| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,744.50 |
$9,489 |
3.5× |
| Abdomen 2 views (74019) |
$330 |
$660 |
3.2× |
| Acute gi blood loss imaging (78278) |
$1,059.50 |
$2,119 |
2.7× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$638 |
$1,276 |
0.5× |
| Angio Adrenal Bilat Select (75733) |
$3,421.50 |
$6,843 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$1,819.50 |
$3,639 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,819.50 |
$3,639 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$1,622.50 |
$3,245 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,421.50 |
$6,843 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,421.50 |
$6,843 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,421.50 |
$6,843 |
1.1× |
| Angiography Spinal Selective Rs&I (75705) |
$2,851.50 |
$5,703 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,421.50 |
$6,843 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,619.50 |
$3,239 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,268.50 |
$4,537 |
0.7× |
| Ankle 2 views (73600) |
$171 |
$342 |
2.0× |
| Aortogram thoracic (75605) |
$3,745 |
$7,490 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,896 |
$3,792 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,819.50 |
$3,639 |
0.6× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$2,746.50 |
$5,493 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,615.50 |
$5,231 |
0.8× |
| Arthrogram ankle (73615) |
$349 |
$698 |
1.0× |
| Arthrogram elbow (73085) |
$330.50 |
$661 |
1.0× |
| Arthrogram hip (73525) |
$304.50 |
$609 |
0.9× |
| Arthrogram knee (73580) |
$432.50 |
$865 |
1.3× |
| Arthrogram shoulder (73040) |
$304.50 |
$609 |
0.9× |
| Arthrogram wrist (73115) |
$262.50 |
$525 |
0.8× |
| Basic dosimetry (77300) |
$265 |
$530 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$836.50 |
$1,673 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$837.50 |
$1,675 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$909.50 |
$1,819 |
2.3× |
| Bone age studies (77072) |
$212 |
$424 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$909 |
$1,818 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$837.50 |
$1,675 |
2.1× |
| Bone survey complete (77075) |
$889.50 |
$1,779 |
8.7× |
| Bone survey infant (77076) |
$591.50 |
$1,183 |
5.8× |
| Bowel imaging (78290) |
$778.50 |
$1,557 |
2.0× |
| Brachytx isodose complex (77318) |
$1,107 |
$2,214 |
3.0× |
| Brachytx isodose intermed (77317) |
$856 |
$1,712 |
2.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$708.50 |
$1,417 |
1.9× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$547 |
$1,094 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$621.50 |
$1,243 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,816 |
$9,632 |
3.5× |
| Brain Imaging Vascular Flow Only (78610) |
$255.50 |
$511 |
0.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$547 |
$1,094 |
1.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$952 |
$1,904 |
2.4× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,935.50 |
$5,871 |
3.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,357 |
$4,714 |
6.9× |
| Cardiac shunt detection (78428) |
$365 |
$730 |
0.9× |
| Cephalogram, orthodontic Non-Facility (70350) |
$121 |
$242 |
1.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$489.50 |
$979 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$221 |
$442 |
2.6× |
| Chest 1 view (71045) |
$126.50 |
$253 |
1.5× |
| Chest xray 3 views (71047) |
$198.50 |
$397 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$600.50 |
$1,201 |
3.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$426.50 |
$853 |
0.6× |
| Clavicle complete (73000) |
$203 |
$406 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$327 |
$654 |
3.2× |
| Continuing medical physics consltj pr wk (77336) |
$478 |
$956 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,108 |
$6,216 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,625.50 |
$3,251 |
7.0× |
| CT abdomen w contrast (74160) |
$1,189 |
$2,378 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,474 |
$2,948 |
8.6× |
| CT abdomen w/o contrast (74150) |
$821 |
$1,642 |
8.0× |
| CT angio hrt w/3d image (75574) |
$318.75 |
$637.50 |
0.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,330.50 |
$2,661 |
7.8× |
| CT angiography upper extremity lt (73206) |
$1,330.50 |
$2,661 |
7.8× |
| CT c-spine w/contrast (72126) |
$1,358.50 |
$2,717 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,046.50 |
$2,093 |
10.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,705 |
$3,410 |
10.0× |
| CT chest w contrast (71260) |
$1,240.50 |
$2,481 |
7.2× |
| CT chest w/wo contrast (71270) |
$1,485 |
$2,970 |
8.7× |
| CT colonography screening (74263) |
$322 |
$644 |
1.4× |
| CT colonography w/dye (74262) |
$375 |
$750 |
2.2× |
| CT colonography w/o cntrst (74261) |
$322 |
$644 |
3.2× |
