| 3-D radiotherapy plan dose-volume histograms (77295) |
$9,427 |
$9,427 |
5.7× |
| Abdomen 2 views (74019) |
$567 |
$567 |
4.5× |
| Acute gi blood loss imaging (78278) |
$1,152 |
$1,152 |
2.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$2,471 |
$2,471 |
1.6× |
| Angio Adrenal Bilat Select (75733) |
$8,940 |
$8,940 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$8,940 |
$8,940 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$8,940 |
$8,940 |
2.4× |
| Angiography internal mammary rs&i (75756) |
$4,348 |
$4,348 |
1.1× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$8,940 |
$8,940 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,940 |
$8,940 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,940 |
$8,940 |
2.4× |
| Angiography Spinal Selective Rs&I (75705) |
$15,659 |
$15,659 |
2.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$15,659 |
$15,659 |
2.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,209 |
$3,209 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,348 |
$4,348 |
1.1× |
| Ankle 2 views (73600) |
$292 |
$292 |
2.8× |
| Aortogram thoracic (75605) |
$8,940 |
$8,940 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$8,940 |
$8,940 |
2.4× |
| Aortography abdominal serialography rs&i (75625) |
$8,940 |
$8,940 |
2.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$8,940 |
$8,940 |
2.4× |
| Artery X-Rays Adrenal Gland (75731) |
$8,940 |
$8,940 |
2.4× |
| Arthrogram ankle (73615) |
$1,313 |
$1,313 |
3.1× |
| Arthrogram elbow (73085) |
$1,193 |
$1,193 |
2.9× |
| Arthrogram hip (73525) |
$1,193 |
$1,193 |
2.9× |
| Arthrogram knee (73580) |
$1,313 |
$1,313 |
3.1× |
| Arthrogram shoulder (73040) |
$1,193 |
$1,193 |
2.9× |
| Arthrogram wrist (73115) |
$1,313 |
$1,313 |
3.1× |
| Basic dosimetry (77300) |
$589 |
$589 |
3.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,086 |
$1,086 |
2.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,086 |
$1,086 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,193 |
$1,193 |
2.5× |
| Bone age studies (77072) |
$257 |
$257 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,277 |
$1,277 |
2.7× |
| Bone survey complete (77075) |
$535 |
$535 |
4.3× |
| Bone survey infant (77076) |
$409 |
$409 |
3.3× |
| Bowel imaging (78290) |
$1,085 |
$1,085 |
2.3× |
| Brachytx isodose complex (77318) |
$1,609 |
$1,609 |
3.6× |
| Brachytx isodose intermed (77317) |
$1,609 |
$1,609 |
3.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$873 |
$873 |
1.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$9,492 |
$9,492 |
5.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,576 |
$1,576 |
3.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,576 |
$1,576 |
3.3× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$4,696 |
$4,696 |
5.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,768 |
$3,768 |
9.0× |
| Cardiac shunt detection (78428) |
$1,283 |
$1,283 |
2.7× |
| Cardiovasc nucl exam unlisted (78499) |
$1,040 |
$1,040 |
2.2× |
| Cephalogram, orthodontic Non-Facility (70350) |
$226 |
$226 |
2.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,784 |
$1,784 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$378 |
$378 |
3.6× |
| Chest 1 view (71045) |
$206 |
$206 |
2.0× |
| Chest xray 3 views (71047) |
$206 |
$206 |
2.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$868 |
$868 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$758 |
$758 |
3.6× |
| Cineradiography/videoradiography (76120) |
$882 |
$882 |
7.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$3,341 |
$3,341 |
3.6× |
| Clavicle complete (73000) |
$322 |
$322 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$526 |
$526 |
4.2× |
| Continuing medical physics consltj pr wk (77336) |
$954 |
$954 |
5.9× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$569 |
$569 |
2.7× |
| Corpora cavernosography (74445) |
$1,563 |
$1,563 |
12.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,630 |
$2,630 |
6.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,240 |
$1,240 |
4.3× |
| CT abdomen w contrast (74160) |
$1,911 |
$1,911 |
9.1× |
| CT abdomen w wo contrast (74170) |
$2,274 |
$2,274 |
10.8× |
| CT abdomen w/o contrast (74150) |
