Imaging prices at William P. Clements Jr. University Hospital (UT Southwestern)

Dallas, TX · every code in this section with a posted price and a Medicare benchmark.

430 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
3-D radiotherapy plan dose-volume histograms (77295) $1,654 $3,308 1.2×
Acute gi blood loss imaging (78278) $1,059 $2,118 2.6×
Angiography internal mammary rs&i (75756) $1,543.50 $3,087 0.5×
Angiography pulmonary bilateral slctv rs&i (75743) $4,784 $9,568 1.5×
Angiography visceral slctv/supraslctv rs&i (75726) $7,486 $14,972 1.3×
Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) $4,784 $9,568 1.5×
Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) $4,784 $9,568 1.5×
Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) $6,657.50 $13,315 1.2×
Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) $4,784 $9,568 1.5×
Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) $5,600.50 $11,201 1.0×
Angrph cath f-up std tcat other than thrombylsis (75898) $1,149.50 $2,299 0.4×
Angrph pulmonary nonslctv cath/ven njx rs&i (75746) $1,531 $3,062 0.5×
Ankle 2 views (73600) $153.50 $307 1.8×
Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) $4,784 $9,568 1.5×
Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) $4,784 $9,568 1.5×
Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) $4,784 $9,568 0.9×
Aortography, thoracic, without serialography, radiological supervision and interpretation Age Under 21 (75600) $4,784 $9,568 1.5×
Basic radiation dosimetry calculation (77300) $386 $772 2.9×
Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) $431.50 $863 1.1×
Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) $679 $1,358 1.2×
Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) $6,328 $12,656 4.4×
Card MRI w/stress img & dye (75563) $1,688 $3,376 2.1×
Cardiac MRI morphology & function w/o contrast (75557) $1,046.50 $2,093 4.4×
Cardiac MRI w/stress img (75559) $1,046.50 $2,093 1.9×
Cardiac MRI w/wo contrast & further seq (75561) $1,688 $3,376 4.8×
Cisternography, positive contrast, radiological supervision and interpretation Age Under 21 (70015) $1,094 $2,188 1.4×
Clavicle complete (73000) $133 $266 1.5×
Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) $775.50 $1,551 4.4×
Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) $453.50 $907 4.3×
Computed tomographic (CT) colonography, screening, including image postprocessing (74263) $3,572 $7,144 14.9×
Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) $1,695.50 $3,391 4.8×
Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) $1,102.50 $2,205 6.3×
Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) $1,097 $2,194 6.2×
Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) $1,388.50 $2,777 7.9×
Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) $906 $1,812 5.1×
Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) $1,597 $3,194 9.1×
Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) $1,042 $2,084 5.9×
Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) $1,319.50 $2,639 7.5×
Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) $269 $538 3.1×
Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) $1,172.50 $2,345 6.7×
Computed tomography, lower extremity; without contrast material Age Under 21 (73700) $710.50 $1,421 6.8×
Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) $1,350 $2,700 7.7×
Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) $1,348.50 $2,697 7.7×
Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) $1,402.50 $2,805 8.0×
Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) $1,062.50 $2,125 10.1×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) $1,579.50 $3,159 9.0×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) $923.50 $1,847 8.8×
Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) $1,348.50 $2,697 7.7×
Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) $1,545.50 $3,091 8.8×
Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) $1,348.50 $2,697 7.7×
Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) $1,168.50 $2,337 6.6×
Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) $314 $628 2.3×
Csf shunt evaluation (78645) $728 $1,456 1.3×
CT abdomen and pelvis without and with contrast (74178) $1,795.50 $3,591 5.1×
CT abdomen and pelvis without contrast (74176) $1,243 $2,486 5.2×
CT abdomen w & w/o contrast (74170) $1,167 $2,334 6.6×
CT abdomen w/contrast (74160) $1,372.50 $2,745 7.8×
CT abdomen w/o contrast (74150) $618 $1,236 5.9×
CT angio hrt w/3d image (75574) $933.50 $1,867 2.7×
CT cervical spine w/contrast (72126) $1,373.50 $2,747 3.9×
CT cervical spine w/o contrast (72125) $803 $1,606 7.6×
CT chest w/contrast (71260) $1,374.50 $2,749 7.8×
CT extremity upper w & w/o contrast (73202) $1,226.50 $2,453 7.0×
CT extremity upper w/o contrast (73200) $645.50 $1,291 6.1×
CT head/brain with contrast (70460) $1,817 $3,634 10.3×
CT head/brain without and with contrast (70470) $1,551.50 $3,103 8.8×
CT heart c+ cardiac strux&morph cgen hrt ds (75573) $821.50 $1,643 2.3×
CT heart contrast eval cardiac structure&morph (75572) $616.50 $1,233 1.8×
CT heart no contrast quant eval coronry calcium (75571) $190 $380 2.2×
CT l-spine w/contrast (72132) $1,219.50 $2,439 3.5×
CT limited/localized follow up study (76380) $404 $808 4.6×
CT lower extremity w/dye (73701) $1,584.50 $3,169 9.0×
CT lumbar spine w/o contrast (72131) $923.50 $1,847 8.8×
CT maxillofacial w/wo contrast (70488) $1,551.50 $3,103 8.8×
CT neck w/contrast (70491) $1,818.50 $3,637 10.3×
CT neck w/o contrast (70490) $818.50 $1,637 7.8×
CT pelvis w & w/o contrast (72194) $1,173.50 $2,347 6.7×
CT pelvis w/o contrast (72192) $617.50 $1,235 5.9×
CT thoracic spine w/contrast (72129) $1,219.50 $2,439 6.9×
CT thoracic spine w/o contrast (72128) $923.50 $1,847 8.8×
CT thorax lung cancer scr c- (71271) $151.50 $303 1.4×
CT thorax w/o contrast (71250) $797.50 $1,595 7.6×
CT upper extremity w/dye (73201) $1,439.50 $2,879 4.1×
CTA head w contrast (70496) $1,597 $3,194 9.1×
Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) $452 $904 1.3×
Dilation ureters/urethra rs&i (74485) $2,438 $4,876 1.2×
Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) $3,730.50 $7,461 1.9×
Diskography lumbar s&i (72295) $3,730.50 $7,461 1.9×
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) $112 $224 1.1×
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) $56 $112 0.5×
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) $152.50 $305 1.5×
Dxa bone density study axial skeleton (77085) $274.50 $549 2.6×
Dxa bone density/peripheral (77081) $52 $104 0.6×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) $303.50 $607 0.6×
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) $201 $402 0.8×
Esophageal motility (78258) $425.50 $851 1.1×
Fetal biophys profile w/o nst (76819) $116 $232 1.1×
Fluoroscopy up to 1 hour physician/qhp time (76000) $235 $470 1.0×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) $943 $1,886 1.7×
Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) $788 $1,576 2.0×
Gastroesophageal reflux study (78262) $490 $980 1.2×
Gated heart planar single (78472) $956.50 $1,913 2.4×
Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) $1,705 $3,410 2.4×
Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) $1,695 $3,390 2.4×
Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) $2,338 $4,676 3.3×
Heart infarct image (78466) $450 $900 1.1×
Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) $4,784 $9,568 1.5×
Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) $4,784 $9,568 1.5×
Hepatobil syst imag inc gb w/pharma intervenj (78227) $1,731 $3,462 3.2×
Hepatobiliary syst imaging including gallbladder (78226) $1,086.50 $2,173 2.7×
Ht muscle image spect sing (78451) $1,225 $2,450 0.9×
Infusion or instillation of radioelement solution (includes 3-month follow-up care) (77750) $360.50 $721 0.9×
Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) $5,755.50 $11,511 4.1×
Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) $2,485 $4,970 3.6×
Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) $679.50 $1,359 1.7×
Intracavitary radiation source application - complex (77763) $2,338 $4,676 3.3×
Intracavitary radiation source application - simple (77761) $2,338 $4,676 4.2×
Isodose brachytherapy complex 10+ sources (77318) $2,572 $5,144 6.8×
Isodose brachytherapy intermed 5 to 10 sources (77317) $2,572 $5,144 6.8×
Isodose brachytherapy plan simple 1 to 4 source (77316) $2,572 $5,144 6.8×
Isodose teletherapy plan complex multi tx w/cal (77307) $1,417.50 $2,835 3.8×
Isodose teletherapy plan simple 1 or 2 port w/cal (77306) $1,625 $3,250 4.3×
Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) $1,022.50 $2,045 1.9×
Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) $631 $1,262 1.2×
Leveen/shunt patency exam (78291) $481.50 $963 1.2×
Liver and spleen imaging (78215) $753.50 $1,507 1.9×
Liver imaging (78201) $750 $1,500 1.4×
Liver imaging with flow (78202) $750 $1,500 1.4×
Lung perf&ventilat diferentl (78598) $1,164.50 $2,329 2.1×
Lung perfusion imaging (78580) $883 $1,766 2.2×
Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) $6,706.50 $13,413 2.1×
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) $2,243 $4,486 6.4×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) $1,695.50 $3,391 4.8×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) $1,634 $3,268 6.8×
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) $2,042.50 $4,085 5.8×
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) $2,145.50 $4,291 6.1×
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) $1,602.50 $3,205 6.7×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) $1,695.50 $3,391 4.8×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $2,042.50 $4,085 5.8×
Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) $2,216.50 $4,433 6.3×
Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) $2,071.50 $4,143 5.9×
Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) $1,954 $3,908 5.6×
Magnetic resonance elastography (76391) $1,070.50 $2,141 4.5×
Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) $903 $1,806 3.8×
Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) $371.50 $743 1.5×
Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) $579 $1,158 2.4×
Mammary ductogram single (77053) $551 $1,102 2.3×
Mandible min 4v (70110) $194 $388 1.8×
Mr safety determination physician/other qhp (76016) $1,159.50 $2,319 13.3×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $1,159.50 $2,319 19.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $1,159.50 $2,319 39.9×
Mr safety implt electronics prepj supvj phys/qhp (76018) $493.50 $987 5.2×
Mr safety med physics xm customization plng&mntr (76017) $1,678.59 $3,357.18 7.0×
MRA head w/o contrast (70544) $1,657 $3,314 6.9×
MRA neck w/ contrast (70548) $1,622 $3,244 4.6×
MRA neck w/o contrast (70547) $1,563.50 $3,127 6.5×
MRI abdomen w/contrast (74182) $1,622 $3,244 4.6×
MRI abdomen w/o contrast (74181) $1,563.50 $3,127 6.5×
MRI abdomen w/wo contrast (74183) $1,954 $3,908 5.6×
MRI any jt lower extrem w/contrast material (73722) $1,855 $3,710 2.4×
MRI bone marrow (77084) $1,138 $2,276 4.7×
MRI breast c- bilateral (77047) $2,053.50 $4,107 8.6×
MRI breast without contrast material unilateral (77046) $1,869 $3,738 7.8×
MRI c-spine w&w/o cont (72156) $2,248 $4,496 6.4×
MRI cervical spine w/contrast (72142) $2,428 $4,856 6.9×
MRI chest w/contrast (71551) $1,622 $3,244 2.1×
MRI chest w/o contrast (71550) $1,211.50 $2,423 5.1×
MRI chest w/wo contrast (71552) $1,954 $3,908 5.6×
MRI fetal sngl/1st gestation (74712) $1,280 $2,560 5.3×
MRI joint upr extr w/o&w/dye (73223) $1,772.50 $3,545 5.1×
MRI joint upr extrem w/dye (73222) $3,427.50 $6,855 4.4×
MRI joint upr extrem w/o dye (73221) $1,094 $2,188 4.6×
MRI lumbar spine w/contrast (72149) $1,466 $2,932 4.2×
