| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,395 |
$8,790 |
3.0× |
| Abdomen 2 views (74019) |
$144.50 |
$289 |
1.3× |
| Acute gi blood loss imaging (78278) |
$812 |
$1,624 |
1.9× |
| Angio Adrenal Bilat Select (75733) |
$2,080 |
$4,160 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,717 |
$5,434 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,538 |
$5,076 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,080 |
$4,160 |
0.6× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,843 |
$5,686 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,030.50 |
$4,061 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,030.50 |
$4,061 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$3,328 |
$6,656 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,324.50 |
$8,649 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$498 |
$996 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,030.50 |
$4,061 |
0.6× |
| Ankle 2 views (73600) |
$1,109.50 |
$2,219 |
12.2× |
| Aortogram thoracic (75605) |
$4,831.50 |
$9,663 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,136.50 |
$6,273 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$2,602.50 |
$5,205 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,542.50 |
$5,085 |
0.8× |
| Arthrogram hip (73525) |
$986.50 |
$1,973 |
2.7× |
| Arthrogram shoulder (73040) |
$733 |
$1,466 |
2.0× |
| Arthrogram wrist (73115) |
$453 |
$906 |
1.2× |
| Basic dosimetry (77300) |
$621.50 |
$1,243 |
4.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$3,145 |
$6,290 |
7.5× |
| Bone &/joint imaging whole body (78306) |
$4,137.50 |
$8,275 |
9.9× |
| Bone age studies (77072) |
$109 |
$218 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$4,758 |
$9,516 |
11.4× |
| Bone survey complete (77075) |
$2,197.50 |
$4,395 |
20.1× |
| Bowel imaging (78290) |
$481 |
$962 |
1.2× |
| Brachytx isodose complex (77318) |
$2,133 |
$4,266 |
5.5× |
| Brachytx isodose intermed (77317) |
$1,684.50 |
$3,369 |
4.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,452 |
$2,904 |
3.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,355.50 |
$10,711 |
3.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,620.50 |
$5,241 |
6.3× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,989.50 |
$3,979 |
2.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,989.50 |
$3,979 |
5.5× |
| Cervical spine 2 or 3 views (72040) |
$895.50 |
$1,791 |
9.9× |
| Chest 1 view (71045) |
$109 |
$218 |
1.2× |
| Chest xray 3 views (71047) |
$144 |
$288 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$920.50 |
$1,841 |
5.0× |
| Cineradiography/videoradiography (76120) |
$589 |
$1,178 |
5.4× |
| Clavicle complete (73000) |
$365 |
$730 |
4.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$129 |
$258 |
1.2× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$168 |
$336 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$644.50 |
$1,289 |
4.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,501.50 |
$13,003 |
17.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,939.50 |
$7,879 |
15.8× |
| CT abdomen w contrast (74160) |
$3,903 |
$7,806 |
21.3× |
| CT abdomen w wo contrast (74170) |
$5,315.50 |
$10,631 |
29.0× |
| CT abdomen w/o contrast (74150) |
$2,445.50 |
$4,891 |
22.4× |
| CT angio hrt w/3d image (75574) |
$2,244.50 |
$4,489 |
6.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,574.50 |
$3,149 |
8.6× |
| CT angiography upper extremity lt (73206) |
$2,928 |
$5,856 |
16.0× |
| CT c-spine w/contrast (72126) |
$3,009.50 |
$6,019 |
8.3× |
| CT c-spine w/o contrast (72125) |
$1,505 |
$3,010 |
13.8× |
| CT cervical spine w&w/o contrast (72127) |
$3,372 |
$6,744 |
18.4× |
| CT chest w contrast (71260) |
$2,487.50 |
$4,975 |
13.6× |
| CT chest w/wo contrast (71270) |
$2,604.50 |
$5,209 |
14.2× |
| CT colonography screening (74263) |
$457 |
$914 |
1.8× |
| CT colonography w/dye (74262) |
$773 |
$1,546 |
4.2× |
| CT colonography w/o cntrst (74261) |
$773 |
$1,546 |
7.1× |
| CT head/brain with contrast (70460) |
