| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,659 |
$12,370 |
5.4× |
| Abdomen 2 views (74019) |
$245 |
$350 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,540.70 |
$2,201 |
3.3× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$2,525.60 |
$3,608 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$450.10 |
$643 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$423.50 |
$605 |
0.1× |
| Angiography internal mammary rs&i (75756) |
$5,669.30 |
$8,099 |
1.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$10,601.50 |
$15,145 |
1.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,899.60 |
$8,428 |
1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,398.70 |
$9,141 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$12,756.02 |
$18,222.88 |
2.0× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$417.90 |
$597 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$226 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,257.30 |
$8,939 |
1.7× |
| Ankle 2 views (73600) |
$298.90 |
$427 |
3.0× |
| Aortogram thoracic (75605) |
$9,774.10 |
$13,963 |
1.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$462.70 |
$661 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$409.50 |
$585 |
0.1× |
| Arthrogram ankle (73615) |
$814.10 |
$1,163 |
2.0× |
| Arthrogram elbow (73085) |
$814.10 |
$1,163 |
2.0× |
| Arthrogram hip (73525) |
$3,062.50 |
$4,375 |
7.6× |
| Arthrogram knee (73580) |
$814.10 |
$1,163 |
2.0× |
| Arthrogram shoulder (73040) |
$847 |
$1,210 |
2.1× |
| Arthrogram wrist (73115) |
$783.30 |
$1,119 |
1.9× |
| Basic dosimetry (77300) |
$728 |
$1,040 |
4.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,482.60 |
$2,118 |
3.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,141 |
$1,630 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$2,760.10 |
$3,943 |
5.9× |
| Bone age studies (77072) |
$331.80 |
$474 |
2.7× |
| Bone Imaging 3 Phase (78315) |
$2,760.10 |
$3,943 |
5.9× |
| Bone Marrow Imaging Limited Area (78102) |
$731.50 |
$1,045 |
1.6× |
| Bone survey complete (77075) |
$695.10 |
$993 |
5.7× |
| Bone survey infant (77076) |
$568.40 |
$812 |
4.7× |
| Bowel imaging (78290) |
$1,055.60 |
$1,508 |
2.3× |
| Brachytx isodose complex (77318) |
$1,118.60 |
$1,598 |
2.6× |
| Brachytx isodose intermed (77317) |
$1,118.60 |
$1,598 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,432.20 |
$2,046 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,116 |
$5,880 |
2.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$84.70 |
$121 |
0.2× |
| Cardiac shunt detection (78428) |
$1,180.90 |
$1,687 |
2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,407.70 |
$2,011 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$312.90 |
$447 |
3.1× |
| Chest 1 view (71045) |
$242.20 |
$346 |
2.4× |
| Chest xray 3 views (71047) |
$209.30 |
$299 |
2.1× |
| Cholecystography, oral contrast Non-Facility (74290) |
$352.80 |
$504 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$392 |
$560 |
1.9× |
| Cineradiography/videoradiography (76120) |
$483 |
$690 |
4.0× |
| Clavicle complete (73000) |
$247.10 |
$353 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$245.70 |
$351 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$1,072.40 |
$1,532 |
6.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,137.40 |
$4,482 |
7.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,124.90 |
$1,607 |
4.1× |
| CT abdomen w contrast (74160) |
$891.80 |
$1,274 |
4.4× |
| CT abdomen w wo contrast (74170) |
$966.70 |
$1,381 |
4.7× |
| CT abdomen w/o contrast (74150) |
$420.70 |
$601 |
3.5× |
| CT angio hrt w/3d image (75574) |
$835.80 |
$1,194 |
2.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$977.20 |
$1,396 |
4.8× |
| CT angiography upper extremity lt (73206) |
$840.70 |
$1,201 |
4.1× |
| CT c-spine w/contrast (72126) |
$1,873.20 |
$2,676 |
4.6× |
| CT c-spine w/o contrast (72125) |
$525 |
$750 |
4.3× |
| CT cervical spine w&w/o contrast (72127) |
$966.70 |
$1,381 |
4.7× |
| CT chest w contrast (71260) |
$885.50 |
$1,265 |
4.3× |
| CT chest w/wo contrast (71270) |
$975.80 |
$1,394 |
4.8× |
| CT colonography screening (74263) |
$926.80 |
$1,324 |
3.3× |
| CT colonography w/dye (74262) |
$625.10 |
$893 |
3.1× |
| CT colonography w/o cntrst (74261) |
$625.10 |
$893 |
5.1× |
| CT head/brain with contrast (70460) |
$750.40 |
$1,072 |
3.7× |
| CT head/brain without and with contrast (70470) |
$900.20 |
$1,286 |
4.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$251.30 |
$359 |
2.5× |
| CT hrt w/3d image congen (75573) |
$609.70 |
$871 |
1.5× |
| CT iac w contrast (70481) |
$497.70 |
$711 |
2.4× |
| CT limited/localized follow up study (76380) |
$680.40 |
$972 |
6.7× |
| CT lower ext w/o (73700) |
$793.80 |
$1,134 |
