| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,732.10 |
$3,184 |
1.2× |
| Abdomen 2 views (74019) |
$66.37 |
$122 |
0.6× |
| Acute gi blood loss imaging (78278) |
$1,027.34 |
$1,888.50 |
2.5× |
| Angiography extremity bilateral rs&i (75716) |
$681.63 |
$1,253 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$715.36 |
$1,315 |
0.2× |
| Angiography internal mammary rs&i (75756) |
$969.41 |
$1,782 |
0.3× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,016.60 |
$1,868.75 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$683.26 |
$1,256 |
0.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$789.89 |
$1,452 |
0.2× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,315.39 |
$2,418 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$743.65 |
$1,367 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,795.07 |
$5,138 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$746.91 |
$1,373 |
0.2× |
| Ankle 2 views (73600) |
$101.72 |
$187 |
1.1× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$636.48 |
$1,170 |
0.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,154.91 |
$2,123 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$633.22 |
$1,164 |
0.2× |
| Arthrogram hip (73525) |
$413.44 |
$760 |
1.1× |
| Arthrogram knee (73580) |
$931.87 |
$1,713 |
2.6× |
| Arthrogram shoulder (73040) |
$381.07 |
$700.50 |
1.1× |
| Arthrogram wrist (73115) |
$729.50 |
$1,341 |
2.0× |
| Basic dosimetry (77300) |
$207.54 |
$381.50 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$685.98 |
$1,261 |
1.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,565.63 |
$2,878 |
3.8× |
| Bone &/joint imaging whole body (78306) |
$877.47 |
$1,613 |
2.1× |
| Bone age studies (77072) |
$139 |
$255.50 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,004.50 |
$1,846.50 |
2.4× |
| Bone survey complete (77075) |
$356.86 |
$656 |
3.3× |
| Bone survey infant (77076) |
$382.16 |
$702.50 |
3.5× |
| Bowel imaging (78290) |
$958.26 |
$1,761.50 |
2.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,201.70 |
$2,209 |
3.1× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,213.12 |
$2,230 |
2.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,202.27 |
$9,563 |
3.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,181.02 |
$2,171 |
2.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$4,039.20 |
$7,425 |
11.2× |
| Cardiac shunt detection (78428) |
$609.28 |
$1,120 |
1.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,017.15 |
$3,708 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$62.02 |
$114 |
0.7× |
| Chest 1 view (71045) |
$102 |
$187.50 |
1.1× |
| Chest xray 3 views (71047) |
$156.13 |
$287 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$450.44 |
$828 |
2.5× |
| Clavicle complete (73000) |
$103.90 |
$191 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,090.44 |
$2,004.50 |
10.1× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$1,212.03 |
$2,228 |
13.5× |
| Continuing medical physics consltj pr wk (77336) |
$838.85 |
$1,542 |
6.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,833.28 |
$3,370 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,286.29 |
$2,364.50 |
5.2× |
| CT abdomen w contrast (74160) |
$1,197.34 |
$2,201 |
6.6× |
| CT abdomen w wo contrast (74170) |
$1,348.58 |
$2,479 |
7.4× |
| CT abdomen w/o contrast (74150) |
$725.42 |
$1,333.50 |
6.7× |
| CT angio hrt w/3d image (75574) |
$3,081.22 |
$5,664 |
8.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,824.58 |
$3,354 |
10.0× |
| CT angiography upper extremity lt (73206) |
$1,667.64 |
$3,065.50 |
9.2× |
| CT c-spine w/contrast (72126) |
$2,159.68 |
$3,970 |
6.0× |
| CT c-spine w/o contrast (72125) |
$836.13 |
$1,537 |
7.7× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,411.14 |
$2,594 |
7.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,346.67 |
$2,475.50 |
7.4× |
| CT chest w contrast (71260) |
$953.90 |
$1,753.50 |
5.3× |
| CT chest w/wo contrast (71270) |
$1,192.45 |
$2,192 |
6.6× |
| CT colonography screening (74263) |
$7,272.74 |
$13,369 |
29.4× |
| CT colonography w/dye (74262) |
$4,670.78 |
$8,586 |
25.7× |
| CT colonography w/o cntrst (74261) |
$4,083.26 |
$7,506 |
37.7× |
| CT head/brain with contrast (70460) |
$824.98 |
$1,516.50 |
4.5× |
| CT head/brain without and with contrast (70470) |
$992.26 |
$1,824 |
