| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,305.90 |
$10,437 |
4.7× |
| Abdomen 2 views (74019) |
$272.30 |
$389 |
2.3× |
| Acute gi blood loss imaging (78278) |
$1,408.40 |
$2,012 |
3.2× |
| Angio Adrenal Bilat Select (75733) |
$8,597.40 |
$12,282 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$6,876.80 |
$9,824 |
2.0× |
| Angiography extremity unilateral rs&i (75710) |
$6,876.80 |
$9,824 |
2.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,876.80 |
$9,824 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,597.40 |
$12,282 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,597.40 |
$12,282 |
2.4× |
| Angiography Spinal Selective Rs&I (75705) |
$3,905.30 |
$5,579 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$7,614.60 |
$10,878 |
1.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,171.60 |
$7,388 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$8,270.50 |
$11,815 |
2.4× |
| Ankle 2 views (73600) |
$277.90 |
$397 |
2.9× |
| Aortogram thoracic (75605) |
$8,597.40 |
$12,282 |
1.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,890.80 |
$9,844 |
2.0× |
| Aortography abdominal serialography rs&i (75625) |
$6,876.80 |
$9,824 |
2.0× |
| Artery X-Rays Adrenal Gland (75731) |
$8,597.40 |
$12,282 |
2.4× |
| Arthrogram ankle (73615) |
$1,325.10 |
$1,893 |
3.4× |
| Arthrogram elbow (73085) |
$1,357.30 |
$1,939 |
3.5× |
| Arthrogram hip (73525) |
$1,357.30 |
$1,939 |
3.5× |
| Arthrogram knee (73580) |
$1,330.70 |
$1,901 |
3.4× |
| Arthrogram shoulder (73040) |
$1,357.30 |
$1,939 |
3.5× |
| Arthrogram wrist (73115) |
$1,135.40 |
$1,622 |
2.9× |
| Basic dosimetry (77300) |
$425.60 |
$608 |
2.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$815.50 |
$1,165 |
1.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,249.50 |
$1,785 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$1,382.50 |
$1,975 |
3.1× |
| Bone age studies (77072) |
$294.70 |
$421 |
2.5× |
| Bone Imaging 3 Phase (78315) |
$1,696.10 |
$2,423 |
3.8× |
| Bone survey complete (77075) |
$1,021.30 |
$1,459 |
8.8× |
| Bone survey infant (77076) |
$769.30 |
$1,099 |
6.6× |
| Bowel imaging (78290) |
$923.30 |
$1,319 |
2.1× |
| Brachytx isodose complex (77318) |
$1,099 |
$1,570 |
2.6× |
| Brachytx isodose intermed (77317) |
$1,099 |
$1,570 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$396.20 |
$566 |
0.9× |
| Brain imaging < 4 static views (78600) |
$1,190 |
$1,700 |
2.7× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,190 |
$1,700 |
2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,905.40 |
$2,722 |
3.1× |
| Brain Imaging Vascular Flow Only (78610) |
$1,137.50 |
$1,625 |
1.9× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,190 |
$1,700 |
2.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,725.80 |
$3,894 |
6.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,577.80 |
$2,254 |
3.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,880.50 |
$4,115 |
3.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,880.50 |
$4,115 |
7.4× |
| Cardiovasc nucl exam unlisted (78499) |
$2,181.20 |
$3,116 |
4.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,192.10 |
$1,703 |
2.0× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$2,071.30 |
$2,959 |
3.4× |
| Cervical spine 2 or 3 views (72040) |
$336 |
$480 |
3.5× |
| Chest 1 view (71045) |
$237.30 |
$339 |
2.4× |
| Chest xray 3 views (71047) |
$368.90 |
$527 |
3.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$548.80 |
$784 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$613.20 |
$876 |
3.1× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,843.40 |
$4,062 |
3.3× |
| Clavicle complete (73000) |
$294.70 |
$421 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$323.40 |
$462 |
2.8× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$308 |
$440 |
3.2× |
| Continuing medical physics consltj pr wk (77336) |
$784.70 |
$1,121 |
5.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$876.40 |
$1,252 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,444.70 |
$4,921 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,234.40 |
