| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,254.18 |
$5,009.28 |
1.4× |
| Abdomen 1 View (74018) |
$112.64 |
$250.32 |
1.1× |
| Abdomen 2 views (74019) |
$140.34 |
$311.87 |
1.1× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$587.75 |
$1,306.11 |
1.2× |
| Adrenal Cortex & Medulla Img (78075) |
$1,960.40 |
$4,356.45 |
1.3× |
| Angio internal mammary (75756) |
$3,740.70 |
$8,312.66 |
1.0× |
| Angio pulmonary bilat (75743) |
$4,246.80 |
$9,437.33 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,701.56 |
$8,225.70 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$5,231.68 |
$11,625.95 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$4,501.61 |
$10,003.57 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,246.80 |
$9,437.33 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,807.13 |
$4,015.85 |
0.5× |
| Ankle 2 views (73600) |
$122.65 |
$272.55 |
1.2× |
| Aortography thoracic serialography rs&i (75605) |
$6,573.28 |
$14,607.28 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,246.80 |
$9,437.33 |
1.1× |
| Artery X-Rays Abdomen (75726) |
$6,967.67 |
$15,483.71 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$2,608.06 |
$5,795.69 |
0.7× |
| Artery X-Rays Pelvis (75736) |
$6,967.67 |
$15,483.71 |
1.0× |
| Artery X-Rays Spine (75705) |
$6,573.28 |
$14,607.28 |
1.0× |
| Arthrogram ankle (73615) |
$1,042.89 |
$2,317.54 |
2.5× |
| Arthrogram hip (73525) |
$1,105.47 |
$2,456.59 |
2.6× |
| Arthrogram Wrist (73115) |
$949.46 |
$2,109.92 |
2.3× |
| Basic radiation dosimetry calculation (77300) |
$238.71 |
$530.47 |
1.5× |
| Bone age studies (77072) |
$188.82 |
$419.60 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$672.86 |
$1,495.24 |
1.4× |
| Bone Imaging Limited Area (78300) |
$587.75 |
$1,306.11 |
1.2× |
| Bone Imaging Multiple Areas (78305) |
$587.75 |
$1,306.11 |
1.2× |
| Bone Imaging Whole Body (78306) |
$672.86 |
$1,495.24 |
1.4× |
| Bone marrow imaging limited area (78102) |
$587.75 |
$1,306.11 |
1.2× |
| Bone marrow imaging; multiple areas (78103) |
$587.75 |
$1,306.11 |
1.2× |
| Bone marrow imaging; whole body (78104) |
$587.75 |
$1,306.11 |
1.2× |
| Bone survey infant (77076) |
$223.71 |
$497.13 |
1.8× |
| Brachytx isodose complex (77318) |
$542.85 |
$1,206.34 |
1.2× |
| Brachytx isodose intermed (77317) |
$542.85 |
$1,206.34 |
1.2× |
| Brachytx Isodose Plan Simple (77316) |
$313.31 |
$696.24 |
0.7× |
| Brain Flow Imaging Only (78610) |
$786.90 |
$1,748.67 |
1.2× |
| Brain Image W/Flow < 4 Views (78601) |
$588.39 |
$1,307.53 |
1.2× |
| Brain imaging < 4 static views (78600) |
$551.76 |
$1,226.14 |
1.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$756.19 |
$1,680.42 |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$756.19 |
$1,680.42 |
1.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$587.75 |
$1,306.11 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$749.99 |
$1,666.64 |
1.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$1,424.07 |
$3,164.60 |
1.5× |
| Cardiac Shunt Detection (78428) |
$587.75 |
$1,306.11 |
1.2× |
| Cat Scan Follow-Up Study (76380) |
$104.30 |
$231.78 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$742.36 |
$1,649.68 |
1.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$756.19 |
$1,680.42 |
1.2× |
| Cerebrospinal Fluid Scan (78630) |
$756.19 |
$1,680.42 |
1.2× |
| Chest 1 view (71045) |
$112.64 |
$250.32 |
1.1× |
| Chest 2 views (71046) |
$119.40 |
$265.34 |
1.1× |
| Chest 3 views (71047) |
$112.64 |
$250.32 |
1.1× |
| Chest 4 or more views (71048) |
$129.95 |
$288.77 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$224.50 |
$498.90 |
1.1× |
| Cisternography Positive Contrast Rs&I (70015) |
$892.90 |
$1,984.21 |
1.0× |
| Clavicle complete (73000) |
$119.40 |
$265.34 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$157.45 |
$349.89 |
1.3× |
| Continuing medical physics consltj pr wk (77336) |
$238.71 |
$530.47 |
