| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,811.90 |
$4,326 |
1.9× |
| Abdomen 2 views (74019) |
$215.80 |
$332 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,191.45 |
$1,833 |
2.9× |
| Angiography extremity bilateral rs&i (75716) |
$4,479.80 |
$6,892 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$4,690.40 |
$7,216 |
1.4× |
| Angiography internal mammary rs&i (75756) |
$4,549.35 |
$6,999 |
1.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$8,045.70 |
$12,378 |
1.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,016.05 |
$7,717 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,510.35 |
$6,939 |
1.4× |
| Angiography Spinal Selective Rs&I (75705) |
$8,069.10 |
$12,414 |
1.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,092.50 |
$12,450 |
1.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,510.35 |
$6,939 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,204.85 |
$6,469 |
1.3× |
| Ankle 2 views (73600) |
$253.18 |
$389.50 |
2.8× |
| Aortogram thoracic (75605) |
$7,707.05 |
$11,857 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,125.55 |
$6,347 |
1.3× |
| Aortography abdominal serialography rs&i (75625) |
$4,321.20 |
$6,648 |
1.3× |
| Basic dosimetry (77300) |
$267.80 |
$412 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,231.75 |
$1,895 |
3.0× |
| Bone Marrow Imaging Limited Area (78102) |
$1,636.05 |
$2,517 |
3.9× |
| Bone survey complete (77075) |
$413.40 |
$636 |
3.8× |
| Brachytx isodose complex (77318) |
$750.10 |
$1,154 |
1.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$570.70 |
$878 |
1.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,219.75 |
$3,415 |
3.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,106.40 |
$7,856 |
3.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,045.55 |
$3,147 |
4.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,361.45 |
$3,633 |
6.5× |
| Cardiac shunt detection (78428) |
$1,827.80 |
$2,812 |
4.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,015.65 |
$3,101 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$275.60 |
$424 |
3.0× |
| Chest 1 view (71045) |
$145.60 |
$224 |
1.6× |
| Chest xray 3 views (71047) |
$227.50 |
$350 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$386.10 |
$594 |
2.1× |
| Clavicle complete (73000) |
$295.10 |
$454 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,517.10 |
$2,334 |
13.9× |
| Continuing medical physics consltj pr wk (77336) |
$571.35 |
$879 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,821.65 |
$4,341 |
7.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,876.55 |
$2,887 |
7.5× |
| CT abdomen w contrast (74160) |
$2,938 |
$4,520 |
16.0× |
| CT abdomen w wo contrast (74170) |
$2,029.30 |
$3,122 |
11.1× |
| CT abdomen w/o contrast (74150) |
$1,162.85 |
$1,789 |
10.7× |
| CT angio hrt w/3d image (75574) |
$2,695.55 |
$4,147 |
7.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,033.85 |
$3,129 |
11.1× |
| CT angiography upper extremity lt (73206) |
$1,341.60 |
$2,064 |
7.3× |
| CT c-spine w/contrast (72126) |
$2,219.75 |
$3,415 |
6.1× |
| CT c-spine w/o contrast (72125) |
$1,764.75 |
$2,715 |
16.2× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$2,743.65 |
$4,221 |
15.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,818.70 |
$2,798 |
9.9× |
| CT chest w contrast (71260) |
$1,914.25 |
$2,945 |
10.5× |
| CT chest w/wo contrast (71270) |
$2,308.15 |
$3,551 |
12.6× |
| CT head/brain with contrast (70460) |
$1,703 |
$2,620 |
9.3× |
| CT head/brain without and with contrast (70470) |
$2,065.05 |
$3,177 |
11.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,415.05 |
$2,177 |
3.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$244.40 |
$376 |
2.7× |
| CT hrt w/3d image congen (75573) |
$1,086.80 |
$1,672 |
3.0× |
| CT iac w contrast (70481) |
$1,125.80 |
$1,732 |
6.1× |
| CT limited/localized follow up study (76380) |
$770.25 |
$1,185 |
8.5× |
| CT lower ext w/o (73700) |
$1,528.15 |
$2,351 |
14.0× |
| CT lower extremity w wo contrast (73702) |
$1,786.85 |
$2,749 |
9.8× |
| CT lower extremity w/contrast material (73701) |
$1,719.25 |
$2,645 |
9.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,408.55 |
$2,167 |
7.7× |
| CT lumbar spine w/contrast (72132) |
$1,246.05 |
$1,917 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$911.95 |
$1,403 |
8.4× |
| CT maxillofacial w contrast (70487) |
$1,678.30 |
$2,582 |
9.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,803.75 |
$2,775 |
9.8× |
| CT maxillofacial wo contrast (70486) |
$1,402.05 |
$2,157 |
12.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,699.10 |
$2,614 |
9.3× |
| CT orbits w/o contrast (70480) |
$917.80 |
$1,412 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,682.85 |
$2,589 |
15.4× |
| CT pelvis w/wo contrast (72194) |
$2,423.20 |
$3,728 |
13.2× |
| CT scan of arm combo (73202) |
$1,636.70 |
$2,518 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$2,009.80 |
$3,092 |
11.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,048.15 |
$3,151 |
11.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,418.95 |
$2,183 |
13.0× |
| CT thoracic spine w/contrast (72129) |
$2,208.70 |
