| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,354 |
$5,885 |
1.4× |
| Abdomen 2 views (74019) |
$367.60 |
$919 |
3.0× |
| Acute gi blood loss imaging (78278) |
$1,575.40 |
$3,938.50 |
3.3× |
| Angio Adrenal Bilat Select (75733) |
$1,742.80 |
$4,357 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$3,034.60 |
$7,586.50 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$3,101.60 |
$7,754 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,496.60 |
$6,241.50 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,873.80 |
$12,184.50 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,639.60 |
$11,599 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,385.80 |
$8,464.50 |
0.9× |
| Angiography Spinal Selective Rs&I (75705) |
$4,127.80 |
$10,319.50 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,297.20 |
$8,243 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,680.40 |
$4,201 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,171.60 |
$5,429 |
0.6× |
| Ankle 2 views (73600) |
$318.40 |
$796 |
3.1× |
| Aortogram thoracic (75605) |
$4,873.80 |
$12,184.50 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,128 |
$7,820 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$3,070.40 |
$7,676 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,057.40 |
$5,143.50 |
0.6× |
| Arthrogram ankle (73615) |
$466 |
$1,165 |
1.1× |
| Arthrogram elbow (73085) |
$466 |
$1,165 |
1.1× |
| Arthrogram hip (73525) |
$603.20 |
$1,508 |
1.5× |
| Arthrogram knee (73580) |
$895.20 |
$2,238 |
2.2× |
| Arthrogram shoulder (73040) |
$846.80 |
$2,117 |
2.1× |
| Arthrogram wrist (73115) |
$466 |
$1,165 |
1.1× |
| Basic dosimetry (77300) |
$422.80 |
$1,057 |
2.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,045.60 |
$2,614 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$2,317.20 |
$5,793 |
4.9× |
| Bone age studies (77072) |
$214.80 |
$537 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$2,816.80 |
$7,042 |
6.0× |
| Bone Marrow Imaging Limited Area (78102) |
$512.80 |
$1,282 |
1.1× |
| Bone survey complete (77075) |
$1,903.20 |
$4,758 |
15.4× |
| Bone survey infant (77076) |
$230.20 |
$575.50 |
1.9× |
| Bowel imaging (78290) |
$2,134.40 |
$5,336 |
4.5× |
| Brachytx isodose complex (77318) |
$1,134 |
$2,835 |
2.6× |
| Brachytx isodose intermed (77317) |
$832 |
$2,080 |
1.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$700.40 |
$1,751 |
1.6× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$367.60 |
$919 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,106.80 |
$2,767 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,892.40 |
$12,231 |
2.9× |
| Brain Imaging Vascular Flow Only (78610) |
$924 |
$2,310 |
1.4× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$811.20 |
$2,028 |
1.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,916.80 |
$4,792 |
4.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$4,440 |
$11,100 |
10.8× |
| Cardiac shunt detection (78428) |
$694 |
$1,735 |
1.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,084 |
$2,710 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$435.60 |
$1,089 |
4.2× |
| Chest 1 view (71045) |
$240.80 |
$602 |
2.3× |
| Chest xray 3 views (71047) |
$207.60 |
$519 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$546 |
$1,365 |
2.6× |
| Cineradiography/videoradiography (76120) |
$493.20 |
$1,233 |
4.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,066.80 |
$2,667 |
1.2× |
| Clavicle complete (73000) |
$301.60 |
$754 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$384.40 |
$961 |
3.1× |
| Continuing medical physics consltj pr wk (77336) |
$593.60 |
$1,484 |
3.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$330.80 |
$827 |
1.6× |
| Corpora cavernosography (74445) |
$579.20 |
$1,448 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,702.40 |
$14,256 |
13.8× |
| CT abdomen and pelvis without contrast (74176) |
$4,624.60 |
$11,561.50 |
16.4× |
| CT abdomen w contrast (74160) |
$2,868.60 |
$7,171.50 |
13.8× |
| CT abdomen w wo contrast (74170) |
$3,121.80 |
$7,804.50 |
15.1× |
| CT abdomen w/o contrast (74150) |
$2,618.40 |
$6,546 |
21.2× |
| CT angio hrt w/3d image (75574) |
$2,091.80 |
$5,229.50 |
5.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,424.80 |
