| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,799 |
$7,598 |
2.3× |
| Abdomen 1 View (74018) |
$126.50 |
$253 |
1.2× |
| Abdomen 2 views (74019) |
$242 |
$484 |
1.9× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,135 |
$2,270 |
2.4× |
| Adrenal Cortex & Medulla Img (78075) |
$1,624 |
$3,248 |
1.0× |
| Angio internal mammary (75756) |
$3,639.50 |
$7,279 |
1.0× |
| Angio pulmonary bilat (75743) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,639.50 |
$7,279 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,759.50 |
$11,519 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,110 |
$8,220 |
1.1× |
| Ankle 2 views (73600) |
$74.50 |
$149 |
0.7× |
| Aortography thoracic serialography rs&i (75605) |
$9,937 |
$19,874 |
1.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$6,187.50 |
$12,375 |
1.6× |
| Artery X-Rays Abdomen (75726) |
$9,937 |
$19,874 |
1.5× |
| Artery X-Rays Adrenal Gland (75731) |
$4,110 |
$8,220 |
1.1× |
| Artery X-Rays Pelvis (75736) |
$9,937 |
$19,874 |
1.5× |
| Artery X-Rays Spine (75705) |
$6,226 |
$12,452 |
0.9× |
| Arthrogram ankle (73615) |
$667 |
$1,334 |
1.6× |
| Arthrogram hip (73525) |
$882.50 |
$1,765 |
2.1× |
| Arthrogram Wrist (73115) |
$940.50 |
$1,881 |
2.2× |
| Basic radiation dosimetry calculation (77300) |
$490.50 |
$981 |
3.0× |
| Bone age studies (77072) |
$119 |
$238 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$751.50 |
$1,503 |
1.6× |
| Bone Imaging Limited Area (78300) |
$525 |
$1,050 |
1.1× |
| Bone Imaging Multiple Areas (78305) |
$599.50 |
$1,199 |
1.3× |
| Bone Imaging Whole Body (78306) |
$751.50 |
$1,503 |
1.6× |
| Bone marrow imaging limited area (78102) |
$766 |
$1,532 |
1.6× |
| Bone marrow imaging; multiple areas (78103) |
$766 |
$1,532 |
1.6× |
| Bone marrow imaging; whole body (78104) |
$359.50 |
$719 |
0.8× |
| Bone survey infant (77076) |
$274 |
$548 |
2.2× |
| Brachytx isodose complex (77318) |
$738.50 |
$1,477 |
1.6× |
| Brachytx isodose intermed (77317) |
$738.50 |
$1,477 |
1.6× |
| Brachytx Isodose Plan Simple (77316) |
$607 |
$1,214 |
1.4× |
| Brain Image W/Flow < 4 Views (78601) |
$1,476.50 |
$2,953 |
3.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$868 |
$1,736 |
1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,670 |
$5,340 |
1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$912.50 |
$1,825 |
1.9× |
Cardiac MRI w/w/o contrast & further seq (75561)
range across 2 matching MRF lines |
$249.50–$1,444 |
$499–$2,888 |
varies |
| Cat Scan Follow-Up Study (76380) |
$506.50 |
$1,013 |
4.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$500.50 |
$1,001 |
0.8× |
| Cerebrospinal Fluid Scan (78630) |
$1,403.50 |
$2,807 |
2.2× |
| Chest 1 view (71045) |
$117 |
$234 |
1.1× |
| Chest 2 views (71046) |
$126.50 |
$253 |
1.2× |
| Chest 3 views (71047) |
$134 |
$268 |
1.3× |
| Chest 4 or more views (71048) |
$223.50 |
$447 |
1.8× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$208.50 |
$417 |
1.7× |
| Clavicle complete (73000) |
$93 |
$186 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$377.50 |
$755 |
3.0× |
| Continuing medical physics consltj pr wk (77336) |
$490.50 |
$981 |
3.0× |
| Contrast Exam Abdominl Aorta (75625) |
$5,759.50 |
$11,519 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$649.50 |
$1,299 |
1.6× |
| Contrast X-Ray Of Elbow (73085) |
$726.50 |
$1,453 |
1.7× |
| Contrast X-Ray Of Knee Joint (73580) |
$930.50 |
$1,861 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,158.50 |
$2,317 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$747 |
$1,494 |
2.6× |
| CT abdomen w contrast (74160) |
$865.50 |
$1,731 |
4.1× |
| CT abdomen w wo contrast (74170) |
$1,123.50 |
$2,247 |
5.3× |
| CT abdomen w/o contrast (74150) |
$791 |
$1,582 |
6.3× |
