80 |
$628 |
2.4× |
| Radex elbow complete minimum 3 views (73080) |
$380.80 |
$1,088 |
4.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$384.30 |
$1,098 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$233.10 |
$666 |
2.5× |
| Radex foot complete minimum 3 views (73630) |
$384.65 |
$1,099 |
4.1× |
| Radex Hand Minimum 3 Views (73130) |
$377.30 |
$1,078 |
4.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$213.50 |
$610 |
2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$332.15 |
$949 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$213.85 |
$611 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$268.80 |
$768 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$323.40 |
$924 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$142.80 |
$408 |
1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$811.30 |
$2,318 |
4.3× |
| Radex Spine 1 View Specify Level (72020) |
$263.20 |
$752 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$245.70 |
$702 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$350 |
$1,000 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$212.45 |
$607 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$183.75 |
$525 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$382.20 |
$1,092 |
4.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$544.25 |
$1,555 |
4.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,934.60 |
$36,956 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$554.40 |
$1,584 |
5.1× |
| Radiation treatment delivery level 2 (77407) |
$588 |
$1,680 |
1.4× |
| Radiation treatment delivery level 3 (77412) |
$971.25 |
$2,775 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$272.65 |
$779 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$317.45 |
$907 |
2.8× |
| Radiologic exam colon double contrast study (74280) |
$869.40 |
$2,484 |
4.6× |
| Radiologic exam colon single contrast study (74270) |
$716.80 |
$2,048 |
3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$582.05 |
$1,663 |
3.1× |
| Radiologic exam knee complete 4/more views (73564) |
$444.85 |
$1,271 |
4.0× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$371 |
$1,060 |
3.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$533.05 |
$1,523 |
2.8× |
| Radiologic exam swallow function contrast study (74230) |
$459.90 |
$1,314 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$522.55 |
$1,493 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$137.55 |
$393 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$141.05 |
$403 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$277.20 |
$792 |
3.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$504.35 |
$1,441 |
4.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$262.15 |
$749 |
2.8× |
| Ribs bilateral 3 views (71110) |
$396.20 |
$1,132 |
3.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,391.95 |
$3,977 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,556.05 |
$7,303 |
4.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,574.65 |
$4,499 |
2.7× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,907.15 |
$5,449 |
3.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,824.15 |
$8,069 |
2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,883.65 |
$8,239 |
1.9× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,369.85 |
$6,771 |
1.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,065.05 |
$3,043 |
4.3× |
| Rp Therapy Intravenous Administration (79101) |
$1,156.40 |
$3,304 |
4.6× |
| Scapula (73010) |
$253.05 |
$723 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$33.95 |
$97 |
1.5× |
| Shoulder 1 view (73020) |
$140.70 |
$402 |
1.5× |
| Shoulder Arthrography (73040) |
$456.75 |
$1,305 |
1.2× |
| Sialogram (70390) |
$542.50 |
$1,550 |
2.1× |
| Skull less than 4 views (70250) |
$338.45 |
$967 |
3.0× |
| Special dosimetry (77331) |
$418.60 |
$1,196 |
2.9× |
| Special Physics Consult (77370) |
$1,313.90 |
$3,754 |
9.2× |
| Special teletherapy port plan (77321) |
$1,214.15 |
$3,469 |
3.0× |
| Special treatment procedure (77470) |
$2,061.85 |
$5,891 |
3.5× |
| Stereotactic Body Radiation Delivery (77373) |
$13,699 |
$39,140 |
7.2× |
| Sternoclavicular joints (71130) |
$281.75 |
$805 |
3.0× |
| Superior sagittal sinus venogram (75870) |
$1,357.65 |
$3,879 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,754.20 |
$5,012 |
4.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$966 |
$2,760 |
2.4× |
| Testicular Imaging W/Flow (78761) |
$987 |
$2,820 |
2.3× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,892.10 |
$5,406 |
4.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$967.05 |
$2,763 |
2.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$942.20 |
$2,692 |
6.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$662.90 |
$1,894 |
3.5× |
| Thoracic spine 2 views (72070) |
$245.70 |
$702 |
2.2× |
| Thoracic spine 3 views (72072) |
$264.95 |
$757 |
2.4× |
| Thoracolumbar 2 views (72080) |
$302.05 |
$863 |
3.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$703.15 |
$2,009 |
1.6× |
| Thyroid Met Imaging Body (78018) |
$1,884.05 |
$5,383 |
3.3× |
| Thyroid Uptake Measurement (78012) |
$654.15 |
$1,869 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,298.85 |
$3,711 |
3.0× |
| Tx Devices Design & Construction Complex (77334) |
$1,145.90 |
$3,274 |
2.9× |
| Tx devices design & construction intermediate (77333) |
$723.10 |
$2,066 |
5.0× |
| Tx devices design & construction simple (77332) |
$386.40 |
$1,104 |
2.7× |
| Ultrasound Breast Limited (76642) |
$141.05 |
$403 |
1.5× |
| Ultrasound Elastography Parenchyma (76981) |
$138.60 |
$396 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$430.85 |
$1,231 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$549.50 |