$3,192 |
8.4× |
| CT abdomen w contrast (74160) |
$1,406.30 |
$2,009 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,722.70 |
$2,461 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,093.40 |
$1,562 |
9.4× |
| CT angio hrt w/3d image (75574) |
$2,316.30 |
$3,309 |
6.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,310.70 |
$3,301 |
11.8× |
| CT angiography upper extremity lt (73206) |
$1,764 |
$2,520 |
9.0× |
| CT c-spine w/contrast (72126) |
$1,374.80 |
$1,964 |
3.5× |
| CT c-spine w/o contrast (72125) |
$1,080.10 |
$1,543 |
9.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,118.90 |
$3,027 |
10.8× |
| CT chest w contrast (71260) |
$1,451.80 |
$2,074 |
7.4× |
| CT chest w/wo contrast (71270) |
$1,790.60 |
$2,558 |
9.2× |
| CT head/brain with contrast (70460) |
$1,145.20 |
$1,636 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,407.70 |
$2,011 |
7.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,255.80 |
$1,794 |
3.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$131.60 |
$188 |
1.4× |
| CT hrt w/3d image congen (75573) |
$1,599.50 |
$2,285 |
4.1× |
| CT iac w contrast (70481) |
$1,145.20 |
$1,636 |
5.9× |
| CT limited/localized follow up study (76380) |
$1,038.10 |
$1,483 |
10.7× |
| CT lower ext w/o (73700) |
$959.70 |
$1,371 |
8.2× |
| CT lower extremity w wo contrast (73702) |
$1,902.60 |
$2,718 |
9.7× |
| CT lower extremity w/contrast material (73701) |
$1,228.50 |
$1,755 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,237.90 |
$3,197 |
11.4× |
| CT lumbar spine w/contrast (72132) |
$1,451.80 |
$2,074 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,141 |
$1,630 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,145.20 |
$1,636 |
5.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,759.80 |
$2,514 |
9.0× |
| CT maxillofacial wo contrast (70486) |
$663.95 |
$948.50 |
5.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,407.70 |
$2,011 |
7.2× |
| CT orbits w/o contrast (70480) |
$885.50 |
$1,265 |
7.6× |
| CT pelvis w/o contrast (72192) |
$1,141 |
$1,630 |
9.8× |
| CT pelvis w/wo contrast (72194) |
$2,153.20 |
$3,076 |
11.0× |
| CT scan of arm combo (73202) |
$1,521.80 |
$2,174 |
7.8× |
| CT soft tissue neck w contrast (70491) |
$1,145.20 |
$1,636 |
5.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,407.70 |
$2,011 |
7.2× |
| CT soft tissue neck w/o contrast (70490) |
$885.50 |
$1,265 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$1,451.80 |
$2,074 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,141 |
$1,630 |
9.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,237.90 |
$3,197 |
11.4× |
| CT thorax w/o contrast (71250) |
$868.70 |
$1,241 |
7.5× |
| CT upper ext wo (73200) |
$959.70 |
$1,371 |
8.2× |
| CT upper extremity with contrast (73201) |
$1,228.50 |
$1,755 |
3.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,557.80 |
$3,654 |
13.1× |
| Cta Abdomen (74175) |
$2,007.60 |
$2,868 |
10.3× |
| CTA abdomen pelvis (74174) |
$3,770.90 |
$5,387 |
9.7× |
| CTA chest (71275) |
$2,107 |
$3,010 |
10.8× |
| Cta Head (70496) |
$1,710.80 |
$2,444 |
8.8× |
| Cta Neck (70498) |
$1,710.80 |
$2,444 |
8.8× |
| Cta Pelvis (72191) |
$2,205.70 |
$3,151 |
11.3× |
| Cystography minimum 3 views rs&i (74430) |
$548.10 |
$783 |
1.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,737.90 |
$8,197 |
2.5× |
| Diskogram cervical (72285) |
$2,481.50 |
$3,545 |
1.1× |
| Diskography lumbar (72295) |
$1,850.10 |
$2,643 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$1,000.30 |
$1,429 |
8.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,000.30 |
$1,429 |
8.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$371 |
$530 |
3.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$401.10 |
$573 |
4.1× |
| Dxa bone density study axial skeleton (77085) |
$283.50 |
$405 |
2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$850.50 |
$1,215 |
3.2× |
| Esophageal motility (78258) |
$1,169 |
$1,670 |
2.6× |
| Esophagus (74220) |
$558.60 |
$798 |
2.9× |
| Facial bones min 3 views (70150) |
$442.40 |
