| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,340 |
$8,680 |
3.2× |
| Abdomen 2 views (74019) |
$265 |
$530 |
2.6× |
| Acute gi blood loss imaging (78278) |
$590.50 |
$1,181 |
1.5× |
| Angio Adrenal Bilat Select (75733) |
$4,703 |
$9,406 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$3,487 |
$6,974 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$3,378.50 |
$6,757 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$2,083 |
$4,166 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,878 |
$11,756 |
1.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,878 |
$11,756 |
1.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,878 |
$11,756 |
1.9× |
| Angiography Spinal Selective Rs&I (75705) |
$3,661.50 |
$7,323 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,878 |
$11,756 |
1.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,862.50 |
$3,725 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,912.50 |
$5,825 |
0.9× |
| Ankle 2 views (73600) |
$184.50 |
$369 |
2.2× |
| Aortogram thoracic (75605) |
$3,661.50 |
$7,323 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,526.50 |
$7,053 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$3,378.50 |
$6,757 |
1.1× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,526.50 |
$7,053 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$3,358 |
$6,716 |
1.1× |
| Arthrogram ankle (73615) |
$592 |
$1,184 |
1.7× |
| Arthrogram elbow (73085) |
$957 |
$1,914 |
2.8× |
| Arthrogram hip (73525) |
$957 |
$1,914 |
2.8× |
| Arthrogram knee (73580) |
$307.50 |
$615 |
0.9× |
| Arthrogram shoulder (73040) |
$578 |
$1,156 |
1.7× |
| Arthrogram wrist (73115) |
$775.50 |
$1,551 |
2.3× |
| Basic dosimetry (77300) |
$413.50 |
$827 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,013.50 |
$2,027 |
2.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,043 |
$2,086 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,132 |
$2,264 |
2.9× |
| Bone age studies (77072) |
$118.50 |
$237 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$1,177.50 |
$2,355 |
3.0× |
| Bone Marrow Imaging Limited Area (78102) |
$867.50 |
$1,735 |
2.2× |
| Bone survey complete (77075) |
$831.25 |
$1,662.50 |
8.1× |
| Bone survey infant (77076) |
$201.50 |
$403 |
2.0× |
| Bowel imaging (78290) |
$1,043 |
$2,086 |
2.7× |
| Brachytx isodose complex (77318) |
$2,544.50 |
$5,089 |
6.9× |
| Brachytx isodose intermed (77317) |
$2,105 |
$4,210 |
5.7× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,664 |
$3,328 |
4.5× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$2,774 |
$5,548 |
7.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,667.50 |
$7,335 |
6.9× |
| Brain Imaging Vascular Flow Only (78610) |
$467 |
$934 |
0.9× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$3,189.50 |
$6,379 |
6.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,136.50 |
$2,273 |
2.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,187.50 |
$4,375 |
2.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,923 |
$3,846 |
5.6× |
| Cardiac shunt detection (78428) |
$717 |
$1,434 |
1.8× |
| Cephalogram, orthodontic Non-Facility (70350) |
$141.50 |
$283 |
1.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,004 |
$2,008 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$226.50 |
$453 |
2.6× |
| Chest 1 view (71045) |
$157.25 |
$314.50 |
1.8× |
| Chest xray 3 views (71047) |
$276.75 |
$553.50 |
3.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$175 |
$350 |
1.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,245 |
$2,490 |
1.6× |
| Clavicle complete (73000) |
$244 |
$488 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$317.25 |
$634.50 |
3.1× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$507 |
$1,014 |
5.9× |
| Continuing medical physics consltj pr wk (77336) |
$554.50 |
$1,109 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,259 |
$4,518 |
6.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,541.50 |
$3,083 |
6.6× |
| CT abdomen w contrast (74160) |
$1,054.50 |
$2,109 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,130 |
$2,260 |
6.6× |
| CT abdomen w/o contrast (74150) |
$754 |
$1,508 |
7.3× |
| CT angio hrt w/3d image (75574) |
$375 |
$750 |
1.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,782 |
$5,564 |
16.1× |
| CT angiography upper extremity lt (73206) |
$2,789.50 |
$5,579 |
16.2× |
| CT c-spine w/contrast (72126) |
$1,518 |
$3,036 |
4.4× |
| CT c-spine w/o contrast (72125) |
$1,265 |
$2,530 |
12.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,736.50 |
$3,473 |
10.1× |
| CT chest w contrast (71260) |
$1,497.10 |
$2,994.20 |
8.7× |
| CT chest w/wo contrast (71270) |
$1,963.50 |
$3,927 |
11.4× |
| CT colonography screening (74263) |
$433 |
$866 |
1.8× |
| CT colonography w/dye (74262) |
$536.50 |
$1,073 |
3.1× |
| CT colonography w/o cntrst (74261) |
