| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,654 |
$3,308 |
1.2× |
| Abdomen 2 views (74019) |
$342 |
$684 |
3.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,059 |
$2,118 |
2.6× |
| Angiography extremity bilateral rs&i (75716) |
$4,784 |
$9,568 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,784 |
$9,568 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$1,543.50 |
$3,087 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,657.50 |
$13,315 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,784 |
$9,568 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,784 |
$9,568 |
1.5× |
| Angiography Spinal Selective Rs&I (75705) |
$5,600.50 |
$11,201 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,486 |
$14,972 |
1.3× |
| 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× |
| Antegrade urography radiological supvj & interpj (74425) |
$695.50 |
$1,391 |
2.0× |
| Aortogram thoracic (75605) |
$4,784 |
$9,568 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,784 |
$9,568 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$4,784 |
$9,568 |
1.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,784 |
$9,568 |
1.5× |
| Arthrogram elbow (73085) |
$644 |
$1,288 |
1.8× |
| Arthrogram hip (73525) |
$745.50 |
$1,491 |
2.1× |
| Arthrogram shoulder (73040) |
$815 |
$1,630 |
2.3× |
| Arthrogram wrist (73115) |
$644 |
$1,288 |
1.8× |
| Arthrography knee lt (73580) |
$644 |
$1,288 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$386 |
$772 |
2.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$619.50 |
$1,239 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$818.50 |
$1,637 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$1,105.50 |
$2,211 |
2.8× |
| Bone age studies (77072) |
$99.50 |
$199 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,249.50 |
$2,499 |
3.1× |
| Bone Marrow Imaging Limited Area (78102) |
$384.50 |
$769 |
1.0× |
| Bone survey complete (77075) |
$204.50 |
$409 |
1.9× |
| Brachytx isodose complex (77318) |
$2,572 |
$5,144 |
6.8× |
| Brachytx isodose intermed (77317) |
$2,572 |
$5,144 |
6.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,572 |
$5,144 |
6.8× |
| Brain image w/flow 4 + views (78606) |
$679 |
$1,358 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$431.50 |
$863 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,328 |
$12,656 |
4.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,688 |
$3,376 |
4.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$728 |
$1,456 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$199 |
$398 |
2.3× |
| Chest 1 view (71045) |
$251 |
$502 |
2.9× |
| Chest 3 views (71047) |
$355.50 |
$711 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$295 |
$590 |
1.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,094 |
$2,188 |
1.4× |
| Clavicle complete (73000) |
$133 |
$266 |
1.5× |
| Complete single session course of cranial lesion surgery using radiation (77371) |
$20,655 |
$41,310 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$151.50 |
$303 |
1.4× |
| Continuing medical physics consltj pr wk (77336) |
$314 |
$628 |
2.3× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$138 |
$276 |
0.8× |
| 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 contrast (74160) |
$1,372.50 |
$2,745 |
7.8× |
| CT abdomen w wo contrast (74170) |
$1,167 |
$2,334 |
6.6× |
| 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 angiography upper extremity lt (73206) |
$1,319.50 |
$2,639 |
7.5× |
| CT c-spine w/o contrast (72125) |
$803 |
$1,606 |
7.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,172.50 |
$2,345 |
6.7× |
| CT cervical spine with contrast (72126) |
$1,373.50 |
$2,747 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,168.50 |
$2,337 |
6.6× |
| CT chest with contrast (71260) |
$1,374.50 |
$2,749 |
7.8× |
| CT colonography screening (74263) |
$3,572 |
$7,144 |
14.9× |
| CT colonography w/dye (74262) |
$775.50 |
$1,551 |
4.4× |
| CT colonography w/o cntrst (74261) |
$453.50 |
$907 |
4.3× |
| 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 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 hrt w/3d image congen (75573) |
$821.50 |
$1,643 |
2.3× |
| CT iac w contrast (70481) |
$1,579.50 |
$3,159 |
9.0× |
| CT limited/localized follow up study (76380) |
$404 |
$808 |
4.6× |
| CT lower ext w/o (73700) |
$710.50 |
$1,421 |
6.8× |
| CT lower extremity w wo contrast (73702) |
$1,350 |
$2,700 |
7.7× |
| CT lower extremity with contrast (73701) |