$3,398 |
12.1× |
| CT thoracic spine w/o contrast (72128) |
$1,257.10 |
$1,934 |
11.5× |
| CT thoracic spine w/wo contrast (72130) |
$4,229.55 |
$6,507 |
23.1× |
| CT thorax w/o contrast (71250) |
$1,449.50 |
$2,230 |
13.3× |
| CT upper ext wo (73200) |
$1,121.25 |
$1,725 |
10.3× |
| CT upper extremity with contrast (73201) |
$1,503.45 |
$2,313 |
4.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,176.85 |
$3,349 |
11.9× |
| Cta Abdomen (74175) |
$2,082.60 |
$3,204 |
11.4× |
| CTA abdomen pelvis (74174) |
$2,342.60 |
$3,604 |
6.4× |
| CTA chest (71275) |
$1,692.60 |
$2,604 |
9.2× |
| Cta Head (70496) |
$1,388.40 |
$2,136 |
7.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,743.65 |
$4,221 |
7.5× |
| Cta Neck (70498) |
$1,284.40 |
$1,976 |
7.0× |
| Cta Pelvis (72191) |
$1,610.05 |
$2,477 |
8.8× |
| Cystography minimum 3 views rs&i (74430) |
$579.80 |
$892 |
1.6× |
| Diskography lumbar (72295) |
$3,378.70 |
$5,198 |
1.7× |
| Esophagus (74220) |
$391.30 |
$602 |
2.1× |
| Facial bones min 3 views (70150) |
$360.10 |
$554 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$473.85 |
$729 |
1.9× |
| Foot 2 views (73620) |
$255.45 |
$393 |
2.8× |
| Forearm 2 views (73090) |
$287.30 |
$442 |
3.2× |
| Functional MRI brain by phys/psych (70555) |
$2,618.85 |
$4,029 |
10.5× |
| Functional MRI brain by tech (70554) |
$2,175.55 |
$3,347 |
8.7× |
| Gastric mucosa imaging (78261) |
$1,525.55 |
$2,347 |
3.7× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,612.65 |
$2,481 |
2.8× |
| Hand 2 views (73120) |
$144.95 |
$223 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$703.30 |
$1,082 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,054.35 |
$4,699 |
4.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,540.90 |
$6,986 |
6.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,756.70 |
$7,318 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,722.25 |
$7,265 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,669.55 |
$4,107 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,270.10 |
$1,954 |
3.0× |
| Interstitial radiation source applic complex (77778) |
$953.55 |
$1,467 |
1.3× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$11,773.45 |
$18,113 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,422.20 |
$2,188 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,439.10 |
$2,214 |
2.5× |
| Knee 3 views (73562) |
$133.25 |
$205 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$1,132.95 |
$1,743 |
2.0× |
| Lung perfusion differential (78597) |
$817.05 |
$1,257 |
2.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,549.35 |
$6,999 |
1.4× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,510.35 |
$6,939 |
1.4× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$2,458.30 |
$3,782 |
3.8× |
| Lymphoscintigraphy (78195) |
$1,250.60 |
$1,924 |
2.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,659.80 |
$4,092 |
3.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,943.20 |
$4,528 |
8.1× |
| Magnetic Resonance Elastography (76391) |
$594.10 |
$914 |
2.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,488.50 |
$2,290 |
3.8× |
| MRA head w & w/o contrast (70546) |
$2,688.40 |
$4,136 |
7.4× |
| MRA head w/o contrast (70544) |
$1,272.70 |
$1,958 |
5.1× |
| MRA head with contrast (70545) |
$4,618.25 |
$7,105 |
12.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,783.95 |
$4,283 |
7.6× |
| MRA neck w/o contrast (70547) |
$1,240.85 |
$1,909 |
5.0× |
| MRI abdomen w contrast (74182) |
$1,530.75 |
$2,355 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,356.60 |
$5,164 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$2,028 |
$3,120 |
8.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,273.05 |
$3,497 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,902.25 |
$4,465 |
8.0× |
| MRI c-spine with contrast (72142) |
$2,283.45 |
$3,513 |
6.3× |
| MRI cardiac w/o contrast (75557) |
$1,268.80 |
$1,952 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$2,198.30 |
$3,382 |
8.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,054.65 |
$3,161 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,750.45 |
$2,693 |
7.0× |
| MRI chest with contrast (71551) |
$3,935.75 |
$6,055 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,317.90 |
$3,566 |
6.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,253.85 |
$1,929 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,068.30 |
$3,182 |
8.3× |
| MRI orbit face neck w contrast (70542) |
$2,148.90 |
$3,306 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,120 |
$4,800 |
8.6× |
| MRI pelvis w/contrast (72196) |
$2,315.30 |
$3,562 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,635.45 |
$5,593 |
10.0× |
| MRI pelvis w/o contrast (72195) |
$1,753.05 |
$2,697 |
7.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,965.95 |
$4,563 |
8.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,959.75 |
$3,015 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,163.20 |
$3,328 |
5.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,057.90 |
$3,166 |
5.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,943.85 |
$4,529 |
8.1× |
| MRI temporomandibular joint (70336) |
