| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,335.40 |
$7,622 |
3.7× |
| Abdomen 2 views (74019) |
$864.50 |
$1,235 |
7.9× |
| Acute gi blood loss imaging (78278) |
$2,945.60 |
$4,208 |
7.1× |
| Angio Adrenal Bilat Select (75733) |
$13,023.50 |
$18,605 |
3.9× |
| Angiography extremity bilateral rs&i (75716) |
$10,148.60 |
$14,498 |
3.1× |
| Angiography extremity unilateral rs&i (75710) |
$10,410.40 |
$14,872 |
3.2× |
| Angiography internal mammary rs&i (75756) |
$5,914.30 |
$8,449 |
1.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$13,023.50 |
$18,605 |
2.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$13,023.50 |
$18,605 |
3.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$13,023.50 |
$18,605 |
3.9× |
| Angiography Spinal Selective Rs&I (75705) |
$22,136.10 |
$31,623 |
3.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,799.30 |
$13,999 |
1.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,485.70 |
$3,551 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,552.80 |
$6,504 |
1.4× |
| Ankle 2 views (73600) |
$648.20 |
$926 |
7.1× |
| Aortogram thoracic (75605) |
$13,023.50 |
$18,605 |
2.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$17,285.10 |
$24,693 |
5.2× |
| Aortography abdominal serialography rs&i (75625) |
$8,642.20 |
$12,346 |
2.6× |
| Artery X-Rays Adrenal Gland (75731) |
$18,153.10 |
$25,933 |
5.5× |
| Arthrogram elbow (73085) |
$2,667.35 |
$3,810.50 |
7.3× |
| Arthrogram hip (73525) |
$2,205.35 |
$3,150.50 |
6.1× |
| Arthrogram knee (73580) |
$2,667.35 |
$3,810.50 |
7.3× |
| Arthrogram shoulder (73040) |
$2,667.35 |
$3,810.50 |
7.3× |
| Arthrogram wrist (73115) |
$3,324.65 |
$4,749.50 |
9.1× |
| Basic dosimetry (77300) |
$625.10 |
$893 |
4.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$2,524.90 |
$3,607 |
6.0× |
| Bone &/joint imaging whole body (78306) |
$3,032.40 |
$4,332 |
7.3× |
| Bone age studies (77072) |
$563.15 |
$804.50 |
5.2× |
| Bone Imaging 3 Phase (78315) |
$4,120.20 |
$5,886 |
9.9× |
| Bone survey complete (77075) |
$1,255.80 |
$1,794 |
11.5× |
| Bone survey infant (77076) |
$1,052.80 |
$1,504 |
9.6× |
| Bowel imaging (78290) |
$1,717.80 |
$2,454 |
4.1× |
| Brachytx isodose complex (77318) |
$1,938.30 |
$2,769 |
5.0× |
| Brachytx isodose intermed (77317) |
$1,938.30 |
$2,769 |
5.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,442 |
$2,060 |
3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,087 |
$4,410 |
5.4× |
| Brain Imaging Vascular Flow Only (78610) |
$1,428 |
$2,040 |
2.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,917.30 |
$2,739 |
3.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,114 |
$3,020 |
5.1× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,937.60 |
$2,768 |
2.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$8,384.95 |
$11,978.50 |
23.0× |
| Cardiac shunt detection (78428) |
$1,583.40 |
$2,262 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,041.20 |
$2,916 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$636.30 |
$909 |
7.0× |
| Chest 1 view (71045) |
$736.05 |
$1,051.50 |
8.1× |
| Chest xray 3 views (71047) |
$700 |
$1,000 |
7.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$995.40 |
$1,422 |
5.4× |
| Clavicle complete (73000) |
$517.65 |
$739.50 |
5.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,577.05 |
$3,681.50 |
23.6× |
| Continuing medical physics consltj pr wk (77336) |
$859.60 |
$1,228 |
6.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$9,319.80 |
$13,314 |
25.6× |
| CT abdomen and pelvis without contrast (74176) |
$5,521.60 |
$7,888 |
22.2× |
| CT abdomen w contrast (74160) |
$3,762.50 |
$5,375 |
20.5× |
| CT abdomen w wo contrast (74170) |
$4,250.40 |
$6,072 |
23.2× |
| CT abdomen w/o contrast (74150) |
$2,870.70 |
$4,101 |
26.3× |
| CT angio hrt w/3d image (75574) |
