| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,995.20 |
$7,136 |
3.1× |
| Abdomen 2 views (74019) |
$286.30 |
$409 |
2.3× |
| Acute gi blood loss imaging (78278) |
$1,531.60 |
$2,188 |
3.2× |
| Angio Adrenal Bilat Select (75733) |
$3,198.30 |
$4,569 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,354.40 |
$4,792 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,198.30 |
$4,569 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$3,354.40 |
$4,792 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,694.90 |
$6,707 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,354.40 |
$4,792 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,198.30 |
$4,569 |
0.9× |
| Angiography Spinal Selective Rs&I (75705) |
$4,694.90 |
$6,707 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,513.20 |
$7,876 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,059.80 |
$1,514 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,054.30 |
$8,649 |
1.6× |
| Ankle 2 views (73600) |
$438.90 |
$627 |
4.3× |
| Aortogram thoracic (75605) |
$4,694.90 |
$6,707 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,198.30 |
$4,569 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$3,474.80 |
$4,964 |
0.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,354.40 |
$4,792 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$3,354.40 |
$4,792 |
0.9× |
| Arthrogram ankle (73615) |
$1,165.50 |
$1,665 |
2.8× |
| Arthrogram elbow (73085) |
$847 |
$1,210 |
2.1× |
| Arthrogram hip (73525) |
$1,444.80 |
$2,064 |
3.5× |
| Arthrogram knee (73580) |
$1,079.40 |
$1,542 |
2.6× |
| Arthrogram shoulder (73040) |
$1,187.90 |
$1,697 |
2.9× |
| Arthrogram wrist (73115) |
$1,330.70 |
$1,901 |
3.2× |
| Basic dosimetry (77300) |
$618.80 |
$884 |
3.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$956.90 |
$1,367 |
2.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,100.40 |
$1,572 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,080.10 |
$1,543 |
2.3× |
| Bone age studies (77072) |
$367.15 |
$524.50 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$1,106 |
$1,580 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$970.90 |
$1,387 |
2.1× |
| Bone survey complete (77075) |
$815.50 |
$1,165 |
6.6× |
| Bone survey infant (77076) |
$597.80 |
$854 |
4.8× |
| Bowel imaging (78290) |
$1,801.80 |
$2,574 |
3.8× |
| Brachytx isodose complex (77318) |
$1,174.60 |
$1,678 |
2.7× |
| Brachytx isodose intermed (77317) |
$1,068.20 |
$1,526 |
2.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$886.20 |
$1,266 |
2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$919.10 |
$1,313 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,417.40 |
$4,882 |
2.0× |
| Brain Imaging Vascular Flow Only (78610) |
$976.50 |
$1,395 |
1.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$761.60 |
$1,088 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$578.90 |
$827 |
1.2× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,045.80 |
$1,494 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,473.80 |
$3,534 |
6.0× |
| Cardiac shunt detection (78428) |
$654.50 |
$935 |
1.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,616.30 |
$2,309 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$277.20 |
$396 |
2.7× |
| Chest 1 view (71045) |
$435.40 |
$622 |
4.2× |
| Chest xray 3 views (71047) |
$308 |
$440 |
3.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$449.40 |
$642 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$454.30 |
$649 |
2.2× |
| Clavicle complete (73000) |
$239.40 |
$342 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$594.30 |
$849 |
4.8× |
| Continuing medical physics consltj pr wk (77336) |
$563.50 |
$805 |
3.5× |
| Corpora cavernosography (74445) |
$1,892.80 |
$2,704 |
15.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,430 |
$4,900 |
8.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,087.40 |
$2,982 |
7.4× |
| CT abdomen w contrast (74160) |
$1,817.20 |
$2,596 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,830.50 |
$2,615 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,499.40 |
$2,142 |
12.1× |
| CT angio hrt w/3d image (75574) |
$2,122.40 |
$3,032 |
5.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,338 |
$3,340 |
11.3× |
| CT angiography upper extremity lt (73206) |
$987.70 |
$1,411 |
4.8× |
| CT c-spine w/contrast (72126) |
$3,682.70 |
$5,261 |
8.9× |
| CT c-spine w/o contrast (72125) |
$1,365 |
$1,950 |
11.1× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$362.60 |
$518 |
1.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,097.20 |
$2,996 |
10.1× |
| CT chest w contrast (71260) |
$1,493.10 |
$2,133 |
7.2× |
| CT chest w/wo contrast (71270) |
$2,278.50 |
$3,255 |
11.0× |
| CT head/brain with contrast (70460) |
$2,421.30 |
$3,459 |
