| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,219.90 |
$7,457 |
3.4× |
| Abdomen 1 View (74018) |
$41.30 |
$59 |
0.4× |
| Abdomen 2 views (74019) |
$41.30 |
$59 |
0.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$430.50 |
$615 |
1.0× |
| Adrenal Cortex & Medulla Img (78075) |
$1,531.60 |
$2,188 |
1.1× |
| Angio internal mammary (75756) |
$1,456.70 |
$2,081 |
0.4× |
| Angio pulmonary bilat (75743) |
$4,390.40 |
$6,272 |
1.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$4,390.40 |
$6,272 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$4,390.40 |
$6,272 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$4,390.40 |
$6,272 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,390.40 |
$6,272 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,456.70 |
$2,081 |
0.4× |
| Ankle 2 views (73600) |
$67.20 |
$96 |
0.7× |
| Aortography thoracic serialography rs&i (75605) |
$4,390.40 |
$6,272 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,390.40 |
$6,272 |
1.2× |
| Artery X-Rays Abdomen (75726) |
$8,183 |
$11,690 |
1.3× |
| Artery X-Rays Adrenal Gland (75731) |
$4,390.40 |
$6,272 |
1.2× |
| Artery X-Rays Pelvis (75736) |
$4,390.40 |
$6,272 |
0.7× |
| Artery X-Rays Spine (75705) |
$8,183 |
$11,690 |
1.3× |
| Arthrogram ankle (73615) |
$500.50 |
$715 |
1.3× |
| Arthrogram hip (73525) |
$694.40 |
$992 |
1.8× |
| Arthrogram Wrist (73115) |
$500.50 |
$715 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$366.80 |
$524 |
2.4× |
| Bone age studies (77072) |
$67.20 |
$96 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$499.80 |
$714 |
1.1× |
| Bone Imaging Limited Area (78300) |
$430.50 |
$615 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$451.50 |
$645 |
1.0× |
| Bone Imaging Whole Body (78306) |
$474.60 |
$678 |
1.1× |
| Bone marrow imaging limited area (78102) |
$1,498 |
$2,140 |
3.4× |
| Bone marrow imaging; multiple areas (78103) |
$460.60 |
$658 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$460.60 |
$658 |
1.0× |
| Bone survey infant (77076) |
$104.30 |
$149 |
0.9× |
| Brachytx isodose complex (77318) |
$601.30 |
$859 |
1.4× |
| Brachytx isodose intermed (77317) |
$601.30 |
$859 |
1.4× |
| Brachytx Isodose Plan Simple (77316) |
$217 |
$310 |
0.5× |
| Brain Flow Imaging Only (78610) |
$708.40 |
$1,012 |
1.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$708.40 |
$1,012 |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,331.40 |
$1,902 |
2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,733.20 |
$2,476 |
1.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$508.20 |
$726 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,081.80 |
$2,974 |
5.4× |
| Cardiac MRI w/w/o contrast w/stress (75563) |
$4,736.20 |
$6,766 |
5.4× |
| Cardiac Shunt Detection (78428) |
$508.20 |
$726 |
1.1× |
| Cardiovasc nucl exam unlisted (78499) |
$508.20 |
$726 |
1.1× |
| Cat Scan Follow-Up Study (76380) |
$235.90 |
$337 |
2.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$708.40 |
$1,012 |
1.2× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$3,139.50 |
$4,485 |
5.2× |
| Cerebrospinal Fluid Scan (78630) |
$708.40 |
$1,012 |
1.2× |
| Chest 1 view (71045) |
$80.50 |
$115 |
0.8× |
| Chest 2 views (71046) |
$80.50 |
$115 |
0.8× |
| Chest 3 views (71047) |
$80.50 |
$115 |
0.8× |
| Chest 4 or more views (71048) |
$200.20 |
$286 |
1.7× |
| Cholecystography Oral Contrast (74290) |
$71.40 |
$102 |
0.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$98.70 |
$141 |
0.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,642.20 |
$2,346 |
1.9× |
| Clavicle complete (73000) |
$67.20 |
$96 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$146.30 |
$209 |
1.3× |
| Continuing medical physics consltj pr wk (77336) |
$195.30 |
$279 |
1.3× |
| Contrast Exam Abdominl Aorta (75625) |
$4,390.40 |
$6,272 |
1.2× |
| Contrast X-Ray Bladder (74430) |
