| 3-D radiotherapy plan dose-volume histograms (77295) |
$11,901.75 |
$15,869 |
7.2× |
| Abdomen 2 views (74019) |
$648 |
$864 |
5.2× |
| Acute gi blood loss imaging (78278) |
$4,017.75 |
$5,357 |
8.4× |
| Angio Adrenal Bilat Select (75733) |
$17,713.50 |
$23,618 |
4.7× |
| Angiography extremity bilateral rs&i (75716) |
$9,004.12 |
$12,005.50 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$8,898.75 |
$11,865 |
2.4× |
| Angiography internal mammary rs&i (75756) |
$6,134.25 |
$8,179 |
1.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$9,483 |
$12,644 |
1.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$9,063.75 |
$12,085 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$17,713.50 |
$23,618 |
4.7× |
| Angiography Spinal Selective Rs&I (75705) |
$12,364.50 |
$16,486 |
1.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,493 |
$19,324 |
2.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,326.50 |
$7,102 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$7,720.50 |
$10,294 |
2.0× |
| Ankle 2 views (73600) |
$922.50 |
$1,230 |
8.8× |
| Aortogram thoracic (75605) |
$12,647.25 |
$16,863 |
1.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,679.75 |
$7,573 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$9,825 |
$13,100 |
2.6× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$9,063.75 |
$12,085 |
2.4× |
| Artery X-Rays Adrenal Gland (75731) |
$9,063.75 |
$12,085 |
2.4× |
| Arthrogram ankle (73615) |
$3,107.25 |
$4,143 |
7.4× |
| Arthrogram elbow (73085) |
$3,107.25 |
$4,143 |
7.4× |
| Arthrogram hip (73525) |
$2,736 |
$3,648 |
6.5× |
| Arthrogram knee (73580) |
$2,280.75 |
$3,041 |
5.5× |
| Arthrogram shoulder (73040) |
$2,280.75 |
$3,041 |
5.5× |
| Arthrogram wrist (73115) |
$3,107.25 |
$4,143 |
7.4× |
| Basic dosimetry (77300) |
$1,001.25 |
$1,335 |
6.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$2,054.25 |
$2,739 |
4.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$3,300 |
$4,400 |
6.9× |
| Bone &/joint imaging whole body (78306) |
$3,698.25 |
$4,931 |
7.7× |
| Bone age studies (77072) |
$906.75 |
$1,209 |
7.2× |
| Bone Imaging 3 Phase (78315) |
$4,329.75 |
$5,773 |
9.0× |
| Bone survey complete (77075) |
$1,204.50 |
$1,606 |
9.6× |
| Bone survey infant (77076) |
$860.25 |
$1,147 |
6.9× |
| Bowel imaging (78290) |
$2,324.25 |
$3,099 |
4.9× |
| Brachytx isodose complex (77318) |
$3,167.25 |
$4,223 |
7.1× |
| Brachytx isodose intermed (77317) |
$4,323.75 |
$5,765 |
9.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,554 |
$2,072 |
3.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$4,178.25 |
$5,571 |
6.4× |
| Brain Imaging Vascular Flow Only (78610) |
$2,649.75 |
$3,533 |
4.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$4,261.50 |
$5,682 |
8.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$6,522 |
$8,696 |
15.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,161.50 |
$2,882 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$827.25 |
$1,103 |
7.9× |
| Chest 1 view (71045) |
$432 |
$576 |
4.1× |
| Chest xray 3 views (71047) |
$775.50 |
$1,034 |
7.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$864 |
$1,152 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,350.75 |
$1,801 |
6.4× |
| Clavicle complete (73000) |
$714.75 |
$953 |
6.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,788 |
$2,384 |
14.3× |
| Continuing medical physics consltj pr wk (77336) |
$1,626.75 |
$2,169 |
10.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$11,358 |
$15,144 |
27.2× |
| CT abdomen and pelvis without contrast (74176) |
$7,003.50 |
$9,338 |
24.5× |
| CT abdomen w contrast (74160) |
$4,488.75 |
$5,985 |
21.4× |
| CT abdomen w wo contrast (74170) |
$4,696.50 |
$6,262 |
22.3× |
| CT abdomen w/o contrast (74150) |
$4,404 |
$5,872 |
35.2× |
| CT angio hrt w/3d image (75574) |
$2,239.50 |
$2,986 |
