| 3-D radiotherapy plan dose-volume histograms (77295) |
$10,427.09 |
$10,427.09 |
6.3× |
| Abdomen 2 views (74019) |
$507 |
$507 |
4.0× |
| Acute gi blood loss imaging (78278) |
$1,347.87 |
$1,347.87 |
2.8× |
| Angiography extremity bilateral rs&i (75716) |
$11,552 |
$11,552 |
3.1× |
| Angiography extremity unilateral rs&i (75710) |
$11,059 |
$11,059 |
2.9× |
| Angiography internal mammary rs&i (75756) |
$4,636.49 |
$4,636.49 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,861.75 |
$7,861.75 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$10,254.78 |
$10,254.78 |
2.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$9,767.43 |
$9,767.43 |
2.6× |
| Angiography Spinal Selective Rs&I (75705) |
$16,016 |
$16,016 |
2.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$16,016 |
$16,016 |
2.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,934 |
$3,934 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,737.85 |
$3,737.85 |
1.0× |
| Ankle 2 views (73600) |
$483.79 |
$483.79 |
4.6× |
| Aortogram thoracic (75605) |
$14,217.51 |
$14,217.51 |
2.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$10,920.65 |
$10,920.65 |
2.9× |
| Aortography abdominal serialography rs&i (75625) |
$16,016 |
$16,016 |
4.2× |
| Arthrogram hip (73525) |
$1,346.80 |
$1,346.80 |
3.2× |
| Arthrogram knee (73580) |
$2,134 |
$2,134 |
5.1× |
| Arthrogram shoulder (73040) |
$2,072 |
$2,072 |
5.0× |
| Basic dosimetry (77300) |
$766.88 |
$766.88 |
4.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,264.08 |
$1,264.08 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$1,646.40 |
$1,646.40 |
3.4× |
| Bone age studies (77072) |
$611 |
$611 |
4.9× |
| Bone Imaging 3 Phase (78315) |
$1,630.66 |
$1,630.66 |
3.4× |
| Bone Marrow Imaging Limited Area (78102) |
$1,347.87 |
$1,347.87 |
2.8× |
| Bone survey complete (77075) |
$673 |
$673 |
5.4× |
| Bone survey infant (77076) |
$580.45 |
$580.45 |
4.6× |
| Bowel imaging (78290) |
$1,372 |
$1,372 |
2.9× |
| Brachytx isodose complex (77318) |
$1,737.32 |
$1,737.32 |
3.9× |
| Brachytx isodose intermed (77317) |
$1,737.32 |
$1,737.32 |
3.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$926 |
$926 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,788.97 |
$1,788.97 |
2.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,392 |
$5,392 |
3.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,788.97 |
$1,788.97 |
2.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,958 |
$2,958 |
7.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,564.98 |
$1,564.98 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$640.99 |
$640.99 |
6.1× |
| Chest 1 view (71045) |
$267 |
$267 |
2.6× |
| Chest xray 3 views (71047) |
$343 |
$343 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$870.75 |
$870.75 |
4.1× |
| Cineradiography/videoradiography (76120) |
$605.42 |
$605.42 |
4.8× |
| Clavicle complete (73000) |
$478.90 |
$478.90 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,163 |
$1,163 |
9.3× |
| Continuing medical physics consltj pr wk (77336) |
$863.79 |
$863.79 |
5.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$553.04 |
$553.04 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,509 |
$3,509 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,083 |
$2,083 |
7.3× |
| CT abdomen w contrast (74160) |
$1,545 |
$1,545 |
7.3× |
| CT abdomen w wo contrast (74170) |
$1,838 |
$1,838 |
8.7× |
| CT abdomen w/o contrast (74150) |
$1,255 |
$1,255 |
10.0× |
| CT angio hrt w/3d image (75574) |
$2,095 |
$2,095 |
5.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,408 |
$2,408 |
11.5× |
| CT angiography upper extremity lt (73206) |
$1,996 |
$1,996 |
9.5× |
| CT c-spine w/contrast (72126) |
$1,843 |
$1,843 |
4.4× |
| CT c-spine w/o contrast (72125) |
$1,165 |
$1,165 |
9.3× |
| CT chest w contrast (71260) |
$1,475 |
$1,475 |
7.0× |
| CT chest w/wo contrast (71270) |
$2,205 |
$2,205 |
10.5× |
| CT colonography screening (74263) |
$3,894 |
$3,894 |