$3,348 |
$6,696 |
18.3× |
| CT head/brain without and with contrast (70470) |
$3,639 |
$7,278 |
19.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,495.50 |
$2,991 |
4.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$340.50 |
$681 |
3.7× |
| CT hrt w/3d image congen (75573) |
$2,065.50 |
$4,131 |
5.7× |
| CT iac w contrast (70481) |
$2,842 |
$5,684 |
15.5× |
| CT limited/localized follow up study (76380) |
$173.50 |
$347 |
1.9× |
| CT lower ext w/o (73700) |
$912 |
$1,824 |
8.4× |
| CT lower extremity w/contrast material (73701) |
$1,002.50 |
$2,005 |
5.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,032.50 |
$2,065 |
5.6× |
| CT lumbar spine w/contrast (72132) |
$875 |
$1,750 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$785 |
$1,570 |
7.2× |
| CT maxillofacial w contrast (70487) |
$5,032 |
$10,064 |
27.5× |
| CT maxillofacial w/wo contrast (70488) |
$6,123 |
$12,246 |
33.4× |
| CT maxillofacial wo contrast (70486) |
$3,965 |
$7,930 |
36.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,097 |
$6,194 |
16.9× |
| CT orbits w/o contrast (70480) |
$2,386.50 |
$4,773 |
21.9× |
| CT pelvis w/o contrast (72192) |
$1,336.50 |
$2,673 |
12.2× |
| CT pelvis w/wo contrast (72194) |
$2,161.50 |
$4,323 |
11.8× |
| CT soft tissue neck w contrast (70491) |
$3,998 |
$7,996 |
21.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,143 |
$4,286 |
11.7× |
| CT soft tissue neck w/o contrast (70490) |
$3,424.50 |
$6,849 |
31.4× |
| CT thoracic spine w/contrast (72129) |
$1,046.50 |
$2,093 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$586 |
$1,172 |
5.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,046.50 |
$2,093 |
5.7× |
| CT thorax w/o contrast (71250) |
$2,015 |
$4,030 |
18.5× |
| CT unlisted procedure (76497) |
$846 |
$1,692 |
9.3× |
| CT upper ext wo (73200) |
$1,593.50 |
$3,187 |
14.6× |
| CT upper extremity with contrast (73201) |
$1,992 |
$3,984 |
5.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,358 |
$4,716 |
12.9× |
| Cta Abdomen (74175) |
$5,448.50 |
$10,897 |
29.7× |
| CTA abdomen pelvis (74174) |
$7,728 |
$15,456 |
21.2× |
| CTA chest (71275) |
$2,911.50 |
$5,823 |
15.9× |
| Cta Head (70496) |
$3,760.50 |
$7,521 |
20.5× |
| Cta Neck (70498) |
$4,608 |
$9,216 |
25.2× |
| Cta Pelvis (72191) |
$2,108.50 |
$4,217 |
11.5× |
| Cystography minimum 3 views rs&i (74430) |
$1,150.50 |
$2,301 |
3.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,125 |
$2,250 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$538.50 |
$1,077 |
4.9× |
| Dxa bone density study axial skeleton (77085) |
$600.50 |
$1,201 |
5.5× |
| Esophagus (74220) |
$672.50 |
$1,345 |
3.7× |
| Facial bones min 3 views (70150) |
$457.50 |
$915 |
4.2× |
| Fluoroscopy up to 1 hr (76000) |
$730.50 |
$1,461 |
2.9× |
| Foot 2 views (73620) |
$665 |
$1,330 |
7.3× |
| Forearm 2 views (73090) |
$321.50 |
$643 |
3.5× |
| Functional MRI brain by phys/psych (70555) |
$2,660.50 |
$5,321 |
10.7× |
| Functional MRI brain by tech (70554) |
$3,422 |
$6,844 |
13.7× |
| Hand 2 views (73120) |
$1,025 |
$2,050 |
9.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$684 |
$1,368 |
0.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,246.50 |
$2,493 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,888 |
$3,776 |
2.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,917.50 |
$7,835 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,956.50 |
$7,913 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,693.50 |
$3,387 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,236.50 |
$2,473 |
3.0× |
| Interstitial radiation source applic complex (77778) |
$3,206.50 |
$6,413 |
4.4× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$6,826.50 |
$13,653 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$816.50 |
$1,633 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$622 |
$1,244 |
1.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,295.50 |
$2,591 |
2.3× |
| Knee 3 views (73562) |
$859 |
$1,718 |
9.5× |
