| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,801.60 |
$9,504 |
2.4× |
| Abdomen 2 views (74019) |
$220.40 |
$551 |
1.8× |
| Acute gi blood loss imaging (78278) |
$969.20 |
$2,423 |
2.1× |
| Angio Adrenal Bilat Select (75733) |
$2,015.20 |
$5,038 |
0.5× |
| Angiography extremity bilateral rs&i (75716) |
$2,492 |
$6,230 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,308 |
$5,770 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$6,698 |
$16,745 |
1.8× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,889.20 |
$7,223 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,981.20 |
$7,453 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,264.40 |
$5,661 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$4,784 |
$11,960 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,383.20 |
$10,958 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$743.60 |
$1,859 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,273.20 |
$3,183 |
0.3× |
| Ankle 2 views (73600) |
$200.40 |
$501 |
2.0× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$3,102 |
$7,755 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,854 |
$7,135 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,332.40 |
$5,831 |
0.6× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$4,110.80 |
$10,277 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$1,769.60 |
$4,424 |
0.5× |
| Arthrogram ankle (73615) |
$564.80 |
$1,412 |
1.4× |
| Arthrogram elbow (73085) |
$687.60 |
$1,719 |
1.7× |
| Arthrogram hip (73525) |
$794.80 |
$1,987 |
2.0× |
| Arthrogram knee (73580) |
$737.20 |
$1,843 |
1.8× |
| Arthrogram shoulder (73040) |
$754 |
$1,885 |
1.9× |
| Arthrogram wrist (73115) |
$699.20 |
$1,748 |
1.7× |
| Basic dosimetry (77300) |
$363.60 |
$909 |
2.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$950.40 |
$2,376 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$965.60 |
$2,414 |
2.1× |
| Bone age studies (77072) |
$225.60 |
$564 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$969.20 |
$2,423 |
2.1× |
| Bone Marrow Imaging Limited Area (78102) |
$942.40 |
$2,356 |
2.0× |
| Bone survey complete (77075) |
$309.20 |
$773 |
2.5× |
| Bone survey infant (77076) |
$309.20 |
$773 |
2.5× |
| Bowel imaging (78290) |
$960 |
$2,400 |
2.1× |
| Brachytx isodose complex (77318) |
$242 |
$605 |
0.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$855.60 |
$2,139 |
2.0× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,523.60 |
$3,809 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,700 |
$9,250 |
2.2× |
| Brain Imaging Vascular Flow Only (78610) |
$592 |
$1,480 |
0.9× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$385.60 |
$964 |
0.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$999.20 |
$2,498 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$969.20 |
$2,423 |
2.1× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,068.80 |
$5,172 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,542.80 |
$3,857 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,199.20 |
$2,998 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$200.40 |
$501 |
2.0× |
| Chest 1 view (71045) |
$170 |
$425 |
1.7× |
| Chest xray 3 views (71047) |
$170 |
$425 |
1.7× |
| Cholecystography, oral contrast Non-Facility (74290) |
$249.20 |
$623 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$452.80 |
$1,132 |
2.2× |
| Clavicle complete (73000) |
$195.20 |
$488 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$265.60 |
$664 |
2.2× |
| Continuing medical physics consltj pr wk (77336) |
$345.60 |
$864 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,673.20 |
$4,183 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,148.40 |
$2,871 |
4.1× |
| CT abdomen w contrast (74160) |
$985.20 |
$2,463 |
4.8× |
| CT abdomen w wo contrast (74170) |
$1,270.40 |
$3,176 |
6.2× |
| CT abdomen w/o contrast (74150) |
$662.40 |
$1,656 |
5.4× |
| CT angio hrt w/3d image (75574) |
$1,006.40 |
$2,516 |
2.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,286 |
$3,215 |
6.3× |
| CT angiography upper extremity lt (73206) |
$1,212.80 |
$3,032 |
5.9× |
| CT c-spine w/contrast (72126) |
$1,052.80 |
$2,632 |
2.6× |
| CT c-spine w/o contrast (72125) |
$713.20 |
$1,783 |
5.8× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,450.40 |
$3,626 |
7.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,136.80 |
$2,842 |
5.6× |
| CT chest w contrast (71260) |
$904.80 |
$2,262 |
4.4× |
| CT chest w/wo contrast (71270) |
$1,106 |
$2,765 |