$433 |
$866 |
4.2× |
| CT head/brain with contrast (70460) |
$1,503.50 |
$3,007 |
8.7× |
| CT head/brain without and with contrast (70470) |
$1,618.50 |
$3,237 |
9.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,068 |
$2,136 |
3.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$48.25 |
$96.50 |
0.6× |
| CT hrt w/3d image congen (75573) |
$1,068 |
$2,136 |
3.1× |
| CT iac w contrast (70481) |
$1,145.50 |
$2,291 |
6.6× |
| CT limited/localized follow up study (76380) |
$533.50 |
$1,067 |
6.2× |
| CT lower ext w/o (73700) |
$1,002.88 |
$2,005.76 |
9.8× |
| CT lower extremity w wo contrast (73702) |
$1,504 |
$3,008 |
8.7× |
| CT lower extremity w/contrast material (73701) |
$1,393 |
$2,786 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,955 |
$3,910 |
11.3× |
| CT lumbar spine w/contrast (72132) |
$1,722.50 |
$3,445 |
5.0× |
| CT lumbar spine w/o contrast (72131) |
$1,574.50 |
$3,149 |
15.3× |
| CT maxillofacial w contrast (70487) |
$802.50 |
$1,605 |
4.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,796.50 |
$3,593 |
10.4× |
| CT maxillofacial wo contrast (70486) |
$670 |
$1,340 |
6.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,776.50 |
$3,553 |
10.3× |
| CT orbits w/o contrast (70480) |
$670 |
$1,340 |
6.5× |
| CT pelvis w/o contrast (72192) |
$1,078.92 |
$2,157.83 |
10.5× |
| CT pelvis w/wo contrast (72194) |
$2,008.50 |
$4,017 |
11.6× |
| CT scan of arm combo (73202) |
$1,681 |
$3,362 |
9.7× |
| CT soft tissue neck w contrast (70491) |
$1,379 |
$2,758 |
8.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,585 |
$3,170 |
9.2× |
| CT soft tissue neck w/o contrast (70490) |
$848.50 |
$1,697 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$1,810.50 |
$3,621 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,262.50 |
$2,525 |
12.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,776.50 |
$3,553 |
10.3× |
| CT thorax w/o contrast (71250) |
$993.12 |
$1,986.23 |
9.7× |
| CT upper ext wo (73200) |
$1,353.50 |
$2,707 |
13.2× |
| CT upper extremity with contrast (73201) |
$1,520 |
$3,040 |
4.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,567.50 |
$7,135 |
20.7× |
| Cta Abdomen (74175) |
$3,308.50 |
$6,617 |
19.2× |
| CTA abdomen pelvis (74174) |
$6,390.50 |
$12,781 |
18.6× |
| CTA chest (71275) |
$1,513.78 |
$3,027.57 |
8.8× |
| Cta Head (70496) |
$2,691.50 |
$5,383 |
15.6× |
| Cta Neck (70498) |
$2,637.50 |
$5,275 |
15.3× |
| Cta Pelvis (72191) |
$3,082.50 |
$6,165 |
17.9× |
| Cystography minimum 3 views rs&i (74430) |
$276.50 |
$553 |
0.8× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$375.50 |
$751 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,347 |
$4,694 |
1.1× |
| Diskogram cervical (72285) |
$1,771 |
$3,542 |
0.9× |
| Diskography lumbar (72295) |
$1,859.50 |
$3,719 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$132.50 |
$265 |
1.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$132.50 |
$265 |
1.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$426 |
$852 |
4.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$266 |
$532 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$311 |
$622 |
3.6× |
| Dxa bone density study axial skeleton (77085) |
$1,002 |
$2,004 |
9.7× |
| Echo exam of eye (76529) |
$228.50 |
$457 |
2.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$280 |
$560 |
1.2× |
| Esophagus (74220) |
$380.50 |
$761 |
2.2× |
| Facial bones min 3 views (70150) |
$322 |
$644 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$327.50 |
$655 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$252 |
$504 |
2.5× |
| Fetal Echo (76825) |
$983.25 |
$1,966.50 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$779.50 |
$1,559 |
3.3× |
| Foot 2 views (73620) |
$186 |
$372 |
2.2× |
| Forearm 2 views (73090) |
$214 |
$428 |
2.5× |
| Functional MRI brain by phys/psych (70555) |
$1,639 |
$3,278 |
7.0× |
| Functional MRI brain by tech (70554) |
$2,034.50 |
$4,069 |
8.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,098 |
$2,196 |
2.8× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,313.50 |
$2,627 |
2.5× |
| Hand 2 views (73120) |
$129 |
$258 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,374 |
$4,748 |
3.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,729 |
$5,458 |
4.0× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,957 |
$5,914 |
4.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,703 |
$9,406 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,526.50 |
$7,053 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,495.50 |
$2,991 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,495.50 |
$2,991 |
3.8× |
| Hysterosalpingogram (74740) |
$366 |
$732 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$2,957 |
$5,914 |
4.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,813.50 |
$3,627 |
