| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,500 |
$6,500 |
3.9× |
| Abdomen 2 views (74019) |
$649 |
$649 |
5.2× |
| Acute gi blood loss imaging (78278) |
$1,149 |
$1,149 |
2.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$3,479 |
$3,479 |
2.2× |
| Angio Adrenal Bilat Select (75733) |
$9,095 |
$9,095 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$9,095 |
$9,095 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$9,095 |
$9,095 |
2.4× |
| Angiography internal mammary rs&i (75756) |
$8,074 |
$8,074 |
2.1× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$14,533 |
$14,533 |
2.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$9,095 |
$9,095 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$9,095 |
$9,095 |
2.4× |
| Angiography Spinal Selective Rs&I (75705) |
$14,032 |
$14,032 |
2.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,032 |
$14,032 |
2.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,714 |
$3,714 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,121 |
$4,121 |
1.1× |
| Ankle 2 views (73600) |
$649 |
$649 |
6.2× |
| Aortogram thoracic (75605) |
$14,533 |
$14,533 |
2.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$9,095 |
$9,095 |
2.4× |
| Aortography abdominal serialography rs&i (75625) |
$9,095 |
$9,095 |
2.4× |
| Artery X-Rays Adrenal Gland (75731) |
$9,095 |
$9,095 |
2.4× |
| Arthrogram ankle (73615) |
$2,309 |
$2,309 |
5.5× |
| Arthrogram elbow (73085) |
$1,803 |
$1,803 |
4.3× |
| Arthrogram hip (73525) |
$1,803 |
$1,803 |
4.3× |
| Arthrogram knee (73580) |
$2,309 |
$2,309 |
5.5× |
| Arthrogram shoulder (73040) |
$1,468 |
$1,468 |
3.5× |
| Arthrogram wrist (73115) |
$1,549 |
$1,549 |
3.7× |
| Basic dosimetry (77300) |
$598 |
$598 |
3.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,171 |
$1,171 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,171 |
$1,171 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,171 |
$1,171 |
2.4× |
| Bone age studies (77072) |
$570 |
$570 |
4.5× |
| Bone Imaging 3 Phase (78315) |
$1,171 |
$1,171 |
2.4× |
| Bone Marrow Imaging Limited Area (78102) |
$1,254 |
$1,254 |
2.6× |
| Bone survey complete (77075) |
$662 |
$662 |
5.3× |
| Bone survey infant (77076) |
$763 |
$763 |
6.1× |
| Bowel imaging (78290) |
$1,149 |
$1,149 |
2.4× |
| Brachytx isodose complex (77318) |
$2,009 |
$2,009 |
4.5× |
| Brachytx isodose intermed (77317) |
$2,009 |
$2,009 |
4.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,015 |
$1,015 |
2.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,032 |
$2,032 |
3.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,835 |
$6,835 |
4.0× |
| Brain Imaging Vascular Flow Only (78610) |
$1,658 |
$1,658 |
2.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,424 |
$1,424 |
3.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,424 |
$1,424 |
3.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$4,269 |
$4,269 |
10.2× |
| Cardiac shunt detection (78428) |
$1,340 |
$1,340 |
2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,658 |
$1,658 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$320 |
$320 |
3.1× |
| Chest 1 view (71045) |
$320 |
$320 |
3.1× |
| Chest xray 3 views (71047) |
$357 |
$357 |
3.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$659 |
$659 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$853 |
$853 |
4.1× |
| Clavicle complete (73000) |
$527 |
$527 |
5.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$693 |
$693 |
5.5× |
| Continuing medical physics consltj pr wk (77336) |
$721 |
$721 |
4.5× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$706 |
$706 |
3.4× |
| Corpora cavernosography (74445) |
$1,525 |
$1,525 |
12.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,432 |
$2,432 |
5.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,714 |
$1,714 |
6.0× |
| CT abdomen w contrast (74160) |
$1,905 |
$1,905 |
9.1× |
| CT abdomen w wo contrast (74170) |
$2,096 |
$2,096 |
10.0× |
| CT abdomen w/o contrast (74150) |
$967 |
$967 |
7.7× |
| CT angio hrt w/3d image (75574) |
$1,658 |
$1,658 |
4.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,183 |
$2,183 |
10.4× |
| CT angiography upper extremity lt (73206) |
$1,814 |
$1,814 |
8.6× |
| CT c-spine w/contrast (72126) |
$2,781 |
$2,781 |
6.7× |
| CT c-spine w/o contrast (72125) |
$1,412 |
$1,412 |
11.3× |
| CT cervical spine w&w/o contrast (72127) |
$3,060 |
$3,060 |
14.6× |
| CT chest w contrast (71260) |
$1,905 |
$1,905 |
9.1× |
