| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,619.29 |
$1,619.29 |
1.1× |
| Abdomen 2 views (74019) |
$2,452.13 |
$2,452.13 |
22.5× |
| Acute gi blood loss imaging (78278) |
$4,391.73 |
$4,391.73 |
10.5× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$7,049.68 |
$7,049.68 |
5.2× |
| Angio Adrenal Bilat Select (75733) |
$7,700.42 |
$7,700.42 |
2.3× |
| Angiography extremity bilateral rs&i (75716) |
$12,668.12 |
$12,668.12 |
3.8× |
| Angiography extremity unilateral rs&i (75710) |
$18,137.91 |
$18,137.91 |
5.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$11,029.19 |
$11,029.19 |
1.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$9,442.88 |
$9,442.88 |
2.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$7,656.76 |
$7,656.76 |
2.3× |
| Angiography Spinal Selective Rs&I (75705) |
$11,029.19 |
$11,029.19 |
1.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$11,920.86 |
$11,920.86 |
2.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$12,303.34 |
$12,303.34 |
3.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$7,656.76 |
$7,656.76 |
2.3× |
| Ankle 2 views (73600) |
$1,471.89 |
$1,471.89 |
16.2× |
| Aortogram thoracic (75605) |
$7,966.97 |
$7,966.97 |
1.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$16,275.26 |
$16,275.26 |
4.9× |
| Aortography abdominal serialography rs&i (75625) |
$7,258.62 |
$7,258.62 |
2.2× |
| Artery X-Rays Adrenal Gland (75731) |
$7,569.97 |
$7,569.97 |
2.3× |
| Arthrogram ankle (73615) |
$3,623.79 |
$3,623.79 |
9.9× |
| Arthrogram elbow (73085) |
$2,829.54 |
$2,829.54 |
7.8× |
| Arthrogram hip (73525) |
$2,829.54 |
$2,829.54 |
7.8× |
| Arthrogram knee (73580) |
$2,829.54 |
$2,829.54 |
7.8× |
| Arthrogram shoulder (73040) |
$2,829.54 |
$2,829.54 |
7.8× |
| Arthrogram wrist (73115) |
$2,829.54 |
$2,829.54 |
7.8× |
| Basic dosimetry (77300) |
$1,447.60 |
$1,447.60 |
10.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$8,727.40 |
$8,727.40 |
20.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$9,050.45 |
$9,050.45 |
21.7× |
| Bone &/joint imaging whole body (78306) |
$10,419.64 |
$10,419.64 |
25.0× |
| Bone age studies (77072) |
$1,521.70 |
$1,521.70 |
13.9× |
| Bone Imaging 3 Phase (78315) |
$10,511.25 |
$10,511.25 |
25.2× |
| Bone Marrow Imaging Limited Area (78102) |
$3,627.84 |
$3,627.84 |
8.7× |
| Bone survey complete (77075) |
$4,181.60 |
$4,181.60 |
38.3× |
| Bone survey infant (77076) |
$2,544.04 |
$2,544.04 |
23.3× |
| Bowel imaging (78290) |
$8,566 |
$8,566 |
20.5× |
| Brachytx isodose complex (77318) |
$6,709.74 |
$6,709.74 |
17.2× |
| Brachytx isodose intermed (77317) |
$5,114.18 |
$5,114.18 |
13.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$5,681.65 |
$5,681.65 |
14.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$10,645.38 |
$10,645.38 |
18.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$23,930.08 |
$23,930.08 |
16.0× |
| Brain Imaging Vascular Flow Only (78610) |
$7,966.52 |
$7,966.52 |
14.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$7,747.64 |
$7,747.64 |
13.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$713 |
$713 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$13,800.57 |
$13,800.57 |
33.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$8,445.91 |
$8,445.91 |
14.9× |
| Cardiac shunt detection (78428) |
$1,599.62 |
$1,599.62 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$8,281.28 |
$8,281.28 |
14.6× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$6,035.82 |
$6,035.82 |
10.6× |
