| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,598 |
$3,995 |
1.1× |
| Abdomen 2 views (74019) |
$393.60 |
$984 |
3.6× |
| Acute gi blood loss imaging (78278) |
$1,136 |
$2,840 |
2.7× |
| Angiography extremity bilateral rs&i (75716) |
$4,484.80 |
$11,212 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,870.40 |
$9,676 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$2,299.60 |
$5,749 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,316.80 |
$8,292 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,374 |
$8,435 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,638.40 |
$6,596 |
0.8× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,210.80 |
$5,527 |
0.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,976 |
$7,440 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$936.80 |
$2,342 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,190 |
$5,475 |
0.7× |
| Ankle 2 views (73600) |
$342.80 |
$857 |
3.8× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,862.80 |
$7,157 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,558 |
$8,895 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$3,250.80 |
$8,127 |
1.0× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$2,444.40 |
$6,111 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,010 |
$5,025 |
0.6× |
| Arthrogram elbow (73085) |
$531.60 |
$1,329 |
1.5× |
| Arthrogram hip (73525) |
$556 |
$1,390 |
1.5× |
| Arthrogram knee (73580) |
$636 |
$1,590 |
1.7× |
| Arthrogram shoulder (73040) |
$766 |
$1,915 |
2.1× |
| Arthrogram wrist (73115) |
$723.20 |
$1,808 |
2.0× |
| Basic dosimetry (77300) |
$158.80 |
$397 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,083.20 |
$2,708 |
2.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$643.20 |
$1,608 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,309.60 |
$3,274 |
3.1× |
| Bone age studies (77072) |
$156.80 |
$392 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,837.60 |
$4,594 |
4.4× |
| Bone survey complete (77075) |
$395.20 |
$988 |
3.6× |
| Bone survey infant (77076) |
$313.60 |
$784 |
2.9× |
| Bowel imaging (78290) |
$536 |
$1,340 |
1.3× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,152 |
$2,880 |
2.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,132.40 |
$7,831 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,906.80 |
$4,767 |
4.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,358 |
$3,395 |
3.7× |
| Cardiac shunt detection (78428) |
$861.20 |
$2,153 |
2.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$931.20 |
$2,328 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$309.40 |
$773.50 |
3.4× |
| Chest 1 view (71045) |
$242 |
$605 |
2.7× |
| Chest xray 3 views (71047) |
$274 |
$685 |
3.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$292.40 |
$731 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$483.20 |
$1,208 |
2.6× |
| Clavicle complete (73000) |
$310 |
$775 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,196.60 |
$2,991.50 |
11.0× |
| Continuing medical physics consltj pr wk (77336) |
$160 |
$400 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,212.40 |
$8,031 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,785.60 |
$6,964 |
11.2× |
| CT abdomen w contrast (74160) |
$1,511.60 |
$3,779 |
8.3× |
| CT abdomen w wo contrast (74170) |
$2,095.20 |
$5,238 |
11.4× |
| CT abdomen w/o contrast (74150) |
$1,380 |
$3,450 |
12.6× |
| CT angio hrt w/3d image (75574) |
$908.40 |
$2,271 |
2.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,813.60 |
$7,034 |
15.4× |
| CT angiography upper extremity lt (73206) |
$2,067.60 |
$5,169 |
11.3× |
| CT c-spine w/contrast (72126) |
$2,019.20 |
$5,048 |
5.5× |
| CT c-spine w/o contrast (72125) |
$1,894.80 |
$4,737 |
17.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,125.60 |
$5,314 |
11.6× |
| CT chest w contrast (71260) |
$1,538.40 |
$3,846 |
8.4× |
| CT chest w/wo contrast (71270) |
$1,609.60 |
$4,024 |
8.8× |
| CT colonography screening (74263) |
$285.60 |
$714 |
1.1× |
| CT colonography w/dye (74262) |
$542.40 |
$1,356 |
3.0× |
| CT colonography w/o cntrst (74261) |
$490.80 |
$1,227 |
4.5× |
| CT head/brain with contrast (70460) |
$1,856 |
$4,640 |
10.1× |
| CT head/brain without and with contrast (70470) |
$1,758.80 |
$4,397 |
9.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,487.60 |
$3,719 |
4.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$252 |
$630 |
2.8× |
| CT hrt w/3d image congen (75573) |
$472.80 |
$1,182 |
1.3× |
| CT iac w contrast (70481) |
$1,460.80 |
$3,652 |
8.0× |
| CT limited/localized follow up study (76380) |
$617.20 |
$1,543 |
6.8× |
| CT lower ext w/o (73700) |
$1,351.60 |
$3,379 |
12.4× |
| CT lower extremity w wo contrast (73702) |
$1,768 |
$4,420 |
9.7× |
| CT lower extremity w/contrast material (73701) |
$1,644 |
$4,110 |
9.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,072 |
$5,180 |
11.3× |
| CT lumbar spine w/contrast (72132) |
$1,968 |
$4,920 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$1,846.60 |
$4,616.50 |
16.9× |
