| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,045.01 |
$2,045.01 |
1.4× |
| Abdomen 2 views (74019) |
$5,409.15 |
$5,409.15 |
49.5× |
| Acute gi blood loss imaging (78278) |
$8,349.48 |
$8,349.48 |
20.0× |
| Angio Adrenal Bilat Select (75733) |
$48,328.94 |
$48,328.94 |
14.7× |
| Angiography extremity bilateral rs&i (75716) |
$42,802.76 |
$42,802.76 |
13.0× |
| Angiography extremity unilateral rs&i (75710) |
$32,713.66 |
$32,713.66 |
9.9× |
| Angiography internal mammary rs&i (75756) |
$37,767.15 |
$37,767.15 |
11.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$40,412.41 |
$40,412.41 |
7.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$44,835.04 |
$44,835.04 |
13.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$37,767.15 |
$37,767.15 |
11.5× |
| Angiography Spinal Selective Rs&I (75705) |
$37,767.15 |
$37,767.15 |
6.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$12,325.26 |
$12,325.26 |
2.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$7,561.03 |
$7,561.03 |
2.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$40,412.41 |
$40,412.41 |
12.3× |
| Ankle 2 views (73600) |
$2,321.99 |
$2,321.99 |
25.6× |
| Aortogram thoracic (75605) |
$40,455.05 |
$40,455.05 |
7.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$44,335 |
$44,335 |
13.4× |
| Aortography abdominal serialography rs&i (75625) |
$53,744.80 |
$53,744.80 |
16.3× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$31,637.78 |
$31,637.78 |
9.6× |
| Artery X-Rays Adrenal Gland (75731) |
$39,089.78 |
$39,089.78 |
11.9× |
| Arthrogram ankle (73615) |
$7,195.67 |
$7,195.67 |
19.8× |
| Arthrogram elbow (73085) |
$7,082.24 |
$7,082.24 |
19.4× |
| Arthrogram hip (73525) |
$6,684.02 |
$6,684.02 |
18.3× |
| Arthrogram knee (73580) |
$7,627.39 |
$7,627.39 |
20.9× |
| Arthrogram shoulder (73040) |
$6,528.05 |
$6,528.05 |
17.9× |
| Arthrogram wrist (73115) |
$9,930.45 |
$9,930.45 |
27.3× |
| Basic dosimetry (77300) |
$98.28 |
$98.28 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$5,971.67 |
$5,971.67 |
14.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$10,493.26 |
$10,493.26 |
25.1× |
| Bone &/joint imaging whole body (78306) |
$10,982.20 |
$10,982.20 |
26.3× |
| Bone age studies (77072) |
$1,888.54 |
$1,888.54 |
17.3× |
| Bone Imaging 3 Phase (78315) |
$13,481.22 |
$13,481.22 |
32.3× |
| Bone Marrow Imaging Limited Area (78102) |
$5,971.67 |
$5,971.67 |
14.3× |
| Bone survey complete (77075) |
$4,825.28 |
$4,825.28 |
44.2× |
| Bone survey infant (77076) |
$4,851.81 |
$4,851.81 |
44.4× |
| Bowel imaging (78290) |
$9,189.41 |
$9,189.41 |
22.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,183.45 |
$2,183.45 |
5.6× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$11,542.16 |
$11,542.16 |
27.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$8,842.56 |
$8,842.56 |
15.6× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$6,481.50 |
$6,481.50 |
11.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$7,183.56 |
$7,183.56 |
17.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$8,470.64 |
$8,470.64 |
14.9× |
| Cervical spine 2 or 3 views (72040) |
$3,007.57 |
$3,007.57 |
33.1× |
| Chest 1 view (71045) |
$800.45 |
$800.45 |
8.8× |
| Chest xray 3 views (71047) |
$3,113.65 |
$3,113.65 |
34.3× |
| Cholecystography, oral contrast Non-Facility (74290) |
$4,241.51 |
$4,241.51 |
23.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$4,586.48 |
$4,586.48 |
25.0× |
| Clavicle complete (73000) |
$2,582.91 |
$2,582.91 |
28.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,614.11 |
$2,614.11 |
23.9× |
