| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,672.40 |
$9,181 |
2.4× |
| Abdomen 2 views (74019) |
$424.80 |
$1,062 |
3.6× |
| Acute gi blood loss imaging (78278) |
$1,250.40 |
$3,126 |
2.8× |
| Angiography extremity bilateral rs&i (75716) |
$5,378.80 |
$13,447 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,999.20 |
$12,498 |
1.4× |
| Angiography internal mammary rs&i (75756) |
$4,999.20 |
$12,498 |
1.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$12,086 |
$30,215 |
1.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,064.80 |
$17,662 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$7,064.80 |
$17,662 |
2.0× |
| Angiography Spinal Selective Rs&I (75705) |
$8,291.20 |
$20,728 |
1.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$12,086 |
$30,215 |
1.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,262.80 |
$10,657 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,380.80 |
$5,952 |
0.7× |
| Ankle 2 views (73600) |
$222 |
$555 |
2.3× |
| Aortogram thoracic (75605) |
$15,108 |
$37,770 |
2.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$8,830 |
$22,075 |
2.5× |
| Aortography abdominal serialography rs&i (75625) |
$4,999.20 |
$12,498 |
1.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$4,999.20 |
$12,498 |
1.4× |
| Artery X-Rays Adrenal Gland (75731) |
$3,874.40 |
$9,686 |
1.1× |
| Arthrogram hip (73525) |
$1,616.40 |
$4,041 |
4.2× |
| Arthrogram knee (73580) |
$1,616.40 |
$4,041 |
4.2× |
| Arthrogram shoulder (73040) |
$1,616.40 |
$4,041 |
4.2× |
| Arthrogram wrist (73115) |
$959.20 |
$2,398 |
2.5× |
| Basic dosimetry (77300) |
$193.60 |
$484 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,439.60 |
$3,599 |
3.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$2,195.20 |
$5,488 |
4.9× |
| Bone &/joint imaging whole body (78306) |
$1,952.40 |
$4,881 |
4.4× |
| Bone age studies (77072) |
$424.80 |
$1,062 |
3.6× |
| Bone Imaging 3 Phase (78315) |
$1,985.60 |
$4,964 |
4.5× |
| Bone Marrow Imaging Limited Area (78102) |
$766.80 |
$1,917 |
1.7× |
| Bone survey complete (77075) |
$424.80 |
$1,062 |
3.6× |
| Bone survey infant (77076) |
$424.80 |
$1,062 |
3.6× |
| Bowel imaging (78290) |
$1,250.40 |
$3,126 |
2.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,349.60 |
$5,874 |
1.5× |
| Brain Imaging Vascular Flow Only (78610) |
$1,622 |
$4,055 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,250.40 |
$3,126 |
2.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,415.60 |
$6,039 |
2.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,425.20 |
$6,063 |
6.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,622 |
$4,055 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$222 |
$555 |
2.3× |
| Chest 1 view (71045) |
$219.60 |
$549 |
2.3× |
| Chest xray 3 views (71047) |
$219.60 |
$549 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$424.80 |
$1,062 |
2.2× |
| Clavicle complete (73000) |
$222 |
$555 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$130.80 |
$327 |
1.1× |
| Continuing medical physics consltj pr wk (77336) |
$244.40 |
$611 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,342.80 |
$3,357 |
3.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,302.80 |
$3,257 |
4.9× |
| CT abdomen w contrast (74160) |
$1,342.80 |
$3,357 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,342.80 |
$3,357 |
6.9× |
| CT abdomen w/o contrast (74150) |
$630.80 |
$1,577 |
5.4× |
| CT angio hrt w/3d image (75574) |
$1,342.80 |
$3,357 |
3.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,342.80 |
$3,357 |
6.9× |
| CT angiography upper extremity lt (73206) |
$1,342.80 |
$3,357 |
6.9× |
| CT c-spine w/contrast (72126) |
$2,425.20 |
$6,063 |
6.2× |
| CT c-spine w/o contrast (72125) |
$630.80 |
$1,577 |
5.4× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,714 |
$4,285 |
8.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,342.80 |
$3,357 |
6.9× |
| CT chest w contrast (71260) |
$1,342.80 |
$3,357 |
6.9× |
| CT chest w/wo contrast (71270) |
$1,342.80 |
$3,357 |
6.9× |
| CT head/brain with contrast (70460) |
$1,342.80 |
$3,357 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,342.80 |
$3,357 |
6.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,342.80 |
$3,357 |
3.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$44.40 |
$111 |
0.5× |
| CT iac w contrast (70481) |
$1,342.80 |
$3,357 |
6.9× |
| CT limited/localized follow up study (76380) |
$330.40 |
$826 |
3.4× |
| CT lower ext w/o (73700) |
$630.80 |
$1,577 |
5.4× |
| CT lower extremity w wo contrast (73702) |
$1,342.80 |
$3,357 |
6.9× |
| CT lower extremity w/contrast material (73701) |
$1,342.80 |
$3,357 |
