| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,746.42 |
$8,815.10 |
2.3× |
| Abdomen 2 views (74019) |
$303.08 |
$713.13 |
2.4× |
| Acute gi blood loss imaging (78278) |
$893.63 |
$2,102.67 |
1.9× |
| Angiography extremity bilateral rs&i (75716) |
$7,007.47 |
$16,488.17 |
1.9× |
| Angiography extremity unilateral rs&i (75710) |
$7,007.47 |
$16,488.17 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$4,022.80 |
$9,465.40 |
1.1× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,007.47 |
$16,488.17 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,110.99 |
$16,731.73 |
1.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,967.05 |
$16,393.07 |
1.8× |
| Angiography Spinal Selective Rs&I (75705) |
$12,457.66 |
$29,312.15 |
1.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$12,457.66 |
$29,312.15 |
1.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,249.15 |
$5,292.12 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,236.20 |
$5,261.64 |
0.6× |
| Ankle 2 views (73600) |
$232.80 |
$547.75 |
2.2× |
| Aortogram thoracic (75605) |
$6,583.50 |
$15,490.58 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$7,007.47 |
$16,488.17 |
1.9× |
| Aortography abdominal serialography rs&i (75625) |
$7,007.47 |
$16,488.17 |
1.9× |
| Artery X-Rays Adrenal Gland (75731) |
$7,111.03 |
$16,731.84 |
1.9× |
| Arthrogram ankle (73615) |
$922.91 |
$2,171.56 |
2.2× |
| Arthrogram elbow (73085) |
$922.91 |
$2,171.56 |
2.2× |
| Arthrogram hip (73525) |
$922.91 |
$2,171.56 |
2.2× |
| Arthrogram knee (73580) |
$922.91 |
$2,171.56 |
2.2× |
| Arthrogram shoulder (73040) |
$922.91 |
$2,171.56 |
2.2× |
| Arthrogram wrist (73115) |
$936.55 |
$2,203.65 |
2.2× |
| Basic dosimetry (77300) |
$618.59 |
$1,455.50 |
3.8× |
| Bone &/joint imaging whole body (78306) |
$881.07 |
$2,073.10 |
1.8× |
| Bone age studies (77072) |
$155.96 |
$366.98 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$881.07 |
$2,073.10 |
1.8× |
| Bone survey complete (77075) |
$247.22 |
$581.68 |
2.0× |
| Bone survey infant (77076) |
$246.14 |
$579.14 |
2.0× |
| Bowel imaging (78290) |
$893.63 |
$2,102.67 |
1.9× |
| Brachytx isodose complex (77318) |
$822.83 |
$1,936.06 |
1.8× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$793.94 |
$1,868.10 |
1.7× |
| Brain Imaging Vascular Flow Only (78610) |
$1,441.79 |
$3,392.45 |
2.2× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,240.59 |
$2,919.03 |
2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,615.87 |
$3,802.05 |
3.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,471.58 |
$3,462.54 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$155.96 |
$366.98 |
1.5× |
| Chest 1 view (71045) |
$155.96 |
$366.98 |
1.5× |
| Chest xray 3 views (71047) |
$155.96 |
$366.98 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$276.98 |
$651.73 |
1.3× |
| Clavicle complete (73000) |
$155.96 |
$366.98 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$265.28 |
$624.18 |
2.1× |
| Continuing medical physics consltj pr wk (77336) |
$420.56 |
$989.55 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,233.15 |
$2,901.53 |
2.9× |
| CT abdomen and pelvis without contrast (74176) |
$852.80 |
$2,006.60 |
3.0× |
| CT abdomen w contrast (74160) |
$787.06 |
$1,851.90 |
3.7× |
| CT abdomen w wo contrast (74170) |
$886.32 |
$2,085.47 |
4.2× |
| CT abdomen w/o contrast (74150) |
$483.68 |
$1,138.07 |
3.9× |
| CT angio hrt w/3d image (75574) |
$1,311.12 |
$3,084.97 |
3.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$936.51 |
$2,203.55 |
4.5× |
| CT angiography upper extremity lt (73206) |
$928.14 |
$2,183.84 |
4.4× |
| CT c-spine w/contrast (72126) |
$787.06 |
$1,851.90 |
1.9× |
| CT c-spine w/o contrast (72125) |
$483.68 |
$1,138.07 |
3.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,308.56 |
$3,078.96 |
6.2× |
| CT cervical spine w&w/o contrast (72127) |
$886.32 |
$2,085.47 |
4.2× |
| CT chest w contrast (71260) |
$787.06 |
$1,851.90 |
3.7× |
| CT chest w/wo contrast (71270) |
$886.32 |
$2,085.47 |
4.2× |
