| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,430.20 |
$7,151 |
1.0× |
| Abdomen 2 views (74019) |
$199 |
$995 |
1.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$480.20 |
$2,401 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$717.40 |
$3,587 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$902.20 |
$4,511 |
0.3× |
| Angiography extremity unilateral rs&i (75710) |
$777.20 |
$3,886 |
0.2× |
| Angiography internal mammary rs&i (75756) |
$934 |
$4,670 |
0.3× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$617.20 |
$3,086 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,234.20 |
$6,171 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$533.80 |
$2,669 |
0.2× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$860.60 |
$4,303 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$900.60 |
$4,503 |
0.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$353.60 |
$1,768 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$476 |
$2,380 |
0.2× |
| Ankle 2 views (73600) |
$108 |
$540 |
1.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$263.40 |
$1,317 |
0.8× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$883.60 |
$4,418 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,099 |
$5,495 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$839.60 |
$4,198 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$995.40 |
$4,977 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$550.20 |
$2,751 |
0.2× |
| Basic radiation dosimetry calculation (77300) |
$133.60 |
$668 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$329 |
$1,645 |
0.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$397.20 |
$1,986 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$519 |
$2,595 |
1.3× |
| Bone age studies (77072) |
$126.40 |
$632 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$513.40 |
$2,567 |
1.3× |
| Bone Marrow Imaging Limited Area (78102) |
$214 |
$1,070 |
0.5× |
| Bone survey complete (77075) |
$420.20 |
$2,101 |
4.1× |
| Brachytx isodose complex (77318) |
$389.20 |
$1,946 |
1.0× |
| Brachytx isodose intermed (77317) |
$279 |
$1,395 |
0.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$279 |
$1,395 |
0.8× |
| Brain image w/flow 4 + views (78606) |
$459.60 |
$2,298 |
0.9× |
| Brain imaging < 4 static views w vascular flow (78601) |
$426.80 |
$2,134 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,895.40 |
$9,477 |
1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$953.20 |
$4,766 |
2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$215.80 |
$1,079 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$159.40 |
$797 |
1.8× |
| Chest 1 view (71045) |
$90.60 |
$453 |
1.1× |
| Chest 3 views (71047) |
$129.20 |
$646 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$241.40 |
$1,207 |
1.4× |
| Cineradiography/videoradiography (76120) |
$197.40 |
$987 |
1.9× |
| Clavicle complete (73000) |
$97.80 |
$489 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$49.60 |
$248 |
0.5× |
| Continuing medical physics consltj pr wk (77336) |
$139.80 |
$699 |
1.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$135.80 |
$679 |
0.8× |
| Corpora cavernosography (74445) |
$426.20 |
$2,131 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,465.40 |
$7,327 |
4.2× |
| CT abdomen and pelvis without contrast (74176) |
$885.40 |
$4,427 |
3.7× |
| CT abdomen w contrast (74160) |
$859.40 |
$4,297 |
4.9× |
| CT abdomen w wo contrast (74170) |
$1,070.40 |
$5,352 |
6.2× |
| CT abdomen w/o contrast (74150) |
$690.60 |
$3,453 |
6.7× |
| CT angio hrt w/3d image (75574) |
$680.70 |
$3,403.50 |
2.0× |
| CT angiography upper extremity lt (73206) |
$926 |
$4,630 |
5.3× |
| CT c-spine w/o contrast (72125) |
$833.40 |
$4,167 |
8.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,072.20 |
$5,361 |
6.2× |
| CT cervical spine with contrast (72126) |
$908.40 |
$4,542 |
2.6× |
| CT chest w/wo contrast (71270) |
$837.20 |
$4,186 |
4.8× |
| CT chest with contrast (71260) |
$758 |
$3,790 |
4.4× |
| CT head/brain with contrast (70460) |
$677.80 |
$3,389 |
3.9× |
| CT head/brain without and with contrast (70470) |
$895.40 |
$4,477 |
5.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$696.60 |
$3,483 |
2.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$335.10 |
$1,675.50 |
3.9× |
| CT hrt w/3d image congen (75573) |
$733.60 |
$3,668 |
2.1× |
| CT iac w contrast (70481) |
$681 |
$3,405 |
3.9× |
| CT limited/localized follow up study (76380) |
$316.80 |
$1,584 |
3.7× |
| CT lower ext w/o (73700) |
$561.20 |
$2,806 |
5.4× |
| CT lower extremity w wo contrast (73702) |
$652 |
$3,260 |
3.7× |
| CT lower extremity with contrast (73701) |
$625 |
$3,125 |
3.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,038.60 |
$5,193 |
6.0× |
| CT lumbar spine w/o contrast (72131) |