| Continuing medical physics consltj pr wk (77336) |
$215.65 |
$215.65 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$35,649.33 |
$35,649.33 |
97.9× |
| CT abdomen and pelvis without contrast (74176) |
$32,369.83 |
$32,369.83 |
129.9× |
| CT abdomen w contrast (74160) |
$18,330.36 |
$18,330.36 |
100.1× |
| CT abdomen w wo contrast (74170) |
$20,600.86 |
$20,600.86 |
112.5× |
| CT abdomen w/o contrast (74150) |
$17,058.98 |
$17,058.98 |
156.3× |
| CT angio hrt w/3d image (75574) |
$23,024.94 |
$23,024.94 |
63.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$23,024.94 |
$23,024.94 |
125.7× |
| CT angiography upper extremity lt (73206) |
$23,024.94 |
$23,024.94 |
125.7× |
| CT c-spine w/contrast (72126) |
$17,435.66 |
$17,435.66 |
47.9× |
| CT c-spine w/o contrast (72125) |
$16,760.52 |
$16,760.52 |
153.5× |
| CT cervical spine w&w/o contrast (72127) |
$18,903.30 |
$18,903.30 |
103.2× |
| CT chest w contrast (71260) |
$18,233.11 |
$18,233.11 |
99.5× |
| CT chest w/wo contrast (71270) |
$20,356.25 |
$20,356.25 |
111.1× |
| CT head/brain with contrast (70460) |
$16,608.88 |
$16,608.88 |
90.7× |
| CT head/brain without and with contrast (70470) |
$17,332.99 |
$17,332.99 |
94.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$18,233.11 |
$18,233.11 |
50.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$17,650.89 |
$17,650.89 |
194.2× |
| CT hrt w/3d image congen (75573) |
$18,760.49 |
$18,760.49 |
51.5× |
| CT iac w contrast (70481) |
$12,905.54 |
$12,905.54 |
70.5× |
| CT limited/localized follow up study (76380) |
$5,875.49 |
$5,875.49 |
64.7× |
| CT lower ext w/o (73700) |
$14,309.55 |
$14,309.55 |
131.1× |
| CT lower extremity w wo contrast (73702) |
$17,890.62 |
$17,890.62 |
97.7× |
| CT lower extremity w/contrast material (73701) |
$17,323.13 |
$17,323.13 |
94.6× |
| CT lumbar spine w & w/o contrast (72133) |
$23,382.72 |
$23,382.72 |
127.7× |
| CT lumbar spine w/contrast (72132) |
$20,762.34 |
$20,762.34 |
57.0× |
| CT lumbar spine w/o contrast (72131) |
$18,042.31 |
$18,042.31 |
165.3× |
| CT maxillofacial w contrast (70487) |
$17,230.16 |
$17,230.16 |
94.1× |
| CT maxillofacial w/wo contrast (70488) |
$17,230.16 |
$17,230.16 |
94.1× |
| CT maxillofacial wo contrast (70486) |
$17,230.16 |
$17,230.16 |
157.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$13,053.29 |
$13,053.29 |
71.3× |
| CT orbits w/o contrast (70480) |
$12,866.41 |
$12,866.41 |
117.9× |
| CT pelvis w/o contrast (72192) |
$17,900.47 |
$17,900.47 |
164.0× |
| CT pelvis w/wo contrast (72194) |
$17,900.47 |
$17,900.47 |
97.7× |
| CT scan of arm combo (73202) |
$20,273.12 |
$20,273.12 |
110.7× |
| CT soft tissue neck w contrast (70491) |
$14,617.78 |
$14,617.78 |
79.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$25,801.59 |
$25,801.59 |
140.9× |
| CT soft tissue neck w/o contrast (70490) |
$19,015.79 |
$19,015.79 |
174.2× |
| CT thoracic spine w/contrast (72129) |
$19,749.62 |
$19,749.62 |
107.8× |
| CT thoracic spine w/o contrast (72128) |
$16,031.57 |
$16,031.57 |
146.8× |
| CT thoracic spine w/wo contrast (72130) |
$24,288.67 |
$24,288.67 |
132.6× |
| CT thorax w/o contrast (71250) |
$17,650.89 |
$17,650.89 |
161.7× |
| CT upper ext wo (73200) |
$16,491.49 |
$16,491.49 |
151.1× |
| CT upper extremity with contrast (73201) |
$17,029.57 |
$17,029.57 |
46.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$23,024.94 |
$23,024.94 |
125.7× |
| Cta Abdomen (74175) |
$23,024.94 |
$23,024.94 |
125.7× |
| CTA abdomen pelvis (74174) |
$25,709.17 |
$25,709.17 |
70.6× |
| CTA chest (71275) |
$23,024.94 |
$23,024.94 |
125.7× |
| Cta Head (70496) |