$175 |
$250 |
0.5× |
| Contrast X-Ray Of Elbow (73085) |
$694.40 |
$992 |
1.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$500.50 |
$715 |
1.3× |
| Corpora cavernosography (74445) |
$175 |
$250 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,798.20 |
$5,426 |
9.8× |
| CT abdomen and pelvis without contrast (74176) |
$713.30 |
$1,019 |
2.7× |
| CT abdomen w contrast (74160) |
$734.30 |
$1,049 |
3.8× |
| CT abdomen w wo contrast (74170) |
$827.40 |
$1,182 |
4.2× |
| CT abdomen w/o contrast (74150) |
$373.80 |
$534 |
3.2× |
| CT Angio Abdomen and Pelvis (74174) |
$1,150.80 |
$1,644 |
3.0× |
| CT Angio Chest (71275) |
$861.70 |
$1,231 |
4.4× |
| CT Angio Head (70496) |
$868 |
$1,240 |
4.4× |
| CT angio hrt w/3d image (75574) |
$654.50 |
$935 |
1.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$861.70 |
$1,231 |
4.4× |
| CT Angio Neck (70498) |
$868 |
$1,240 |
4.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$861.70 |
$1,231 |
4.4× |
| CT cervical spine w/ contrast (72126) |
$739.90 |
$1,057 |
1.9× |
| CT cervical spine w/o contrast (72125) |
$376.60 |
$538 |
3.2× |
| CT cervical spine w/wo cont (72127) |
$833 |
$1,190 |
4.3× |
| CT chest w contrast (71260) |
$734.30 |
$1,049 |
3.8× |
| CT chest w/wo contrast (71270) |
$827.40 |
$1,182 |
4.2× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$133.70 |
$191 |
1.1× |
| CT head/brain with contrast (70460) |
$739.90 |
$1,057 |
3.8× |
| CT head/brain without and with contrast (70470) |
$833 |
$1,190 |
4.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$654.50 |
$935 |
1.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65.80 |
$94 |
0.7× |
| CT hrt w/3d image congen (75573) |
$654.50 |
$935 |
1.7× |
| CT iac w contrast (70481) |
$739.90 |
$1,057 |
3.8× |
| CT l-spine w&w/o contrast (72133) |
$827.40 |
$1,182 |
4.2× |
| CT lower ext w/o (73700) |
$373.80 |
$534 |
3.2× |
| CT lower extremity w/contrast material (73701) |
$734.30 |
$1,049 |
3.8× |
| CT lumbar spine w contrast (72132) |
$734.30 |
$1,049 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$373.80 |
$534 |
3.2× |
| CT maxillofacial w contrast (70487) |
$739.90 |
$1,057 |
3.8× |
| CT maxillofacial wo contrast (70486) |
$376.60 |
$538 |
3.2× |
| CT neck tissue combo (70492) |
$833 |
$1,190 |
4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$833 |
$1,190 |
4.3× |
| CT orbits w/o contrast (70480) |
$376.60 |
$538 |
3.2× |
| CT pelvis w&w/o contrast (72194) |
$827.40 |
$1,182 |
4.2× |
| CT pelvis w/o contrast (72192) |
$373.80 |
$534 |
3.2× |
| CT scan of leg combo (73702) |
$827.40 |
$1,182 |
4.2× |
| CT scans face/jaw combo (70488) |
$833 |
$1,190 |
4.3× |
| CT soft tissue neck w contrast (70491) |
$739.90 |
$1,057 |
3.8× |
| CT soft tissue neck w/o contrast (70490) |
$376.60 |
$538 |
3.2× |
| CT thoracic spine w contrast (72129) |
$734.30 |
$1,049 |
3.8× |
| CT thoracic spine w/o contrast (72128) |
$373.80 |
$534 |
3.2× |
| CT thoracic spine w/wo cont (72130) |
$827.40 |
$1,182 |
4.2× |
| CT thorax w/o contrast (71250) |
$384.30 |
$549 |
3.3× |
| CT unlisted procedure (76497) |
$354.20 |
$506 |
3.7× |
| CT upper ext wo (73200) |
$373.80 |
$534 |
3.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$827.40 |
$1,182 |
4.2× |
| CT upper extremity with contrast (73201) |
$734.30 |
$1,049 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$861.70 |
$1,231 |
4.4× |
| Cta Abdomen (74175) |
$861.70 |
$1,231 |
4.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,566.90 |
$3,667 |
6.6× |
| CTA pelvis (72191) |
$861.70 |
$1,231 |
4.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$213.50 |
$305 |
0.8× |
| Dilation ureters/urethra rs&i (74485) |
$800.80 |
$1,144 |
0.3× |
| Discography Cerv/Thor Spine (72285) |
$4,057.90 |
$5,797 |
1.9× |
| Diskography lumbar (72295) |
$4,057.90 |
$5,797 |