2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,592 |
$3,184 |
2.9× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,376 |
$2,752 |
2.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$343.50 |
$687 |
3.3× |
| Kidney imaging morphology (78700) |
$913.50 |
$1,827 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,207.50 |
$2,415 |
2.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,389 |
$2,778 |
2.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,598 |
$3,196 |
3.0× |
| Knee 3 views (73562) |
$277.75 |
$555.50 |
3.2× |
| Liver & spleen imaging static only (78215) |
$1,202 |
$2,404 |
3.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,381 |
$2,762 |
3.5× |
| Liver imaging static only (78201) |
$1,223 |
$2,446 |
2.3× |
| Liver imaging w/vascular flow (78202) |
$1,223 |
$2,446 |
2.3× |
| Lung perf&ventilat diferentl (78598) |
$1,356.50 |
$2,713 |
2.5× |
| Lung perfusion differential (78597) |
$1,356.50 |
$2,713 |
3.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,140 |
$4,280 |
0.7× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,140 |
$4,280 |
0.7× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,315.50 |
$2,631 |
0.8× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,315.50 |
$2,631 |
2.1× |
| Lymphoscintigraphy (78195) |
$482 |
$964 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,249.50 |
$4,499 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,241.50 |
$4,483 |
6.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,977 |
$5,954 |
8.7× |
| Magnetic Resonance Elastography (76391) |
$1,192 |
$2,384 |
5.1× |
| Mammary ductogram or galactogram multiple (77054) |
$651.50 |
$1,303 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$413 |
$826 |
1.8× |
| MRA head w & w/o contrast (70546) |
$2,906 |
$5,812 |
8.5× |
| MRA head w/o contrast (70544) |
$2,356 |
$4,712 |
10.0× |
| MRA head with contrast (70545) |
$2,708 |
$5,416 |
7.9× |
| MRA neck w contrast (70548) |
$2,704.50 |
$5,409 |
7.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,007.50 |
$6,015 |
8.8× |
| MRA neck w/o contrast (70547) |
$2,504.50 |
$5,009 |
10.7× |
| MRI abdomen w contrast (74182) |
$1,997.50 |
$3,995 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,339 |
$6,678 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$1,905 |
$3,810 |
8.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,416.50 |
$4,833 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,195.50 |
$6,391 |
9.3× |
| MRI breast w/o contrast bilateral (77047) |
$2,752.50 |
$5,505 |
11.7× |
| MRI breast wo contrast unilateral (77046) |
$2,300.50 |
$4,601 |
9.8× |
| MRI c-spine with contrast (72142) |
$2,668 |
$5,336 |
7.8× |
| MRI cardiac w/o contrast (75557) |
$1,362.50 |
$2,725 |
5.8× |
| MRI cervical spine w/o contrast (72141) |
$2,340.50 |
$4,681 |
10.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,409.50 |
$4,819 |
7.0× |
| MRI chest w/o contrast (71550) |
$1,627.50 |
$3,255 |
6.9× |
| MRI chest with contrast (71551) |
$1,872 |
$3,744 |
2.4× |
| MRI fetal sngl/1st gestation (74712) |
$568.50 |
$1,137 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,288 |
$4,576 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,977 |
$5,954 |
8.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,241.50 |
$4,483 |
9.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,938 |
$3,876 |
8.3× |
| MRI orbit face neck w contrast (70542) |
$2,313.50 |
$4,627 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,360 |
$6,720 |
9.8× |
| MRI pelvis w/contrast (72196) |
$2,241.50 |
$4,483 |
6.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,526 |
$7,052 |
10.3× |
| MRI pelvis w/o contrast (72195) |
$1,916.50 |
$3,833 |
8.2× |
| MRI spectroscopy (76390) |
$1,719.50 |
$3,439 |
20.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,526.50 |
$7,053 |
10.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,862 |
$5,724 |
8.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,593.50 |
$7,187 |
10.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,862 |
$5,724 |
8.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,450 |
$6,900 |
10.1× |
| MRI temporomandibular joint (70336) |
$2,034.50 |
$4,069 |
8.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,130 |
$4,260 |
9.1× |
| MRI up ext w/o contrast (73218) |
$1,976 |
$3,952 |
8.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,028.50 |
$4,057 |
8.6× |
| MRI, joint upper extrem combo (73223) |
$2,588.50 |
$5,177 |
7.5× |
| Myelogram Cervical (72240) |
$1,489.50 |
$2,979 |
1.9× |
| Myelogram Lumbar (72265) |
$1,847 |
$3,694 |
2.4× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$2,263 |
$4,526 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,449 |
$2,898 |
1.1× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,811 |
$3,622 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,585.25 |