$1,584.50 |
$3,169 |
9.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,348.50 |
$2,697 |
7.7× |
| CT lumbar spine w/o contrast (72131) |
$923.50 |
$1,847 |
8.8× |
| CT lumbar spine with contrast (72132) |
$1,219.50 |
$2,439 |
3.5× |
| CT maxillofacial w contrast (70487) |
$1,402.50 |
$2,805 |
8.0× |
| CT maxillofacial w/o contrast (70486) |
$1,062.50 |
$2,125 |
10.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,551.50 |
$3,103 |
8.8× |
| CT neck soft tissue w contrast (70491) |
$1,818.50 |
$3,637 |
10.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,348.50 |
$2,697 |
7.7× |
| CT orbits w/o contrast (70480) |
$923.50 |
$1,847 |
8.8× |
| 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 scan for measuring calcium and other minerals in bone (77078) |
$269 |
$538 |
3.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,545.50 |
$3,091 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$818.50 |
$1,637 |
7.8× |
| 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 thoracic spine w/wo contrast (72130) |
$1,348.50 |
$2,697 |
7.7× |
| CT thorax w/o contrast (71250) |
$797.50 |
$1,595 |
7.6× |
| CT unlisted procedure (76497) |
$187.50 |
$375 |
2.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,226.50 |
$2,453 |
7.0× |
| CT upper extremity w/o contrast rt (73200) |
$645.50 |
$1,291 |
6.1× |
| CT upper extremity with contrast (73201) |
$1,439.50 |
$2,879 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,097 |
$2,194 |
6.2× |
| Cta Abdomen (74175) |
$1,102.50 |
$2,205 |
6.3× |
| CTA abdomen pelvis (74174) |
$1,695.50 |
$3,391 |
4.8× |
| CTA chest (71275) |
$1,388.50 |
$2,777 |
7.9× |
| Cta Head (70496) |
$1,597 |
$3,194 |
9.1× |
| CTA lwr ext w&w/o contrast (73706) |
$906 |
$1,812 |
5.1× |
| Cta Neck (70498) |
$1,597 |
$3,194 |
9.1× |
| Cta Pelvis (72191) |
$1,042 |
$2,084 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$452 |
$904 |
1.3× |
| Diskogram cervical (72285) |
$3,730.50 |
$7,461 |
1.9× |
| Diskography lumbar (72295) |
$3,730.50 |
$7,461 |
1.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$56 |
$112 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$112 |
$224 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$152.50 |
$305 |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$52 |
$104 |
0.6× |
| Dxa bone density study axial skeleton (77085) |
$274.50 |
$549 |
2.6× |
| Echo exam of fetal heart (76825) |
$303.50 |
$607 |
0.6× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$201 |
$402 |
0.8× |
| Echoencephalography real time imaging (76506) |
$208 |
$416 |
2.0× |
| Esophageal motility (78258) |
$425.50 |
$851 |
1.1× |
| Esophagus (74220) |
$270.50 |
$541 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$116 |
$232 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$235 |
$470 |
1.0× |
| Foot 2 views (73620) |
$176.50 |
$353 |
2.0× |
| Forearm 2 views (73090) |
$229 |
$458 |
2.6× |
| Functional MRI brain by phys/psych (70555) |
$371.50 |
$743 |
1.5× |
| Functional MRI brain by tech (70554) |
$903 |
$1,806 |
3.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$943 |
$1,886 |
1.7× |
| Gated Heart Planar Single (78472) |
$956.50 |
$1,913 |
2.4× |
| Hand 2 views (73120) |
$176.50 |
$353 |
1.7× |
| Hand 3 views (73130) |
$229 |
$458 |
2.6× |
| 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× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$2,338 |
$4,676 |
6.0× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$2,338 |
$4,676 |
6.0× |
| 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× |
| 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× |
| Humerus Min 2 Views Left (73060) |
$181 |
$362 |
2.1× |
| Hysterosalpingogram (74740) |
$768 |
$1,536 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$2,485 |
$4,970 |
3.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,338 |
$4,676 |
3.3× |
| Intracavitary radiation source applic simple (77761) |
$2,338 |
$4,676 |
4.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$99.50 |
$199 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,022.50 |
$2,045 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$631 |
$1,262 |
1.2× |
| Knee 3 views (73562) |
$226.50 |
$453 |
2.6× |
| Liver & spleen imaging static only (78215) |
$753.50 |
$1,507 |
1.9× |
| Liver imaging static only (78201) |
$750 |
$1,500 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$750 |
$1,500 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$1,164.50 |
