| 3-D radiotherapy plan dose-volume histograms (77295) |
$885 |
$3,540 |
0.6× |
| Abdomen 2 views (74019) |
$262.25 |
$1,049 |
2.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$711.50 |
$2,846 |
1.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,653.50 |
$18,614 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,805.75 |
$11,223 |
0.9× |
| Angiography Spinal Selective Rs&I (75705) |
$4,653.50 |
$18,614 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,653.50 |
$18,614 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,107.25 |
$4,429 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,135.25 |
$4,541 |
0.4× |
| Ankle 2 views (73600) |
$120 |
$480 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$386.50 |
$1,546 |
1.1× |
| Aortogram thoracic (75605) |
$4,653.50 |
$18,614 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,805.75 |
$11,223 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,805.75 |
$11,223 |
0.9× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,805.75 |
$11,223 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$850 |
$3,400 |
0.3× |
| Arthrogram elbow (73085) |
$386.50 |
$1,546 |
1.1× |
| Arthrogram hip (73525) |
$386.50 |
$1,546 |
1.1× |
| Arthrogram shoulder (73040) |
$386.50 |
$1,546 |
1.1× |
| Arthrogram wrist (73115) |
$392.75 |
$1,571 |
1.1× |
| Arthrography knee lt (73580) |
$635.25 |
$2,541 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$222.50 |
$890 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$209.75 |
$839 |
0.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$475.75 |
$1,903 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$637.25 |
$2,549 |
1.6× |
| Bone age studies (77072) |
$117 |
$468 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$677.75 |
$2,711 |
1.7× |
| Bone Marrow Imaging Limited Area (78102) |
$345.25 |
$1,381 |
0.9× |
| Bone survey complete (77075) |
$137.25 |
$549 |
1.3× |
| Brain imaging < 4 static views w vascular flow (78601) |
$201.75 |
$807 |
0.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$251.25 |
$1,005 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,623 |
$6,492 |
1.1× |
| Brain Imaging Vascular Flow Only (78610) |
$301 |
$1,204 |
0.6× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$57.50 |
$230 |
5.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$471.75 |
$1,887 |
1.3× |
| Cardiac shunt detection (78428) |
$311.50 |
$1,246 |
0.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$332.75 |
$1,331 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$250.25 |
$1,001 |
2.9× |
| Chest 1 view (71045) |
$168 |
$672 |
1.9× |
| Chest 3 views (71047) |
$276.25 |
$1,105 |
3.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$276.50 |
$1,106 |
1.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$689.25 |
$2,757 |
0.9× |
| Clavicle complete (73000) |
$166.75 |
$667 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$104.50 |
$418 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$105.50 |
$422 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,160 |
$8,640 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,857.25 |
$7,429 |
7.7× |
| CT abdomen w contrast (74160) |
$1,269 |
$5,076 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,503.75 |
$6,015 |
8.5× |
| CT abdomen w/o contrast (74150) |
$1,113.50 |
$4,454 |
10.6× |
| CT angio hrt w/3d image (75574) |
$1,383.75 |
$5,535 |
3.9× |
| CT angiography upper extremity lt (73206) |
$1,137.50 |
$4,550 |
6.5× |
| CT c-spine w/o contrast (72125) |
$1,261.25 |
$5,045 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,493.75 |
$5,975 |
8.5× |
| CT cervical spine with contrast (72126) |
$1,106 |
$4,424 |
3.2× |
| CT chest w/wo contrast (71270) |
$1,650.75 |
$6,603 |
9.4× |
| CT chest with contrast (71260) |
$1,428.25 |
$5,713 |
8.1× |
| CT colonography screening (74263) |
$768.75 |
$3,075 |
3.2× |
| CT colonography w/dye (74262) |
$803.25 |
$3,213 |
4.6× |
| CT colonography w/o cntrst (74261) |
$890.50 |
$3,562 |
8.5× |
| CT head/brain with contrast (70460) |
$1,077.25 |
$4,309 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,276 |
$5,104 |
7.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,079.50 |
$4,318 |
3.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$854.50 |
$3,418 |
9.8× |
| CT hrt w/3d image congen (75573) |
$1,105.50 |
$4,422 |
3.2× |
| CT iac w contrast (70481) |
$851.25 |
$3,405 |
4.8× |
| CT limited/localized follow up study (76380) |
$112.75 |
$451 |
1.3× |
| CT lower ext w/o (73700) |
$643.75 |
$2,575 |
6.1× |
| CT lower extremity w wo contrast (73702) |
$804.75 |
$3,219 |
4.6× |
| CT lower extremity with contrast (73701) |
$679.25 |
$2,717 |
3.9× |
| CT lumbar spine w & w/o contrast (72133) |
$773.25 |
$3,093 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$572.75 |
$2,291 |
5.5× |
| CT lumbar spine with contrast (72132) |