13.6× |
| CT colonography w/o cntrst (74261) |
$2,436 |
$2,436 |
19.4× |
| CT head/brain with contrast (70460) |
$1,256 |
$1,256 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,382 |
$1,382 |
6.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,465 |
$1,465 |
3.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,064 |
$1,064 |
10.2× |
| CT iac w contrast (70481) |
$1,282 |
$1,282 |
6.1× |
| CT limited/localized follow up study (76380) |
$731 |
$731 |
7.0× |
| CT lower ext w/o (73700) |
$1,410.52 |
$1,410.52 |
11.3× |
| CT lower extremity w wo contrast (73702) |
$1,800 |
$1,800 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$1,957.44 |
$1,957.44 |
9.3× |
| CT lumbar spine w/contrast (72132) |
$2,150 |
$2,150 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$1,382 |
$1,382 |
11.0× |
| CT maxillofacial w contrast (70487) |
$1,256 |
$1,256 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,391 |
$1,391 |
6.6× |
| CT maxillofacial wo contrast (70486) |
$1,014 |
$1,014 |
8.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,903 |
$1,903 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,014 |
$1,014 |
8.1× |
| CT pelvis w/o contrast (72192) |
$1,346 |
$1,346 |
10.7× |
| CT pelvis w/wo contrast (72194) |
$2,040 |
$2,040 |
9.7× |
| CT soft tissue neck w contrast (70491) |
$1,282 |
$1,282 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,678 |
$1,678 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,014 |
$1,014 |
8.1× |
| CT thoracic spine w/contrast (72129) |
$1,546 |
$1,546 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,407 |
$1,407 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,665 |
$2,665 |
12.7× |
| CT thorax w/o contrast (71250) |
$1,163 |
$1,163 |
9.3× |
| CT upper ext wo (73200) |
$1,207.50 |
$1,207.50 |
9.6× |
| CT upper extremity with contrast (73201) |
$2,687.50 |
$2,687.50 |
6.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,895 |
$1,895 |
9.0× |
| Cta Abdomen (74175) |
$1,701 |
$1,701 |
8.1× |
| CTA abdomen pelvis (74174) |
$5,483 |
$5,483 |
13.1× |
| CTA chest (71275) |
$1,752 |
$1,752 |
8.3× |
| Cta Head (70496) |
$1,508 |
$1,508 |
7.2× |
| Cta Neck (70498) |
$1,400 |
$1,400 |
6.7× |
| Cta Pelvis (72191) |
$2,254 |
$2,254 |
10.7× |
| Cystography minimum 3 views rs&i (74430) |
$1,186 |
$1,186 |
2.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$1,258.20 |
$1,258.20 |
10.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$978 |
$978 |
7.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$543 |
$543 |
4.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$636 |
$636 |
5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$369 |
$369 |
3.5× |
| Dxa bone density study axial skeleton (77085) |
$615 |
$615 |
4.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$3,415.50 |
$3,415.50 |
11.9× |
| Esophagus (74220) |
$808.22 |
$808.22 |
3.8× |
| Facial bones min 3 views (70150) |
$611 |
$611 |
4.9× |
| Fetal biophysical profile non-stress testing (76818) |
$978 |
$978 |
7.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$932 |
$932 |
7.4× |
| Fetal Echo (76825) |
$2,530 |
$2,530 |
3.9× |
| Fluoroscopy up to 1 hr (76000) |
$930 |
$930 |
3.3× |
| Foot 2 views (73620) |
$401.65 |
$401.65 |
3.9× |
| Forearm 2 views (73090) |
$462.90 |
$462.90 |
4.4× |
| Hand 2 views (73120) |
$641.55 |
$641.55 |
5.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$7,532 |
$7,532 |
9.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,895.80 |
$4,895.80 |
5.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$7,253.61 |
$7,253.61 |
8.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$10,370.19 |
$10,370.19 |
2.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,981.18 |
$1,981.18 |
3.0× |
| Hysterosalpingogram (74740) |
$2,176 |
$2,176 |
7.6× |
| Interstitial radiation source applic complex (77778) |
$9,358.44 |
$9,358.44 |
11.2× |
| Kidney imaging morphology (78700) |
$1,347.87 |
$1,347.87 |