| CT chest w/wo contrast (71270) |
$2,096 |
$2,096 |
10.0× |
| CT colonography screening (74263) |
$2,966 |
$2,966 |
10.4× |
| CT colonography w/dye (74262) |
$1,832 |
$1,832 |
8.7× |
| CT colonography w/o cntrst (74261) |
$950 |
$950 |
7.6× |
| CT head/brain with contrast (70460) |
$2,716 |
$2,716 |
12.9× |
| CT head/brain without and with contrast (70470) |
$3,025 |
$3,025 |
14.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,170 |
$1,170 |
2.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$254 |
$254 |
2.4× |
| CT hrt w/3d image congen (75573) |
$1,552 |
$1,552 |
3.7× |
| CT iac w contrast (70481) |
$2,207 |
$2,207 |
10.5× |
| CT limited/localized follow up study (76380) |
$550 |
$550 |
5.3× |
| CT lower ext w/o (73700) |
$950 |
$950 |
7.6× |
| CT lower extremity w wo contrast (73702) |
$2,096 |
$2,096 |
10.0× |
| CT lower extremity w/contrast material (73701) |
$1,905 |
$1,905 |
9.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,096 |
$2,096 |
10.0× |
| CT lumbar spine w/contrast (72132) |
$1,905 |
$1,905 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$967 |
$967 |
7.7× |
| CT maxillofacial w contrast (70487) |
$2,716 |
$2,716 |
12.9× |
| CT maxillofacial w/wo contrast (70488) |
$3,025 |
$3,025 |
14.4× |
| CT maxillofacial wo contrast (70486) |
$1,387 |
$1,387 |
11.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,116 |
$2,116 |
10.1× |
| CT orbits w/o contrast (70480) |
$1,387 |
$1,387 |
11.1× |
| CT pelvis w/o contrast (72192) |
$950 |
$950 |
7.6× |
| CT pelvis w/wo contrast (72194) |
$2,096 |
$2,096 |
10.0× |
| CT scan of arm combo (73202) |
$2,096 |
$2,096 |
10.0× |
| CT soft tissue neck w contrast (70491) |
$2,781 |
$2,781 |
13.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,060 |
$3,060 |
14.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,387 |
$1,387 |
11.1× |
| CT thoracic spine w/contrast (72129) |
$1,905 |
$1,905 |
9.1× |
| CT thoracic spine w/o contrast (72128) |
$967 |
$967 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$2,096 |
$2,096 |
10.0× |
| CT thorax w/o contrast (71250) |
$950 |
$950 |
7.6× |
| CT upper ext wo (73200) |
$950 |
$950 |
7.6× |
| CT upper extremity with contrast (73201) |
$1,905 |
$1,905 |
4.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,013 |
$2,013 |
9.6× |
| Cta Abdomen (74175) |
$2,070 |
$2,070 |
9.8× |
| CTA abdomen pelvis (74174) |
$2,915 |
$2,915 |
7.0× |
| CTA chest (71275) |
$2,153 |
$2,153 |
10.2× |
| Cta Head (70496) |
$3,187 |
$3,187 |
15.2× |
| Cta Neck (70498) |
$3,187 |
$3,187 |
15.2× |
| Cta Pelvis (72191) |
$2,183 |
$2,183 |
10.4× |
| Cystography minimum 3 views rs&i (74430) |
$1,525 |
$1,525 |
3.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$1,936 |
$1,936 |
6.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$10,642 |
$10,642 |
4.2× |
| Diskogram cervical (72285) |
$10,988 |
$10,988 |
4.7× |
| Diskography lumbar (72295) |
$10,988 |
$10,988 |
4.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$392 |
$392 |
3.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$663 |
$663 |
5.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$303 |
$303 |
2.9× |
| Dxa bone density study axial skeleton (77085) |
$494 |
$494 |
3.9× |
| Esophagus (74220) |
$659 |
$659 |
3.1× |
| Facial bones min 3 views (70150) |
$547 |
$547 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$799 |
$799 |
6.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$722 |
$722 |
5.8× |
| Fluoroscopy up to 1 hr (76000) |
$730 |
$730 |
2.6× |
| Foot 2 views (73620) |
$529 |
$529 |
5.1× |
| Forearm 2 views (73090) |
$649 |
$649 |
6.2× |
| Hand 2 views (73120) |
$853 |
$853 |
6.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,779 |
$3,779 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,442 |
$3,442 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,017 |
$4,017 |
4.8× |
| Heart first pass single,planar (78481) |
$1,755 |
$1,755 |
2.7× |
| Heart Infarct Image (78466) |
$1,424 |
$1,424 |
3.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$9,095 |
$9,095 |
2.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$9,095 |
$9,095 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,486 |
$1,486 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,486 |
$1,486 |
3.1× |
| Hysterosalpingogram (74740) |
$1,858 |
$1,858 |
6.5× |
| Interstitial radiation source applic complex (77778) |
$5,583 |
$5,583 |
6.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$493 |
$493 |
3.9× |
