| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,961.90 |
$8,517 |
3.9× |
| Abdomen 2 views (74019) |
$375.20 |
$536 |
3.2× |
| Acute gi blood loss imaging (78278) |
$1,243.90 |
$1,777 |
2.8× |
| Angio Adrenal Bilat Select (75733) |
$1,783.60 |
$2,548 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$6,240.50 |
$8,915 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$5,003.60 |
$7,148 |
1.4× |
| Angiography internal mammary rs&i (75756) |
$1,061.90 |
$1,517 |
0.3× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,614.40 |
$6,592 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,337 |
$11,910 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$7,391.30 |
$10,559 |
2.1× |
| Angiography Spinal Selective Rs&I (75705) |
$13,710.20 |
$19,586 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,509.60 |
$10,728 |
1.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,358.70 |
$1,941 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,286.90 |
$3,267 |
0.6× |
| Ankle 2 views (73600) |
$347.90 |
$497 |
3.6× |
| Aortogram thoracic (75605) |
$5,054.70 |
$7,221 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,105.40 |
$8,722 |
1.7× |
| Aortography abdominal serialography rs&i (75625) |
$4,535.30 |
$6,479 |
1.3× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,077.90 |
$4,397 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$4,402.30 |
$6,289 |
1.3× |
| Arthrogram elbow (73085) |
$928.90 |
$1,327 |
2.4× |
| Arthrogram hip (73525) |
$833.70 |
$1,191 |
2.1× |
| Arthrogram knee (73580) |
$506.10 |
$723 |
1.3× |
| Arthrogram shoulder (73040) |
$1,075.20 |
$1,536 |
2.8× |
| Arthrogram wrist (73115) |
$627.90 |
$897 |
1.6× |
| Basic dosimetry (77300) |
$466.90 |
$667 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$544.60 |
$778 |
1.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$490 |
$700 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$1,094.10 |
$1,563 |
2.5× |
| Bone age studies (77072) |
$303.80 |
$434 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$1,182.30 |
$1,689 |
2.7× |
| Bone Marrow Imaging Limited Area (78102) |
$431.20 |
$616 |
1.0× |
| Bone survey complete (77075) |
$1,057 |
$1,510 |
9.1× |
| Bone survey infant (77076) |
$591.50 |
$845 |
5.1× |
| Bowel imaging (78290) |
$879.90 |
$1,257 |
2.0× |
| Brachytx isodose complex (77318) |
$336 |
$480 |
0.8× |
| Brachytx isodose intermed (77317) |
$295.40 |
$422 |
0.7× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$199.50 |
$285 |
0.5× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$828.80 |
$1,184 |
1.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,274 |
$1,820 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,532.20 |
$5,046 |
2.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,451.80 |
$2,074 |
3.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,753.10 |
$3,933 |
7.1× |
| Cardiac shunt detection (78428) |
$739.20 |
$1,056 |
1.7× |
| Cardiovasc nucl exam unlisted (78499) |
$362.60 |
$518 |
0.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,012.20 |
$1,446 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$445.90 |
$637 |
4.6× |
| Chest 1 view (71045) |
$386.40 |
$552 |
4.0× |
| Chest xray 3 views (71047) |
$624.40 |
$892 |
6.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$476 |
$680 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$776.30 |
$1,109 |
4.0× |
| Cineradiography/videoradiography (76120) |
$372.40 |
$532 |
3.2× |
| Clavicle complete (73000) |
$363.30 |
$519 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$228.90 |
$327 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$681.10 |
$973 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,818.50 |
$5,455 |
9.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,693.60 |
$3,848 |
10.1× |
| CT abdomen w contrast (74160) |
$1,672.30 |
$2,389 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,909.60 |
$2,728 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,346.80 |
$1,924 |
11.6× |
| CT angio hrt w/3d image (75574) |
$1,656.20 |
$2,366 |
4.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,322.60 |
$3,318 |
11.9× |
| CT angiography upper extremity lt (73206) |
$2,322.60 |
$3,318 |
11.9× |
| CT c-spine w/contrast (72126) |
$1,771.70 |
$2,531 |
4.6× |
| CT c-spine w/o contrast (72125) |
$1,644.30 |
$2,349 |
14.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,838.90 |
$2,627 |
9.4× |
| CT chest w contrast (71260) |
$1,684.20 |
