| 3-D radiotherapy plan dose-volume histograms (77295) |
$9,118.20 |
$14,028 |
5.9× |
| Abdomen 2 views (74019) |
$353.60 |
$544 |
3.0× |
| Acute gi blood loss imaging (78278) |
$942.50 |
$1,450 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$6,238.70 |
$9,598 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$5,460 |
$8,400 |
1.6× |
| Angiography internal mammary rs&i (75756) |
$4,689.10 |
$7,214 |
1.3× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,081.40 |
$9,356 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,031.05 |
$10,817 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,689.10 |
$7,214 |
1.3× |
| Angiography Spinal Selective Rs&I (75705) |
$9,313.85 |
$14,329 |
1.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,313.85 |
$14,329 |
1.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,648.45 |
$5,613 |
1.0× |
| Ankle 2 views (73600) |
$198.90 |
$306 |
2.1× |
| Aortogram thoracic (75605) |
$6,081.40 |
$9,356 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,878.30 |
$10,582 |
2.0× |
| Aortography abdominal serialography rs&i (75625) |
$5,397.60 |
$8,304 |
1.5× |
| Arthrogram ankle (73615) |
$433.55 |
$667 |
1.1× |
| Arthrogram elbow (73085) |
$751.40 |
$1,156 |
1.9× |
| Arthrogram hip (73525) |
$774.15 |
$1,191 |
2.0× |
| Arthrogram knee (73580) |
$433.55 |
$667 |
1.1× |
| Arthrogram shoulder (73040) |
$774.15 |
$1,191 |
2.0× |
| Arthrogram wrist (73115) |
$429.65 |
$661 |
1.1× |
| Basic dosimetry (77300) |
$424.78 |
$653.50 |
2.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$640.25 |
$985 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$703.95 |
$1,083 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,008.80 |
$1,552 |
2.3× |
| Bone age studies (77072) |
$160.55 |
$247 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$857.35 |
$1,319 |
1.9× |
| Bone survey complete (77075) |
$566.15 |
$871 |
4.9× |
| Bone survey infant (77076) |
$585 |
$900 |
5.0× |
| Bowel imaging (78290) |
$769.60 |
$1,184 |
1.7× |
| Brachytx isodose complex (77318) |
$1,283.75 |
$1,975 |
3.1× |
| Brachytx isodose intermed (77317) |
$1,229.80 |
$1,892 |
2.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,176.50 |
$1,810 |
2.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,969.20 |
$4,568 |
1.9× |
| Brain Imaging Vascular Flow Only (78610) |
$744.90 |
$1,146 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$808.60 |
$1,244 |
1.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,194.40 |
$3,376 |
2.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,480.70 |
$2,278 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,085.50 |
$1,670 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$267.80 |
$412 |
2.8× |
| Chest 1 view (71045) |
$218.08 |
$335.50 |
2.2× |
| Chest xray 3 views (71047) |
$279.50 |
$430 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$397.15 |
$611 |
2.0× |
| Clavicle complete (73000) |
$170.30 |
$262 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$221.65 |
$341 |
1.9× |
| Continuing medical physics consltj pr wk (77336) |
$475.15 |
$731 |
3.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,510.95 |
$3,863 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,843.40 |
$2,836 |
6.9× |
| CT abdomen w contrast (74160) |
$839.48 |
$1,291.50 |
4.3× |
| CT abdomen w wo contrast (74170) |
$1,233.70 |
$1,898 |
6.3× |
| CT abdomen w/o contrast (74150) |
$561.60 |
$864 |
4.8× |
| CT angio hrt w/3d image (75574) |
$1,103.70 |
$1,698 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$963.30 |
$1,482 |
4.9× |
| CT angiography upper extremity lt (73206) |
$963.30 |
$1,482 |
4.9× |
| CT c-spine w/contrast (72126) |
$935.35 |
$1,439 |
2.4× |
| CT c-spine w/o contrast (72125) |
$846.95 |
$1,303 |
7.3× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,243.45 |
$1,913 |
6.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,129.05 |
$1,737 |
5.8× |
| CT chest w contrast (71260) |
$844.02 |
$1,298.50 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,388.40 |
$2,136 |
7.1× |
| CT colonography screening (74263) |
$649.35 |
$999 |
2.4× |
| CT colonography w/dye (74262) |
$827.45 |
$1,273 |
4.2× |
| CT colonography w/o cntrst (74261) |
$566.15 |
$871 |
4.9× |
| CT head/brain with contrast (70460) |
$956.15 |
$1,471 |
4.9× |
| CT head/brain without and with contrast (70470) |
$1,183 |
$1,820 |
