| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,195 |
$6,195 |
4.7× |
| Abdomen 2 views (74019) |
$448.50 |
$448.50 |
4.5× |
| Acute gi blood loss imaging (78278) |
$3,260 |
$3,260 |
8.5× |
| Angio Adrenal Bilat Select (75733) |
$727.50 |
$727.50 |
0.2× |
| Angiography extremity bilateral rs&i (75716) |
$3,146.50 |
$3,146.50 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$4,593 |
$4,593 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$5,443 |
$5,443 |
1.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,660 |
$6,660 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,573.50 |
$2,573.50 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,349 |
$4,349 |
1.4× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$484 |
$484 |
0.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,257 |
$6,257 |
1.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,567 |
$1,567 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,184.50 |
$2,184.50 |
0.7× |
| Ankle 2 views (73600) |
$503 |
$503 |
6.0× |
| Aortogram thoracic (75605) |
$3,698 |
$3,698 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,789 |
$6,789 |
2.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,959.50 |
$3,959.50 |
1.3× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$72 |
$72 |
0.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,312 |
$3,312 |
1.1× |
| Arthrogram ankle (73615) |
$1,197 |
$1,197 |
3.6× |
| Arthrogram elbow (73085) |
$1,197 |
$1,197 |
3.6× |
| Arthrogram hip (73525) |
$1,031 |
$1,031 |
3.1× |
| Arthrogram knee (73580) |
$1,197 |
$1,197 |
3.6× |
| Arthrogram shoulder (73040) |
$1,439 |
$1,439 |
4.3× |
| Arthrogram wrist (73115) |
$1,031 |
$1,031 |
3.1× |
| Basic dosimetry (77300) |
$680 |
$680 |
5.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$871 |
$871 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$2,206 |
$2,206 |
5.8× |
| Bone age studies (77072) |
$503 |
$503 |
5.0× |
| Bone Imaging 3 Phase (78315) |
$2,369 |
$2,369 |
6.2× |
| Bone survey complete (77075) |
$892.50 |
$892.50 |
8.9× |
| Bone survey infant (77076) |
$300 |
$300 |
3.0× |
| Bowel imaging (78290) |
$3,111 |
$3,111 |
8.1× |
| Brachytx isodose complex (77318) |
$1,841 |
$1,841 |
5.1× |
| Brachytx isodose intermed (77317) |
$1,841 |
$1,841 |
5.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$680 |
$680 |
1.9× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,321 |
$1,321 |
3.4× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,767 |
$1,767 |
3.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,238 |
$2,238 |
5.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,098.50 |
$1,098.50 |
1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,409 |
$3,409 |
10.2× |
| Cardiac shunt detection (78428) |
$679 |
$679 |
1.8× |
| Cephalogram, orthodontic Non-Facility (70350) |
$24 |
$24 |
0.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,118 |
$2,118 |
4.1× |
| Cervical spine 2 or 3 views (72040) |
$503 |
$503 |
6.0× |
| Chest 1 view (71045) |
$140 |
$140 |
1.7× |
| Chest xray 3 views (71047) |
$462 |
$462 |
5.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$651.50 |
$651.50 |
3.9× |
| Cineradiography/videoradiography (76120) |
$216 |
$216 |
2.2× |
| Clavicle complete (73000) |
$503 |
$503 |
6.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$290 |
$290 |
2.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$144 |
$144 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$720.50 |
$720.50 |
5.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$502 |
$502 |
3.0× |
| Corpora cavernosography (74445) |
$224 |
$224 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$7,116 |
$7,116 |
21.3× |
| CT abdomen and pelvis without contrast (74176) |
$4,453 |
$4,453 |
19.5× |
| CT abdomen w contrast (74160) |
$3,751 |
$3,751 |
22.3× |
| CT abdomen w wo contrast (74170) |
$4,916 |
$4,916 |
29.2× |
