| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,886.50 |
$9,773 |
3.3× |
| Abdomen 2 views (74019) |
$281.50 |
$563 |
2.5× |
| Acute gi blood loss imaging (78278) |
$1,107 |
$2,214 |
2.6× |
| Angio Adrenal Bilat Select (75733) |
$2,036.50 |
$4,073 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,936.50 |
$5,873 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,865 |
$5,730 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,204.50 |
$2,409 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,582 |
$5,164 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,582 |
$5,164 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,646.50 |
$3,293 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,497.50 |
$2,995 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,938.50 |
$5,877 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,646.50 |
$3,293 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,204.50 |
$2,409 |
0.4× |
| Ankle 2 views (73600) |
$283 |
$566 |
3.0× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,742 |
$5,484 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,839.50 |
$5,679 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,839.50 |
$5,679 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$1,761.50 |
$3,523 |
0.5× |
| Arthrogram ankle (73615) |
$1,039.50 |
$2,079 |
2.8× |
| Arthrogram elbow (73085) |
$756 |
$1,512 |
2.0× |
| Arthrogram hip (73525) |
$997 |
$1,994 |
2.7× |
| Arthrogram knee (73580) |
$623.50 |
$1,247 |
1.7× |
| Arthrogram shoulder (73040) |
$1,143.50 |
$2,287 |
3.1× |
| Arthrogram wrist (73115) |
$623.50 |
$1,247 |
1.7× |
| Basic dosimetry (77300) |
$647.50 |
$1,295 |
4.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,498.50 |
$2,997 |
3.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,574 |
$3,148 |
3.7× |
| Bone &/joint imaging whole body (78306) |
$1,723.50 |
$3,447 |
4.0× |
| Bone age studies (77072) |
$211 |
$422 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,725.50 |
$3,451 |
4.0× |
| Bone Marrow Imaging Limited Area (78102) |
$1,644 |
$3,288 |
3.8× |
| Bone survey complete (77075) |
$355.50 |
$711 |
3.2× |
| Bone survey infant (77076) |
$211 |
$422 |
1.9× |
| Bowel imaging (78290) |
$1,107 |
$2,214 |
2.6× |
| Brachytx isodose complex (77318) |
$1,574 |
$3,148 |
3.9× |
| Brachytx isodose intermed (77317) |
$1,207.50 |
$2,415 |
3.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$566.50 |
$1,133 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,088 |
$2,176 |
2.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,379 |
$8,758 |
2.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,428.50 |
$2,857 |
3.3× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,206.50 |
$2,413 |
1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,128.50 |
$2,257 |
3.0× |
| Cardiac shunt detection (78428) |
$1,490 |
$2,980 |
3.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$900 |
$1,800 |
1.5× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$946 |
$1,892 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$320 |
$640 |
3.4× |
| Chest 1 view (71045) |
$247 |
$494 |
2.6× |
| Chest xray 3 views (71047) |
$254.50 |
$509 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$546.50 |
$1,093 |
2.9× |
| Clavicle complete (73000) |
$277 |
$554 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$418.50 |
$837 |
3.7× |
| Continuing medical physics consltj pr wk (77336) |
$629.50 |
$1,259 |
4.4× |
| Corpora cavernosography (74445) |
$287.50 |
$575 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,149 |
$2,298 |
3.1× |
| CT abdomen and pelvis without contrast (74176) |
$747 |
$1,494 |
2.9× |
| CT abdomen w contrast (74160) |
$885.50 |
$1,771 |
4.7× |
| CT abdomen w wo contrast (74170) |
$1,051.50 |
$2,103 |
5.6× |
| CT abdomen w/o contrast (74150) |
$651.50 |
$1,303 |
5.8× |
| CT angio hrt w/3d image (75574) |
$794 |
$1,588 |
2.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,030 |
$2,060 |
5.5× |
| CT angiography upper extremity lt (73206) |
$900 |
$1,800 |
4.8× |
| CT c-spine w/contrast (72126) |
$853 |
$1,706 |
2.3× |
| CT c-spine w/o contrast (72125) |
$660 |
$1,320 |
5.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$938.50 |
$1,877 |
5.0× |
| CT cervical spine w&w/o contrast (72127) |
$886.50 |
$1,773 |
4.7× |
| CT chest w contrast (71260) |
$885.50 |
