| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,505.50 |
$8,674 |
4.0× |
| Abdomen 1 View (74018) |
$232.50 |
$310 |
2.3× |
| Abdomen 2 views (74019) |
$276.75 |
$369 |
2.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,213.50 |
$1,618 |
2.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$3,396 |
$4,528 |
2.2× |
| Adrenal Cortex & Medulla Img (78075) |
$3,236.25 |
$4,315 |
2.1× |
| Angio internal mammary (75756) |
$8,295 |
$11,060 |
2.2× |
| Angio pulmonary bilat (75743) |
$8,295 |
$11,060 |
2.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$8,295 |
$11,060 |
2.2× |
| Angiography extremity bilateral rs&i (75716) |
$8,301 |
$11,068 |
2.2× |
| Angiography extremity unilateral rs&i (75710) |
$8,301 |
$11,068 |
2.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,295 |
$11,060 |
2.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$8,301 |
$11,068 |
2.2× |
| Ankle 2 views (73600) |
$232.50 |
$310 |
2.3× |
| Aortography thoracic serialography rs&i (75605) |
$14,313 |
$19,084 |
2.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$8,295 |
$11,060 |
2.2× |
| Artery X-Rays Abdomen (75726) |
$14,317.50 |
$19,090 |
2.2× |
| Artery X-Rays Adrenal Gland (75731) |
$8,295 |
$11,060 |
2.2× |
| Artery X-Rays Pelvis (75736) |
$14,317.50 |
$19,090 |
2.2× |
| Artery X-Rays Spine (75705) |
$14,313 |
$19,084 |
2.2× |
| Arthrogram ankle (73615) |
$1,024.50 |
$1,366 |
2.5× |
| Arthrogram hip (73525) |
$1,026 |
$1,368 |
2.5× |
| Arthrogram Wrist (73115) |
$1,024.50 |
$1,366 |
2.5× |
| Basic radiation dosimetry calculation (77300) |
$649.50 |
$866 |
4.1× |
| Bone age studies (77072) |
$298.50 |
$398 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,056 |
$1,408 |
2.2× |
| Bone Imaging Limited Area (78300) |
$997.50 |
$1,330 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$997.50 |
$1,330 |
2.1× |
| Bone Imaging Whole Body (78306) |
$1,056 |
$1,408 |
2.2× |
| Bone marrow imaging limited area (78102) |
$997.50 |
$1,330 |
2.1× |
| Bone marrow imaging; multiple areas (78103) |
$997.50 |
$1,330 |
2.1× |
| Bone marrow imaging; whole body (78104) |
$997.50 |
$1,330 |
2.1× |
| Bone survey infant (77076) |
$305.25 |
$407 |
2.5× |
| Brachytx isodose complex (77318) |
$1,197 |
$1,596 |
2.7× |
| Brachytx isodose intermed (77317) |
$1,031.25 |
$1,375 |
2.3× |
| Brachytx Isodose Plan Simple (77316) |
$1,031.25 |
$1,375 |
2.3× |
| Brain Flow Imaging Only (78610) |
$1,335 |
$1,780 |
2.1× |
| Brain Image W/Flow < 4 Views (78601) |
$997.50 |
$1,330 |
2.1× |
| Brain imaging < 4 static views (78600) |
$997.50 |
$1,330 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,335 |
$1,780 |
2.1× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,335 |
$1,780 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,278 |
$5,704 |
2.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$997.50 |
$1,330 |
2.1× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$1,335 |
$1,780 |
2.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,400 |
$3,200 |
5.8× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$2,100 |
$2,800 |
2.3× |
| Cardiac Shunt Detection (78428) |
$997.50 |
$1,330 |
2.1× |
| Cat Scan Follow-Up Study (76380) |
$435 |
$580 |
4.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,335 |
$1,780 |
2.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$1,335 |
$1,780 |
2.1× |
| Cerebrospinal Fluid Scan (78630) |
$1,335 |
$1,780 |
2.1× |
| Chest 1 view (71045) |
$246.75 |
$329 |
2.4× |
| Chest 2 views (71046) |
$285 |
$380 |
2.8× |
| Chest 3 views (71047) |
$283.50 |
$378 |
2.8× |
| Chest 4 or more views (71048) |
$296.25 |
$395 |
2.4× |
| Cholecystography Oral Contrast (74290) |
$504 |
$672 |
2.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$327.75 |
$437 |
2.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,064.75 |
$2,753 |
2.2× |
| Clavicle complete (73000) |
$264.75 |
$353 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$652.50 |
$870 |
5.3× |
| Continuing medical physics consltj pr wk (77336) |
$727.50 |
$970 |
4.6× |
| Contrast Exam Abdominl Aorta (75625) |
$8,301 |
$11,068 |
2.2× |
| Contrast X-Ray Bladder (74430) |
$1,026 |
$1,368 |
2.5× |
| Contrast X-Ray Of Elbow (73085) |
$1,024.50 |
$1,366 |
2.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,024.50 |
$1,366 |
2.5× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$504 |
$672 |
2.4× |
| Corpora cavernosography (74445) |
$296.25 |
$395 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,472.50 |
