| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,032.30 |
$7,189 |
3.5× |
| Abdomen 2 views (74019) |
$333.85 |
$476.93 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,339.80 |
$1,914 |
3.2× |
| Angiography extremity bilateral rs&i (75716) |
$3,694.60 |
$5,278 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$2,639.70 |
$3,771 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,522 |
$6,460 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,758 |
$3,940 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,718.70 |
$6,741 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,876.70 |
$2,681 |
0.6× |
| Ankle 2 views (73600) |
$668.15 |
$954.50 |
7.4× |
| Aortogram thoracic (75605) |
$4,718.70 |
$6,741 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,031 |
$4,330 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,431.10 |
$3,473 |
0.7× |
| Arthrogram ankle (73615) |
$1,781.50 |
$2,545 |
4.9× |
| Arthrogram elbow (73085) |
$1,781.50 |
$2,545 |
4.9× |
| Arthrogram hip (73525) |
$1,781.50 |
$2,545 |
4.9× |
| Arthrogram knee (73580) |
$1,781.50 |
$2,545 |
4.9× |
| Arthrogram shoulder (73040) |
$1,781.50 |
$2,545 |
4.9× |
| Arthrogram wrist (73115) |
$1,781.50 |
$2,545 |
4.9× |
| Basic dosimetry (77300) |
$6,673.80 |
$9,534 |
47.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$770 |
$1,100 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$2,203.60 |
$3,148 |
5.3× |
| Bone age studies (77072) |
$225.40 |
$322 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,416.28 |
$2,023.26 |
3.4× |
| Bone survey complete (77075) |
$1,043 |
$1,490 |
9.6× |
| Bowel imaging (78290) |
$827.40 |
$1,182 |
2.0× |
| Brachytx isodose complex (77318) |
$2,398.90 |
$3,427 |
6.1× |
| Brachytx isodose intermed (77317) |
$2,265.20 |
$3,236 |
5.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,064.30 |
$2,949 |
5.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$770 |
$1,100 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,791.15 |
$6,844.50 |
3.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,020.20 |
$2,886 |
4.8× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,544.20 |
$2,206 |
2.7× |
| Cephalogram, orthodontic Non-Facility (70350) |
$70 |
$100 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$707 |
$1,010 |
7.8× |
| Chest 1 view (71045) |
$207.92 |
$297.04 |
2.3× |
| Chest xray 3 views (71047) |
$350.70 |
$501 |
3.9× |
| Cholecystography, oral contrast Non-Facility (74290) |
$331.80 |
$474 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$464.47 |
$663.52 |
2.5× |
| Clavicle complete (73000) |
$675.50 |
$965 |
7.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,572.54 |
$6,532.20 |
12.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,910.78 |
$4,158.26 |
11.7× |
| CT abdomen w contrast (74160) |
$3,498.60 |
$4,998 |
19.1× |
| CT abdomen w wo contrast (74170) |
$4,384.10 |
$6,263 |
23.9× |
| CT abdomen w/o contrast (74150) |
$3,082.10 |
$4,403 |
28.2× |
| CT angio hrt w/3d image (75574) |
$2,111.20 |
$3,016 |
5.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,473.58 |
$2,105.10 |
8.0× |
| CT angiography upper extremity lt (73206) |
$2,660 |
$3,800 |
14.5× |
| CT c-spine w/contrast (72126) |
$3,470.60 |
$4,958 |
9.5× |
| CT c-spine w/o contrast (72125) |
$372.57 |
$532.24 |
3.4× |
| CT cervical spine w&w/o contrast (72127) |
$4,126.50 |
$5,895 |
22.5× |
| CT chest w contrast (71260) |
$1,850.02 |
$2,642.89 |
10.1× |
| CT chest w/wo contrast (71270) |
$2,128.48 |
$3,040.68 |
11.6× |
| CT head/brain with contrast (70460) |
$1,813.30 |
$2,590.42 |
9.9× |
| CT head/brain without and with contrast (70470) |
$530.60 |
$758 |
2.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$240.10 |
$343 |
2.6× |
| CT iac w contrast (70481) |
$2,187.12 |
$3,124.46 |
11.9× |
| CT lower ext w/o (73700) |
$2,524.90 |
$3,607 |
23.1× |
| CT lower extremity w wo contrast (73702) |
$1,294.30 |
$1,849 |
7.1× |
| CT lower extremity w/contrast material (73701) |
$3,410.40 |
$4,872 |
18.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,699.08 |
$2,427.26 |
9.3× |
| CT lumbar spine w/contrast (72132) |
$3,074.40 |
$4,392 |
8.4× |
| CT lumbar spine w/o contrast (72131) |
$375.20 |
$536 |
3.4× |
| CT maxillofacial w contrast (70487) |
$3,640 |
$5,200 |
