| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,912.83 |
$6,987.20 |
2.7× |
| Abdomen 2 views (74019) |
$174.16 |
$311 |
1.6× |
| Acute gi blood loss imaging (78278) |
$3,105.70 |
$5,545.90 |
7.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$1,114.68 |
$1,990.50 |
0.8× |
| Ankle 2 views (73600) |
$174.16 |
$311 |
1.9× |
| Arthrogram ankle (73615) |
$304.53 |
$543.80 |
0.8× |
| Arthrogram elbow (73085) |
$295.96 |
$528.50 |
0.8× |
| Arthrogram hip (73525) |
$278.66 |
$497.60 |
0.8× |
| Arthrogram knee (73580) |
$278.66 |
$497.60 |
0.8× |
| Arthrogram shoulder (73040) |
$278.66 |
$497.60 |
0.8× |
| Arthrogram wrist (73115) |
$278.77 |
$497.80 |
0.8× |
| Basic dosimetry (77300) |
$489.05 |
$873.30 |
3.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,035.16 |
$1,848.50 |
2.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$958.61 |
$1,711.80 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,035.16 |
$1,848.50 |
2.5× |
| Bone age studies (77072) |
$139.33 |
$248.80 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,294.05 |
$2,310.80 |
3.1× |
| Bone Marrow Imaging Limited Area (78102) |
$830.09 |
$1,482.30 |
2.0× |
| Bone survey complete (77075) |
$208.99 |
$373.20 |
1.9× |
| Bone survey infant (77076) |
$278.66 |
$497.60 |
2.5× |
| Bowel imaging (78290) |
$1,035.16 |
$1,848.50 |
2.5× |
| Brain imaging < 4 static views (78600) |
$575.29 |
$1,027.30 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$920.75 |
$1,644.20 |
2.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,192.58 |
$2,129.60 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,554.78 |
$4,562.10 |
1.7× |
| Brain Imaging Vascular Flow Only (78610) |
$552.44 |
$986.50 |
1.0× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$708.23 |
$1,264.70 |
1.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,298.25 |
$2,318.30 |
3.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,552.94 |
$2,773.10 |
3.7× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$949.03 |
$1,694.70 |
1.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,310.06 |
$4,125.10 |
6.3× |
| Cardiovasc nucl exam unlisted (78499) |
$665.62 |
$1,188.60 |
1.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,357.89 |
$2,424.80 |
2.4× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$693.56 |
$1,238.50 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$174.16 |
$311 |
1.9× |
| Chest 1 view (71045) |
$174.16 |
$311 |
1.9× |
| Chest xray 3 views (71047) |
$138.54 |
$247.40 |
1.5× |
| Cholecystography, oral contrast Non-Facility (74290) |
$201.99 |
$360.70 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$208.99 |
$373.20 |
1.1× |
| Clavicle complete (73000) |
$174.16 |
$311 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$912.46 |
$1,629.40 |
8.3× |
| Continuing medical physics consltj pr wk (77336) |
$488.82 |
$872.90 |
3.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,281.27 |
$4,073.70 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,368.81 |
$2,444.30 |
5.5× |
| CT abdomen w contrast (74160) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT abdomen w/o contrast (74150) |
$910.67 |
$1,626.20 |
8.3× |
| CT angio hrt w/3d image (75574) |
$4,562.54 |
$8,147.40 |
12.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,281.27 |
$4,073.70 |
12.4× |
| CT angiography upper extremity lt (73206) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT c-spine w/contrast (72126) |
$1,368.81 |
$2,444.30 |
3.7× |
| CT c-spine w/o contrast (72125) |
$912.46 |
$1,629.40 |
8.3× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$351.23 |
$627.20 |
1.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,083.26 |
$1,934.40 |
5.9× |
| CT chest w contrast (71260) |
$912.46 |
$1,629.40 |
5.0× |
| CT chest w/wo contrast (71270) |
$912.55 |
$1,629.55 |
5.0× |
| CT colonography screening (74263) |
$2,281.27 |
$4,073.70 |
9.1× |
| CT colonography w/dye (74262) |
$2,281.27 |
$4,073.70 |
12.4× |
| CT colonography w/o cntrst (74261) |
$2,281.27 |
$4,073.70 |
20.8× |
| CT head/brain with contrast (70460) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$698.60 |
$1,247.50 |
1.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$912.46 |
$1,629.40 |
10.0× |
| CT hrt w/3d image congen (75573) |
$4,553.86 |
$8,131.90 |
12.5× |
| CT iac w contrast (70481) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT limited/localized follow up study (76380) |
$600.99 |
$1,073.20 |
6.6× |
| CT lower ext w/o (73700) |
$1,520.96 |
$2,716 |
13.9× |