$4,630 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,400 |
$3,200 |
8.5× |
| CT abdomen w contrast (74160) |
$1,965 |
$2,620 |
9.5× |
| CT abdomen w wo contrast (74170) |
$2,182.50 |
$2,910 |
10.5× |
| CT abdomen w/o contrast (74150) |
$1,747.50 |
$2,330 |
14.1× |
| CT Angio Abdomen and Pelvis (74174) |
$3,427.50 |
$4,570 |
8.3× |
| CT Angio Chest (71275) |
$1,912.50 |
$2,550 |
9.2× |
| CT Angio Head (70496) |
$2,040 |
$2,720 |
9.8× |
| CT angio hrt w/3d image (75574) |
$1,965 |
$2,620 |
4.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,380 |
$1,840 |
6.7× |
| CT Angio Neck (70498) |
$1,965 |
$2,620 |
9.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,380 |
$1,840 |
6.7× |
| CT bone density (77078) |
$345 |
$460 |
3.4× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$750.75 |
$1,001 |
3.6× |
| CT cervical spine w/ contrast (72126) |
$1,822.50 |
$2,430 |
4.4× |
| CT cervical spine w/o contrast (72125) |
$1,530 |
$2,040 |
12.4× |
| CT cervical spine w/wo cont (72127) |
$1,980 |
$2,640 |
9.6× |
| CT chest w contrast (71260) |
$1,747.50 |
$2,330 |
8.4× |
| CT chest w/wo contrast (71270) |
$1,965 |
$2,620 |
9.5× |
| CT colonography screening (74263) |
$2,617.50 |
$3,490 |
9.3× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$1,492.50 |
$1,990 |
7.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$1,162.50 |
$1,550 |
9.4× |
| CT head/brain with contrast (70460) |
$1,530 |
$2,040 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,747.50 |
$2,330 |
8.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,095 |
$1,460 |
2.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$292.50 |
$390 |
2.8× |
| CT hrt w/3d image congen (75573) |
$1,237.50 |
$1,650 |
3.0× |
| CT iac w contrast (70481) |
$1,597.50 |
$2,130 |
7.7× |
| CT l-spine w&w/o contrast (72133) |
$2,182.50 |
$2,910 |
10.5× |
| CT lower ext w/o (73700) |
$1,380 |
$1,840 |
11.2× |
| CT lower extremity w/contrast material (73701) |
$1,822.50 |
$2,430 |
8.8× |
| CT lumbar spine w contrast (72132) |
$1,890 |
$2,520 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,597.50 |
$2,130 |
12.9× |
| CT maxillofacial w contrast (70487) |
$1,597.50 |
$2,130 |
7.7× |
| CT maxillofacial wo contrast (70486) |
$1,335 |
$1,780 |
10.8× |
| CT neck tissue combo (70492) |
$1,965 |
$2,620 |
9.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,747.50 |
$2,330 |
8.4× |
| CT orbits w/o contrast (70480) |
$1,455 |
$1,940 |
11.8× |
| CT pelvis w&w/o contrast (72194) |
$1,747.50 |
$2,330 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,485 |
$1,980 |
12.0× |
| CT scan of leg combo (73702) |
$2,107.50 |
$2,810 |
10.2× |
| CT scans face/jaw combo (70488) |
$1,672.50 |
$2,230 |
8.1× |
| CT soft tissue neck w contrast (70491) |
$1,747.50 |
$2,330 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,552.50 |
$2,070 |
12.6× |
| CT thoracic spine w contrast (72129) |
$1,627.50 |
$2,170 |
7.9× |
| CT thoracic spine w/o contrast (72128) |
$1,312.50 |
$1,750 |
10.6× |
| CT thoracic spine w/wo cont (72130) |
$1,747.50 |
$2,330 |
8.4× |
| CT thorax w/o contrast (71250) |
$1,552.50 |
$2,070 |
12.6× |
| CT unlisted procedure (76497) |
$367.50 |
$490 |
3.6× |
| CT upper ext wo (73200) |
$1,380 |
$1,840 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,777.50 |
$2,370 |
8.6× |
| CT upper extremity with contrast (73201) |
$1,597.50 |
$2,130 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,890 |
$2,520 |
9.1× |
| Cta Abdomen (74175) |
$2,272.50 |
$3,030 |
11.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,062 |
$1,416 |
2.6× |
| CTA pelvis (72191) |
$1,530 |
$2,040 |
7.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$652.50 |
$870 |
2.3× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$1,335 |
$1,780 |
2.1× |
| Dilation ureters/urethra rs&i (74485) |
$5,172.75 |
$6,897 |
2.1× |
| Discography Cerv/Thor Spine (72285) |
$5,006.25 |
$6,675 |
2.2× |
| Diskography lumbar (72295) |
$5,006.25 |
$6,675 |
2.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$305.25 |
$407 |
2.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$404.25 |
$539 |
3.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$305.25 |
$407 |
2.5× |
| Dxa Bone Density Axial (77080) |
$320.25 |
$427 |
2.6× |
| Dxa bone density study (77085) |
$296.25 |
$395 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$232.50 |
$310 |
2.3× |
| Echo exam of fetal heart (76825) |
$1,462.50 |
$1,950 |
2.3× |
| Echo exam uterus (76831) |
$690 |
$920 |
2.4× |