$23,024.94 |
$23,024.94 |
125.7× |
| Cta Neck (70498) |
$23,024.94 |
$23,024.94 |
125.7× |
| Cta Pelvis (72191) |
$23,024.94 |
$23,024.94 |
125.7× |
| Cystography minimum 3 views rs&i (74430) |
$1,578.93 |
$1,578.93 |
4.3× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$2,127.35 |
$2,127.35 |
8.5× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,622.02 |
$3,622.02 |
1.7× |
| Diskography lumbar (72295) |
$12,514.79 |
$12,514.79 |
6.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,998.36 |
$1,998.36 |
18.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$1,915.02 |
$1,915.02 |
21.1× |
| Esophagus (74220) |
$4,263.57 |
$4,263.57 |
23.3× |
| Facial bones min 3 views (70150) |
$3,246.34 |
$3,246.34 |
29.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$3,227.64 |
$3,227.64 |
29.6× |
| Fluoroscopy up to 1 hr (76000) |
$6,300.09 |
$6,300.09 |
25.3× |
| Foot 2 views (73620) |
$2,206.99 |
$2,206.99 |
24.3× |
| Forearm 2 views (73090) |
$2,755.42 |
$2,755.42 |
30.3× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$16,869.26 |
$16,869.26 |
67.7× |
| Hand 2 views (73120) |
$2,321.99 |
$2,321.99 |
21.3× |
| Heart first pass single,planar (78481) |
$10,748.19 |
$10,748.19 |
19.0× |
| Heart Infarct Image (78466) |
$9,348.24 |
$9,348.24 |
22.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$12,356.51 |
$12,356.51 |
21.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$9,945.90 |
$9,945.90 |
23.8× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$1.48 |
$1.48 |
0.0× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$1.48 |
$1.48 |
0.0× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$1.48 |
$1.48 |
0.0× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$1.48 |
$1.48 |
0.0× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$222.99 |
$222.99 |
0.6× |
| Hysterosalpingogram (74740) |
$6,019.41 |
$6,019.41 |
24.2× |
| Interstitial radiation source applic complex (77778) |
$75,638.48 |
$75,638.48 |
104.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$6,240.56 |
$6,240.56 |
57.2× |
| Kidney imaging morphology (78700) |
$6,677.91 |
$6,677.91 |
16.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$8,905.28 |
$8,905.28 |
15.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$11,496.24 |
$11,496.24 |
20.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$13,694.29 |
$13,694.29 |
24.2× |
| Knee 3 views (73562) |
$6,696.18 |
$6,696.18 |
73.7× |
| Liver & spleen imaging static only (78215) |
$6,790.77 |
$6,790.77 |
16.3× |
| Liver imaging static only (78201) |
$6,765.66 |
$6,765.66 |
11.9× |
| Liver imaging w/vascular flow (78202) |
$6,314.37 |
$6,314.37 |
11.1× |
| Lung perf&ventilat diferentl (78598) |
$15,303.22 |
$15,303.22 |
27.0× |
| Lung perfusion differential (78597) |
$10,507.24 |
$10,507.24 |
25.2× |
| Lung ventilation imaging (78579) |
$9,431.87 |
$9,431.87 |
22.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$40,455.05 |
$40,455.05 |
12.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$7,992.42 |
$7,992.42 |
2.4× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$7,333.49 |
$7,333.49 |
4.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$3,709.40 |
$3,709.40 |
5.7× |
| Lymphoscintigraphy (78195) |
$8,349.48 |
$8,349.48 |
14.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$12,646.29 |
$12,646.29 |
15.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$12,646.29 |
$12,646.29 |
34.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$15,509.13 |
$15,509.13 |
42.6× |
| Mammary ductogram or galactogram multiple (77054) |
$4,225.52 |
$4,225.52 |
17.0× |