6.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$65.65 |
$101 |
0.7× |
| CT hrt w/3d image congen (75573) |
$1,017.90 |
$1,566 |
2.6× |
| CT iac w contrast (70481) |
$812.50 |
$1,250 |
4.2× |
| CT limited/localized follow up study (76380) |
$606.45 |
$933 |
6.3× |
| CT lower ext w/o (73700) |
$819.32 |
$1,260.50 |
7.0× |
| CT lower extremity w wo contrast (73702) |
$1,337.05 |
$2,057 |
6.8× |
| CT lower extremity w/contrast material (73701) |
$1,113.45 |
$1,713 |
5.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,129.05 |
$1,737 |
5.8× |
| CT lumbar spine w/contrast (72132) |
$1,090.05 |
$1,677 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$1,051.70 |
$1,618 |
9.0× |
| CT maxillofacial w contrast (70487) |
$956.15 |
$1,471 |
4.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,183 |
$1,820 |
6.1× |
| CT maxillofacial wo contrast (70486) |
$824.85 |
$1,269 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,270.75 |
$1,955 |
6.5× |
| CT orbits w/o contrast (70480) |
$733.85 |
$1,129 |
6.3× |
| CT pelvis w/o contrast (72192) |
$941.85 |
$1,449 |
8.1× |
| CT pelvis w/wo contrast (72194) |
$1,402.70 |
$2,158 |
7.2× |
| CT scan of arm combo (73202) |
$1,419.60 |
$2,184 |
7.3× |
| CT soft tissue neck w contrast (70491) |
$1,048.45 |
$1,613 |
5.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,195.35 |
$1,839 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$968.50 |
$1,490 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$1,093.95 |
$1,683 |
5.6× |
| CT thoracic spine w/o contrast (72128) |
$1,057.55 |
$1,627 |
9.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,129.05 |
$1,737 |
5.8× |
| CT thorax w/o contrast (71250) |
$796.25 |
$1,225 |
6.8× |
| CT unlisted procedure (76497) |
$206.70 |
$318 |
2.1× |
| CT upper ext wo (73200) |
$890.50 |
$1,370 |
7.6× |
| CT upper extremity with contrast (73201) |
$1,155.05 |
$1,777 |
3.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,167.40 |
$1,796 |
6.0× |
| Cta Abdomen (74175) |
$1,069.90 |
$1,646 |
5.5× |
| CTA abdomen pelvis (74174) |
$2,139.15 |
$3,291 |
5.5× |
| CTA chest (71275) |
$1,092.65 |
$1,681 |
5.6× |
| Cta Head (70496) |
$1,560.65 |
$2,401 |
8.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,285.75 |
$5,055 |
8.5× |
| Cta Neck (70498) |
$1,562.60 |
$2,404 |
8.0× |
| Cta Pelvis (72191) |
$1,069.90 |
$1,646 |
5.5× |
| Cystography minimum 3 views rs&i (74430) |
$430.30 |
$662 |
1.1× |
| Diskography lumbar (72295) |
$3,262.35 |
$5,019 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$200.85 |
$309 |
1.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$433.55 |
$667 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$323.05 |
$497 |
3.3× |
| Dxa bone density study axial skeleton (77085) |
$928.85 |
$1,429 |
8.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$517.40 |
$796 |
1.9× |
| Esophagus (74220) |
$529.10 |
$814 |
2.7× |
| Facial bones min 3 views (70150) |
$280.15 |
$431 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$416 |
$640 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$416 |
$640 |
3.6× |
| Fetal Echo (76825) |
$721.50 |
$1,110 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$869.70 |
$1,338 |
3.3× |
| Foot 2 views (73620) |
$131.30 |
$202 |
1.4× |
| Forearm 2 views (73090) |
$237.90 |
$366 |
2.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,190.15 |
$1,831 |
2.7× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,585.35 |
$2,439 |
2.6× |
| Hand 2 views (73120) |
$127.40 |
$196 |
1.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,473.60 |
$5,344 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$5,211.05 |
$8,017 |
6.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$5,556.85 |
$8,549 |
7.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,689.10 |
$7,214 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,689.10 |
$7,214 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$942.50 |
$1,450 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$942.50 |
$1,450 |
2.1× |
| Hysterosalpingogram (74740) |
$434.20 |
$668 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$2,941.90 |
$4,526 |
3.8× |
| Intracavitary Radiation Source Applic Complex (77763) |
$5,752.50 |
$8,850 |
7.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$4,933.50 |
$7,590 |
8.0× |
| Intracavitary Radiation Source Applic Simple (77761) |
$4,109.95 |
$6,323 |