| Echo Guide For Artery Repair (76936) |
$830.25 |
$1,107 |
3.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$700.50 |
$934 |
2.5× |
| Echograp Trans R Pros Study (76873) |
$588.75 |
$785 |
4.8× |
| Esophageal Motility Study (78258) |
$997.50 |
$1,330 |
2.1× |
| Esophagram (74220) |
$458.25 |
$611 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$382.50 |
$510 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$479.25 |
$639 |
3.9× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$1,152 |
$1,536 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$654.75 |
$873 |
2.3× |
| Follow-Up Angiography (75898) |
$8,301 |
$11,068 |
2.2× |
| Foot 2 views (73620) |
$255.75 |
$341 |
2.5× |
| Forearm 2 views (73090) |
$248.25 |
$331 |
2.4× |
| Gastric emptying imaging study (78264) |
$1,056 |
$1,408 |
2.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,014 |
$1,352 |
2.1× |
| Gastric Mucosa Imaging (78261) |
$997.50 |
$1,330 |
2.1× |
| Gastroesophageal Reflux Exam (78262) |
$997.50 |
$1,330 |
2.1× |
| Gastrointestinal Protein Loss (78282) |
$997.50 |
$1,330 |
2.1× |
| Gated Heart Planar Single (78472) |
$997.50 |
$1,330 |
2.1× |
| Gated Heart, Multiple (78473) |
$997.50 |
$1,330 |
2.1× |
| GI Endoscopic US S&I (76975) |
$740.25 |
$987 |
2.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,438.50 |
$1,918 |
2.2× |
| Hand 2 views (73120) |
$334.50 |
$446 |
2.7× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$3,460.50 |
$4,614 |
4.2× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,070.75 |
$2,761 |
2.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$2,070.75 |
$2,761 |
2.5× |
| Heart first pass single,planar (78481) |
$1,335 |
$1,780 |
2.1× |
| Heart Image (Pet) Multiple (78492) |
$4,278 |
$5,704 |
2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$8,295 |
$11,060 |
2.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$8,295 |
$11,060 |
2.2× |
| Hepatobil Syst Image W/Drug (78227) |
$1,335 |
$1,780 |
2.1× |
| Hepatobiliary System Imaging (78226) |
$1,056 |
$1,408 |
2.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$1,641.75 |
$2,189 |
2.5× |
| Ht Musc Image Planar Mult (78454) |
$3,396 |
$4,528 |
2.2× |
| Ht Muscle Image Spect Sing (78451) |
$3,278.25 |
$4,371 |
2.1× |
| Hyperthermia external generated superficial (77600) |
$1,392.75 |
$1,857 |
3.1× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$2,051.25 |
$2,735 |
3.1× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$3,210.75 |
$4,281 |
4.9× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$1,822.50 |
$2,430 |
2.8× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$2,538.75 |
$3,385 |
3.1× |
| Hysterosalpingogram (74740) |
$654.75 |
$873 |
2.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$571.50 |
$762 |
5.6× |
| Infant hip ultrasound, limited static exam (76886) |
$357.75 |
$477 |
3.5× |
| Infusion Ivp (74410) |
$504 |
$672 |
2.4× |
| Interstitial radiation source applic complex (77778) |
$2,504.25 |
$3,339 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,168.25 |
$2,891 |
2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,641.75 |
$2,189 |
2.5× |
| Intracavitary radiation source applic simple (77761) |
$1,641.75 |
$2,189 |
2.5× |
| Joint Survey Single View (77077) |
$296.25 |
$395 |
2.4× |
| K Flow/Funct Image Multiple (78709) |
$1,335 |
$1,780 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$1,386 |
$1,848 |
2.2× |
| K Flow/Funct Image W/O Drug (78707) |
$1,386 |
$1,848 |
2.2× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$997.50 |
$1,330 |
2.1× |
| Kidney Imaging Morphol (78700) |
$997.50 |
$1,330 |
2.1× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$997.50 |
$1,330 |
2.1× |
| Knee 3 Views (73562) |
$342.75 |
$457 |
3.3× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$997.50 |
$1,330 |
2.1× |
| Leveen/Shunt Patency Exam (78291) |
$997.50 |
$1,330 |
2.1× |
| Liver & Spleen Imaging Static Only (78215) |
$997.50 |
$1,330 |
2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$997.50 |
$1,330 |
2.1× |
| Liver imaging static only (78201) |
$1,386 |
$1,848 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,600.50 |
$2,134 |
2.5× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,335 |
$1,780 |
2.1× |
| Lung perfusion differential (78597) |
$997.50 |
$1,330 |
2.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,386 |
$1,848 |
2.2× |
| Lung Ventilation Imaging (78579) |
$997.50 |
$1,330 |
2.1× |
| Lymph System Imaging (78195) |
$1,335 |
