| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,193.15 |
$6,491.44 |
3.2× |
| Abdomen 2 views (74019) |
$407.04 |
$508.80 |
3.3× |
| Acute gi blood loss imaging (78278) |
$1,320.34 |
$1,650.42 |
2.8× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$2,167.49 |
$2,709.36 |
1.4× |
| Angio Adrenal Bilat Select (75733) |
$3,542.94 |
$4,428.68 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$4,305.92 |
$5,382.39 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,833.81 |
$4,792.26 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$2,713.60 |
$3,392 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,960.38 |
$8,700.48 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,527.68 |
$4,409.60 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,527.68 |
$4,409.60 |
0.9× |
| Angiography Spinal Selective Rs&I (75705) |
$5,544.22 |
$6,930.28 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,579.86 |
$11,974.82 |
1.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,853.38 |
$6,066.72 |
1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,308.90 |
$4,136.12 |
0.9× |
| Ankle 2 views (73600) |
$420.61 |
$525.76 |
4.1× |
| Aortogram thoracic (75605) |
$5,766.40 |
$7,208 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,882.14 |
$4,852.68 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,444.58 |
$4,305.72 |
0.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,813.46 |
$4,766.82 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,542.94 |
$4,428.68 |
0.9× |
| Arthrogram hip (73525) |
$917.54 |
$1,146.92 |
2.2× |
| Arthrogram shoulder (73040) |
$926.02 |
$1,157.52 |
2.2× |
| Basic dosimetry (77300) |
$708.93 |
$886.16 |
4.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,191.44 |
$1,489.30 |
2.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,060 |
$1,325 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,234.69 |
$1,543.36 |
2.6× |
| Bone age studies (77072) |
$289.17 |
$361.46 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,924.15 |
$2,405.19 |
4.1× |
| Bone survey complete (77075) |
$1,231.30 |
$1,539.12 |
10.0× |
| Bowel imaging (78290) |
$725.04 |
$906.30 |
1.5× |
| Brachytx isodose complex (77318) |
$1,440.75 |
$1,800.94 |
3.3× |
| Brachytx isodose intermed (77317) |
$1,156.63 |
$1,445.79 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$800.51 |
$1,000.64 |
1.8× |
| Brain imaging < 4 static views (78600) |
$368.88 |
$461.10 |
0.8× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,209.25 |
$1,511.56 |
2.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,079.50 |
$1,349.38 |
1.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,631.55 |
$2,039.44 |
3.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,087.14 |
$1,358.92 |
2.3× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$2,081.84 |
$2,602.30 |
3.2× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,803.70 |
$2,254.62 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,803.70 |
$2,254.62 |
4.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,293.20 |
$1,616.50 |
2.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$1,528.94 |
$1,911.18 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$420.61 |
$525.76 |
4.1× |
| Chest 1 view (71045) |
$214.54 |
$268.18 |
2.1× |
| Chest xray 3 views (71047) |
$318 |
$397.50 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,020.99 |
$1,276.24 |
4.9× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,170.24 |
$1,462.80 |
1.3× |
| Clavicle complete (73000) |
$420.61 |
$525.76 |
4.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$343.44 |
$429.30 |
2.8× |
| Continuing medical physics consltj pr wk (77336) |
$708.93 |
$886.16 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,535.96 |
$5,669.94 |
11.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,812.18 |
$2,265.22 |
6.4× |
| CT abdomen w contrast (74160) |
$1,639.18 |
$2,048.98 |
7.9× |
| CT abdomen w wo contrast (74170) |
$1,884.26 |
$2,355.32 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,355.14 |
$1,693.94 |
11.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,163.21 |
$3,954.01 |
15.3× |
| CT angiography upper extremity lt (73206) |
$2,089.62 |
$2,612.02 |
10.1× |
| CT c-spine w/contrast (72126) |
$2,612.69 |
$3,265.86 |
6.3× |
| CT c-spine w/o contrast (72125) |
$2,298.08 |
$2,872.60 |
18.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,845.04 |
$3,556.30 |
13.7× |
