| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,567.90 |
$5,097 |
2.2× |
| Abdomen 2 views (74019) |
$438.20 |
$626 |
3.5× |
| Acute gi blood loss imaging (78278) |
$928.20 |
$1,326 |
1.9× |
| Angiography extremity bilateral rs&i (75716) |
$2,527 |
$3,610 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$1,891.75 |
$2,702.50 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$1,103.90 |
$1,577 |
0.3× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,319 |
$6,170 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,681.90 |
$8,117 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,339.30 |
$6,199 |
1.1× |
| Angiography Spinal Selective Rs&I (75705) |
$11,900 |
$17,000 |
1.8× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$3,221.40 |
$4,602 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,187.90 |
$1,697 |
0.3× |
| Ankle 2 views (73600) |
$240.10 |
$343 |
2.3× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,220.40 |
$3,172 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$7,033.60 |
$10,048 |
1.9× |
| Aortography abdominal serialography rs&i (75625) |
$7,909.30 |
$11,299 |
2.1× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$5,652.50 |
$8,075 |
1.5× |
| Artery X-Rays Adrenal Gland (75731) |
$7,267.40 |
$10,382 |
1.9× |
| Arthrogram ankle (73615) |
$747.60 |
$1,068 |
1.8× |
| Arthrogram elbow (73085) |
$637.70 |
$911 |
1.5× |
| Arthrogram hip (73525) |
$1,015 |
$1,450 |
2.4× |
| Arthrogram knee (73580) |
$516.60 |
$738 |
1.2× |
| Arthrogram shoulder (73040) |
$751.80 |
$1,074 |
1.8× |
| Arthrogram wrist (73115) |
$592.20 |
$846 |
1.4× |
| Basic dosimetry (77300) |
$355.60 |
$508 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$761.60 |
$1,088 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,399.30 |
$1,999 |
2.9× |
| Bone &/joint imaging whole body (78306) |
$1,036.70 |
$1,481 |
2.2× |
| Bone age studies (77072) |
$255.50 |
$365 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$721 |
$1,030 |
1.5× |
| Bone Marrow Imaging Limited Area (78102) |
$434 |
$620 |
0.9× |
| Bone survey complete (77075) |
$453.60 |
$648 |
3.6× |
| Bone survey infant (77076) |
$516.60 |
$738 |
4.1× |
| Bowel imaging (78290) |
$810.60 |
$1,158 |
1.7× |
| Brachytx isodose complex (77318) |
$1,155.70 |
$1,651 |
2.6× |
| Brachytx isodose intermed (77317) |
$993.30 |
$1,419 |
2.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$574 |
$820 |
1.3× |
| Brain imaging < 4 static views (78600) |
$702.80 |
$1,004 |
1.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$871.50 |
$1,245 |
1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,302.90 |
$6,147 |
2.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$702.80 |
$1,004 |
1.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$823.90 |
$1,177 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$963.20 |
$1,376 |
2.0× |
| Cardiac shunt detection (78428) |
$681.80 |
$974 |
1.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,775.90 |
$2,537 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$394.80 |
$564 |
3.8× |
| Chest 1 view (71045) |
$169.40 |
$242 |
1.6× |
| Chest xray 3 views (71047) |
$324.10 |
$463 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$625.80 |
$894 |
3.0× |
| Clavicle complete (73000) |
$236.60 |
$338 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,040.20 |
$1,486 |
8.3× |
| Continuing medical physics consltj pr wk (77336) |
$388.50 |
$555 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,347.40 |
$4,782 |
8.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,614.20 |
$2,306 |
5.6× |
| CT abdomen w contrast (74160) |
$1,457.40 |
$2,082 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,927.10 |
$2,753 |
9.2× |
| CT abdomen w/o contrast (74150) |
$931 |
$1,330 |
7.4× |
| CT angio hrt w/3d image (75574) |
$534.80 |
$764 |
1.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,365 |
$1,950 |
6.5× |
| CT angiography upper extremity lt (73206) |
$1,365 |
$1,950 |
6.5× |
| CT c-spine w/contrast (72126) |
$1,540 |
$2,200 |
3.7× |
| CT c-spine w/o contrast (72125) |
$909.30 |
$1,299 |
7.3× |
| CT cervical spine w&w/o contrast (72127) |
$603.40 |
$862 |
2.9× |
| CT chest w contrast (71260) |
$1,243.90 |
$1,777 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,801.10 |
$2,573 |
8.6× |
| CT head/brain with contrast (70460) |