$2,406 |
8.6× |
| CT chest w/wo contrast (71270) |
$1,909.60 |
$2,728 |
9.8× |
| CT colonography screening (74263) |
$1,784.30 |
$2,549 |
6.7× |
| CT colonography w/dye (74262) |
$1,731.80 |
$2,474 |
8.9× |
| CT colonography w/o cntrst (74261) |
$1,718.50 |
$2,455 |
14.8× |
| CT head/brain with contrast (70460) |
$1,390.90 |
$1,987 |
7.1× |
| CT head/brain without and with contrast (70470) |
$1,971.90 |
$2,817 |
10.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,242.50 |
$1,775 |
3.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$76.30 |
$109 |
0.8× |
| CT iac w contrast (70481) |
$1,232.70 |
$1,761 |
6.3× |
| CT limited/localized follow up study (76380) |
$789.60 |
$1,128 |
8.1× |
| CT lower ext w/o (73700) |
$1,371.30 |
$1,959 |
11.8× |
| CT lower extremity w wo contrast (73702) |
$1,672.30 |
$2,389 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$1,486.80 |
$2,124 |
7.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,909.60 |
$2,728 |
9.8× |
| CT lumbar spine w/contrast (72132) |
$1,672.30 |
$2,389 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,534.40 |
$2,192 |
13.2× |
| CT maxillofacial w contrast (70487) |
$1,390.90 |
$1,987 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,957.90 |
$2,797 |
10.0× |
| CT maxillofacial wo contrast (70486) |
$1,355.20 |
$1,936 |
11.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,471.40 |
$2,102 |
7.5× |
| CT orbits w/o contrast (70480) |
$1,180.20 |
$1,686 |
10.1× |
| CT pelvis w/o contrast (72192) |
$1,346.80 |
$1,924 |
11.6× |
| CT pelvis w/wo contrast (72194) |
$1,909.60 |
$2,728 |
9.8× |
| CT scan of arm combo (73202) |
$1,558.20 |
$2,226 |
8.0× |
| CT soft tissue neck w contrast (70491) |
$1,487.50 |
$2,125 |
7.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,755.60 |
$2,508 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,357.30 |
$1,939 |
11.7× |
| CT thoracic spine w/contrast (72129) |
$1,672.30 |
$2,389 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,545.60 |
$2,208 |
13.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,736 |
$2,480 |
8.9× |
| CT thorax w/o contrast (71250) |
$1,357.30 |
$1,939 |
11.7× |
| CT upper ext wo (73200) |
$1,287.30 |
$1,839 |
11.0× |
| CT upper extremity with contrast (73201) |
$1,416.80 |
$2,024 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,656.20 |
$2,366 |
8.5× |
| Cta Abdomen (74175) |
$2,322.60 |
$3,318 |
11.9× |
| CTA abdomen pelvis (74174) |
$4,560.50 |
$6,515 |
11.7× |
| CTA chest (71275) |
$2,339.40 |
$3,342 |
12.0× |
| Cta Head (70496) |
$2,510.20 |
$3,586 |
12.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$599.20 |
$856 |
1.5× |
| Cta Neck (70498) |
$2,510.20 |
$3,586 |
12.8× |
| Cta Pelvis (72191) |
$2,322.60 |
$3,318 |
11.9× |
| Cystography minimum 3 views rs&i (74430) |
$714.70 |
$1,021 |
1.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,153.60 |
$1,648 |
0.5× |
| Diskogram cervical (72285) |
$2,896.60 |
$4,138 |
1.3× |
| Diskography lumbar (72295) |
$2,331 |
$3,330 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$417.20 |
$596 |
3.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$527.10 |
$753 |
4.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$605.50 |
$865 |
5.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$189.35 |
$270.50 |
2.0× |
| Dxa bone density study axial skeleton (77085) |
$763 |
$1,090 |
6.5× |
| Esophagus (74220) |
$676.90 |
$967 |
3.5× |
| Facial bones min 3 views (70150) |
$665 |
$950 |
5.7× |
| Fetal biophysical profile non-stress testing (76818) |
$1,169.70 |
$1,671 |
10.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$640.50 |
$915 |
5.5× |
| Fetal Echo (76825) |
$1,467.90 |
$2,097 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$633.50 |
$905 |
2.4× |
| Foot 2 views (73620) |
$347.90 |
$497 |
3.6× |
| Forearm 2 views (73090) |
$363.30 |
$519 |
3.7× |
| Functional MRI brain by tech (70554) |
$2,069.20 |
$2,956 |
7.8× |
| Hand 2 views (73120) |
$364.70 |
$521 |
3.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$497 |
$710 |
0.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,169.70 |
$1,671 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,423.80 |
$2,034 |
1.8× |
| Heart Infarct Image (78466) |
$482.30 |
$689 |
1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,772.60 |
$6,818 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,968 |
$4,240 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,140.30 |