| CT head/brain with contrast (70460) |
$787.06 |
$1,851.90 |
3.7× |
| CT head/brain without and with contrast (70470) |
$886.32 |
$2,085.47 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$701.74 |
$1,651.16 |
1.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$71.96 |
$169.30 |
0.7× |
| CT hrt w/3d image congen (75573) |
$1,311.12 |
$3,084.97 |
3.1× |
| CT iac w contrast (70481) |
$787.06 |
$1,851.90 |
3.7× |
| CT limited/localized follow up study (76380) |
$275.50 |
$648.25 |
2.6× |
| CT lower ext w/o (73700) |
$490.83 |
$1,154.89 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$916.28 |
$2,155.96 |
4.4× |
| CT lower extremity w/contrast material (73701) |
$787.06 |
$1,851.90 |
3.7× |
| CT lumbar spine w & w/o contrast (72133) |
$886.32 |
$2,085.47 |
4.2× |
| CT lumbar spine w/contrast (72132) |
$787.06 |
$1,851.90 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$483.68 |
$1,138.07 |
3.9× |
| CT maxillofacial w contrast (70487) |
$787.06 |
$1,851.90 |
3.7× |
| CT maxillofacial w/wo contrast (70488) |
$886.32 |
$2,085.47 |
4.2× |
| CT maxillofacial wo contrast (70486) |
$526.56 |
$1,238.96 |
4.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$886.32 |
$2,085.47 |
4.2× |
| CT orbits w/o contrast (70480) |
$483.68 |
$1,138.07 |
3.9× |
| CT pelvis w/o contrast (72192) |
$483.68 |
$1,138.07 |
3.9× |
| CT pelvis w/wo contrast (72194) |
$886.32 |
$2,085.47 |
4.2× |
| CT scan of arm combo (73202) |
$886.32 |
$2,085.47 |
4.2× |
| CT soft tissue neck w contrast (70491) |
$787.06 |
$1,851.90 |
3.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$886.32 |
$2,085.47 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$483.68 |
$1,138.07 |
3.9× |
| CT thoracic spine w/contrast (72129) |
$787.06 |
$1,851.90 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$483.68 |
$1,138.07 |
3.9× |
| CT thoracic spine w/wo contrast (72130) |
$899.42 |
$2,116.29 |
4.3× |
| CT thorax w/o contrast (71250) |
$483.68 |
$1,138.07 |
3.9× |
| CT upper ext wo (73200) |
$490.83 |
$1,154.89 |
3.9× |
| CT upper extremity with contrast (73201) |
$787.06 |
$1,851.90 |
1.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$959.26 |
$2,257.09 |
4.6× |
| Cta Abdomen (74175) |
$922.87 |
$2,171.46 |
4.4× |
| CTA abdomen pelvis (74174) |
$1,233.15 |
$2,901.53 |
2.9× |
| CTA chest (71275) |
$922.87 |
$2,171.46 |
4.4× |
| Cta Head (70496) |
$922.87 |
$2,171.46 |
4.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,251.38 |
$2,944.43 |
3.0× |
| Cta Neck (70498) |
$922.87 |
$2,171.46 |
4.4× |
| Cta Pelvis (72191) |
$922.86 |
$2,171.43 |
4.4× |
| Cystography minimum 3 views rs&i (74430) |
$700.62 |
$1,648.52 |
1.7× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$390.06 |
$917.79 |
0.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,325.28 |
$7,824.18 |
1.3× |
| Diskography lumbar (72295) |
$7,620.44 |
$17,930.45 |
3.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$199.20 |
$468.70 |
1.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$197.76 |
$465.30 |
1.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$171.79 |
$404.20 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$245.22 |
$577 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$139.29 |
$327.74 |
1.3× |
| Dxa bone density study axial skeleton (77085) |
$271.19 |
$638.09 |
2.2× |
| Esophagus (74220) |
$276.98 |
$651.73 |
1.3× |
| Facial bones min 3 views (70150) |
$247.22 |
$581.68 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$366.01 |
$861.20 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$366.01 |
$861.20 |
2.9× |
| Fetal Echo (76825) |
$770.81 |
$1,813.68 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$426.12 |
$1,002.64 |
1.5× |
| Foot 2 views (73620) |
$155.97 |
$366.98 |
1.5× |
| Forearm 2 views (73090) |
$232.80 |
$547.76 |
2.2× |
| Hand 2 views (73120) |
$158.27 |
$372.40 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,516.64 |
$5,921.51 |
3.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,577.34 |
$6,064.32 |
