| 3-D radiotherapy plan dose-volume histograms (77295) |
$9,107.04 |
$18,973 |
5.1× |
| Abdomen 1 View (74018) |
$131.04 |
$273 |
1.2× |
| Abdomen 2 views (74019) |
$157.44 |
$328 |
1.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$2,515.20 |
$5,240 |
4.9× |
| Adrenal Cortex & Medulla Img (78075) |
$2,222.40 |
$4,630 |
1.3× |
| Angio internal mammary (75756) |
$1,608.96 |
$3,352 |
0.4× |
| Angio pulmonary bilat (75743) |
$4,749.60 |
$9,895 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$4,886.40 |
$10,180 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,803.52 |
$7,924 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,770.08 |
$5,771 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,973.28 |
$4,111 |
0.5× |
| Ankle 2 views (73600) |
$137.76 |
$287 |
1.2× |
| Aortography thoracic serialography rs&i (75605) |
$5,078.40 |
$10,580 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,727.84 |
$5,683 |
0.7× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,917.44 |
$6,078 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$2,003.04 |
$4,173 |
0.5× |
| Artery X-Rays Pelvis (75736) |
$3,947.52 |
$8,224 |
0.6× |
| Artery X-Rays Spine (75705) |
$3,803.52 |
$7,924 |
0.5× |
| Arthrogram ankle (73615) |
$1,068.96 |
$2,227 |
2.4× |
| Arthrogram hip (73525) |
$545.76 |
$1,137 |
1.2× |
| Arthrogram Wrist (73115) |
$593.28 |
$1,236 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$539.04 |
$1,123 |
3.1× |
| Bone age studies (77072) |
$145.92 |
$304 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$2,027.52 |
$4,224 |
3.9× |
| Bone Imaging Limited Area (78300) |
$1,336.80 |
$2,785 |
2.6× |
| Bone Imaging Multiple Areas (78305) |
$1,538.88 |
$3,206 |
3.0× |
| Bone Imaging Whole Body (78306) |
$1,932 |
$4,025 |
3.8× |
| Bone marrow imaging limited area (78102) |
$745.92 |
$1,554 |
1.5× |
| Bone marrow imaging; multiple areas (78103) |
$820.80 |
$1,710 |
1.6× |
| Bone marrow imaging; whole body (78104) |
$820.80 |
$1,710 |
1.6× |
| Bone survey infant (77076) |
$685.44 |
$1,428 |
5.1× |
| Brachytx isodose complex (77318) |
$5,624.16 |
$11,717 |
11.7× |
| Brachytx isodose intermed (77317) |
$4,850.40 |
$10,105 |
10.1× |
| Brachytx Isodose Plan Simple (77316) |
$4,104 |
$8,550 |
8.5× |
| Brain Flow Imaging Only (78610) |
$705.60 |
$1,470 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$1,248 |
$2,600 |
2.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,372.80 |
$2,860 |
2.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,372.80 |
$2,860 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,828 |
$7,975 |
2.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,600.80 |
$3,335 |
3.6× |
| Cat Scan Follow-Up Study (76380) |
$770.88 |
$1,606 |
6.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,564.32 |
$3,259 |
2.2× |
| Cerebrospinal Fluid Scan (78630) |
$1,800.48 |
$3,751 |
2.6× |
| Chest 1 view (71045) |
$128.16 |
$267 |
1.1× |
| Chest 2 views (71046) |
$236.16 |
$492 |
2.1× |
| Chest 3 views (71047) |
$301.44 |
$628 |
2.7× |
| Chest 4 or more views (71048) |
$310.08 |
$646 |
2.3× |
| Cholecystography Oral Contrast (74290) |
$407.52 |
$849 |
1.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$956.16 |
$1,992 |
0.9× |
| Clavicle complete (73000) |
$145.92 |
$304 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$108 |
$225 |
0.8× |
| Continuing medical physics consltj pr wk (77336) |
$879.36 |
$1,832 |
5.1× |
| Contrast Exam Abdominl Aorta (75625) |
$3,423.36 |
$7,132 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$326.40 |
$680 |
0.7× |
| Contrast X-Ray Of Elbow (73085) |
$349.92 |
$729 |
0.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,068.96 |
$2,227 |
2.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$312.96 |
$652 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,532.16 |
$3,192 |
3.4× |
| CT abdomen and pelvis without contrast (74176) |
$607.68 |
$1,266 |
2.0× |
| CT abdomen w contrast (74160) |
$1,104.96 |
$2,302 |
4.9× |
| CT abdomen w wo contrast (74170) |
