| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,131.60 |
$10,329 |
2.6× |
| Abdomen 2 views (74019) |
$314.40 |
$786 |
2.6× |
| Acute gi blood loss imaging (78278) |
$1,292.40 |
$3,231 |
2.8× |
| Angio Adrenal Bilat Select (75733) |
$2,015.20 |
$5,038 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$4,720.80 |
$11,802 |
1.3× |
| Angiography extremity unilateral rs&i (75710) |
$4,315.20 |
$10,788 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$3,564.40 |
$8,911 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,279 |
$10,697.50 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,564.40 |
$8,911 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,564.40 |
$8,911 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$5,926.80 |
$14,817 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,383.20 |
$10,958 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,033.60 |
$2,584 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,257.20 |
$5,643 |
0.6× |
| Ankle 2 views (73600) |
$270.80 |
$677 |
2.7× |
| Aortogram thoracic (75605) |
$5,926.80 |
$14,817 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,076 |
$10,190 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$5,140 |
$12,850 |
1.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,564.40 |
$8,911 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$1,769.60 |
$4,424 |
0.5× |
| Arthrogram ankle (73615) |
$733.60 |
$1,834 |
1.8× |
| Arthrogram elbow (73085) |
$678.80 |
$1,697 |
1.7× |
| Arthrogram hip (73525) |
$743.60 |
$1,859 |
1.8× |
| Arthrogram knee (73580) |
$828.40 |
$2,071 |
2.1× |
| Arthrogram shoulder (73040) |
$634.80 |
$1,587 |
1.6× |
| Arthrogram wrist (73115) |
$649.20 |
$1,623 |
1.6× |
| Basic dosimetry (77300) |
$456 |
$1,140 |
2.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,116.80 |
$2,792 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,302.80 |
$3,257 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$1,444 |
$3,610 |
3.1× |
| Bone age studies (77072) |
$256.40 |
$641 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,734.40 |
$4,336 |
3.7× |
| Bone Marrow Imaging Limited Area (78102) |
$942.40 |
$2,356 |
2.0× |
| Bone survey complete (77075) |
$684.80 |
$1,712 |
5.7× |
| Bone survey infant (77076) |
$307.60 |
$769 |
2.5× |
| Bowel imaging (78290) |
$1,161.20 |
$2,903 |
2.5× |
| Brachytx isodose complex (77318) |
$1,734.40 |
$4,336 |
4.0× |
| Brachytx isodose intermed (77317) |
$1,239.20 |
$3,098 |
2.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,052 |
$2,630 |
2.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,523.60 |
$3,809 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,288 |
$10,720 |
2.6× |
| Brain Imaging Vascular Flow Only (78610) |
$620 |
$1,550 |
1.0× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$810.40 |
$2,026 |
1.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$999.20 |
$2,498 |
2.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,524.80 |
$3,812 |
3.3× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,068.80 |
$5,172 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,542.80 |
$3,857 |
3.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,016.80 |
$2,542 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$278.80 |
$697 |
2.8× |
| Chest 1 view (71045) |
$246.80 |
$617 |
2.4× |
| Chest xray 3 views (71047) |
$303.60 |
$759 |
3.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$336.80 |
$842 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$471.20 |
$1,178 |
2.3× |
| Clavicle complete (73000) |
$250 |
$625 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$265.60 |
$664 |
2.2× |
| Continuing medical physics consltj pr wk (77336) |
$661.20 |
$1,653 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,908.40 |
$9,771 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,480.40 |
$6,201 |
9.0× |
| CT abdomen w contrast (74160) |
$2,142.80 |
$5,357 |
10.5× |
| CT abdomen w wo contrast (74170) |
$2,366.80 |
$5,917 |
11.7× |
| CT abdomen w/o contrast (74150) |
$1,876.40 |
$4,691 |
15.5× |
| CT angio hrt w/3d image (75574) |
$1,006.40 |
$2,516 |
2.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,256.80 |
$5,642 |
11.1× |
| CT angiography upper extremity lt (73206) |
$1,930.80 |
$4,827 |
9.5× |
| CT c-spine w/contrast (72126) |
$1,937.60 |
$4,844 |
4.8× |
| CT c-spine w/o contrast (72125) |
$1,868 |
$4,670 |
15.4× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,450.40 |
$3,626 |
7.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,272 |
$5,680 |
11.2× |
| CT chest w contrast (71260) |
$1,931.60 |
$4,829 |
9.5× |
| CT chest w/wo contrast (71270) |
$2,176.40 |
$5,441 |
10.7× |