19.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,995.88 |
$2,851.26 |
10.9× |
| CT maxillofacial wo contrast (70486) |
$391.30 |
$559 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$4,007.50 |
$5,725 |
21.9× |
| CT orbits w/o contrast (70480) |
$1,983.77 |
$2,833.96 |
18.2× |
| CT pelvis w/o contrast (72192) |
$382.06 |
$545.80 |
3.5× |
| CT pelvis w/wo contrast (72194) |
$3,910.90 |
$5,587 |
21.4× |
| CT scan of arm combo (73202) |
$3,442.60 |
$4,918 |
18.8× |
| CT soft tissue neck w contrast (70491) |
$1,673.84 |
$2,391.20 |
9.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,048.90 |
$2,927 |
11.2× |
| CT soft tissue neck w/o contrast (70490) |
$459.20 |
$656 |
4.2× |
| CT thoracic spine w/contrast (72129) |
$3,534.30 |
$5,049 |
19.3× |
| CT thoracic spine w/o contrast (72128) |
$371.64 |
$530.92 |
3.4× |
| CT thoracic spine w/wo contrast (72130) |
$3,711.40 |
$5,302 |
20.3× |
| CT thorax w/o contrast (71250) |
$1,461.56 |
$2,087.95 |
13.4× |
| CT upper ext wo (73200) |
$2,497.60 |
$3,568 |
22.9× |
| CT upper extremity with contrast (73201) |
$2,621.50 |
$3,745 |
7.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,856.70 |
$4,081 |
15.6× |
| Cta Abdomen (74175) |
$3,115 |
$4,450 |
17.0× |
| CTA abdomen pelvis (74174) |
$3,479 |
$4,970 |
9.5× |
| CTA chest (71275) |
$1,880.49 |
$2,686.42 |
10.3× |
| Cta Head (70496) |
$802.90 |
$1,147 |
4.4× |
| Cta Neck (70498) |
$1,927.32 |
$2,753.32 |
10.5× |
| Cta Pelvis (72191) |
$3,047.80 |
$4,354 |
16.6× |
| Cystography minimum 3 views rs&i (74430) |
$640.50 |
$915 |
1.8× |
| Diskogram cervical (72285) |
$1,630.30 |
$2,329 |
0.8× |
| Diskography lumbar (72295) |
$1,781.50 |
$2,545 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$648.20 |
$926 |
5.9× |
| Esophagus (74220) |
$697.90 |
$997 |
3.8× |
| Facial bones min 3 views (70150) |
$588.70 |
$841 |
5.4× |
| Fetal biophysical profile non-stress testing (76818) |
$315 |
$450 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$778.40 |
$1,112 |
3.1× |
| Foot 2 views (73620) |
$486.50 |
$695 |
5.4× |
| Forearm 2 views (73090) |
$587.30 |
$839 |
6.5× |
| Functional MRI brain by tech (70554) |
$2,457 |
$3,510 |
9.9× |
| Hand 2 views (73120) |
$430.50 |
$615 |
3.9× |
| Heart Infarct Image (78466) |
$963.90 |
$1,377 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,862.70 |
$2,661 |
4.5× |
| Interstitial radiation source applic complex (77778) |
$1,439.20 |
$2,056 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$447.30 |
$639 |
4.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,882.30 |
$2,689 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,125.20 |
$3,036 |
3.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$827.40 |
$1,182 |
1.5× |
| Knee 3 views (73562) |
$797.30 |
$1,139 |
8.8× |
| Liver & spleen imaging static only (78215) |
$2,128 |
$3,040 |
5.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,034.60 |
$1,478 |
2.5× |
| Lung ventilation imaging (78579) |
$1,498 |
$2,140 |
3.6× |
| Lymphoscintigraphy (78195) |
$1,745.10 |
$2,493 |
3.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,296 |
$3,280 |
2.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,362.10 |
$4,803 |
9.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,581.50 |
$6,545 |
12.6× |
| MRA head w & w/o contrast (70546) |
$906.50 |
$1,295 |
2.5× |
| MRA head w/o contrast (70544) |
$653.10 |
$933 |
2.6× |
| MRA head with contrast (70545) |
$3,777.20 |
$5,396 |
10.4× |
| MRA neck w contrast (70548) |
$3,576.30 |
$5,109 |
9.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,378.60 |
$3,398 |
6.5× |
| MRA neck w/o contrast (70547) |
$2,321.90 |
$3,317 |
9.3× |
| MRI abdomen w contrast (74182) |
$3,892 |
$5,560 |
10.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,090.08 |
$2,985.84 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$3,707.20 |
$5,296 |
14.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,576.60 |
$6,538 |
5.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,700.80 |
$8,144 |
15.6× |
| MRI breast wo contrast unilateral (77046) |
$1,833.30 |
$2,619 |
7.4× |
| MRI c-spine with contrast (72142) |
$4,139.80 |
$5,914 |
11.4× |
| MRI cervical spine w/o contrast (72141) |
$2,248.05 |
$3,211.50 |
9.0× |
| MRI chest w/o & w/contrast material (71552) |