$2,329 |
2.1× |
| Lung perfusion differential (78597) |
$745.50 |
$1,491 |
1.9× |
| Lung Ventilation Imaging (78579) |
$826 |
$1,652 |
2.1× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$6,706.50 |
$13,413 |
2.1× |
| Lymphoscintigraphy (78195) |
$1,426 |
$2,852 |
2.6× |
| Mammary ductogram or galactogram multiple (77054) |
$579 |
$1,158 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$551 |
$1,102 |
2.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$99.50 |
$199 |
1.1× |
| Meckels Diverticulum (78290) |
$679.50 |
$1,359 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,435.50 |
$2,871 |
3.8× |
| Mr elastography (76391) |
$1,070.50 |
$2,141 |
4.5× |
| 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 & w/o contrast (70546) |
$2,071.50 |
$4,143 |
5.9× |
| MRA head w/o contrast (70544) |
$1,657 |
$3,314 |
6.9× |
| MRA head with contrast (70545) |
$2,216.50 |
$4,433 |
6.3× |
| MRA neck w contrast (70548) |
$1,622 |
$3,244 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,954 |
$3,908 |
5.6× |
| 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 & w/contrast material (74183) |
$1,954 |
$3,908 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,563.50 |
$3,127 |
6.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,855 |
$3,710 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,427.50 |
$6,855 |
4.4× |
| MRI bone marrow blood supply (77084) |
$1,138 |
$2,276 |
4.7× |
| MRI breast w/o contrast bilateral (77047) |
$2,053.50 |
$4,107 |
8.6× |
| MRI breast w/o contrast unilat (77046) |
$1,869 |
$3,738 |
7.8× |
| MRI c-spine with contrast (72142) |
$2,428 |
$4,856 |
6.9× |
| MRI cardiac w/o cont stress (75559) |
$1,046.50 |
$2,093 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$1,046.50 |
$2,093 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,798.50 |
$3,597 |
7.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,954 |
$3,908 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,211.50 |
$2,423 |
5.1× |
| MRI chest with contrast (71551) |
$1,622 |
$3,244 |
2.1× |
| MRI fetal sngl/1st gestation (74712) |
$1,280 |
$2,560 |
5.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,695.50 |
$3,391 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,695.50 |
$3,391 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,634 |
$3,268 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,602.50 |
$3,205 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,585 |
$5,170 |
7.4× |
| MRI orbit/face/neck w/contrast (70542) |
$2,145.50 |
$4,291 |
6.1× |
| MRI pelvis w contrast (72196) |
$1,865.50 |
$3,731 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,054.50 |
$4,109 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$1,274.50 |
$2,549 |
5.3× |
| MRI scan of arm joint before and after contrast (73223) |
$1,772.50 |
$3,545 |
5.1× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,688 |
$3,376 |
2.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,243 |
$4,486 |
6.4× |
| MRI spectroscopy (76390) |
$1,080 |
$2,160 |
12.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,248 |
$4,496 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,466 |
$2,932 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,779 |
$3,558 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,879 |
$3,758 |
5.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,264 |
$4,528 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,811 |
$3,622 |
7.6× |
| MRI tmj (70336) |
$994.50 |
$1,989 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,094 |
$2,188 |
4.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,042.50 |
$4,085 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,266.50 |
$2,533 |
5.3× |
| Myelogram Cervical (72240) |
$1,094 |
$2,188 |
1.4× |
| Myelogram Lumbar (72265) |
$1,094 |
$2,188 |
1.4× |
| Myelogram thoracic (72255) |
$1,094 |
$2,188 |
1.4× |
| Myelography 2 or more regions (72270) |
$1,203.50 |
$2,407 |
1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$100 |
— |
| Myocardial infarct spect (78469) |
$562.50 |
$1,125 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,775 |
$3,550 |
1.4× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$2,267.50 |
$4,535 |
1.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,794.50 |
$7,589 |
2.6× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$4,036.50 |
$8,073 |
1.8× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$4,331 |
$8,662 |
