| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,723.36 |
$5,319.08 |
2.8× |
| Abdomen 2 views (74019) |
$421.66 |
$602.37 |
4.2× |
| Acute gi blood loss imaging (78278) |
$1,581.84 |
$2,259.77 |
4.1× |
| Ankle 2 views (73600) |
$348.52 |
$497.88 |
4.2× |
| Arthrogram ankle (73615) |
$927.48 |
$1,324.96 |
2.8× |
| Arthrogram elbow (73085) |
$927.48 |
$1,324.96 |
2.8× |
| Arthrogram hip (73525) |
$927.48 |
$1,324.96 |
2.8× |
| Arthrogram knee (73580) |
$927.48 |
$1,324.96 |
2.8× |
| Arthrogram shoulder (73040) |
$927.48 |
$1,324.96 |
2.8× |
| Arthrogram wrist (73115) |
$927.48 |
$1,324.96 |
2.8× |
| Basic dosimetry (77300) |
$344.81 |
$492.58 |
2.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,581.84 |
$2,259.77 |
4.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,581.84 |
$2,259.77 |
4.1× |
| Bone &/joint imaging whole body (78306) |
$1,581.84 |
$2,259.77 |
4.1× |
| Bone age studies (77072) |
$421.66 |
$602.37 |
4.2× |
| Bone Imaging 3 Phase (78315) |
$1,581.84 |
$2,259.77 |
4.1× |
| Bone survey complete (77075) |
$546.86 |
$781.22 |
5.5× |
| Bone survey infant (77076) |
$281.96 |
$402.80 |
2.8× |
| Bowel imaging (78290) |
$1,581.84 |
$2,259.77 |
4.1× |
| Brachytx isodose complex (77318) |
$950.70 |
$1,358.13 |
2.6× |
| Brachytx isodose intermed (77317) |
$950.70 |
$1,358.13 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$950.70 |
$1,358.13 |
2.6× |
| Brain imaging < 4 static views (78600) |
$1,581.84 |
$2,259.77 |
4.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,581.84 |
$2,259.77 |
3.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,662.30 |
$3,803.28 |
6.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$3,245.11 |
$4,635.86 |
4.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,245.11 |
$4,635.86 |
9.7× |
| Cervical spine 2 or 3 views (72040) |
$348.52 |
$497.88 |
4.2× |
| Chest 1 view (71045) |
$348.52 |
$497.88 |
4.2× |
| Chest xray 3 views (71047) |
$354.78 |
$506.82 |
4.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$462.32 |
$660.45 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$704.68 |
$1,006.68 |
4.2× |
| Clavicle complete (73000) |
$348.52 |
$497.88 |
4.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$359.94 |
$514.20 |
3.6× |
| Continuing medical physics consltj pr wk (77336) |
$671.51 |
$959.30 |
5.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$462.32 |
$660.45 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,830.30 |
$4,043.28 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,979.66 |
$2,828.08 |
8.6× |
| CT abdomen w contrast (74160) |
$1,877.64 |
$2,682.33 |
11.2× |
| CT abdomen w wo contrast (74170) |
$2,080.20 |
$2,971.71 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,884.68 |
$2,692.40 |
18.8× |
| CT angio hrt w/3d image (75574) |
$2,090.22 |
$2,986.02 |
6.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,558.86 |
$3,655.51 |
15.2× |
| CT angiography upper extremity lt (73206) |
$2,838.20 |
$4,054.56 |
16.9× |
| CT c-spine w/contrast (72126) |
$2,151.80 |
$3,074 |
6.4× |
| CT c-spine w/o contrast (72125) |
$1,966.30 |
$2,809 |
19.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,399.63 |
$3,428.04 |
14.3× |
| CT chest w contrast (71260) |
$1,817.90 |
$2,597 |
10.8× |
| CT chest w/wo contrast (71270) |
$2,522.06 |
$3,602.94 |
15.0× |
| CT head/brain with contrast (70460) |
$2,139.93 |
$3,057.04 |
12.7× |
| CT head/brain without and with contrast (70470) |
$2,507.96 |
$3,582.80 |
14.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,090.22 |
$2,986.02 |
6.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,159.44 |
$1,656.34 |
13.9× |
| CT hrt w/3d image congen (75573) |
$2,090.22 |
$2,986.02 |
6.2× |
| CT iac w contrast (70481) |
$1,966.30 |
$2,809 |
11.7× |
| CT limited/localized follow up study (76380) |
$1,238.06 |
$1,768.65 |
14.8× |
| CT lower ext w/o (73700) |
$2,183.98 |
$3,119.96 |
21.8× |