| CT head/brain with contrast (70460) |
$1,124.50 |
$2,249 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,383.50 |
$2,767 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$545 |
$1,090 |
1.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$75 |
$150 |
0.9× |
| CT hrt w/3d image congen (75573) |
$963 |
$1,926 |
2.8× |
| CT iac w contrast (70481) |
$1,154 |
$2,308 |
6.7× |
| CT limited/localized follow up study (76380) |
$675.50 |
$1,351 |
8.0× |
| CT lower ext w/o (73700) |
$974 |
$1,948 |
9.5× |
| CT lower extremity w wo contrast (73702) |
$1,431 |
$2,862 |
8.4× |
| CT lower extremity w/contrast material (73701) |
$1,330.50 |
$2,661 |
7.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,705 |
$3,410 |
10.0× |
| CT lumbar spine w/contrast (72132) |
$1,349 |
$2,698 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,046.50 |
$2,093 |
10.3× |
| CT maxillofacial w contrast (70487) |
$909.50 |
$1,819 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,293 |
$2,586 |
7.6× |
| CT maxillofacial wo contrast (70486) |
$885 |
$1,770 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,460 |
$2,920 |
8.5× |
| CT orbits w/o contrast (70480) |
$923 |
$1,846 |
9.0× |
| CT pelvis w/o contrast (72192) |
$807 |
$1,614 |
7.9× |
| CT pelvis w/wo contrast (72194) |
$1,544 |
$3,088 |
9.0× |
| CT scan of arm combo (73202) |
$1,431 |
$2,862 |
8.4× |
| CT soft tissue neck w contrast (70491) |
$946 |
$1,892 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,321 |
$2,642 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$932 |
$1,864 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$1,241.50 |
$2,483 |
7.3× |
| CT thoracic spine w/o contrast (72128) |
$1,010.50 |
$2,021 |
9.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,705 |
$3,410 |
10.0× |
| CT thorax w/o contrast (71250) |
$982.50 |
$1,965 |
9.6× |
| CT upper ext wo (73200) |
$974 |
$1,948 |
9.5× |
| CT upper extremity with contrast (73201) |
$1,330.50 |
$2,661 |
3.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,072.50 |
$4,145 |
12.1× |
| Cta Abdomen (74175) |
$1,407.50 |
$2,815 |
8.2× |
| CTA abdomen pelvis (74174) |
$2,598 |
$5,196 |
7.6× |
| CTA chest (71275) |
$1,252.50 |
$2,505 |
7.3× |
| Cta Head (70496) |
$1,137 |
$2,274 |
6.6× |
| Cta Neck (70498) |
$1,101.50 |
$2,203 |
6.4× |
| Cta Pelvis (72191) |
$1,354 |
$2,708 |
7.9× |
| Cystography minimum 3 views rs&i (74430) |
$306 |
$612 |
0.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$299.50 |
$599 |
1.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,021 |
$2,042 |
0.5× |
| Diskogram cervical (72285) |
$2,149 |
$4,298 |
1.1× |
| Diskography lumbar (72295) |
$1,650.50 |
$3,301 |
0.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$152 |
$304 |
1.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$152 |
$304 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$370 |
$740 |
3.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$392 |
$784 |
3.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$247.50 |
$495 |
2.9× |
| Dxa bone density study axial skeleton (77085) |
$267 |
$534 |
2.6× |
| Echo exam of eye (76529) |
$262.50 |
$525 |
3.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$320.50 |
$641 |
1.4× |
| Esophagus (74220) |
$473 |
$946 |
2.8× |
| Facial bones min 3 views (70150) |
$410.50 |
$821 |
4.0× |
| Fetal biophysical profile non-stress testing (76818) |
$374.75 |
$749.50 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$414 |
$828 |
4.1× |
| Fetal Echo (76825) |
$1,078 |
$2,156 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$189.50 |
$379 |
0.8× |
| Foot 2 views (73620) |
$175.50 |
$351 |
2.1× |
| Forearm 2 views (73090) |
$186.50 |
$373 |
2.2× |
| 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) |
$1,098.50 |
$2,197 |
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) |
$161 |
$322 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,197.50 |
$2,395 |
1.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,177.50 |
$4,355 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,400.50 |
$6,801 |
5.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,421.50 |
$6,843 |
1.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,746.50 |
$5,493 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,906 |
$3,812 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,374 |
$2,748 |
3.5× |
| Hysterosalpingogram (74740) |
$219.50 |
$439 |
0.9× |
| Interstitial radiation source applic complex (77778) |
$1,164 |
$2,328 |
1.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,018 |
$2,036 |
1.5× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$816.50 |
$1,633 |
1.5× |
| Intracavitary Radiation Source Applic Simple (77761) |
$682.50 |
$1,365 |
1.3× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$4,492.50 |
$8,985 |
0.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$417.50 |
$835 |
4.1× |
| Kidney imaging morphology (78700) |