5.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,025.31 |
$3,723 |
5.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$53.86 |
$99 |
0.6× |
| CT iac w contrast (70481) |
$1,394.82 |
$2,564 |
7.7× |
| CT limited/localized follow up study (76380) |
$1,099.97 |
$2,022 |
12.2× |
| CT lower ext w/o (73700) |
$895.15 |
$1,645.50 |
8.3× |
| CT lower extremity w wo contrast (73702) |
$1,492.46 |
$2,743.50 |
8.2× |
| CT lower extremity w/contrast material (73701) |
$1,155.18 |
$2,123.50 |
6.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,417.94 |
$2,606.50 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$1,158.44 |
$2,129.50 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$912.29 |
$1,677 |
8.4× |
| CT maxillofacial w contrast (70487) |
$863.88 |
$1,588 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,045.84 |
$1,922.50 |
5.8× |
| CT maxillofacial wo contrast (70486) |
$731.68 |
$1,345 |
6.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,618.68 |
$2,975.50 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,173.68 |
$2,157.50 |
10.8× |
| CT pelvis w/o contrast (72192) |
$663.41 |
$1,219.50 |
6.1× |
| CT pelvis w/wo contrast (72194) |
$1,394.82 |
$2,564 |
7.7× |
| CT scan of arm combo (73202) |
$724.88 |
$1,332.50 |
4.0× |
| CT soft tissue neck w contrast (70491) |
$1,042.84 |
$1,917 |
5.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,323.82 |
$2,433.50 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$819.80 |
$1,507 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$1,181.84 |
$2,172.50 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$884.54 |
$1,626 |
8.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,379.86 |
$2,536.50 |
7.6× |
| CT thorax w/o contrast (71250) |
$787.16 |
$1,447 |
7.3× |
| CT unlisted procedure (76497) |
$1,484.58 |
$2,729 |
16.5× |
| CT upper ext wo (73200) |
$867.68 |
$1,595 |
8.0× |
| CT upper extremity with contrast (73201) |
$1,181.02 |
$2,171 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,023.68 |
$3,720 |
11.1× |
| Cta Abdomen (74175) |
$1,611.88 |
$2,963 |
8.9× |
| CTA abdomen pelvis (74174) |
$2,184.70 |
$4,016 |
6.0× |
| CTA chest (71275) |
$1,212.03 |
$2,228 |
6.7× |
| Cta Head (70496) |
$1,463.63 |
$2,690.50 |
8.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,359.20 |
$6,175 |
9.3× |
| Cta Neck (70498) |
$1,410.04 |
$2,592 |
7.8× |
| Cta Pelvis (72191) |
$1,542.51 |
$2,835.50 |
8.5× |
| Cystography minimum 3 views rs&i (74430) |
$132.74 |
$244 |
0.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$1,116.29 |
$2,052 |
4.5× |
| Diskography lumbar (72295) |
$698.50 |
$1,284 |
0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$298.11 |
$548 |
2.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$268.46 |
$493.50 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$184.42 |
$339 |
2.0× |
| Dxa bone density study axial skeleton (77085) |
$167.01 |
$307 |
1.5× |
| Esophagus (74220) |
$310.62 |
$571 |
1.7× |
| Facial bones min 3 views (70150) |
$55.49 |
$102 |
0.5× |
| Fetal biophysical profile non-stress testing (76818) |
$347.62 |
$639 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$282.34 |
$519 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$221.40 |
$407 |
0.9× |
| Foot 2 views (73620) |
$92.21 |
$169.50 |
1.0× |
| Forearm 2 views (73090) |
$75.62 |
$139 |
0.8× |
| Hand 2 views (73120) |
$107.71 |
$198 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,068.83 |
$3,803 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,795.62 |
$5,139 |
3.9× |
| Heart Infarct Image (78466) |
$1,093.44 |
$2,010 |
2.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$688.70 |
$1,266 |
0.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,212.30 |
$2,228.50 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,027.08 |
$1,888 |
2.5× |
| Hysterosalpingogram (74740) |
$284.51 |
$523 |
1.2× |
| Image fusion (77399) |
$587.52 |
$1,080 |
4.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$671.84 |
$1,235 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$527.40 |
$969.50 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,795.74 |
$3,301 |
3.2× |
| Knee 3 views (73562) |
$128.11 |
$235.50 |
1.4× |
| Liver & spleen imaging static only (78215) |
$569.57 |
$1,047 |
1.4× |
| Liver imaging static only (78201) |
$794.24 |