| CT colonography screening (74263) |
$881.20 |
$2,203 |
3.2× |
| CT colonography w/dye (74262) |
$1,177.60 |
$2,944 |
5.8× |
| CT colonography w/o cntrst (74261) |
$728.40 |
$1,821 |
6.0× |
| CT head/brain with contrast (70460) |
$1,722.80 |
$4,307 |
8.5× |
| CT head/brain without and with contrast (70470) |
$1,921.20 |
$4,803 |
9.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$876.80 |
$2,192 |
2.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$47.60 |
$119 |
0.5× |
| CT hrt w/3d image congen (75573) |
$911.20 |
$2,278 |
2.3× |
| CT iac w contrast (70481) |
$2,091.20 |
$5,228 |
10.3× |
| CT limited/localized follow up study (76380) |
$768.40 |
$1,921 |
7.6× |
| CT lower ext w/o (73700) |
$1,470 |
$3,675 |
12.1× |
| CT lower extremity w wo contrast (73702) |
$2,924 |
$7,310 |
14.4× |
| CT lower extremity w/contrast material (73701) |
$2,686.80 |
$6,717 |
13.2× |
| CT lumbar spine w & w/o contrast (72133) |
$2,304 |
$5,760 |
11.3× |
| CT lumbar spine w/contrast (72132) |
$2,080 |
$5,200 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$1,734.40 |
$4,336 |
14.3× |
| CT maxillofacial w contrast (70487) |
$1,896.40 |
$4,741 |
9.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,102.80 |
$5,257 |
10.4× |
| CT maxillofacial wo contrast (70486) |
$729.20 |
$1,823 |
6.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,522.80 |
$6,307 |
12.4× |
| CT orbits w/o contrast (70480) |
$1,900.40 |
$4,751 |
15.7× |
| CT pelvis w/o contrast (72192) |
$1,516.40 |
$3,791 |
12.5× |
| CT pelvis w/wo contrast (72194) |
$1,976 |
$4,940 |
9.7× |
| CT scan of arm combo (73202) |
$2,801.60 |
$7,004 |
13.8× |
| CT soft tissue neck w contrast (70491) |
$1,734.40 |
$4,336 |
8.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,090.80 |
$5,227 |
10.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,648.80 |
$4,122 |
13.6× |
| CT thoracic spine w/contrast (72129) |
$1,871.20 |
$4,678 |
9.2× |
| CT thoracic spine w/o contrast (72128) |
$1,646.40 |
$4,116 |
13.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,982.40 |
$4,956 |
9.8× |
| CT thorax w/o contrast (71250) |
$1,189 |
$2,972.50 |
9.8× |
| CT upper ext wo (73200) |
$1,416.80 |
$3,542 |
11.7× |
| CT upper extremity with contrast (73201) |
$2,287.20 |
$5,718 |
5.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,694.80 |
$11,737 |
23.1× |
| Cta Abdomen (74175) |
$3,195.60 |
$7,989 |
15.7× |
| CTA abdomen pelvis (74174) |
$2,842.40 |
$7,106 |
7.0× |
| CTA chest (71275) |
$2,552.40 |
$6,381 |
12.6× |
| Cta Head (70496) |
$2,501.60 |
$6,254 |
12.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$5,004.80 |
$12,512 |
12.4× |
| Cta Neck (70498) |
$2,503.20 |
$6,258 |
12.3× |
| Cta Pelvis (72191) |
$2,219.20 |
$5,548 |
10.9× |
| Cystography minimum 3 views rs&i (74430) |
$618.40 |
$1,546 |
1.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$342 |
$855 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,231.40 |
$8,078.50 |
1.3× |
| Diskogram cervical (72285) |
$2,362 |
$5,905 |
1.0× |
| Diskography lumbar (72295) |
$2,362 |
$5,905 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$249.60 |
$624 |
2.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$272 |
$680 |
2.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$220 |
$550 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$307.60 |
$769 |
2.5× |
| Dxa bone density study axial skeleton (77085) |
$446 |
$1,115 |
3.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$833.20 |
$2,083 |
3.0× |
| Esophagus (74220) |
$497.60 |
$1,244 |
2.4× |
| Facial bones min 3 views (70150) |
$389.60 |
$974 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$336.40 |
$841 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$613.60 |
$1,534 |
5.1× |
| Fetal Echo (76825) |
$1,003.20 |
$2,508 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$342 |
$855 |
1.2× |
| Foot 2 views (73620) |
$314.40 |
$786 |
3.1× |
| Forearm 2 views (73090) |
$296 |
$740 |
2.9× |
| Hand 2 views (73120) |
$283.60 |
$709 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,160 |
$5,400 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,566.80 |
$6,417 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,160 |
$5,400 |
2.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,564.40 |
$8,911 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,564.40 |
$8,911 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,695.20 |
$4,238 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,292.80 |
$3,232 |
2.8× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$2,042 |
$5,105 |
2.5× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$1,221.20 |
$3,053 |
2.7× |
| Hysterosalpingogram (74740) |