| CT lower extremity w wo contrast (73702) |
$2,433.37 |
$4,345.30 |
13.2× |
| CT lower extremity w/contrast material (73701) |
$1,977.19 |
$3,530.70 |
10.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,821.51 |
$3,252.70 |
9.9× |
| CT lumbar spine w/contrast (72132) |
$1,368.81 |
$2,444.30 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$912.46 |
$1,629.40 |
8.3× |
| CT maxillofacial w contrast (70487) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT maxillofacial wo contrast (70486) |
$1,824.98 |
$3,258.90 |
16.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT orbits w/o contrast (70480) |
$797.74 |
$1,424.55 |
7.3× |
| CT pelvis w/o contrast (72192) |
$1,368.81 |
$2,444.30 |
12.5× |
| CT pelvis w/wo contrast (72194) |
$1,824.98 |
$3,258.90 |
9.9× |
| CT scan of arm combo (73202) |
$2,281.22 |
$4,073.60 |
12.4× |
| CT soft tissue neck w contrast (70491) |
$912.46 |
$1,629.40 |
5.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT soft tissue neck w/o contrast (70490) |
$608.33 |
$1,086.30 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$1,368.81 |
$2,444.30 |
7.5× |
| CT thoracic spine w/o contrast (72128) |
$912.46 |
$1,629.40 |
8.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,081.47 |
$1,931.20 |
5.9× |
| CT thorax w/o contrast (71250) |
$684.43 |
$1,222.20 |
6.3× |
| CT upper ext wo (73200) |
$1,368.81 |
$2,444.30 |
12.5× |
| CT upper extremity with contrast (73201) |
$1,824.98 |
$3,258.90 |
5.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,824.98 |
$3,258.90 |
9.9× |
| Cta Abdomen (74175) |
$1,824.98 |
$3,258.90 |
9.9× |
| CTA abdomen pelvis (74174) |
$3,193.90 |
$5,703.40 |
8.7× |
| CTA chest (71275) |
$912.46 |
$1,629.40 |
5.0× |
| Cta Head (70496) |
$1,824.98 |
$3,258.90 |
9.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,007.66 |
$1,799.40 |
2.8× |
| Cta Neck (70498) |
$1,368.81 |
$2,444.30 |
7.5× |
| Cta Pelvis (72191) |
$1,688.90 |
$3,015.90 |
9.2× |
| Cystography minimum 3 views rs&i (74430) |
$556.14 |
$993.10 |
1.5× |
| Diskography lumbar (72295) |
$1,049.22 |
$1,873.60 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$604.97 |
$1,080.30 |
5.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$105.11 |
$187.70 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$144.76 |
$258.50 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$92.85 |
$165.80 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$302.12 |
$539.50 |
2.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$105.11 |
$187.70 |
0.4× |
| Esophageal motility (78258) |
$422.63 |
$754.70 |
1.0× |
| Esophagus (74220) |
$208.99 |
$373.20 |
1.1× |
| Facial bones min 3 views (70150) |
$139.33 |
$248.80 |
1.3× |
| Fetal biophysical profile non-stress testing (76818) |
$457.74 |
$817.40 |
4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$457.74 |
$817.40 |
4.2× |
| Fetal Echo (76825) |
$210.34 |
$375.60 |
0.4× |
| Fluoroscopy up to 1 hr (76000) |
$1,249.42 |
$2,231.10 |
5.0× |
| Foot 2 views (73620) |
$148.06 |
$264.40 |
1.6× |
| Forearm 2 views (73090) |
$139.33 |
$248.80 |
1.5× |
| Functional MRI brain by tech (70554) |
$1,898.57 |
$3,390.30 |
7.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$3,053.90 |
$5,453.40 |
7.3× |
| Gastric mucosa imaging (78261) |
$995.01 |
$1,776.80 |
2.4× |
| Gastrointestinal protein loss Facility (78282) |
$793.63 |
$1,417.20 |
1.9× |
| Hand 2 views (73120) |
$139.33 |
$248.80 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$581.84 |
$1,039 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$581.84 |
$1,039 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$581.84 |
$1,039 |
0.8× |
| Heart first pass single,planar (78481) |
$858.20 |
$1,532.50 |
1.5× |
| Heart Infarct Image (78466) |
$1,098.61 |
$1,961.80 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,070.54 |
$3,697.40 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,811.66 |
$3,235.10 |
4.3× |
| Hysterosalpingogram (74740) |
$208.99 |
$373.20 |
0.8× |
| Interstitial radiation source applic complex (77778) |
$1,532.44 |
$2,736.50 |
2.1× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,459.86 |
$2,606.90 |
2.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,194.42 |
$2,132.90 |
2.1× |
| Intracavitary Radiation Source Applic Simple (77761) |
$929.10 |
$1,659.10 |
1.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$152.43 |
$272.20 |
1.4× |
| Kidney imaging morphology (78700) |
$1,294.05 |
$2,310.80 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,552.94 |