$632 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$532 |
$760 |
4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$532 |
$760 |
4.6× |
| Fetal Echo (76825) |
$3,188.50 |
$4,555 |
5.2× |
| Fluoroscopy up to 1 hr (76000) |
$674.80 |
$964 |
2.5× |
| Foot 2 views (73620) |
$277.90 |
$397 |
2.9× |
| Forearm 2 views (73090) |
$294.70 |
$421 |
3.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,091.30 |
$1,559 |
2.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,161.30 |
$1,659 |
1.9× |
| Hand 2 views (73120) |
$277.90 |
$397 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,292.50 |
$3,275 |
3.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,292.50 |
$3,275 |
3.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,292.50 |
$3,275 |
3.0× |
| Heart Infarct Image (78466) |
$1,264.20 |
$1,806 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,157.10 |
$1,653 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$751.10 |
$1,073 |
1.7× |
| Hysterosalpingogram (74740) |
$1,052.10 |
$1,503 |
4.0× |
| Interstitial radiation source applic complex (77778) |
$3,679.90 |
$5,257 |
4.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,639.70 |
$3,771 |
3.4× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,375.80 |
$3,394 |
3.9× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,246.70 |
$1,781 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$655.20 |
$936 |
5.6× |
| Kidney imaging morphology (78700) |
$1,009.40 |
$1,442 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,232 |
$1,760 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,260 |
$1,800 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,362.20 |
$1,946 |
2.3× |
| Knee 3 views (73562) |
$372.40 |
$532 |
3.8× |
| Liver & spleen imaging static only (78215) |
$1,041.60 |
$1,488 |
2.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,481.90 |
$2,117 |
3.3× |
| Liver imaging static only (78201) |
$903 |
$1,290 |
1.5× |
| Liver imaging w/vascular flow (78202) |
$956.90 |
$1,367 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$1,029 |
$1,470 |
1.7× |
| Lung perfusion differential (78597) |
$875.70 |
$1,251 |
2.0× |
| Lung ventilation imaging (78579) |
$581 |
$830 |
1.3× |
| Lymphoscintigraphy (78195) |
$2,851.10 |
$4,073 |
4.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,258.90 |
$3,227 |
2.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,468.90 |
$3,527 |
6.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,126.90 |
$4,467 |
8.0× |
| Mammary ductogram or galactogram multiple (77054) |
$1,419.60 |
$2,028 |
5.3× |
| Mammary ductogram or galactogram single (77053) |
$788.20 |
$1,126 |
3.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$417.90 |
$597 |
4.3× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$264.60 |
$378 |
0.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$7,305.90 |
$10,437 |
17.5× |
| Mr safety determination physician/other qhp (76016) |
$261.80 |
$374 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$72.80 |
$104 |
2.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$256.90 |
$367 |
2.4× |
| Mr safety implt pos&/immoblj (76019) |
$166.60 |
$238 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$718.90 |
$1,027 |
2.7× |
| MRA head w & w/o contrast (70546) |
$2,419.90 |
$3,457 |
6.2× |
| MRA head w/o contrast (70544) |
$2,004.10 |
$2,863 |
7.5× |
| MRA head with contrast (70545) |
$2,101.40 |
$3,002 |
5.4× |
| MRA neck w contrast (70548) |
$2,109.10 |
$3,013 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,260.30 |
$3,229 |
5.8× |
| MRA neck w/o contrast (70547) |
$2,004.10 |
$2,863 |
7.5× |
| MRI abdomen w contrast (74182) |
$2,564.10 |
$3,663 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,213.70 |
$4,591 |
8.3× |
| MRI abdomen w/o contrast (74181) |
$2,501.80 |
$3,574 |
9.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,126.90 |
$4,467 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,088.70 |
$5,841 |
10.5× |
| MRI bone marrow blood supply (77084) |
$2,604 |
$3,720 |
9.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,345.40 |