6.5× |
| CT lower extremity w wo contrast (73702) |
$674.10 |
$963 |
3.3× |
| CT lower extremity w/contrast material (73701) |
$829.50 |
$1,185 |
4.1× |
| CT lumbar spine w & w/o contrast (72133) |
$674.10 |
$963 |
3.3× |
| CT lumbar spine w/contrast (72132) |
$1,018.50 |
$1,455 |
2.5× |
| CT lumbar spine w/o contrast (72131) |
$521.50 |
$745 |
4.3× |
| CT maxillofacial w contrast (70487) |
$800.80 |
$1,144 |
3.9× |
| CT maxillofacial w/wo contrast (70488) |
$938 |
$1,340 |
4.6× |
| CT maxillofacial wo contrast (70486) |
$674.80 |
$964 |
5.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$593.60 |
$848 |
2.9× |
| CT orbits w/o contrast (70480) |
$422.80 |
$604 |
3.5× |
| CT pelvis w/o contrast (72192) |
$399.70 |
$571 |
3.3× |
| CT pelvis w/wo contrast (72194) |
$1,005.20 |
$1,436 |
4.9× |
| CT scan of arm combo (73202) |
$966.70 |
$1,381 |
4.7× |
| CT soft tissue neck w contrast (70491) |
$885.50 |
$1,265 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,005.90 |
$1,437 |
4.9× |
| CT soft tissue neck w/o contrast (70490) |
$593.60 |
$848 |
4.9× |
| CT thoracic spine w/contrast (72129) |
$864.50 |
$1,235 |
4.2× |
| CT thoracic spine w/o contrast (72128) |
$571.20 |
$816 |
4.7× |
| CT thoracic spine w/wo contrast (72130) |
$966.70 |
$1,381 |
4.7× |
| CT thorax w/o contrast (71250) |
$674.80 |
$964 |
5.6× |
| CT unlisted procedure (76497) |
$765.10 |
$1,093 |
7.6× |
| CT upper ext wo (73200) |
$571.90 |
$817 |
4.7× |
| CT upper extremity with contrast (73201) |
$795.20 |
$1,136 |
2.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,458.10 |
$2,083 |
7.2× |
| Cta Abdomen (74175) |
$937.30 |
$1,339 |
4.6× |
| CTA abdomen pelvis (74174) |
$1,124.90 |
$1,607 |
2.8× |
| CTA chest (71275) |
$997.50 |
$1,425 |
4.9× |
| Cta Head (70496) |
$937.30 |
$1,339 |
4.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$793.80 |
$1,134 |
2.0× |
| Cta Neck (70498) |
$975.80 |
$1,394 |
4.8× |
| Cta Pelvis (72191) |
$920.50 |
$1,315 |
4.5× |
| Cystography minimum 3 views rs&i (74430) |
$821.80 |
$1,174 |
2.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,828.70 |
$4,041 |
1.2× |
| Diskogram cervical (72285) |
$7,678.30 |
$10,969 |
3.4× |
| Diskography lumbar (72295) |
$7,678.30 |
$10,969 |
3.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$316.40 |
$452 |
2.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$142.80 |
$204 |
1.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$280 |
$254 |
2.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$588.70 |
$841 |
4.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$161.70 |
$231 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$663.60 |
$948 |
5.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$859.60 |
$1,228 |
3.1× |
| Esophagus (74220) |
$649.60 |
$928 |
3.2× |
| Facial bones min 3 views (70150) |
$249.90 |
$357 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$421.40 |
$602 |
3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$240 |
— |
| Fetal Echo (76825) |
$147.70 |
$211 |
0.2× |
| Fluoroscopy up to 1 hr (76000) |
$21 |
$30 |
0.1× |
| Foot 2 views (73620) |
$247.10 |
$353 |
2.4× |
| Forearm 2 views (73090) |
$247.10 |
$353 |
2.4× |
| Functional MRI brain by phys/psych (70555) |
$186.20 |
$266 |
0.7× |
| Functional MRI brain by tech (70554) |
$436.10 |
$623 |
1.6× |
| Hand 2 views (73120) |
$249.90 |
$357 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$5,099.50 |
$7,285 |
6.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,877.30 |
$5,539 |
4.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,728.20 |
$5,326 |
4.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,654.90 |
$9,507 |
1.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,135.50 |
$8,765 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,079 |
$2,970 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,012.50 |
$2,875 |
4.3× |
| Hysterosalpingogram (74740) |
$1,012.20 |
$1,446 |
3.7× |
| Image fusion (77399) |
$275.80 |
$394 |
1.8× |
| Interstitial radiation source applic complex (77778) |
$1,505.70 |
$2,151 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$318.50 |
$455 |
2.6× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,245.30 |
$1,779 |
2.7× |
| Kidney imaging morphology (78700) |
$731.50 |
$1,045 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,572.90 |
$2,247 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,483.30 |
$2,119 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,407.70 |
$2,011 |
2.2× |
| Knee 3 views (73562) |
$457.10 |
$653 |
4.5× |
| Liver & spleen imaging static only (78215) |
$849.10 |
$1,213 |
1.8× |
| Lung perfusion differential (78597) |
$1,342.60 |
$1,918 |
2.9× |
| Lung ventilation imaging (78579) |
$731.50 |
$1,045 |