$1,570 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$270.55 |
$773 |
2.4× |
| Unlisted Dx Radiographic Procedure (76499) |
$397.17 |
$1,134.75 |
4.3× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine (78199) |
$419.04 |
$1,197.24 |
1.0× |
Unlisted magnetic resonance procedure (76498)
range across 4 matching MRF lines |
$81.20–$531.03 |
$231.98–$1,517.22 |
varies |
Unlisted us procedure (76999)
range across 2 matching MRF lines |
$84.32–$288.11 |
$240.89–$823.17 |
varies |
| Upper gi w/o kub (74240) |
$457.80 |
$1,308 |
2.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$58.45 |
$167 |
5.3× |
| Urea breath test c-14 isotopic analysis (78268) |
$340.55 |
$973 |
3.6× |
| Ureteral Reflux Study (78740) |
$987 |
$2,820 |
2.3× |
| Urethrocystogram voiding (74455) |
$673.40 |
$1,924 |
2.6× |
| Urethrocystography retrograde (74450) |
$772.80 |
$2,208 |
3.0× |
| Us breast unilateral complete (76641) |
$143.15 |
$409 |
1.3× |
| Us chest (76604) |
$459.20 |
$1,312 |
4.1× |
| Us complete joint (76881) |
$290.85 |
$831 |
2.6× |
| Us exam, pelvic, limited (76857) |
$413.35 |
$1,181 |
3.7× |
| Us head (76506) |
$532.35 |
$1,521 |
4.8× |
| Us kidney transplant (76776) |
$743.05 |
$2,123 |
6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$391.65 |
$1,119 |
3.5× |
| Us ob detailed single fetus (76811) |
$623.35 |
$1,781 |
2.4× |
| Us ob limited 1 or more fetuses (76815) |
$391.65 |
$1,119 |
3.5× |
| Us ob transvaginal (76817) |
$472.85 |
$1,351 |
4.2× |
| Us pelvic non ob complete (76856) |
$646.45 |
$1,847 |
5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$510.30 |
$1,458 |
4.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$279.30 |
$798 |
2.5× |
| Us retroperitoneal complete (76770) |
$736.05 |
$2,103 |
6.6× |
| Us retroperitoneal limited (76775) |
$489.30 |
$1,398 |
4.4× |
| Us scrotum and contents (76870) |
$461.30 |
$1,318 |
4.1× |
| Us spinal canal and contents (76800) |
$260.05 |
$743 |
2.3× |
| Us thyroid (76536) |
$461.30 |
$1,318 |
4.1× |
| Vein X-Ray Chest (75827) |
$2,593.85 |
$7,411 |
1.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,512 |
$4,320 |
0.4× |
| Vein X-Ray Spleen/Liver (75810) |
$2,918.65 |
$8,339 |
0.9× |
| Venogram Sinus/Jugular (75860) |
$1,876.70 |
$5,362 |
0.6× |
| Venography Adrenal Unilateral (75840) |
$1,840.65 |
$5,259 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$2,446.85 |
$6,991 |
0.7× |
| Venography extremity bilateral rs&i (75822) |
$1,376.55 |
$3,933 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,314.60 |
$3,756 |
0.8× |
| Venography Renal Bilateral (75833) |
$1,881.60 |
$5,376 |
0.6× |
| Venography Renal Unilateral (75831) |
$1,770.30 |
$5,058 |
0.5× |
| Venous sampling by catheter (75893) |
$3,184.65 |
$9,099 |
0.5× |
| Wrist 2 views (73100) |
$217 |
$620 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$235.90 |
$674 |
2.5× |
| X-ray antegrade pyelogram tube (74425) |
$597.80 |
$1,708 |
1.6× |
| X-Ray Aorta Leg Arteries (75630) |
$3,621.45 |
$10,347 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$319.20 |
$912 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$226.80 |
$648 |
2.4× |
| X-Ray Exam Breast Specimen (76098) |
$954.45 |
$2,727 |
1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$241.50 |
$690 |
2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$449.05 |
$1,283 |
4.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$511.35 |
$1,461 |
4.6× |
| X-Ray Exam Hip Uni 1 View (73501) |
$180.60 |
$516 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$330.40 |
$944 |
3.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$346.85 |
$991 |
3.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$268.45 |
$767 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$333.90 |
$954 |
3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$668.15 |
$1,909 |
6.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$705.25 |
$2,015 |
6.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$331.10 |
$946 |
3.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$786.45 |
$2,247 |
7.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$345.10 |
$986 |
3.1× |
| X-ray eye for foreign body (70030) |
$252.35 |
$721 |
2.7× |
| X-ray humerus (73060) |
$269.15 |
$769 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$691.60 |
$1,976 |
3.7× |
| X-ray IV pyelogram+tomography (74415) |
$747.95 |
$2,137 |
4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$134.40 |
$384 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$250.95 |
$717 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$464.10 |
$1,326 |
4.2× |
| X-ray nose-rectum child f.b. (76010) |
$389.90 |
$1,114 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$488.60 |
$1,396 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$349.65 |
$999 |
3.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$249.55 |
$713 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$271.25 |
$775 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$247.10 |
$706 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$588.35 |
$1,681 |
5.3× |
| X-ray thoracic spine 4 vw (72074) |
$278.25 |
$795 |
2.5× |
| X-Ray Tmj Unilat (70328) |
$200.90 |
$574 |
2.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$391.65 |
$1,119 |
1.1× |
| X-Rays Bone Length Studies (77073) |
$555.80 |
$1,588 |
5.0× |
| X-Rays Bone Survey Complete (77075) |
$942.90 |
$2,694 |
8.5× |
| Xr c-spine 4 or 5 views (72050) |
$465.50 |
$1,330 |
4.2× |
| Xr facial bones less than 3 views (70140) |
$256.20 |
$732 |
2.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$262.50 |
$750 |
2.4× |
| Xr orbits complete 4 views (70200) |
$227.15 |
$649 |
2.0× |
| Xr Tomogram Single Plane (76100) |
$202.65 |
$579 |
1.8× |