| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,340 |
$8,680 |
3.2× |
| Abdomen 2 views (74019) |
$400.50 |
$801 |
3.9× |
| Acute gi blood loss imaging (78278) |
$974.50 |
$1,949 |
2.5× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$638 |
$1,276 |
0.5× |
| Angio Adrenal Bilat Select (75733) |
$3,919 |
$7,838 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$2,905.50 |
$5,811 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,325.50 |
$4,651 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,736 |
$3,472 |
0.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,898.50 |
$9,797 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,898.50 |
$9,797 |
1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,898.50 |
$9,797 |
1.6× |
| Angiography Spinal Selective Rs&I (75705) |
$3,051 |
$6,102 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,898.50 |
$9,797 |
0.9× |
| 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) |
$2,427.50 |
$4,855 |
0.8× |
| Ankle 2 views (73600) |
$269 |
$538 |
3.2× |
| Aortogram thoracic (75605) |
$3,051 |
$6,102 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,939 |
$5,878 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$2,939 |
$5,878 |
1.0× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$2,939 |
$5,878 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$2,798.50 |
$5,597 |
0.9× |
| Arthrogram ankle (73615) |
$790.50 |
$1,581 |
2.3× |
| Arthrogram elbow (73085) |
$798 |
$1,596 |
2.3× |
| Arthrogram hip (73525) |
$798 |
$1,596 |
2.3× |
| Arthrogram knee (73580) |
$790.50 |
$1,581 |
2.3× |
| Arthrogram shoulder (73040) |
$917 |
$1,834 |
2.7× |
| Arthrogram wrist (73115) |
$1,036 |
$2,072 |
3.0× |
| Basic dosimetry (77300) |
$413.50 |
$827 |
3.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$827.50 |
$1,655 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$974.50 |
$1,949 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$1,392.50 |
$2,785 |
3.6× |
| Bone age studies (77072) |
$91.50 |
$183 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,885 |
$3,770 |
4.8× |
| Bone Marrow Imaging Limited Area (78102) |
$811 |
$1,622 |
2.1× |
| Bone survey complete (77075) |
$897 |
$1,794 |
8.8× |
| Bone survey infant (77076) |
$226.50 |
$453 |
2.2× |
| Bowel imaging (78290) |
$974.50 |
$1,949 |
2.5× |
| Brachytx isodose complex (77318) |
$2,544.50 |
$5,089 |
7.0× |
| Brachytx isodose intermed (77317) |
$2,105 |
$4,210 |
5.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,664 |
$3,328 |
4.6× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$2,254 |
$4,508 |
5.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,833.50 |
$7,667 |
7.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,530.50 |
$5,061 |
1.8× |
| Brain Imaging Vascular Flow Only (78610) |
$436.50 |
$873 |
0.8× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$2,671.50 |
$5,343 |
5.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,348 |
$2,696 |
3.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,444 |
$4,888 |
3.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,148 |
$4,296 |
6.3× |
| Cardiac shunt detection (78428) |
$670 |
$1,340 |
1.7× |
| Cephalogram, orthodontic Non-Facility (70350) |
$158.50 |
$317 |
1.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$938.50 |
$1,877 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$374 |
$748 |
4.4× |
| Chest 1 view (71045) |
$234 |
$468 |
2.8× |
| Chest xray 3 views (71047) |
$406.50 |
$813 |
4.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$486 |
$972 |
2.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,217.50 |
$2,435 |
1.6× |
| Clavicle complete (73000) |
$296.50 |
$593 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$298.25 |
$596.50 |
2.9× |
| Continuing medical physics consltj pr wk (77336) |
$555.50 |
$1,111 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,834.50 |
$7,669 |
11.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,900.50 |
$5,801 |
12.5× |
| CT abdomen w contrast (74160) |
$1,642.50 |
$3,285 |
9.6× |
| CT abdomen w wo contrast (74170) |
$1,890.50 |
$3,781 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,427.50 |
$2,855 |
14.0× |
| CT angio hrt w/3d image (75574) |
$375 |
$750 |
1.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,984 |
$3,968 |
11.6× |
| CT angiography upper extremity lt (73206) |
$1,274.50 |
$2,549 |
7.4× |
| CT c-spine w/contrast (72126) |
$1,839 |
$3,678 |
5.4× |
| CT c-spine w/o contrast (72125) |
$1,600 |
$3,200 |
15.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,113.50 |
$4,227 |
12.3× |
| CT chest w contrast (71260) |
$1,779.50 |
$3,559 |
10.4× |
| CT chest w/wo contrast (71270) |
$1,947 |
$3,894 |
11.4× |
| CT colonography screening (74263) |
$408 |
$816 |