$1,460 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$1,800.10 |
$3,309 |
3.2× |
| Lung perfusion differential (78597) |
$611.46 |
$1,124 |
1.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,099.71 |
$5,698 |
0.9× |
| Lymphoscintigraphy (78195) |
$1,530.82 |
$2,814 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,224.68 |
$4,089.50 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$4,632.43 |
$8,515.50 |
12.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,786.10 |
$5,121.50 |
7.7× |
| Mammary ductogram or galactogram multiple (77054) |
$608.19 |
$1,118 |
2.5× |
| Mammary ductogram or galactogram single (77053) |
$456.42 |
$839 |
1.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$254.05 |
$467 |
2.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,896.66 |
$3,486.50 |
4.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$74.53 |
$137 |
2.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$201.28 |
$370 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,449.08 |
$4,502 |
6.8× |
| MRA head w/o contrast (70544) |
$1,767.46 |
$3,249 |
7.2× |
| MRA neck w contrast (70548) |
$1,865.65 |
$3,429.50 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,678.66 |
$4,924 |
7.4× |
| MRA neck w/o contrast (70547) |
$1,854.76 |
$3,409.50 |
7.5× |
| MRI abdomen w contrast (74182) |
$2,199.12 |
$4,042.50 |
6.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,294.59 |
$4,218 |
6.4× |
| MRI abdomen w/o contrast (74181) |
$1,551.76 |
$2,852.50 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,256.24 |
$4,147.50 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,604.13 |
$4,787 |
7.2× |
| MRI breast w/o contrast bilateral (77047) |
$1,619.48 |
$2,977 |
6.6× |
| MRI breast wo contrast unilateral (77046) |
$2,772.77 |
$5,097 |
11.2× |
| MRI c-spine with contrast (72142) |
$2,220.06 |
$4,081 |
6.1× |
| MRI cardiac w/o contrast (75557) |
$2,909.86 |
$5,349 |
11.8× |
| MRI cervical spine w/o contrast (72141) |
$1,575.15 |
$2,895.50 |
6.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,408.44 |
$6,265.50 |
9.4× |
| MRI chest w/o contrast (71550) |
$2,554.90 |
$4,696.50 |
10.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,982.06 |
$3,643.50 |
5.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,123.78 |
$3,904 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,501.98 |
$2,761 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,641.25 |
$3,017 |
6.6× |
| MRI orbit face neck w contrast (70542) |
$1,649.40 |
$3,032 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,058.92 |
$5,623 |
8.5× |
| MRI pelvis w/contrast (72196) |
$2,017.70 |
$3,709 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,450.45 |
$4,504.50 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,528.10 |
$2,809 |
6.2× |
| MRI spectroscopy (76390) |
$2,179.26 |
$4,006 |
24.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,265.76 |
$4,165 |
6.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,974.18 |
$3,629 |
5.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,215.17 |
$4,072 |
6.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,979.08 |
$3,638 |
5.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,368.58 |
$4,354 |
6.6× |
| MRI temporomandibular joint (70336) |
$2,002.46 |
$3,681 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,658.92 |
$3,049.50 |
6.7× |
| MRI up ext w/o contrast (73218) |
$2,636.50 |
$4,846.50 |
10.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,349.12 |
$2,480 |
5.5× |
| MRI, joint upper extrem combo (73223) |
$2,609.56 |
$4,797 |
7.2× |
| Myelography 2 or more regions (72270) |
$980.29 |
$1,802 |
1.2× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$7,290.14 |
$13,401 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,668.19 |
$6,743 |
2.5× |
| Myocardial infarct spect (78469) |
$1,227.26 |
$2,256 |
2.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,525.92 |
$2,805 |
1.1× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,411.55 |
$4,433 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,583.04 |
$2,910 |
1.2× |
| Myocardial spect single study at rest or stress (78451) |
$1,141.31 |
$2,098 |
0.9× |
| N-invas est c ffr sw aly CTA (75580) |
$2,353.34 |
$4,326 |
2.6× |
| Neck soft tissue (70360) |
$118.59 |
$218 |
1.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$368.83 |