$1,629 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$997.50 |
$1,425 |
2.2× |
| Hysterosalpingogram (74740) |
$950.60 |
$1,358 |
3.6× |
| Interstitial radiation source applic complex (77778) |
$2,953.30 |
$4,219 |
3.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$390.60 |
$558 |
3.4× |
| Kidney imaging morphology (78700) |
$506.10 |
$723 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$962.50 |
$1,375 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,131.20 |
$1,616 |
1.9× |
| Knee 3 views (73562) |
$434.70 |
$621 |
4.5× |
| Liver & spleen imaging static only (78215) |
$872.20 |
$1,246 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$942.20 |
$1,346 |
1.6× |
| Lung perfusion differential (78597) |
$754.60 |
$1,078 |
1.7× |
| Lung ventilation imaging (78579) |
$1,111.60 |
$1,588 |
2.5× |
| Lymphoscintigraphy (78195) |
$1,243.90 |
$1,777 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,856 |
$4,080 |
3.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,704.80 |
$3,864 |
7.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,028.90 |
$4,327 |
7.8× |
| Mammary ductogram or galactogram multiple (77054) |
$1,108.80 |
$1,584 |
4.2× |
| Mammary ductogram or galactogram single (77053) |
$835.80 |
$1,194 |
3.1× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,869 |
$2,670 |
4.5× |
| MRA head w & w/o contrast (70546) |
$2,852.50 |
$4,075 |
7.3× |
| MRA head w/o contrast (70544) |
$2,251.90 |
$3,217 |
8.5× |
| MRA head with contrast (70545) |
$2,260.30 |
$3,229 |
5.8× |
| MRA neck w contrast (70548) |
$2,268.70 |
$3,241 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,650.90 |
$3,787 |
6.8× |
| MRA neck w/o contrast (70547) |
$2,191 |
$3,130 |
8.2× |
| MRI abdomen w contrast (74182) |
$2,704.80 |
$3,864 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,895.50 |
$5,565 |
10.0× |
| MRI abdomen w/o contrast (74181) |
$2,487.80 |
$3,554 |
9.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,856 |
$4,080 |
3.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,140.90 |
$4,487 |
8.1× |
| MRI bone marrow blood supply (77084) |
$2,361.10 |
$3,373 |
8.9× |
| MRI breast w/o contrast bilateral (77047) |
$1,948.80 |
$2,784 |
7.3× |
| MRI breast wo contrast unilateral (77046) |
$2,216.20 |
$3,166 |
8.3× |
| MRI c-spine with contrast (72142) |
$2,975.70 |
$4,251 |
7.7× |
| MRI cardiac w/o contrast (75557) |
$2,899.40 |
$4,142 |
10.9× |
| MRI cervical spine w/o contrast (72141) |
$2,790.90 |
$3,987 |
10.5× |
| MRI chest w/o & w/contrast material (71552) |
$4,249.70 |
$6,071 |
10.9× |
| MRI chest w/o contrast (71550) |
$2,326.10 |
$3,323 |
8.7× |
| MRI chest with contrast (71551) |
$2,457.70 |
$3,511 |
2.8× |
| MRI fetal sngl/1st gestation (74712) |
$2,112.60 |
$3,018 |
7.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,556.40 |
$3,652 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,116.40 |
$4,452 |
8.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,527 |
$3,610 |
9.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,365.30 |
$3,379 |
8.9× |
| MRI orbit face neck w contrast (70542) |
$2,610.30 |
$3,729 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,168.20 |
$4,526 |
8.1× |
| MRI pelvis w/contrast (72196) |
$2,457.70 |
$3,511 |
6.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,301.90 |
$4,717 |
8.5× |
| MRI pelvis w/o contrast (72195) |
$2,397.50 |
$3,425 |
9.0× |
| MRI spectroscopy (76390) |
$1,253 |
$1,790 |
12.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,721.20 |
$5,316 |
9.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,725.10 |
$3,893 |
7.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,922.10 |
$5,603 |
10.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,136.70 |
$4,481 |
8.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,922.10 |
$5,603 |
10.1× |
| MRI temporomandibular joint (70336) |
$2,487.80 |
$3,554 |
9.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,942.80 |
$4,204 |
11.1× |
| MRI up ext w/o contrast (73218) |
$1,994.65 |
$2,849.50 |
7.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,615.20 |
$3,736 |
9.8× |
| MRI, joint upper extrem combo (73223) |
$3,164 |
$4,520 |
8.1× |
| Myelogram Cervical (72240) |
$1,718.50 |
$2,455 |
2.0× |
| Myelogram Lumbar (72265) |
$1,354.50 |
$1,935 |
1.6× |
| Myelogram thoracic (72255) |
$1,558.20 |
$2,226 |
1.8× |
| Myelography 2 or more regions (72270) |
$1,963.50 |
$2,805 |
2.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,230.20 |