| CT maxillofacial w contrast (70487) |
$1,624 |
$4,060 |
8.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,158.80 |
$5,397 |
11.8× |
| CT maxillofacial wo contrast (70486) |
$1,415.60 |
$3,539 |
13.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,510.80 |
$3,777 |
8.2× |
| CT orbits w/o contrast (70480) |
$1,367.20 |
$3,418 |
12.5× |
| CT pelvis w/o contrast (72192) |
$2,433.20 |
$6,083 |
22.3× |
| CT pelvis w/wo contrast (72194) |
$3,120 |
$7,800 |
17.0× |
| CT scan of arm combo (73202) |
$1,436.20 |
$3,590.50 |
7.8× |
| CT soft tissue neck w contrast (70491) |
$1,508.40 |
$3,771 |
8.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,315.20 |
$5,788 |
12.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,764.80 |
$4,412 |
16.2× |
| CT thoracic spine w/contrast (72129) |
$1,642 |
$4,105 |
9.0× |
| CT thoracic spine w/o contrast (72128) |
$1,605.40 |
$4,013.50 |
14.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,801.60 |
$4,504 |
9.8× |
| CT thorax w/o contrast (71250) |
$1,244 |
$3,110 |
11.4× |
| CT unlisted procedure (76497) |
$279.60 |
$699 |
3.1× |
| CT upper ext wo (73200) |
$1,289.20 |
$3,223 |
11.8× |
| CT upper extremity with contrast (73201) |
$1,303.60 |
$3,259 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,910.80 |
$7,277 |
15.9× |
| Cta Abdomen (74175) |
$3,347.20 |
$8,368 |
18.3× |
| CTA abdomen pelvis (74174) |
$4,621.20 |
$11,553 |
12.7× |
| CTA chest (71275) |
$3,168.80 |
$7,922 |
17.3× |
| Cta Head (70496) |
$3,253.60 |
$8,134 |
17.8× |
| Cta Neck (70498) |
$2,849.60 |
$7,124 |
15.6× |
| Cta Pelvis (72191) |
$2,516.80 |
$6,292 |
13.7× |
| Cystography minimum 3 views rs&i (74430) |
$480 |
$1,200 |
1.3× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$492.80 |
$1,232 |
2.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,313.20 |
$3,283 |
0.6× |
| Diskogram cervical (72285) |
$1,785.20 |
$4,463 |
0.9× |
| Diskography lumbar (72295) |
$1,547.20 |
$3,868 |
0.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$276.40 |
$691 |
2.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$319.40 |
$798.50 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$126 |
$315 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$129.60 |
$324 |
1.2× |
| Esophageal motility (78258) |
$842.80 |
$2,107 |
2.0× |
| Esophagus (74220) |
$370.40 |
$926 |
2.0× |
| Facial bones min 3 views (70150) |
$351.20 |
$878 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$375.60 |
$939 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$401.60 |
$1,004 |
3.7× |
| Fetal Echo (76825) |
$714 |
$1,785 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$506.80 |
$1,267 |
2.0× |
| Foot 2 views (73620) |
$283.60 |
$709 |
3.1× |
| Forearm 2 views (73090) |
$338.40 |
$846 |
3.7× |
| Functional MRI brain by tech (70554) |
$213.80 |
$534.50 |
0.9× |
| Hand 2 views (73120) |
$288.20 |
$720.50 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$512.60 |
$1,281.50 |
0.7× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$566.60 |
$1,416.50 |
0.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$611.40 |
$1,528.50 |
0.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,179.20 |
$7,948 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,825.60 |
$7,064 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,426.80 |
$3,567 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,276.80 |
$3,192 |
3.1× |
| Hysterosalpingogram (74740) |
$554 |
$1,385 |
2.2× |
| Image fusion (77399) |
$132.80 |
$332 |
0.9× |
| Interstitial radiation source applic complex (77778) |
$1,062.80 |
$2,657 |
1.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$171.80 |
$429.50 |
1.6× |
| Kidney imaging morphology (78700) |
$889.60 |
$2,224 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,093.40 |
$2,733.50 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,389.60 |
$3,474 |
2.5× |
| Knee 3 views (73562) |
$342.80 |
$857 |
3.8× |
| Liver & spleen imaging static only (78215) |
$1,044.80 |
$2,612 |
2.5× |
| Lung perf&ventilat diferentl (78598) |
$1,138.40 |
$2,846 |
2.0× |
| Lung ventilation imaging (78579) |
$519.20 |
$1,298 |
1.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,408.80 |
$3,522 |
0.4× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$939.20 |
$2,348 |
0.3× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$900.40 |
$2,251 |
1.4× |
| Lymphoscintigraphy (78195) |
$1,651.60 |
$4,129 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,561.20 |
$3,903 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,358 |
$3,395 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,934.80 |
$4,837 |
5.3× |
| Mammary ductogram or galactogram single (77053) |
$206.80 |
$517 |
0.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$257.60 |
$644 |
2.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$537.80 |
$1,344.50 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,873.20 |
$4,683 |
5.1× |
| MRA head w/o contrast (70544) |
$1,404.40 |
$3,511 |
5.6× |
| MRA head with contrast (70545) |
$1,511.20 |
$3,778 |
4.1× |