5.4× |
| CT colonography screening (74263) |
$881.20 |
$2,203 |
3.2× |
| CT colonography w/dye (74262) |
$1,177.60 |
$2,944 |
5.8× |
| CT colonography w/o cntrst (74261) |
$728.40 |
$1,821 |
6.0× |
| CT head/brain with contrast (70460) |
$866.40 |
$2,166 |
4.2× |
| CT head/brain without and with contrast (70470) |
$962.80 |
$2,407 |
4.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$876.80 |
$2,192 |
2.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$47.60 |
$119 |
0.5× |
| CT hrt w/3d image congen (75573) |
$911.20 |
$2,278 |
2.2× |
| CT iac w contrast (70481) |
$1,079.20 |
$2,698 |
5.3× |
| CT limited/localized follow up study (76380) |
$406 |
$1,015 |
4.0× |
| CT lower ext w/o (73700) |
$696 |
$1,740 |
5.7× |
| CT lower extremity w wo contrast (73702) |
$1,161.60 |
$2,904 |
5.7× |
| CT lower extremity w/contrast material (73701) |
$900 |
$2,250 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,143.20 |
$2,858 |
5.6× |
| CT lumbar spine w/contrast (72132) |
$1,052.80 |
$2,632 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$707.20 |
$1,768 |
5.8× |
| CT maxillofacial w contrast (70487) |
$930.40 |
$2,326 |
4.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,125.20 |
$2,813 |
5.5× |
| CT maxillofacial wo contrast (70486) |
$729.20 |
$1,823 |
6.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,226.80 |
$3,067 |
6.0× |
| CT orbits w/o contrast (70480) |
$729.20 |
$1,823 |
6.0× |
| CT pelvis w/o contrast (72192) |
$664.80 |
$1,662 |
5.4× |
| CT pelvis w/wo contrast (72194) |
$1,124 |
$2,810 |
5.5× |
| CT scan of arm combo (73202) |
$1,161.60 |
$2,904 |
5.7× |
| CT soft tissue neck w contrast (70491) |
$888 |
$2,220 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,096 |
$2,740 |
5.4× |
| CT soft tissue neck w/o contrast (70490) |
$691.60 |
$1,729 |
5.7× |
| CT thoracic spine w/contrast (72129) |
$910 |
$2,275 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$710.40 |
$1,776 |
5.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,146 |
$2,865 |
5.6× |
| CT thorax w/o contrast (71250) |
$705.60 |
$1,764 |
5.8× |
| CT upper ext wo (73200) |
$692.80 |
$1,732 |
5.7× |
| CT upper extremity with contrast (73201) |
$1,052.80 |
$2,632 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,286.40 |
$3,216 |
6.3× |
| Cta Abdomen (74175) |
$1,286.80 |
$3,217 |
6.3× |
| CTA abdomen pelvis (74174) |
$1,781.20 |
$4,453 |
4.4× |
| CTA chest (71275) |
$1,121.20 |
$2,803 |
5.5× |
| Cta Head (70496) |
$1,214.40 |
$3,036 |
5.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,416.40 |
$6,041 |
5.9× |
| Cta Neck (70498) |
$1,202 |
$3,005 |
5.9× |
| Cta Pelvis (72191) |
$1,286 |
$3,215 |
6.3× |
| Cystography minimum 3 views rs&i (74430) |
$448.80 |
$1,122 |
1.1× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$379.20 |
$948 |
1.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,978 |
$9,945 |
1.6× |
| Diskogram cervical (72285) |
$4,056.40 |
$10,141 |
1.8× |
| Diskography lumbar (72295) |
$2,151.20 |
$5,378 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$249.60 |
$624 |
2.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$272 |
$680 |
2.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$287.20 |
$718 |
2.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$284 |
$710 |
2.3× |
| Dxa bone density study axial skeleton (77085) |
$290.80 |
$727 |
2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$833.20 |
$2,083 |
3.0× |
| Esophagus (74220) |
$454.80 |
$1,137 |
2.2× |
| Facial bones min 3 views (70150) |
$229.60 |
$574 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$336.40 |
$841 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$287.20 |
$718 |
2.4× |
| Fetal Echo (76825) |
$1,003.20 |
$2,508 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$456.80 |
$1,142 |
1.6× |
| Foot 2 views (73620) |
$195.20 |
$488 |
1.9× |
| Forearm 2 views (73090) |
$195.20 |
$488 |
1.9× |
| Hand 2 views (73120) |
$225.60 |
$564 |
1.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,127.60 |
$5,319 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,600.40 |
$6,501 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,120.80 |
$7,802 |
3.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,359.20 |
$8,398 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,218.40 |
$3,046 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$969.20 |
$2,423 |
2.1× |
| Hysterosalpingogram (74740) |
$488.40 |
$1,221 |
1.8× |
| Image fusion (77399) |
$363.60 |
$909 |
2.3× |