| Mammary ductogram or galactogram single (77053) |
$3,473.01 |
$3,473.01 |
13.9× |
| Mr safety determination physician/other qhp (76016) |
$150 |
$150 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$135 |
$135 |
4.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$150 |
$150 |
1.5× |
| Mr safety implt pos&/immoblj (76019) |
$150 |
$150 |
2.4× |
| MRA head w & w/o contrast (70546) |
$10,028.33 |
$10,028.33 |
27.5× |
| MRA head w/o contrast (70544) |
$10,636.45 |
$10,636.45 |
42.7× |
| MRA head with contrast (70545) |
$10,636.45 |
$10,636.45 |
29.2× |
| MRA neck w contrast (70548) |
$10,319.71 |
$10,319.71 |
28.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$12,202.89 |
$12,202.89 |
33.5× |
| MRA neck w/o contrast (70547) |
$6,447.73 |
$6,447.73 |
25.9× |
| MRI abdomen w contrast (74182) |
$15,462.69 |
$15,462.69 |
42.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$21,255.92 |
$21,255.92 |
58.3× |
| MRI abdomen w/o contrast (74181) |
$14,939.12 |
$14,939.12 |
60.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$12,646.29 |
$12,646.29 |
15.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$15,509.13 |
$15,509.13 |
42.6× |
| MRI bone marrow blood supply (77084) |
$7,575.10 |
$7,575.10 |
30.4× |
| MRI breast w/o contrast bilateral (77047) |
$5,826.29 |
$5,826.29 |
23.4× |
| MRI c-spine with contrast (72142) |
$14,466.14 |
$14,466.14 |
39.7× |
| MRI cervical spine w/o contrast (72141) |
$13,148.74 |
$13,148.74 |
52.8× |
| MRI chest w/o & w/contrast material (71552) |
$21,255.92 |
$21,255.92 |
58.3× |
| MRI chest w/o contrast (71550) |
$10,611.05 |
$10,611.05 |
42.6× |
| MRI chest with contrast (71551) |
$15,462.69 |
$15,462.69 |
18.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$12,646.29 |
$12,646.29 |
34.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$15,509.13 |
$15,509.13 |
42.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$11,928.47 |
$11,928.47 |
47.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$19,110.93 |
$19,110.93 |
76.7× |
| MRI orbit face neck w contrast (70542) |
$10,636.45 |
$10,636.45 |
29.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$19,110.93 |
$19,110.93 |
52.5× |
| MRI pelvis w/contrast (72196) |
$16,547.87 |
$16,547.87 |
45.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$21,255.92 |
$21,255.92 |
58.3× |
| MRI pelvis w/o contrast (72195) |
$13,955.30 |
$13,955.30 |
56.0× |
| MRI spectroscopy (76390) |
$5,007.85 |
$5,007.85 |
55.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$21,871.59 |
$21,871.59 |
60.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$12,169.19 |
$12,169.19 |
33.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$21,871.59 |
$21,871.59 |
60.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$12,654.76 |
$12,654.76 |
34.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$21,871.59 |
$21,871.59 |
60.0× |
| MRI temporomandibular joint (70336) |
$10,611.05 |
$10,611.05 |
42.6× |
| MRI thoracic spine w/o contrast (72146) |
$14,466.14 |
$14,466.14 |
58.1× |
| MRI up ext w/o contrast (73218) |
$11,928.47 |
$11,928.47 |
47.9× |
| MRI upper ext joint w/o contrast (73221) |
$11,928.47 |
$11,928.47 |
47.9× |
| MRI, joint upper extrem combo (73223) |
$15,509.13 |
$15,509.13 |
42.6× |
| Myelogram Cervical (72240) |
$11,761.04 |
$11,761.04 |
14.4× |
| Myelogram Lumbar (72265) |
$11,394.48 |
$11,394.48 |
13.9× |
| Myelogram thoracic (72255) |
$15,779.17 |
$15,779.17 |
19.3× |
| Myelography 2 or more regions (72270) |
$19,082.54 |
$19,082.54 |
23.3× |
| Myocardial infarct spect (78469) |
$14,392.21 |
$14,392.21 |