$895.20 |
$4,476 |
8.6× |
| CT lumbar spine with contrast (72132) |
$963 |
$4,815 |
2.8× |
| CT maxillofacial w contrast (70487) |
$717.40 |
$3,587 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$681.60 |
$3,408 |
6.6× |
| CT maxillofacial w/wo contrast (70488) |
$910 |
$4,550 |
5.2× |
| CT neck soft tissue w contrast (70491) |
$693 |
$3,465 |
4.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$884.40 |
$4,422 |
5.1× |
| CT orbits w/o contrast (70480) |
$669 |
$3,345 |
6.5× |
| CT pelvis w & w/o contrast (72194) |
$1,128.40 |
$5,642 |
6.5× |
| CT pelvis w/o contrast (72192) |
$637 |
$3,185 |
6.1× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$126.80 |
$634 |
1.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$901.40 |
$4,507 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$582.40 |
$2,912 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$806.80 |
$4,034 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$684 |
$3,420 |
6.6× |
| CT thoracic spine w/wo contrast (72130) |
$964 |
$4,820 |
5.5× |
| CT thorax w/o contrast (71250) |
$582.40 |
$2,912 |
5.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$919.40 |
$4,597 |
5.3× |
| CT upper extremity w/o contrast rt (73200) |
$660.80 |
$3,304 |
6.4× |
| CT upper extremity with contrast (73201) |
$727.60 |
$3,638 |
2.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,070.40 |
$5,352 |
6.2× |
| Cta Abdomen (74175) |
$891.40 |
$4,457 |
5.1× |
| CTA abdomen pelvis (74174) |
$1,226.60 |
$6,133 |
3.5× |
| CTA chest (71275) |
$908.40 |
$4,542 |
5.2× |
| Cta Head (70496) |
$1,066 |
$5,330 |
6.1× |
| CTA lwr ext w&w/o contrast (73706) |
$926 |
$4,630 |
5.3× |
| Cta Neck (70498) |
$926 |
$4,630 |
5.3× |
| Cta Pelvis (72191) |
$852.60 |
$4,263 |
4.9× |
| Cystography minimum 3 views rs&i (74430) |
$189.40 |
$947 |
0.5× |
| Diskography lumbar (72295) |
$389.40 |
$1,947 |
0.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$146.80 |
$734 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$85.60 |
$428 |
0.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$112.40 |
$562 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$119.60 |
$598 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$105.20 |
$526 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$108.60 |
$543 |
1.0× |
| Echo exam of fetal heart (76825) |
$217.60 |
$1,088 |
0.4× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$93 |
$465 |
0.4× |
| Echoencephalography real time imaging (76506) |
$237.80 |
$1,189 |
2.3× |
| Esophagus (74220) |
$209.60 |
$1,048 |
1.2× |
| Fetal biophysical profile non-stress testing (76818) |
$187 |
$935 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$217.80 |
$1,089 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$283.80 |
$1,419 |
1.2× |
| Foot 2 views (73620) |
$86.10 |
$430.50 |
1.0× |
| Forearm 2 views (73090) |
$94.80 |
$474 |
1.1× |
| Functional MRI brain by phys/psych (70555) |
$1,084.20 |
$5,421 |
4.6× |
| Functional MRI brain by tech (70554) |
$1,056.20 |
$5,281 |
4.5× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$740 |
$3,700 |
1.4× |
| Gated Heart Planar Single (78472) |
$448 |
$2,240 |
1.1× |
| Hand 2 views (73120) |
$105.60 |
$528 |
1.0× |
| Hand 3 views (73130) |
$114.40 |
$572 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$947.20 |
$4,736 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,852.40 |
$9,262 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,852.40 |
$9,262 |
2.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$237.60 |
$1,188 |
0.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$647.40 |
$3,237 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$522.20 |
$2,611 |
1.3× |
| Ht muscle image spect sing (78451) |
$1,335.60 |
$6,678 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$85.90 |
$429.50 |
1.0× |
| Hysterosalpingogram (74740) |
$246.80 |
$1,234 |
1.0× |
| Image fusion (77399) |
$93 |
$465 |
0.7× |
| Interstitial radiation source applic complex (77778) |
$491.60 |
$2,458 |
0.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,083.80 |
$5,419 |
1.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,103.20 |
$5,516 |
2.0× |
| Intracavitary radiation source applic simple (77761) |
$482.80 |
$2,414 |
0.9× |
Intraop radiaj tx deliver xray single tx session (77424)
likely a partial charge, not the full procedure |
$119.40 |
$597 |
0.0× |
Io rad tx deliver by elctrns (77425)
likely a partial charge, not the full procedure |
$196.20 |
$981 |
0.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$105.20 |
$526 |
1.0× |
| Kidney funcj study non-img radioisotopic study (78725) |
$246.80 |
$1,234 |
0.6× |
| Kidney imaging morphology (78700) |
$327 |
$1,635 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$470 |
$2,350 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$386 |