$1,243 |
$1,243 |
9.9× |
| CT angio hrt w/3d image (75574) |
$1,173 |
$1,173 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,967 |
$3,967 |
18.9× |
| CT angiography upper extremity lt (73206) |
$2,472 |
$2,472 |
11.8× |
| CT c-spine w/contrast (72126) |
$1,321 |
$1,321 |
3.2× |
| CT c-spine w/o contrast (72125) |
$1,476 |
$1,476 |
11.8× |
| CT cervical spine w&w/o contrast (72127) |
$3,174 |
$3,174 |
15.1× |
| CT chest w contrast (71260) |
$1,826 |
$1,826 |
8.7× |
| CT chest w/wo contrast (71270) |
$2,726 |
$2,726 |
13.0× |
| CT colonography screening (74263) |
$2,847 |
$2,847 |
10.0× |
| CT colonography w/dye (74262) |
$2,450 |
$2,450 |
11.7× |
| CT colonography w/o cntrst (74261) |
$1,610 |
$1,610 |
12.9× |
| CT head/brain with contrast (70460) |
$1,205 |
$1,205 |
5.7× |
| CT head/brain without and with contrast (70470) |
$1,492 |
$1,492 |
7.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,472 |
$1,472 |
3.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$690 |
$690 |
6.6× |
| CT hrt w/3d image congen (75573) |
$2,080 |
$2,080 |
5.0× |
| CT iac w contrast (70481) |
$1,622 |
$1,622 |
7.7× |
| CT limited/localized follow up study (76380) |
$1,173 |
$1,173 |
11.2× |
| CT lower ext w/o (73700) |
$1,445 |
$1,445 |
11.5× |
| CT lower extremity w wo contrast (73702) |
$2,223 |
$2,223 |
10.6× |
| CT lower extremity w/contrast material (73701) |
$2,086 |
$2,086 |
9.9× |
| CT lumbar spine w & w/o contrast (72133) |
$3,801 |
$3,801 |
18.1× |
| CT lumbar spine w/contrast (72132) |
$1,889 |
$1,889 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$1,366 |
$1,366 |
10.9× |
| CT maxillofacial w contrast (70487) |
$1,619 |
$1,619 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,913 |
$1,913 |
9.1× |
| CT maxillofacial wo contrast (70486) |
$1,181 |
$1,181 |
9.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,664 |
$1,664 |
7.9× |
| CT orbits w/o contrast (70480) |
$1,283 |
$1,283 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,331 |
$1,331 |
10.6× |
| CT pelvis w/wo contrast (72194) |
$2,065 |
$2,065 |
9.8× |
| CT scan of arm combo (73202) |
$1,741 |
$1,741 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,533 |
$1,533 |
7.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,255 |
$2,255 |
10.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,194 |
$1,194 |
9.5× |
| CT thoracic spine w/contrast (72129) |
$1,912 |
$1,912 |
9.1× |
| CT thoracic spine w/o contrast (72128) |
$1,740 |
$1,740 |
13.9× |
| CT thoracic spine w/wo contrast (72130) |
$2,694 |
$2,694 |
12.8× |
| CT thorax w/o contrast (71250) |
$1,443 |
$1,443 |
11.5× |
| CT unlisted procedure (76497) |
$1,173 |
$1,173 |
11.2× |
| CT upper ext wo (73200) |
$1,532 |
$1,532 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,361 |
$1,361 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,969 |
$1,969 |
9.4× |
| Cta Abdomen (74175) |
$2,804 |
$2,804 |
13.3× |
| CTA abdomen pelvis (74174) |
$2,601 |
$2,601 |
6.2× |
| CTA chest (71275) |
$2,167 |
$2,167 |
10.3× |
| Cta Head (70496) |
$2,541 |
$2,541 |
12.1× |
| Cta Neck (70498) |
$2,361 |
$2,361 |
11.2× |
| Cta Pelvis (72191) |
$3,040 |
$3,040 |
14.5× |
| Cystography minimum 3 views rs&i (74430) |
$1,446 |
$1,446 |
3.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$2,813 |
$2,813 |
9.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$6,741 |
$6,741 |
2.7× |
| Diskogram cervical (72285) |
$10,531 |
$10,531 |
4.5× |
| Diskography lumbar (72295) |
$10,531 |
$10,531 |
4.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$852 |
$852 |
6.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$246 |
$246 |
2.4× |
| Dxa bone density study axial skeleton (77085) |
$321 |
$321 |
2.6× |
| Esophagus (74220) |
$779 |
$779 |
3.7× |
| Facial bones min 3 views (70150) |
$455 |
$455 |
3.6× |
| Fetal biophysical profile non-stress testing (76818) |
$410 |
$410 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$598 |
$598 |
2.1× |
| Foot 2 views (73620) |
$323 |
$323 |
3.1× |
| Forearm 2 views (73090) |
$323 |
$323 |
3.1× |
| Functional MRI brain by phys/psych (70555) |
$2,945 |
$2,945 |
10.3× |
| Functional MRI brain by tech (70554) |
$2,945 |