$489.50 |
$979 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$512.50 |
$1,025 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$694.50 |
$1,389 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$717.50 |
$1,435 |
1.4× |
| Knee 3 views (73562) |
$238.50 |
$477 |
2.8× |
| Liver & spleen imaging static only (78215) |
$472 |
$944 |
1.2× |
| Liver imaging static only (78201) |
$381.50 |
$763 |
0.7× |
| Liver imaging w/vascular flow (78202) |
$381.50 |
$763 |
0.7× |
| Lung perf&ventilat diferentl (78598) |
$1,174 |
$2,348 |
2.2× |
| Lung perfusion differential (78597) |
$785 |
$1,570 |
2.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,666 |
$3,332 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,666 |
$3,332 |
0.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,024.50 |
$2,049 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,024.50 |
$2,049 |
1.7× |
| Lymphoscintigraphy (78195) |
$1,005.50 |
$2,011 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,088 |
$4,176 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,105.50 |
$4,211 |
6.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,490.50 |
$4,981 |
7.3× |
| Magnetic Resonance Elastography (76391) |
$1,204.50 |
$2,409 |
5.2× |
| Mammary ductogram or galactogram multiple (77054) |
$715 |
$1,430 |
3.1× |
| Mammary ductogram or galactogram single (77053) |
$452.50 |
$905 |
1.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,130.50 |
$2,261 |
3.1× |
| MRA head w & w/o contrast (70546) |
$2,753.50 |
$5,507 |
8.1× |
| MRA head w/o contrast (70544) |
$1,675 |
$3,350 |
7.2× |
| MRA head with contrast (70545) |
$1,868.50 |
$3,737 |
5.5× |
| MRA neck w contrast (70548) |
$1,845 |
$3,690 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,753.50 |
$5,507 |
8.1× |
| MRA neck w/o contrast (70547) |
$1,692.50 |
$3,385 |
7.3× |
| MRI abdomen w contrast (74182) |
$2,056.50 |
$4,113 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,194.50 |
$6,389 |
9.4× |
| MRI abdomen w/o contrast (74181) |
$1,906.50 |
$3,813 |
8.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,088 |
$4,176 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,790.50 |
$7,581 |
11.1× |
| MRI breast w/o contrast bilateral (77047) |
$3,079.50 |
$6,159 |
13.2× |
| MRI breast wo contrast unilateral (77046) |
$2,757.50 |
$5,515 |
11.8× |
| MRI c-spine with contrast (72142) |
$1,812 |
$3,624 |
5.3× |
| MRI cardiac w/o contrast (75557) |
$1,659 |
$3,318 |
7.1× |
| MRI cervical spine w/o contrast (72141) |
$1,629 |
$3,258 |
7.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,771.50 |
$7,543 |
11.1× |
| MRI chest w/o contrast (71550) |
$2,029 |
$4,058 |
8.7× |
| MRI chest with contrast (71551) |
$2,241 |
$4,482 |
2.9× |
| MRI fetal sngl/1st gestation (74712) |
$539 |
$1,078 |
2.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,092.50 |
$4,185 |
6.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,279.50 |
$4,559 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,567 |
$3,134 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,634.50 |
$3,269 |
7.0× |
| MRI orbit face neck w contrast (70542) |
$1,708 |
$3,416 |
5.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,075.50 |
$6,151 |
9.0× |
| MRI pelvis w/contrast (72196) |
$2,092.50 |
$4,185 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,012 |
$6,024 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,691 |
$3,382 |
7.3× |
| MRI spectroscopy (76390) |
$1,830.50 |
$3,661 |
21.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,208.50 |
$6,417 |
9.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,233.50 |
$4,467 |
6.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,187 |
$6,374 |
9.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,233.50 |
$4,467 |
6.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,112 |
$6,224 |
9.1× |
| MRI temporomandibular joint (70336) |
$1,895.50 |
$3,791 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,855 |
$3,710 |
8.0× |
| MRI up ext w/o contrast (73218) |
$1,895.50 |
$3,791 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,757 |
$3,514 |
7.5× |
| MRI, joint upper extrem combo (73223) |
$3,790.50 |
$7,581 |
11.1× |
| Myelogram Cervical (72240) |
$909.50 |
$1,819 |
1.2× |
| Myelogram Lumbar (72265) |
$992.50 |
$1,985 |
1.3× |
| Myelogram thoracic (72255) |
$919 |
$1,838 |
1.2× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$2,263 |
$4,526 |
1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$638 |
$1,276 |
0.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$759 |
$1,518 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$1,908 |
$3,816 |
1.5× |
| Myocardial spect single study at rest or stress (78451) |
$1,664.50 |
$3,329 |
1.3× |
| Neck soft tissue (70360) |
$184.50 |
$369 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$303 |
$606 |
0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$197.50 |
