| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,905.60 |
$2,382 |
1.2× |
| Abdomen 2 views (74019) |
$244 |
$305 |
2.1× |
| Acute gi blood loss imaging (78278) |
$867.60 |
$1,084.50 |
1.9× |
| Ankle 2 views (73600) |
$279.20 |
$349 |
2.9× |
| Arthrogram ankle (73615) |
$492.80 |
$616 |
1.3× |
| Arthrogram elbow (73085) |
$492.80 |
$616 |
1.3× |
| Arthrogram hip (73525) |
$493.60 |
$617 |
1.3× |
| Arthrogram knee (73580) |
$493.60 |
$617 |
1.3× |
| Arthrogram shoulder (73040) |
$436.40 |
$545.50 |
1.1× |
| Arthrogram wrist (73115) |
$378.80 |
$473.50 |
1.0× |
| Basic dosimetry (77300) |
$196.80 |
$246 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$486 |
$607.50 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$559.60 |
$699.50 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$909.60 |
$1,137 |
2.0× |
| Bone age studies (77072) |
$119.60 |
$149.50 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$804 |
$1,005 |
1.8× |
| Bone survey complete (77075) |
$448.40 |
$560.50 |
3.8× |
| Bone survey infant (77076) |
$314.80 |
$393.50 |
2.7× |
| Bowel imaging (78290) |
$522.40 |
$653 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,119.20 |
$1,399 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$199.20 |
$249 |
2.1× |
| Chest 1 view (71045) |
$154 |
$192.50 |
1.6× |
| Chest xray 3 views (71047) |
$208.80 |
$261 |
2.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$262 |
$327.50 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$380.40 |
$475.50 |
1.9× |
| Clavicle complete (73000) |
$159.20 |
$199 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$357.20 |
$446.50 |
3.1× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$230.40 |
$288 |
2.4× |
| Continuing medical physics consltj pr wk (77336) |
$268.80 |
$336 |
1.8× |
| Corpora cavernosography (74445) |
$733.80 |
$917.26 |
6.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,227.60 |
$2,784.50 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,718.80 |
$2,148.50 |
6.5× |
| CT abdomen w contrast (74160) |
$1,068 |
$1,335 |
5.5× |
| CT abdomen w wo contrast (74170) |
$1,273.20 |
$1,591.50 |
6.5× |
| CT abdomen w/o contrast (74150) |
$832 |
$1,040 |
7.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,283.20 |
$1,604 |
6.6× |
| CT angiography upper extremity lt (73206) |
$932.80 |
$1,166 |
4.8× |
| CT c-spine w/contrast (72126) |
$1,144 |
$1,430 |
2.9× |
| CT c-spine w/o contrast (72125) |
$968.40 |
$1,210.50 |
8.3× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$302 |
$377.50 |
1.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,206.80 |
$1,508.50 |
6.2× |
| CT chest w contrast (71260) |
$1,047.20 |
$1,309 |
5.4× |
| CT chest w/wo contrast (71270) |
$1,148.40 |
$1,435.50 |
5.9× |
| CT head/brain with contrast (70460) |
$1,010 |
$1,262.50 |
5.2× |
| CT head/brain without and with contrast (70470) |
$1,168.40 |
$1,460.50 |
6.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,178.40 |
$1,473 |
3.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$298.40 |
$373 |
3.1× |
| CT hrt w/3d image congen (75573) |
$1,224.80 |
$1,531 |
3.2× |
| CT iac w contrast (70481) |
$1,068.40 |
$1,335.50 |
5.5× |
| CT limited/localized follow up study (76380) |
$526 |
$657.50 |
5.4× |
| CT lower ext w/o (73700) |
$886.80 |
$1,108.50 |
7.6× |
| CT lower extremity w wo contrast (73702) |
$1,194.40 |
$1,493 |
6.1× |
| CT lower extremity w/contrast material (73701) |
$1,055.60 |
$1,319.50 |
5.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,251.60 |
$1,564.50 |
6.4× |
| CT lumbar spine w/contrast (72132) |
$1,177.20 |
$1,471.50 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$889.60 |
$1,112 |
7.6× |
| CT maxillofacial w contrast (70487) |
$973.60 |
$1,217 |
5.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,076.40 |
$1,345.50 |
5.5× |
| CT maxillofacial wo contrast (70486) |
$1,244.80 |
$1,556 |
10.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,189.60 |
$1,487 |
6.1× |
| CT orbits w/o contrast (70480) |
$773.20 |
$966.50 |
6.6× |
| CT pelvis w/o contrast (72192) |
$878.80 |
$1,098.50 |
7.5× |
| CT pelvis w/wo contrast (72194) |
$1,155.60 |
$1,444.50 |
5.9× |
| CT scan of arm combo (73202) |
$1,167.60 |
$1,459.50 |
6.0× |
| CT soft tissue neck w contrast (70491) |
$1,025.20 |
$1,281.50 |
5.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,150.80 |