$1,922 |
5.1× |
| MRI breast wo contrast unilateral (77046) |
$1,344 |
$1,920 |
5.1× |
| MRI c-spine with contrast (72142) |
$1,974.70 |
$2,821 |
5.1× |
| MRI cardiac w/o cont stress (75559) |
$2,305.80 |
$3,294 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$2,437.40 |
$3,482 |
9.2× |
| MRI cervical spine w/o contrast (72141) |
$1,733.20 |
$2,476 |
6.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,564.10 |
$3,663 |
6.6× |
| MRI chest w/o contrast (71550) |
$2,193.10 |
$3,133 |
8.2× |
| MRI chest with contrast (71551) |
$2,437.40 |
$3,482 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,756.60 |
$3,938 |
7.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,126.90 |
$4,467 |
8.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,805.30 |
$2,579 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,148.70 |
$1,641 |
4.3× |
| MRI orbit face neck w contrast (70542) |
$1,276.10 |
$1,823 |
3.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,418.20 |
$2,026 |
3.6× |
| MRI pelvis w/contrast (72196) |
$2,564.10 |
$3,663 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,213.70 |
$4,591 |
8.3× |
| MRI pelvis w/o contrast (72195) |
$2,437.40 |
$3,482 |
9.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,751.35 |
$3,930.50 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,052.70 |
$4,361 |
7.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,686.50 |
$6,695 |
12.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,879.10 |
$4,113 |
7.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,869.60 |
$5,528 |
10.0× |
| MRI temporomandibular joint (70336) |
$2,437.40 |
$3,482 |
9.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,726.50 |
$3,895 |
10.3× |
| MRI up ext w/o contrast (73218) |
$2,023.70 |
$2,891 |
7.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,632.75 |
$2,332.50 |
6.1× |
| MRI, joint upper extrem combo (73223) |
$3,126.90 |
$4,467 |
8.0× |
| Musculoskeletal Nuclear Exam (78399) |
$4,407.90 |
$6,297 |
9.9× |
| Myelogram Cervical (72240) |
$3,060.40 |
$4,372 |
3.5× |
| Myelogram Lumbar (72265) |
$2,630.60 |
$3,758 |
3.0× |
| Myelogram thoracic (72255) |
$2,793 |
$3,990 |
3.2× |
| Myelography 2 or more regions (72270) |
$3,929.80 |
$5,614 |
4.5× |
| Myocardial infarct spect (78469) |
$1,275.40 |
$1,822 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,550.40 |
$5,072 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$2,552.20 |
$3,646 |
1.8× |
| Neck soft tissue (70360) |
$202.30 |
$289 |
2.1× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$640.50 |
$915 |
1.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,099.70 |
$1,571 |
2.5× |
| Nm adrenal scan (78075) |
$2,116.10 |
$3,023 |
1.5× |
| Nm cardiac blood pool multiple (78473) |
$2,298.10 |
$3,283 |
5.2× |
| Nm cisternogram (78630) |
$1,905.40 |
$2,722 |
3.1× |
| Nm csf leak detection (78650) |
$1,905.40 |
$2,722 |
1.3× |
| Nm gastric emptying study (78264) |
$1,091.30 |
$1,559 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$1,211 |
$1,730 |
2.7× |
| Nm kidney scan w/flow (78701) |
$1,167.60 |
$1,668 |
2.6× |
| Nm peritoneal-venous shunt patency (78291) |
$1,278.20 |
$1,826 |
2.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,305.90 |
$10,437 |
4.7× |
| Nuclear medicine study of endocrine organs (78099) |
$991.20 |
$1,416 |
2.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,243.20 |
$1,776 |
2.8× |
| Nuclear Rx Oral Admin (79005) |
$685.30 |
$979 |
2.6× |
| Ob us nuchal meas 1 gest (76813) |
$789.60 |
$1,128 |
6.8× |
| Orthopantogram (70355) |
$504.70 |
$721 |
5.2× |
| Osseous survey limited (77074) |
$556.50 |
$795 |
4.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,412.60 |
$2,018 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$664.30 |
$949 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$730.80 |
$1,044 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$294.70 |
$421 |
2.5× |
| Perineogram (74775) |
$868 |
$1,240 |
3.3× |
| Peritoneogram after injection (74190) |
$1,444.10 |
$2,063 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$5,890.50 |