$747.60 |
$1,869 |
2.7× |
| Image fusion (77399) |
$363.60 |
$909 |
2.3× |
| Interstitial radiation source applic complex (77778) |
$2,522 |
$6,305 |
3.1× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,877.20 |
$4,693 |
2.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$153.60 |
$384 |
1.3× |
| Kidney imaging morphology (78700) |
$482 |
$1,205 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,452.40 |
$3,631 |
2.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,475.20 |
$3,688 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,281.20 |
$3,203 |
2.0× |
| Knee 3 views (73562) |
$371.20 |
$928 |
3.7× |
| Liver & spleen imaging static only (78215) |
$1,236 |
$3,090 |
2.7× |
| Liver imaging static only (78201) |
$1,752.40 |
$4,381 |
2.8× |
| Liver imaging w/vascular flow (78202) |
$1,645.20 |
$4,113 |
2.6× |
| Lung perf&ventilat diferentl (78598) |
$1,914.40 |
$4,786 |
3.0× |
| Lung perfusion differential (78597) |
$1,148.40 |
$2,871 |
2.5× |
| Lung ventilation imaging (78579) |
$971.20 |
$2,428 |
2.1× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,267.20 |
$8,168 |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,217.20 |
$3,043 |
1.7× |
| Lymphoscintigraphy (78195) |
$1,636.80 |
$4,092 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,416.40 |
$6,041 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,063.20 |
$7,658 |
7.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,484 |
$8,710 |
8.6× |
| Mammary ductogram or galactogram multiple (77054) |
$602 |
$1,505 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$605.20 |
$1,513 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$923.20 |
$2,308 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$66 |
$165 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,589.20 |
$6,473 |
6.4× |
| MRA head w/o contrast (70544) |
$2,491.20 |
$6,228 |
9.0× |
| MRA head with contrast (70545) |
$2,555.20 |
$6,388 |
6.3× |
| MRA neck w contrast (70548) |
$2,589.20 |
$6,473 |
6.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,785.20 |
$6,963 |
6.9× |
| MRA neck w/o contrast (70547) |
$2,524.40 |
$6,311 |
9.1× |
| MRI abdomen w contrast (74182) |
$1,452.40 |
$3,631 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,725.20 |
$6,813 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$2,203.20 |
$5,508 |
8.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,446 |
$6,115 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,842 |
$7,105 |
7.0× |
| MRI bone marrow blood supply (77084) |
$2,493.20 |
$6,233 |
9.0× |
| MRI breast w/o contrast bilateral (77047) |
$2,308.40 |
$5,771 |
8.4× |
| MRI breast wo contrast unilateral (77046) |
$1,874 |
$4,685 |
6.8× |
| MRI c-spine with contrast (72142) |
$2,923.60 |
$7,309 |
7.2× |
| MRI cardiac w/o cont stress (75559) |
$1,475.20 |
$3,688 |
2.3× |
| MRI cardiac w/o contrast (75557) |
$1,402.80 |
$3,507 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$2,332.40 |
$5,831 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,792.80 |
$9,482 |
9.4× |
| MRI chest w/o contrast (71550) |
$2,453.20 |
$6,133 |
8.9× |
| MRI chest with contrast (71551) |
$1,694 |
$4,235 |
1.9× |
| MRI fetal sngl/1st gestation (74712) |
$1,336.80 |
$3,342 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,497.20 |
$3,743 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,273.60 |
$5,684 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,118.40 |
$5,296 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,996.80 |
$4,992 |
7.2× |
| MRI orbit face neck w contrast (70542) |
$1,996.80 |
$4,992 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,369.60 |
$8,424 |
8.3× |
| MRI pelvis w/contrast (72196) |
$2,733.60 |
$6,834 |
6.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,990 |
$7,475 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$2,253.60 |
$5,634 |
8.2× |
| MRI spectroscopy (76390) |
$859.20 |
$2,148 |
8.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,932.40 |
$9,831 |
9.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,644 |
$6,610 |
6.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,431.20 |
$8,578 |
8.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,684.80 |
$6,712 |
6.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,898 |
$9,745 |
9.6× |
| MRI temporomandibular joint (70336) |
$2,145.20 |
$5,363 |
7.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,194.40 |
$5,486 |
7.9× |
| MRI up ext w/o contrast (73218) |
$2,133.60 |
$5,334 |
7.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,028.80 |
$5,072 |
7.3× |
| MRI, joint upper extrem combo (73223) |
$3,745.60 |
$9,364 |
9.3× |
| Myelogram Cervical (72240) |
