| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,849.55 |
$5,699.10 |
2.1× |
| Abdomen 2 views (74019) |
$206 |
$412 |
2.0× |
| Acute gi blood loss imaging (78278) |
$794.25 |
$1,588.50 |
2.0× |
| Angiography extremity bilateral rs&i (75716) |
$1,622.86 |
$3,245.72 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,622.86 |
$3,245.72 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,787.20 |
$5,574.39 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,471 |
$2,942 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,622.86 |
$3,245.72 |
0.5× |
| Angiography Spinal Selective Rs&I (75705) |
$2,787.20 |
$5,574.39 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,787.20 |
$5,574.39 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,622.86 |
$3,245.72 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,622.86 |
$3,245.72 |
0.5× |
| Ankle 2 views (73600) |
$218 |
$436 |
2.6× |
| Aortogram thoracic (75605) |
$2,787.20 |
$5,574.39 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,622.86 |
$3,245.72 |
0.5× |
| Aortography abdominal serialography rs&i (75625) |
$1,622.86 |
$3,245.72 |
0.5× |
| Arthrogram ankle (73615) |
$233.50 |
$467 |
0.7× |
| Arthrogram elbow (73085) |
$374.50 |
$749 |
1.1× |
| Arthrogram hip (73525) |
$327.88 |
$655.75 |
1.0× |
| Arthrogram knee (73580) |
$272.70 |
$545.40 |
0.8× |
| Arthrogram shoulder (73040) |
$455.13 |
$910.25 |
1.3× |
| Arthrogram wrist (73115) |
$347 |
$694 |
1.0× |
| Basic dosimetry (77300) |
$261.11 |
$522.21 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$601.88 |
$1,203.75 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$694.50 |
$1,389 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$999.50 |
$1,999 |
2.6× |
| Bone age studies (77072) |
$206 |
$412 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$1,018.38 |
$2,036.75 |
2.6× |
| Bone Marrow Imaging Limited Area (78102) |
$248.05 |
$496.10 |
0.6× |
| Bone survey complete (77075) |
$276.75 |
$553.50 |
2.7× |
| Bone survey infant (77076) |
$206 |
$412 |
2.0× |
| Bowel imaging (78290) |
$312 |
$624 |
0.8× |
| Brachytx isodose complex (77318) |
$956.03 |
$1,912.05 |
2.6× |
| Brachytx isodose intermed (77317) |
$956.03 |
$1,912.05 |
2.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$956.03 |
$1,912.05 |
2.6× |
| Brain imaging < 4 static views (78600) |
$293.43 |
$586.85 |
0.8× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$347.88 |
$695.75 |
0.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,905.41 |
$11,810.81 |
4.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,313.13 |
$2,626.25 |
3.4× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,265.88 |
$4,531.75 |
3.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,818 |
$3,636 |
5.3× |
| Cardiac shunt detection (78428) |
$237.88 |
$475.75 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$206 |
$412 |
2.4× |
| Chest 1 view (71045) |
$95.75 |
$191.50 |
1.1× |
| Chest xray 3 views (71047) |
$207 |
$414 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$224.97 |
$449.93 |
1.3× |
| Clavicle complete (73000) |
$206 |
$412 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$427.60 |
$855.19 |
4.2× |
| Continuing medical physics consltj pr wk (77336) |
$350.50 |
$701 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,746.50 |
$3,493 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,272.50 |
$2,545 |
5.5× |
| CT abdomen w contrast (74160) |
$1,272.50 |
$2,545 |
7.4× |
| CT abdomen w wo contrast (74170) |
$1,272.50 |
$2,545 |
7.4× |
| CT abdomen w/o contrast (74150) |
$1,272.50 |
$2,545 |
12.5× |
| CT angio hrt w/3d image (75574) |
$1,300.43 |
$2,600.85 |
3.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,272.50 |
$2,545 |
7.4× |
| CT angiography upper extremity lt (73206) |
$1,272.50 |
$2,545 |
7.4× |
| CT c-spine w/contrast (72126) |
$1,272.50 |
$2,545 |
3.7× |
| CT c-spine w/o contrast (72125) |
$1,272.50 |
$2,545 |
12.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,272.50 |
$2,545 |
7.4× |
| CT chest w contrast (71260) |
$1,401 |
$2,802 |
8.2× |
| CT chest w/wo contrast (71270) |
$1,272.50 |
$2,545 |
7.4× |
| CT head/brain with contrast (70460) |
$1,272.50 |
$2,545 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,272.50 |
$2,545 |
7.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,300.43 |
$2,600.85 |