$1,930 |
0.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$375.40 |
$1,877 |
0.7× |
| Knee 3 views (73562) |
$136.20 |
$681 |
1.6× |
| Liver & spleen imaging static only (78215) |
$408.40 |
$2,042 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$352.20 |
$1,761 |
0.9× |
| Liver imaging static only (78201) |
$352.20 |
$1,761 |
0.7× |
| Liver imaging w/vascular flow (78202) |
$390 |
$1,950 |
0.7× |
| Lung perf&ventilat diferentl (78598) |
$426.20 |
$2,131 |
0.8× |
| Lung perfusion differential (78597) |
$380.40 |
$1,902 |
1.0× |
| Lung Ventilation Imaging (78579) |
$380.40 |
$1,902 |
1.0× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$907.60 |
$4,538 |
0.3× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$645.40 |
$3,227 |
1.0× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$934 |
$4,670 |
0.6× |
| Lymphoscintigraphy (78195) |
$520 |
$2,600 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$187.40 |
$937 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$142.60 |
$713 |
0.6× |
| Meckels Diverticulum (78290) |
$342 |
$1,710 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$464.20 |
$2,321 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,189.20 |
$5,946 |
3.4× |
| MRA head w/o contrast (70544) |
$989.20 |
$4,946 |
4.2× |
| MRA head with contrast (70545) |
$1,011.80 |
$5,059 |
2.9× |
| MRA neck w contrast (70548) |
$831.80 |
$4,159 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$897 |
$4,485 |
2.6× |
| MRA neck w/o contrast (70547) |
$742 |
$3,710 |
3.1× |
| MRI abdomen w contrast (74182) |
$1,080 |
$5,400 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,219.80 |
$6,099 |
3.5× |
| MRI abdomen w/o contrast (74181) |
$990.40 |
$4,952 |
4.2× |
| MRI any jnt lwr ext with con lt (73722) |
$905 |
$4,525 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$885.60 |
$4,428 |
1.1× |
| MRI breast w/o contrast bilateral (77047) |
$1,097.40 |
$5,487 |
4.6× |
| MRI breast w/o contrast unilat (77046) |
$841.40 |
$4,207 |
3.6× |
| MRI c-spine with contrast (72142) |
$1,247.20 |
$6,236 |
3.6× |
| MRI cardiac w/o cont stress (75559) |
$897.20 |
$4,486 |
1.7× |
| MRI cardiac w/o contrast (75557) |
$796 |
$3,980 |
3.4× |
| MRI cervical spine w/o contrast (72141) |
$1,205 |
$6,025 |
5.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,042.40 |
$5,212 |
3.0× |
| MRI chest w/o contrast (71550) |
$864.80 |
$4,324 |
3.7× |
| MRI chest with contrast (71551) |
$960.40 |
$4,802 |
1.2× |
| MRI fetal sngl/1st gestation (74712) |
$990.40 |
$4,952 |
4.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,013.40 |
$5,067 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$916.60 |
$4,583 |
2.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$840.40 |
$4,202 |
3.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$963 |
$4,815 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,012.40 |
$5,062 |
2.9× |
| MRI orbit/face/neck w/contrast (70542) |
$977.60 |
$4,888 |
2.8× |
| MRI pelvis w contrast (72196) |
$1,080.20 |
$5,401 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,198.20 |
$5,991 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$851.20 |
$4,256 |
3.6× |
| MRI scan of arm joint before and after contrast (73223) |
$976.60 |
$4,883 |
2.8× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$975 |
$4,875 |
1.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,046.60 |
$5,233 |
3.0× |
| MRI spectroscopy (76390) |
$693 |
$3,465 |
8.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,262.80 |
$6,314 |
3.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,247.20 |
$6,236 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,262.80 |
$6,314 |
3.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,287.20 |
$6,436 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,262.80 |
$6,314 |
3.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,174.40 |
$5,872 |
5.0× |
| MRI tmj (70336) |
$870.60 |
$4,353 |
3.7× |
| MRI upper ext joint w/o contrast (73221) |
$818.60 |
$4,093 |
3.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,161.80 |
$5,809 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$885.80 |
$4,429 |
3.7× |
| Myelogram Cervical (72240) |
$520.40 |
$2,602 |
0.7× |
| Myelogram Lumbar (72265) |
$393 |
$1,965 |
0.5× |
| Myelogram thoracic (72255) |
$393 |
$1,965 |
0.5× |
| Myelography 2 or more regions (72270) |
$607.60 |
$3,038 |
0.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,005.80 |
$10,029 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$1,406 |
$7,030 |
1.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,179.60 |
$10,898 |
1.5× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,285.20 |
$11,426 |
1.0× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$2,179.60 |
$10,898 |