| CT Angio Abdomen and Pelvis (74174) |
$1,409 |
$2,818 |
3.4× |
| CT Angio Chest (71275) |
$869.50 |
$1,739 |
4.1× |
| CT Angio Head (70496) |
$726 |
$1,452 |
3.5× |
CT angio hrt w/3d image (75574)
range across 2 matching MRF lines |
$535.50–$586 |
$1,071–$1,172 |
varies |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$642 |
$1,284 |
3.1× |
| CT Angio Neck (70498) |
$631.50 |
$1,263 |
3.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$734.50 |
$1,469 |
3.5× |
| CT cervical spine w/ contrast (72126) |
$849.50 |
$1,699 |
2.0× |
| CT cervical spine w/o contrast (72125) |
$742 |
$1,484 |
5.9× |
| CT cervical spine w/wo cont (72127) |
$1,222.50 |
$2,445 |
5.8× |
| CT chest w contrast (71260) |
$886.50 |
$1,773 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,082 |
$2,164 |
5.1× |
| CT head/brain with contrast (70460) |
$727.50 |
$1,455 |
3.5× |
| CT head/brain without and with contrast (70470) |
$882 |
$1,764 |
4.2× |
CT heart contrast eval cardiac structure&morph (75572)
range across 2 matching MRF lines |
$476–$535.50 |
$952–$1,071 |
varies |
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines |
$56–$94 |
$112–$188 |
varies |
CT hrt w/3d image congen (75573)
range across 2 matching MRF lines |
$535.50–$555 |
$1,071–$1,110 |
varies |
| CT iac w contrast (70481) |
$422.50 |
$845 |
2.0× |
| CT l-spine w&w/o contrast (72133) |
$752 |
$1,504 |
3.6× |
| CT lower ext w/o (73700) |
$528.50 |
$1,057 |
4.2× |
| CT lower extremity w/contrast material (73701) |
$538.50 |
$1,077 |
2.6× |
| CT lumbar spine w contrast (72132) |
$779 |
$1,558 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$376 |
$752 |
3.0× |
| CT maxillofacial w contrast (70487) |
$721.50 |
$1,443 |
3.4× |
| CT maxillofacial wo contrast (70486) |
$655 |
$1,310 |
5.2× |
| CT neck tissue combo (70492) |
$958 |
$1,916 |
4.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$884 |
$1,768 |
4.2× |
| CT orbits w/o contrast (70480) |
$358.50 |
$717 |
2.9× |
| CT pelvis w&w/o contrast (72194) |
$1,038.50 |
$2,077 |
4.9× |
| CT pelvis w/o contrast (72192) |
$747 |
$1,494 |
6.0× |
| CT scan of leg combo (73702) |
$1,039 |
$2,078 |
4.9× |
| CT scans face/jaw combo (70488) |
$632 |
$1,264 |
3.0× |
| CT soft tissue neck w contrast (70491) |
$809 |
$1,618 |
3.8× |
| CT soft tissue neck w/o contrast (70490) |
$377.50 |
$755 |
3.0× |
| CT thoracic spine w contrast (72129) |
$566 |
$1,132 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$496 |
$992 |
4.0× |
| CT thoracic spine w/wo cont (72130) |
$1,211.50 |
$2,423 |
5.8× |
| CT thorax w/o contrast (71250) |
$758 |
$1,516 |
6.0× |
| CT unlisted procedure (76497) |
$114.50 |
$229 |
1.1× |
| CT upper ext wo (73200) |
$523.50 |
$1,047 |
4.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,070.50 |
$2,141 |
5.1× |
| CT upper extremity with contrast (73201) |
$758 |
$1,516 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$940 |
$1,880 |
4.5× |
| Cta Abdomen (74175) |
$739.50 |
$1,479 |
3.5× |
| CTA pelvis (72191) |
$693 |
$1,386 |
3.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,866 |
$3,732 |
0.7× |
| Discography Cerv/Thor Spine (72285) |
$2,351 |
$4,702 |
1.0× |
| Diskography lumbar (72295) |
$2,351 |
$4,702 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$80 |
$160 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$315.50 |
$631 |
2.5× |
| Dxa Bone Density Axial (77080) |
$314 |
$628 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$62.50 |
$125 |
0.6× |
| Echo exam uterus (76831) |
$549 |
$1,098 |
1.9× |
| Echo Guide For Artery Repair (76936) |
$581.50 |
$1,163 |
2.2× |
| Echograp Trans R Pros Study (76873) |
$149 |
$298 |
1.2× |
| Esophagram (74220) |
$535.50 |
$1,071 |
2.5× |
| Fetal Biophys Profile W/Nst (76818) |
$240 |