2.0× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$3,794.50 |
$7,589 |
2.5× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$2,882.50 |
$5,765 |
3.3× |
| Neck soft tissue (70360) |
$160.50 |
$321 |
1.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$360.50 |
$721 |
0.9× |
| Nm bone marrow multiple (78103) |
$477 |
$954 |
1.2× |
| Nm bone marrow wb (78104) |
$573 |
$1,146 |
1.4× |
| Nm cisternogram (78630) |
$701.50 |
$1,403 |
1.3× |
| Nm csf leak detection (78650) |
$682.50 |
$1,365 |
0.5× |
| Nm gastric emptying study (78264) |
$1,299.50 |
$2,599 |
3.2× |
| Nm gastroesophageal reflux study (78262) |
$490 |
$980 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$481.50 |
$963 |
1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,755.50 |
$11,511 |
4.1× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$4,052.50 |
$8,105 |
2.8× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$6,190.50 |
$12,381 |
4.3× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$4,052.50 |
$8,105 |
2.8× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$788 |
$1,576 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$211.50 |
$423 |
0.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$300.50 |
$601 |
2.9× |
| Osseous survey infant (77076) |
$297 |
$594 |
2.8× |
| Osseous survey limited (77074) |
$204.50 |
$409 |
1.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,371 |
$2,742 |
2.5× |
| Parathyrd planar w/wo subtrj (78071) |
$1,426 |
$2,852 |
3.6× |
| Parathyroid imaging (78070) |
$584.50 |
$1,169 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$199 |
$398 |
1.9× |
| Peritoneogram rs&i (74190) |
$551 |
$1,102 |
1.0× |
| PET image w/CT, skull-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 limited area chest head/neck (78811) |
$6,000 |
$12,000 |
4.6× |
| PET whole body (78813) |
$6,190.50 |
$12,381 |
4.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,042.50 |
$4,085 |
5.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,784 |
$9,568 |
1.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,531 |
$3,062 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$883 |
$1,766 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,424.50 |
$2,849 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$551 |
$1,102 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 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 hips bilateral with pelvis 2 views (73521) |
$264.50 |
$529 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$99.50 |
$199 |
0.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$172 |
$344 |
1.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,389.50 |
$8,779 |
0.6× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$2,109.50 |
$4,219 |
3.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$1,575 |
$3,150 |
15.4× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$2,338 |
$4,676 |
6.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$194 |
$388 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$179 |
$358 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$386.50 |
$773 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$333.50 |
$667 |
3.8× |
| 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 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 Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$247 |
$494 |
2.8× |
| Radiological examination surgical specimen (76098) |
$694 |
$1,388 |
1.3× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$122.50 |
$245 |
0.5× |
| Review by radiologist of adrenal gland vein image (75840) |
$4,472.50 |
$8,945 |
1.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$4,784 |
$9,568 |
1.5× |
| Ribs bilateral 3 views (71110) |
$178.50 |
$357 |
1.7× |
| 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 single day imaging (78802) |
$1,230 |
$2,460 |
2.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,329.50 |
$2,659 |
2.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,095 |
$4,190 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,503.50 |
$5,007 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,323 |
$6,646 |
2.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$177.50 |
$355 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$381.50 |
$763 |
1.6× |
| Rp Therapy Intravenous Administration (79101) |
$139.50 |
$279 |
0.6× |
| Sacroiliac Joints < 3 Views (72200) |
$176 |
$352 |
1.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$333.50 |
$667 |
1.4× |