1.8× |
| CT colonography w/dye (74262) |
$452.50 |
$905 |
2.6× |
| CT colonography w/o cntrst (74261) |
$408 |
$816 |
4.0× |
| CT head/brain with contrast (70460) |
$1,526.50 |
$3,053 |
8.9× |
| CT head/brain without and with contrast (70470) |
$1,755.50 |
$3,511 |
10.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,007 |
$2,014 |
3.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$169 |
$338 |
2.0× |
| CT hrt w/3d image congen (75573) |
$1,007 |
$2,014 |
3.0× |
| CT iac w contrast (70481) |
$1,620.50 |
$3,241 |
9.5× |
| CT limited/localized follow up study (76380) |
$650 |
$1,300 |
7.7× |
| CT lower ext w/o (73700) |
$1,296 |
$2,592 |
12.7× |
| CT lower extremity w wo contrast (73702) |
$1,723.50 |
$3,447 |
10.1× |
| CT lower extremity w/contrast material (73701) |
$1,500 |
$3,000 |
8.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,140 |
$4,280 |
12.5× |
| CT lumbar spine w/contrast (72132) |
$1,862 |
$3,724 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,608.50 |
$3,217 |
15.8× |
| CT maxillofacial w contrast (70487) |
$1,562.50 |
$3,125 |
9.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,796.50 |
$3,593 |
10.5× |
| CT maxillofacial wo contrast (70486) |
$1,359.50 |
$2,719 |
13.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,863 |
$3,726 |
10.9× |
| CT orbits w/o contrast (70480) |
$1,360 |
$2,720 |
13.3× |
| CT pelvis w/o contrast (72192) |
$1,474 |
$2,948 |
14.5× |
| CT pelvis w/wo contrast (72194) |
$1,753.50 |
$3,507 |
10.2× |
| CT scan of arm combo (73202) |
$1,723.50 |
$3,447 |
10.1× |
| CT soft tissue neck w contrast (70491) |
$1,678 |
$3,356 |
9.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,940 |
$3,880 |
11.3× |
| CT soft tissue neck w/o contrast (70490) |
$642.50 |
$1,285 |
6.3× |
| CT thoracic spine w/contrast (72129) |
$1,862 |
$3,724 |
10.9× |
| CT thoracic spine w/o contrast (72128) |
$1,608.50 |
$3,217 |
15.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,140 |
$4,280 |
12.5× |
| CT thorax w/o contrast (71250) |
$1,372.50 |
$2,745 |
13.5× |
| CT upper ext wo (73200) |
$1,296 |
$2,592 |
12.7× |
| CT upper extremity with contrast (73201) |
$1,500 |
$3,000 |
4.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,708 |
$3,416 |
10.0× |
| Cta Abdomen (74175) |
$2,188 |
$4,376 |
12.8× |
| CTA abdomen pelvis (74174) |
$4,441 |
$8,882 |
13.0× |
| CTA chest (71275) |
$2,328 |
$4,656 |
13.6× |
| Cta Head (70496) |
$2,221 |
$4,442 |
13.0× |
| Cta Neck (70498) |
$2,231 |
$4,462 |
13.0× |
| Cta Pelvis (72191) |
$2,257.50 |
$4,515 |
13.2× |
| Cystography minimum 3 views rs&i (74430) |
$654 |
$1,308 |
1.9× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$367.50 |
$735 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,295.50 |
$4,591 |
1.1× |
| Diskogram cervical (72285) |
$1,989 |
$3,978 |
1.0× |
| Diskography lumbar (72295) |
$2,089.50 |
$4,179 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$150.50 |
$301 |
1.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$482.75 |
$965.50 |
4.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$383 |
$766 |
3.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$588 |
$1,176 |
5.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$331.50 |
$663 |
3.9× |
| Dxa bone density study axial skeleton (77085) |
$834.50 |
$1,669 |
8.2× |
| Echo exam of eye (76529) |
$247.50 |
$495 |
2.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$319 |
$638 |
1.4× |
| Esophagus (74220) |
$512 |
$1,024 |
3.0× |
| Facial bones min 3 views (70150) |
$534 |
$1,068 |
5.2× |
| Fetal biophysical profile non-stress testing (76818) |
$440.25 |
$880.50 |
4.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$392 |
$784 |
3.8× |
| Fetal Echo (76825) |
$1,099 |
$2,198 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$948 |
$1,896 |
4.1× |
| Foot 2 views (73620) |
$296 |
$592 |
3.5× |
| Forearm 2 views (73090) |
$329.50 |
$659 |
3.9× |
| Functional MRI brain by phys/psych (70555) |
$2,011 |
$4,022 |
8.6× |
| Functional MRI brain by tech (70554) |
$2,496.50 |
$4,993 |
10.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,364 |
$2,728 |
3.5× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,544 |
$3,088 |
2.9× |
| Hand 2 views (73120) |
$244 |
$488 |
2.4× |
| 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 |
4.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,919 |
$7,838 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,939 |
$5,878 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,555 |
$3,110 |
2.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,122 |
$2,244 |
2.9× |
| Hysterosalpingogram (74740) |
$825.50 |
$1,651 |
3.5× |
| Interstitial radiation source applic complex (77778) |
$2,957 |
$5,914 |