5.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,578.50 |
$3,438 |
12.3× |
| CT angiography upper extremity lt (73206) |
$2,788.50 |
$3,718 |
13.3× |
| CT c-spine w/contrast (72126) |
$3,367.50 |
$4,490 |
8.1× |
| CT c-spine w/o contrast (72125) |
$4,434.75 |
$5,913 |
35.4× |
| CT cervical spine w&w/o contrast (72127) |
$7,481.25 |
$9,975 |
35.6× |
| CT chest w contrast (71260) |
$4,396.50 |
$5,862 |
20.9× |
| CT chest w/wo contrast (71270) |
$3,368.25 |
$4,491 |
16.0× |
| CT head/brain with contrast (70460) |
$4,768.50 |
$6,358 |
22.7× |
| CT head/brain without and with contrast (70470) |
$5,342.25 |
$7,123 |
25.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,463.75 |
$3,285 |
5.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$109.50 |
$146 |
1.0× |
| CT hrt w/3d image congen (75573) |
$2,441.25 |
$3,255 |
5.8× |
| CT iac w contrast (70481) |
$3,754.50 |
$5,006 |
17.9× |
| CT limited/localized follow up study (76380) |
$3,026.25 |
$4,035 |
29.0× |
| CT lower ext w/o (73700) |
$4,621.50 |
$6,162 |
36.9× |
| CT lower extremity w wo contrast (73702) |
$3,397.50 |
$4,530 |
16.2× |
| CT lower extremity w/contrast material (73701) |
$3,033.75 |
$4,045 |
14.4× |
| CT lumbar spine w & w/o contrast (72133) |
$6,093 |
$8,124 |
29.0× |
| CT lumbar spine w/contrast (72132) |
$2,761.50 |
$3,682 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$3,504.75 |
$4,673 |
28.0× |
| CT maxillofacial w contrast (70487) |
$1,731.38 |
$2,308.50 |
8.2× |
| CT maxillofacial w/wo contrast (70488) |
$4,167 |
$5,556 |
19.8× |
| CT maxillofacial wo contrast (70486) |
$1,334.62 |
$1,779.50 |
10.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$7,763.25 |
$10,351 |
36.9× |
| CT orbits w/o contrast (70480) |
$5,579.25 |
$7,439 |
44.5× |
| CT pelvis w/o contrast (72192) |
$1,686 |
$2,248 |
13.5× |
| CT pelvis w/wo contrast (72194) |
$3,453 |
$4,604 |
16.4× |
| CT scan of arm combo (73202) |
$4,414.50 |
$5,886 |
21.0× |
| CT soft tissue neck w contrast (70491) |
$4,201.50 |
$5,602 |
20.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,267.75 |
$4,357 |
15.5× |
| CT soft tissue neck w/o contrast (70490) |
$2,692.50 |
$3,590 |
21.5× |
| CT thoracic spine w/contrast (72129) |
$4,140.75 |
$5,521 |
19.7× |
| CT thoracic spine w/o contrast (72128) |
$4,151.25 |
$5,535 |
33.1× |
| CT thoracic spine w/wo contrast (72130) |
$4,458 |
$5,944 |
21.2× |
| CT thorax w/o contrast (71250) |
$3,633 |
$4,844 |
29.0× |
| CT unlisted procedure (76497) |
$2,562.75 |
$3,417 |
24.6× |
| CT upper ext wo (73200) |
$4,705.50 |
$6,274 |
37.6× |
| CT upper extremity with contrast (73201) |
$3,328.50 |
$4,438 |
8.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$434.25 |
$579 |
2.1× |
| Cta Abdomen (74175) |
$2,640 |
$3,520 |
12.6× |
| CTA abdomen pelvis (74174) |
$6,672.75 |
$8,897 |
16.0× |
| CTA chest (71275) |
$4,226.25 |
$5,635 |
20.1× |
| Cta Head (70496) |
$3,825.75 |
$5,101 |
18.2× |
| Cta Neck (70498) |
$434.25 |
$579 |
2.1× |
| Cta Pelvis (72191) |
$1,618.50 |
$2,158 |
7.7× |
| Cystography minimum 3 views rs&i (74430) |
$1,144.12 |
$1,525.50 |
2.7× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$3,066 |
$4,088 |
10.7× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$4,193.25 |
$5,591 |
1.7× |
| Diskogram cervical (72285) |
$1,624.50 |
$2,166 |
0.7× |
| Diskography lumbar (72295) |
$10,802.25 |
$14,403 |
4.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$1,086 |
$1,448 |
8.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,641.75 |
$2,189 |
13.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$703.50 |
$938 |
5.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,984.88 |
$2,646.50 |
15.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$412.50 |
$550 |
4.0× |
| Dxa bone density study axial skeleton (77085) |
$1,307.25 |
$1,743 |
10.4× |
| Esophagus (74220) |
$1,134 |