3.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$55.50 |
$111 |
0.7× |
| CT hrt w/3d image congen (75573) |
$1,300.43 |
$2,600.85 |
3.8× |
| CT iac w contrast (70481) |
$1,272.50 |
$2,545 |
7.4× |
| CT limited/localized follow up study (76380) |
$600 |
$1,200 |
7.1× |
| CT lower ext w/o (73700) |
$1,225 |
$2,450 |
12.0× |
| CT lower extremity w wo contrast (73702) |
$1,272.50 |
$2,545 |
7.4× |
| CT lower extremity w/contrast material (73701) |
$1,272.50 |
$2,545 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,272.50 |
$2,545 |
7.4× |
| CT lumbar spine w/contrast (72132) |
$1,272.50 |
$2,545 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,272.50 |
$2,545 |
12.5× |
| CT maxillofacial w contrast (70487) |
$1,272.50 |
$2,545 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,272.50 |
$2,545 |
7.4× |
| CT maxillofacial wo contrast (70486) |
$1,102.50 |
$2,205 |
10.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,272.50 |
$2,545 |
7.4× |
| CT orbits w/o contrast (70480) |
$1,272.50 |
$2,545 |
12.5× |
| CT pelvis w/o contrast (72192) |
$1,272.50 |
$2,545 |
12.5× |
| CT pelvis w/wo contrast (72194) |
$1,272.50 |
$2,545 |
7.4× |
| CT scan of arm combo (73202) |
$1,272.50 |
$2,545 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$1,272.50 |
$2,545 |
7.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,272.50 |
$2,545 |
7.4× |
| CT soft tissue neck w/o contrast (70490) |
$999 |
$1,998 |
9.8× |
| CT thoracic spine w/contrast (72129) |
$1,272.50 |
$2,545 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,272.50 |
$2,545 |
12.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,272.50 |
$2,545 |
7.4× |
| CT thorax w/o contrast (71250) |
$1,272.50 |
$2,545 |
12.5× |
| CT upper ext wo (73200) |
$1,212.50 |
$2,425 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,272.50 |
$2,545 |
3.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,272.50 |
$2,545 |
7.4× |
| Cta Abdomen (74175) |
$1,272.50 |
$2,545 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,526.42 |
$3,052.83 |
4.5× |
| CTA chest (71275) |
$1,272.50 |
$2,545 |
7.4× |
| Cta Head (70496) |
$1,129 |
$2,258 |
6.6× |
| Cta Neck (70498) |
$1,272.50 |
$2,545 |
7.4× |
| Cta Pelvis (72191) |
$1,272.50 |
$2,545 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$417.88 |
$835.75 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,056.22 |
$2,112.43 |
0.5× |
| Diskogram cervical (72285) |
$1,006.86 |
$2,013.71 |
0.5× |
| Diskography lumbar (72295) |
$1,006.86 |
$2,013.71 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$160 |
$320 |
1.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$222.50 |
$445 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$309 |
$618 |
3.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$91.51 |
$183.01 |
1.1× |
| Echo exam of eye (76529) |
$339.15 |
$678.30 |
4.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$320 |
$640 |
1.4× |
| Esophagus (74220) |
$329.69 |
$659.38 |
1.9× |
| Facial bones min 3 views (70150) |
$206 |
$412 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$206 |
$412 |
2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$206 |
$412 |
2.0× |
| Fetal Echo (76825) |
$640 |
$1,280 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$425.25 |
$850.50 |
1.8× |
| Foot 2 views (73620) |
$206 |
$412 |
2.4× |
| Forearm 2 views (73090) |
$227.38 |
$454.75 |
2.7× |
| Hand 2 views (73120) |
$206 |
$412 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,428.38 |
$2,856.75 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,086.08 |
$2,172.15 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,684.69 |
$3,369.37 |
2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,622.86 |
$3,245.72 |
0.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,622.86 |
$3,245.72 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,503.50 |
$3,007 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,083 |
$2,166 |
2.8× |
| Hysterosalpingogram (74740) |
$526.50 |
$1,053 |
2.3× |
| Image fusion (77399) |
$348.13 |
$696.25 |
2.7× |
| Interstitial radiation source applic complex (77778) |
$1,357.50 |
$2,715 |
2.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$910.50 |
$1,821 |
1.3× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$956.03 |
$1,912.05 |
1.8× |
| Intracavitary Radiation Source Applic Simple (77761) |
$956.03 |