| Kidney imaging morphology (78700) |
$1,490 |
$1,490 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,490 |
$1,490 |
2.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,490 |
$1,490 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,755 |
$1,755 |
2.7× |
| Knee 3 views (73562) |
$570 |
$570 |
5.5× |
| Liver & spleen imaging static only (78215) |
$1,329 |
$1,329 |
2.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,329 |
$1,329 |
2.8× |
| Liver imaging static only (78201) |
$2,973 |
$2,973 |
4.6× |
| Liver imaging w/vascular flow (78202) |
$2,973 |
$2,973 |
4.6× |
| Lung perf&ventilat diferentl (78598) |
$1,587 |
$1,587 |
2.4× |
| Lung ventilation imaging (78579) |
$1,346 |
$1,346 |
2.8× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,296 |
$2,296 |
1.2× |
| Lymphoscintigraphy (78195) |
$1,691 |
$1,691 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$4,052 |
$4,052 |
4.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$4,052 |
$4,052 |
9.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,586 |
$4,586 |
11.0× |
| Mammary ductogram or galactogram multiple (77054) |
$1,779 |
$1,779 |
6.2× |
| Mammary ductogram or galactogram single (77053) |
$1,598 |
$1,598 |
5.6× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$263 |
$263 |
2.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,030 |
$2,030 |
4.5× |
| Mr safety determination physician/other qhp (76016) |
$273 |
$273 |
2.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$73 |
$73 |
2.1× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$337 |
$337 |
3.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$861 |
$861 |
3.0× |
| MRA head w & w/o contrast (70546) |
$4,429 |
$4,429 |
10.6× |
| MRA head w/o contrast (70544) |
$2,648 |
$2,648 |
9.3× |
| MRA head with contrast (70545) |
$3,431 |
$3,431 |
8.2× |
| MRA neck w contrast (70548) |
$3,431 |
$3,431 |
8.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,429 |
$4,429 |
10.6× |
| MRA neck w/o contrast (70547) |
$2,648 |
$2,648 |
9.3× |
| MRI abdomen w contrast (74182) |
$4,046 |
$4,046 |
9.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,640.50 |
$4,640.50 |
11.1× |
| MRI abdomen w/o contrast (74181) |
$1,910 |
$1,910 |
6.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,052 |
$4,052 |
4.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,586 |
$4,586 |
11.0× |
| MRI bone marrow blood supply (77084) |
$2,807 |
$2,807 |
9.8× |
| MRI breast w/o contrast bilateral (77047) |
$5,738 |
$5,738 |
20.1× |
| MRI breast wo contrast unilateral (77046) |
$4,654 |
$4,654 |
16.3× |
| MRI c-spine with contrast (72142) |
$3,908 |
$3,908 |
9.3× |
| MRI cardiac w/o contrast (75557) |
$2,741 |
$2,741 |
9.6× |
| MRI cervical spine w/o contrast (72141) |
$2,648 |
$2,648 |
9.3× |
| MRI chest w/o & w/contrast material (71552) |
$4,694 |
$4,694 |
11.2× |
| MRI chest w/o contrast (71550) |
$2,741 |
$2,741 |
9.6× |
| MRI chest with contrast (71551) |
$4,062 |
$4,062 |
4.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,967 |
$3,967 |
9.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$7,062 |
$7,062 |
16.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,222 |
$4,222 |
14.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,648 |
$2,648 |
9.3× |
| MRI orbit face neck w contrast (70542) |
$3,908 |
$3,908 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,533 |
$4,533 |
10.8× |
| MRI pelvis w/contrast (72196) |
$3,553 |
$3,553 |
8.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,694 |
$4,694 |
11.2× |
| MRI pelvis w/o contrast (72195) |
$2,741 |
$2,741 |
9.6× |
| MRI spectroscopy (76390) |
$3,374 |
$3,374 |
32.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,533 |
$4,533 |
10.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,046 |
$4,046 |
9.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,694 |
$4,694 |
11.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,967 |
$3,967 |
9.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,694 |
$4,694 |
11.2× |
| MRI temporomandibular joint (70336) |
$4,222 |
$4,222 |
14.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,741 |
$2,741 |
9.6× |
| MRI up ext w/o contrast (73218) |
$2,741 |
$2,741 |
9.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,741 |
$2,741 |
9.6× |
| MRI, joint upper extrem combo (73223) |
$4,694 |
$4,694 |
11.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,288 |
$4,288 |
2.8× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,288 |