11.7× |
| CT head/brain without and with contrast (70470) |
$1,876.70 |
$2,681 |
9.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$970.90 |
$1,387 |
2.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$92.40 |
$132 |
0.9× |
| CT hrt w/3d image congen (75573) |
$432.60 |
$618 |
1.0× |
| CT iac w contrast (70481) |
$2,291.80 |
$3,274 |
11.1× |
| CT limited/localized follow up study (76380) |
$333.90 |
$477 |
3.2× |
| CT lower ext w/o (73700) |
$1,791.30 |
$2,559 |
14.5× |
| CT lower extremity w wo contrast (73702) |
$2,150.40 |
$3,072 |
10.4× |
| CT lower extremity w/contrast material (73701) |
$1,603.70 |
$2,291 |
7.7× |
| CT lumbar spine w & w/o contrast (72133) |
$3,192.70 |
$4,561 |
15.4× |
| CT lumbar spine w/contrast (72132) |
$2,414.30 |
$3,449 |
5.9× |
| CT lumbar spine w/o contrast (72131) |
$1,365 |
$1,950 |
11.1× |
| CT maxillofacial w contrast (70487) |
$1,694.70 |
$2,421 |
8.2× |
| CT maxillofacial w/wo contrast (70488) |
$4,432.40 |
$6,332 |
21.4× |
| CT maxillofacial wo contrast (70486) |
$1,194.20 |
$1,706 |
9.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,636.20 |
$3,766 |
12.7× |
| CT orbits w/o contrast (70480) |
$1,430.80 |
$2,044 |
11.6× |
| CT pelvis w/o contrast (72192) |
$1,282.40 |
$1,832 |
10.4× |
| CT pelvis w/wo contrast (72194) |
$2,098.60 |
$2,998 |
10.1× |
| CT scan of arm combo (73202) |
$1,974.70 |
$2,821 |
9.5× |
| CT soft tissue neck w contrast (70491) |
$1,299.20 |
$1,856 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,149.30 |
$4,499 |
15.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,709.40 |
$2,442 |
13.8× |
| CT thoracic spine w/contrast (72129) |
$2,641.80 |
$3,774 |
12.7× |
| CT thoracic spine w/o contrast (72128) |
$1,159.20 |
$1,656 |
9.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,806.70 |
$2,581 |
8.7× |
| CT thorax w/o contrast (71250) |
$1,383.20 |
$1,976 |
11.2× |
| CT upper ext wo (73200) |
$1,281 |
$1,830 |
10.4× |
| CT upper extremity with contrast (73201) |
$1,850.80 |
$2,644 |
4.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,879.50 |
$2,685 |
9.1× |
| Cta Abdomen (74175) |
$2,043.30 |
$2,919 |
9.9× |
| CTA abdomen pelvis (74174) |
$3,513.30 |
$5,019 |
8.5× |
| CTA chest (71275) |
$1,749.30 |
$2,499 |
8.4× |
| Cta Head (70496) |
$2,642.85 |
$3,775.50 |
12.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$721 |
$1,030 |
1.7× |
| Cta Neck (70498) |
$1,719.90 |
$2,457 |
8.3× |
| Cta Pelvis (72191) |
$2,975.70 |
$4,251 |
14.4× |
| Cystography minimum 3 views rs&i (74430) |
$646.10 |
$923 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,534.70 |
$3,621 |
1.0× |
| Diskogram cervical (72285) |
$4,585 |
$6,550 |
2.0× |
| Diskography lumbar (72295) |
$3,767.40 |
$5,382 |
1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$296.80 |
$424 |
2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$343.70 |
$491 |
2.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$424.90 |
$607 |
3.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$290.50 |
$415 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$116.20 |
$166 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$195.30 |
$279 |
1.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$765.10 |
$1,093 |
2.7× |
| Esophageal motility (78258) |
$595 |
$850 |
1.3× |
| Esophagus (74220) |
$490 |
$700 |
2.4× |
| Facial bones min 3 views (70150) |
$578.90 |
$827 |
4.7× |
| Fetal biophysical profile non-stress testing (76818) |
$811.30 |
$1,159 |
6.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$376.60 |
$538 |
3.0× |
| Fetal Echo (76825) |
$1,049.30 |
$1,499 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$276.50 |
$395 |
1.0× |
| Foot 2 views (73620) |
$195.30 |
$279 |
1.9× |
| Forearm 2 views (73090) |
$241.50 |
$345 |
2.3× |
| Functional MRI brain by phys/psych (70555) |
$1,064.70 |
$1,521 |
3.8× |
| Functional MRI brain by tech (70554) |
$1,275.40 |
$1,822 |
4.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,775.20 |
$2,536 |
3.8× |
| Gastric mucosa imaging (78261) |
$514.50 |
$735 |
1.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$2,070.60 |
$2,958 |
3.2× |
| Hand 2 views (73120) |
$273 |
$390 |
2.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,168.60 |
$3,098 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,634.80 |
$3,764 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,056.20 |
$4,366 |
3.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,945.50 |
$7,065 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,354.40 |
$4,792 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,277.50 |
$1,825 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$798 |
$1,140 |
1.7× |
| Hysterosalpingogram (74740) |
$1,201.90 |
$1,717 |
4.3× |
| Image fusion (77399) |
$345.80 |
$494 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$3,285.10 |
