| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,855.60 |
$5,508 |
2.3× |
| Abdomen 2 views (74019) |
$152.60 |
$218 |
1.2× |
| Acute gi blood loss imaging (78278) |
$548.80 |
$784 |
1.1× |
| Angio Adrenal Bilat Select (75733) |
$1,147.30 |
$1,639 |
0.3× |
| Angiography extremity bilateral rs&i (75716) |
$7,006.30 |
$10,009 |
1.9× |
| Angiography extremity unilateral rs&i (75710) |
$7,182 |
$10,260 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$1,147.30 |
$1,639 |
0.3× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,319 |
$6,170 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$987 |
$1,410 |
0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,147.30 |
$1,639 |
0.3× |
| 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 |
$2,532.39 |
$3,617.70 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$157.50 |
$225 |
0.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,147.30 |
$1,639 |
0.3× |
| Ankle 2 views (73600) |
$200.20 |
$286 |
1.9× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$745.50 |
$1,065 |
0.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,745.60 |
$8,208 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$7,006.30 |
$10,009 |
1.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$4,053 |
$5,790 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$1,147.30 |
$1,639 |
0.3× |
| Arthrogram ankle (73615) |
$926.80 |
$1,324 |
2.2× |
| Arthrogram elbow (73085) |
$488.60 |
$698 |
1.2× |
| Arthrogram hip (73525) |
$544.60 |
$778 |
1.3× |
| Arthrogram knee (73580) |
$489.30 |
$699 |
1.2× |
| Arthrogram shoulder (73040) |
$926.80 |
$1,324 |
2.2× |
| Arthrogram wrist (73115) |
$655.20 |
$936 |
1.6× |
| Basic dosimetry (77300) |
$315 |
$450 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$948.50 |
$1,355 |
2.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$143.50 |
$205 |
0.3× |
| Bone &/joint imaging whole body (78306) |
$918.40 |
$1,312 |
1.9× |
| Bone age studies (77072) |
$215.60 |
$308 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$695.10 |
$993 |
1.5× |
| Bone Marrow Imaging Limited Area (78102) |
$191.10 |
$273 |
0.4× |
| Bone survey complete (77075) |
$350.70 |
$501 |
2.8× |
| Bone survey infant (77076) |
$81.90 |
$117 |
0.7× |
| Bowel imaging (78290) |
$681.80 |
$974 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,002.40 |
$1,432 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$592.90 |
$847 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,361 |
$6,230 |
2.5× |
| Brain Imaging Vascular Flow Only (78610) |
$279.30 |
$399 |
0.4× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$335.30 |
$479 |
0.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$935.90 |
$1,337 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$204.40 |
$292 |
2.0× |
| Chest 1 view (71045) |
$133.35 |
$190.50 |
1.3× |
| Chest xray 3 views (71047) |
$140 |
$200 |
1.3× |
| Cholecystography, oral contrast Non-Facility (74290) |
$143.50 |
$205 |
0.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$239.40 |
$342 |
1.1× |
| Clavicle complete (73000) |
$196 |
$280 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,096.20 |
$1,566 |
8.7× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$202.30 |
$289 |
1.9× |
| Continuing medical physics consltj pr wk (77336) |
$434.70 |
$621 |
2.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$281.40 |
$402 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,290.80 |
$1,844 |
3.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,297.80 |
$1,854 |
4.5× |
| CT abdomen w contrast (74160) |
$747.60 |
$1,068 |
3.6× |
| CT abdomen w wo contrast (74170) |
$1,446.90 |
$2,067 |
6.9× |
| CT abdomen w/o contrast (74150) |
$511 |
$730 |
4.1× |
| CT angio hrt w/3d image (75574) |
$931.70 |
$1,331 |
2.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,003.28 |
$1,433.25 |
4.8× |
| CT angiography upper extremity lt (73206) |
$579.60 |
$828 |
2.8× |
| CT c-spine w/contrast (72126) |
$651.70 |
$931 |
1.6× |
| CT c-spine w/o contrast (72125) |
$822.50 |
$1,175 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,052.10 |
$1,503 |
5.0× |
| CT chest w contrast (71260) |
$1,331.40 |
$1,902 |
6.3× |
| CT chest w/wo contrast (71270) |
$919.10 |
$1,313 |
4.4× |
| CT head/brain with contrast (70460) |
$861 |
$1,230 |
4.1× |
| CT head/brain without and with contrast (70470) |
$793.10 |
$1,133 |
3.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$600.60 |
$858 |
1.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$599.20 |
$856 |
5.7× |