4.4× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,813.50 |
$3,627 |
2.7× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,592 |
$3,184 |
3.0× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,376 |
$2,752 |
2.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$3,906.50 |
$7,813 |
0.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$386.50 |
$773 |
3.8× |
| Kidney imaging morphology (78700) |
$776 |
$1,552 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,031.50 |
$2,063 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,031.50 |
$2,063 |
1.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,031.50 |
$2,063 |
1.9× |
| Knee 3 views (73562) |
$335 |
$670 |
3.9× |
| Liver & spleen imaging static only (78215) |
$1,123 |
$2,246 |
2.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,208 |
$2,416 |
3.1× |
| Liver imaging static only (78201) |
$1,143 |
$2,286 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,143 |
$2,286 |
2.2× |
| Lung perf&ventilat diferentl (78598) |
$1,268 |
$2,536 |
2.4× |
| Lung perfusion differential (78597) |
$1,268 |
$2,536 |
3.3× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,782.50 |
$3,565 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,782.50 |
$3,565 |
0.6× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,096 |
$2,192 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,096 |
$2,192 |
1.8× |
| Lymphoscintigraphy (78195) |
$1,392.50 |
$2,785 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,555.50 |
$5,111 |
3.3× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$989 |
$1,978 |
5.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$937 |
$1,874 |
1.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$1,041 |
$2,082 |
6.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,207.50 |
$4,415 |
6.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,539 |
$5,078 |
7.5× |
| Magnetic Resonance Elastography (76391) |
$1,128 |
$2,256 |
4.8× |
| 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) |
$7,911.50 |
$15,823 |
21.7× |
| MRA head w & w/o contrast (70546) |
$3,323 |
$6,646 |
9.8× |
| MRA head w/o contrast (70544) |
$2,513.50 |
$5,027 |
10.8× |
| MRA head with contrast (70545) |
$2,890.50 |
$5,781 |
8.5× |
| MRA neck w contrast (70548) |
$2,431.50 |
$4,863 |
7.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,242.50 |
$6,485 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,115.50 |
$4,231 |
9.1× |
| MRI abdomen w contrast (74182) |
$2,150 |
$4,300 |
6.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,853.50 |
$5,707 |
8.4× |
| MRI abdomen w/o contrast (74181) |
$1,625.50 |
$3,251 |
7.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,555.50 |
$5,111 |
3.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,433.50 |
$6,867 |
10.1× |
| MRI breast w/o contrast bilateral (77047) |
$3,075 |
$6,150 |
13.2× |
| MRI breast wo contrast unilateral (77046) |
$2,753 |
$5,506 |
11.8× |
| MRI c-spine with contrast (72142) |
$2,636.50 |
$5,273 |
7.7× |
| MRI cardiac w/o contrast (75557) |
$1,522 |
$3,044 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$2,000 |
$4,000 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,691.50 |
$5,383 |
7.9× |
| MRI chest w/o contrast (71550) |
$1,818 |
$3,636 |
7.8× |
| MRI chest with contrast (71551) |
$2,091.50 |
$4,183 |
2.7× |
| MRI fetal sngl/1st gestation (74712) |
$538 |
$1,076 |
2.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,555.50 |
$5,111 |
7.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,940 |
$5,880 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,932.50 |
$3,865 |
8.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,467 |
$4,934 |
10.6× |
| MRI orbit face neck w contrast (70542) |
$2,838.50 |
$5,677 |
8.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,546.50 |
$7,093 |
10.4× |
| MRI pelvis w/contrast (72196) |
$2,891 |
$5,782 |
8.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,166 |
$6,332 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$1,862 |
$3,724 |
8.0× |
| MRI spectroscopy (76390) |
$1,920.50 |
$3,841 |
22.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,272.50 |
$6,545 |
9.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,644 |
$5,288 |
7.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,315.50 |
$6,631 |
9.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,644 |
$5,288 |
7.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,315.50 |
$6,631 |
9.7× |
| MRI temporomandibular joint (70336) |
$2,272.50 |
$4,545 |
9.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,000 |
$4,000 |
8.6× |
| MRI up ext w/o contrast (73218) |
$1,920.50 |
$3,841 |
8.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,932.50 |
$3,865 |
8.3× |
| MRI, joint upper extrem combo (73223) |
$3,585.50 |