6.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,342.80 |
$3,357 |
6.9× |
| CT lumbar spine w/contrast (72132) |
$2,425.20 |
$6,063 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$630.80 |
$1,577 |
5.4× |
| CT maxillofacial w contrast (70487) |
$1,342.80 |
$3,357 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,342.80 |
$3,357 |
6.9× |
| CT maxillofacial wo contrast (70486) |
$630.80 |
$1,577 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,342.80 |
$3,357 |
6.9× |
| CT orbits w/o contrast (70480) |
$630.80 |
$1,577 |
5.4× |
| CT pelvis w/o contrast (72192) |
$630.80 |
$1,577 |
5.4× |
| CT pelvis w/wo contrast (72194) |
$1,342.80 |
$3,357 |
6.9× |
| CT scan of arm combo (73202) |
$1,342.80 |
$3,357 |
6.9× |
| CT soft tissue neck w contrast (70491) |
$1,342.80 |
$3,357 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,342.80 |
$3,357 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$630.80 |
$1,577 |
5.4× |
| CT thoracic spine w/contrast (72129) |
$1,342.80 |
$3,357 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$630.80 |
$1,577 |
5.4× |
| CT thorax w/o contrast (71250) |
$630.80 |
$1,577 |
5.4× |
| CT upper ext wo (73200) |
$630.80 |
$1,577 |
5.4× |
| CT upper extremity with contrast (73201) |
$1,342.80 |
$3,357 |
3.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,342.80 |
$3,357 |
6.9× |
| Cta Abdomen (74175) |
$1,342.80 |
$3,357 |
6.9× |
| CTA abdomen pelvis (74174) |
$1,342.80 |
$3,357 |
3.5× |
| CTA chest (71275) |
$1,342.80 |
$3,357 |
6.9× |
| Cta Head (70496) |
$1,342.80 |
$3,357 |
6.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,685.60 |
$6,714 |
6.9× |
| Cta Neck (70498) |
$1,342.80 |
$3,357 |
6.9× |
| Cta Pelvis (72191) |
$1,342.80 |
$3,357 |
6.9× |
| Cystography minimum 3 views rs&i (74430) |
$904.40 |
$2,261 |
2.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,250.40 |
$8,126 |
1.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$259.20 |
$648 |
2.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$520 |
$1,300 |
4.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$425.60 |
$1,064 |
3.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$272.80 |
$682 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$520 |
$1,300 |
2.0× |
| Esophagus (74220) |
$904.40 |
$2,261 |
4.6× |
| Facial bones min 3 views (70150) |
$424.80 |
$1,062 |
3.6× |
| Fetal biophysical profile non-stress testing (76818) |
$420.80 |
$1,052 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$420.80 |
$1,052 |
3.6× |
| Fetal Echo (76825) |
$1,844 |
$4,610 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$455.20 |
$1,138 |
1.7× |
| Foot 2 views (73620) |
$222 |
$555 |
2.3× |
| Forearm 2 views (73090) |
$222 |
$555 |
2.3× |
| Hand 2 views (73120) |
$424.80 |
$1,062 |
3.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,049.60 |
$12,624 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,049.60 |
$12,624 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,622 |
$4,055 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$671.20 |
$1,678 |
1.5× |
| Hysterosalpingogram (74740) |
$876.80 |
$2,192 |
3.3× |
| Image fusion (77399) |
$244.40 |
$611 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$2,555.60 |
$6,389 |
3.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,622 |
$4,055 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,622 |
$4,055 |
2.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$858.80 |
$2,147 |
1.4× |
| Knee 3 views (73562) |
$222 |
$555 |
2.3× |
| Liver & spleen imaging static only (78215) |
$1,250.40 |
$3,126 |
2.8× |
| Lung perf&ventilat diferentl (78598) |
$1,622 |
$4,055 |
2.7× |
| Lung ventilation imaging (78579) |
$1,250.40 |
$3,126 |
2.8× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,338.40 |
$10,846 |
1.2× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,185.20 |
$2,963 |
1.7× |
| Lymphoscintigraphy (78195) |
$1,622 |
$4,055 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,623.20 |
$9,058 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,425.20 |
$6,063 |
6.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,425.20 |
$6,063 |
6.2× |
| Magnetic Resonance Elastography (76391) |
$446 |
$1,115 |
1.7× |
| Mammary ductogram or galactogram single (77053) |
$876.80 |
$2,192 |
3.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$648 |
$1,620 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$60.80 |
$152 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,425.20 |
$6,063 |
6.2× |
| MRA head w/o contrast (70544) |
$1,302.80 |
$3,257 |
4.9× |
| MRA head with contrast (70545) |
$1,342.80 |
$3,357 |
3.5× |
| MRA neck w contrast (70548) |
$1,342.80 |
$3,357 |