| CT hrt w/3d image congen (75573) |
$202.30 |
$289 |
0.5× |
| CT iac w contrast (70481) |
$600.60 |
$858 |
2.9× |
| CT limited/localized follow up study (76380) |
$141.40 |
$202 |
1.4× |
| CT lower ext w/o (73700) |
$1,597.75 |
$2,282.50 |
12.8× |
| CT lower extremity w wo contrast (73702) |
$1,446.90 |
$2,067 |
6.9× |
| CT lower extremity w/contrast material (73701) |
$879.38 |
$1,256.25 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,281 |
$1,830 |
6.1× |
| CT lumbar spine w/contrast (72132) |
$712.60 |
$1,018 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$455.70 |
$651 |
3.6× |
| CT maxillofacial w contrast (70487) |
$651.70 |
$931 |
3.1× |
| CT maxillofacial w/wo contrast (70488) |
$641.20 |
$916 |
3.1× |
| CT maxillofacial wo contrast (70486) |
$751.10 |
$1,073 |
6.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$687.40 |
$982 |
3.3× |
| CT orbits w/o contrast (70480) |
$445.20 |
$636 |
3.6× |
| CT pelvis w/o contrast (72192) |
$511 |
$730 |
4.1× |
| CT pelvis w/wo contrast (72194) |
$744.80 |
$1,064 |
3.5× |
| CT scan of arm combo (73202) |
$788.90 |
$1,127 |
3.8× |
| CT soft tissue neck w contrast (70491) |
$1,148 |
$1,640 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$756 |
$1,080 |
3.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,198.40 |
$1,712 |
9.6× |
| CT thoracic spine w/contrast (72129) |
$712.60 |
$1,018 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$586.60 |
$838 |
4.7× |
| CT thoracic spine w/wo contrast (72130) |
$966.70 |
$1,381 |
4.6× |
| CT thorax w/o contrast (71250) |
$1,339.80 |
$1,914 |
10.7× |
| CT upper ext wo (73200) |
$1,271.20 |
$1,816 |
10.1× |
| CT upper extremity with contrast (73201) |
$712.60 |
$1,018 |
1.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$854 |
$1,220 |
4.1× |
| Cta Abdomen (74175) |
$945 |
$1,350 |
4.5× |
| CTA abdomen pelvis (74174) |
$1,214.50 |
$1,735 |
2.9× |
| CTA chest (71275) |
$523.60 |
$748 |
2.5× |
| Cta Head (70496) |
$842.10 |
$1,203 |
4.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,624.70 |
$2,321 |
3.9× |
| Cta Neck (70498) |
$782.60 |
$1,118 |
3.7× |
| Cta Pelvis (72191) |
$1,024.80 |
$1,464 |
4.9× |
| Cystography minimum 3 views rs&i (74430) |
$810.60 |
$1,158 |
1.9× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$690.90 |
$987 |
0.3× |
| Diskogram cervical (72285) |
$583.80 |
$834 |
0.2× |
| Diskography lumbar (72295) |
$691.60 |
$988 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$331.10 |
$473 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$112.70 |
$161 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$474.60 |
$678 |
3.8× |
| Esophagus (74220) |
$440.30 |
$629 |
2.1× |
| Facial bones min 3 views (70150) |
$294 |
$420 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$289.80 |
$414 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$265.65 |
$379.50 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$571.20 |
$816 |
2.0× |
| Foot 2 views (73620) |
$176.75 |
$252.50 |
1.7× |
| Forearm 2 views (73090) |
$200.20 |
$286 |
1.9× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$770.70 |
$1,101 |
2.7× |
| Hand 2 views (73120) |
$117.74 |
$168.19 |
0.9× |
| Heart first pass single,planar (78481) |
$398.30 |
$569 |
0.6× |
| Heart Infarct Image (78466) |
$1,214.50 |
$1,735 |
2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,147.30 |
$1,639 |
0.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,147.30 |
$1,639 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,190.70 |
$1,701 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$918.40 |
$1,312 |
1.9× |
| Hysterosalpingogram (74740) |
$683.90 |
$977 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$140 |
$200 |
1.1× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$150.50 |
$215 |
0.3× |
| Kidney imaging morphology (78700) |
$289.10 |
$413 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$993.30 |
$1,419 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$993.30 |
$1,419 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$730.10 |
$1,043 |
1.1× |
| Knee 3 views (73562) |
$300.30 |
$429 |
2.9× |
| Liver & spleen imaging static only (78215) |
$536.20 |
$766 |
1.1× |
| Liver imaging static only (78201) |
$517.30 |
$739 |
0.8× |
| Liver imaging w/vascular flow (78202) |
$3,206.70 |
$4,581 |
4.9× |
| Lung perf&ventilat diferentl (78598) |
$737.80 |
$1,054 |
1.1× |
| Lung perfusion differential (78597) |
$618.80 |
$884 |
1.3× |
| Lung ventilation imaging (78579) |
$618.10 |
$883 |