$1,780 |
2.1× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$4,141.50 |
$5,522 |
2.2× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$1,571.25 |
$2,095 |
2.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$8,295 |
$11,060 |
2.2× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$8,295 |
$11,060 |
2.2× |
| Magnetic Image Jaw Joint (70336) |
$1,620 |
$2,160 |
5.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
$5,670 |
$7,560 |
27.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
$5,317.50 |
$7,090 |
8.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
$5,430 |
$7,240 |
26.2× |
| Magnetic Resonance Elastography (76391) |
$840 |
$1,120 |
3.0× |
| Mammary ductogram or galactogram multiple (77054) |
$652.50 |
$870 |
2.3× |
| Mammary ductogram or galactogram single (77053) |
$652.50 |
$870 |
2.3× |
| Meckels Divert Exam (78290) |
$997.50 |
$1,330 |
2.1× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$3,008.25 |
$4,011 |
6.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,945.50 |
$2,594 |
4.4× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,910 |
$3,880 |
7.1× |
| MRA head w/o contrast (70544) |
$2,092.50 |
$2,790 |
7.4× |
| MRA head with contrast (70545) |
$2,617.50 |
$3,490 |
6.4× |
| MRA neck w contrast (70548) |
$2,040 |
$2,720 |
4.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,257.50 |
$3,010 |
5.5× |
| MRA neck w/o contrast (70547) |
$2,040 |
$2,720 |
7.2× |
| MRI abdomen w contrast (74182) |
$1,972.50 |
$2,630 |
4.8× |
| MRI abdomen w/o contrast (74181) |
$2,107.50 |
$2,810 |
7.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,107.50 |
$2,810 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,400 |
$3,200 |
5.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,257.50 |
$3,010 |
2.4× |
| MRI bone marrow blood supply (77084) |
$1,230 |
$1,640 |
4.4× |
| MRI brain functional w/o physician admnistration (70554) |
$1,890 |
$2,520 |
6.7× |
| MRI brain functional w/physician admnistration (70555) |
$2,677.50 |
$3,570 |
9.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,312.50 |
$1,750 |
4.7× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$870 |
$1,160 |
3.1× |
| MRI cardiac w/o cont stress (75559) |
$1,597.50 |
$2,130 |
2.5× |
| MRI cardiac w/o contrast (75557) |
$1,312.50 |
$1,750 |
4.7× |
| MRI cervical spine w contrast (72142) |
$2,040 |
$2,720 |
4.9× |
| MRI cervical spine w/o cont (72141) |
$1,635 |
$2,180 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,822.50 |
$2,430 |
6.5× |
| MRI chest with contrast (71551) |
$2,062.50 |
$2,750 |
2.2× |
| MRI chest wo w contrast (71552) |
$2,182.50 |
$2,910 |
5.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,965 |
$2,620 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,730 |
$3,640 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,672.50 |
$2,230 |
5.9× |
| MRI lumbar spine w contrast (72149) |
$1,965 |
$2,620 |
4.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,182.50 |
$2,910 |
5.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,380 |
$1,840 |
4.9× |
| MRI orbit face neck w contrast (70542) |
$1,732.50 |
$2,310 |
4.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,812.50 |
$3,750 |
6.8× |
| MRI pelvis w contrast (72196) |
$2,100 |
$2,800 |
5.1× |
| MRI pelvis w/o contrast (72195) |
$2,040 |
$2,720 |
7.2× |
| MRI spectroscopy (76390) |
$1,597.50 |
$2,130 |
15.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,965 |
$2,620 |
7.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,732.50 |
$2,310 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,597.50 |
$2,130 |
5.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,257.50 |
$3,010 |
5.5× |
| MRI, abdomen, combo (74183) |
$2,872.50 |
$3,830 |
7.0× |
| MRI, dorsal spine combo (72157) |
$2,325 |
$3,100 |
5.6× |
| MRI, dorsal spine contrast (72147) |
$2,257.50 |
$3,010 |
5.5× |
| MRI, joint upper extrem (73221) |
$2,407.50 |
$3,210 |
8.5× |
| MRI, joint upper extrem combo (73223) |
$2,692.50 |
$3,590 |
6.5× |
| MRI, lumbar spine combo (72158) |
$2,610 |
$3,480 |
6.3× |
| Myelogram cervical (72240) |
$2,064.75 |
$2,753 |
2.2× |
| Myelogram Lumbar (72265) |
$2,066.25 |
$2,755 |
2.2× |
| Myelography thoracic (72255) |
$2,064.75 |
$2,753 |
2.2× |
| Myelograpy 2/more regions rs&i (72270) |
$2,064.75 |
$2,753 |
2.2× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$997.50 |
$1,330 |
2.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,811.50 |
$5,082 |
2.5× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,335 |