$1,912.05 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$613.13 |
$1,226.25 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$986.88 |
$1,973.75 |
1.9× |
| Knee 3 views (73562) |
$247.38 |
$494.75 |
2.9× |
| Liver & spleen imaging static only (78215) |
$552.25 |
$1,104.50 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,337.50 |
$2,675 |
3.4× |
| Liver imaging static only (78201) |
$735.13 |
$1,470.25 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$735.13 |
$1,470.25 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$879.67 |
$1,759.34 |
1.7× |
| Lung perfusion differential (78597) |
$542.69 |
$1,085.37 |
1.4× |
| Lung ventilation imaging (78579) |
$506.39 |
$1,012.77 |
1.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,537.13 |
$3,074.25 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,622.86 |
$3,245.72 |
0.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,125 |
$2,250 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$942.50 |
$1,885 |
1.5× |
| Lymphoscintigraphy (78195) |
$771.88 |
$1,543.75 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,430.63 |
$2,861.25 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,430.63 |
$2,861.25 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,542.28 |
$5,084.55 |
7.5× |
| Magnetic Resonance Elastography (76391) |
$803.38 |
$1,606.75 |
3.5× |
| Mammary ductogram or galactogram multiple (77054) |
$381 |
$762 |
1.6× |
| Mammary ductogram or galactogram single (77053) |
$258.63 |
$517.25 |
1.1× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$327.75 |
$655.50 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$819.44 |
$1,638.88 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,274.51 |
$4,549.01 |
6.7× |
| MRA head w/o contrast (70544) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRA head with contrast (70545) |
$1,150 |
$2,300 |
3.4× |
| MRA neck w contrast (70548) |
$1,430.88 |
$2,861.75 |
4.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,274.51 |
$4,549.01 |
6.7× |
| MRA neck w/o contrast (70547) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI abdomen w contrast (74182) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,548.43 |
$5,096.86 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,430.63 |
$2,861.25 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,542.28 |
$5,084.55 |
7.5× |
| MRI breast w/o contrast bilateral (77047) |
$3,133.38 |
$6,266.75 |
13.5× |
| MRI breast wo contrast unilateral (77046) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI c-spine with contrast (72142) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI cardiac w/o cont stress (75559) |
$1,928.13 |
$3,856.25 |
3.6× |
| MRI cardiac w/o contrast (75557) |
$1,280 |
$2,560 |
5.5× |
| MRI cervical spine w/o contrast (72141) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,527.50 |
$5,055 |
7.4× |
| MRI chest w/o contrast (71550) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI chest with contrast (71551) |
$1,430.63 |
$2,861.25 |
1.9× |
| MRI fetal sngl/1st gestation (74712) |
$538 |
$1,076 |
2.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,542.28 |
$5,084.55 |
7.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,609 |
$3,218 |
6.9× |
| MRI orbit face neck w contrast (70542) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,542.28 |
$5,084.55 |
7.5× |
| MRI pelvis w/contrast (72196) |
$1,430.88 |
$2,861.75 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,548.43 |
$5,096.86 |
7.5× |
| MRI pelvis w/o contrast (72195) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,582.90 |
$5,165.80 |
7.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,582.90 |
$5,165.80 |
7.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,430.63 |
$2,861.25 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,582.90 |
$5,165.80 |
7.6× |
| MRI temporomandibular joint (70336) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI up ext w/o contrast (73218) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,430.63 |
$2,861.25 |
6.1× |
| MRI, joint upper extrem combo (73223) |
$2,542.28 |
$5,084.55 |
7.5× |
| Myelogram Cervical (72240) |
$493.07 |
$986.13 |
0.6× |
| Myelogram Lumbar (72265) |
$632.38 |
$1,264.75 |
0.8× |
| Myelogram thoracic (72255) |
$448.13 |
$896.26 |
0.6× |
| Myelography 2 or more regions (72270) |
$632.80 |
$1,265.60 |
0.8× |
| Myocardial infarct spect (78469) |
