| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,372 |
$7,965 |
4.5× |
| Abdomen 2 views (74019) |
$437.60 |
$547 |
4.1× |
| Acute gi blood loss imaging (78278) |
$1,661.60 |
$2,077 |
4.0× |
| Angiography extremity bilateral rs&i (75716) |
$5,244.80 |
$6,556 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$5,349.60 |
$6,687 |
1.6× |
| Angiography internal mammary rs&i (75756) |
$2,980 |
$3,725 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,953.60 |
$6,192 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,627.20 |
$7,034 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,957.60 |
$6,197 |
1.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,027.20 |
$6,284 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,669.60 |
$2,087 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,851.20 |
$3,564 |
0.9× |
| Ankle 2 views (73600) |
$348 |
$435 |
3.9× |
| Aortogram thoracic (75605) |
$5,688.80 |
$7,111 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,911.20 |
$6,139 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$5,635.20 |
$7,044 |
1.7× |
| Arthrogram hip (73525) |
$1,072 |
$1,340 |
3.0× |
| Arthrogram knee (73580) |
$1,136 |
$1,420 |
3.2× |
| Arthrogram shoulder (73040) |
$1,120.80 |
$1,401 |
3.1× |
| Arthrogram wrist (73115) |
$962.40 |
$1,203 |
2.7× |
| Basic dosimetry (77300) |
$760.80 |
$951 |
5.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,358.40 |
$1,698 |
3.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,450.40 |
$1,813 |
3.5× |
| Bone &/joint imaging whole body (78306) |
$1,857.60 |
$2,322 |
4.5× |
| Bone age studies (77072) |
$432.80 |
$541 |
4.0× |
| Bone Imaging 3 Phase (78315) |
$1,639.20 |
$2,049 |
4.0× |
| Bone survey complete (77075) |
$954.40 |
$1,193 |
8.8× |
| Bone survey infant (77076) |
$496 |
$620 |
4.6× |
| Bowel imaging (78290) |
$1,551.20 |
$1,939 |
3.8× |
| Brachytx isodose complex (77318) |
$2,101.60 |
$2,627 |
5.4× |
| Brachytx isodose intermed (77317) |
$1,696 |
$2,120 |
4.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,260.80 |
$1,576 |
3.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,457.60 |
$3,072 |
4.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,942.40 |
$2,428 |
4.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,557.60 |
$1,947 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$451.20 |
$564 |
5.0× |
| Chest 1 view (71045) |
$307.20 |
$384 |
3.4× |
| Chest xray 3 views (71047) |
$457.60 |
$572 |
5.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$658.40 |
$823 |
3.6× |
| Clavicle complete (73000) |
$365.60 |
$457 |
4.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,102.40 |
$1,378 |
10.2× |
| Continuing medical physics consltj pr wk (77336) |
$923.20 |
$1,154 |
6.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,288.80 |
$5,361 |
11.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,476 |
$4,345 |
14.1× |
| CT abdomen w contrast (74160) |
$2,364 |
$2,955 |
13.1× |
| CT abdomen w wo contrast (74170) |
$2,673.60 |
$3,342 |
14.8× |
| CT abdomen w/o contrast (74150) |
$1,928.80 |
$2,411 |
17.9× |
| CT angio hrt w/3d image (75574) |
$2,303.20 |
$2,879 |
6.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,539.20 |
$3,174 |
14.0× |
| CT angiography upper extremity lt (73206) |
$2,582.40 |
$3,228 |
14.3× |
| CT c-spine w/contrast (72126) |
$2,451.20 |
$3,064 |
6.8× |
| CT c-spine w/o contrast (72125) |
$1,996.80 |
$2,496 |
18.5× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$800 |
$1,000 |
4.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,843.20 |
$3,554 |
15.7× |
| CT chest w contrast (71260) |
$2,296.80 |
$2,871 |
12.7× |
| CT chest w/wo contrast (71270) |
$2,644 |
$3,305 |
14.6× |
| CT colonography w/dye (74262) |
$1,632.80 |
$2,041 |
9.0× |
| CT colonography w/o cntrst (74261) |
$1,518.40 |
$1,898 |
14.1× |
| CT head/brain with contrast (70460) |
$2,047.20 |
$2,559 |
11.3× |
| CT head/brain without and with contrast (70470) |
$2,363.20 |
$2,954 |
13.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,015.20 |
$2,519 |
5.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$258.40 |
$323 |
2.9× |
| CT hrt w/3d image congen (75573) |
$2,031.20 |
$2,539 |
5.6× |
| CT iac w contrast (70481) |
$2,210.40 |
$2,763 |
12.2× |
| CT limited/localized follow up study (76380) |
$992.80 |
$1,241 |
11.1× |
| CT lower ext w/o (73700) |
$1,751.20 |
$2,189 |
16.2× |
| CT lower extremity w wo contrast (73702) |
$2,492 |
$3,115 |
13.8× |
| CT lower extremity w/contrast material (73701) |