$2,945 |
10.3× |
| Hand 2 views (73120) |
$278 |
$278 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,807 |
$2,807 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,807 |
$2,807 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,807 |
$2,807 |
3.4× |
| Heart first pass single,planar (78481) |
$1,576 |
$1,576 |
2.4× |
| Heart Infarct Image (78466) |
$1,560 |
$1,560 |
3.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$8,940 |
$8,940 |
2.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,940 |
$8,940 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,891 |
$1,891 |
2.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,891 |
$1,891 |
3.9× |
| Hysterosalpingogram (74740) |
$1,782 |
$1,782 |
6.2× |
| Image fusion (77399) |
$437 |
$437 |
2.7× |
| Interstitial radiation source applic complex (77778) |
$5,244 |
$5,244 |
6.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,098 |
$2,098 |
2.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,854 |
$1,854 |
2.8× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,854 |
$1,854 |
2.8× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$15,554 |
$15,554 |
1.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$585 |
$585 |
4.7× |
| Kidney imaging morphology (78700) |
$1,428 |
$1,428 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,396 |
$1,396 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,470 |
$1,470 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,011 |
$2,011 |
3.1× |
| Knee 3 views (73562) |
$378 |
$378 |
3.6× |
| Liver & spleen imaging static only (78215) |
$1,121 |
$1,121 |
2.3× |
| Liver imaging static only (78201) |
$1,745 |
$1,745 |
2.7× |
| Lung perf&ventilat diferentl (78598) |
$1,695 |
$1,695 |
2.6× |
| Lung perfusion differential (78597) |
$1,047 |
$1,047 |
2.2× |
| Lung ventilation imaging (78579) |
$1,025 |
$1,025 |
2.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,290 |
$4,290 |
1.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,671 |
$2,671 |
0.7× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,671 |
$2,671 |
1.4× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,588 |
$1,588 |
2.1× |
| Lymphoscintigraphy (78195) |
$1,150 |
$1,150 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,945 |
$2,945 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,945 |
$2,945 |
7.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,945 |
$2,945 |
7.0× |
| Magnetic Resonance Elastography (76391) |
$10,334 |
$10,334 |
36.1× |
| Mammary ductogram or galactogram multiple (77054) |
$1,530 |
$1,530 |
5.4× |
| Mammary ductogram or galactogram single (77053) |
$1,530 |
$1,530 |
5.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$351 |
$351 |
3.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,443 |
$2,443 |
5.4× |
| Mr safety determination physician/other qhp (76016) |
$273 |
$273 |
2.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$76 |
$76 |
2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$444 |
$444 |
3.9× |
| Mr safety implt pos&/immoblj (76019) |
$211 |
$211 |
3.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$870 |
$870 |
3.0× |
| MRA head w & w/o contrast (70546) |
$3,779 |
$3,779 |
9.0× |
| MRA head w/o contrast (70544) |
$2,945 |
$2,945 |
10.3× |
| MRA head with contrast (70545) |
$2,945 |
$2,945 |
7.0× |
| MRA neck w contrast (70548) |
$2,945 |
$2,945 |
7.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,930 |
$3,930 |
9.4× |
| MRA neck w/o contrast (70547) |
$2,945 |
$2,945 |
10.3× |
| MRI abdomen w contrast (74182) |
$2,945 |
$2,945 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,521 |
$3,521 |
8.4× |
| MRI abdomen w/o contrast (74181) |
$2,945 |
$2,945 |
10.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,983 |
$2,983 |
3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,945 |
$2,945 |
7.0× |
| MRI breast w/o contrast bilateral (77047) |
$3,653 |
$3,653 |
12.8× |
| MRI breast wo contrast unilateral (77046) |
$3,322 |
$3,322 |
11.6× |
| MRI c-spine with contrast (72142) |
$3,705 |
$3,705 |
8.9× |
| MRI cardiac w/o cont stress (75559) |
$2,945 |
$2,945 |
4.5× |
| MRI cardiac w/o contrast (75557) |
$2,945 |
$2,945 |
10.3× |