$633.13 |
$1,266.25 |
1.2× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,040 |
$2,079.99 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,043.83 |
$4,087.65 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$1,040 |
$2,079.99 |
0.8× |
| Neck soft tissue (70360) |
$206 |
$412 |
2.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$457.13 |
$914.25 |
1.2× |
| Nm bone marrow wb (78104) |
$415.64 |
$831.27 |
1.1× |
| Nm cisternogram (78630) |
$513.04 |
$1,026.08 |
1.0× |
| Nm gastric emptying study (78264) |
$720.42 |
$1,440.83 |
1.8× |
| Nm peritoneal-venous shunt patency (78291) |
$312.18 |
$624.36 |
0.8× |
| Nm red cell sequestration (78140) |
$401.12 |
$802.23 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$206 |
$412 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,849.55 |
$5,699.10 |
2.1× |
| Nuclear Rx Oral Admin (79005) |
$839.38 |
$1,678.75 |
3.7× |
| Ob us nuchal meas 1 gest (76813) |
$276 |
$552 |
2.7× |
| Osseous survey limited (77074) |
$206 |
$412 |
2.0× |
| Parathyrd planar w/spect&CT (78072) |
$964.57 |
$1,929.13 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$207.19 |
$414.37 |
0.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,056.28 |
$2,112.55 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$206 |
$412 |
2.0× |
| Perineogram (74775) |
$362.32 |
$724.63 |
1.6× |
| PET image w/CT, skull-thigh (78815) |
$5,520.98 |
$11,041.96 |
4.0× |
| PET imaging CT for attenuation limited area (78814) |
$5,520.98 |
$11,041.96 |
4.0× |
| PET imaging for CT attenuation whole body (78816) |
$5,520.98 |
$11,041.96 |
4.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,622.86 |
$3,245.72 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$625.25 |
$1,250.50 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$908.11 |
$1,816.21 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$342.63 |
$685.25 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$237.63 |
$475.25 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$206 |
$412 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$248.63 |
$497.25 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$206 |
$412 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$206 |
$412 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$206 |
$412 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$206 |
$412 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$222.38 |
$444.75 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$206 |
$412 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$206 |
$412 |
2.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$387.75 |
$775.50 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$212.75 |
$425.50 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$392.25 |
$784.50 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$206 |
$412 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$206 |
$412 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$295.50 |
$591 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$225.75 |
$451.50 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$206 |
$412 |
2.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$253 |
$506 |
2.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$187.50 |
$375 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$213 |
$426 |
2.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$206 |
$412 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$206 |
$412 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$206 |
$412 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$206 |
$412 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$210.75 |
$421.50 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$206 |
$412 |
2.0× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$16,141.39 |
$32,282.78 |
2.2× |
| Radiation treatment delivery level 1 (77402) |
$341.42 |
$682.83 |
3.4× |
| Radiation treatment delivery level 2 (77407) |
$346.42 |
$692.83 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$527.75 |
$1,055.50 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$206 |
$412 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$216.75 |
$433.50 |
2.1× |
| Radiologic exam chest 2 views (71046) |
$168.95 |
$337.89 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$417.88 |
$835.75 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$288.77 |