$2,099.20 |
$2,624 |
11.6× |
| CT lumbar spine w & w/o contrast (72133) |
$3,072.80 |
$3,841 |
17.0× |
| CT lumbar spine w/contrast (72132) |
$2,434.40 |
$3,043 |
6.8× |
| CT lumbar spine w/o contrast (72131) |
$1,996.80 |
$2,496 |
18.5× |
| CT maxillofacial w contrast (70487) |
$2,211.20 |
$2,764 |
12.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,536 |
$3,170 |
14.0× |
| CT maxillofacial wo contrast (70486) |
$1,876 |
$2,345 |
17.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,452.80 |
$3,066 |
13.5× |
| CT orbits w/o contrast (70480) |
$1,824 |
$2,280 |
16.9× |
| CT pelvis w/o contrast (72192) |
$1,715.20 |
$2,144 |
15.9× |
| CT pelvis w/wo contrast (72194) |
$2,484 |
$3,105 |
13.7× |
| CT scan of arm combo (73202) |
$2,449.60 |
$3,062 |
13.5× |
| CT soft tissue neck w contrast (70491) |
$2,211.20 |
$2,764 |
12.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,640 |
$3,300 |
14.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,799.20 |
$2,249 |
16.7× |
| CT thoracic spine w/contrast (72129) |
$2,369.60 |
$2,962 |
13.1× |
| CT thoracic spine w/o contrast (72128) |
$1,924 |
$2,405 |
17.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,856.80 |
$3,571 |
15.8× |
| CT thorax w/o contrast (71250) |
$1,964.80 |
$2,456 |
18.2× |
| CT upper ext wo (73200) |
$1,744.80 |
$2,181 |
16.2× |
| CT upper extremity with contrast (73201) |
$2,151.20 |
$2,689 |
6.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,056 |
$3,820 |
16.9× |
| Cta Abdomen (74175) |
$2,702.40 |
$3,378 |
14.9× |
| CTA abdomen pelvis (74174) |
$4,071.20 |
$5,089 |
11.3× |
| CTA chest (71275) |
$2,758.40 |
$3,448 |
15.2× |
| Cta Head (70496) |
$2,606.40 |
$3,258 |
14.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,000 |
$5,000 |
11.1× |
| Cta Neck (70498) |
$2,615.20 |
$3,269 |
14.4× |
| Cta Pelvis (72191) |
$2,580 |
$3,225 |
14.3× |
| Cystography minimum 3 views rs&i (74430) |
$844 |
$1,055 |
2.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,719.20 |
$3,399 |
1.3× |
| Diskogram cervical (72285) |
$2,961.60 |
$3,702 |
1.5× |
| Diskography lumbar (72295) |
$3,970.40 |
$4,963 |
2.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$720.80 |
$901 |
6.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$491.20 |
$614 |
4.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$530.40 |
$663 |
4.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$284 |
$355 |
3.2× |
| Esophagus (74220) |
$668 |
$835 |
3.7× |
| Facial bones min 3 views (70150) |
$570.40 |
$713 |
5.3× |
| Fetal biophysical profile non-stress testing (76818) |
$867.20 |
$1,084 |
8.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$640 |
$800 |
5.9× |
| Fetal Echo (76825) |
$1,369.60 |
$1,712 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$695.20 |
$869 |
2.8× |
| Foot 2 views (73620) |
$371.20 |
$464 |
4.1× |
| Forearm 2 views (73090) |
$391.20 |
$489 |
4.4× |
| Hand 2 views (73120) |
$348.80 |
$436 |
3.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,248 |
$6,560 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,854.40 |
$2,318 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,804 |
$2,255 |
4.4× |
| Hysterosalpingogram (74740) |
$1,033.60 |
$1,292 |
4.2× |
| Interstitial radiation source applic complex (77778) |
$3,843.20 |
$4,804 |
5.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$332.80 |
$416 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,862.40 |
$2,328 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,971.20 |
$2,464 |
3.5× |
| Knee 3 views (73562) |
$532.80 |
$666 |
5.9× |
| Liver & spleen imaging static only (78215) |
$1,660 |
$2,075 |
4.0× |
| Liver imaging static only (78201) |
$1,880 |
$2,350 |
3.4× |
| Lymphoscintigraphy (78195) |
$1,313.60 |
$1,642 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,234.40 |
$4,043 |
4.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,265.60 |
$4,082 |
9.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,688.80 |
$4,611 |
10.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,980.80 |
$2,476 |
5.1× |
| MRA head w & w/o contrast (70546) |
$3,830.40 |
$4,788 |
10.6× |
| MRA head w/o contrast (70544) |
$3,235.20 |
$4,044 |
13.1× |
| MRA head with contrast (70545) |
$3,181.60 |
$3,977 |
8.8× |
| MRA neck w contrast (70548) |
$3,063.20 |
$3,829 |
8.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,708 |
$4,635 |
10.3× |
| MRA neck w/o contrast (70547) |
$3,235.20 |
$4,044 |
13.1× |
| MRI abdomen w contrast (74182) |
$3,464.80 |
$4,331 |