1.5× |
| Contrast Exam Abdominl Aorta (75625) |
$4,501.61 |
$10,003.57 |
1.2× |
| Contrast X-Ray Bladder (74430) |
$472.56 |
$1,050.13 |
1.1× |
| Contrast X-Ray Of Elbow (73085) |
$1,042.89 |
$2,317.54 |
2.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,042.89 |
$2,317.54 |
2.5× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$224.50 |
$498.90 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$639.88 |
$1,421.95 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$376.56 |
$836.80 |
1.3× |
| CT abdomen w contrast (74160) |
$442.32 |
$982.93 |
2.1× |
| CT abdomen w wo contrast (74170) |
$442.32 |
$982.93 |
2.1× |
| CT abdomen w/o contrast (74150) |
$216.79 |
$481.75 |
1.7× |
| CT Angio Abdomen and Pelvis (74174) |
$603.66 |
$1,341.46 |
1.4× |
| CT Angio Chest (71275) |
$417.28 |
$927.30 |
2.0× |
| CT Angio Head (70496) |
$417.28 |
$927.30 |
2.0× |
| CT angio hrt w/3d image (75574) |
$442.32 |
$982.93 |
1.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$417.28 |
$927.30 |
2.0× |
| CT Angio Neck (70498) |
$417.28 |
$927.30 |
2.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$386.37 |
$858.60 |
1.8× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$118.35 |
$263 |
0.6× |
| CT cervical spine w/ contrast (72126) |
$664.31 |
$1,476.25 |
1.6× |
| CT cervical spine w/o contrast (72125) |
$229.79 |
$510.65 |
1.8× |
| CT cervical spine w/wo cont (72127) |
$386.37 |
$858.60 |
1.8× |
| CT chest w contrast (71260) |
$442.32 |
$982.93 |
2.1× |
| CT chest w/wo contrast (71270) |
$386.37 |
$858.60 |
1.8× |
| CT colonography screening (74263) |
$1,113.33 |
$2,474.06 |
3.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$386.37 |
$858.60 |
1.8× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$179.40 |
$398.66 |
1.4× |
| CT head/brain with contrast (70460) |
$417.28 |
$927.30 |
2.0× |
| CT head/brain without and with contrast (70470) |
$417.28 |
$927.30 |
2.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$383.70 |
$852.67 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$81.62 |
$181.38 |
0.8× |
| CT hrt w/3d image congen (75573) |
$386.37 |
$858.60 |
0.9× |
| CT iac w contrast (70481) |
$386.37 |
$858.60 |
1.8× |
| CT l-spine w&w/o contrast (72133) |
$386.37 |
$858.60 |
1.8× |
| CT lower ext w/o (73700) |
$215.26 |
$478.36 |
1.7× |
| CT lower extremity w/contrast material (73701) |
$386.37 |
$858.60 |
1.8× |
| CT lumbar spine w contrast (72132) |
$738.30 |
$1,640.66 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$216.79 |
$481.75 |
1.7× |
| CT maxillofacial w contrast (70487) |
$417.28 |
$927.30 |
2.0× |
| CT maxillofacial wo contrast (70486) |
$215.26 |
$478.36 |
1.7× |
| CT neck tissue combo (70492) |
$386.37 |
$858.60 |
1.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$386.37 |
$858.60 |
1.8× |
| CT orbits w/o contrast (70480) |
$215.26 |
$478.36 |
1.7× |
| CT pelvis w&w/o contrast (72194) |
$417.28 |
$927.30 |
2.0× |
| CT pelvis w/o contrast (72192) |
$203.08 |
$451.28 |
1.6× |
| CT scan of leg combo (73702) |
$409.55 |
$910.12 |
1.9× |
| CT scans face/jaw combo (70488) |
$417.28 |
$927.30 |
2.0× |
| CT soft tissue neck w contrast (70491) |
$442.32 |
$982.93 |
2.1× |
| CT soft tissue neck w/o contrast (70490) |
$215.26 |
$478.36 |
1.7× |
| CT thoracic spine w contrast (72129) |
$427.39 |
$949.75 |
2.0× |
| CT thoracic spine w/o contrast (72128) |
$216.79 |
$481.75 |
1.7× |
| CT thoracic spine w/wo cont (72130) |
$386.37 |
$858.60 |
1.8× |
| CT thorax w/o contrast (71250) |
$203.08 |
$451.28 |
1.6× |
| CT unlisted procedure (76497) |
$104.30 |
$231.78 |
1.0× |
| CT upper ext wo (73200) |
$215.26 |
$478.36 |
1.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$386.37 |
$858.60 |
1.8× |
| CT upper extremity with contrast (73201) |
$704.17 |
$1,564.83 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$417.28 |
$927.30 |
2.0× |
| Cta Abdomen (74175) |
$417.28 |
$927.30 |