| Cervical spine 2 or 3 views (72040) |
$2,713.76 |
$2,713.76 |
29.9× |
| Chest 1 view (71045) |
$1,544.91 |
$1,544.91 |
17.0× |
| Chest xray 3 views (71047) |
$2,462.52 |
$2,462.52 |
27.1× |
| Cholecystography, oral contrast Non-Facility (74290) |
$3,446.23 |
$3,446.23 |
18.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$3,362.76 |
$3,362.76 |
18.4× |
| Clavicle complete (73000) |
$1,048.92 |
$1,048.92 |
11.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$10,883.16 |
$10,883.16 |
99.7× |
| Continuing medical physics consltj pr wk (77336) |
$595.75 |
$595.75 |
4.2× |
| Corpora cavernosography (74445) |
$1,328.77 |
$1,328.77 |
12.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$20,840.35 |
$20,840.35 |
57.2× |
| CT abdomen and pelvis without contrast (74176) |
$16,321.89 |
$16,321.89 |
65.5× |
| CT abdomen w contrast (74160) |
$10,883.16 |
$10,883.16 |
59.4× |
| CT abdomen w wo contrast (74170) |
$13,534.14 |
$13,534.14 |
73.9× |
| CT abdomen w/o contrast (74150) |
$10,009.59 |
$10,009.59 |
91.7× |
| CT angio hrt w/3d image (75574) |
$15,446.33 |
$15,446.33 |
42.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$9,688.10 |
$9,688.10 |
52.9× |
| CT angiography upper extremity lt (73206) |
$4,189.88 |
$4,189.88 |
22.9× |
| CT c-spine w/contrast (72126) |
$10,277.66 |
$10,277.66 |
28.2× |
| CT c-spine w/o contrast (72125) |
$9,148.55 |
$9,148.55 |
83.8× |
| CT cervical spine w&w/o contrast (72127) |
$11,174.67 |
$11,174.67 |
61.0× |
| CT chest w contrast (71260) |
$10,883.16 |
$10,883.16 |
59.4× |
| CT chest w/wo contrast (71270) |
$13,541.58 |
$13,541.58 |
73.9× |
| CT head/brain with contrast (70460) |
$10,589.87 |
$10,589.87 |
57.8× |
| CT head/brain without and with contrast (70470) |
$12,003.63 |
$12,003.63 |
65.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$15,116.56 |
$15,116.56 |
41.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$15,116.56 |
$15,116.56 |
166.3× |
| CT hrt w/3d image congen (75573) |
$16,563.36 |
$16,563.36 |
45.5× |
| CT iac w contrast (70481) |
$7,618.58 |
$7,618.58 |
41.6× |
| CT limited/localized follow up study (76380) |
$6,200.78 |
$6,200.78 |
68.2× |
| CT lower ext w/o (73700) |
$14,882.67 |
$14,882.67 |
136.3× |
| CT lower extremity w wo contrast (73702) |
$17,371.36 |
$17,371.36 |
94.8× |
| CT lower extremity w/contrast material (73701) |
$16,342.13 |
$16,342.13 |
89.2× |
| CT lumbar spine w & w/o contrast (72133) |
$13,560.68 |
$13,560.68 |
74.0× |
| CT lumbar spine w/contrast (72132) |
$10,277.66 |
$10,277.66 |
28.2× |
| CT lumbar spine w/o contrast (72131) |
$9,148.55 |
$9,148.55 |
83.8× |
| CT maxillofacial w contrast (70487) |
$10,634.84 |
$10,634.84 |
58.1× |
| CT maxillofacial w/wo contrast (70488) |
$11,088.04 |
$11,088.04 |
60.5× |
| CT maxillofacial wo contrast (70486) |
$9,020.77 |
$9,020.77 |
82.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$11,984.76 |
$11,984.76 |
65.4× |
| CT orbits w/o contrast (70480) |
$9,020.77 |
$9,020.77 |
82.6× |
| CT pelvis w/o contrast (72192) |
$9,968.21 |
$9,968.21 |
91.3× |
| CT pelvis w/wo contrast (72194) |
$11,974.19 |
$11,974.19 |
65.4× |
| CT scan of arm combo (73202) |
$9,643.67 |
$9,643.67 |
52.6× |
| CT soft tissue neck w contrast (70491) |
$10,022.07 |
$10,022.07 |
54.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$12,082.76 |
$12,082.76 |
66.0× |
| CT soft tissue neck w/o contrast (70490) |
$9,148.55 |
$9,148.55 |
83.8× |
| CT thoracic spine w/contrast (72129) |
$8,212.14 |
$8,212.14 |
44.8× |
| CT thoracic spine w/o contrast (72128) |