$7,171 |
10.5× |
| Myelogram Cervical (72240) |
$1,241.50 |
$2,483 |
1.6× |
| Myelogram Lumbar (72265) |
$1,539 |
$3,078 |
2.0× |
| 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) |
$1,354 |
$2,708 |
1.1× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,693 |
$3,386 |
1.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,168 |
$6,336 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$1,693 |
$3,386 |
1.3× |
| Neck soft tissue (70360) |
$438.50 |
$877 |
5.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$931 |
$1,862 |
2.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$197.50 |
$395 |
0.5× |
| Nm adrenal scan (78075) |
$1,261.50 |
$2,523 |
1.0× |
| Nm bone marrow multi (78103) |
$934 |
$1,868 |
2.4× |
| Nm bone marrow wb (78104) |
$1,165.50 |
$2,331 |
3.0× |
| Nm cisternogram (78630) |
$856 |
$1,712 |
1.6× |
| Nm gastric emptying study (78264) |
$1,364 |
$2,728 |
3.5× |
| Nm gastroesophageal reflux study (78262) |
$651 |
$1,302 |
1.7× |
| Nm kidney scan w/flow (78701) |
$776 |
$1,552 |
2.0× |
| Nm peritoneal-venous shunt patency (78291) |
$651 |
$1,302 |
1.7× |
| Noncardiac Vascular Flow Imaging (78445) |
$438 |
$876 |
1.1× |
| Nonvascular shunt X-ray (75809) |
$206 |
$412 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,123.50 |
$8,247 |
3.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$796.50 |
$1,593 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$1,187 |
$2,374 |
5.2× |
| Ob us nuchal meas 1 gest (76813) |
$540.25 |
$1,080.50 |
5.3× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$407 |
$814 |
4.0× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$96.50 |
$193 |
3.4× |
| Orthopantogram (70355) |
$375.50 |
$751 |
4.4× |
| Osseous survey limited (77074) |
$762 |
$1,524 |
7.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,811 |
$3,622 |
3.4× |
| Parathyroid Planar Imaging (78070) |
$1,369 |
$2,738 |
3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,582 |
$3,164 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$328 |
$656 |
3.2× |
| Perineogram (74775) |
$484 |
$968 |
2.1× |
| 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) |
$5,070.50 |
$10,141 |
4.0× |
| PET whole body (78813) |
$5,070.50 |
$10,141 |
3.6× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$5,070.50 |
$10,141 |
3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,919 |
$7,838 |
1.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,619.50 |
$3,239 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$494 |
$988 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,415 |
$2,830 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$326.50 |
$653 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$315.50 |
$631 |
3.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$280 |
$560 |
3.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$451 |
$902 |
5.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$134.50 |
$269 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$169.50 |
$339 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$322 |
$644 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$202 |
$404 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$316.50 |
$633 |
3.7× |
| Radex Hand Minimum 3 Views (73130) |
$281.50 |
$563 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$219.50 |
$439 |
2.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$340.50 |
$681 |
3.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$352 |
$704 |
3.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$417.50 |
$835 |
4.1× |
| Radex Humerus Minimum 2 Views (73060) |
$337 |
$674 |
4.0× |
| Radex Kne 1/2 Views (73560) |
$262 |
$524 |
3.1× |
| Radex Kne Compl 4/More Views (73564) |
$434.50 |
$869 |
4.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$411 |
$822 |
4.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$298 |
$596 |
3.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$434 |
$868 |
4.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$319 |
$638 |
3.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$476.50 |
$953 |
5.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$570.50 |
$1,141 |
5.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$365.50 |
$731 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$251 |
$502 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$163 |
$326 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$299 |
$598 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$322 |
$644 |
3.2× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$14,869 |
$29,738 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,508.50 |
$21,017 |
1.5× |
| 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) |
$277 |
$554 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$455 |