2.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$235.35 |
$523 |
0.6× |
| CTA pelvis (72191) |
$386.37 |
$858.60 |
1.8× |
| Dilation ureters/urethra rs&i (74485) |
$2,861.82 |
$6,359.59 |
1.1× |
| Discography Cerv/Thor Spine (72285) |
$2,852.70 |
$6,339.33 |
1.2× |
| Diskography lumbar (72295) |
$3,023.86 |
$6,719.69 |
1.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$200.73 |
$446.06 |
1.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$237.59 |
$527.97 |
1.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$200.87 |
$446.37 |
1.6× |
| Dxa Bone Density Axial (77080) |
$184.87 |
$410.82 |
1.5× |
| Dxa bone density study (77085) |
$161.49 |
$358.86 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$103.38 |
$229.73 |
1.0× |
| Echo exam of fetal heart (76825) |
$756.60 |
$1,681.33 |
1.2× |
| Echo exam uterus (76831) |
$404.10 |
$898 |
1.4× |
| Echo Guide For Artery Repair (76936) |
$395.54 |
$878.97 |
1.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$476.69 |
$1,059.31 |
1.7× |
| Echograp Trans R Pros Study (76873) |
$214.08 |
$475.74 |
1.7× |
| Esophagram (74220) |
$257.02 |
$571.15 |
1.2× |
| Fetal Biophys Profile W/Nst (76818) |
$205.92 |
$457.59 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$235.73 |
$523.84 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$334.94 |
$744.32 |
1.2× |
| Follow-Up Angiography (75898) |
$1,673.70 |
$3,719.34 |
0.4× |
| Foot 2 views (73620) |
$119.40 |
$265.34 |
1.1× |
| Forearm 2 views (73090) |
$130 |
$288.90 |
1.2× |
| Gastric emptying imaging study (78264) |
$672.86 |
$1,495.24 |
1.4× |
| Gastroesophageal Reflux Exam (78262) |
$587.75 |
$1,306.11 |
1.2× |
| Gated Heart Planar Single (78472) |
$587.75 |
$1,306.11 |
1.2× |
| Gated Heart, Multiple (78473) |
$587.75 |
$1,306.11 |
1.2× |
| Hand 2 views (73120) |
$183.74 |
$408.31 |
1.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,257.39 |
$2,794.19 |
1.5× |
| Heart first pass single,planar (78481) |
$756.19 |
$1,680.42 |
1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,246.80 |
$9,437.33 |
1.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,246.80 |
$9,437.33 |
1.1× |
| Hepatobil Syst Image W/Drug (78227) |
$849.85 |
$1,888.56 |
1.3× |
| Hepatobiliary System Imaging (78226) |
$587.75 |
$1,306.11 |
1.2× |
| Ht Musc Image Planar Mult (78454) |
$2,029.14 |
$4,509.21 |
1.3× |
| Ht Muscle Image Spect Sing (78451) |
$2,029.14 |
$4,509.21 |
1.3× |
| Hysterosalpingogram (74740) |
$399.16 |
$887.01 |
1.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$115.05 |
$255.67 |
1.1× |
| Infant hip ultrasound, limited static exam (76886) |
$115.64 |
$256.98 |
1.1× |
| Infusion Ivp (74410) |
$336.81 |
$748.47 |
1.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,085.84 |
$2,412.97 |
1.3× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$749.28 |
$1,665.06 |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$880.06 |
$1,955.70 |
1.3× |
| Joint Survey Single View (77077) |
$173.34 |
$385.21 |
1.4× |
| K Flow/Funct Image Multiple (78709) |
$756.19 |
$1,680.42 |
1.2× |
| K Flow/Funct Image W/Drug (78708) |
$865.68 |
$1,923.74 |
1.3× |
| K Flow/Funct Image W/O Drug (78707) |
$756.19 |
$1,680.42 |
1.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$569.05 |
$1,264.56 |
1.2× |
| Kidney Imaging Morphol (78700) |
$643.93 |
$1,430.95 |
1.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$587.75 |
$1,306.11 |
1.2× |
| Knee 3 Views (73562) |
$119.40 |
$265.34 |
1.1× |
| Leveen/Shunt Patency Exam (78291) |
$587.75 |
$1,306.11 |
1.2× |
| Liver & Spleen Imaging Static Only (78215) |
$587.75 |
$1,306.11 |
1.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$587.75 |
$1,306.11 |
1.2× |
| Liver imaging w/vascular flow (78202) |
$1,481.98 |
$3,293.28 |
2.3× |
| Lung Perf&Ventilat Diferentl (78598) |
$816.68 |
$1,814.85 |
1.3× |
| Lung perfusion differential (78597) |
$660.40 |
$1,467.55 |