$7,485.07 |
$7,485.07 |
68.6× |
| CT thoracic spine w/wo contrast (72130) |
$14,166.19 |
$14,166.19 |
77.3× |
| CT thorax w/o contrast (71250) |
$10,009.59 |
$10,009.59 |
91.7× |
| CT unlisted procedure (76497) |
$3,949.26 |
$3,949.26 |
43.5× |
| CT upper ext wo (73200) |
$6,423.33 |
$6,423.33 |
58.8× |
| CT upper extremity with contrast (73201) |
$8,147.89 |
$8,147.89 |
22.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$7,368.39 |
$7,368.39 |
40.2× |
| Cta Abdomen (74175) |
$4,189.88 |
$4,189.88 |
22.9× |
| CTA abdomen pelvis (74174) |
$22,507.57 |
$22,507.57 |
61.8× |
| CTA chest (71275) |
$13,140.56 |
$13,140.56 |
71.7× |
| Cta Head (70496) |
$4,189.88 |
$4,189.88 |
22.9× |
| Cta Neck (70498) |
$4,189.88 |
$4,189.88 |
22.9× |
| Cta Pelvis (72191) |
$3,034.06 |
$3,034.06 |
16.6× |
| Cystography minimum 3 views rs&i (74430) |
$2,632.33 |
$2,632.33 |
7.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$5,203.70 |
$5,203.70 |
20.9× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$2,983.98 |
$2,983.98 |
5.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,641.61 |
$1,641.61 |
0.8× |
| Diskogram cervical (72285) |
$11,019.23 |
$11,019.23 |
5.4× |
| Diskography lumbar (72295) |
$10,263.68 |
$10,263.68 |
5.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$2,544.72 |
$2,544.72 |
23.3× |
| Esophagus (74220) |
$2,059.88 |
$2,059.88 |
11.2× |
| Facial bones min 3 views (70150) |
$3,356.62 |
$3,356.62 |
30.7× |
| Fetal biophysical profile non-stress testing (76818) |
$7,431.38 |
$7,431.38 |
68.1× |
| Fluoroscopy up to 1 hr (76000) |
$2,424.61 |
$2,424.61 |
9.7× |
| Foot 2 views (73620) |
$1,468.62 |
$1,468.62 |
16.2× |
| Forearm 2 views (73090) |
$1,540.91 |
$1,540.91 |
17.0× |
| Hand 2 views (73120) |
$1,461.71 |
$1,461.71 |
13.4× |
| Heart first pass single,planar (78481) |
$2,668.17 |
$2,668.17 |
4.7× |
| Heart Infarct Image (78466) |
$6,884.89 |
$6,884.89 |
16.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$9,742.24 |
$9,742.24 |
3.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$7,898.06 |
$7,898.06 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$13,217.11 |
$13,217.11 |
23.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$11,014.28 |
$11,014.28 |
26.4× |
| Hysterosalpingogram (74740) |
$2,831.18 |
$2,831.18 |
11.4× |
| Interstitial radiation source applic complex (77778) |
$4,762.84 |
$4,762.84 |
6.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$6,651.12 |
$6,651.12 |
11.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$5,924.25 |
$5,924.25 |
10.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$10,574.56 |
$10,574.56 |
18.6× |
| Knee 3 views (73562) |
$2,001.71 |
$2,001.71 |
22.0× |
| Liver & spleen imaging static only (78215) |
$10,472.89 |
$10,472.89 |
25.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$6,389.57 |
$6,389.57 |
15.3× |
| Liver imaging static only (78201) |
$11,553.75 |
$11,553.75 |
20.4× |
| Liver imaging w/vascular flow (78202) |
$5,496.74 |
$5,496.74 |
9.7× |
| Lung perf&ventilat diferentl (78598) |
$19,265.44 |
$19,265.44 |
34.0× |
| Lung perfusion differential (78597) |
$9,614.21 |
$9,614.21 |
23.0× |
| Lung ventilation imaging (78579) |
$11,905.36 |
$11,905.36 |
28.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,352.72 |
$4,352.72 |
1.3× |
| Lymphoscintigraphy (78195) |
$8,733.82 |
$8,733.82 |
15.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$25,656.88 |
$25,656.88 |
31.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$16,214.43 |