1.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$137.20 |
$196 |
1.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$340.90 |
$487 |
2.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$184.80 |
$264 |
1.6× |
| Echo exam of fetal heart (76825) |
$382.20 |
$546 |
0.6× |
| Echo exam uterus (76831) |
$291.20 |
$416 |
1.1× |
| Echo Guide For Artery Repair (76936) |
$268.80 |
$384 |
1.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$948.50 |
$1,355 |
3.6× |
| Echograp Trans R Pros Study (76873) |
$291.20 |
$416 |
2.5× |
| Esophagram (74220) |
$376.60 |
$538 |
1.9× |
| Fetal Biophys Profile W/Nst (76818) |
$244.30 |
$349 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$205.10 |
$293 |
1.8× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$2,747.50 |
$3,925 |
10.3× |
| Fluoroscopy up to 1 hr (76000) |
$294.70 |
$421 |
1.1× |
| Follow-Up Angiography (75898) |
$1,456.70 |
$2,081 |
0.4× |
| Foot 2 views (73620) |
$67.20 |
$96 |
0.7× |
| Forearm 2 views (73090) |
$67.20 |
$96 |
0.7× |
| Gastric emptying imaging study (78264) |
$430.50 |
$615 |
1.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$4,393.90 |
$6,277 |
9.9× |
| Gastroesophageal Reflux Exam (78262) |
$430.50 |
$615 |
1.0× |
| Gated Heart Planar Single (78472) |
$508.20 |
$726 |
1.1× |
| GI Endoscopic US S&I (76975) |
$463.40 |
$662 |
1.7× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$6,591.90 |
$9,417 |
10.9× |
| Hand 2 views (73120) |
$67.20 |
$96 |
0.6× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77772) |
$2,695 |
$3,850 |
3.5× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$2,545.20 |
$3,636 |
3.3× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$1,850.10 |
$2,643 |
2.4× |
| Heart first pass single,planar (78481) |
$508.20 |
$726 |
0.8× |
| Heart Image (Pet) Multiple (78492) |
$1,733.20 |
$2,476 |
1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,390.40 |
$6,272 |
1.2× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$4,390.40 |
$6,272 |
1.2× |
| Hepatobil Syst Image W/Drug (78227) |
$494.20 |
$706 |
0.8× |
| Hepatobiliary System Imaging (78226) |
$494.20 |
$706 |
1.1× |
| Ht Musc Image Planar Mult (78454) |
$1,528.10 |
$2,183 |
1.1× |
| Ht Muscle Image Spect Sing (78451) |
$1,528.10 |
$2,183 |
1.1× |
| Hysterosalpingogram (74740) |
$213.50 |
$305 |
0.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$137.20 |
$196 |
1.4× |
| Infant hip ultrasound, limited static exam (76886) |
$137.20 |
$196 |
1.4× |
| Infusion Ivp (74410) |
$175 |
$250 |
0.9× |
| Interstitial radiation source applic complex (77778) |
$1,551.90 |
$2,217 |
2.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$609.70 |
$871 |
0.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$609.70 |
$871 |
1.0× |
| Intracavitary radiation source applic simple (77761) |
$609.70 |
$871 |
1.0× |
| Joint Survey Single View (77077) |
$67.20 |
$96 |
0.6× |
| K Flow/Funct Image Multiple (78709) |
$610.40 |
$872 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$581 |
$830 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$553.70 |
$791 |
0.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$341.60 |
$488 |
0.8× |
| Kidney Imaging Morphol (78700) |
$2,370.20 |
$3,386 |
5.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$2,486.40 |
$3,552 |
5.6× |
| Knee 3 Views (73562) |
$70.70 |
$101 |
0.7× |
| Leveen/Shunt Patency Exam (78291) |
$430.50 |
$615 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$494.20 |
$706 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$494.20 |
$706 |
1.1× |
| Liver imaging static only (78201) |
$7,791 |
$11,130 |
12.9× |
| Lung Perf&Ventilat Diferentl (78598) |
$569.80 |
$814 |
0.9× |
| Lung perfusion differential (78597) |
$406 |
$580 |
0.9× |
| Lung Ventilat&Perfus Imaging (78582) |
$569.80 |
$814 |
0.9× |
| Lung Ventilation Imaging (78579) |
$406 |
$580 |
0.9× |