$652.75 |
$2,611 |
1.9× |
| CT maxillofacial w contrast (70487) |
$851.25 |
$3,405 |
4.8× |
| CT maxillofacial w/o contrast (70486) |
$746.50 |
$2,986 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,008 |
$4,032 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$675.75 |
$2,703 |
3.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,008 |
$4,032 |
5.7× |
| CT orbits w/o contrast (70480) |
$746.50 |
$2,986 |
7.1× |
| CT pelvis w & w/o contrast (72194) |
$757.50 |
$3,030 |
4.3× |
| CT pelvis w/o contrast (72192) |
$561 |
$2,244 |
5.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$706.50 |
$2,826 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$523.25 |
$2,093 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$1,004.75 |
$4,019 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$881.25 |
$3,525 |
8.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,190 |
$4,760 |
6.8× |
| CT thorax w/o contrast (71250) |
$940.50 |
$3,762 |
9.0× |
| CT unlisted procedure (76497) |
$169.25 |
$677 |
1.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,104.75 |
$4,419 |
6.3× |
| CT upper extremity w/o contrast rt (73200) |
$884 |
$3,536 |
8.4× |
| CT upper extremity with contrast (73201) |
$932.75 |
$3,731 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,316.50 |
$5,266 |
7.5× |
| Cta Abdomen (74175) |
$1,432.50 |
$5,730 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,494.75 |
$9,979 |
7.1× |
| CTA chest (71275) |
$1,393.50 |
$5,574 |
7.9× |
| Cta Head (70496) |
$702 |
$2,808 |
4.0× |
| CTA lwr ext w&w/o contrast (73706) |
$766.75 |
$3,067 |
4.4× |
| Cta Neck (70498) |
$673.50 |
$2,694 |
3.8× |
| Cta Pelvis (72191) |
$608 |
$2,432 |
3.5× |
| Cystography minimum 3 views rs&i (74430) |
$386.50 |
$1,546 |
1.1× |
| Diskography lumbar (72295) |
$1,243.75 |
$4,975 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$113.25 |
$453 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$113.25 |
$453 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$122.50 |
$490 |
1.2× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$206.50 |
$826 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$90 |
$360 |
0.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$53.50 |
$214 |
0.6× |
| Dxa bone density study axial skeleton (77085) |
$134.25 |
$537 |
1.3× |
| Echo exam of fetal heart (76825) |
$378 |
$1,512 |
0.7× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$189.75 |
$759 |
0.8× |
| Echoencephalography real time imaging (76506) |
$169.88 |
$679.50 |
1.6× |
| Esophageal motility (78258) |
$452.50 |
$1,810 |
1.1× |
| Esophagus (74220) |
$184.25 |
$737 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$153.25 |
$613 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$125 |
$500 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$270.38 |
$1,081.50 |
1.1× |
| Foot 2 views (73620) |
$80.75 |
$323 |
0.9× |
| Forearm 2 views (73090) |
$127.25 |
$509 |
1.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$235.75 |
$943 |
1.0× |
| Functional MRI brain by phys/psych (70555) |
$842.75 |
$3,371 |
3.5× |
| Functional MRI brain by tech (70554) |
$782 |
$3,128 |
3.3× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$605.25 |
$2,421 |
1.1× |
| Gated Heart Planar Single (78472) |
$597.50 |
$2,390 |
1.5× |
| Hand 2 views (73120) |
$113.25 |
$453 |
1.1× |
| Hand 3 views (73130) |
$80.75 |
$323 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,805.75 |
$11,223 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$834.75 |
$3,339 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$602.25 |
$2,409 |
1.5× |
| Ht muscle image spect sing (78451) |
$1,455.50 |
$5,822 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$161.75 |
$647 |
1.9× |
| Hysterosalpingogram (74740) |
$235.75 |
$943 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$811.50 |
$3,246 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$113.25 |
$453 |
1.1× |
| Kidney funcj study non-img radioisotopic study (78725) |
$440 |
$1,760 |
1.1× |
| Kidney imaging morphology (78700) |
$457 |
$1,828 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$777.50 |
$3,110 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$452.25 |
$1,809 |
0.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$441.25 |
$1,765 |
0.8× |
| Knee 3 views (73562) |
$232.75 |
$931 |
2.7× |
| Liver & spleen imaging static only (78215) |
$341.75 |
$1,367 |
0.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$249 |
$996 |
0.6× |
| Liver imaging static only (78201) |
$386.50 |
$1,546 |
0.7× |
| Lung perf&ventilat diferentl (78598) |
$685.25 |
$2,741 |
1.3× |
| Lung perfusion differential (78597) |
$495.25 |
$1,981 |
1.2× |
| Lung Ventilation Imaging (78579) |
$287 |
$1,148 |
0.7× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$2,805.75 |
$11,223 |
0.9× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$638.25 |
