| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$4,868 |
$12,170 |
3.4× |
| Acute gi blood loss imaging (78278) |
$790.40 |
$1,976 |
1.9× |
| Angio adrenal unilat select (75731) |
$5,234 |
$13,085 |
1.6× |
| Angio extremity unilateral (75710) |
$5,234 |
$13,085 |
1.6× |
| Angio pulmonary unilateral (75741) |
$5,234 |
$13,085 |
1.6× |
| Angiogram extremity bilateral (75716) |
$6,281.60 |
$15,704 |
1.9× |
| Angiogram pelvic (75736) |
$5,234 |
$13,085 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$5,234 |
$13,085 |
1.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,234 |
$13,085 |
1.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,542.40 |
$21,356 |
1.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,327.20 |
$3,318 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,234 |
$13,085 |
1.6× |
| Ankle 2 views (73600) |
$308.40 |
$771 |
3.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$5,234 |
$13,085 |
1.6× |
| Arthrography knee lt (73580) |
$1,217.20 |
$3,043 |
3.3× |
| Arthrography wrist lt (73115) |
$979.20 |
$2,448 |
2.7× |
| Barium enema (74270) |
$813.20 |
$2,033 |
4.4× |
| Basic dosimetry (77300) |
$535.20 |
$1,338 |
3.8× |
| Bilat selctv renal venogram (75833) |
$5,234 |
$13,085 |
1.6× |
| Bone age studies (77072) |
$422.80 |
$1,057 |
3.9× |
| Bone imaging limited area (78300) |
$790.40 |
$1,976 |
1.9× |
| Bone marrow imaging whole body (78104) |
$790.40 |
$1,976 |
1.9× |
| Bone survey complete (77075) |
$604 |
$1,510 |
5.5× |
| Bowel imaging (78290) |
$790.40 |
$1,976 |
1.9× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,354 |
$3,385 |
3.5× |
| Brain image w/flow 4 + views (78606) |
$1,013.60 |
$2,534 |
1.8× |
| Card MRI w/stress img & dye (75563) |
$2,951.60 |
$7,379 |
3.6× |
| Cardiac MRI w/stress img (75559) |
$2,535.80 |
$6,339.50 |
4.4× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$2,953.60 |
$7,384 |
8.1× |
| Cardiac shunt detection (78428) |
$790.40 |
$1,976 |
1.9× |
| Cerebrospinal fluid leakage (78650) |
$2,731.20 |
$6,828 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$547.20 |
$1,368 |
3.0× |
| Cisternogram (78630) |
$1,013.60 |
$2,534 |
1.8× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$1,680 |
$4,200 |
2.1× |
| Clavicle complete (73000) |
$281.60 |
$704 |
3.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,406.60 |
$6,016.50 |
13.1× |
| Continuing medical physics consltj pr wk (77336) |
$535.20 |
$1,338 |
3.8× |
| Contrast exam abdominl aorta (75625) |
$5,234 |
$13,085 |
1.6× |
| Contrast exam thoracic aorta (75605) |
$5,234 |
$13,085 |
0.9× |
| Corpora cavernosography (74445) |
$410 |
$1,025 |
3.8× |
| Csf shunt evaluation (78645) |
$1,013.60 |
$2,534 |
1.8× |
| CT - st neck w&wo contr (70492) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,805.80 |
$9,514.50 |
10.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,337 |
$5,842.50 |
9.4× |
| CT abdomen w wo contrast (74170) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT abdomen w/contrast (74160) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT abdomen w/o contrast (74150) |
$1,460 |
$3,650 |
13.4× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$3,805.80 |
$9,514.50 |
10.4× |
| CT angio abdom w/o & w/dye (74175) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT angio abdominal arteries (75635) |
$2,448.60 |
$6,121.50 |
13.4× |
| CT angio hrt w/3d image (75574) |
$1,104.60 |
$2,761.50 |
3.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT cervical spine w/contrast (72126) |
$2,406.60 |
$6,016.50 |
6.6× |
| CT cervical spine w/o contrast (72125) |
$1,460 |
$3,650 |
13.4× |
| CT chest w/contrast (71260) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT extremity upper w & w/o contrast (73202) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT head/brain with contrast (70460) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT head/brain without and with contrast (70470) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$231.60 |