| Lymph System Imaging (78195) |
$460.60 |
$658 |
0.8× |
| Lymphangiography Extremity Only Bilateral Rs&I (75803) |
$1,437.80 |
$2,054 |
0.8× |
| Lymphangiography extremity only unilateral rs&i (75801) |
$633.50 |
$905 |
0.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,437.80 |
$2,054 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,437.80 |
$2,054 |
0.4× |
| Magnetic Image Jaw Joint (70336) |
$1,211 |
$1,730 |
4.6× |
| Meckels Divert Exam (78290) |
$430.50 |
$615 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$528.50 |
$755 |
1.3× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,442.30 |
$3,489 |
6.3× |
| MRA head w/o contrast (70544) |
$1,460.90 |
$2,087 |
5.5× |
| MRA head with contrast (70545) |
$2,113.30 |
$3,019 |
5.4× |
| MRA neck w contrast (70548) |
$2,113.30 |
$3,019 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,442.30 |
$3,489 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,460.90 |
$2,087 |
5.5× |
| MRI abdomen w contrast (74182) |
$1,750.70 |
$2,501 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,211 |
$1,730 |
4.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,750.70 |
$2,501 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,022.30 |
$2,889 |
5.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,750.70 |
$2,501 |
2.0× |
| MRI bone marrow blood supply (77084) |
$1,211 |
$1,730 |
4.6× |
| MRI cardiac w/o cont stress (75559) |
$1,211 |
$1,730 |
2.0× |
| MRI cardiac w/o contrast (75557) |
$1,211 |
$1,730 |
4.6× |
| MRI cervical spine w contrast (72142) |
$2,113.30 |
$3,019 |
5.4× |
| MRI cervical spine w/o cont (72141) |
$1,460.90 |
$2,087 |
5.5× |
| MRI chest w/o contrast (71550) |
$1,211 |
$1,730 |
4.6× |
| MRI chest with contrast (71551) |
$1,750.70 |
$2,501 |
2.0× |
| MRI chest wo w contrast (71552) |
$2,081.80 |
$2,974 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,750.70 |
$2,501 |
4.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,081.80 |
$2,974 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,211 |
$1,730 |
4.6× |
| MRI lumbar spine w contrast (72149) |
$1,750.70 |
$2,501 |
4.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,513.70 |
$3,591 |
6.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,460.90 |
$2,087 |
5.5× |
| MRI orbit face neck w contrast (70542) |
$2,113.30 |
$3,019 |
5.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,513.70 |
$3,591 |
6.5× |
| MRI pelvis w contrast (72196) |
$1,750.70 |
$2,501 |
4.5× |
| MRI pelvis w/o & w contrast (72197) |
$2,022.30 |
$2,889 |
5.2× |
| MRI pelvis w/o contrast (72195) |
$1,211 |
$1,730 |
4.6× |
| MRI spectroscopy (76390) |
$2,014.60 |
$2,878 |
20.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,211 |
$1,730 |
4.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,750.70 |
$2,501 |
4.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,211 |
$1,730 |
4.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,022.30 |
$2,889 |
5.2× |
| MRI, abdomen, combo (74183) |
$2,081.80 |
$2,974 |
5.4× |
| MRI, dorsal spine combo (72157) |
$2,081.80 |
$2,974 |
5.4× |
| MRI, dorsal spine contrast (72147) |
$1,750.70 |
$2,501 |
4.5× |
| MRI, joint upper extrem (73221) |
$1,246 |
$1,780 |
4.7× |
| MRI, joint upper extrem combo (73223) |
$2,022.30 |
$2,889 |
5.2× |
| MRI, lumbar spine combo (72158) |
$2,081.80 |
$2,974 |
5.4× |
| Musculoskeletal Nuclear Exam (78399) |
$430.50 |
$615 |
1.0× |
| Myelogram cervical (72240) |
$1,219.40 |
$1,742 |
1.4× |
| Myelogram Lumbar (72265) |
$1,354.50 |
$1,935 |
1.6× |
| Myelography thoracic (72255) |
$1,219.40 |
$1,742 |
1.4× |
| Myelograpy 2/more regions rs&i (72270) |
$1,219.40 |
$1,742 |
1.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$6,494.60 |
$9,278 |
4.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,528.10 |
$2,183 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,528.10 |