| MRA neck w/o contrast (70547) |
$1,272.20 |
$3,180.50 |
5.1× |
| MRI abdomen w contrast (74182) |
$1,358 |
$3,395 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,682.40 |
$4,206 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,207.60 |
$3,019 |
4.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,358 |
$3,395 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,727.20 |
$4,318 |
4.7× |
| MRI c-spine with contrast (72142) |
$1,678 |
$4,195 |
4.6× |
| MRI cardiac w/o cont stress (75559) |
$1,358 |
$3,395 |
2.4× |
| MRI cardiac w/o contrast (75557) |
$1,371.60 |
$3,429 |
5.5× |
| MRI cervical spine w/o contrast (72141) |
$1,549 |
$3,872.50 |
6.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,682.40 |
$4,206 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,207.60 |
$3,019 |
4.8× |
| MRI chest with contrast (71551) |
$1,358 |
$3,395 |
1.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,358 |
$3,395 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,842.40 |
$4,606 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,258.40 |
$3,146 |
5.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,207.60 |
$3,019 |
4.8× |
| MRI orbit face neck w contrast (70542) |
$1,358 |
$3,395 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,774.40 |
$4,436 |
4.9× |
| MRI pelvis w/contrast (72196) |
$1,358 |
$3,395 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,682.40 |
$4,206 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,219.60 |
$3,049 |
4.9× |
| MRI spectroscopy (76390) |
$1,371.60 |
$3,429 |
15.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,049.20 |
$5,123 |
5.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,930 |
$4,825 |
5.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,090.40 |
$5,226 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,678 |
$4,195 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,115.20 |
$5,288 |
5.8× |
| MRI temporomandibular joint (70336) |
$1,207.60 |
$3,019 |
4.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,624.80 |
$4,062 |
6.5× |
| MRI up ext w/o contrast (73218) |
$1,332.80 |
$3,332 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,297.40 |
$3,243.50 |
5.2× |
| MRI, joint upper extrem combo (73223) |
$1,924 |
$4,810 |
5.3× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,530.40 |
$8,826 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,576.80 |
$6,442 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,600 |
$4,000 |
1.2× |
| Neck soft tissue (70360) |
$253 |
$632.50 |
2.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$298.40 |
$746 |
0.7× |
| Nm bone marrow wb (78104) |
$893.60 |
$2,234 |
2.1× |
| Nm cisternogram (78630) |
$802.40 |
$2,006 |
1.4× |
| Nm csf leak detection (78650) |
$1,023.20 |
$2,558 |
0.8× |
| Nm gastric emptying study (78264) |
$1,276.40 |
$3,191 |
3.1× |
| Nm peritoneal-venous shunt patency (78291) |
$926.80 |
$2,317 |
2.2× |
| Nonvascular shunt X-ray (75809) |
$287.20 |
$718 |
2.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,344.60 |
$5,861.50 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$939.60 |
$2,349 |
3.9× |
| Osseous survey limited (77074) |
$313.60 |
$784 |
2.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,167.20 |
$2,918 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$848.40 |
$2,121 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$219.60 |
$549 |
2.0× |
| Perineogram (74775) |
$170 |
$425 |
0.7× |
| Peritoneogram after injection (74190) |
$436.40 |
$1,091 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$3,803.20 |
$9,508 |
2.5× |
| PET imaging CT for attenuation limited area (78814) |
$3,671.60 |
$9,179 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$3,769.60 |
$9,424 |
2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,921.20 |
$7,303 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,460.80 |
$3,652 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,237.20 |
$3,093 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,262 |
$3,155 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$352 |
$880 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$365 |
$912.50 |
4.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$289.20 |
$723 |
3.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$366.20 |
$915.50 |
4.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$214.40 |
$536 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$228 |
$570 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$241.60 |
$604 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$258.20 |
$645.50 |
2.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$332.40 |
$831 |
3.7× |
| Radex Hand Minimum 3 Views (73130) |
$331 |
$827.50 |
3.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$242.80 |
$607 |
2.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$252.20 |
$630.50 |
2.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$387.60 |
$969 |
3.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$423.60 |
$1,059 |
3.9× |
| Radex Humerus Minimum 2 Views (73060) |