$1,525.20 |
$3,813 |
1.7× |
| Myelogram Lumbar (72265) |
$1,346.80 |
$3,367 |
1.5× |
| Myelogram thoracic (72255) |
$1,410 |
$3,525 |
1.6× |
| Myelography 2 or more regions (72270) |
$1,889.60 |
$4,724 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$6,914 |
$17,285 |
2.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$5,657.60 |
$14,144 |
2.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,049.20 |
$5,123 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,233.20 |
$8,083 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$2,414 |
$6,035 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$2,293.20 |
$5,733 |
2.3× |
| Neck soft tissue (70360) |
$258.40 |
$646 |
2.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$257.20 |
$643 |
0.6× |
| Nm bone marrow multi (78103) |
$941.60 |
$2,354 |
2.0× |
| Nm bone marrow wb (78104) |
$999.20 |
$2,498 |
2.2× |
| Nm cardiac blood pool multiple (78473) |
$1,666 |
$4,165 |
3.6× |
| Nm cisternogram (78630) |
$1,300 |
$3,250 |
2.1× |
| Nm csf leak detection (78650) |
$1,754 |
$4,385 |
1.2× |
| Nm gastric emptying study (78264) |
$1,394 |
$3,485 |
3.0× |
| Nm gastroesophageal reflux study (78262) |
$844 |
$2,110 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$309.20 |
$773 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,379.20 |
$13,448 |
3.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,631.20 |
$4,078 |
3.5× |
| Nuclear Rx Oral Admin (79005) |
$1,326.40 |
$3,316 |
4.9× |
| Ob us nuchal meas 1 gest (76813) |
$652.80 |
$1,632 |
5.4× |
| Osseous survey limited (77074) |
$449.20 |
$1,123 |
3.7× |
| Parathyrd planar w/spect&CT (78072) |
$1,242.80 |
$3,107 |
2.0× |
| Parathyroid Planar Imaging (78070) |
$1,434.40 |
$3,586 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$939.60 |
$2,349 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$294.40 |
$736 |
2.4× |
| Peritoneogram after injection (74190) |
$448.80 |
$1,122 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$4,930.40 |
$12,326 |
3.0× |
| PET imaging CT for attenuation limited area (78814) |
$3,958 |
$9,895 |
2.4× |
| PET imaging for CT attenuation whole body (78816) |
$5,191.60 |
$12,979 |
3.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,294.80 |
$15,737 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,359.20 |
$5,898 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,057.60 |
$2,644 |
2.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,771.20 |
$4,428 |
2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$678.80 |
$1,697 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$328 |
$820 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$300.80 |
$752 |
3.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$320.80 |
$802 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$275.60 |
$689 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$410.40 |
$1,026 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$250 |
$625 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$322.40 |
$806 |
3.2× |
| Radex Hand Minimum 3 Views (73130) |
$305.20 |
$763 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$371.60 |
$929 |
3.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$569.60 |
$1,424 |
4.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$589.60 |
$1,474 |
4.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$668.40 |
$1,671 |
5.5× |
| Radex Humerus Minimum 2 Views (73060) |
$280.80 |
$702 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$306 |
$765 |
3.0× |
| Radex Kne Compl 4/More Views (73564) |
$444.80 |
$1,112 |
3.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$467.20 |
$1,168 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$264.80 |
$662 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$321.20 |
$803 |
2.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$340.40 |
$851 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$365.60 |
$914 |
3.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$339.20 |
$848 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$294.80 |
$737 |
2.9× |
| Radex Toe Minimum 2 Views (73660) |
$250 |
$625 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$270 |
$675 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$332 |
$830 |
3.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,772 |
$29,430 |
1.4× |
| Radiation treatment delivery level 1 (77402) |
$915.60 |
$2,289 |
7.7× |
| Radiation treatment delivery level 2 (77407) |
$2,044.40 |
$5,111 |
4.6× |
| Radiation treatment delivery level 3 (77412) |
$2,594.80 |
$6,487 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$252 |
$630 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$381.60 |