$2,773.10 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,552.94 |
$2,773.10 |
2.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,294.05 |
$2,310.80 |
2.3× |
| Knee 3 views (73562) |
$174.19 |
$311.05 |
1.9× |
| Liver & spleen imaging static only (78215) |
$935.59 |
$1,670.70 |
2.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,259.55 |
$2,249.20 |
3.0× |
| Liver imaging static only (78201) |
$794.75 |
$1,419.20 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$997.42 |
$1,781.10 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,035.16 |
$1,848.50 |
1.8× |
| Lung perfusion differential (78597) |
$1,806.73 |
$3,226.30 |
4.3× |
| Lung ventilation imaging (78579) |
$799.29 |
$1,427.30 |
1.9× |
| Lymphoscintigraphy (78195) |
$2,588.04 |
$4,621.50 |
4.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,234.06 |
$5,775.10 |
3.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,696.17 |
$6,600.30 |
10.1× |
| Magnetic Resonance Elastography (76391) |
$2,450.39 |
$4,375.70 |
9.8× |
| Mammary ductogram or galactogram single (77053) |
$201.99 |
$360.70 |
0.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$137.37 |
$245.30 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$977.87 |
$1,746.20 |
2.5× |
| MRA head w & w/o contrast (70546) |
$2,772.11 |
$4,950.20 |
7.6× |
| MRA head w/o contrast (70544) |
$1,848.11 |
$3,300.20 |
7.4× |
| MRA head with contrast (70545) |
$2,310.06 |
$4,125.10 |
6.3× |
| MRA neck w contrast (70548) |
$1,848.95 |
$3,301.70 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,310.06 |
$4,125.10 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,386 |
$2,475 |
5.5× |
| MRI abdomen w contrast (74182) |
$3,118.53 |
$5,568.80 |
8.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,465.11 |
$6,187.70 |
9.5× |
| MRI abdomen w/o contrast (74181) |
$2,772.11 |
$4,950.20 |
11.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,158.28 |
$7,425.50 |
5.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,234.06 |
$5,775.10 |
8.9× |
| MRI bone marrow blood supply (77084) |
$2,075.98 |
$3,707.10 |
8.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,155.11 |
$2,062.70 |
4.6× |
| MRI breast wo contrast unilateral (77046) |
$924.39 |
$1,650.70 |
3.7× |
| MRI c-spine with contrast (72142) |
$1,682.35 |
$3,004.20 |
4.6× |
| MRI cardiac w/o contrast (75557) |
$1,386 |
$2,475 |
5.5× |
| MRI cervical spine w/o contrast (72141) |
$1,386 |
$2,475 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,003.22 |
$5,362.90 |
8.2× |
| MRI chest w/o contrast (71550) |
$2,079 |
$3,712.50 |
8.3× |
| MRI chest with contrast (71551) |
$2,541.06 |
$4,537.60 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,934.97 |
$3,455.30 |
5.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,465.11 |
$6,187.70 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,772.11 |
$4,950.20 |
11.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,848.11 |
$3,300.20 |
7.4× |
| MRI orbit face neck w contrast (70542) |
$2,310.06 |
$4,125.10 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,696.17 |
$6,600.30 |
10.1× |
| MRI pelvis w/contrast (72196) |
$2,205.39 |
$3,938.20 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,234.06 |
$5,775.10 |
8.9× |
| MRI pelvis w/o contrast (72195) |
$2,310.06 |
$4,125.10 |
9.2× |
| MRI spectroscopy (76390) |
$952 |
$1,700 |
10.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,085.72 |
$3,724.50 |
5.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,647.94 |
$2,942.75 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,085.72 |
$3,724.50 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,647.94 |
$2,942.75 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,085.72 |
$3,724.50 |
5.7× |
| MRI temporomandibular joint (70336) |
$2,079 |
$3,712.50 |
8.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,313.23 |
$2,345.05 |
5.3× |
| MRI up ext w/o contrast (73218) |
$2,772.11 |
$4,950.20 |
11.1× |
| MRI upper ext joint w/o contrast (73221) |
$2,310.06 |
$4,125.10 |
9.2× |
| MRI, joint upper extrem combo (73223) |
$3,234.06 |
$5,775.10 |
8.9× |
| Musculoskeletal Nuclear Exam (78399) |
$665.62 |
$1,188.60 |
1.6× |
| Myelogram Cervical (72240) |
$203.17 |
$362.80 |
0.2× |
| Myelogram Lumbar (72265) |
$265.72 |
$474.50 |
0.3× |
| Myelogram thoracic (72255) |
$463.51 |
$827.70 |
0.6× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,098.61 |
$1,961.80 |
1.9× |
| Myocardial infarct spect (78469) |
$1,552.94 |
$2,773.10 |
2.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,057.89 |
