| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,304.90 |
$5,122 |
1.6× |
| Abdomen 2 views (74019) |
$126.90 |
$282 |
1.2× |
| Acute gi blood loss imaging (78278) |
$565.65 |
$1,257 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$3,066.30 |
$6,814 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,924.10 |
$6,498 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$2,786.85 |
$6,193 |
0.8× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,909.70 |
$6,466 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,657.15 |
$8,127 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,607.30 |
$5,794 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$4,973.85 |
$11,053 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,973.85 |
$11,053 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,155.95 |
$4,791 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,786.85 |
$6,193 |
0.8× |
| Ankle 2 views (73600) |
$126.90 |
$282 |
1.4× |
| Aortogram thoracic (75605) |
$3,654.90 |
$8,122 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,087.45 |
$6,861 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$3,070.80 |
$6,824 |
0.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,101.85 |
$6,893 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,392.65 |
$5,317 |
0.7× |
| Arthrogram ankle (73615) |
$357.30 |
$794 |
1.0× |
| Arthrogram elbow (73085) |
$406.80 |
$904 |
1.1× |
| Arthrogram hip (73525) |
$373.95 |
$831 |
1.0× |
| Arthrogram knee (73580) |
$352.35 |
$783 |
1.0× |
| Arthrogram shoulder (73040) |
$373.95 |
$831 |
1.0× |
| Arthrogram wrist (73115) |
$373.95 |
$831 |
1.0× |
| Basic dosimetry (77300) |
$220.95 |
$491 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$515.25 |
$1,145 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$1,054.35 |
$2,343 |
2.5× |
| Bone age studies (77072) |
$126.90 |
$282 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$1,005.30 |
$2,234 |
2.4× |
| Bone survey complete (77075) |
$234 |
$520 |
2.1× |
| Bone survey infant (77076) |
$169.65 |
$377 |
1.5× |
| Bowel imaging (78290) |
$514.80 |
$1,144 |
1.2× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$360.45 |
$801 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,858.95 |
$4,131 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$609.75 |
$1,355 |
1.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$907.65 |
$2,017 |
2.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$786.15 |
$1,747 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$126.90 |
$282 |
1.4× |
| Chest 1 view (71045) |
$102.15 |
$227 |
1.1× |
| Chest xray 3 views (71047) |
$88.65 |
$197 |
1.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$196.20 |
$436 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$187.20 |
$416 |
1.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$737.55 |
$1,639 |
0.9× |
| Clavicle complete (73000) |
$128.25 |
$285 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$96.30 |
$214 |
0.9× |
| Continuing medical physics consltj pr wk (77336) |
$375.75 |
$835 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,007.55 |
$2,239 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$604.80 |
$1,344 |
2.4× |
| CT abdomen w contrast (74160) |
$604.80 |
$1,344 |
3.3× |
| CT abdomen w wo contrast (74170) |
$646.65 |
$1,437 |
3.5× |
| CT abdomen w/o contrast (74150) |
$425.70 |
$946 |
3.9× |
| CT angio hrt w/3d image (75574) |
$721.35 |
$1,603 |
2.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$531.90 |
$1,182 |
2.9× |
| CT angiography upper extremity lt (73206) |
$629.55 |
$1,399 |
3.4× |
| CT c-spine w/contrast (72126) |
$504.90 |
$1,122 |
1.4× |
| CT c-spine w/o contrast (72125) |
$432 |
$960 |
3.9× |
| CT cervical spine w&w/o contrast (72127) |
$462.15 |
$1,027 |
2.5× |
| CT chest w contrast (71260) |
$482.40 |
$1,072 |
2.6× |
| CT chest w/wo contrast (71270) |
$604.80 |
$1,344 |
3.3× |
| CT colonography w/o cntrst (74261) |
$247.95 |
$551 |
2.3× |
| CT head/brain with contrast (70460) |
$604.80 |
$1,344 |
3.3× |
| CT head/brain without and with contrast (70470) |
$581.85 |
$1,293 |
3.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$452.25 |
$1,005 |
1.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$31.50 |