$3,186 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,630.20 |
$5,186 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$2,746.80 |
$3,924 |
1.9× |
| Neck soft tissue (70360) |
$345.80 |
$494 |
3.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$366.10 |
$523 |
0.8× |
| Nm adrenal scan (78075) |
$2,566.90 |
$3,667 |
1.8× |
| Nm bone marrow wb (78104) |
$938 |
$1,340 |
2.1× |
| Nm cisternogram (78630) |
$542.50 |
$775 |
0.9× |
| Nm csf leak detection (78650) |
$506.10 |
$723 |
0.4× |
| Nm gastric emptying study (78264) |
$1,140.30 |
$1,629 |
2.6× |
| Nm gastroesophageal reflux study (78262) |
$803.60 |
$1,148 |
1.8× |
| Nm peritoneal-venous shunt patency (78291) |
$837.20 |
$1,196 |
1.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$476.70 |
$681 |
1.1× |
| Nonvascular shunt X-ray (75809) |
$540.40 |
$772 |
4.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,164.20 |
$8,806 |
4.0× |
| Nuclear Rx Oral Admin (79005) |
$893.90 |
$1,277 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$668.50 |
$955 |
5.7× |
| Osseous survey limited (77074) |
$870.80 |
$1,244 |
7.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,183.70 |
$1,691 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$826 |
$1,180 |
1.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$860.30 |
$1,229 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$366.10 |
$523 |
3.1× |
| Peritoneogram after injection (74190) |
$490 |
$700 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$3,926.30 |
$5,609 |
2.5× |
| PET imaging CT for attenuation limited area (78814) |
$4,162.90 |
$5,947 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$4,084.50 |
$5,835 |
2.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$2,772.70 |
$3,961 |
1.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$11,045.30 |
$15,779 |
3.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,482.90 |
$3,547 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$860.30 |
$1,229 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,554.70 |
$2,221 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$540.40 |
$772 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$438.90 |
$627 |
4.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$348.60 |
$498 |
3.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$450.80 |
$644 |
4.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$189 |
$270 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$205.80 |
$294 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$311.50 |
$445 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$297.50 |
$425 |
3.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$438.90 |
$627 |
4.5× |
| Radex Hand Minimum 3 Views (73130) |
$438.90 |
$627 |
4.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$266.70 |
$381 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$328.30 |
$469 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$309.40 |
$442 |
2.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$494.20 |
$706 |
4.2× |
| Radex Humerus Minimum 2 Views (73060) |
$404.60 |
$578 |
4.2× |
| Radex Kne 1/2 Views (73560) |
$370.30 |
$529 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$463.40 |
$662 |
4.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$635.60 |
$908 |
5.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$423.50 |
$605 |
4.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$508.20 |
$726 |
4.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$467.60 |
$668 |
4.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$319.20 |
$456 |
3.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$362.60 |
$518 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$529.90 |
$757 |
5.5× |
| Radex Toe Minimum 2 Views (73660) |
$361.90 |
$517 |
3.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$385 |
$550 |
3.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$438.90 |
$627 |
4.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$598.50 |
$855 |
5.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$19,775.70 |
$28,251 |
2.4× |
| Radiation treatment delivery level 3 (77412) |
$820.40 |
$1,172 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$341.60 |
$488 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$527.80 |
$754 |
4.5× |
| Radiologic exam chest 2 views (71046) |
$567 |
$810 |
5.8× |
| Radiologic exam colon single contrast study (74270) |
$1,047.20 |
$1,496 |