1.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$5,669.30 |
$8,099 |
1.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,996.30 |
$5,709 |
1.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,352 |
$3,360 |
1.3× |
| Lymphoscintigraphy (78195) |
$2,006.90 |
$2,867 |
3.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,680 |
$2,400 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,012.90 |
$1,447 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,432.20 |
$2,046 |
3.5× |
| Magnetic Resonance Elastography (76391) |
$462.70 |
$661 |
1.7× |
| Mammary ductogram or galactogram single (77053) |
$811.30 |
$1,159 |
2.9× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$953.40 |
$1,362 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,273.90 |
$4,677 |
7.5× |
| Mr safety determination physician/other qhp (76016) |
$164.50 |
$235 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$46.20 |
$66 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$171.50 |
$245 |
1.6× |
| Mr safety implt pos&/immoblj (76019) |
$111.30 |
$159 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$451.50 |
$645 |
1.6× |
| MRA head w & w/o contrast (70546) |
$1,343.30 |
$1,919 |
3.3× |
| MRA head w/o contrast (70544) |
$1,035.30 |
$1,479 |
3.7× |
| MRA head with contrast (70545) |
$780.50 |
$1,115 |
1.9× |
| MRA neck w contrast (70548) |
$1,042.30 |
$1,489 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,291.50 |
$1,845 |
3.2× |
| MRA neck w/o contrast (70547) |
$884.10 |
$1,263 |
3.2× |
| MRI abdomen w contrast (74182) |
$1,165.50 |
$1,665 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,725.50 |
$2,465 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$1,044.40 |
$1,492 |
3.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,042.30 |
$1,489 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,440.60 |
$2,058 |
3.6× |
| MRI bone marrow blood supply (77084) |
$924 |
$1,320 |
3.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,859.90 |
$2,657 |
6.7× |
| MRI breast wo contrast unilateral (77046) |
$1,355.20 |
$1,936 |
4.9× |
| MRI c-spine with contrast (72142) |
$1,073.80 |
$1,534 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$1,054.20 |
$1,506 |
3.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,836.80 |
$2,624 |
4.5× |
| MRI chest w/o contrast (71550) |
$1,147.30 |
$1,639 |
4.1× |
| MRI chest with contrast (71551) |
$1,142.40 |
$1,632 |
1.3× |
| MRI fetal sngl/1st gestation (74712) |
$581 |
$830 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$793.10 |
$1,133 |
2.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,377.60 |
$1,968 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$902.30 |
$1,289 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,061.90 |
$1,517 |
3.8× |
| MRI orbit face neck w contrast (70542) |
$1,184.40 |
$1,692 |
2.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,435 |
$2,050 |
3.5× |
| MRI pelvis w/contrast (72196) |
$958.30 |
$1,369 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,724.80 |
$2,464 |
4.3× |
| MRI pelvis w/o contrast (72195) |
$1,054.20 |
$1,506 |
3.8× |
| MRI spectroscopy (76390) |
$1,074.50 |
$1,535 |
10.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,750 |
$2,500 |
4.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,157.10 |
$1,653 |
2.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,750 |
$2,500 |
4.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,219.40 |
$1,742 |
3.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,494.50 |
$2,135 |
3.7× |
| MRI temporomandibular joint (70336) |
$864.50 |
$1,235 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,113.70 |
$1,591 |
4.0× |
| MRI up ext w/o contrast (73218) |
$902.30 |
$1,289 |
3.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,500.10 |
$2,143 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$1,225.70 |
$1,751 |
3.0× |
| Musculoskeletal Nuclear Exam (78399) |
$767.90 |
$1,097 |
1.7× |
| Myelogram Cervical (72240) |
$1,474.90 |
$2,107 |
1.6× |
| Myelogram Lumbar (72265) |
$1,474.90 |
$2,107 |
1.6× |
| Myelogram thoracic (72255) |
$1,474.90 |
$2,107 |
1.6× |
| Myelography 2 or more regions (72270) |
$1,653.40 |
$2,362 |
1.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,652.90 |
$6,647 |
3.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$4,641.70 |
$6,631 |
1.8× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,780.30 |
$6,829 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,641.70 |
$6,631 |
1.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,525.60 |
$3,608 |
1.7× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,525.60 |
$3,608 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$168.70 |
$241 |
0.1× |
| Myocardial spect single study at rest or stress (78451) |