3.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$7,111.03 |
$16,731.84 |
1.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,967.05 |
$16,393.07 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,013.32 |
$2,384.26 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,028.29 |
$2,419.50 |
2.1× |
| Hysterosalpingogram (74740) |
$864.65 |
$2,034.46 |
3.0× |
| Interstitial radiation source applic complex (77778) |
$3,660.58 |
$8,613.13 |
4.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,150.99 |
$2,708.20 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,134.22 |
$2,668.76 |
1.7× |
| Knee 3 views (73562) |
$232.80 |
$547.76 |
2.2× |
| Liver & spleen imaging static only (78215) |
$1,013.32 |
$2,384.26 |
2.1× |
| Liver imaging static only (78201) |
$1,795.47 |
$4,224.64 |
2.8× |
| Lung perf&ventilat diferentl (78598) |
$1,189.19 |
$2,798.10 |
1.8× |
| Lung perfusion differential (78597) |
$844.61 |
$1,987.31 |
1.8× |
| Lung ventilation imaging (78579) |
$844.61 |
$1,987.31 |
1.8× |
| Lymphoscintigraphy (78195) |
$941.98 |
$2,216.44 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,348.10 |
$3,172 |
1.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,408.74 |
$3,314.68 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,581.12 |
$3,720.28 |
3.8× |
| Mammary ductogram or galactogram multiple (77054) |
$859.67 |
$2,022.76 |
3.0× |
| Mammary ductogram or galactogram single (77053) |
$877.43 |
$2,064.53 |
3.1× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$1,276.22 |
$3,002.87 |
12.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,125.56 |
$2,648.39 |
2.5× |
| Mr safety determination physician/other qhp (76016) |
$114.43 |
$269.24 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$31.82 |
$74.88 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$119.30 |
$280.71 |
1.0× |
| MRA head w & w/o contrast (70546) |
$1,663.88 |
$3,915 |
4.0× |
| MRA head w/o contrast (70544) |
$931.77 |
$2,192.40 |
3.3× |
| MRA head with contrast (70545) |
$1,839.03 |
$4,327.14 |
4.4× |
| MRA neck w contrast (70548) |
$1,368.02 |
$3,218.87 |
3.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRA neck w/o contrast (70547) |
$931.77 |
$2,192.40 |
3.3× |
| MRI abdomen w contrast (74182) |
$1,368.02 |
$3,218.87 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI abdomen w/o contrast (74181) |
$931.77 |
$2,192.40 |
3.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,348.10 |
$3,172 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI breast w/o contrast bilateral (77047) |
$1,405.41 |
$3,306.84 |
4.9× |
| MRI breast wo contrast unilateral (77046) |
$1,432.70 |
$3,371.07 |
5.0× |
| MRI c-spine with contrast (72142) |
$1,368.02 |
$3,218.87 |
3.3× |
| MRI cardiac w/o cont stress (75559) |
$926.11 |
$2,179.08 |
1.4× |
| MRI cardiac w/o contrast (75557) |
$1,472.20 |
$3,464.02 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$931.77 |
$2,192.40 |
3.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI chest w/o contrast (71550) |
$931.77 |
$2,192.40 |
3.3× |
| MRI chest with contrast (71551) |
$1,877.25 |
$4,417.05 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,708.90 |
$4,020.93 |
4.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,581.12 |
$3,720.28 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$945.54 |
$2,224.80 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$931.77 |
$2,192.40 |
3.3× |
| MRI orbit face neck w contrast (70542) |
$1,368.02 |
$3,218.87 |
3.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI pelvis w/contrast (72196) |
$1,839.03 |
$4,327.14 |
4.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$931.77 |
$2,192.40 |
3.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,368.02 |
$3,218.87 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,368.02 |
$3,218.87 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,558.10 |
$3,666.10 |
3.7× |
| MRI temporomandibular joint (70336) |
$945.54 |
$2,224.80 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$931.77 |
$2,192.40 |