$2,183 |
1.1× |
| Myocrd Img Pet Metab Eval Single Study Cncrnt CT (78429) |
$7,369.60 |
$10,528 |
4.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$15,493.10 |
$22,133 |
9.7× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$17,112.20 |
$24,446 |
7.0× |
| Myocrd Img Pet Prfuj W/Metab 2rtracer Cncrnt CT (78433) |
$14,051.10 |
$20,073 |
5.7× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$14,051.10 |
$20,073 |
8.3× |
| N-invas est c ffr sw aly CTA (75580) |
$2,021.60 |
$2,888 |
2.1× |
| Neck soft tissue (70360) |
$41.30 |
$59 |
0.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$341.60 |
$488 |
0.8× |
| Nm csf leak detection (78650) |
$708.40 |
$1,012 |
0.5× |
| Nm unlisted gi procedure (78299) |
$430.50 |
$615 |
1.0× |
| Nm whole blood volume (78122) |
$750.40 |
$1,072 |
1.2× |
| Nonvascular Shunt X-Ray (75809) |
$64.40 |
$92 |
0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,745.10 |
$2,493 |
1.1× |
| Nuclear medicine study of endocrine organs (78099) |
$247.10 |
$353 |
0.6× |
| Nuclear Rx Intra-Arterial (79445) |
$1,460.90 |
$2,087 |
5.6× |
| Nuclear Rx Oral Admin (79005) |
$1,460.90 |
$2,087 |
5.6× |
| Ob us nuchal meas 1 gest (76813) |
$205.10 |
$293 |
1.8× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$231.70 |
$331 |
2.0× |
| Optic foramina (70190) |
$67.20 |
$96 |
0.7× |
| Panoramic X-ray of jaws (70355) |
$49.70 |
$71 |
0.5× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$5,618.20 |
$8,026 |
9.3× |
| Parathyroid Planar Imaging (78070) |
$381.50 |
$545 |
0.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,563 |
$5,090 |
8.0× |
| Pelvis 1 or 2 views (72170) |
$67.20 |
$96 |
0.6× |
| Perineogram (74775) |
$175 |
$250 |
0.7× |
| Peritoneogram Rs&I (74190) |
$2,162.30 |
$3,089 |
3.6× |
| Pet Image Skull-Thigh (78812) |
$8,115.10 |
$11,593 |
5.1× |
| Pet Image W/Ct Lmtd (78814) |
$11,543 |
$16,490 |
7.2× |
| PET image w/CT, full body (78816) |
$11,543 |
$16,490 |
7.2× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$11,543 |
$16,490 |
7.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$6,494.60 |
$9,278 |
4.5× |
| Pet Myocardial Sngl Study (78491) |
$1,733.20 |
$2,476 |
1.1× |
| PET whole body (78813) |
$9,733.50 |
$13,905 |
6.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,390.40 |
$6,272 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$406 |
$580 |
0.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$64.40 |
$92 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$213.50 |
$305 |
0.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$67.20 |
$96 |
0.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$67.20 |
$96 |
0.7× |
| Radex elbow complete minimum 3 views (73080) |
$67.20 |
$96 |
0.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$104.30 |
$149 |
0.9× |
| Radex fingr minimum 2 views (73140) |
$67.20 |
$96 |
0.7× |
| Radex foot complete minimum 3 views (73630) |
$67.20 |
$96 |
0.7× |
| Radex Hand Minimum 3 Views (73130) |
$67.20 |
$96 |
0.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$67.20 |
$96 |
0.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$67.20 |
$96 |
0.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$67.20 |
$96 |
0.7× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$98.70 |
$141 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$67.20 |
$96 |
0.7× |
| Radex shoulder complete minimum 2 views (73030) |
$67.20 |
$96 |
0.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$67.20 |
$96 |
0.7× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$104.30 |
$149 |
0.5× |
| Radex Spine 1 View Specify Level (72020) |
$67.20 |
$96 |
0.7× |
| Radex Sternum Minimum 2 Views (71120) |
$67.20 |
$96 |
0.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$67.20 |
$96 |
0.7× |
| Radex Toe Minimum 2 Views (73660) |
$67.20 |
$96 |
0.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$104.30 |
