| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$7,718.25 |
$10,291 |
5.3× |
| Acute gi blood loss imaging (78278) |
$2,040.75 |
$2,721 |
4.9× |
| Angio adrenal bilat select (75733) |
$6,915.75 |
$9,221 |
2.1× |
| Angio adrenal unilat select (75731) |
$4,362.75 |
$5,817 |
1.3× |
| Angio extremity unilateral (75710) |
$13,521.75 |
$18,029 |
4.1× |
| Angio pulmonary unilateral (75741) |
$8,295.75 |
$11,061 |
2.5× |
| Angiogram extremity bilateral (75716) |
$16,417.50 |
$21,890 |
5.0× |
| Angiogram pelvic (75736) |
$3,074.25 |
$4,099 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$3,166.50 |
$4,222 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,020.50 |
$10,694 |
2.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,745 |
$7,660 |
1.0× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$3,751.12 |
$5,001.50 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,221 |
$5,628 |
1.3× |
| Ankle 2 views (73600) |
$566.25 |
$755 |
6.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$8,779.12 |
$11,705.50 |
2.7× |
| Arthrography knee lt (73580) |
$1,090.50 |
$1,454 |
3.0× |
| Arthrography wrist lt (73115) |
$1,029 |
$1,372 |
2.8× |
| Barium enema (74270) |
$1,569 |
$2,092 |
8.6× |
| Basic dosimetry (77300) |
$921.75 |
$1,229 |
6.6× |
| Bilat selctv renal venogram (75833) |
$6,484.88 |
$8,646.50 |
2.0× |
| Bone age studies (77072) |
$525.75 |
$701 |
4.8× |
| Bone imaging limited area (78300) |
$1,431.75 |
$1,909 |
3.4× |
| Bone marrow imaging whole body (78104) |
$1,625.25 |
$2,167 |
3.9× |
| Bone survey complete (77075) |
$1,467 |
$1,956 |
13.4× |
| Bowel imaging (78290) |
$991.50 |
$1,322 |
2.4× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$708 |
$944 |
1.2× |
| Brain image w/flow 4 + views (78606) |
$2,987.25 |
$3,983 |
5.3× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$780.75 |
$1,041 |
1.9× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$2,476.50 |
$3,302 |
4.4× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$1,644.75 |
$2,193 |
2.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$3,350.25 |
$4,467 |
8.0× |
| Cerebrospinal fluid leakage (78650) |
$1,767 |
$2,356 |
1.3× |
| Chg hyperthermia generated by intracavitary probes (77620) |
$337.50 |
$450 |
0.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,242 |
$1,656 |
6.8× |
| Cisternogram (78630) |
$2,730 |
$3,640 |
4.8× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$442.50 |
$590 |
0.5× |
| Clavicle complete (73000) |
$645 |
$860 |
7.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,823.75 |
$3,765 |
15.4× |
| Continuing medical physics consltj pr wk (77336) |
$901.50 |
$1,202 |
6.4× |
| Contrast exam abdominl aorta (75625) |
$15,205.12 |
$20,273.50 |
4.6× |
| Contrast exam thoracic aorta (75605) |
$8,838.38 |
$11,784.50 |
1.5× |
| Csf shunt evaluation (78645) |
$1,079.25 |
$1,439 |
1.9× |
| CT - st neck w&wo contr (70492) |
$5,481 |
$7,308 |
29.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$11,562 |
$15,416 |
31.7× |
| CT abdomen and pelvis without contrast (74176) |
$9,735.38 |
$12,980.50 |
39.1× |
| CT abdomen w wo contrast (74170) |
$4,359 |
$5,812 |
23.8× |
| CT abdomen w/contrast (74160) |
$5,048.25 |
$6,731 |
27.6× |
| CT abdomen w/o contrast (74150) |
$3,810 |
$5,080 |
34.9× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$12,619.50 |
$16,826 |
34.6× |
| CT angio abdom w/o & w/dye (74175) |
$6,308.25 |
$8,411 |
34.4× |
| CT angio abdominal arteries (75635) |
$4,804.12 |
$6,405.50 |
26.2× |
| CT angio hrt w/3d image (75574) |