$3,562 |
6.9× |
| CT angiography upper extremity lt (73206) |
$1,424.80 |
$3,562 |
6.9× |
| CT c-spine w/contrast (72126) |
$2,494 |
$6,235 |
6.1× |
| CT c-spine w/o contrast (72125) |
$1,985.20 |
$4,963 |
16.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,348 |
$5,870 |
11.3× |
| CT chest w contrast (71260) |
$2,603.80 |
$6,509.50 |
12.6× |
| CT chest w/wo contrast (71270) |
$3,230.80 |
$8,077 |
15.6× |
| CT head/brain with contrast (70460) |
$2,094 |
$5,235 |
10.1× |
| CT head/brain without and with contrast (70470) |
$2,432.60 |
$6,081.50 |
11.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,656 |
$6,640 |
6.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$501 |
$1,252.50 |
4.9× |
| CT hrt w/3d image congen (75573) |
$3,883.20 |
$9,708 |
9.4× |
| CT iac w contrast (70481) |
$2,148.20 |
$5,370.50 |
10.4× |
| CT limited/localized follow up study (76380) |
$880.40 |
$2,201 |
8.6× |
| CT lower ext w/o (73700) |
$1,499.80 |
$3,749.50 |
12.1× |
| CT lower extremity w wo contrast (73702) |
$1,402.40 |
$3,506 |
6.8× |
| CT lower extremity w/contrast material (73701) |
$1,682.40 |
$4,206 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$3,088 |
$7,720 |
14.9× |
| CT lumbar spine w/contrast (72132) |
$2,478 |
$6,195 |
6.0× |
| CT lumbar spine w/o contrast (72131) |
$2,084.40 |
$5,211 |
16.9× |
| CT maxillofacial w contrast (70487) |
$1,734.60 |
$4,336.50 |
8.4× |
| CT maxillofacial w/wo contrast (70488) |
$2,539.20 |
$6,348 |
12.3× |
| CT maxillofacial wo contrast (70486) |
$1,605 |
$4,012.50 |
13.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,004.40 |
$7,511 |
14.5× |
| CT orbits w/o contrast (70480) |
$1,785.20 |
$4,463 |
14.5× |
| CT pelvis w/o contrast (72192) |
$1,970.80 |
$4,927 |
16.0× |
| CT pelvis w/wo contrast (72194) |
$2,709.60 |
$6,774 |
13.1× |
| CT scan of arm combo (73202) |
$1,460.40 |
$3,651 |
7.0× |
| CT soft tissue neck w contrast (70491) |
$1,720 |
$4,300 |
8.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,114.80 |
$5,287 |
10.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,540.80 |
$3,852 |
12.5× |
| CT thoracic spine w/contrast (72129) |
$2,344 |
$5,860 |
11.3× |
| CT thoracic spine w/o contrast (72128) |
$2,005.20 |
$5,013 |
16.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,842 |
$7,105 |
13.7× |
| CT thorax w/o contrast (71250) |
$2,202.80 |
$5,507 |
17.8× |
| CT unlisted procedure (76497) |
$1,141.20 |
$2,853 |
11.1× |
| CT upper ext wo (73200) |
$1,416.40 |
$3,541 |
11.5× |
| CT upper extremity with contrast (73201) |
$1,587.20 |
$3,968 |
3.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,025.20 |
$7,563 |
14.6× |
| Cta Abdomen (74175) |
$3,121.80 |
$7,804.50 |
15.1× |
| CTA abdomen pelvis (74174) |
$612.80 |
$1,532 |
1.5× |
| CTA chest (71275) |
$2,496.40 |
$6,241 |
12.0× |
| Cta Head (70496) |
$3,466 |
$8,665 |
16.7× |
| Cta Neck (70498) |
$3,047.60 |
$7,619 |
14.7× |
| Cta Pelvis (72191) |
$2,709.60 |
$6,774 |
13.1× |
| Cystography minimum 3 views rs&i (74430) |
$1,073.20 |
$2,683 |
2.6× |
| Diskogram cervical (72285) |
$1,699.60 |
$4,249 |
0.7× |
| Diskography lumbar (72295) |
$1,426.40 |
$3,566 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$199.20 |
$498 |
1.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$456.40 |
$1,141 |
3.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$382.60 |
$956.50 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$206 |
$515 |
2.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$955.20 |
$2,388 |
3.4× |
| Esophagus (74220) |
$422.80 |
$1,057 |
2.0× |
| Facial bones min 3 views (70150) |
$594.80 |
$1,487 |
4.8× |
| Fetal biophysical profile non-stress testing (76818) |
$548.80 |
$1,372 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$471.60 |
$1,179 |
3.8× |
| Fetal Echo (76825) |
$955.20 |
$2,388 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$602.80 |
$1,507 |
2.1× |
| Foot 2 views (73620) |
$318.40 |
$796 |
3.1× |
| Forearm 2 views (73090) |
$339.60 |
$849 |
3.3× |
| Functional MRI brain by phys/psych (70555) |
$2,978.20 |
$7,445.50 |
10.6× |
| Hand 2 views (73120) |
$361.60 |
$904 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,918.40 |
$4,796 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,302 |
