| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,346.90 |
$8,226 |
3.6× |
| Abdomen 2 views (74019) |
$268.45 |
$413 |
2.4× |
| Acute gi blood loss imaging (78278) |
$976.95 |
$1,503 |
2.3× |
| Angiography extremity bilateral rs&i (75716) |
$23,523.79 |
— |
6.9× |
| Angiography extremity unilateral rs&i (75710) |
$27,630.63 |
— |
8.1× |
| Angiography internal mammary rs&i (75756) |
$4,635.15 |
$7,131 |
1.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,877 |
$10,580 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,841.55 |
$8,987 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,697.25 |
$8,765 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$3,773.90 |
$5,806 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$48,404.16 |
— |
8.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,705.60 |
$2,624 |
0.5× |
| Ankle 2 views (73600) |
$271.70 |
— |
2.9× |
| Aortogram thoracic (75605) |
$4,001.40 |
$6,156 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,042.05 |
$7,757 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$23,523.79 |
— |
6.9× |
| Arthrogram hip (73525) |
$538.85 |
$829 |
1.4× |
| Arthrogram shoulder (73040) |
$734.50 |
$1,130 |
1.9× |
| Basic dosimetry (77300) |
$524.55 |
$807 |
3.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$930.15 |
$1,431 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,249.30 |
$1,922 |
2.9× |
| Bone age studies (77072) |
$217.10 |
$334 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,369.55 |
$2,107 |
3.2× |
| Bone survey complete (77075) |
$263.90 |
$406 |
2.3× |
| Bone survey infant (77076) |
$237.90 |
$366 |
2.1× |
| Bowel imaging (78290) |
$846.30 |
$1,302 |
2.0× |
| Brachytx isodose complex (77318) |
$765.70 |
$1,178 |
1.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$300.95 |
$463 |
0.7× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,395.55 |
$2,147 |
3.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,149.95 |
$7,923 |
3.3× |
| Brain Imaging Vascular Flow Only (78610) |
$1,808.95 |
$2,783 |
3.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,256.45 |
$1,933 |
2.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,571.70 |
$2,418 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,481.05 |
$3,817 |
6.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,054.95 |
$1,623 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$261.30 |
$402 |
2.8× |
| Chest 1 view (71045) |
$12,404.14 |
— |
132.0× |
| Chest xray 3 views (71047) |
$209.95 |
$323 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$359.45 |
$553 |
1.9× |
| Clavicle complete (73000) |
$183.95 |
— |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,298.05 |
$1,997 |
11.5× |
| Continuing medical physics consltj pr wk (77336) |
$556.40 |
$856 |
3.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,078.40 |
$4,736 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,087.80 |
— |
8.1× |
| CT abdomen w contrast (74160) |
$1,409.20 |
$2,168 |
7.4× |
| CT abdomen w wo contrast (74170) |
$1,571.70 |
$2,418 |
8.3× |
| CT abdomen w/o contrast (74150) |
$998.40 |
$1,536 |
8.8× |
| CT angio hrt w/3d image (75574) |
$852.80 |
$1,312 |
2.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,196 |
$1,840 |
6.3× |
| CT angiography upper extremity lt (73206) |
$1,318.85 |
$2,029 |
7.0× |
| CT c-spine w/contrast (72126) |
$1,684.80 |
$2,592 |
4.5× |
| CT c-spine w/o contrast (72125) |
$1,299.35 |
$1,999 |
11.5× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$785.85 |
$1,209 |
4.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,147.60 |
$3,304 |
11.3× |
| CT chest w contrast (71260) |
$4,800.90 |
— |
25.3× |
| CT chest w/wo contrast (71270) |
$1,552.85 |
$2,389 |
8.2× |
| CT colonography w/dye (74262) |
$1,083.55 |
$1,667 |
5.7× |
| CT colonography w/o cntrst (74261) |
$429.65 |
$661 |
3.8× |
| CT head/brain with contrast (70460) |
$1,375.40 |
$2,116 |
7.3× |
| CT head/brain without and with contrast (70470) |
$1,571.70 |
$2,418 |
8.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$518.05 |
$797 |
1.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$51.35 |
$79 |
0.5× |
| CT iac w contrast (70481) |
$1,333.15 |
$2,051 |
7.0× |
| CT limited/localized follow up study (76380) |
$354.25 |
$545 |
3.8× |
| CT lower ext w/o (73700) |
$1,304.22 |
— |
11.6× |
| CT lower extremity w wo contrast (73702) |
$1,875.90 |
$2,886 |
9.9× |
| CT lower extremity w/contrast material (73701) |
$1,342.90 |
$2,066 |
7.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,742 |
$2,680 |
9.2× |
| CT lumbar spine w/contrast (72132) |
$1,482.65 |