1.0× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,264.40 |
$6,322 |
1.5× |
| Neck soft tissue (70360) |
$71.10 |
$355.50 |
0.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$372.40 |
$1,862 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$98 |
$490 |
0.2× |
| Nm bone marrow wb (78104) |
$449 |
$2,245 |
1.1× |
| Nm cisternogram (78630) |
$337.20 |
$1,686 |
0.6× |
| Nm csf leak detection (78650) |
$449.80 |
$2,249 |
0.4× |
| Nm gastric emptying study (78264) |
$610.20 |
$3,051 |
1.5× |
| Nm gastroesophageal reflux study (78262) |
$275.40 |
$1,377 |
0.7× |
| Nm peritoneal-venous shunt patency (78291) |
$230.80 |
$1,154 |
0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,336.20 |
$11,681 |
1.7× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,116.80 |
$10,584 |
1.5× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,406 |
$7,030 |
1.1× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,005.80 |
$10,029 |
1.4× |
| Nuclear medicine study of digestive tracts (78299) |
$630.40 |
$3,152 |
1.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$202 |
$1,010 |
0.5× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$471.20 |
$2,356 |
1.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$665.80 |
$3,329 |
1.7× |
| Nuclear Rx Oral Admin (79005) |
$355.80 |
$1,779 |
1.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$155.80 |
$779 |
1.5× |
| Orthopantogram (70355) |
$103.20 |
$516 |
1.2× |
| Osseous survey infant (77076) |
$177.30 |
$886.50 |
1.7× |
| Osseous survey limited (77074) |
$253.40 |
$1,267 |
2.4× |
| Parathyrd planar w/spect&CT (78072) |
$502.60 |
$2,513 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$412.40 |
$2,062 |
1.0× |
| Parathyroid imaging (78070) |
$364.20 |
$1,821 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$108.80 |
$544 |
1.0× |
| Perineogram (74775) |
$125.80 |
$629 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$2,129 |
$10,645 |
1.5× |
| PET imaging CT for attenuation limited area (78814) |
$1,161.60 |
$5,808 |
0.8× |
| PET imaging for CT attenuation whole body (78816) |
$2,211.60 |
$11,058 |
1.6× |
| PET whole body (78813) |
$2,129 |
$10,645 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,181.40 |
$5,907 |
3.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$300.40 |
$1,502 |
0.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$300.40 |
$1,502 |
0.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$407.80 |
$2,039 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$426.20 |
$2,131 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$190.80 |
$954 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$186 |
$930 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$203.40 |
$1,017 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$156 |
$780 |
1.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$143.20 |
$716 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$212.60 |
$1,063 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,327 |
$31,635 |
0.9× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$279 |
$1,395 |
0.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$155.20 |
$776 |
1.5× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$232.40 |
$1,162 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128.80 |
$644 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$163.20 |
$816 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$217.80 |
$1,089 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$121.60 |
$608 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$306.20 |
$1,531 |
1.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$213 |
$1,065 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$261.20 |
$1,306 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$219.40 |
$1,097 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$123.60 |
$618 |
1.4× |
| Radiological examination surgical specimen (76098) |
$13.10 |
$65.50 |
0.0× |
| Review by radiologist of adrenal gland vein image (75840) |
$399.20 |
$1,996 |
0.1× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$291.60 |
$1,458 |
0.1× |
| Ribs bilateral 3 views (71110) |
$129.60 |
$648 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$511.40 |
$2,557 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$483.30 |
$2,416.50 |
0.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$519.70 |
$2,598.50 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$795.60 |
$3,978 |
0.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,018.20 |
$5,091 |
0.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$924.20 |
$4,621 |
0.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$20,102.80 |
$100,514 |
86.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$478.60 |
$2,393 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$1,460.70 |
$7,303.50 |
6.3× |