$1,771 |
4.7× |
| CT chest w/wo contrast (71270) |
$1,051.50 |
$2,103 |
5.6× |
| CT colonography screening (74263) |
$507.50 |
$1,015 |
2.0× |
| CT colonography w/o cntrst (74261) |
$364 |
$728 |
3.2× |
| CT head/brain with contrast (70460) |
$853 |
$1,706 |
4.5× |
| CT head/brain without and with contrast (70470) |
$1,013 |
$2,026 |
5.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$794 |
$1,588 |
2.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$364 |
$728 |
3.9× |
| CT hrt w/3d image congen (75573) |
$695 |
$1,390 |
1.9× |
| CT iac w contrast (70481) |
$746 |
$1,492 |
4.0× |
| CT limited/localized follow up study (76380) |
$416 |
$832 |
4.5× |
| CT lower ext w/o (73700) |
$651.50 |
$1,303 |
5.8× |
| CT lower extremity w wo contrast (73702) |
$919.50 |
$1,839 |
4.9× |
| CT lower extremity w/contrast material (73701) |
$885.50 |
$1,771 |
4.7× |
| CT lumbar spine w & w/o contrast (72133) |
$919.50 |
$1,839 |
4.9× |
| CT lumbar spine w/contrast (72132) |
$885.50 |
$1,771 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$651.50 |
$1,303 |
5.8× |
| CT maxillofacial w contrast (70487) |
$853 |
$1,706 |
4.5× |
| CT maxillofacial w/wo contrast (70488) |
$886.50 |
$1,773 |
4.7× |
| CT maxillofacial wo contrast (70486) |
$628 |
$1,256 |
5.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$886.50 |
$1,773 |
4.7× |
| CT orbits w/o contrast (70480) |
$628 |
$1,256 |
5.6× |
| CT pelvis w/o contrast (72192) |
$587.50 |
$1,175 |
5.2× |
| CT pelvis w/wo contrast (72194) |
$946.50 |
$1,893 |
5.0× |
| CT scan of arm combo (73202) |
$919.50 |
$1,839 |
4.9× |
| CT soft tissue neck w contrast (70491) |
$853 |
$1,706 |
4.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,013.50 |
$2,027 |
5.4× |
| CT soft tissue neck w/o contrast (70490) |
$628 |
$1,256 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$885.50 |
$1,771 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$651.50 |
$1,303 |
5.8× |
| CT thoracic spine w/wo contrast (72130) |
$919.50 |
$1,839 |
4.9× |
| CT thorax w/o contrast (71250) |
$651.50 |
$1,303 |
5.8× |
| CT unlisted procedure (76497) |
$186.50 |
$373 |
2.0× |
| CT upper ext wo (73200) |
$651.50 |
$1,303 |
5.8× |
| CT upper extremity with contrast (73201) |
$885.50 |
$1,771 |
2.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,030 |
$2,060 |
5.5× |
| Cta Abdomen (74175) |
$1,030 |
$2,060 |
5.5× |
| CTA abdomen pelvis (74174) |
$1,926 |
$3,852 |
5.1× |
| CTA chest (71275) |
$1,030 |
$2,060 |
5.5× |
| Cta Head (70496) |
$992 |
$1,984 |
5.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,088 |
$4,176 |
5.6× |
| Cta Neck (70498) |
$992 |
$1,984 |
5.3× |
| Cta Pelvis (72191) |
$900 |
$1,800 |
4.8× |
| Cystography minimum 3 views rs&i (74430) |
$527.50 |
$1,055 |
1.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$219 |
$438 |
0.9× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$476 |
$952 |
0.2× |
| Diskogram cervical (72285) |
$1,186 |
$2,372 |
0.6× |
| Diskography lumbar (72295) |
$1,186 |
$2,372 |
0.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$545 |
$1,090 |
4.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$559.50 |
$1,119 |
5.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$362 |
$724 |
3.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$566 |
$1,132 |
5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$269 |
$538 |
2.9× |
| Dxa bone density study axial skeleton (77085) |
$374 |
$748 |
3.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$559.50 |
$1,119 |
2.2× |
| Esophagus (74220) |
$503 |
$1,006 |
2.7× |
| Facial bones min 3 views (70150) |
$296.50 |
$593 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$646 |
$1,292 |
5.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$482.50 |
$965 |
4.3× |
| Fetal Echo (76825) |
$594 |
$1,188 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$569 |
$1,138 |
2.2× |
| Foot 2 views (73620) |
$339.50 |
$679 |
3.6× |
| Forearm 2 views (73090) |
$329.50 |
$659 |
3.5× |
| Functional MRI brain by phys/psych (70555) |
$731 |
$1,462 |
2.9× |
| Functional MRI brain by tech (70554) |
$731 |
$1,462 |
2.9× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,442.50 |
$2,885 |
3.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,665.50 |
$3,331 |
2.9× |
| Hand 2 views (73120) |
$316.50 |
$633 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,806 |