6.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$105.95 |
$163 |
0.9× |
| Kidney imaging morphology (78700) |
$540.15 |
$831 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$810.55 |
$1,247 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$845.65 |
$1,301 |
1.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$882.05 |
$1,357 |
1.5× |
| Knee 3 views (73562) |
$230.10 |
$354 |
2.4× |
| Liver & spleen imaging static only (78215) |
$755.95 |
$1,163 |
1.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$966.55 |
$1,487 |
2.2× |
| Liver imaging static only (78201) |
$885.30 |
$1,362 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$2,122.25 |
$3,265 |
3.5× |
| Lung perfusion differential (78597) |
$1,562.60 |
$2,404 |
3.5× |
| Lung ventilation imaging (78579) |
$587.60 |
$904 |
1.3× |
| Lymphoscintigraphy (78195) |
$808.60 |
$1,244 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,565.85 |
$2,409 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,444.30 |
$2,222 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,484.30 |
$3,822 |
6.4× |
| Mammary ductogram or galactogram single (77053) |
$454.35 |
$699 |
1.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$134.55 |
$207 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$989.30 |
$1,522 |
2.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$19.50 |
$30 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$74.10 |
$114 |
0.7× |
| Mr safety implt pos&/immoblj (76019) |
$48.10 |
$74 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$195.65 |
$301 |
0.7× |
| MRA head w & w/o contrast (70546) |
$2,578.55 |
$3,967 |
6.6× |
| MRA head w/o contrast (70544) |
$1,192.75 |
$1,835 |
4.5× |
| MRA head with contrast (70545) |
$1,358.50 |
$2,090 |
3.5× |
| MRA neck w contrast (70548) |
$1,358.50 |
$2,090 |
3.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,578.55 |
$3,967 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,116.05 |
$1,717 |
4.2× |
| MRI abdomen w contrast (74182) |
$1,589.90 |
$2,446 |
4.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,620.15 |
$4,031 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,352 |
$2,080 |
5.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,565.85 |
$2,409 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,817.75 |
$4,335 |
7.2× |
| MRI bone marrow blood supply (77084) |
$924.95 |
$1,423 |
3.5× |
| MRI breast w/o contrast bilateral (77047) |
$2,343.25 |
$3,605 |
8.8× |
| MRI breast wo contrast unilateral (77046) |
$1,612.65 |
$2,481 |
6.1× |
| MRI c-spine with contrast (72142) |
$2,037.10 |
$3,134 |
5.2× |
| MRI cardiac w/o cont stress (75559) |
$1,652.30 |
$2,542 |
2.7× |
| MRI cardiac w/o contrast (75557) |
$1,047.15 |
$1,611 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$917.15 |
$1,411 |
3.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,819.70 |
$4,338 |
7.3× |
| MRI chest w/o contrast (71550) |
$1,463.80 |
$2,252 |
5.5× |
| MRI fetal sngl/1st gestation (74712) |
$1,483.30 |
$2,282 |
5.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,565.85 |
$2,409 |
4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,483.65 |
$3,821 |
6.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,097.20 |
$1,688 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,560.65 |
$2,401 |
5.9× |
| MRI orbit face neck w contrast (70542) |
$1,565.85 |
$2,409 |
4.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,436.20 |
$3,748 |
6.3× |
| MRI pelvis w/contrast (72196) |
$2,282.80 |
$3,512 |
5.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,841.80 |
$4,372 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$1,482 |
$2,280 |
5.6× |
| MRI spectroscopy (76390) |
$1,128.40 |
$1,736 |
11.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,648.75 |
$4,075 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,425.45 |
$2,193 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,648.75 |
$4,075 |
6.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,402.70 |
$2,158 |
3.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,648.75 |
$4,075 |
6.8× |
| MRI temporomandibular joint (70336) |
$1,162.20 |
$1,788 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,383.85 |
$2,129 |
5.2× |
| MRI up ext w/o contrast (73218) |
$1,155.70 |
$1,778 |
4.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,118 |
$1,720 |
4.2× |
| MRI, joint upper extrem combo (73223) |
$2,789.15 |