| CT chest w contrast (71260) |
$1,692.61 |
$2,115.76 |
8.2× |
| CT chest w/wo contrast (71270) |
$1,884.26 |
$2,355.32 |
9.1× |
| CT head/brain with contrast (70460) |
$1,812.18 |
$2,265.22 |
8.7× |
| CT head/brain without and with contrast (70470) |
$2,298.08 |
$2,872.60 |
11.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,646.82 |
$2,058.52 |
4.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$951.46 |
$1,189.32 |
9.3× |
| CT iac w contrast (70481) |
$1,757.06 |
$2,196.32 |
8.5× |
| CT lower ext w/o (73700) |
$1,122.75 |
$1,403.44 |
9.1× |
| CT lower extremity w wo contrast (73702) |
$1,717.58 |
$2,146.98 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,339.84 |
$1,674.80 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,692.61 |
$2,115.76 |
8.2× |
| CT lumbar spine w/contrast (72132) |
$2,674.76 |
$3,343.45 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$2,290.45 |
$2,863.06 |
18.5× |
| CT maxillofacial w contrast (70487) |
$1,757.06 |
$2,196.32 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$2,089.47 |
$2,611.84 |
10.1× |
| CT maxillofacial wo contrast (70486) |
$1,526.40 |
$1,908 |
12.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,825.32 |
$2,281.65 |
8.8× |
| CT orbits w/o contrast (70480) |
$1,513.68 |
$1,892.10 |
12.3× |
| CT pelvis w/o contrast (72192) |
$1,249.95 |
$1,562.44 |
10.1× |
| CT pelvis w/wo contrast (72194) |
$1,884.26 |
$2,355.32 |
9.1× |
| CT scan of arm combo (73202) |
$1,692.18 |
$2,115.23 |
8.2× |
| CT soft tissue neck w contrast (70491) |
$1,845.25 |
$2,306.56 |
8.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,296.38 |
$2,870.48 |
11.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,651.06 |
$2,063.82 |
13.4× |
| CT thoracic spine w/contrast (72129) |
$2,545.70 |
$3,182.12 |
12.3× |
| CT thoracic spine w/o contrast (72128) |
$1,121.06 |
$1,401.32 |
9.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,692.61 |
$2,115.76 |
8.2× |
| CT thorax w/o contrast (71250) |
$1,249.95 |
$1,562.44 |
10.1× |
| CT upper ext wo (73200) |
$1,122.77 |
$1,403.46 |
9.1× |
| CT upper extremity with contrast (73201) |
$1,339.84 |
$1,674.80 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$5,444.16 |
$6,805.20 |
26.3× |
| Cta Abdomen (74175) |
$1,534.16 |
$1,917.70 |
7.4× |
| CTA abdomen pelvis (74174) |
$2,371.86 |
$2,964.82 |
5.8× |
| CTA chest (71275) |
$1,586.61 |
$1,983.26 |
7.7× |
| Cta Head (70496) |
$3,855.01 |
$4,818.76 |
18.6× |
| Cta Neck (70498) |
$1,958.03 |
$2,447.54 |
9.4× |
| Cta Pelvis (72191) |
$1,534.03 |
$1,917.54 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$934.50 |
$1,168.12 |
2.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,968 |
$3,710 |
1.2× |
| Diskogram cervical (72285) |
$4,094.14 |
$5,117.68 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$289.17 |
$361.46 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$680.94 |
$851.18 |
6.6× |
| Dxa bone density study axial skeleton (77085) |
$619.42 |
$774.27 |
5.0× |
| Esophagus (74220) |
$464.70 |
$580.88 |
2.2× |
| Facial bones min 3 views (70150) |
$312.06 |
$390.08 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$251.86 |
$314.82 |
2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$545.26 |
$681.58 |
4.4× |
| Fluoroscopy up to 1 hr (76000) |
$579.18 |
$723.98 |
2.1× |
| Foot 2 views (73620) |
$420.61 |
$525.76 |
4.1× |
| Forearm 2 views (73090) |
$420.61 |
$525.76 |
4.1× |
| Hand 2 views (73120) |
$209.46 |
$261.82 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,664.21 |
$4,580.26 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,357.02 |
$5,446.28 |
5.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,825.97 |
$6,032.46 |
5.9× |
| Heart first pass single,planar (78481) |
$1,534.03 |
$1,917.54 |
2.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,431.01 |
$4,288.76 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$884.46 |
$1,105.58 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,060 |
$1,325 |
2.2× |
| Hysterosalpingogram (74740) |
$1,082.90 |
$1,353.62 |
3.8× |
| Interstitial radiation source applic complex (77778) |
$4,464.72 |
$5,580.90 |
5.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,674.38 |
$4,592.98 |
4.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,527.04 |
$3,158.80 |
3.9× |
| Intracavitary Radiation Source Applic Simple (77761) |
$2,527.04 |
$3,158.80 |
3.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,143.10 |