$2,281 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$1,298.70 |
$1,998 |
11.5× |
| CT maxillofacial w contrast (70487) |
$1,227.85 |
$1,889 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,420.90 |
$2,186 |
7.5× |
| CT maxillofacial wo contrast (70486) |
$893.10 |
— |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,539.20 |
$2,368 |
8.1× |
| CT orbits w/o contrast (70480) |
$1,068.60 |
$1,644 |
9.5× |
| CT pelvis w/o contrast (72192) |
$993.20 |
$1,528 |
8.8× |
| CT pelvis w/wo contrast (72194) |
$1,483.95 |
$2,283 |
7.8× |
| CT scan of arm combo (73202) |
$1,483.30 |
$2,282 |
7.8× |
| CT soft tissue neck w contrast (70491) |
$1,414.40 |
$2,176 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,488.50 |
$2,290 |
7.9× |
| CT soft tissue neck w/o contrast (70490) |
$856.05 |
$1,317 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$1,422.20 |
$2,188 |
7.5× |
| CT thoracic spine w/o contrast (72128) |
$1,173.90 |
$1,806 |
10.4× |
| CT thoracic spine w/wo contrast (72130) |
$3,021.85 |
$4,649 |
16.0× |
| CT thorax w/o contrast (71250) |
$1,134.25 |
— |
10.0× |
| CT upper ext wo (73200) |
$1,017.25 |
— |
9.0× |
| CT upper extremity with contrast (73201) |
$1,288.30 |
$1,982 |
3.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,787.50 |
$2,750 |
9.4× |
| Cta Abdomen (74175) |
$1,718.60 |
$2,644 |
9.1× |
| CTA abdomen pelvis (74174) |
$2,910.05 |
$4,477 |
7.7× |
| CTA chest (71275) |
$1,900.92 |
— |
10.0× |
| Cta Head (70496) |
$1,784.90 |
$2,746 |
9.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,571.70 |
$2,418 |
4.2× |
| Cta Neck (70498) |
$1,820.65 |
$2,801 |
9.6× |
| Cta Pelvis (72191) |
$1,430 |
$2,200 |
7.6× |
| Cystography minimum 3 views rs&i (74430) |
$834.60 |
$1,284 |
2.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,493.05 |
$2,297 |
0.7× |
| Diskography lumbar (72295) |
$2,558.40 |
$3,936 |
1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$284.70 |
$438 |
2.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$485.55 |
$747 |
4.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$277.55 |
— |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$394.55 |
— |
4.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$625.30 |
$962 |
2.4× |
| Esophagus (74220) |
$419.90 |
$646 |
2.2× |
| Facial bones min 3 views (70150) |
$156 |
$240 |
1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$213.20 |
$328 |
1.9× |
| Fetal Echo (76825) |
$971.10 |
$1,494 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$518.70 |
— |
2.0× |
| Foot 2 views (73620) |
$206.05 |
$317 |
2.2× |
| Forearm 2 views (73090) |
$335.40 |
— |
3.6× |
| Functional MRI brain by tech (70554) |
$1,608.75 |
$2,475 |
6.2× |
| Hand 2 views (73120) |
$197.60 |
$304 |
1.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,126.15 |
$3,271 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,806.05 |
$4,317 |
3.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,186.65 |
$6,441 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,596.15 |
$7,071 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,235 |
$1,900 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,235 |
$1,900 |
2.9× |
| Interstitial radiation source applic complex (77778) |
$3,281.85 |
$5,049 |
4.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$235.95 |
$363 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,091.35 |
$1,679 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,371.50 |
$2,110 |
2.3× |
| Knee 3 views (73562) |
$244.08 |
— |
2.6× |
| Lung perf&ventilat diferentl (78598) |
$1,418.30 |
$2,182 |
2.4× |
| Lung perfusion differential (78597) |
$863.85 |
$1,329 |
2.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$7,910.50 |
$12,170 |
2.3× |
| Lymphoscintigraphy (78195) |
$1,249.30 |
$1,922 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,870.70 |
$2,878 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,379.65 |
$3,661 |
6.3× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$79.30 |
$122 |
0.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$3,674.45 |
$5,653 |
9.1× |
| Mr safety determination physician/other qhp (76016) |
$118.30 |
$182 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$33.15 |
$51 |
1.1× |
| MRA head w & w/o contrast (70546) |
$5,134.35 |
— |
13.6× |
| MRA head w/o contrast (70544) |
$1,573.65 |
$2,421 |
6.1× |
| MRA head with contrast (70545) |
$1,817.40 |
$2,796 |
4.8× |
| MRA neck w contrast (70548) |
$1,663.35 |
$2,559 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,564.90 |
$3,946 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,433.90 |