$1,866.24 |
$3,888 |
8.3× |
| CT abdomen w/o contrast (74150) |
$916.32 |
$1,909 |
6.8× |
| CT Angio Abdomen and Pelvis (74174) |
$2,965.44 |
$6,178 |
6.6× |
| CT Angio Chest (71275) |
$1,455.36 |
$3,032 |
6.5× |
| CT Angio Head (70496) |
$1,189.92 |
$2,479 |
5.3× |
| CT angio hrt w/3d image (75574) |
$585.12 |
$1,219 |
1.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,620.96 |
$3,377 |
7.2× |
| CT Angio Neck (70498) |
$1,189.92 |
$2,479 |
5.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,620.96 |
$3,377 |
7.2× |
| CT cervical spine w/ contrast (72126) |
$1,249.92 |
$2,604 |
2.8× |
| CT cervical spine w/o contrast (72125) |
$955.68 |
$1,991 |
7.1× |
| CT cervical spine w/wo cont (72127) |
$1,333.44 |
$2,778 |
5.9× |
| CT chest w contrast (71260) |
$1,142.88 |
$2,381 |
5.1× |
| CT chest w/wo contrast (71270) |
$1,866.24 |
$3,888 |
8.3× |
| CT head/brain with contrast (70460) |
$915.84 |
$1,908 |
4.1× |
| CT head/brain without and with contrast (70470) |
$1,142.88 |
$2,381 |
5.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$542.40 |
$1,130 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$95.52 |
$199 |
0.9× |
| CT hrt w/3d image congen (75573) |
$542.40 |
$1,130 |
1.2× |
| CT iac w contrast (70481) |
$918.24 |
$1,913 |
4.1× |
| CT l-spine w&w/o contrast (72133) |
$1,515.84 |
$3,158 |
6.7× |
| CT lower ext w/o (73700) |
$803.52 |
$1,674 |
6.0× |
| CT lower extremity w/contrast material (73701) |
$1,351.20 |
$2,815 |
6.0× |
| CT lumbar spine w contrast (72132) |
$1,456.32 |
$3,034 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$955.68 |
$1,991 |
7.1× |
| CT maxillofacial w contrast (70487) |
$621.60 |
$1,295 |
2.8× |
| CT maxillofacial wo contrast (70486) |
$605.76 |
$1,262 |
4.5× |
| CT neck tissue combo (70492) |
$1,144.80 |
$2,385 |
5.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,310.40 |
$2,730 |
5.8× |
| CT orbits w/o contrast (70480) |
$767.52 |
$1,599 |
5.7× |
| CT pelvis w&w/o contrast (72194) |
$1,866.24 |
$3,888 |
8.3× |
| CT pelvis w/o contrast (72192) |
$954.72 |
$1,989 |
7.1× |
| CT scan of leg combo (73702) |
$1,717.44 |
$3,578 |
7.6× |
| CT scans face/jaw combo (70488) |
$711.36 |
$1,482 |
3.2× |
| CT soft tissue neck w contrast (70491) |
$918.24 |
$1,913 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$767.52 |
$1,599 |
5.7× |
| CT thoracic spine w contrast (72129) |
$1,551.36 |
$3,232 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$955.68 |
$1,991 |
7.1× |
| CT thoracic spine w/wo cont (72130) |
$1,605.60 |
$3,345 |
7.1× |
| CT thorax w/o contrast (71250) |
$955.68 |
$1,991 |
7.1× |
| CT unlisted procedure (76497) |
$417.60 |
$870 |
3.7× |
| CT upper ext wo (73200) |
$803.52 |
$1,674 |
6.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,554.72 |
$3,239 |
6.9× |
| CT upper extremity with contrast (73201) |
$1,384.32 |
$2,884 |
3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,398.72 |
$2,914 |
6.2× |
| Cta Abdomen (74175) |
$1,398.72 |
$2,914 |
6.2× |
| CTA pelvis (72191) |
$1,398.72 |
$2,914 |
6.2× |
| Diskography lumbar (72295) |
$2,397.60 |
$4,995 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$1,237.92 |
$2,579 |
9.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,237.92 |
$2,579 |
9.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$355.68 |
$741 |
2.6× |
| Dxa Bone Density Axial (77080) |
$552.96 |
$1,152 |
4.1× |
| Dxa bone density study (77085) |
$557.76 |
$1,162 |
4.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$294.72 |
$614 |
2.6× |
| Echo exam of fetal heart (76825) |
$1,237.92 |
$2,579 |
1.8× |
| Echo exam uterus (76831) |
$427.68 |
$891 |
1.4× |
| Echo Guide For Artery Repair (76936) |
$452.64 |
$943 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,224.48 |
$2,551 |
4.0× |
| Echograp Trans R Pros Study (76873) |
$1,081.92 |
$2,254 |
8.0× |
| Esophagram (74220) |
$492 |
$1,025 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$1,085.76 |
$2,262 |
8.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,085.76 |