| Interstitial radiation source applic complex (77778) |
$2,524 |
$6,310 |
3.1× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,718.80 |
$4,297 |
2.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$179.20 |
$448 |
1.5× |
| Kidney imaging morphology (78700) |
$654 |
$1,635 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,115.20 |
$2,788 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,137.20 |
$2,843 |
1.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,281.20 |
$3,203 |
2.0× |
| Knee 3 views (73562) |
$200.40 |
$501 |
2.0× |
| Liver & spleen imaging static only (78215) |
$960 |
$2,400 |
2.1× |
| Liver imaging static only (78201) |
$983.20 |
$2,458 |
1.6× |
| Liver imaging w/vascular flow (78202) |
$1,123.60 |
$2,809 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,234 |
$3,085 |
1.9× |
| Lung perfusion differential (78597) |
$957.20 |
$2,393 |
2.1× |
| Lung ventilation imaging (78579) |
$890.40 |
$2,226 |
1.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$5,193.60 |
$12,984 |
1.4× |
| Lymphoscintigraphy (78195) |
$912.40 |
$2,281 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,746 |
$4,365 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,497.20 |
$3,743 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,590 |
$3,975 |
3.9× |
| Mammary ductogram or galactogram multiple (77054) |
$662.40 |
$1,656 |
2.4× |
| Mammary ductogram or galactogram single (77053) |
$528.80 |
$1,322 |
1.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$980.40 |
$2,451 |
2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$66 |
$165 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,672.40 |
$4,181 |
4.1× |
| MRA head w/o contrast (70544) |
$1,434.40 |
$3,586 |
5.2× |
| MRA head with contrast (70545) |
$1,497.20 |
$3,743 |
3.7× |
| MRA neck w contrast (70548) |
$1,497.20 |
$3,743 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,544.80 |
$3,862 |
3.8× |
| MRA neck w/o contrast (70547) |
$1,452.40 |
$3,631 |
5.2× |
| MRI abdomen w contrast (74182) |
$1,452.40 |
$3,631 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,542.80 |
$3,857 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$1,402.80 |
$3,507 |
5.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,746 |
$4,365 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,542.80 |
$3,857 |
3.8× |
| MRI bone marrow blood supply (77084) |
$1,497.20 |
$3,743 |
5.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,158.40 |
$2,896 |
4.2× |
| MRI breast wo contrast unilateral (77046) |
$1,447.20 |
$3,618 |
5.2× |
| MRI c-spine with contrast (72142) |
$1,516.40 |
$3,791 |
3.7× |
| MRI cardiac w/o cont stress (75559) |
$1,475.20 |
$3,688 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$1,402.80 |
$3,507 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$1,362.40 |
$3,406 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,590 |
$3,975 |
3.9× |
| MRI chest w/o contrast (71550) |
$1,402.80 |
$3,507 |
5.0× |
| MRI chest with contrast (71551) |
$1,694 |
$4,235 |
1.9× |
| MRI fetal sngl/1st gestation (74712) |
$1,336.80 |
$3,342 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,497.20 |
$3,743 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,542.80 |
$3,857 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,402.80 |
$3,507 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,402.80 |
$3,507 |
5.0× |
| MRI orbit face neck w contrast (70542) |
$1,452.40 |
$3,631 |
3.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,542.80 |
$3,857 |
3.8× |
| MRI pelvis w/contrast (72196) |
$1,452.40 |
$3,631 |
3.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,542.80 |
$3,857 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$1,402.80 |
$3,507 |
5.0× |
| MRI spectroscopy (76390) |
$859.20 |
$2,148 |
8.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,542.80 |
$3,857 |
3.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,516.40 |
$3,791 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,542.80 |
$3,857 |
3.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,592 |
$3,980 |
3.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,542.80 |
$3,857 |
3.8× |
| MRI temporomandibular joint (70336) |
$1,291.20 |
$3,228 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,402.80 |
$3,507 |
5.0× |
| MRI up ext w/o contrast (73218) |
$1,402.80 |
$3,507 |
5.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,402.80 |
$3,507 |
5.0× |
| MRI, joint upper extrem combo (73223) |
$1,542.80 |
$3,857 |
3.8× |