$954 |
3.2× |
| Radiologic exam chest 2 views (71046) |
$299.20 |
$748 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$904.80 |
$2,262 |
4.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$503.20 |
$1,258 |
2.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$643.60 |
$1,609 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$570.40 |
$1,426 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$333.20 |
$833 |
3.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$248.40 |
$621 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$327.60 |
$819 |
3.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$220.40 |
$551 |
1.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$195.20 |
$488 |
1.6× |
| Radiological examination surgical specimen (76098) |
$572 |
$1,430 |
0.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$890 |
$2,225 |
3.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,160 |
$5,400 |
4.8× |
| Ribs bilateral 3 views (71110) |
$483.60 |
$1,209 |
4.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,139.60 |
$2,849 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,206 |
$3,015 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,098.40 |
$7,746 |
4.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,811.60 |
$4,529 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,959.20 |
$4,898 |
3.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,318.40 |
$8,296 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,877.60 |
$7,194 |
1.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$497.60 |
$1,244 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$1,008.40 |
$2,521 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$278 |
$695 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$302 |
$755 |
1.1× |
| Scapula (73010) |
$285.20 |
$713 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$40 |
$100 |
1.7× |
| Sella turcica (70240) |
$219.60 |
$549 |
2.2× |
| Shoulder 1 view (73020) |
$250 |
$625 |
2.5× |
| Sialogram (70390) |
$495.20 |
$1,238 |
1.8× |
| Simulation intermediate (77285) |
$1,262 |
$3,155 |
2.9× |
| Small bowel series (74250) |
$571.20 |
$1,428 |
2.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$890 |
$2,225 |
2.1× |
| Special dosimetry (77331) |
$184.40 |
$461 |
1.2× |
| Special Physics Consult (77370) |
$509.20 |
$1,273 |
3.3× |
| Special treatment procedure (77470) |
$2,365.60 |
$5,914 |
3.7× |
| Spine thoracic 3 views (72072) |
$371.20 |
$928 |
3.1× |
| Stereotactic Body Radiation Delivery (77373) |
$5,084.60 |
$12,711.50 |
2.5× |
| Superior sagittal sinus venogram (75870) |
$2,257.20 |
$5,643 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$328.40 |
$821 |
2.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,204.80 |
$3,012 |
2.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$958.80 |
$2,397 |
2.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$540.40 |
$1,351 |
2.0× |
| Testicular Imaging With Vascular Flow (78761) |
$634 |
$1,585 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,674.80 |
$4,187 |
3.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$796 |
$1,990 |
5.1× |
| Thoracolumbar 2 views (72080) |
$286.80 |
$717 |
2.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,015.20 |
$5,038 |
3.2× |
| Thyroid imaging w/blood flow (78013) |
$912 |
$2,280 |
2.0× |
| Thyroid uptake measurement (78012) |
$510.80 |
$1,277 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$943.20 |
$2,358 |
2.0× |
| Tmj unilateral (70328) |
$257.20 |
$643 |
2.6× |
| Tomogram (76100) |
$494 |
$1,235 |
4.1× |
| Treatment device complex (77334) |
$904.20 |
$2,260.50 |
2.1× |
| Treatment device intermediate (77333) |
$502.20 |
$1,255.50 |
3.2× |
| Treatment devices simple (77332) |
$390.40 |
$976 |
2.5× |
| Ultrasound breast complete (76641) |
$438 |
$1,095 |
3.6× |
| Ultrasound elastography first target lesion (76982) |
$287.20 |
$718 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$514 |
$1,285 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$582.80 |
$1,457 |
4.8× |
| Umbilical-artery Doppler (OB) (76820) |
$220 |
$550 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$431.20 |
$1,078 |
4.3× |
| Unlisted fluoroscopic procedure (76496) |
$220 |
$550 |
2.2× |
| Unlisted magnetic resonance procedure (76498) |
$5,513.20 |
$13,783 |
54.7× |
| Ureteral reflux study (78740) |
$482 |
$1,205 |
1.0× |
| Urethrocystogram voiding (74455) |
$672.40 |
$1,681 |
2.4× |
| Urethrocystography retrograde rs&i (74450) |
$612 |
$1,530 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$529.60 |
$1,324 |
2.6× |
| Us breast unilateral limited (76642) |
$514 |
$1,285 |
5.1× |
| Us chest (76604) |