$3,612 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,888 |
$3,776 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,229 |
$4,458 |
3.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,848 |
$3,696 |
0.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,204.50 |
$2,409 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,387 |
$2,774 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,135.50 |
$2,271 |
2.6× |
| Hysterosalpingogram (74740) |
$663.50 |
$1,327 |
2.6× |
| Interstitial radiation source applic complex (77778) |
$2,877.50 |
$5,755 |
3.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,996.50 |
$3,993 |
2.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,913.50 |
$3,827 |
3.2× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,830 |
$3,660 |
3.1× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$37,382 |
$74,764 |
4.7× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$31,152.50 |
$62,305 |
3.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$211 |
$422 |
1.9× |
| Kidney imaging morphology (78700) |
$912.50 |
$1,825 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,105 |
$2,210 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,306 |
$2,612 |
2.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,566.50 |
$3,133 |
2.7× |
| Knee 3 views (73562) |
$301 |
$602 |
3.2× |
| Liver & spleen imaging static only (78215) |
$1,320.50 |
$2,641 |
3.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,320.50 |
$2,641 |
3.1× |
| Liver imaging static only (78201) |
$1,254 |
$2,508 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,320.50 |
$2,641 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$1,158 |
$2,316 |
2.0× |
| Lung perfusion differential (78597) |
$741.50 |
$1,483 |
1.7× |
| Lung ventilation imaging (78579) |
$741.50 |
$1,483 |
1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,988.50 |
$3,977 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,176 |
$2,352 |
0.3× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,186.50 |
$2,373 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$525.50 |
$1,051 |
0.8× |
| Lymphoscintigraphy (78195) |
$1,056 |
$2,112 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$835 |
$1,670 |
1.0× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$774.50 |
$1,549 |
4.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$728.50 |
$1,457 |
1.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$1,056.50 |
$2,113 |
5.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,381.50 |
$2,763 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,381.50 |
$2,763 |
3.7× |
| Magnetic Resonance Elastography (76391) |
$500.50 |
$1,001 |
2.0× |
| Mammary ductogram or galactogram multiple (77054) |
$326 |
$652 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$283.50 |
$567 |
1.1× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$297.50 |
$595 |
3.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,569 |
$5,138 |
6.4× |
| Mr safety determination physician/other qhp (76016) |
$132.50 |
$265 |
1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$37 |
$74 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$145.50 |
$291 |
1.4× |
| Mr safety implt pos&/immoblj (76019) |
$94 |
$188 |
1.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$363.50 |
$727 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,269 |
$2,538 |
3.4× |
| MRA head w/o contrast (70544) |
$833.50 |
$1,667 |
3.3× |
| MRA head with contrast (70545) |
$852.50 |
$1,705 |
2.3× |
| MRA neck w contrast (70548) |
$886 |
$1,772 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,269 |
$2,538 |
3.4× |
| MRA neck w/o contrast (70547) |
$833.50 |
$1,667 |
3.3× |
| MRI abdomen w contrast (74182) |
$887.50 |
$1,775 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,421 |
$2,842 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$835 |
$1,670 |
3.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$887.50 |
$1,775 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,419 |
$2,838 |
3.8× |
| MRI breast w/o contrast bilateral (77047) |
$521.50 |
$1,043 |
2.0× |
| MRI breast wo contrast unilateral (77046) |
$500.50 |
$1,001 |
2.0× |
| MRI c-spine with contrast (72142) |
$887.50 |
$1,775 |
2.4× |
| MRI cardiac w/o cont stress (75559) |
$898 |
$1,796 |
1.5× |
| MRI cardiac w/o contrast (75557) |
$681 |