$338.60 |
$846.50 |
3.7× |
| Radex Kne 1/2 Views (73560) |
$271.40 |
$678.50 |
3.0× |
| Radex Kne Compl 4/More Views (73564) |
$410 |
$1,025 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$292.80 |
$732 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$242.40 |
$606 |
2.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$219.20 |
$548 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$367.40 |
$918.50 |
4.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$117.60 |
$294 |
1.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$312 |
$780 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$272.40 |
$681 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$179.60 |
$449 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$337.60 |
$844 |
3.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$323 |
$807.50 |
3.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$256.40 |
$641 |
2.3× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$8,325.20 |
$20,813 |
1.1× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$1,096.80 |
$2,742 |
0.1× |
| Radiation treatment delivery level 1 (77402) |
$147.20 |
$368 |
1.4× |
| Radiation treatment delivery level 2 (77407) |
$261.40 |
$653.50 |
0.6× |
| Radiation treatment delivery level 3 (77412) |
$271 |
$677.50 |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$234.80 |
$587 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$420.40 |
$1,051 |
3.9× |
| Radiologic exam chest 2 views (71046) |
$275.20 |
$688 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$608.40 |
$1,521 |
3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$402.80 |
$1,007 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$482.80 |
$1,207 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$386.40 |
$966 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$267.80 |
$669.50 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$341.20 |
$853 |
3.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$158.40 |
$396 |
1.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$94 |
$235 |
0.9× |
| Radiological examination surgical specimen (76098) |
$325.20 |
$813 |
0.6× |
| Ribs bilateral 3 views (71110) |
$374 |
$935 |
3.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,100 |
$2,750 |
2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,104.40 |
$2,761 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,044 |
$5,110 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,210 |
$3,025 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,425.20 |
$3,563 |
2.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,815.20 |
$4,538 |
1.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,600 |
$4,000 |
1.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$792.40 |
$1,981 |
3.3× |
| Rp Therapy Intravenous Administration (79101) |
$1,058.40 |
$2,646 |
4.3× |
| Sacroiliac Joints < 3 Views (72200) |
$138 |
$345 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$314 |
$785 |
1.3× |
| Salivary gland imaging (78230) |
$478.40 |
$1,196 |
1.1× |
| Scapula (73010) |
$271.20 |
$678 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$39.31 |
$98.28 |
1.7× |
| Shoulder 1 view (73020) |
$215.20 |
$538 |
2.4× |
| Sialogram (70390) |
$205.20 |
$513 |
0.8× |
| Simulation intermediate (77285) |
$488.40 |
$1,221 |
1.2× |
| Small bowel series (74250) |
$459.40 |
$1,148.50 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$328.80 |
$822 |
0.8× |
| Special dosimetry (77331) |
$143 |
$357.50 |
1.0× |
| Special Physics Consult (77370) |
$160 |
$400 |
1.1× |
| Special treatment procedure (77470) |
$510.40 |
$1,276 |
0.9× |
| Spine thoracic 3 views (72072) |
$320.40 |
$801 |
2.9× |
| Splenoportograpy rs&i (75810) |
$2,152.80 |
$5,382 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$1,878.80 |
$4,697 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$3,766 |
$9,415 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$433 |
$1,082.50 |
1.1× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$357.80 |
$894.50 |
0.9× |
| Testicular Imaging With Vascular Flow (78761) |
$757.20 |
$1,893 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$437.20 |
$1,093 |
1.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$168.40 |
$421 |
1.2× |
| Thoracolumbar 2 views (72080) |
$216.80 |
$542 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,991.20 |
$4,978 |
3.5× |
| Thyroid imaging w/blood flow (78013) |
$286 |
$715 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$458 |
$1,145 |
1.1× |
| Tomogram (76100) |
$427.60 |
$1,069 |
3.9× |
| Treatment device complex (77334) |
$366.40 |
$916 |
0.9× |
| Treatment device intermediate (77333) |
$165.40 |
$413.50 |
1.2× |
| Treatment devices simple (77332) |
$184.20 |
$460.50 |
1.3× |
| Ultrasound breast complete (76641) |
$275.80 |
$689.50 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$586 |
$1,465 |
5.4× |
| Ultrasound, abdomen limited (76705) |
$460 |
$1,150 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$261.20 |
$653 |
2.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$71.60 |
