| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,345.50 |
$2,070 |
0.9× |
| Abdomen 2 views (74019) |
$395.20 |
$608 |
3.4× |
| Acute gi blood loss imaging (78278) |
$1,550.58 |
$2,385.50 |
3.5× |
| Angiography extremity bilateral rs&i (75716) |
$7,195.82 |
$11,070.50 |
2.0× |
| Angiography extremity unilateral rs&i (75710) |
$7,260.50 |
$11,170 |
2.1× |
| Angiography internal mammary rs&i (75756) |
$5,613.40 |
$8,636 |
1.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,093.40 |
$7,836 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,977.40 |
$9,196 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,423.60 |
$8,344 |
1.5× |
| Angiography Spinal Selective Rs&I (75705) |
$4,439.50 |
$6,830 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$11,911.58 |
$18,325.50 |
1.9× |
| Ankle 2 views (73600) |
$297.38 |
$457.50 |
3.1× |
| Aortogram thoracic (75605) |
$5,543.85 |
$8,529 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$7,189.32 |
$11,060.50 |
2.0× |
| Aortography abdominal serialography rs&i (75625) |
$7,380.42 |
$11,354.50 |
2.1× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,641.95 |
$5,603 |
1.0× |
| Arthrogram elbow (73085) |
$1,123.20 |
$1,728 |
2.9× |
| Arthrogram hip (73525) |
$947.05 |
$1,457 |
2.4× |
| Arthrogram knee (73580) |
$880.75 |
$1,355 |
2.3× |
| Arthrogram shoulder (73040) |
$1,045.20 |
$1,608 |
2.7× |
| Arthrogram wrist (73115) |
$666.90 |
$1,026 |
1.7× |
| Basic dosimetry (77300) |
$143 |
$220 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,209.65 |
$1,861 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,780.02 |
$2,738.50 |
4.0× |
| Bone age studies (77072) |
$180.70 |
$278 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$2,416.05 |
$3,717 |
5.4× |
| Bone Marrow Imaging Limited Area (78102) |
$1,502.80 |
$2,312 |
3.4× |
| Bone survey complete (77075) |
$1,053 |
$1,620 |
9.0× |
| Bone survey infant (77076) |
$1,308.45 |
$2,013 |
11.2× |
| Bowel imaging (78290) |
$1,344.52 |
$2,068.50 |
3.0× |
| Brachytx isodose complex (77318) |
$1,235 |
$1,900 |
3.0× |
| Brachytx isodose intermed (77317) |
$1,096.55 |
$1,687 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$897.32 |
$1,380.50 |
2.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,496.30 |
$2,302 |
2.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,398.15 |
$2,151 |
3.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,967.22 |
$3,026.50 |
4.4× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,795.98 |
$4,301.50 |
3.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,710.50 |
$4,170 |
7.0× |
| Cardiac shunt detection (78428) |
$1,061.45 |
$1,633 |
2.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,080.32 |
$3,200.50 |
3.4× |
| Cervical spine 2 or 3 views (72040) |
$389.68 |
$599.50 |
4.0× |
| Chest 1 view (71045) |
$257.40 |
$396 |
2.7× |
| Chest xray 3 views (71047) |
$323.70 |
$498 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$882.38 |
$1,357.50 |
4.5× |
| Clavicle complete (73000) |
$299 |
$460 |
3.1× |
| Continuing medical physics consltj pr wk (77336) |
$972.40 |
$1,496 |
6.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,627.35 |
$7,119 |
11.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,767.70 |
$4,258 |
10.4× |
| CT abdomen w contrast (74160) |
$2,380.95 |
$3,663 |
12.2× |
| CT abdomen w wo contrast (74170) |
$2,906.15 |
$4,471 |
14.9× |
| CT abdomen w/o contrast (74150) |
$1,638.98 |
$2,521.50 |
14.1× |
| CT angio hrt w/3d image (75574) |
$4,123.60 |
$6,344 |
10.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,761.55 |
$5,787 |
19.2× |
| CT angiography upper extremity lt (73206) |
$2,379 |
$3,660 |
12.2× |
| CT c-spine w/contrast (72126) |
$1,675.70 |
$2,578 |
4.3× |
| CT c-spine w/o contrast (72125) |
$1,947.08 |
$2,995.50 |
16.7× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$2,970.50 |
$4,570 |
15.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,124.85 |
$3,269 |
10.9× |
| CT chest w contrast (71260) |
$2,405.32 |
$3,700.50 |
12.3× |
| CT chest w/wo contrast (71270) |
$2,954.25 |
$4,545 |
15.1× |
| CT head/brain with contrast (70460) |
$1,152.45 |
$1,773 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,464.12 |
$2,252.50 |
7.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$835.90 |
$1,286 |
2.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$178.75 |
$275 |
1.8× |
| CT iac w contrast (70481) |