| Liver & spleen imaging static only (78215) |
$2,057 |
$4,114 |
4.9× |
| Liver imaging static only (78201) |
$1,353 |
$2,706 |
2.4× |
| Liver imaging w/vascular flow (78202) |
$774.50 |
$1,549 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$544.50 |
$1,089 |
1.0× |
| Lung perfusion differential (78597) |
$353.50 |
$707 |
0.8× |
| Lung ventilation imaging (78579) |
$728 |
$1,456 |
1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,030.50 |
$4,061 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$689 |
$1,378 |
0.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$776.50 |
$1,553 |
0.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$550.50 |
$1,101 |
0.8× |
| Lymphoscintigraphy (78195) |
$1,786 |
$3,572 |
3.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,042 |
$6,084 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,951.50 |
$5,903 |
8.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,352.50 |
$6,705 |
9.2× |
| Magnetic Resonance Elastography (76391) |
$1,560.50 |
$3,121 |
6.3× |
| Mammary ductogram or galactogram multiple (77054) |
$629 |
$1,258 |
2.5× |
| Mammary ductogram or galactogram single (77053) |
$465.50 |
$931 |
1.9× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$604.50 |
$1,209 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,159 |
$2,318 |
3.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$242.50 |
$485 |
8.0× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$660 |
$1,320 |
6.6× |
| Mr safety implt pos&/immoblj (76019) |
$660 |
$1,320 |
10.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$660 |
$1,320 |
2.6× |
| MRA head w & w/o contrast (70546) |
$3,885.50 |
$7,771 |
10.7× |
| MRA head w/o contrast (70544) |
$2,326.50 |
$4,653 |
9.3× |
| MRA head with contrast (70545) |
$3,885.50 |
$7,771 |
10.7× |
| MRA neck w contrast (70548) |
$2,181.50 |
$4,363 |
6.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,566.50 |
$5,133 |
7.0× |
| MRA neck w/o contrast (70547) |
$1,540 |
$3,080 |
6.2× |
| MRI abdomen w contrast (74182) |
$4,384 |
$8,768 |
12.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,192 |
$8,384 |
11.5× |
| MRI abdomen w/o contrast (74181) |
$2,781.50 |
$5,563 |
11.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,139.50 |
$6,279 |
3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,693 |
$7,386 |
10.1× |
| MRI breast w/o contrast bilateral (77047) |
$1,506 |
$3,012 |
6.0× |
| MRI breast wo contrast unilateral (77046) |
$1,810 |
$3,620 |
7.3× |
| MRI c-spine with contrast (72142) |
$2,954 |
$5,908 |
8.1× |
| MRI cardiac w/o cont stress (75559) |
$1,730 |
$3,460 |
3.0× |
| MRI cardiac w/o contrast (75557) |
$1,730 |
$3,460 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$2,084.50 |
$4,169 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,510 |
$7,020 |
9.6× |
| MRI chest w/o contrast (71550) |
$2,106.50 |
$4,213 |
8.5× |
| MRI chest with contrast (71551) |
$6,282 |
$12,564 |
7.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,204.50 |
$6,409 |
8.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,769.50 |
$7,539 |
10.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,262.50 |
$4,525 |
9.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,978 |
$3,956 |
7.9× |
| MRI orbit face neck w contrast (70542) |
$2,801.50 |
$5,603 |
7.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,296.50 |
$6,593 |
9.0× |
| MRI pelvis w/contrast (72196) |
$4,245.50 |
$8,491 |
11.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,170 |
$8,340 |
11.4× |
| MRI pelvis w/o contrast (72195) |
$2,619 |
$5,238 |
10.5× |
| MRI spectroscopy (76390) |
$2,279.50 |
$4,559 |
25.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,475 |
$6,950 |
9.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,734.50 |
$5,469 |
7.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,216.50 |
$6,433 |
8.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,150.50 |
$6,301 |
8.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,707 |
$7,414 |
