| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,799 |
$7,598 |
2.3× |
| Abdomen 2 views (74019) |
$242 |
$484 |
1.9× |
| Acute gi blood loss imaging (78278) |
$1,135 |
$2,270 |
2.4× |
| Angio Adrenal Bilat Select (75733) |
$3,639.50 |
$7,279 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$3,639.50 |
$7,279 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$9,937 |
$19,874 |
1.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,759.50 |
$11,519 |
1.5× |
| Angiography Spinal Selective Rs&I (75705) |
$6,226 |
$12,452 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,937 |
$19,874 |
1.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,046 |
$4,092 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,110 |
$8,220 |
1.1× |
| Ankle 2 views (73600) |
$74.50 |
$149 |
0.7× |
| Aortogram thoracic (75605) |
$9,937 |
$19,874 |
1.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,110 |
$8,220 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$5,759.50 |
$11,519 |
1.5× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$6,187.50 |
$12,375 |
1.6× |
| Artery X-Rays Adrenal Gland (75731) |
$4,110 |
$8,220 |
1.1× |
| Arthrogram ankle (73615) |
$667 |
$1,334 |
1.6× |
| Arthrogram elbow (73085) |
$726.50 |
$1,453 |
1.7× |
| Arthrogram hip (73525) |
$882.50 |
$1,765 |
2.1× |
| Arthrogram knee (73580) |
$930.50 |
$1,861 |
2.2× |
| Arthrogram shoulder (73040) |
$923 |
$1,846 |
2.2× |
| Arthrogram wrist (73115) |
$940.50 |
$1,881 |
2.2× |
| Basic dosimetry (77300) |
$490.50 |
$981 |
3.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$525 |
$1,050 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$599.50 |
$1,199 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$751.50 |
$1,503 |
1.6× |
| Bone age studies (77072) |
$119 |
$238 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$751.50 |
$1,503 |
1.6× |
| Bone Marrow Imaging Limited Area (78102) |
$766 |
$1,532 |
1.6× |
| Bone survey complete (77075) |
$274 |
$548 |
2.2× |
| Bone survey infant (77076) |
$274 |
$548 |
2.2× |
| Bowel imaging (78290) |
$487.50 |
$975 |
1.0× |
| Brachytx isodose complex (77318) |
$738.50 |
$1,477 |
1.6× |
| Brachytx isodose intermed (77317) |
$738.50 |
$1,477 |
1.6× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$607 |
$1,214 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,476.50 |
$2,953 |
3.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$868 |
$1,736 |
1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,670 |
$5,340 |
1.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$912.50 |
$1,825 |
1.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$865.50 |
$1,731 |
1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$846.75 |
$1,693.50 |
2.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$500.50 |
$1,001 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$161.50 |
$323 |
1.5× |
| Chest 1 view (71045) |
$117 |
$234 |
1.1× |
| Chest xray 3 views (71047) |
$134 |
$268 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$477 |
$954 |
2.3× |
| Cineradiography/videoradiography (76120) |
$208.50 |
$417 |
1.7× |
| Clavicle complete (73000) |
$93 |
$186 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$377.50 |
$755 |
3.0× |
| Continuing medical physics consltj pr wk (77336) |
$490.50 |
$981 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,158.50 |
$2,317 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$747 |
$1,494 |
2.6× |
| CT abdomen w contrast (74160) |
$865.50 |
$1,731 |
4.1× |
| CT abdomen w wo contrast (74170) |
$1,123.50 |
$2,247 |
5.3× |
| CT abdomen w/o contrast (74150) |
$791 |
$1,582 |
6.3× |
| CT angio hrt w/3d image (75574) |
$560.75 |
$1,121.50 |
1.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$642 |
$1,284 |
3.1× |
| CT angiography upper extremity lt (73206) |
$734.50 |
$1,469 |
3.5× |
| CT c-spine w/contrast (72126) |
$849.50 |
$1,699 |
2.0× |
| CT c-spine w/o contrast (72125) |
$742 |
$1,484 |
5.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,222.50 |
$2,445 |
5.8× |
| CT chest w contrast (71260) |
$886.50 |
$1,773 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,082 |
$2,164 |
5.1× |
| CT head/brain with contrast (70460) |
$727.50 |
$1,455 |
3.5× |
| CT head/brain without and with contrast (70470) |
$882 |
$1,764 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$505.75 |