$480 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$195.50 |
$391 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$544.50 |
$1,089 |
1.9× |
| Follow-Up Angiography (75898) |
$2,046 |
$4,092 |
0.5× |
| Foot 2 views (73620) |
$86 |
$172 |
0.8× |
| Forearm 2 views (73090) |
$123 |
$246 |
1.2× |
| Gastric emptying imaging study (78264) |
$751.50 |
$1,503 |
1.6× |
| Gastroesophageal Reflux Exam (78262) |
$569.50 |
$1,139 |
1.2× |
| Gated Heart Planar Single (78472) |
$865.50 |
$1,731 |
1.8× |
| Hand 2 views (73120) |
$167 |
$334 |
1.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$1,444.50 |
$2,889 |
1.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$1,555 |
$3,110 |
1.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,555 |
$3,110 |
1.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,759.50 |
$11,519 |
1.5× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,639.50 |
$7,279 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$975.50 |
$1,951 |
1.5× |
| Hepatobiliary System Imaging (78226) |
$755.50 |
$1,511 |
1.6× |
| Ht Musc Image Planar Mult (78454) |
$2,129.50 |
$4,259 |
1.4× |
| Ht Muscle Image Spect Sing (78451) |
$2,462.50 |
$4,925 |
1.6× |
| Hysterosalpingogram (74740) |
$925.50 |
$1,851 |
3.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$224.50 |
$449 |
2.2× |
| Infant hip ultrasound, limited static exam (76886) |
$224.50 |
$449 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$2,120.50 |
$4,241 |
2.5× |
| K Flow/Funct Image W/Drug (78708) |
$975.50 |
$1,951 |
1.5× |
| K Flow/Funct Image W/O Drug (78707) |
$975.50 |
$1,951 |
1.5× |
| Kidney Imaging Morphol (78700) |
$705.50 |
$1,411 |
1.5× |
| Knee 3 Views (73562) |
$126.50 |
$253 |
1.2× |
| Leveen/Shunt Patency Exam (78291) |
$521 |
$1,042 |
1.1× |
| Liver & Spleen Imaging Static Only (78215) |
$658 |
$1,316 |
1.4× |
| Liver imaging static only (78201) |
$1,216.50 |
$2,433 |
1.9× |
| Lung Perf&Ventilat Diferentl (78598) |
$818.50 |
$1,637 |
1.3× |
| Lung perfusion differential (78597) |
$492.50 |
$985 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$975.50 |
$1,951 |
1.5× |
| Lung Ventilation Imaging (78579) |
$807.50 |
$1,615 |
1.7× |
| Lymph System Imaging (78195) |
$975.50 |
$1,951 |
1.5× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$2,888.50 |
$5,777 |
1.5× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,124 |
$2,248 |
1.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,791.50 |
$9,583 |
1.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,889 |
$3,778 |
0.5× |
| Magnetic Image Jaw Joint (70336) |
$1,413.50 |
$2,827 |
4.9× |
| Magnetic Resonance Elastography (76391) |
$460 |
$920 |
1.6× |
| Mammary ductogram or galactogram multiple (77054) |
$229 |
$458 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$374.50 |
$749 |
1.3× |
| Meckels Divert Exam (78290) |
$487.50 |
$975 |
1.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$796 |
$1,592 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$693.50 |
$1,387 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,244.50 |
$2,489 |
3.0× |
| MRA head w/o contrast (70544) |
$1,244.50 |
$2,489 |
4.4× |
| MRA head with contrast (70545) |
$1,244.50 |
$2,489 |
3.0× |
| MRA neck w contrast (70548) |
$1,348 |
$2,696 |
3.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,383.50 |
$2,767 |
3.3× |
| MRA neck w/o contrast (70547) |
$1,191 |
$2,382 |
4.2× |
| MRI abdomen w contrast (74182) |
$2,774 |
$5,548 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,287 |
$2,574 |
4.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,648 |
$3,296 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,691.50 |
$3,383 |
4.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,717 |
$3,434 |
1.8× |
| MRI bone marrow blood supply (77084) |