$1,780 |
2.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,396 |
$4,528 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,311.25 |
$4,415 |
2.2× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$4,278 |
$5,704 |
2.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$4,278 |
$5,704 |
2.5× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$7,895.25 |
$10,527 |
3.0× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$5,598 |
$7,464 |
2.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$5,313 |
$7,084 |
3.0× |
| Neck soft tissue (70360) |
$240 |
$320 |
2.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,506.75 |
$2,009 |
3.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,005.75 |
$1,341 |
2.1× |
| Nm csf leak detection (78650) |
$3,396 |
$4,528 |
2.2× |
| Nm myocard infarct spect (78469) |
$1,335 |
$1,780 |
2.1× |
| Nm red cell survival study (78130) |
$997.50 |
$1,330 |
2.1× |
| Nm whole blood volume (78122) |
$1,335 |
$1,780 |
2.1× |
| Nonvascular Shunt X-Ray (75809) |
$296.25 |
$395 |
2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,261 |
$8,348 |
3.8× |
| Nuclear Rx Intra-Arterial (79445) |
$581.25 |
$775 |
2.1× |
| Nuclear Rx Oral Admin (79005) |
$581.25 |
$775 |
2.1× |
| Ob us nuchal meas 1 gest (76813) |
$501.75 |
$669 |
4.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$305.25 |
$407 |
2.5× |
| Oph us dx ant sgm us immersion b-scan/hr biom (76513) |
$307.50 |
$410 |
2.5× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$334.50 |
$446 |
2.1× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$305.25 |
$407 |
2.5× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$255.75 |
$341 |
2.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$305.25 |
$407 |
2.5× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$85.50 |
$114 |
2.5× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$324 |
$432 |
2.6× |
| Optic foramina (70190) |
$240 |
$320 |
2.3× |
| Panoramic X-ray of jaws (70355) |
$240 |
$320 |
2.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,335 |
$1,780 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$997.50 |
$1,330 |
2.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$997.50 |
$1,330 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$276.75 |
$369 |
2.2× |
| Perineogram (74775) |
$652.50 |
$870 |
2.3× |
| Peritoneogram Rs&I (74190) |
$1,400.25 |
$1,867 |
2.2× |
| Pet Image Skull-Thigh (78812) |
$4,278 |
$5,704 |
2.5× |
| Pet Image W/Ct Lmtd (78814) |
$4,278 |
$5,704 |
2.5× |
| PET image w/CT, full body (78816) |
$4,371.75 |
$5,829 |
2.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,890.25 |
$5,187 |
2.3× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$3,811.50 |
$5,082 |
2.5× |
| Pet Myocardial Sngl Study (78491) |
$4,278 |
$5,704 |
2.5× |
| PET whole body (78813) |
$4,278 |
$5,704 |
2.5× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$3,396 |
$4,528 |
2.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$3,396 |
$4,528 |
2.2× |
| Platelet survival study Non-Facility (78191) |
$997.50 |
$1,330 |
2.1× |
| Proton trmt simple w/comp (77522) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery complex (77525) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery intermediate (77523) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery simple w/o compensation (77520) |
$2,715.75 |
$3,621 |
4.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$8,295 |
$11,060 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$997.50 |
$1,330 |
2.1× |
| Quan&Charac C Atherosclerotc Plaq Asses Sev C Ds (75577) |
$3,984 |
$5,312 |
3.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$534 |
$712 |
4.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,404 |
$1,872 |
2.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$284.25 |
$379 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.50 |
$310 |
2.3× |
| Radex elbow complete minimum 3 views (73080) |
$277.50 |
$370 |
2.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$298.50 |
$398 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$232.50 |
$310 |
2.3× |
| Radex foot complete minimum 3 views (73630) |
$298.50 |
$398 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$338.25 |
$451 |
3.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$240 |
$320 |
2.3× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$296.25 |
$395 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$240 |
$320 |
