| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,551.98 |
$9,253.30 |
4.1× |
| Abdomen 2 views (74019) |
$270.58 |
$450.97 |
2.7× |
| Acute gi blood loss imaging (78278) |
$532.94 |
$888.24 |
1.4× |
| Angio Adrenal Bilat Select (75733) |
$7,308.83 |
$12,181.38 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$7,308.83 |
$12,181.38 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,654.41 |
$6,090.69 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$3,654.41 |
$6,090.69 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,300.35 |
$10,500.58 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,200.36 |
$7,000.60 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,654.41 |
$6,090.69 |
1.2× |
| Angiography Spinal Selective Rs&I (75705) |
$6,300.35 |
$10,500.58 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,300.35 |
$10,500.58 |
1.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,391.81 |
$7,319.68 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,654.41 |
$6,090.69 |
1.2× |
| Ankle 2 views (73600) |
$204.27 |
$340.45 |
2.4× |
| Aortogram thoracic (75605) |
$6,300.35 |
$10,500.58 |
1.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,654.41 |
$6,090.69 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,654.41 |
$6,090.69 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$3,654.41 |
$6,090.69 |
1.2× |
| Arthrogram ankle (73615) |
$394.69 |
$657.81 |
1.2× |
| Arthrogram elbow (73085) |
$440.92 |
$734.86 |
1.3× |
| Arthrogram hip (73525) |
$2,673.94 |
$4,456.57 |
7.9× |
| Arthrogram knee (73580) |
$488.97 |
$814.95 |
1.4× |
| Arthrogram shoulder (73040) |
$470.69 |
$784.48 |
1.4× |
| Arthrogram wrist (73115) |
$293.08 |
$488.47 |
0.9× |
| Basic dosimetry (77300) |
$636.35 |
$1,060.59 |
4.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$314.32 |
$523.87 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$684.93 |
$1,141.55 |
1.8× |
| Bone age studies (77072) |
$132.11 |
$220.19 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$804.33 |
$1,340.55 |
2.1× |
| Bone Marrow Imaging Limited Area (78102) |
$383.93 |
$639.88 |
1.0× |
| Bone survey complete (77075) |
$525.65 |
$876.09 |
5.2× |
| Bone survey infant (77076) |
$161.63 |
$269.39 |
1.6× |
| Bowel imaging (78290) |
$465.09 |
$775.15 |
1.2× |
| Brachytx isodose complex (77318) |
$999.70 |
$1,666.17 |
2.7× |
| Brachytx isodose intermed (77317) |
$584.76 |
$974.60 |
1.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$459.11 |
$765.18 |
1.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$411.92 |
$686.53 |
0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,532.13 |
$5,886.89 |
2.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$973.38 |
$1,622.30 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$238 |
$396.67 |
2.8× |
| Chest 1 view (71045) |
$179.93 |
$299.89 |
2.1× |
| Chest xray 3 views (71047) |
$216.62 |
$361.04 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$496.65 |
$827.75 |
2.9× |
| Clavicle complete (73000) |
$214.57 |
$357.61 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$368.78 |
$614.64 |
3.6× |
| Continuing medical physics consltj pr wk (77336) |
$894.35 |
$1,490.58 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,953.33 |
$4,922.21 |
8.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,134.41 |
$3,557.35 |
9.2× |
| CT abdomen w contrast (74160) |
$1,198.40 |
$1,997.34 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,502.42 |
$2,504.04 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,116.57 |
$1,860.95 |
10.9× |
| CT angio hrt w/3d image (75574) |
$1,613.86 |
$2,689.76 |
4.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,230.85 |
$2,051.42 |
7.2× |
| CT angiography upper extremity lt (73206) |
$1,230.85 |
$2,051.42 |
7.2× |
| CT c-spine w/contrast (72126) |
$738.79 |
$1,231.32 |
2.2× |
| CT c-spine w/o contrast (72125) |
$679.25 |
$1,132.08 |
6.7× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$247.30 |
$412.16 |
1.4× |
| CT cervical spine w&w/o contrast (72127) |
$849.13 |
$1,415.22 |
5.0× |
| CT chest w contrast (71260) |
$1,243.54 |
$2,072.57 |
7.3× |
| CT chest w/wo contrast (71270) |
$1,461.50 |
$2,435.84 |
8.5× |
| CT head/brain with contrast (70460) |
$477.47 |
$795.79 |
2.8× |
| CT head/brain without and with contrast (70470) |
$626.15 |
$1,043.58 |
3.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,613.86 |
$2,689.76 |