$2,553 |
1.0× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$1,107.25 |
$4,429 |
0.7× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,107.25 |
$4,429 |
0.3× |
| Lymphoscintigraphy (78195) |
$344.50 |
$1,378 |
0.6× |
| Mammary ductogram or galactogram multiple (77054) |
$235.75 |
$943 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$235.75 |
$943 |
1.0× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$80.75 |
$323 |
0.9× |
| Meckels Diverticulum (78290) |
$491.25 |
$1,965 |
1.2× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$907.75 |
$3,631 |
2.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$415.75 |
$1,663 |
1.1× |
| Mr elastography (76391) |
$275 |
$1,100 |
1.1× |
| Mr safety determination physician/other qhp (76016) |
$112.50 |
$450 |
1.3× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$75 |
$300 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$31.25 |
$125 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$115 |
$460 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$212.50 |
$850 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,291.50 |
$5,166 |
3.7× |
| MRA head w/o contrast (70544) |
$1,225.25 |
$4,901 |
5.1× |
| MRA head with contrast (70545) |
$1,193.50 |
$4,774 |
3.4× |
| MRA neck w contrast (70548) |
$1,404 |
$5,616 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,291.50 |
$5,166 |
3.7× |
| MRA neck w/o contrast (70547) |
$1,095.50 |
$4,382 |
4.6× |
| MRI abdomen w contrast (74182) |
$1,440.75 |
$5,763 |
4.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,583.50 |
$6,334 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,297.50 |
$5,190 |
5.4× |
| MRI any jnt lwr ext with con lt (73722) |
$803.25 |
$3,213 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$803.25 |
$3,213 |
1.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,073.75 |
$4,295 |
4.5× |
| MRI breast w/o contrast unilat (77046) |
$799.75 |
$3,199 |
3.3× |
| MRI c-spine with contrast (72142) |
$1,558.50 |
$6,234 |
4.4× |
| MRI cardiac w/o cont stress (75559) |
$487.50 |
$1,950 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$774.50 |
$3,098 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$1,404 |
$5,616 |
5.9× |
| MRI chest w/o & w/contrast material (71552) |
$541.25 |
$2,165 |
1.5× |
| MRI chest w/o contrast (71550) |
$443.50 |
$1,774 |
1.9× |
| MRI chest with contrast (71551) |
$803.25 |
$3,213 |
1.0× |
| MRI fetal sngl/1st gestation (74712) |
$780.50 |
$3,122 |
3.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$499 |
$1,996 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$494.75 |
$1,979 |
1.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$445.50 |
$1,782 |
1.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$936 |
$3,744 |
3.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,142.75 |
$4,571 |
3.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,044 |
$4,176 |
3.0× |
| MRI pelvis w contrast (72196) |
$1,279 |
$5,116 |
3.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,480.75 |
$5,923 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,039 |
$4,156 |
4.3× |
| MRI scan of arm joint before and after contrast (73223) |
$696.50 |
$2,786 |
2.0× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$689.25 |
$2,757 |
0.9× |
| MRI scan of leg joint before and after contrast (73723) |
$543.75 |
$2,175 |
1.6× |
| MRI spectroscopy (76390) |
$526.75 |
$2,107 |
6.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,714 |
$6,856 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$946.50 |
$3,786 |
2.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,041 |
$4,164 |
3.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,709.75 |
$6,839 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,879.50 |
$7,518 |
5.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,540 |
$6,160 |
6.4× |
| MRI tmj (70336) |
$274.75 |
$1,099 |
1.1× |
| MRI upper ext joint w/o contrast (73221) |
$570.75 |
$2,283 |
2.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$696.50 |
$2,786 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$570.75 |
$2,283 |
2.4× |
| Myelogram Cervical (72240) |
$689.25 |
$2,757 |
0.9× |
| Myelography 2 or more regions (72270) |
$689.25 |
$2,757 |
0.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,244.50 |
$4,978 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,455.50 |
$5,822 |
1.1× |
| Neck soft tissue (70360) |
$148 |
$592 |
1.7× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$145.50 |
$582 |
0.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$372.50 |
$1,490 |
0.9× |
| Nm bone marrow wb (78104) |
$591 |
$2,364 |
1.5× |
| Nm cisternogram (78630) |
$422.75 |
$1,691 |
0.8× |
| Nm csf leak detection (78650) |
$566.75 |
$2,267 |
0.4× |
| Nm gastric emptying study (78264) |
$571.75 |
$2,287 |
1.4× |
| Nm gastroesophageal reflux study (78262) |