| CT abdomen w/o contrast (74150) |
$2,169.50 |
$2,169.50 |
21.6× |
| CT angio hrt w/3d image (75574) |
$2,207 |
$2,207 |
6.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,676 |
$3,676 |
21.8× |
| CT angiography upper extremity lt (73206) |
$3,079 |
$3,079 |
18.3× |
| CT c-spine w/contrast (72126) |
$2,850.50 |
$2,850.50 |
8.5× |
| CT c-spine w/o contrast (72125) |
$2,382 |
$2,382 |
23.8× |
| CT cervical spine w&w/o contrast (72127) |
$3,486.50 |
$3,486.50 |
20.7× |
| CT chest w contrast (71260) |
$2,979 |
$2,979 |
17.7× |
| CT chest w/wo contrast (71270) |
$3,454 |
$3,454 |
20.5× |
| CT head/brain with contrast (70460) |
$2,294 |
$2,294 |
13.6× |
| CT head/brain without and with contrast (70470) |
$3,011 |
$3,011 |
17.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,726 |
$1,726 |
5.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$504 |
$504 |
6.0× |
| CT hrt w/3d image congen (75573) |
$900.50 |
$900.50 |
2.7× |
| CT iac w contrast (70481) |
$4,219.50 |
$4,219.50 |
25.1× |
| CT limited/localized follow up study (76380) |
$938 |
$938 |
11.2× |
| CT lower ext w/o (73700) |
$2,382 |
$2,382 |
23.8× |
| CT lower extremity w wo contrast (73702) |
$3,171 |
$3,171 |
18.8× |
| CT lower extremity w/contrast material (73701) |
$2,573 |
$2,573 |
15.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,643 |
$2,643 |
15.7× |
| CT lumbar spine w/contrast (72132) |
$2,967 |
$2,967 |
8.9× |
| CT lumbar spine w/o contrast (72131) |
$2,382 |
$2,382 |
23.8× |
| CT maxillofacial w contrast (70487) |
$2,988.50 |
$2,988.50 |
17.8× |
| CT maxillofacial w/wo contrast (70488) |
$4,684.50 |
$4,684.50 |
27.8× |
| CT maxillofacial wo contrast (70486) |
$2,271 |
$2,271 |
22.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$5,143 |
$5,143 |
30.6× |
| CT orbits w/o contrast (70480) |
$2,382 |
$2,382 |
23.8× |
| CT pelvis w/o contrast (72192) |
$2,382 |
$2,382 |
23.8× |
| CT pelvis w/wo contrast (72194) |
$4,916 |
$4,916 |
29.2× |
| CT scan of arm combo (73202) |
$3,578 |
$3,578 |
21.3× |
| CT soft tissue neck w contrast (70491) |
$3,164 |
$3,164 |
18.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$5,143 |
$5,143 |
30.6× |
| CT soft tissue neck w/o contrast (70490) |
$2,382 |
$2,382 |
23.8× |
| CT thoracic spine w/contrast (72129) |
$2,443 |
$2,443 |
14.5× |
| CT thoracic spine w/o contrast (72128) |
$2,382 |
$2,382 |
23.8× |
| CT thoracic spine w/wo contrast (72130) |
$3,037.50 |
$3,037.50 |
18.1× |
| CT thorax w/o contrast (71250) |
$2,382 |
$2,382 |
23.8× |
| CT unlisted procedure (76497) |
$130 |
$130 |
1.6× |
| CT upper ext wo (73200) |
$2,271 |
$2,271 |
22.6× |
| CT upper extremity with contrast (73201) |
$2,675 |
$2,675 |
8.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,689 |
$4,689 |
27.9× |
| Cta Abdomen (74175) |
$4,689 |
$4,689 |
27.9× |
| CTA abdomen pelvis (74174) |
$6,545.50 |
$6,545.50 |
19.6× |
| CTA chest (71275) |
$3,506 |
$3,506 |
20.8× |
| Cta Head (70496) |
$4,435 |
$4,435 |
26.4× |
| Cta Neck (70498) |
$4,435 |
$4,435 |
26.4× |
| Cta Pelvis (72191) |
$3,218 |
$3,218 |
19.1× |
| Cystography minimum 3 views rs&i (74430) |
$966 |
$966 |
2.9× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,527.50 |
$1,527.50 |
0.8× |
| Diskogram cervical (72285) |
$2,272 |
$2,272 |
1.2× |
| Diskography lumbar (72295) |
$3,582 |
$3,582 |
1.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$574.50 |
$574.50 |
5.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$855.50 |
$855.50 |
8.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$482 |
$482 |
4.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$713.50 |
$713.50 |
7.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$593 |
$593 |
7.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$673 |
$673 |
2.9× |
| Esophagus (74220) |
$889 |
$889 |
5.3× |
| Facial bones min 3 views (70150) |
$592 |
$592 |
5.9× |
| Fetal biophysical profile non-stress testing (76818) |