9.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,850.40 |
$4,813 |
10.7× |
| MRI abdomen w/o contrast (74181) |
$2,804.80 |
$3,506 |
11.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,164 |
$3,955 |
3.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,810.40 |
$4,763 |
10.6× |
| MRI breast w/o contrast bilateral (77047) |
$3,612 |
$4,515 |
14.7× |
| MRI c-spine with contrast (72142) |
$3,477.60 |
$4,347 |
9.7× |
| MRI cervical spine w/o contrast (72141) |
$2,959.20 |
$3,699 |
12.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,921.60 |
$4,902 |
10.9× |
| MRI chest w/o contrast (71550) |
$2,727.20 |
$3,409 |
11.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,207.20 |
$4,009 |
8.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,701.60 |
$4,627 |
10.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,974.40 |
$3,718 |
12.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,105.60 |
$3,882 |
12.6× |
| MRI orbit face neck w contrast (70542) |
$3,270.40 |
$4,088 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,011.20 |
$5,014 |
11.1× |
| MRI pelvis w/contrast (72196) |
$3,341.60 |
$4,177 |
9.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,837.60 |
$4,797 |
10.7× |
| MRI pelvis w/o contrast (72195) |
$2,744 |
$3,430 |
11.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,034.40 |
$5,043 |
11.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,376.80 |
$4,221 |
9.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,034.40 |
$5,043 |
11.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,460.80 |
$4,326 |
9.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,034.40 |
$5,043 |
11.2× |
| MRI temporomandibular joint (70336) |
$2,739.20 |
$3,424 |
11.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,976 |
$3,720 |
12.1× |
| MRI up ext w/o contrast (73218) |
$3,222.40 |
$4,028 |
13.1× |
| MRI upper ext joint w/o contrast (73221) |
$3,040.80 |
$3,801 |
12.3× |
| MRI, joint upper extrem combo (73223) |
$3,881.60 |
$4,852 |
10.8× |
| Myelogram Lumbar (72265) |
$1,912 |
$2,390 |
2.4× |
| Myelography 2 or more regions (72270) |
$2,435.20 |
$3,044 |
3.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,842.40 |
$4,803 |
2.9× |
| Myocardial spect single study at rest or stress (78451) |
$2,913.60 |
$3,642 |
2.2× |
| Neck soft tissue (70360) |
$328.80 |
$411 |
3.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$801.60 |
$1,002 |
1.9× |
| Nm gastric emptying study (78264) |
$1,236 |
$1,545 |
3.0× |
| Nm peritoneal-venous shunt patency (78291) |
$1,260 |
$1,575 |
3.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$8,612 |
$10,765 |
6.0× |
| Nuclear Rx Oral Admin (79005) |
$1,599.20 |
$1,999 |
6.6× |
| Ob us nuchal meas 1 gest (76813) |
$509.60 |
$637 |
4.7× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$499.20 |
$624 |
4.6× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$415.20 |
$519 |
3.8× |
| Osseous survey limited (77074) |
$568.80 |
$711 |
5.3× |
| Parathyrd planar w/spect&CT (78072) |
$2,148.80 |
$2,686 |
3.8× |
| Parathyroid Planar Imaging (78070) |
$1,509.60 |
$1,887 |
3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,752.80 |
$2,191 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$351.20 |
$439 |
3.3× |
| PET image w/CT, skull-thigh (78815) |
$6,978.40 |
$8,723 |
4.7× |
| PET imaging for CT attenuation whole body (78816) |
$6,875.20 |
$8,594 |
4.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,476 |
$1,845 |
3.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,065.60 |
$2,582 |
3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$950.40 |
$1,188 |
1.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$513.60 |
$642 |
5.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$408 |
$510 |
4.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$437.60 |
$547 |
4.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$319.20 |
$399 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$461.60 |
$577 |
4.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$621.60 |
$777 |
5.8× |
| Radex fingr minimum 2 views (73140) |
$319.20 |
$399 |
3.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$438.40 |
$548 |
4.9× |
| Radex Hand Minimum 3 Views (73130) |
$505.60 |
$632 |
5.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$292.80 |
$366 |
3.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$469.60 |
$587 |
4.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$506.40 |
$633 |
4.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$639.20 |
$799 |
