| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,286.25 |
$1,715 |
0.9× |
| Abdomen 2 views (74019) |
$224.25 |
$299 |
2.1× |
| Acute gi blood loss imaging (78278) |
$2,777.25 |
$3,703 |
6.7× |
| Angiography extremity bilateral rs&i (75716) |
$4,463.25 |
$5,951 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,375 |
$4,500 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,045 |
$4,060 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,864 |
$5,152 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,226.25 |
$5,635 |
1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,258.75 |
$4,345 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$4,113 |
$5,484 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,348 |
$8,464 |
1.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,503 |
$2,004 |
0.5× |
| Ankle 2 views (73600) |
$231 |
$308 |
2.6× |
| Aortogram thoracic (75605) |
$3,758.25 |
$5,011 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,870 |
$5,160 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,108.75 |
$4,145 |
1.0× |
| Arthrogram elbow (73085) |
$848.25 |
$1,131 |
2.4× |
| Arthrogram hip (73525) |
$871.50 |
$1,162 |
2.4× |
| Arthrogram knee (73580) |
$948 |
$1,264 |
2.6× |
| Arthrogram shoulder (73040) |
$795 |
$1,060 |
2.2× |
| Arthrogram wrist (73115) |
$869.25 |
$1,159 |
2.4× |
| Basic dosimetry (77300) |
$175.50 |
$234 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,838.25 |
$2,451 |
4.4× |
| Bone &/joint imaging whole body (78306) |
$1,961.25 |
$2,615 |
4.7× |
| Bone age studies (77072) |
$263.25 |
$351 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,792.50 |
$2,390 |
4.3× |
| Bone Marrow Imaging Limited Area (78102) |
$1,149 |
$1,532 |
2.8× |
| Bone survey complete (77075) |
$373.50 |
$498 |
3.5× |
| Bone survey infant (77076) |
$300.75 |
$401 |
2.8× |
| Bowel imaging (78290) |
$1,016.25 |
$1,355 |
2.5× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,100.25 |
$1,467 |
2.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,885.50 |
$6,514 |
3.3× |
| Brain Imaging Vascular Flow Only (78610) |
$1,100.25 |
$1,467 |
2.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,725 |
$2,300 |
4.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,059.50 |
$2,746 |
5.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,075.50 |
$1,434 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$192 |
$256 |
2.1× |
| Chest 1 view (71045) |
$181.50 |
$242 |
2.0× |
| Chest xray 3 views (71047) |
$242.25 |
$323 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$391.50 |
$522 |
2.2× |
| Clavicle complete (73000) |
$231 |
$308 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$244.50 |
$326 |
2.3× |
| Continuing medical physics consltj pr wk (77336) |
$201 |
$268 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,625 |
$3,500 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,762.50 |
$2,350 |
7.1× |
| CT abdomen w contrast (74160) |
$1,282.50 |
$1,710 |
7.1× |
| CT abdomen w wo contrast (74170) |
$1,431 |
$1,908 |
7.9× |
| CT abdomen w/o contrast (74150) |
$1,062.75 |
$1,417 |
9.8× |
| CT angio hrt w/3d image (75574) |
$1,725 |
$2,300 |
4.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,584.38 |
$2,112.50 |
8.7× |
| CT angiography upper extremity lt (73206) |
$1,782 |
$2,376 |
9.8× |
| CT c-spine w/contrast (72126) |
$1,070.25 |
$1,427 |
3.0× |
| CT c-spine w/o contrast (72125) |
$862.50 |
$1,150 |
8.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,125 |
$1,500 |
6.2× |
| CT chest w contrast (71260) |
$1,362.75 |
$1,817 |
7.5× |
| CT chest w/wo contrast (71270) |
$1,425 |
$1,900 |
7.9× |
| CT head/brain with contrast (70460) |
$1,282.50 |
$1,710 |
7.1× |
| CT head/brain without and with contrast (70470) |
$1,314 |
$1,752 |
7.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,425 |
$1,900 |
4.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$174.75 |
$233 |
1.9× |
| CT iac w contrast (70481) |
$1,530 |
$2,040 |
8.4× |
| CT limited/localized follow up study (76380) |
$568.50 |
$758 |
6.3× |
| CT lower ext w/o (73700) |
$1,168.12 |
$1,557.50 |
10.8× |
| CT lower extremity w wo contrast (73702) |
$1,564.50 |
$2,086 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$1,703.44 |
$2,271.25 |
9.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,492.50 |
$1,990 |
8.2× |
| CT lumbar spine w/contrast (72132) |
$1,422 |
$1,896 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$881.25 |
$1,175 |
8.2× |
| CT maxillofacial w contrast (70487) |
$1,387.50 |
$1,850 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,500 |
$2,000 |
8.3× |
| CT maxillofacial wo contrast (70486) |
$1,167 |
$1,556 |
10.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,620 |
$2,160 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,260 |
$1,680 |
11.7× |
| CT pelvis w/o contrast (72192) |
$1,181.25 |
$1,575 |
10.9× |
| CT pelvis w/wo contrast (72194) |
$1,462.50 |
$1,950 |
8.1× |
| CT scan of arm combo (73202) |
$1,500 |
$2,000 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,574.25 |
$2,099 |
8.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,638.75 |
$2,185 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,080 |
$1,440 |
10.0× |
| CT thoracic spine w/contrast (72129) |
$1,402.50 |
$1,870 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$881.25 |