10.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,225 |
$4,450 |
8.9× |
| MRI up ext w/o contrast (73218) |
$1,979 |
$3,958 |
7.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,040.50 |
$4,081 |
8.2× |
| MRI, joint upper extrem combo (73223) |
$3,458 |
$6,916 |
9.5× |
| Myelogram Cervical (72240) |
$909 |
$1,818 |
1.1× |
| Myelogram Lumbar (72265) |
$1,212 |
$2,424 |
1.5× |
| Myelogram thoracic (72255) |
$909 |
$1,818 |
1.1× |
| Myelography 2 or more regions (72270) |
$3,254 |
$6,508 |
4.0× |
| N-invas est c ffr sw aly CTA (75580) |
$327.50 |
$655 |
0.4× |
| Neck soft tissue (70360) |
$182.50 |
$365 |
2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$312.50 |
$625 |
0.7× |
| Nm bone marrow wb (78104) |
$658.50 |
$1,317 |
1.6× |
| Nm cisternogram (78630) |
$1,091.50 |
$2,183 |
1.9× |
| Nm gastric emptying study (78264) |
$3,474 |
$6,948 |
8.3× |
| Nm peritoneal-venous shunt patency (78291) |
$409 |
$818 |
1.0× |
| Nm red cell sequestration (78140) |
$458.50 |
$917 |
1.1× |
| Noncardiac Vascular Flow Imaging (78445) |
$274.50 |
$549 |
0.7× |
| Nonvascular shunt X-ray (75809) |
$280 |
$560 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,390.50 |
$12,781 |
4.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$408 |
$816 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$2,803.50 |
$5,607 |
11.5× |
| Parathyrd planar w/spect&CT (78072) |
$2,180.50 |
$4,361 |
3.8× |
| Parathyroid Planar Imaging (78070) |
$1,022.50 |
$2,045 |
2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,000.50 |
$4,001 |
4.8× |
| Pelvis 1 or 2 views (72170) |
$540.50 |
$1,081 |
5.0× |
| Perineogram (74775) |
$315 |
$630 |
1.3× |
| Peritoneogram after injection (74190) |
$263 |
$526 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$5,164 |
$10,328 |
3.5× |
| PET imaging CT for attenuation limited area (78814) |
$4,647 |
$9,294 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$5,267 |
$10,534 |
3.5× |
| Platelet survival study Non-Facility (78191) |
$603 |
$1,206 |
1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,031.50 |
$10,063 |
1.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,079 |
$4,158 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$922.50 |
$1,845 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,298.50 |
$2,597 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$579.50 |
$1,159 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$992.50 |
$1,985 |
10.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$399.50 |
$799 |
4.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$284 |
$568 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$167.50 |
$335 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$270 |
$540 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$319 |
$638 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$716 |
$1,432 |
7.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$644 |
$1,288 |
7.1× |
| Radex Hand Minimum 3 Views (73130) |
$979.50 |
$1,959 |
10.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$383 |
$766 |
4.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$664 |
$1,328 |
6.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$472.50 |
$945 |
4.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$721.50 |
$1,443 |
6.6× |
| Radex Humerus Minimum 2 Views (73060) |
$717 |
$1,434 |
7.9× |
| Radex Kne 1/2 Views (73560) |
$746.50 |
$1,493 |
8.2× |
| Radex Kne Compl 4/More Views (73564) |
$963.50 |
$1,927 |
8.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$160 |
$320 |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$457 |
$914 |
5.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$779.50 |
$1,559 |
7.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$1,153 |
$2,306 |
12.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$656.50 |
$1,313 |
7.2× |
| Radex Toe Minimum 2 Views (73660) |
$153 |
$306 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$803.50 |
$1,607 |
8.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$372.50 |
$745 |