$1,339.80 |
$1,914 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,676.50 |
$2,395 |
8.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$235.20 |
$336 |
2.3× |
| CT hrt w/3d image congen (75573) |
$235.20 |
$336 |
0.6× |
| CT iac w contrast (70481) |
$958.30 |
$1,369 |
4.6× |
| CT lower ext w/o (73700) |
$1,770.12 |
$2,528.75 |
14.1× |
| CT lower extremity w wo contrast (73702) |
$2,334.50 |
$3,335 |
11.1× |
| CT lower extremity w/contrast material (73701) |
$2,293.38 |
$3,276.25 |
10.9× |
| CT lumbar spine w & w/o contrast (72133) |
$603.40 |
$862 |
2.9× |
| CT lumbar spine w/contrast (72132) |
$1,656.90 |
$2,367 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$385.70 |
$551 |
3.1× |
| CT maxillofacial w contrast (70487) |
$1,245.30 |
$1,779 |
5.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,141 |
$1,630 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$959.70 |
$1,371 |
7.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,374.80 |
$1,964 |
6.5× |
| CT orbits w/o contrast (70480) |
$872.20 |
$1,246 |
7.0× |
| CT pelvis w/o contrast (72192) |
$930.30 |
$1,329 |
7.4× |
| CT pelvis w/wo contrast (72194) |
$1,676.50 |
$2,395 |
8.0× |
| CT scan of arm combo (73202) |
$1,572.90 |
$2,247 |
7.5× |
| CT soft tissue neck w contrast (70491) |
$1,195.60 |
$1,708 |
5.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,847.30 |
$2,639 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,202.60 |
$1,718 |
9.6× |
| CT thoracic spine w/contrast (72129) |
$1,730.40 |
$2,472 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,253.70 |
$1,791 |
10.0× |
| CT thoracic spine w/wo contrast (72130) |
$603.40 |
$862 |
2.9× |
| CT thorax w/o contrast (71250) |
$1,195.60 |
$1,708 |
9.5× |
| CT unlisted procedure (76497) |
$1,540 |
$2,200 |
14.8× |
| CT upper ext wo (73200) |
$364 |
$520 |
2.9× |
| CT upper extremity with contrast (73201) |
$1,596 |
$2,280 |
3.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,859.90 |
$2,657 |
8.8× |
| Cta Abdomen (74175) |
$1,514.10 |
$2,163 |
7.2× |
| CTA abdomen pelvis (74174) |
$1,230.60 |
$1,758 |
2.9× |
| CTA chest (71275) |
$603.40 |
$862 |
2.9× |
| Cta Head (70496) |
$1,715 |
$2,450 |
8.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,430 |
$4,900 |
8.2× |
| Cta Neck (70498) |
$1,715 |
$2,450 |
8.2× |
| Cta Pelvis (72191) |
$1,739.50 |
$2,485 |
8.3× |
| Cystography minimum 3 views rs&i (74430) |
$982.80 |
$1,404 |
2.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,336.30 |
$1,909 |
0.5× |
| Diskography lumbar (72295) |
$2,573.90 |
$3,677 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$707.70 |
$1,011 |
5.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$444.50 |
$635 |
3.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$366.10 |
$523 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$309.40 |
$442 |
3.0× |
| Dxa bone density study axial skeleton (77085) |
$415.80 |
$594 |
3.3× |
| Esophagus (74220) |
$480.90 |
$687 |
2.3× |
| Facial bones min 3 views (70150) |
$395.50 |
$565 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$285.60 |
$408 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$500.85 |
$715.50 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$624.40 |
$892 |
2.2× |
| Foot 2 views (73620) |
$300.12 |
$428.75 |
2.9× |
| Forearm 2 views (73090) |
$237.30 |
$339 |
2.3× |
| Functional MRI brain by tech (70554) |
$1,381.10 |
$1,973 |
4.8× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$769.30 |
$1,099 |
2.7× |
| Hand 2 views (73120) |
$252.88 |
$361.25 |
2.0× |
| Heart Infarct Image (78466) |
$1,260 |
$1,800 |
2.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,141.60 |
$4,488 |
0.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,275.70 |
$3,251 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,195.60 |
$1,708 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,036.70 |
$1,481 |
2.2× |
| Hysterosalpingogram (74740) |
$576.10 |
$823 |
2.0× |
| Image fusion (77399) |
$650.30 |
$929 |
4.0× |
| Interstitial radiation source applic complex (77778) |
$3,862.60 |
$5,518 |
4.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,232 |
$1,760 |
1.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$854 |
$1,220 |
1.3× |
| Intracavitary Radiation Source Applic Simple (77761) |
$574 |
$820 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$273.70 |