$448 |
$1,120 |
3.7× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$403.20 |
$1,008 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$616.40 |
$1,541 |
5.1× |
| Us elastography parenchyma (76981) |
$261.60 |
$654 |
2.2× |
| Us encephalogram (76506) |
$450 |
$1,125 |
3.7× |
| Us hips infant static (76886) |
$272 |
$680 |
2.7× |
| Us infant hips w manipulation (76885) |
$403.60 |
$1,009 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$411.60 |
$1,029 |
3.4× |
| Us ob detailed single fetus (76811) |
$565.60 |
$1,414 |
2.0× |
| Us ob limited (76815) |
$388.80 |
$972 |
3.2× |
| Us ob transvaginal (76817) |
$409 |
$1,022.50 |
3.4× |
| Us pelvic non ob complete (76856) |
$701.60 |
$1,754 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$440.40 |
$1,101 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$598 |
$1,495 |
4.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$307.60 |
$769 |
2.5× |
| Us retroperitoneal complete (76770) |
$629.20 |
$1,573 |
5.2× |
| Us retroperitoneal limited (76775) |
$479.60 |
$1,199 |
4.0× |
| Us scrotum and contents (76870) |
$511.20 |
$1,278 |
4.2× |
| Us soft tissue head/neck (76536) |
$574 |
$1,435 |
4.7× |
| Us spinal canal and contents (76800) |
$312.80 |
$782 |
2.6× |
| Us transrectal (76872) |
$348 |
$870 |
2.9× |
| Us transrectal prostate volume (76873) |
$300.80 |
$752 |
2.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$490.40 |
$1,226 |
4.1× |
| Venogram extremity bilateral (75822) |
$2,182.80 |
$5,457 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$1,396.80 |
$3,492 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$3,719.60 |
$9,299 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$2,763.20 |
$6,908 |
1.5× |
| Venography Renal Bilateral (75833) |
$3,564.40 |
$8,911 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$3,564.40 |
$8,911 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,564.40 |
$8,911 |
1.0× |
| Venous sampling by catheter (75893) |
$5,926.80 |
$14,817 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$177.60 |
$444 |
1.8× |
| Wrist 2 views (73100) |
$255.20 |
$638 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$439.20 |
$1,098 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$344.40 |
$861 |
3.4× |
| X-ray b.e. reductn intuss (74283) |
$728.80 |
$1,822 |
3.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$918 |
$2,295 |
4.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$287.60 |
$719 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$487.20 |
$1,218 |
4.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$640.40 |
$1,601 |
5.3× |
| X-ray exam of femur 2/> (73552) |
$333.20 |
$833 |
3.3× |
| X-ray eye for foreign body (70030) |
$216.40 |
$541 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$361.60 |
$904 |
3.6× |
| X-ray IV pyelogram (ivp) (74400) |
$756.40 |
$1,891 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$252.40 |
$631 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$357.20 |
$893 |
3.5× |
| X-ray leg, infant (73592) |
$192.80 |
$482 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$394.40 |
$986 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$341.80 |
$854.50 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$250 |
$625 |
2.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$372.40 |
$931 |
3.1× |
| X-ray retrograde pyelogram (74420) |
$1,016.40 |
$2,541 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$265.20 |
$663 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$382 |
$955 |
3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$441.20 |
$1,103 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$342.80 |
$857 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$342.80 |
$857 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$527.20 |
$1,318 |
5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$492.80 |
$1,232 |
4.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$322.80 |
$807 |
2.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$673.20 |
$1,683 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$254 |
$635 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$264.40 |
$661 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$264 |
$660 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$307.60 |
$769 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$378.80 |
$947 |
3.1× |
| Xr bone length studies (77073) |
$288 |
$720 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$544 |
$1,360 |
4.5× |
| Xr c-spine 6 or more views (72052) |
$497.20 |
$1,243 |
4.1× |
| Xr chest 4+ views (71048) |
$314.80 |
$787 |
2.6× |
| Xr urogram antegrade (74425) |
$678.80 |
$1,697 |
1.7× |