$395 |
0.5× |
| Nm adrenal scan (78075) |
$872.50 |
$1,745 |
0.7× |
| Nm bone marrow multi (78103) |
$837.50 |
$1,675 |
2.1× |
| Nm bone marrow wb (78104) |
$909.50 |
$1,819 |
2.3× |
| Nm cardiac blood pool multiple (78473) |
$975 |
$1,950 |
2.5× |
| Nm cisternogram (78630) |
$809.50 |
$1,619 |
1.5× |
| Nm gastric emptying study (78264) |
$917.50 |
$1,835 |
2.4× |
| Nm gastroesophageal reflux study (78262) |
$1,504.50 |
$3,009 |
3.9× |
| Nm kidney scan w/flow (78701) |
$512.50 |
$1,025 |
1.3× |
| Nm peritoneal-venous shunt patency (78291) |
$493.50 |
$987 |
1.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$303 |
$606 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,080 |
$8,160 |
3.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$645 |
$1,290 |
1.7× |
| Nuclear Rx Oral Admin (79005) |
$411.50 |
$823 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$421.75 |
$843.50 |
4.1× |
| Orthopantogram (70355) |
$180 |
$360 |
2.1× |
| Osseous survey limited (77074) |
$355 |
$710 |
3.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,216.50 |
$2,433 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$870 |
$1,740 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$870 |
$1,740 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$193 |
$386 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$4,409 |
$8,818 |
3.2× |
| PET imaging CT for attenuation limited area (78814) |
$4,409 |
$8,818 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,409 |
$8,818 |
3.2× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$5,425.50 |
$10,851 |
4.3× |
| PET whole body (78813) |
$5,425.50 |
$10,851 |
3.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$5,425.50 |
$10,851 |
3.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,421.50 |
$6,843 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,619.50 |
$3,239 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$521.50 |
$1,043 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,242.50 |
$2,485 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$333 |
$666 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$213 |
$426 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$194 |
$388 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$207.50 |
$415 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$145.50 |
$291 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$183 |
$366 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$348.50 |
$697 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$98.50 |
$197 |
1.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$221 |
$442 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$203 |
$406 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$154 |
$308 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$277 |
$554 |
2.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$214.50 |
$429 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$301 |
$602 |
3.0× |
| Radex Humerus Minimum 2 Views (73060) |
$198 |
$396 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$191.50 |
$383 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$275 |
$550 |
2.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$258 |
$516 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$243 |
$486 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$315.50 |
$631 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$237 |
$474 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$189 |
$378 |
2.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$283.50 |
$567 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$265.50 |
$531 |
3.1× |
| Radex Toe Minimum 2 Views (73660) |
$102 |
$204 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$154.50 |
$309 |
1.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$201 |
$402 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$348.50 |
$697 |
3.4× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$17,099.50 |
$34,199 |
2.4× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,508.50 |
$21,017 |
1.5× |
| Radiation treatment delivery level 1 (77402) |
$316 |
$632 |
3.2× |
| Radiation treatment delivery level 2 (77407) |
$405 |
$810 |
1.1× |
| Radiation treatment delivery level 3 (77412) |
$493 |
$986 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$190.50 |
$381 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$330 |
$660 |
3.2× |
| Radiologic exam chest 2 views (71046) |
$154 |
$308 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$697 |
$1,394 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$479 |
$958 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$678 |
$1,356 |
4.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$458.50 |
$917 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$241 |
$482 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$208 |