5.9× |
| Radex Humerus Minimum 2 Views (73060) |
$532.80 |
$666 |
5.9× |
| Radex Kne 1/2 Views (73560) |
$446.40 |
$558 |
5.0× |
| Radex Kne Compl 4/More Views (73564) |
$640.80 |
$801 |
5.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$496.80 |
$621 |
4.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$404.80 |
$506 |
4.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$456.80 |
$571 |
4.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$530.40 |
$663 |
5.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$332.80 |
$416 |
3.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$392.80 |
$491 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$415.20 |
$519 |
4.6× |
| Radex Toe Minimum 2 Views (73660) |
$322.40 |
$403 |
3.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$385.60 |
$482 |
3.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$510.40 |
$638 |
5.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$612 |
$765 |
5.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,160 |
$15,200 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$752.80 |
$941 |
7.1× |
| Radiation treatment delivery level 2 (77407) |
$2,852.80 |
$3,566 |
7.2× |
| Radiation treatment delivery level 3 (77412) |
$4,083.20 |
$5,104 |
7.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$357.60 |
$447 |
4.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$536 |
$670 |
5.0× |
| Radiologic exam chest 2 views (71046) |
$386.40 |
$483 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$886.40 |
$1,108 |
4.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$632 |
$790 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,020 |
$1,275 |
5.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$908.80 |
$1,136 |
5.0× |
| Radiologic examination femur 1 view (73551) |
$561.60 |
$702 |
6.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$532.80 |
$666 |
5.9× |
| Radiological examination surgical specimen (76098) |
$720 |
$900 |
1.3× |
| Ribs bilateral 3 views (71110) |
$604.80 |
$756 |
5.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,514.40 |
$1,893 |
3.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,861.60 |
$4,827 |
6.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,763.20 |
$3,454 |
4.9× |
| Rp Therapy Intravenous Administration (79101) |
$1,130.40 |
$1,413 |
4.7× |
| Sacroiliac Joints < 3 Views (72200) |
$359.20 |
$449 |
3.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$676 |
$845 |
2.7× |
| Scapula (73010) |
$404 |
$505 |
3.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$93.60 |
$117 |
4.0× |
| Shoulder 1 view (73020) |
$303.20 |
$379 |
3.4× |
| Simulation intermediate (77285) |
$1,747.20 |
$2,184 |
4.5× |
| Small bowel series (74250) |
$760.80 |
$951 |
4.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,494.40 |
$1,868 |
3.9× |
| Special dosimetry (77331) |
$709.60 |
$887 |
5.1× |
| Special Physics Consult (77370) |
$1,028.80 |
$1,286 |
7.4× |
| Special treatment procedure (77470) |
$3,086.40 |
$3,858 |
5.4× |
| Spine thoracic 3 views (72072) |
$529.60 |
$662 |
4.9× |
| Stereotactic Body Radiation Delivery (77373) |
$6,920 |
$8,650 |
3.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$540 |
$675 |
5.1× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$1,495.20 |
$1,869 |
38.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,169.60 |
$2,712 |
5.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,082.40 |
$1,353 |
2.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,710.40 |
$3,388 |
7.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,495.20 |
$1,869 |
10.8× |
| Thoracolumbar 2 views (72080) |
$385.60 |
$482 |
4.3× |
| Thyroid imaging w/blood flow (78013) |
$975.20 |
$1,219 |
2.4× |
| Thyroid uptake measurement (78012) |
$887.20 |
$1,109 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,316.80 |
$1,646 |
3.2× |
| Tmj unilateral (70328) |
$287.20 |
$359 |
3.2× |
| Treatment device complex (77334) |
$1,589.60 |
$1,987 |
4.1× |
| Treatment device intermediate (77333) |
$928.80 |
$1,161 |
6.7× |
| Treatment devices simple (77332) |
$707.20 |
$884 |
5.1× |
| Ultrasound breast complete (76641) |
$536 |
$670 |
5.0× |
| Ultrasound Exam Aaa Screen (76706) |
$488 |
$610 |
4.5× |
| Ultrasound, abdomen limited (76705) |
$743.20 |
$929 |
6.9× |
| Umbilical-artery Doppler (OB) (76820) |
$396 |
$495 |
3.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$311.20 |
$389 |
3.5× |
| Unlisted fluoroscopic procedure (76496) |
$400 |
$500 |
4.5× |