3.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,425.20 |
$6,063 |
6.2× |
| MRA neck w/o contrast (70547) |
$1,302.80 |
$3,257 |
4.9× |
| MRI abdomen w contrast (74182) |
$2,425.20 |
$6,063 |
6.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,425.20 |
$6,063 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,302.80 |
$3,257 |
4.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,623.20 |
$9,058 |
4.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,425.20 |
$6,063 |
6.2× |
| MRI bone marrow blood supply (77084) |
$1,302.80 |
$3,257 |
4.9× |
| MRI c-spine with contrast (72142) |
$2,425.20 |
$6,063 |
6.2× |
| MRI cardiac w/o cont stress (75559) |
$1,302.80 |
$3,257 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$1,302.80 |
$3,257 |
4.9× |
| MRI cervical spine w/o contrast (72141) |
$1,302.80 |
$3,257 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,425.20 |
$6,063 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,302.80 |
$3,257 |
4.9× |
| MRI chest with contrast (71551) |
$3,623.20 |
$9,058 |
4.1× |
| MRI fetal sngl/1st gestation (74712) |
$1,048.80 |
$2,622 |
3.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,342.80 |
$3,357 |
3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,425.20 |
$6,063 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,302.80 |
$3,257 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,302.80 |
$3,257 |
4.9× |
| MRI orbit face neck w contrast (70542) |
$2,425.20 |
$6,063 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,425.20 |
$6,063 |
6.2× |
| MRI pelvis w/contrast (72196) |
$2,425.20 |
$6,063 |
6.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,425.20 |
$6,063 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$1,302.80 |
$3,257 |
4.9× |
| MRI spectroscopy (76390) |
$937.60 |
$2,344 |
9.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,425.20 |
$6,063 |
6.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,425.20 |
$6,063 |
6.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,425.20 |
$6,063 |
6.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,425.20 |
$6,063 |
6.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,425.20 |
$6,063 |
6.2× |
| MRI temporomandibular joint (70336) |
$1,302.80 |
$3,257 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,302.80 |
$3,257 |
4.9× |
| MRI up ext w/o contrast (73218) |
$1,302.80 |
$3,257 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,302.80 |
$3,257 |
4.9× |
| MRI, joint upper extrem combo (73223) |
$2,425.20 |
$6,063 |
6.2× |
| Myelogram Cervical (72240) |
$2,440 |
$6,100 |
2.8× |
| Myelogram Lumbar (72265) |
$2,440 |
$6,100 |
2.8× |
| Myelogram thoracic (72255) |
$2,440 |
$6,100 |
2.8× |
| Myelography 2 or more regions (72270) |
$2,440 |
$6,100 |
2.8× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$5,950.40 |
$14,876 |
2.4× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$5,128 |
$12,820 |
2.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,342.80 |
$5,857 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$4,303.60 |
$10,759 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,318.40 |
$5,796 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$2,438 |
$6,095 |
2.5× |
| Neck soft tissue (70360) |
$222 |
$555 |
2.3× |
| Nm cisternogram (78630) |
$1,622 |
$4,055 |
2.7× |
| Nm gastric emptying study (78264) |
$1,250.40 |
$3,126 |
2.8× |
| Nm gastroesophageal reflux study (78262) |
$1,250.40 |
$3,126 |
2.8× |
| Nonvascular shunt X-ray (75809) |
$227.60 |
$569 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,566.80 |
$11,417 |
3.0× |
| Nuclear Rx Oral Admin (79005) |
$853.20 |
$2,133 |
3.3× |
| Ob us nuchal meas 1 gest (76813) |
$256.80 |
$642 |
2.2× |
| Osseous survey limited (77074) |
$424.80 |
$1,062 |
3.6× |
| Parathyroid Planar Imaging (78070) |
$1,250.40 |
$3,126 |
2.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,337.60 |
$3,344 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$424.80 |
$1,062 |
3.6× |
| PET image w/CT, skull-thigh (78815) |
$4,878 |
$12,195 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$2,349.60 |
$5,874 |
1.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,049.60 |
$12,624 |
1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,380.80 |
$5,952 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,250.40 |
$3,126 |
2.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,622 |
$4,055 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$939.60 |
$2,349 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$222 |
$555 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$222 |
$555 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$222 |
$555 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$142 |