$4,291 |
7.2× |
| Myelogram Cervical (72240) |
$1,522.95 |
$2,343 |
1.7× |
| Myelogram Lumbar (72265) |
$1,250.60 |
$1,924 |
1.4× |
| Myelogram thoracic (72255) |
$1,522.95 |
$2,343 |
1.7× |
| Myelography 2 or more regions (72270) |
$1,535.30 |
$2,362 |
1.8× |
| Myocardial infarct spect (78469) |
$914.55 |
$1,407 |
1.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,251.60 |
$3,464 |
1.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,348.45 |
$3,613 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,863.90 |
$4,406 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,237.30 |
$3,442 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$815.10 |
$1,254 |
0.9× |
| Neck soft tissue (70360) |
$189.15 |
$291 |
2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$286.65 |
$441 |
0.6× |
| Nm bone marrow wb (78104) |
$904.80 |
$1,392 |
2.0× |
| Nm cardiac blood pool multiple (78473) |
$1,199.90 |
$1,846 |
2.7× |
| Nm cisternogram (78630) |
$913.90 |
$1,406 |
1.5× |
| Nm csf leak detection (78650) |
$966.55 |
$1,487 |
0.7× |
| Nm gastric emptying study (78264) |
$793 |
$1,220 |
1.8× |
| Nm gastroesophageal reflux study (78262) |
$769.60 |
$1,184 |
1.7× |
| Nm kidney scan w/flow (78701) |
$545.35 |
$839 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$808.60 |
$1,244 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$255.45 |
$393 |
2.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$9,398.02 |
$14,458.50 |
6.1× |
| Nuclear Rx Oral Admin (79005) |
$371.15 |
$571 |
1.4× |
| Ob us nuchal meas 1 gest (76813) |
$263.90 |
$406 |
2.3× |
| Osseous survey limited (77074) |
$566.15 |
$871 |
4.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,751.75 |
$2,695 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$618.80 |
$952 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,593.15 |
$2,451 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$206.05 |
$317 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$3,798.60 |
$5,844 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$3,485.95 |
$5,363 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,046.90 |
$6,226 |
2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,689.10 |
$7,214 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,648.45 |
$5,613 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$757.90 |
$1,166 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,147.25 |
$1,765 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$555.10 |
$854 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$230.10 |
$354 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$196.30 |
$302 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$219.70 |
$338 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$243.10 |
$374 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$423.15 |
$651 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$742.30 |
$1,142 |
6.4× |
| Radex fingr minimum 2 views (73140) |
$174.85 |
$269 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$224.25 |
$345 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$191.10 |
$294 |
2.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$182.65 |
$281 |
1.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$1,036.75 |
$1,595 |
8.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$508.95 |
$783 |
4.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,558.70 |
$2,398 |
13.4× |
| Radex Humerus Minimum 2 Views (73060) |
$230.75 |
$355 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$205.40 |
$316 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$273.65 |
$421 |
2.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$297.70 |
$458 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$224.25 |
$345 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$312 |
$480 |
2.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$254.80 |
$392 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$90.35 |
$139 |
0.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$310.05 |
$477 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$304.85 |
$469 |
3.1× |
| Radex Toe Minimum 2 Views (73660) |
$170.95 |
$263 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$237.90 |
$366 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$239.20 |
$368 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,112.80 |
$1,712 |