$579 |
2.5× |
| CT limited/localized follow up study (76380) |
$458.60 |
$1,146.50 |
5.0× |
| CT lower ext w/wo contrast (73702) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT lower extremity w contrast (73701) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT lower extremity w/o contrast unilateral (73700) |
$1,460 |
$3,650 |
13.4× |
| CT lumbar spine w/contrast (72132) |
$2,406.60 |
$6,016.50 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$1,460 |
$3,650 |
13.4× |
| CT lumbar spine w/o then w/ con (72133) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT maxillofacial area w/o contrast (70486) |
$1,460 |
$3,650 |
13.4× |
| CT maxillofacial w/contrast (70487) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT maxillofacial w/o then w/ con (70488) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT orbit sella ear w/o con (70480) |
$1,460 |
$3,650 |
13.4× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT pelvis w & w/o contrast (72194) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT pelvis w/o contrast (72192) |
$1,460 |
$3,650 |
13.4× |
| CT soft tissue neck w/contrast (70491) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,460 |
$3,650 |
13.4× |
| CT spine cervical w/wo contrast (72127) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT thoracic spine w/contrast (72129) |
$2,406.60 |
$6,016.50 |
13.1× |
| CT thoracic spine w/o contrast (72128) |
$1,460 |
$3,650 |
13.4× |
| CT thoracic spine w/o then w/ con (72130) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT thorax lung cancer scr c- (71271) |
$443.20 |
$1,108 |
4.1× |
| CT thorax w/o contrast (71250) |
$1,460 |
$3,650 |
13.4× |
| CT thorax w/o then w/ contrast (71270) |
$2,709.40 |
$6,773.50 |
14.8× |
| CT upper extremity w/dye (73201) |
$2,406.60 |
$6,016.50 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,460 |
$3,650 |
13.4× |
| CTA chest w/wo contrast (71275) |
$2,709.40 |
$6,773.50 |
14.8× |
| CTA head w contrast (70496) |
$3,387.20 |
$8,468 |
18.5× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,709.40 |
$6,773.50 |
14.8× |
| Cta Neck (70498) |
$2,709.40 |
$6,773.50 |
14.8× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,709.40 |
$6,773.50 |
14.8× |
| Dilation ureters/urethra rs&i (74485) |
$5,684.80 |
$14,212 |
2.6× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$9,660.40 |
$24,151 |
4.7× |
| Diskography lumbar (72295) |
$3,317.60 |
$8,294 |
1.6× |
| Doppler echo fetal spectral display complete (76827) |
$754.80 |
$1,887 |
6.9× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$754.80 |
$1,887 |
6.9× |
| Doppler fetal mid cerebral artery (76821) |
$250 |
$625 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$2,048 |
$5,120 |
8.2× |
| Esophogram (74220) |
$547.20 |
$1,368 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$858 |
$2,145 |
7.9× |
| Fetal biophysical profile w/o nst (76819) |
$714.80 |
$1,787 |
6.5× |
| Fetal echo complete (76825) |
$2,048 |
$5,120 |
3.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$369.60 |
$924 |
1.5× |
| Full mouth X-ray of teeth (70320) |
$807.20 |
$2,018 |
3.2× |
| Functional MRI brain by tech (70554) |
$1,813.40 |
$4,533.50 |
7.3× |
| Gastric emptying study (78264) |
$790.40 |
$1,976 |
1.9× |
| Gated heart planar single (78472) |
$790.40 |
$1,976 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,454 |
$8,635 |
4.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,454 |
$8,635 |
4.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,459.60 |
$8,649 |
4.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,234 |
$13,085 |
1.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$5,234 |
$13,085 |
1.6× |
| Hepatobil syst image w/drug (78227) |
$790.40 |
$1,976 |
1.4× |
| Hepatobiliary system imaging (78226) |
$790.40 |
$1,976 |
1.9× |
| Humerus min 2 views (73060) |
$307.60 |
$769 |
3.4× |
| Hysterosalpingography (74740) |
$1,326.80 |
$3,317 |
5.3× |
| Imrt planning (77301) |