| MRI cervical spine w/o contrast (72141) |
$2,945 |
$2,945 |
10.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,637 |
$3,637 |
8.7× |
| MRI chest w/o contrast (71550) |
$2,945 |
$2,945 |
10.3× |
| MRI chest with contrast (71551) |
$4,444 |
$4,444 |
4.7× |
| MRI fetal sngl/1st gestation (74712) |
$2,945 |
$2,945 |
10.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,945 |
$2,945 |
7.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,945 |
$2,945 |
7.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,945 |
$2,945 |
10.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,167 |
$3,167 |
11.1× |
| MRI orbit face neck w contrast (70542) |
$4,701 |
$4,701 |
11.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,509 |
$3,509 |
8.4× |
| MRI pelvis w/contrast (72196) |
$3,218 |
$3,218 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,945 |
$2,945 |
7.0× |
| MRI pelvis w/o contrast (72195) |
$2,945 |
$2,945 |
10.3× |
| MRI spectroscopy (76390) |
$2,945 |
$2,945 |
28.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,707 |
$3,707 |
8.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,326 |
$3,326 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,231 |
$3,231 |
7.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,594 |
$3,594 |
8.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,605 |
$3,605 |
8.6× |
| MRI temporomandibular joint (70336) |
$2,945 |
$2,945 |
10.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,945 |
$2,945 |
10.3× |
| MRI up ext w/o contrast (73218) |
$2,945 |
$2,945 |
10.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,945 |
$2,945 |
10.3× |
| MRI, joint upper extrem combo (73223) |
$3,145 |
$3,145 |
7.5× |
| Myelogram Cervical (72240) |
$2,093 |
$2,093 |
2.2× |
| Myelogram Lumbar (72265) |
$2,093 |
$2,093 |
2.2× |
| Myelogram thoracic (72255) |
$2,093 |
$2,093 |
2.2× |
| Myelography 2 or more regions (72270) |
$2,093 |
$2,093 |
2.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,422 |
$4,422 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,990 |
$4,990 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$7,992 |
$7,992 |
4.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$5,332 |
$5,332 |
3.1× |
| Myocardial infarct spect (78469) |
$2,530 |
$2,530 |
3.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,696 |
$4,696 |
3.0× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,696 |
$4,696 |
3.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,696 |
$4,696 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$4,696 |
$4,696 |
3.0× |
| N-invas est c ffr sw aly CTA (75580) |
$3,427 |
$3,427 |
3.3× |
| Neck soft tissue (70360) |
$444 |
$444 |
4.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$926 |
$926 |
1.9× |
| Nm bone marrow wb (78104) |
$1,158 |
$1,158 |
2.4× |
| Nm cardiac blood pool multiple (78473) |
$1,665 |
$1,665 |
3.5× |
| Nm gastric emptying study (78264) |
$1,171 |
$1,171 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$1,156 |
$1,156 |
2.4× |
| Nm peritoneal-venous shunt patency (78291) |
$1,085 |
$1,085 |
2.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,065 |
$1,065 |
2.2× |
| Nonvascular shunt X-ray (75809) |
$966 |
$966 |
7.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,165 |
$8,165 |
4.9× |
| Nuclear Rx Oral Admin (79005) |
$1,121 |
$1,121 |
4.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$482 |
$482 |
3.8× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$1,495 |
$1,495 |
11.9× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$2,498 |
$2,498 |
15.7× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$407 |
$407 |
11.7× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$723 |
$723 |
5.8× |
| Orthopantogram (70355) |
$226 |
$226 |
2.2× |
| Osseous survey limited (77074) |
$357 |
$357 |
2.8× |
| Parathyrd planar w/spect&CT (78072) |
$2,484 |
$2,484 |
3.8× |
| Parathyroid Planar Imaging (78070) |
$965 |
$965 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,484 |
$2,484 |
5.2× |
| Pelvis 1 or 2 views (72170) |
$275 |
$275 |
2.2× |
| Perineogram (74775) |
$1,446 |
$1,446 |
5.1× |
| Peritoneogram after injection (74190) |
$4,264 |
$4,264 |
6.5× |