9.6× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$41,507.70 |
$63,858 |
5.1× |
| Radiation treatment delivery level 1 (77402) |
$643.50 |
$990 |
5.7× |
| Radiation treatment delivery level 2 (77407) |
$1,930.50 |
$2,970 |
4.5× |
| Radiation treatment delivery level 3 (77412) |
$2,895.75 |
$4,455 |
4.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$293.80 |
$452 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$462.80 |
$712 |
4.0× |
| Radiologic exam chest 2 views (71046) |
$172.90 |
$266 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$516.10 |
$794 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$602.88 |
$927.50 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$570.05 |
$877 |
2.9× |
| Radiologic examination femur 1 view (73551) |
$209.95 |
$323 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$237.90 |
$366 |
2.5× |
| Radiological examination surgical specimen (76098) |
$437.45 |
$673 |
0.7× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$561.60 |
$864 |
0.9× |
| Ribs bilateral 3 views (71110) |
$273.65 |
$421 |
2.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$769.60 |
$1,184 |
1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$923 |
$1,420 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$985.40 |
$1,516 |
1.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$981.50 |
$1,510 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,222.65 |
$1,881 |
2.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,235 |
$1,900 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,084.20 |
$1,668 |
0.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$981.50 |
$1,510 |
0.7× |
| Rp Therapy Intravenous Administration (79101) |
$429 |
$660 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$235.30 |
$362 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$364 |
$560 |
1.4× |
| Scapula (73010) |
$213.85 |
$329 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$51.35 |
$79 |
2.2× |
| Shoulder 1 view (73020) |
$153.40 |
$236 |
1.6× |
| Simulation intermediate (77285) |
$871.65 |
$1,341 |
2.1× |
| Small bowel series (74250) |
$652.60 |
$1,004 |
3.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$524.88 |
$807.50 |
1.3× |
| Special dosimetry (77331) |
$670.15 |
$1,031 |
4.5× |
| Special Physics Consult (77370) |
$815.42 |
$1,254.50 |
5.4× |
| Special treatment procedure (77470) |
$2,547.35 |
$3,919 |
4.1× |
| Spine thoracic 3 views (72072) |
$323.05 |
$497 |
2.8× |
| Stereotactic Body Radiation Delivery (77373) |
$8,589.10 |
$13,214 |
4.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$213.20 |
$328 |
1.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,106 |
$3,240 |
5.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,896.70 |
$2,918 |
4.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,090.70 |
$1,678 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$653.90 |
$1,006 |
4.4× |
| Thoracolumbar 2 views (72080) |
$293.80 |
$452 |
3.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,013.35 |
$1,559 |
1.7× |
| Thyroid imaging w/blood flow (78013) |
$690.95 |
$1,063 |
1.6× |
| Thyroid uptake measurement (78012) |
$385.45 |
$593 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$607.10 |
$934 |
1.4× |
| Tmj unilateral (70328) |
$252.85 |
$389 |
2.6× |
| Treatment device complex (77334) |
$917.80 |
$1,412 |
2.2× |
| Treatment device intermediate (77333) |
$772.20 |
$1,188 |
5.2× |
| Treatment devices simple (77332) |
$585.65 |
$901 |
3.9× |
| Ultrasound breast complete (76641) |
$437.78 |
$673.50 |
3.8× |
| Ultrasound elastography first target lesion (76982) |
$328.25 |
$505 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$335.40 |
$516 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$347.10 |
$534 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$380.25 |
$585 |
3.3× |
| Unlisted magnetic resonance procedure (76498) |
$377 |
$580 |
3.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,343.55 |
$2,067 |
11.8× |
| Unlisted ultrasound procedure (76999) |
$172.90 |
$266 |
1.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$128.38 |
$197.50 |
11.6× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$288.60 |
$444 |
3.1× |
| Urethrocystogram voiding (74455) |
$434.20 |
$668 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$403.65 |
$621 |
1.5× |
| Us breast unilateral limited (76642) |
$437.78 |
$673.50 |
4.5× |
| Us chest (76604) |