$678 |
0.9× |
| Nm bone marrow wb (78104) |
$1,417.12 |
$2,605 |
3.4× |
| Nm cisternogram (78630) |
$1,997.02 |
$3,671 |
3.6× |
| Nm gastric emptying study (78264) |
$977.30 |
$1,796.50 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$1,407.87 |
$2,588 |
3.4× |
| Nm kidney scan w/flow (78701) |
$1,251.74 |
$2,301 |
3.0× |
| Nonvascular shunt X-ray (75809) |
$645.73 |
$1,187 |
6.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,471.70 |
$11,896.50 |
4.5× |
| Nuclear Rx Oral Admin (79005) |
$324.22 |
$596 |
1.3× |
| Ob us nuchal meas 1 gest (76813) |
$244.80 |
$450 |
2.3× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$171.08 |
$314.50 |
1.6× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$32.64 |
$60 |
1.1× |
| Osseous survey limited (77074) |
$260.30 |
$478.50 |
2.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,135.06 |
$2,086.50 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$1,612.96 |
$2,965 |
3.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,935.55 |
$3,558 |
4.7× |
| Pelvis 1 or 2 views (72170) |
$58.21 |
$107 |
0.5× |
| Peritoneogram after injection (74190) |
$183.87 |
$338 |
0.3× |
| PET image w/CT, skull-thigh (78815) |
$2,901.96 |
$5,334.50 |
2.0× |
| PET imaging CT for attenuation limited area (78814) |
$5,103.81 |
$9,382 |
3.4× |
| PET imaging for CT attenuation whole body (78816) |
$2,833.15 |
$5,208 |
1.9× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$618.53 |
$1,137 |
0.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$699.04 |
$1,285 |
0.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$496.67 |
$913 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,289.82 |
$2,371 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$965.32 |
$1,774.50 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$175.98 |
$323.50 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$42.43 |
$78 |
0.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$88.68 |
$163 |
1.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$81.60 |
$150 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$142.52 |
$262 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$225.48 |
$414.50 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$362.84 |
$667 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$38.62 |
$71 |
0.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$41.89 |
$77 |
0.5× |
| Radex Hand Minimum 3 Views (73130) |
$122.40 |
$225 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$114.24 |
$210 |
1.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$204.54 |
$376 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$127.84 |
$235 |
1.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$200.46 |
$368.50 |
1.9× |
| Radex Humerus Minimum 2 Views (73060) |
$122.67 |
$225.50 |
1.4× |
| Radex Kne 1/2 Views (73560) |
$111.52 |
$205 |
1.2× |
| Radex Kne Compl 4/More Views (73564) |
$77.25 |
$142 |
0.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$90.85 |
$167 |
0.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$61.47 |
$113 |
0.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$143.08 |
$263 |
1.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$54.40 |
$100 |
0.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$123.48 |
$227 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$129.74 |
$238.50 |
1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$198.29 |
$364.50 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$103.09 |
$189.50 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$102.54 |
$188.50 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$83.23 |
$153 |
0.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$404.46 |
$743.50 |
3.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,573.57 |
$13,922 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$396.03 |
$728 |
3.7× |
| Radiation treatment delivery level 2 (77407) |
$1,578.69 |
$2,902 |
4.0× |
| Radiation treatment delivery level 3 (77412) |
$647.90 |
$1,191 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$116.14 |
$213.50 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$171.90 |
$316 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$83.78 |
$154 |
0.9× |
| Radiologic exam colon single contrast study (74270) |
$589.97 |
$1,084.50 |
3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$340.54 |