$16,214.43 |
44.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$19,843.35 |
$19,843.35 |
54.5× |
| Mammary ductogram or galactogram multiple (77054) |
$3,364.04 |
$3,364.04 |
13.5× |
| Mammary ductogram or galactogram single (77053) |
$2,516.83 |
$2,516.83 |
10.1× |
| MRA head w & w/o contrast (70546) |
$18,819.61 |
$18,819.61 |
51.7× |
| MRA head w/o contrast (70544) |
$18,819.61 |
$18,819.61 |
75.5× |
| MRA neck w contrast (70548) |
$18,819.61 |
$18,819.61 |
51.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$18,819.61 |
$18,819.61 |
51.7× |
| MRA neck w/o contrast (70547) |
$18,819.61 |
$18,819.61 |
75.5× |
| MRI abdomen w contrast (74182) |
$20,069.10 |
$20,069.10 |
55.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$22,864.20 |
$22,864.20 |
62.8× |
| MRI abdomen w/o contrast (74181) |
$18,023.51 |
$18,023.51 |
72.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$22,145.39 |
$22,145.39 |
27.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$25,800.12 |
$25,800.12 |
70.8× |
| MRI breast w/o contrast bilateral (77047) |
$18,037.21 |
$18,037.21 |
72.4× |
| MRI breast wo contrast unilateral (77046) |
$14,398.47 |
$14,398.47 |
57.8× |
| MRI c-spine with contrast (72142) |
$19,131.88 |
$19,131.88 |
52.5× |
| MRI cervical spine w/o contrast (72141) |
$16,635.48 |
$16,635.48 |
66.8× |
| MRI chest w/o & w/contrast material (71552) |
$22,555.71 |
$22,555.71 |
61.9× |
| MRI chest w/o contrast (71550) |
$17,714.91 |
$17,714.91 |
71.1× |
| MRI chest with contrast (71551) |
$17,714.91 |
$17,714.91 |
21.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$17,304.73 |
$17,304.73 |
47.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$22,145.39 |
$22,145.39 |
60.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$16,794.98 |
$16,794.98 |
67.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$23,057.10 |
$23,057.10 |
92.5× |
| MRI orbit face neck w contrast (70542) |
$18,216.42 |
$18,216.42 |
50.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$18,216.42 |
$18,216.42 |
50.0× |
| MRI pelvis w/contrast (72196) |
$23,258.17 |
$23,258.17 |
63.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$23,856.80 |
$23,856.80 |
65.5× |
| MRI pelvis w/o contrast (72195) |
$18,417.45 |
$18,417.45 |
73.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$27,342.37 |
$27,342.37 |
75.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$18,206.98 |
$18,206.98 |
50.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$25,822.15 |
$25,822.15 |
70.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$19,170.42 |
$19,170.42 |
52.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$27,405.68 |
$27,405.68 |
75.2× |
| MRI temporomandibular joint (70336) |
$17,714.91 |
$17,714.91 |
71.1× |
| MRI thoracic spine w/o contrast (72146) |
$16,674.04 |
$16,674.04 |
66.9× |
| MRI up ext w/o contrast (73218) |
$17,836.05 |
$17,836.05 |
71.6× |
| MRI upper ext joint w/o contrast (73221) |
$19,843.35 |
$19,843.35 |
79.6× |
| MRI, joint upper extrem combo (73223) |
$22,676.83 |
$22,676.83 |
62.2× |
| Myelogram Cervical (72240) |
$14,012.04 |
$14,012.04 |
17.1× |
| Myelogram Lumbar (72265) |
$14,012.04 |
$14,012.04 |
17.1× |
| Myelogram thoracic (72255) |
$14,012.04 |
$14,012.04 |
17.1× |
| Myelography 2 or more regions (72270) |
$19,930.10 |
$19,930.10 |
24.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$23,930.08 |
$23,930.08 |
17.7× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$713 |
$713 |