1.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$557.90 |
$797 |
0.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$557.90 |
$797 |
0.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$493.50 |
$705 |
0.3× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$493.50 |
$705 |
0.7× |
| Lymphoscintigraphy (78195) |
$743.40 |
$1,062 |
1.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,067.50 |
$1,525 |
1.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,759.10 |
$2,513 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,378.30 |
$1,969 |
3.3× |
| Mammary ductogram or galactogram multiple (77054) |
$403.20 |
$576 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$816.20 |
$1,166 |
2.9× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$252 |
$360 |
2.4× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$627.20 |
$896 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$847 |
$1,210 |
1.9× |
| MRA head w & w/o contrast (70546) |
$1,851.50 |
$2,645 |
4.4× |
| MRA head w/o contrast (70544) |
$1,051.40 |
$1,502 |
3.7× |
| MRA head with contrast (70545) |
$1,051.40 |
$1,502 |
2.5× |
| MRA neck w contrast (70548) |
$1,051.40 |
$1,502 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,851.50 |
$2,645 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,949.50 |
$2,785 |
6.8× |
| MRI abdomen w contrast (74182) |
$1,612.10 |
$2,303 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,445.50 |
$2,065 |
3.5× |
| MRI abdomen w/o contrast (74181) |
$1,255.28 |
$1,793.25 |
4.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,043 |
$1,490 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,404.90 |
$2,007 |
3.4× |
| MRI breast w/o contrast bilateral (77047) |
$302.40 |
$432 |
1.1× |
| MRI breast wo contrast unilateral (77046) |
$403.20 |
$576 |
1.4× |
| MRI c-spine with contrast (72142) |
$1,242.50 |
$1,775 |
3.0× |
| MRI cervical spine w/o contrast (72141) |
$556.50 |
$795 |
1.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,109.80 |
$3,014 |
5.0× |
| MRI chest w/o contrast (71550) |
$1,673.70 |
$2,391 |
5.9× |
| MRI chest with contrast (71551) |
$1,612.10 |
$2,303 |
1.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,759.10 |
$2,513 |
4.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,033.72 |
$1,476.75 |
2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,981 |
$2,830 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$399 |
$570 |
1.4× |
| MRI orbit face neck w contrast (70542) |
$1,715.70 |
$2,451 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,000.30 |
$1,429 |
2.4× |
| MRI pelvis w/contrast (72196) |
$1,239.70 |
$1,771 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,589.70 |
$2,271 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$1,489.42 |
$2,127.75 |
5.2× |
| MRI spectroscopy (76390) |
$1,370.60 |
$1,958 |
13.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,422.40 |
$2,032 |
3.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,076.60 |
$1,538 |
2.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,435.70 |
$2,051 |
3.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,235.50 |
$1,765 |
3.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,578.40 |
$5,112 |
8.6× |
| MRI temporomandibular joint (70336) |
$1,078 |
$1,540 |
3.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,393.35 |
$1,990.50 |
4.9× |
| MRI up ext w/o contrast (73218) |
$1,370.25 |
$1,957.50 |
4.8× |
| MRI upper ext joint w/o contrast (73221) |
$536.55 |
$766.50 |
1.9× |
| MRI, joint upper extrem combo (73223) |
$1,334.20 |
$1,906 |
3.2× |
| Myelogram Cervical (72240) |
$347.90 |
$497 |
0.4× |
| Myelogram Lumbar (72265) |
$460.60 |
$658 |
0.5× |
| Myelogram thoracic (72255) |
$414.40 |
$592 |
0.4× |
| Myelography 2 or more regions (72270) |
$1,055.60 |
$1,508 |
1.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,260.60 |
$4,658 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$3,674.30 |
$5,249 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,674.30 |
$5,249 |
2.1× |
| Myocardial infarct spect (78469) |
$3,206.70 |
$4,581 |
4.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,423.10 |
$2,033 |
0.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,423.10 |
$2,033 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,140.90 |
$4,487 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,816.10 |
$4,023 |
1.8× |
| Neck soft tissue (70360) |
$198.10 |
$283 |
1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$81.20 |
$116 |
0.2× |
| Nm bone marrow multi (78103) |
$189 |
$270 |
0.4× |