$4,496.80 |
$6,424 |
12.3× |
| MRI chest w/o contrast (71550) |
$3,966.20 |
$5,666 |
15.9× |
| MRI chest with contrast (71551) |
$4,163.60 |
$5,948 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,531.50 |
$5,045 |
9.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,425.40 |
$6,322 |
12.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,204.20 |
$6,006 |
16.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,149.49 |
$3,070.70 |
8.6× |
| MRI orbit face neck w contrast (70542) |
$3,835.30 |
$5,479 |
10.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,737 |
$3,910 |
7.5× |
| MRI pelvis w/contrast (72196) |
$3,498.60 |
$4,998 |
9.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,156.58 |
$3,080.84 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$3,331.30 |
$4,759 |
13.4× |
| MRI spectroscopy (76390) |
$3,454.50 |
$4,935 |
38.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,525.59 |
$5,036.56 |
9.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,978.10 |
$5,683 |
10.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,816.75 |
$5,452.50 |
10.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,978.80 |
$5,684 |
10.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,495 |
$7,850 |
15.1× |
| MRI temporomandibular joint (70336) |
$4,076.80 |
$5,824 |
16.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,172.45 |
$3,103.50 |
8.7× |
| MRI up ext w/o contrast (73218) |
$3,202.50 |
$4,575 |
12.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,940.30 |
$2,771.85 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$4,186.70 |
$5,981 |
11.5× |
| Myelogram Cervical (72240) |
$1,630.30 |
$2,329 |
2.0× |
| Myelogram Lumbar (72265) |
$1,630.30 |
$2,329 |
2.0× |
| Myelogram thoracic (72255) |
$2,153.20 |
$3,076 |
2.6× |
| Myelography 2 or more regions (72270) |
$1,872.50 |
$2,675 |
2.3× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,403.40 |
$4,862 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,820.60 |
$5,458 |
2.8× |
| Neck soft tissue (70360) |
$501.90 |
$717 |
5.5× |
| Nm cardiac blood pool multiple (78473) |
$1,469.30 |
$2,099 |
3.5× |
| Nm cisternogram (78630) |
$1,500.80 |
$2,144 |
2.6× |
| Nm csf leak detection (78650) |
$1,330.70 |
$1,901 |
1.0× |
| Nm gastric emptying study (78264) |
$1,792.70 |
$2,561 |
4.3× |
| Nm gastroesophageal reflux study (78262) |
$1,379.70 |
$1,971 |
3.3× |
| Nm peritoneal-venous shunt patency (78291) |
$827.40 |
$1,182 |
2.0× |
| Nonvascular shunt X-ray (75809) |
$1,872.50 |
$2,675 |
17.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$827.40 |
$1,182 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$1,962.80 |
$2,804 |
8.1× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$103.25 |
$147.50 |
0.9× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$22.40 |
$32 |
0.7× |
| Orthopantogram (70355) |
$203 |
$290 |
2.2× |
| Osseous survey limited (77074) |
$404.60 |
$578 |
3.7× |
| Parathyroid Planar Imaging (78070) |
$1,562.40 |
$2,232 |
3.7× |
| Pelvis 1 or 2 views (72170) |
$270.54 |
$386.48 |
2.5× |
| PET image w/CT, skull-thigh (78815) |
$5,512.50 |
$7,875 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$4,398.45 |
$6,283.50 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$5,781.65 |
$8,259.50 |
3.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,924.60 |
$4,178 |
2.2× |
| PET whole body (78813) |
$5,260.50 |
$7,515 |
3.5× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,899 |
$5,570 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,747.20 |
$2,496 |
4.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,942.80 |
$4,204 |
5.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$490 |
$700 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$549.50 |
$785 |
6.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$624.40 |
$892 |
6.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$837.55 |
$1,196.50 |
9.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$225.40 |
$322 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$588.35 |
$840.50 |
5.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$352.80 |
$504 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$639.45 |
$913.50 |
7.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$728 |
$1,040 |
8.0× |