1.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$756.19 |
$1,680.42 |
1.2× |
| Lung Ventilation Imaging (78579) |
$587.75 |
$1,306.11 |
1.2× |
| Lymph System Imaging (78195) |
$742.36 |
$1,649.68 |
1.1× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,264.34 |
$2,809.65 |
0.7× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$800.36 |
$1,778.57 |
1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,943.52 |
$6,541.16 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,446.38 |
$3,214.18 |
0.4× |
| Magnetic Image Jaw Joint (70336) |
$416.58 |
$925.73 |
1.5× |
| Mammary ductogram or galactogram multiple (77054) |
$348.67 |
$774.82 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$336.34 |
$747.42 |
1.2× |
| Meckels Divert Exam (78290) |
$587.75 |
$1,306.11 |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$621.46 |
$1,381.02 |
1.4× |
| Mra Head W/O & W/Contrast Material (70546) |
$749.99 |
$1,666.64 |
1.8× |
| MRA head w/o contrast (70544) |
$449.36 |
$998.58 |
1.6× |
| MRA head with contrast (70545) |
$649.20 |
$1,442.66 |
1.6× |
| MRA neck w contrast (70548) |
$612.45 |
$1,361 |
1.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$749.99 |
$1,666.64 |
1.8× |
| MRA neck w/o contrast (70547) |
$449.36 |
$998.58 |
1.6× |
| MRI abdomen w contrast (74182) |
$655.13 |
$1,455.84 |
1.6× |
| MRI abdomen w/o contrast (74181) |
$423.92 |
$942.05 |
1.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,055.46 |
$2,345.46 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$749.99 |
$1,666.64 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,055.46 |
$2,345.46 |
1.1× |
| MRI bone marrow blood supply (77084) |
$471.99 |
$1,048.86 |
1.7× |
| MRI brain functional w/o physician admnistration (70554) |
$392.52 |
$872.27 |
1.4× |
| MRI Breast W/O Contrast Bilateral (77047) |
$310.51 |
$690.02 |
1.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$392.95 |
$873.22 |
1.4× |
| MRI cardiac w/o cont stress (75559) |
$720.53 |
$1,601.18 |
1.1× |
| MRI cardiac w/o contrast (75557) |
$449.36 |
$998.58 |
1.6× |
| MRI cervical spine w contrast (72142) |
$749.99 |
$1,666.64 |
1.8× |
| MRI cervical spine w/o cont (72141) |
$449.36 |
$998.58 |
1.6× |
| MRI chest w/o contrast (71550) |
$449.36 |
$998.58 |
1.6× |
| MRI chest with contrast (71551) |
$977.28 |
$2,171.73 |
1.0× |
| MRI chest wo w contrast (71552) |
$844.62 |
$1,876.94 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$612.45 |
$1,361 |
1.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$707.54 |
$1,572.30 |
1.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$449.36 |
$998.58 |
1.6× |
| MRI lumbar spine w contrast (72149) |
$655.13 |
$1,455.84 |
1.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$844.62 |
$1,876.94 |
2.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$423.92 |
$942.05 |
1.5× |
| MRI orbit face neck w contrast (70542) |
$655.13 |
$1,455.84 |
1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$844.62 |
$1,876.94 |
2.0× |
| MRI pelvis w contrast (72196) |
$612.45 |
$1,361 |
1.5× |
| MRI pelvis w/o & w contrast (72197) |
$844.62 |
$1,876.94 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$449.36 |
$998.58 |
1.6× |
| MRI spectroscopy (76390) |
$651.37 |
$1,447.49 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$449.36 |
$998.58 |
1.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$655.13 |
$1,455.84 |
1.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$449.36 |
$998.58 |
1.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$749.99 |
$1,666.64 |
1.8× |
| MRI, abdomen, combo (74183) |
$844.62 |
$1,876.94 |
2.0× |
| MRI, dorsal spine combo (72157) |
$796.81 |
$1,770.69 |
1.9× |
| MRI, dorsal spine contrast (72147) |
$701.13 |
$1,558.07 |
1.7× |
| MRI, joint upper extrem (73221) |
$449.36 |
$998.58 |
1.6× |
| MRI, joint upper extrem combo (73223) |
$796.81 |
$1,770.69 |
1.9× |
| MRI, lumbar spine combo (72158) |