$1,512 |
5.4× |
| Facial bones min 3 views (70150) |
$970.50 |
$1,294 |
7.7× |
| Fetal biophysical profile non-stress testing (76818) |
$1,556.25 |
$2,075 |
12.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$783.75 |
$1,045 |
6.3× |
| Fluoroscopy up to 1 hr (76000) |
$708.75 |
$945 |
2.5× |
| Foot 2 views (73620) |
$836.25 |
$1,115 |
8.0× |
| Forearm 2 views (73090) |
$1,201.50 |
$1,602 |
11.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$4,359.75 |
$5,813 |
9.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$5,784 |
$7,712 |
8.9× |
| Hand 2 views (73120) |
$852 |
$1,136 |
6.8× |
| Heart Infarct Image (78466) |
$4,672.50 |
$6,230 |
9.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$7,166.25 |
$9,555 |
1.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$17,713.50 |
$23,618 |
4.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,569.25 |
$4,759 |
5.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,692.75 |
$2,257 |
3.5× |
| Hysterosalpingogram (74740) |
$3,377.25 |
$4,503 |
11.8× |
| Interstitial radiation source applic complex (77778) |
$3,671.25 |
$4,895 |
4.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$1,190.25 |
$1,587 |
9.5× |
| Kidney imaging morphology (78700) |
$1,623.75 |
$2,165 |
3.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,606.25 |
$3,475 |
4.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,772 |
$3,696 |
4.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,578.75 |
$2,105 |
2.4× |
| Knee 3 views (73562) |
$1,169.25 |
$1,559 |
11.2× |
| Liver & spleen imaging static only (78215) |
$2,350.50 |
$3,134 |
4.9× |
| Liver imaging static only (78201) |
$4,363.50 |
$5,818 |
6.7× |
| Lung perf&ventilat diferentl (78598) |
$2,134.50 |
$2,846 |
3.3× |
| Lung perfusion differential (78597) |
$1,797 |
$2,396 |
3.8× |
| Lung ventilation imaging (78579) |
$2,052.75 |
$2,737 |
4.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,066 |
$4,088 |
0.8× |
| Lymphoscintigraphy (78195) |
$4,007.25 |
$5,343 |
6.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$8,964 |
$11,952 |
9.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$9,918.75 |
$13,225 |
23.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$6,035.25 |
$8,047 |
14.4× |
| Mammary ductogram or galactogram multiple (77054) |
$1,453.88 |
$1,938.50 |
5.1× |
| Mammary ductogram or galactogram single (77053) |
$1,842 |
$2,456 |
6.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$827.25 |
$1,103 |
7.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,022 |
$2,696 |
4.5× |
| Mr safety determination physician/other qhp (76016) |
$61.50 |
$82 |
0.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$9.75 |
$13 |
0.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$97.50 |
$130 |
0.9× |
| Mr safety implt pos&/immoblj (76019) |
$128.25 |
$171 |
1.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$192.75 |
$257 |
0.7× |
| MRA head w & w/o contrast (70546) |
$5,442 |
$7,256 |
13.0× |
| MRA head w/o contrast (70544) |
$4,308.75 |
$5,745 |
15.1× |
| MRA head with contrast (70545) |
$5,178 |
$6,904 |
12.4× |
| MRA neck w contrast (70548) |
$4,130.25 |
$5,507 |
9.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$7,341 |
$9,788 |
17.6× |
| MRA neck w/o contrast (70547) |
$4,413 |
$5,884 |
15.4× |
| MRI abdomen w contrast (74182) |
$13,468.50 |
$17,958 |
32.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$8,641.50 |
$11,522 |
20.7× |
| MRI abdomen w/o contrast (74181) |
$5,713.50 |
$7,618 |
20.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$9,813.75 |
$13,085 |
10.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,734.50 |
$7,646 |
13.7× |
| MRI breast w/o contrast bilateral (77047) |
$11,914.50 |
$15,886 |
41.7× |
| MRI breast wo contrast unilateral (77046) |
$11,128.50 |
$14,838 |
38.9× |
| MRI c-spine with contrast (72142) |
$13,128.75 |