$4,288 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$4,288 |
$4,288 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$4,288 |
$4,288 |
2.8× |
| N-invas est c ffr sw aly CTA (75580) |
$3,625 |
$3,625 |
3.5× |
| Neck soft tissue (70360) |
$440 |
$440 |
4.2× |
| Nm bone marrow wb (78104) |
$1,254 |
$1,254 |
2.6× |
| Nm cisternogram (78630) |
$2,032 |
$2,032 |
3.1× |
| Nm gastric emptying study (78264) |
$1,149 |
$1,149 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$1,149 |
$1,149 |
2.4× |
| Nm kidney scan w/flow (78701) |
$1,490 |
$1,490 |
3.1× |
| Nm peritoneal-venous shunt patency (78291) |
$1,149 |
$1,149 |
2.4× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,222 |
$1,222 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,592 |
$7,592 |
4.6× |
| Nuclear Rx Oral Admin (79005) |
$1,297 |
$1,297 |
4.6× |
| Ob us nuchal meas 1 gest (76813) |
$613 |
$613 |
4.9× |
| Orthopantogram (70355) |
$303 |
$303 |
2.9× |
| Osseous survey limited (77074) |
$662 |
$662 |
5.3× |
| Parathyroid Planar Imaging (78070) |
$1,346 |
$1,346 |
2.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,296 |
$2,296 |
4.8× |
| Pelvis 1 or 2 views (72170) |
$493 |
$493 |
3.9× |
| Peritoneogram after injection (74190) |
$3,730 |
$3,730 |
5.7× |
| PET image w/CT, skull-thigh (78815) |
$7,628 |
$7,628 |
4.5× |
| PET imaging CT for attenuation limited area (78814) |
$6,378 |
$6,378 |
3.7× |
| PET imaging for CT attenuation whole body (78816) |
$7,628 |
$7,628 |
4.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$9,095 |
$9,095 |
2.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$5,264 |
$5,264 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,346 |
$1,346 |
2.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,684 |
$1,684 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,386 |
$2,386 |
3.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$649 |
$649 |
6.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$527 |
$527 |
5.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$649 |
$649 |
6.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$290 |
$290 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$550 |
$550 |
4.4× |
| Radex fingr minimum 2 views (73140) |
$450 |
$450 |
4.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$527 |
$527 |
5.1× |
| Radex Hand Minimum 3 Views (73130) |
$649 |
$649 |
6.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$263 |
$263 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$550 |
$550 |
4.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$550 |
$550 |
4.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$989 |
$989 |
7.9× |
| Radex Humerus Minimum 2 Views (73060) |
$305 |
$305 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$447 |
$447 |
4.3× |
| Radex Kne Compl 4/More Views (73564) |
$570 |
$570 |
4.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$475 |
$475 |
3.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$335 |
$335 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$350 |
$350 |
2.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$527 |
$527 |
5.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$345 |
$345 |
3.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$406 |
$406 |
3.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$411 |
$411 |
3.9× |
| Radex Toe Minimum 2 Views (73660) |
$450 |
$450 |
4.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$493 |
$493 |
3.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$527 |
$527 |
5.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$34,631 |
$34,631 |
3.9× |
| Radiation treatment delivery level 1 (77402) |
$686 |
$686 |
5.6× |
| Radiation treatment delivery level 2 (77407) |
$1,049 |
$1,049 |
2.3× |
| Radiation treatment delivery level 3 (77412) |
$1,117 |
$1,117 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$388 |
$388 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$649 |
$649 |
5.2× |
| Radiologic exam chest 2 views (71046) |
$357 |
$357 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$853 |
$853 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$659 |
$659 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$853 |
$853 |
4.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$853 |
$853 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$527 |
$527 |
5.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$522 |
$522 |
5.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$527 |