2.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,821 |
$1,821 |
2.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,458.35 |
$2,458.35 |
3.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,821 |
$1,821 |
2.8× |
| Knee 3 views (73562) |
$423.50 |
$423.50 |
4.1× |
| Liver & spleen imaging static only (78215) |
$1,372 |
$1,372 |
2.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,372 |
$1,372 |
2.9× |
| Lung perf&ventilat diferentl (78598) |
$1,821 |
$1,821 |
2.8× |
| Lung ventilation imaging (78579) |
$1,372 |
$1,372 |
2.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,737.85 |
$3,737.85 |
1.0× |
| Lymphoscintigraphy (78195) |
$1,576.94 |
$1,576.94 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,901.18 |
$2,901.18 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,789.75 |
$2,789.75 |
6.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,231.31 |
$3,231.31 |
7.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,835 |
$2,835 |
6.3× |
| Mr safety determination physician/other qhp (76016) |
$111.85 |
$111.85 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$31.96 |
$31.96 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$117.18 |
$117.18 |
1.0× |
| Mr safety implt pos&/immoblj (76019) |
$75.46 |
$75.46 |
1.1× |
| Mr safety med physics xm customization plng&mntr (76017) |
$306.26 |
$306.26 |
1.1× |
| MRA head w & w/o contrast (70546) |
$3,049 |
$3,049 |
7.3× |
| MRA head w/o contrast (70544) |
$1,995 |
$1,995 |
7.0× |
| MRA head with contrast (70545) |
$2,838 |
$2,838 |
6.8× |
| MRA neck w contrast (70548) |
$2,838 |
$2,838 |
6.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,662 |
$3,662 |
8.8× |
| MRA neck w/o contrast (70547) |
$2,002 |
$2,002 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,281 |
$3,281 |
7.8× |
| MRI abdomen w/o contrast (74181) |
$1,985 |
$1,985 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,838 |
$2,838 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,980 |
$2,980 |
7.1× |
| MRI c-spine with contrast (72142) |
$2,838 |
$2,838 |
6.8× |
| MRI cardiac w/o contrast (75557) |
$2,402 |
$2,402 |
8.4× |
| MRI cervical spine w/o contrast (72141) |
$1,961 |
$1,961 |
6.9× |
| MRI chest w/o & w/contrast material (71552) |
$4,141 |
$4,141 |
9.9× |
| MRI chest w/o contrast (71550) |
$2,321 |
$2,321 |
8.1× |
| MRI fetal sngl/1st gestation (74712) |
$1,746.02 |
$1,746.02 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,068.67 |
$3,068.67 |
7.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,663.75 |
$3,663.75 |
8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,146.79 |
$2,146.79 |
7.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,951 |
$2,951 |
10.3× |
| MRI orbit face neck w contrast (70542) |
$4,136 |
$4,136 |
9.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,359 |
$4,359 |
10.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,321.11 |
$3,321.11 |
7.9× |
| MRI pelvis w/o contrast (72195) |
$2,336.97 |
$2,336.97 |
8.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,325 |
$3,325 |
8.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,838 |
$2,838 |
6.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,452 |
$3,452 |
8.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,838 |
$2,838 |
6.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,325 |
$3,325 |
8.0× |
| MRI temporomandibular joint (70336) |
$2,369.60 |
$2,369.60 |
8.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,961 |
$1,961 |
6.9× |
| MRI up ext w/o contrast (73218) |
$2,442.84 |
$2,442.84 |
8.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,808.40 |
$2,808.40 |
9.8× |
| MRI, joint upper extrem combo (73223) |
$2,931 |
$2,931 |
7.0× |
| Myelogram Cervical (72240) |
$3,492.24 |
$3,492.24 |
3.7× |
| Myelogram Lumbar (72265) |
$3,492.24 |
$3,492.24 |
3.7× |
| Myelogram thoracic (72255) |
$3,492.24 |
$3,492.24 |
3.7× |
| Myelography 2 or more regions (72270) |
$3,492.24 |
$3,492.24 |
3.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,300 |