MRI lumbar spine w/wo contrast (72158) $1,779 $3,558 5.1×
MRI orbit/face/neck w&w/o cont (70543) $2,585 $5,170 7.4×
MRI pelvis w & w/o contrast (72197) $2,054.50 $4,109 5.9×
MRI pelvis w/contrast (72196) $1,865.50 $3,731 5.3×
MRI pelvis w/o contrast (72195) $1,274.50 $2,549 5.3×
MRI spectroscopy (76390) $1,080 $2,160 12.4×
MRI spine cervical w/o contrast (72141) $1,798.50 $3,597 7.5×
MRI t-spine w&w/o cont (72157) $2,264 $4,528 6.5×
MRI thoracic spine w/contrast (72147) $1,879 $3,758 5.4×
MRI thoracic spine w/o contrst (72146) $1,811 $3,622 7.6×
MRI tmj (70336) $994.50 $1,989 4.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,266.50 $2,533 5.3×
Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) $1,435.50 $2,871 3.8×
Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) $1,203.50 $2,407 1.5×
Myelography, posterior fossa, radiological supervision and interpretation Age Under 21 (70010) $1,094 $2,188 3.1×
Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) $3,794.50 $7,589 2.5×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) $4,052.50 $8,105 2.8×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) $4,052.50 $8,105 2.8×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) $3,794.50 $7,589 2.6×
Myocardial spect multiple studies (78452) $1,775 $3,550 1.4×
Myocrd img PET 2rtracer CT (78433) $4,331 $8,662 2.0×
Myocrd img PET metab eval single study (78459) $50 $100 0.0×
Myocrd img PET metab eval single study cncrnt CT (78429) $2,267.50 $4,535 1.6×
Myocrd img PET rst&strs CT (78431) $4,036.50 $8,073 1.8×
N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) $2,882.50 $5,765 3.3×
Nm bone 3 phase (78315) $1,249.50 $2,499 3.1×
Nm bone imaging whole body (78306) $1,105.50 $2,211 2.8×
Nm bone marrow ltd (78102) $384.50 $769 1.0×
Nm bone marrow multi (78103) $477 $954 1.2×
Nm bone marrow wb (78104) $573 $1,146 1.4×
Nm csf cisternogram (78630) $701.50 $1,403 1.3×
Nm csf leak detection (78650) $682.50 $1,365 0.5×
Nm gastric emptying (78264) $1,299.50 $2,599 3.2×
Nm lung ventilation imaging (78579) $826 $1,652 2.1×
Nm lymph system (78195) $1,426 $2,852 2.6×
Nm myocard infarct spect (78469) $562.50 $1,125 1.0×
Nm salivary gland (78230) $340 $680 0.8×
Nuclear medicine study of bone and/or joint limited area (78300) $619.50 $1,239 1.5×
Nuclear medicine study of bone and/or joint multiple areas (78305) $818.50 $1,637 2.0×
Nuclear medicine study of salivary gland with serial images (78231) $234 $468 0.6×
Ob us limited fetus(s) (76815) $233 $466 2.2×
Optic foramina (70190) $99.50 $199 1.1×
Parathyrd planar w/spect&CT (78072) $1,371 $2,742 2.5×
Parathyroid planar imaging (78070) $584.50 $1,169 1.5×
Parathyroid planar imaging w/wo subtraction (78071) $1,426 $2,852 3.6×
Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) $4,784 $9,568 1.5×
PET imaging CT attenuation skull base mid-thigh (78815) $6,108.50 $12,217 4.3×
PET imaging CT for attenuation limited area (78814) $6,319.50 $12,639 4.4×
PET imaging for CT attenuation whole body (78816) $6,104 $12,208 4.2×
PET imaging whole body (78813) $6,190.50 $12,381 4.3×
Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) $6,000 $12,000 4.6×
Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) $6,190.50 $12,381 4.3×
Prq transhepatc portograpy w/o hemodyn evl intrp (75887) $1,531 $3,062 0.5×
Pulmonary ventilation & perfusion imaging (78582) $1,424.50 $2,849 2.6×
Quant differential pulm perfusion w/wo imaging (78597) $745.50 $1,491 1.9×
Radex abscess/fistula/sinus tract rs&i (76080) $551 $1,102 1.0×
Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) $175.50 $351 2.0×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $365.50 $731 3.5×
Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) $149.50 $299 1.4×
Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) $172 $344 1.6×
Radex hip unilateral with pelvis 1 view (73501) $159.50 $319 1.8×
Radex hip unilateral with pelvis 2-3 views (73502) $256.50 $513 2.9×