3.3× |
| MRI up ext w/o contrast (73218) |
$931.77 |
$2,192.40 |
3.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,836 |
$4,320 |
6.4× |
| MRI, joint upper extrem combo (73223) |
$1,581.12 |
$3,720.28 |
3.8× |
| Myocardial infarct spect (78469) |
$1,228.86 |
$2,891.43 |
1.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,700.39 |
$8,706.81 |
2.4× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,700.39 |
$8,706.81 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,700.39 |
$8,706.81 |
2.4× |
| Myocardial spect single study at rest or stress (78451) |
$3,646.50 |
$8,580.01 |
2.4× |
| N-invas est c ffr sw aly CTA (75580) |
$3,804.21 |
$8,951.08 |
3.7× |
| Neck soft tissue (70360) |
$155.96 |
$366.98 |
1.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$705.32 |
$1,659.57 |
1.5× |
| Nm cardiac blood pool multiple (78473) |
$885.90 |
$2,084.47 |
1.8× |
| Nm gastric emptying study (78264) |
$880.62 |
$2,072.05 |
1.8× |
| Nm kidney scan w/flow (78701) |
$1,150.99 |
$2,708.20 |
2.4× |
| Nm peritoneal-venous shunt patency (78291) |
$893.63 |
$2,102.67 |
1.9× |
| Nonvascular shunt X-ray (75809) |
$249.33 |
$586.67 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,746.42 |
$8,815.10 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$695.76 |
$1,637.06 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$366.01 |
$861.20 |
2.9× |
| Parathyrd planar w/spect&CT (78072) |
$685.23 |
$1,612.30 |
1.1× |
| Parathyroid Planar Imaging (78070) |
$780.42 |
$1,836.26 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$508.74 |
$1,197.05 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$155.96 |
$366.98 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,092.79 |
$9,630.10 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,621.17 |
$3,814.52 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$844.61 |
$1,987.31 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,171.88 |
$2,757.35 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$864.65 |
$2,034.46 |
1.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$158.27 |
$372.40 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.80 |
$547.75 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$232.80 |
$547.75 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$155.96 |
$366.98 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$169.25 |
$398.23 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$287.90 |
$677.42 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$158.27 |
$372.40 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$232.80 |
$547.76 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$232.80 |
$547.76 |
2.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$311.93 |
$733.96 |
3.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$386.04 |
$908.33 |
3.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$250.87 |
$590.28 |
2.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$514.18 |
$1,209.83 |
4.1× |
| Radex Humerus Minimum 2 Views (73060) |
$232.80 |
$547.75 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$232.80 |
$547.76 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$307.33 |
$723.13 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$247.22 |
$581.68 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$155.96 |
$366.98 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$155.96 |
$366.98 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$307.32 |
$723.10 |
2.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$155.96 |
$366.98 |
1.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$247.22 |
$581.68 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$155.96 |
$366.98 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$155.96 |
$366.98 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$247.22 |
$581.68 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$307.32 |
$723.10 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,983.31 |
$30,548.96 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$130.28 |
