| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,349.33 |
$4,999 |
2.3× |
| Abdomen 2 views (74019) |
$184.92 |
$276 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$4,561.36 |
$6,808 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,966.40 |
$5,920 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,533.22 |
$6,766 |
0.8× |
| Ankle 2 views (73600) |
$333.66 |
$498 |
3.7× |
| Aortography abdominal serialography rs&i (75625) |
$4,251.15 |
$6,345 |
1.3× |
| Basic dosimetry (77300) |
$1,017.06 |
$1,518 |
7.3× |
| Bone &/joint imaging whole body (78306) |
$925.94 |
$1,382 |
2.2× |
| Bone age studies (77072) |
$147.74 |
$220.50 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,087.41 |
$1,623 |
2.6× |
| Bone survey complete (77075) |
$408.03 |
$609 |
3.8× |
| Brachytx isodose intermed (77317) |
$840.18 |
$1,254 |
2.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$777.20 |
$1,160 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$190.95 |
$285 |
2.1× |
| Chest 1 view (71045) |
$288.77 |
$431 |
3.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$371.18 |
$554 |
2.1× |
| Clavicle complete (73000) |
$164.48 |
$245.50 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$412.72 |
$616 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,037.47 |
$3,041 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,540.33 |
$2,299 |
6.3× |
| CT abdomen w contrast (74160) |
$999.64 |
$1,492 |
5.5× |
| CT abdomen w wo contrast (74170) |
$1,155.08 |
$1,724 |
6.4× |
| CT abdomen w/o contrast (74150) |
$825.44 |
$1,232 |
7.7× |
| CT angiography upper extremity lt (73206) |
$1,159.10 |
$1,730 |
6.4× |
| CT c-spine w/contrast (72126) |
$1,091.43 |
$1,629 |
3.0× |
| CT c-spine w/o contrast (72125) |
$1,143.69 |
$1,707 |
10.6× |
| CT chest w contrast (71260) |
$1,063.29 |
$1,587 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,186.57 |
$1,771 |
6.6× |
| CT head/brain with contrast (70460) |
$998.64 |
$1,490.50 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,128.95 |
$1,685 |
6.2× |
| CT iac w contrast (70481) |
$954.08 |
$1,424 |
5.3× |
| CT lower ext w/o (73700) |
$1,288.41 |
$1,923 |
11.9× |
| CT lower extremity w/contrast material (73701) |
$1,481.88 |
$2,211.75 |
8.2× |
| CT lumbar spine w/contrast (72132) |
$1,059.94 |
$1,582 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$1,059.94 |
$1,582 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,002.99 |
$1,497 |
5.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,168.88 |
$1,744.60 |
6.5× |
| CT maxillofacial wo contrast (70486) |
$872.34 |
$1,302 |
8.1× |
| CT orbits w/o contrast (70480) |
$841.86 |
$1,256.50 |
7.8× |
| CT pelvis w/o contrast (72192) |
$820.75 |
$1,225 |
7.6× |
| CT soft tissue neck w contrast (70491) |
$893.11 |
$1,333 |
4.9× |
| CT soft tissue neck w/o contrast (70490) |
$776.53 |
$1,159 |
7.2× |
| CT thoracic spine w/contrast (72129) |
$1,110.86 |
$1,658 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$1,059.94 |
$1,582 |
9.8× |
| CT thorax w/o contrast (71250) |
$914.88 |
$1,365.50 |
8.5× |
| CT upper ext wo (73200) |
$855.59 |
$1,277 |
7.9× |
| CT upper extremity with contrast (73201) |
$960.11 |
$1,433 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,364.79 |
$2,037 |
7.5× |
| Cta Abdomen (74175) |
$1,181.21 |
$1,763 |
6.5× |
| CTA abdomen pelvis (74174) |
$1,756.07 |
$2,621 |
4.9× |
| CTA chest (71275) |
$1,083.39 |
$1,617 |
6.0× |
| Cta Head (70496) |
$1,259.60 |
$1,880 |
7.0× |
| Cta Neck (70498) |
$1,259.60 |
$1,880 |
7.0× |
| Cystography minimum 3 views rs&i (74430) |
$502.50 |
$750 |
1.4× |
| Esophagus (74220) |
$349.07 |
$521 |
1.9× |
| Facial bones min 3 views (70150) |
$222.44 |
$332 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$414.06 |
$618 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$436.84 |
$652 |
1.8× |
| Foot 2 views (73620) |
$162.81 |
$243 |
1.8× |
| Forearm 2 views (73090) |
$176.21 |
$263 |
2.0× |
| Hand 2 views (73120) |
$157.45 |
$235 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,506.83 |
$2,249 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,733.29 |
$2,587 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,184.56 |
$1,768 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,108.85 |