$910 |
4.5× |
| Radiologic exam chest 2 views (71046) |
$281.50 |
$563 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$975 |
$1,950 |
5.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$587.50 |
$1,175 |
3.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$852.50 |
$1,705 |
5.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$852.50 |
$1,705 |
5.0× |
| Radiologic examination femur 1 view (73551) |
$328.25 |
$656.50 |
3.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$311 |
$622 |
3.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$299.50 |
$599 |
2.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$140 |
$280 |
1.4× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$165.50 |
$331 |
0.7× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$165.50 |
$331 |
0.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$74 |
$148 |
0.9× |
| Radiological examination surgical specimen (76098) |
$610 |
$1,220 |
1.1× |
| 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 |
7.3× |
| 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) |
$378 |
$756 |
0.7× |
| Ribs bilateral 3 views (71110) |
$612.50 |
$1,225 |
6.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,127.50 |
$2,255 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,127.50 |
$2,255 |
2.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,289.50 |
$4,579 |
4.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,289.50 |
$4,579 |
4.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,385.50 |
$4,771 |
1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,790 |
$5,580 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,385.50 |
$4,771 |
1.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$874.50 |
$1,749 |
3.8× |
| Rp Therapy Intravenous Administration (79101) |
$615 |
$1,230 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$244.50 |
$489 |
2.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$655 |
$1,310 |
2.8× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$651 |
$1,302 |
1.7× |
| Scapula (73010) |
$388 |
$776 |
3.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$18.50 |
$37 |
0.8× |
| Sella turcica (70240) |
$158.50 |
$317 |
1.9× |
| Shoulder 1 view (73020) |
$222.50 |
$445 |
2.6× |
| Sialogram (70390) |
$628.50 |
$1,257 |
2.7× |
| Simulation intermediate (77285) |
$946 |
$1,892 |
2.6× |
| Small bowel series (74250) |
$788.50 |
$1,577 |
4.6× |
| 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) |
$360.50 |
$721 |
3.5× |
| Spleen imaging only (78185) |
$679 |
$1,358 |
1.7× |
| Splenoportograpy rs&i (75810) |
$2,798.50 |
$5,597 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$10,508.50 |
$21,017 |
6.0× |
| Superior sagittal sinus venogram (75870) |
$1,619.50 |
$3,239 |
0.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$246 |
$492 |
2.5× |
| 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 |
2.2× |
| Testicular Imaging With Vascular Flow (78761) |
$774 |
$1,548 |
2.0× |
| 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) |
$480 |
$960 |
5.7× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$760 |
$1,520 |
1.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,747 |
$3,494 |
3.3× |
| Thyroid imaging w/blood flow (78013) |
$573.50 |
$1,147 |
1.5× |
| Thyroid uptake measurement (78012) |
$347 |
$694 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,091 |
$2,182 |
2.8× |
| Tmj unilateral (70328) |
$341.50 |
$683 |
4.0× |
| Tomogram (76100) |
$154.50 |
$309 |
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 |
3.0× |
| Ultrasound breast complete (76641) |
$561 |
$1,122 |
5.5× |
| Ultrasound elastography first target lesion (76982) |
$332 |
$664 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$691.50 |
$1,383 |
6.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$677.50 |
$1,355 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$722.50 |
$1,445 |
7.1× |
| Umbilical-artery Doppler (OB) (76820) |
$417 |
$834 |
4.1× |
| Unlisted magnetic resonance procedure (76498) |
$1,163 |
$2,326 |
13.7× |
| Unlisted ultrasound procedure (76999) |
$119 |
$238 |
1.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$108.50 |
$217 |
9.8× |
| Ureteral reflux study (78740) |
$854 |
$1,708 |
2.2× |
| Urethrocystogram voiding (74455) |
$513.50 |
$1,027 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$513.50 |
$1,027 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,350 |
$2,700 |
7.9× |
| Us breast unilateral limited (76642) |
$548 |
$1,096 |
6.5× |
| Us chest (76604) |
$389 |
$778 |
3.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$437 |
$874 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$784 |
$1,568 |
7.7× |
| Us elastography parenchyma (76981) |
$332 |
$664 |
3.3× |