$626 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$631.58 |
$1,161 |
3.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$706.12 |
$1,298 |
3.9× |
| Radiologic examination femur 1 view (73551) |
$101.46 |
$186.50 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$41.34 |
$76 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$198.56 |
$365 |
1.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$195.84 |
$360 |
1.8× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$186.05 |
$342 |
0.8× |
| Radiological examination surgical specimen (76098) |
$93.30 |
$171.50 |
0.2× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$324.22 |
$596 |
1.3× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$397.66 |
$731 |
0.7× |
| Renal Cyst Study (74470) |
$903.58 |
$1,661 |
1.6× |
| Ribs bilateral 3 views (71110) |
$144.16 |
$265 |
1.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,046.66 |
$1,924 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,454.66 |
$2,674 |
3.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,377.70 |
$6,209 |
6.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,461.18 |
$2,686 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,025.44 |
$1,885 |
1.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,319.07 |
$4,263 |
1.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,816.68 |
$3,339.50 |
1.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,247.12 |
$2,292.50 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$324.22 |
$596 |
1.3× |
| Rp Therapy Intravenous Administration (79101) |
$324.22 |
$596 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$150.14 |
$276 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$353.60 |
$650 |
1.4× |
| Scapula (73010) |
$102.28 |
$188 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$90.85 |
$167 |
3.9× |
| Sella turcica (70240) |
$68.54 |
$126 |
0.8× |
| Shoulder 1 view (73020) |
$80.78 |
$148.50 |
0.9× |
| Sialogram (70390) |
$347.07 |
$638 |
1.4× |
| Simulation intermediate (77285) |
$231.20 |
$425 |
0.6× |
| Small bowel series (74250) |
$426.76 |
$784.50 |
2.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$446.90 |
$821.50 |
1.2× |
| Special dosimetry (77331) |
$269.82 |
$496 |
1.9× |
| Special Physics Consult (77370) |
$757.25 |
$1,392 |
5.4× |
| Special treatment procedure (77470) |
$1,293.64 |
$2,378 |
2.3× |
| Spine thoracic 3 views (72072) |
$63.65 |
$117 |
0.6× |
| Stereotactic Body Radiation Delivery (77373) |
$8,100.70 |
$14,891 |
4.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$965.87 |
$1,775.50 |
2.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$653.89 |
$1,202 |
1.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,631.73 |
$2,999.50 |
4.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$915.82 |
$1,683.50 |
6.6× |
| Thoracolumbar 2 views (72080) |
$120.77 |
$222 |
1.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,688.03 |
$3,103 |
3.0× |
| Thyroid imaging w/blood flow (78013) |
$1,131.52 |
$2,080 |
2.7× |
| Thyroid uptake measurement (78012) |
$289.96 |
$533 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$731.68 |
$1,345 |
1.8× |
| Tmj unilateral (70328) |
$105.54 |
$194 |
1.2× |
| Treatment device complex (77334) |
$573.64 |
$1,054.50 |
1.5× |
| Treatment device intermediate (77333) |
$772.48 |
$1,420 |
5.6× |
| Treatment devices simple (77332) |
$249.16 |
$458 |
1.8× |
| Ultrasound breast complete (76641) |
$423.50 |
$778.50 |
3.9× |
| Ultrasound Exam Aaa Screen (76706) |
$150.69 |
$277 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$300.28 |
$552 |
2.8× |
| Umbilical-artery Doppler (OB) (76820) |
$215.97 |
$397 |
2.0× |
| Unlisted magnetic resonance procedure (76498) |
$4,059.33 |
$7,462 |
45.1× |
| Ureteral reflux study (78740) |
$817.09 |
$1,502 |
2.0× |
| Urethrocystogram voiding (74455) |
$357.68 |
$657.50 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$763.23 |
$1,403 |
3.1× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$802.94 |
$1,476 |
4.4× |
| Us breast unilateral limited (76642) |
$270.91 |
$498 |
3.0× |
| Us chest (76604) |
$233.38 |
$429 |
2.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,580.86 |
$2,906 |
7.1× |
| Us compl joint r-t w/image documentation (76881) |
$273.90 |
$503.50 |
2.5× |
| Us elastography parenchyma (76981) |