| Salivary gland imaging (78230) |
$340 |
$680 |
0.8× |
| Salivary gland imaging serial images (78231) |
$234 |
$468 |
0.6× |
| Scanogram (77073) |
$246 |
$492 |
2.3× |
| Scapula complete (73010) |
$133 |
$266 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$70 |
$140 |
3.0× |
| Sella turcica (70240) |
$99.50 |
$199 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$153 |
$306 |
1.5× |
| Simulation intermediate (77285) |
$2,568 |
$5,136 |
6.8× |
| Small bowel series (74250) |
$194 |
$388 |
1.1× |
| Spec medical radj physics consltj (77370) |
$386.50 |
$773 |
2.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$400 |
$800 |
1.1× |
| Special dosimetry (77331) |
$386 |
$772 |
2.9× |
| Special treatment procedure (77470) |
$1,284 |
$2,568 |
2.3× |
| Spine thoracic 3 views (72072) |
$235 |
$470 |
2.2× |
| Splenoportograpy rs&i (75810) |
$2,802.50 |
$5,605 |
0.9× |
| Stereotactic body radiation delivery (77373) |
$14,720 |
$29,440 |
8.2× |
| Superior sagittal sinus venogram (75870) |
$2,246 |
$4,492 |
0.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$316 |
$632 |
3.1× |
| Tbs Technical Calculation Only (77091) |
$182.50 |
$365 |
2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,417.50 |
$2,835 |
3.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,625 |
$3,250 |
4.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,273.50 |
$4,547 |
6.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,339.50 |
$2,679 |
9.9× |
| Thoracolumbar 2 views (72080) |
$164 |
$328 |
1.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,197 |
$2,394 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$764.50 |
$1,529 |
1.9× |
| Tmj unilateral (70328) |
$114.50 |
$229 |
1.3× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$182.50 |
$365 |
2.1× |
| Treatment device intermediate (77333) |
$684.50 |
$1,369 |
5.1× |
| Treatment devices simple (77332) |
$541 |
$1,082 |
4.0× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,060.50 |
$4,121 |
3.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$631.50 |
$1,263 |
1.6× |
| Tx devices design & construction complex (77334) |
$912.50 |
$1,825 |
2.4× |
| Ultrasound elastography first target lesion (76982) |
$267 |
$534 |
2.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$298 |
$596 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$435.50 |
$871 |
4.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$99.50 |
$199 |
1.1× |
| Unlisted fluoroscopic procedure (76496) |
$246.50 |
$493 |
2.8× |
| Unlisted magnetic resonance procedure (76498) |
$1,325 |
$2,650 |
15.2× |
| Unlisted Ultrasound Procedure (76999) |
$139.50 |
$279 |
1.6× |
| Upper Extremity Infant (73092) |
$99.50 |
$199 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$467.50 |
$935 |
2.0× |
| Urethrocystography voiding (74455) |
$467.50 |
$935 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$309 |
$618 |
1.8× |
| Us abdl aorta screen aaa (76706) |
$252.50 |
$505 |
2.4× |
| Us breast unilateral complete (76641) |
$356 |
$712 |
3.4× |
| Us breast unilateral limited (76642) |
$280.50 |
$561 |
3.2× |
| Us chest (76604) |
$220 |
$440 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$362.50 |
$725 |
3.5× |
| Us elastography parenchyma (76981) |
$267 |
$534 |
2.5× |
| Us guided compression repair (76936) |
$372 |
$744 |
1.7× |
| Us infant hips limited static (76886) |
$309.50 |
$619 |
3.5× |
| Us kidney transplant (76776) |
$338 |
$676 |
3.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$185 |
$370 |
1.8× |
| Us ob detailed single fetus (76811) |
$207.50 |
$415 |
0.9× |
| Us ob transvaginal (76817) |
$259 |
$518 |
2.5× |
| Us pelvic non ob complete (76856) |
$495.50 |
$991 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$328 |
$656 |
3.1× |
| Us pregnancy ltd (76815) |
$233 |
$466 |
2.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$311.50 |
$623 |
3.0× |
| Us retroperitoneal complete (76770) |
$428 |
$856 |
4.1× |
| Us retroperitoneal limited (76775) |
$330 |
$660 |
3.1× |
| Us scrotum and contents (76870) |
$491 |
$982 |
4.7× |
| Us soft tissue head/neck (76536) |
$440.50 |
$881 |
4.2× |
| Us spinal canal and contents (76800) |
$188.50 |
$377 |
1.8× |
| Us transrectal (76872) |
$154 |
$308 |
1.5× |
| Us transrectal prostate volume (76873) |
$261 |
$522 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$221.50 |
$443 |
2.1× |
| Venogram extremity bilateral (75822) |
$1,543.50 |
$3,087 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,784 |