$1,313.50 |
$2,627 |
4.6× |
| MRI Breast W/O Contrast Bilateral (77047) |
$460 |
$920 |
1.6× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$460 |
$920 |
1.6× |
MRI cardiac w/o contrast (75557)
range across 2 matching MRF lines |
$216.50–$1,213.50 |
$433–$2,427 |
varies |
| MRI cervical spine w contrast (72142) |
$1,661.50 |
$3,323 |
4.0× |
| MRI cervical spine w/o cont (72141) |
$1,155 |
$2,310 |
4.0× |
| MRI chest w/o contrast (71550) |
$1,080.50 |
$2,161 |
3.8× |
| MRI chest with contrast (71551) |
$1,708 |
$3,416 |
1.8× |
| MRI chest wo w contrast (71552) |
$844.50 |
$1,689 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,308.50 |
$2,617 |
3.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,670.50 |
$3,341 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,548 |
$3,096 |
5.4× |
| MRI lumbar spine w contrast (72149) |
$1,444.50 |
$2,889 |
3.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,705.50 |
$3,411 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,774 |
$5,548 |
9.7× |
| MRI orbit face neck w contrast (70542) |
$1,479.50 |
$2,959 |
3.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$924 |
$1,848 |
2.2× |
| MRI pelvis w contrast (72196) |
$1,556 |
$3,112 |
3.7× |
| MRI pelvis w/o & w contrast (72197) |
$1,503 |
$3,006 |
3.6× |
| MRI pelvis w/o contrast (72195) |
$1,224 |
$2,448 |
4.3× |
| MRI spectroscopy (76390) |
$1,211 |
$2,422 |
11.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,213.50 |
$2,427 |
4.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,603 |
$3,206 |
3.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,577 |
$3,154 |
5.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,717 |
$3,434 |
4.1× |
| MRI, abdomen, combo (74183) |
$1,473 |
$2,946 |
3.5× |
| MRI, dorsal spine combo (72157) |
$1,546.50 |
$3,093 |
3.7× |
| MRI, dorsal spine contrast (72147) |
$1,552.50 |
$3,105 |
3.7× |
| MRI, joint upper extrem (73221) |
$1,659.50 |
$3,319 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$1,670.50 |
$3,341 |
4.0× |
| MRI, lumbar spine combo (72158) |
$1,736.50 |
$3,473 |
4.2× |
| Myelogram cervical (72240) |
$807 |
$1,614 |
0.9× |
| Myelogram Lumbar (72265) |
$961 |
$1,922 |
1.0× |
| Myelography thoracic (72255) |
$995.50 |
$1,991 |
1.1× |
| Myelograpy 2/more regions rs&i (72270) |
$995.50 |
$1,991 |
1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,129.50 |
$4,259 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,462.50 |
$4,925 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,812.50 |
$3,625 |
1.8× |
| Neck soft tissue (70360) |
$126.50 |
$253 |
1.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$670 |
$1,340 |
1.4× |
| Nm csf leak detection (78650) |
$1,755.50 |
$3,511 |
1.1× |
| Nonvascular Shunt X-Ray (75809) |
$224 |
$448 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,799 |
$7,598 |
2.3× |
| Nuclear Rx Intra-Arterial (79445) |
$442.50 |
$885 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$427 |
$854 |
1.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$185 |
$370 |
1.5× |
| Panoramic X-ray of jaws (70355) |
$132 |
$264 |
1.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,036.50 |
$2,073 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$860 |
$1,720 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$741 |
$1,482 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$156.50 |
$313 |
1.2× |
| Peritoneogram Rs&I (74190) |
$973 |
$1,946 |
1.5× |
| Pet Image W/Ct Lmtd (78814) |
$2,831.50 |
$5,663 |
1.7× |
| PET image w/CT, full body (78816) |
$4,207 |
$8,414 |
2.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,769.50 |
$7,539 |
2.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,203 |
$8,406 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$751.50 |
$1,503 |
