| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,119.20 |
$5,298 |
1.4× |
| Abdomen 2 views (74019) |
$806.40 |
$2,016 |
7.1× |
| Acute gi blood loss imaging (78278) |
$2,478.40 |
$6,196 |
5.7× |
| Angio Adrenal Bilat Select (75733) |
$7,214.80 |
$18,037 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$6,490.40 |
$16,226 |
1.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,132 |
$7,830 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$1,214.40 |
$3,036 |
0.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,748.80 |
$9,372 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,124.80 |
$12,812 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,500.80 |
$8,752 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$6,613 |
$16,532.50 |
1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,124 |
$12,810 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,584 |
$11,460 |
1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,194.40 |
$12,986 |
1.5× |
| Ankle 2 views (73600) |
$664.80 |
$1,662 |
7.0× |
| Aortogram thoracic (75605) |
$10,764.80 |
$26,912 |
1.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,155.40 |
$12,888.50 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$2,352.80 |
$5,882 |
0.7× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,783 |
$9,457.50 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$3,387.20 |
$8,468 |
1.0× |
| Arthrogram ankle (73615) |
$1,050 |
$2,625 |
2.8× |
| Arthrogram elbow (73085) |
$1,073.20 |
$2,683 |
2.8× |
| Arthrogram hip (73525) |
$2,377 |
$5,942.50 |
6.2× |
| Arthrogram knee (73580) |
$1,784.40 |
$4,461 |
4.7× |
| Arthrogram shoulder (73040) |
$2,474.40 |
$6,186 |
6.5× |
| Arthrogram wrist (73115) |
$1,073.20 |
$2,683 |
2.8× |
| Basic dosimetry (77300) |
$2,119.20 |
$5,298 |
14.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,763.20 |
$4,408 |
4.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$2,177.60 |
$5,444 |
5.0× |
| Bone &/joint imaging whole body (78306) |
$2,898.80 |
$7,247 |
6.6× |
| Bone age studies (77072) |
$403.40 |
$1,008.50 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$2,966.80 |
$7,417 |
6.8× |
| Bone Marrow Imaging Limited Area (78102) |
$2,309.60 |
$5,774 |
5.3× |
| Bone survey complete (77075) |
$1,644 |
$4,110 |
14.4× |
| Bone survey infant (77076) |
$1,466 |
$3,665 |
12.8× |
| Bowel imaging (78290) |
$2,646.40 |
$6,616 |
6.1× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,953.20 |
$4,883 |
4.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,426.80 |
$8,567 |
5.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,154.80 |
$15,387 |
3.9× |
| Brain Imaging Vascular Flow Only (78610) |
$3,321.60 |
$8,304 |
5.6× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$2,461.20 |
$6,153 |
4.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,696.80 |
$6,742 |
6.2× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$2,028 |
$5,070 |
3.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,617.20 |
$6,543 |
4.4× |
| Cervical spine 2 or 3 views (72040) |
$732.80 |
$1,832 |
7.7× |
| Chest 1 view (71045) |
$604.40 |
$1,511 |
6.4× |
| Chest xray 3 views (71047) |
$759.20 |
$1,898 |
8.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,091 |
$2,727.50 |
5.7× |
| Cineradiography/videoradiography (76120) |
$144 |
$360 |
1.3× |
| Cisternography Positive Contrast Rs&I (70015) |
$3,157.20 |
$7,893 |
3.7× |
| Clavicle complete (73000) |
$517.60 |
$1,294 |
5.4× |
| Continuing medical physics consltj pr wk (77336) |
$1,765.60 |
$4,414 |