$4,868 |
$12,170 |
3.4× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$790.40 |
$1,976 |
1.9× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$3,079.20 |
$7,698 |
4.2× |
| Intracavitary radiation source applic complex (77763) |
$2,936.80 |
$7,342 |
4.0× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,231.20 |
$3,078 |
3.1× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$477.20 |
$1,193 |
1.2× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,380.80 |
$3,452 |
3.5× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$788.80 |
$1,972 |
2.0× |
| Ivp (74400) |
$833.60 |
$2,084 |
4.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,013.60 |
$2,534 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,013.60 |
$2,534 |
1.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,013.60 |
$2,534 |
1.8× |
| Liver & spleen; static only (78215) |
$790.40 |
$1,976 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$1,013.60 |
$2,534 |
1.8× |
| Lung perfusion differential (78597) |
$790.40 |
$1,976 |
1.9× |
| Lung ventilat&perfus imaging (78582) |
$1,013.20 |
$2,533 |
1.8× |
| Lung ventilation imaging (78579) |
$790.40 |
$1,976 |
1.9× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,592.40 |
$3,981 |
1.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,327.20 |
$3,318 |
2.0× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$5,234 |
$13,085 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,953.60 |
$7,384 |
8.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,953.60 |
$7,384 |
8.1× |
| Mammary ductogram multiple ducts (77054) |
$1,149.20 |
$2,873 |
4.6× |
| Mammary ductogram single (77053) |
$1,149.20 |
$2,873 |
4.6× |
| Mlc device(s) for imrt (77338) |
$1,380.80 |
$3,452 |
3.5× |
| Mr safety determination physician/other qhp (76016) |
$146 |
$365 |
1.6× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$98 |
$245 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$40.40 |
$101 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$152 |
$380 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$399.60 |
$999 |
1.6× |
| MRA head w & w/o contrast (70546) |
$2,953.60 |
$7,384 |
8.1× |
| MRA head w/contrast (70545) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRA head w/o contrast (70544) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRA neck w/contrast (70548) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRA neck w/o contrast (70547) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRA neck w/wo contrast (70549) |
$2,953.60 |
$7,384 |
8.1× |
| MRI abdomen w/contrast (74182) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,953.60 |
$7,384 |
8.1× |
| MRI abdomen w/o contrast (74181) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI any jnt lwr ext with con lt (73722) |
$2,611.40 |
$6,528.50 |
3.2× |
| MRI bone marrow (77084) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI breast without contrast bilateral (77047) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI breast without contrast material unilateral (77046) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI cardiac w/o contrast (75557) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI cervical spine w/o contrast (72141) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI cervical spine with contrast (72142) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI chest w & w/o contrast (71552) |
$2,953.60 |
$7,384 |
8.1× |
| MRI chest w/contrast (71551) |
$2,611.40 |
$6,528.50 |
3.2× |
| MRI chest w/o contrast (71550) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI fetal sngl/1st gestation (74712) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI joint upper ext w/contrast (73222) |
$2,611.40 |
$6,528.50 |
3.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,953.60 |
$7,384 |
8.1× |
| MRI joint upr extrem w/o dye (73221) |
$1,813.40 |
$4,533.50 |
7.3× |