1.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$25,322.56 |
$25,322.56 |
17.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$25,322.56 |
$25,322.56 |
17.0× |
| Myocardial infarct spect (78469) |
$13,311.55 |
$13,311.55 |
23.5× |
| Myocardial Spect Multiple Studies (78452) |
$23,662.20 |
$23,662.20 |
17.5× |
| Myocardial spect single study at rest or stress (78451) |
$12,671.01 |
$12,671.01 |
9.4× |
| Neck soft tissue (70360) |
$1,833.29 |
$1,833.29 |
20.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$8,733.82 |
$8,733.82 |
20.9× |
| Nm bone marrow multi (78103) |
$8,090.70 |
$8,090.70 |
19.4× |
| Nm bone marrow wb (78104) |
$8,090.70 |
$8,090.70 |
19.4× |
| Nm cardiac blood pool multiple (78473) |
$10,338.69 |
$10,338.69 |
24.8× |
| Nm cisternogram (78630) |
$12,130.20 |
$12,130.20 |
21.4× |
| Nm csf leak detection (78650) |
$8,282.68 |
$8,282.68 |
6.1× |
| Nm gastric emptying study (78264) |
$8,071.14 |
$8,071.14 |
19.3× |
| Nm gastroesophageal reflux study (78262) |
$5,318.52 |
$5,318.52 |
12.7× |
| Nm kidney scan w/flow (78701) |
$2,428.23 |
$2,428.23 |
5.8× |
| Nm peritoneal-venous shunt patency (78291) |
$8,532.33 |
$8,532.33 |
20.4× |
| Noncardiac Vascular Flow Imaging (78445) |
$4,471.17 |
$4,471.17 |
10.7× |
| Nonvascular shunt X-ray (75809) |
$5,348.78 |
$5,348.78 |
49.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$6,447.93 |
$6,447.93 |
15.4× |
| Nuclear Rx Oral Admin (79005) |
$15,289.56 |
$15,289.56 |
62.7× |
| Parathyroid Planar Imaging (78070) |
$6,144.04 |
$6,144.04 |
14.7× |
| Pelvis 1 or 2 views (72170) |
$1,678.36 |
$1,678.36 |
15.4× |
| PET image w/CT, skull-thigh (78815) |
$23,425.88 |
$23,425.88 |
15.7× |
| PET imaging CT for attenuation limited area (78814) |
$23,425.88 |
$23,425.88 |
15.7× |
| PET imaging for CT attenuation whole body (78816) |
$23,425.88 |
$23,425.88 |
15.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$23,425.88 |
$23,425.88 |
17.3× |
| PET whole body (78813) |
$24,090.02 |
$24,090.02 |
16.1× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$23,425.88 |
$23,425.88 |
15.7× |
| Proton tx delivery intermediate (77523) |
$1,948.32 |
$1,948.32 |
1.5× |
| Proton tx delivery simple w/o compensation (77520) |
$1,156.03 |
$1,156.03 |
2.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$10,485.99 |
$10,485.99 |
3.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$14,342.11 |
$14,342.11 |
4.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$9,614.21 |
$9,614.21 |
23.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$18,386.98 |
$18,386.98 |
32.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$996.88 |
$996.88 |
1.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$1,613.01 |
$1,613.01 |
17.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$1,441.15 |
$1,441.15 |
15.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$1,678.36 |
$1,678.36 |
18.5× |
| Radex fingr minimum 2 views (73140) |
$1,540.91 |
$1,540.91 |
17.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$1,702.50 |
$1,702.50 |
18.7× |
| Radex Hand Minimum 3 Views (73130) |
$1,692.08 |
$1,692.08 |
18.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$1,857.24 |
$1,857.24 |
20.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$2,034.12 |
$2,034.12 |
18.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$3,811.46 |
$3,811.46 |
34.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$4,284.68 |
$4,284.68 |
39.2× |
| Radex Humerus Minimum 2 Views (73060) |
$1,506.46 |
$1,506.46 |
16.6× |