$2,262 |
8.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$395.52 |
$824 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$915.84 |
$1,908 |
3.0× |
| Follow-Up Angiography (75898) |
$1,224.96 |
$2,552 |
0.3× |
| Foot 2 views (73620) |
$137.76 |
$287 |
1.2× |
| Forearm 2 views (73090) |
$145.92 |
$304 |
1.3× |
| Gastric emptying imaging study (78264) |
$1,629.60 |
$3,395 |
3.2× |
| Gastroesophageal Reflux Exam (78262) |
$1,087.20 |
$2,265 |
2.1× |
| Gated Heart Planar Single (78472) |
$3,522.24 |
$7,338 |
6.9× |
| Gated Heart, Multiple (78473) |
$3,522.24 |
$7,338 |
6.9× |
| Hand 2 views (73120) |
$137.76 |
$287 |
1.0× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$5,592 |
$11,650 |
6.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$4,661.28 |
$9,711 |
5.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$4,194.72 |
$8,739 |
4.7× |
| Heart first pass single,planar (78481) |
$788.64 |
$1,643 |
1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,658.40 |
$9,705 |
1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,658.40 |
$9,705 |
1.1× |
| Hepatobil Syst Image W/Drug (78227) |
$2,547.84 |
$5,308 |
3.6× |
| Hepatobiliary System Imaging (78226) |
$2,515.20 |
$5,240 |
4.9× |
| Ht Muscle Image Spect Sing (78451) |
$2,336.16 |
$4,867 |
1.4× |
| Hysterosalpingogram (74740) |
$359.04 |
$748 |
1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$794.40 |
$1,655 |
7.1× |
| Infant hip ultrasound, limited static exam (76886) |
$373.92 |
$779 |
3.3× |
| Interstitial radiation source applic complex (77778) |
$8,246.40 |
$17,180 |
9.2× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$6,025.44 |
$12,553 |
0.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$6,025.44 |
$12,553 |
0.6× |
| Joint Survey Single View (77077) |
$685.44 |
$1,428 |
5.1× |
| K Flow/Funct Image Multiple (78709) |
$2,046.24 |
$4,263 |
2.9× |
| K Flow/Funct Image W/Drug (78708) |
$2,046.24 |
$4,263 |
2.9× |
| K Flow/Funct Image W/O Drug (78707) |
$2,046.24 |
$4,263 |
2.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,088.64 |
$2,268 |
2.1× |
| Kidney Imaging Morphol (78700) |
$472.80 |
$985 |
0.9× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$1,860 |
$3,875 |
3.6× |
| Knee 3 Views (73562) |
$158.88 |
$331 |
1.4× |
| Leveen/Shunt Patency Exam (78291) |
$832.80 |
$1,735 |
1.6× |
| Liver & Spleen Imaging Static Only (78215) |
$673.44 |
$1,403 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,160.64 |
$2,418 |
2.3× |
| Liver imaging static only (78201) |
$896.16 |
$1,867 |
1.3× |
| Liver imaging w/vascular flow (78202) |
$896.16 |
$1,867 |
1.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$772.32 |
$1,609 |
1.1× |
| Lung perfusion differential (78597) |
$1,098.24 |
$2,288 |
2.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,098.24 |
$2,288 |
1.6× |
| Lung Ventilation Imaging (78579) |
$845.28 |
$1,761 |
1.6× |
| Lymph System Imaging (78195) |
$2,460.96 |
$5,127 |
3.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,337.92 |
$6,954 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,003.04 |
$4,173 |
0.5× |
| Magnetic Image Jaw Joint (70336) |
$2,493.12 |
$5,194 |
8.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$964.80 |
$2,010 |
4.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$580.80 |
$1,210 |
0.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$993.12 |
$2,069 |
4.4× |
| Mammary ductogram or galactogram single (77053) |
$1,031.52 |
$2,149 |
3.4× |
| Meckels Divert Exam (78290) |
$833.76 |
$1,737 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$831.84 |
$1,733 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$43.20 |
$90 |
1.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,570.08 |
$3,271 |
3.5× |
| MRA head w/o contrast (70544) |
$1,115.04 |
$2,323 |
3.6× |
| MRA head with contrast (70545) |
$2,157.60 |
$4,495 |
4.8× |
| MRA neck w contrast (70548) |
$1,024.32 |
$2,134 |
2.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,758.24 |
$3,663 |
3.9× |