$4,693 |
4.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,612.10 |
$2,303 |
2.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$744.10 |
$1,063 |
1.1× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,075.90 |
$1,537 |
1.6× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$931 |
$1,330 |
2.0× |
| Kidney imaging morphology (78700) |
$547.40 |
$782 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,478.40 |
$2,112 |
2.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,565.20 |
$2,236 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,319.50 |
$1,885 |
2.1× |
| Knee 3 views (73562) |
$280.70 |
$401 |
2.7× |
| Liver & spleen imaging static only (78215) |
$718.20 |
$1,026 |
1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$907.90 |
$1,297 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$1,257.20 |
$1,796 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$1,745.10 |
$2,493 |
2.7× |
| Lung perfusion differential (78597) |
$670.60 |
$958 |
1.4× |
| Lung ventilation imaging (78579) |
$1,042.30 |
$1,489 |
2.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,198.30 |
$4,569 |
0.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,626.40 |
$3,752 |
0.7× |
| Lymphoscintigraphy (78195) |
$1,171.10 |
$1,673 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,463.30 |
$3,519 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,801.80 |
$2,574 |
4.4× |
| Mammary ductogram or galactogram multiple (77054) |
$603.40 |
$862 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$532.70 |
$761 |
1.9× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$198.80 |
$284 |
1.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,068.20 |
$1,526 |
2.4× |
| MRA head w & w/o contrast (70546) |
$3,712.10 |
$5,303 |
9.0× |
| MRA head w/o contrast (70544) |
$2,394.70 |
$3,421 |
8.5× |
| MRA head with contrast (70545) |
$3,712.10 |
$5,303 |
9.0× |
| MRA neck w contrast (70548) |
$2,965.90 |
$4,237 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,518.20 |
$5,026 |
8.5× |
| MRA neck w/o contrast (70547) |
$2,364.60 |
$3,378 |
8.4× |
| MRI abdomen w contrast (74182) |
$1,869 |
$2,670 |
4.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,671.90 |
$3,817 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$2,333.80 |
$3,334 |
8.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,637.60 |
$3,768 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,606.10 |
$3,723 |
6.3× |
| MRI bone marrow blood supply (77084) |
$1,843.10 |
$2,633 |
6.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,428 |
$2,040 |
5.1× |
| MRI breast wo contrast unilateral (77046) |
$1,223.60 |
$1,748 |
4.3× |
| MRI cardiac w/o cont stress (75559) |
$1,064 |
$1,520 |
1.6× |
| MRI cardiac w/o contrast (75557) |
$1,488.90 |
$2,127 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,461.60 |
$2,088 |
5.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,953 |
$2,790 |
4.7× |
| MRI chest w/o contrast (71550) |
$2,456.30 |
$3,509 |
8.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$737.80 |
$1,054 |
1.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,433.90 |
$3,477 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,958.90 |
$4,227 |
10.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,255 |
$4,650 |
11.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,507.40 |
$3,582 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,720.90 |
$3,887 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$2,310 |
$3,300 |
8.2× |
| MRI spectroscopy (76390) |
$1,619.10 |
$2,313 |
15.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,553.60 |
$3,648 |
6.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,461.20 |
$3,516 |
6.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,462.60 |
$3,518 |
6.0× |
| MRI temporomandibular joint (70336) |
$1,896.30 |
$2,709 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,010.40 |
$2,872 |
7.1× |
| MRI up ext w/o contrast (73218) |
$1,936.20 |
$2,766 |
6.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,285.50 |
$3,265 |
8.1× |
| MRI, joint upper extrem combo (73223) |
$1,959.30 |
$2,799 |
4.8× |
| Myelogram Cervical (72240) |
$1,537.20 |
$2,196 |
1.7× |
| Myelogram Lumbar (72265) |
$924.70 |
$1,321 |
1.0× |
| Myelogram thoracic (72255) |
$1,370.60 |
$1,958 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,370.60 |
$1,958 |
1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,164.70 |
$4,521 |
2.1× |
| Myocardial infarct spect (78469) |
$1,257.20 |
$1,796 |
2.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,785 |
$2,550 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,334.50 |
$3,335 |
1.5× |
| Myocardial spect single study at rest or stress (78451) |
$1,780.80 |
$2,544 |
1.2× |
| Neck soft tissue (70360) |