$1,438.50 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$796.40 |
$995.50 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$1,064 |
$1,330 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$874.40 |
$1,093 |
7.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,156 |
$1,445 |
5.9× |
| CT thorax w/o contrast (71250) |
$491.20 |
$614 |
4.2× |
| CT upper ext wo (73200) |
$767.20 |
$959 |
6.6× |
| CT upper extremity with contrast (73201) |
$1,058.40 |
$1,323 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,491.20 |
$1,864 |
7.6× |
| Cta Abdomen (74175) |
$1,469.20 |
$1,836.50 |
7.5× |
| CTA abdomen pelvis (74174) |
$1,941.20 |
$2,426.50 |
5.0× |
| CTA chest (71275) |
$1,566.80 |
$1,958.50 |
8.0× |
| Cta Head (70496) |
$1,397.60 |
$1,747 |
7.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$470 |
$587.50 |
1.2× |
| Cta Neck (70498) |
$1,307.60 |
$1,634.50 |
6.7× |
| Cta Pelvis (72191) |
$1,126 |
$1,407.50 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$363.43 |
$454.28 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$91.60 |
$114.50 |
0.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$118 |
$147.50 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$204 |
$255 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$258 |
$322.50 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$145.20 |
$181.50 |
1.5× |
| Dxa bone density study axial skeleton (77085) |
$225.60 |
$282 |
1.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$193.60 |
$242 |
0.7× |
| Esophagus (74220) |
$399.60 |
$499.50 |
2.0× |
| Facial bones min 3 views (70150) |
$228.40 |
$285.50 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$343.20 |
$429 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$288.80 |
$361 |
2.5× |
| Fetal Echo (76825) |
$322 |
$402.50 |
0.5× |
| Fluoroscopy up to 1 hr (76000) |
$374.80 |
$468.50 |
1.4× |
| Foot 2 views (73620) |
$154 |
$192.50 |
1.6× |
| Forearm 2 views (73090) |
$184.40 |
$230.50 |
1.9× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$767.20 |
$959 |
1.7× |
| Hand 2 views (73120) |
$176 |
$220 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,012 |
$1,265 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$922.80 |
$1,153.50 |
2.1× |
| Hysterosalpingogram (74740) |
$460.40 |
$575.50 |
1.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$208 |
$260 |
1.8× |
| Kidney imaging morphology (78700) |
$478 |
$597.50 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$796.80 |
$996 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,211.20 |
$1,514 |
2.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$952.80 |
$1,191 |
1.6× |
| Knee 3 views (73562) |
$180 |
$225 |
1.9× |
| Liver & spleen imaging static only (78215) |
$872.40 |
$1,090.50 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$96 |
$120 |
0.2× |
| Lung perfusion differential (78597) |
$491.20 |
$614 |
1.1× |
| Lung ventilation imaging (78579) |
$796 |
$995 |
1.8× |
| Lymphoscintigraphy (78195) |
$1,055.60 |
$1,319.50 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,599.20 |
$1,999 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,342 |
$1,677.50 |
3.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,729.20 |
$2,161.50 |
4.4× |
| Mammary ductogram or galactogram multiple (77054) |
$369.60 |
$462 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$280.40 |
$350.50 |
1.1× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$214.80 |
$268.50 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$703.20 |
$879 |
1.7× |
| MRA head w & w/o contrast (70546) |
$1,766.40 |
$2,208 |
4.5× |
| MRA head w/o contrast (70544) |
$1,293.20 |
$1,616.50 |
4.9× |
| MRA head with contrast (70545) |
$1,409.20 |
$1,761.50 |
3.6× |
| MRA neck w contrast (70548) |
$1,498 |
$1,872.50 |
3.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,029.60 |
$2,537 |
5.2× |
| MRA neck w/o contrast (70547) |
$1,195.60 |
$1,494.50 |
4.5× |
| MRI abdomen w contrast (74182) |
$1,354.80 |
$1,693.50 |
3.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,920.80 |
$2,401 |
4.9× |
| MRI abdomen w/o contrast (74181) |
$1,176 |
$1,470 |
4.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,540.40 |
$1,925.50 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,834 |
$2,292.50 |
4.7× |
| MRI bone marrow blood supply (77084) |
$677.20 |
$846.50 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,552.40 |