$355 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$424.80 |
$1,062 |
3.6× |
| Radex fingr minimum 2 views (73140) |
$222 |
$555 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$222 |
$555 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$222 |
$555 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$222 |
$555 |
2.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$424.80 |
$1,062 |
3.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$455.20 |
$1,138 |
3.9× |
| Radex Humerus Minimum 2 Views (73060) |
$222 |
$555 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$222 |
$555 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$424.80 |
$1,062 |
3.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$424.80 |
$1,062 |
3.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$222 |
$555 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$424.80 |
$1,062 |
3.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$222 |
$555 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$222 |
$555 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$424.80 |
$1,062 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$222 |
$555 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$222 |
$555 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$424.80 |
$1,062 |
3.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$222 |
$555 |
2.3× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$40,811.60 |
$102,029 |
5.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$16,382.80 |
$40,957 |
2.0× |
| Radiation treatment delivery level 1 (77402) |
$359.60 |
$899 |
3.2× |
| Radiation treatment delivery level 2 (77407) |
$896 |
$2,240 |
2.1× |
| Radiation treatment delivery level 3 (77412) |
$1,131.20 |
$2,828 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$222 |
$555 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$165.60 |
$414 |
1.4× |
| Radiologic exam chest 2 views (71046) |
$219.60 |
$549 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$904.40 |
$2,261 |
4.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$904.40 |
$2,261 |
4.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$834 |
$2,085 |
4.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$222 |
$555 |
2.3× |
| Radiological examination surgical specimen (76098) |
$1,741.20 |
$4,353 |
2.9× |
| Ribs bilateral 3 views (71110) |
$424.80 |
$1,062 |
3.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,250.40 |
$3,126 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$762.80 |
$1,907 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,698.40 |
$11,746 |
7.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,303.60 |
$10,759 |
7.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,684.40 |
$6,711 |
4.4× |
| Rp therapy intra-arterial particulate admn (79445) |
$547.60 |
$1,369 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$853.20 |
$2,133 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$424.80 |
$1,062 |
3.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$868.40 |
$2,171 |
3.3× |
| Scapula (73010) |
$424.80 |
$1,062 |
3.6× |
| Shoulder 1 view (73020) |
$222 |
$555 |
2.3× |
| Small bowel series (74250) |
$424.80 |
$1,062 |
2.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$648 |
$1,620 |
1.6× |
| Special dosimetry (77331) |
$244.40 |
$611 |
1.6× |
| Special Physics Consult (77370) |
$174.40 |
$436 |
1.2× |
| Special treatment procedure (77470) |
$1,976 |
$4,940 |
3.2× |
| Spine thoracic 3 views (72072) |
$424.80 |
$1,062 |
3.6× |
| Stereotactic Body Radiation Delivery (77373) |
$2,672.80 |
$6,682 |
1.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$237.20 |
$593 |
2.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$648 |
$1,620 |
1.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$648 |
$1,620 |
1.6× |
| Testicular Imaging With Vascular Flow (78761) |
$1,250.40 |
$3,126 |
2.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$557.20 |
$1,393 |
1.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$244.40 |
$611 |
1.6× |
| Thoracolumbar 2 views (72080) |
$222 |
$555 |
2.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,622 |
$4,055 |
2.7× |
| Thyroid uptake measurement (78012) |
$1,250.40 |
$3,126 |
2.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,250.40 |
$3,126 |
2.8× |
| Tomogram (76100) |
$424.80 |
$1,062 |
3.6× |
| Treatment device complex (77334) |
$786.80 |
$1,967 |
1.9× |
| Treatment device intermediate (77333) |
$324.40 |
$811 |
2.2× |
| Treatment devices simple (77332) |
$244.40 |
$611 |
1.6× |
| Ultrasound breast complete (76641) |
$420.80 |
$1,052 |
3.6× |
| Ultrasound elastography first target lesion (76982) |
