| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,820 |
$2,600 |
1.2× |
| Abdomen 2 views (74019) |
$172.90 |
$247 |
1.5× |
| Acute gi blood loss imaging (78278) |
$1,008 |
$1,440 |
2.3× |
| Angio Adrenal Bilat Select (75733) |
$10,756.20 |
$15,366 |
3.1× |
| Angiography extremity bilateral rs&i (75716) |
$7,200.20 |
$10,286 |
2.0× |
| Angiography extremity unilateral rs&i (75710) |
$7,200.20 |
$10,286 |
2.0× |
| Angiography internal mammary rs&i (75756) |
$4,883.20 |
$6,976 |
1.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,200.20 |
$10,286 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,200.20 |
$10,286 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$7,200.20 |
$10,286 |
2.0× |
| Angiography Spinal Selective Rs&I (75705) |
$8,827 |
$12,610 |
1.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$13,421.10 |
$19,173 |
2.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$6,045.90 |
$8,637 |
1.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,838.80 |
$5,484 |
1.1× |
| Ankle 2 views (73600) |
$161.70 |
$231 |
1.7× |
| Aortogram thoracic (75605) |
$19,433.40 |
$27,762 |
3.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$10,756.20 |
$15,366 |
3.1× |
| Aortography abdominal serialography rs&i (75625) |
$7,200.20 |
$10,286 |
2.0× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$7,200.20 |
$10,286 |
2.0× |
| Artery X-Rays Adrenal Gland (75731) |
$10,756.20 |
$15,366 |
3.1× |
| Arthrogram ankle (73615) |
$1,169.70 |
$1,671 |
3.0× |
| Arthrogram elbow (73085) |
$1,169 |
$1,670 |
3.0× |
| Arthrogram hip (73525) |
$1,208.20 |
$1,726 |
3.1× |
| Arthrogram knee (73580) |
$1,439.90 |
$2,057 |
3.7× |
| Arthrogram shoulder (73040) |
$1,068.90 |
$1,527 |
2.7× |
| Arthrogram wrist (73115) |
$1,191.40 |
$1,702 |
3.1× |
| Basic dosimetry (77300) |
$204.40 |
$292 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,009.40 |
$1,442 |
2.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,009.40 |
$1,442 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,009.40 |
$1,442 |
2.3× |
| Bone age studies (77072) |
$338.10 |
$483 |
2.9× |
| Bone Imaging 3 Phase (78315) |
$1,009.40 |
$1,442 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$1,343.30 |
$1,919 |
3.0× |
| Bone survey complete (77075) |
$256.20 |
$366 |
2.2× |
| Bone survey infant (77076) |
$256.20 |
$366 |
2.2× |
| Bowel imaging (78290) |
$1,008 |
$1,440 |
2.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,355.20 |
$1,936 |
2.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,198.20 |
$7,426 |
3.3× |
| Brain Imaging Vascular Flow Only (78610) |
$1,238.30 |
$1,769 |
2.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,191.40 |
$1,702 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,191.40 |
$1,702 |
2.7× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,249.80 |
$3,214 |
2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,267.70 |
$1,811 |
3.3× |
| Cardiac shunt detection (78428) |
$2,047.50 |
$2,925 |
4.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,659.70 |
$2,371 |
2.7× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$1,878.10 |
$2,683 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$161.70 |
$231 |
1.7× |
| Chest 1 view (71045) |
$123.90 |
$177 |
1.3× |
| Chest xray 3 views (71047) |
$310.80 |
$444 |
3.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$1,005.90 |
$1,437 |
5.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$507.50 |
$725 |
2.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,966.60 |
$4,238 |
3.4× |
| Clavicle complete (73000) |
$161.70 |
$231 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$196 |
$280 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$204.40 |
$292 |
1.4× |
| Corpora cavernosography (74445) |
$1,662.50 |
$2,375 |
14.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,050 |
$1,500 |
2.7× |
| CT abdomen and pelvis without contrast (74176) |
$592.20 |
$846 |
2.2× |
| CT abdomen w contrast (74160) |
$609.70 |
$871 |
3.1× |
| CT abdomen w wo contrast (74170) |
$686 |
$980 |
3.5× |
| CT abdomen w/o contrast (74150) |
$310.10 |
$443 |