$5,755 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,766 |
$4,415 |
2.1× |
| Heart first pass single,planar (78481) |
$1,013.20 |
$2,533 |
1.6× |
| Heart Infarct Image (78466) |
$624.40 |
$1,561 |
1.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,566.40 |
$6,416 |
0.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,030.80 |
$7,577 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,142.60 |
$2,856.50 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,142.60 |
$2,856.50 |
2.4× |
| Hysterosalpingogram (74740) |
$658.80 |
$1,647 |
2.3× |
| Image fusion (77399) |
$819.20 |
$2,048 |
5.2× |
| Interstitial radiation source applic complex (77778) |
$1,809.80 |
$4,524.50 |
2.2× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,778.80 |
$4,447 |
2.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,410.40 |
$3,526 |
2.2× |
| Intracavitary Radiation Source Applic Simple (77761) |
$903.60 |
$2,259 |
1.4× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$17,322.80 |
$43,307 |
2.0× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$17,322.80 |
$43,307 |
2.0× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$313.20 |
$783 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,347.20 |
$3,368 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,321.20 |
$3,303 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,646 |
$4,115 |
2.6× |
| Knee 3 views (73562) |
$522.40 |
$1,306 |
5.1× |
| Liver & spleen imaging static only (78215) |
$1,339.20 |
$3,348 |
2.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,072.40 |
$5,181 |
4.4× |
| Liver imaging static only (78201) |
$1,939.20 |
$4,848 |
3.0× |
| Liver imaging w/vascular flow (78202) |
$1,503.60 |
$3,759 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$2,728 |
$6,820 |
4.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,535.40 |
$3,838.50 |
0.4× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,139.20 |
$2,848 |
0.3× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,190.60 |
$2,976.50 |
0.6× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,029.60 |
$2,574 |
1.4× |
| Lymphoscintigraphy (78195) |
$2,431.60 |
$6,079 |
3.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,756 |
$6,890 |
3.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$928.40 |
$2,321 |
1.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$267.60 |
$669 |
1.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,929.60 |
$7,324 |
7.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,821.20 |
$7,053 |
6.8× |
| Mammary ductogram or galactogram multiple (77054) |
$928.80 |
$2,322 |
3.3× |
| Mammary ductogram or galactogram single (77053) |
$275.20 |
$688 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$6,492.40 |
$16,231 |
14.7× |
| Mr safety determination physician/other qhp (76016) |
$40 |
$100 |
0.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$40 |
$100 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$40 |
$100 |
0.4× |
| Mr safety implt pos&/immoblj (76019) |
$40 |
$100 |
0.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$40 |
$100 |
0.1× |
| MRA head w & w/o contrast (70546) |
$5,318 |
$13,295 |
12.9× |
| MRA head w/o contrast (70544) |
$2,925.20 |
$7,313 |
10.4× |
| MRA head with contrast (70545) |
$2,796.80 |
$6,992 |
6.8× |
| MRA neck w contrast (70548) |
$2,796.80 |
$6,992 |
6.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,722 |
$9,305 |
9.0× |
| MRA neck w/o contrast (70547) |
$2,925.20 |
$7,313 |
10.4× |
| MRI abdomen w contrast (74182) |
$2,796.80 |
$6,992 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,730.80 |
$11,827 |
11.5× |
| MRI abdomen w/o contrast (74181) |
$2,720.80 |
$6,802 |
9.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,775.20 |
$6,938 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,121.60 |
$12,804 |
12.4× |
| MRI bone marrow blood supply (77084) |
$2,450 |
$6,125 |
8.7× |
| MRI breast w/o contrast bilateral (77047) |
$4,746.80 |
$11,867 |
16.8× |
| MRI breast wo contrast unilateral (77046) |
$3,240 |
$8,100 |
11.5× |
| MRI c-spine with contrast (72142) |
$2,863.20 |
$7,158 |
6.9× |
| MRI cardiac w/o contrast (75557) |
$2,260.60 |
$5,651.50 |
8.0× |
| MRI cervical spine w/o contrast (72141) |