| Radex Hand Minimum 3 Views (73130) |
$862.75 |
$1,232.50 |
9.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$393.05 |
$561.50 |
4.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$767.20 |
$1,096 |
7.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$410.68 |
$586.68 |
3.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,200.50 |
$1,715 |
11.0× |
| Radex Humerus Minimum 2 Views (73060) |
$593.60 |
$848 |
6.5× |
| Radex Kne 1/2 Views (73560) |
$554.05 |
$791.50 |
6.1× |
| Radex Kne Compl 4/More Views (73564) |
$793.10 |
$1,133 |
7.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$689.50 |
$985 |
6.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$624.40 |
$892 |
6.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$742 |
$1,060 |
6.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$961.10 |
$1,373 |
10.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$317.10 |
$453 |
3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$646.10 |
$923 |
7.1× |
| Radex Toe Minimum 2 Views (73660) |
$614.25 |
$877.50 |
6.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$852.60 |
$1,218 |
9.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$432.60 |
$618 |
4.0× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$49,711.20 |
$71,016 |
6.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$29,341.90 |
$41,917 |
3.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$237.80 |
$339.72 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$326.90 |
$467 |
3.0× |
| Radiologic exam chest 2 views (71046) |
$260 |
$371.44 |
2.9× |
| Radiologic exam colon single contrast study (74270) |
$1,227.10 |
$1,753 |
6.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,074.50 |
$1,535 |
5.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,318.80 |
$1,884 |
7.2× |
| Radiologic examination femur 1 view (73551) |
$612.15 |
$874.50 |
6.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$225.40 |
$322 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$817.95 |
$1,168.50 |
9.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$302.40 |
$432 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$241.50 |
$345 |
2.2× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$769.30 |
$1,099 |
8.5× |
| Radiological examination surgical specimen (76098) |
$673.05 |
$961.50 |
1.2× |
| Ribs bilateral 3 views (71110) |
$795.20 |
$1,136 |
7.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,050.70 |
$1,501 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,108.05 |
$3,011.50 |
5.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,964.10 |
$5,663 |
7.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,792.30 |
$3,989 |
4.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,724.45 |
$2,463.50 |
3.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,058.70 |
$2,941 |
1.5× |
| Scapula (73010) |
$847.70 |
$1,211 |
7.8× |
| Sella turcica (70240) |
$225.40 |
$322 |
2.5× |
| Shoulder 1 view (73020) |
$407.40 |
$582 |
4.5× |
| Simulation intermediate (77285) |
$672.70 |
$961 |
1.7× |
| Small bowel series (74250) |
$994.70 |
$1,421 |
5.4× |
| Special dosimetry (77331) |
$380.10 |
$543 |
2.7× |
| Special Physics Consult (77370) |
$1,024.10 |
$1,463 |
7.3× |
| Special treatment procedure (77470) |
$2,274.65 |
$3,249.50 |
3.9× |
| Stereotactic Body Radiation Delivery (77373) |
$5,465.60 |
$7,808 |
2.9× |
| Superior sagittal sinus venogram (75870) |
$2,044 |
$2,920 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$812 |
$1,160 |
2.1× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,630.30 |
$2,329 |
6.5× |
| Testicular Imaging With Vascular Flow (78761) |
$770 |
$1,100 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,238.30 |
$1,769 |
3.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$459.90 |
$657 |
3.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,684.90 |
$2,407 |
3.0× |
| Thyroid imaging w/blood flow (78013) |
$1,127.70 |
$1,611 |
2.7× |
| Thyroid uptake measurement (78012) |
$1,034.60 |
$1,478 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,034.60 |
$1,478 |
2.5× |
| Treatment device complex (77334) |
$1,654.10 |
$2,363 |
4.2× |
| Treatment device intermediate (77333) |
$2,142.70 |
$3,061 |
15.3× |
| Treatment devices simple (77332) |
$2,041.20 |