25.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$10,794.18 |
$10,794.18 |
8.0× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$18,107.28 |
$18,107.28 |
13.4× |
| Myocardial Spect Multiple Studies (78452) |
$19,415.28 |
$19,415.28 |
14.4× |
| Myocardial spect single study at rest or stress (78451) |
$10,296.88 |
$10,296.88 |
7.6× |
| N-invas est c ffr sw aly CTA (75580) |
$3,000 |
$3,000 |
3.3× |
| Neck soft tissue (70360) |
$2,715.60 |
$2,715.60 |
29.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$2,877.78 |
$2,877.78 |
6.9× |
| Nm adrenal scan (78075) |
$10,535.07 |
$10,535.07 |
7.8× |
| Nm bone marrow wb (78104) |
$10,982.20 |
$10,982.20 |
26.3× |
| Nm cardiac blood pool multiple (78473) |
$9,782.86 |
$9,782.86 |
23.4× |
| Nm cisternogram (78630) |
$5,700.07 |
$5,700.07 |
10.1× |
| Nm gastric emptying study (78264) |
$9,640.76 |
$9,640.76 |
23.1× |
| Nm peritoneal-venous shunt patency (78291) |
$4,137.09 |
$4,137.09 |
9.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$4,020.12 |
$4,020.12 |
9.6× |
| Nonvascular shunt X-ray (75809) |
$3,347.23 |
$3,347.23 |
30.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,096.85 |
$3,096.85 |
2.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$7,129.23 |
$7,129.23 |
17.1× |
| Nuclear Rx Oral Admin (79005) |
$3,046.41 |
$3,046.41 |
12.5× |
| Osseous survey limited (77074) |
$3,785.96 |
$3,785.96 |
34.7× |
| Parathyroid Planar Imaging (78070) |
$5,206.94 |
$5,206.94 |
12.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,822.08 |
$1,822.08 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$2,569.68 |
$2,569.68 |
23.5× |
| Peritoneogram after injection (74190) |
$6,696.18 |
$6,696.18 |
11.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$28,853.66 |
$28,853.66 |
21.3× |
| PET whole body (78813) |
$28,853.66 |
$28,853.66 |
19.3× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$28,853.66 |
$28,853.66 |
19.3× |
| Proton tx delivery intermediate (77523) |
$1.48 |
$1.48 |
0.0× |
| Proton tx delivery simple w/o compensation (77520) |
$1.48 |
$1.48 |
0.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$25,247.41 |
$25,247.41 |
7.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$23,136.01 |
$23,136.01 |
7.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$8,675.44 |
$8,675.44 |
20.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$10,773.31 |
$10,773.31 |
19.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,808.52 |
$2,808.52 |
4.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$2,932.36 |
$2,932.36 |
32.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$2,715.60 |
$2,715.60 |
29.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$2,963.30 |
$2,963.30 |
32.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$3,440.94 |
$3,440.94 |
37.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$4,206.09 |
$4,206.09 |
38.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$5,453.35 |
$5,453.35 |
50.0× |
| Radex fingr minimum 2 views (73140) |
$2,808.52 |
$2,808.52 |
30.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$2,808.52 |
$2,808.52 |
30.9× |
| Radex Hand Minimum 3 Views (73130) |
$2,808.52 |
$2,808.52 |
30.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$2,246.79 |
$2,246.79 |
24.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$3,450.81 |
$3,450.81 |
31.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$2,808.52 |
$2,808.52 |
25.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$4,093.18 |
$4,093.18 |
37.5× |
| Radex Humerus Minimum 2 Views (73060) |
$2,808.52 |
$2,808.52 |
30.9× |
| Radex Kne 1/2 Views (73560) |