$527 |
5.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$818 |
$818 |
1.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$411 |
$411 |
3.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$411 |
$411 |
3.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$930 |
$930 |
8.9× |
| Radiological examination surgical specimen (76098) |
$1,813 |
$1,813 |
2.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,445 |
$1,445 |
5.2× |
| Renal Cyst Study (74470) |
$3,730 |
$3,730 |
5.7× |
| Ribs bilateral 3 views (71110) |
$547 |
$547 |
4.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,343 |
$1,343 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,811 |
$1,811 |
3.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,254 |
$4,254 |
6.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,467 |
$3,467 |
5.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,021 |
$3,021 |
4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$5,807 |
$5,807 |
3.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$5,321 |
$5,321 |
3.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$902 |
$902 |
3.2× |
| Rp Therapy Intravenous Administration (79101) |
$1,297 |
$1,297 |
4.6× |
| Sacroiliac Joints < 3 Views (72200) |
$455 |
$455 |
3.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,292 |
$1,292 |
4.5× |
| Salivary gland imaging (78230) |
$1,149 |
$1,149 |
2.4× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$1,149 |
$1,149 |
2.4× |
| Scapula (73010) |
$378 |
$378 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$152 |
$152 |
6.5× |
| Sella turcica (70240) |
$330 |
$330 |
3.2× |
| Shoulder 1 view (73020) |
$325 |
$325 |
3.1× |
| Sialogram (70390) |
$1,858 |
$1,858 |
6.5× |
| Simulation intermediate (77285) |
$1,542 |
$1,542 |
3.4× |
| Small bowel series (74250) |
$739 |
$739 |
3.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,735 |
$1,735 |
3.9× |
| Special dosimetry (77331) |
$673 |
$673 |
4.2× |
| Special Physics Consult (77370) |
$835 |
$835 |
5.2× |
| Special treatment procedure (77470) |
$3,485 |
$3,485 |
5.3× |
| Spine thoracic 3 views (72072) |
$547 |
$547 |
4.4× |
| Spleen imaging only (78185) |
$1,254 |
$1,254 |
2.6× |
| Stereotactic Body Radiation Delivery (77373) |
$14,049 |
$14,049 |
6.6× |
| Superior sagittal sinus venogram (75870) |
$2,432 |
$2,432 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,649 |
$1,649 |
3.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,067 |
$1,067 |
2.4× |
| Testicular Imaging With Vascular Flow (78761) |
$1,490 |
$1,490 |
3.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,883 |
$1,883 |
4.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$835 |
$835 |
5.2× |
| Thoracolumbar 2 views (72080) |
$330 |
$330 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,343 |
$1,343 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$1,266 |
$1,266 |
2.6× |
| Thyroid uptake measurement (78012) |
$1,105 |
$1,105 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,346 |
$1,346 |
2.8× |
| Tmj unilateral (70328) |
$330 |
$330 |
3.2× |
| Tomogram (76100) |
$706 |
$706 |
5.6× |
| Treatment device complex (77334) |
$1,637 |
$1,637 |
3.6× |
| Treatment device intermediate (77333) |
$1,127 |
$1,127 |
7.0× |
| Treatment devices simple (77332) |
$1,127 |
$1,127 |
7.0× |
| Ultrasound breast complete (76641) |
$868 |
$868 |
6.9× |
| Ultrasound elastography first target lesion (76982) |
$678 |
$678 |
5.4× |
| Ultrasound Exam Aaa Screen (76706) |
$732 |
$732 |
5.8× |
| Ultrasound, abdomen limited (76705) |
$708 |
$708 |
5.7× |
| Umbilical-artery Doppler (OB) (76820) |
$390 |
$390 |
3.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$265 |
$265 |
2.5× |
| Unlisted magnetic resonance procedure (76498) |
$536 |
$536 |
5.1× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$50 |
$50 |
4.5× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$435 |
$435 |
4.6× |
| Ureteral reflux study (78740) |
$1,517 |
$1,517 |
3.2× |
| Urethrocystogram voiding (74455) |
$1,525 |
$1,525 |
5.3× |
| Urethrocystography retrograde rs&i (74450) |
$1,525 |
$1,525 |
5.3× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,525 |
$1,525 |
7.3× |
| Us breast unilateral limited (76642) |
$868 |
$868 |
8.3× |
| Us chest (76604) |
$621 |
$621 |
5.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$761 |
$761 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$739 |
$739 |
5.9× |
| Us elastography parenchyma (76981) |
$678 |
$678 |