$2,445.45 |
$3,493.50 |
6.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$14,109.55 |
$20,156.50 |
77.0× |
| CT angiography upper extremity lt (73206) |
$10,433.85 |
$14,905.50 |
57.0× |
| CT c-spine w/contrast (72126) |
$7,376.25 |
$10,537.50 |
20.2× |
| CT c-spine w/o contrast (72125) |
$2,772 |
$3,960 |
25.4× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$9,243.15 |
$13,204.50 |
50.5× |
| CT chest w contrast (71260) |
$4,070.50 |
$5,815 |
22.2× |
| CT chest w/wo contrast (71270) |
$5,706.40 |
$8,152 |
31.2× |
| CT colonography screening (74263) |
$1,807.40 |
$2,582 |
7.3× |
| CT colonography w/dye (74262) |
$2,982 |
$4,260 |
16.3× |
| CT colonography w/o cntrst (74261) |
$937.65 |
$1,339.50 |
8.6× |
| CT head/brain with contrast (70460) |
$5,901.70 |
$8,431 |
32.2× |
| CT head/brain without and with contrast (70470) |
$7,258.30 |
$10,369 |
39.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,360.05 |
$3,371.50 |
6.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$637 |
$910 |
7.0× |
| CT hrt w/3d image congen (75573) |
$3,400.25 |
$4,857.50 |
9.3× |
| CT iac w contrast (70481) |
$5,901.70 |
$8,431 |
32.2× |
| CT limited/localized follow up study (76380) |
$1,673.70 |
$2,391 |
18.4× |
| CT lower ext w/o (73700) |
$2,379.30 |
$3,399 |
21.8× |
| CT lower extremity w/contrast material (73701) |
$10,305.05 |
$14,721.50 |
56.3× |
| CT lumbar spine w & w/o contrast (72133) |
$9,073.05 |
$12,961.50 |
49.5× |
| CT lumbar spine w/contrast (72132) |
$5,901.70 |
$8,431 |
16.2× |
| CT lumbar spine w/o contrast (72131) |
$2,860.20 |
$4,086 |
26.2× |
| CT maxillofacial w contrast (70487) |
$3,682.70 |
$5,261 |
20.1× |
| CT maxillofacial w/wo contrast (70488) |
$6,776.70 |
$9,681 |
37.0× |
| CT maxillofacial wo contrast (70486) |
$2,690.10 |
$3,843 |
24.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$6,430.20 |
$9,186 |
35.1× |
| CT orbits w/o contrast (70480) |
$2,387 |
$3,410 |
21.9× |
| CT pelvis w/o contrast (72192) |
$2,774.10 |
$3,963 |
25.4× |
| CT pelvis w/wo contrast (72194) |
$3,952.20 |
$5,646 |
21.6× |
| CT scan of arm combo (73202) |
$9,073.05 |
$12,961.50 |
49.5× |
| CT soft tissue neck w contrast (70491) |
$3,567.90 |
$5,097 |
19.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,952.20 |
$5,646 |
21.6× |
| CT soft tissue neck w/o contrast (70490) |
$2,252.60 |
$3,218 |
20.6× |
| CT thoracic spine w/contrast (72129) |
$5,901.70 |
$8,431 |
32.2× |
| CT thoracic spine w/o contrast (72128) |
$2,677.50 |
$3,825 |
24.5× |
| CT thorax w/o contrast (71250) |
$2,669.10 |
$3,813 |
24.4× |
| CT unlisted procedure (76497) |
$362.95 |
$518.50 |
4.0× |
| CT upper ext wo (73200) |
$2,909.55 |
$4,156.50 |
26.7× |
| CT upper extremity with contrast (73201) |
$7,991.90 |
$11,417 |
21.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$5,988.15 |
$8,554.50 |
32.7× |
| Cta Abdomen (74175) |
$13,398 |
$19,140 |
73.1× |
| CTA abdomen pelvis (74174) |
$10,703.35 |
$15,290.50 |
29.4× |
| CTA chest (71275) |
$8,202.95 |
$11,718.50 |
44.8× |
| Cta Head (70496) |
$9,243.15 |
$13,204.50 |
50.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$9,243.15 |
$13,204.50 |
25.4× |
| Cta Neck (70498) |
$5,670.35 |
$8,100.50 |
31.0× |
| Cta Pelvis (72191) |
$10,433.85 |
$14,905.50 |
57.0× |
| Cystography minimum 3 views rs&i (74430) |
$1,467.90 |
$2,097 |
4.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,684 |
$8,120 |
2.6× |
| Diskography lumbar (72295) |
$4,142.60 |
$5,918 |
2.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$763 |
$1,090 |
7.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$842.10 |
$1,203 |
7.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$3,324.30 |
$4,749 |
30.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$918.40 |
$1,312 |
8.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$397.25 |