2.7× |
| CT angio hrt w/3d image (75574) |
$1,755.60 |
$2,508 |
4.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$714.70 |
$1,021 |
3.7× |
| CT angiography upper extremity lt (73206) |
$1,432.20 |
$2,046 |
7.3× |
| CT c-spine w/contrast (72126) |
$683.90 |
$977 |
1.8× |
| CT c-spine w/o contrast (72125) |
$347.20 |
$496 |
3.0× |
| CT cervical spine w&w/o contrast (72127) |
$2,742.60 |
$3,918 |
14.0× |
| CT chest w contrast (71260) |
$609.70 |
$871 |
3.1× |
| CT chest w/wo contrast (71270) |
$686 |
$980 |
3.5× |
| CT colonography w/dye (74262) |
$1,551.20 |
$2,216 |
7.9× |
| CT colonography w/o cntrst (74261) |
$1,036.70 |
$1,481 |
8.9× |
| CT head/brain with contrast (70460) |
$683.90 |
$977 |
3.5× |
| CT head/brain without and with contrast (70470) |
$770 |
$1,100 |
3.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,321.90 |
$3,317 |
6.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,520.40 |
$2,172 |
15.7× |
| CT hrt w/3d image congen (75573) |
$1,755.60 |
$2,508 |
4.5× |
| CT iac w contrast (70481) |
$683.90 |
$977 |
3.5× |
| CT limited/localized follow up study (76380) |
$1,103.20 |
$1,576 |
11.4× |
| CT lower ext w/o (73700) |
$310.10 |
$443 |
2.7× |
| CT lower extremity w wo contrast (73702) |
$2,085.30 |
$2,979 |
10.7× |
| CT lower extremity w/contrast material (73701) |
$609.70 |
$871 |
3.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,447.90 |
$3,497 |
12.5× |
| CT lumbar spine w/contrast (72132) |
$609.70 |
$871 |
1.6× |
| CT lumbar spine w/o contrast (72131) |
$310.10 |
$443 |
2.7× |
| CT maxillofacial w contrast (70487) |
$683.90 |
$977 |
3.5× |
| CT maxillofacial w/wo contrast (70488) |
$770 |
$1,100 |
3.9× |
| CT maxillofacial wo contrast (70486) |
$347.20 |
$496 |
3.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,189.20 |
$4,556 |
16.3× |
| CT orbits w/o contrast (70480) |
$347.20 |
$496 |
3.0× |
| CT pelvis w/o contrast (72192) |
$310.10 |
$443 |
2.7× |
| CT pelvis w/wo contrast (72194) |
$2,688.70 |
$3,841 |
13.8× |
| CT scan of arm combo (73202) |
$1,699.60 |
$2,428 |
8.7× |
| CT soft tissue neck w contrast (70491) |
$683.90 |
$977 |
3.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,650.50 |
$5,215 |
18.7× |
| CT soft tissue neck w/o contrast (70490) |
$347.20 |
$496 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$609.70 |
$871 |
3.1× |
| CT thoracic spine w/o contrast (72128) |
$310.10 |
$443 |
2.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,512.70 |
$2,161 |
7.7× |
| CT thorax w/o contrast (71250) |
$310.10 |
$443 |
2.7× |
| CT unlisted procedure (76497) |
$265.30 |
$379 |
2.7× |
| CT upper ext wo (73200) |
$310.10 |
$443 |
2.7× |
| CT upper extremity with contrast (73201) |
$609.70 |
$871 |
1.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$714.70 |
$1,021 |
3.7× |
| Cta Abdomen (74175) |
$714.70 |
$1,021 |
3.7× |
| CTA abdomen pelvis (74174) |
$954.80 |
$1,364 |
2.5× |
| CTA chest (71275) |
$714.70 |
$1,021 |
3.7× |
| Cta Head (70496) |
$800.10 |
$1,143 |
4.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,304 |
$4,720 |
8.5× |
| Cta Neck (70498) |
$800.10 |
$1,143 |
4.1× |
| Cta Pelvis (72191) |
$3,317.30 |
$4,739 |
17.0× |
| Cystography minimum 3 views rs&i (74430) |
$1,268.40 |
$1,812 |
3.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,821.20 |
$8,316 |
2.5× |
| Diskogram cervical (72285) |
$7,161.70 |
$10,231 |
3.3× |
| Diskography lumbar (72295) |
$4,657.80 |
$6,654 |
2.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$171.50 |
$245 |
1.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$130.90 |
$187 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$510.30 |
$729 |
4.4× |
| Esophagus (74220) |
$507.50 |
$725 |
2.6× |
| Facial bones min 3 views (70150) |
$256.20 |
$366 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$256.20 |
$366 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$256.20 |
$366 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$482.30 |
$689 |
1.8× |
| Foot 2 views (73620) |
$161.70 |
$231 |
1.7× |
| Forearm 2 views (73090) |
$161.70 |
$231 |
1.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,415.40 |