$17,505 |
31.4× |
| MRI cervical spine w/o contrast (72141) |
$8,215.50 |
$10,954 |
28.7× |
| MRI chest w/o & w/contrast material (71552) |
$7,704.75 |
$10,273 |
18.4× |
| MRI chest w/o contrast (71550) |
$6,756 |
$9,008 |
23.6× |
| MRI chest with contrast (71551) |
$7,295.25 |
$9,727 |
7.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$8,682 |
$11,576 |
20.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,748.25 |
$6,331 |
11.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,564.75 |
$4,753 |
12.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$5,731.50 |
$7,642 |
20.0× |
| MRI orbit face neck w contrast (70542) |
$10,899.75 |
$14,533 |
26.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$6,824.25 |
$9,099 |
16.3× |
| MRI pelvis w/contrast (72196) |
$12,446.25 |
$16,595 |
29.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$8,641.50 |
$11,522 |
20.7× |
| MRI pelvis w/o contrast (72195) |
$3,803.25 |
$5,071 |
13.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$14,243.25 |
$18,991 |
34.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$6,565.50 |
$8,754 |
15.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,889 |
$7,852 |
14.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$7,418.25 |
$9,891 |
17.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$9,566.25 |
$12,755 |
22.9× |
| MRI temporomandibular joint (70336) |
$6,764.25 |
$9,019 |
23.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,516.75 |
$4,689 |
12.3× |
| MRI up ext w/o contrast (73218) |
$6,113.25 |
$8,151 |
21.4× |
| MRI upper ext joint w/o contrast (73221) |
$5,295 |
$7,060 |
18.5× |
| MRI, joint upper extrem combo (73223) |
$6,066 |
$8,088 |
14.5× |
| Myelogram Cervical (72240) |
$1,899.75 |
$2,533 |
2.0× |
| Myelogram Lumbar (72265) |
$1,859.25 |
$2,479 |
2.0× |
| Myelogram thoracic (72255) |
$2,589.75 |
$3,453 |
2.8× |
| Myelography 2 or more regions (72270) |
$5,813.25 |
$7,751 |
6.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,488 |
$5,984 |
2.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$5,746.50 |
$7,662 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$8,012.25 |
$10,683 |
5.2× |
| Myocardial spect single study at rest or stress (78451) |
$3,803.25 |
$5,071 |
2.5× |
| Neck soft tissue (70360) |
$913.50 |
$1,218 |
8.8× |
| Nm adrenal scan (78075) |
$4,864.50 |
$6,486 |
3.1× |
| Nm bone marrow wb (78104) |
$2,076.75 |
$2,769 |
4.3× |
| Nm cardiac blood pool multiple (78473) |
$3,829.50 |
$5,106 |
8.0× |
| Nm cisternogram (78630) |
$2,814 |
$3,752 |
4.3× |
| Nm csf leak detection (78650) |
$2,109.75 |
$2,813 |
1.4× |
| Nm gastric emptying study (78264) |
$3,502.50 |
$4,670 |
7.3× |
| Nm gastroesophageal reflux study (78262) |
$1,725 |
$2,300 |
3.6× |
| Nm kidney scan w/flow (78701) |
$1,862.25 |
$2,483 |
3.9× |
| Nm peritoneal-venous shunt patency (78291) |
$1,404.75 |
$1,873 |
2.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$2,518.50 |
$3,358 |
5.3× |
| Nonvascular shunt X-ray (75809) |
$1,514.25 |
$2,019 |
12.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,451 |
$11,268 |
5.1× |
| Nuclear Rx Oral Admin (79005) |
$1,328.25 |
$1,771 |
4.7× |
| Ob us nuchal meas 1 gest (76813) |
$1,597.50 |
$2,130 |
12.8× |
| Osseous survey limited (77074) |
$1,233 |
$1,644 |
9.8× |
| Parathyroid Planar Imaging (78070) |
$2,027.25 |
$2,703 |
4.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,390.75 |
$4,521 |
7.1× |
| Pelvis 1 or 2 views (72170) |
$747 |
$996 |
6.0× |
| Peritoneogram after injection (74190) |
$3,066 |
$4,088 |
4.7× |
| PET image w/CT, skull-thigh (78815) |
$8,530.50 |
$11,374 |
5.0× |
| PET imaging for CT attenuation whole body (78816) |
$8,995.50 |
$11,994 |
5.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$7,166.25 |
$9,555 |
1.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,900.75 |