$416 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$413.50 |
$827 |
4.1× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$100 |
$200 |
1.0× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$265.50 |
$531 |
1.1× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$265.50 |
$531 |
1.1× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$153.50 |
$307 |
1.8× |
| Radiological examination surgical specimen (76098) |
$277 |
$554 |
0.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$700 |
$1,400 |
3.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,520.50 |
$3,041 |
4.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$925 |
$1,850 |
2.5× |
| Renal Cyst Study (74470) |
$390.50 |
$781 |
0.7× |
| Ribs bilateral 3 views (71110) |
$264 |
$528 |
2.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$544.50 |
$1,089 |
1.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$655.50 |
$1,311 |
1.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,450 |
$4,900 |
4.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,450 |
$4,900 |
4.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,450 |
$4,900 |
4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,670.50 |
$3,341 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,670.50 |
$3,341 |
1.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,670.50 |
$3,341 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$651 |
$1,302 |
2.9× |
| Rp Therapy Intravenous Administration (79101) |
$411.50 |
$823 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$255.25 |
$510.50 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$347 |
$694 |
1.5× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$510.50 |
$1,021 |
1.3× |
| Scapula (73010) |
$243 |
$486 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$82.50 |
$165 |
3.5× |
| Sella turcica (70240) |
$132.50 |
$265 |
1.6× |
| Shoulder 1 view (73020) |
$186.50 |
$373 |
2.2× |
| Sialogram (70390) |
$560.50 |
$1,121 |
2.4× |
| Simulation intermediate (77285) |
$956 |
$1,912 |
2.6× |
| Small bowel series (74250) |
$407.50 |
$815 |
2.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$713.50 |
$1,427 |
2.0× |
| Special dosimetry (77331) |
$222 |
$444 |
1.7× |
| Special Physics Consult (77370) |
$673.50 |
$1,347 |
5.1× |
| Special treatment procedure (77470) |
$1,894.50 |
$3,789 |
3.5× |
| Speech evaluation complex (70371) |
$388 |
$776 |
1.7× |
| Spine thoracic 3 views (72072) |
$223.50 |
$447 |
2.2× |
| Spleen imaging only (78185) |
$381.50 |
$763 |
1.0× |
| Splenoportograpy rs&i (75810) |
$2,615.50 |
$5,231 |
0.8× |
| Stereotactic Body Radiation Delivery (77373) |
$7,462 |
$14,924 |
4.3× |
| Superior sagittal sinus venogram (75870) |
$1,619.50 |
$3,239 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$107 |
$214 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$847 |
$1,694 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$608 |
$1,216 |
1.7× |
| Testicular Imaging With Vascular Flow (78761) |
$828 |
$1,656 |
2.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,123 |
$2,246 |
3.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$590 |
$1,180 |
4.5× |
| Thoracolumbar 2 views (72080) |
$112.50 |
$225 |
1.3× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$413.50 |
$827 |
1.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$864.50 |
$1,729 |
1.6× |
| Thyroid imaging w/blood flow (78013) |
$903.50 |
$1,807 |
2.3× |
| Thyroid uptake measurement (78012) |
$703.50 |
$1,407 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$926 |
$1,852 |
2.4× |
| Tmj unilateral (70328) |
$158.50 |
$317 |
1.9× |
| Tomogram (76100) |
$165.50 |
$331 |
1.6× |
| Treatment device complex (77334) |
$587 |
$1,174 |
1.6× |
| Treatment device intermediate (77333) |
$432 |
$864 |
3.3× |
| Treatment devices simple (77332) |
$246.50 |
$493 |
1.9× |
| Ultrasound breast complete (76641) |
$387 |
$774 |
3.8× |
| Ultrasound elastography first target lesion (76982) |
$336.50 |
$673 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$302.50 |
$605 |
3.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$687.50 |
$1,375 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$500 |
$1,000 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$411 |
$822 |
4.0× |
| Unlisted fluoroscopic procedure (76496) |
$196 |
$392 |
2.3× |
| Unlisted magnetic resonance procedure (76498) |
$1,165 |
$2,330 |
13.7× |
| Unlisted ultrasound procedure (76999) |
$121 |
$242 |
1.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$348.50 |
$697 |
31.5× |
| Ureteral reflux study (78740) |
$341.50 |
$683 |
0.9× |
| Urethrocystogram voiding (74455) |
$301 |
$602 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$313.50 |
$627 |
1.3× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$642.50 |
$1,285 |
3.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$662 |
$1,324 |
3.9× |
| Us breast unilateral limited (76642) |
$351.50 |