| Mri Lower Extremity W/O Dye (73718) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI lumbar spine with contrast (72149) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI lumbar w/wo contrast (72158) |
$2,953.60 |
$7,384 |
8.1× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI orbit/face/neck w/contrast (70542) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$2,953.60 |
$7,384 |
8.1× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI pelvis w/ contrast (72196) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI pelvis w/wo contrast (72197) |
$2,953.60 |
$7,384 |
8.1× |
| MRI spectroscopy (76390) |
$1,813.40 |
$4,533.50 |
20.0× |
| MRI spine cervical wo/w contrast (72156) |
$2,953.60 |
$7,384 |
8.1× |
| MRI spine thoracic w/contrast (72147) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI thoracic spine w wo contrast (72157) |
$2,953.60 |
$7,384 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,813.40 |
$4,533.50 |
7.3× |
| MRI tmj (70336) |
$2,096.60 |
$5,241.50 |
8.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,813.40 |
$4,533.50 |
7.3× |
| Mri Upper Extremity W/Dye (73219) |
$2,611.40 |
$6,528.50 |
7.2× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,953.60 |
$7,384 |
8.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$5,020.40 |
$12,551 |
3.4× |
| Myocardial spect single study at rest or stress (78451) |
$2,731.20 |
$6,828 |
2.0× |
| Myocrd img PET metab eval single study (78459) |
$5,522.40 |
$13,806 |
4.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,495.20 |
$6,238 |
2.8× |
| Nm bone 3 phase (78315) |
$790.40 |
$1,976 |
1.9× |
| Nm bone imaging whole body (78306) |
$790.40 |
$1,976 |
1.9× |
| Nm bone marrow scan limited (78102) |
$790.40 |
$1,976 |
1.9× |
| Nm bone multi (78305) |
$790.40 |
$1,976 |
1.9× |
| Nm heart perfusion spect stress rest (78452) |
$2,731.20 |
$6,828 |
2.0× |
| Nm kidney function (78725) |
$790.40 |
$1,976 |
1.9× |
| Nm kidney imaging morphology (78700) |
$790.40 |
$1,976 |
1.9× |
| Nm lymph system (78195) |
$1,013.60 |
$2,534 |
1.8× |
| Nm thyroid imaging only (78013) |
$790.40 |
$1,976 |
1.9× |
| Nose to rectum for fb child (76010) |
$724 |
$1,810 |
8.0× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$790.40 |
$1,976 |
1.9× |
| Nuclear rx IV admin (79101) |
$1,005.60 |
$2,514 |
4.1× |
| Ob us < 14 wks single fetus (76801) |
$754.80 |
$1,887 |
6.9× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$754.80 |
$1,887 |
6.9× |
| Oral radiopharm rx (79005) |
$1,257.60 |
$3,144 |
5.2× |
| Orthopantogram (70355) |
$255.60 |
$639 |
2.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,013.60 |
$2,534 |
1.8× |
| Parathyroid imaging (78070) |
$790.40 |
$1,976 |
1.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$790.40 |
$1,976 |
1.9× |
| Peritoneal-venous shunt patency test (78291) |
$790.40 |
$1,976 |
1.9× |
| Peritoneogram rs&i (74190) |
$1,818.40 |
$4,546 |
3.2× |
| PET brain metabolic eval (78608) |
$5,522.40 |
$13,806 |
3.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,718.40 |
$16,796 |
4.5× |
| PET imaging CT for attenuation limited area (78814) |
$6,718.40 |
$16,796 |
4.5× |
| PET imaging for CT attenuation whole body (78816) |
$6,718.40 |
$16,796 |
4.5× |
| Proton treatment complex (77525) |
$5,446.40 |
$13,616 |
4.2× |
| Proton trmt intermediate (77523) |
$5,446.40 |
$13,616 |
4.2× |
| Proton trmt simple w/comp (77522) |
$5,446.40 |
$13,616 |
4.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,857.60 |
$7,144 |
0.9× |
| Pulmonary perfusion imaging particulate (78580) |
$790.40 |
$1,976 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,326.80 |
$3,317 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$255.60 |
$639 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$422.80 |
$1,057 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$807.20 |
$2,018 |
7.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$807.20 |
$2,018 |
7.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$283.60 |
$709 |
3.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$353.60 |