$577.54 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$355.38 |
$710.75 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$338.50 |
$677 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$206 |
$412 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$206 |
$412 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$206 |
$412 |
2.0× |
| Radiological examination surgical specimen (76098) |
$329.88 |
$659.75 |
0.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$744.66 |
$1,489.32 |
2.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$453.03 |
$906.05 |
1.2× |
| Ribs bilateral 3 views (71110) |
$206 |
$412 |
2.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$559.59 |
$1,119.17 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$734.63 |
$1,469.25 |
1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,101 |
$4,202 |
4.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$683.65 |
$1,367.30 |
1.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,310.29 |
$2,620.58 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$673.11 |
$1,346.22 |
0.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$377.13 |
$754.25 |
1.7× |
| Rp Therapy Intravenous Administration (79101) |
$360.25 |
$720.50 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$206 |
$412 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$196.38 |
$392.75 |
0.8× |
| Scapula (73010) |
$206 |
$412 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$15 |
$30 |
0.6× |
| Sella turcica (70240) |
$206 |
$412 |
2.4× |
| Shoulder 1 view (73020) |
$206 |
$412 |
2.4× |
| Simulation intermediate (77285) |
$585.76 |
$1,171.52 |
1.6× |
| Small bowel series (74250) |
$341.13 |
$682.25 |
2.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$556.13 |
$1,112.25 |
1.5× |
| Special dosimetry (77331) |
$151 |
$302 |
1.2× |
| Special Physics Consult (77370) |
$412.64 |
$825.27 |
3.1× |
| Special treatment procedure (77470) |
$1,225.38 |
$2,450.75 |
2.3× |
| Stereotactic Body Radiation Delivery (77373) |
$11,529.57 |
$23,059.13 |
6.6× |
| Superior sagittal sinus venogram (75870) |
$1,622.86 |
$3,245.72 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$176 |
$352 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$558.38 |
$1,116.75 |
1.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$457.13 |
$914.25 |
1.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$793.80 |
$1,587.60 |
2.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$365.17 |
$730.33 |
2.8× |
| Thoracolumbar 2 views (72080) |
$206 |
$412 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,036.50 |
$2,073 |
2.0× |
| Thyroid imaging w/blood flow (78013) |
$645.54 |
$1,291.07 |
1.7× |
| Thyroid uptake measurement (78012) |
$248.05 |
$496.10 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$777 |
$1,554 |
2.0× |
| Tmj unilateral (70328) |
$206 |
$412 |
2.4× |
| Treatment device complex (77334) |
$454.23 |
$908.46 |
1.2× |
| Treatment device intermediate (77333) |
$344.67 |
$689.33 |
2.6× |
| Treatment devices simple (77332) |
$235.23 |
$470.45 |
1.8× |
| Ultrasound breast complete (76641) |
$379.63 |
$759.25 |
3.7× |
| Ultrasound elastography first target lesion (76982) |
$265.50 |
$531 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$239.71 |
$479.42 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$452.13 |
$904.25 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$222.50 |
$445 |
2.2× |
| Unlisted genitourinary px dx nuclear medicine (78799) |
$557.21 |
$1,114.41 |
1.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,194.32 |
$2,388.64 |
12.0× |
| Unlisted ultrasound procedure (76999) |
$179.25 |
$358.50 |
2.1× |
| Urethrocystogram voiding (74455) |
$487.50 |
$975 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$362.38 |
$724.75 |
1.6× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$209.50 |
$419 |
1.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$227.75 |
$455.50 |
1.3× |
| Us breast unilateral limited (76642) |
$274.50 |
$549 |
3.2× |
| Us chest (76604) |
$193.63 |
$387.25 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$325.25 |
$650.50 |
3.2× |
| Us elastography parenchyma (76981) |
$265.50 |
$531 |
2.6× |
| Us encephalogram (76506) |
$286.25 |
$572.50 |
2.8× |
| Us hips infant static (76886) |
$339.15 |
$678.30 |
4.0× |