| PET image w/CT, skull-thigh (78815) |
$11,975 |
$11,975 |
7.0× |
| PET imaging CT for attenuation limited area (78814) |
$8,983 |
$8,983 |
5.2× |
| PET imaging for CT attenuation whole body (78816) |
$14,969 |
$14,969 |
8.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$5,332 |
$5,332 |
3.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$8,940 |
$8,940 |
2.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,348 |
$4,348 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,025 |
$1,025 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,442 |
$1,442 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,790 |
$1,790 |
2.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$343 |
$343 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$304 |
$304 |
2.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$344 |
$344 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$223 |
$223 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$354 |
$354 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$670 |
$670 |
5.3× |
| Radex fingr minimum 2 views (73140) |
$260 |
$260 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$333 |
$333 |
3.2× |
| Radex Hand Minimum 3 Views (73130) |
$326 |
$326 |
3.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$223 |
$223 |
2.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$354 |
$354 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$354 |
$354 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$670 |
$670 |
5.3× |
| Radex Humerus Minimum 2 Views (73060) |
$315 |
$315 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$305 |
$305 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$432 |
$432 |
3.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$490 |
$490 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$378 |
$378 |
3.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$461 |
$461 |
3.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$330 |
$330 |
3.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$330 |
$330 |
3.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$354 |
$354 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$415 |
$415 |
4.0× |
| Radex Toe Minimum 2 Views (73660) |
$270 |
$270 |
2.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$351 |
$351 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$351 |
$351 |
3.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$670 |
$670 |
5.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$30,172 |
$30,172 |
3.4× |
| Radiation treatment delivery level 1 (77402) |
$815 |
$815 |
6.7× |
| Radiation treatment delivery level 2 (77407) |
$955 |
$955 |
2.1× |
| Radiation treatment delivery level 3 (77412) |
$1,211 |
$1,211 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$345 |
$345 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$567 |
$567 |
4.5× |
| Radiologic exam chest 2 views (71046) |
$206 |
$206 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$1,042 |
$1,042 |
5.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,062 |
$1,062 |
5.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$960 |
$960 |
4.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$854 |
$854 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$223 |
$223 |
2.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$989 |
$989 |
9.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$335 |
$335 |
3.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$257 |
$257 |
0.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$387 |
$387 |
3.1× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$882 |
$882 |
8.5× |
| Radiological examination surgical specimen (76098) |
$1,121 |
$1,121 |
1.7× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$2,149 |
$2,149 |
7.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$787 |
$787 |
1.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$787 |
$787 |
1.7× |
| Renal Cyst Study (74470) |
$4,135 |
$4,135 |
6.3× |
| Ribs bilateral 3 views (71110) |
$391 |
$391 |
3.1× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,279 |
$1,279 |
2.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,551 |
$2,551 |