$2,206 |
5.6× |
| MRI abdomen w contrast (74182) |
$1,767.35 |
$2,719 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,419.95 |
$3,723 |
6.4× |
| MRI abdomen w/o contrast (74181) |
$1,600.95 |
$2,463 |
6.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,923.35 |
$2,959 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,452.90 |
— |
6.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,746.55 |
$2,687 |
6.8× |
| MRI c-spine with contrast (72142) |
$1,875.90 |
$2,886 |
5.0× |
| MRI cardiac w/o cont stress (75559) |
$2,080.65 |
$3,201 |
3.5× |
| MRI cardiac w/o contrast (75557) |
$1,610.05 |
$2,477 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$1,593.15 |
$2,451 |
6.2× |
| MRI chest w/o & w/contrast material (71552) |
$2,122.25 |
$3,265 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,233.70 |
$1,898 |
4.8× |
| MRI fetal sngl/1st gestation (74712) |
$512.85 |
$789 |
2.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,469.35 |
$3,799 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,422.20 |
$2,188 |
5.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,446.90 |
$2,226 |
5.6× |
| MRI orbit face neck w contrast (70542) |
$1,522.95 |
$2,343 |
4.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,468.05 |
$3,797 |
6.6× |
| MRI pelvis w/contrast (72196) |
$2,137.85 |
$3,289 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,471.30 |
$3,802 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,509.30 |
$2,322 |
5.9× |
| MRI spectroscopy (76390) |
$990.60 |
$1,524 |
10.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,661.75 |
$4,095 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,716 |
$2,640 |
4.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,648.10 |
$4,074 |
7.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,716 |
$2,640 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,531.75 |
$3,895 |
6.7× |
| MRI temporomandibular joint (70336) |
$1,316.25 |
$2,025 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,534.65 |
$2,361 |
6.0× |
| MRI up ext w/o contrast (73218) |
$1,474.85 |
$2,269 |
5.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,498.25 |
$2,305 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$2,141.10 |
$3,294 |
5.7× |
| Myelogram thoracic (72255) |
$1,364.35 |
$2,099 |
1.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,682.60 |
$7,204 |
3.3× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,269.50 |
$5,030 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,541.55 |
$6,987 |
1.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,613.35 |
$5,559 |
2.6× |
| Myocardial spect single study at rest or stress (78451) |
$3,018.60 |
$4,644 |
2.2× |
| Neck soft tissue (70360) |
$204.75 |
$315 |
2.2× |
| Nm cisternogram (78630) |
$1,318.85 |
$2,029 |
2.2× |
| Nm csf leak detection (78650) |
$1,483.95 |
$2,283 |
1.1× |
| Nm gastric emptying study (78264) |
$1,079.65 |
$1,661 |
2.5× |
| Nonvascular shunt X-ray (75809) |
$256.75 |
$395 |
2.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,854.20 |
$7,468 |
3.2× |
| Nuclear Rx Oral Admin (79005) |
$1,018.55 |
$1,567 |
4.0× |
| Ob us nuchal meas 1 gest (76813) |
$210.60 |
$324 |
1.9× |
| Orthopantogram (70355) |
$177.45 |
$273 |
1.9× |
| Osseous survey limited (77074) |
$217.10 |
$334 |
1.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,440.40 |
$2,216 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$780 |
$1,200 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,004.60 |
$3,084 |
4.6× |
| Pelvis 1 or 2 views (72170) |
$24,059.55 |
— |
213.1× |
| PET image w/CT, skull-thigh (78815) |
$7,154.68 |
— |
4.6× |
| PET imaging CT for attenuation limited area (78814) |
$4,963.40 |
$7,636 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$6,114.55 |
$9,407 |
4.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,186.65 |
$6,441 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$676 |
$1,040 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,493.05 |
$2,297 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$884 |
$1,360 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$195.65 |
— |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$206.05 |
$317 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$199.55 |
— |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$143 |
$220 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$215.80 |
$332 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$269.75 |
$415 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$147.88 |
— |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$206.70 |