3.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$17,671.50 |
$35,343 |
2.3× |
| Radiation treatment delivery level 1 (77402) |
$172 |
$344 |
1.6× |
| Radiation treatment delivery level 2 (77407) |
$295 |
$590 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$811.50 |
$1,623 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$79 |
$158 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$144.50 |
$289 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$137.50 |
$275 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$390 |
$780 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$311.50 |
$623 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$489 |
$978 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$680.50 |
$1,361 |
7.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$742.50 |
$1,485 |
8.2× |
| Radiological examination surgical specimen (76098) |
$796.50 |
$1,593 |
1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$778 |
$1,556 |
3.2× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,470.50 |
$2,941 |
6.0× |
| Red cell survival study Non-Facility (78130) |
$458.50 |
$917 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,153 |
$2,306 |
2.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$753 |
$1,506 |
1.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$794 |
$1,588 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,059 |
$2,118 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,328.50 |
$4,657 |
4.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,588.50 |
$5,177 |
4.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,328.50 |
$4,657 |
1.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,246.50 |
$2,493 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$365 |
$730 |
1.5× |
| Rp Therapy Intravenous Administration (79101) |
$156 |
$312 |
0.6× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$391.50 |
$783 |
0.9× |
| Scapula (73010) |
$710.50 |
$1,421 |
6.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$88.50 |
$177 |
3.8× |
| Simulation intermediate (77285) |
$1,245 |
$2,490 |
3.2× |
| Small bowel series (74250) |
$834 |
$1,668 |
4.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$758 |
$1,516 |
1.9× |
| Special dosimetry (77331) |
$545 |
$1,090 |
3.9× |
| Special Physics Consult (77370) |
$979 |
$1,958 |
7.0× |
| Special treatment procedure (77470) |
$2,137.50 |
$4,275 |
3.7× |
| Speech evaluation complex (70371) |
$116.50 |
$233 |
0.5× |
| Spine thoracic 3 views (72072) |
$458 |
$916 |
4.2× |
| Splenoportograpy rs&i (75810) |
$2,212.50 |
$4,425 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$3,084.50 |
$6,169 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,219.50 |
$2,439 |
3.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$622 |
$1,244 |
1.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,481.50 |
$2,963 |
3.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$786.50 |
$1,573 |
5.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,185.50 |
$4,371 |
3.9× |
| Thyroid imaging w/blood flow (78013) |
$1,064.50 |
$2,129 |
2.5× |
| Thyroid uptake measurement (78012) |
$2,484 |
$4,968 |
6.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,330 |
$2,660 |
3.2× |
| Treatment device complex (77334) |
$1,147.50 |
$2,295 |
2.9× |
| Treatment device intermediate (77333) |
$402 |
$804 |
2.9× |
| Treatment devices simple (77332) |
$620 |
$1,240 |
4.4× |
| Ultrasound breast complete (76641) |
$891.50 |
$1,783 |
8.2× |
| Ultrasound elastography first target lesion (76982) |
$615 |
$1,230 |
5.6× |
| Ultrasound Exam Aaa Screen (76706) |
$500 |
$1,000 |
4.6× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$952.50 |
$1,905 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$1,275 |
$2,550 |
11.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$784 |
$1,568 |
8.6× |
| Unlisted fluoroscopic procedure (76496) |
$128 |
$256 |
1.4× |
| Unlisted genitourinary px dx nuclear medicine (78799) |
$417.50 |
$835 |
1.0× |