$306.54 |
1.1× |
| Radiation treatment delivery level 2 (77407) |
$492.28 |
$1,158.31 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$695.04 |
$1,635.40 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$155.96 |
$366.98 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$155.96 |
$366.98 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$411.31 |
$967.79 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$309.50 |
$728.24 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$411.31 |
$967.79 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$411.31 |
$967.79 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$158.27 |
$372.40 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$232.80 |
$547.75 |
2.2× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$164.32 |
$386.63 |
1.3× |
| Radiological examination surgical specimen (76098) |
$864.65 |
$2,034.46 |
1.3× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$984.44 |
$2,316.34 |
3.5× |
| Ribs bilateral 3 views (71110) |
$247.22 |
$581.68 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$477.85 |
$1,124.36 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,194.50 |
$7,516.47 |
4.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,904.82 |
$4,481.92 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,880.48 |
$4,424.65 |
2.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$351.14 |
$826.20 |
1.3× |
| Rp Therapy Intravenous Administration (79101) |
$695.76 |
$1,637.06 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$519.06 |
$1,221.33 |
1.8× |
| Scapula (73010) |
$155.96 |
$366.98 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68.27 |
$160.64 |
2.9× |
| Shoulder 1 view (73020) |
$158.27 |
$372.40 |
1.5× |
| Simulation intermediate (77285) |
$1,142.20 |
$2,687.53 |
2.5× |
| Small bowel series (74250) |
$276.98 |
$651.73 |
1.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,125.56 |
$2,648.39 |
2.5× |
| Special dosimetry (77331) |
$414.44 |
$975.14 |
2.6× |
| Special Physics Consult (77370) |
$414.44 |
$975.14 |
2.6× |
| Special treatment procedure (77470) |
$1,493.74 |
$3,514.68 |
2.3× |
| Spine thoracic 3 views (72072) |
$246.14 |
$579.14 |
2.0× |
| Stereotactic Body Radiation Delivery (77373) |
$12,983.31 |
$30,548.96 |
6.1× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$1,034.46 |
$2,434.02 |
8.5× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$1,025.05 |
$2,411.89 |
8.4× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$341.68 |
$803.96 |
7.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$543.40 |
$1,278.58 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$310.28 |
$730.08 |
0.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,125.56 |
$2,648.39 |
2.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$414.44 |
$975.14 |
2.6× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$547.71 |
$1,288.72 |
1.1× |
| Thyroid imaging w/blood flow (78013) |
$506.18 |
$1,191.01 |
1.1× |
| Thyroid uptake measurement (78012) |
$547.71 |
$1,288.72 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$780.42 |
$1,836.26 |
1.6× |
| Treatment device complex (77334) |
$2,281.01 |
$5,367.09 |
5.1× |
| Treatment device intermediate (77333) |
$1,151.92 |
$2,710.38 |
7.2× |
| Treatment devices simple (77332) |
$771.74 |
$1,815.86 |
4.8× |
| Ultrasound breast complete (76641) |
$574.24 |
$1,351.16 |
4.6× |
| Ultrasound elastography first target lesion (76982) |
$177.02 |
$416.51 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$314.02 |
$738.86 |
2.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$345.36 |
$812.61 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$366.01 |
$861.20 |
2.9× |
| Umbilical-artery Doppler (OB) (76820) |
$236.74 |
$557.04 |
1.9× |
| Unlisted fluoroscopic procedure (76496) |
$86.67 |
$203.92 |
0.8× |
| Urethrocystogram voiding (74455) |
$710.97 |
$1,672.88 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$873.78 |
$2,055.98 |
3.1× |
| Us breast unilateral limited (76642) |