$844.62 |
$1,876.94 |
2.0× |
| Myelogram cervical (72240) |
$937.65 |
$2,083.67 |
1.0× |
| Myelogram Lumbar (72265) |
$993.91 |
$2,208.69 |
1.1× |
| Myelography thoracic (72255) |
$937.65 |
$2,083.67 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$937.65 |
$2,083.67 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$587.75 |
$1,306.11 |
1.2× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$742.36 |
$1,649.68 |
1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,768.90 |
$3,930.89 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,150.89 |
$4,779.76 |
1.4× |
| Neck soft tissue (70360) |
$119.40 |
$265.34 |
1.1× |
| Nervous system nuclear exam (78699) |
$551.76 |
$1,226.14 |
1.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$569.05 |
$1,264.56 |
1.2× |
| Nm csf leak detection (78650) |
$1,610.19 |
$3,578.20 |
1.0× |
| Nm myocard infarct spect (78469) |
$1,574.58 |
$3,499.07 |
2.4× |
| Nm red cell survival study (78130) |
$588.39 |
$1,307.53 |
1.2× |
| Nm unlisted gi procedure (78299) |
$587.75 |
$1,306.11 |
1.2× |
| Nonvascular Shunt X-Ray (75809) |
$187.42 |
$416.49 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,254.18 |
$5,009.28 |
1.4× |
| Nuclear medicine study of endocrine organs (78099) |
$561.49 |
$1,247.76 |
1.2× |
| Nuclear Rx Intra-Arterial (79445) |
$389.71 |
$866.02 |
1.4× |
| Nuclear Rx Oral Admin (79005) |
$446.14 |
$991.41 |
1.6× |
| Ob us nuchal meas 1 gest (76813) |
$215.26 |
$478.36 |
1.7× |
| Optic foramina (70190) |
$170.60 |
$379.10 |
1.6× |
| Panoramic X-ray of jaws (70355) |
$103.38 |
$229.73 |
1.0× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$756.19 |
$1,680.42 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$623.02 |
$1,384.49 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$747.76 |
$1,661.68 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$183.74 |
$408.31 |
1.5× |
| Perineogram (74775) |
$348.67 |
$774.82 |
1.2× |
| Peritoneogram Rs&I (74190) |
$795.03 |
$1,766.74 |
1.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,299.69 |
$5,110.42 |
1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,246.80 |
$9,437.33 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$587.75 |
$1,306.11 |
1.2× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$627.30 |
$1,394 |
0.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$187.42 |
$416.49 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$726.41 |
$1,614.24 |
1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$130 |
$288.90 |
1.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$119.40 |
$265.34 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$130 |
$288.90 |
1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$202.42 |
$449.81 |
1.6× |
| Radex fingr minimum 2 views (73140) |
$119.40 |
$265.34 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$119.40 |
$265.34 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$130 |
$288.90 |
1.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$104.30 |
$231.78 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$144.10 |
$320.21 |
1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$119.40 |
$265.34 |
1.1× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$158.60 |
$352.44 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$119.40 |
$265.34 |
1.1× |
| Radex shoulder complete minimum 2 views (73030) |
$119.40 |
$265.34 |
1.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$110.56 |
$245.69 |
1.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$361.15 |
$802.55 |
1.7× |
| Radex Spine 1 View Specify Level (72020) |
$112.64 |
$250.32 |
1.1× |
| Radex Sternum Minimum 2 Views (71120) |
$119.40 |
$265.34 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$112.64 |
$250.32 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$119.40 |
$265.34 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$173.34 |
$385.21 |