| Nm bone marrow wb (78104) |
$283.50 |
$405 |
0.6× |
| Nm cardiac blood pool multiple (78473) |
$909.30 |
$1,299 |
1.9× |
| Nm cisternogram (78630) |
$956.20 |
$1,366 |
1.5× |
| Nm gastric emptying study (78264) |
$948.50 |
$1,355 |
2.0× |
| Nm gastroesophageal reflux study (78262) |
$398.30 |
$569 |
0.8× |
| Nm peritoneal-venous shunt patency (78291) |
$1,281 |
$1,830 |
2.7× |
| Nonvascular shunt X-ray (75809) |
$265.30 |
$379 |
2.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,875.70 |
$11,251 |
4.7× |
| Nuclear medicine study of endocrine organs (78099) |
$1,214.50 |
$1,735 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$832.30 |
$1,189 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$331.10 |
$473 |
2.6× |
| Orthopantogram (70355) |
$65.10 |
$93 |
0.6× |
| Osseous survey limited (77074) |
$397.60 |
$568 |
3.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,342.60 |
$1,918 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$685.30 |
$979 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,539.30 |
$2,199 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$233.10 |
$333 |
1.9× |
| Perineogram (74775) |
$613.20 |
$876 |
2.1× |
| Peritoneogram after injection (74190) |
$139.30 |
$199 |
0.2× |
| PET image w/CT, skull-thigh (78815) |
$4,361 |
$6,230 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$4,568.20 |
$6,526 |
2.7× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$229.60 |
$328 |
0.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,147.30 |
$1,639 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$637.70 |
$911 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,190.70 |
$1,701 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$809.90 |
$1,157 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$250.25 |
$357.50 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$199.50 |
$285 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$250.25 |
$357.50 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$144.20 |
$206 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$239.40 |
$342 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$386.40 |
$552 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$119.70 |
$171 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$250.25 |
$357.50 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$300.30 |
$429 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$161 |
$230 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$203 |
$290 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$357 |
$510 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$630 |
$900 |
5.0× |
| Radex Humerus Minimum 2 Views (73060) |
$250.25 |
$357.50 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$238.88 |
$341.25 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$262.50 |
$375 |
2.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$252.70 |
$361 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$159.60 |
$228 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$136.85 |
$195.50 |
1.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$176.75 |
$252.50 |
1.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$116.20 |
$166 |
1.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$218.40 |
$312 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$156.62 |
$223.75 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$150.15 |
$214.50 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$218.40 |
$312 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$250.25 |
$357.50 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$386.40 |
$552 |
3.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$15,884.40 |
$22,692 |
1.8× |
| Radiation treatment delivery level 1 (77402) |
$778.40 |
$1,112 |
6.4× |
| Radiation treatment delivery level 2 (77407) |
$1,785 |
$2,550 |
3.9× |
| Radiation treatment delivery level 3 (77412) |
$1,972.95 |
$2,818.50 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$198.10 |
$283 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$127.40 |
$182 |
1.0× |
| Radiologic exam chest 2 views (71046) |
$198.10 |
$283 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$354.20 |
$506 |
1.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$434 |
$620 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$426.30 |
$609 |
2.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$440.30 |
$629 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$182 |
$260 |
1.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$73.50 |