$884 |
3.9× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$422.80 |
$1,057 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$422.80 |
$1,057 |
3.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$807.20 |
$2,018 |
7.4× |
| Radex spine cervical 2 or 3 views (72040) |
$422.80 |
$1,057 |
4.7× |
| Radex spine cervical 4 or 5 views (72050) |
$422.80 |
$1,057 |
3.9× |
| Radex spine cervical 6 or more views (72052) |
$504 |
$1,260 |
4.6× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$353.60 |
$884 |
3.9× |
| Radiation delivery stereotactic cranial linear (77372) |
$34,551.20 |
$86,378 |
4.5× |
| Radiation tx delivery lvl 1 (77402) |
$521.60 |
$1,304 |
4.9× |
| Radiation tx delivery lvl 2 (77407) |
$521.60 |
$1,304 |
1.3× |
| Radiation tx delivery lvl 3 (77412) |
$1,057.20 |
$2,643 |
1.8× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$550.80 |
$1,377 |
5.0× |
| Radiologic exam esophagus double contrast study (74221) |
$737.60 |
$1,844 |
4.0× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$559.60 |
$1,399 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$813.20 |
$2,033 |
4.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$806.80 |
$2,017 |
4.4× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$193.20 |
$483 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$307.60 |
$769 |
3.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$380 |
$950 |
3.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$565.60 |
$1,414 |
5.2× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$502.40 |
$1,256 |
5.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$1,453.20 |
$3,633 |
6.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$919.20 |
$2,298 |
2.3× |
| Renal cyst study (74470) |
$2,557.60 |
$6,394 |
4.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$790.40 |
$1,976 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$790.40 |
$1,976 |
1.9× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,731.20 |
$6,828 |
4.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,731.20 |
$6,828 |
4.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,731.20 |
$6,828 |
4.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,731.20 |
$6,828 |
2.0× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$3,165.20 |
$7,913 |
2.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,165.20 |
$7,913 |
2.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$935.20 |
$2,338 |
3.8× |
| Saline infused sonohysterogram (76831) |
$1,314.80 |
$3,287 |
5.3× |
| Salivary gland funct study (78232) |
$790.40 |
$1,976 |
1.9× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$54.40 |
$136 |
2.3× |
| Selective spinal angiogram (75705) |
$8,542.40 |
$21,356 |
1.5× |
| Shoulder arthrogram (73040) |
$676.80 |
$1,692 |
1.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$380 |
$950 |
3.5× |
| Simulation complex (77290) |
$1,738.80 |
$4,347 |
4.4× |
| Simulation intermediate (77285) |
$1,380.80 |
$3,452 |
3.5× |
| Simulation simple (77280) |
$788.80 |
$1,972 |
5.6× |
| Small bowel series (74250) |
$547.20 |
$1,368 |
3.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,380.80 |
$3,452 |
3.5× |
| Special dosimetry (77331) |
$788.80 |
$1,972 |
5.6× |
| Special physics consult (77370) |
$788.80 |
$1,972 |
5.6× |
| Special treatment procedure (77470) |
$2,392.80 |
$5,982 |
4.1× |
| Speech evaluation complex (70371) |
$502.40 |
$1,256 |
2.0× |
| Splenoportography (75810) |
$5,234 |
$13,085 |
1.6× |
| Stereotactic body radiation delivery (77373) |
$9,100.20 |
$22,750.50 |
4.9× |
| Superior sagittal sinus venogram (75870) |
$1,286 |
$3,215 |
0.4× |
| Tbs technical calculation only (77091) |
$251.20 |
$628 |
2.8× |
| Testicular imaging w/flow (78761) |
$790.40 |
$1,976 |
1.9× |
| Therapeutic enema barium or air (74283) |
$414.80 |
$1,037 |
2.3× |
| Thyroid met imaging body (78018) |
$1,013.60 |
$2,534 |
1.8× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$790.40 |
$1,976 |
1.9× |