$431.60 |
$664 |
3.7× |
| Us compl joint r-t w/image documentation (76881) |
$614.25 |
$945 |
5.3× |
| Us elastography parenchyma (76981) |
$328.25 |
$505 |
2.8× |
| Us encephalogram (76506) |
$438.10 |
$674 |
3.8× |
| Us hips infant static (76886) |
$197.28 |
$303.50 |
2.0× |
| Us infant hips w manipulation (76885) |
$349.70 |
$538 |
3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$463.45 |
$713 |
4.0× |
| Us ob limited (76815) |
$347.75 |
$535 |
3.0× |
| Us ob transvaginal (76817) |
$237.90 |
$366 |
2.0× |
| Us pelvic non ob complete (76856) |
$544.05 |
$837 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$286 |
$440 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$486.20 |
$748 |
4.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$239.85 |
$369 |
2.1× |
| Us retroperitoneal complete (76770) |
$419.90 |
$646 |
3.6× |
| Us retroperitoneal limited (76775) |
$373.75 |
$575 |
3.2× |
| Us scrotum and contents (76870) |
$463.45 |
$713 |
4.0× |
| Us soft tissue head/neck (76536) |
$463.45 |
$713 |
4.0× |
| Us spinal canal and contents (76800) |
$486.20 |
$748 |
4.2× |
| Us transrectal (76872) |
$570.05 |
$877 |
4.9× |
| Us, eye b-scan (76512) |
$198.25 |
$305 |
1.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$457.60 |
$704 |
3.9× |
| Venogram extremity bilateral (75822) |
$1,793.35 |
$2,759 |
1.0× |
| Venogram Extremity Unilateral (75820) |
$1,793.35 |
$2,759 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,689.10 |
$7,214 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$3,864.90 |
$5,946 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$4,689.10 |
$7,214 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,689.10 |
$7,214 |
1.3× |
| Venous sampling by catheter (75893) |
$6,081.40 |
$9,356 |
1.0× |
| Wrist 2 views (73100) |
$140.40 |
$216 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$449.15 |
$691 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$290.55 |
$447 |
3.0× |
| X-ray b.e. reductn intuss (74283) |
$687.05 |
$1,057 |
3.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$652.60 |
$1,004 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$183.30 |
$282 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$618.80 |
$952 |
6.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$890.50 |
$1,370 |
7.6× |
| X-ray exam of femur 2/> (73552) |
$280.80 |
$432 |
2.9× |
| X-ray eye for foreign body (70030) |
$198.25 |
$305 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$243.10 |
$374 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$579.80 |
$892 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$191.10 |
$294 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$205.40 |
$316 |
2.1× |
| X-ray leg, infant (73592) |
$237.90 |
$366 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$293.80 |
$452 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$341.90 |
$526 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$237.25 |
$365 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$230.10 |
$354 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$616.20 |
$948 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$219.70 |
$338 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$264.55 |
$407 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$429.65 |
$661 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$317.20 |
$488 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$248.30 |
$382 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$258.05 |
$397 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$310.05 |
$477 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$237.90 |
$366 |
2.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$687.05 |
$1,057 |
3.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$239.20 |
$368 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$200.20 |
$308 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$248.30 |
$382 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$238.55 |
$367 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$355.55 |
$547 |
3.1× |
| Xr bone length studies (77073) |
$143.65 |
$221 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$335.40 |
$516 |
2.9× |
| Xr c-spine 6 or more views (72052) |
$403.65 |
$621 |
3.5× |
| Xr chest 4+ views (71048) |
$291.85 |
$449 |
2.5× |
| Xr urogram antegrade (74425) |
$498.22 |
$766.50 |
1.3× |