$105 |
0.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$150.15 |
$214.50 |
1.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$116.20 |
$166 |
0.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$170.80 |
$244 |
1.4× |
| Radiological examination surgical specimen (76098) |
$925.40 |
$1,322 |
1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$814.80 |
$1,164 |
2.9× |
| Renal Cyst Study (74470) |
$112 |
$160 |
0.2× |
| Ribs bilateral 3 views (71110) |
$294 |
$420 |
2.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$203 |
$290 |
0.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$855.40 |
$1,222 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,964.90 |
$2,807 |
3.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,017.10 |
$1,453 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,194.20 |
$1,706 |
1.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,389.10 |
$3,413 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,850.70 |
$5,501 |
2.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$814.80 |
$1,164 |
2.9× |
| Rp Therapy Intravenous Administration (79101) |
$158.20 |
$226 |
0.6× |
| Sacroiliac Joints < 3 Views (72200) |
$140 |
$200 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$553 |
$790 |
1.9× |
| Salivary gland imaging (78230) |
$1,214.50 |
$1,735 |
2.5× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$296.80 |
$424 |
0.6× |
| Scapula (73010) |
$140 |
$200 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$60.38 |
$86.25 |
2.6× |
| Sella turcica (70240) |
$49 |
$70 |
0.5× |
| Shoulder 1 view (73020) |
$175 |
$250 |
1.7× |
| Sialogram (70390) |
$261.10 |
$373 |
0.9× |
| Simulation intermediate (77285) |
$1,048.60 |
$1,498 |
2.3× |
| Small bowel series (74250) |
$281.40 |
$402 |
1.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$948.50 |
$1,355 |
2.1× |
| Special dosimetry (77331) |
$287.70 |
$411 |
1.8× |
| Special Physics Consult (77370) |
$632.10 |
$903 |
3.9× |
| Special treatment procedure (77470) |
$1,919.40 |
$2,742 |
2.9× |
| Spine thoracic 3 views (72072) |
$294 |
$420 |
2.3× |
| Spleen imaging only (78185) |
$221.90 |
$317 |
0.5× |
| Splenoportograpy rs&i (75810) |
$1,147.30 |
$1,639 |
0.3× |
| Stereotactic Body Radiation Delivery (77373) |
$4,179.70 |
$5,971 |
2.0× |
| Superior sagittal sinus venogram (75870) |
$1,147.30 |
$1,639 |
0.3× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$413 |
$590 |
3.4× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$413 |
$590 |
3.4× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$1,199.10 |
$1,713 |
26.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,217.30 |
$1,739 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$424.20 |
$606 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,659 |
$2,370 |
3.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$884.10 |
$1,263 |
5.5× |
| Thoracolumbar 2 views (72080) |
$151.20 |
$216 |
1.4× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$553.70 |
$791 |
1.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$553.70 |
$791 |
0.9× |
| Thyroid imaging w/blood flow (78013) |
$313.60 |
$448 |
0.7× |
| Thyroid uptake measurement (78012) |
$391.30 |
$559 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$918.40 |
$1,312 |
1.9× |
| Tmj unilateral (70328) |
$148.40 |
$212 |
1.4× |
| Tomogram (76100) |
$133.70 |
$191 |
1.1× |
| Treatment device complex (77334) |
$817.60 |
$1,168 |
1.8× |
| Treatment device intermediate (77333) |
$496.30 |
$709 |
3.1× |
| Treatment devices simple (77332) |
$496.30 |
$709 |
3.1× |
| Ultrasound breast complete (76641) |
$281.05 |
$401.50 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$320.60 |
$458 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$265.65 |
$379.50 |
2.1× |
| Umbilical-artery Doppler (OB) (76820) |
$190.40 |
$272 |
1.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$211.40 |
$302 |
2.0× |
| Unlisted fluoroscopic procedure (76496) |
$92.40 |
$132 |
0.9× |
| Unlisted ultrasound procedure (76999) |
$255.50 |
$365 |
2.4× |
| Ureteral reflux study (78740) |
$307.30 |
$439 |
0.6× |
| Urethrocystogram voiding (74455) |
$345.80 |
$494 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$400.40 |
$572 |
1.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$209.30 |
$299 |
1.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$264.60 |
$378 |
1.3× |
| Us breast unilateral limited (76642) |
$268.80 |
$384 |
2.6× |
| Us chest (76604) |
$322.70 |
$461 |
2.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$309.40 |