$8,415 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$5,890.50 |
$8,415 |
3.7× |
| PET imaging for CT attenuation whole body (78816) |
$5,890.50 |
$8,415 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,028.30 |
$1,469 |
2.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,029 |
$1,470 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$858.90 |
$1,227 |
1.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$342.30 |
$489 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$267.40 |
$382 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$321.30 |
$459 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$183.40 |
$262 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$303.10 |
$433 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$578.90 |
$827 |
5.0× |
| Radex fingr minimum 2 views (73140) |
$237.30 |
$339 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$298.90 |
$427 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$298.90 |
$427 |
3.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$151.20 |
$216 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$476 |
$680 |
4.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$303.10 |
$433 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$905.80 |
$1,294 |
7.8× |
| Radex Humerus Minimum 2 Views (73060) |
$321.30 |
$459 |
3.3× |
| Radex Kne 1/2 Views (73560) |
$320.60 |
$458 |
3.3× |
| Radex Kne Compl 4/More Views (73564) |
$473.20 |
$676 |
4.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$351.40 |
$502 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$294.70 |
$421 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$402.50 |
$575 |
3.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$362.60 |
$518 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$351.40 |
$502 |
3.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$786.80 |
$1,124 |
6.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$468.30 |
$669 |
4.8× |
| Radex Toe Minimum 2 Views (73660) |
$237.30 |
$339 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$294.70 |
$421 |
2.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$298.90 |
$427 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$578.90 |
$827 |
5.0× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$12,317.90 |
$17,597 |
1.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,317.90 |
$17,597 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$533.40 |
$762 |
4.7× |
| Radiation treatment delivery level 3 (77412) |
$897.40 |
$1,282 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$249.20 |
$356 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$427.70 |
$611 |
3.7× |
| Radiologic exam chest 2 views (71046) |
$312.90 |
$447 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$802.90 |
$1,147 |
4.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$792.40 |
$1,132 |
4.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,031.80 |
$1,474 |
5.3× |
| Radiologic examination femur 1 view (73551) |
$287.70 |
$411 |
3.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$820.40 |
$1,172 |
8.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$294.70 |
$421 |
3.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$693 |
$990 |
5.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$351.40 |
$502 |
3.0× |
| Radiological examination surgical specimen (76098) |
$1,267.70 |
$1,811 |
2.1× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,444.10 |
$2,063 |
5.6× |
| Renal Cyst Study (74470) |
$779.10 |
$1,113 |
1.3× |
| Ribs bilateral 3 views (71110) |
$501.20 |
$716 |
4.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,411.90 |
$2,017 |
3.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,411.90 |
$2,017 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,169.60 |
$4,528 |
5.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,680.70 |
$2,401 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,814.30 |
$5,449 |
6.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,654.30 |
$6,649 |