| Us infant hips w manipulation (76885) |
$174.88 |
$349.75 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$303.13 |
$606.25 |
3.0× |
| Us ob detailed single fetus (76811) |
$454.50 |
$909 |
2.0× |
| Us ob limited (76815) |
$221.50 |
$443 |
2.2× |
| Us ob transvaginal (76817) |
$356.38 |
$712.75 |
3.5× |
| Us pelvic non ob complete (76856) |
$549.88 |
$1,099.75 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$291.88 |
$583.75 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$380.75 |
$761.50 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$339.15 |
$678.30 |
3.3× |
| Us retroperitoneal complete (76770) |
$312 |
$624 |
3.1× |
| Us retroperitoneal limited (76775) |
$280.13 |
$560.25 |
2.7× |
| Us scrotum and contents (76870) |
$384.38 |
$768.75 |
3.8× |
| Us soft tissue head/neck (76536) |
$420 |
$840 |
4.1× |
| Us spinal canal and contents (76800) |
$244.88 |
$489.75 |
2.4× |
| Us transrectal (76872) |
$251.75 |
$503.50 |
2.5× |
| Us transrectal prostate volume (76873) |
$339.15 |
$678.30 |
3.3× |
| Us, eye b-scan (76512) |
$293.63 |
$587.25 |
2.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$264.99 |
$529.98 |
2.6× |
| Venogram extremity bilateral (75822) |
$753.63 |
$1,507.25 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$800.96 |
$1,601.92 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,622.86 |
$3,245.72 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$1,305.61 |
$2,611.21 |
0.9× |
| Venography Orbital Rs&I (75880) |
$498.40 |
$996.80 |
0.8× |
| Venography Renal Bilateral (75833) |
$1,622.86 |
$3,245.72 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,622.86 |
$3,245.72 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,622.86 |
$3,245.72 |
0.5× |
| Venous sampling by catheter (75893) |
$2,787.20 |
$5,574.39 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$206 |
$412 |
2.4× |
| Wrist 2 views (73100) |
$206 |
$412 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$226.63 |
$453.25 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$206 |
$412 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$279 |
$558 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$552 |
$1,104 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$206 |
$412 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$241.88 |
$483.75 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$274 |
$548 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$291.63 |
$583.25 |
3.4× |
| X-ray eye for foreign body (70030) |
$155 |
$310 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$206 |
$412 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$528.75 |
$1,057.50 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$206 |
$412 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$206 |
$412 |
2.4× |
| X-ray leg, infant (73592) |
$206 |
$412 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$248.13 |
$496.25 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$319.38 |
$638.75 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$206 |
$412 |
2.4× |
| X-ray optic foramen (70190) |
$206 |
$412 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$206 |
$412 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$739.98 |
$1,479.95 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$206 |
$412 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$248.88 |
$497.75 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$274.25 |
$548.50 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$206 |
$412 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$220.25 |
$440.50 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$261.75 |
$523.50 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$249.50 |
$499 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$228.88 |
$457.75 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$206 |
$412 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$206 |
$412 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$206 |
$412 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$274.50 |
$549 |
2.7× |
| Xr bone length studies (77073) |
$185.88 |
$371.75 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$206 |
$412 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$250.75 |
$501.50 |
2.5× |
| Xr chest 4+ views (71048) |
$222.50 |
$445 |
2.2× |
| Xr urogram antegrade (74425) |
$397.80 |
$795.60 |
1.2× |