$70 |
0.3× |
| CT iac w contrast (70481) |
$604.80 |
$1,344 |
3.3× |
| CT limited/localized follow up study (76380) |
$414 |
$920 |
4.5× |
| CT lower ext w/o (73700) |
$425.70 |
$946 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$191.70 |
$426 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$531.90 |
$1,182 |
2.9× |
| CT lumbar spine w & w/o contrast (72133) |
$467.55 |
$1,039 |
2.5× |
| CT lumbar spine w/contrast (72132) |
$604.80 |
$1,344 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$425.70 |
$946 |
3.9× |
| CT maxillofacial w contrast (70487) |
$490.05 |
$1,089 |
2.7× |
| CT maxillofacial w/wo contrast (70488) |
$581.40 |
$1,292 |
3.2× |
| CT maxillofacial wo contrast (70486) |
$425.70 |
$946 |
3.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$494.10 |
$1,098 |
2.7× |
| CT orbits w/o contrast (70480) |
$425.70 |
$946 |
3.9× |
| CT pelvis w/o contrast (72192) |
$474.75 |
$1,055 |
4.3× |
| CT pelvis w/wo contrast (72194) |
$629.55 |
$1,399 |
3.4× |
| CT scan of arm combo (73202) |
$71.10 |
$158 |
0.4× |
| CT soft tissue neck w contrast (70491) |
$423.45 |
$941 |
2.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$604.80 |
$1,344 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$425.70 |
$946 |
3.9× |
| CT thoracic spine w/contrast (72129) |
$604.80 |
$1,344 |
3.3× |
| CT thoracic spine w/o contrast (72128) |
$407.70 |
$906 |
3.7× |
| CT thoracic spine w/wo contrast (72130) |
$194.85 |
$433 |
1.1× |
| CT thorax w/o contrast (71250) |
$425.70 |
$946 |
3.9× |
| CT unlisted procedure (76497) |
$414 |
$920 |
4.5× |
| CT upper ext wo (73200) |
$425.70 |
$946 |
3.9× |
| CT upper extremity with contrast (73201) |
$493.20 |
$1,096 |
1.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$806.40 |
$1,792 |
4.4× |
| Cta Abdomen (74175) |
$806.40 |
$1,792 |
4.4× |
| CTA abdomen pelvis (74174) |
$552.15 |
$1,227 |
1.5× |
| CTA chest (71275) |
$649.80 |
$1,444 |
3.5× |
| Cta Head (70496) |
$806.40 |
$1,792 |
4.4× |
| Cta Neck (70498) |
$604.80 |
$1,344 |
3.3× |
| Cta Pelvis (72191) |
$452.25 |
$1,005 |
2.5× |
| Cystography minimum 3 views rs&i (74430) |
$460.80 |
$1,024 |
1.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,716.75 |
$3,815 |
0.8× |
| Diskography lumbar (72295) |
$2,377.80 |
$5,284 |
1.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$249.75 |
$555 |
2.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$176.85 |
$393 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$152.55 |
$339 |
1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$81.90 |
$182 |
0.9× |
| Dxa bone density study axial skeleton (77085) |
$190.80 |
$424 |
1.7× |
| Echo exam of eye (76529) |
$79.65 |
$177 |
0.9× |
| Esophagus (74220) |
$188.10 |
$418 |
1.0× |
| Facial bones min 3 views (70150) |
$165.60 |
$368 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$280.80 |
$624 |
2.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$262.80 |
$584 |
2.4× |
| Fetal Echo (76825) |
$638.55 |
$1,419 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$256.05 |
$569 |
1.0× |
| Foot 2 views (73620) |
$132.75 |
$295 |
1.5× |
| Forearm 2 views (73090) |
$126.90 |
$282 |
1.4× |
| Functional MRI brain by phys/psych (70555) |
$499.95 |
$1,111 |
2.0× |
| Functional MRI brain by tech (70554) |
$544.05 |
$1,209 |
2.2× |
| Hand 2 views (73120) |
$144.90 |
$322 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$853.20 |
$1,896 |
1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,087.45 |
$6,861 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,087.45 |
$6,861 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$793.80 |
$1,764 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$490.95 |
$1,091 |
1.2× |
| Hysterosalpingogram (74740) |
$335.25 |
$745 |
1.3× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$409.05 |
$909 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$682.20 |
$1,516 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,217.70 |
$2,706 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$643.50 |
$1,430 |
1.1× |
| Knee 3 views (73562) |
$126.90 |
$282 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$462.15 |
$1,027 |
0.8× |
| Lung perfusion differential (78597) |