$3,551.48 |
$3,551.48 |
39.1× |
| Radex Kne Compl 4/More Views (73564) |
$6,589.98 |
$6,589.98 |
60.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$3,847.90 |
$3,847.90 |
35.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$2,569.68 |
$2,569.68 |
28.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$3,573.63 |
$3,573.63 |
32.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$3,272.89 |
$3,272.89 |
36.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$2,096.40 |
$2,096.40 |
23.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$4,206.09 |
$4,206.09 |
38.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$3,290.60 |
$3,290.60 |
36.2× |
| Radex Toe Minimum 2 Views (73660) |
$2,180.46 |
$2,180.46 |
24.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$2,755.42 |
$2,755.42 |
25.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$2,666.97 |
$2,666.97 |
29.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$5,749.62 |
$5,749.62 |
52.7× |
| Radiation treatment delivery level 1 (77402) |
$130.57 |
$130.57 |
1.2× |
| Radiation treatment delivery level 2 (77407) |
$152.58 |
$152.58 |
0.4× |
| Radiation treatment delivery level 3 (77412) |
$173.10 |
$173.10 |
0.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$4,237.02 |
$4,237.02 |
46.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$6,877.49 |
$6,877.49 |
63.0× |
| Radiologic exam chest 2 views (71046) |
$1,911.36 |
$1,911.36 |
21.0× |
| Radiologic exam colon single contrast study (74270) |
$6,731.52 |
$6,731.52 |
36.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$4,263.57 |
$4,263.57 |
23.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$4,290.12 |
$4,290.12 |
23.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$5,289.70 |
$5,289.70 |
28.9× |
| Radiologic examination femur 1 view (73551) |
$2,842.87 |
$2,842.87 |
31.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$3,617.86 |
$3,617.86 |
39.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$2,454.65 |
$2,454.65 |
4.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$2,910.24 |
$2,910.24 |
26.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$2,215.84 |
$2,215.84 |
20.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$2,538.67 |
$2,538.67 |
27.9× |
| Radiological examination surgical specimen (76098) |
$841.22 |
$841.22 |
1.5× |
| Renal Cyst Study (74470) |
$9,867.30 |
$9,867.30 |
17.3× |
| Ribs bilateral 3 views (71110) |
$3,082.72 |
$3,082.72 |
28.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$10,489.09 |
$10,489.09 |
25.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$11,951.74 |
$11,951.74 |
28.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$22,804.35 |
$22,804.35 |
40.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$13,146.88 |
$13,146.88 |
23.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$17,513.05 |
$17,513.05 |
30.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$17,513.05 |
$17,513.05 |
13.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,916.61 |
$1,916.61 |
7.9× |
| Sacroiliac Joints < 3 Views (72200) |
$2,091.96 |
$2,091.96 |
19.2× |
| Scapula (73010) |
$2,189.29 |
$2,189.29 |
20.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$173.53 |
$173.53 |
7.4× |
| Sella turcica (70240) |
$2,162.74 |
$2,162.74 |
23.8× |
| Shoulder 1 view (73020) |
$1,110.13 |
$1,110.13 |
12.2× |
| Sialogram (70390) |
$1,530.31 |
$1,530.31 |
6.1× |
| Simulation intermediate (77285) |
$407.83 |
$407.83 |
1.0× |
| Small bowel series (74250) |
$8,682.01 |
$8,682.01 |
47.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$294.86 |