$3,674.80 |
1.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,695.73 |
$4,813.80 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,105.70 |
$5,545.90 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$3,105.70 |
$5,545.90 |
2.3× |
| N-invas est c ffr sw aly CTA (75580) |
$2,063.88 |
$3,685.50 |
2.3× |
| Neck soft tissue (70360) |
$174.16 |
$311 |
1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$464.07 |
$828.70 |
1.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$345.02 |
$616.10 |
0.8× |
| Nm bone marrow multi (78103) |
$902.61 |
$1,611.80 |
2.2× |
| Nm bone marrow wb (78104) |
$980 |
$1,750 |
2.3× |
| Nm cardiac blood pool multiple (78473) |
$968.69 |
$1,729.80 |
2.3× |
| Nm cisternogram (78630) |
$4,140.98 |
$7,394.60 |
7.3× |
| Nm csf leak detection (78650) |
$1,758.62 |
$3,140.40 |
1.3× |
| Nm gastric emptying study (78264) |
$2,329.21 |
$4,159.30 |
5.6× |
| Nm gastroesophageal reflux study (78262) |
$3,105.70 |
$5,545.90 |
7.4× |
| Nm kidney scan w/flow (78701) |
$1,071.67 |
$1,913.70 |
2.6× |
| Nm peritoneal-venous shunt patency (78291) |
$1,354.08 |
$2,418 |
3.2× |
| Noncardiac Vascular Flow Imaging (78445) |
$552.44 |
$986.50 |
1.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$22,491.67 |
$40,163.70 |
15.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,207.30 |
$2,155.90 |
2.9× |
| Nuclear Rx Oral Admin (79005) |
$97.66 |
$174.40 |
0.4× |
| Ob us nuchal meas 1 gest (76813) |
$305.09 |
$544.80 |
2.8× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$238.34 |
$425.60 |
2.2× |
| Orthopantogram (70355) |
$138.54 |
$247.40 |
1.5× |
| Osseous survey limited (77074) |
$208.99 |
$373.20 |
1.9× |
| Parathyrd planar w/spect&CT (78072) |
$3,795.79 |
$6,778.20 |
6.7× |
| Parathyroid Planar Imaging (78070) |
$3,105.70 |
$5,545.90 |
7.4× |
| Pelvis 1 or 2 views (72170) |
$174.16 |
$311 |
1.6× |
| Perineogram (74775) |
$302.90 |
$540.90 |
1.2× |
| PET image w/CT, skull-thigh (78815) |
$2,554.78 |
$4,562.10 |
1.7× |
| PET imaging CT for attenuation limited area (78814) |
$2,554.78 |
$4,562.10 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$2,554.78 |
$4,562.10 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$776.38 |
$1,386.40 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,035.16 |
$1,848.50 |
1.8× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,863.01 |
$3,326.80 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$506.97 |
$905.30 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$174.16 |
$311 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$121.66 |
$217.25 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$139.33 |
$248.80 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$261.24 |
$466.50 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$253.06 |
$451.90 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$275.18 |
$491.40 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$174.16 |
$311 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$174.16 |
$311 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$139.33 |
$248.80 |
1.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$348.35 |
$622.05 |
3.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$357.17 |
$637.80 |
3.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$287.39 |
$513.20 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$399.45 |
$713.30 |
3.6× |
| Radex Humerus Minimum 2 Views (73060) |
$139.33 |
$248.80 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$174.16 |
$311 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$139.33 |
$248.80 |
1.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$139.33 |
$248.80 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$139.33 |
$248.80 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$139.33 |
$248.80 |
1.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$174.16 |
$311 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$139.33 |
$248.80 |
1.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$139.33 |
$248.80 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$139.33 |
$248.80 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$174.16 |
$311 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$139.33 |
$248.80 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$174.16 |
$311 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$319.20 |
$570 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,825.78 |
$13,974.60 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$896.78 |