| Myelogram Cervical (72240) |
$1,525.20 |
$3,813 |
1.7× |
| Myelogram Lumbar (72265) |
$1,346.80 |
$3,367 |
1.5× |
| Myelogram thoracic (72255) |
$1,410 |
$3,525 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,889.60 |
$4,724 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$7,052.40 |
$17,631 |
2.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$5,770 |
$14,425 |
2.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,049.20 |
$5,123 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,926.40 |
$7,316 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$2,662.40 |
$6,656 |
1.8× |
| N-invas est c ffr sw aly CTA (75580) |
$2,293.20 |
$5,733 |
2.3× |
| Neck soft tissue (70360) |
$195.20 |
$488 |
1.9× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$257.20 |
$643 |
0.6× |
| Nm bone marrow multi (78103) |
$941.60 |
$2,354 |
2.0× |
| Nm bone marrow wb (78104) |
$999.20 |
$2,498 |
2.1× |
| Nm cardiac blood pool multiple (78473) |
$999.20 |
$2,498 |
2.1× |
| Nm cisternogram (78630) |
$1,457.20 |
$3,643 |
2.3× |
| Nm csf leak detection (78650) |
$1,652.40 |
$4,131 |
1.1× |
| Nm gastric emptying study (78264) |
$960 |
$2,400 |
2.1× |
| Nm gastroesophageal reflux study (78262) |
$966.40 |
$2,416 |
2.1× |
| Nonvascular shunt X-ray (75809) |
$309.20 |
$773 |
2.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,067.60 |
$10,169 |
2.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$710 |
$1,775 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$692 |
$1,730 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$287.20 |
$718 |
2.4× |
| Osseous survey limited (77074) |
$291.60 |
$729 |
2.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,242.80 |
$3,107 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$885.20 |
$2,213 |
1.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$939.60 |
$2,349 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$225.60 |
$564 |
1.8× |
| Peritoneogram after injection (74190) |
$448.80 |
$1,122 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$3,634 |
$9,085 |
2.2× |
| PET imaging CT for attenuation limited area (78814) |
$3,590 |
$8,975 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$3,700 |
$9,250 |
2.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,294.80 |
$15,737 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,359.20 |
$5,898 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$641.60 |
$1,604 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,234 |
$3,085 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$768.40 |
$1,921 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$200.40 |
$501 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$195.20 |
$488 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$195.20 |
$488 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$180.80 |
$452 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$277.20 |
$693 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$182 |
$455 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$213.20 |
$533 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$195.20 |
$488 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$180.80 |
$452 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$259.60 |
$649 |
2.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$229.60 |
$574 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$309.60 |
$774 |
2.5× |
| Radex Humerus Minimum 2 Views (73060) |
$195.20 |
$488 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$195.20 |
$488 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$299.60 |
$749 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$229.60 |
$574 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$195.20 |
$488 |
1.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$225.60 |
$564 |
1.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$200.40 |
$501 |
2.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$195.20 |
$488 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$229.60 |
$574 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$197.60 |
$494 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$178 |
$445 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$231.20 |
$578 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$213.20 |
$533 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,774.40 |
$31,936 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$526.40 |
$1,316 |
4.4× |
| Radiation treatment delivery level 2 (77407) |
$1,404.80 |
$3,512 |
3.1× |