$1,362 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$835 |
$1,670 |
3.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,233.50 |
$2,467 |
3.3× |
| MRI chest w/o contrast (71550) |
$730 |
$1,460 |
2.9× |
| MRI chest with contrast (71551) |
$776 |
$1,552 |
0.9× |
| MRI fetal sngl/1st gestation (74712) |
$537 |
$1,074 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$887.50 |
$1,775 |
2.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,380.50 |
$2,761 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$835 |
$1,670 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$728.50 |
$1,457 |
2.8× |
| MRI orbit face neck w contrast (70542) |
$774.50 |
$1,549 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,419 |
$2,838 |
3.8× |
| MRI pelvis w/contrast (72196) |
$932 |
$1,864 |
2.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,421 |
$2,842 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$835 |
$1,670 |
3.3× |
| MRI spectroscopy (76390) |
$822 |
$1,644 |
8.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,479 |
$2,958 |
4.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$887.50 |
$1,775 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,479 |
$2,958 |
4.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$887.50 |
$1,775 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,479 |
$2,958 |
4.0× |
| MRI temporomandibular joint (70336) |
$634 |
$1,268 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$835 |
$1,670 |
3.3× |
| MRI up ext w/o contrast (73218) |
$835 |
$1,670 |
3.3× |
| MRI upper ext joint w/o contrast (73221) |
$835 |
$1,670 |
3.3× |
| MRI, joint upper extrem combo (73223) |
$1,381.50 |
$2,763 |
3.7× |
| Myelogram Cervical (72240) |
$784.50 |
$1,569 |
0.9× |
| Myelogram Lumbar (72265) |
$784.50 |
$1,569 |
0.9× |
| Myelogram thoracic (72255) |
$784.50 |
$1,569 |
0.9× |
| Myelography 2 or more regions (72270) |
$784.50 |
$1,569 |
0.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,056 |
$8,112 |
2.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,968 |
$5,936 |
2.1× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,968 |
$5,936 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,728.50 |
$7,457 |
2.7× |
| Myocardial spect single study at rest or stress (78451) |
$3,024 |
$6,048 |
2.2× |
| N-invas est c ffr sw aly CTA (75580) |
$5,209.50 |
$10,419 |
5.7× |
| Neck soft tissue (70360) |
$250.50 |
$501 |
2.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$716.50 |
$1,433 |
1.7× |
| Nm adrenal scan (78075) |
$2,193.50 |
$4,387 |
1.6× |
| Nm bone marrow multi (78103) |
$1,719 |
$3,438 |
4.0× |
| Nm bone marrow wb (78104) |
$1,794 |
$3,588 |
4.2× |
| Nm cisternogram (78630) |
$900 |
$1,800 |
1.5× |
| Nm csf leak detection (78650) |
$1,135 |
$2,270 |
0.8× |
| Nm gastric emptying study (78264) |
$1,274 |
$2,548 |
3.0× |
| Nm gastroesophageal reflux study (78262) |
$1,329 |
$2,658 |
3.1× |
| Nm peritoneal-venous shunt patency (78291) |
$1,204 |
$2,408 |
2.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$799 |
$1,598 |
1.9× |
| Nonvascular shunt X-ray (75809) |
$498 |
$996 |
4.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,718.50 |
$11,437 |
3.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$800.50 |
$1,601 |
1.9× |
| Nuclear Rx Oral Admin (79005) |
$851.50 |
$1,703 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$436 |
$872 |
3.9× |
| Orthopantogram (70355) |
$241.50 |
$483 |
2.6× |
| Osseous survey limited (77074) |
$332.50 |
$665 |
3.0× |
| Parathyrd planar w/spect&CT (78072) |
$1,360.50 |
$2,721 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$867 |
$1,734 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,123 |
$2,246 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$280.50 |
$561 |
2.5× |
| Peritoneogram after injection (74190) |
$314.50 |
$629 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$5,133 |
$10,266 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$4,911 |
$9,822 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$5,356.50 |
$10,713 |
3.5× |
| Proton trmt simple w/comp (77522) |
$4,580.50 |
$9,161 |
3.4× |
| Proton tx delivery complex (77525) |
$4,790.50 |
$9,581 |
3.6× |
| Proton tx delivery intermediate (77523) |
$4,678.50 |
$9,357 |
3.5× |
| Proton tx delivery simple w/o compensation (77520) |
$3,720 |
$7,440 |