$1,400.10 |
$2,154 |
7.2× |
| CT limited/localized follow up study (76380) |
$616.20 |
$948 |
6.4× |
| CT lower ext w/o (73700) |
$1,944.80 |
$2,992 |
16.7× |
| CT lower extremity w/contrast material (73701) |
$2,444.65 |
$3,761 |
12.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,438.15 |
$3,751 |
12.5× |
| CT lumbar spine w/contrast (72132) |
$2,020.85 |
$3,109 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$1,913.28 |
$2,943.50 |
16.4× |
| CT maxillofacial w contrast (70487) |
$2,514.20 |
$3,868 |
12.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,201.85 |
$1,849 |
6.1× |
| CT maxillofacial wo contrast (70486) |
$2,062.45 |
$3,173 |
17.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,719.25 |
$2,645 |
8.8× |
| CT orbits w/o contrast (70480) |
$836.88 |
$1,287.50 |
7.2× |
| CT pelvis w/o contrast (72192) |
$1,494.35 |
$2,299 |
12.8× |
| CT pelvis w/wo contrast (72194) |
$1,508.65 |
$2,321 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$2,404.68 |
$3,699.50 |
12.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,390.35 |
$2,139 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,946.42 |
$2,994.50 |
16.7× |
| CT thoracic spine w/contrast (72129) |
$1,511.58 |
$2,325.50 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,923.68 |
$2,959.50 |
16.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,892.80 |
$2,912 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,910.02 |
$2,938.50 |
16.4× |
| CT unlisted procedure (76497) |
$215.15 |
$331 |
2.2× |
| CT upper ext wo (73200) |
$1,938.30 |
$2,982 |
16.6× |
| CT upper extremity with contrast (73201) |
$2,501.85 |
$3,849 |
6.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,061.85 |
$6,249 |
20.8× |
| Cta Abdomen (74175) |
$3,773.25 |
$5,805 |
19.3× |
| CTA abdomen pelvis (74174) |
$4,628 |
$7,120 |
11.9× |
| CTA chest (71275) |
$3,697.20 |
$5,688 |
18.9× |
| Cta Head (70496) |
$4,880.85 |
$7,509 |
25.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,879.88 |
$7,507.50 |
12.6× |
| Cta Neck (70498) |
$4,990.38 |
$7,677.50 |
25.5× |
| Cta Pelvis (72191) |
$2,701.72 |
$4,156.50 |
13.8× |
| Cystography minimum 3 views rs&i (74430) |
$594.75 |
$915 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$293.15 |
$451 |
2.5× |
| Echo exam of eye (76529) |
$189.80 |
$292 |
2.0× |
| Esophagus (74220) |
$918.45 |
$1,413 |
4.7× |
| Facial bones min 3 views (70150) |
$393.58 |
$605.50 |
3.4× |
| Fetal biophysical profile non-stress testing (76818) |
$526.50 |
$810 |
4.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$651.95 |
$1,003 |
5.6× |
| Fluoroscopy up to 1 hr (76000) |
$717.28 |
$1,103.50 |
2.7× |
| Foot 2 views (73620) |
$299 |
$460 |
3.1× |
| Forearm 2 views (73090) |
$309.72 |
$476.50 |
3.2× |
| Hand 2 views (73120) |
$412.10 |
$634 |
3.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,305.55 |
$3,547 |
3.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,285.40 |
$3,516 |
2.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,143.80 |
$9,452 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,620.82 |
$5,570.50 |
6.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,033.55 |
$4,667 |
6.8× |
| Interstitial radiation source applic complex (77778) |
$3,166.15 |
$4,871 |
4.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$334.10 |
$514 |
2.9× |
| Kidney imaging morphology (78700) |
$653.25 |
$1,005 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,498.25 |
$2,305 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,413.10 |
$2,174 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$3,383.25 |
$5,205 |
5.6× |
| Knee 3 views (73562) |
$550.55 |
$847 |
5.7× |
| Liver & spleen imaging static only (78215) |
$1,489.80 |
$2,292 |
3.3× |
| Lung perfusion differential (78597) |
$1,566.50 |
$2,410 |
3.5× |
| Lymphoscintigraphy (78195) |
$2,400.78 |
$3,693.50 |
4.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,991.28 |
$3,063.50 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,386.15 |
$3,671 |
6.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,042.35 |
$6,219 |
10.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$360.10 |
$554 |
0.9× |
| MRA head w & w/o contrast (70546) |
$5,407.35 |
$8,319 |
13.9× |
| MRA head w/o contrast (70544) |
$3,490.50 |
$5,370 |
13.1× |
| MRA head with contrast (70545) |
$3,204.50 |
$4,930 |
8.2× |
| MRA neck w contrast (70548) |
$3,607.50 |