$438.25 |
$1,753 |
1.1× |
| Nm whole blood volume (78122) |
$497 |
$1,988 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,880.75 |
$7,523 |
1.4× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,010.50 |
$4,042 |
0.8× |
| Nuclear medicine of heart pumping function (78473) |
$551.25 |
$2,205 |
1.4× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$1,623 |
$6,492 |
1.1× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$1,392.75 |
$5,571 |
1.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$756.75 |
$3,027 |
0.6× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$495.50 |
$1,982 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$483.25 |
$1,933 |
2.1× |
| Nuclr Rx Interstit Colloid (79300) |
$107.25 |
$429 |
0.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$161.50 |
$646 |
1.5× |
| Orthopantogram (70355) |
$101.25 |
$405 |
1.2× |
| Osseous survey infant (77076) |
$113.25 |
$453 |
1.1× |
| Osseous survey limited (77074) |
$113.25 |
$453 |
1.1× |
| Parathyrd planar w/spect&CT (78072) |
$515 |
$2,060 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$483.50 |
$1,934 |
1.2× |
| Parathyroid imaging (78070) |
$273.50 |
$1,094 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$207.12 |
$828.50 |
2.0× |
| Peritoneogram rs&i (74190) |
$487.50 |
$1,950 |
0.9× |
| PET image w/CT, skull-thigh (78815) |
$1,623 |
$6,492 |
1.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,623 |
$6,492 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,623 |
$6,492 |
1.1× |
| PET imaging limited area chest head/neck (78811) |
$1,450.50 |
$5,802 |
1.1× |
| PET whole body (78813) |
$1,623 |
$6,492 |
1.1× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$587.50 |
$2,350 |
0.5× |
| Pr gi endoscopic ultrasound (76975) |
$235.75 |
$943 |
1.0× |
| Pr heart first pass single,planar (78481) |
$274.75 |
$1,099 |
0.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$450.50 |
$1,802 |
1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,805.75 |
$11,223 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$850 |
$3,400 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$432.75 |
$1,731 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$431 |
$1,724 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$487.50 |
$1,950 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$95.50 |
$382 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$222.25 |
$889 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$237.25 |
$949 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$113.25 |
$453 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$208.25 |
$833 |
2.0× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$293.75 |
$1,175 |
0.5× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$170.50 |
$682 |
1.7× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$309.50 |
$1,238 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$113.25 |
$453 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$207 |
$828 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$267.25 |
$1,069 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$201.75 |
$807 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$274.75 |
$1,099 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$392.25 |
$1,569 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$364.25 |
$1,457 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$195 |
$780 |
2.2× |
| Radiological examination surgical specimen (76098) |
$487.50 |
$1,950 |
0.9× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$127.50 |
$510 |
0.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$240.75 |
$963 |
0.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,805.75 |
$11,223 |
0.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,805.75 |
$11,223 |
0.9× |
| Ribs bilateral 3 views (71110) |
$113.25 |
$453 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$582.50 |
$2,330 |
1.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$740.88 |
$2,963.50 |
1.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$819 |
$3,276 |
1.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$651.50 |
$2,606 |
0.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$860.25 |
$3,441 |
0.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$676.50 |
$2,706 |
0.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$127.50 |
$510 |
0.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$471.50 |
$1,886 |
2.0× |
| Rp Therapy Intravenous Administration (79101) |
$127.50 |
$510 |
0.5× |
| Sacroiliac Joints < 3 Views (72200) |
$113.25 |
$453 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$235.75 |
$943 |
1.0× |
| Salivary gland imaging serial images (78231) |
$205.50 |
$822 |
0.5× |
| Scanogram (77073) |
$113.25 |
$453 |
1.1× |
| Scapula complete (73010) |
$193.25 |
$773 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$192.50 |