6.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,317.50 |
$4,635 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$854.50 |
$1,709 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,333 |
$2,666 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$300 |
$600 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$339 |
$678 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$246.50 |
$493 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$323 |
$646 |
3.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$211 |
$422 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$346.50 |
$693 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$491 |
$982 |
4.4× |
| Radex fingr minimum 2 views (73140) |
$241.50 |
$483 |
2.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$339.50 |
$679 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$322 |
$644 |
3.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$147.50 |
$295 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$200 |
$400 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$211 |
$422 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$577 |
$1,154 |
5.1× |
| Radex Humerus Minimum 2 Views (73060) |
$285 |
$570 |
3.1× |
| Radex Kne 1/2 Views (73560) |
$255.50 |
$511 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$320.50 |
$641 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$250.50 |
$501 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$269 |
$538 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$337 |
$674 |
3.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$298 |
$596 |
3.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$211 |
$422 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$347.50 |
$695 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$276 |
$552 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$264 |
$528 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$211 |
$422 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$339.50 |
$679 |
3.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$519 |
$1,038 |
4.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$24,352.50 |
$48,705 |
3.1× |
| Radiation treatment delivery level 1 (77402) |
$398.50 |
$797 |
3.6× |
| Radiation treatment delivery level 2 (77407) |
$458 |
$916 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$919 |
$1,838 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$256 |
$512 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$306 |
$612 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$247 |
$494 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$575 |
$1,150 |
3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$503 |
$1,006 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$575 |
$1,150 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$428 |
$856 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$211 |
$422 |
2.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$219 |
$438 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$328 |
$656 |
3.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$222 |
$444 |
2.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$211 |
$422 |
1.9× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$308 |
$616 |
3.3× |
| Radiological examination surgical specimen (76098) |
$520 |
$1,040 |
0.9× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$1,047 |
$2,094 |
4.2× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,746 |
$3,492 |
7.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$3,266 |
$6,532 |
13.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$886 |
$1,772 |
2.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$877.50 |
$1,755 |
2.1× |
| Renal Cyst Study (74470) |
$305 |
$610 |
0.5× |
| Ribs bilateral 3 views (71110) |
$353.50 |
$707 |
3.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,001.50 |
$2,003 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,001.50 |
$2,003 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,397.50 |
$6,795 |
5.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,397.50 |
$6,795 |
5.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,397.50 |
$6,795 |
5.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,397.50 |
$6,795 |
2.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,854 |
$7,708 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,397.50 |
$6,795 |