| CT lower extremity w wo contrast (73702) |
$2,719.69 |
$3,885.26 |
16.2× |
| CT lower extremity w/contrast material (73701) |
$2,435.51 |
$3,479.29 |
14.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,461.22 |
$3,516.02 |
14.6× |
| CT lumbar spine w/contrast (72132) |
$2,151.80 |
$3,074 |
6.4× |
| CT lumbar spine w/o contrast (72131) |
$1,966.30 |
$2,809 |
19.6× |
| CT maxillofacial w contrast (70487) |
$1,438 |
$2,054.28 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,664.31 |
$2,377.58 |
9.9× |
| CT maxillofacial wo contrast (70486) |
$1,979.66 |
$2,828.08 |
19.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,424.86 |
$3,464.08 |
14.4× |
| CT orbits w/o contrast (70480) |
$1,899.16 |
$2,713.07 |
18.9× |
| CT pelvis w/o contrast (72192) |
$1,664.31 |
$2,377.58 |
16.6× |
| CT pelvis w/wo contrast (72194) |
$2,341.01 |
$3,344.30 |
13.9× |
| CT scan of arm combo (73202) |
$2,448.81 |
$3,498.30 |
14.6× |
| CT soft tissue neck w contrast (70491) |
$1,966.30 |
$2,809 |
11.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,664.31 |
$2,377.58 |
9.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,979.66 |
$2,828.08 |
19.7× |
| CT thoracic spine w/contrast (72129) |
$2,151.80 |
$3,074 |
12.8× |
| CT thoracic spine w/o contrast (72128) |
$1,966.30 |
$2,809 |
19.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,399.63 |
$3,428.04 |
14.3× |
| CT thorax w/o contrast (71250) |
$443.72 |
$633.88 |
4.4× |
| CT upper ext wo (73200) |
$1,966.30 |
$2,809 |
19.6× |
| CT upper extremity with contrast (73201) |
$2,183.98 |
$3,119.96 |
6.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,665.05 |
$2,378.64 |
9.9× |
| Cta Abdomen (74175) |
$2,399.63 |
$3,428.04 |
14.3× |
| CTA abdomen pelvis (74174) |
$2,558.10 |
$3,654.42 |
7.6× |
| CTA chest (71275) |
$2,399.63 |
$3,428.04 |
14.3× |
| Cta Head (70496) |
$1,602.72 |
$2,289.60 |
9.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,040.72 |
$4,343.88 |
9.1× |
| Cta Neck (70498) |
$1,438 |
$2,054.28 |
8.5× |
| Cta Pelvis (72191) |
$2,430.42 |
$3,472.03 |
14.4× |
| Cystography minimum 3 views rs&i (74430) |
$927.48 |
$1,324.96 |
2.8× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$627.75 |
$896.78 |
2.7× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,319.99 |
$7,599.98 |
2.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$484.53 |
$692.18 |
4.8× |
| Esophageal motility (78258) |
$1,581.84 |
$2,259.77 |
4.1× |
| Esophagus (74220) |
$704.68 |
$1,006.68 |
4.2× |
| Facial bones min 3 views (70150) |
$421.66 |
$602.37 |
4.2× |
| Fetal biophysical profile non-stress testing (76818) |
$543.89 |
$776.98 |
5.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$321.29 |
$458.98 |
3.2× |
| Fluoroscopy up to 1 hr (76000) |
$783.78 |
$1,119.67 |
3.4× |
| Foot 2 views (73620) |
$348.52 |
$497.88 |
4.2× |
| Forearm 2 views (73090) |
$348.52 |
$497.88 |
4.2× |
| Hand 2 views (73120) |
$421.66 |
$602.37 |
4.2× |
| Heart Infarct Image (78466) |
$1,581.84 |
$2,259.77 |
4.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,073.02 |
$2,961.45 |
4.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,581.84 |
$2,259.77 |
4.1× |
| Hysterosalpingogram (74740) |
$939.80 |
$1,342.56 |
4.1× |
| Image fusion (77399) |
$496.40 |
$709.14 |
3.9× |
| Interstitial radiation source applic complex (77778) |
$1,801.83 |
$2,574.04 |
2.7× |
| Kidney imaging morphology (78700) |
$2,073.02 |
$2,961.45 |
5.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,073.02 |
$2,961.45 |
4.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,073.02 |
$2,961.45 |
4.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,073.02 |
$2,961.45 |
4.0× |
| Knee 3 views (73562) |
$348.52 |
$497.88 |
4.2× |
| Liver & spleen imaging static only (78215) |
$1,581.84 |
$2,259.77 |
4.1× |
| Lung perf&ventilat diferentl (78598) |
$2,073.02 |
$2,961.45 |
4.0× |
| Lung perfusion differential (78597) |