$5,170.50 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,811 |
$3,622 |
1.4× |
| Neck soft tissue (70360) |
$341 |
$682 |
4.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$931 |
$1,862 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$227 |
$454 |
0.6× |
| Nm adrenal scan (78075) |
$1,350 |
$2,700 |
1.1× |
| Nm bone marrow multi (78103) |
$999.50 |
$1,999 |
2.5× |
| Nm bone marrow wb (78104) |
$1,247 |
$2,494 |
3.2× |
| Nm cisternogram (78630) |
$916 |
$1,832 |
1.7× |
| Nm gastric emptying study (78264) |
$846.50 |
$1,693 |
2.2× |
| Nm gastroesophageal reflux study (78262) |
$696.50 |
$1,393 |
1.8× |
| Nm kidney scan w/flow (78701) |
$1,050 |
$2,100 |
2.7× |
| Nm peritoneal-venous shunt patency (78291) |
$696.50 |
$1,393 |
1.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$468.50 |
$937 |
1.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,123.50 |
$8,247 |
3.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$979 |
$1,958 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$1,269.50 |
$2,539 |
5.5× |
| Ob us nuchal meas 1 gest (76813) |
$509.50 |
$1,019 |
5.0× |
| Orthopantogram (70355) |
$334.50 |
$669 |
3.9× |
| Osseous survey limited (77074) |
$713.75 |
$1,427.50 |
6.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,036 |
$2,072 |
1.9× |
| Parathyroid Planar Imaging (78070) |
$365.50 |
$731 |
0.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$965 |
$1,930 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$248.50 |
$497 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$4,409 |
$8,818 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$4,409 |
$8,818 |
3.1× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$5,425 |
$10,850 |
4.3× |
| PET whole body (78813) |
$5,425 |
$10,850 |
3.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$5,425 |
$10,850 |
3.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,703 |
$9,406 |
1.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,862.50 |
$3,725 |
0.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$705 |
$1,410 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,141 |
$2,282 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$334.50 |
$669 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$232 |
$464 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$204.75 |
$409.50 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$246.50 |
$493 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$232 |
$464 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$267 |
$534 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$307 |
$614 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$143 |
$286 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$196 |
$392 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$196 |
$392 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$149 |
$298 |
1.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$302.50 |
$605 |
2.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$237.50 |
$475 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$391 |
$782 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$220.50 |
$441 |
2.6× |
| Radex Kne 1/2 Views (73560) |
$185.50 |
$371 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$242.50 |
$485 |
2.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$363.25 |
$726.50 |
3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$256.75 |
$513.50 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$406.75 |
$813.50 |
4.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$198 |
$396 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$424.50 |
$849 |
5.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$534.25 |
$1,068.50 |
5.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$354.25 |
$708.50 |
4.1× |
| Radex Toe Minimum 2 Views (73660) |
$191.50 |
$383 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$120 |
$240 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$214 |
$428 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$335 |
$670 |
3.3× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$14,869 |
$29,738 |
2.1× |
| Radiation treatment delivery level 1 (77402) |
$371 |
$742 |
3.7× |
| Radiation treatment delivery level 2 (77407) |
$371 |
$742 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$564.50 |
$1,129 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$167 |
$334 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$273.50 |
$547 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$143 |
$286 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$482.50 |
$965 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$294 |
$588 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,056 |
$2,112 |
6.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$686 |