| MRA neck w/o contrast (70547) |
$1,005.12 |
$2,094 |
3.3× |
| MRI abdomen w contrast (74182) |
$5,627.52 |
$11,724 |
12.5× |
| MRI abdomen w/o contrast (74181) |
$2,060.64 |
$4,293 |
6.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,419.20 |
$5,040 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,443.68 |
$5,091 |
5.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,563.20 |
$5,340 |
2.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,330.40 |
$4,855 |
7.6× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$2,200.80 |
$4,585 |
7.2× |
| MRI cardiac w/o contrast (75557) |
$1,441.44 |
$3,003 |
4.7× |
| MRI cervical spine w contrast (72142) |
$2,434.08 |
$5,071 |
5.4× |
| MRI cervical spine w/o cont (72141) |
$2,259.36 |
$4,707 |
7.4× |
| MRI chest w/o contrast (71550) |
$1,745.76 |
$3,637 |
5.7× |
| MRI chest with contrast (71551) |
$3,562.08 |
$7,421 |
3.5× |
| MRI chest wo w contrast (71552) |
$2,723.04 |
$5,673 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,576.64 |
$5,368 |
5.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,604 |
$5,425 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,523.84 |
$5,258 |
8.2× |
| MRI lumbar spine w contrast (72149) |
$2,490.72 |
$5,189 |
5.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,205.92 |
$6,679 |
7.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,483.68 |
$3,091 |
4.8× |
| MRI orbit face neck w contrast (70542) |
$2,649.60 |
$5,520 |
5.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,163.68 |
$6,591 |
7.1× |
| MRI pelvis w contrast (72196) |
$4,992.96 |
$10,402 |
11.1× |
| MRI pelvis w/o & w contrast (72197) |
$3,012.48 |
$6,276 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$2,396.16 |
$4,992 |
7.8× |
| MRI spectroscopy (76390) |
$1,465.44 |
$3,053 |
13.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,314.56 |
$4,822 |
7.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$4,472.64 |
$9,318 |
10.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,213.76 |
$4,612 |
7.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,604 |
$5,425 |
5.8× |
| MRI, abdomen, combo (74183) |
$3,006.72 |
$6,264 |
6.7× |
| MRI, dorsal spine combo (72157) |
$2,961.60 |
$6,170 |
6.6× |
| MRI, dorsal spine contrast (72147) |
$2,490.72 |
$5,189 |
5.6× |
| MRI, joint upper extrem (73221) |
$2,523.84 |
$5,258 |
8.2× |
| MRI, joint upper extrem combo (73223) |
$2,604 |
$5,425 |
5.8× |
| MRI, lumbar spine combo (72158) |
$2,978.40 |
$6,205 |
6.6× |
| Myelogram cervical (72240) |
$1,266.72 |
$2,639 |
1.3× |
| Myelogram Lumbar (72265) |
$1,266.72 |
$2,639 |
1.3× |
| Myelograpy 2/more regions rs&i (72270) |
$1,266.72 |
$2,639 |
1.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,051.84 |
$6,358 |
1.8× |
| N-invas est c ffr sw aly CTA (75580) |
$2,263.68 |
$4,716 |
2.0× |
| Neck soft tissue (70360) |
$80.16 |
$167 |
0.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$275.04 |
$573 |
0.5× |
| Nm csf leak detection (78650) |
$1,800.48 |
$3,751 |
1.1× |
| Nm whole blood volume (78122) |
$703.68 |
$1,466 |
1.0× |
| Nonvascular Shunt X-Ray (75809) |
$544.80 |
$1,135 |
4.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,262.72 |
$17,214 |
4.6× |
| Nuclear Rx Intra-Arterial (79445) |
$646.56 |
$1,347 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$1,931.04 |
$4,023 |
6.4× |
| Ob us nuchal meas 1 gest (76813) |
$547.68 |
$1,141 |
4.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$162.24 |
$338 |
1.2× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$2,117.28 |
$4,411 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$1,587.84 |
$3,308 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,628.64 |
$3,393 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$145.92 |
$304 |
1.1× |
| Peritoneogram Rs&I (74190) |
$1,377.12 |
$2,869 |
2.0× |
| Pet Image Skull-Thigh (78812) |
$3,145.44 |
$6,553 |
1.7× |
| Pet Image W/Ct Lmtd (78814) |
$3,718.08 |
$7,746 |
2.0× |
| PET image w/CT, full body (78816) |
$5,181.60 |
$10,795 |