$1,175 |
8.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,477.50 |
$1,970 |
8.1× |
| CT thorax w/o contrast (71250) |
$900 |
$1,200 |
8.3× |
| CT unlisted procedure (76497) |
$487.50 |
$650 |
5.4× |
| CT upper ext wo (73200) |
$1,116 |
$1,488 |
10.3× |
| CT upper extremity with contrast (73201) |
$1,425 |
$1,900 |
4.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,938.75 |
$2,585 |
10.7× |
| Cta Abdomen (74175) |
$1,515.75 |
$2,021 |
8.4× |
| CTA abdomen pelvis (74174) |
$2,754 |
$3,672 |
7.6× |
| CTA chest (71275) |
$1,612.50 |
$2,150 |
8.9× |
| Cta Head (70496) |
$1,575 |
$2,100 |
8.7× |
| Cta Neck (70498) |
$1,575 |
$2,100 |
8.7× |
| Cta Pelvis (72191) |
$1,237.50 |
$1,650 |
6.8× |
| Cystography minimum 3 views rs&i (74430) |
$813 |
$1,084 |
2.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$904.50 |
$1,206 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$410.25 |
$547 |
3.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,154.25 |
$1,539 |
10.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$215.25 |
$287 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$266.25 |
$355 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$217.50 |
$290 |
2.4× |
| Echo exam of eye (76529) |
$234 |
$312 |
2.6× |
| Esophagus (74220) |
$404.25 |
$539 |
2.2× |
| Facial bones min 3 views (70150) |
$316.50 |
$422 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$640.50 |
$854 |
5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$408 |
$544 |
3.8× |
| Fetal Echo (76825) |
$1,019.25 |
$1,359 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$570 |
$760 |
2.3× |
| Foot 2 views (73620) |
$228 |
$304 |
2.5× |
| Forearm 2 views (73090) |
$236.25 |
$315 |
2.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,401.75 |
$1,869 |
3.4× |
| Hand 2 views (73120) |
$241.50 |
$322 |
2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,954 |
$5,272 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,766.50 |
$5,022 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,884.75 |
$2,513 |
3.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,488 |
$1,984 |
3.6× |
| Hysterosalpingogram (74740) |
$904.50 |
$1,206 |
3.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,920 |
$2,560 |
3.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,785 |
$2,380 |
3.2× |
| Knee 3 views (73562) |
$231 |
$308 |
2.6× |
| Liver & spleen imaging static only (78215) |
$1,228.50 |
$1,638 |
3.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,944 |
$2,592 |
4.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,208 |
$2,944 |
0.7× |
| Lymphoscintigraphy (78195) |
$2,777.25 |
$3,703 |
4.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,034 |
$2,712 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,980.75 |
$2,641 |
5.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,856 |
$3,808 |
7.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$46.50 |
$62 |
1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$174 |
$232 |
1.8× |
| MRA head w & w/o contrast (70546) |
$2,364.75 |
$3,153 |
6.6× |
| MRA head w/o contrast (70544) |
$1,503 |
$2,004 |
6.1× |
| MRA head with contrast (70545) |
$1,763.25 |
$2,351 |
4.9× |
| MRA neck w contrast (70548) |
$1,994.25 |
$2,659 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,439 |
$3,252 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,384.50 |
$1,846 |
5.6× |
| MRI abdomen w contrast (74182) |
$1,662.75 |
$2,217 |
4.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,229.75 |
$2,973 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,595.25 |
$2,127 |
6.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,233.50 |
$2,978 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,483.25 |
$3,311 |
6.9× |
| MRI bone marrow blood supply (77084) |
$1,273.50 |
$1,698 |
5.2× |
| MRI breast w/o contrast bilateral (77047) |
$2,577 |
$3,436 |
10.4× |
| MRI breast wo contrast unilateral (77046) |
$1,946.25 |
$2,595 |
7.9× |
| MRI c-spine with contrast (72142) |
$1,815 |
$2,420 |
5.0× |
| MRI cardiac w/o contrast (75557) |
$1,519.50 |
$2,026 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$1,595.25 |
$2,127 |
6.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,156.25 |
$2,875 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,519.50 |
$2,026 |
6.2× |
| MRI chest with contrast (71551) |
$2,487.75 |
$3,317 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,980.75 |
$2,641 |
5.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,237.25 |
$2,983 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,445.25 |
$1,927 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,424.25 |
$1,899 |
5.8× |
| MRI orbit face neck w contrast (70542) |
$1,869.75 |
$2,493 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,268 |
$3,024 |
6.3× |
| MRI pelvis w/contrast (72196) |
$1,803 |
$2,404 |
5.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,726.25 |
$3,635 |
7.6× |
| MRI pelvis w/o contrast (72195) |
$1,595.25 |
$2,127 |
6.5× |
| MRI spectroscopy (76390) |
$1,811.25 |
$2,415 |
20.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,483.25 |
$3,311 |
6.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,763.25 |
$2,351 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,364.75 |
$3,153 |