$1,432 |
$1,432 |
14.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$783 |
$783 |
7.8× |
| Fetal Echo (76825) |
$1,020.50 |
$1,020.50 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$1,123 |
$1,123 |
4.9× |
| Foot 2 views (73620) |
$463.50 |
$463.50 |
5.6× |
| Forearm 2 views (73090) |
$503 |
$503 |
6.0× |
| Functional MRI brain by tech (70554) |
$2,051.50 |
$2,051.50 |
9.0× |
| Hand 2 views (73120) |
$364 |
$364 |
3.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,326 |
$1,326 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,326 |
$1,326 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,326 |
$1,326 |
2.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,080 |
$5,080 |
1.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,080 |
$5,080 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,575.50 |
$3,575.50 |
6.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$99 |
$99 |
0.3× |
| Hysterosalpingogram (74740) |
$1,525 |
$1,525 |
6.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,923 |
$1,923 |
2.9× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,923 |
$1,923 |
3.6× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,923 |
$1,923 |
3.6× |
| Kidney imaging morphology (78700) |
$1,565 |
$1,565 |
4.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,923 |
$2,923 |
5.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,688 |
$3,688 |
7.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$4,993 |
$4,993 |
9.6× |
| Knee 3 views (73562) |
$503 |
$503 |
6.0× |
| Liver & spleen imaging static only (78215) |
$2,423 |
$2,423 |
6.3× |
| Liver imaging static only (78201) |
$513 |
$513 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$517 |
$517 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$1,566 |
$1,566 |
3.0× |
| Lung ventilation imaging (78579) |
$1,283 |
$1,283 |
3.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$186 |
$186 |
0.1× |
| Lymphoscintigraphy (78195) |
$2,762 |
$2,762 |
5.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,362 |
$2,362 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$5,665.50 |
$5,665.50 |
16.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$6,984 |
$6,984 |
20.9× |
| Mammary ductogram or galactogram multiple (77054) |
$639 |
$639 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$549 |
$549 |
2.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$122 |
$122 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,869 |
$1,869 |
5.2× |
| MRA head w & w/o contrast (70546) |
$5,988 |
$5,988 |
17.9× |
| MRA head w/o contrast (70544) |
$2,824 |
$2,824 |
12.3× |
| MRA head with contrast (70545) |
$3,815 |
$3,815 |
11.4× |
| MRA neck w contrast (70548) |
$3,567 |
$3,567 |
10.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$5,371 |
$5,371 |
16.0× |
| MRA neck w/o contrast (70547) |
$2,881 |
$2,881 |
12.6× |
| MRI abdomen w contrast (74182) |
$5,274 |
$5,274 |
15.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$7,043 |
$7,043 |
21.0× |
| MRI abdomen w/o contrast (74181) |
$4,007 |
$4,007 |
17.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$5,917 |
$5,917 |
7.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$7,082 |
$7,082 |
21.2× |
| MRI breast w/o contrast bilateral (77047) |
$6,905.50 |
$6,905.50 |
30.2× |
| MRI breast wo contrast unilateral (77046) |
$5,371.50 |
$5,371.50 |
23.5× |
| MRI c-spine with contrast (72142) |
$5,504 |
$5,504 |
16.4× |
| MRI cardiac w/o cont stress (75559) |
$811.50 |
$811.50 |
1.5× |
| MRI cardiac w/o contrast (75557) |
$2,261 |
$2,261 |
9.9× |
| MRI cervical spine w/o contrast (72141) |
$4,272 |
$4,272 |
18.7× |
| MRI chest w/o & w/contrast material (71552) |
$5,288 |
$5,288 |
15.8× |
| MRI chest w/o contrast (71550) |
$2,991.50 |
$2,991.50 |
13.1× |
| MRI chest with contrast (71551) |
$4,268.50 |
$4,268.50 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$6,049 |