$1,940.50 |
5.8× |
| MRI breast wo contrast unilateral (77046) |
$1,165.60 |
$1,457 |
4.4× |
| MRI c-spine with contrast (72142) |
$1,562.40 |
$1,953 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,250 |
$1,562.50 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,981.20 |
$2,476.50 |
5.1× |
| MRI chest w/o contrast (71550) |
$990 |
$1,237.50 |
3.7× |
| MRI chest with contrast (71551) |
$1,251.20 |
$1,564 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,360.80 |
$1,701 |
3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,844.40 |
$2,305.50 |
4.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,169.20 |
$1,461.50 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,125.20 |
$1,406.50 |
4.2× |
| MRI orbit face neck w contrast (70542) |
$1,270 |
$1,587.50 |
3.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,862 |
$2,327.50 |
4.8× |
| MRI pelvis w/contrast (72196) |
$1,376 |
$1,720 |
3.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,890 |
$2,362.50 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,226 |
$1,532.50 |
4.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,844.80 |
$2,306 |
4.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,844.80 |
$2,306 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,935.60 |
$2,419.50 |
5.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,562 |
$1,952.50 |
4.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,813.20 |
$2,266.50 |
4.7× |
| MRI temporomandibular joint (70336) |
$729.20 |
$911.50 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,262 |
$1,577.50 |
4.7× |
| MRI up ext w/o contrast (73218) |
$1,169.60 |
$1,462 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,120 |
$1,400 |
4.2× |
| MRI, joint upper extrem combo (73223) |
$1,841.60 |
$2,302 |
4.7× |
| Myelogram Cervical (72240) |
$898.40 |
$1,123 |
1.0× |
| Myelogram Lumbar (72265) |
$893.20 |
$1,116.50 |
1.0× |
| Myelogram thoracic (72255) |
$899.60 |
$1,124.50 |
1.0× |
| Myelography 2 or more regions (72270) |
$926 |
$1,157.50 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,440 |
$3,050 |
1.7× |
| Myocardial spect single study at rest or stress (78451) |
$1,718.80 |
$2,148.50 |
1.2× |
| N-invas est c ffr sw aly CTA (75580) |
$820.80 |
$1,026 |
0.9× |
| Neck soft tissue (70360) |
$154.40 |
$193 |
1.6× |
| Nm gastric emptying study (78264) |
$898 |
$1,122.50 |
2.0× |
| Nm kidney scan w/flow (78701) |
$771.20 |
$964 |
1.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,134.80 |
$2,668.50 |
1.4× |
| Ob us nuchal meas 1 gest (76813) |
$141.20 |
$176.50 |
1.2× |
| Osseous survey limited (77074) |
$272 |
$340 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$614.80 |
$768.50 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$888.80 |
$1,111 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$208.80 |
$261 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$505.20 |
$631.50 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,025.60 |
$1,282 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$390.40 |
$488 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$188.80 |
$236 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$151.60 |
$189.50 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$177.20 |
$221.50 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$165.20 |
$206.50 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$271.20 |
$339 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$301.20 |
$376.50 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$146.80 |
$183.50 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$188 |
$235 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$190.40 |
$238 |
2.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$155.60 |
$194.50 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$264 |
$330 |
2.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$269.60 |
$337 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$358.40 |
$448 |
3.1× |
| Radex Humerus Minimum 2 Views (73060) |
$160.80 |
$201 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$166.40 |
$208 |
1.7× |
| Radex Kne Compl 4/More Views (73564) |
$257.60 |
$322 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$260 |
$325 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$170.40 |
$213 |
1.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$293.20 |
$366.50 |