$490.50 |
$1,090 |
1.2× |
| Lymphoscintigraphy (78195) |
$647.10 |
$1,438 |
1.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$724.05 |
$1,609 |
0.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$361.35 |
$803 |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$922.05 |
$2,049 |
2.5× |
| Magnetic Resonance Elastography (76391) |
$163.35 |
$363 |
0.7× |
| Mammary ductogram or galactogram multiple (77054) |
$496.35 |
$1,103 |
2.0× |
| Mammary ductogram or galactogram single (77053) |
$496.35 |
$1,103 |
2.0× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$133.65 |
$297 |
0.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$562.50 |
$1,250 |
1.4× |
| Mr safety determination physician/other qhp (76016) |
$99.90 |
$222 |
1.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$32.40 |
$72 |
1.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$106.20 |
$236 |
1.1× |
| Mr safety implt pos&/immoblj (76019) |
$67.05 |
$149 |
1.1× |
| Mr safety med physics xm customization plng&mntr (76017) |
$269.55 |
$599 |
1.1× |
| MRA head w & w/o contrast (70546) |
$1,046.25 |
$2,325 |
2.9× |
| MRA head w/o contrast (70544) |
$697.50 |
$1,550 |
2.8× |
| MRA head with contrast (70545) |
$872.10 |
$1,938 |
2.4× |
| MRA neck w contrast (70548) |
$812.70 |
$1,806 |
2.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,341.90 |
$2,982 |
3.7× |
| MRA neck w/o contrast (70547) |
$625.95 |
$1,391 |
2.5× |
| MRI abdomen w contrast (74182) |
$973.80 |
$2,164 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,308.15 |
$2,907 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$576.90 |
$1,282 |
2.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$904.95 |
$2,011 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,220.85 |
$2,713 |
3.3× |
| MRI breast w/o contrast bilateral (77047) |
$214.20 |
$476 |
0.9× |
| MRI breast wo contrast unilateral (77046) |
$261.90 |
$582 |
1.0× |
| MRI c-spine with contrast (72142) |
$900 |
$2,000 |
2.5× |
| MRI cardiac w/o contrast (75557) |
$820.80 |
$1,824 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$700.20 |
$1,556 |
2.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,133.55 |
$2,519 |
3.1× |
| MRI chest w/o contrast (71550) |
$801.45 |
$1,781 |
3.2× |
| MRI chest with contrast (71551) |
$598.05 |
$1,329 |
0.7× |
| MRI fetal sngl/1st gestation (74712) |
$269.55 |
$599 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$548.10 |
$1,218 |
1.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,066.05 |
$2,369 |
2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,046.25 |
$2,325 |
4.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$758.70 |
$1,686 |
3.0× |
| MRI orbit face neck w contrast (70542) |
$481.05 |
$1,069 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,395.45 |
$3,101 |
3.8× |
| MRI pelvis w/contrast (72196) |
$959.40 |
$2,132 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,220.85 |
$2,713 |
3.3× |
| MRI pelvis w/o contrast (72195) |
$872.10 |
$1,938 |
3.5× |
| MRI spectroscopy (76390) |
$544.50 |
$1,210 |
6.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,187.10 |
$2,638 |
3.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$697.50 |
$1,550 |
1.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,187.10 |
$2,638 |
3.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$548.10 |
$1,218 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,177.65 |
$2,617 |
3.2× |
| MRI temporomandibular joint (70336) |
$625.95 |
$1,391 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$593.10 |
$1,318 |
2.4× |
| MRI up ext w/o contrast (73218) |
$1,046.25 |
$2,325 |
4.2× |
| MRI upper ext joint w/o contrast (73221) |
$872.10 |
$1,938 |
3.5× |
| MRI, joint upper extrem combo (73223) |
$1,026.45 |
$2,281 |
2.8× |
| Myelogram Cervical (72240) |
$700.20 |
$1,556 |
0.9× |
| Myelogram Lumbar (72265) |
$715.95 |
$1,591 |
0.9× |
| Myelogram thoracic (72255) |
$715.95 |
$1,591 |
0.9× |
| Myelography 2 or more regions (72270) |
$715.95 |
$1,591 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,637.10 |
$3,638 |
1.2× |
| Myocardial spect single study at rest or stress (78451) |
$1,637.10 |
$3,638 |
1.2× |
| Neck soft tissue (70360) |
$126.90 |