$1,581.84 |
$2,259.77 |
4.1× |
| Lung ventilation imaging (78579) |
$1,581.84 |
$2,259.77 |
4.1× |
| Lymphoscintigraphy (78195) |
$2,073.02 |
$2,961.45 |
4.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,070.86 |
$4,386.94 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,406.70 |
$3,438.13 |
7.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,245.11 |
$4,635.86 |
9.7× |
| Mammary ductogram or galactogram multiple (77054) |
$646.29 |
$923.26 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$661.87 |
$945.52 |
2.9× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$288.60 |
$412.28 |
3.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$950.70 |
$1,358.13 |
2.6× |
| MRA head w & w/o contrast (70546) |
$3,373.88 |
$4,819.82 |
10.1× |
| MRA head w/o contrast (70544) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRA head with contrast (70545) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRA neck w contrast (70548) |
$3,478.66 |
$4,969.51 |
10.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,373.88 |
$4,819.82 |
10.1× |
| MRA neck w/o contrast (70547) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI abdomen w contrast (74182) |
$3,070.86 |
$4,386.94 |
9.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI abdomen w/o contrast (74181) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,070.86 |
$4,386.94 |
4.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI breast wo contrast unilateral (77046) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI c-spine with contrast (72142) |
$3,245.11 |
$4,635.86 |
9.7× |
| MRI cardiac w/o cont stress (75559) |
$3,245.11 |
$4,635.86 |
6.2× |
| MRI cardiac w/o contrast (75557) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI cervical spine w/o contrast (72141) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI chest w/o & w/contrast material (71552) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI chest w/o contrast (71550) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI chest with contrast (71551) |
$3,070.86 |
$4,386.94 |
4.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,070.86 |
$4,386.94 |
9.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,070.86 |
$4,386.94 |
9.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI orbit face neck w contrast (70542) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,070.86 |
$4,386.94 |
9.2× |
| MRI pelvis w/contrast (72196) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,478.66 |
$4,969.51 |
10.4× |
| MRI pelvis w/o contrast (72195) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,058.84 |
$7,226.91 |
15.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,497.58 |
$3,567.96 |
7.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,058.84 |
$7,226.91 |
15.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,245.11 |
$4,635.86 |
9.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,058.84 |
$7,226.91 |
15.1× |
| MRI temporomandibular joint (70336) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI up ext w/o contrast (73218) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI upper ext joint w/o contrast (73221) |
$3,245.11 |
$4,635.86 |
14.2× |
| MRI, joint upper extrem combo (73223) |
$3,274.76 |
$4,678.22 |
9.8× |
| Myelogram Cervical (72240) |
$2,051.79 |
$2,931.12 |
2.7× |
| Myelogram Lumbar (72265) |
$2,051.79 |
$2,931.12 |
2.7× |
| Myelogram thoracic (72255) |
$2,051.79 |
$2,931.12 |
2.7× |
| Myelography 2 or more regions (72270) |
$2,051.79 |
$2,931.12 |
2.7× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,808.10 |
$4,011.57 |
2.3× |
| Myocardial Spect Multiple Studies (78452) |
$5,446.03 |
$7,780.03 |
4.4× |
| Myocardial spect single study at rest or stress (78451) |
$2,808.10 |
$4,011.57 |
2.3× |
| N-invas est c ffr sw aly CTA (75580) |
$2,642.17 |
$3,774.52 |
3.2× |
| Neck soft tissue (70360) |
$241.90 |
$345.56 |
2.9× |