$5,300 |
3.4× |
| Myocardial Spect Multiple Studies (78452) |
$5,050.53 |
$5,050.53 |
3.3× |
| Myocardial spect single study at rest or stress (78451) |
$4,570 |
$4,570 |
2.9× |
| Neck soft tissue (70360) |
$457.18 |
$457.18 |
4.4× |
| Nm cardiac blood pool multiple (78473) |
$1,372 |
$1,372 |
2.9× |
| Nm gastric emptying study (78264) |
$1,814.48 |
$1,814.48 |
3.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$9,710 |
$9,710 |
5.9× |
| Nuclear Rx Oral Admin (79005) |
$1,030 |
$1,030 |
3.7× |
| Ob us nuchal meas 1 gest (76813) |
$594 |
$594 |
4.7× |
| Osseous survey limited (77074) |
$611 |
$611 |
4.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,793.88 |
$2,793.88 |
4.3× |
| Pelvis 1 or 2 views (72170) |
$611 |
$611 |
4.9× |
| PET image w/CT, skull-thigh (78815) |
$7,457 |
$7,457 |
4.4× |
| PET imaging CT for attenuation limited area (78814) |
$5,656 |
$5,656 |
3.3× |
| PET imaging for CT attenuation whole body (78816) |
$9,224 |
$9,224 |
5.4× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$5,300 |
$5,300 |
3.4× |
| PET whole body (78813) |
$8,444 |
$8,444 |
4.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$6,806 |
$6,806 |
4.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$10,370.19 |
$10,370.19 |
2.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$9,767.43 |
$9,767.43 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,372 |
$1,372 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,821 |
$1,821 |
2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,176 |
$2,176 |
3.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$515.61 |
$515.61 |
4.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$427.57 |
$427.57 |
4.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$510.52 |
$510.52 |
4.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$369 |
$369 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$843.77 |
$843.77 |
6.7× |
| Radex fingr minimum 2 views (73140) |
$424.78 |
$424.78 |
4.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$493.45 |
$493.45 |
4.7× |
| Radex Hand Minimum 3 Views (73130) |
$702.65 |
$702.65 |
6.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$369 |
$369 |
3.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$611 |
$611 |
4.9× |
| Radex Humerus Minimum 2 Views (73060) |
$421.38 |
$421.38 |
4.0× |
| Radex Kne 1/2 Views (73560) |
$401 |
$401 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$744 |
$744 |
5.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$611 |
$611 |
4.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$369 |
$369 |
3.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$642 |
$642 |
5.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$487.12 |
$487.12 |
4.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$369 |
$369 |
3.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$642 |
$642 |
5.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$379 |
$379 |
3.6× |
| Radex Toe Minimum 2 Views (73660) |
$369 |
$369 |
3.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$502 |
$502 |
4.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$18,090 |
$18,090 |
2.0× |
| Radiation treatment delivery level 1 (77402) |
$655.83 |
$655.83 |
5.4× |
| Radiation treatment delivery level 2 (77407) |
$752 |
$752 |
1.6× |
| Radiation treatment delivery level 3 (77412) |
$1,442.40 |
$1,442.40 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$265 |
$265 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$339 |
$339 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$1,166.40 |
$1,166.40 |
5.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$643 |
$643 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$677 |
$677 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$913.95 |
$913.95 |
4.3× |
| Radiologic examination femur 1 view (73551) |
$369 |
$369 |
3.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$427 |
$427 |
4.1× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$1,164 |