$1,428.88 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,978.38 |
$2,472.98 |
3.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,102.40 |
$1,378 |
1.7× |
| Knee 3 views (73562) |
$420.61 |
$525.76 |
4.1× |
| Liver & spleen imaging static only (78215) |
$1,611.20 |
$2,014 |
3.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,655.30 |
$2,069.12 |
3.5× |
| Liver imaging static only (78201) |
$1,270.30 |
$1,587.88 |
2.0× |
| Liver imaging w/vascular flow (78202) |
$1,252.50 |
$1,565.62 |
2.0× |
| Lung perfusion differential (78597) |
$794.58 |
$993.22 |
1.7× |
| Lung ventilation imaging (78579) |
$1,302.53 |
$1,628.16 |
2.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,214.12 |
$2,767.66 |
2.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$919.23 |
$1,149.04 |
1.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$1,267.76 |
$1,584.70 |
6.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,143.74 |
$2,679.68 |
5.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,144.59 |
$2,680.74 |
5.2× |
| Mammary ductogram or galactogram multiple (77054) |
$684.34 |
$855.42 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$585.97 |
$732.46 |
2.1× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$537.72 |
$672.15 |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,506.90 |
$1,883.62 |
3.4× |
| MRA head w & w/o contrast (70546) |
$4,097.49 |
$5,121.86 |
9.9× |
| MRA head w/o contrast (70544) |
$2,677.22 |
$3,346.52 |
9.5× |
| MRA head with contrast (70545) |
$2,671.02 |
$3,338.77 |
6.5× |
| MRA neck w contrast (70548) |
$2,974.78 |
$3,718.48 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,720.18 |
$4,650.22 |
9.0× |
| MRA neck w/o contrast (70547) |
$2,677.14 |
$3,346.42 |
9.5× |
| MRI abdomen w contrast (74182) |
$3,037.54 |
$3,796.92 |
7.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,733.74 |
$4,667.18 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$2,369.31 |
$2,961.64 |
8.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,143.74 |
$2,679.68 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,418.29 |
$4,272.86 |
8.3× |
| MRI breast w/o contrast bilateral (77047) |
$3,083.33 |
$3,854.16 |
10.9× |
| MRI breast wo contrast unilateral (77046) |
$2,615.23 |
$3,269.04 |
9.3× |
| MRI c-spine with contrast (72142) |
$2,456.62 |
$3,070.77 |
6.0× |
| MRI cardiac w/o cont stress (75559) |
$1,803.70 |
$2,254.62 |
2.8× |
| MRI cardiac w/o contrast (75557) |
$1,803.70 |
$2,254.62 |
6.4× |
| MRI cervical spine w/o contrast (72141) |
$2,041.14 |
$2,551.42 |
7.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,267.93 |
$1,584.91 |
3.1× |
| MRI chest w/o contrast (71550) |
$2,078.44 |
$2,598.06 |
7.4× |
| MRI chest with contrast (71551) |
$2,281.97 |
$2,852.46 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,143.74 |
$2,679.68 |
5.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,078.44 |
$2,598.06 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,284.51 |
$2,855.64 |
8.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,144.59 |
$2,680.74 |
7.6× |
| MRI orbit face neck w contrast (70542) |
$2,694.10 |
$3,367.62 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,597.22 |
$4,496.52 |
8.7× |
| MRI pelvis w/contrast (72196) |
$2,041.14 |
$2,551.42 |
5.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,140.78 |
$5,175.98 |
10.0× |
| MRI pelvis w/o contrast (72195) |
$3,736.29 |
$4,670.36 |
13.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,001.92 |
$3,752.40 |
7.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,492.27 |
$3,115.34 |
6.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,974.02 |
$3,717.52 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,492.27 |
$3,115.34 |
6.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,001.92 |
$3,752.40 |
7.3× |
| MRI temporomandibular joint (70336) |
$2,144.59 |
$2,680.74 |
7.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,041.14 |
$2,551.42 |
7.2× |
| MRI up ext w/o contrast (73218) |
$2,062.34 |
$2,577.92 |
7.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,144.59 |
$2,680.74 |
7.6× |
| MRI, joint upper extrem combo (73223) |
$2,143.74 |
$2,679.68 |
5.2× |
| Myelogram Cervical (72240) |
$2,327.76 |
$2,909.70 |
2.5× |
| Myelogram Lumbar (72265) |
$2,242.96 |
$2,803.70 |
2.4× |
| Myelogram thoracic (72255) |
$1,743.49 |
$2,179.36 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,662.30 |