| Treatment device intermediate (77333) |
$794.80 |
$1,987 |
5.7× |
| Treatment devices complex (77334) |
$1,588 |
$3,970 |
4.1× |
| Treatment devices simple (77332) |
$721.60 |
$1,804 |
5.1× |
| Ultrasound breast limited (76642) |
$376.80 |
$942 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$754.80 |
$1,887 |
6.9× |
| Umbilical-artery Doppler (OB) (76820) |
$250 |
$625 |
2.3× |
| Unlisted CT procedure (76497) |
$3,550.20 |
$8,875.50 |
39.1× |
| Unlisted diagnostic radiographic procedure (76499) |
$494 |
$1,235 |
5.4× |
| Unlisted fluoroscopic procedure (76496) |
$5,234 |
$13,085 |
57.6× |
| Unlisted magnetic resonance procedure (76498) |
$5,791.20 |
$14,478 |
63.7× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$1,368.80 |
$3,422 |
123.8× |
| Ureteral reflux study (78740) |
$790.40 |
$1,976 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$833.60 |
$2,084 |
3.3× |
| Urethrocystography voiding (74455) |
$1,326.80 |
$3,317 |
5.3× |
| Urography antegrade (74425) |
$1,326.80 |
$3,317 |
3.6× |
| Urography retrograde w/wo kub (74420) |
$1,326.80 |
$3,317 |
3.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$553.60 |
$1,384 |
5.1× |
| Us breast uni real time with image complete (76641) |
$376.80 |
$942 |
3.5× |
| Us chest (76604) |
$472.80 |
$1,182 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$754.80 |
$1,887 |
6.9× |
| Us elastography parenchyma (76981) |
$1,143.20 |
$2,858 |
10.5× |
| Us encephalogram (76506) |
$632 |
$1,580 |
5.8× |
| Us guided compression repair (76936) |
$494.80 |
$1,237 |
2.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$775.60 |
$1,939 |
8.5× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$754.80 |
$1,887 |
8.3× |
| Us kidney transplanted (76776) |
$807.20 |
$2,018 |
7.4× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$494.80 |
$1,237 |
4.5× |
| Us ob detailed single fetus (76811) |
$922.80 |
$2,307 |
3.7× |
| Us ob followup per fetus (76816) |
$547.20 |
$1,368 |
5.0× |
| Us ob limited 1 or more fetuses (76815) |
$646.40 |
$1,616 |
5.9× |
| Us obstetric transvaginal (76817) |
$646.40 |
$1,616 |
5.9× |
| Us pelvic limited or f/u non-ob (76857) |
$547.20 |
$1,368 |
5.0× |
| Us pelvis complete (76856) |
$754.80 |
$1,887 |
6.9× |
| Us retroperitoneal complete (76770) |
$804 |
$2,010 |
7.4× |
| Us retroperitoneal limited (76775) |
$754.80 |
$1,887 |
6.9× |
| Us scrotum (76870) |
$754.80 |
$1,887 |
6.9× |
| Us soft tissue head/neck (76536) |
$754.80 |
$1,887 |
6.9× |
| Us spinal canal (76800) |
$547.20 |
$1,368 |
5.0× |
| Us transrectal (76872) |
$754.80 |
$1,887 |
6.9× |
| Us transrectal prostate volume (76873) |
$754.80 |
$1,887 |
6.9× |
| Us trgt dyn mbubb 1st les (76978) |
$1,342 |
$3,355 |
3.7× |
| Vein X-ray liver w/hemodynam (75885) |
$5,234 |
$13,085 |
1.6× |
| Venogram extremity bilateral (75822) |
$1,592.40 |
$3,981 |
1.0× |
| Venogram ivc w serialography (75825) |
$5,234 |
$13,085 |
1.6× |
| Venogram svc w serialography (75827) |
$1,327.20 |
$3,318 |
0.8× |
| Venography adrenal unilateral selective rs&i (75840) |
$5,234 |
$13,085 |
1.6× |
| Venography ext unilateral (75820) |
$1,327.20 |
$3,318 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$5,234 |
$13,085 |
1.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,234 |
$13,085 |
1.6× |
| Venous sampling by catheter (75893) |
$5,234 |
$13,085 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$371.60 |
$929 |
4.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$369.60 |
$924 |
4.1× |
| X-ray aorta leg arteries (75630) |
$5,234 |
$13,085 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$813.20 |
$2,033 |
4.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$307.60 |
$769 |
3.4× |
| X-ray exam hips bi 3-4 views (73522) |
$422.80 |
$1,057 |
3.9× |
| X-ray exam of finger(s) (73140) |
$248.80 |
$622 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$306 |
$765 |
3.4× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$263.60 |
$659 |