1.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$220 |
$440 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,064.50 |
$2,129 |
1.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$71 |
$142 |
0.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$127.50 |
$255 |
1.2× |
| Radex elbow complete minimum 3 views (73080) |
$70.50 |
$141 |
0.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$137.50 |
$275 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$70.50 |
$141 |
0.7× |
| Radex foot complete minimum 3 views (73630) |
$90 |
$180 |
0.9× |
| Radex Hand Minimum 3 Views (73130) |
$128.50 |
$257 |
1.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$126 |
$252 |
1.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$161 |
$322 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$174.50 |
$349 |
1.7× |
| Radex shoulder complete minimum 2 views (73030) |
$76 |
$152 |
0.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$179 |
$358 |
1.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$645 |
$1,290 |
3.1× |
| Radex Spine 1 View Specify Level (72020) |
$137 |
$274 |
1.3× |
| Radex Sternum Minimum 2 Views (71120) |
$195.50 |
$391 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$391 |
$782 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$105 |
$210 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$201 |
$402 |
1.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$132 |
$264 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$413 |
$826 |
3.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$14,413 |
$28,826 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$218.50 |
$437 |
1.8× |
| Radiation treatment delivery level 2 (77407) |
$423.50 |
$847 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$454 |
$908 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$267 |
$534 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$223.50 |
$447 |
1.8× |
| Radiologic exam colon double contrast study (74280) |
$959.50 |
$1,919 |
4.6× |
| Radiologic exam colon single contrast study (74270) |
$585 |
$1,170 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$337.50 |
$675 |
1.6× |
| Radiologic exam knee complete 4/more views (73564) |
$142 |
$284 |
1.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$207.50 |
$415 |
1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$1,610 |
$3,220 |
7.7× |
| Radiologic exam swallow function contrast study (74230) |
$477 |
$954 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$472.50 |
$945 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$116.50 |
$233 |
1.1× |
| Radiologic examination femur minimum 2 views (73552) |
$132 |
$264 |
1.3× |
| Radiologic examination knee 1/2 views (73560) |
$116.50 |
$233 |
1.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$274 |
$548 |
2.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$143 |
$286 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$108.50 |
$217 |
1.0× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$132 |
$264 |
1.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$508 |
$1,016 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$405.50 |
$811 |
0.9× |
| Renal Cyst Study (74470) |
$296 |
$592 |
0.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$751.50 |
$1,503 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,592.50 |
$3,185 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,566 |
$5,132 |
3.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,566 |
$5,132 |
3.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,358 |
$4,716 |
1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,675 |
$5,350 |
1.6× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,358 |
$4,716 |
1.5× |
| Salivary Gland Imaging Serial Images (78231) |