$9,568 |
1.5× |
| Venography caval superior serialography rs&i (75827) |
$1,531 |
$3,062 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,543.50 |
$3,087 |
1.0× |
| Venography Renal Bilateral (75833) |
$4,841.50 |
$9,683 |
1.5× |
| Venography renal unilateral selective rs&i (75831) |
$4,784 |
$9,568 |
1.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$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× |
| Wrist 2 views (73100) |
$153 |
$306 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$354.50 |
$709 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$99.50 |
$199 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$225.50 |
$451 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$497.50 |
$995 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$153 |
$306 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$153 |
$306 |
1.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$149.50 |
$299 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$159.50 |
$319 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$256.50 |
$513 |
2.9× |
| X-ray exam hip uni 4/> views (73503) |
$264.50 |
$529 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$351.50 |
$703 |
3.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$364.50 |
$729 |
3.5× |
| X-ray exam of femur 1 (73551) |
$161 |
$322 |
1.8× |
| X-ray eye for foreign body (70030) |
$109.50 |
$219 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$153 |
$306 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$99.50 |
$199 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$259.50 |
$519 |
3.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,438 |
$4,876 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$260 |
$520 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$126.50 |
$253 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$306 |
$612 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$154 |
$308 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$99.50 |
$199 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$248.50 |
$497 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$235 |
$470 |
2.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$235 |
$470 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$99.50 |
$199 |
1.1× |
| X-ray of voice box or throat (70370) |
$246.50 |
$493 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$153 |
$306 |
1.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$153.50 |
$307 |
1.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$942.50 |
$1,885 |
2.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$150.50 |
$301 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$231.50 |
$463 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$178.50 |
$357 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$246.50 |
$493 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$176 |
$352 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$173 |
$346 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$153 |
$306 |
1.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$99.50 |
$199 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$352.50 |
$705 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$229 |
$458 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$181 |
$362 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$109.50 |
$219 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$109.50 |
$219 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$199 |
$398 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$153.50 |
$307 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$160 |
$320 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$153 |
$306 |
1.8× |
| Xr arthrogram ankle (73615) |
$644 |
$1,288 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$235 |
$470 |
2.2× |
| Xr chest 4+ views (71048) |
$409.50 |
$819 |
3.9× |
| Xr finger(s) 2+ views (73140) |
$176 |
$352 |
2.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$153 |
$306 |
1.5× |
| Xr myelogram posterior fossa (70010) |
$1,094 |
$2,188 |
3.1× |
| Xr optic foramina (70190) |
$99.50 |
$199 |
1.1× |
| Xr shoulder 1 view (73020) |
$133.50 |
$267 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$306.50 |
$613 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$153 |
$306 |
1.8× |
| Xr tmj bilateral (70330) |
$114.50 |
$229 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$198.50 |
$397 |
2.3× |