$2,525.60 |
$3,608 |
1.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$4,780.30 |
$6,829 |
2.9× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$4,827.20 |
$6,896 |
2.7× |
| Neck soft tissue (70360) |
$296.80 |
$424 |
2.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$731.50 |
$1,045 |
1.6× |
| Nm adrenal scan (78075) |
$2,525.60 |
$3,608 |
1.7× |
| Nm bone marrow multi (78103) |
$731.50 |
$1,045 |
1.6× |
| Nm bone marrow wb (78104) |
$787.50 |
$1,125 |
1.7× |
| Nm cisternogram (78630) |
$1,407.70 |
$2,011 |
2.2× |
| Nm csf leak detection (78650) |
$2,525.60 |
$3,608 |
1.7× |
| Nm gastric emptying study (78264) |
$1,723.40 |
$2,462 |
3.7× |
| Nm gastroesophageal reflux study (78262) |
$731.50 |
$1,045 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$853.30 |
$1,219 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$349.30 |
$499 |
2.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,933.40 |
$12,762 |
5.6× |
| Nuclear medicine study of endocrine organs (78099) |
$767.90 |
$1,097 |
1.7× |
| Nuclear Rx Oral Admin (79005) |
$1,421.70 |
$2,031 |
5.2× |
| Ob us nuchal meas 1 gest (76813) |
$407.40 |
$582 |
3.4× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$86.10 |
$123 |
0.7× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$20.30 |
$29 |
0.6× |
| Osseous survey limited (77074) |
$324.10 |
$463 |
2.7× |
| Parathyrd planar w/spect&CT (78072) |
$1,407.70 |
$2,011 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$772.10 |
$1,103 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$331.80 |
$474 |
2.7× |
| Peritoneogram after injection (74190) |
$1,177.40 |
$1,682 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$4,972.80 |
$7,104 |
3.0× |
| PET imaging CT for attenuation limited area (78814) |
$4,780.30 |
$6,829 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,972.80 |
$7,104 |
3.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,525.60 |
$3,608 |
1.7× |
| PET whole body (78813) |
$3,995.60 |
$5,708 |
2.4× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$4,116 |
$5,880 |
2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,398.70 |
$9,141 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,441.60 |
$3,488 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$821.80 |
$1,174 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,407.70 |
$2,011 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,177.40 |
$1,682 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$311.50 |
$445 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$247.10 |
$353 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$247.10 |
$353 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$247.10 |
$353 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$331.80 |
$474 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$411.60 |
$588 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$308 |
$440 |
3.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$247.10 |
$353 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$240.10 |
$343 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$247.10 |
$353 |
2.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$224.70 |
$321 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$331.80 |
$474 |
2.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$556.50 |
$795 |
4.6× |
| Radex Humerus Minimum 2 Views (73060) |
$247.10 |
$353 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$286.30 |
$409 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$311.50 |
$445 |
2.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$249.20 |
$356 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$210 |
$300 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$331.80 |
$474 |
2.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$459.20 |
$656 |
4.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$161.70 |
$231 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$528.50 |
$755 |
4.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$368.20 |
$526 |
3.6× |
| Radex Toe Minimum 2 Views (73660) |
$247.10 |
$353 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$249.90 |
$357 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$247.10 |
$353 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$411.60 |
$588 |
3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,850.20 |
$19,786 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$4,076.80 |
$5,824 |
34.4× |
| Radiation treatment delivery level 2 (77407) |
$4,076.80 |
$5,824 |
9.1× |
| Radiation treatment delivery level 3 (77412) |
$4,076.80 |
$5,824 |
6.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$255.50 |
$365 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$196 |