$5,227.50 |
$6,970 |
14.3× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,090.75 |
$4,121 |
16.9× |
| CT cervical spine w/contrast (72126) |
$6,099.38 |
$8,132.50 |
16.7× |
| CT cervical spine w/o contrast (72125) |
$3,161.25 |
$4,215 |
29.0× |
| CT chest w/contrast (71260) |
$3,933 |
$5,244 |
21.5× |
| CT colonography diag w cont (74262) |
$3,963 |
$5,284 |
21.6× |
| CT colonography w/o cntrst (74261) |
$3,963 |
$5,284 |
36.3× |
| CT extremity upper w & w/o contrast (73202) |
$5,220.75 |
$6,961 |
28.5× |
| CT head/brain with contrast (70460) |
$6,150.38 |
$8,200.50 |
33.6× |
| CT head/brain without and with contrast (70470) |
$4,939.50 |
$6,586 |
27.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,963 |
$5,284 |
10.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$5,598 |
$7,464 |
61.6× |
| CT hrt w/3d image congen (75573) |
$3,963 |
$5,284 |
10.9× |
| CT limited/localized follow up study (76380) |
$1,189.50 |
$1,586 |
13.1× |
| CT lower ext w/wo contrast (73702) |
$7,503.38 |
$10,004.50 |
41.0× |
| CT lower extremity w contrast (73701) |
$4,663.88 |
$6,218.50 |
25.5× |
| CT lower extremity w/o contrast unilateral (73700) |
$3,655.50 |
$4,874 |
33.5× |
| CT lumbar spine w/contrast (72132) |
$6,219.75 |
$8,293 |
17.1× |
| CT lumbar spine w/o contrast (72131) |
$3,506.25 |
$4,675 |
32.1× |
| CT lumbar spine w/o then w/ con (72133) |
$6,761.25 |
$9,015 |
36.9× |
| CT maxillofacial area w/o contrast (70486) |
$3,864 |
$5,152 |
35.4× |
| CT maxillofacial w/contrast (70487) |
$2,946 |
$3,928 |
16.1× |
| CT maxillofacial w/o then w/ con (70488) |
$5,787.75 |
$7,717 |
31.6× |
| CT orbit sella ear w/o con (70480) |
$3,929.25 |
$5,239 |
36.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$5,157 |
$6,876 |
28.2× |
| CT pelvis w & w/o contrast (72194) |
$7,014.75 |
$9,353 |
38.3× |
| CT pelvis w/o contrast (72192) |
$4,221.75 |
$5,629 |
38.7× |
| CT soft tissue neck w/contrast (70491) |
$3,432.75 |
$4,577 |
18.7× |
| CT soft tissue neck w/o contrast (70490) |
$2,905.50 |
$3,874 |
26.6× |
| CT spine cervical w/wo contrast (72127) |
$4,255.50 |
$5,674 |
23.2× |
| CT thoracic spine w/contrast (72129) |
$4,924.88 |
$6,566.50 |
26.9× |
| CT thoracic spine w/o contrast (72128) |
$3,161.25 |
$4,215 |
29.0× |
| CT thoracic spine w/o then w/ con (72130) |
$6,651.75 |
$8,869 |
36.3× |
| CT thorax lung cancer scr c- (71271) |
$4,261.88 |
$5,682.50 |
39.0× |
| CT thorax w/o contrast (71250) |
$5,490 |
$7,320 |
50.3× |
| CT thorax w/o then w/ contrast (71270) |
$6,459.75 |
$8,613 |
35.3× |
| CT upper extremity w/dye (73201) |
$3,813 |
$5,084 |
10.5× |
| CT upper extremity w/o contrast rt (73200) |
$3,280.50 |
$4,374 |
30.0× |
| CTA chest w/wo contrast (71275) |
$3,101.25 |
$4,135 |
16.9× |
| CTA head w contrast (70496) |
$6,536.25 |
$8,715 |
35.7× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$4,413.75 |
$5,885 |
24.1× |
| Cta Neck (70498) |
$5,033.62 |
$6,711.50 |
27.5× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,782.50 |
$3,710 |
15.2× |
| Diskography lumbar (72295) |
$15,862.50 |
$21,150 |
7.8× |
| Doppler echo fetal spectral display complete (76827) |
$1,694.25 |
$2,259 |
15.5× |
| Doppler fetal mid cerebral artery (76821) |
$855 |
$1,140 |
7.8× |
| Esophogram (74220) |
$1,325.25 |
$1,767 |
7.2× |
| Fetal biophysical profile non-stress testing (76818) |
$1,037.62 |
$1,383.50 |
9.5× |
| Fetal biophysical profile w/o nst (76819) |
$1,285.12 |
$1,713.50 |
11.8× |
| Fetal echo complete (76825) |
$4,274.25 |
$5,699 |