$391 |
2.2× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,260 |
$1,800 |
2.6× |
| Kidney imaging morphology (78700) |
$945 |
$1,350 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,203.30 |
$1,719 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,422.40 |
$2,032 |
2.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$907.90 |
$1,297 |
1.4× |
| Knee 3 views (73562) |
$360.50 |
$515 |
3.5× |
| Liver & spleen imaging static only (78215) |
$567 |
$810 |
1.2× |
| Liver imaging static only (78201) |
$1,841 |
$2,630 |
2.8× |
| Liver imaging w/vascular flow (78202) |
$2,227.40 |
$3,182 |
3.4× |
| Lung perf&ventilat diferentl (78598) |
$1,040.20 |
$1,486 |
1.6× |
| Lung perfusion differential (78597) |
$393.40 |
$562 |
0.8× |
| Lung ventilation imaging (78579) |
$295.40 |
$422 |
0.6× |
| Lymphoscintigraphy (78195) |
$1,195.60 |
$1,708 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,827.70 |
$2,611 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,827.70 |
$2,611 |
4.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,657.20 |
$3,796 |
6.4× |
| Mammary ductogram or galactogram single (77053) |
$849.10 |
$1,213 |
3.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$261.10 |
$373 |
2.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$966 |
$1,380 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,760.80 |
$3,944 |
6.6× |
| MRA head w/o contrast (70544) |
$1,381.10 |
$1,973 |
4.8× |
| MRA head with contrast (70545) |
$1,381.10 |
$1,973 |
3.3× |
| MRA neck w contrast (70548) |
$1,381.10 |
$1,973 |
3.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,401.70 |
$3,431 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,381.10 |
$1,973 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,271.90 |
$1,817 |
3.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,720.90 |
$3,887 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$1,381.10 |
$1,973 |
4.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,827.70 |
$2,611 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,657.20 |
$3,796 |
6.4× |
| MRI bone marrow blood supply (77084) |
$852.60 |
$1,218 |
3.0× |
| MRI breast w/o contrast bilateral (77047) |
$2,436 |
$3,480 |
8.5× |
| MRI c-spine with contrast (72142) |
$1,381.10 |
$1,973 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$1,381.10 |
$1,973 |
4.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,760.80 |
$3,944 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,381.10 |
$1,973 |
4.8× |
| MRI chest with contrast (71551) |
$1,271.90 |
$1,817 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,827.70 |
$2,611 |
4.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,992.90 |
$2,847 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,827.70 |
$2,611 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,381.10 |
$1,973 |
4.8× |
| MRI orbit face neck w contrast (70542) |
$1,381.10 |
$1,973 |
3.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,760.80 |
$3,944 |
6.6× |
| MRI pelvis w/contrast (72196) |
$1,269.80 |
$1,814 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,720.90 |
$3,887 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,381.10 |
$1,973 |
4.8× |
| MRI spectroscopy (76390) |
$1,343.30 |
$1,919 |
12.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,760.80 |
$3,944 |
6.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,381.10 |
$1,973 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,760.80 |
$3,944 |
6.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,381.10 |
$1,973 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,760.80 |
$3,944 |
6.6× |
| MRI temporomandibular joint (70336) |
$1,101.10 |
$1,573 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,381.10 |
$1,973 |
4.8× |
| MRI up ext w/o contrast (73218) |
$1,827.70 |
$2,611 |
6.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,827.70 |
$2,611 |
6.4× |
| MRI, joint upper extrem combo (73223) |
$2,657.20 |
$3,796 |
6.4× |
| Myelogram Cervical (72240) |
$963.90 |
$1,377 |
1.0× |
| Myelogram Lumbar (72265) |
$994.70 |
$1,421 |
1.1× |
| Myelogram thoracic (72255) |
$1,010.80 |
$1,444 |
1.1× |
| Myelography 2 or more regions (72270) |
$959 |
$1,370 |
1.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,945.50 |
$7,065 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,598.70 |