4.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$156.98 |
$261.64 |
1.8× |
| CT hrt w/3d image congen (75573) |
$1,613.86 |
$2,689.76 |
4.7× |
| CT iac w contrast (70481) |
$535.13 |
$891.88 |
3.1× |
| CT limited/localized follow up study (76380) |
$620.01 |
$1,033.35 |
7.3× |
| CT lower ext w/o (73700) |
$1,025.59 |
$1,709.32 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$1,274.34 |
$2,123.90 |
7.4× |
| CT lower extremity w/contrast material (73701) |
$1,108.11 |
$1,846.85 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,342.29 |
$2,237.15 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$1,314.08 |
$2,190.13 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$1,208.27 |
$2,013.79 |
11.8× |
| CT maxillofacial w contrast (70487) |
$583.67 |
$972.79 |
3.4× |
| CT maxillofacial w/wo contrast (70488) |
$907.56 |
$1,512.60 |
5.3× |
| CT maxillofacial wo contrast (70486) |
$543.85 |
$906.41 |
5.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$655.73 |
$1,092.89 |
3.8× |
| CT orbits w/o contrast (70480) |
$494.54 |
$824.24 |
4.8× |
| CT pelvis w/o contrast (72192) |
$1,017.83 |
$1,696.39 |
10.0× |
| CT pelvis w/wo contrast (72194) |
$1,450.92 |
$2,418.20 |
8.5× |
| CT scan of arm combo (73202) |
$1,274.34 |
$2,123.90 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$536.65 |
$894.41 |
3.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$617.14 |
$1,028.57 |
3.6× |
| CT soft tissue neck w/o contrast (70490) |
$514.28 |
$857.13 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$1,389.52 |
$2,315.87 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$1,208.27 |
$2,013.79 |
11.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,597.94 |
$2,663.24 |
9.3× |
| CT thorax w/o contrast (71250) |
$932.48 |
$1,554.14 |
9.1× |
| CT upper ext wo (73200) |
$1,025.59 |
$1,709.32 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,108.11 |
$1,846.85 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,613.86 |
$2,689.76 |
9.4× |
| Cta Abdomen (74175) |
$1,613.86 |
$2,689.76 |
9.4× |
| CTA abdomen pelvis (74174) |
$3,354.68 |
$5,591.13 |
9.9× |
| CTA chest (71275) |
$1,128.57 |
$1,880.95 |
6.6× |
| Cta Head (70496) |
$672.03 |
$1,120.05 |
3.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$491.87 |
$819.79 |
1.4× |
| Cta Neck (70498) |
$599.89 |
$999.82 |
3.5× |
| Cta Pelvis (72191) |
$1,740.82 |
$2,901.36 |
10.2× |
| Cystography minimum 3 views rs&i (74430) |
$384.78 |
$641.30 |
1.1× |
| Diskogram cervical (72285) |
$2,425.34 |
$4,042.24 |
1.3× |
| Diskography lumbar (72295) |
$1,889.24 |
$3,148.74 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$218.87 |
$364.79 |
2.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$450.70 |
$751.16 |
4.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$209.42 |
$349.03 |
2.5× |
| Echo exam of eye (76529) |
$80.32 |
$133.86 |
0.9× |
| Esophagus (74220) |
$424.31 |
$707.19 |
2.5× |
| Facial bones min 3 views (70150) |
$273.61 |
$456.01 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$413.76 |
$689.60 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$319.07 |
$531.79 |
3.1× |
| Fetal Echo (76825) |
$660.36 |
$1,100.60 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$489.75 |
$816.25 |
2.1× |
| Foot 2 views (73620) |
$200.52 |
$334.20 |
2.4× |
| Forearm 2 views (73090) |
$201.45 |
$335.75 |
2.4× |
| Hand 2 views (73120) |
$167.26 |
$278.76 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,689.47 |
$4,482.45 |
4.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,062.45 |
$5,104.08 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,062.45 |
$5,104.08 |
4.5× |
| Heart first pass single,planar (78481) |
$973.38 |
$1,622.30 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,176.47 |
$6,960.79 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,654.41 |
$6,090.69 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$974.14 |
$1,623.56 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$819.88 |
$1,366.46 |
2.1× |
| Hysterosalpingogram (74740) |
$756.59 |
$1,260.98 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$2,211.28 |
$3,685.46 |
3.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,471.56 |
$2,452.60 |
2.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,152.31 |
$1,920.52 |
2.1× |
| Intracavitary Radiation Source Applic Simple (77761) |
$731.44 |
$1,219.06 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$491.62 |