$2,022 |
3.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,878.10 |
$2,683 |
3.1× |
| Hand 2 views (73120) |
$161.70 |
$231 |
1.4× |
| Heart first pass single,planar (78481) |
$2,114.70 |
$3,021 |
3.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$11,729.20 |
$16,756 |
3.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$11,729.20 |
$16,756 |
3.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,159.20 |
$1,656 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,159.20 |
$1,656 |
2.6× |
| Hysterosalpingogram (74740) |
$2,020.90 |
$2,887 |
7.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$933.80 |
$1,334 |
1.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$889.70 |
$1,271 |
1.4× |
| Intracavitary Radiation Source Applic Simple (77761) |
$847 |
$1,210 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$214.20 |
$306 |
1.8× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,321.60 |
$1,888 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,556.10 |
$2,223 |
2.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,297.80 |
$1,854 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,556.10 |
$2,223 |
2.6× |
| Knee 3 views (73562) |
$161.70 |
$231 |
1.7× |
| Liver & spleen imaging static only (78215) |
$1,159.20 |
$1,656 |
2.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,370.20 |
$3,386 |
5.3× |
| Liver imaging static only (78201) |
$4,571 |
$6,530 |
7.6× |
| Lung perf&ventilat diferentl (78598) |
$3,364.20 |
$4,806 |
5.6× |
| Lung perfusion differential (78597) |
$952 |
$1,360 |
2.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,521 |
$5,030 |
1.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,521 |
$5,030 |
1.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$3,521 |
$5,030 |
2.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,778.70 |
$2,541 |
2.5× |
| Lymphoscintigraphy (78195) |
$1,076.60 |
$1,538 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,240.30 |
$4,629 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,096.20 |
$1,566 |
2.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,267.70 |
$1,811 |
3.3× |
| Mammary ductogram or galactogram multiple (77054) |
$1,510.60 |
$2,158 |
5.7× |
| Mammary ductogram or galactogram single (77053) |
$730.10 |
$1,043 |
2.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$168.70 |
$241 |
1.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$551.60 |
$788 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,219.40 |
$1,742 |
3.1× |
| MRA head w/o contrast (70544) |
$730.10 |
$1,043 |
2.7× |
| MRA head with contrast (70545) |
$1,054.90 |
$1,507 |
2.7× |
| MRA neck w contrast (70548) |
$1,054.90 |
$1,507 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,219.40 |
$1,742 |
3.1× |
| MRA neck w/o contrast (70547) |
$730.10 |
$1,043 |
2.7× |
| MRI abdomen w contrast (74182) |
$3,583.30 |
$5,119 |
9.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,267.70 |
$1,811 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$758.10 |
$1,083 |
2.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,096.20 |
$1,566 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,267.70 |
$1,811 |
3.3× |
| MRI bone marrow blood supply (77084) |
$1,848.70 |
$2,641 |
7.0× |
| MRI c-spine with contrast (72142) |
$1,054.90 |
$1,507 |
2.7× |
| MRI cardiac w/o cont stress (75559) |
$1,801.10 |
$2,573 |
3.0× |
| MRI cardiac w/o contrast (75557) |
$1,801.10 |
$2,573 |
6.8× |
| MRI cervical spine w/o contrast (72141) |
$730.10 |
$1,043 |
2.7× |
| MRI chest w/o & w/contrast material (71552) |
$4,168.50 |
$5,955 |
10.7× |
| MRI chest w/o contrast (71550) |
$2,816.80 |
$4,024 |
10.6× |
| MRI chest with contrast (71551) |
$3,033.10 |
$4,333 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,096.20 |
$1,566 |
2.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,267.70 |
$1,811 |
3.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$758.10 |
$1,083 |
2.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$730.10 |
$1,043 |
2.7× |
| MRI orbit face neck w contrast (70542) |
$2,615.20 |