$1,601.40 |
8.4× |
| Radiation treatment delivery level 2 (77407) |
$7,476.95 |
$13,351.70 |
18.5× |
| Radiation treatment delivery level 3 (77412) |
$1,306.82 |
$2,333.60 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$208.99 |
$373.20 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$139.33 |
$248.80 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$174.16 |
$311 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$374.86 |
$669.40 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$208.99 |
$373.20 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$208.99 |
$373.20 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$174.16 |
$311 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$139.33 |
$248.80 |
1.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$138.66 |
$247.60 |
1.3× |
| Radiological examination surgical specimen (76098) |
$69.66 |
$124.40 |
0.1× |
| Radiopharm Dacryocystography (78660) |
$438.54 |
$783.10 |
1.0× |
| Ribs bilateral 3 views (71110) |
$139.33 |
$248.80 |
1.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$541.92 |
$967.70 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,086.74 |
$1,940.60 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,278.24 |
$5,854 |
5.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,294.05 |
$2,310.80 |
2.3× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,552.94 |
$2,773.10 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$138.54 |
$247.40 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$610.34 |
$1,089.90 |
2.4× |
| Scapula (73010) |
$139.33 |
$248.80 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$29.06 |
$51.90 |
1.2× |
| Shoulder 1 view (73020) |
$174.16 |
$311 |
1.9× |
| Sialogram (70390) |
$821.74 |
$1,467.40 |
3.3× |
| Simulation intermediate (77285) |
$3,912.83 |
$6,987.20 |
10.0× |
| Small bowel series (74250) |
$417.98 |
$746.40 |
2.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$587.83 |
$1,049.70 |
1.5× |
| Special dosimetry (77331) |
$501.14 |
$894.90 |
3.6× |
| Special Physics Consult (77370) |
$2,934.62 |
$5,240.40 |
20.8× |
| Special treatment procedure (77470) |
$2,096.75 |
$3,744.20 |
3.6× |
| Spine thoracic 3 views (72072) |
$139.33 |
$248.80 |
1.3× |
| Spleen imaging only (78185) |
$877.07 |
$1,566.20 |
2.1× |
| Stereotactic Body Radiation Delivery (77373) |
$1,956.58 |
$3,493.90 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$935.48 |
$1,670.50 |
0.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$595.28 |
$1,063 |
5.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,445.52 |
$4,367 |
6.2× |
| Testicular Imaging With Vascular Flow (78761) |
$1,441.33 |
$2,573.80 |
3.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,912.83 |
$6,987.20 |
10.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$3,912.83 |
$6,987.20 |
27.8× |
| Thoracolumbar 2 views (72080) |
$175.68 |
$313.70 |
1.9× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$830.09 |
$1,482.30 |
2.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,164.24 |
$2,079 |
2.0× |
| Thyroid imaging w/blood flow (78013) |
$695.02 |
$1,241.10 |
1.7× |
| Thyroid uptake measurement (78012) |
$1,552.94 |
$2,773.10 |
3.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,035.16 |
$1,848.50 |
2.5× |
| Tmj unilateral (70328) |
$139.38 |
$248.90 |
1.5× |
| Tomogram (76100) |
$141.29 |
$252.30 |
1.3× |
| Treatment device complex (77334) |
$978.26 |
$1,746.90 |
2.5× |
| Treatment device intermediate (77333) |
$638.51 |
$1,140.20 |
4.5× |
| Treatment devices simple (77332) |
$489.05 |
$873.30 |
3.5× |
| Ultrasound breast complete (76641) |
$357.67 |
$638.70 |
3.3× |
| Ultrasound elastography first target lesion (76982) |
$405.94 |
$724.90 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$279.44 |
$499 |
2.6× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$333.31 |
$595.20 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$305.09 |
$544.80 |
2.8× |
| Umbilical-artery Doppler (OB) (76820) |
$197.54 |
$352.75 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$341.38 |
$609.60 |
3.7× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$673.46 |
$1,202.60 |
1.6× |
| Unlisted genitourinary px dx nuclear medicine (78799) |
$805.62 |
$1,438.60 |
1.9× |
| Unlisted magnetic resonance procedure (76498) |
$2,772.11 |
$4,950.20 |
30.4× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$735.39 |
$1,313.20 |
1.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$841.74 |
$1,503.10 |