$6,049 |
18.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$7,081 |
$7,081 |
21.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,055 |
$4,055 |
17.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$4,225 |
$4,225 |
18.5× |
| MRI orbit face neck w contrast (70542) |
$5,433 |
$5,433 |
16.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$6,947 |
$6,947 |
20.8× |
| MRI pelvis w/contrast (72196) |
$4,988.50 |
$4,988.50 |
14.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,555 |
$6,555 |
19.6× |
| MRI pelvis w/o contrast (72195) |
$3,599 |
$3,599 |
15.7× |
| MRI spectroscopy (76390) |
$3,429.50 |
$3,429.50 |
41.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$7,178 |
$7,178 |
21.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$6,229 |
$6,229 |
18.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$7,178 |
$7,178 |
21.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$6,118 |
$6,118 |
18.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$7,178 |
$7,178 |
21.4× |
| MRI temporomandibular joint (70336) |
$3,830 |
$3,830 |
16.7× |
| MRI thoracic spine w/o contrast (72146) |
$4,343 |
$4,343 |
19.0× |
| MRI up ext w/o contrast (73218) |
$4,051 |
$4,051 |
17.7× |
| MRI upper ext joint w/o contrast (73221) |
$4,235 |
$4,235 |
18.5× |
| MRI, joint upper extrem combo (73223) |
$7,080 |
$7,080 |
21.2× |
| Myelogram Cervical (72240) |
$1,731.50 |
$1,731.50 |
2.3× |
| Myelogram Lumbar (72265) |
$1,519 |
$1,519 |
2.0× |
| Myelogram thoracic (72255) |
$1,731.50 |
$1,731.50 |
2.3× |
| Myelography 2 or more regions (72270) |
$2,381 |
$2,381 |
3.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,134.50 |
$2,134.50 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,526.50 |
$2,526.50 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,379.50 |
$2,379.50 |
1.9× |
| Neck soft tissue (70360) |
$410 |
$410 |
4.9× |
| Nm bone marrow wb (78104) |
$603 |
$603 |
1.6× |
| Nm cardiac blood pool multiple (78473) |
$489.50 |
$489.50 |
1.3× |
| Nm cisternogram (78630) |
$2,421 |
$2,421 |
4.6× |
| Nm gastric emptying study (78264) |
$3,004 |
$3,004 |
7.8× |
| Nm gastroesophageal reflux study (78262) |
$2,948 |
$2,948 |
7.7× |
| Nm peritoneal-venous shunt patency (78291) |
$1,612 |
$1,612 |
4.2× |
| Nonvascular shunt X-ray (75809) |
$533 |
$533 |
5.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,112 |
$6,112 |
4.6× |
| Nuclear Rx Oral Admin (79005) |
$1,237 |
$1,237 |
5.5× |
| Ob us nuchal meas 1 gest (76813) |
$368 |
$368 |
3.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$247.50 |
$247.50 |
2.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$290 |
$290 |
2.9× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$277 |
$277 |
2.2× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$71.50 |
$71.50 |
2.6× |
| Orthopantogram (70355) |
$338 |
$338 |
4.0× |
| Osseous survey limited (77074) |
$798 |
$798 |
8.0× |
| Parathyroid Planar Imaging (78070) |
$3,035 |
$3,035 |
7.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,817 |
$2,817 |
7.3× |
| Pelvis 1 or 2 views (72170) |
$541 |
$541 |
5.4× |
| Peritoneogram after injection (74190) |
$65 |
$65 |
0.1× |
| PET image w/CT, skull-thigh (78815) |
$8,572 |
$8,572 |
6.2× |
| PET imaging CT for attenuation limited area (78814) |
$8,572 |
$8,572 |
6.2× |
| PET imaging for CT attenuation whole body (78816) |
$7,981 |
$7,981 |
5.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,154 |
$5,154 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,152 |
$4,152 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,245 |
$1,245 |
3.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,168 |
$1,168 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,538 |
$1,538 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$503 |
$503 |
6.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$479.50 |
$479.50 |