| Us encephalogram (76506) |
$771.50 |
$1,543 |
7.6× |
| Us hips infant static (76886) |
$163.50 |
$327 |
1.9× |
| Us infant hips w manipulation (76885) |
$269.50 |
$539 |
3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$306.50 |
$613 |
3.0× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$392 |
$784 |
3.8× |
| Us ob detailed single fetus (76811) |
$687 |
$1,374 |
3.0× |
| Us ob limited (76815) |
$499.50 |
$999 |
4.9× |
| Us ob transvaginal (76817) |
$423.50 |
$847 |
4.2× |
| Us pelvic non ob complete (76856) |
$737 |
$1,474 |
7.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$430 |
$860 |
4.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$497 |
$994 |
4.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$202 |
$404 |
2.0× |
| Us retroperitoneal complete (76770) |
$758.50 |
$1,517 |
7.4× |
| Us retroperitoneal limited (76775) |
$559 |
$1,118 |
5.5× |
| Us scrotum and contents (76870) |
$708.50 |
$1,417 |
6.9× |
| Us soft tissue head/neck (76536) |
$588.50 |
$1,177 |
5.8× |
| Us spinal canal and contents (76800) |
$546 |
$1,092 |
5.4× |
| Us transrectal (76872) |
$662 |
$1,324 |
6.5× |
| Us transrectal prostate volume (76873) |
$581 |
$1,162 |
5.7× |
| Us, eye b-scan (76512) |
$337 |
$674 |
3.3× |
| Us,transplanted kidney, real time/ doppler (76776) |
$595.50 |
$1,191 |
5.8× |
| Vasogram (74440) |
$603.50 |
$1,207 |
2.6× |
| Venogram adrenal unilat (75840) |
$3,919 |
$7,838 |
1.3× |
| Venogram extremity bilateral (75822) |
$2,079.50 |
$4,159 |
1.4× |
| Venogram Extremity Unilateral (75820) |
$1,388 |
$2,776 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,919 |
$7,838 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$1,736 |
$3,472 |
1.1× |
| Venography Orbital Rs&I (75880) |
$2,427.50 |
$4,855 |
4.0× |
| Venography Renal Bilateral (75833) |
$3,919 |
$7,838 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$3,919 |
$7,838 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,782.50 |
$3,565 |
0.6× |
| Venous sampling by catheter (75893) |
$3,919 |
$7,838 |
0.7× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$796.50 |
$1,593 |
1.5× |
| Vertebral fracture assessment via dxa (77086) |
$160 |
$320 |
1.9× |
| Wrist 2 views (73100) |
$254.50 |
$509 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$494.50 |
$989 |
4.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$308.50 |
$617 |
3.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,120.50 |
$2,241 |
6.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$268.50 |
$537 |
3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$250.50 |
$501 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$357.50 |
$715 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$334 |
$668 |
3.9× |
| X-ray eye for foreign body (70030) |
$181.50 |
$363 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$314.50 |
$629 |
3.7× |
| X-ray IV pyelogram (ivp) (74400) |
$1,198.50 |
$2,397 |
7.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$193.50 |
$387 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$216 |
$432 |
2.5× |
| X-ray leg, infant (73592) |
$238.50 |
$477 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$366.50 |
$733 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$779.50 |
$1,559 |
7.6× |
| X-ray nose-rectum child f.b. (76010) |
$165.50 |
$331 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$533.50 |
$1,067 |
5.2× |
| X-ray retrograde pyelogram (74420) |
$965 |
$1,930 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$336.50 |
$673 |
4.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$446.50 |
$893 |
4.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$705 |
$1,410 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$420.50 |
$841 |
4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$419.50 |
$839 |
4.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$803.50 |
$1,607 |
9.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$704.50 |
$1,409 |
6.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$529 |
$1,058 |
5.2× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,117 |
$2,234 |
6.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$281 |
$562 |
3.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$399.50 |
$799 |
4.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$347 |
$694 |
4.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$337 |
$674 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$588.50 |
$1,177 |
5.8× |
| Xr bone length studies (77073) |
$130 |
$260 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$444 |
$888 |
4.4× |
| Xr c-spine 6 or more views (72052) |
$597.50 |
$1,195 |
5.9× |
| Xr chest 4+ views (71048) |
$508 |
$1,016 |
5.0× |
| Xr urogram antegrade (74425) |
$518 |
$1,036 |
1.5× |