2.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,034.80 |
$5,764 |
2.8× |
| Rp Therapy Intravenous Administration (79101) |
$653.10 |
$933 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$237.30 |
$339 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,596.70 |
$2,281 |
6.0× |
| Scapula (73010) |
$294.70 |
$421 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$41.30 |
$59 |
1.8× |
| Sella turcica (70240) |
$373.10 |
$533 |
3.8× |
| Shoulder 1 view (73020) |
$267.40 |
$382 |
2.8× |
| Sialogram (70390) |
$879.90 |
$1,257 |
3.3× |
| Simulation intermediate (77285) |
$1,489.60 |
$2,128 |
3.6× |
| Small bowel series (74250) |
$613.20 |
$876 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,097.60 |
$1,568 |
2.6× |
| Special dosimetry (77331) |
$425.60 |
$608 |
2.8× |
| Special Physics Consult (77370) |
$917.70 |
$1,311 |
6.1× |
| Special treatment procedure (77470) |
$1,908.90 |
$2,727 |
3.1× |
| Spine thoracic 3 views (72072) |
$412.30 |
$589 |
3.5× |
| Spleen imaging only (78185) |
$1,275.40 |
$1,822 |
2.9× |
| Stereotactic Body Radiation Delivery (77373) |
$6,590.50 |
$9,415 |
3.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$396.20 |
$566 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$396.20 |
$566 |
0.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,293.60 |
$1,848 |
4.9× |
| Testicular Imaging With Vascular Flow (78761) |
$1,465.10 |
$2,093 |
3.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,955.10 |
$2,793 |
4.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$913.50 |
$1,305 |
6.1× |
| Thoracolumbar 2 views (72080) |
$412.30 |
$589 |
4.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,554 |
$2,220 |
2.6× |
| Thyroid imaging w/blood flow (78013) |
$944.30 |
$1,349 |
2.1× |
| Thyroid uptake measurement (78012) |
$600.60 |
$858 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,238.30 |
$1,769 |
2.8× |
| Tmj unilateral (70328) |
$439.60 |
$628 |
4.5× |
| Tomogram (76100) |
$927.50 |
$1,325 |
8.0× |
| Treatment device complex (77334) |
$855.40 |
$1,222 |
2.1× |
| Treatment device intermediate (77333) |
$787.50 |
$1,125 |
5.3× |
| Treatment devices simple (77332) |
$787.50 |
$1,125 |
5.3× |
| Ultrasound breast complete (76641) |
$291.90 |
$417 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$290.50 |
$415 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$451.50 |
$645 |
3.9× |
| Umbilical-artery Doppler (OB) (76820) |
$398.30 |
$569 |
3.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$1,021.30 |
$1,459 |
10.5× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$631.40 |
$902 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$2,046.80 |
$2,924 |
21.1× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$1,152.90 |
$1,647 |
2.6× |
| Unlisted ns dx nm (78699) |
$1,169 |
$1,670 |
2.6× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$725.90 |
$1,037 |
1.6× |
| Unlisted ultrasound procedure (76999) |
$702.80 |
$1,004 |
7.2× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$434 |
$620 |
39.2× |
| Ureteral reflux study (78740) |
$1,071 |
$1,530 |
2.4× |
| Urethrocystogram voiding (74455) |
$742.70 |
$1,061 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$548.10 |
$783 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,743.70 |
$2,491 |
8.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$3,388 |
$4,840 |
17.3× |
| Us breast unilateral limited (76642) |
$291.90 |
$417 |
3.0× |
| Us chest (76604) |
$422.80 |
$604 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$318.50 |
$455 |
2.7× |
| Us elastography parenchyma (76981) |
$494.90 |
$707 |
4.2× |
| Us encephalogram (76506) |
$393.40 |
$562 |
3.4× |
| Us hips infant static (76886) |
$1,003.10 |
$1,433 |
10.3× |
| Us infant hips w manipulation (76885) |
$1,957.20 |
$2,796 |
20.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$293.30 |
$419 |
2.5× |
| Us ob detailed single fetus (76811) |
$702.80 |
$1,004 |
2.6× |
| Us ob limited (76815) |
$393.40 |
$562 |
3.4× |
| Us ob transvaginal (76817) |
$449.40 |
$642 |
3.9× |
| Us pelvic non ob complete (76856) |
$653.80 |