| Nm cisternogram (78630) |
$2,073.02 |
$2,961.45 |
4.0× |
| Nm gastric emptying study (78264) |
$1,581.84 |
$2,259.77 |
4.1× |
| Nm gastroesophageal reflux study (78262) |
$1,581.84 |
$2,259.77 |
4.1× |
| Nm peritoneal-venous shunt patency (78291) |
$3,455.50 |
$4,936.42 |
9.0× |
| Nonvascular shunt X-ray (75809) |
$276.17 |
$394.52 |
2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,613.54 |
$5,162.20 |
2.7× |
| Nuclear Rx Oral Admin (79005) |
$1,451.90 |
$2,074.14 |
6.5× |
| Ob us nuchal meas 1 gest (76813) |
$457.82 |
$654.02 |
4.6× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$352.45 |
$503.50 |
3.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$325.56 |
$465.08 |
3.2× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$76.06 |
$108.65 |
2.7× |
| Orthopantogram (70355) |
$636.64 |
$909.48 |
7.6× |
| Osseous survey limited (77074) |
$316.10 |
$451.56 |
3.2× |
| Parathyroid Planar Imaging (78070) |
$3,455.50 |
$4,936.42 |
9.0× |
| Pelvis 1 or 2 views (72170) |
$421.66 |
$602.37 |
4.2× |
| PET image w/CT, skull-thigh (78815) |
$5,007.02 |
$7,152.88 |
3.7× |
| PET imaging for CT attenuation whole body (78816) |
$5,007.02 |
$7,152.88 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,581.84 |
$2,259.77 |
4.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,073.02 |
$2,961.45 |
4.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$2,040.50 |
$2,915 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,115.85 |
$3,022.63 |
4.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$348.52 |
$497.88 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$348.52 |
$497.88 |
4.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$348.52 |
$497.88 |
4.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$348.52 |
$497.88 |
4.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$392.09 |
$560.12 |
3.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$446.54 |
$637.91 |
4.5× |
| Radex fingr minimum 2 views (73140) |
$348.52 |
$497.88 |
4.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$348.52 |
$497.88 |
4.2× |
| Radex Hand Minimum 3 Views (73130) |
$348.52 |
$497.88 |
4.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$348.52 |
$497.88 |
4.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$383.59 |
$547.98 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$350.58 |
$500.82 |
3.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$421.88 |
$602.68 |
4.2× |
| Radex Humerus Minimum 2 Views (73060) |
$348.52 |
$497.88 |
4.2× |
| Radex Kne 1/2 Views (73560) |
$348.52 |
$497.88 |
4.2× |
| Radex Kne Compl 4/More Views (73564) |
$421.66 |
$602.37 |
4.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$421.66 |
$602.37 |
4.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$421.66 |
$602.37 |
5.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$469.36 |
$670.50 |
4.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$348.52 |
$497.88 |
4.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$348.52 |
$497.88 |
4.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$348.52 |
$497.88 |
3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$421.66 |
$602.37 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$348.52 |
$497.88 |
4.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$421.66 |
$602.37 |
4.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$348.52 |
$497.88 |
4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$514.61 |
$735.15 |
5.1× |
| Radiation treatment delivery level 1 (77402) |
$284.38 |
$406.25 |
2.9× |
| Radiation treatment delivery level 2 (77407) |
$682.97 |
$975.66 |
1.8× |
| Radiation treatment delivery level 3 (77412) |
$682.97 |
$975.66 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$288.60 |
$412.28 |
3.5× |
| Radiologic exam chest 2 views (71046) |
$379.71 |
$542.44 |
4.5× |
| Radiologic exam colon single contrast study (74270) |
$704.68 |
$1,006.68 |