6.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,763.25 |
$2,351 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,483.25 |
$3,311 |
6.9× |
| MRI temporomandibular joint (70336) |
$1,384.50 |
$1,846 |
5.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,595.25 |
$2,127 |
6.5× |
| MRI up ext w/o contrast (73218) |
$1,445.25 |
$1,927 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,595.25 |
$2,127 |
6.5× |
| MRI, joint upper extrem combo (73223) |
$2,364.75 |
$3,153 |
6.6× |
| Myocardial Spect Multiple Studies (78452) |
$3,795 |
$5,060 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,727 |
$3,636 |
2.0× |
| Neck soft tissue (70360) |
$315.75 |
$421 |
3.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$695.25 |
$927 |
1.7× |
| Nm cisternogram (78630) |
$2,016.75 |
$2,689 |
3.6× |
| Nm gastric emptying study (78264) |
$1,764.75 |
$2,353 |
4.3× |
| Nonvascular shunt X-ray (75809) |
$243.75 |
$325 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$1,031.25 |
$1,375 |
4.3× |
| Ob us nuchal meas 1 gest (76813) |
$271.50 |
$362 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$1,289.25 |
$1,719 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$241.50 |
$322 |
2.2× |
| Peritoneogram after injection (74190) |
$475.50 |
$634 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$5,291.25 |
$7,055 |
3.6× |
| PET imaging CT for attenuation limited area (78814) |
$5,268.75 |
$7,025 |
3.6× |
| PET imaging for CT attenuation whole body (78816) |
$5,634 |
$7,512 |
3.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,069.50 |
$5,426 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,401 |
$1,868 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,002.75 |
$1,337 |
2.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,983.75 |
$2,645 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$679.50 |
$906 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$273 |
$364 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$231 |
$308 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$252.75 |
$337 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$254.25 |
$339 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$208.50 |
$278 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$249 |
$332 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$315.94 |
$421.25 |
3.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$192 |
$256 |
2.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$221.25 |
$295 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$312.75 |
$417 |
2.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$525 |
$700 |
4.9× |
| Radex Humerus Minimum 2 Views (73060) |
$192.75 |
$257 |
2.1× |
| Radex Kne 1/2 Views (73560) |
$225.75 |
$301 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$309.38 |
$412.50 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$241.50 |
$322 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$348.75 |
$465 |
3.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$171.75 |
$229 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$249 |
$332 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$265.50 |
$354 |
3.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$241.50 |
$322 |
2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$242.25 |
$323 |
2.7× |
| Radex Toe Minimum 2 Views (73660) |
$173.25 |
$231 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$318.75 |
$425 |
3.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$273 |
$364 |
3.0× |
| Radiation treatment delivery level 3 (77412) |
$686.25 |
$915 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$210.75 |
$281 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$351.75 |
$469 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$210.75 |
$281 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$487.50 |
$650 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$414 |
$552 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$545.25 |
$727 |
3.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$496.50 |
$662 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$210.75 |
$281 |
2.3× |
| Radiological examination surgical specimen (76098) |
$434.25 |
$579 |
0.8× |
| Ribs bilateral 3 views (71110) |
$201 |
$268 |
1.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,644.75 |
$2,193 |
4.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,570.75 |
$4,761 |
6.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,836.50 |
$3,782 |
5.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,777.25 |
$3,703 |
4.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$864.75 |
$1,153 |
3.6× |
| Rp Therapy Intravenous Administration (79101) |
$1,091.25 |
$1,455 |
4.5× |
| Sacroiliac Joints < 3 Views (72200) |
$271.50 |
$362 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$617.25 |
$823 |
2.5× |
| Scapula (73010) |
$252.75 |
$337 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$57.75 |
$77 |
2.5× |
| Shoulder 1 view (73020) |
$213 |
$284 |
2.4× |
| Small bowel series (74250) |
$444 |
$592 |
2.4× |
| Special dosimetry (77331) |
$139.50 |
$186 |
1.0× |
| Special treatment procedure (77470) |
$288.75 |
$385 |
0.5× |
| Spine thoracic 3 views (72072) |
$259.50 |
$346 |
2.4× |
| Stereotactic Body Radiation Delivery (77373) |
$2,305.50 |