2.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$851.50 |
$1,703 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$681 |
$1,362 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$312.50 |
$625 |
2.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$669 |
$1,338 |
2.6× |
| Salivary gland imaging (78230) |
$1,204 |
$2,408 |
2.8× |
| Scapula (73010) |
$334 |
$668 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$89.25 |
$178.50 |
3.8× |
| Sella turcica (70240) |
$211 |
$422 |
2.3× |
| Shoulder 1 view (73020) |
$242 |
$484 |
2.6× |
| Sialogram (70390) |
$498 |
$996 |
1.9× |
| Simulation intermediate (77285) |
$1,658 |
$3,316 |
4.1× |
| Small bowel series (74250) |
$575 |
$1,150 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,299 |
$2,598 |
3.2× |
| Special dosimetry (77331) |
$647.50 |
$1,295 |
4.5× |
| Special Physics Consult (77370) |
$600 |
$1,200 |
4.2× |
| Special treatment procedure (77470) |
$2,538.50 |
$5,077 |
4.3× |
| Speech evaluation complex (70371) |
$340 |
$680 |
1.3× |
| Spine thoracic 3 views (72072) |
$343 |
$686 |
3.1× |
| Spleen imaging only (78185) |
$1,287.50 |
$2,575 |
3.0× |
| Splenoportograpy rs&i (75810) |
$1,309.50 |
$2,619 |
0.4× |
| Stereotactic Body Radiation Delivery (77373) |
$14,818 |
$29,636 |
7.7× |
| Superior sagittal sinus venogram (75870) |
$1,204.50 |
$2,409 |
0.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$557.50 |
$1,115 |
5.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$566.50 |
$1,133 |
1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$460.50 |
$921 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$1,127 |
$2,254 |
2.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,007 |
$4,014 |
5.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$731.50 |
$1,463 |
5.1× |
| Thoracolumbar 2 views (72080) |
$211 |
$422 |
2.3× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,173 |
$2,346 |
2.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,420 |
$2,840 |
2.4× |
| Thyroid imaging w/blood flow (78013) |
$550.50 |
$1,101 |
1.3× |
| Thyroid uptake measurement (78012) |
$420 |
$840 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$984 |
$1,968 |
2.3× |
| Tmj unilateral (70328) |
$262.50 |
$525 |
2.8× |
| Tomogram (76100) |
$538.50 |
$1,077 |
4.8× |
| Treatment device complex (77334) |
$1,010 |
$2,020 |
2.5× |
| Treatment device intermediate (77333) |
$995 |
$1,990 |
6.9× |
| Treatment devices simple (77332) |
$948.50 |
$1,897 |
6.6× |
| Ultrasound breast complete (76641) |
$1,144.50 |
$2,289 |
10.2× |
| Ultrasound elastography first target lesion (76982) |
$450.50 |
$901 |
4.0× |
| Ultrasound Exam Aaa Screen (76706) |
$515 |
$1,030 |
4.6× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$525 |
$1,050 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$658 |
$1,316 |
5.9× |
| Umbilical-artery Doppler (OB) (76820) |
$378 |
$756 |
3.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$259 |
$518 |
2.8× |
| Unlisted fluoroscopic procedure (76496) |
$256 |
$512 |
2.7× |
| Unlisted magnetic resonance procedure (76498) |
$729.50 |
$1,459 |
7.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,129 |
$2,258 |
10.3× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$854.50 |
$1,709 |
2.0× |
| Unlisted ultrasound procedure (76999) |
$234.50 |
$469 |
2.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$39.50 |
$79 |
3.6× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$322.50 |
$645 |
3.4× |
| Ureteral reflux study (78740) |
$952.50 |
$1,905 |
2.2× |
| Urethrocystogram voiding (74455) |
$615 |
$1,230 |
2.4× |
| Urethrocystography retrograde rs&i (74450) |
$584 |
$1,168 |
2.3× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$946 |
$1,892 |
5.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,040 |
$2,080 |
5.5× |
| Us breast unilateral limited (76642) |
$744 |
$1,488 |
8.0× |
| Us chest (76604) |
$437.50 |
$875 |
3.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,077.50 |
$2,155 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$706 |
$1,412 |
6.3× |
| Us elastography parenchyma (76981) |
$450.50 |
$901 |
4.0× |
| Us encephalogram (76506) |
$276 |
$552 |
2.5× |
| Us hips infant static (76886) |
$367 |
$734 |
3.9× |
| Us infant hips w manipulation (76885) |
$403 |
$806 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$455 |
$910 |
4.1× |