$1,011.50 |
1.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$75 |
$150 |
0.7× |
| CT hrt w/3d image congen (75573) |
$545.25 |
$1,090.50 |
1.3× |
| CT iac w contrast (70481) |
$422.50 |
$845 |
2.0× |
| CT limited/localized follow up study (76380) |
$506.50 |
$1,013 |
4.9× |
| CT lower ext w/o (73700) |
$528.50 |
$1,057 |
4.2× |
| CT lower extremity w wo contrast (73702) |
$1,039 |
$2,078 |
4.9× |
| CT lower extremity w/contrast material (73701) |
$538.50 |
$1,077 |
2.6× |
| CT lumbar spine w & w/o contrast (72133) |
$752 |
$1,504 |
3.6× |
| CT lumbar spine w/contrast (72132) |
$779 |
$1,558 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$376 |
$752 |
3.0× |
| CT maxillofacial w contrast (70487) |
$721.50 |
$1,443 |
3.4× |
| CT maxillofacial w/wo contrast (70488) |
$632 |
$1,264 |
3.0× |
| CT maxillofacial wo contrast (70486) |
$655 |
$1,310 |
5.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$884 |
$1,768 |
4.2× |
| CT orbits w/o contrast (70480) |
$358.50 |
$717 |
2.9× |
| CT pelvis w/o contrast (72192) |
$747 |
$1,494 |
6.0× |
| CT pelvis w/wo contrast (72194) |
$1,038.50 |
$2,077 |
4.9× |
| CT scan of arm combo (73202) |
$1,070.50 |
$2,141 |
5.1× |
| CT soft tissue neck w contrast (70491) |
$809 |
$1,618 |
3.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$958 |
$1,916 |
4.6× |
| CT soft tissue neck w/o contrast (70490) |
$377.50 |
$755 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$566 |
$1,132 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$496 |
$992 |
4.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,211.50 |
$2,423 |
5.8× |
| CT thorax w/o contrast (71250) |
$758 |
$1,516 |
6.0× |
| CT unlisted procedure (76497) |
$114.50 |
$229 |
1.1× |
| CT upper ext wo (73200) |
$523.50 |
$1,047 |
4.2× |
| CT upper extremity with contrast (73201) |
$758 |
$1,516 |
1.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$940 |
$1,880 |
4.5× |
| Cta Abdomen (74175) |
$739.50 |
$1,479 |
3.5× |
| CTA abdomen pelvis (74174) |
$1,409 |
$2,818 |
3.4× |
| CTA chest (71275) |
$869.50 |
$1,739 |
4.1× |
| Cta Head (70496) |
$726 |
$1,452 |
3.5× |
| Cta Neck (70498) |
$631.50 |
$1,263 |
3.0× |
| Cta Pelvis (72191) |
$693 |
$1,386 |
3.3× |
| Cystography minimum 3 views rs&i (74430) |
$649.50 |
$1,299 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,866 |
$3,732 |
0.7× |
| Diskogram cervical (72285) |
$2,351 |
$4,702 |
1.0× |
| Diskography lumbar (72295) |
$2,351 |
$4,702 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$80 |
$160 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$315.50 |
$631 |
2.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$314 |
$628 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$62.50 |
$125 |
0.6× |
| Esophagus (74220) |
$535.50 |
$1,071 |
2.5× |
| Facial bones min 3 views (70150) |
$137.50 |
$275 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$240 |
$480 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$195.50 |
$391 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$544.50 |
$1,089 |
1.9× |
| Foot 2 views (73620) |
$86 |
$172 |
0.8× |
| Forearm 2 views (73090) |
$123 |
$246 |
1.2× |
| Hand 2 views (73120) |
$167 |
$334 |
1.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,555 |
$3,110 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,555 |
$3,110 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,444.50 |
$2,889 |
1.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,759.50 |
$11,519 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,639.50 |
$7,279 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$975.50 |
$1,951 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$755.50 |
$1,511 |
1.6× |
| Hysterosalpingogram (74740) |
$925.50 |
$1,851 |
3.2× |
| Interstitial radiation source applic complex (77778) |
$2,120.50 |
$4,241 |
2.5× |
| Kidney imaging morphology (78700) |
$705.50 |
$1,411 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$975.50 |
$1,951 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$975.50 |
$1,951 |
1.5× |
| Knee 3 views (73562) |
$126.50 |
$253 |
1.2× |
| Liver & spleen imaging static only (78215) |
$658 |
$1,316 |
1.4× |
| Liver imaging static only (78201) |
$1,216.50 |
$2,433 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$818.50 |
$1,637 |
1.3× |
| Lung perfusion differential (78597) |
$492.50 |
$985 |
1.0× |