$567.50 |
4.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,031.80 |
$1,474 |
4.1× |
| Esophagus (74220) |
$872.90 |
$1,247 |
4.8× |
| Facial bones min 3 views (70150) |
$563.15 |
$804.50 |
5.2× |
| Fetal biophysical profile non-stress testing (76818) |
$763 |
$1,090 |
7.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$914.90 |
$1,307 |
8.4× |
| Fetal Echo (76825) |
$3,324.30 |
$4,749 |
5.8× |
| Fluoroscopy up to 1 hr (76000) |
$1,131.90 |
$1,617 |
4.5× |
| Foot 2 views (73620) |
$729.40 |
$1,042 |
8.0× |
| Forearm 2 views (73090) |
$795.55 |
$1,136.50 |
8.8× |
| Functional MRI brain by tech (70554) |
$3,286.15 |
$4,694.50 |
13.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$4,503.80 |
$6,434 |
6.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,288.90 |
$6,127 |
5.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,288.90 |
$6,127 |
5.9× |
| Heart Infarct Image (78466) |
$2,606.80 |
$3,724 |
6.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$18,153.10 |
$25,933 |
5.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$13,023.50 |
$18,605 |
3.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,671.90 |
$3,817 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,671.90 |
$3,817 |
6.4× |
| Hysterosalpingogram (74740) |
$3,362.10 |
$4,803 |
13.5× |
| Image fusion (77399) |
$642.60 |
$918 |
4.6× |
| Interstitial radiation source applic complex (77778) |
$4,589.20 |
$6,556 |
6.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,155.60 |
$4,508 |
4.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$4,960.90 |
$7,087 |
8.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,406.90 |
$4,867 |
6.0× |
| Knee 3 views (73562) |
$556.15 |
$794.50 |
6.1× |
| Liver & spleen imaging static only (78215) |
$2,552.90 |
$3,647 |
6.1× |
| Liver imaging static only (78201) |
$3,621.80 |
$5,174 |
6.4× |
| Lung perfusion differential (78597) |
$2,086.70 |
$2,981 |
5.0× |
| Lung ventilation imaging (78579) |
$1,583.40 |
$2,262 |
3.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$5,632.90 |
$8,047 |
1.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,388.80 |
$1,984 |
2.1× |
| Lymphoscintigraphy (78195) |
$2,573.20 |
$3,676 |
4.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$7,704.20 |
$11,006 |
9.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$11,842.60 |
$16,918 |
64.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$11,842.60 |
$16,918 |
20.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$11,842.60 |
$16,918 |
64.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$7,704.20 |
$11,006 |
21.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$11,805.85 |
$16,865.50 |
32.4× |
| Mammary ductogram or galactogram multiple (77054) |
$3,362.10 |
$4,803 |
13.5× |
| Mammary ductogram or galactogram single (77053) |
$3,362.10 |
$4,803 |
13.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$939.40 |
$1,342 |
2.4× |
| Mr safety determination physician/other qhp (76016) |
$157.50 |
$225 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$49 |
$70 |
1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$178.50 |
$255 |
1.8× |
| Mr safety implt pos&/immoblj (76019) |
$115.50 |
$165 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$467.60 |
$668 |
1.9× |
| MRA head w & w/o contrast (70546) |
$9,474.50 |
$13,535 |
26.0× |
| MRA head w/o contrast (70544) |
$4,985.40 |
$7,122 |
20.0× |
| MRA head with contrast (70545) |
$7,704.20 |
$11,006 |
21.1× |
| MRA neck w contrast (70548) |
$7,704.20 |
$11,006 |
21.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$9,474.50 |
$13,535 |
26.0× |
| MRA neck w/o contrast (70547) |
$4,694.20 |
$6,706 |
18.8× |
| MRI abdomen w contrast (74182) |
$7,704.20 |
$11,006 |
21.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$9,475.20 |