$282 |
1.4× |
| Nm cisternogram (78630) |
$763.20 |
$1,696 |
1.3× |
| Nm csf leak detection (78650) |
$848.25 |
$1,885 |
0.6× |
| Nm gastric emptying study (78264) |
$1,246.95 |
$2,771 |
3.0× |
| Nm gastroesophageal reflux study (78262) |
$626.85 |
$1,393 |
1.5× |
| Nm peritoneal-venous shunt patency (78291) |
$555.75 |
$1,235 |
1.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$490.95 |
$1,091 |
1.2× |
| Nonvascular shunt X-ray (75809) |
$219.15 |
$487 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,771.65 |
$3,937 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$923.40 |
$2,052 |
3.8× |
| Ob us nuchal meas 1 gest (76813) |
$262.80 |
$584 |
2.4× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$96.30 |
$214 |
0.9× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$26.10 |
$58 |
0.9× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$96.30 |
$214 |
0.9× |
| Orthopantogram (70355) |
$176.40 |
$392 |
1.9× |
| Osseous survey limited (77074) |
$184.50 |
$410 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$817.65 |
$1,817 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$657 |
$1,460 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$128.25 |
$285 |
1.2× |
| Peritoneogram after injection (74190) |
$821.25 |
$1,825 |
1.4× |
| PET image w/CT, skull-thigh (78815) |
$1,859.85 |
$4,133 |
1.2× |
| PET imaging CT for attenuation limited area (78814) |
$2,455.20 |
$5,456 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,827.80 |
$6,284 |
1.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,241.55 |
$2,759 |
0.9× |
| PET whole body (78813) |
$2,735.55 |
$6,079 |
1.8× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$1,805.40 |
$4,012 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,087.45 |
$6,861 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,319.85 |
$2,933 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$546.75 |
$1,215 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$611.55 |
$1,359 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$480.15 |
$1,067 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$126.90 |
$282 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$120.15 |
$267 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$128.25 |
$285 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$138.15 |
$307 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$149.85 |
$333 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$126.90 |
$282 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$126.90 |
$282 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$126.90 |
$282 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$102.15 |
$227 |
1.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$126.90 |
$282 |
1.2× |
| Radex Humerus Minimum 2 Views (73060) |
$126.90 |
$282 |
1.4× |
| Radex Kne 1/2 Views (73560) |
$126.90 |
$282 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$126.90 |
$282 |
1.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$137.70 |
$306 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$123.75 |
$275 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$131.85 |
$293 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$126.90 |
$282 |
1.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$126.90 |
$282 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$165.60 |
$368 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$126.90 |
$282 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$126.90 |
$282 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$126.90 |
$282 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$126.90 |
$282 |
1.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$5,000.85 |
$11,113 |
0.6× |
| Radiation treatment delivery level 1 (77402) |
$366.75 |
$815 |
3.4× |
| Radiation treatment delivery level 2 (77407) |
$234.90 |
$522 |
0.6× |
| Radiation treatment delivery level 3 (77412) |
$370.35 |
$823 |
0.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$126.90 |
$282 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$138.15 |
$307 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$126.90 |
$282 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$243.45 |
$541 |