$2,899.60 |
$7,249 |
10.3× |
| MRI chest w/o & w/contrast material (71552) |
$5,444.40 |
$13,611 |
13.2× |
| MRI chest w/o contrast (71550) |
$2,597.20 |
$6,493 |
9.2× |
| MRI chest with contrast (71551) |
$2,796.80 |
$6,992 |
3.0× |
| MRI fetal sngl/1st gestation (74712) |
$628 |
$1,570 |
2.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,929.60 |
$7,324 |
7.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,122 |
$7,805 |
7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,724.60 |
$6,811.50 |
9.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,861 |
$7,152.50 |
10.2× |
| MRI orbit face neck w contrast (70542) |
$2,605.20 |
$6,513 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,923.20 |
$7,308 |
7.1× |
| MRI pelvis w/contrast (72196) |
$2,498.40 |
$6,246 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$5,570.80 |
$13,927 |
13.5× |
| MRI pelvis w/o contrast (72195) |
$2,617.60 |
$6,544 |
9.3× |
| MRI spectroscopy (76390) |
$2,683.60 |
$6,709 |
26.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,684.60 |
$14,211.50 |
13.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,929.60 |
$7,324 |
7.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,673.80 |
$14,184.50 |
13.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,965.20 |
$7,413 |
7.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,673.80 |
$14,184.50 |
13.8× |
| MRI temporomandibular joint (70336) |
$2,221.20 |
$5,553 |
7.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,653 |
$6,632.50 |
9.4× |
| MRI up ext w/o contrast (73218) |
$1,947.60 |
$4,869 |
6.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,741.20 |
$6,853 |
9.7× |
| MRI, joint upper extrem combo (73223) |
$5,073.60 |
$12,684 |
12.3× |
| Myelogram Cervical (72240) |
$949.60 |
$2,374 |
1.0× |
| Myelogram Lumbar (72265) |
$1,310 |
$3,275 |
1.4× |
| Myelogram thoracic (72255) |
$1,190.80 |
$2,977 |
1.3× |
| Myelography 2 or more regions (72270) |
$2,498.80 |
$6,247 |
2.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$8,134.40 |
$20,336 |
5.3× |
| Myocardial infarct spect (78469) |
$888.40 |
$2,221 |
1.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,321.60 |
$5,804 |
1.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,653.60 |
$6,634 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,205.20 |
$10,513 |
2.7× |
| Myocardial spect single study at rest or stress (78451) |
$1,852 |
$4,630 |
1.2× |
| N-invas est c ffr sw aly CTA (75580) |
$1,428 |
$3,570 |
1.4× |
| Neck soft tissue (70360) |
$244.80 |
$612 |
2.4× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$484.80 |
$1,212 |
1.1× |
| Nm adrenal scan (78075) |
$2,002.40 |
$5,006 |
1.3× |
| Nm bone marrow wb (78104) |
$872.40 |
$2,181 |
1.8× |
| Nm cardiac blood pool multiple (78473) |
$1,808.40 |
$4,521 |
3.8× |
| Nm cisternogram (78630) |
$2,670.80 |
$6,677 |
4.2× |
| Nm csf leak detection (78650) |
$1,097.20 |
$2,743 |
0.7× |
| Nm gastric emptying study (78264) |
$2,060 |
$5,150 |
4.4× |
| Nm gastroesophageal reflux study (78262) |
$961.60 |
$2,404 |
2.0× |
| Nm kidney scan w/flow (78701) |
$696.40 |
$1,741 |
1.5× |
| Nm peritoneal-venous shunt patency (78291) |
$783.60 |
$1,959 |
1.7× |
| Noncardiac Vascular Flow Imaging (78445) |
$408 |
$1,020 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$9,313.60 |
$23,284 |
5.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,065.20 |
$2,663 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$2,181.60 |
$5,454 |
7.9× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$282.40 |
$706 |
2.3× |
| Orthopantogram (70355) |
$458 |
$1,145 |
4.5× |
| Osseous survey limited (77074) |
$438.40 |
$1,096 |
3.5× |
| Parathyrd planar w/spect&CT (78072) |
$3,215.20 |
$8,038 |
5.0× |
| Parathyroid Planar Imaging (78070) |
$2,304.80 |
$5,762 |
4.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,215.20 |
$8,038 |
6.8× |
| Pelvis 1 or 2 views (72170) |
$391 |
$977.50 |
3.2× |
| Peritoneogram after injection (74190) |
$260.40 |
$651 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$7,598 |
$18,995 |
4.5× |
| PET imaging CT for attenuation limited area (78814) |
$5,285.20 |
$13,213 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$8,258.40 |
$20,646 |