2.3× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$267 |
$356 |
2.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$298.50 |
$398 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$270.75 |
$361 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$240 |
$320 |
2.3× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$877.50 |
$1,170 |
4.2× |
| Radex Spine 1 View Specify Level (72020) |
$240 |
$320 |
2.3× |
| Radex Sternum Minimum 2 Views (71120) |
$240 |
$320 |
2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$240 |
$320 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$232.50 |
$310 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$298.50 |
$398 |
2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$319.50 |
$426 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$491.25 |
$655 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,077 |
$29,436 |
2.5× |
| Radiation treatment delivery level 1 (77402) |
$556.50 |
$742 |
4.6× |
| Radiation treatment delivery level 2 (77407) |
$755.25 |
$1,007 |
1.7× |
| Radiation treatment delivery level 3 (77412) |
$1,072.50 |
$1,430 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$298.50 |
$398 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$312.75 |
$417 |
2.5× |
| Radiologic exam colon double contrast study (74280) |
$663.75 |
$885 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$509.25 |
$679 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$458.25 |
$611 |
2.2× |
| Radiologic exam knee complete 4/more views (73564) |
$380.25 |
$507 |
3.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$312.75 |
$417 |
2.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$509.25 |
$679 |
2.5× |
| Radiologic exam swallow function contrast study (74230) |
$483 |
$644 |
2.3× |
| Radiologic exam teeth complete full mouth (70320) |
$652.50 |
$870 |
2.3× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$652.50 |
$870 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$458.25 |
$611 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$240 |
$320 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$330 |
$440 |
3.2× |
| Radiologic examination knee 1/2 views (73560) |
$250.50 |
$334 |
2.4× |
| Radiologic Examination Osseous Survey Limited (77074) |
$296.25 |
$395 |
2.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$240 |
$320 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$242.25 |
$323 |
2.4× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,400.25 |
$1,867 |
2.2× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$240 |
$320 |
2.3× |
| Radiopharm Dacryocystography (78660) |
$997.50 |
$1,330 |
2.1× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$581.25 |
$775 |
2.1× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$581.25 |
$775 |
2.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$581.25 |
$775 |
2.1× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$997.50 |
$1,330 |
2.1× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$1,335 |
$1,780 |
2.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,068.75 |
$1,425 |
2.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$755.25 |
$1,007 |
1.7× |
| Renal Cyst Study (74470) |
$1,400.25 |
$1,867 |
2.2× |
| Ribs bilateral 3 views (71110) |
$400.50 |
$534 |
3.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$997.50 |
$1,330 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$997.50 |
$1,330 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,396 |
$4,528 |
5.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$3,396 |
$4,528 |
5.3× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,311.25 |
$4,415 |
5.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,396 |
$4,528 |
2.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,812.25 |
$5,083 |
2.3× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$3,396 |
$4,528 |
2.2× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$581.25 |
$775 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$581.25 |
$775 |
2.1× |
| Salivary Gland Function Study (78232) |
$997.50 |
$1,330 |
2.1× |
| Salivary Gland Imaging (78230) |
$997.50 |
$1,330 |
2.1× |
| Salivary Gland Imaging Serial Images (78231) |
$997.50 |
$1,330 |
2.1× |
| Scapula (73010) |
$298.50 |
$398 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$123 |
$164 |
5.3× |
| Sella turcica (70240) |
$240 |
$320 |
2.3× |
| Shoulder 1 view (73020) |
$240 |
$320 |
2.3× |
| Shoulder Arthrography (73040) |
$1,026 |
$1,368 |
2.5× |
| Sialogram (70390) |