7.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,758.75 |
$2,345 |
7.1× |
| Full mouth X-ray of teeth (70320) |
$307.50 |
$410 |
1.2× |
| Gastric emptying study (78264) |
$3,304.50 |
$4,406 |
7.9× |
| Gastroesophageal reflux study (78262) |
$1,337.25 |
$1,783 |
3.2× |
| Gated heart planar single (78472) |
$3,396.75 |
$4,529 |
8.1× |
| Heart infarct image (78466) |
$829.50 |
$1,106 |
2.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,905.25 |
$5,207 |
1.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$4,012.50 |
$5,350 |
1.2× |
| Hepatobil syst image w/drug (78227) |
$3,123.75 |
$4,165 |
5.5× |
| Hepatobiliary system imaging (78226) |
$3,473.25 |
$4,631 |
8.3× |
| Humerus min 2 views (73060) |
$1,065.75 |
$1,421 |
11.7× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators (77615) |
$1,011 |
$1,348 |
1.8× |
| Hyperthermia ntrstl prb 5/< (77610) |
$674.25 |
$899 |
1.2× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) (77605) |
$1,250.25 |
$1,667 |
1.7× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) (77600) |
$954 |
$1,272 |
2.4× |
| Hysterosalpingography (74740) |
$2,019.75 |
$2,693 |
8.1× |
| Image fusion (77399) |
$1,187.25 |
$1,583 |
8.5× |
| Imrt planning (77301) |
$5,581.50 |
$7,442 |
3.9× |
| Infusion of radioelement (77750) |
$529.50 |
$706 |
1.3× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$8,474.25 |
$11,299 |
11.7× |
| Intracavitary radiation source applic complex (77763) |
$2,052 |
$2,736 |
2.8× |
| Intracavitary radiation source applic intermed (77762) |
$1,945.50 |
$2,594 |
3.4× |
| Intracavitary radiation source applic simple (77761) |
$1,523.62 |
$2,031.50 |
2.6× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$46,524 |
$62,032 |
6.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,884 |
$2,512 |
4.8× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$740.25 |
$987 |
1.9× |
| Ivp (74400) |
$1,554 |
$2,072 |
8.5× |
| Ivp w tomography (74415) |
$1,064.25 |
$1,419 |
5.8× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$2,571 |
$3,428 |
4.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,802.75 |
$3,737 |
4.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,415 |
$3,220 |
4.3× |
| Kidney w vascular flow (78701) |
$1,752 |
$2,336 |
4.2× |
| Liver & spleen; static only (78215) |
$2,152.50 |
$2,870 |
5.2× |
| Liver & spleen; w vasc flow (78216) |
$1,095 |
$1,460 |
2.6× |
| Liver imaging w/vascular flow (78202) |
$1,140 |
$1,520 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$2,210.25 |
$2,947 |
3.9× |
| Lung perfusion differential (78597) |
$2,210.25 |
$2,947 |
5.3× |
| Lung ventilat&perfus imaging (78582) |
$3,942.75 |
$5,257 |
7.0× |
| Lung ventilation imaging (78579) |
$819.75 |
$1,093 |
2.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,590 |
$2,120 |
1.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,817.25 |
$2,423 |
2.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$4,302.38 |
$5,736.50 |
1.3× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,045.25 |
$2,727 |
0.6× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,949.75 |
$7,933 |
16.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$6,319.50 |
$8,426 |
17.3× |
| Mammary ductogram multiple ducts (77054) |
$1,186.50 |
$1,582 |
4.8× |
| Mammary ductogram single (77053) |
$932.25 |
$1,243 |
3.7× |
| Mlc device(s) for imrt (77338) |
$1,485.75 |
$1,981 |
3.8× |
| MRA head w & w/o contrast (70546) |
$8,073 |
$10,764 |
22.2× |
| MRA head w/contrast (70545) |
$4,092 |
$5,456 |
11.2× |