$5,550 |
9.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$5,290.35 |
$8,139 |
13.6× |
| MRA neck w/o contrast (70547) |
$3,391.70 |
$5,218 |
12.8× |
| MRI abdomen w contrast (74182) |
$2,050.10 |
$3,154 |
5.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,130.10 |
$6,354 |
10.6× |
| MRI abdomen w/o contrast (74181) |
$2,690.35 |
$4,139 |
10.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,349.75 |
$3,615 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,833.05 |
$5,897 |
9.9× |
| MRI bone marrow blood supply (77084) |
$1,270.42 |
$1,954.50 |
4.8× |
| MRI c-spine with contrast (72142) |
$2,395.90 |
$3,686 |
6.2× |
| MRI cardiac w/o cont stress (75559) |
$1,962.35 |
$3,019 |
3.2× |
| MRI cardiac w/o contrast (75557) |
$1,180.40 |
$1,816 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$2,690.35 |
$4,139 |
10.1× |
| MRI chest w/o & w/contrast material (71552) |
$4,905.55 |
$7,547 |
12.6× |
| MRI chest w/o contrast (71550) |
$2,018.90 |
$3,106 |
7.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,478.45 |
$3,813 |
6.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,199.65 |
$6,461 |
10.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,081.65 |
$4,741 |
11.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,151.52 |
$4,848.50 |
11.9× |
| MRI orbit face neck w contrast (70542) |
$2,333.18 |
$3,589.50 |
6.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,095.65 |
$6,301 |
10.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,174.95 |
$6,423 |
10.7× |
| MRI pelvis w/o contrast (72195) |
$3,088.15 |
$4,751 |
11.6× |
| MRI spectroscopy (76390) |
$239.52 |
$368.50 |
2.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,491.48 |
$5,371.50 |
9.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,270.45 |
$3,493 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,972.15 |
$6,111 |
10.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,042.95 |
$3,143 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,524.95 |
$5,423 |
9.1× |
| MRI temporomandibular joint (70336) |
$1,428.70 |
$2,198 |
5.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,551.90 |
$3,926 |
9.6× |
| MRI up ext w/o contrast (73218) |
$3,101.15 |
$4,771 |
11.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,083.25 |
$3,205 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$3,889.60 |
$5,984 |
10.0× |
| Myelogram Lumbar (72265) |
$1,216.15 |
$1,871 |
1.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,919.80 |
$4,492 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,036.50 |
$6,210 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$3,664.70 |
$5,638 |
2.5× |
| Neck soft tissue (70360) |
$285.02 |
$438.50 |
2.9× |
| Nm adrenal scan (78075) |
$3,083.60 |
$4,744 |
2.1× |
| Nm gastric emptying study (78264) |
$1,987.05 |
$3,057 |
4.5× |
| Nonvascular shunt X-ray (75809) |
$326.95 |
$503 |
2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,810.08 |
$12,015.50 |
5.1× |
| Nuclear Rx Oral Admin (79005) |
$1,097.85 |
$1,689 |
4.2× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$298.35 |
$459 |
2.6× |
| Orthopantogram (70355) |
$271.70 |
$418 |
2.8× |
| Osseous survey limited (77074) |
$507 |
$780 |
4.4× |
| Parathyroid Planar Imaging (78070) |
$2,507.05 |
$3,857 |
5.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,491.75 |
$2,295 |
3.3× |
| Pelvis 1 or 2 views (72170) |
$336.70 |
$518 |
2.9× |
| PET image w/CT, skull-thigh (78815) |
$4,382.30 |
$6,742 |
2.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,589.25 |
$2,445 |
3.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,592.20 |
$3,988 |
4.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,353.62 |
$2,082.50 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$371.15 |
$571 |
3.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$265.85 |
$409 |
2.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$340.60 |
$524 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$286.65 |
$441 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$360.10 |
$554 |
3.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$319.80 |
$492 |
3.3× |
| Radex Hand Minimum 3 Views (73130) |
$451.75 |
$695 |
4.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$329.55 |
$507 |
3.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$548.28 |
$843.50 |
4.7× |
| Radex Humerus Minimum 2 Views (73060) |
$313.62 |
$482.50 |