$149 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$67.20 |
$96 |
0.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$67.20 |
$96 |
0.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,085.10 |
$8,693 |
0.7× |
| Radiation treatment delivery level 1 (77402) |
$188.30 |
$269 |
1.7× |
| Radiation treatment delivery level 2 (77407) |
$193.20 |
$276 |
0.4× |
| Radiation treatment delivery level 3 (77412) |
$394.10 |
$563 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$104.30 |
$149 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$41.30 |
$59 |
0.4× |
| Radiologic exam colon double contrast study (74280) |
$104.30 |
$149 |
0.5× |
| Radiologic exam colon single contrast study (74270) |
$104.30 |
$149 |
0.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,143.80 |
$1,634 |
5.9× |
| Radiologic exam knee complete 4/more views (73564) |
$74.20 |
$106 |
0.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$67.20 |
$96 |
0.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$71.40 |
$102 |
0.4× |
| Radiologic exam swallow function contrast study (74230) |
$71.40 |
$102 |
0.4× |
| Radiologic exam teeth complete full mouth (70320) |
$55.30 |
$79 |
0.2× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$49.70 |
$71 |
0.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$104.30 |
$149 |
0.5× |
| Radiologic examination femur 1 view (73551) |
$67.20 |
$96 |
0.7× |
| Radiologic examination femur minimum 2 views (73552) |
$67.20 |
$96 |
0.7× |
| Radiologic examination knee 1/2 views (73560) |
$67.20 |
$96 |
0.7× |
| Radiologic Examination Osseous Survey Limited (77074) |
$104.30 |
$149 |
0.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$41.30 |
$59 |
0.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$67.20 |
$96 |
0.7× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$67.20 |
$96 |
0.1× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$49.70 |
$71 |
0.5× |
| Renal Cyst Study (74470) |
$482.30 |
$689 |
0.8× |
| Ribs bilateral 3 views (71110) |
$104.30 |
$149 |
0.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,608.90 |
$3,727 |
5.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$508.20 |
$726 |
1.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,531.60 |
$2,188 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$870.10 |
$1,243 |
1.4× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,684.90 |
$2,407 |
2.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$8,628.90 |
$12,327 |
6.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$9,056.60 |
$12,938 |
5.7× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$8,215.90 |
$11,737 |
5.7× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$201.60 |
$288 |
0.8× |
| Rp Therapy Intravenous Administration (79101) |
$1,384.60 |
$1,978 |
5.3× |
| Rp Therapy Unlisted Procedure (79999) |
$268.80 |
$384 |
1.0× |
| Salivary Gland Imaging Serial Images (78231) |
$430.50 |
$615 |
1.0× |
| Scapula (73010) |
$67.20 |
$96 |
0.6× |
| Sella turcica (70240) |
$67.20 |
$96 |
0.7× |
| Shoulder 1 view (73020) |
$67.20 |
$96 |
0.7× |
| Shoulder Arthrography (73040) |
$694.40 |
$992 |
1.8× |
| Sialogram (70390) |
$213.50 |
$305 |
0.8× |
| Skull less than 4 views (70250) |
$67.20 |
$96 |
0.6× |
| Special dosimetry (77331) |
$195.30 |
$279 |
1.3× |
| Special Physics Consult (77370) |
$366.80 |
$524 |
2.4× |
| Special teletherapy port plan (77321) |
$528.50 |
$755 |
1.3× |
| Special treatment procedure (77470) |
$781.90 |
$1,117 |
1.3× |
| Speech evaluation, complex (70371) |
$98.70 |
$141 |
0.4× |
| Spleen Imaging (78185) |
$2,377.90 |
$3,397 |
5.3× |
| Srs Multisource (77371) |
$54,418 |
$77,740 |
6.6× |
| Stereotactic Body Radiation Delivery (77373) |
$3,255.70 |
$4,651 |
1.6× |
| Sternoclavicular joints (71130) |
$67.20 |
$96 |
0.7× |
| Superior sagittal sinus venogram (75870) |