$287.70 |
$411 |
2.8× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$655.90 |
$937 |
1.4× |
| Nm adrenal scan (78075) |
$1,191.40 |
$1,702 |
0.8× |
| Nm cardiac blood pool multiple (78473) |
$1,017.10 |
$1,453 |
2.2× |
| Nm cisternogram (78630) |
$2,337.30 |
$3,339 |
3.6× |
| Nm csf leak detection (78650) |
$1,191.40 |
$1,702 |
0.8× |
| Nm gastric emptying study (78264) |
$1,307.60 |
$1,868 |
2.8× |
| Nm gastroesophageal reflux study (78262) |
$583.10 |
$833 |
1.2× |
| Nm kidney scan w/flow (78701) |
$763 |
$1,090 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$797.30 |
$1,139 |
1.7× |
| Nm red cell sequestration (78140) |
$728 |
$1,040 |
1.5× |
| Noncardiac Vascular Flow Imaging (78445) |
$823.20 |
$1,176 |
1.7× |
| Nonvascular shunt X-ray (75809) |
$218.40 |
$312 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,525.90 |
$5,037 |
2.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$708.40 |
$1,012 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$545.30 |
$779 |
2.0× |
| Ob us nuchal meas 1 gest (76813) |
$369.60 |
$528 |
3.0× |
| Osseous survey limited (77074) |
$652.40 |
$932 |
5.3× |
| Parathyrd planar w/spect&CT (78072) |
$760.20 |
$1,086 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$945.70 |
$1,351 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,031.80 |
$1,474 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$280.70 |
$401 |
2.3× |
| Peritoneogram after injection (74190) |
$1,242.50 |
$1,775 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$3,626.70 |
$5,181 |
2.1× |
| PET imaging CT for attenuation limited area (78814) |
$3,164.70 |
$4,521 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$3,290.70 |
$4,701 |
1.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,637.60 |
$3,768 |
1.7× |
| PET whole body (78813) |
$2,637.60 |
$3,768 |
1.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,164.70 |
$4,521 |
1.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,715.90 |
$6,737 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,626.40 |
$3,752 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,148 |
$1,640 |
2.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,196.30 |
$1,709 |
1.9× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,923.60 |
$2,748 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$947.10 |
$1,353 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$253.40 |
$362 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$168.70 |
$241 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$262.50 |
$375 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$368.90 |
$527 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$406 |
$580 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$496.30 |
$709 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$175 |
$250 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$249.90 |
$357 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$261.10 |
$373 |
2.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$298.20 |
$426 |
2.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$447.30 |
$639 |
3.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$645.40 |
$922 |
5.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,075.90 |
$1,537 |
8.7× |
| Radex Humerus Minimum 2 Views (73060) |
$200.90 |
$287 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$211.40 |
$302 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$336.70 |
$481 |
2.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$595.70 |
$851 |
4.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$459.20 |
$656 |
4.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$319.90 |
$457 |
2.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$329.70 |
$471 |
3.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$304.15 |
$434.50 |
3.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$347.90 |
$497 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$547.40 |
$782 |
5.3× |
| Radex Toe Minimum 2 Views (73660) |
$156.10 |
$223 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$401.80 |
$574 |
3.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$393.75 |
$562.50 |
3.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$581.70 |
$831 |
4.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$20,983.20 |
$29,976 |
2.4× |
| Radiation treatment delivery level 1 (77402) |
$436.10 |
$623 |
3.6× |
| Radiation treatment delivery level 2 (77407) |
$559.30 |
$799 |
1.2× |
| Radiation treatment delivery level 3 (77412) |
$655.90 |
$937 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$188.30 |
$269 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$313.60 |
$448 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$256.90 |
$367 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$1,288.35 |