$5,141 |
2.1× |
| Myocardial infarct spect (78469) |
$1,054.90 |
$1,507 |
1.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,258.50 |
$4,655 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,545.50 |
$5,065 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$1,747.90 |
$2,497 |
1.1× |
| N-invas est c ffr sw aly CTA (75580) |
$2,160.90 |
$3,087 |
2.1× |
| Neck soft tissue (70360) |
$282.10 |
$403 |
2.7× |
| Nm bone marrow multi (78103) |
$513.80 |
$734 |
1.1× |
| Nm bone marrow wb (78104) |
$434 |
$620 |
0.9× |
| Nm cisternogram (78630) |
$739.20 |
$1,056 |
1.1× |
| Nm csf leak detection (78650) |
$548.80 |
$784 |
0.4× |
| Nm gastric emptying study (78264) |
$1,036.70 |
$1,481 |
2.2× |
| Nm peritoneal-venous shunt patency (78291) |
$1,399.30 |
$1,999 |
2.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$496.30 |
$709 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$140.70 |
$201 |
1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,949.40 |
$5,642 |
2.4× |
| Nuclear medicine study of endocrine organs (78099) |
$1,260 |
$1,800 |
2.6× |
| Nuclear Rx Oral Admin (79005) |
$828.80 |
$1,184 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$364 |
$520 |
2.9× |
| Osseous survey limited (77074) |
$453.60 |
$648 |
3.6× |
| Parathyrd planar w/spect&CT (78072) |
$445.20 |
$636 |
0.7× |
| Parathyroid Planar Imaging (78070) |
$1,096.20 |
$1,566 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,036.70 |
$1,481 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$394.80 |
$564 |
3.2× |
| PET image w/CT, skull-thigh (78815) |
$4,302.90 |
$6,147 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$4,568.20 |
$6,526 |
2.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,275.70 |
$3,251 |
0.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,100.40 |
$1,572 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,036.70 |
$1,481 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,344 |
$1,920 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$625.10 |
$893 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$322 |
$460 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$319.38 |
$456.25 |
3.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$322.88 |
$461.25 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$257.60 |
$368 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$325.50 |
$465 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$252 |
$360 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$151.20 |
$216 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$315.88 |
$451.25 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$335.12 |
$478.75 |
3.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$290.50 |
$415 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$366.10 |
$523 |
2.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$386.75 |
$552.50 |
3.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$539.88 |
$771.25 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$299.25 |
$427.50 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$302.75 |
$432.50 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$476.88 |
$681.25 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$387.10 |
$553 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$338.80 |
$484 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$496.30 |
$709 |
4.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$186.90 |
$267 |
1.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$241.50 |
$345 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$382.90 |
$547 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$522.38 |
$746.25 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$152.25 |
$217.50 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$208.60 |
$298 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$278.60 |
$398 |
2.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$20,643.70 |
$29,491 |
2.3× |
| Radiation treatment delivery level 1 (77402) |
$357 |
$510 |
2.9× |
| Radiation treatment delivery level 2 (77407) |
$406.70 |
$581 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$686.70 |
$981 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$422.10 |
$603 |
4.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$443.10 |
$633 |
3.5× |
| Radiologic exam chest 2 views (71046) |