$1,164 |
4.1× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$1,164 |
$1,164 |
4.1× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$416 |
$416 |
4.0× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$623.17 |
$623.17 |
6.0× |
| Radiological examination surgical specimen (76098) |
$2,196 |
$2,196 |
3.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$7,253.61 |
$7,253.61 |
15.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$4,895.80 |
$4,895.80 |
10.6× |
| Renal Cyst Study (74470) |
$2,940.97 |
$2,940.97 |
4.5× |
| Ribs bilateral 3 views (71110) |
$611 |
$611 |
4.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,570 |
$4,570 |
7.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,119.06 |
$2,119.06 |
3.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,570 |
$4,570 |
7.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,805 |
$1,805 |
1.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,436.75 |
$2,436.75 |
1.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,030 |
$1,030 |
3.7× |
| Rp Therapy Intravenous Administration (79101) |
$1,030 |
$1,030 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$611 |
$611 |
4.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$932 |
$932 |
3.3× |
| Scapula (73010) |
$506.58 |
$506.58 |
4.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$182.12 |
$182.12 |
7.8× |
| Shoulder 1 view (73020) |
$369 |
$369 |
3.5× |
| Simulation intermediate (77285) |
$2,071.50 |
$2,071.50 |
4.6× |
| Small bowel series (74250) |
$623 |
$623 |
3.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,804 |
$1,804 |
4.0× |
| Special dosimetry (77331) |
$664 |
$664 |
4.1× |
| Special Physics Consult (77370) |
$1,389.15 |
$1,389.15 |
8.6× |
| Special treatment procedure (77470) |
$4,221.45 |
$4,221.45 |
6.4× |
| Spine thoracic 3 views (72072) |
$673 |
$673 |
5.4× |
| Stereotactic Body Radiation Delivery (77373) |
$10,341 |
$10,341 |
4.8× |
| Superior sagittal sinus venogram (75870) |
$3,737.85 |
$3,737.85 |
1.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,542.05 |
$2,542.05 |
5.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$990.97 |
$990.97 |
2.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,075.40 |
$3,075.40 |
6.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,435.26 |
$1,435.26 |
8.9× |
| Thoracolumbar 2 views (72080) |
$448 |
$448 |
4.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,372 |
$1,372 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$1,347.87 |
$1,347.87 |
2.8× |
| Thyroid uptake measurement (78012) |
$1,372 |
$1,372 |
2.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,372 |
$1,372 |
2.9× |
| Tmj unilateral (70328) |
$369 |
$369 |
3.5× |
| Treatment device complex (77334) |
$2,435.40 |
$2,435.40 |
5.4× |
| Treatment device intermediate (77333) |
$1,070 |
$1,070 |
6.6× |
| Treatment devices simple (77332) |
$1,070 |
$1,070 |
6.6× |
| Ultrasound breast complete (76641) |
$1,796 |
$1,796 |
14.3× |
| Ultrasound Exam Aaa Screen (76706) |
$457 |
$457 |
3.6× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$334 |
$334 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$932 |
$932 |
7.4× |
| Umbilical-artery Doppler (OB) (76820) |
$543 |
$543 |
4.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$317.80 |
$317.80 |
3.0× |
| Ureteral reflux study (78740) |
$1,372 |
$1,372 |
2.9× |
| Urethrocystogram voiding (74455) |
$2,176 |
$2,176 |
7.6× |
| Urethrocystography retrograde rs&i (74450) |
$1,186 |
$1,186 |
4.1× |
| Us breast unilateral limited (76642) |
$559 |
$559 |
5.4× |
| Us chest (76604) |
$752.39 |
$752.39 |
6.0× |
| Us compl joint r-t w/image documentation (76881) |
$859 |
$859 |
6.9× |
| Us elastography parenchyma (76981) |
$964 |
$964 |
7.7× |
| Us encephalogram (76506) |
$591 |
$591 |
4.7× |
| Us infant hips w manipulation (76885) |
$717 |
$717 |
6.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$559 |
$559 |
4.5× |
| Us ob detailed single fetus (76811) |