Radex hip unilateral with pelvis minimum 4 views (73503) $264.50 $529 2.5×
Radex hips bilateral with pelvis 2 views (73521) $264.50 $529 2.5×
Radex hips bilateral with pelvis minimum 5 views (73523) $364.50 $729 3.5×
Radex spine cervical 2 or 3 views (72040) $199 $398 2.3×
Radex spine cervical 4 or 5 views (72050) $306.50 $613 2.9×
Radex spine cervical 6 or more views (72052) $235 $470 2.2×
Radex spine thoracolumbar junction min 2 views (72080) $164 $328 1.9×
Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) $20,655 $41,310 2.8×
Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) $4,389.50 $8,779 0.6×
Radiation tx delivery lvl 1 (77402) $1,575 $3,150 15.4×
Radiation tx delivery lvl 2 (77407) $2,338 $4,676 6.0×
Radiation tx delivery lvl 3 (77412) $2,109.50 $4,219 3.8×
Radiologic exam abdomen 3+ views (74021) $386.50 $773 3.7×
Radiologic exam chest 3 views (71047) $355.50 $711 4.1×
Radiologic exam chest 4+ views (71048) $409.50 $819 3.9×
Radiologic exam colon double contrast study (74280) $497.50 $995 2.8×
Radiologic exam colon single contrast study (74270) $502.50 $1,005 2.9×
Radiologic exam esophagus double contrast study (74221) $410 $820 2.3×
Radiologic exam esophagus single contrast study (74220) $270.50 $541 1.5×
Radiologic exam small int single contrast study (74250) $194 $388 1.1×
Radiologic exam swallow function contrast study (74230) $295 $590 1.7×
Radiologic exam upr gi trc double contrast study (74246) $427 $854 2.4×
Radiologic exam upr gi trc single contrast study (74240) $252 $504 1.4×
Radiologic examination femur 1 view (73551) $161 $322 1.8×
Radiologic examination femur minimum 2 views (73552) $247 $494 2.8×
Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) $225.50 $451 2.6×
Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) $354.50 $709 3.4×
Radiologic examination, elbow; 2 views Age Under 21 (73070) $153 $306 1.8×
Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) $153 $306 1.8×
Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) $99.50 $199 1.1×
Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) $259.50 $519 3.0×
Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) $229 $458 2.6×
Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) $154 $308 1.8×
Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) $306 $612 2.9×
Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) $126.50 $253 1.4×
Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) $99.50 $199 0.9×
Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) $153 $306 1.5×
Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) $99.50 $199 1.1×
Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s),… (74210) $138 $276 0.8×
Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) $178.50 $357 1.7×
Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) $231.50 $463 2.2×
Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) $176 $352 1.7×
Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) $815 $1,630 2.3×
Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) $173 $346 2.0×
Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) $99.50 $199 1.1×
Radiologic examination, skull; less than 4 views Age Under 21 (70250) $229 $458 2.2×
Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) $248.50 $497 2.4×
Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) $235 $470 2.2×
Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) $235 $470 2.2×
Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) $153.50 $307 1.5×
Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) $153 $306 1.8×
Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) $99.50 $199 1.1×
Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) $181 $362 2.1×
Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) $99.50 $199 1.1×
Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) $153 $306 1.5×
Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Age Under 21 (70370) $246.50 $493 2.8×
Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) $109.50 $219 1.3×
Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) $160 $320 1.8×
Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) $99.50 $199 0.9×
Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) $1,329.50 $2,659 2.4×
Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) $122.50 $245 0.5×
Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) $139.50 $279 0.6×
Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) $211.50 $423 0.9×
Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) $177.50 $355 0.8×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) $2,338 $4,676 6.0×
Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) $2,338 $4,676 6.0×
Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) $467.50 $935 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $631.50 $1,263 1.6×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $831 $1,662 2.1×
Rp loclzj tum plnr whole body 2+ days imaging (78804) $2,060.50 $4,121 3.8×
Rp loclzj tum plnr whole body single day imaging (78802) $1,230 $2,460 2.3×
Rp loclzj tum spect 2 areas (78831) $2,095 $4,190 1.6×
Rp loclzj tum spect w/CT 1 (78830) $3,323 $6,646 2.6×
Rp loclzj tum spect w/CT 2 (78832) $2,503.50 $5,007 1.7×
Rp therapy intra-arterial particulate admn (79445) $381.50 $763 1.6×
Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) $333.50 $667 1.4×
Scapula complete (73010) $133 $266 1.3×
Screening digital breast tomosynthesis bi (77063) $70 $140 —
Shuntogram indwelling nonvascular shunt rs&i (75809) $153 $306 1.5×
Simulation intermediate (77285) $2,568 $5,136 6.8×
Special dosimetry (77331) $386 $772 2.9×
Special physics consult (77370) $386.50 $773 2.9×
Special teletherapy port plan (77321) $400 $800 1.1×
Special treatment procedure (77470) $1,284 $2,568 2.3×
Splenoportography, radiological supervision and interpretation Age Under 21 (75810) $2,802.50 $5,605 0.9×
Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) $14,720 $29,440 8.2×
Surface application of low dose rate radionuclide source (77789) $316 $632 3.1×
Tbs technical calculation only (77091) $182.50 $365 2.1×
Ther rad simulaj-aided field setting complex (77290) $2,273.50 $4,547 6.0×
Thyroid met imaging body (78018) $1,197 $2,394 2.2×
Thyroid uptake w/blood flow sngle/mult quan meas (78014) $764.50 $1,529 1.9×
Tr simulation simple (77280) $1,339.50 $2,679 9.9×
Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) $182.50 $365 2.1×
Treatment device complex (77334) $912.50 $1,825 2.4×
Treatment device intermediate (77333) $684.50 $1,369 5.1×
Treatment device simple (77332) $541 $1,082 4.0×
Ultrasound breast limited (76642) $280.50 $561 3.2×
Ultrasound, abdomen limited (76705) $435.50 $871 4.1×
Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) $221.50 $443 2.1×
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) $495.50 $991 4.7×
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) $207.50 $415 0.9×
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) $311.50 $623 3.0×
Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) $338 $676 3.2×
Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) $261 $522 2.5×
Unlisted CT procedure (76497) $187.50 $375 2.1×
Unlisted fluoroscopic procedure (76496) $246.50 $493 2.8×
Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) $1,325 $2,650 15.2×
Urethrocystography retrograde rs&i (74450) $467.50 $935 2.0×
Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) $309 $618 1.8×
Urography antegrade rs&i (74425) $695.50 $1,391 2.0×
Us abdominal aorta real time screen study aaa (76706) $252.50 $505 2.4×
Us breast uni real time with image complete (76641) $356 $712 3.4×
Us chest (76604) $220 $440 2.1×
Us compl joint r-t w/image documentation (76881) $362.50 $725 3.5×
Us elastography organ (76981) $267 $534 2.5×
Us encephalogram (76506) $208 $416 2.0×
Us exam, pelvic, limited (76857) $328 $656 3.1×
Us guided compression repair (76936) $372 $744 1.7×