| MRA head w/o contrast (70544) |
$4,725 |
$6,300 |
19.0× |
| MRA neck w/contrast (70548) |
$6,276.75 |
$8,369 |
17.2× |
| MRA neck w/o contrast (70547) |
$4,581.75 |
$6,109 |
18.4× |
| MRA neck w/wo contrast (70549) |
$7,539.38 |
$10,052.50 |
20.7× |
| MRI abdomen w/contrast (74182) |
$6,046.12 |
$8,061.50 |
16.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$6,144.38 |
$8,192.50 |
16.9× |
| MRI abdomen w/o contrast (74181) |
$5,871 |
$7,828 |
23.6× |
| MRI any jnt lwr ext with con lt (73722) |
$4,602 |
$6,136 |
5.6× |
| MRI bone marrow (77084) |
$3,839.25 |
$5,119 |
15.4× |
| MRI breast without contrast bilateral (77047) |
$4,099.50 |
$5,466 |
16.5× |
| MRI breast without contrast material unilateral (77046) |
$1,963.50 |
$2,618 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$4,932.75 |
$6,577 |
19.8× |
| MRI cervical spine with contrast (72142) |
$6,616.50 |
$8,822 |
18.2× |
| MRI chest w & w/o contrast (71552) |
$7,326.75 |
$9,769 |
20.1× |
| MRI chest w/contrast (71551) |
$5,046.75 |
$6,729 |
6.2× |
| MRI chest w/o contrast (71550) |
$4,938 |
$6,584 |
19.8× |
| MRI joint upper ext w/contrast (73222) |
$3,305.25 |
$4,407 |
4.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$6,608.62 |
$8,811.50 |
18.1× |
| MRI joint upr extrem w/o dye (73221) |
$3,795.75 |
$5,061 |
15.2× |
| Mri Lower Extremity W/O Dye (73718) |
$4,784.25 |
$6,379 |
19.2× |
| MRI lumbar spine with contrast (72149) |
$5,223 |
$6,964 |
14.3× |
| MRI lumbar w/wo contrast (72158) |
$6,468 |
$8,624 |
17.8× |
| MRI lwr ext w/o jnts with con rt (73719) |
$4,584.75 |
$6,113 |
12.6× |
| MRI orbit/face/neck w/contrast (70542) |
$3,271.88 |
$4,362.50 |
9.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$8,808.75 |
$11,745 |
24.2× |
| MRI orbit/face/neck w/o contrast (70540) |
$4,221 |
$5,628 |
16.9× |
| MRI pelvis w/ contrast (72196) |
$4,181.25 |
$5,575 |
11.5× |
| MRI pelvis w/o contrast (72195) |
$4,904.25 |
$6,539 |
19.7× |
| MRI pelvis w/wo contrast (72197) |
$5,477.25 |
$7,303 |
15.0× |
| MRI spectroscopy (76390) |
$3,733.12 |
$4,977.50 |
41.1× |
| MRI spine cervical wo/w contrast (72156) |
$9,515.25 |
$12,687 |
26.1× |
| MRI spine thoracic w/contrast (72147) |
$6,616.50 |
$8,822 |
18.2× |
| MRI thoracic spine w wo contrast (72157) |
$6,884.62 |
$9,179.50 |
18.9× |
| MRI thoracic spine w/o contrast (72146) |
$4,899.75 |
$6,533 |
19.7× |
| MRI tmj (70336) |
$4,287 |
$5,716 |
17.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$5,949.75 |
$7,933 |
23.9× |
| Mri Upper Extremity W/Dye (73219) |
$4,470 |
$5,960 |
12.3× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$5,845.50 |
$7,794 |
16.0× |
| Myelogram thoracic (72255) |
$2,229.75 |
$2,973 |
2.7× |
| Myelography 2 or more regions (72270) |
$3,029.25 |
$4,039 |
3.7× |
| Myelography lumbosacral (72265) |
$2,229.75 |
$2,973 |
2.7× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$5,971.50 |
$7,962 |
4.4× |
| Myocardial perfusion planar multiple studies (78454) |
$5,971.50 |
$7,962 |
4.4× |
| Myocardial spect single study at rest or stress (78451) |
$609.75 |
$813 |
0.5× |
| Nm adrenal imaging (78075) |
$1,709.25 |
$2,279 |
1.3× |
| Nm bone 3 phase (78315) |
$6,125.25 |
$8,167 |
14.7× |
| Nm bone imaging whole body (78306) |
$4,398 |
$5,864 |
10.5× |
| Nm bone marrow scan limited (78102) |
$645.75 |
$861 |
1.5× |
| Nm bone multi (78305) |
$1,153.50 |
$1,538 |
2.8× |
| Nm heart perfusion spect stress rest (78452) |
$8,389.50 |
$11,186 |
6.2× |
| Nm kidney function (78725) |
$493.50 |
$658 |
1.2× |