5.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,869 |
$3,869 |
5.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,198 |
$2,198 |
3.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,548 |
$2,548 |
3.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,586 |
$4,586 |
3.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,751 |
$4,751 |
3.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$841 |
$841 |
3.0× |
| Rp Therapy Intravenous Administration (79101) |
$1,157 |
$1,157 |
4.1× |
| Sacroiliac Joints < 3 Views (72200) |
$303 |
$303 |
2.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$867 |
$867 |
3.0× |
| Salivary gland imaging (78230) |
$1,085 |
$1,085 |
2.3× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$1,085 |
$1,085 |
2.3× |
| Scapula (73010) |
$300 |
$300 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$364 |
$364 |
15.6× |
| Sella turcica (70240) |
$237 |
$237 |
2.3× |
| Shoulder 1 view (73020) |
$278 |
$278 |
2.7× |
| Sialogram (70390) |
$1,782 |
$1,782 |
6.2× |
| Simulation intermediate (77285) |
$1,598 |
$1,598 |
3.6× |
| Small bowel series (74250) |
$1,062 |
$1,062 |
5.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,598 |
$1,598 |
3.6× |
| Special dosimetry (77331) |
$797 |
$797 |
4.9× |
| Special Physics Consult (77370) |
$1,487 |
$1,487 |
9.2× |
| Special treatment procedure (77470) |
$4,559 |
$4,559 |
6.9× |
| Spine thoracic 3 views (72072) |
$359 |
$359 |
2.9× |
| Spleen imaging only (78185) |
$1,158 |
$1,158 |
2.4× |
| Splenoportograpy rs&i (75810) |
$8,940 |
$8,940 |
2.4× |
| Stereotactic Body Radiation Delivery (77373) |
$10,639 |
$10,639 |
5.0× |
| Superior sagittal sinus venogram (75870) |
$3,684 |
$3,684 |
1.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$989 |
$989 |
8.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,609 |
$1,609 |
3.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$873 |
$873 |
1.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,313 |
$1,313 |
4.6× |
| Testicular Imaging With Vascular Flow (78761) |
$1,396 |
$1,396 |
2.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,337 |
$2,337 |
5.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,211 |
$1,211 |
7.5× |
| Thoracolumbar 2 views (72080) |
$450 |
$450 |
4.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,659 |
$1,659 |
2.5× |
| Thyroid imaging w/blood flow (78013) |
$926 |
$926 |
1.9× |
| Thyroid uptake measurement (78012) |
$926 |
$926 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$963 |
$963 |
2.0× |
| Tomogram (76100) |
$812 |
$812 |
6.5× |
| Treatment device complex (77334) |
$1,151 |
$1,151 |
2.6× |
| Treatment device intermediate (77333) |
$1,098 |
$1,098 |
6.8× |
| Treatment devices simple (77332) |
$1,098 |
$1,098 |
6.8× |
| Ultrasound breast complete (76641) |
$452 |
$452 |
3.6× |
| Ultrasound elastography first target lesion (76982) |
$510 |
$510 |
4.1× |
| Ultrasound Exam Aaa Screen (76706) |
$439 |
$439 |
3.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$914 |
$914 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$751 |
$751 |
6.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$2,886 |
$2,886 |
27.7× |
| Unlisted magnetic resonance procedure (76498) |
$307.50 |
$307.50 |
2.9× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$926 |
$926 |
1.9× |
| Unlisted ultrasound procedure (76999) |
$892 |
$892 |
8.6× |
| Ureteral reflux study (78740) |
$1,396 |
$1,396 |
2.9× |
| Urethrocystogram voiding (74455) |
$1,446 |
$1,446 |
5.1× |
| Urethrocystography retrograde rs&i (74450) |
$1,446 |
$1,446 |
5.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,446 |
$1,446 |
6.9× |
| Us breast unilateral limited (76642) |
$452 |
$452 |
4.3× |
| Us chest (76604) |
$581 |
$581 |
4.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,474 |
$1,474 |
5.7× |
| Us compl joint r-t w/image documentation (76881) |
$767 |
$767 |
6.1× |
| Us elastography parenchyma (76981) |
$510 |
$510 |
4.1× |
| Us infant hips w manipulation (76885) |
$709 |
$709 |
6.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$407 |
$407 |
3.2× |
| Us ob detailed single fetus (76811) |
$860 |
$860 |
3.0× |
| Us ob limited (76815) |
$581 |
$581 |
4.6× |