$3,736 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,219.40 |
$1,742 |
3.1× |
| MRI pelvis w/contrast (72196) |
$2,809.80 |
$4,014 |
7.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,267.70 |
$1,811 |
3.3× |
| MRI pelvis w/o contrast (72195) |
$758.10 |
$1,083 |
2.9× |
| MRI spectroscopy (76390) |
$2,121 |
$3,030 |
21.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,219.40 |
$1,742 |
3.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,096.20 |
$1,566 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,267.70 |
$1,811 |
3.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,096.20 |
$1,566 |
2.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,267.70 |
$1,811 |
3.3× |
| MRI temporomandibular joint (70336) |
$2,054.50 |
$2,935 |
7.7× |
| MRI thoracic spine w/o contrast (72146) |
$758.10 |
$1,083 |
2.9× |
| MRI up ext w/o contrast (73218) |
$758.10 |
$1,083 |
2.9× |
| MRI upper ext joint w/o contrast (73221) |
$758.10 |
$1,083 |
2.9× |
| MRI, joint upper extrem combo (73223) |
$1,267.70 |
$1,811 |
3.3× |
| Myelogram Cervical (72240) |
$3,353 |
$4,790 |
3.8× |
| Myelogram Lumbar (72265) |
$3,175.90 |
$4,537 |
3.6× |
| Myelogram thoracic (72255) |
$2,549.40 |
$3,642 |
2.9× |
| Myelography 2 or more regions (72270) |
$4,027.80 |
$5,754 |
4.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,444.30 |
$6,349 |
3.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$9,723 |
$13,890 |
4.0× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$5,101.60 |
$7,288 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,074 |
$5,820 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$7,956.20 |
$11,366 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,074 |
$5,820 |
2.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,586.10 |
$5,123 |
2.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,586.10 |
$5,123 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,586.10 |
$5,123 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$3,586.10 |
$5,123 |
2.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$5,343.80 |
$7,634 |
3.4× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$9,723 |
$13,890 |
5.7× |
| Neck soft tissue (70360) |
$286.30 |
$409 |
3.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$719.60 |
$1,028 |
1.6× |
| Nm adrenal scan (78075) |
$3,599.40 |
$5,142 |
2.5× |
| Nm bone marrow multi (78103) |
$1,603.70 |
$2,291 |
3.6× |
| Nm bone marrow wb (78104) |
$1,076.60 |
$1,538 |
2.4× |
| Nm cisternogram (78630) |
$2,095.80 |
$2,994 |
3.5× |
| Nm csf leak detection (78650) |
$1,341.20 |
$1,916 |
0.9× |
| Nm gastric emptying study (78264) |
$1,008 |
$1,440 |
2.3× |
| Nm gastroesophageal reflux study (78262) |
$1,670.20 |
$2,386 |
3.7× |
| Nm kidney scan w/flow (78701) |
$1,327.90 |
$1,897 |
3.0× |
| Nm peritoneal-venous shunt patency (78291) |
$1,768.90 |
$2,527 |
4.0× |
| Noncardiac Vascular Flow Imaging (78445) |
$965.30 |
$1,379 |
2.2× |
| Nonvascular shunt X-ray (75809) |
$452.20 |
$646 |
3.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,820 |
$2,600 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$884.80 |
$1,264 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$525.70 |
$751 |
4.5× |
| Osseous survey limited (77074) |
$256.20 |
$366 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$3,361.40 |
$4,802 |
5.6× |
| Parathyroid Planar Imaging (78070) |
$895.30 |
$1,279 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,193.80 |
$3,134 |
4.9× |
| Pelvis 1 or 2 views (72170) |
$161.70 |
$231 |
1.4× |
| Peritoneogram after injection (74190) |
$3,502.10 |
$5,003 |
5.8× |
| PET image w/CT, skull-thigh (78815) |
$7,681.10 |
$10,973 |
4.8× |
| PET imaging CT for attenuation limited area (78814) |
$6,400.10 |
$9,143 |
4.0× |
| PET imaging for CT attenuation whole body (78816) |
$4,074 |
$5,820 |
2.6× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$4,140.50 |
$5,915 |
2.9× |
| PET whole body (78813) |
$4,074 |
$5,820 |
2.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$4,074 |
$5,820 |
2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$10,756.20 |