1.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$119.40 |
$265.34 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$292.22 |
$649.38 |
2.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,947.15 |
$26,549.22 |
1.4× |
| Radiation treatment delivery level 1 (77402) |
$220.40 |
$489.77 |
1.8× |
| Radiation treatment delivery level 2 (77407) |
$207.92 |
$462.05 |
0.4× |
| Radiation treatment delivery level 3 (77412) |
$425.57 |
$945.71 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$174.41 |
$387.57 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$148.77 |
$330.59 |
1.2× |
| Radiologic exam colon double contrast study (74280) |
$348.58 |
$774.62 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$290.75 |
$646.11 |
1.4× |
| Radiologic exam knee complete 4/more views (73564) |
$164.96 |
$366.58 |
1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$164.96 |
$366.58 |
1.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$187.42 |
$416.49 |
0.9× |
| Radiologic exam swallow function contrast study (74230) |
$202.42 |
$449.81 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$290.75 |
$646.11 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$104.30 |
$231.78 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$119.40 |
$265.34 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$112.64 |
$250.32 |
1.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$200.12 |
$444.71 |
1.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$131.37 |
$291.93 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$119.40 |
$265.34 |
1.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$413.69 |
$919.31 |
0.6× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$756.19 |
$1,680.42 |
1.2× |
| Renal Cyst Study (74470) |
$747.76 |
$1,661.68 |
1.1× |
| Ribs bilateral 3 views (71110) |
$214.56 |
$476.80 |
1.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$587.75 |
$1,306.11 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$634.77 |
$1,410.60 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,029.14 |
$4,509.21 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,643.62 |
$3,652.50 |
2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,729.84 |
$3,844.09 |
2.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$389.71 |
$866.02 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$389.71 |
$866.02 |
1.4× |
| Rp Therapy Unlisted Procedure (79999) |
$413.09 |
$917.98 |
1.5× |
| Salivary Gland Function Study (78232) |
$587.75 |
$1,306.11 |
1.2× |
| Salivary Gland Imaging (78230) |
$587.75 |
$1,306.11 |
1.2× |
| Salivary Gland Imaging Serial Images (78231) |
$587.75 |
$1,306.11 |
1.2× |
| Scapula (73010) |
$164.74 |
$366.09 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.67 |
$103.71 |
2.0× |
| Sella turcica (70240) |
$104.30 |
$231.78 |
1.0× |
| Shoulder 1 view (73020) |
$112.64 |
$250.32 |
1.1× |
| Shoulder Arthrography (73040) |
$1,020.37 |
$2,267.48 |
2.4× |
| Sialogram (70390) |
$348.67 |
$774.82 |
1.2× |
| Skull less than 4 views (70250) |
$155.62 |
$345.82 |
1.2× |
| Special dosimetry (77331) |
$208.52 |
$463.37 |
1.3× |
| Special Physics Consult (77370) |
$221.03 |
$491.18 |
1.4× |
| Special teletherapy port plan (77321) |
$542.85 |
$1,206.34 |
1.2× |
| Special treatment procedure (77470) |
$932.87 |
$2,073.04 |
1.4× |
| Speech evaluation, complex (70371) |
$291.70 |
$648.23 |
1.0× |
| Spleen Imaging (78185) |
$587.75 |
$1,306.11 |
1.2× |
| Srs Multisource (77371) |
$11,947.15 |
$26,549.22 |
1.4× |
| Stereotactic Body Radiation Delivery (77373) |
$3,051.11 |
$6,780.25 |
1.4× |
| Sternoclavicular joints (71130) |
$110.56 |
$245.69 |
1.1× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$68.85 |
$153 |
0.6× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$68.85 |
$153 |
0.6× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$25.20 |
$56 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$475.70 |