$703 |
4.1× |
| Us chest (76604) |
$488 |
$976 |
4.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,052 |
$2,104 |
5.0× |
| Us compl joint r-t w/image documentation (76881) |
$488 |
$976 |
4.8× |
| Us elastography parenchyma (76981) |
$336.50 |
$673 |
3.3× |
| Us encephalogram (76506) |
$375 |
$750 |
3.7× |
| Us hips infant static (76886) |
$171 |
$342 |
2.0× |
| Us infant hips w manipulation (76885) |
$492 |
$984 |
5.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$90.50 |
$181 |
0.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$404 |
$808 |
4.0× |
| Us ob detailed single fetus (76811) |
$551 |
$1,102 |
2.4× |
| Us ob limited (76815) |
$428 |
$856 |
4.2× |
| Us ob transvaginal (76817) |
$428 |
$856 |
4.2× |
| Us pelvic non ob complete (76856) |
$491.50 |
$983 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$322.50 |
$645 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$364.75 |
$729.50 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$211.25 |
$422.50 |
2.1× |
| Us retroperitoneal complete (76770) |
$500 |
$1,000 |
4.9× |
| Us retroperitoneal limited (76775) |
$383 |
$766 |
3.8× |
| Us scrotum and contents (76870) |
$495 |
$990 |
4.9× |
| Us soft tissue head/neck (76536) |
$454 |
$908 |
4.5× |
| Us spinal canal and contents (76800) |
$375 |
$750 |
3.7× |
| Us transrectal (76872) |
$392 |
$784 |
3.8× |
| Us transrectal prostate volume (76873) |
$615 |
$1,230 |
6.0× |
| Us, eye b-scan (76512) |
$275 |
$550 |
2.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$496.50 |
$993 |
4.9× |
| Vasogram (74440) |
$353.50 |
$707 |
1.5× |
| Venogram adrenal unilat (75840) |
$3,421.50 |
$6,843 |
1.1× |
| Venogram extremity bilateral (75822) |
$765 |
$1,530 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$765 |
$1,530 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$3,421.50 |
$6,843 |
1.1× |
| Venography caval superior serialography rs&i (75827) |
$1,622.50 |
$3,245 |
1.1× |
| Venography Orbital Rs&I (75880) |
$297.50 |
$595 |
0.5× |
| Venography Renal Bilateral (75833) |
$3,421.50 |
$6,843 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$3,421.50 |
$6,843 |
1.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,666 |
$3,332 |
0.5× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,643 |
$5,286 |
0.5× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$434.50 |
$869 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$149.50 |
$299 |
1.8× |
| Wrist 2 views (73100) |
$171 |
$342 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$404.50 |
$809 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$258 |
$516 |
3.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$812.50 |
$1,625 |
4.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$162 |
$324 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$196 |
$392 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$251 |
$502 |
2.5× |
| X-ray exam of femur 2/> (73552) |
$306 |
$612 |
3.6× |
| X-ray eye for foreign body (70030) |
$221 |
$442 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$221.50 |
$443 |
2.6× |
| X-ray IV pyelogram (ivp) (74400) |
$531.50 |
$1,063 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161 |
$322 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$203 |
$406 |
2.4× |
| X-ray leg, infant (73592) |
$176.50 |
$353 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$241 |
$482 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$353.50 |
$707 |
3.5× |
| X-ray nose-rectum child f.b. (76010) |
$206 |
$412 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$350.50 |
$701 |
3.4× |
| X-ray retrograde pyelogram (74420) |
$517 |
$1,034 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$261.50 |
$523 |
3.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$306 |
$612 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$406.50 |
$813 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$264 |
$528 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$264 |
$528 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$382.50 |
$765 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$357 |
$714 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$258 |
$516 |
2.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$407.50 |
$815 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$169 |
$338 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$297 |
$594 |
3.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$258 |
$516 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$178 |
$356 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$270.50 |
$541 |
2.7× |
| Xr bone length studies (77073) |
$140 |
$280 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$348.50 |
$697 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$385.50 |
$771 |
3.8× |
| Xr chest 4+ views (71048) |
$245 |
$490 |
2.4× |
| Xr urogram antegrade (74425) |
$375.50 |
$751 |
1.1× |