$15,366 |
3.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,171.90 |
$8,817 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$952 |
$1,360 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,342.60 |
$1,918 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,540.70 |
$2,201 |
2.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$161.70 |
$231 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$161.70 |
$231 |
1.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$161.70 |
$231 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$631.40 |
$902 |
6.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$662.90 |
$947 |
5.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$696.50 |
$995 |
6.0× |
| Radex fingr minimum 2 views (73140) |
$161.70 |
$231 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$161.70 |
$231 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$161.70 |
$231 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$241.50 |
$345 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$284.20 |
$406 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$469 |
$670 |
4.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$894.60 |
$1,278 |
7.7× |
| Radex Humerus Minimum 2 Views (73060) |
$161.70 |
$231 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$161.70 |
$231 |
1.7× |
| Radex Kne Compl 4/More Views (73564) |
$161.70 |
$231 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$256.20 |
$366 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$161.70 |
$231 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$161.70 |
$231 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$161.70 |
$231 |
1.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$161.70 |
$231 |
1.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$379.40 |
$542 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$161.70 |
$231 |
1.7× |
| Radex Toe Minimum 2 Views (73660) |
$161.70 |
$231 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$256.20 |
$366 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$170.10 |
$243 |
1.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$730.80 |
$1,044 |
6.3× |
| Radiation treatment delivery level 1 (77402) |
$176.40 |
$252 |
1.6× |
| Radiation treatment delivery level 2 (77407) |
$179.90 |
$257 |
0.4× |
| Radiation treatment delivery level 3 (77412) |
$369.60 |
$528 |
0.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$172.90 |
$247 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$172.90 |
$247 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$123.90 |
$177 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$751.10 |
$1,073 |
3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,481.90 |
$2,117 |
7.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$751.10 |
$1,073 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$751.10 |
$1,073 |
3.8× |
| Radiologic examination femur 1 view (73551) |
$284.20 |
$406 |
2.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$286.30 |
$409 |
3.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$161.70 |
$231 |
1.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$744.10 |
$1,063 |
6.4× |
| Radiological examination surgical specimen (76098) |
$2,086.70 |
$2,981 |
3.4× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,458.80 |
$2,084 |
5.6× |
| Renal Cyst Study (74470) |
$797.30 |
$1,139 |
1.3× |
| Ribs bilateral 3 views (71110) |
$256.20 |
$366 |
2.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,191.40 |
$1,702 |
2.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,792.70 |
$2,561 |
4.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,599.40 |
$5,142 |
5.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,498.20 |
$6,426 |
7.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,599.40 |
$5,142 |
5.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,498.20 |
$6,426 |
3.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,498.20 |
$6,426 |
2.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,498.20 |
$6,426 |
3.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,106.70 |