| Lung ventilation imaging (78579) |
$807.50 |
$1,615 |
1.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,791.50 |
$9,583 |
1.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,889 |
$3,778 |
0.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,888.50 |
$5,777 |
1.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,124 |
$2,248 |
1.5× |
| Lymphoscintigraphy (78195) |
$975.50 |
$1,951 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,717 |
$3,434 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,603 |
$3,206 |
3.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,717 |
$3,434 |
4.1× |
| Magnetic Resonance Elastography (76391) |
$460 |
$920 |
1.6× |
| Mammary ductogram or galactogram multiple (77054) |
$229 |
$458 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$374.50 |
$749 |
1.3× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$143 |
$286 |
1.4× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$796 |
$1,592 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$693.50 |
$1,387 |
1.5× |
| MRA head w & w/o contrast (70546) |
$1,244.50 |
$2,489 |
3.0× |
| MRA head w/o contrast (70544) |
$1,244.50 |
$2,489 |
4.4× |
| MRA head with contrast (70545) |
$1,244.50 |
$2,489 |
3.0× |
| MRA neck w contrast (70548) |
$1,348 |
$2,696 |
3.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,383.50 |
$2,767 |
3.3× |
| MRA neck w/o contrast (70547) |
$1,191 |
$2,382 |
4.2× |
| MRI abdomen w contrast (74182) |
$2,774 |
$5,548 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,473 |
$2,946 |
3.5× |
| MRI abdomen w/o contrast (74181) |
$1,287 |
$2,574 |
4.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,648 |
$3,296 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,691.50 |
$3,383 |
4.0× |
| MRI bone marrow blood supply (77084) |
$1,313.50 |
$2,627 |
4.6× |
| MRI breast w/o contrast bilateral (77047) |
$460 |
$920 |
1.6× |
| MRI breast wo contrast unilateral (77046) |
$460 |
$920 |
1.6× |
| MRI c-spine with contrast (72142) |
$1,661.50 |
$3,323 |
4.0× |
| MRI cardiac w/o contrast (75557) |
$715 |
$1,430 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$1,155 |
$2,310 |
4.0× |
| MRI chest w/o & w/contrast material (71552) |
$844.50 |
$1,689 |
2.0× |
| MRI chest w/o contrast (71550) |
$1,080.50 |
$2,161 |
3.8× |
| MRI chest with contrast (71551) |
$1,708 |
$3,416 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,308.50 |
$2,617 |
3.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,670.50 |
$3,341 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,548 |
$3,096 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,774 |
$5,548 |
9.7× |
| MRI orbit face neck w contrast (70542) |
$1,479.50 |
$2,959 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$924 |
$1,848 |
2.2× |
| MRI pelvis w/contrast (72196) |
$1,556 |
$3,112 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,503 |
$3,006 |
3.6× |
| MRI pelvis w/o contrast (72195) |
$1,224 |
$2,448 |
4.3× |
| MRI spectroscopy (76390) |
$1,211 |
$2,422 |
11.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,705.50 |
$3,411 |
4.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,444.50 |
$2,889 |
3.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,736.50 |
$3,473 |
4.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,552.50 |
$3,105 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,546.50 |
$3,093 |
3.7× |
| MRI temporomandibular joint (70336) |
$1,413.50 |
$2,827 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,213.50 |
$2,427 |
4.2× |
| MRI up ext w/o contrast (73218) |
$1,577 |
$3,154 |
5.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,659.50 |
$3,319 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$1,670.50 |
$3,341 |
4.0× |
| Myelogram Cervical (72240) |
$807 |
$1,614 |
0.9× |
| Myelogram Lumbar (72265) |
$961 |
$1,922 |
1.0× |
| Myelogram thoracic (72255) |
$995.50 |
$1,991 |
1.1× |
| Myelography 2 or more regions (72270) |
$995.50 |
$1,991 |
1.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,129.50 |
$4,259 |
1.4× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,129.50 |
$4,259 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,462.50 |
$4,925 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,462.50 |
$4,925 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,812.50 |
$3,625 |
1.8× |
| Neck soft tissue (70360) |