5.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$503 |
$503 |
6.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$460.50 |
$460.50 |
5.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$503 |
$503 |
5.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$779 |
$779 |
7.8× |
| Radex fingr minimum 2 views (73140) |
$454.50 |
$454.50 |
5.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$503 |
$503 |
6.0× |
| Radex Hand Minimum 3 Views (73130) |
$503 |
$503 |
6.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$295 |
$295 |
3.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$711 |
$711 |
7.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$635.50 |
$635.50 |
6.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$922.50 |
$922.50 |
9.2× |
| Radex Humerus Minimum 2 Views (73060) |
$503 |
$503 |
6.0× |
| Radex Kne 1/2 Views (73560) |
$185.50 |
$185.50 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$503 |
$503 |
5.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$340 |
$340 |
3.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$406 |
$406 |
4.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$503 |
$503 |
5.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$503 |
$503 |
6.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$350 |
$350 |
4.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$637 |
$637 |
6.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$503 |
$503 |
6.0× |
| Radex Toe Minimum 2 Views (73660) |
$363.50 |
$363.50 |
4.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$555.50 |
$555.50 |
5.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$528 |
$528 |
6.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$491 |
$491 |
4.9× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$22,392 |
$22,392 |
3.2× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,392 |
$22,392 |
3.2× |
| Radiation treatment delivery level 1 (77402) |
$1,004 |
$1,004 |
10.3× |
| Radiation treatment delivery level 2 (77407) |
$1,004 |
$1,004 |
2.7× |
| Radiation treatment delivery level 3 (77412) |
$1,004 |
$1,004 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$434 |
$434 |
5.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$474.50 |
$474.50 |
4.7× |
| Radiologic exam chest 2 views (71046) |
$400 |
$400 |
4.8× |
| Radiologic exam colon single contrast study (74270) |
$1,312 |
$1,312 |
7.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,176 |
$1,176 |
7.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,162 |
$1,162 |
6.9× |
| Radiologic examination femur 1 view (73551) |
$515 |
$515 |
6.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$488 |
$488 |
5.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$788 |
$788 |
1.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$434 |
$434 |
4.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$261 |
$261 |
2.6× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$290 |
$290 |
1.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$131 |
$131 |
1.6× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$523.50 |
$523.50 |
6.3× |
| Radiological examination surgical specimen (76098) |
$609.50 |
$609.50 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$446 |
$446 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$446 |
$446 |
1.2× |
| Ribs bilateral 3 views (71110) |
$703 |
$703 |
7.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,803 |
$1,803 |
4.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,773 |
$1,773 |
4.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,889 |
$1,889 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,534 |
$2,534 |
4.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,051 |
$1,051 |
2.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$394 |
$394 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$1,252 |
$1,252 |
5.6× |
| Sacroiliac Joints < 3 Views (72200) |
$449.50 |
$449.50 |