$633.50 |
$905 |
0.2× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$249.20 |
$356 |
2.6× |
| Tbs technical calculation only (77091) |
$249.20 |
$356 |
2.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$217 |
$310 |
0.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$217 |
$310 |
0.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$389.20 |
$556 |
1.5× |
| Testicular Imaging W/Flow (78761) |
$553.70 |
$791 |
1.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$528.50 |
$755 |
1.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$528.50 |
$755 |
1.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$195.30 |
$279 |
1.3× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$309.40 |
$442 |
1.6× |
| Thoracic spine 2 views (72070) |
$67.20 |
$96 |
0.6× |
| Thoracic spine 3 views (72072) |
$104.30 |
$149 |
0.9× |
| Thoracolumbar 2 views (72080) |
$67.20 |
$96 |
0.7× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$508.20 |
$726 |
1.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$2,198 |
$3,140 |
4.9× |
| Thyroid Met Imaging Body (78018) |
$508.20 |
$726 |
0.8× |
| Thyroid Uptake Measurement (78012) |
$1,610 |
$2,300 |
3.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,837.80 |
$4,054 |
6.4× |
| Tx Devices Design & Construction Complex (77334) |
$1,120.70 |
$1,601 |
2.7× |
| Tx devices design & construction intermediate (77333) |
$362.60 |
$518 |
2.4× |
| Tx devices design & construction simple (77332) |
$362.60 |
$518 |
2.4× |
| Ultrasound Breast Limited (76642) |
$270.90 |
$387 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$329.70 |
$471 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$205.10 |
$293 |
1.8× |
| Umbilical-artery Doppler (OB) (76820) |
$184.80 |
$264 |
1.6× |
| Unlisted Dx Radiographic Procedure (76499) |
$118.30 |
$169 |
1.2× |
| Unlisted fluoroscopic procedure (76496) |
$294.70 |
$421 |
3.0× |
| Unlisted genitourinary px dx nuclear medicine (78799) |
$553.70 |
$791 |
1.2× |
Unlisted magnetic resonance procedure (76498)
range across 2 matching MRF lines |
$172.90–$182 |
$247–$260 |
varies |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$186.90 |
$267 |
0.4× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$406 |
$580 |
0.9× |
| Unlisted us procedure (76999) |
$137.20 |
$196 |
1.4× |
| Upper gi w/o kub (74240) |
$104.30 |
$149 |
0.5× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$16.10 |
$23 |
1.5× |
| Ureteral Reflux Study (78740) |
$553.70 |
$791 |
1.2× |
| Urethrocystogram voiding (74455) |
$175 |
$250 |
0.7× |
| Urethrocystography retrograde (74450) |
$175 |
$250 |
0.7× |
| Us breast unilateral complete (76641) |
$270.90 |
$387 |
2.3× |
| Us chest (76604) |
$205.10 |
$293 |
1.8× |
| Us complete joint (76881) |
$205.10 |
$293 |
1.8× |
| Us exam, pelvic, limited (76857) |
$137.20 |
$196 |
1.2× |
| Us head (76506) |
$205.10 |
$293 |
1.8× |
| Us kidney transplant (76776) |
$205.10 |
$293 |
1.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$137.20 |
$196 |
1.2× |
| Us ob detailed single fetus (76811) |
$291.20 |
$416 |
1.1× |
| Us ob limited 1 or more fetuses (76815) |
$205.10 |
$293 |
1.8× |
| Us ob transvaginal (76817) |
$205.10 |
$293 |
1.8× |
| Us pelvic non ob complete (76856) |
$205.10 |
$293 |
1.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$205.10 |
$293 |
1.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$137.20 |
$196 |
1.2× |
| Us retroperitoneal complete (76770) |
$205.10 |
$293 |
1.8× |
| Us retroperitoneal limited (76775) |
$205.10 |
$293 |
1.8× |
| Us scrotum and contents (76870) |
$205.10 |
$293 |
1.8× |
| Us spinal canal and contents (76800) |
$137.20 |
$196 |
1.2× |
| Us thyroid (76536) |
$205.10 |
$293 |
1.8× |
| Us transrectal (76872) |
$205.10 |
$293 |
1.8× |
| Vascular Flow Imaging (78445) |
$411.60 |
$588 |
0.9× |
| Vasogram (74440) |
$175 |