$1,057.11 |
1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$415.53 |
$923.40 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$530.34 |
$1,178.53 |
1.9× |
| Testicular Imaging W/Flow (78761) |
$587.75 |
$1,306.11 |
1.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$621.46 |
$1,381.02 |
1.4× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$542.85 |
$1,206.34 |
1.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$208.52 |
$463.37 |
1.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$279.85 |
$621.89 |
1.3× |
| Thoracic spine 2 views (72070) |
$198.44 |
$440.98 |
1.6× |
| Thoracic spine 3 views (72072) |
$214.56 |
$476.80 |
1.7× |
| Thoracolumbar 2 views (72080) |
$104.30 |
$231.78 |
1.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$587.75 |
$1,306.11 |
1.2× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$587.75 |
$1,306.11 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$561.49 |
$1,247.76 |
1.2× |
| Thyroid Met Imaging Body (78018) |
$774.45 |
$1,721 |
1.2× |
| Thyroid Uptake Measurement (78012) |
$539.32 |
$1,198.48 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$672.86 |
$1,495.24 |
1.4× |
| Tx Devices Design & Construction Complex (77334) |
$621.46 |
$1,381.02 |
1.4× |
| Tx devices design & construction intermediate (77333) |
$243.16 |
$540.35 |
1.5× |
| Tx devices design & construction simple (77332) |
$257.74 |
$572.76 |
1.6× |
| Ultrasound Breast Limited (76642) |
$151.54 |
$336.76 |
1.5× |
| Ultrasound Elastography Parenchyma (76981) |
$204.91 |
$455.36 |
1.6× |
| Ultrasound Exam Aaa Screen (76706) |
$216.16 |
$480.36 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$235.73 |
$523.84 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$181.01 |
$402.25 |
1.4× |
| Unlisted Dx Radiographic Procedure (76499) |
$104.30 |
$231.78 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$114.06 |
$253.46 |
1.1× |
| Unlisted magnetic resonance procedure (76498) |
$334.45 |
$743.23 |
3.2× |
| Unlisted us procedure (76999) |
$121.96 |
$271.01 |
1.2× |
| Upper gi w/o kub (74240) |
$290.75 |
$646.11 |
1.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$15.82 |
$35.16 |
1.4× |
| Urea breath test c-14 isotopic analysis (78268) |
$135.05 |
$300.11 |
1.4× |
| Ureteral Reflux Study (78740) |
$587.75 |
$1,306.11 |
1.2× |
| Urethrocystogram voiding (74455) |
$401.93 |
$893.17 |
1.4× |
| Urethrocystography retrograde (74450) |
$376.56 |
$836.80 |
1.3× |
| Us breast unilateral complete (76641) |
$158.10 |
$351.34 |
1.3× |
| Us chest (76604) |
$209.81 |
$466.25 |
1.7× |
| Us complete joint (76881) |
$235.73 |
$523.84 |
1.9× |
| Us exam, pelvic, limited (76857) |
$181.01 |
$402.25 |
1.4× |
| Us head (76506) |
$194.27 |
$431.72 |
1.6× |
| Us kidney transplant (76776) |
$205.92 |
$457.59 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$181.01 |
$402.25 |
1.4× |
| Us ob detailed single fetus (76811) |
$371.96 |
$826.58 |
1.3× |
| Us ob limited 1 or more fetuses (76815) |
$209.81 |
$466.25 |
1.7× |
| Us ob transvaginal (76817) |
$224.34 |
$498.54 |
1.8× |
| Us pelvic non ob complete (76856) |
$235.73 |
$523.84 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$216.16 |
$480.36 |
1.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$181.01 |
$402.25 |
1.4× |
| Us retroperitoneal complete (76770) |
$222.39 |
$494.20 |
1.8× |
| Us retroperitoneal limited (76775) |
$229.79 |
$510.65 |
1.8× |
| Us scrotum and contents (76870) |
$229.79 |
$510.65 |
1.8× |
| Us spinal canal and contents (76800) |
$163.39 |
$363.08 |
1.3× |
| Us thyroid (76536) |
$229.79 |
$510.65 |
1.8× |
| Us transrectal (76872) |
$222.39 |
$494.20 |
1.8× |
| Vascular Flow Imaging (78445) |
$580.61 |
$1,290.24 |
1.2× |
| Vasogram (74440) |
$348.67 |
$774.82 |
1.2× |
| Vein X-Ray Chest (75827) |
$1,454.65 |
$3,232.56 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,807.13 |
$4,015.85 |
0.5× |
| Vein X-Ray Spleen/Liver (75810) |