| Radex Kne 1/2 Views (73560) |
$2,001.71 |
$2,001.71 |
22.0× |
| Radex Kne Compl 4/More Views (73564) |
$2,210.49 |
$2,210.49 |
20.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$2,232.21 |
$2,232.21 |
20.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$1,585.65 |
$1,585.65 |
17.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$1,678.36 |
$1,678.36 |
15.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$1,647.54 |
$1,647.54 |
18.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$2,742.15 |
$2,742.15 |
30.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$2,479.90 |
$2,479.90 |
27.3× |
| Radex Toe Minimum 2 Views (73660) |
$1,506.46 |
$1,506.46 |
16.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$1,645.35 |
$1,645.35 |
15.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$1,674.90 |
$1,674.90 |
18.4× |
| Radiation treatment delivery level 1 (77402) |
$649.11 |
$649.11 |
6.1× |
| Radiation treatment delivery level 2 (77407) |
$649.11 |
$649.11 |
1.6× |
| Radiation treatment delivery level 3 (77412) |
$667.71 |
$667.71 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$1,678.36 |
$1,678.36 |
18.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$2,737.59 |
$2,737.59 |
25.1× |
| Radiologic exam chest 2 views (71046) |
$1,960.56 |
$1,960.56 |
21.6× |
| Radiologic exam colon single contrast study (74270) |
$3,576.90 |
$3,576.90 |
19.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$2,398.29 |
$2,398.29 |
13.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$3,906.93 |
$3,906.93 |
21.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$3,906.93 |
$3,906.93 |
21.3× |
| Radiologic examination femur 1 view (73551) |
$1,486.61 |
$1,486.61 |
16.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$1,509.79 |
$1,509.79 |
16.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,260.18 |
$1,260.18 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$3,013.89 |
$3,013.89 |
27.6× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$5,668.15 |
$5,668.15 |
22.7× |
| Radiological examination surgical specimen (76098) |
$808.23 |
$808.23 |
1.4× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$15,557.74 |
$15,557.74 |
63.8× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$16,824.63 |
$16,824.63 |
69.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$15,295.04 |
$15,295.04 |
62.8× |
| Renal Cyst Study (74470) |
$7,000.88 |
$7,000.88 |
12.3× |
| Ribs bilateral 3 views (71110) |
$2,188.67 |
$2,188.67 |
20.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$8,474.79 |
$8,474.79 |
20.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$8,733.82 |
$8,733.82 |
20.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$6,165.18 |
$6,165.18 |
10.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,981.03 |
$4,981.03 |
8.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$9,501.57 |
$9,501.57 |
16.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$16,824.63 |
$16,824.63 |
69.0× |
| Rp Therapy Intravenous Administration (79101) |
$8,986.29 |
$8,986.29 |
36.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$4,906.47 |
$4,906.47 |
19.7× |
| Salivary gland function study (78232) |
$8,877.87 |
$8,877.87 |
21.3× |
| Scapula (73010) |
$1,630.39 |
$1,630.39 |
14.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$88.22 |
$88.22 |
3.8× |
| Shoulder 1 view (73020) |
$1,537.28 |
$1,537.28 |
16.9× |
| Sialogram (70390) |
$681.69 |
$681.69 |
2.7× |
| Simulation intermediate (77285) |
$817.27 |
$817.27 |
2.1× |