$126.50 |
$253 |
1.2× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$670 |
$1,340 |
1.4× |
| Nm adrenal scan (78075) |
$1,624 |
$3,248 |
1.0× |
| Nm bone marrow multi (78103) |
$766 |
$1,532 |
1.6× |
| Nm bone marrow wb (78104) |
$359.50 |
$719 |
0.8× |
| Nm cisternogram (78630) |
$1,403.50 |
$2,807 |
2.2× |
| Nm csf leak detection (78650) |
$1,755.50 |
$3,511 |
1.1× |
| Nm gastric emptying study (78264) |
$751.50 |
$1,503 |
1.6× |
| Nm gastroesophageal reflux study (78262) |
$569.50 |
$1,139 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$521 |
$1,042 |
1.1× |
| Nonvascular shunt X-ray (75809) |
$224 |
$448 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,799 |
$7,598 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$427 |
$854 |
1.5× |
| Orthopantogram (70355) |
$132 |
$264 |
1.3× |
| Osseous survey limited (77074) |
$274 |
$548 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,036.50 |
$2,073 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$860 |
$1,720 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$741 |
$1,482 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$156.50 |
$313 |
1.2× |
| Peritoneogram after injection (74190) |
$973 |
$1,946 |
1.5× |
| PET image w/CT, skull-thigh (78815) |
$3,769.50 |
$7,539 |
2.2× |
| PET imaging CT for attenuation limited area (78814) |
$2,831.50 |
$5,663 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$4,207 |
$8,414 |
2.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,203 |
$8,406 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,110 |
$8,220 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$751.50 |
$1,503 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$975.50 |
$1,951 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,064.50 |
$2,129 |
1.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$71 |
$142 |
0.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$127.50 |
$255 |
1.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$70.50 |
$141 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$132 |
$264 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$210 |
$420 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$413 |
$826 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$70.50 |
$141 |
0.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$90 |
$180 |
0.9× |
| Radex Hand Minimum 3 Views (73130) |
$128.50 |
$257 |
1.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$121.50 |
$243 |
1.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$210 |
$420 |
1.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$210 |
$420 |
1.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$413 |
$826 |
3.3× |
| Radex Humerus Minimum 2 Views (73060) |
$97 |
$194 |
0.9× |
| Radex Kne 1/2 Views (73560) |
$116.50 |
$233 |
1.1× |
| Radex Kne Compl 4/More Views (73564) |
$142 |
$284 |
1.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$267 |
$534 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$174.50 |
$349 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$207.50 |
$415 |
1.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$76 |
$152 |
0.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$179 |
$358 |
1.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$224 |
$448 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$391 |
$782 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$105 |
$210 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$201 |
$402 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$132 |
$264 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$413 |
$826 |
3.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$14,413 |
$28,826 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$218.50 |
$437 |
1.8× |
| Radiation treatment delivery level 2 (77407) |
$423.50 |
$847 |
0.9× |
| Radiation treatment delivery level 3 (77412) |
$454 |
$908 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$126.50 |
$253 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$223.50 |
$447 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$126.50 |
$253 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$585 |
$1,170 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$337.50 |
$675 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$472.50 |
$945 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$500.50 |