$1,655 |
2.7× |
| Hysterosalpingogram (74740) |
$403.34 |
$602 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,128.28 |
$1,684 |
2.0× |
| Knee 3 views (73562) |
$341.36 |
$509.50 |
3.8× |
| Lymphoscintigraphy (78195) |
$887.75 |
$1,325 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,781.53 |
$2,659 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,939.32 |
$2,894.50 |
5.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$784.57 |
$1,171 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,898.44 |
$2,833.50 |
5.3× |
| MRA head w/o contrast (70544) |
$1,460.26 |
$2,179.50 |
5.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,763.44 |
$2,632 |
4.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,049.20 |
$3,058.50 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,556.41 |
$2,323 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,772.15 |
$2,645 |
2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,003.30 |
$2,990 |
5.6× |
| MRI cervical spine w/o contrast (72141) |
$1,654.90 |
$2,470 |
6.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,697.78 |
$2,534 |
4.7× |
| MRI chest w/o contrast (71550) |
$1,305.83 |
$1,949 |
5.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,995.57 |
$4,471 |
8.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,439.83 |
$2,149 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,914.86 |
$2,858 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,987.22 |
$2,966 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$1,528.94 |
$2,282 |
6.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,982.53 |
$2,959 |
5.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,982.53 |
$2,959 |
5.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,809.67 |
$2,701 |
5.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,982.53 |
$2,959 |
5.5× |
| MRI temporomandibular joint (70336) |
$1,216.72 |
$1,816 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,654.90 |
$2,470 |
6.7× |
| MRI up ext w/o contrast (73218) |
$1,421.74 |
$2,122 |
5.8× |
| MRI upper ext joint w/o contrast (73221) |
$2,323.56 |
$3,468 |
9.4× |
| MRI, joint upper extrem combo (73223) |
$2,040.82 |
$3,046 |
5.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,366.44 |
$3,532 |
1.8× |
| Neck soft tissue (70360) |
$144.72 |
$216 |
1.6× |
| Nm gastric emptying study (78264) |
$1,127.61 |
$1,683 |
2.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,236.41 |
$6,323 |
3.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,068.65 |
$1,595 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$189.61 |
$283 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$3,860.20 |
$5,761.50 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$3,830.39 |
$5,717 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$434.16 |
$648 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$291.45 |
$435 |
3.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$158.12 |
$236 |
1.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$292.79 |
$437 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$151.76 |
$226.50 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$280.40 |
$418.50 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$268.34 |
$400.50 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$172.53 |
$257.50 |
1.9× |
| Radex Humerus Minimum 2 Views (73060) |
$288.44 |
$430.50 |
3.2× |
| Radex Kne 1/2 Views (73560) |
$201 |
$300 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$261.30 |
$390 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$186.26 |
$278 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$303.51 |
$453 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$127.30 |
$190 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$154.10 |
$230 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$206.36 |
$308 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$198.32 |
$296 |
2.2× |
| Radiation treatment delivery level 1 (77402) |
$503.84 |
$752 |
4.8× |
| Radiation treatment delivery level 2 (77407) |
$1,580.53 |
$2,359 |
4.0× |
| Radiation treatment delivery level 3 (77412) |
$665.31 |
$993 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$164.82 |