| Nm kidney imaging morphology (78700) |
$2,187.75 |
$2,917 |
5.2× |
| Nm liver image static only (78201) |
$1,080 |
$1,440 |
1.9× |
| Nm lymph system (78195) |
$3,928.88 |
$5,238.50 |
6.9× |
| Nm myocard infarct spect (78469) |
$1,644.75 |
$2,193 |
2.9× |
| Nm thyroid imaging only (78013) |
$1,157.25 |
$1,543 |
2.8× |
| Nose to rectum for fb child (76010) |
$519 |
$692 |
5.7× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$2,798.25 |
$3,731 |
4.9× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$864.75 |
$1,153 |
1.5× |
| Nuclear rx IV admin (79101) |
$881.25 |
$1,175 |
3.6× |
| Ob us < 14 wks single fetus (76801) |
$1,075.50 |
$1,434 |
9.9× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$487.50 |
$650 |
4.5× |
| Oral radiopharm rx (79005) |
$3,396.75 |
$4,529 |
13.9× |
| Orthopantogram (70355) |
$223.50 |
$298 |
2.5× |
| Parathyroid imaging (78070) |
$2,320.50 |
$3,094 |
5.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,443 |
$1,924 |
3.5× |
| Peritoneal-venous shunt patency test (78291) |
$962.25 |
$1,283 |
2.3× |
| Peritoneogram rs&i (74190) |
$3,571.50 |
$4,762 |
6.3× |
| PET brain metabolic eval (78608) |
$5,970 |
$7,960 |
4.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,970 |
$7,960 |
4.0× |
| PET imaging CT for attenuation limited area (78814) |
$5,970 |
$7,960 |
4.0× |
| PET imaging for CT attenuation whole body (78816) |
$5,970 |
$7,960 |
4.0× |
| Proton treatment complex (77525) |
$1,097.25 |
$1,463 |
0.8× |
| Proton trmt simple w/o comp (77520) |
$672 |
$896 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,644 |
$6,192 |
1.4× |
| Pulmonary perfusion imaging particulate (78580) |
$1,543.12 |
$2,057.50 |
3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,029.50 |
$2,706 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$439.50 |
$586 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$365.25 |
$487 |
3.3× |
| Radex hip unilateral with pelvis 1 view (73501) |
$585.75 |
$781 |
6.4× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$1,192.50 |
$1,590 |
13.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$989.25 |
$1,319 |
9.1× |
| Radex spine cervical 2 or 3 views (72040) |
$1,176 |
$1,568 |
12.9× |
| Radex spine cervical 4 or 5 views (72050) |
$2,340 |
$3,120 |
21.4× |
| Radex spine cervical 6 or more views (72052) |
$1,551 |
$2,068 |
14.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$794.25 |
$1,059 |
8.7× |
| Radiation delivery stereotactic cranial linear (77372) |
$17,656.50 |
$23,542 |
2.3× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$780 |
$1,040 |
7.1× |
| Radiologic exam esophagus double contrast study (74221) |
$1,440.75 |
$1,921 |
7.9× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$381.75 |
$509 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,572.75 |
$2,097 |
8.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,426.50 |
$1,902 |
7.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$1,137 |
$1,516 |
12.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,259.25 |
$1,679 |
11.5× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$241.50 |
$322 |
2.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$1,186.50 |
$1,582 |
10.9× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$1,236.75 |
$1,649 |
11.3× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$162 |
$216 |
0.7× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$469.50 |
$626 |
5.2× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$829.50 |
$1,106 |
3.4× |
| Renal cyst study (74470) |