$308.90 |
$726.81 |
3.0× |
| Us chest (76604) |
$366.01 |
$861.20 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$371.42 |
$873.92 |
3.0× |
| Us elastography parenchyma (76981) |
$161.61 |
$380.25 |
1.3× |
| Us encephalogram (76506) |
$371.41 |
$873.91 |
3.0× |
| Us hips infant static (76886) |
$244.92 |
$576.28 |
2.3× |
| Us infant hips w manipulation (76885) |
$236.80 |
$557.18 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$290.62 |
$683.82 |
2.3× |
| Us ob detailed single fetus (76811) |
$519.06 |
$1,221.33 |
1.8× |
| Us ob limited (76815) |
$366.01 |
$861.20 |
2.9× |
| Us ob transvaginal (76817) |
$366.01 |
$861.20 |
2.9× |
| Us pelvic non ob complete (76856) |
$366.01 |
$861.20 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$244.92 |
$576.28 |
2.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$366.01 |
$861.20 |
2.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$244.92 |
$576.28 |
2.0× |
| Us retroperitoneal complete (76770) |
$371.42 |
$873.92 |
3.0× |
| Us retroperitoneal limited (76775) |
$366.01 |
$861.20 |
2.9× |
| Us scrotum and contents (76870) |
$371.42 |
$873.92 |
3.0× |
| Us soft tissue head/neck (76536) |
$366.01 |
$861.20 |
2.9× |
| Us spinal canal and contents (76800) |
$276.76 |
$651.20 |
2.2× |
| Us transrectal (76872) |
$1,220.38 |
$2,871.48 |
9.7× |
| Us transrectal prostate volume (76873) |
$199.20 |
$468.70 |
1.6× |
| Us, eye b-scan (76512) |
$154.88 |
$364.43 |
1.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$371.42 |
$873.92 |
3.0× |
| Venogram extremity bilateral (75822) |
$2,249.15 |
$5,292.12 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$2,249.15 |
$5,292.12 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$7,007.47 |
$16,488.17 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$2,249.15 |
$5,292.12 |
1.2× |
| Venography Renal Bilateral (75833) |
$6,903.91 |
$16,244.50 |
1.8× |
| Venography renal unilateral selective rs&i (75831) |
$7,007.47 |
$16,488.17 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,203.64 |
$5,185.02 |
0.6× |
| Wrist 2 views (73100) |
$232.79 |
$547.74 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$411.31 |
$967.79 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$158.27 |
$372.40 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$316.54 |
$744.80 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$403.18 |
$948.66 |
3.2× |
| X-ray exam of femur 2/> (73552) |
$232.80 |
$547.76 |
2.2× |
| X-ray eye for foreign body (70030) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$158.27 |
$372.40 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$155.96 |
$366.98 |
1.5× |
| X-ray leg, infant (73592) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$158.27 |
$372.40 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$250.87 |
$590.28 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$197.40 |
$464.46 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$1,055.86 |
$2,484.38 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$247.22 |
$581.68 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$247.22 |
$581.68 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$155.96 |
$366.98 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$197.40 |
$464.46 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$247.22 |
$581.68 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$155.96 |
$366.98 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$232.80 |
$547.75 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$155.96 |
$366.98 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$158.27 |
$372.40 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$155.96 |
$366.98 |
1.2× |
| Xr bone length studies (77073) |
$197.40 |
$464.46 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$247.22 |
$581.68 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$247.22 |
$581.68 |
2.0× |
| Xr chest 4+ views (71048) |
$323.09 |
$760.21 |
2.6× |
| Xr urogram antegrade (74425) |
$710.97 |
$1,672.88 |
1.7× |