$430.50 |
$861 |
0.9× |
| Scapula (73010) |
$167 |
$334 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$110.50 |
$221 |
4.7× |
| Sella turcica (70240) |
$143 |
$286 |
1.4× |
| Shoulder 1 view (73020) |
$139.50 |
$279 |
1.3× |
| Shoulder Arthrography (73040) |
$923 |
$1,846 |
2.2× |
| Sialogram (70390) |
$293 |
$586 |
1.0× |
| Skull less than 4 views (70250) |
$192 |
$384 |
1.5× |
| Special dosimetry (77331) |
$490.50 |
$981 |
3.0× |
| Special Physics Consult (77370) |
$490.50 |
$981 |
3.0× |
| Special teletherapy port plan (77321) |
$1,088 |
$2,176 |
2.4× |
| Special treatment procedure (77470) |
$1,592 |
$3,184 |
2.4× |
| Spleen Imaging (78185) |
$530.50 |
$1,061 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$8,571 |
$17,142 |
4.0× |
| Sternoclavicular joints (71130) |
$136.50 |
$273 |
1.3× |
| Superior sagittal sinus venogram (75870) |
$2,417.50 |
$4,835 |
0.6× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$135.50 |
$271 |
1.3× |
| Tbs technical calculation only (77091) |
$135.50 |
$271 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$607 |
$1,214 |
1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$607 |
$1,214 |
1.4× |
| Testicular Imaging W/Flow (78761) |
$461.50 |
$923 |
1.0× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,088 |
$2,176 |
2.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,009.50 |
$2,019 |
2.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$490.50 |
$981 |
3.0× |
| Thoracic spine 2 views (72070) |
$137.50 |
$275 |
1.1× |
| Thoracic spine 3 views (72072) |
$154.50 |
$309 |
1.2× |
| Thoracolumbar 2 views (72080) |
$195 |
$390 |
1.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$751.50 |
$1,503 |
1.6× |
| Thyroid Met Imaging Body (78018) |
$975.50 |
$1,951 |
1.5× |
| Thyroid Uptake Measurement (78012) |
$510.50 |
$1,021 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$751.50 |
$1,503 |
1.6× |
| Tx Devices Design & Construction Complex (77334) |
$802.50 |
$1,605 |
1.8× |
| Tx devices design & construction intermediate (77333) |
$745 |
$1,490 |
4.6× |
| Tx devices design & construction simple (77332) |
$802.50 |
$1,605 |
5.0× |
| Ultrasound Breast Limited (76642) |
$192.50 |
$385 |
1.8× |
| Ultrasound Exam Aaa Screen (76706) |
$142.50 |
$285 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$186.50 |
$373 |
1.5× |
| Umbilical-artery Doppler (OB) (76820) |
$158.50 |
$317 |
1.3× |
| Unlisted fluoroscopic procedure (76496) |
$116.50 |
$233 |
1.1× |
| Unlisted magnetic resonance procedure (76498) |
$137 |
$274 |
1.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$845.50 |
$1,691 |
6.9× |
| Upper gi w/o kub (74240) |
$500.50 |
$1,001 |
2.4× |
| Urethrocystogram voiding (74455) |
$416 |
$832 |
1.5× |
| Urethrocystography retrograde (74450) |
$416 |
$832 |
1.5× |
| Us breast unilateral complete (76641) |
$210 |
$420 |
1.7× |
| Us chest (76604) |
$228 |
$456 |
1.8× |
| Us complete joint (76881) |
$218.50 |
$437 |
1.7× |
| Us exam, pelvic, limited (76857) |
$181 |
$362 |
1.4× |
| Us head (76506) |
$236.50 |
$473 |
1.9× |
| Us kidney transplant (76776) |
$224 |
$448 |
1.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$138 |
$276 |
1.1× |
| Us ob detailed single fetus (76811) |
$396 |
$792 |
1.4× |
| Us ob limited 1 or more fetuses (76815) |
$165.50 |
$331 |
1.3× |
| Us ob transvaginal (76817) |
$193.50 |
$387 |
1.5× |
| Us pelvic non ob complete (76856) |
$197 |
$394 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$158 |
$316 |
1.3× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$327.50 |
$655 |
2.6× |
| Us retroperitoneal complete (76770) |
$201 |
$402 |
1.6× |
| Us retroperitoneal limited (76775) |
$188.50 |
$377 |
1.5× |
| Us scrotum and contents (76870) |
$249.50 |
$499 |
2.0× |