$13,536 |
26.0× |
| MRI abdomen w/o contrast (74181) |
$3,329.90 |
$4,757 |
13.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$7,704.20 |
$11,006 |
9.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$9,475.20 |
$13,536 |
26.0× |
| MRI bone marrow blood supply (77084) |
$13,135.15 |
$18,764.50 |
52.7× |
| MRI breast w/o contrast bilateral (77047) |
$6,979.70 |
$9,971 |
28.0× |
| MRI breast wo contrast unilateral (77046) |
$6,572.65 |
$9,389.50 |
26.4× |
| MRI c-spine with contrast (72142) |
$7,704.20 |
$11,006 |
21.1× |
| MRI cardiac w/o contrast (75557) |
$6,815.90 |
$9,737 |
27.4× |
| MRI cervical spine w/o contrast (72141) |
$3,974.60 |
$5,678 |
16.0× |
| MRI chest w/o & w/contrast material (71552) |
$9,446.50 |
$13,495 |
25.9× |
| MRI chest w/o contrast (71550) |
$5,453 |
$7,790 |
21.9× |
| MRI chest with contrast (71551) |
$7,704.20 |
$11,006 |
9.4× |
| MRI fetal sngl/1st gestation (74712) |
$1,508.50 |
$2,155 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$7,704.20 |
$11,006 |
21.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$6,150.90 |
$8,787 |
16.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,182.90 |
$4,547 |
12.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$5,453 |
$7,790 |
21.9× |
| MRI orbit face neck w contrast (70542) |
$7,704.20 |
$11,006 |
21.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$9,475.20 |
$13,536 |
26.0× |
| MRI pelvis w/contrast (72196) |
$7,704.20 |
$11,006 |
21.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$9,474.50 |
$13,535 |
26.0× |
| MRI pelvis w/o contrast (72195) |
$3,976 |
$5,680 |
16.0× |
| MRI spectroscopy (76390) |
$1,948.45 |
$2,783.50 |
21.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$9,475.20 |
$13,536 |
26.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$7,704.20 |
$11,006 |
21.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$9,475.20 |
$13,536 |
26.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$7,704.20 |
$11,006 |
21.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$9,475.20 |
$13,536 |
26.0× |
| MRI temporomandibular joint (70336) |
$7,893.90 |
$11,277 |
31.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,974.60 |
$5,678 |
16.0× |
| MRI up ext w/o contrast (73218) |
$5,779.90 |
$8,257 |
23.2× |
| MRI upper ext joint w/o contrast (73221) |
$4,037.60 |
$5,768 |
16.2× |
| MRI, joint upper extrem combo (73223) |
$12,478.90 |
$17,827 |
34.3× |
| Myelogram Cervical (72240) |
$8,005.90 |
$11,437 |
9.8× |
| Myelogram Lumbar (72265) |
$8,005.90 |
$11,437 |
9.8× |
| Myelography 2 or more regions (72270) |
$8,005.90 |
$11,437 |
9.8× |
| Myocardial Spect Multiple Studies (78452) |
$5,505.50 |
$7,865 |
4.1× |
| Myocardial spect single study at rest or stress (78451) |
$5,505.50 |
$7,865 |
4.1× |
| N-invas est c ffr sw aly CTA (75580) |
$13,911.45 |
$19,873.50 |
15.5× |
| Neck soft tissue (70360) |
$681.80 |
$974 |
7.5× |
| Nm bone marrow wb (78104) |
$2,355.50 |
$3,365 |
5.6× |
| Nm cisternogram (78630) |
$2,040.50 |
$2,915 |
3.6× |
| Nm gastric emptying study (78264) |
$2,895.90 |
$4,137 |
6.9× |
| Nm gastroesophageal reflux study (78262) |
$1,865.50 |
$2,665 |
4.5× |
| Nm peritoneal-venous shunt patency (78291) |
$1,583.40 |
$2,262 |
3.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,738.80 |
$2,484 |
4.2× |
| Nonvascular shunt X-ray (75809) |
$499.10 |
$713 |
4.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,736.80 |
$9,624 |
4.7× |
| Nuclear Rx Oral Admin (79005) |
$2,951.90 |
$4,217 |
12.1× |
| Orthopantogram (70355) |
$697.90 |
$997 |
7.7× |
| Osseous survey limited (77074) |
$933.10 |
$1,333 |
8.5× |
| Parathyrd planar w/spect&CT (78072) |
$3,687.60 |
$5,268 |
6.5× |
| Parathyroid Planar Imaging (78070) |
$1,839.60 |
$2,628 |
4.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,582.70 |