| Us ob detailed single fetus (76811) |
$770 |
$1,540 |
3.0× |
| Us ob limited (76815) |
$451 |
$902 |
4.0× |
| Us ob transvaginal (76817) |
$523.50 |
$1,047 |
4.7× |
| Us pelvic non ob complete (76856) |
$682.50 |
$1,365 |
6.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$476.50 |
$953 |
4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$654 |
$1,308 |
5.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$566 |
$1,132 |
5.1× |
| Us retroperitoneal complete (76770) |
$582.50 |
$1,165 |
5.2× |
| Us retroperitoneal limited (76775) |
$556 |
$1,112 |
5.0× |
| Us scrotum and contents (76870) |
$714 |
$1,428 |
6.4× |
| Us soft tissue head/neck (76536) |
$640.50 |
$1,281 |
5.7× |
| Us spinal canal and contents (76800) |
$380 |
$760 |
3.4× |
| Us transrectal (76872) |
$625.50 |
$1,251 |
5.6× |
| Us transrectal prostate volume (76873) |
$346 |
$692 |
3.1× |
| Us, eye b-scan (76512) |
$418.50 |
$837 |
3.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$556 |
$1,112 |
5.0× |
| Venogram adrenal unilat (75840) |
$1,721 |
$3,442 |
0.5× |
| Venogram extremity bilateral (75822) |
$1,238 |
$2,476 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$1,208 |
$2,416 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$1,890.50 |
$3,781 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,890.50 |
$3,781 |
1.1× |
| Venography Renal Bilateral (75833) |
$1,646.50 |
$3,293 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,646.50 |
$3,293 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,292.50 |
$2,585 |
0.4× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,858 |
$5,716 |
4.3× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,742 |
$5,484 |
0.5× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$800.50 |
$1,601 |
1.4× |
| Vertebral fracture assessment via dxa (77086) |
$256 |
$512 |
2.7× |
| Wrist 2 views (73100) |
$335 |
$670 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$437.50 |
$875 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$301 |
$602 |
3.2× |
| X-ray b.e. reductn intuss (74283) |
$732.50 |
$1,465 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$578.50 |
$1,157 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$309.50 |
$619 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$147.50 |
$295 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$346.50 |
$693 |
3.1× |
| X-ray exam of femur 2/> (73552) |
$211 |
$422 |
2.3× |
| X-ray eye for foreign body (70030) |
$189.50 |
$379 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$282 |
$564 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$946 |
$1,892 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$238 |
$476 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$144.50 |
$289 |
1.5× |
| X-ray leg, infant (73592) |
$211 |
$422 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$575.50 |
$1,151 |
5.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$575.50 |
$1,151 |
5.1× |
| X-ray nose-rectum child f.b. (76010) |
$219 |
$438 |
2.3× |
| X-ray optic foramen (70190) |
$347.50 |
$695 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$363 |
$726 |
3.2× |
| X-ray retrograde pyelogram (74420) |
$754.50 |
$1,509 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300 |
$600 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$329 |
$658 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$449 |
$898 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$337 |
$674 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$312 |
$624 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$211 |
$422 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$516 |
$1,032 |
4.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$344.50 |
$689 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$320 |
$640 |
3.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$285 |
$570 |
3.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$228.50 |
$457 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$322.50 |
$645 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$365 |
$730 |
3.3× |
| Xr bone length studies (77073) |
$211 |
$422 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$521 |
$1,042 |
4.6× |
| Xr c-spine 6 or more views (72052) |
$577 |
$1,154 |
5.1× |
| Xr chest 4+ views (71048) |
$272 |
$544 |
2.4× |
| Xr urogram antegrade (74425) |
$719 |
$1,438 |
1.9× |