$770 |
8.2× |
| Sella turcica (70240) |
$80.75 |
$323 |
0.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$113.25 |
$453 |
1.1× |
| Sialogram (70390) |
$235.75 |
$943 |
1.0× |
| Simulation intermediate (77285) |
$495.25 |
$1,981 |
1.3× |
| Small bowel series (74250) |
$184.25 |
$737 |
1.0× |
| Spec medical radj physics consltj (77370) |
$188.25 |
$753 |
1.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$149.25 |
$597 |
0.4× |
| Special dosimetry (77331) |
$56.50 |
$226 |
0.4× |
| Special treatment procedure (77470) |
$326.75 |
$1,307 |
0.6× |
| Speech evaluation complex (70371) |
$181.25 |
$725 |
0.8× |
| Spine thoracic 3 views (72072) |
$113.25 |
$453 |
1.1× |
| Splenoportograpy rs&i (75810) |
$1,107.25 |
$4,429 |
0.3× |
| Superior sagittal sinus venogram (75870) |
$952.75 |
$3,811 |
0.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$127.25 |
$509 |
1.2× |
| Tbs Technical Calculation Only (77091) |
$87 |
$348 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$268.50 |
$1,074 |
0.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$149.50 |
$598 |
0.4× |
| Testicular Imaging With Vascular Flow (78761) |
$208.75 |
$835 |
0.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$527.50 |
$2,110 |
1.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$295.50 |
$1,182 |
2.2× |
| Therapeutic Enema (74283) |
$229.75 |
$919 |
1.3× |
| Thoracolumbar 2 views (72080) |
$122.25 |
$489 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$704.25 |
$2,817 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$216.25 |
$865 |
0.5× |
| Thyroid uptake measurement (78012) |
$170.25 |
$681 |
0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$290.50 |
$1,162 |
0.7× |
| Tomogram (76100) |
$191.75 |
$767 |
1.8× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$86.75 |
$347 |
1.0× |
| Treatment device intermediate (77333) |
$86.25 |
$345 |
0.6× |
| Treatment devices simple (77332) |
$143 |
$572 |
1.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$993 |
$3,972 |
1.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$584 |
$2,336 |
1.5× |
| Tx devices design & construction complex (77334) |
$149.25 |
$597 |
0.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$23.25 |
$93 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$237 |
$948 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$159.75 |
$639 |
1.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$80.75 |
$323 |
0.9× |
| Unlisted fluoroscopic procedure (76496) |
$80.75 |
$323 |
0.9× |
| Unlisted magnetic resonance procedure (76498) |
$898.50 |
$3,594 |
10.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$372.50 |
$1,490 |
0.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$148.25 |
$593 |
1.4× |
| Upper Extremity Infant (73092) |
$113.25 |
$453 |
1.1× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$95.50 |
$382 |
1.0× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$296.50 |
$1,186 |
0.7× |
| Urethrocystography retrograde rs&i (74450) |
$506.75 |
$2,027 |
2.1× |
| Urethrocystography voiding (74455) |
$402 |
$1,608 |
1.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$153 |
$612 |
0.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$183.50 |
$734 |
1.0× |
| Us breast unilateral complete (76641) |
$216.25 |
$865 |
2.1× |
| Us breast unilateral limited (76642) |
$146 |
$584 |
1.7× |
| Us chest (76604) |
$191 |
$764 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$230.50 |
$922 |
2.2× |
| Us elastography parenchyma (76981) |
$174.75 |
$699 |
1.7× |
| Us fetal nuchal translucency 1st gestation (76813) |
$113.25 |
$453 |
1.1× |
| Us guided compression repair (76936) |
$419.75 |
$1,679 |
1.9× |
| Us infant hips dynamic (76885) |
$195.50 |
$782 |
2.2× |
| Us infant hips limited static (76886) |
$80.75 |
$323 |
0.9× |
| Us kidney transplant (76776) |
$212.50 |
$850 |
2.0× |
| Us ob detailed single fetus (76811) |
$185.50 |
$742 |
0.8× |
| Us ob transvaginal (76817) |
$125.50 |
$502 |
1.2× |
| Us pelvic non ob complete (76856) |
$182.25 |
$729 |
1.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$113.25 |
$453 |
1.1× |
| Us pregnancy ltd (76815) |
$113.25 |
$453 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$138.75 |
$555 |
1.3× |
| Us retroperitoneal complete (76770) |
$212.50 |
$850 |
2.0× |
| Us retroperitoneal limited (76775) |
$163 |
$652 |
1.6× |
| Us scrotum and contents (76870) |
$375.25 |
$1,501 |
3.6× |
| Us soft tissue head/neck (76536) |
$188.25 |
$753 |
1.8× |
| Us spinal canal and contents (76800) |
$113.25 |
$453 |
1.1× |
| Us transrectal (76872) |
$144.50 |
$578 |
1.4× |
| Us transrectal prostate volume (76873) |
$98 |
$392 |
0.9× |
| Us xtr non-vasc lmtd (76882) |
$157.50 |
$630 |
1.5× |
| Us, eye b-scan (76512) |
$135.25 |
$541 |
1.3× |
| Use of externally generated heat to increase temperature of cancer cell, heating to depths 4.0 cm or less (77600) |