$1,840.50 |
6.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$448 |
$640 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$384.30 |
$549 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$439.60 |
$628 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$251.30 |
$359 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$223.30 |
$319 |
2.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$371 |
$530 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$393.40 |
$562 |
3.2× |
| Radiological examination surgical specimen (76098) |
$703.50 |
$1,005 |
1.1× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$548.80 |
$784 |
2.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,400.70 |
$2,001 |
5.1× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$2,168.60 |
$3,098 |
7.9× |
| Red cell survival study Non-Facility (78130) |
$687.40 |
$982 |
1.5× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$687.40 |
$982 |
1.1× |
| Ribs bilateral 3 views (71110) |
$461.30 |
$659 |
3.7× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$822.50 |
$1,175 |
1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$938.70 |
$1,341 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,611.40 |
$2,302 |
2.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,200.50 |
$1,715 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,258.90 |
$3,227 |
3.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,026.80 |
$4,324 |
2.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,876.30 |
$4,109 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,535.40 |
$3,622 |
1.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$698.60 |
$998 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$674.80 |
$964 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$218.40 |
$312 |
1.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$596.40 |
$852 |
2.1× |
| Salivary gland function study (78232) |
$652.40 |
$932 |
1.4× |
| Salivary gland imaging (78230) |
$533.40 |
$762 |
1.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$658 |
$940 |
1.4× |
| Scapula (73010) |
$366.80 |
$524 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$55.30 |
$79 |
2.4× |
| Sella turcica (70240) |
$228.90 |
$327 |
2.2× |
| Shoulder 1 view (73020) |
$291.90 |
$417 |
2.8× |
| Sialogram (70390) |
$623.70 |
$891 |
2.2× |
| Simulation intermediate (77285) |
$1,068.20 |
$1,526 |
2.4× |
| Small bowel series (74250) |
$746.90 |
$1,067 |
3.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,068.20 |
$1,526 |
2.4× |
| Special dosimetry (77331) |
$383.60 |
$548 |
2.4× |
| Special Physics Consult (77370) |
$591.50 |
$845 |
3.7× |
| Special treatment procedure (77470) |
$1,723.40 |
$2,462 |
2.6× |
| Spine thoracic 3 views (72072) |
$324.80 |
$464 |
2.6× |
| Splenoportograpy rs&i (75810) |
$3,354.40 |
$4,792 |
0.9× |
| Superior sagittal sinus venogram (75870) |
$909.30 |
$1,299 |
0.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$461.30 |
$659 |
1.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$429.10 |
$613 |
1.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$759.50 |
$1,085 |
2.7× |
| Testicular Imaging With Vascular Flow (78761) |
$659.40 |
$942 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,159.90 |
$1,657 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$660.80 |
$944 |
4.2× |
| Thoracolumbar 2 views (72080) |
$347.20 |
$496 |
3.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,365.70 |
$1,951 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$401.10 |
$573 |
0.8× |
| Thyroid uptake measurement (78012) |
$1,161.30 |
$1,659 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,281.70 |
$1,831 |
2.7× |
| Tmj unilateral (70328) |
$124.60 |
$178 |
1.2× |
| Tomogram (76100) |
$438.20 |
$626 |
3.5× |
| Treatment device complex (77334) |
$1,205.40 |
$1,722 |
2.7× |
| Treatment device intermediate (77333) |
$634.20 |
$906 |
4.0× |
| Treatment devices simple (77332) |
$386.40 |
$552 |
2.4× |
| Ultrasound breast complete (76641) |
$681.45 |
$973.50 |
5.5× |
| Ultrasound Exam Aaa Screen (76706) |
$506.10 |
$723 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$557.90 |
$797 |
4.5× |
| Umbilical-artery Doppler (OB) (76820) |
$392.70 |
$561 |
3.2× |
| Unlisted ultrasound procedure (76999) |
$192.50 |
$275 |
1.9× |
| Ureteral reflux study (78740) |
$567 |
$810 |
1.2× |
| Urethrocystogram voiding (74455) |
$718.20 |
$1,026 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$980.70 |
$1,401 |
3.5× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$926.10 |
$1,323 |
4.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,028.30 |
$1,469 |
5.0× |
| Us breast unilateral limited (76642) |
$720.30 |
$1,029 |
7.0× |
| Us chest (76604) |
$574.70 |
$821 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$763.35 |