$1,026 |
$1,026 |
3.6× |
| Us ob limited (76815) |
$932 |
$932 |
7.4× |
| Us ob transvaginal (76817) |
$1,118.40 |
$1,118.40 |
8.9× |
| Us pelvic non ob complete (76856) |
$953.85 |
$953.85 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$590.69 |
$590.69 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$932 |
$932 |
7.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$834.30 |
$834.30 |
6.7× |
| Us retroperitoneal complete (76770) |
$978 |
$978 |
7.8× |
| Us retroperitoneal limited (76775) |
$932 |
$932 |
7.4× |
| Us scrotum and contents (76870) |
$932 |
$932 |
7.4× |
| Us soft tissue head/neck (76536) |
$932 |
$932 |
7.4× |
| Us spinal canal and contents (76800) |
$678 |
$678 |
5.4× |
| Us transrectal (76872) |
$932 |
$932 |
7.4× |
| Us, eye b-scan (76512) |
$886.96 |
$886.96 |
7.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$932 |
$932 |
7.4× |
| Venogram extremity bilateral (75822) |
$3,934 |
$3,934 |
2.1× |
| Venogram Extremity Unilateral (75820) |
$3,532 |
$3,532 |
1.9× |
| Venography caval inferior serialography rs&i (75825) |
$11,003 |
$11,003 |
2.9× |
| Venography Renal Bilateral (75833) |
$10,254.78 |
$10,254.78 |
2.7× |
| Venography renal unilateral selective rs&i (75831) |
$9,767.43 |
$9,767.43 |
2.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,636.49 |
$4,636.49 |
1.2× |
| Venous sampling by catheter (75893) |
$12,095 |
$12,095 |
1.8× |
| Vertebral fracture assessment via dxa (77086) |
$317.80 |
$317.80 |
3.0× |
| Wrist 2 views (73100) |
$407.67 |
$407.67 |
3.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$734.75 |
$734.75 |
5.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$327.56 |
$327.56 |
3.1× |
| X-ray b.e. reductn intuss (74283) |
$1,003.11 |
$1,003.11 |
4.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,186 |
$1,186 |
5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$478.90 |
$478.90 |
4.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$388 |
$388 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$642 |
$642 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$426.50 |
$426.50 |
4.1× |
| X-ray eye for foreign body (70030) |
$424 |
$424 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$369 |
$369 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$369 |
$369 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$369 |
$369 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$611 |
$611 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$673.65 |
$673.65 |
5.4× |
| X-ray nose-rectum child f.b. (76010) |
$1,186 |
$1,186 |
11.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$727.90 |
$727.90 |
5.8× |
| X-ray retrograde pyelogram (74420) |
$2,176 |
$2,176 |
5.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$478.77 |
$478.77 |
4.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$665.22 |
$665.22 |
5.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$841.05 |
$841.05 |
6.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$810.07 |
$810.07 |
6.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$472.19 |
$472.19 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$460.34 |
$460.34 |
4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$611 |
$611 |
4.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$549.90 |
$549.90 |
4.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$369 |
$369 |
3.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$455.40 |
$455.40 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$414 |
$414 |
4.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$659 |
$659 |
5.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$685 |
$685 |
5.5× |
| Xr bone length studies (77073) |
$477.90 |
$477.90 |
3.8× |
| Xr c-spine 4 or 5 views (72050) |
$643.10 |
$643.10 |
5.1× |
| Xr c-spine 6 or more views (72052) |
$744.49 |
$744.49 |
5.9× |
| Xr chest 4+ views (71048) |
$512 |
$512 |
4.1× |
| Xr urogram antegrade (74425) |
$1,931.65 |
$1,931.65 |
4.6× |