$652.50 |
$870 |
2.3× |
| Skull less than 4 views (70250) |
$298.50 |
$398 |
2.4× |
| Special dosimetry (77331) |
$384 |
$512 |
2.4× |
| Special Physics Consult (77370) |
$483.75 |
$645 |
3.0× |
| Special teletherapy port plan (77321) |
$1,031.25 |
$1,375 |
2.3× |
| Special treatment procedure (77470) |
$1,641.75 |
$2,189 |
2.5× |
| Speech evaluation, complex (70371) |
$652.50 |
$870 |
2.3× |
| Spleen Imaging (78185) |
$997.50 |
$1,330 |
2.1× |
| Srs Multisource (77371) |
$22,077 |
$29,436 |
2.5× |
| Stereotactic Body Radiation Delivery (77373) |
$6,561 |
$8,748 |
3.1× |
| Sternoclavicular joints (71130) |
$240 |
$320 |
2.3× |
| Superior sagittal sinus venogram (75870) |
$8,295 |
$11,060 |
2.2× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$324 |
$432 |
2.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$324 |
$432 |
2.7× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$117 |
$156 |
2.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$372.75 |
$497 |
3.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,031.25 |
$1,375 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,031.25 |
$1,375 |
2.3× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$652.50 |
$870 |
2.3× |
| Testicular Imaging W/Flow (78761) |
$997.50 |
$1,330 |
2.1× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$1,620 |
$2,160 |
3.7× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$1,397.25 |
$1,863 |
3.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$983.25 |
$1,311 |
6.2× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$735.75 |
$981 |
3.6× |
| Thoracic spine 2 views (72070) |
$282 |
$376 |
2.3× |
| Thoracic spine 3 views (72072) |
$364.50 |
$486 |
3.0× |
| Thoracolumbar 2 views (72080) |
$249.75 |
$333 |
2.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$997.50 |
$1,330 |
2.1× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$997.50 |
$1,330 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$997.50 |
$1,330 |
2.1× |
| Thyroid Met Imaging Body (78018) |
$1,335 |
$1,780 |
2.1× |
| Thyroid Uptake Measurement (78012) |
$997.50 |
$1,330 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$997.50 |
$1,330 |
2.1× |
| Tx Devices Design & Construction Complex (77334) |
$1,743 |
$2,324 |
3.9× |
| Tx devices design & construction intermediate (77333) |
$384 |
$512 |
2.4× |
| Tx devices design & construction simple (77332) |
$597.75 |
$797 |
3.8× |
| Ultrasound Breast Limited (76642) |
$435 |
$580 |
4.2× |
| Ultrasound elastography first target lesion (76982) |
$338.25 |
$451 |
2.7× |
| Ultrasound Elastography Parenchyma (76981) |
$363.75 |
$485 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$292.50 |
$390 |
2.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$1,012.50 |
$1,350 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$600 |
$800 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$327 |
$436 |
2.6× |
| Unlisted Dx Radiographic Procedure (76499) |
$87 |
$116 |
0.8× |
| Unlisted fluoroscopic procedure (76496) |
$272.25 |
$363 |
2.6× |
| Unlisted magnetic resonance procedure (76498) |
$435 |
$580 |
4.2× |
| Upper gi w/o kub (74240) |
$509.25 |
$679 |
2.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$24.75 |
$33 |
2.2× |
| Urea breath test c-14 isotopic analysis (78268) |
$208.50 |
$278 |
2.2× |
| Ureteral Reflux Study (78740) |
$997.50 |
$1,330 |
2.1× |
| Urethrocystogram voiding (74455) |
$654.75 |
$873 |
2.3× |
| Urethrocystography retrograde (74450) |
$654.75 |
$873 |
2.3× |
| Us bone density measurement (76977) |
$336 |
$448 |
2.7× |
| Us breast unilateral complete (76641) |
$840 |
$1,120 |
6.8× |
| Us chest (76604) |
$405 |
$540 |
3.3× |
| Us complete joint (76881) |
$342.75 |
$457 |
2.8× |
| Us exam, pelvic, limited (76857) |
$435 |
$580 |
3.5× |
| Us head (76506) |
$502.50 |
$670 |
4.1× |
| Us kidney transplant (76776) |
$412.50 |
$550 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$300 |
$400 |
2.4× |
| Us ob detailed single fetus (76811) |
$748.50 |
$998 |
2.7× |
| Us ob limited 1 or more fetuses (76815) |
$305.25 |
$407 |
2.5× |
| Us ob transvaginal (76817) |
$532.50 |
$710 |
4.3× |
| Us pelvic non ob complete (76856) |
$600 |
$800 |
4.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$467.25 |
$623 |
3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$507 |
$676 |
4.1× |
| Us retroperitoneal complete (76770) |
$630 |
$840 |
5.1× |
| Us retroperitoneal limited (76775) |
$480 |
$640 |
3.9× |
| Us scrotum and contents (76870) |