$1,581 |
4.3× |
| Rp Therapy Intravenous Administration (79101) |
$1,094.10 |
$1,563 |
4.2× |
| Sacroiliac Joints < 3 Views (72200) |
$597.80 |
$854 |
5.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$362.60 |
$518 |
1.4× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$1,008 |
$1,440 |
2.3× |
| Scapula (73010) |
$161.70 |
$231 |
1.4× |
| Sella turcica (70240) |
$184.80 |
$264 |
1.9× |
| Shoulder 1 view (73020) |
$161.70 |
$231 |
1.7× |
| Sialogram (70390) |
$934.50 |
$1,335 |
3.5× |
| Simulation intermediate (77285) |
$551.60 |
$788 |
1.3× |
| Small bowel series (74250) |
$507.50 |
$725 |
2.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$827.40 |
$1,182 |
2.0× |
| Special dosimetry (77331) |
$204.40 |
$292 |
1.4× |
| Special Physics Consult (77370) |
$204.40 |
$292 |
1.4× |
| Special treatment procedure (77470) |
$731.50 |
$1,045 |
1.2× |
| Speech evaluation complex (70371) |
$2,405.90 |
$3,437 |
9.0× |
| Spine thoracic 3 views (72072) |
$256.20 |
$366 |
2.2× |
| Spleen imaging only (78185) |
$1,421.70 |
$2,031 |
3.2× |
| Splenoportograpy rs&i (75810) |
$10,756.20 |
$15,366 |
3.1× |
| Stereotactic Body Radiation Delivery (77373) |
$3,398.50 |
$4,855 |
1.7× |
| Superior sagittal sinus venogram (75870) |
$3,838.80 |
$5,484 |
1.1× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$356.30 |
$509 |
3.7× |
| Tbs technical calculation only (77091) |
$356.30 |
$509 |
3.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$565.60 |
$808 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$1,829.80 |
$2,614 |
4.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$551.60 |
$788 |
1.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$204.40 |
$292 |
1.4× |
| Thoracolumbar 2 views (72080) |
$161.70 |
$231 |
1.7× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,191.40 |
$1,702 |
2.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,191.40 |
$1,702 |
2.0× |
| Thyroid imaging w/blood flow (78013) |
$722.40 |
$1,032 |
1.6× |
| Thyroid uptake measurement (78012) |
$1,131.20 |
$1,616 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$895.30 |
$1,279 |
2.0× |
| Tmj unilateral (70328) |
$161.70 |
$231 |
1.7× |
| Tomogram (76100) |
$1,138.90 |
$1,627 |
9.8× |
| Treatment device complex (77334) |
$378.70 |
$541 |
0.9× |
| Treatment device intermediate (77333) |
$378.70 |
$541 |
2.5× |
| Treatment devices simple (77332) |
$378.70 |
$541 |
2.5× |
| Ultrasound breast complete (76641) |
$231.70 |
$331 |
2.0× |
| Ultrasound Exam Aaa Screen (76706) |
$92.40 |
$132 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$256.20 |
$366 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$302.40 |
$432 |
2.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$289.80 |
$414 |
3.0× |
| Unlisted fluoroscopic procedure (76496) |
$1,098.30 |
$1,569 |
11.3× |
| Unlisted ultrasound procedure (76999) |
$171.50 |
$245 |
1.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$553 |
$790 |
50.0× |
| Ureteral reflux study (78740) |
$1,365.70 |
$1,951 |
3.1× |
| Urethrocystogram voiding (74455) |
$1,701.70 |
$2,431 |
6.4× |
| Urethrocystography retrograde rs&i (74450) |
$1,268.40 |
$1,812 |
4.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,268.40 |
$1,812 |
6.5× |
| Us breast unilateral limited (76642) |
$216.65 |
$309.50 |
2.2× |
| Us chest (76604) |
$256.20 |
$366 |
2.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,429.40 |
$2,042 |
5.9× |
| Us compl joint r-t w/image documentation (76881) |
$256.20 |
$366 |
2.2× |
| Us elastography parenchyma (76981) |
$270.20 |
$386 |
2.3× |
| Us encephalogram (76506) |
$256.20 |
$366 |
2.2× |
| Us hips infant static (76886) |
$171.50 |
$245 |
1.8× |
| Us infant hips w manipulation (76885) |
$787.50 |
$1,125 |
8.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$171.50 |
$245 |
1.5× |
| Us ob detailed single fetus (76811) |
$362.60 |
$518 |
1.4× |
| Us ob limited (76815) |
$256.20 |
$366 |
2.2× |
| Us ob transvaginal (76817) |
$256.20 |
$366 |
2.2× |
| Us pelvic non ob complete (76856) |
$256.20 |
$366 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$171.50 |