2.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$266.40 |
$666 |
2.9× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$368 |
$920 |
3.4× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$441.60 |
$1,104 |
4.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$272.80 |
$682 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$297.20 |
$743 |
3.3× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$321.60 |
$804 |
3.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$368 |
$920 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$337.20 |
$843 |
3.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$533.60 |
$1,334 |
4.9× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$306 |
$765 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$549.60 |
$1,374 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$313.60 |
$784 |
3.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$727.60 |
$1,819 |
8.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$381.20 |
$953 |
4.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$422.80 |
$1,057 |
3.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$353.60 |
$884 |
3.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$227.60 |
$569 |
2.5× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$288.80 |
$722 |
3.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$300.40 |
$751 |
3.3× |
| Xr abdomen 1 view (74018) |
$230 |
$575 |
2.5× |
| Xr abdomen 2 views (74019) |
$275.60 |
$689 |
2.5× |
| Xr abdomen 3 views (74021) |
$343.60 |
$859 |
3.1× |
| Xr arthrogram ankle (73615) |
$1,217.20 |
$3,043 |
3.3× |
| Xr arthrogram elbow (73085) |
$676.80 |
$1,692 |
1.9× |
| Xr arthrogram hip (73525) |
$676.80 |
$1,692 |
1.9× |
| Xr bone density appendicular (77081) |
$255.60 |
$639 |
2.8× |
| Xr bone density axial (77080) |
$494 |
$1,235 |
4.5× |
| Xr bone length study (77073) |
$342 |
$855 |
3.1× |
| Xr bone survey infant (77076) |
$554.80 |
$1,387 |
5.1× |
| Xr bone survey limited (77074) |
$565.60 |
$1,414 |
5.2× |
| Xr chest 1 view (71045) |
$259.60 |
$649 |
2.9× |
| Xr chest 2 views (71046) |
$298.40 |
$746 |
3.3× |
| Xr chest 3 views (71047) |
$326.40 |
$816 |
3.6× |
| Xr cystogram 3+ views (74430) |
$833.60 |
$2,084 |
2.3× |
| Xr eye foreign body (70030) |
$230 |
$575 |
2.5× |
| Xr facial bones 3 views (70150) |
$472.40 |
$1,181 |
4.3× |
| Xr joint survey 1 view (77077) |
$422.80 |
$1,057 |
3.9× |
| Xr lower extremity 2 views infant (73592) |
$289.20 |
$723 |
3.2× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$389.20 |
$973 |
3.6× |
| Xr mandible 4 views (70110) |
$470.80 |
$1,177 |
4.3× |
| Xr nasal bones (70160) |
$288.40 |
$721 |
3.2× |
| Xr pelvis 3 views (72190) |
$422.80 |
$1,057 |
3.9× |
| Xr spine 1 view (72020) |
$311.20 |
$778 |
3.4× |
| Xr sternum 2 views (71120) |
$341.20 |
$853 |
3.8× |
| Xr surgical specimen (76098) |
$1,679.20 |
$4,198 |
2.9× |
| Xr upper extremity 2 views infant (73092) |
$368 |
$920 |
3.4× |
| Xray elbow 2 views (73070) |
$278.40 |
$696 |
3.1× |
| Xray forearm 2 views (73090) |
$266.40 |
$666 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$307.60 |
$769 |
3.4× |
| Xray neck soft tissue (70360) |
$263.20 |
$658 |
2.9× |
| Xray orbits complete min 4 views (70200) |
$422.80 |
$1,057 |
3.9× |
| Xray pelvis 1 or 2 views (72170) |
$422.80 |
$1,057 |
3.9× |
| Xray ribs bilateral 3 views (71110) |
$520.80 |
$1,302 |
4.8× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$422.80 |
$1,057 |
3.9× |
| Xray scapula complete (73010) |
$307.60 |
$769 |
2.8× |
| Xray shoulder 1 view (73020) |
$303.20 |
$758 |
3.3× |
| Xray sinuses paranasal <3 views (70210) |
$289.20 |
$723 |
3.2× |
| Xray spine thoracic 2 views (72070) |
$422.80 |
$1,057 |
3.9× |
| Xray spine thoracic 3 views (72072) |
$470.80 |
$1,177 |
4.3× |
| Xray tibia-fibula 2 views bil (73590) |
$307.60 |
$769 |
3.4× |
| Xray tmj open - closed unilat (70328) |
$353.60 |
$884 |
3.9× |
| Xray tmj's bilateral open-clsc (70330) |
$353.60 |
$884 |
3.9× |