$1,001 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$116.50 |
$233 |
1.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$143 |
$286 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$108.50 |
$217 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$161 |
$322 |
1.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$209.50 |
$419 |
1.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$132 |
$264 |
1.3× |
| Radiological examination surgical specimen (76098) |
$973 |
$1,946 |
1.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$508 |
$1,016 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$405.50 |
$811 |
0.9× |
| Renal Cyst Study (74470) |
$296 |
$592 |
0.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$751.50 |
$1,503 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,592.50 |
$3,185 |
2.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,566 |
$5,132 |
3.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,566 |
$5,132 |
3.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,358 |
$4,716 |
1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,675 |
$5,350 |
1.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,358 |
$4,716 |
1.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$442.50 |
$885 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$549 |
$1,098 |
1.9× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$430.50 |
$861 |
0.9× |
| Scapula (73010) |
$167 |
$334 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$110.50 |
$221 |
4.7× |
| Sella turcica (70240) |
$143 |
$286 |
1.4× |
| Shoulder 1 view (73020) |
$139.50 |
$279 |
1.3× |
| Sialogram (70390) |
$293 |
$586 |
1.0× |
| Simulation intermediate (77285) |
$1,009.50 |
$2,019 |
2.2× |
| Small bowel series (74250) |
$1,610 |
$3,220 |
7.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,088 |
$2,176 |
2.4× |
| Special dosimetry (77331) |
$490.50 |
$981 |
3.0× |
| Special Physics Consult (77370) |
$490.50 |
$981 |
3.0× |
| Special treatment procedure (77470) |
$1,592 |
$3,184 |
2.4× |
| Spine thoracic 3 views (72072) |
$154.50 |
$309 |
1.2× |
| Spleen imaging only (78185) |
$530.50 |
$1,061 |
1.1× |
| Splenoportograpy rs&i (75810) |
$4,203 |
$8,406 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$8,571 |
$17,142 |
4.0× |
| Superior sagittal sinus venogram (75870) |
$2,417.50 |
$4,835 |
0.6× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$135.50 |
$271 |
1.3× |
| Tbs technical calculation only (77091) |
$135.50 |
$271 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$607 |
$1,214 |
1.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$607 |
$1,214 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$461.50 |
$923 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,088 |
$2,176 |
2.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$490.50 |
$981 |
3.0× |
| Thoracolumbar 2 views (72080) |
$195 |
$390 |
1.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$975.50 |
$1,951 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$751.50 |
$1,503 |
1.6× |
| Thyroid uptake measurement (78012) |
$510.50 |
$1,021 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$751.50 |
$1,503 |
1.6× |
| Tmj unilateral (70328) |
$132 |
$264 |
1.3× |
| Treatment device complex (77334) |
$802.50 |
$1,605 |
1.8× |
| Treatment device intermediate (77333) |
$745 |
$1,490 |
4.6× |
| Treatment devices simple (77332) |
$802.50 |
$1,605 |
5.0× |
| Ultrasound breast complete (76641) |
$210 |
$420 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$142.50 |
$285 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$186.50 |
$373 |
1.5× |
| Umbilical-artery Doppler (OB) (76820) |
$158.50 |
$317 |
1.3× |
| Unlisted fluoroscopic procedure (76496) |
$116.50 |
$233 |
1.1× |
| Unlisted magnetic resonance procedure (76498) |
$137 |
$274 |
1.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$845.50 |
$1,691 |
6.9× |
| Urethrocystogram voiding (74455) |
$416 |
$832 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$416 |
$832 |
1.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,134.50 |
$2,269 |
5.4× |
| Us breast unilateral limited (76642) |
$192.50 |
$385 |
1.8× |
| Us chest (76604) |
$228 |
$456 |
1.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$581.50 |
$1,163 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$218.50 |