$245 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$256.20 |
$366 |
2.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$171.50 |
$245 |
1.5× |
| Us retroperitoneal complete (76770) |
$256.20 |
$366 |
2.2× |
| Us retroperitoneal limited (76775) |
$256.20 |
$366 |
2.2× |
| Us scrotum and contents (76870) |
$256.20 |
$366 |
2.2× |
| Us soft tissue head/neck (76536) |
$256.20 |
$366 |
2.2× |
| Us spinal canal and contents (76800) |
$171.50 |
$245 |
1.5× |
| Us transrectal (76872) |
$256.20 |
$366 |
2.2× |
| Us, eye b-scan (76512) |
$199.50 |
$285 |
1.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$623.70 |
$891 |
5.4× |
| Vasogram (74440) |
$1,662.50 |
$2,375 |
6.3× |
| Venogram adrenal unilat (75840) |
$10,756.20 |
$15,366 |
3.1× |
| Venogram extremity bilateral (75822) |
$3,570.70 |
$5,101 |
2.0× |
| Venogram Extremity Unilateral (75820) |
$2,390.50 |
$3,415 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$5,189.80 |
$7,414 |
1.5× |
| Venography caval superior serialography rs&i (75827) |
$2,390.50 |
$3,415 |
1.4× |
| Venography Orbital Rs&I (75880) |
$3,570.70 |
$5,101 |
5.1× |
| Venography Renal Bilateral (75833) |
$6,528.20 |
$9,326 |
1.9× |
| Venography renal unilateral selective rs&i (75831) |
$6,233.50 |
$8,905 |
1.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,390.50 |
$3,415 |
0.7× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$3,570.70 |
$5,101 |
5.1× |
| Venous sampling by catheter (75893) |
$6,233.50 |
$8,905 |
1.0× |
| Wrist 2 views (73100) |
$161.70 |
$231 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$452.20 |
$646 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$161.70 |
$231 |
1.7× |
| X-ray b.e. reductn intuss (74283) |
$2,161.60 |
$3,088 |
11.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,693.60 |
$3,848 |
13.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$161.70 |
$231 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$266 |
$380 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$469 |
$670 |
4.0× |
| X-ray exam of femur 2/> (73552) |
$284.20 |
$406 |
2.9× |
| X-ray eye for foreign body (70030) |
$286.30 |
$409 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$161.70 |
$231 |
1.7× |
| X-ray IV pyelogram (ivp) (74400) |
$1,918 |
$2,740 |
9.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161.70 |
$231 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$161.70 |
$231 |
1.7× |
| X-ray leg, infant (73592) |
$161.70 |
$231 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$161.70 |
$231 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,143.80 |
$1,634 |
9.8× |
| X-ray nose-rectum child f.b. (76010) |
$286.30 |
$409 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$161.70 |
$231 |
1.4× |
| X-ray retrograde pyelogram (74420) |
$1,268.40 |
$1,812 |
3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$161.70 |
$231 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$256.20 |
$366 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$268.80 |
$384 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$683.20 |
$976 |
5.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$161.70 |
$231 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$161.70 |
$231 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$991.20 |
$1,416 |
8.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$161.70 |
$231 |
1.4× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,845.20 |
$2,636 |
9.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$161.70 |
$231 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$161.70 |
$231 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$161.70 |
$231 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$161.70 |
$231 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$849.80 |
$1,214 |
7.3× |
| Xr bone length studies (77073) |
$504 |
$720 |
4.3× |
| Xr c-spine 4 or 5 views (72050) |
$256.20 |
$366 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$268.80 |
$384 |
2.3× |
| Xr chest 4+ views (71048) |
$702.80 |
$1,004 |
6.0× |
| Xr urogram antegrade (74425) |
$1,268.40 |
$1,812 |
3.3× |