$294.86 |
0.8× |
| Special dosimetry (77331) |
$406.72 |
$406.72 |
2.9× |
| Special Physics Consult (77370) |
$516 |
$516 |
3.7× |
| Special treatment procedure (77470) |
$2,170.64 |
$2,170.64 |
3.8× |
| Speech evaluation complex (70371) |
$3,007.57 |
$3,007.57 |
12.1× |
| Spine thoracic 3 views (72072) |
$6,174.23 |
$6,174.23 |
56.6× |
| Splenoportograpy rs&i (75810) |
$23,136.01 |
$23,136.01 |
7.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$4,222.54 |
$4,222.54 |
16.9× |
| Testicular Imaging With Vascular Flow (78761) |
$6,163.93 |
$6,163.93 |
14.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,329.38 |
$1,329.38 |
3.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$253.79 |
$253.79 |
1.8× |
| Thoracolumbar 2 views (72080) |
$4,206.09 |
$4,206.09 |
46.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$9,615.69 |
$9,615.69 |
17.0× |
| Thyroid imaging w/blood flow (78013) |
$6,677.91 |
$6,677.91 |
16.0× |
| Thyroid uptake measurement (78012) |
$5,516.17 |
$5,516.17 |
13.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$5,516.17 |
$5,516.17 |
13.2× |
| Tomogram (76100) |
$4,957.99 |
$4,957.99 |
45.4× |
| Treatment device complex (77334) |
$237.64 |
$237.64 |
0.6× |
| Treatment device intermediate (77333) |
$140.83 |
$140.83 |
1.0× |
| Treatment devices simple (77332) |
$98.28 |
$98.28 |
0.7× |
| Ultrasound breast complete (76641) |
$622.49 |
$622.49 |
5.7× |
| Ultrasound, abdomen limited (76705) |
$4,100.29 |
$4,100.29 |
37.6× |
| Unlisted magnetic resonance procedure (76498) |
$12,342.31 |
$12,342.31 |
135.8× |
| Unlisted ultrasound procedure (76999) |
$4,142.08 |
$4,142.08 |
45.6× |
| Ureteral reflux study (78740) |
$4,717.99 |
$4,717.99 |
11.3× |
| Urethrocystogram voiding (74455) |
$5,506.38 |
$5,506.38 |
22.1× |
| Urethrocystography retrograde rs&i (74450) |
$7,156.15 |
$7,156.15 |
28.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$6,249.43 |
$6,249.43 |
34.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$6,696.18 |
$6,696.18 |
36.6× |
| Us breast unilateral limited (76642) |
$622.49 |
$622.49 |
6.8× |
| Us chest (76604) |
$3,001.04 |
$3,001.04 |
27.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$15,280.99 |
$15,280.99 |
67.8× |
| Us compl joint r-t w/image documentation (76881) |
$5,747.36 |
$5,747.36 |
52.6× |
| Us encephalogram (76506) |
$4,915.31 |
$4,915.31 |
45.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$4,305.13 |
$4,305.13 |
39.4× |
| Us ob limited (76815) |
$3,485.85 |
$3,485.85 |
31.9× |
| Us ob transvaginal (76817) |
$3,168.99 |
$3,168.99 |
29.0× |
| Us pelvic non ob complete (76856) |
$4,672.91 |
$4,672.91 |
42.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$1,759.65 |
$1,759.65 |
16.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$5,513.01 |
$5,513.01 |
50.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$1,479.57 |
$1,479.57 |
13.6× |
| Us retroperitoneal complete (76770) |
$3,582 |
$3,582 |
32.8× |
| Us retroperitoneal limited (76775) |
$4,585.09 |
$4,585.09 |
42.0× |
| Us scrotum and contents (76870) |
$5,015.62 |
$5,015.62 |
45.9× |
| Us soft tissue head/neck (76536) |
$3,995.77 |
$3,995.77 |
36.6× |
| Us spinal canal and contents (76800) |
$4,142.08 |
$4,142.08 |
37.9× |
| Us transrectal (76872) |
$7,585.28 |
$7,585.28 |
69.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$2,587.30 |
$2,587.30 |
23.7× |
| Venogram adrenal unilat (75840) |
$14,576.89 |
$14,576.89 |
4.4× |
| Venogram extremity bilateral (75822) |
$7,114.02 |
$7,114.02 |
4.3× |
| Venogram Extremity Unilateral (75820) |
$3,650.12 |
$3,650.12 |
2.2× |