$9,201 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,768.50 |
$2,358 |
3.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$3,078 |
$4,104 |
4.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,080.75 |
$1,441 |
1.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$1,323 |
$1,764 |
12.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$574.50 |
$766 |
5.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$1,323 |
$1,764 |
12.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$573.75 |
$765 |
5.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$733.50 |
$978 |
5.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$1,419 |
$1,892 |
11.3× |
| Radex fingr minimum 2 views (73140) |
$1,125.75 |
$1,501 |
10.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$1,201.50 |
$1,602 |
11.5× |
| Radex Hand Minimum 3 Views (73130) |
$1,353.75 |
$1,805 |
13.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$492.75 |
$657 |
4.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$733.50 |
$978 |
5.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$996 |
$1,328 |
7.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,480.88 |
$1,974.50 |
11.8× |
| Radex Humerus Minimum 2 Views (73060) |
$729 |
$972 |
7.0× |
| Radex Kne 1/2 Views (73560) |
$797.25 |
$1,063 |
7.6× |
| Radex Kne Compl 4/More Views (73564) |
$703.50 |
$938 |
5.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$1,546.50 |
$2,062 |
12.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$726 |
$968 |
7.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$809.25 |
$1,079 |
6.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$1,228.50 |
$1,638 |
11.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$556.50 |
$742 |
5.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$350.25 |
$467 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$938.25 |
$1,251 |
9.0× |
| Radex Toe Minimum 2 Views (73660) |
$834 |
$1,112 |
8.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$474.75 |
$633 |
3.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$1,458.75 |
$1,945 |
14.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,419 |
$1,892 |
11.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$25,784.25 |
$34,379 |
2.9× |
| Radiation treatment delivery level 1 (77402) |
$963.75 |
$1,285 |
7.9× |
| Radiation treatment delivery level 2 (77407) |
$1,190.25 |
$1,587 |
2.6× |
| Radiation treatment delivery level 3 (77412) |
$2,760 |
$3,680 |
4.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$675 |
$900 |
6.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$648 |
$864 |
5.2× |
| Radiologic exam chest 2 views (71046) |
$789.75 |
$1,053 |
7.6× |
| Radiologic exam colon single contrast study (74270) |
$1,329 |
$1,772 |
6.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$118.50 |
$158 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,654.50 |
$2,206 |
7.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$840.75 |
$1,121 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$460.50 |
$614 |
4.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$1,163.25 |
$1,551 |
11.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$1,066.50 |
$1,422 |
8.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$857.25 |
$1,143 |
6.8× |
| Radiological examination surgical specimen (76098) |
$3,326.25 |
$4,435 |
5.1× |
| Renal Cyst Study (74470) |
$6,202.50 |
$8,270 |
9.5× |
| Ribs bilateral 3 views (71110) |
$978 |
$1,304 |
7.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$2,553 |
$3,404 |
5.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,913.75 |
$3,885 |
6.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,381.50 |
$5,842 |
6.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$9,162.75 |
$12,217 |
14.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,626 |
$6,168 |