$819.37 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$540.78 |
$901.30 |
1.0× |
| Knee 3 views (73562) |
$200.52 |
$334.20 |
2.4× |
| Liver & spleen imaging static only (78215) |
$509.81 |
$849.69 |
1.3× |
| Lung perf&ventilat diferentl (78598) |
$411.92 |
$686.53 |
0.8× |
| Lung perfusion differential (78597) |
$403.69 |
$672.81 |
1.0× |
| Lymphoscintigraphy (78195) |
$582.30 |
$970.50 |
1.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,055.87 |
$3,426.45 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,972.47 |
$3,287.45 |
5.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,468.80 |
$4,114.67 |
7.3× |
| Mammary ductogram or galactogram multiple (77054) |
$742.27 |
$1,237.11 |
3.2× |
| Mammary ductogram or galactogram single (77053) |
$392.27 |
$653.79 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,998.52 |
$3,330.86 |
5.5× |
| Mr safety determination physician/other qhp (76016) |
$375 |
$625 |
4.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$94.63 |
$157.71 |
3.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$1,217.24 |
$2,028.74 |
13.1× |
| Mr safety implt pos&/immoblj (76019) |
$257.41 |
$429.01 |
4.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$1,352.49 |
$2,254.15 |
5.8× |
| MRA head w & w/o contrast (70546) |
$4,558.19 |
$7,596.99 |
13.4× |
| MRA head w/o contrast (70544) |
$1,970.68 |
$3,284.46 |
8.5× |
| MRA head with contrast (70545) |
$2,488.24 |
$4,147.06 |
7.3× |
| MRA neck w contrast (70548) |
$2,295.88 |
$3,826.47 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,680.61 |
$4,467.68 |
7.9× |
| MRA neck w/o contrast (70547) |
$1,970.68 |
$3,284.46 |
8.5× |
| MRI abdomen w contrast (74182) |
$1,837.48 |
$3,062.46 |
5.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,581.46 |
$4,302.44 |
7.6× |
| MRI abdomen w/o contrast (74181) |
$1,597.81 |
$2,663.01 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,075.12 |
$3,458.53 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,563.44 |
$4,272.40 |
7.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,940.77 |
$3,234.62 |
8.3× |
| MRI breast wo contrast unilateral (77046) |
$1,639.35 |
$2,732.25 |
7.0× |
| MRI c-spine with contrast (72142) |
$2,287.60 |
$3,812.66 |
6.7× |
| MRI cervical spine w/o contrast (72141) |
$1,989.20 |
$3,315.33 |
8.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,454.64 |
$4,091.07 |
7.2× |
| MRI chest w/o contrast (71550) |
$1,347.38 |
$2,245.64 |
5.8× |
| MRI chest with contrast (71551) |
$1,414.98 |
$2,358.30 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,716.26 |
$2,860.43 |
5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,563.44 |
$4,272.40 |
7.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,586.21 |
$2,643.69 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,444.60 |
$2,407.66 |
6.2× |
| MRI orbit face neck w contrast (70542) |
$1,562.78 |
$2,604.64 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,481.31 |
$4,135.52 |
7.3× |
| MRI pelvis w/contrast (72196) |
$1,493.51 |
$2,489.19 |
4.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,463.63 |
$4,106.05 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$1,121.42 |
$1,869.04 |
4.8× |
| MRI spectroscopy (76390) |
$197 |
$328.33 |
2.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,404.07 |
$7,340.12 |
12.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,987.76 |
$3,312.94 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,670.06 |
$6,116.76 |
10.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,150.63 |
$3,584.38 |
6.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,583.40 |
$4,305.66 |
7.6× |
| MRI temporomandibular joint (70336) |
$1,599.74 |
$2,666.23 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,870.12 |
$3,116.86 |
8.0× |
| MRI up ext w/o contrast (73218) |
$1,586.21 |
$2,643.69 |
6.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,787.71 |
$2,979.52 |
7.7× |
| MRI, joint upper extrem combo (73223) |
$2,563.44 |
$4,272.40 |
7.5× |
| Myelogram Cervical (72240) |
$1,275.37 |
$2,125.62 |
1.7× |
| Myelogram Lumbar (72265) |
$1,011.08 |
$1,685.14 |
1.3× |
| Myelogram thoracic (72255) |
$2,331.80 |
$3,886.33 |
3.0× |
| Myelography 2 or more regions (72270) |
$1,606.12 |
$2,676.87 |
2.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,532.13 |
$5,886.89 |
2.8× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$3,532.13 |
$5,886.89 |