4.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$704.68 |
$1,006.68 |
4.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$918.40 |
$1,311.99 |
5.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$784.93 |
$1,121.32 |
4.7× |
| Radiologic examination femur 1 view (73551) |
$324.13 |
$463.03 |
3.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$261.19 |
$373.12 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$348.52 |
$497.88 |
4.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,423.94 |
$2,034.19 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$577.83 |
$825.46 |
5.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$421.66 |
$602.37 |
4.2× |
| Radiological examination surgical specimen (76098) |
$2,115.85 |
$3,022.63 |
4.0× |
| Renal Cyst Study (74470) |
$1,423.94 |
$2,034.19 |
2.7× |
| Ribs bilateral 3 views (71110) |
$421.66 |
$602.37 |
4.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$3,455.50 |
$4,936.42 |
9.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,764.26 |
$3,948.94 |
7.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$5,446.03 |
$7,780.03 |
10.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,764.26 |
$3,948.94 |
5.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,581.84 |
$2,259.77 |
3.0× |
| Rp Therapy Intravenous Administration (79101) |
$1,740.93 |
$2,487.04 |
7.8× |
| Sacroiliac Joints < 3 Views (72200) |
$386.40 |
$552 |
3.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$627.75 |
$896.78 |
2.7× |
| Scapula (73010) |
$421.66 |
$602.37 |
4.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$106.85 |
$152.64 |
4.6× |
| Sella turcica (70240) |
$261.19 |
$373.12 |
3.1× |
| Shoulder 1 view (73020) |
$348.52 |
$497.88 |
4.2× |
| Sialogram (70390) |
$627.75 |
$896.78 |
2.7× |
| Simulation intermediate (77285) |
$950.70 |
$1,358.13 |
2.6× |
| Small bowel series (74250) |
$704.68 |
$1,006.68 |
4.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$950.70 |
$1,358.13 |
2.6× |
| Special dosimetry (77331) |
$461.53 |
$659.32 |
3.6× |
| Special Physics Consult (77370) |
$481.56 |
$687.94 |
3.7× |
| Special treatment procedure (77470) |
$2,419.67 |
$3,456.66 |
4.6× |
| Spine thoracic 3 views (72072) |
$348.52 |
$497.88 |
3.5× |
| Stereotactic Body Radiation Delivery (77373) |
$4,560.11 |
$6,514.43 |
2.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$255.39 |
$364.84 |
2.6× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$93.50 |
$133.56 |
2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$950.70 |
$1,358.13 |
2.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$950.70 |
$1,358.13 |
2.6× |
| Testicular Imaging With Vascular Flow (78761) |
$2,073.02 |
$2,961.45 |
5.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,073.68 |
$1,533.82 |
3.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$517.18 |
$738.82 |
4.0× |
| Thoracolumbar 2 views (72080) |
$266.38 |
$380.54 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,581.84 |
$2,259.77 |
3.0× |
| Thyroid imaging w/blood flow (78013) |
$1,581.84 |
$2,259.77 |
4.1× |
| Thyroid uptake measurement (78012) |
$1,581.84 |
$2,259.77 |
4.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,581.84 |
$2,259.77 |
4.1× |
| Tmj unilateral (70328) |
$348.52 |
$497.88 |
4.2× |
| Tomogram (76100) |
$537.21 |
$767.44 |
5.4× |
| Treatment device complex (77334) |
$950.70 |
$1,358.13 |
2.6× |
| Treatment device intermediate (77333) |
$344.81 |
$492.58 |
2.7× |
| Treatment devices simple (77332) |
$344.81 |
$492.58 |
2.7× |
| Ultrasound breast complete (76641) |
$348 |
$497.14 |
3.5× |
| Ultrasound Exam Aaa Screen (76706) |
$652.22 |
$931.74 |
6.5× |
| Ultrasound, abdomen limited (76705) |
$493.43 |
$704.90 |
4.9× |
| Unlisted ultrasound procedure (76999) |
$279.74 |
$399.62 |
3.4× |
| Urethrocystogram voiding (74455) |
$627.75 |
$896.78 |
2.7× |
| Urethrocystography retrograde rs&i (74450) |