$2,084.55 |
$3,207 |
8.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,008.15 |
$1,551 |
4.0× |
| MRI up ext w/o contrast (73218) |
$1,288.95 |
$1,983 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$2,332.20 |
$3,588 |
9.4× |
| MRI, joint upper extrem combo (73223) |
$2,987.40 |
$4,596 |
8.2× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$5,580.25 |
$8,585 |
2.4× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,455.75 |
$6,855 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,069.95 |
$4,723 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$3,188.25 |
$4,905 |
2.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,719.95 |
$5,723 |
2.5× |
| N-invas est c ffr sw aly CTA (75580) |
$2,685.15 |
$4,131 |
3.0× |
| Neck soft tissue (70360) |
$201.50 |
$310 |
2.2× |
| Nm bone marrow wb (78104) |
$2,134.60 |
$3,284 |
5.1× |
| Nm cisternogram (78630) |
$1,547 |
$2,380 |
2.7× |
| Nm csf leak detection (78650) |
$3,312.40 |
$5,096 |
2.5× |
| Nm gastric emptying study (78264) |
$1,196 |
$1,840 |
2.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,208.50 |
$11,090 |
5.0× |
| Nuclear Rx Oral Admin (79005) |
$871 |
$1,340 |
3.6× |
| Parathyrd planar w/spect&CT (78072) |
$1,461.20 |
$2,248 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$206.05 |
$317 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$3,995.55 |
$6,147 |
2.7× |
| PET imaging CT for attenuation limited area (78814) |
$4,659.85 |
$7,169 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$5,541.90 |
$8,526 |
3.7× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$4,098.25 |
$6,305 |
2.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,645.55 |
$7,147 |
1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,663.10 |
$7,174 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$738.40 |
$1,136 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,112.15 |
$1,711 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$779.35 |
$1,199 |
1.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$306.80 |
$472 |
3.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$260 |
$400 |
2.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$329.55 |
$507 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$669.50 |
$1,030 |
6.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$777.40 |
$1,196 |
7.1× |
| Radex fingr minimum 2 views (73140) |
$267.80 |
$412 |
2.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$307.45 |
$473 |
3.4× |
| Radex Hand Minimum 3 Views (73130) |
$303.55 |
$467 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$135.20 |
$208 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$273 |
$420 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$219.05 |
$337 |
2.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$291.85 |
$449 |
2.7× |
| Radex Humerus Minimum 2 Views (73060) |
$262.28 |
$403.50 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$295.10 |
$454 |
3.2× |
| Radex Kne Compl 4/More Views (73564) |
$319.15 |
$491 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$302.25 |
$465 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$226.85 |
$349 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$159.25 |
$245 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$323.70 |
$498 |
3.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$330.85 |
$509 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$253.50 |
$390 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$301.60 |
$464 |
3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$789.10 |
$1,214 |
7.2× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$9,653.80 |
$14,852 |
1.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,992.50 |
$18,450 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$1,053 |
$1,620 |
9.9× |
| Radiation treatment delivery level 2 (77407) |
$3,061.18 |
$4,709.50 |
7.6× |
| Radiation treatment delivery level 3 (77412) |
$1,706.25 |
$2,625 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$200.85 |
$309 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$178.10 |
$274 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$564.20 |
$868 |
3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$663 |
$1,020 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$432.25 |
$665 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$341.90 |
$526 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$134.55 |
$207 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$311.35 |
$479 |
3.4× |
| Radiological examination surgical specimen (76098) |
$791.70 |
$1,218 |
1.4× |
| Ribs bilateral 3 views (71110) |
$172.25 |
$265 |
1.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,145.95 |
$1,763 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,117.05 |
$3,257 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,593.20 |
$5,528 |
2.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,477.50 |
$5,350 |
2.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$867.10 |
$1,334 |
3.6× |
| Rp Therapy Intravenous Administration (79101) |
$862.55 |
$1,327 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$172.90 |
$266 |
1.6× |