2.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$54.40 |
$68 |
0.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$154.40 |
$193 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$72.40 |
$90.50 |
0.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$197.20 |
$246.50 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$148 |
$185 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$164.80 |
$206 |
1.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$181.20 |
$226.50 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$406 |
$507.50 |
3.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$9,525.60 |
$11,907 |
1.2× |
| Radiation treatment delivery level 1 (77402) |
$276 |
$345 |
2.4× |
| Radiation treatment delivery level 2 (77407) |
$948 |
$1,185 |
2.2× |
| Radiation treatment delivery level 3 (77412) |
$1,360 |
$1,700 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$305.60 |
$382 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$255.60 |
$319.50 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$176.80 |
$221 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$498 |
$622.50 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$392.40 |
$490.50 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$134.80 |
$168.50 |
0.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$405.60 |
$507 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$180.40 |
$225.50 |
1.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$46.80 |
$58.50 |
0.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$184.40 |
$230.50 |
1.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$246.40 |
$308 |
2.1× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$167.60 |
$209.50 |
1.4× |
| Radiological examination surgical specimen (76098) |
$343.20 |
$429 |
0.6× |
| Ribs bilateral 3 views (71110) |
$274 |
$342.50 |
2.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$74.40 |
$93 |
0.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$82.40 |
$103 |
0.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$91.20 |
$114 |
0.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$121.60 |
$152 |
0.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$204 |
$255 |
0.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$237.60 |
$297 |
0.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$165.60 |
$207 |
0.1× |
| Sacroiliac Joints < 3 Views (72200) |
$152.40 |
$190.50 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$324.40 |
$405.50 |
1.2× |
| Scapula (73010) |
$212.40 |
$265.50 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$76 |
$95 |
3.3× |
| Shoulder 1 view (73020) |
$151.20 |
$189 |
1.6× |
| Sialogram (70390) |
$442 |
$552.50 |
1.7× |
| Simulation intermediate (77285) |
$537.60 |
$672 |
1.3× |
| Small bowel series (74250) |
$376 |
$470 |
1.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$492 |
$615 |
1.2× |
| Special dosimetry (77331) |
$216 |
$270 |
1.4× |
| Special Physics Consult (77370) |
$338.40 |
$423 |
2.3× |
| Special treatment procedure (77470) |
$831.60 |
$1,039.50 |
1.4× |
| Spine thoracic 3 views (72072) |
$262.40 |
$328 |
2.3× |
| Stereotactic Body Radiation Delivery (77373) |
$3,520.80 |
$4,401 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$618 |
$772.50 |
1.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$524.40 |
$655.50 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$545.20 |
$681.50 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$568.80 |
$711 |
1.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$324 |
$405 |
2.2× |
| Thoracolumbar 2 views (72080) |
$214.40 |
$268 |
2.2× |
| Thyroid imaging w/blood flow (78013) |
$314.80 |
$393.50 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$592.40 |
$740.50 |
1.3× |
| Tmj unilateral (70328) |
$172.80 |
$216 |
1.8× |
| Tomogram (76100) |
$198.40 |
$248 |
1.7× |
| Treatment device complex (77334) |
$508.80 |
$636 |
1.2× |
| Treatment device intermediate (77333) |
$204 |
$255 |
1.4× |
| Treatment devices simple (77332) |
$186 |
$232.50 |
1.2× |
| Ultrasound breast complete (76641) |
$285.60 |
$357 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$309.60 |
$387 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$72 |
$90 |
0.6× |
| Umbilical-artery Doppler (OB) (76820) |
$262.40 |
$328 |
2.3× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$268.80 |
$336 |