$2,261 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$477.40 |
$682 |
4.4× |
| Peritoneogram after injection (74190) |
$5,024.60 |
$7,178 |
8.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$11,473.70 |
$16,391 |
3.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,346.20 |
$9,066 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$3,259.90 |
$4,657 |
7.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$3,269 |
$4,670 |
5.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,682.10 |
$2,403 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$697.20 |
$996 |
7.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$379.40 |
$542 |
4.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$679.70 |
$971 |
7.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$719.60 |
$1,028 |
6.6× |
| Radex fingr minimum 2 views (73140) |
$441 |
$630 |
4.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$609.70 |
$871 |
6.7× |
| Radex Hand Minimum 3 Views (73130) |
$678.30 |
$969 |
7.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$401.10 |
$573 |
4.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$800.80 |
$1,144 |
7.3× |
| Radex Humerus Minimum 2 Views (73060) |
$636.30 |
$909 |
7.0× |
| Radex Kne 1/2 Views (73560) |
$539 |
$770 |
5.9× |
| Radex Kne Compl 4/More Views (73564) |
$380.80 |
$544 |
3.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$694.05 |
$991.50 |
6.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$563.15 |
$804.50 |
6.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$867.30 |
$1,239 |
7.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$475.30 |
$679 |
5.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$801.50 |
$1,145 |
7.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$952.70 |
$1,361 |
10.5× |
| Radex Toe Minimum 2 Views (73660) |
$527.80 |
$754 |
5.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$563.15 |
$804.50 |
5.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$716.10 |
$1,023 |
7.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$28,570.50 |
$40,815 |
3.7× |
| Radiation treatment delivery level 1 (77402) |
$3,257.10 |
$4,653 |
30.6× |
| Radiation treatment delivery level 2 (77407) |
$3,257.10 |
$4,653 |
8.1× |
| Radiation treatment delivery level 3 (77412) |
$3,257.10 |
$4,653 |
5.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$882 |
$1,260 |
9.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$934.15 |
$1,334.50 |
8.6× |
| Radiologic exam chest 2 views (71046) |
$667.10 |
$953 |
7.3× |
| Radiologic exam colon single contrast study (74270) |
$1,753.85 |
$2,505.50 |
9.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,483.30 |
$2,119 |
8.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,128.40 |
$1,612 |
6.2× |
| Radiologic examination femur 1 view (73551) |
$1,044.75 |
$1,492.50 |
11.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$758.10 |
$1,083 |
8.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$758.10 |
$1,083 |
6.9× |
| Radiological examination surgical specimen (76098) |
$2,842.70 |
$4,061 |
5.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,197 |
$1,710 |
3.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,197 |
$1,710 |
3.0× |
| Ribs bilateral 3 views (71110) |
$1,508.50 |
$2,155 |
13.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$5,994.80 |
$8,564 |
10.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$5,134.85 |
$7,335.50 |
9.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,523.80 |
$5,034 |
6.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,764.20 |
$6,806 |
3.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,396.30 |
$7,709 |
3.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,445 |
$6,350 |
3.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,204 |
$1,720 |