$4,257.75 |
$5,677 |
7.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,155.50 |
$2,874 |
5.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,687 |
$4,916 |
8.8× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,839.75 |
$6,453 |
8.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,792 |
$5,056 |
6.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,614.50 |
$3,486 |
4.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,271.25 |
$1,695 |
5.2× |
| Saline infused sonohysterogram (76831) |
$1,293.75 |
$1,725 |
5.2× |
| Salivary gland imaging (78230) |
$689.25 |
$919 |
1.7× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$123.75 |
$165 |
5.3× |
| Selective spinal angiogram (75705) |
$12,958.50 |
$17,278 |
2.2× |
| Shoulder arthrogram (73040) |
$2,424.75 |
$3,233 |
6.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,034.25 |
$1,379 |
9.5× |
| Simulation complex (77290) |
$2,194.12 |
$2,925.50 |
5.6× |
| Simulation intermediate (77285) |
$1,393.50 |
$1,858 |
3.6× |
| Simulation simple (77280) |
$858 |
$1,144 |
6.1× |
| Small bowel series (74250) |
$1,497.75 |
$1,997 |
8.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,445.25 |
$1,927 |
3.7× |
| Special dosimetry (77331) |
$1,203.75 |
$1,605 |
8.6× |
| Special physics consult (77370) |
$928.88 |
$1,238.50 |
6.6× |
| Special treatment procedure (77470) |
$2,471.62 |
$3,295.50 |
4.3× |
| Speech evaluation complex (70371) |
$627.75 |
$837 |
2.5× |
| Splenoportography (75810) |
$4,644 |
$6,192 |
1.4× |
| Stereotactic body radiation delivery (77373) |
$3,866.25 |
$5,155 |
2.1× |
| Superior sagittal sinus venogram (75870) |
$3,175.12 |
$4,233.50 |
1.0× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$927 |
$1,236 |
8.7× |
| Testicular imaging w/flow (78761) |
$844.50 |
$1,126 |
2.0× |
| Thyroid met imaging body (78018) |
$2,103.75 |
$2,805 |
3.7× |
| Thyroid uptake single/multiple quant measurement (78012) |
$306 |
$408 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,750.88 |
$2,334.50 |
4.2× |
| Treatment device intermediate (77333) |
$1,468.50 |
$1,958 |
10.5× |
| Treatment devices complex (77334) |
$2,204.62 |
$2,939.50 |
5.6× |
| Treatment devices simple (77332) |
$894 |
$1,192 |
6.4× |
| Ultrasound breast limited (76642) |
$1,234.50 |
$1,646 |
13.6× |
| Ultrasound, abdomen limited (76705) |
$1,877.25 |
$2,503 |
17.2× |
| Umbilical-artery Doppler (OB) (76820) |
$1,104.75 |
$1,473 |
10.1× |
| Unlisted magnetic resonance procedure (76498) |
$2,286 |
$3,048 |
25.2× |
| Unlisted procedure, clinical brachytherapy (77799) |
$674.25 |
$899 |
6.3× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$1,683.75 |
$2,245 |
12.0× |
| Ureteral reflux study (78740) |
$891 |
$1,188 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$1,527.75 |
$2,037 |
6.1× |
| Urethrocystography voiding (74455) |
$1,644 |
$2,192 |
6.6× |
| Urography antegrade (74425) |
$1,166.25 |
$1,555 |
3.2× |
| Urography retrograde w/wo kub (74420) |
$1,344.75 |
$1,793 |
3.7× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$1,128.38 |
$1,504.50 |
6.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$634.50 |
$846 |
5.8× |
| Us breast uni real time with image complete (76641) |
$1,352.25 |
$1,803 |
12.4× |
| Us chest (76604) |
$709.88 |
$946.50 |
6.5× |
| Us compl joint r-t w/image documentation (76881) |
$937.50 |
$1,250 |
8.6× |
| Us encephalogram (76506) |
$786.38 |
$1,048.50 |
7.2× |
| Us guided compression repair (76936) |
$2,874 |
$3,832 |
12.7× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$949.50 |