1.6× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,532.13 |
$5,886.89 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$3,532.13 |
$5,886.89 |
1.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,082.14 |
$1,803.57 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,311.45 |
$3,852.41 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$1,082.14 |
$1,803.57 |
0.9× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$3,532.13 |
$5,886.89 |
2.4× |
| N-invas est c ffr sw aly CTA (75580) |
$1,367.36 |
$2,278.93 |
1.6× |
| Neck soft tissue (70360) |
$226.05 |
$376.75 |
2.7× |
| Nm bone marrow multi (78103) |
$421.15 |
$701.92 |
1.1× |
| Nm cisternogram (78630) |
$666.73 |
$1,111.22 |
1.3× |
| Nm csf leak detection (78650) |
$1,082.14 |
$1,803.57 |
0.9× |
| Nm gastric emptying study (78264) |
$643.62 |
$1,072.70 |
1.7× |
| Nm gastroesophageal reflux study (78262) |
$354.79 |
$591.31 |
0.9× |
| Nm peritoneal-venous shunt patency (78291) |
$383.93 |
$639.88 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$284.11 |
$473.51 |
2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,658.40 |
$9,430.66 |
4.2× |
| Nuclear Rx Oral Admin (79005) |
$1,999.46 |
$3,332.43 |
8.8× |
| Orthopantogram (70355) |
$99.32 |
$165.54 |
1.2× |
| Osseous survey limited (77074) |
$205.21 |
$342.01 |
2.0× |
| Parathyrd planar w/spect&CT (78072) |
$1,709.49 |
$2,849.15 |
3.2× |
| Parathyroid Planar Imaging (78070) |
$692.14 |
$1,153.56 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,425.58 |
$2,375.97 |
3.7× |
| Pelvis 1 or 2 views (72170) |
$147.11 |
$245.18 |
1.4× |
| PET image w/CT, skull-thigh (78815) |
$3,532.13 |
$5,886.89 |
2.5× |
| PET imaging CT for attenuation limited area (78814) |
$3,532.13 |
$5,886.89 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$3,532.13 |
$5,886.89 |
2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,654.41 |
$6,090.69 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$314.32 |
$523.87 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$462.82 |
$771.36 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$420.43 |
$700.72 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$218.79 |
$364.65 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$161.16 |
$268.60 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$200.05 |
$333.41 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$103.07 |
$171.78 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$353.72 |
$589.53 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$119 |
$198.33 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$215.51 |
$359.18 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$185.53 |
$309.21 |
2.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$79.87 |
$133.11 |
0.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$257.68 |
$429.47 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$224.29 |
$373.82 |
2.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$551.89 |
$919.82 |
5.4× |
| Radex Humerus Minimum 2 Views (73060) |
$131.65 |
$219.42 |
1.6× |
| Radex Kne 1/2 Views (73560) |
$193.49 |
$322.48 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$245.96 |
$409.93 |
2.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$261.89 |
$436.49 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$199.11 |
$331.85 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$161.82 |
$269.70 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$180.38 |
$300.64 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$121.82 |
$203.03 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$322.79 |
$537.99 |
3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$243.24 |
$405.40 |
2.9× |
| Radex Toe Minimum 2 Views (73660) |
$121.82 |
$203.03 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$125.09 |
$208.49 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$210.83 |
$351.38 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$353.72 |
$589.53 |
3.5× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$46,846.70 |
$78,077.84 |
6.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$15,129.37 |
$25,215.62 |
2.1× |
| Radiation treatment delivery level 1 (77402) |
$685.81 |
$1,143.02 |
6.9× |
| Radiation treatment delivery level 2 (77407) |
$741 |
$1,235 |
2.0× |
| Radiation treatment delivery level 3 (77412) |
$926.59 |
$1,544.32 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$248.96 |