$3,074 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,286.25 |
$1,715 |
3.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$665.25 |
$887 |
4.8× |
| Thoracolumbar 2 views (72080) |
$240.75 |
$321 |
2.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,380 |
$1,840 |
2.5× |
| Thyroid imaging w/blood flow (78013) |
$576 |
$768 |
1.4× |
| Thyroid uptake measurement (78012) |
$576 |
$768 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,488 |
$1,984 |
3.6× |
| Tomogram (76100) |
$323.25 |
$431 |
3.0× |
| Treatment device complex (77334) |
$336.75 |
$449 |
0.9× |
| Treatment device intermediate (77333) |
$252 |
$336 |
1.8× |
| Ultrasound breast complete (76641) |
$408.75 |
$545 |
3.8× |
| Ultrasound Exam Aaa Screen (76706) |
$409.50 |
$546 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$475.50 |
$634 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$215.25 |
$287 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$129.38 |
$172.50 |
1.4× |
| Urethrocystogram voiding (74455) |
$648.75 |
$865 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$741.75 |
$989 |
3.0× |
| Us breast unilateral limited (76642) |
$374.06 |
$498.75 |
4.2× |
| Us chest (76604) |
$358.50 |
$478 |
3.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$973.50 |
$1,298 |
4.4× |
| Us compl joint r-t w/image documentation (76881) |
$594 |
$792 |
5.5× |
| Us elastography parenchyma (76981) |
$271.50 |
$362 |
2.5× |
| Us encephalogram (76506) |
$384.75 |
$513 |
3.6× |
| Us hips infant static (76886) |
$475.50 |
$634 |
5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$378.75 |
$505 |
3.5× |
| Us ob detailed single fetus (76811) |
$588.75 |
$785 |
2.4× |
| Us ob limited (76815) |
$269.25 |
$359 |
2.5× |
| Us ob transvaginal (76817) |
$315 |
$420 |
2.9× |
| Us pelvic non ob complete (76856) |
$498 |
$664 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$385.50 |
$514 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$362.25 |
$483 |
3.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$222 |
$296 |
2.1× |
| Us retroperitoneal complete (76770) |
$475.50 |
$634 |
4.4× |
| Us retroperitoneal limited (76775) |
$461.25 |
$615 |
4.3× |
| Us scrotum and contents (76870) |
$372.75 |
$497 |
3.4× |
| Us soft tissue head/neck (76536) |
$480 |
$640 |
4.4× |
| Us spinal canal and contents (76800) |
$475.50 |
$634 |
4.4× |
| Us, eye b-scan (76512) |
$448.12 |
$597.50 |
4.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$493.50 |
$658 |
4.6× |
| Venogram extremity bilateral (75822) |
$1,315.50 |
$1,754 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$1,182.75 |
$1,577 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$3,037.50 |
$4,050 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,674.75 |
$2,233 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$511.50 |
$682 |
0.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,361 |
$3,148 |
0.7× |
| Wrist 2 views (73100) |
$240 |
$320 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$354.75 |
$473 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$196.50 |
$262 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$600 |
$800 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$210 |
$280 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$192.75 |
$257 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$330.75 |
$441 |
3.1× |
| X-ray exam of femur 2/> (73552) |
$192.75 |
$257 |
2.1× |
| X-ray eye for foreign body (70030) |
$184.50 |
$246 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$241.50 |
$322 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$639 |
$852 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$282.75 |
$377 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$232.50 |
$310 |
2.6× |
| X-ray leg, infant (73592) |
$221.25 |
$295 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$192 |
$256 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$381 |
$508 |
3.5× |
| X-ray nose-rectum child f.b. (76010) |
$315.75 |
$421 |
3.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$265.50 |
$354 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$793.50 |
$1,058 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$285.75 |
$381 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$295.50 |
$394 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$472.50 |
$630 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$318.75 |
$425 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$209.25 |
$279 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$265.50 |
$354 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$384 |
$512 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$318.75 |
$425 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$236.25 |
$315 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$219.75 |
$293 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$265.50 |
$354 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$171.75 |
$229 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$344.25 |
$459 |
3.2× |
| Xr bone length studies (77073) |
$231 |
$308 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$324.75 |
$433 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$409.50 |
$546 |
3.8× |
| Xr chest 4+ views (71048) |
$265.50 |
$354 |
2.5× |
| Xr urogram antegrade (74425) |
$666.75 |
$889 |
1.8× |