2.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,102.40 |
$10,630 |
2.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,460 |
$5,125 |
1.5× |
| PET whole body (78813) |
$3,145.44 |
$6,553 |
1.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,981.12 |
$8,294 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$845.28 |
$1,761 |
1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$183.84 |
$383 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$274.56 |
$572 |
0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$147.84 |
$308 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$131.52 |
$274 |
1.2× |
| Radex elbow complete minimum 3 views (73080) |
$158.88 |
$331 |
1.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$219.36 |
$457 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$117.60 |
$245 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$147.84 |
$308 |
1.3× |
| Radex Hand Minimum 3 Views (73130) |
$147.84 |
$308 |
1.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$328.32 |
$684 |
2.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$625.44 |
$1,303 |
4.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$145.92 |
$304 |
1.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$159.36 |
$332 |
1.4× |
| Radex shoulder complete minimum 2 views (73030) |
$158.88 |
$331 |
1.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$172.32 |
$359 |
1.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$839.04 |
$1,748 |
3.7× |
| Radex Spine 1 View Specify Level (72020) |
$314.88 |
$656 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$180.96 |
$377 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$232.32 |
$484 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$117.60 |
$245 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$284.64 |
$593 |
2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$147.84 |
$308 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$792.48 |
$1,651 |
5.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$16,218.72 |
$33,789 |
1.7× |
| Radiation treatment delivery level 1 (77402) |
$844.80 |
$1,760 |
6.4× |
| Radiation treatment delivery level 2 (77407) |
$1,168.32 |
$2,434 |
2.4× |
| Radiation treatment delivery level 3 (77412) |
$1,480.32 |
$3,084 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$172.80 |
$360 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$183.84 |
$383 |
1.4× |
| Radiologic exam colon double contrast study (74280) |
$948.96 |
$1,977 |
4.2× |
| Radiologic exam colon single contrast study (74270) |
$720.48 |
$1,501 |
3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$614.88 |
$1,281 |
2.7× |
| Radiologic exam knee complete 4/more views (73564) |
$172.80 |
$360 |
1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$187.20 |
$390 |
1.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$244.32 |
$509 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$598.56 |
$1,247 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$710.40 |
$1,480 |
3.1× |
| Radiologic examination femur 1 view (73551) |
$306.24 |
$638 |
2.7× |
| Radiologic examination femur minimum 2 views (73552) |
$261.60 |
$545 |
2.3× |
| Radiologic examination knee 1/2 views (73560) |
$145.92 |
$304 |
1.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$569.28 |
$1,186 |
4.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$145.92 |
$304 |
1.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$522.24 |
$1,088 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$489.12 |
$1,019 |
1.0× |
| Ribs bilateral 3 views (71110) |
$220.32 |
$459 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,300.32 |
$2,709 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,468.80 |
$3,060 |
2.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,315.52 |
$4,824 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,315.52 |
$4,824 |
3.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,315.52 |
$4,824 |
3.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,315.52 |