$250 |
0.7× |
| Vein X-Ray Chest (75827) |
$1,456.70 |
$2,081 |
0.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$1,456.70 |
$2,081 |
0.4× |
| Vein X-Ray Skull Epidural (75872) |
$1,456.70 |
$2,081 |
2.1× |
| Vein X-Ray Spleen/Liver (75810) |
$4,390.40 |
$6,272 |
1.2× |
| Venogram Sinus/Jugular (75860) |
$1,456.70 |
$2,081 |
0.4× |
| Venography Adrenal Unilateral (75840) |
$4,390.40 |
$6,272 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$4,390.40 |
$6,272 |
1.2× |
| Venography extremity bilateral rs&i (75822) |
$2,083.20 |
$2,976 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$1,456.70 |
$2,081 |
0.8× |
| Venography Orbital Rs&I (75880) |
$1,456.70 |
$2,081 |
2.1× |
| Venography Renal Bilateral (75833) |
$4,390.40 |
$6,272 |
1.2× |
| Venography Renal Unilateral (75831) |
$4,390.40 |
$6,272 |
1.2× |
| Venous sampling by catheter (75893) |
$4,390.40 |
$6,272 |
0.7× |
| Wrist 2 views (73100) |
$67.20 |
$96 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$67.20 |
$96 |
0.7× |
| X-ray antegrade pyelogram tube (74425) |
$175 |
$250 |
0.5× |
| X-Ray Aorta Leg Arteries (75630) |
$4,390.40 |
$6,272 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$104.30 |
$149 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$67.20 |
$96 |
0.7× |
| X-Ray Exam Breast Specimen (76098) |
$430.50 |
$615 |
0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$67.20 |
$96 |
0.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$67.20 |
$96 |
0.6× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$67.20 |
$96 |
0.6× |
| X-Ray Exam Hip Uni 1 View (73501) |
$58.10 |
$83 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$67.20 |
$96 |
0.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$67.20 |
$96 |
0.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$104.30 |
$149 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$104.30 |
$149 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$104.30 |
$149 |
0.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$104.30 |
$149 |
0.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$67.20 |
$96 |
0.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$104.30 |
$149 |
0.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$104.30 |
$149 |
0.9× |
| X-ray eye for foreign body (70030) |
$41.30 |
$59 |
0.4× |
| X-ray humerus (73060) |
$67.20 |
$96 |
0.7× |
| X-ray IV pyelogram (ivp) (74400) |
$175 |
$250 |
0.9× |
| X-ray IV pyelogram+tomography (74415) |
$184.80 |
$264 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$67.20 |
$96 |
0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$67.20 |
$96 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$67.20 |
$96 |
0.6× |
| X-ray nose-rectum child f.b. (76010) |
$41.30 |
$59 |
0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104.30 |
$149 |
0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$67.20 |
$96 |
0.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$67.20 |
$96 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$67.20 |
$96 |
0.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$67.20 |
$96 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104.30 |
$149 |
0.9× |
| X-ray thoracic spine 4 vw (72074) |
$116.20 |
$166 |
1.0× |
| X-Ray Tmj Unilat (70328) |
$67.20 |
$96 |
0.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$175 |
$250 |
0.5× |
| X-Rays Bone Length Studies (77073) |
$67.20 |
$96 |
0.6× |
| X-Rays Bone Survey Complete (77075) |
$104.30 |
$149 |
0.9× |
| Xr c-spine 4 or 5 views (72050) |
$104.30 |
$149 |
0.9× |
| Xr facial bones less than 3 views (70140) |
$67.20 |
$96 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$67.20 |
$96 |
0.6× |
| Xr myelogram posterior fossa (70010) |
$1,834 |
$2,620 |
4.7× |
| Xr orbits complete 4 views (70200) |
$67.20 |
$96 |
0.6× |
| Xr Tomogram Single Plane (76100) |
$64.40 |
$92 |
0.6× |