$5,827.88 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$3,108.77 |
$3,885.96 |
2.0× |
| Neck soft tissue (70360) |
$420.61 |
$525.76 |
4.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,065.09 |
$1,331.36 |
2.3× |
| Nm cardiac blood pool multiple (78473) |
$1,205.86 |
$1,507.32 |
2.6× |
| Nm cisternogram (78630) |
$1,792.67 |
$2,240.84 |
2.8× |
| Nm csf leak detection (78650) |
$1,696 |
$2,120 |
1.1× |
| Nm gastric emptying study (78264) |
$1,874.08 |
$2,342.60 |
4.0× |
| Nm kidney scan w/flow (78701) |
$1,221.12 |
$1,526.40 |
2.6× |
| Nonvascular shunt X-ray (75809) |
$613.95 |
$767.44 |
5.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,396.67 |
$6,745.84 |
3.3× |
| Nuclear Rx Oral Admin (79005) |
$1,556.08 |
$1,945.10 |
5.6× |
| Ob us nuchal meas 1 gest (76813) |
$537.63 |
$672.04 |
4.4× |
| Osseous survey limited (77074) |
$953.15 |
$1,191.44 |
7.7× |
| Parathyroid Planar Imaging (78070) |
$744.54 |
$930.68 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,674.80 |
$2,093.50 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$223.02 |
$278.78 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$6,003.84 |
$7,504.80 |
3.6× |
| PET imaging CT for attenuation limited area (78814) |
$5,886.82 |
$7,358.52 |
3.5× |
| PET imaging for CT attenuation whole body (78816) |
$6,186.16 |
$7,732.70 |
3.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,505.84 |
$3,132.30 |
1.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,744.77 |
$4,680.96 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$993.01 |
$1,241.26 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,437.36 |
$1,796.70 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$914.14 |
$1,142.68 |
1.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$420.61 |
$525.76 |
4.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$420.61 |
$525.76 |
4.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$248.46 |
$310.58 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$180.46 |
$225.57 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$413.40 |
$516.75 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$569.77 |
$712.21 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$373.97 |
$467.46 |
3.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$248.46 |
$310.58 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$308.67 |
$385.84 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$420.61 |
$525.76 |
4.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$487.60 |
$609.50 |
3.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$630.06 |
$787.58 |
5.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$658.97 |
$823.71 |
5.3× |
| Radex Humerus Minimum 2 Views (73060) |
$228.96 |
$286.20 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$420.61 |
$525.76 |
4.1× |
| Radex Kne Compl 4/More Views (73564) |
$474.58 |
$593.23 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$658.90 |
$823.62 |
5.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$420.61 |
$525.76 |
4.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$267.97 |
$334.96 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$267.97 |
$334.96 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$252.70 |
$315.88 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$312.91 |
$391.14 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$420.61 |
$525.76 |
4.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$248.46 |
$310.58 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$569.77 |
$712.21 |
4.6× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$49,149.23 |
$61,436.54 |
5.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$16,954.91 |
$21,193.64 |
1.9× |
| Radiation treatment delivery level 1 (77402) |
$306.13 |
$382.66 |
2.5× |
| Radiation treatment delivery level 2 (77407) |
$390.08 |
$487.60 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$727.58 |
$909.48 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$217.94 |
$272.42 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$466.40 |
$583 |
3.8× |
| Radiologic exam chest 2 views (71046) |
$180.62 |
$225.78 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$504.56 |
$630.70 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$995.55 |
$1,244.44 |
4.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$931.10 |
$1,163.88 |
4.5× |
| Radiologic examination femur 1 view (73551) |