$264.60 |
$378 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$581.70 |
$831 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$462 |
$660 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$480.90 |
$687 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$480.90 |
$687 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$290.50 |
$415 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$238.70 |
$341 |
2.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$469 |
$670 |
3.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$264.60 |
$378 |
2.1× |
| Radiological examination surgical specimen (76098) |
$504.70 |
$721 |
0.8× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$845.60 |
$1,208 |
3.0× |
| Ribs bilateral 3 views (71110) |
$324.10 |
$463 |
2.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,032.50 |
$1,475 |
2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,077.60 |
$2,968 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$695.80 |
$994 |
1.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,450.75 |
$2,072.50 |
2.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,085 |
$1,550 |
0.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$845.60 |
$1,208 |
3.0× |
| Rp Therapy Intravenous Administration (79101) |
$901.60 |
$1,288 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$309.40 |
$442 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,173.20 |
$1,676 |
4.1× |
| Salivary gland function study (78232) |
$945 |
$1,350 |
2.0× |
| Salivary gland imaging (78230) |
$1,260 |
$1,800 |
2.6× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$427 |
$610 |
0.9× |
| Scapula (73010) |
$282.10 |
$403 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$53.02 |
$75.75 |
2.3× |
| Shoulder 1 view (73020) |
$238.88 |
$341.25 |
2.3× |
| Sialogram (70390) |
$381.50 |
$545 |
1.3× |
| Simulation intermediate (77285) |
$707.70 |
$1,011 |
1.6× |
| Small bowel series (74250) |
$516.60 |
$738 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$515.20 |
$736 |
1.1× |
| Special dosimetry (77331) |
$431.90 |
$617 |
2.7× |
| Special Physics Consult (77370) |
$599.90 |
$857 |
3.7× |
| Special treatment procedure (77470) |
$1,536.50 |
$2,195 |
2.3× |
| Spine thoracic 3 views (72072) |
$394.80 |
$564 |
3.2× |
| Splenoportograpy rs&i (75810) |
$3,399.20 |
$4,856 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$4,401.60 |
$6,288 |
2.1× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$263.20 |
$376 |
2.2× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$849.80 |
$1,214 |
19.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,040.90 |
$1,487 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$756.70 |
$1,081 |
1.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,124.90 |
$1,607 |
2.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$494.20 |
$706 |
3.1× |
| Thoracolumbar 2 views (72080) |
$261.10 |
$373 |
2.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,344 |
$1,920 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$357 |
$510 |
0.7× |
| Thyroid uptake measurement (78012) |
$224.70 |
$321 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$530.60 |
$758 |
1.1× |
| Tmj unilateral (70328) |
$312.20 |
$446 |
3.0× |
| Treatment device complex (77334) |
$955.50 |
$1,365 |
2.1× |
| Treatment device intermediate (77333) |
$399.70 |
$571 |
2.5× |
| Treatment devices simple (77332) |
$376.60 |
$538 |
2.3× |
| Ultrasound breast complete (76641) |
$938.88 |
$1,341.25 |
7.5× |
| Ultrasound Exam Aaa Screen (76706) |
$316.40 |
$452 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$452.55 |
$646.50 |
3.6× |
| Umbilical-artery Doppler (OB) (76820) |
$349.30 |
$499 |
2.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$261.10 |
$373 |
2.5× |
| Unlisted ultrasound procedure (76999) |
$265.30 |
$379 |
2.5× |
| Ureteral reflux study (78740) |
$452.20 |
$646 |
0.9× |
| Urethrocystogram voiding (74455) |
$453.60 |
$648 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$491.40 |
$702 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$597.10 |
$853 |
2.8× |
| Us breast unilateral limited (76642) |
$881.65 |
$1,259.50 |
8.5× |
| Us chest (76604) |
$508.90 |
$727 |
4.1× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$784.70 |
$1,121 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$245 |
$350 |