4.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$299.50 |
$299.50 |
1.3× |
| Scapula (73010) |
$427 |
$427 |
4.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$239 |
$239 |
10.2× |
| Sella turcica (70240) |
$327 |
$327 |
3.9× |
| Shoulder 1 view (73020) |
$503 |
$503 |
6.0× |
| Sialogram (70390) |
$837.50 |
$837.50 |
3.7× |
| Simulation intermediate (77285) |
$1,867 |
$1,867 |
5.2× |
| Small bowel series (74250) |
$889 |
$889 |
5.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,841 |
$1,841 |
5.1× |
| Special dosimetry (77331) |
$680 |
$680 |
5.3× |
| Special Physics Consult (77370) |
$720.50 |
$720.50 |
5.6× |
| Special treatment procedure (77470) |
$473 |
$473 |
0.9× |
| Spine thoracic 3 views (72072) |
$633.50 |
$633.50 |
6.3× |
| Stereotactic Body Radiation Delivery (77373) |
$8,621.50 |
$8,621.50 |
5.0× |
| Superior sagittal sinus venogram (75870) |
$170 |
$170 |
0.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$680 |
$680 |
1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$680 |
$680 |
1.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,197 |
$1,197 |
5.2× |
| Testicular Imaging With Vascular Flow (78761) |
$97 |
$97 |
0.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,867 |
$1,867 |
5.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$691 |
$691 |
5.4× |
| Thoracolumbar 2 views (72080) |
$503 |
$503 |
6.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$3,123 |
$3,123 |
6.0× |
| Thyroid imaging w/blood flow (78013) |
$1,445 |
$1,445 |
3.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,011 |
$2,011 |
5.2× |
| Tmj unilateral (70328) |
$306 |
$306 |
3.7× |
| Tomogram (76100) |
$728.50 |
$728.50 |
7.3× |
| Treatment device complex (77334) |
$1,280 |
$1,280 |
3.6× |
| Treatment device intermediate (77333) |
$1,280 |
$1,280 |
9.9× |
| Treatment devices simple (77332) |
$1,280 |
$1,280 |
9.9× |
| Ultrasound breast complete (76641) |
$887 |
$887 |
8.8× |
| Ultrasound Exam Aaa Screen (76706) |
$1,147 |
$1,147 |
11.4× |
| Ultrasound, abdomen limited (76705) |
$1,109 |
$1,109 |
11.1× |
| Umbilical-artery Doppler (OB) (76820) |
$773 |
$773 |
7.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$516 |
$516 |
6.2× |
| Unlisted fluoroscopic procedure (76496) |
$118 |
$118 |
1.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$2,087 |
$2,087 |
21.3× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$201.50 |
$201.50 |
1.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$59 |
$59 |
5.3× |
| Ureteral reflux study (78740) |
$2,020 |
$2,020 |
5.3× |
| Urethrocystogram voiding (74455) |
$1,252.50 |
$1,252.50 |
5.5× |
| Urethrocystography retrograde rs&i (74450) |
$1,276 |
$1,276 |
5.6× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,134.50 |
$1,134.50 |
6.7× |
| Us breast unilateral limited (76642) |
$522 |
$522 |
6.3× |
| Us chest (76604) |
$98 |
$98 |
1.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$285 |
$285 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$775 |
$775 |
7.7× |
| Us elastography parenchyma (76981) |
$187 |
$187 |
1.9× |
| Us encephalogram (76506) |
$889 |
$889 |
8.9× |
| Us hips infant static (76886) |
$216.50 |
$216.50 |
2.6× |
| Us infant hips w manipulation (76885) |
$889 |
$889 |
10.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$518 |
$518 |
5.2× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$42 |
$42 |
0.4× |
| Us ob detailed single fetus (76811) |
$1,404 |
$1,404 |
6.1× |
| Us ob limited (76815) |
$294 |
$294 |
2.9× |
| Us ob transvaginal (76817) |
$582 |
$582 |
5.8× |
| Us pelvic non ob complete (76856) |
$1,198.50 |
$1,198.50 |
12.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$775 |
$775 |
7.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$619.50 |
$619.50 |
6.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$605 |
$605 |
6.0× |
| Us retroperitoneal complete (76770) |
$1,326 |
$1,326 |
13.2× |