| Unlisted magnetic resonance procedure (76498) |
$1,871.20 |
$2,339 |
20.8× |
| Unlisted ultrasound procedure (76999) |
$452.80 |
$566 |
5.0× |
| Ureteral reflux study (78740) |
$1,508 |
$1,885 |
3.7× |
| Urethrocystogram voiding (74455) |
$960 |
$1,200 |
3.9× |
| Urethrocystography retrograde rs&i (74450) |
$884.80 |
$1,106 |
3.6× |
| Us breast unilateral limited (76642) |
$481.60 |
$602 |
5.4× |
| Us chest (76604) |
$524 |
$655 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$608 |
$760 |
5.6× |
| Us encephalogram (76506) |
$328.80 |
$411 |
3.0× |
| Us infant hips w manipulation (76885) |
$485.60 |
$607 |
5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$238.40 |
$298 |
2.2× |
| Us ob detailed single fetus (76811) |
$611.20 |
$764 |
2.5× |
| Us ob limited (76815) |
$344 |
$430 |
3.2× |
| Us ob transvaginal (76817) |
$371.20 |
$464 |
3.4× |
| Us pelvic non ob complete (76856) |
$772 |
$965 |
7.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$410.40 |
$513 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$426.40 |
$533 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$460.80 |
$576 |
4.3× |
| Us retroperitoneal complete (76770) |
$724 |
$905 |
6.7× |
| Us retroperitoneal limited (76775) |
$399.20 |
$499 |
3.7× |
| Us scrotum and contents (76870) |
$614.40 |
$768 |
5.7× |
| Us soft tissue head/neck (76536) |
$637.60 |
$797 |
5.9× |
| Us spinal canal and contents (76800) |
$292.80 |
$366 |
2.7× |
| Us transrectal (76872) |
$680.80 |
$851 |
6.3× |
| Us, eye b-scan (76512) |
$423.20 |
$529 |
3.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$668.80 |
$836 |
6.2× |
| Venogram extremity bilateral (75822) |
$2,334.40 |
$2,918 |
1.4× |
| Venogram Extremity Unilateral (75820) |
$1,908 |
$2,385 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$2,675.20 |
$3,344 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$2,295.20 |
$2,869 |
1.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,350.40 |
$4,188 |
1.0× |
| Wrist 2 views (73100) |
$349.60 |
$437 |
3.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$706.40 |
$883 |
6.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$452.80 |
$566 |
5.0× |
| X-ray b.e. reductn intuss (74283) |
$1,075.20 |
$1,344 |
5.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,103.20 |
$1,379 |
6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$388.80 |
$486 |
4.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$350.40 |
$438 |
3.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$582.40 |
$728 |
5.4× |
| X-ray exam of femur 2/> (73552) |
$556 |
$695 |
6.2× |
| X-ray eye for foreign body (70030) |
$324.80 |
$406 |
3.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$335.20 |
$419 |
3.7× |
| X-ray IV pyelogram (ivp) (74400) |
$1,000 |
$1,250 |
5.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$348 |
$435 |
3.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$356.80 |
$446 |
4.0× |
| X-ray leg, infant (73592) |
$393.60 |
$492 |
4.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$444 |
$555 |
4.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$670.40 |
$838 |
6.2× |
| X-ray nose-rectum child f.b. (76010) |
$360 |
$450 |
4.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$472.80 |
$591 |
4.4× |
| X-ray retrograde pyelogram (74420) |
$1,088.80 |
$1,361 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$412.80 |
$516 |
4.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$503.20 |
$629 |
4.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$641.60 |
$802 |
5.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$116 |
$145 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$404.80 |
$506 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$473.60 |
$592 |
5.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$771.20 |
$964 |
7.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$410.40 |
$513 |
3.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$267.20 |
$334 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$365.60 |
$457 |
4.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$365.60 |
$457 |
4.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$405.60 |
$507 |
3.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$501.60 |
$627 |
4.6× |
| Xr bone length studies (77073) |
$540 |
$675 |
5.0× |
| Xr c-spine 4 or 5 views (72050) |
$604 |
$755 |
5.6× |
| Xr c-spine 6 or more views (72052) |
$865.60 |
$1,082 |
8.0× |
| Xr chest 4+ views (71048) |
$584.80 |
$731 |
5.4× |
| Xr urogram antegrade (74425) |
$940 |
$1,175 |
2.6× |