| Sacroiliac Joints < 3 Views (72200) |
$112.40 |
$562 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$191.80 |
$959 |
0.8× |
| Salivary gland function study (78232) |
$519 |
$2,595 |
1.3× |
| Scanogram (77073) |
$113.40 |
$567 |
1.1× |
| Scapula complete (73010) |
$90.80 |
$454 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$36.20 |
$181 |
1.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$204.40 |
$1,022 |
2.0× |
| Sialogram (70390) |
$167.40 |
$837 |
0.7× |
| Simulation intermediate (77285) |
$193.20 |
$966 |
0.5× |
| Small bowel series (74250) |
$204.60 |
$1,023 |
1.2× |
| Spec medical radj physics consltj (77370) |
$615.60 |
$3,078 |
4.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$108 |
$540 |
0.3× |
| Special dosimetry (77331) |
$276.60 |
$1,383 |
2.1× |
| Special treatment procedure (77470) |
$615.60 |
$3,078 |
1.1× |
| Speech evaluation complex (70371) |
$210.40 |
$1,052 |
0.9× |
| Spine thoracic 3 views (72072) |
$157.80 |
$789 |
1.5× |
| Spleen imaging only (78185) |
$197.80 |
$989 |
0.5× |
| Splenoportograpy rs&i (75810) |
$575.60 |
$2,878 |
0.2× |
| Stereotactic body radiation delivery (77373) |
$1,071 |
$5,355 |
0.6× |
| Superior sagittal sinus venogram (75870) |
$629.80 |
$3,149 |
0.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$123 |
$615 |
1.2× |
| Tbs Technical Calculation Only (77091) |
$56.80 |
$284 |
0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$230.40 |
$1,152 |
0.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$230.40 |
$1,152 |
0.6× |
| Testicular Imaging With Vascular Flow (78761) |
$211.40 |
$1,057 |
0.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$372.20 |
$1,861 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$155.40 |
$777 |
1.2× |
| Therapeutic Enema (74283) |
$306.20 |
$1,531 |
1.8× |
| Thoracolumbar 2 views (72080) |
$279.20 |
$1,396 |
3.2× |
| Thyroid carcinoma metastases img addl study (78016) |
$173.20 |
$866 |
0.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$480.80 |
$2,404 |
0.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$293 |
$1,465 |
0.7× |
| Thyroid uptake measurement (78012) |
$480.20 |
$2,401 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$377 |
$1,885 |
1.0× |
| Tomogram (76100) |
$275.20 |
$1,376 |
2.7× |
| Treatment device intermediate (77333) |
$193.20 |
$966 |
1.4× |
| Treatment devices simple (77332) |
$193.20 |
$966 |
1.4× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$932.60 |
$4,663 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$453.90 |
$2,269.50 |
1.1× |
| Tx devices design & construction complex (77334) |
$327.80 |
$1,639 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$258.80 |
$1,294 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$262 |
$1,310 |
2.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$670.20 |
$3,351 |
7.8× |
| Unlisted magnetic resonance procedure (76498) |
$1,197.40 |
$5,987 |
13.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$186 |
$930 |
1.8× |
| Unlisted Ultrasound Procedure (76999) |
$169.10 |
$845.50 |
2.0× |
| Upper Extremity Infant (73092) |
$84 |
$420 |
0.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$264.20 |
$1,321 |
0.7× |
| Urethrocystography retrograde rs&i (74450) |
$163.20 |
$816 |
0.7× |
| Urethrocystography voiding (74455) |
$278.20 |
$1,391 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$257.40 |
$1,287 |
1.5× |
| Us abdl aorta screen aaa (76706) |
$194.80 |
$974 |
1.9× |
| Us breast unilateral complete (76641) |
$139.40 |
$697 |
1.3× |
| Us breast unilateral limited (76642) |
$110.20 |
$551 |
1.3× |
| Us chest (76604) |
$170.20 |
$851 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$221.80 |
$1,109 |
2.1× |
| Us guided compression repair (76936) |
$303.80 |
$1,519 |
1.4× |
| Us infant hips dynamic (76885) |
$166.80 |
$834 |
1.9× |
| Us infant hips limited static (76886) |
$166.80 |
$834 |
1.9× |
| Us kidney transplant (76776) |
$246.20 |
$1,231 |
2.4× |
| Us ob detailed single fetus (76811) |
$159 |
$795 |
0.7× |
| Us ob transvaginal (76817) |
$259.20 |
$1,296 |
2.5× |
| Us pelvic non ob complete (76856) |
$257.80 |
$1,289 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$145 |
$725 |
1.4× |
| Us pregnancy ltd (76815) |
$262 |
$1,310 |
2.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$204.20 |
$1,021 |
2.0× |
| Us retroperitoneal complete (76770) |
$331.80 |
$1,659 |
3.2× |
| Us retroperitoneal limited (76775) |
$133.80 |
$669 |
1.3× |
| Us scrotum and contents (76870) |
$273.20 |
$1,366 |
2.6× |
| Us soft tissue head/neck (76536) |
$233.40 |
$1,167 |
2.3× |
| Us spinal canal and contents (76800) |
$221.80 |
$1,109 |
2.1× |
| Us transrectal (76872) |
$225.40 |
$1,127 |
2.2× |
| Us transrectal prostate volume (76873) |
$1,018.80 |
$5,094 |
9.8× |
| Us xtr non-vasc lmtd (76882) |