| Small bowel series (74250) |
$3,700.54 |
$3,700.54 |
20.2× |
| Special dosimetry (77331) |
$1,651.52 |
$1,651.52 |
11.8× |
| Special Physics Consult (77370) |
$1,414.89 |
$1,414.89 |
10.1× |
| Special treatment procedure (77470) |
$2,737.84 |
$2,737.84 |
4.7× |
| Spine thoracic 3 views (72072) |
$2,177.15 |
$2,177.15 |
19.9× |
| Splenoportograpy rs&i (75810) |
$11,079.77 |
$11,079.77 |
3.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$609.49 |
$609.49 |
1.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$609.49 |
$609.49 |
1.6× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$2,035.29 |
$2,035.29 |
8.2× |
| Testicular Imaging With Vascular Flow (78761) |
$5,753.13 |
$5,753.13 |
13.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,941.04 |
$1,941.04 |
5.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$609.49 |
$609.49 |
4.3× |
| Thoracolumbar 2 views (72080) |
$2,177.15 |
$2,177.15 |
24.0× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$5,740.33 |
$5,740.33 |
13.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$9,169.71 |
$9,169.71 |
16.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$8,631.36 |
$8,631.36 |
20.7× |
| Tomogram (76100) |
$2,818.52 |
$2,818.52 |
25.8× |
| Treatment device complex (77334) |
$717.84 |
$717.84 |
1.8× |
| Treatment device intermediate (77333) |
$717.84 |
$717.84 |
5.1× |
| Treatment devices simple (77332) |
$717.84 |
$717.84 |
5.1× |
| Ultrasound breast complete (76641) |
$4,468.33 |
$4,468.33 |
40.9× |
| Ultrasound Exam Aaa Screen (76706) |
$5,990.13 |
$5,990.13 |
54.9× |
| Ultrasound, abdomen limited (76705) |
$4,440.13 |
$4,440.13 |
40.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$8,953.55 |
$8,953.55 |
98.5× |
| Unlisted ultrasound procedure (76999) |
$4,141.24 |
$4,141.24 |
45.6× |
| Urethrocystogram voiding (74455) |
$2,707 |
$2,707 |
10.9× |
| Urethrocystography retrograde rs&i (74450) |
$2,707.87 |
$2,707.87 |
10.9× |
| Us breast unilateral limited (76642) |
$4,078.10 |
$4,078.10 |
44.9× |
| Us chest (76604) |
$3,984.42 |
$3,984.42 |
36.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$12,964.35 |
$12,964.35 |
57.5× |
| Us compl joint r-t w/image documentation (76881) |
$11,147.07 |
$11,147.07 |
102.1× |
| Us encephalogram (76506) |
$7,431.38 |
$7,431.38 |
68.1× |
| Us hips infant static (76886) |
$6,439.50 |
$6,439.50 |
70.9× |
| Us infant hips w manipulation (76885) |
$7,540.13 |
$7,540.13 |
83.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$7,431.38 |
$7,431.38 |
68.1× |
| Us ob limited (76815) |
$3,797.59 |
$3,797.59 |
34.8× |
| Us ob transvaginal (76817) |
$4,477.15 |
$4,477.15 |
41.0× |
| Us pelvic non ob complete (76856) |
$5,418.75 |
$5,418.75 |
49.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$4,647.81 |
$4,647.81 |
42.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$5,587.34 |
$5,587.34 |
51.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$6,329.27 |
$6,329.27 |
58.0× |
| Us retroperitoneal complete (76770) |
$4,911.38 |
$4,911.38 |
45.0× |
| Us retroperitoneal limited (76775) |
$5,899 |
$5,899 |
54.0× |
| Us scrotum and contents (76870) |
$4,656.10 |
$4,656.10 |
42.6× |
| Us soft tissue head/neck (76536) |
$4,473.26 |
$4,473.26 |
41.0× |
| Us spinal canal and contents (76800) |
$7,431.38 |
$7,431.38 |
68.1× |
| Us transrectal (76872) |
$4,170.87 |
$4,170.87 |
38.2× |
| Us transrectal prostate volume (76873) |
$9,851.92 |
$9,851.92 |
90.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$9,945.66 |
$9,945.66 |
91.1× |