$200.40 |
$501 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$225.60 |
$564 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$420.80 |
$1,052 |
3.6× |
| Umbilical-artery Doppler (OB) (76820) |
$420.80 |
$1,052 |
3.6× |
| Unlisted fluoroscopic procedure (76496) |
$220 |
$550 |
2.3× |
| Urethrocystogram voiding (74455) |
$876.80 |
$2,192 |
3.3× |
| Urethrocystography retrograde rs&i (74450) |
$876.80 |
$2,192 |
3.3× |
| Us breast unilateral limited (76642) |
$219.60 |
$549 |
2.3× |
| Us chest (76604) |
$420.80 |
$1,052 |
3.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$456.80 |
$1,142 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$420.80 |
$1,052 |
3.6× |
| Us elastography parenchyma (76981) |
$214.40 |
$536 |
1.8× |
| Us encephalogram (76506) |
$420.80 |
$1,052 |
3.6× |
| Us hips infant static (76886) |
$219.60 |
$549 |
2.3× |
| Us infant hips w manipulation (76885) |
$219.60 |
$549 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$420.80 |
$1,052 |
3.6× |
| Us ob detailed single fetus (76811) |
$420.80 |
$1,052 |
1.6× |
| Us ob limited (76815) |
$420.80 |
$1,052 |
3.6× |
| Us ob transvaginal (76817) |
$420.80 |
$1,052 |
3.6× |
| Us pelvic non ob complete (76856) |
$420.80 |
$1,052 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$420.80 |
$1,052 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$420.80 |
$1,052 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$420.80 |
$1,052 |
3.6× |
| Us retroperitoneal complete (76770) |
$420.80 |
$1,052 |
3.6× |
| Us retroperitoneal limited (76775) |
$420.80 |
$1,052 |
3.6× |
| Us scrotum and contents (76870) |
$420.80 |
$1,052 |
3.6× |
| Us soft tissue head/neck (76536) |
$420.80 |
$1,052 |
3.6× |
| Us spinal canal and contents (76800) |
$420.80 |
$1,052 |
3.6× |
| Us transrectal (76872) |
$420.80 |
$1,052 |
3.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$420.80 |
$1,052 |
3.6× |
| Venogram extremity bilateral (75822) |
$2,287.20 |
$5,718 |
1.3× |
| Venogram Extremity Unilateral (75820) |
$1,426 |
$3,565 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$7,136 |
$17,840 |
2.0× |
| Venography caval superior serialography rs&i (75827) |
$2,348.40 |
$5,871 |
1.3× |
| Venography Renal Bilateral (75833) |
$5,049.60 |
$12,624 |
1.4× |
| Venography renal unilateral selective rs&i (75831) |
$7,136 |
$17,840 |
2.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,999.20 |
$12,498 |
1.4× |
| Venous sampling by catheter (75893) |
$8,375.20 |
$20,938 |
1.4× |
| Wrist 2 views (73100) |
$222 |
$555 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$222 |
$555 |
2.3× |
| X-ray b.e. reductn intuss (74283) |
$904.40 |
$2,261 |
4.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$904.40 |
$2,261 |
4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$222 |
$555 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$222 |
$555 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$165.60 |
$414 |
1.4× |
| X-ray exam of femur 2/> (73552) |
$222 |
$555 |
2.3× |
| X-ray eye for foreign body (70030) |
$222 |
$555 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$222 |
$555 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$904.40 |
$2,261 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$222 |
$555 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$46.40 |
$116 |
0.5× |
| X-ray leg, infant (73592) |
$222 |
$555 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$433.60 |
$1,084 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$424.80 |
$1,062 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$191.20 |
$478 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$424.80 |
$1,062 |
3.6× |
| X-ray retrograde pyelogram (74420) |
$1,632.80 |
$4,082 |
4.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$222 |
$555 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$222 |
$555 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$222 |
$555 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$424.80 |
$1,062 |
3.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$424.80 |
$1,062 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$222 |
$555 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$222 |
$555 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$222 |
$555 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$424.80 |
$1,062 |
3.6× |
| Xr bone length studies (77073) |
$424.80 |
$1,062 |
3.6× |
| Xr c-spine 4 or 5 views (72050) |
$424.80 |
$1,062 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$424.80 |
$1,062 |
3.6× |
| Xr chest 4+ views (71048) |
$420.80 |
$1,052 |
3.6× |
| Xr urogram antegrade (74425) |
$969.20 |
$2,423 |
2.5× |