| Unlisted magnetic resonance procedure (76498) |
$961.50 |
$1,923 |
10.6× |
| Ureteral reflux study (78740) |
$408 |
$816 |
1.0× |
| Urethrocystogram voiding (74455) |
$959 |
$1,918 |
3.8× |
| Urethrocystography retrograde rs&i (74450) |
$959 |
$1,918 |
3.8× |
| Us breast unilateral limited (76642) |
$607.50 |
$1,215 |
6.7× |
| Us chest (76604) |
$680 |
$1,360 |
6.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,182.50 |
$2,365 |
5.2× |
| Us compl joint r-t w/image documentation (76881) |
$2,387 |
$4,774 |
21.9× |
| Us elastography parenchyma (76981) |
$615 |
$1,230 |
5.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$1,270.50 |
$2,541 |
11.6× |
| Us pelvic non ob complete (76856) |
$1,910 |
$3,820 |
17.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$840 |
$1,680 |
7.7× |
| Us retroperitoneal complete (76770) |
$930.50 |
$1,861 |
8.5× |
| Us retroperitoneal limited (76775) |
$538 |
$1,076 |
4.9× |
| Us scrotum and contents (76870) |
$1,261 |
$2,522 |
11.6× |
| Us soft tissue head/neck (76536) |
$966.50 |
$1,933 |
8.9× |
| Us transrectal (76872) |
$978.50 |
$1,957 |
9.0× |
| Us transrectal prostate volume (76873) |
$1,588 |
$3,176 |
14.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$780.50 |
$1,561 |
7.1× |
| Venogram adrenal unilat (75840) |
$2,030.50 |
$4,061 |
0.6× |
| Venogram extremity bilateral (75822) |
$1,475 |
$2,950 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,260.50 |
$2,521 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$4,442.50 |
$8,885 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$1,022 |
$2,044 |
0.6× |
| Venography Renal Bilateral (75833) |
$3,917.50 |
$7,835 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,447.50 |
$6,895 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,030.50 |
$4,061 |
0.6× |
| Venous sampling by catheter (75893) |
$3,328 |
$6,656 |
0.6× |
| Wrist 2 views (73100) |
$840.50 |
$1,681 |
9.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$144.50 |
$289 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$157 |
$314 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$546.50 |
$1,093 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$530.50 |
$1,061 |
5.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$615.50 |
$1,231 |
5.6× |
| X-ray exam of femur 2/> (73552) |
$800.50 |
$1,601 |
8.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$320.50 |
$641 |
3.5× |
| X-ray IV pyelogram (ivp) (74400) |
$875 |
$1,750 |
4.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$137.50 |
$275 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$859 |
$1,718 |
9.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$492.50 |
$985 |
4.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$783 |
$1,566 |
7.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$737 |
$1,474 |
6.8× |
| X-ray retrograde pyelogram (74420) |
$437.50 |
$875 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$484.50 |
$969 |
5.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$553 |
$1,106 |
5.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$692 |
$1,384 |
6.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$366.50 |
$733 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$321.50 |
$643 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$830 |
$1,660 |
9.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,035 |
$2,070 |
9.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$828 |
$1,656 |
7.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$487.50 |
$975 |
5.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$412 |
$824 |
4.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$361 |
$722 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$507 |
$1,014 |
4.6× |
| Xr bone length studies (77073) |
$252.50 |
$505 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$1,235 |
$2,470 |
11.3× |
| Xr c-spine 6 or more views (72052) |
$646.50 |
$1,293 |
5.9× |
| Xr chest 4+ views (71048) |
$156 |
$312 |
1.4× |
| Xr urogram antegrade (74425) |
$437.50 |
$875 |
1.2× |