5.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$752.50 |
$1,075 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$814.80 |
$1,164 |
4.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$678.30 |
$969 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$492.80 |
$704 |
5.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$397.60 |
$568 |
4.1× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$195.30 |
$279 |
1.7× |
| Radiological examination surgical specimen (76098) |
$1,111.60 |
$1,588 |
1.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$884.10 |
$1,263 |
3.4× |
| Ribs bilateral 3 views (71110) |
$600.60 |
$858 |
5.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,088.50 |
$1,555 |
2.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,166.20 |
$1,666 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,917.30 |
$2,739 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,552.60 |
$2,218 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,446.50 |
$3,495 |
4.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,934.70 |
$5,621 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,157.70 |
$4,511 |
2.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$652.40 |
$932 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$1,005.20 |
$1,436 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$270.90 |
$387 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$589.40 |
$842 |
2.2× |
| Scapula (73010) |
$388.50 |
$555 |
3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$37.80 |
$54 |
1.6× |
| Shoulder 1 view (73020) |
$341.60 |
$488 |
3.5× |
| Sialogram (70390) |
$343.70 |
$491 |
1.3× |
| Simulation intermediate (77285) |
$918.40 |
$1,312 |
2.2× |
| Small bowel series (74250) |
$877.80 |
$1,254 |
4.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$295.40 |
$422 |
0.7× |
| Special dosimetry (77331) |
$522.90 |
$747 |
3.5× |
| Special Physics Consult (77370) |
$799.40 |
$1,142 |
5.3× |
| Special treatment procedure (77470) |
$1,925.70 |
$2,751 |
3.1× |
| Spine thoracic 3 views (72072) |
$565.60 |
$808 |
4.9× |
| Splenoportograpy rs&i (75810) |
$2,518.60 |
$3,598 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$5,237.40 |
$7,482 |
2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$221.90 |
$317 |
0.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$169.40 |
$242 |
0.4× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$488.60 |
$698 |
1.8× |
| Testicular Imaging With Vascular Flow (78761) |
$380.10 |
$543 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,798.30 |
$2,569 |
4.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$502.60 |
$718 |
3.4× |
| Thoracolumbar 2 views (72080) |
$445.90 |
$637 |
4.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,451.80 |
$2,074 |
2.4× |
| Thyroid imaging w/blood flow (78013) |
$595 |
$850 |
1.3× |
| Thyroid uptake measurement (78012) |
$272.30 |
$389 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$933.10 |
$1,333 |
2.1× |
| Tmj unilateral (70328) |
$410.20 |
$586 |
4.2× |
| Treatment device complex (77334) |
$1,157.10 |
$1,653 |
2.8× |
| Treatment device intermediate (77333) |
$832.30 |
$1,189 |
5.6× |
| Treatment devices simple (77332) |
$770.70 |
$1,101 |
5.1× |
| Ultrasound breast complete (76641) |
$669.90 |
$957 |
5.8× |
| Ultrasound Exam Aaa Screen (76706) |
$718.90 |
$1,027 |
6.2× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$390.60 |
$558 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$672 |
$960 |
5.8× |
| Umbilical-artery Doppler (OB) (76820) |
$713.30 |
$1,019 |
6.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$243.60 |
$348 |
2.5× |
| Unlisted fluoroscopic procedure (76496) |
$719.60 |
$1,028 |
7.4× |
| Unlisted magnetic resonance procedure (76498) |
$2,926 |
$4,180 |
30.2× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$1,262.80 |
$1,804 |
2.8× |
| Unlisted ultrasound procedure (76999) |
$193.20 |
$276 |
2.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$144.90 |
$207 |
13.1× |
| Ureteral reflux study (78740) |
$482.30 |
$689 |
1.1× |
| Urethrocystogram voiding (74455) |
$746.90 |
$1,067 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$690.20 |
$986 |
2.6× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$671.30 |
$959 |
3.4× |
| Us breast unilateral limited (76642) |
$362.60 |
$518 |
3.7× |
| Us chest (76604) |
$518.70 |
$741 |
4.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$952.70 |