$487.60 |
$609.50 |
4.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$420.61 |
$525.76 |
4.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$312.06 |
$390.08 |
2.5× |
| Radiological examination surgical specimen (76098) |
$1,148.19 |
$1,435.24 |
1.8× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$689.42 |
$861.78 |
2.5× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,032.02 |
$1,290.02 |
3.7× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,857.12 |
$2,321.40 |
6.7× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$689.42 |
$861.78 |
2.5× |
| Ribs bilateral 3 views (71110) |
$350.22 |
$437.78 |
2.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,819.81 |
$2,274.76 |
3.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,221.12 |
$1,526.40 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,300 |
$4,124.99 |
5.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,889.98 |
$3,612.48 |
4.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,889.98 |
$3,612.48 |
4.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,110.26 |
$5,137.82 |
2.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,664 |
$5,830 |
2.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,110.26 |
$5,137.82 |
2.7× |
| Rp Therapy Intravenous Administration (79101) |
$1,356.80 |
$1,696 |
4.9× |
| Sacroiliac Joints < 3 Views (72200) |
$209.46 |
$261.82 |
1.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$636 |
$795 |
2.3× |
| Salivary gland imaging (78230) |
$517.28 |
$646.60 |
1.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$534.24 |
$667.80 |
1.1× |
| Scapula (73010) |
$420.61 |
$525.76 |
3.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$172.84 |
$216.05 |
7.4× |
| Shoulder 1 view (73020) |
$209.46 |
$261.82 |
2.0× |
| Sialogram (70390) |
$594.45 |
$743.06 |
2.1× |
| Simulation intermediate (77285) |
$1,354.26 |
$1,692.82 |
3.1× |
| Small bowel series (74250) |
$518.98 |
$648.72 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,172.78 |
$1,465.98 |
2.7× |
| Special dosimetry (77331) |
$708.93 |
$886.16 |
4.5× |
| Special Physics Consult (77370) |
$875.98 |
$1,094.98 |
5.5× |
| Special treatment procedure (77470) |
$2,202.26 |
$2,752.82 |
3.4× |
| Spine thoracic 3 views (72072) |
$494.38 |
$617.98 |
4.0× |
| Spleen imaging only (78185) |
$750.48 |
$938.10 |
1.6× |
| Splenoportograpy rs&i (75810) |
$4,034.78 |
$5,043.48 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$5,350.88 |
$6,688.60 |
2.5× |
| Superior sagittal sinus venogram (75870) |
$4,853.38 |
$6,066.72 |
1.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$708.93 |
$886.16 |
5.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,299.98 |
$1,624.98 |
2.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$655.50 |
$819.38 |
1.5× |
| Testicular Imaging With Vascular Flow (78761) |
$565.62 |
$707.02 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,715.50 |
$2,144.38 |
3.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$908.21 |
$1,135.26 |
5.7× |
| Thoracolumbar 2 views (72080) |
$420.61 |
$525.76 |
4.1× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,129.02 |
$1,411.28 |
2.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$625.82 |
$782.28 |
1.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,163.25 |
$2,704.06 |
3.4× |
| Thyroid imaging w/blood flow (78013) |
$592.75 |
$740.94 |
1.3× |
| Thyroid uptake measurement (78012) |
$376.51 |
$470.64 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$476.58 |
$595.72 |
1.0× |
| Tmj unilateral (70328) |
$420.61 |
$525.76 |
4.1× |
| Treatment device complex (77334) |
$1,196.53 |
$1,495.66 |
2.7× |
| Treatment device intermediate (77333) |
$749.63 |
$937.04 |
4.7× |
| Treatment devices simple (77332) |
$585.97 |
$732.46 |
3.7× |
| Ultrasound breast complete (76641) |
$559.68 |
$699.60 |
4.5× |
| Ultrasound Exam Aaa Screen (76706) |
$479.12 |
$598.90 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$812.38 |
$1,015.48 |
6.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,924.96 |
$2,406.20 |
16.0× |
| Unlisted ultrasound procedure (76999) |
$681.79 |
$852.24 |
6.6× |
| Urethrocystogram voiding (74455) |
$803.06 |
$1,003.82 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$1,036.26 |
$1,295.32 |
3.7× |
| Us breast unilateral limited (76642) |
$462.16 |
$577.70 |
4.5× |
| Us chest (76604) |
$619.89 |
$774.86 |
5.0× |
| Us compl joint r-t w/image documentation (76881) |