$1,090.50 |
6.2× |
| Us encephalogram (76506) |
$309.40 |
$442 |
2.5× |
| Us hips infant static (76886) |
$302.40 |
$432 |
2.9× |
| Us infant hips w manipulation (76885) |
$422.80 |
$604 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$350 |
$500 |
2.8× |
| Us ob detailed single fetus (76811) |
$632.80 |
$904 |
2.2× |
| Us ob limited (76815) |
$448 |
$640 |
3.6× |
| Us ob transvaginal (76817) |
$369.60 |
$528 |
3.0× |
| Us pelvic non ob complete (76856) |
$557.90 |
$797 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$478.80 |
$684 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$369.60 |
$528 |
3.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$688.80 |
$984 |
5.6× |
| Us retroperitoneal complete (76770) |
$687.40 |
$982 |
5.6× |
| Us retroperitoneal limited (76775) |
$478.80 |
$684 |
3.9× |
| Us scrotum and contents (76870) |
$453.60 |
$648 |
3.7× |
| Us soft tissue head/neck (76536) |
$574.70 |
$821 |
4.7× |
| Us spinal canal and contents (76800) |
$480.20 |
$686 |
3.9× |
| Us transrectal (76872) |
$690.90 |
$987 |
5.6× |
| Us transrectal prostate volume (76873) |
$915.60 |
$1,308 |
7.4× |
| Us, eye b-scan (76512) |
$253.40 |
$362 |
2.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$369.60 |
$528 |
3.0× |
| Vasogram (74440) |
$569.10 |
$813 |
2.0× |
| Venogram adrenal unilat (75840) |
$3,354.40 |
$4,792 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,380.40 |
$1,972 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$1,380.40 |
$1,972 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$3,623.20 |
$5,176 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,380.40 |
$1,972 |
0.7× |
| Venography Orbital Rs&I (75880) |
$3,354.40 |
$4,792 |
4.5× |
| Venography Renal Bilateral (75833) |
$3,354.40 |
$4,792 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$3,623.20 |
$5,176 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,354.40 |
$4,792 |
0.9× |
| Venous sampling by catheter (75893) |
$4,694.90 |
$6,707 |
0.7× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$1,213.80 |
$1,734 |
1.9× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,215.90 |
$1,737 |
1.9× |
| Wrist 2 views (73100) |
$182.70 |
$261 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$663.60 |
$948 |
5.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$466.20 |
$666 |
4.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,231.30 |
$1,759 |
5.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$495.60 |
$708 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$471.45 |
$673.50 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$546.70 |
$781 |
4.4× |
| X-ray exam of femur 2/> (73552) |
$281.40 |
$402 |
2.7× |
| X-ray eye for foreign body (70030) |
$255.50 |
$365 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.70 |
$281 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$946.40 |
$1,352 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$326.20 |
$466 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$387.80 |
$554 |
3.8× |
| X-ray leg, infant (73592) |
$249.90 |
$357 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$282.80 |
$404 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$501.90 |
$717 |
4.1× |
| X-ray nose-rectum child f.b. (76010) |
$464.80 |
$664 |
4.5× |
| X-ray optic foramen (70190) |
$290.50 |
$415 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$471.80 |
$674 |
3.8× |
| X-ray retrograde pyelogram (74420) |
$810.60 |
$1,158 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$238.70 |
$341 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$276.15 |
$394.50 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$733.60 |
$1,048 |
5.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$224 |
$320 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$227.50 |
$325 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$452.20 |
$646 |
4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$733.60 |
$1,048 |
5.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$507.50 |
$725 |
4.1× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,242.50 |
$1,775 |
6.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$415.80 |
$594 |
4.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$387.80 |
$554 |
3.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$394.10 |
$563 |
3.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$242.90 |
$347 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$231.70 |
$331 |
1.9× |
| Xr bone length studies (77073) |
$1,379.70 |
$1,971 |
11.2× |
| Xr c-spine 4 or 5 views (72050) |
$319.90 |
$457 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$601.30 |
$859 |
4.9× |
| Xr chest 4+ views (71048) |
$372.40 |
$532 |
3.0× |
| Xr urogram antegrade (74425) |
$834.40 |
$1,192 |
2.0× |