$457.50 |
$610 |
3.7× |
| Us spinal canal and contents (76800) |
$720 |
$960 |
5.8× |
| Us thyroid (76536) |
$585 |
$780 |
4.7× |
| Us transrectal (76872) |
$501.75 |
$669 |
4.1× |
| Vascular Flow Imaging (78445) |
$997.50 |
$1,330 |
2.1× |
| Vasogram (74440) |
$652.50 |
$870 |
2.3× |
| Vein X-Ray Chest (75827) |
$4,141.50 |
$5,522 |
2.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$8,295 |
$11,060 |
2.2× |
| Vein X-Ray Skull Epidural (75872) |
$1,612.50 |
$2,150 |
2.2× |
| Vein X-Ray Spleen/Liver (75810) |
$8,295 |
$11,060 |
2.2× |
| Venogram Sinus/Jugular (75860) |
$8,301 |
$11,068 |
2.2× |
| Venography Adrenal Unilateral (75840) |
$8,301 |
$11,068 |
2.2× |
| Venography caval inferior serialography rs&i (75825) |
$8,301 |
$11,068 |
2.2× |
| Venography extremity bilateral rs&i (75822) |
$4,141.50 |
$5,522 |
2.2× |
| Venography extremity unilateral rs&i (75820) |
$4,146.75 |
$5,529 |
2.2× |
| Venography Orbital Rs&I (75880) |
$1,612.50 |
$2,150 |
2.2× |
| Venography Renal Bilateral (75833) |
$8,295 |
$11,060 |
2.2× |
| Venography Renal Unilateral (75831) |
$8,295 |
$11,060 |
2.2× |
| Venous sampling by catheter (75893) |
$14,313 |
$19,084 |
2.2× |
| Venous thrombosis imaging (78457) |
$1,600.50 |
$2,134 |
2.5× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,893.75 |
$2,525 |
4.0× |
| Vertebral fracture assessment via dxa (77086) |
$240 |
$320 |
2.3× |
| Wrist 2 views (73100) |
$240 |
$320 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$240 |
$320 |
2.3× |
| X-ray antegrade pyelogram tube (74425) |
$1,026 |
$1,368 |
2.5× |
| X-Ray Aorta Leg Arteries (75630) |
$8,301 |
$11,068 |
2.2× |
| X-Ray Bend Only L-S Spine (72120) |
$298.50 |
$398 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$232.50 |
$310 |
2.3× |
| X-Ray Exam Breast Specimen (76098) |
$1,374.75 |
$1,833 |
2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$240 |
$320 |
2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$616.50 |
$822 |
5.0× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$473.25 |
$631 |
3.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$240 |
$320 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$359.25 |
$479 |
3.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$314.25 |
$419 |
2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$421.50 |
$562 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$633.75 |
$845 |
5.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$645.75 |
$861 |
5.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$318 |
$424 |
2.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$306 |
$408 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$356.25 |
$475 |
2.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$299.25 |
$399 |
2.4× |
| X-ray eye for foreign body (70030) |
$240 |
$320 |
2.3× |
| X-ray head for orthodontia (70350) |
$240 |
$320 |
2.3× |
| X-ray humerus (73060) |
$232.50 |
$310 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$525 |
$700 |
2.5× |
| X-ray IV pyelogram+tomography (74415) |
$564.75 |
$753 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240 |
$320 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$240 |
$320 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$325.50 |
$434 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$240 |
$320 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$473.25 |
$631 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$296.25 |
$395 |
2.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$298.50 |
$398 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$268.50 |
$358 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$240 |
$320 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$298.50 |
$398 |
2.4× |
| X-Ray Stress View (77071) |
$240 |
$320 |
2.3× |
| X-ray thoracic spine 4 vw (72074) |
$296.25 |
$395 |
2.4× |
| X-Ray Tmj Unilat (70328) |
$240 |
$320 |
2.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,026 |
$1,368 |
2.5× |
| X-Rays Bone Length Studies (77073) |
$276.75 |
$369 |
2.2× |
| X-Rays Bone Survey Complete (77075) |
$708 |
$944 |
5.7× |
| Xr c-spine 4 or 5 views (72050) |
$372.75 |
$497 |
3.0× |
| Xr facial bones less than 3 views (70140) |
$240 |
$320 |
2.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$296.25 |
$395 |
2.4× |
| Xr myelogram posterior fossa (70010) |
$1,024.50 |
$1,366 |
2.5× |
| Xr orbits complete 4 views (70200) |
$298.50 |
$398 |
2.4× |
| Xr Tomogram Single Plane (76100) |
$296.25 |
$395 |
2.4× |