7.9× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$665.62 |
$1,188.60 |
1.6× |
| Unlisted ultrasound procedure (76999) |
$501.22 |
$895.05 |
5.5× |
| Ureteral reflux study (78740) |
$1,073.58 |
$1,917.10 |
2.6× |
| Urethrocystogram voiding (74455) |
$417.98 |
$746.40 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$358.06 |
$639.40 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$278.77 |
$497.80 |
1.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$228.54 |
$408.10 |
1.2× |
| Us breast unilateral limited (76642) |
$268.24 |
$479 |
2.9× |
| Us chest (76604) |
$259.84 |
$464 |
2.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$820.23 |
$1,464.70 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$457.21 |
$816.45 |
4.2× |
| Us elastography parenchyma (76981) |
$405.94 |
$724.90 |
3.7× |
| Us encephalogram (76506) |
$304.78 |
$544.25 |
2.8× |
| Us hips infant static (76886) |
$456.68 |
$815.50 |
5.0× |
| Us infant hips w manipulation (76885) |
$457.21 |
$816.45 |
5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$300.72 |
$537 |
2.7× |
| Us ob detailed single fetus (76811) |
$456.68 |
$815.50 |
1.8× |
| Us ob limited (76815) |
$459.20 |
$820 |
4.2× |
| Us ob transvaginal (76817) |
$305.09 |
$544.80 |
2.8× |
| Us pelvic non ob complete (76856) |
$406.87 |
$726.55 |
3.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$306.43 |
$547.20 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$457.74 |
$817.40 |
4.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$456.68 |
$815.50 |
4.2× |
| Us retroperitoneal complete (76770) |
$305.09 |
$544.80 |
2.8× |
| Us retroperitoneal limited (76775) |
$457.21 |
$816.45 |
4.2× |
| Us scrotum and contents (76870) |
$624.82 |
$1,115.75 |
5.7× |
| Us soft tissue head/neck (76536) |
$456.57 |
$815.30 |
4.2× |
| Us spinal canal and contents (76800) |
$457.74 |
$817.40 |
4.2× |
| Us transrectal (76872) |
$601.16 |
$1,073.50 |
5.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$630.95 |
$1,126.70 |
5.8× |
| Venogram extremity bilateral (75822) |
$966.95 |
$1,726.70 |
0.6× |
| Venogram Extremity Unilateral (75820) |
$455.39 |
$813.20 |
0.3× |
| Venography caval superior serialography rs&i (75827) |
$1,232.56 |
$2,201 |
0.7× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$602.84 |
$1,076.50 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$151.09 |
$269.80 |
1.7× |
| Wrist 2 views (73100) |
$174.16 |
$311 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$139.33 |
$248.80 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$139.33 |
$248.80 |
1.5× |
| X-ray b.e. reductn intuss (74283) |
$275.30 |
$491.60 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$278.66 |
$497.60 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$148.06 |
$264.40 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$278.66 |
$497.60 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$374.58 |
$668.90 |
3.4× |
| X-ray exam of femur 2/> (73552) |
$139.33 |
$248.80 |
1.5× |
| X-ray eye for foreign body (70030) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$139.33 |
$248.80 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$208.99 |
$373.20 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$139.33 |
$248.80 |
1.5× |
| X-ray leg, infant (73592) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$174.16 |
$311 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$139.33 |
$248.80 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$121.94 |
$217.75 |
1.1× |
| X-ray retrograde pyelogram (74420) |
$278.66 |
$497.60 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$139.33 |
$248.80 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$139.33 |
$248.80 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$139.33 |
$248.80 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$139.33 |
$248.80 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$174.19 |
$311.05 |
1.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$605.86 |
$1,081.90 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$139.33 |
$248.80 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$175.68 |
$313.70 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$139.33 |
$248.80 |
1.3× |
| Xr bone length studies (77073) |
$209.16 |
$373.50 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$139.33 |
$248.80 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$208.99 |
$373.20 |
1.9× |
| Xr chest 4+ views (71048) |
$138.49 |
$247.30 |
1.3× |
| Xr urogram antegrade (74425) |
$794.08 |
$1,418 |
2.2× |