$1,474.97 |
$2,107.10 |
6.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$728.65 |
$1,040.92 |
4.3× |
| Us breast unilateral limited (76642) |
$348 |
$497.14 |
4.2× |
| Us chest (76604) |
$299.03 |
$427.18 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$471.17 |
$673.10 |
4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$442.82 |
$632.59 |
4.4× |
| Us ob detailed single fetus (76811) |
$819.91 |
$1,171.30 |
3.6× |
| Us ob limited (76815) |
$408.10 |
$583 |
4.1× |
| Us ob transvaginal (76817) |
$364.96 |
$521.36 |
3.6× |
| Us pelvic non ob complete (76856) |
$546.86 |
$781.22 |
5.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$316.84 |
$452.62 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$315.35 |
$450.50 |
3.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$359.13 |
$513.04 |
3.6× |
| Us retroperitoneal complete (76770) |
$652.22 |
$931.74 |
6.5× |
| Us retroperitoneal limited (76775) |
$436.37 |
$623.38 |
4.4× |
| Us scrotum and contents (76870) |
$510.50 |
$729.28 |
5.1× |
| Us soft tissue head/neck (76536) |
$483.05 |
$690.06 |
4.8× |
| Us transrectal (76872) |
$276.17 |
$394.52 |
2.8× |
| Us transrectal prostate volume (76873) |
$401.43 |
$573.46 |
4.0× |
| Us, eye b-scan (76512) |
$325.56 |
$465.08 |
3.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$621.80 |
$888.28 |
6.2× |
| Venogram extremity bilateral (75822) |
$12,284.81 |
$17,549.72 |
8.1× |
| Venogram Extremity Unilateral (75820) |
$6,142.41 |
$8,774.86 |
4.1× |
| Venography caval inferior serialography rs&i (75825) |
$10,442.09 |
$14,917.26 |
3.4× |
| Venography caval superior serialography rs&i (75827) |
$9,887.13 |
$14,124.46 |
6.5× |
| Wrist 2 views (73100) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$434.82 |
$621.16 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$312.64 |
$446.63 |
3.7× |
| X-ray b.e. reductn intuss (74283) |
$462.32 |
$660.45 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,261.06 |
$1,801.51 |
7.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$384.14 |
$548.76 |
3.8× |
| X-ray exam of femur 2/> (73552) |
$348.52 |
$497.88 |
4.2× |
| X-ray eye for foreign body (70030) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$421.66 |
$602.37 |
5.1× |
| X-ray IV pyelogram (ivp) (74400) |
$661.02 |
$944.30 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$421.66 |
$602.37 |
5.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$348.52 |
$497.88 |
4.2× |
| X-ray leg, infant (73592) |
$232.25 |
$331.78 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$421.66 |
$602.37 |
4.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$611.78 |
$873.97 |
6.1× |
| X-ray nose-rectum child f.b. (76010) |
$228.67 |
$326.67 |
2.7× |
| X-ray optic foramen (70190) |
$261.19 |
$373.12 |
3.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$421.66 |
$602.37 |
4.2× |
| X-ray retrograde pyelogram (74420) |
$927.48 |
$1,324.96 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$421.66 |
$602.37 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$690.19 |
$985.98 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$522.49 |
$746.41 |
5.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$374.62 |
$535.16 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$593.45 |
$847.78 |
5.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$421.66 |
$602.37 |
4.2× |
| X-Ray Small Bowel Enteroclysis (74251) |
$816.20 |
$1,166 |
4.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$348.52 |
$497.88 |
4.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$421.66 |
$602.37 |
4.2× |
| Xr bone length studies (77073) |
$421.66 |
$602.37 |
4.2× |
| Xr c-spine 4 or 5 views (72050) |
$421.66 |
$602.37 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$412.66 |
$589.50 |
4.1× |
| Xr chest 4+ views (71048) |
$421.66 |
$602.37 |
4.2× |
| Xr urogram antegrade (74425) |
$927.48 |
$1,324.96 |
2.8× |