$1,372 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$250.50 |
$501 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$214 |
$428 |
2.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$266.50 |
$533 |
2.6× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$138 |
$276 |
1.3× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$147.50 |
$295 |
0.6× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$147.50 |
$295 |
0.6× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$66 |
$132 |
0.8× |
| Radiological examination surgical specimen (76098) |
$242 |
$484 |
0.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$874.50 |
$1,749 |
3.8× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,729 |
$5,458 |
7.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,374 |
$4,748 |
6.3× |
| Renal Cyst Study (74470) |
$387 |
$774 |
0.7× |
| Ribs bilateral 3 views (71110) |
$545.50 |
$1,091 |
5.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,169 |
$2,338 |
3.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,285.50 |
$2,571 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,414.50 |
$2,829 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,556 |
$3,112 |
2.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,882.50 |
$3,765 |
1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,071 |
$4,142 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,712 |
$3,424 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$935.50 |
$1,871 |
4.1× |
| Rp Therapy Intravenous Administration (79101) |
$658.50 |
$1,317 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$218 |
$436 |
2.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$560.50 |
$1,121 |
2.4× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$696.50 |
$1,393 |
1.8× |
| Scapula (73010) |
$289.75 |
$579.50 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$63.50 |
$127 |
2.7× |
| Sella turcica (70240) |
$141.50 |
$283 |
1.7× |
| Shoulder 1 view (73020) |
$198 |
$396 |
2.3× |
| Sialogram (70390) |
$643 |
$1,286 |
2.7× |
| Simulation intermediate (77285) |
$946 |
$1,892 |
2.6× |
| Small bowel series (74250) |
$569 |
$1,138 |
3.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$919 |
$1,838 |
2.5× |
| Special dosimetry (77331) |
$378.50 |
$757 |
2.9× |
| Special Physics Consult (77370) |
$575.50 |
$1,151 |
4.4× |
| Special treatment procedure (77470) |
$1,850 |
$3,700 |
3.4× |
| Spine thoracic 3 views (72072) |
$362 |
$724 |
3.5× |
| Spleen imaging only (78185) |
$727 |
$1,454 |
1.8× |
| Splenoportograpy rs&i (75810) |
$3,358 |
$6,716 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$10,508.50 |
$21,017 |
6.0× |
| Superior sagittal sinus venogram (75870) |
$1,862.50 |
$3,725 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$905.50 |
$1,811 |
2.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$788 |
$1,576 |
2.1× |
| Testicular Imaging With Vascular Flow (78761) |
$828 |
$1,656 |
2.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,275.50 |
$2,551 |
3.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$636 |
$1,272 |
4.8× |
| Thoracolumbar 2 views (72080) |
$377 |
$754 |
4.4× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$813.50 |
$1,627 |
2.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,869.50 |
$3,739 |
3.5× |
| Thyroid imaging w/blood flow (78013) |
$613.50 |
$1,227 |
1.6× |
| Thyroid uptake measurement (78012) |
$1,342.50 |
$2,685 |
3.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,129.50 |
$2,259 |
2.9× |
| Tmj unilateral (70328) |
$319.75 |
$639.50 |
3.7× |
| Tomogram (76100) |
$158.50 |
$317 |
1.5× |
| Treatment device complex (77334) |
$514 |
$1,028 |
1.4× |
| Treatment device intermediate (77333) |
$448 |
$896 |
3.4× |
| Treatment devices simple (77332) |
$389.50 |
$779 |
2.9× |
| Ultrasound breast complete (76641) |
$466.50 |
$933 |
4.5× |
| Ultrasound elastography first target lesion (76982) |
$307 |
$614 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$331 |
$662 |
3.2× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$626.50 |
$1,253 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$504 |
$1,008 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$500 |
$1,000 |
4.9× |
| Unlisted magnetic resonance procedure (76498) |
$1,041 |
$2,082 |
12.2× |
| Unlisted ultrasound procedure (76999) |
$109.50 |
$219 |
1.3× |
| Ureteral reflux study (78740) |
$913.50 |
$1,827 |
2.3× |
| Urethrocystogram voiding (74455) |
$525 |
$1,050 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$271 |
$542 |
1.2× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$361 |
$722 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,380.50 |
$2,761 |
8.0× |
| Us breast unilateral limited (76642) |
$241 |
$482 |
2.8× |
| Us chest (76604) |
$359.50 |
$719 |
3.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$525 |