— |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$281.45 |
— |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$174.20 |
$268 |
1.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$202.15 |
$311 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$325.65 |
$501 |
2.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$349.05 |
$537 |
3.1× |
| Radex Humerus Minimum 2 Views (73060) |
$202.80 |
— |
2.2× |
| Radex Kne 1/2 Views (73560) |
$200.20 |
$308 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$339.95 |
— |
3.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$176.15 |
$271 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$143 |
$220 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$275.60 |
$424 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$350.35 |
— |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$130.65 |
$201 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$261.30 |
$402 |
2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$139.10 |
$214 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$220.68 |
— |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$556.40 |
$856 |
4.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$300.30 |
— |
3.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$310.70 |
$478 |
2.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$14,486.55 |
$22,287 |
1.8× |
| Radiation treatment delivery level 1 (77402) |
$2,009.15 |
$3,091 |
18.2× |
| Radiation treatment delivery level 2 (77407) |
$2,149.55 |
$3,307 |
5.2× |
| Radiation treatment delivery level 3 (77412) |
$2,289.95 |
$3,523 |
3.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$200.20 |
— |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$309.40 |
$476 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$323.05 |
— |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$549.25 |
$845 |
2.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$488.80 |
$752 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$410.80 |
$632 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$142.35 |
$219 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$323.05 |
— |
3.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$248.95 |
$383 |
2.2× |
| Radiological examination surgical specimen (76098) |
$404.30 |
$622 |
0.7× |
| Ribs bilateral 3 views (71110) |
$373.75 |
$575 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$733.85 |
$1,129 |
1.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$722.80 |
$1,112 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,030.30 |
$4,662 |
5.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,710.80 |
$2,632 |
2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,590.55 |
$2,447 |
1.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,847 |
$4,380 |
1.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,710.80 |
$2,632 |
1.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$659.10 |
$1,014 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$89.05 |
$137 |
0.8× |
| Scapula (73010) |
$252.85 |
$389 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$248.95 |
— |
10.6× |
| Shoulder 1 view (73020) |
$14,948.98 |
— |
159.1× |
| Small bowel series (74250) |
$400.40 |
$616 |
2.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$871.65 |
$1,341 |
2.2× |
| Special dosimetry (77331) |
$524.55 |
$807 |
3.6× |
| Special Physics Consult (77370) |
$308.10 |
$474 |
2.1× |
| Special treatment procedure (77470) |
$25,262.25 |
— |
42.3× |
| Speech evaluation complex (70371) |
$173.55 |
$267 |
0.7× |
| Spine thoracic 3 views (72072) |
$340.60 |
$524 |
3.0× |
| Stereotactic Body Radiation Delivery (77373) |
$4,306.25 |
$6,625 |
2.2× |
| Superior sagittal sinus venogram (75870) |
$1,195.35 |
$1,839 |
0.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,647.10 |
$2,534 |
4.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,318.20 |
$2,028 |
3.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$295.75 |
$455 |
2.0× |
| Thoracolumbar 2 views (72080) |
$308.75 |
$475 |
3.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,254.50 |
$1,930 |
2.1× |
| Thyroid uptake measurement (78012) |
$676 |
$1,040 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$942.50 |
$1,450 |
2.2× |
| Tmj unilateral (70328) |
$92.95 |
$143 |
1.0× |
| Treatment device complex (77334) |
$1,005.55 |
$1,547 |
2.5× |
| Treatment device intermediate (77333) |
$678.60 |
$1,044 |
4.7× |
| Treatment devices simple (77332) |
$527.80 |
$812 |
3.6× |
| Ultrasound breast complete (76641) |
$250.90 |
$386 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$229.45 |