4.9× |
| Rp Therapy Intravenous Administration (79101) |
$1,034.60 |
$1,478 |
4.2× |
| Salivary gland function study (78232) |
$1,872.50 |
$2,675 |
4.5× |
| Scapula (73010) |
$563.15 |
$804.50 |
5.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$110.60 |
$158 |
4.7× |
| Shoulder 1 view (73020) |
$379.40 |
$542 |
4.2× |
| Simulation intermediate (77285) |
$1,442 |
$2,060 |
3.7× |
| Small bowel series (74250) |
$1,100.75 |
$1,572.50 |
6.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,442 |
$2,060 |
3.7× |
| Special dosimetry (77331) |
$641.20 |
$916 |
4.6× |
| Special Physics Consult (77370) |
$893.20 |
$1,276 |
6.4× |
| Special treatment procedure (77470) |
$2,327.50 |
$3,325 |
4.0× |
| Splenoportograpy rs&i (75810) |
$13,023.50 |
$18,605 |
3.9× |
| Stereotactic Body Radiation Delivery (77373) |
$22,677.90 |
$32,397 |
12.1× |
| Superior sagittal sinus venogram (75870) |
$6,346.20 |
$9,066 |
1.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$555.10 |
$793 |
5.2× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$783.30 |
$1,119 |
8.6× |
| Tbs technical calculation only (77091) |
$783.30 |
$1,119 |
8.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,500.80 |
$2,144 |
3.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$973 |
$1,390 |
2.5× |
| Testicular Imaging With Vascular Flow (78761) |
$2,605.40 |
$3,722 |
6.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,995.70 |
$2,851 |
5.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$998.90 |
$1,427 |
7.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$3,406.20 |
$4,866 |
6.0× |
| Thyroid imaging w/blood flow (78013) |
$1,627.50 |
$2,325 |
3.9× |
| Thyroid uptake measurement (78012) |
$1,948.10 |
$2,783 |
4.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,968.70 |
$4,241 |
7.1× |
| Treatment device complex (77334) |
$1,442 |
$2,060 |
3.7× |
| Treatment device intermediate (77333) |
$1,001 |
$1,430 |
7.1× |
| Treatment devices simple (77332) |
$1,051.40 |
$1,502 |
7.5× |
| Ultrasound breast complete (76641) |
$1,394.75 |
$1,992.50 |
12.8× |
| Ultrasound elastography first target lesion (76982) |
$872.90 |
$1,247 |
8.0× |
| Ultrasound Exam Aaa Screen (76706) |
$1,124.90 |
$1,607 |
10.3× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$872.90 |
$1,247 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$903.70 |
$1,291 |
8.3× |
| Umbilical-artery Doppler (OB) (76820) |
$3,324.30 |
$4,749 |
30.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$493.15 |
$704.50 |
5.4× |
| Unlisted magnetic resonance procedure (76498) |
$7,559.65 |
$10,799.50 |
83.2× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$520.10 |
$743 |
1.2× |
| Ureteral reflux study (78740) |
$1,952.30 |
$2,789 |
4.7× |
| Urethrocystogram voiding (74455) |
$2,934.40 |
$4,192 |
11.8× |
| Urethrocystography retrograde rs&i (74450) |
$2,934.40 |
$4,192 |
11.8× |
| Us breast unilateral limited (76642) |
$932.40 |
$1,332 |
10.3× |
| Us chest (76604) |
$1,109.50 |
$1,585 |
10.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$2,678.20 |
$3,826 |
11.9× |
| Us compl joint r-t w/image documentation (76881) |
$681.80 |
$974 |
6.2× |
| Us elastography parenchyma (76981) |
$872.90 |
$1,247 |
8.0× |
| Us encephalogram (76506) |
$1,020.25 |
$1,457.50 |
9.3× |
| Us hips infant static (76886) |
$1,206.80 |
$1,724 |
13.3× |
| Us infant hips w manipulation (76885) |
$1,206.80 |
$1,724 |
13.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$553.70 |
$791 |
5.1× |
| Us ob detailed single fetus (76811) |
$907.55 |
$1,296.50 |
3.6× |
| Us ob limited (76815) |
$684.60 |
$978 |
6.3× |
| Us ob transvaginal (76817) |
$504 |
$720 |
4.6× |
| Us pelvic non ob complete (76856) |
$1,018.50 |
$1,455 |
9.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$526.75 |
$752.50 |