Us inft hips r-t img lmtd static phys/qhp manj (76886) $309.50 $619 3.5×
Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) $185 $370 1.8×
US OB Follow-Up/Repeat (76816) $300.50 $601 2.9×
Us ob transvaginal (76817) $259 $518 2.5×
Us retroperitoneal complete (76770) $428 $856 4.1×
Us retroperitoneal ltd (76775) $330 $660 3.1×
Us scrotum (76870) $491 $982 4.7×
Us soft tissue head/neck (76536) $440.50 $881 4.2×
Us spinal canal (76800) $188.50 $377 1.8×
Us transrectal (76872) $154 $308 1.5×
Us trgt dyn mbubb 1st les (76978) $298 $596 0.9×
Us unlstd proc (76999) $139.50 $279 1.6×
Use 1st target lesion (76982) $267 $534 2.5×
Venogram sinus/jugular (75860) $2,246 $4,492 0.7×
Venography adrenal unilateral selective rs&i (75840) $4,472.50 $8,945 1.4×
Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) $99.50 $199 1.1×
Venography renal unilateral selective rs&i (75831) $4,784 $9,568 1.5×
Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) $4,784 $9,568 1.5×
Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) $1,531 $3,062 1.0×
Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) $1,543.50 $3,087 1.0×
Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) $1,543.50 $3,087 1.0×
Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) $2,246 $4,492 0.7×
Venous sampling thru cath w/wo angiography rs& (75893) $11,587 $23,174 2.1×
Vertebral fracture assessment via dxa (77086) $128 $256 1.5×
X-ray exam hips bi 3-4 views (73522) $351.50 $703 3.3×
X-ray exam of finger(s) (73140) $176 $352 2.0×
X-ray exam of knee 1 or 2 (73560) $198.50 $397 2.3×
X-ray exam ribs bil 3 views (71110) $178.50 $357 1.7×
X-ray exam ribs uni 2 views (71100) $150.50 $301 1.7×
X-ray heel (73650) $260 $520 3.0×
X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) $246.50 $493 2.3×
X-ray retrograde pyelogram (74420) $942.50 $1,885 2.7×
Xr abdomen 1 view (74018) $179 $358 2.0×
Xr abdomen 2 views (74019) $342 $684 3.3×
Xr arthrogram ankle (73615) $644 $1,288 1.8×
Xr arthrogram elbow (73085) $644 $1,288 1.8×
Xr arthrogram hip (73525) $745.50 $1,491 2.1×
Xr arthrogram knee (73580) $644 $1,288 1.8×
Xr arthrogram wrist (73115) $644 $1,288 1.8×
Xr bone age studies (77072) $99.50 $199 0.9×
Xr bone length study (77073) $246 $492 2.3×
Xr bone survey infant (77076) $297 $594 2.8×
Xr bone survey ltd (77074) $204.50 $409 1.9×
Xr chest 1 view (71045) $251 $502 2.9×
Xr chest 2 views (71046) $333.50 $667 3.8×
Xr eye foreign body (70030) $109.50 $219 1.3×
Xr facial bones 3+ views (70150) $153 $306 1.5×
Xr foot arthritis pa only bilateral - report(ortho pro) (73620) $176.50 $353 2.0×
Xr forearm 2 views (73090) $229 $458 2.6×
Xr hand 2v (73120) $176.50 $353 1.7×
Xr hysterosalpingogram (74740) $768 $1,536 3.2×
Xr joint survey 1 view (77077) $99.50 $199 0.9×
Xr myelogram c-spine (72240) $1,094 $2,188 1.4×
Xr myelogram l-spine (72265) $1,094 $2,188 1.4×
Xr myelogram t-spine (72255) $1,094 $2,188 1.4×
Xr neck soft tissue (70360) $160.50 $321 1.8×
Xr o knee w/ merchant view bilat - report(ortho pro) (73562) $226.50 $453 2.6×
Xr osseous survey complete (77075) $204.50 $409 1.9×
Xr pelvis 1-2 views (72170) $199 $398 1.9×
Xr pelvis min 3 view (72190) $153.50 $307 1.5×
Xr peritoneogram (74190) $551 $1,102 1.0×
Xr sacrum/coccyx 2+ views (72220) $176 $352 2.0×
Xr sella turcica (70240) $99.50 $199 1.1×
Xr shoulder 1 view (73020) $133.50 $267 1.5×
Xr sinuses 3+ views (70220) $153 $306 1.8×
Xr skull min 4 view (70260) $352.50 $705 3.4×
Xr spine 1 view (72020) $181 $362 2.1×
Xr spine thoracic 3v (72072) $235 $470 2.2×
Xr sternum 2+ views (71120) $109.50 $219 1.3×
Xr stress view joint (77071) $99.50 $199 1.1×
Xr surgical specimen (76098) $694 $1,388 1.3×
Xr t-spine 2 views (72070) $199 $398 1.9×
Xr tibia/fibula 2 views (73590) $153 $306 1.8×
Xr tmj bilateral (70330) $114.50 $229 1.3×
Xr tmj unilateral (70328) $114.50 $229 1.3×
Xr venogram renal bilat (75833) $4,841.50 $9,683 1.5×
Xr wrist 2 views (73100) $153 $306 1.8×