$4,824 |
1.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,457.60 |
$5,120 |
1.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,315.52 |
$4,824 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$316.80 |
$660 |
1.1× |
| Scapula (73010) |
$145.92 |
$304 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.08 |
$96 |
2.0× |
| Shoulder 1 view (73020) |
$288.96 |
$602 |
2.6× |
| Shoulder Arthrography (73040) |
$545.76 |
$1,137 |
1.2× |
| Skull less than 4 views (70250) |
$172.80 |
$360 |
1.3× |
| Special dosimetry (77331) |
$1,151.04 |
$2,398 |
6.7× |
| Special Physics Consult (77370) |
$2,028.48 |
$4,226 |
11.7× |
| Special teletherapy port plan (77321) |
$3,399.84 |
$7,083 |
7.1× |
| Special treatment procedure (77470) |
$1,603.20 |
$3,340 |
2.3× |
| Stereotactic Body Radiation Delivery (77373) |
$2,551.20 |
$5,315 |
1.1× |
| Sternoclavicular joints (71130) |
$249.60 |
$520 |
2.2× |
| Superior sagittal sinus venogram (75870) |
$1,420.32 |
$2,959 |
0.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$5,576.16 |
$11,617 |
11.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$3,374.88 |
$7,031 |
7.0× |
| Testicular Imaging W/Flow (78761) |
$497.28 |
$1,036 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$4,032 |
$8,400 |
8.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$3,156.48 |
$6,576 |
6.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$2,950.56 |
$6,147 |
17.1× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$1,047.84 |
$2,183 |
4.6× |
| Thoracic spine 2 views (72070) |
$180.96 |
$377 |
1.3× |
| Thoracic spine 3 views (72072) |
$206.40 |
$430 |
1.5× |
| Thoracolumbar 2 views (72080) |
$187.20 |
$390 |
1.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$630.24 |
$1,313 |
1.2× |
| Thyroid Met Imaging Body (78018) |
$1,848 |
$3,850 |
2.6× |
| Thyroid Uptake Measurement (78012) |
$266.88 |
$556 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,730.40 |
$3,605 |
3.4× |
| Tx Devices Design & Construction Complex (77334) |
$1,151.04 |
$2,398 |
2.4× |
| Tx devices design & construction simple (77332) |
$450.72 |
$939 |
2.6× |
| Ultrasound Breast Limited (76642) |
$417.12 |
$869 |
3.7× |
| Ultrasound elastography first target lesion (76982) |
$239.52 |
$499 |
1.8× |
| Ultrasound Elastography Parenchyma (76981) |
$253.92 |
$529 |
1.9× |
| Ultrasound Exam Aaa Screen (76706) |
$303.36 |
$632 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$398.40 |
$830 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$315.36 |
$657 |
2.3× |
| Unlisted Dx Radiographic Procedure (76499) |
$145.92 |
$304 |
1.3× |
| Unlisted fluoroscopic procedure (76496) |
$2,128.32 |
$4,434 |
19.0× |
Unlisted magnetic resonance procedure (76498)
range across 3 matching MRF lines |
$156.96–$567.84 |
$327–$1,183 |
varies |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$563.52 |
$1,174 |
4.3× |
| Unlisted us procedure (76999) |
$805.44 |
$1,678 |
7.2× |
| Upper gi w/o kub (74240) |
$710.40 |
$1,480 |
3.1× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$271.20 |
$565 |
24.5× |
| Urethrocystogram voiding (74455) |
$725.28 |
$1,511 |
2.4× |
| Urethrocystography retrograde (74450) |
$683.04 |
$1,423 |
2.2× |
| Us breast unilateral complete (76641) |
$463.20 |
$965 |
3.4× |
| Us chest (76604) |
$365.76 |
$762 |
2.7× |
| Us complete joint (76881) |
$683.04 |
$1,423 |
5.1× |
| Us exam, pelvic, limited (76857) |
$295.68 |
$616 |
2.2× |
| Us head (76506) |
$904.80 |
$1,885 |
6.7× |
| Us kidney transplant (76776) |
$525.12 |
$1,094 |
3.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$96 |
$200 |
0.7× |
| Us ob detailed single fetus (76811) |
$1,174.08 |
$2,446 |
3.8× |
| Us ob limited 1 or more fetuses (76815) |
$381.12 |
$794 |
2.8× |
| Us ob transvaginal (76817) |
$501.12 |
$1,044 |
3.7× |
| Us pelvic non ob complete (76856) |
$430.08 |
$896 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$342.72 |
$714 |
2.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$558.72 |
$1,164 |
4.2× |