$362.94 |
$453.68 |
2.9× |
| Us encephalogram (76506) |
$723.34 |
$904.18 |
5.9× |
| Us infant hips w manipulation (76885) |
$242.53 |
$303.16 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$541.87 |
$677.34 |
4.4× |
| Us ob detailed single fetus (76811) |
$1,003.18 |
$1,253.98 |
3.6× |
| Us ob limited (76815) |
$342.16 |
$427.71 |
2.8× |
| Us ob transvaginal (76817) |
$599.54 |
$749.42 |
4.9× |
| Us pelvic non ob complete (76856) |
$823.41 |
$1,029.26 |
6.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$585.12 |
$731.40 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$781.86 |
$977.32 |
6.3× |
| Us retroperitoneal complete (76770) |
$723.34 |
$904.18 |
5.9× |
| Us retroperitoneal limited (76775) |
$723.34 |
$904.18 |
5.9× |
| Us scrotum and contents (76870) |
$822.56 |
$1,028.20 |
6.7× |
| Us soft tissue head/neck (76536) |
$675.43 |
$844.29 |
5.5× |
| Us spinal canal and contents (76800) |
$814.93 |
$1,018.66 |
6.6× |
| Us transrectal (76872) |
$677.76 |
$847.20 |
5.5× |
| Us transrectal prostate volume (76873) |
$806.45 |
$1,008.06 |
6.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$888.70 |
$1,110.88 |
7.2× |
| Vasogram (74440) |
$584.27 |
$730.34 |
2.1× |
| Venogram adrenal unilat (75840) |
$4,019.52 |
$5,024.40 |
1.1× |
| Venogram extremity bilateral (75822) |
$2,226.42 |
$2,783.03 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$1,988.56 |
$2,485.70 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,527.77 |
$4,409.71 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$3,571.36 |
$4,464.19 |
1.9× |
| Venography Renal Bilateral (75833) |
$4,106.02 |
$5,132.52 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$3,743.50 |
$4,679.37 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,555.66 |
$4,444.58 |
1.0× |
| Wrist 2 views (73100) |
$420.61 |
$525.76 |
4.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$754.72 |
$943.40 |
6.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$267.97 |
$334.96 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$656.22 |
$820.28 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$209.46 |
$261.82 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$420.61 |
$525.76 |
4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$487.60 |
$609.50 |
3.9× |
| X-ray exam of femur 2/> (73552) |
$395.97 |
$494.96 |
3.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$299.34 |
$374.18 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$994.70 |
$1,243.38 |
4.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$420.61 |
$525.76 |
4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$420.61 |
$525.76 |
4.1× |
| X-ray leg, infant (73592) |
$215.39 |
$269.24 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$275.60 |
$344.50 |
2.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$937.89 |
$1,172.36 |
7.6× |
| X-ray optic foramen (70190) |
$367.18 |
$458.98 |
3.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$312.06 |
$390.08 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$722.50 |
$903.12 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$489.30 |
$611.62 |
4.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$623.28 |
$779.10 |
5.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$398.56 |
$498.20 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$420.61 |
$525.76 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$420.61 |
$525.76 |
4.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$312.06 |
$390.08 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$770.83 |
$963.54 |
6.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$245.07 |
$306.34 |
2.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$964.18 |
$1,205.22 |
4.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$312.91 |
$391.14 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$206.91 |
$258.64 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$259.49 |
$324.36 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$193.22 |
$241.52 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$312.91 |
$391.14 |
2.5× |
| Xr bone length studies (77073) |
$357.86 |
$447.32 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$784.40 |
$980.50 |
6.4× |
| Xr c-spine 6 or more views (72052) |
$446.90 |
$558.62 |
3.6× |
| Xr chest 4+ views (71048) |
$502.86 |
$628.58 |
4.1× |
| Xr urogram antegrade (74425) |
$1,062.54 |
$1,328.18 |
2.6× |