$158 |
$790 |
1.5× |
| Us, eye b-scan (76512) |
$146.40 |
$732 |
1.4× |
| Venogram extremity bilateral (75822) |
$667 |
$3,335 |
0.4× |
| Venogram orbital (75880) |
$75.20 |
$376 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$581 |
$2,905 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$581 |
$2,905 |
0.4× |
| Venography epidural rs&i (75872) |
$445.60 |
$2,228 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$506 |
$2,530 |
0.3× |
| Venography Renal Bilateral (75833) |
$744 |
$3,720 |
0.2× |
| Venography renal unilateral selective rs&i (75831) |
$481 |
$2,405 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$419 |
$2,095 |
0.1× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$484.80 |
$2,424 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$122.80 |
$614 |
1.4× |
| Wrist 2 views (73100) |
$94.30 |
$471.50 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$187.40 |
$937 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$96.20 |
$481 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$123.20 |
$616 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$342 |
$1,710 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$100.60 |
$503 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$112.40 |
$562 |
1.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$209.40 |
$1,047 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$85.80 |
$429 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$127.20 |
$636 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$141.40 |
$707 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$171.60 |
$858 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$177.60 |
$888 |
1.7× |
| X-ray exam of femur 1 (73551) |
$94.20 |
$471 |
1.1× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$315.60 |
$1,578 |
1.8× |
| X-ray eye for foreign body (70030) |
$107.60 |
$538 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$177.60 |
$888 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$143.20 |
$716 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$146 |
$730 |
1.7× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$384 |
$1,920 |
0.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$90.60 |
$453 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$101.60 |
$508 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$151.40 |
$757 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$159.40 |
$797 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$75.20 |
$376 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$151.40 |
$757 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$220.60 |
$1,103 |
2.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$151.40 |
$757 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$113.20 |
$566 |
1.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$126.40 |
$632 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$104 |
$520 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$140.20 |
$701 |
1.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$100.80 |
$504 |
0.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$275.40 |
$1,377 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$108.60 |
$543 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$132 |
$660 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$263.40 |
$1,317 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$121.20 |
$606 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$102.20 |
$511 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$153.80 |
$769 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$155.80 |
$779 |
1.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$143.20 |
$716 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$204.20 |
$1,021 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$182.40 |
$912 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$123.40 |
$617 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$109.20 |
$546 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$102.20 |
$511 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$147.80 |
$739 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$157.80 |
$789 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$84 |
$420 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$116.80 |
$584 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$208.80 |
$1,044 |
2.0× |
| Xr chest 4+ views (71048) |
$136.60 |
$683 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$91.80 |
$459 |
1.1× |
| Xr shoulder 1 view (73020) |
$98.60 |
$493 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$179.20 |
$896 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$96.20 |
$481 |
1.1× |
| Xr tmj bilateral (70330) |
$130.40 |
$652 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$128 |
$640 |
1.5× |