$414.93 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$285.87 |
$476.45 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$196.93 |
$328.21 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$481.75 |
$802.91 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$424.31 |
$707.19 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$542.27 |
$903.79 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$237.17 |
$395.28 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$386.12 |
$643.54 |
4.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$232.37 |
$387.29 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$169.13 |
$281.89 |
1.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$106.36 |
$177.26 |
1.0× |
| Radiological examination surgical specimen (76098) |
$473.36 |
$788.93 |
0.9× |
| Renal Cyst Study (74470) |
$964.11 |
$1,606.85 |
1.8× |
| Ribs bilateral 3 views (71110) |
$248.30 |
$413.84 |
2.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$574.36 |
$957.27 |
1.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,391.33 |
$2,318.88 |
2.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,082.14 |
$1,803.57 |
2.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,236.73 |
$2,061.22 |
2.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,328.53 |
$2,214.21 |
1.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,600.01 |
$2,666.69 |
1.3× |
| Rp Therapy Intravenous Administration (79101) |
$189.59 |
$315.99 |
0.8× |
| Sacroiliac Joints < 3 Views (72200) |
$107.75 |
$179.59 |
1.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$463.68 |
$772.80 |
1.2× |
| Scapula (73010) |
$99.32 |
$165.54 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$56.19 |
$93.65 |
2.4× |
| Sella turcica (70240) |
$69.25 |
$115.42 |
0.8× |
| Shoulder 1 view (73020) |
$93.70 |
$156.16 |
1.1× |
| Sialogram (70390) |
$413.81 |
$689.69 |
1.8× |
| Simulation intermediate (77285) |
$1,442.56 |
$2,404.26 |
3.9× |
| Small bowel series (74250) |
$510.16 |
$850.27 |
3.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$995.38 |
$1,658.97 |
2.7× |
| Special dosimetry (77331) |
$552.52 |
$920.86 |
4.2× |
| Special Physics Consult (77370) |
$606.26 |
$1,010.44 |
4.6× |
| Special treatment procedure (77470) |
$2,044.51 |
$3,407.52 |
3.8× |
| Spine thoracic 3 views (72072) |
$263.75 |
$439.59 |
2.6× |
| Stereotactic Body Radiation Delivery (77373) |
$14,020.78 |
$23,367.96 |
8.0× |
| Superior sagittal sinus venogram (75870) |
$3,654.41 |
$6,090.69 |
1.2× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$235.42 |
$392.36 |
2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,714.49 |
$2,857.48 |
4.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$567.56 |
$945.94 |
1.6× |
| Testicular Imaging With Vascular Flow (78761) |
$314.32 |
$523.87 |
0.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,954.22 |
$3,257.04 |
5.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,045.93 |
$1,743.21 |
8.0× |
| Thoracolumbar 2 views (72080) |
$314.83 |
$524.71 |
3.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$845.33 |
$1,408.89 |
1.6× |
| Thyroid uptake measurement (78012) |
$314.32 |
$523.87 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$470.86 |
$784.77 |
1.2× |
| Tmj unilateral (70328) |
$221.13 |
$368.55 |
2.6× |
| Tomogram (76100) |
$246.43 |
$410.72 |
2.4× |
| Treatment device complex (77334) |
$757.82 |
$1,263.04 |
2.1× |
| Treatment device intermediate (77333) |
$698.71 |
$1,164.51 |
5.3× |
| Treatment devices simple (77332) |
$583.69 |
$972.81 |
4.5× |
| Ultrasound breast complete (76641) |
$442.90 |
$738.17 |
4.3× |
| Ultrasound Exam Aaa Screen (76706) |
$251.54 |
$419.23 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$335.79 |
$559.65 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$218.87 |
$364.79 |
2.1× |
| Unlisted fluoroscopic procedure (76496) |
$224.68 |
$374.47 |
2.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,953.13 |
$3,255.22 |
19.6× |
| Urethrocystogram voiding (74455) |
$854.80 |
$1,424.66 |
3.7× |
| Urethrocystography retrograde rs&i (74450) |
$281.63 |
$469.39 |
1.2× |
| Us breast unilateral limited (76642) |
$415.82 |
$693.04 |
4.9× |
| Us chest (76604) |
$276.53 |
$460.88 |
2.7× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$764.12 |
$1,273.54 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$302.60 |
$504.33 |
3.0× |
| Us elastography parenchyma (76981) |