$1,361 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$726.60 |
$1,038 |
6.2× |
| Us encephalogram (76506) |
$521.50 |
$745 |
4.5× |
| Us hips infant static (76886) |
$374.50 |
$535 |
3.9× |
| Us infant hips w manipulation (76885) |
$404.60 |
$578 |
4.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$583.10 |
$833 |
5.0× |
| Us ob detailed single fetus (76811) |
$833 |
$1,190 |
3.1× |
| Us ob limited (76815) |
$514.50 |
$735 |
4.4× |
| Us ob transvaginal (76817) |
$746.20 |
$1,066 |
6.4× |
| Us pelvic non ob complete (76856) |
$808.50 |
$1,155 |
6.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$521.50 |
$745 |
4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$722.40 |
$1,032 |
6.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$584.50 |
$835 |
5.0× |
| Us retroperitoneal complete (76770) |
$808.50 |
$1,155 |
6.9× |
| Us retroperitoneal limited (76775) |
$501.90 |
$717 |
4.3× |
| Us scrotum and contents (76870) |
$753.90 |
$1,077 |
6.5× |
| Us soft tissue head/neck (76536) |
$709.10 |
$1,013 |
6.1× |
| Us spinal canal and contents (76800) |
$473.20 |
$676 |
4.1× |
| Us transrectal (76872) |
$296.10 |
$423 |
2.5× |
| Us transrectal prostate volume (76873) |
$434.70 |
$621 |
3.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$653.10 |
$933 |
5.6× |
| Venogram extremity bilateral (75822) |
$1,627.50 |
$2,325 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,501.50 |
$2,145 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$4,298 |
$6,140 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$4,319.70 |
$6,171 |
2.5× |
| Venography Renal Bilateral (75833) |
$3,896.20 |
$5,566 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$3,556.70 |
$5,081 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,598.80 |
$2,284 |
0.5× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,909.20 |
$4,156 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$537.60 |
$768 |
5.5× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$844.20 |
$1,206 |
1.4× |
| Wrist 2 views (73100) |
$350 |
$500 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$703.50 |
$1,005 |
6.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$406.70 |
$581 |
4.2× |
| X-ray b.e. reductn intuss (74283) |
$996.10 |
$1,423 |
5.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,554 |
$2,220 |
8.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$362.60 |
$518 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$295.40 |
$422 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$311.50 |
$445 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$518.70 |
$741 |
5.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$409.50 |
$585 |
4.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$452.20 |
$646 |
4.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$700 |
$1,000 |
7.2× |
| X-ray leg, infant (73592) |
$385.70 |
$551 |
4.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$445.90 |
$637 |
3.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$788.90 |
$1,127 |
6.8× |
| X-ray nose-rectum child f.b. (76010) |
$310.80 |
$444 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$499.10 |
$713 |
4.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$545.30 |
$779 |
5.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$574.70 |
$821 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$694.40 |
$992 |
6.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$498.40 |
$712 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$464.10 |
$663 |
4.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$514.50 |
$735 |
5.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$354.20 |
$506 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$347.90 |
$497 |
3.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$891.80 |
$1,274 |
4.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$347.90 |
$497 |
3.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$282.80 |
$404 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$455.70 |
$651 |
4.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$445.90 |
$637 |
3.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$628.60 |
$898 |
5.4× |
| Xr bone length studies (77073) |
$472.50 |
$675 |
4.1× |
| Xr c-spine 4 or 5 views (72050) |
$687.40 |
$982 |
5.9× |
| Xr c-spine 6 or more views (72052) |
$749 |
$1,070 |
6.4× |
| Xr chest 4+ views (71048) |
$686.70 |
$981 |
5.9× |
| Xr urogram antegrade (74425) |
$665.70 |
$951 |
1.7× |