$353 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$367.90 |
— |
3.3× |
| Urethrocystogram voiding (74455) |
$457.60 |
$704 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$618.80 |
$952 |
2.4× |
| Us breast unilateral limited (76642) |
$204.10 |
$314 |
2.2× |
| Us chest (76604) |
$287.30 |
$442 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$176.15 |
$271 |
1.6× |
| Us elastography parenchyma (76981) |
$274.95 |
$423 |
2.4× |
| Us encephalogram (76506) |
$287.30 |
$442 |
2.5× |
| Us hips infant static (76886) |
$367.25 |
$565 |
3.9× |
| Us infant hips w manipulation (76885) |
$367.25 |
$565 |
3.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$217.10 |
$334 |
1.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$120.90 |
$186 |
1.1× |
| Us ob detailed single fetus (76811) |
$590.85 |
$909 |
2.3× |
| Us ob limited (76815) |
$905.12 |
— |
8.0× |
| Us ob transvaginal (76817) |
$254.80 |
$392 |
2.3× |
| Us pelvic non ob complete (76856) |
$458.90 |
$706 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$270.40 |
$416 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$299.65 |
$461 |
2.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$283.40 |
$436 |
2.5× |
| Us retroperitoneal complete (76770) |
$439.40 |
— |
3.9× |
| Us retroperitoneal limited (76775) |
$292.50 |
$450 |
2.6× |
| Us scrotum and contents (76870) |
$428.35 |
$659 |
3.8× |
| Us soft tissue head/neck (76536) |
$345.80 |
$532 |
3.1× |
| Us spinal canal and contents (76800) |
$385.45 |
$593 |
3.4× |
| Us, eye b-scan (76512) |
$212.55 |
$327 |
1.9× |
| Venogram extremity bilateral (75822) |
$1,846 |
$2,840 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,654.83 |
— |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$6,040.45 |
$9,293 |
1.8× |
| Venography caval superior serialography rs&i (75827) |
$2,041.65 |
$3,141 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$5,697.25 |
$8,765 |
1.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,267.20 |
$3,488 |
0.7× |
| Venous sampling by catheter (75893) |
$6,676.15 |
$10,271 |
1.1× |
| Wrist 2 views (73100) |
$380.90 |
— |
4.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$373.10 |
$574 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$181.35 |
$279 |
1.9× |
| X-ray b.e. reductn intuss (74283) |
$466.70 |
$718 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$511.55 |
$787 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$410.15 |
— |
4.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$237.90 |
— |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$249.60 |
— |
2.2× |
| X-ray exam of femur 2/> (73552) |
$250.90 |
$386 |
2.7× |
| X-ray eye for foreign body (70030) |
$132.60 |
$204 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$146.25 |
$225 |
1.6× |
| X-ray IV pyelogram (ivp) (74400) |
$537.55 |
$827 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$130.65 |
$201 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$449.80 |
$692 |
4.8× |
| X-ray leg, infant (73592) |
$210.60 |
$324 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$296.40 |
— |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$401.70 |
$618 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$145.60 |
$224 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$241.15 |
$371 |
2.1× |
| X-ray retrograde pyelogram (74420) |
$834.60 |
$1,284 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$169.65 |
$261 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$257.40 |
$396 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$340.60 |
$524 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$230.75 |
$355 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$250.25 |
$385 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$144.95 |
$223 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$250.25 |
$385 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$258.05 |
$397 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$225.55 |
$347 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$125.45 |
$193 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$233.35 |
$359 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$284.70 |
$438 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$340.60 |
$524 |
3.0× |
| Xr bone length studies (77073) |
$217.10 |
$334 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$330.20 |
$508 |
2.9× |
| Xr c-spine 6 or more views (72052) |
$319.15 |
$491 |
2.8× |
| Xr chest 4+ views (71048) |
$219.70 |
$338 |
1.9× |
| Xr urogram antegrade (74425) |
$834.60 |
$1,284 |
2.2× |