$374.27 |
$688 |
3.5× |
| Us encephalogram (76506) |
$294.30 |
$541 |
2.7× |
| Us hips infant static (76886) |
$333.47 |
$613 |
3.7× |
| Us infant hips w manipulation (76885) |
$385.15 |
$708 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$220.86 |
$406 |
2.0× |
| Us ob detailed single fetus (76811) |
$534.75 |
$983 |
2.2× |
| Us ob limited (76815) |
$161.02 |
$296 |
1.5× |
| Us ob transvaginal (76817) |
$212.70 |
$391 |
2.0× |
| Us pelvic non ob complete (76856) |
$269.28 |
$495 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$108.80 |
$200 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$246.43 |
$453 |
2.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$278.80 |
$512.50 |
2.6× |
| Us retroperitoneal complete (76770) |
$349.52 |
$642.50 |
3.2× |
| Us retroperitoneal limited (76775) |
$213.79 |
$393 |
2.0× |
| Us scrotum and contents (76870) |
$316.60 |
$582 |
2.9× |
| Us soft tissue head/neck (76536) |
$215.97 |
$397 |
2.0× |
| Us spinal canal and contents (76800) |
$318.78 |
$586 |
2.9× |
| Us transrectal (76872) |
$436.84 |
$803 |
4.0× |
| Us, eye b-scan (76512) |
$340.54 |
$626 |
3.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$465.66 |
$856 |
4.3× |
| Venogram adrenal unilat (75840) |
$431.94 |
$794 |
0.1× |
| Venogram extremity bilateral (75822) |
$740.38 |
$1,361 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$403.92 |
$742.50 |
0.2× |
| Venography caval inferior serialography rs&i (75825) |
$607.10 |
$1,116 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$918.68 |
$1,688.75 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$660.42 |
$1,214 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$705.02 |
$1,296 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$328.58 |
$604 |
3.6× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$466.75 |
$858 |
0.8× |
| Wrist 2 views (73100) |
$119.14 |
$219 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$154.50 |
$284 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$126.21 |
$232 |
1.4× |
| X-ray b.e. reductn intuss (74283) |
$756.70 |
$1,391 |
4.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,449.22 |
$2,664 |
8.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$46.24 |
$85 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$148.78 |
$273.50 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$172.18 |
$316.50 |
1.6× |
| X-ray exam of femur 2/> (73552) |
$44.06 |
$81 |
0.5× |
| X-ray eye for foreign body (70030) |
$133.82 |
$246 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$118.32 |
$217.50 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$134.91 |
$248 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$131.38 |
$241.50 |
1.5× |
| X-ray leg, infant (73592) |
$118.04 |
$217 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$61.47 |
$113 |
0.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$183.06 |
$336.50 |
1.7× |
| X-ray nose-rectum child f.b. (76010) |
$87.86 |
$161.50 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$144.70 |
$266 |
1.3× |
| X-ray retrograde pyelogram (74420) |
$800.50 |
$1,471.50 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$83.78 |
$154 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$82.69 |
$152 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$181.97 |
$334.50 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$63.10 |
$116 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$56.03 |
$103 |
0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$95.20 |
$175 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$123.49 |
$227 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$145.79 |
$268 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$87.86 |
$161.50 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$149.33 |
$274.50 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$62.02 |
$114 |
0.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$56.03 |
$103 |
0.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$163.20 |
$300 |
1.5× |
| Xr bone length studies (77073) |
$226.58 |
$416.50 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$82.69 |
$152 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$220.59 |
$405.50 |
2.0× |
| Xr chest 4+ views (71048) |
$116.69 |
$214.50 |
1.1× |
| Xr urogram antegrade (74425) |
$895.97 |
$1,647 |
2.5× |