$437 |
1.7× |
| Us encephalogram (76506) |
$236.50 |
$473 |
1.9× |
| Us hips infant static (76886) |
$224.50 |
$449 |
2.2× |
| Us infant hips w manipulation (76885) |
$224.50 |
$449 |
2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$138 |
$276 |
1.1× |
| Us ob detailed single fetus (76811) |
$396 |
$792 |
1.4× |
| Us ob limited (76815) |
$165.50 |
$331 |
1.3× |
| Us ob transvaginal (76817) |
$193.50 |
$387 |
1.5× |
| Us pelvic non ob complete (76856) |
$197 |
$394 |
1.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$181 |
$362 |
1.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$158 |
$316 |
1.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$327.50 |
$655 |
2.6× |
| Us retroperitoneal complete (76770) |
$201 |
$402 |
1.6× |
| Us retroperitoneal limited (76775) |
$188.50 |
$377 |
1.5× |
| Us scrotum and contents (76870) |
$249.50 |
$499 |
2.0× |
| Us soft tissue head/neck (76536) |
$242.50 |
$485 |
1.9× |
| Us spinal canal and contents (76800) |
$325 |
$650 |
2.6× |
| Us transrectal (76872) |
$219 |
$438 |
1.7× |
| Us transrectal prostate volume (76873) |
$149 |
$298 |
1.2× |
| Us, eye b-scan (76512) |
$185 |
$370 |
1.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$224 |
$448 |
1.8× |
| Venogram adrenal unilat (75840) |
$5,759.50 |
$11,519 |
1.5× |
| Venogram extremity bilateral (75822) |
$2,876.50 |
$5,753 |
1.5× |
| Venogram Extremity Unilateral (75820) |
$2,876.50 |
$5,753 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$5,759.50 |
$11,519 |
1.5× |
| Venography caval superior serialography rs&i (75827) |
$2,876.50 |
$5,753 |
1.5× |
| Venography Orbital Rs&I (75880) |
$894.50 |
$1,789 |
1.2× |
| Venography Renal Bilateral (75833) |
$5,759.50 |
$11,519 |
1.5× |
| Venography renal unilateral selective rs&i (75831) |
$5,759.50 |
$11,519 |
1.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,639.50 |
$7,279 |
1.0× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,417.50 |
$4,835 |
3.2× |
| Venous sampling by catheter (75893) |
$6,226 |
$12,452 |
0.9× |
| Wrist 2 views (73100) |
$104 |
$208 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$220 |
$440 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$176.50 |
$353 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$959.50 |
$1,919 |
4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$93.50 |
$187 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$121.50 |
$243 |
1.2× |
| X-ray exam of femur 2/> (73552) |
$132 |
$264 |
1.3× |
| X-ray eye for foreign body (70030) |
$148 |
$296 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$183 |
$366 |
1.8× |
| X-ray IV pyelogram (ivp) (74400) |
$327 |
$654 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$325 |
$650 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$215.50 |
$431 |
2.1× |
| X-ray leg, infant (73592) |
$126 |
$252 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$128 |
$256 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$328.50 |
$657 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$186 |
$372 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$179 |
$358 |
1.4× |
| X-ray retrograde pyelogram (74420) |
$649.50 |
$1,299 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$264 |
$528 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$306.50 |
$613 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$242 |
$484 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$183 |
$366 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$242.50 |
$485 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$229 |
$458 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$192 |
$384 |
1.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$645 |
$1,290 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$137 |
$274 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$136.50 |
$273 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$195.50 |
$391 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$137.50 |
$275 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$167 |
$334 |
1.3× |
| Xr bone length studies (77073) |
$274 |
$548 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$164 |
$328 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$195 |
$390 |
1.6× |
| Xr chest 4+ views (71048) |
$223.50 |
$447 |
1.8× |
| Xr urogram antegrade (74425) |
$1,544.50 |
$3,089 |
3.7× |