$246 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$193.63 |
$289 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$461.63 |
$689 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$369.84 |
$552 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$367.16 |
$548 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$401.33 |
$599 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$200.33 |
$299 |
2.2× |
| Radiological examination surgical specimen (76098) |
$336.34 |
$502 |
0.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$527.29 |
$787 |
2.1× |
| Scapula (73010) |
$179.56 |
$268 |
1.7× |
| Shoulder 1 view (73020) |
$172.94 |
$258.12 |
1.9× |
| Small bowel series (74250) |
$381.90 |
$570 |
2.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$777.20 |
$1,160 |
2.0× |
| Special dosimetry (77331) |
$300.83 |
$449 |
2.2× |
| Special Physics Consult (77370) |
$476.37 |
$711 |
3.4× |
| Spine thoracic 3 views (72072) |
$230.48 |
$344 |
2.1× |
| Stereotactic Body Radiation Delivery (77373) |
$4,218.99 |
$6,297 |
2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,069.99 |
$1,597 |
2.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,270.99 |
$1,897 |
3.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$789.26 |
$1,178 |
5.7× |
| Thoracolumbar 2 views (72080) |
$172.86 |
$258 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$830.80 |
$1,240 |
2.0× |
| Treatment device complex (77334) |
$1,511.52 |
$2,256 |
3.9× |
| Treatment devices simple (77332) |
$529.30 |
$790 |
3.8× |
| Ultrasound Exam Aaa Screen (76706) |
$300.83 |
$449 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$374.53 |
$559 |
3.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$101.84 |
$152 |
1.1× |
| Urethrocystogram voiding (74455) |
$527.96 |
$788 |
2.1× |
| Us breast unilateral limited (76642) |
$278.38 |
$415.50 |
3.1× |
| Us chest (76604) |
$300.83 |
$449 |
2.8× |
| Us infant hips w manipulation (76885) |
$297.48 |
$444 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$304.85 |
$455 |
2.8× |
| Us ob limited (76815) |
$336.34 |
$502 |
3.1× |
| Us ob transvaginal (76817) |
$343.71 |
$513 |
3.2× |
| Us pelvic non ob complete (76856) |
$381.90 |
$570 |
3.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$281.40 |
$420 |
2.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$346.39 |
$517 |
3.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$376.54 |
$562 |
3.5× |
| Us retroperitoneal complete (76770) |
$370.18 |
$552.50 |
3.4× |
| Us retroperitoneal limited (76775) |
$305.86 |
$456.50 |
2.8× |
| Us scrotum and contents (76870) |
$367.83 |
$549 |
3.4× |
| Us soft tissue head/neck (76536) |
$334.33 |
$499 |
3.1× |
| Us transrectal (76872) |
$67 |
$100 |
0.6× |
| Venogram extremity bilateral (75822) |
$1,781.53 |
$2,659 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,808.28 |
$5,684 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$2,793.90 |
$4,170 |
0.9× |
| Wrist 2 views (73100) |
$253.26 |
$378 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$278.72 |
$416 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168.17 |
$251 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$297.48 |
$444 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$262.98 |
$392.50 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$289.44 |
$432 |
3.2× |
| X-ray eye for foreign body (70030) |
$192.29 |
$287 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$211.05 |
$315 |
2.3× |
| X-ray leg, infant (73592) |
$197.32 |
$294.50 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$204.35 |
$305 |
1.9× |
| X-ray nose-rectum child f.b. (76010) |
$156.78 |
$234 |
1.7× |
| X-ray retrograde pyelogram (74420) |
$502.50 |
$750 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$175.54 |
$262 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$243.88 |
$364 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$293.46 |
$438 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$174.87 |
$261 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$172.19 |
$257 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$192.29 |
$287 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$194.64 |
$290.50 |
1.8× |
| Xr urogram antegrade (74425) |
$515.23 |
$769 |
1.4× |