7.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,936 |
$5,248 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$1,743 |
$2,324 |
6.2× |
| Sacroiliac Joints < 3 Views (72200) |
$825 |
$1,100 |
6.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$2,016.75 |
$2,689 |
7.1× |
| Scapula (73010) |
$632.25 |
$843 |
5.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$717.75 |
$957 |
30.7× |
| Sella turcica (70240) |
$606.75 |
$809 |
5.8× |
| Shoulder 1 view (73020) |
$463.50 |
$618 |
4.4× |
| Sialogram (70390) |
$1,981.50 |
$2,642 |
6.9× |
| Simulation intermediate (77285) |
$4,002.75 |
$5,337 |
8.9× |
| Small bowel series (74250) |
$1,916.25 |
$2,555 |
9.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,295.25 |
$1,727 |
2.9× |
| Special dosimetry (77331) |
$396 |
$528 |
2.5× |
| Special Physics Consult (77370) |
$1,122.75 |
$1,497 |
7.0× |
| Special treatment procedure (77470) |
$2,736 |
$3,648 |
4.1× |
| Spine thoracic 3 views (72072) |
$562.88 |
$750.50 |
4.5× |
| Spleen imaging only (78185) |
$1,869.75 |
$2,493 |
3.9× |
| Splenoportograpy rs&i (75810) |
$17,713.50 |
$23,618 |
4.7× |
| Stereotactic Body Radiation Delivery (77373) |
$5,703 |
$7,604 |
2.7× |
| Superior sagittal sinus venogram (75870) |
$6,514.50 |
$8,686 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,231.50 |
$1,642 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,554 |
$2,072 |
3.5× |
| Testicular Imaging With Vascular Flow (78761) |
$2,049.75 |
$2,733 |
4.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$7,641 |
$10,188 |
17.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,722 |
$2,296 |
10.7× |
| Thoracolumbar 2 views (72080) |
$636.75 |
$849 |
6.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,942.50 |
$2,590 |
3.0× |
| Thyroid imaging w/blood flow (78013) |
$1,266 |
$1,688 |
2.6× |
| Thyroid uptake measurement (78012) |
$975.75 |
$1,301 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,265 |
$3,020 |
4.7× |
| Tmj unilateral (70328) |
$512.25 |
$683 |
4.9× |
| Treatment device complex (77334) |
$1,906.50 |
$2,542 |
4.2× |
| Treatment device intermediate (77333) |
$1,240.50 |
$1,654 |
7.7× |
| Treatment devices simple (77332) |
$1,126.50 |
$1,502 |
7.0× |
| Ultrasound breast complete (76641) |
$895.50 |
$1,194 |
7.1× |
| Ultrasound Exam Aaa Screen (76706) |
$1,144.50 |
$1,526 |
9.1× |
| Ultrasound, abdomen limited (76705) |
$918 |
$1,224 |
7.3× |
| Umbilical-artery Doppler (OB) (76820) |
$996.75 |
$1,329 |
8.0× |
| Unlisted magnetic resonance procedure (76498) |
$4,152 |
$5,536 |
39.8× |
| Ureteral reflux study (78740) |
$1,311.75 |
$1,749 |
2.7× |
| Urethrocystogram voiding (74455) |
$1,059 |
$1,412 |
3.7× |
| Urethrocystography retrograde rs&i (74450) |
$2,270.25 |
$3,027 |
7.9× |
| Us breast unilateral limited (76642) |
$938.62 |
$1,251.50 |
9.0× |
| Us chest (76604) |
$650.25 |
$867 |
5.2× |
| Us compl joint r-t w/image documentation (76881) |
$827.25 |
$1,103 |
6.6× |
| Us encephalogram (76506) |
$922.50 |
$1,230 |
7.4× |
| Us infant hips w manipulation (76885) |
$1,642.50 |
$2,190 |
15.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$458.25 |
$611 |
3.7× |
| Us ob detailed single fetus (76811) |
$1,503.75 |
$2,005 |
5.3× |
| Us ob limited (76815) |
$1,313.25 |
$1,751 |
10.5× |
| Us ob transvaginal (76817) |
$1,346.25 |
$1,795 |
10.7× |
| Us pelvic non ob complete (76856) |
$1,552.50 |
$2,070 |
12.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$1,086 |
$1,448 |
8.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,105.50 |
$1,474 |
8.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$697.50 |
$930 |
5.6× |
| Us retroperitoneal complete (76770) |
$1,833 |
$2,444 |
14.6× |
| Us retroperitoneal limited (76775) |
$1,833 |
$2,444 |
14.6× |
| Us scrotum and contents (76870) |
$2,442 |
$3,256 |
19.5× |
| Us soft tissue head/neck (76536) |
$1,988.25 |
$2,651 |
15.9× |