$178.83 |
$298.05 |
1.8× |
| Us encephalogram (76506) |
$218.20 |
$363.67 |
2.1× |
| Us hips infant static (76886) |
$117.66 |
$196.10 |
1.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$233.99 |
$389.99 |
2.3× |
| Us ob detailed single fetus (76811) |
$468.96 |
$781.60 |
2.0× |
| Us ob limited (76815) |
$430.93 |
$718.21 |
4.2× |
| Us ob transvaginal (76817) |
$508.46 |
$847.44 |
5.0× |
| Us pelvic non ob complete (76856) |
$519.43 |
$865.71 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$350.63 |
$584.39 |
3.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$598.34 |
$997.24 |
5.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$304.84 |
$508.06 |
3.0× |
| Us retroperitoneal complete (76770) |
$408.97 |
$681.61 |
4.0× |
| Us retroperitoneal limited (76775) |
$243.59 |
$405.98 |
2.4× |
| Us scrotum and contents (76870) |
$539.33 |
$898.89 |
5.3× |
| Us soft tissue head/neck (76536) |
$539.33 |
$898.89 |
5.3× |
| Us spinal canal and contents (76800) |
$393.86 |
$656.44 |
3.9× |
| Us transrectal (76872) |
$274.70 |
$457.83 |
2.7× |
| Us, eye b-scan (76512) |
$144.74 |
$241.24 |
1.4× |
| Venogram extremity bilateral (75822) |
$3,672.29 |
$6,120.48 |
2.4× |
| Venogram Extremity Unilateral (75820) |
$1,836.14 |
$3,060.24 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$3,654.41 |
$6,090.69 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$1,836.14 |
$3,060.24 |
1.2× |
| Venography Orbital Rs&I (75880) |
$1,022.45 |
$1,704.08 |
1.7× |
| Venography Renal Bilateral (75833) |
$7,308.83 |
$12,181.38 |
2.4× |
| Venography renal unilateral selective rs&i (75831) |
$3,654.41 |
$6,090.69 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,654.41 |
$6,090.69 |
1.2× |
| Venous sampling by catheter (75893) |
$6,300.35 |
$10,500.58 |
1.2× |
| Wrist 2 views (73100) |
$173.82 |
$289.70 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$300.17 |
$500.28 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$134.93 |
$224.88 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$554.01 |
$923.35 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$169.13 |
$281.89 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$128.84 |
$214.73 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$275.94 |
$459.90 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$163.49 |
$272.49 |
1.9× |
| X-ray eye for foreign body (70030) |
$165.57 |
$275.95 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$227.69 |
$379.48 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$336.61 |
$561.02 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$126.50 |
$210.83 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$146.18 |
$243.63 |
1.7× |
| X-ray leg, infant (73592) |
$189.74 |
$316.24 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$276.41 |
$460.69 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$345.74 |
$576.24 |
3.4× |
| X-ray nose-rectum child f.b. (76010) |
$116.73 |
$194.55 |
1.4× |
| X-ray optic foramen (70190) |
$94.64 |
$157.73 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$238.93 |
$398.22 |
2.3× |
| X-ray retrograde pyelogram (74420) |
$526.84 |
$878.06 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$229.67 |
$382.78 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$275 |
$458.34 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$276.41 |
$460.69 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$145.70 |
$242.83 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$208.01 |
$346.68 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$200.98 |
$334.97 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$312.02 |
$520.04 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$260.96 |
$434.93 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$185.99 |
$309.99 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$107.75 |
$179.59 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$189.74 |
$316.24 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$245.02 |
$408.36 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$277.81 |
$463.02 |
2.7× |
| Xr bone length studies (77073) |
$134.93 |
$224.88 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$309.67 |
$516.12 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$309.67 |
$516.12 |
3.0× |
| Xr chest 4+ views (71048) |
$238.28 |
$397.13 |
2.3× |
| Xr urogram antegrade (74425) |
$455.09 |
$758.49 |
1.3× |