5.4× |
| Us encephalogram (76506) |
$684 |
$684 |
5.5× |
| Us hips infant static (76886) |
$579 |
$579 |
5.6× |
| Us infant hips w manipulation (76885) |
$607 |
$607 |
5.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$448 |
$448 |
3.6× |
| Us ob detailed single fetus (76811) |
$1,099 |
$1,099 |
3.8× |
| Us ob limited (76815) |
$621 |
$621 |
5.0× |
| Us ob transvaginal (76817) |
$746 |
$746 |
6.0× |
| Us pelvic non ob complete (76856) |
$782 |
$782 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$507 |
$507 |
4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$753 |
$753 |
6.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$464 |
$464 |
3.7× |
| Us retroperitoneal complete (76770) |
$708 |
$708 |
5.7× |
| Us retroperitoneal limited (76775) |
$739 |
$739 |
5.9× |
| Us scrotum and contents (76870) |
$684 |
$684 |
5.5× |
| Us soft tissue head/neck (76536) |
$684 |
$684 |
5.5× |
| Us spinal canal and contents (76800) |
$627 |
$627 |
5.0× |
| Us transrectal (76872) |
$684 |
$684 |
5.5× |
| Us transrectal prostate volume (76873) |
$925 |
$925 |
7.4× |
| Venogram extremity bilateral (75822) |
$3,368 |
$3,368 |
1.8× |
| Venogram Extremity Unilateral (75820) |
$3,019 |
$3,019 |
1.6× |
| Venography caval inferior serialography rs&i (75825) |
$9,095 |
$9,095 |
2.4× |
| Venography caval superior serialography rs&i (75827) |
$3,763 |
$3,763 |
2.0× |
| Venography Orbital Rs&I (75880) |
$3,763 |
$3,763 |
5.0× |
| Venography Renal Bilateral (75833) |
$9,095 |
$9,095 |
2.4× |
| Venography renal unilateral selective rs&i (75831) |
$9,095 |
$9,095 |
2.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,074 |
$8,074 |
2.1× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$3,763 |
$3,763 |
5.0× |
| Venous sampling by catheter (75893) |
$14,533 |
$14,533 |
2.2× |
| Vertebral fracture assessment via dxa (77086) |
$206 |
$206 |
2.0× |
| Wrist 2 views (73100) |
$500 |
$500 |
4.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$659 |
$659 |
5.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$305 |
$305 |
2.9× |
| X-ray b.e. reductn intuss (74283) |
$805 |
$805 |
3.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,280 |
$1,280 |
6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$447 |
$447 |
4.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$527 |
$527 |
5.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$550 |
$550 |
4.4× |
| X-ray exam of femur 2/> (73552) |
$527 |
$527 |
5.1× |
| X-ray eye for foreign body (70030) |
$514 |
$514 |
4.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$330 |
$330 |
3.2× |
| X-ray IV pyelogram (ivp) (74400) |
$1,525 |
$1,525 |
7.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$411 |
$411 |
3.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$305 |
$305 |
2.9× |
| X-ray leg, infant (73592) |
$447 |
$447 |
4.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$361 |
$361 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$635 |
$635 |
5.1× |
| X-ray nose-rectum child f.b. (76010) |
$389 |
$389 |
3.7× |
| X-ray optic foramen (70190) |
$411 |
$411 |
3.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$411 |
$411 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$2,726 |
$2,726 |
6.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$305 |
$305 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$424 |
$424 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$582 |
$582 |
4.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$493 |
$493 |
3.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$330 |
$330 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$411 |
$411 |
3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$586 |
$586 |
4.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$379 |
$379 |
3.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,280 |
$1,280 |
6.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$305 |
$305 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$347 |
$347 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$347 |
$347 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$493 |
$493 |
3.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$570 |
$570 |
4.5× |
| Xr bone length studies (77073) |
$330 |
$330 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$578 |
$578 |
4.6× |
| Xr c-spine 6 or more views (72052) |
$662 |
$662 |
5.3× |
| Xr chest 4+ views (71048) |
$521 |
$521 |
4.2× |
| Xr urogram antegrade (74425) |
$2,201 |
$2,201 |
5.3× |