4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$504 |
$720 |
4.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$473.20 |
$676 |
4.3× |
| Us retroperitoneal complete (76770) |
$1,566.60 |
$2,238 |
14.4× |
| Us retroperitoneal limited (76775) |
$1,432.90 |
$2,047 |
13.1× |
| Us scrotum and contents (76870) |
$939.40 |
$1,342 |
8.6× |
| Us soft tissue head/neck (76536) |
$789.95 |
$1,128.50 |
7.2× |
| Us spinal canal and contents (76800) |
$907.90 |
$1,297 |
8.3× |
| Us transrectal (76872) |
$1,809.50 |
$2,585 |
16.6× |
| Us transrectal prostate volume (76873) |
$1,530.20 |
$2,186 |
14.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$674.80 |
$964 |
6.2× |
| Venogram adrenal unilat (75840) |
$7,732.20 |
$11,046 |
2.3× |
| Venogram extremity bilateral (75822) |
$6,367.90 |
$9,097 |
3.9× |
| Venogram Extremity Unilateral (75820) |
$3,184.30 |
$4,549 |
1.9× |
| Venography caval inferior serialography rs&i (75825) |
$13,023.50 |
$18,605 |
3.9× |
| Venography caval superior serialography rs&i (75827) |
$4,552.80 |
$6,504 |
2.8× |
| Venography Renal Bilateral (75833) |
$13,023.50 |
$18,605 |
3.9× |
| Venography renal unilateral selective rs&i (75831) |
$7,732.20 |
$11,046 |
2.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,914.30 |
$8,449 |
1.8× |
| Venous sampling by catheter (75893) |
$13,023.50 |
$18,605 |
2.2× |
| Wrist 2 views (73100) |
$732.90 |
$1,047 |
8.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$726.25 |
$1,037.50 |
6.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$4,359.60 |
$6,228 |
48.0× |
| X-ray b.e. reductn intuss (74283) |
$1,100.75 |
$1,572.50 |
6.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,788.15 |
$2,554.50 |
9.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$512.05 |
$731.50 |
5.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$416.50 |
$595 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$830.20 |
$1,186 |
7.6× |
| X-ray exam of femur 2/> (73552) |
$1,006.60 |
$1,438 |
11.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$563.15 |
$804.50 |
6.2× |
| X-ray IV pyelogram (ivp) (74400) |
$2,325.40 |
$3,322 |
12.7× |
| X-ray leg, infant (73592) |
$758.10 |
$1,083 |
8.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$751.80 |
$1,074 |
6.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$909.65 |
$1,299.50 |
8.3× |
| X-ray nose-rectum child f.b. (76010) |
$758.10 |
$1,083 |
8.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$563.15 |
$804.50 |
5.2× |
| X-ray retrograde pyelogram (74420) |
$1,727.60 |
$2,468 |
4.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$777.70 |
$1,111 |
8.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$938.35 |
$1,340.50 |
8.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,120 |
$1,600 |
10.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$466.20 |
$666 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$563.15 |
$804.50 |
6.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$373.80 |
$534 |
4.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$933.10 |
$1,333 |
8.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$681.10 |
$973 |
6.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$423.50 |
$605 |
4.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$563.15 |
$804.50 |
6.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$563.15 |
$804.50 |
6.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$758.10 |
$1,083 |
6.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$563.15 |
$804.50 |
5.2× |
| Xr bone length studies (77073) |
$1,673.70 |
$2,391 |
15.3× |
| Xr c-spine 4 or 5 views (72050) |
$685.30 |
$979 |
6.3× |
| Xr c-spine 6 or more views (72052) |
$933.10 |
$1,333 |
8.5× |
| Xr chest 4+ views (71048) |
$790.65 |
$1,129.50 |
7.2× |
| Xr urogram antegrade (74425) |
$1,749.30 |
$2,499 |
4.8× |