$179 |
0.8× |
| Unlisted fluoroscopic procedure (76496) |
$691.20 |
$1,728 |
7.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$815.60 |
$2,039 |
7.7× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$132.80 |
$332 |
0.9× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$245.60 |
$614 |
22.2× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$65.20 |
$163 |
0.7× |
| Ureteral reflux study (78740) |
$529.60 |
$1,324 |
1.3× |
| Urethrocystogram voiding (74455) |
$555.20 |
$1,388 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$428 |
$1,070 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$833 |
$2,082.50 |
4.5× |
| Us breast unilateral limited (76642) |
$252.60 |
$631.50 |
2.8× |
| Us chest (76604) |
$324 |
$810 |
3.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$330.80 |
$827 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$342.40 |
$856 |
3.1× |
| Us elastography parenchyma (76981) |
$135.20 |
$338 |
1.2× |
| Us encephalogram (76506) |
$280.80 |
$702 |
2.6× |
| Us infant hips w manipulation (76885) |
$372.40 |
$931 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$273.20 |
$683 |
2.5× |
| Us ob detailed single fetus (76811) |
$488 |
$1,220 |
2.0× |
| Us ob limited (76815) |
$376.80 |
$942 |
3.5× |
| Us ob transvaginal (76817) |
$416 |
$1,040 |
3.8× |
| Us pelvic non ob complete (76856) |
$440.80 |
$1,102 |
4.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$291.60 |
$729 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$398.80 |
$997 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$260.40 |
$651 |
2.4× |
| Us retroperitoneal complete (76770) |
$592 |
$1,480 |
5.4× |
| Us retroperitoneal limited (76775) |
$439.60 |
$1,099 |
4.0× |
| Us scrotum and contents (76870) |
$445.60 |
$1,114 |
4.1× |
| Us soft tissue head/neck (76536) |
$393.60 |
$984 |
3.6× |
| Us spinal canal and contents (76800) |
$310.80 |
$777 |
2.8× |
| Us transrectal (76872) |
$135.20 |
$338 |
1.2× |
| Us transrectal prostate volume (76873) |
$309.60 |
$774 |
2.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$429.60 |
$1,074 |
3.9× |
| Venogram extremity bilateral (75822) |
$1,623.20 |
$4,058 |
1.0× |
| Venogram Extremity Unilateral (75820) |
$1,082.20 |
$2,705.50 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,318.40 |
$5,796 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$2,159.60 |
$5,399 |
1.3× |
| Venography Renal Bilateral (75833) |
$2,272 |
$5,680 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,514.80 |
$3,787 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,434.80 |
$3,587 |
0.4× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,480.80 |
$3,702 |
0.3× |
| Vertebral fracture assessment via dxa (77086) |
$83.20 |
$208 |
0.9× |
| Wrist 2 views (73100) |
$372.80 |
$932 |
4.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$429.60 |
$1,074 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$310 |
$775 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$719.20 |
$1,798 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$333.60 |
$834 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$249.80 |
$624.50 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$406 |
$1,015 |
3.7× |
| X-ray exam of femur 2/> (73552) |
$325.80 |
$814.50 |
3.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$155.60 |
$389 |
1.7× |
| X-ray IV pyelogram (ivp) (74400) |
$831 |
$2,077.50 |
4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$199.80 |
$499.50 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$325.60 |
$814 |
3.6× |
| X-ray leg, infant (73592) |
$133 |
$332.50 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$405.80 |
$1,014.50 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$644.40 |
$1,611 |
5.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$164 |
$410 |
1.5× |
| X-ray retrograde pyelogram (74420) |
$842 |
$2,105 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$249.20 |
$623 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$370.80 |
$927 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$556.80 |
$1,392 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$204.80 |
$512 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$262.80 |
$657 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$225.20 |
$563 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$370.80 |
$927 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$246 |
$615 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$231.60 |
$579 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$263.40 |
$658.50 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$296.20 |
$740.50 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$381.20 |
$953 |
3.5× |
| Xr bone length studies (77073) |
$222.60 |
$556.50 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$405.20 |
$1,013 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$412.80 |
$1,032 |
3.8× |
| Xr chest 4+ views (71048) |
$310.80 |
$777 |
2.8× |
| Xr urogram antegrade (74425) |
$529.20 |
$1,323 |
1.5× |