$2,608.06 |
$5,795.69 |
0.7× |
| Venogram Sinus/Jugular (75860) |
$3,740.70 |
$8,312.66 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$4,246.80 |
$9,437.33 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$4,246.80 |
$9,437.33 |
1.1× |
| Venography extremity bilateral rs&i (75822) |
$1,560.32 |
$3,467.37 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,193.14 |
$2,651.41 |
0.6× |
| Venography Renal Bilateral (75833) |
$4,246.80 |
$9,437.33 |
1.1× |
| Venography Renal Unilateral (75831) |
$4,246.80 |
$9,437.33 |
1.1× |
| Venous sampling by catheter (75893) |
$6,573.28 |
$14,607.28 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$104.30 |
$231.78 |
1.0× |
| Wrist 2 views (73100) |
$119.40 |
$265.34 |
1.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$110.56 |
$245.69 |
1.1× |
| X-ray antegrade pyelogram tube (74425) |
$604.41 |
$1,343.14 |
1.4× |
| X-Ray Aorta Leg Arteries (75630) |
$4,501.61 |
$10,003.57 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$143.90 |
$319.78 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$119.40 |
$265.34 |
1.1× |
| X-Ray Exam Breast Specimen (76098) |
$665.38 |
$1,478.63 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$104.30 |
$231.78 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$203.08 |
$451.28 |
1.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$315.60 |
$701.33 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$112.64 |
$250.32 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$110.56 |
$245.69 |
1.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$203.08 |
$451.28 |
1.6× |
X-Ray Exam Hips Bi 2 Views (73521)
range across 2 matching MRF lines |
$13.95–$203.08 |
$31–$451.28 |
varies |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$203.08 |
$451.28 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$297.73 |
$661.63 |
2.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$229.10 |
$509.11 |
1.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$119.40 |
$265.34 |
1.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$229.10 |
$509.11 |
1.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$184.87 |
$410.82 |
1.5× |
| X-ray eye for foreign body (70030) |
$179.10 |
$398.01 |
1.7× |
| X-ray humerus (73060) |
$119.40 |
$265.34 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$336.81 |
$748.47 |
1.6× |
| X-ray IV pyelogram+tomography (74415) |
$365.97 |
$813.26 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$110.56 |
$245.69 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$119.40 |
$265.34 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$164.96 |
$366.58 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$104.30 |
$231.78 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$198.67 |
$441.48 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$198.44 |
$440.98 |
1.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$173.39 |
$385.32 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$119.40 |
$265.34 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$120.38 |
$267.51 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$198.67 |
$441.48 |
1.6× |
| X-Ray Stress View (77071) |
$104.30 |
$231.78 |
1.0× |
| X-ray thoracic spine 4 vw (72074) |
$200.15 |
$444.77 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$104.30 |
$231.78 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$697.41 |
$1,549.79 |
1.7× |
| X-Rays Bone Length Studies (77073) |
$155.42 |
$345.37 |
1.2× |
| X-Rays Bone Survey Complete (77075) |
$229.10 |
$509.11 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$229.10 |
$509.11 |
1.8× |
| Xr facial bones less than 3 views (70140) |
$119.40 |
$265.34 |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$215.86 |
$479.68 |
1.7× |
| Xr orbits complete 4 views (70200) |
$155.62 |
$345.82 |
1.2× |
| Xr Tomogram Single Plane (76100) |
$187.42 |
$416.49 |
1.5× |