3.2× |
| Radex Kne 1/2 Views (73560) |
$463.12 |
$712.50 |
4.8× |
| Radex Kne Compl 4/More Views (73564) |
$559.65 |
$861 |
4.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$330.20 |
$508 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$312.32 |
$480.50 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$404.95 |
$623 |
3.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$356.85 |
$549 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$260.65 |
$401 |
2.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$334.10 |
$514 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$247 |
$380 |
2.5× |
| Radex Toe Minimum 2 Views (73660) |
$470.92 |
$724.50 |
4.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$494 |
$760 |
4.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$582.08 |
$895.50 |
6.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$513.50 |
$790 |
4.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,085.70 |
$33,978 |
2.7× |
| Radiation treatment delivery level 1 (77402) |
$434.20 |
$668 |
3.8× |
| Radiation treatment delivery level 2 (77407) |
$596.70 |
$918 |
1.4× |
| Radiation treatment delivery level 3 (77412) |
$263.90 |
$406 |
0.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$266.50 |
$410 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$411.45 |
$633 |
3.5× |
| Radiologic exam chest 2 views (71046) |
$289.25 |
$445 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$1,164.15 |
$1,791 |
6.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$642.85 |
$989 |
3.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,084.20 |
$1,668 |
5.5× |
| Radiologic examination femur 1 view (73551) |
$277.55 |
$427 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$334.75 |
$515 |
3.5× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$711.75 |
$1,095 |
2.7× |
| Radiological examination surgical specimen (76098) |
$1,366.95 |
$2,103 |
2.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,646.45 |
$2,533 |
3.8× |
| Ribs bilateral 3 views (71110) |
$384.15 |
$591 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,315.60 |
$2,024 |
3.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,441.45 |
$6,833 |
7.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,106.68 |
$4,779.50 |
5.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,652.65 |
$4,081 |
4.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,782.35 |
$5,819 |
2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,910.70 |
$4,478 |
1.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,778.45 |
$5,813 |
2.6× |
| Rp Therapy Intravenous Administration (79101) |
$637.98 |
$981.50 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$258.70 |
$398 |
2.2× |
| Salivary gland function study (78232) |
$746.85 |
$1,149 |
1.7× |
| Scapula (73010) |
$346.12 |
$532.50 |
3.0× |
| Shoulder 1 view (73020) |
$269.10 |
$414 |
2.8× |
| Simulation intermediate (77285) |
$1,786.85 |
$2,749 |
4.3× |
| Small bowel series (74250) |
$1,098.50 |
$1,690 |
5.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,589.90 |
$2,446 |
3.8× |
| Special dosimetry (77331) |
$133.90 |
$206 |
0.9× |
| Special Physics Consult (77370) |
$727.35 |
$1,119 |
4.9× |
| Special treatment procedure (77470) |
$550.55 |
$847 |
0.9× |
| Spine thoracic 3 views (72072) |
$391.95 |
$603 |
3.4× |
| Stereotactic Body Radiation Delivery (77373) |
$9,157.85 |
$14,089 |
4.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,138.15 |
$1,751 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,034.15 |
$1,591 |
2.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,295.15 |
$3,531 |
5.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$133.90 |
$206 |
0.9× |
| Thoracolumbar 2 views (72080) |
$331.18 |
$509.50 |
3.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,150.85 |
$3,309 |
3.6× |
| Thyroid imaging w/blood flow (78013) |
$1,006.20 |
$1,548 |
2.3× |
| Thyroid uptake measurement (78012) |
$1,063.40 |
$1,636 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,654.58 |
$2,545.50 |
3.7× |
| Treatment device complex (77334) |
$1,379.95 |
$2,123 |
3.3× |
| Treatment device intermediate (77333) |
$945.10 |
$1,454 |
6.3× |
| Treatment devices simple (77332) |
$748.15 |
$1,151 |
5.0× |
| Ultrasound breast complete (76641) |
$508.95 |
$783 |
4.4× |
| Ultrasound Exam Aaa Screen (76706) |
$382.20 |
$588 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$607.10 |