$442 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$303.80 |
$434 |
2.4× |
| Us elastography parenchyma (76981) |
$325.50 |
$465 |
2.6× |
| Us encephalogram (76506) |
$322.70 |
$461 |
2.6× |
| Us hips infant static (76886) |
$198.10 |
$283 |
1.9× |
| Us infant hips w manipulation (76885) |
$469 |
$670 |
4.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$320.95 |
$458.50 |
2.6× |
| Us ob detailed single fetus (76811) |
$678.30 |
$969 |
2.4× |
| Us ob limited (76815) |
$312.20 |
$446 |
2.5× |
| Us ob transvaginal (76817) |
$312.20 |
$446 |
2.5× |
| Us pelvic non ob complete (76856) |
$354.20 |
$506 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$306.95 |
$438.50 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$377.30 |
$539 |
3.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$252.70 |
$361 |
2.0× |
| Us retroperitoneal complete (76770) |
$354.20 |
$506 |
2.8× |
| Us retroperitoneal limited (76775) |
$303.80 |
$434 |
2.4× |
| Us scrotum and contents (76870) |
$303.80 |
$434 |
2.4× |
| Us soft tissue head/neck (76536) |
$239.58 |
$342.25 |
1.9× |
| Us spinal canal and contents (76800) |
$250.60 |
$358 |
2.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$223.30 |
$319 |
1.8× |
| Venogram adrenal unilat (75840) |
$1,147.30 |
$1,639 |
0.3× |
| Venogram extremity bilateral (75822) |
$1,239.70 |
$1,771 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$1,526 |
$2,180 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,537.10 |
$5,053 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,323 |
$1,890 |
0.7× |
| Venography Orbital Rs&I (75880) |
$1,147.30 |
$1,639 |
1.5× |
| Venography Renal Bilateral (75833) |
$730.80 |
$1,044 |
0.2× |
| Venography renal unilateral selective rs&i (75831) |
$1,147.30 |
$1,639 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,147.30 |
$1,639 |
0.3× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$1,147.30 |
$1,639 |
1.5× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$745.50 |
$1,065 |
0.1× |
| Wrist 2 views (73100) |
$140 |
$200 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$261.10 |
$373 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$255.50 |
$365 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$506.80 |
$724 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$238.88 |
$341.25 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$161 |
$230 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$299.25 |
$427.50 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$250.25 |
$357.50 |
2.4× |
| X-ray eye for foreign body (70030) |
$247.62 |
$353.75 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$94.50 |
$135 |
0.9× |
| X-ray IV pyelogram (ivp) (74400) |
$352.10 |
$503 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$123.90 |
$177 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$198.10 |
$283 |
1.9× |
| X-ray leg, infant (73592) |
$185.50 |
$265 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$236.60 |
$338 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$306.60 |
$438 |
2.4× |
| X-ray nose-rectum child f.b. (76010) |
$93.80 |
$134 |
0.9× |
| X-ray optic foramen (70190) |
$70.70 |
$101 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$252.70 |
$361 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$870.80 |
$1,244 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$159.60 |
$228 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$245 |
$350 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$221.38 |
$316.25 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$261.10 |
$373 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$204.40 |
$292 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$178.50 |
$255 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$245 |
$350 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$252.70 |
$361 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$140 |
$200 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$148.40 |
$212 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$198.10 |
$283 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$261.10 |
$373 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$293.30 |
$419 |
2.3× |
| Xr bone length studies (77073) |
$227.50 |
$325 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$294 |
$420 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$294 |
$420 |
2.3× |
| Xr chest 4+ views (71048) |
$170.80 |
$244 |
1.4× |
| Xr urogram antegrade (74425) |
$459.90 |
$657 |
1.1× |