| Radiation treatment delivery level 3 (77412) |
$1,719.60 |
$4,299 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$213.20 |
$533 |
2.1× |
| Radiologic exam chest 2 views (71046) |
$213.20 |
$533 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$483.20 |
$1,208 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$502.80 |
$1,257 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$474.40 |
$1,186 |
2.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$189.20 |
$473 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$195.20 |
$488 |
1.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$220.40 |
$551 |
1.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$195.20 |
$488 |
1.6× |
| Radiological examination surgical specimen (76098) |
$465.20 |
$1,163 |
0.7× |
| Ribs bilateral 3 views (71110) |
$229.60 |
$574 |
1.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$969.20 |
$2,423 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$999.20 |
$2,498 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,229.60 |
$5,574 |
3.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,035.20 |
$5,088 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,176 |
$2,940 |
1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,318.40 |
$8,296 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,877.60 |
$7,194 |
1.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$692 |
$1,730 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$713.20 |
$1,783 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$215.20 |
$538 |
1.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$302 |
$755 |
1.1× |
| Scapula (73010) |
$198.40 |
$496 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$36.80 |
$92 |
1.6× |
| Sella turcica (70240) |
$160 |
$400 |
1.6× |
| Shoulder 1 view (73020) |
$195.20 |
$488 |
1.9× |
| Sialogram (70390) |
$574.40 |
$1,436 |
2.1× |
| Simulation intermediate (77285) |
$963.20 |
$2,408 |
2.2× |
| Small bowel series (74250) |
$464.80 |
$1,162 |
2.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,023.20 |
$2,558 |
2.3× |
| Special dosimetry (77331) |
$386.40 |
$966 |
2.5× |
| Special Physics Consult (77370) |
$466 |
$1,165 |
3.0× |
| Special treatment procedure (77470) |
$1,454.40 |
$3,636 |
2.3× |
| Spine thoracic 3 views (72072) |
$229.60 |
$574 |
1.9× |
| Stereotactic Body Radiation Delivery (77373) |
$5,080.40 |
$12,701 |
2.4× |
| Superior sagittal sinus venogram (75870) |
$2,318.80 |
$5,797 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$352.80 |
$882 |
3.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,023.20 |
$2,558 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$963.20 |
$2,408 |
2.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$662.40 |
$1,656 |
2.4× |
| Testicular Imaging With Vascular Flow (78761) |
$841.60 |
$2,104 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,023.20 |
$2,558 |
2.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$386.40 |
$966 |
2.5× |
| Thoracolumbar 2 views (72080) |
$195.20 |
$488 |
1.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,182.40 |
$2,956 |
1.9× |
| Thyroid imaging w/blood flow (78013) |
$434 |
$1,085 |
0.9× |
| Thyroid uptake measurement (78012) |
$329.60 |
$824 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$551.60 |
$1,379 |
1.2× |
| Tmj unilateral (70328) |
$185.60 |
$464 |
1.8× |
| Tomogram (76100) |
$318.80 |
$797 |
2.6× |
| Treatment device complex (77334) |
$829.60 |
$2,074 |
1.9× |
| Treatment device intermediate (77333) |
$466.40 |
$1,166 |
3.0× |
| Treatment devices simple (77332) |
$386.40 |
$966 |
2.5× |
| Ultrasound breast complete (76641) |
$277.60 |
$694 |
2.3× |
| Ultrasound elastography first target lesion (76982) |
$287.20 |
$718 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$287.20 |
$718 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$287.20 |
$718 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$240 |
$600 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$37.20 |
$93 |
0.4× |
| Unlisted fluoroscopic procedure (76496) |
$220 |
$550 |
2.2× |
| Unlisted magnetic resonance procedure (76498) |
$5,513.20 |
$13,783 |
54.3× |
| Ureteral reflux study (78740) |
$999.20 |
$2,498 |
2.1× |
| Urethrocystogram voiding (74455) |
$571.60 |
$1,429 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$306 |
$765 |
1.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$529.60 |
$1,324 |
2.6× |
| Us breast unilateral limited (76642) |
$204.40 |
$511 |
2.0× |
| Us chest (76604) |