| Venography caval inferior serialography rs&i (75825) |
$33,656.88 |
$33,656.88 |
10.2× |
| Venography caval superior serialography rs&i (75827) |
$23,006.88 |
$23,006.88 |
14.0× |
| Venography Renal Bilateral (75833) |
$30,059.19 |
$30,059.19 |
9.1× |
| Venography renal unilateral selective rs&i (75831) |
$14,576.89 |
$14,576.89 |
4.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$12,609.60 |
$12,609.60 |
3.8× |
| Venous sampling by catheter (75893) |
$9,082.63 |
$9,082.63 |
1.6× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$5,620.67 |
$5,620.67 |
9.9× |
| Wrist 2 views (73100) |
$2,206.99 |
$2,206.99 |
24.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$6,713.87 |
$6,713.87 |
61.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$2,932.36 |
$2,932.36 |
32.3× |
| X-ray b.e. reductn intuss (74283) |
$6,731.52 |
$6,731.52 |
36.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$5,930.96 |
$5,930.96 |
32.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$2,321.99 |
$2,321.99 |
25.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$2,808.52 |
$2,808.52 |
30.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$3,450.81 |
$3,450.81 |
31.6× |
| X-ray exam of femur 2/> (73552) |
$3,485.19 |
$3,485.19 |
38.3× |
| X-ray eye for foreign body (70030) |
$2,096.40 |
$2,096.40 |
23.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$2,321.99 |
$2,321.99 |
25.6× |
| X-ray IV pyelogram (ivp) (74400) |
$4,621.82 |
$4,621.82 |
25.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$2,260.05 |
$2,260.05 |
24.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$3,551.48 |
$3,551.48 |
39.1× |
| X-ray leg, infant (73592) |
$2,321.99 |
$2,321.99 |
25.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$4,206.09 |
$4,206.09 |
38.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$5,731.99 |
$5,731.99 |
52.5× |
| X-ray nose-rectum child f.b. (76010) |
$3,352.54 |
$3,352.54 |
36.9× |
| X-ray optic foramen (70190) |
$2,538.67 |
$2,538.67 |
27.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$2,715.60 |
$2,715.60 |
24.9× |
| X-ray retrograde pyelogram (74420) |
$4,966.81 |
$4,966.81 |
13.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$2,321.99 |
$2,321.99 |
25.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$3,839.01 |
$3,839.01 |
35.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$4,228.20 |
$4,228.20 |
38.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$2,450.26 |
$2,450.26 |
22.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$3,427.70 |
$3,427.70 |
37.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$4,776.67 |
$4,776.67 |
52.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$4,803.17 |
$4,803.17 |
44.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$2,476.77 |
$2,476.77 |
22.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$8,115.91 |
$8,115.91 |
44.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$3,440.94 |
$3,440.94 |
37.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$3,520.58 |
$3,520.58 |
38.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$2,715.60 |
$2,715.60 |
29.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$4,206.09 |
$4,206.09 |
38.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$5,749.62 |
$5,749.62 |
52.7× |
| Xr bone length studies (77073) |
$1,475.76 |
$1,475.76 |
13.5× |
| Xr c-spine 4 or 5 views (72050) |
$5,754.12 |
$5,754.12 |
52.7× |
| Xr c-spine 6 or more views (72052) |
$7,607.26 |
$7,607.26 |
69.7× |
| Xr chest 4+ views (71048) |
$3,989.40 |
$3,989.40 |
36.5× |
| Xr urogram antegrade (74425) |
$7,399.78 |
$7,399.78 |
20.3× |