| Us spinal canal and contents (76800) |
$1,515 |
$2,020 |
12.1× |
| Us transrectal (76872) |
$1,229.25 |
$1,639 |
9.8× |
| Us transrectal prostate volume (76873) |
$1,263 |
$1,684 |
10.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,116.75 |
$1,489 |
8.9× |
| Venogram adrenal unilat (75840) |
$17,713.50 |
$23,618 |
4.7× |
| Venogram extremity bilateral (75822) |
$4,078.50 |
$5,438 |
2.2× |
| Venogram Extremity Unilateral (75820) |
$3,783.75 |
$5,045 |
2.0× |
| Venography caval inferior serialography rs&i (75825) |
$11,295 |
$15,060 |
3.0× |
| Venography caval superior serialography rs&i (75827) |
$5,461.50 |
$7,282 |
2.9× |
| Venography Renal Bilateral (75833) |
$17,713.50 |
$23,618 |
4.7× |
| Venography renal unilateral selective rs&i (75831) |
$16,401.75 |
$21,869 |
4.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$6,514.50 |
$8,686 |
1.7× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,783.25 |
$3,711 |
3.7× |
| Venous sampling by catheter (75893) |
$9,184.50 |
$12,246 |
1.4× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$2,004 |
$2,672 |
3.1× |
| Vertebral fracture assessment via dxa (77086) |
$815.25 |
$1,087 |
7.8× |
| Wrist 2 views (73100) |
$735 |
$980 |
7.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,137 |
$1,516 |
9.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$924.75 |
$1,233 |
8.9× |
| X-ray b.e. reductn intuss (74283) |
$3,711 |
$4,948 |
17.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,293 |
$1,724 |
6.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$562.50 |
$750 |
5.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$554.25 |
$739 |
5.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$970.50 |
$1,294 |
7.7× |
| X-ray exam of femur 2/> (73552) |
$887.25 |
$1,183 |
8.5× |
| X-ray eye for foreign body (70030) |
$452.62 |
$603.50 |
4.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$589.50 |
$786 |
5.7× |
| X-ray IV pyelogram (ivp) (74400) |
$2,616 |
$3,488 |
12.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$501 |
$668 |
4.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$468.75 |
$625 |
4.5× |
| X-ray leg, infant (73592) |
$650.25 |
$867 |
6.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$891 |
$1,188 |
7.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,532.25 |
$2,043 |
12.2× |
| X-ray nose-rectum child f.b. (76010) |
$789.75 |
$1,053 |
7.6× |
| X-ray optic foramen (70190) |
$691.50 |
$922 |
6.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,001.25 |
$1,335 |
8.0× |
| X-ray retrograde pyelogram (74420) |
$2,412.75 |
$3,217 |
5.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$900.75 |
$1,201 |
8.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$1,775.25 |
$2,367 |
14.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,357.50 |
$1,810 |
10.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$774 |
$1,032 |
6.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$789.75 |
$1,053 |
7.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,050 |
$1,400 |
10.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,082.25 |
$1,443 |
8.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$873 |
$1,164 |
7.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,668 |
$2,224 |
7.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$616.50 |
$822 |
5.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$783.75 |
$1,045 |
7.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$852.75 |
$1,137 |
8.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$970.50 |
$1,294 |
7.7× |
| Xr bone length studies (77073) |
$520.50 |
$694 |
4.2× |
| Xr c-spine 4 or 5 views (72050) |
$2,262.75 |
$3,017 |
18.1× |
| Xr c-spine 6 or more views (72052) |
$1,380 |
$1,840 |
11.0× |
| Xr chest 4+ views (71048) |
$574.50 |
$766 |
4.6× |
| Xr urogram antegrade (74425) |
$1,782.75 |
$2,377 |
4.3× |