| Venogram extremity bilateral (75822) |
$1,927.38 |
$1,927.38 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$3,542.28 |
$3,542.28 |
2.2× |
| Venography caval inferior serialography rs&i (75825) |
$8,463.56 |
$8,463.56 |
2.6× |
| Venography caval superior serialography rs&i (75827) |
$9,227.50 |
$9,227.50 |
5.6× |
| Venography Renal Bilateral (75833) |
$5,321.71 |
$5,321.71 |
1.6× |
| Venography renal unilateral selective rs&i (75831) |
$7,165.88 |
$7,165.88 |
2.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,746.57 |
$8,746.57 |
2.7× |
| Venous sampling by catheter (75893) |
$5,589.18 |
$5,589.18 |
1.0× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$4,409.74 |
$4,409.74 |
7.8× |
| Wrist 2 views (73100) |
$1,513.29 |
$1,513.29 |
16.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$2,472.88 |
$2,472.88 |
22.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$1,279.37 |
$1,279.37 |
14.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$4,835.79 |
$4,835.79 |
26.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$1,080.08 |
$1,080.08 |
11.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$1,915.83 |
$1,915.83 |
21.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$4,048.07 |
$4,048.07 |
37.1× |
| X-ray exam of femur 2/> (73552) |
$1,723.24 |
$1,723.24 |
19.0× |
| X-ray eye for foreign body (70030) |
$2,049.91 |
$2,049.91 |
22.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$2,479.90 |
$2,479.90 |
27.3× |
| X-ray IV pyelogram (ivp) (74400) |
$3,879.60 |
$3,879.60 |
21.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$1,441.15 |
$1,441.15 |
15.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$2,001.71 |
$2,001.71 |
22.0× |
| X-ray leg, infant (73592) |
$1,855.54 |
$1,855.54 |
20.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,606.12 |
$1,606.12 |
14.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,607.68 |
$1,607.68 |
14.7× |
| X-ray nose-rectum child f.b. (76010) |
$4,814.96 |
$4,814.96 |
53.0× |
| X-ray optic foramen (70190) |
$1,516.77 |
$1,516.77 |
16.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$3,322.29 |
$3,322.29 |
30.4× |
| X-ray retrograde pyelogram (74420) |
$2,785.90 |
$2,785.90 |
7.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$2,297.47 |
$2,297.47 |
25.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$2,297.47 |
$2,297.47 |
21.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$3,270.64 |
$3,270.64 |
30.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$2,101 |
$2,101 |
19.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,671.60 |
$1,671.60 |
18.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$2,933.84 |
$2,933.84 |
32.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$2,672.29 |
$2,672.29 |
24.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$1,537.28 |
$1,537.28 |
14.1× |
| X-Ray Small Bowel Enteroclysis (74251) |
$4,058.31 |
$4,058.31 |
22.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$2,125.72 |
$2,125.72 |
23.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$1,702.50 |
$1,702.50 |
18.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$2,084.29 |
$2,084.29 |
22.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$1,607.08 |
$1,607.08 |
14.7× |
| Xr c-spine 4 or 5 views (72050) |
$3,074.82 |
$3,074.82 |
28.2× |
| Xr c-spine 6 or more views (72052) |
$3,416.59 |
$3,416.59 |
31.3× |
| Xr chest 4+ views (71048) |
$2,561.65 |
$2,561.65 |
23.5× |
| Xr urogram antegrade (74425) |
$3,704.82 |
$3,704.82 |
10.2× |