$1,266 |
10.4× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$459 |
$612 |
5.1× |
| Us kidney transplanted (76776) |
$898.50 |
$1,198 |
8.2× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$605.25 |
$807 |
5.5× |
| Us ob detailed single fetus (76811) |
$1,269.75 |
$1,693 |
5.1× |
| Us ob followup per fetus (76816) |
$533.25 |
$711 |
4.9× |
| Us ob limited 1 or more fetuses (76815) |
$932.25 |
$1,243 |
8.5× |
| Us obstetric transvaginal (76817) |
$1,289.25 |
$1,719 |
11.8× |
| Us pelvic limited or f/u non-ob (76857) |
$1,162.50 |
$1,550 |
10.6× |
| Us pelvis complete (76856) |
$1,983 |
$2,644 |
18.2× |
| Us retroperitoneal complete (76770) |
$1,626.75 |
$2,169 |
14.9× |
| Us retroperitoneal limited (76775) |
$767.25 |
$1,023 |
7.0× |
| Us scrotum (76870) |
$1,177.50 |
$1,570 |
10.8× |
| Us soft tissue head/neck (76536) |
$1,284 |
$1,712 |
11.8× |
| Us spinal canal (76800) |
$592.50 |
$790 |
5.4× |
| Us transrectal (76872) |
$770.62 |
$1,027.50 |
7.1× |
| Us transrectal prostate volume (76873) |
$906.75 |
$1,209 |
8.3× |
| Vascular flow imaging (78445) |
$411.75 |
$549 |
1.0× |
| Vein X-ray liver w/hemodynam (75885) |
$4,644 |
$6,192 |
1.4× |
| Venogram extremity bilateral (75822) |
$3,571.50 |
$4,762 |
2.2× |
| Venogram ivc w serialography (75825) |
$12,861.38 |
$17,148.50 |
3.9× |
| Venogram svc w serialography (75827) |
$4,891.12 |
$6,521.50 |
3.0× |
| Venography adrenal unilateral selective rs&i (75840) |
$4,221 |
$5,628 |
1.3× |
| Venography ext unilateral (75820) |
$1,234.50 |
$1,646 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$4,221 |
$5,628 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,589.75 |
$11,453 |
2.6× |
| Venous sampling by catheter (75893) |
$4,221 |
$5,628 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$432.75 |
$577 |
4.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$1,188 |
$1,584 |
13.1× |
| X-ray aorta leg arteries (75630) |
$17,811.75 |
$23,749 |
5.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,038.50 |
$2,718 |
11.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$1,214.25 |
$1,619 |
13.4× |
| X-ray exam hips bi 3-4 views (73522) |
$2,190.75 |
$2,921 |
20.1× |
| X-ray exam of finger(s) (73140) |
$948.38 |
$1,264.50 |
10.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$560.25 |
$747 |
3.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$363 |
$484 |
4.0× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$638.25 |
$851 |
7.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$1,161 |
$1,548 |
12.8× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$494.25 |
$659 |
4.5× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$1,090.50 |
$1,454 |
12.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$786.75 |
$1,049 |
8.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$286.88 |
$382.50 |
3.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$1,240.50 |
$1,654 |
13.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$1,570.50 |
$2,094 |
14.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$189.75 |
$253 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,437 |
$1,916 |
13.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,701.38 |
$2,268.50 |
15.6× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$818.25 |
$1,091 |
7.5× |
| X-ray perineogram (74775) |
$492 |
$656 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$477 |
$636 |
5.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,034.25 |
$1,379 |