| Us retroperitoneal complete (76770) |
$553.44 |
$1,153 |
4.1× |
| Us retroperitoneal limited (76775) |
$398.40 |
$830 |
3.0× |
| Us scrotum and contents (76870) |
$386.40 |
$805 |
2.9× |
| Us spinal canal and contents (76800) |
$794.40 |
$1,655 |
5.9× |
| Us thyroid (76536) |
$398.40 |
$830 |
3.0× |
| Us transrectal (76872) |
$1,085.76 |
$2,262 |
8.1× |
| Vascular Flow Imaging (78445) |
$378.72 |
$789 |
0.7× |
| Vein X-Ray Chest (75827) |
$3,416.64 |
$7,118 |
1.7× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,844.48 |
$5,926 |
0.7× |
| Vein X-Ray Spleen/Liver (75810) |
$2,090.40 |
$4,355 |
0.5× |
| Venogram Sinus/Jugular (75860) |
$1,732.80 |
$3,610 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$3,759.36 |
$7,832 |
0.9× |
| Venography extremity bilateral rs&i (75822) |
$2,213.76 |
$4,612 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$1,916.16 |
$3,992 |
0.9× |
| Venography Renal Bilateral (75833) |
$3,261.60 |
$6,795 |
0.8× |
| Venography Renal Unilateral (75831) |
$2,770.08 |
$5,771 |
0.7× |
| Venous sampling by catheter (75893) |
$4,544.16 |
$9,467 |
0.6× |
| Wrist 2 views (73100) |
$137.76 |
$287 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$373.92 |
$779 |
3.3× |
| X-ray antegrade pyelogram tube (74425) |
$631.68 |
$1,316 |
1.4× |
| X-Ray Aorta Leg Arteries (75630) |
$3,423.36 |
$7,132 |
0.8× |
| X-Ray Bend Only L-S Spine (72120) |
$248.64 |
$518 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$145.92 |
$304 |
1.3× |
| X-Ray Exam Breast Specimen (76098) |
$665.76 |
$1,387 |
0.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$289.44 |
$603 |
2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$627.36 |
$1,307 |
4.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$709.92 |
$1,479 |
5.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$235.20 |
$490 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$343.20 |
$715 |
3.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$709.92 |
$1,479 |
5.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$323.04 |
$673 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$384.48 |
$801 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$763.68 |
$1,591 |
5.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$329.76 |
$687 |
2.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$167.52 |
$349 |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$315.36 |
$657 |
2.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$188.16 |
$392 |
1.4× |
| X-ray eye for foreign body (70030) |
$125.76 |
$262 |
1.1× |
| X-ray humerus (73060) |
$158.88 |
$331 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$407.04 |
$848 |
1.8× |
| X-ray IV pyelogram+tomography (74415) |
$1,118.40 |
$2,330 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$145.92 |
$304 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$243.84 |
$508 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$187.20 |
$390 |
1.4× |
| X-ray nose-rectum child f.b. (76010) |
$292.80 |
$610 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$249.60 |
$520 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$172.32 |
$359 |
1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$145.92 |
$304 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$158.88 |
$331 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219.36 |
$457 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$250.08 |
$521 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$254.40 |
$530 |
1.9× |
| X-Ray Tmj Unilat (70328) |
$137.76 |
$287 |
1.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$668.64 |
$1,393 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$220.32 |
$459 |
1.6× |
| X-Rays Bone Survey Complete (77075) |
$401.76 |
$837 |
3.0× |
| Xr c-spine 4 or 5 views (72050) |
$250.08 |
$521 |
1.9× |
| Xr facial bones less than 3 views (70140) |
$172.32 |
$359 |
1.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$364.32 |
$759 |
2.7× |
| Xr orbits complete 4 views (70200) |
$220.32 |
$459 |
1.6× |