4.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,321.60 |
$5,804 |
1.5× |
| PET whole body (78813) |
$4,813.20 |
$12,033 |
2.8× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$2,895.60 |
$7,239 |
1.7× |
| Proton tx delivery simple w/o compensation (77520) |
$785.60 |
$1,964 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,426 |
$11,065 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,492 |
$3,730 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,389.40 |
$3,473.50 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,963.60 |
$7,409 |
4.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$389.40 |
$973.50 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$375.20 |
$938 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$339.60 |
$849 |
3.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$339.60 |
$849 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$272.40 |
$681 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$477.60 |
$1,194 |
3.9× |
| Radex fingr minimum 2 views (73140) |
$238.80 |
$597 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$406.40 |
$1,016 |
4.0× |
| Radex Hand Minimum 3 Views (73130) |
$310.80 |
$777 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$167.60 |
$419 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$160.80 |
$402 |
1.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$439.20 |
$1,098 |
3.6× |
| Radex Humerus Minimum 2 Views (73060) |
$363.20 |
$908 |
3.5× |
| Radex Kne 1/2 Views (73560) |
$382.40 |
$956 |
3.7× |
| Radex Kne Compl 4/More Views (73564) |
$475.20 |
$1,188 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$604.80 |
$1,512 |
4.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$334.40 |
$836 |
3.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$449.20 |
$1,123 |
3.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$463.60 |
$1,159 |
4.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$193 |
$482.50 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$328.80 |
$822 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$522.40 |
$1,306 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$219.60 |
$549 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$296.40 |
$741 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$339.60 |
$849 |
3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$752 |
$1,880 |
6.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$19,176 |
$47,940 |
2.2× |
| Radiation treatment delivery level 1 (77402) |
$944 |
$2,360 |
7.8× |
| Radiation treatment delivery level 2 (77407) |
$985.60 |
$2,464 |
2.2× |
| Radiation treatment delivery level 3 (77412) |
$1,358 |
$3,395 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$315.60 |
$789 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$350.40 |
$876 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$391.60 |
$979 |
3.8× |
| Radiologic exam colon single contrast study (74270) |
$407.60 |
$1,019 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$422.80 |
$1,057 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,048 |
$2,620 |
5.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,048 |
$2,620 |
5.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$367.60 |
$919 |
3.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$429.60 |
$1,074 |
3.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$174 |
$435 |
1.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$211.20 |
$528 |
2.1× |
| Radiological examination surgical specimen (76098) |
$136 |
$340 |
0.2× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$3,233.60 |
$8,084 |
11.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$526 |
$1,315 |
1.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$526 |
$1,315 |
1.2× |
| Renal Cyst Study (74470) |
$787 |
$1,967.50 |
1.2× |
| Ribs bilateral 3 views (71110) |
$510.80 |
$1,277 |
4.1× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$600.40 |
$1,501 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$778 |
$1,945 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,616 |
$4,040 |
2.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,616 |
$4,040 |
2.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,116 |
$5,290 |