9.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$616.88 |
$822.50 |
5.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$216 |
$288 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,284.75 |
$1,713 |
14.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$717.75 |
$957 |
7.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,420.50 |
$1,894 |
15.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,291.12 |
$1,721.50 |
11.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$2,834.25 |
$3,779 |
26.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$399 |
$532 |
4.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$516 |
$688 |
5.7× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$391.50 |
$522 |
4.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$1,133.25 |
$1,511 |
12.5× |
| Xr abdomen 1 view (74018) |
$963 |
$1,284 |
10.6× |
| Xr abdomen 2 views (74019) |
$1,437 |
$1,916 |
13.2× |
| Xr abdomen 3 views (74021) |
$957.75 |
$1,277 |
8.8× |
| Xr arthrogram ankle (73615) |
$935.25 |
$1,247 |
2.6× |
| Xr arthrogram elbow (73085) |
$848.25 |
$1,131 |
2.3× |
| Xr arthrogram hip (73525) |
$1,830 |
$2,440 |
5.0× |
| Xr bone density appendicular (77081) |
$297.75 |
$397 |
3.3× |
| Xr bone density axial (77080) |
$1,187.25 |
$1,583 |
10.9× |
| Xr bone length study (77073) |
$540 |
$720 |
4.9× |
| Xr bone survey infant (77076) |
$561.75 |
$749 |
5.1× |
| Xr bone survey limited (77074) |
$429 |
$572 |
3.9× |
| Xr chest 1 view (71045) |
$613.50 |
$818 |
6.8× |
| Xr chest 2 views (71046) |
$1,142.25 |
$1,523 |
12.6× |
| Xr chest 3 views (71047) |
$337.50 |
$450 |
3.7× |
| Xr cystogram 3+ views (74430) |
$1,527.75 |
$2,037 |
4.2× |
| Xr eye foreign body (70030) |
$293.25 |
$391 |
3.2× |
| Xr facial bones 3 views (70150) |
$1,140 |
$1,520 |
10.4× |
| Xr lower extremity 2 views infant (73592) |
$526.50 |
$702 |
5.8× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$620.25 |
$827 |
5.7× |
| Xr mandible 4 views (70110) |
$855.75 |
$1,141 |
7.8× |
| Xr myelogram c-spine (72240) |
$2,229.75 |
$2,973 |
2.7× |
| Xr nasal bones (70160) |
$531 |
$708 |
5.8× |
| Xr pelvis 3 views (72190) |
$326.62 |
$435.50 |
3.0× |
| Xr sella turcica (70240) |
$407.25 |
$543 |
4.5× |
| Xr sialogram (70390) |
$580.50 |
$774 |
2.3× |
| Xr spine 1 view (72020) |
$666 |
$888 |
7.3× |
| Xr sternum 2 views (71120) |
$624.75 |
$833 |
6.9× |
| Xr surgical specimen (76098) |
$1,291.88 |
$1,722.50 |
2.3× |
| Xr upper extremity 2 views infant (73092) |
$537.75 |
$717 |
4.9× |
| Xray elbow 2 views (73070) |
$438.75 |
$585 |
4.8× |
| Xray forearm 2 views (73090) |
$1,059 |
$1,412 |
11.7× |
| Xray knee 1 or 2 views rt (73560) |
$589.88 |
$786.50 |
6.5× |
| Xray neck soft tissue (70360) |
$687.75 |
$917 |
7.6× |
| Xray orbits complete min 4 views (70200) |
$731.25 |
$975 |
6.7× |
| Xray pelvis 1 or 2 views (72170) |
$1,077 |
$1,436 |
9.9× |
| Xray ribs bilateral 3 views (71110) |
$868.50 |
$1,158 |
8.0× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$1,110 |
$1,480 |
10.2× |
| Xray scapula complete (73010) |
$402.75 |
$537 |
3.7× |
| Xray shoulder 1 view (73020) |
$585 |
$780 |
6.4× |
| Xray sinuses paranasal <3 views (70210) |
$348 |
$464 |
3.8× |
| Xray spine thoracic 2 views (72070) |
$1,362.75 |
$1,817 |
12.5× |
| Xray spine thoracic 3 views (72072) |
$1,428.75 |
$1,905 |
13.1× |
| Xray tibia-fibula 2 views bil (73590) |
$1,073.25 |
$1,431 |
11.8× |
| Xray tmj open - closed unilat (70328) |
$180 |
$240 |
2.0× |
| Xray tmj's bilateral open-clsc (70330) |
$729.38 |
$972.50 |
8.0× |