$280 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$242.20 |
$346 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$1,031.80 |
$1,474 |
5.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$534.80 |
$764 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$649.60 |
$928 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$649.60 |
$928 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$161.70 |
$231 |
1.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$161.70 |
$231 |
1.6× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$371 |
$530 |
3.7× |
| Radiological examination surgical specimen (76098) |
$810.60 |
$1,158 |
1.3× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$606.90 |
$867 |
2.2× |
| Ribs bilateral 3 views (71110) |
$249.90 |
$357 |
2.1× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$731.50 |
$1,045 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,429.40 |
$2,042 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,629.90 |
$3,757 |
4.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,560.90 |
$5,087 |
5.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,487.80 |
$3,554 |
3.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,525.60 |
$3,608 |
1.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,782.50 |
$3,975 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,409.70 |
$4,871 |
2.3× |
| Rp Therapy Intravenous Administration (79101) |
$1,152.90 |
$1,647 |
4.3× |
| Sacroiliac Joints < 3 Views (72200) |
$196 |
$280 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$708.40 |
$1,012 |
2.6× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$731.50 |
$1,045 |
1.6× |
| Scapula (73010) |
$331.80 |
$474 |
2.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$95.20 |
$136 |
4.1× |
| Shoulder 1 view (73020) |
$247.10 |
$353 |
2.4× |
| Sialogram (70390) |
$779.80 |
$1,114 |
2.8× |
| Simulation intermediate (77285) |
$1,118.60 |
$1,598 |
2.6× |
| Small bowel series (74250) |
$392 |
$560 |
1.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$2,399.60 |
$3,428 |
5.5× |
| Special dosimetry (77331) |
$697.20 |
$996 |
4.5× |
| Special Physics Consult (77370) |
$973.70 |
$1,391 |
6.2× |
| Special treatment procedure (77470) |
$3,474.80 |
$4,964 |
5.4× |
| Spine thoracic 3 views (72072) |
$331.80 |
$474 |
2.7× |
| Spleen imaging only (78185) |
$1,055.60 |
$1,508 |
2.3× |
| Stereotactic Body Radiation Delivery (77373) |
$7,592.90 |
$10,847 |
3.7× |
| Superior sagittal sinus venogram (75870) |
$2,276.40 |
$3,252 |
0.6× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$161.70 |
$231 |
1.6× |
| Tbs technical calculation only (77091) |
$161.70 |
$231 |
1.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$3,525.90 |
$5,037 |
8.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$3,089.10 |
$4,413 |
7.1× |
| Testicular Imaging With Vascular Flow (78761) |
$845.60 |
$1,208 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,607.50 |
$3,725 |
6.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,376.90 |
$1,967 |
8.8× |
| Thoracolumbar 2 views (72080) |
$247.10 |
$353 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,060.10 |
$2,943 |
3.3× |
| Thyroid imaging w/blood flow (78013) |
$897.40 |
$1,282 |
1.9× |
| Thyroid uptake measurement (78012) |
$863.10 |
$1,233 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,615.60 |
$2,308 |
3.5× |
| Tmj unilateral (70328) |
$232.40 |
$332 |
2.3× |
| Treatment device complex (77334) |
$1,696.80 |
$2,424 |
3.9× |
| Treatment device intermediate (77333) |
$973.70 |
$1,391 |
6.2× |
| Treatment devices simple (77332) |
$1,072.40 |
$1,532 |
6.9× |
| Ultrasound breast complete (76641) |
$558.60 |
$798 |
4.6× |
| Ultrasound elastography first target lesion (76982) |
$681.80 |
$974 |
5.6× |
| Ultrasound Exam Aaa Screen (76706) |
$331.80 |
$474 |
2.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$617.40 |
$882 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$641.90 |
$917 |
5.3× |
| Umbilical-artery Doppler (OB) (76820) |
$472.50 |
$675 |
3.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$161.70 |
$231 |
1.6× |
| Unlisted fluoroscopic procedure (76496) |
$200.20 |
$286 |
2.0× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$767.90 |
$1,097 |
1.7× |
| Unlisted magnetic resonance procedure (76498) |
$462.70 |
$661 |
4.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$731.50 |
$1,045 |
1.6× |
| Unlisted ultrasound procedure (76999) |
$247.10 |
$353 |
2.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$296.80 |
$424 |
26.8× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$258.30 |
$369 |
2.7× |
| Ureteral reflux study (78740) |
$774.90 |
$1,107 |
1.7× |
| Urethrocystogram voiding (74455) |
$795.20 |
$1,136 |
2.9× |
| Urethrocystography retrograde rs&i (74450) |