$934 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$496.30 |
$709 |
4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$525 |
$750 |
4.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$309.40 |
$442 |
2.7× |
| Us retroperitoneal complete (76770) |
$543.20 |
$776 |
4.7× |
| Us retroperitoneal limited (76775) |
$451.50 |
$645 |
3.9× |
| Us scrotum and contents (76870) |
$467.60 |
$668 |
4.0× |
| Us soft tissue head/neck (76536) |
$393.40 |
$562 |
3.4× |
| Us spinal canal and contents (76800) |
$529.20 |
$756 |
4.5× |
| Us transrectal prostate volume (76873) |
$521.50 |
$745 |
4.5× |
| Us, eye b-scan (76512) |
$125.30 |
$179 |
1.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$426.30 |
$609 |
3.7× |
| Venogram extremity bilateral (75822) |
$3,082.80 |
$4,404 |
1.8× |
| Venogram Extremity Unilateral (75820) |
$2,467.50 |
$3,525 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$8,597.40 |
$12,282 |
2.4× |
| Venography caval superior serialography rs&i (75827) |
$8,113 |
$11,590 |
4.6× |
| Venography renal unilateral selective rs&i (75831) |
$9,518.60 |
$13,598 |
2.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,543.10 |
$3,633 |
0.7× |
| Venous sampling by catheter (75893) |
$8,597.40 |
$12,282 |
1.4× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$1,165.50 |
$1,665 |
1.9× |
| Vertebral fracture assessment via dxa (77086) |
$392.70 |
$561 |
4.0× |
| Wrist 2 views (73100) |
$277.90 |
$397 |
2.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$349.30 |
$499 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$375.20 |
$536 |
3.9× |
| X-ray b.e. reductn intuss (74283) |
$1,657.60 |
$2,368 |
8.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,052.80 |
$1,504 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$294.70 |
$421 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.40 |
$262 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$303.10 |
$433 |
2.6× |
| X-ray exam of femur 2/> (73552) |
$183.40 |
$262 |
1.9× |
| X-ray eye for foreign body (70030) |
$295.40 |
$422 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$548.80 |
$784 |
5.7× |
| X-ray IV pyelogram (ivp) (74400) |
$1,246.70 |
$1,781 |
6.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$294.70 |
$421 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$294.70 |
$421 |
3.0× |
| X-ray leg, infant (73592) |
$294.70 |
$421 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$375.20 |
$536 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$630.70 |
$901 |
5.4× |
| X-ray nose-rectum child f.b. (76010) |
$538.30 |
$769 |
5.6× |
| X-ray optic foramen (70190) |
$548.80 |
$784 |
5.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$442.40 |
$632 |
3.8× |
| X-ray retrograde pyelogram (74420) |
$1,238.30 |
$1,769 |
3.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$321.30 |
$459 |
3.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$498.40 |
$712 |
4.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$541.80 |
$774 |
4.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$351.40 |
$502 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$321.30 |
$459 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$442.40 |
$632 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$501.20 |
$716 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$351.40 |
$502 |
3.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$961.80 |
$1,374 |
4.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$237.30 |
$339 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$390.60 |
$558 |
4.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$364.70 |
$521 |
3.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$331.10 |
$473 |
2.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$660.10 |
$943 |
5.7× |
| Xr bone length studies (77073) |
$442.40 |
$632 |
3.8× |
| Xr c-spine 4 or 5 views (72050) |
$501.20 |
$716 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$630.70 |
$901 |
5.4× |
| Xr chest 4+ views (71048) |
$578.90 |
$827 |
5.0× |
| Xr urogram antegrade (74425) |
$628.60 |
$898 |
1.6× |