$1,050 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$628.50 |
$1,257 |
6.1× |
| Us elastography parenchyma (76981) |
$307 |
$614 |
3.0× |
| Us encephalogram (76506) |
$713 |
$1,426 |
6.9× |
| Us hips infant static (76886) |
$151 |
$302 |
1.8× |
| Us infant hips w manipulation (76885) |
$249.50 |
$499 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$85.50 |
$171 |
0.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$377.50 |
$755 |
3.7× |
| Us ob detailed single fetus (76811) |
$452.50 |
$905 |
1.9× |
| Us ob limited (76815) |
$264 |
$528 |
2.6× |
| Us ob transvaginal (76817) |
$330 |
$660 |
3.2× |
| Us pelvic non ob complete (76856) |
$462 |
$924 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$235 |
$470 |
2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$323 |
$646 |
3.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$180 |
$360 |
1.8× |
| Us retroperitoneal complete (76770) |
$512.25 |
$1,024.50 |
5.0× |
| Us retroperitoneal limited (76775) |
$424.50 |
$849 |
4.1× |
| Us scrotum and contents (76870) |
$626 |
$1,252 |
6.1× |
| Us soft tissue head/neck (76536) |
$523 |
$1,046 |
5.1× |
| Us spinal canal and contents (76800) |
$504.50 |
$1,009 |
4.9× |
| Us transrectal (76872) |
$399.75 |
$799.50 |
3.9× |
| Us transrectal prostate volume (76873) |
$536.50 |
$1,073 |
5.2× |
| Us, eye b-scan (76512) |
$313 |
$626 |
3.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$550 |
$1,100 |
5.3× |
| Vasogram (74440) |
$617 |
$1,234 |
2.6× |
| Venogram adrenal unilat (75840) |
$4,703 |
$9,406 |
1.5× |
| Venogram extremity bilateral (75822) |
$2,495 |
$4,990 |
1.6× |
| Venogram Extremity Unilateral (75820) |
$1,665.50 |
$3,331 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$4,703 |
$9,406 |
1.5× |
| Venography caval superior serialography rs&i (75827) |
$2,083 |
$4,166 |
1.3× |
| Venography Orbital Rs&I (75880) |
$2,912.50 |
$5,825 |
4.7× |
| Venography Renal Bilateral (75833) |
$4,703 |
$9,406 |
1.5× |
| Venography renal unilateral selective rs&i (75831) |
$4,703 |
$9,406 |
1.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,140 |
$4,280 |
0.7× |
| Venous sampling by catheter (75893) |
$4,703 |
$9,406 |
0.9× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$852 |
$1,704 |
1.6× |
| Vertebral fracture assessment via dxa (77086) |
$192 |
$384 |
2.2× |
| Wrist 2 views (73100) |
$216.50 |
$433 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$390.25 |
$780.50 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$263 |
$526 |
3.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,146 |
$2,292 |
6.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$200 |
$400 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$149 |
$298 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$335 |
$670 |
3.3× |
| X-ray exam of femur 2/> (73552) |
$129.50 |
$259 |
1.5× |
| X-ray eye for foreign body (70030) |
$183.75 |
$367.50 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$295 |
$590 |
3.4× |
| X-ray IV pyelogram (ivp) (74400) |
$1,225.50 |
$2,451 |
7.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$283 |
$566 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$170 |
$340 |
2.0× |
| X-ray leg, infant (73592) |
$127 |
$254 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$238.50 |
$477 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$482.50 |
$965 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$229 |
$458 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$499.50 |
$999 |
4.9× |
| X-ray retrograde pyelogram (74420) |
$362.50 |
$725 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$264.50 |
$529 |
3.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$274.50 |
$549 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$660 |
$1,320 |
6.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$331.75 |
$663.50 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$234 |
$468 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$639.25 |
$1,278.50 |
7.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$545.50 |
$1,091 |
5.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$377.25 |
$754.50 |
3.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$654.50 |
$1,309 |
3.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$146.50 |
$293 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$374.50 |
$749 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$283 |
$566 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$264 |
$528 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$510.50 |
$1,021 |
5.0× |
| Xr bone length studies (77073) |
$115.50 |
$231 |
1.1× |
| Xr c-spine 4 or 5 views (72050) |
$380.50 |
$761 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$536.75 |
$1,073.50 |
5.2× |
| Xr chest 4+ views (71048) |
$329.75 |
$659.50 |
3.2× |
| Xr urogram antegrade (74425) |
$529.50 |
$1,059 |
1.5× |