3.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,067.60 |
$2,669 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,067.60 |
$2,669 |
0.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,175.60 |
$2,939 |
0.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$656.60 |
$1,641.50 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$629.20 |
$1,573 |
2.3× |
| Sacroiliac Joints < 3 Views (72200) |
$170.40 |
$426 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$981.20 |
$2,453 |
3.5× |
| Scapula (73010) |
$267.60 |
$669 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$66.80 |
$167 |
2.9× |
| Sella turcica (70240) |
$168 |
$420 |
1.6× |
| Shoulder 1 view (73020) |
$155.20 |
$388 |
1.5× |
| Sialogram (70390) |
$376.40 |
$941 |
1.3× |
| Simulation intermediate (77285) |
$1,454.20 |
$3,635.50 |
3.3× |
| Small bowel series (74250) |
$329.40 |
$823.50 |
1.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$3,291.60 |
$8,229 |
7.4× |
| Special dosimetry (77331) |
$1,176 |
$2,940 |
7.4× |
| Special Physics Consult (77370) |
$673 |
$1,682.50 |
4.2× |
| Special treatment procedure (77470) |
$2,076.80 |
$5,192 |
3.2× |
| Speech evaluation complex (70371) |
$850.80 |
$2,127 |
3.0× |
| Spine thoracic 3 views (72072) |
$328.40 |
$821 |
2.7× |
| Splenoportograpy rs&i (75810) |
$3,623.60 |
$9,059 |
1.0× |
| Stereotactic Body Radiation Delivery (77373) |
$6,544.40 |
$16,361 |
3.1× |
| Superior sagittal sinus venogram (75870) |
$2,084.40 |
$5,211 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$174.40 |
$436 |
1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,429.20 |
$3,573 |
3.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$510.80 |
$1,277 |
1.2× |
| Testicular Imaging With Vascular Flow (78761) |
$900.80 |
$2,252 |
1.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$669.20 |
$1,673 |
1.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$945 |
$2,362.50 |
6.0× |
| Thoracolumbar 2 views (72080) |
$196.40 |
$491 |
1.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,147.60 |
$5,369 |
3.3× |
| Thyroid imaging w/blood flow (78013) |
$788.40 |
$1,971 |
1.7× |
| Thyroid uptake measurement (78012) |
$268 |
$670 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$679.80 |
$1,699.50 |
1.4× |
| Tmj unilateral (70328) |
$458.40 |
$1,146 |
4.5× |
| Tomogram (76100) |
$489.60 |
$1,224 |
4.0× |
| Treatment device complex (77334) |
$1,083.20 |
$2,708 |
2.4× |
| Treatment device intermediate (77333) |
$616.40 |
$1,541 |
3.9× |
| Treatment devices simple (77332) |
$403.20 |
$1,008 |
2.5× |
| Ultrasound breast complete (76641) |
$716.80 |
$1,792 |
5.8× |
| Ultrasound elastography first target lesion (76982) |
$211.60 |
$529 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$234 |
$585 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$633.60 |
$1,584 |
5.1× |
| Umbilical-artery Doppler (OB) (76820) |
$547.60 |
$1,369 |
4.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$132.40 |
$331 |
1.3× |
| Unlisted magnetic resonance procedure (76498) |
$2,290.80 |
$5,727 |
22.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$229.20 |
$573 |
1.9× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$2,425.20 |
$6,063 |
15.3× |
| Ureteral reflux study (78740) |
$1,422.80 |
$3,557 |
3.0× |
| Urethrocystogram voiding (74455) |
$436.60 |
$1,091.50 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$405.20 |
$1,013 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$545.20 |
$1,363 |
2.6× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$942 |
$2,355 |
4.5× |
| Us breast unilateral limited (76642) |
$673.20 |
$1,683 |
6.5× |
| Us chest (76604) |
$1,199.20 |
$2,998 |
9.7× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,968 |
$4,920 |
7.7× |
| Us compl joint r-t w/image documentation (76881) |
$772.80 |
$1,932 |
6.3× |
| Us elastography parenchyma (76981) |
$272.40 |
$681 |
2.2× |
| Us encephalogram (76506) |
$969.20 |
$2,423 |
7.8× |
| Us hips infant static (76886) |
$808.40 |
$2,021 |
7.9× |
| Us infant hips w manipulation (76885) |
$936.80 |
$2,342 |
9.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$165.20 |
$413 |
1.3× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$165.20 |
$413 |
1.3× |
| Us ob detailed single fetus (76811) |
$910.80 |