1.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$160.65 |
$357 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$180.45 |
$401 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$182.25 |
$405 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$126.90 |
$282 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$126.90 |
$282 |
1.4× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$138.15 |
$307 |
1.5× |
| Radiological examination surgical specimen (76098) |
$453.15 |
$1,007 |
0.8× |
| Ribs bilateral 3 views (71110) |
$148.95 |
$331 |
1.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$545.85 |
$1,213 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,876.05 |
$4,169 |
3.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$932.40 |
$2,072 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,898.10 |
$4,218 |
3.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,833.75 |
$4,075 |
1.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$107.55 |
$239 |
0.4× |
| Rp Therapy Intravenous Administration (79101) |
$407.25 |
$905 |
1.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$271.35 |
$603 |
1.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$721.35 |
$1,603 |
1.7× |
| Scapula (73010) |
$120.15 |
$267 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$28.35 |
$63 |
1.2× |
| Shoulder 1 view (73020) |
$146.70 |
$326 |
1.6× |
| Sialogram (70390) |
$220.50 |
$490 |
0.9× |
| Simulation intermediate (77285) |
$455.85 |
$1,013 |
1.2× |
| Small bowel series (74250) |
$225.45 |
$501 |
1.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$472.50 |
$1,050 |
1.2× |
| Special dosimetry (77331) |
$238.50 |
$530 |
1.7× |
| Special Physics Consult (77370) |
$379.80 |
$844 |
2.7× |
| Special treatment procedure (77470) |
$1,323.90 |
$2,942 |
2.3× |
| Speech evaluation complex (70371) |
$220.50 |
$490 |
0.9× |
| Spine thoracic 3 views (72072) |
$126.90 |
$282 |
1.2× |
| Splenoportograpy rs&i (75810) |
$2,806.65 |
$6,237 |
0.8× |
| Stereotactic Body Radiation Delivery (77373) |
$2,188.35 |
$4,863 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$2,786.85 |
$6,193 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$512.55 |
$1,139 |
1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$357.30 |
$794 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$694.35 |
$1,543 |
1.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$416.70 |
$926 |
3.0× |
| Thoracolumbar 2 views (72080) |
$142.20 |
$316 |
1.6× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$548.55 |
$1,219 |
1.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,227.15 |
$2,727 |
2.2× |
| Thyroid imaging w/blood flow (78013) |
$366.75 |
$815 |
0.9× |
| Thyroid uptake measurement (78012) |
$526.05 |
$1,169 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$612.45 |
$1,361 |
1.5× |
| Tmj unilateral (70328) |
$138.15 |
$307 |
1.5× |
| Treatment device complex (77334) |
$450 |
$1,000 |
1.1× |
| Treatment devices simple (77332) |
$391.50 |
$870 |
2.8× |
| Ultrasound breast complete (76641) |
$262.80 |
$584 |
2.4× |
| Ultrasound elastography first target lesion (76982) |
$104.85 |
$233 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$262.80 |
$584 |
2.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$187.65 |
$417 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$262.80 |
$584 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$172.80 |
$384 |
1.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$318.60 |
$708 |
3.5× |
| Unlisted fluoroscopic procedure (76496) |
$79.65 |
$177 |
0.9× |
| Unlisted magnetic resonance procedure (76498) |
$763.65 |
$1,697 |
8.4× |
| Ureteral reflux study (78740) |
$597.15 |
$1,327 |
1.4× |
| Urethrocystogram voiding (74455) |
$360.45 |
$801 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$315.90 |
$702 |
1.3× |
| Us breast unilateral limited (76642) |
$242.55 |
$539 |
2.7× |
| Us chest (76604) |
$262.80 |
$584 |
2.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$269.55 |
$599 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$178.42 |
$396.50 |
1.6× |
| Us elastography parenchyma (76981) |
$104.85 |
$233 |
1.0× |
| Us encephalogram (76506) |
$262.80 |
$584 |
2.4× |
| Us infant hips w manipulation (76885) |