| Us spinal canal and contents (76800) |
$325 |
$650 |
2.6× |
| Us thyroid (76536) |
$242.50 |
$485 |
1.9× |
| Us transrectal (76872) |
$219 |
$438 |
1.7× |
| Vein X-Ray Chest (75827) |
$2,876.50 |
$5,753 |
1.5× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$4,110 |
$8,220 |
1.1× |
| Vein X-Ray Skull Epidural (75872) |
$2,417.50 |
$4,835 |
3.2× |
| Vein X-Ray Spleen/Liver (75810) |
$4,203 |
$8,406 |
1.1× |
| Venogram Sinus/Jugular (75860) |
$3,639.50 |
$7,279 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$5,759.50 |
$11,519 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$5,759.50 |
$11,519 |
1.5× |
| Venography extremity bilateral rs&i (75822) |
$2,876.50 |
$5,753 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$2,876.50 |
$5,753 |
1.5× |
| Venography Orbital Rs&I (75880) |
$894.50 |
$1,789 |
1.2× |
| Venography Renal Bilateral (75833) |
$5,759.50 |
$11,519 |
1.5× |
| Venography Renal Unilateral (75831) |
$5,759.50 |
$11,519 |
1.5× |
| Venous sampling by catheter (75893) |
$6,226 |
$12,452 |
0.9× |
| Wrist 2 views (73100) |
$104 |
$208 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$176.50 |
$353 |
1.7× |
| X-ray antegrade pyelogram tube (74425) |
$1,544.50 |
$3,089 |
3.7× |
| X-Ray Aorta Leg Arteries (75630) |
$4,110 |
$8,220 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$224 |
$448 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$93.50 |
$187 |
0.9× |
| X-Ray Exam Breast Specimen (76098) |
$973 |
$1,946 |
1.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$132 |
$264 |
1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$210 |
$420 |
1.7× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$413 |
$826 |
3.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$121.50 |
$243 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$121.50 |
$243 |
1.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$210 |
$420 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$210 |
$420 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$413 |
$826 |
3.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$328.50 |
$657 |
2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$161.50 |
$323 |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$195 |
$390 |
1.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$264 |
$528 |
2.1× |
| X-ray eye for foreign body (70030) |
$148 |
$296 |
1.4× |
| X-ray humerus (73060) |
$97 |
$194 |
0.9× |
| X-ray IV pyelogram (ivp) (74400) |
$327 |
$654 |
1.6× |
| X-ray IV pyelogram+tomography (74415) |
$1,134.50 |
$2,269 |
5.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$325 |
$650 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$215.50 |
$431 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$128 |
$256 |
1.0× |
| X-ray nose-rectum child f.b. (76010) |
$186 |
$372 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$306.50 |
$613 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$242 |
$484 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$183 |
$366 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$242.50 |
$485 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$229 |
$458 |
1.8× |
| X-Ray Stress View (77071) |
$143 |
$286 |
1.4× |
| X-ray thoracic spine 4 vw (72074) |
$167 |
$334 |
1.3× |
| X-Ray Tmj Unilat (70328) |
$132 |
$264 |
1.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$649.50 |
$1,299 |
1.6× |
| X-Rays Bone Length Studies (77073) |
$274 |
$548 |
2.2× |
| X-Rays Bone Survey Complete (77075) |
$274 |
$548 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$164 |
$328 |
1.3× |
| Xr facial bones less than 3 views (70140) |
$183 |
$366 |
1.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$209.50 |
$419 |
1.7× |
| Xr orbits complete 4 views (70200) |
$179 |
$358 |
1.4× |