$468.25 |
$1,873 |
1.2× |
| Vascular flow imaging (78445) |
$170.25 |
$681 |
0.4× |
| Venogram extremity bilateral (75822) |
$952.75 |
$3,811 |
0.6× |
| Venogram orbital (75880) |
$638.25 |
$2,553 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$2,805.75 |
$11,223 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$830.50 |
$3,322 |
0.5× |
| Venography epidural rs&i (75872) |
$638.25 |
$2,553 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$638.25 |
$2,553 |
0.4× |
| Venography Renal Bilateral (75833) |
$2,805.75 |
$11,223 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$2,805.75 |
$11,223 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,805.75 |
$11,223 |
0.9× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$4,653.50 |
$18,614 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$80.75 |
$323 |
0.9× |
| Wrist 2 views (73100) |
$156 |
$624 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$396.75 |
$1,587 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$154.50 |
$618 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$128.25 |
$513 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$361 |
$1,444 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$131.75 |
$527 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$160.50 |
$642 |
1.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$197.75 |
$791 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$82 |
$328 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$126.75 |
$507 |
1.4× |
| X-ray exam hip uni 4/> views (73503) |
$113.25 |
$453 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$260.25 |
$1,041 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$282.75 |
$1,131 |
2.7× |
| X-ray exam of femur 1 (73551) |
$143.50 |
$574 |
1.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$184.25 |
$737 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$113.25 |
$453 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$80.75 |
$323 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$80.75 |
$323 |
0.9× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,793.50 |
$7,174 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$171.25 |
$685 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$80.75 |
$323 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$287.50 |
$1,150 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$211.50 |
$846 |
2.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$80.75 |
$323 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$122.75 |
$491 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$187.50 |
$750 |
1.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$159.25 |
$637 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$80.75 |
$323 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$80.75 |
$323 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$120.50 |
$482 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$241.50 |
$966 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$330.50 |
$1,322 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$116.50 |
$466 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$127.50 |
$510 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$159.25 |
$637 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$143.25 |
$573 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$80.75 |
$323 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$208.75 |
$835 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$274.25 |
$1,097 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$165 |
$660 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$197.75 |
$791 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$157.25 |
$629 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$175.25 |
$701 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$110.25 |
$441 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$100.75 |
$403 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$140.25 |
$561 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$132 |
$528 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$84.25 |
$337 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$178 |
$712 |
2.0× |
| Xr arthrogram ankle (73615) |
$386.50 |
$1,546 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$284.50 |
$1,138 |
2.7× |
| Xr chest 4+ views (71048) |
$243 |
$972 |
2.3× |
| Xr finger(s) 2+ views (73140) |
$149 |
$596 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$113.25 |
$453 |
1.1× |
| Xr optic foramina (70190) |
$80.75 |
$323 |
0.9× |
| Xr shoulder 1 view (73020) |
$193.75 |
$775 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$287.50 |
$1,150 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$227.50 |
$910 |
2.6× |
| Xr tmj bilateral (70330) |
$84.25 |
$337 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$217 |
$868 |
2.5× |