$2,916 |
14.5× |
| Ultrasound breast complete (76641) |
$686.70 |
$981 |
6.3× |
| Ultrasound Exam Aaa Screen (76706) |
$574.70 |
$821 |
5.3× |
| Ultrasound, abdomen limited (76705) |
$510.56 |
$729.37 |
4.7× |
| Unlisted magnetic resonance procedure (76498) |
$2,447.20 |
$3,496 |
26.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,113.70 |
$1,591 |
10.5× |
| Urethrocystogram voiding (74455) |
$1,009.40 |
$1,442 |
4.1× |
| Urethrocystography retrograde rs&i (74450) |
$1,012.90 |
$1,447 |
4.1× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$376.60 |
$538 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,051.40 |
$1,502 |
5.7× |
| Us chest (76604) |
$531.30 |
$759 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$749 |
$1,070 |
6.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$636.30 |
$909 |
5.8× |
| Us ob detailed single fetus (76811) |
$487.90 |
$697 |
2.0× |
| Us ob limited (76815) |
$176.40 |
$252 |
1.6× |
| Us pelvic non ob complete (76856) |
$581.56 |
$830.79 |
5.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$786.10 |
$1,123 |
7.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$639.10 |
$913 |
5.9× |
| Us retroperitoneal complete (76770) |
$344.84 |
$492.64 |
3.2× |
| Us retroperitoneal limited (76775) |
$1,008 |
$1,440 |
9.2× |
| Us scrotum and contents (76870) |
$821.80 |
$1,174 |
7.5× |
| Us soft tissue head/neck (76536) |
$420.10 |
$600.14 |
3.8× |
| Us spinal canal and contents (76800) |
$315 |
$450 |
2.9× |
| Us transrectal (76872) |
$911.40 |
$1,302 |
8.3× |
| Us, eye b-scan (76512) |
$107.10 |
$153 |
1.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$422.80 |
$604 |
3.9× |
| Venogram extremity bilateral (75822) |
$1,864.80 |
$2,664 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,243.90 |
$1,777 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,003.40 |
$2,862 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,691.90 |
$2,417 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,887.10 |
$5,553 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$2,590 |
$3,700 |
0.8× |
| Venous sampling by catheter (75893) |
$4,718.70 |
$6,741 |
0.8× |
| Wrist 2 views (73100) |
$578.20 |
$826 |
6.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$295.40 |
$422 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,491 |
$2,130 |
8.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$454.30 |
$649 |
5.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$566.30 |
$809 |
6.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$1,055.60 |
$1,508 |
9.7× |
| X-ray exam of femur 2/> (73552) |
$700 |
$1,000 |
7.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$415.80 |
$594 |
4.6× |
| X-ray IV pyelogram (ivp) (74400) |
$489.30 |
$699 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$649.60 |
$928 |
7.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$891.80 |
$1,274 |
8.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$731.14 |
$1,044.48 |
6.7× |
| X-ray optic foramen (70190) |
$225.40 |
$322 |
2.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,197 |
$1,710 |
11.0× |
| X-ray retrograde pyelogram (74420) |
$1,143.10 |
$1,633 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$686 |
$980 |
7.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$898.10 |
$1,283 |
8.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$519.40 |
$742 |
4.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$695.80 |
$994 |
7.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,055.60 |
$1,508 |
11.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,110.20 |
$1,586 |
10.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$666.40 |
$952 |
6.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$494.20 |
$706 |
5.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$225.40 |
$322 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$629.30 |
$899 |
6.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$714 |
$1,020 |
6.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$935.20 |
$1,336 |
8.6× |
| Xr bone length studies (77073) |
$464.10 |
$663 |
4.3× |
| Xr c-spine 4 or 5 views (72050) |
$868.70 |
$1,241 |
8.0× |
| Xr c-spine 6 or more views (72052) |
$540.56 |
$772.24 |
5.0× |
| Xr urogram antegrade (74425) |
$909.30 |
$1,299 |
2.5× |