2.0× |
| Us elastography parenchyma (76981) |
$330.40 |
$472 |
2.6× |
| Us encephalogram (76506) |
$994 |
$1,420 |
7.9× |
| Us hips infant static (76886) |
$162.75 |
$232.50 |
1.6× |
| Us infant hips w manipulation (76885) |
$1,004.50 |
$1,435 |
9.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$415.10 |
$593 |
3.3× |
| Us ob detailed single fetus (76811) |
$669.20 |
$956 |
2.3× |
| Us ob limited (76815) |
$338.10 |
$483 |
2.7× |
| Us ob transvaginal (76817) |
$507.50 |
$725 |
4.1× |
| Us pelvic non ob complete (76856) |
$541.10 |
$773 |
4.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$339.15 |
$484.50 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$469 |
$670 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$285.60 |
$408 |
2.3× |
| Us retroperitoneal complete (76770) |
$727.30 |
$1,039 |
5.8× |
| Us retroperitoneal limited (76775) |
$285.60 |
$408 |
2.3× |
| Us scrotum and contents (76870) |
$758.10 |
$1,083 |
6.1× |
| Us soft tissue head/neck (76536) |
$479.50 |
$685 |
3.8× |
| Us spinal canal and contents (76800) |
$424.20 |
$606 |
3.4× |
| Us transrectal (76872) |
$503.30 |
$719 |
4.0× |
| Us transrectal prostate volume (76873) |
$1,063.30 |
$1,519 |
8.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$286.30 |
$409 |
2.3× |
| Venogram extremity bilateral (75822) |
$1,487.50 |
$2,125 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$810.60 |
$1,158 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$7,909.30 |
$11,299 |
2.1× |
| Venography caval superior serialography rs&i (75827) |
$1,508.50 |
$2,155 |
0.8× |
| Venography Renal Bilateral (75833) |
$1,831.90 |
$2,617 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$2,308.60 |
$3,298 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$9,259.60 |
$13,228 |
2.4× |
| Venous sampling by catheter (75893) |
$13,690.60 |
$19,558 |
2.1× |
| Vertebral fracture assessment via dxa (77086) |
$420.70 |
$601 |
4.0× |
| Wrist 2 views (73100) |
$120.05 |
$171.50 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$449.40 |
$642 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$437.50 |
$625 |
4.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$677.60 |
$968 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$131.25 |
$187.50 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$386.75 |
$552.50 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$457.62 |
$653.75 |
3.7× |
| X-ray exam of femur 2/> (73552) |
$354.38 |
$506.25 |
3.4× |
| X-ray eye for foreign body (70030) |
$285.25 |
$407.50 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$293.30 |
$419 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$338.80 |
$484 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$386.75 |
$552.50 |
3.7× |
| X-ray leg, infant (73592) |
$147.70 |
$211 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$477.40 |
$682 |
3.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$574.70 |
$821 |
4.6× |
| X-ray nose-rectum child f.b. (76010) |
$165.20 |
$236 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$420.70 |
$601 |
3.4× |
| X-ray retrograde pyelogram (74420) |
$982.80 |
$1,404 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$311.50 |
$445 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$448 |
$640 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$736.75 |
$1,052.50 |
5.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$311.50 |
$445 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$338.80 |
$484 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$394.80 |
$564 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$506.10 |
$723 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$338.80 |
$484 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$219.10 |
$313 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$320.60 |
$458 |
3.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$322.70 |
$461 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$338.80 |
$484 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$366.10 |
$523 |
2.9× |
| Xr bone length studies (77073) |
$589.40 |
$842 |
4.7× |
| Xr c-spine 4 or 5 views (72050) |
$441.70 |
$631 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$469 |
$670 |
3.7× |
| Xr chest 4+ views (71048) |
$389.20 |
$556 |
3.1× |
| Xr urogram antegrade (74425) |
$413.70 |
$591 |
1.0× |