$2,277 |
3.2× |
| Us ob limited (76815) |
$606 |
$1,515 |
4.9× |
| Us ob transvaginal (76817) |
$672.40 |
$1,681 |
5.4× |
| Us pelvic non ob complete (76856) |
$632.40 |
$1,581 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$598.80 |
$1,497 |
4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$910.80 |
$2,277 |
7.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$392.40 |
$981 |
3.2× |
| Us retroperitoneal complete (76770) |
$1,131.60 |
$2,829 |
9.2× |
| Us retroperitoneal limited (76775) |
$533 |
$1,332.50 |
4.3× |
| Us scrotum and contents (76870) |
$729.20 |
$1,823 |
5.9× |
| Us soft tissue head/neck (76536) |
$950 |
$2,375 |
7.7× |
| Us spinal canal and contents (76800) |
$444.40 |
$1,111 |
3.6× |
| Us transrectal (76872) |
$883.60 |
$2,209 |
7.2× |
| Us transrectal prostate volume (76873) |
$1,015.60 |
$2,539 |
8.2× |
| Us, eye b-scan (76512) |
$365.60 |
$914 |
3.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,770.60 |
$4,426.50 |
14.3× |
| Venogram adrenal unilat (75840) |
$2,428.80 |
$6,072 |
0.7× |
| Venogram extremity bilateral (75822) |
$1,490.80 |
$3,727 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$854.80 |
$2,137 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$2,542.80 |
$6,357 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$2,406.80 |
$6,017 |
1.3× |
| Venography Renal Bilateral (75833) |
$2,979 |
$7,447.50 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$2,406.80 |
$6,017 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,688.40 |
$9,221 |
1.0× |
| Venous sampling by catheter (75893) |
$6,117.20 |
$15,293 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$170 |
$425 |
1.7× |
| Wrist 2 views (73100) |
$312.40 |
$781 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$641.60 |
$1,604 |
5.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$268.80 |
$672 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$792.80 |
$1,982 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$318.40 |
$796 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$396.60 |
$991.50 |
3.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$444.40 |
$1,111 |
3.6× |
| X-ray exam of femur 2/> (73552) |
$394.80 |
$987 |
3.8× |
| X-ray eye for foreign body (70030) |
$118.80 |
$297 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$202 |
$505 |
2.0× |
| X-ray IV pyelogram (ivp) (74400) |
$682.80 |
$1,707 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$159.20 |
$398 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$313.60 |
$784 |
3.1× |
| X-ray leg, infant (73592) |
$256.40 |
$641 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$609.60 |
$1,524 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$339.20 |
$848 |
2.7× |
| X-ray nose-rectum child f.b. (76010) |
$422 |
$1,055 |
4.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$555.20 |
$1,388 |
4.5× |
| X-ray retrograde pyelogram (74420) |
$1,075.60 |
$2,689 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$410.20 |
$1,025.50 |
4.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$221.60 |
$554 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$595.60 |
$1,489 |
4.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$242 |
$605 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$412 |
$1,030 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$650 |
$1,625 |
6.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$588.40 |
$1,471 |
4.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$447.80 |
$1,119.50 |
3.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$260.40 |
$651 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$384 |
$960 |
3.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$159.20 |
$398 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$275.20 |
$688 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$454.20 |
$1,135.50 |
3.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$256.40 |
$641 |
2.1× |
| Xr bone length studies (77073) |
$466 |
$1,165 |
3.8× |
| Xr c-spine 4 or 5 views (72050) |
$561.20 |
$1,403 |
4.5× |
| Xr c-spine 6 or more views (72052) |
$650 |
$1,625 |
5.3× |
| Xr chest 4+ views (71048) |
$541.80 |
$1,354.50 |
4.4× |
| Xr urogram antegrade (74425) |
$1,421.60 |
$3,554 |
3.4× |