24.3× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$77.60 |
$97 |
0.8× |
| Urethrocystogram voiding (74455) |
$412.25 |
$515.31 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$380.27 |
$475.34 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$246 |
$307.50 |
1.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$555.20 |
$694 |
2.8× |
| Us breast unilateral limited (76642) |
$229.20 |
$286.50 |
2.4× |
| Us chest (76604) |
$386.80 |
$483.50 |
3.3× |
| Us compl joint r-t w/image documentation (76881) |
$282.80 |
$353.50 |
2.4× |
| Us hips infant static (76886) |
$244 |
$305 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$274.40 |
$343 |
2.4× |
| Us ob detailed single fetus (76811) |
$562.80 |
$703.50 |
2.1× |
| Us ob limited (76815) |
$146.40 |
$183 |
1.3× |
| Us ob transvaginal (76817) |
$331.60 |
$414.50 |
2.8× |
| Us pelvic non ob complete (76856) |
$383.20 |
$479 |
3.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$289.34 |
$361.67 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$120 |
$150 |
1.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$354 |
$442.50 |
3.0× |
| Us retroperitoneal complete (76770) |
$484.80 |
$606 |
4.2× |
| Us retroperitoneal limited (76775) |
$130.40 |
$163 |
1.1× |
| Us scrotum and contents (76870) |
$368.40 |
$460.50 |
3.2× |
| Us soft tissue head/neck (76536) |
$346.80 |
$433.50 |
3.0× |
| Us transrectal (76872) |
$170.97 |
$213.72 |
1.5× |
| Us, eye b-scan (76512) |
$136.40 |
$170.50 |
1.2× |
| Vasogram (74440) |
$236.76 |
$295.96 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,011.60 |
$1,264.50 |
0.6× |
| Venogram Extremity Unilateral (75820) |
$926.80 |
$1,158.50 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$90 |
$112.50 |
0.9× |
| Wrist 2 views (73100) |
$157.60 |
$197 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$274 |
$342.50 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$237.60 |
$297 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$340.80 |
$426 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$625.60 |
$782 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$152.80 |
$191 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$190.40 |
$238 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$320.40 |
$400.50 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$190.80 |
$238.50 |
2.0× |
| X-ray eye for foreign body (70030) |
$152.40 |
$190.50 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$156.80 |
$196 |
1.6× |
| X-ray IV pyelogram (ivp) (74400) |
$451.20 |
$564 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$177.60 |
$222 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$167.60 |
$209.50 |
1.7× |
| X-ray leg, infant (73592) |
$164.80 |
$206 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$241.60 |
$302 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$334.80 |
$418.50 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$176 |
$220 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$261.20 |
$326.50 |
2.2× |
| X-ray retrograde pyelogram (74420) |
$651.40 |
$814.24 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$183.20 |
$229 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$215.60 |
$269.50 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$274 |
$342.50 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$245.60 |
$307 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$186 |
$232.50 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$226.80 |
$283.50 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$308.40 |
$385.50 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$184.80 |
$231 |
1.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$286.80 |
$358.50 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$133.20 |
$166.50 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$180.80 |
$226 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$171.20 |
$214 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$229.60 |
$287 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$294.40 |
$368 |
2.5× |
| Xr bone length studies (77073) |
$224 |
$280 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$292.80 |
$366 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$336.80 |
$421 |
2.9× |
| Xr chest 4+ views (71048) |
$249.20 |
$311.50 |
2.1× |
| Xr urogram antegrade (74425) |
$428.16 |
$535.20 |
1.1× |