| Us ob transvaginal (76817) |
$803 |
$803 |
6.4× |
| Us pelvic non ob complete (76856) |
$980 |
$980 |
7.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$554 |
$554 |
4.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$645 |
$645 |
5.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$363 |
$363 |
2.9× |
| Us retroperitoneal complete (76770) |
$764 |
$764 |
6.1× |
| Us retroperitoneal limited (76775) |
$625 |
$625 |
5.0× |
| Us scrotum and contents (76870) |
$892 |
$892 |
7.1× |
| Us soft tissue head/neck (76536) |
$807 |
$807 |
6.4× |
| Us spinal canal and contents (76800) |
$590 |
$590 |
4.7× |
| Us transrectal (76872) |
$639 |
$639 |
5.1× |
| Us transrectal prostate volume (76873) |
$838 |
$838 |
6.7× |
| Us, eye b-scan (76512) |
$1,492 |
$1,492 |
11.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$832 |
$832 |
6.6× |
| Venogram extremity bilateral (75822) |
$2,591 |
$2,591 |
1.4× |
| Venogram Extremity Unilateral (75820) |
$2,899 |
$2,899 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$8,940 |
$8,940 |
2.4× |
| Venography caval superior serialography rs&i (75827) |
$4,348 |
$4,348 |
2.3× |
| Venography Orbital Rs&I (75880) |
$4,348 |
$4,348 |
5.8× |
| Venography Renal Bilateral (75833) |
$8,940 |
$8,940 |
2.4× |
| Venography renal unilateral selective rs&i (75831) |
$8,940 |
$8,940 |
2.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,348 |
$4,348 |
1.1× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$4,348 |
$4,348 |
5.8× |
| Venous sampling by catheter (75893) |
$8,940 |
$8,940 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$205 |
$205 |
2.0× |
| Wrist 2 views (73100) |
$267 |
$267 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$644 |
$644 |
5.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$337 |
$337 |
3.2× |
| X-ray b.e. reductn intuss (74283) |
$1,022 |
$1,022 |
4.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,275 |
$1,275 |
6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$330 |
$330 |
3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$223 |
$223 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$354 |
$354 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$223 |
$223 |
2.1× |
| X-ray eye for foreign body (70030) |
$441 |
$441 |
4.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$283 |
$283 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$1,446 |
$1,446 |
6.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$398 |
$398 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$226 |
$226 |
2.2× |
| X-ray leg, infant (73592) |
$268 |
$268 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$438 |
$438 |
3.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$919 |
$919 |
7.3× |
| X-ray nose-rectum child f.b. (76010) |
$487 |
$487 |
4.7× |
| X-ray optic foramen (70190) |
$316 |
$316 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$434 |
$434 |
3.5× |
| X-ray retrograde pyelogram (74420) |
$1,563 |
$1,563 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$331 |
$331 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$465 |
$465 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$533 |
$533 |
4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$351 |
$351 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$324 |
$324 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$465 |
$465 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$533 |
$533 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$311 |
$311 |
2.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$891 |
$891 |
4.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$259 |
$259 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$271 |
$271 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$354 |
$354 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$409 |
$409 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$346 |
$346 |
2.8× |
| Xr bone length studies (77073) |
$290 |
$290 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$491 |
$491 |
3.9× |
| Xr c-spine 6 or more views (72052) |
$756 |
$756 |
6.0× |
| Xr chest 4+ views (71048) |
$397 |
$397 |
3.2× |
| Xr urogram antegrade (74425) |
$1,563 |
$1,563 |
3.7× |