| Scapula (73010) |
$300.30 |
$462 |
2.8× |
| Shoulder 1 view (73020) |
$261.30 |
$402 |
2.9× |
| Small bowel series (74250) |
$592.80 |
$912 |
3.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,037.40 |
$1,596 |
2.7× |
| Special dosimetry (77331) |
$205.40 |
$316 |
1.5× |
| Special Physics Consult (77370) |
$664.95 |
$1,023 |
4.7× |
| Special treatment procedure (77470) |
$892.45 |
$1,373 |
1.5× |
| Spine thoracic 3 views (72072) |
$321.10 |
$494 |
2.9× |
| Splenoportograpy rs&i (75810) |
$4,467.45 |
$6,873 |
1.4× |
| Stereotactic Body Radiation Delivery (77373) |
$11,815.70 |
$18,178 |
6.3× |
| Superior sagittal sinus venogram (75870) |
$4,613.70 |
$7,098 |
1.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$271.05 |
$417 |
2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$575.25 |
$885 |
1.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$569.40 |
$876 |
1.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$3,004.95 |
$4,623 |
7.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,203.15 |
$1,851 |
8.6× |
| Thoracolumbar 2 views (72080) |
$189.80 |
$292 |
2.1× |
| Treatment device complex (77334) |
$576.55 |
$887 |
1.5× |
| Treatment device intermediate (77333) |
$213.20 |
$328 |
1.5× |
| Treatment devices simple (77332) |
$211.25 |
$325 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$636.35 |
$979 |
5.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$400.40 |
$616 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$578.50 |
$890 |
5.3× |
| Unlisted fluoroscopic procedure (76496) |
$441.35 |
$679 |
4.9× |
| Unlisted magnetic resonance procedure (76498) |
$2,278.90 |
$3,506 |
25.1× |
| Urethrocystogram voiding (74455) |
$603.20 |
$928 |
2.4× |
| Urethrocystography retrograde rs&i (74450) |
$454.35 |
$699 |
1.8× |
| Us breast unilateral limited (76642) |
$378.30 |
$582 |
4.2× |
| Us chest (76604) |
$420.55 |
$647 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$233.68 |
$359.50 |
2.1× |
| Us elastography parenchyma (76981) |
$202.80 |
$312 |
1.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$284.70 |
$438 |
2.6× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$298.35 |
$459 |
2.7× |
| Us ob limited (76815) |
$467.35 |
$719 |
4.3× |
| Us ob transvaginal (76817) |
$320.45 |
$493 |
2.9× |
| Us pelvic non ob complete (76856) |
$513.50 |
$790 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$424.45 |
$653 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$374.40 |
$576 |
3.4× |
| Us retroperitoneal complete (76770) |
$427.05 |
$657 |
3.9× |
| Us retroperitoneal limited (76775) |
$366.60 |
$564 |
3.4× |
| Us scrotum and contents (76870) |
$518.70 |
$798 |
4.8× |
| Us soft tissue head/neck (76536) |
$495.30 |
$762 |
4.5× |
| Us, eye b-scan (76512) |
$298.35 |
$459 |
2.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$499.20 |
$768 |
4.6× |
| Venogram extremity bilateral (75822) |
$6,509.10 |
$10,014 |
4.0× |
| Venogram Extremity Unilateral (75820) |
$2,385.50 |
$3,670 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$4,722.25 |
$7,265 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$2,319.85 |
$3,569 |
1.4× |
| Venography Renal Bilateral (75833) |
$5,384.60 |
$8,284 |
1.6× |
| Venography renal unilateral selective rs&i (75831) |
$7,907.90 |
$12,166 |
2.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,564.95 |
$7,023 |
1.4× |
| Venous sampling by catheter (75893) |
$8,167.90 |
$12,566 |
1.4× |
| Wrist 2 views (73100) |
$245.70 |
$378 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$558.35 |
$859 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.12 |
$392.50 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$197.60 |
$304 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$256.10 |
$394 |
2.3× |
| X-ray exam of femur 2/> (73552) |
$136.50 |
$210 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$270.40 |
$416 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$295.10 |
$454 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$354.25 |
$545 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$282.10 |
$434 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$809.90 |
$1,246 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$207.35 |
$319 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$259.35 |
$399 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$344.50 |
$530 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$219.05 |
$337 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$228.15 |
$351 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219.05 |
$337 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$211.90 |
$326 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$222.30 |
$342 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$794.30 |
$1,222 |
8.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$215.15 |
$331 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$360.75 |
$555 |
3.3× |
| Xr bone length studies (77073) |
$344.50 |
$530 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$348.40 |
$536 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$400.40 |
$616 |
3.7× |
| Xr urogram antegrade (74425) |
$696.80 |
$1,072 |
1.9× |