$934 |
5.2× |
| Umbilical-artery Doppler (OB) (76820) |
$453.70 |
$698 |
3.9× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$1,294.80 |
$1,992 |
2.9× |
| Urethrocystogram voiding (74455) |
$615.55 |
$947 |
2.3× |
| Urethrocystography retrograde rs&i (74450) |
$615.55 |
$947 |
2.3× |
| Us breast unilateral limited (76642) |
$415.35 |
$639 |
4.3× |
| Us chest (76604) |
$575.25 |
$885 |
4.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$939.25 |
$1,445 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$673.72 |
$1,036.50 |
5.8× |
| Us encephalogram (76506) |
$870.02 |
$1,338.50 |
7.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$324.35 |
$499 |
2.8× |
| Us ob detailed single fetus (76811) |
$801.45 |
$1,233 |
3.0× |
| Us ob limited (76815) |
$482.30 |
$742 |
4.1× |
| Us ob transvaginal (76817) |
$516.75 |
$795 |
4.4× |
| Us pelvic non ob complete (76856) |
$688.68 |
$1,059.50 |
5.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$560.30 |
$862 |
4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$586.95 |
$903 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$600.60 |
$924 |
5.2× |
| Us retroperitoneal complete (76770) |
$736.45 |
$1,133 |
6.3× |
| Us retroperitoneal limited (76775) |
$583.05 |
$897 |
5.0× |
| Us scrotum and contents (76870) |
$698.10 |
$1,074 |
6.0× |
| Us soft tissue head/neck (76536) |
$695.82 |
$1,070.50 |
6.0× |
| Us spinal canal and contents (76800) |
$1,082.90 |
$1,666 |
9.3× |
| Us transrectal (76872) |
$241.80 |
$372 |
2.1× |
| Us transrectal prostate volume (76873) |
$319.15 |
$491 |
2.7× |
| Us, eye b-scan (76512) |
$373.10 |
$574 |
3.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$548.28 |
$843.50 |
4.7× |
| Venogram extremity bilateral (75822) |
$3,355.95 |
$5,163 |
1.9× |
| Venogram Extremity Unilateral (75820) |
$2,743 |
$4,220 |
1.6× |
| Venography caval inferior serialography rs&i (75825) |
$4,758 |
$7,320 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$3,093.35 |
$4,759 |
1.8× |
| Venography Renal Bilateral (75833) |
$7,715.50 |
$11,870 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$2,758.60 |
$4,244 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,183.70 |
$4,898 |
0.9× |
| Venous sampling by catheter (75893) |
$12,287.60 |
$18,904 |
2.0× |
| Wrist 2 views (73100) |
$327.60 |
$504 |
3.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$460.20 |
$708 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$232.38 |
$357.50 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$283.40 |
$436 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$393.25 |
$605 |
4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$348.40 |
$536 |
3.0× |
| X-ray exam of femur 2/> (73552) |
$442.65 |
$681 |
4.6× |
| X-ray eye for foreign body (70030) |
$265.20 |
$408 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$234 |
$360 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$261.95 |
$403 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$220.02 |
$338.50 |
2.3× |
| X-ray leg, infant (73592) |
$282.75 |
$435 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$378.30 |
$582 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$281.78 |
$433.50 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$365.30 |
$562 |
3.1× |
| X-ray retrograde pyelogram (74420) |
$1,281.48 |
$1,971.50 |
3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$301.92 |
$464.50 |
3.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$378.95 |
$583 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$427.70 |
$658 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$310.05 |
$477 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$220.68 |
$339.50 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$350.68 |
$539.50 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$318.50 |
$490 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$276.90 |
$426 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$259.35 |
$399 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$294.12 |
$452.50 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$340.92 |
$524.50 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$494.65 |
$761 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$621.08 |
$955.50 |
5.3× |
| Xr chest 4+ views (71048) |
$401.38 |
$617.50 |
3.4× |
| Xr urogram antegrade (74425) |
$722.80 |
$1,112 |
1.9× |