$211.05 |
$469 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$262.80 |
$584 |
2.4× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$96.30 |
$214 |
0.9× |
| Us ob detailed single fetus (76811) |
$319.05 |
$709 |
1.3× |
| Us ob limited (76815) |
$262.80 |
$584 |
2.4× |
| Us ob transvaginal (76817) |
$262.80 |
$584 |
2.4× |
| Us pelvic non ob complete (76856) |
$283.05 |
$629 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$262.80 |
$584 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$262.80 |
$584 |
2.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$262.80 |
$584 |
2.4× |
| Us retroperitoneal complete (76770) |
$262.80 |
$584 |
2.4× |
| Us retroperitoneal limited (76775) |
$262.80 |
$584 |
2.4× |
| Us scrotum and contents (76870) |
$220.95 |
$491 |
2.0× |
| Us soft tissue head/neck (76536) |
$262.80 |
$584 |
2.4× |
| Us spinal canal and contents (76800) |
$208.35 |
$463 |
1.9× |
| Us transrectal (76872) |
$182.70 |
$406 |
1.7× |
| Us, eye b-scan (76512) |
$96.30 |
$214 |
0.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$285.30 |
$634 |
2.6× |
| Venogram adrenal unilat (75840) |
$3,087.45 |
$6,861 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,120.05 |
$2,489 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$728.10 |
$1,618 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,839.05 |
$6,309 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,119.15 |
$2,487 |
0.7× |
| Venography Renal Bilateral (75833) |
$2,839.05 |
$6,309 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$3,087.45 |
$6,861 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,213.65 |
$2,697 |
0.4× |
| Venous sampling by catheter (75893) |
$3,599.10 |
$7,998 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$71.10 |
$158 |
0.8× |
| Wrist 2 views (73100) |
$126.90 |
$282 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$126.90 |
$282 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.50 |
$290 |
1.4× |
| X-ray b.e. reductn intuss (74283) |
$187.65 |
$417 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$220.95 |
$491 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$126.90 |
$282 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$158.85 |
$353 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$158.85 |
$353 |
1.5× |
| X-ray exam of femur 2/> (73552) |
$126.90 |
$282 |
1.4× |
| X-ray eye for foreign body (70030) |
$138.15 |
$307 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$79.65 |
$177 |
0.9× |
| X-ray IV pyelogram (ivp) (74400) |
$285.75 |
$635 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$71.10 |
$158 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$126.90 |
$282 |
1.4× |
| X-ray leg, infant (73592) |
$126.90 |
$282 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$143.10 |
$318 |
1.3× |
| X-ray nose-rectum child f.b. (76010) |
$138.15 |
$307 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$131.85 |
$293 |
1.2× |
| X-ray retrograde pyelogram (74420) |
$283.50 |
$630 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$126.90 |
$282 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$140.40 |
$312 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$142.65 |
$317 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$126.90 |
$282 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$126.90 |
$282 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$148.05 |
$329 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$142.20 |
$316 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$126.90 |
$282 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$180 |
$400 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$65.70 |
$146 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$126.90 |
$282 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$130.05 |
$289 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$151.20 |
$336 |
1.4× |
| Xr bone length studies (77073) |
$202.05 |
$449 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$157.50 |
$350 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$167.85 |
$373 |
1.5× |
| Xr chest 4+ views (71048) |
$138.15 |
$307 |
1.3× |
| Xr urogram antegrade (74425) |
$354.60 |
$788 |
1.0× |