| Us retroperitoneal limited (76775) |
$639.50 |
$639.50 |
6.4× |
| Us scrotum and contents (76870) |
$1,005 |
$1,005 |
10.0× |
| Us soft tissue head/neck (76536) |
$140 |
$140 |
1.4× |
| Us spinal canal and contents (76800) |
$889 |
$889 |
8.9× |
| Us transrectal (76872) |
$128 |
$128 |
1.3× |
| Us transrectal prostate volume (76873) |
$157 |
$157 |
1.6× |
| Us, eye b-scan (76512) |
$157.50 |
$157.50 |
1.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,201.50 |
$1,201.50 |
12.0× |
| Venogram adrenal unilat (75840) |
$4,664.50 |
$4,664.50 |
1.5× |
| Venogram extremity bilateral (75822) |
$396 |
$396 |
0.3× |
| Venogram Extremity Unilateral (75820) |
$1,185 |
$1,185 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$475 |
$475 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$2,954.50 |
$2,954.50 |
2.0× |
| Venography Renal Bilateral (75833) |
$2,580 |
$2,580 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$5,123 |
$5,123 |
1.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,670 |
$3,670 |
1.2× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,317 |
$1,317 |
0.2× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$96 |
$96 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$899 |
$899 |
10.8× |
| Wrist 2 views (73100) |
$377 |
$377 |
4.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$754 |
$754 |
7.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$465 |
$465 |
5.6× |
| X-ray b.e. reductn intuss (74283) |
$1,421 |
$1,421 |
8.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,312 |
$1,312 |
7.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$467 |
$467 |
5.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$454 |
$454 |
5.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$780.50 |
$780.50 |
7.8× |
| X-ray exam of femur 2/> (73552) |
$454 |
$454 |
5.4× |
| X-ray eye for foreign body (70030) |
$534 |
$534 |
6.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$454 |
$454 |
5.4× |
| X-ray IV pyelogram (ivp) (74400) |
$992 |
$992 |
5.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$438 |
$438 |
5.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$390.50 |
$390.50 |
4.7× |
| X-ray leg, infant (73592) |
$321 |
$321 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$503 |
$503 |
5.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$978 |
$978 |
9.8× |
| X-ray nose-rectum child f.b. (76010) |
$439.50 |
$439.50 |
5.3× |
| X-ray optic foramen (70190) |
$130 |
$130 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$466 |
$466 |
4.6× |
| X-ray retrograde pyelogram (74420) |
$1,526 |
$1,526 |
4.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$503 |
$503 |
6.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$603.50 |
$603.50 |
6.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$784 |
$784 |
7.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$530.50 |
$530.50 |
5.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$530.50 |
$530.50 |
6.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$454 |
$454 |
5.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$525 |
$525 |
5.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$458 |
$458 |
4.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,521.50 |
$1,521.50 |
9.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$552 |
$552 |
6.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$503 |
$503 |
6.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$503 |
$503 |
6.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$562.50 |
$562.50 |
5.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$658 |
$658 |
6.6× |
| Xr bone length studies (77073) |
$555.50 |
$555.50 |
5.5× |
| Xr c-spine 4 or 5 views (72050) |
$795 |
$795 |
7.9× |
| Xr c-spine 6 or more views (72052) |
$725 |
$725 |
7.2× |
| Xr chest 4+ views (71048) |
$420 |
$420 |
4.2× |
| Xr urogram antegrade (74425) |
$781 |
$781 |
2.3× |