$282.80 |
$707 |
2.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$575.60 |
$1,439 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$325.60 |
$814 |
2.7× |
| Us elastography parenchyma (76981) |
$261.60 |
$654 |
2.1× |
| Us encephalogram (76506) |
$287.20 |
$718 |
2.4× |
| Us infant hips w manipulation (76885) |
$244.40 |
$611 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$243.60 |
$609 |
2.0× |
| Us ob detailed single fetus (76811) |
$565.60 |
$1,414 |
2.0× |
| Us ob limited (76815) |
$284.40 |
$711 |
2.3× |
| Us ob transvaginal (76817) |
$319.20 |
$798 |
2.6× |
| Us pelvic non ob complete (76856) |
$336 |
$840 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$286.80 |
$717 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$287.20 |
$718 |
2.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$276.80 |
$692 |
2.3× |
| Us retroperitoneal complete (76770) |
$337.60 |
$844 |
2.8× |
| Us retroperitoneal limited (76775) |
$287.20 |
$718 |
2.4× |
| Us scrotum and contents (76870) |
$340.80 |
$852 |
2.8× |
| Us soft tissue head/neck (76536) |
$357.60 |
$894 |
2.9× |
| Us spinal canal and contents (76800) |
$312.80 |
$782 |
2.6× |
| Us transrectal (76872) |
$348 |
$870 |
2.9× |
| Us transrectal prostate volume (76873) |
$374.40 |
$936 |
3.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$371.60 |
$929 |
3.0× |
| Venogram extremity bilateral (75822) |
$2,040.40 |
$5,101 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,616.40 |
$4,041 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$6,248.80 |
$15,622 |
1.7× |
| Venography caval superior serialography rs&i (75827) |
$2,218.40 |
$5,546 |
1.2× |
| Venography Renal Bilateral (75833) |
$2,254.80 |
$5,637 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$3,154 |
$7,885 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,818 |
$7,045 |
0.8× |
| Venous sampling by catheter (75893) |
$3,354.40 |
$8,386 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$193.20 |
$483 |
1.9× |
| Wrist 2 views (73100) |
$195.20 |
$488 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$306.80 |
$767 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.40 |
$501 |
2.0× |
| X-ray b.e. reductn intuss (74283) |
$472.80 |
$1,182 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$518 |
$1,295 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$195.20 |
$488 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$213.20 |
$533 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$258.80 |
$647 |
2.1× |
| X-ray exam of femur 2/> (73552) |
$180.80 |
$452 |
1.8× |
| X-ray eye for foreign body (70030) |
$195.20 |
$488 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$195.20 |
$488 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$529.60 |
$1,324 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$195.20 |
$488 |
1.9× |
| X-ray leg, infant (73592) |
$200.40 |
$501 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$287.20 |
$718 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$291.60 |
$729 |
2.4× |
| X-ray nose-rectum child f.b. (76010) |
$206.40 |
$516 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$225.60 |
$564 |
1.8× |
| X-ray retrograde pyelogram (74420) |
$812 |
$2,030 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$195.20 |
$488 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$229.60 |
$574 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$291.60 |
$729 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$225.60 |
$564 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$195.20 |
$488 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$200.40 |
$501 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$291.60 |
$729 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$225.60 |
$564 |
1.8× |
| X-Ray Small Bowel Enteroclysis (74251) |
$518 |
$1,295 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$195.20 |
$488 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$195.20 |
$488 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$195.20 |
$488 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$225.60 |
$564 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$225.60 |
$564 |
1.8× |
| Xr bone length studies (77073) |
$225.60 |
$564 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$291.60 |
$729 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$291.60 |
$729 |
2.4× |
| Xr chest 4+ views (71048) |
$197.20 |
$493 |
1.6× |
| Xr urogram antegrade (74425) |
$636.40 |
$1,591 |
1.6× |