$797.30 |
$1,139 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$700 |
$1,000 |
3.4× |
| Us breast unilateral limited (76642) |
$697.90 |
$997 |
6.9× |
| Us chest (76604) |
$168 |
$240 |
1.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$793.10 |
$1,133 |
3.2× |
| Us compl joint r-t w/image documentation (76881) |
$529.90 |
$757 |
4.4× |
| Us elastography parenchyma (76981) |
$708.40 |
$1,012 |
5.8× |
| Us encephalogram (76506) |
$536.90 |
$767 |
4.4× |
| Us infant hips w manipulation (76885) |
$870.11 |
$1,243.01 |
8.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$331.80 |
$474 |
2.7× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$207.20 |
$296 |
1.7× |
| Us ob detailed single fetus (76811) |
$1,232 |
$1,760 |
4.4× |
| Us ob limited (76815) |
$192.50 |
$275 |
1.6× |
| Us ob transvaginal (76817) |
$191.80 |
$274 |
1.6× |
| Us pelvic non ob complete (76856) |
$799.40 |
$1,142 |
6.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$365.40 |
$169 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$686.70 |
$981 |
5.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$599.20 |
$856 |
4.9× |
| Us retroperitoneal complete (76770) |
$847 |
$1,210 |
7.0× |
| Us retroperitoneal limited (76775) |
$489.30 |
$699 |
4.0× |
| Us scrotum and contents (76870) |
$671.30 |
$959 |
5.5× |
| Us soft tissue head/neck (76536) |
$653.10 |
$933 |
5.4× |
| Us spinal canal and contents (76800) |
$423.50 |
$605 |
3.5× |
| Us transrectal (76872) |
$316.99 |
$406 |
2.6× |
| Us transrectal prostate volume (76873) |
$331.80 |
$474 |
2.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$793.10 |
$1,133 |
6.5× |
| Venogram extremity bilateral (75822) |
$2,550.80 |
$3,644 |
1.4× |
| Venogram Extremity Unilateral (75820) |
$237.30 |
$339 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$401.10 |
$573 |
0.1× |
| Venography caval superior serialography rs&i (75827) |
$3,089.80 |
$4,414 |
1.7× |
| Venography Renal Bilateral (75833) |
$6,135.50 |
$8,765 |
1.7× |
| Venography renal unilateral selective rs&i (75831) |
$403.20 |
$576 |
0.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$410.20 |
$586 |
0.1× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$371.70 |
$531 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$161.70 |
$231 |
1.6× |
| Wrist 2 views (73100) |
$247.10 |
$353 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$398.30 |
$569 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$249.20 |
$356 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,047.90 |
$1,497 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$247.10 |
$353 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$247.10 |
$353 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$233.10 |
$333 |
1.9× |
| X-ray exam of femur 2/> (73552) |
$247.10 |
$353 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$186.20 |
$266 |
1.8× |
| X-ray IV pyelogram (ivp) (74400) |
$632.80 |
$904 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161.70 |
$231 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$140.70 |
$201 |
1.4× |
| X-ray leg, infant (73592) |
$260.40 |
$372 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$331.80 |
$474 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$379.40 |
$542 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$193.90 |
$277 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$240.10 |
$343 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$37.80 |
$54 |
0.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$247.10 |
$353 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$331.80 |
$474 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$331.80 |
$474 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$331.80 |
$474 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$247.10 |
$353 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$249.20 |
$356 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$331.80 |
$474 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$331.80 |
$474 |
2.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$492.10 |
$703 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$247.10 |
$353 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$185.50 |
$265 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$247.10 |
$353 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$331.80 |
$474 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$522.20 |
$746 |
4.3× |
| Xr bone length studies (77073) |
$231 |
$330 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$453.60 |
$648 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$571.20 |
$816 |
4.7× |
| Xr chest 4+ views (71048) |
$547.40 |
$782 |
4.5× |
| Xr urogram antegrade (74425) |
$664.30 |
$949 |
1.6× |