12.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$526.40 |
$1,316 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$9,082.80 |
$22,707 |
23.8× |
| CT abdomen and pelvis without contrast (74176) |
$6,249.60 |
$15,624 |
24.0× |
| CT abdomen w contrast (74160) |
$3,423.60 |
$8,559 |
17.9× |
| CT abdomen w wo contrast (74170) |
$4,362.20 |
$10,905.50 |
22.8× |
| CT abdomen w/o contrast (74150) |
$3,499 |
$8,747.50 |
30.6× |
| CT angio hrt w/3d image (75574) |
$8,679.60 |
$21,699 |
22.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$7,681.20 |
$19,203 |
40.1× |
| CT angiography upper extremity lt (73206) |
$7,697.20 |
$19,243 |
40.1× |
| CT c-spine w/contrast (72126) |
$3,879.60 |
$9,699 |
10.2× |
| CT c-spine w/o contrast (72125) |
$2,905.20 |
$7,263 |
25.4× |
| CT cervical spine w&w/o contrast (72127) |
$3,634.40 |
$9,086 |
19.0× |
| CT chest w contrast (71260) |
$3,975.80 |
$9,939.50 |
20.7× |
| CT chest w/wo contrast (71270) |
$5,716.80 |
$14,292 |
29.8× |
| CT head/brain with contrast (70460) |
$4,305.20 |
$10,763 |
22.5× |
| CT head/brain without and with contrast (70470) |
$4,182.60 |
$10,456.50 |
21.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$5,269.60 |
$13,174 |
13.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$6,080 |
$15,200 |
63.9× |
| CT hrt w/3d image congen (75573) |
$5,217.20 |
$13,043 |
13.7× |
| CT iac w contrast (70481) |
$2,862.20 |
$7,155.50 |
14.9× |
| CT limited/localized follow up study (76380) |
$2,914.40 |
$7,286 |
30.6× |
| CT lower ext w/o (73700) |
$3,156.40 |
$7,891 |
27.6× |
| CT lower extremity w wo contrast (73702) |
$4,103.20 |
$10,258 |
21.4× |
| CT lower extremity w/contrast material (73701) |
$3,820.80 |
$9,552 |
19.9× |
| CT lumbar spine w & w/o contrast (72133) |
$4,989.60 |
$12,474 |
26.0× |
| CT lumbar spine w/contrast (72132) |
$4,350.40 |
$10,876 |
11.4× |
| CT lumbar spine w/o contrast (72131) |
$2,858 |
$7,145 |
25.0× |
| CT maxillofacial w contrast (70487) |
$2,999.20 |
$7,498 |
15.6× |
| CT maxillofacial w/wo contrast (70488) |
$4,014.40 |
$10,036 |
20.9× |
| CT maxillofacial wo contrast (70486) |
$2,639.20 |
$6,598 |
23.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$5,366.40 |
$13,416 |
28.0× |
| CT orbits w/o contrast (70480) |
$3,168.80 |
$7,922 |
27.7× |
| CT pelvis w/o contrast (72192) |
$2,680.80 |
$6,702 |
23.5× |
| CT pelvis w/wo contrast (72194) |
$4,710.40 |
$11,776 |
24.6× |
| CT scan of arm combo (73202) |
$4,692 |
$11,730 |
24.5× |
| CT soft tissue neck w contrast (70491) |
$3,234.20 |
$8,085.50 |
16.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$5,167.60 |
$12,919 |
27.0× |
| CT soft tissue neck w/o contrast (70490) |
$2,620.60 |
$6,551.50 |
22.9× |
| CT thoracic spine w/contrast (72129) |
$3,874.40 |
$9,686 |
20.2× |
| CT thoracic spine w/o contrast (72128) |
$2,485 |
$6,212.50 |
21.7× |
| CT thoracic spine w/wo contrast (72130) |
$4,394 |
$10,985 |
22.9× |
| CT thorax w/o contrast (71250) |
$2,822.60 |
$7,056.50 |
24.7× |
| CT upper ext wo (73200) |
$3,070.40 |
$7,676 |
26.9× |
| CT upper extremity with contrast (73201) |
$3,560.80 |
$8,902 |
9.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$8,114.20 |
$20,285.50 |
42.3× |
| Cta Abdomen (74175) |
$7,261.60 |
$18,154 |
37.9× |
| CTA abdomen pelvis (74174) |
$16,285.60 |
$40,714 |
42.7× |
| CTA chest (71275) |
$5,920.60 |
$14,801.50 |
30.9× |
| Cta Head (70496) |
$4,862.80 |
$12,157 |
25.4× |
| Cta Neck (70498) |
$4,357.60 |
$10,894 |
22.7× |
| Cta Pelvis (72191) |
$7,261.60 |
$18,154 |
37.9× |
| Cystography minimum 3 views rs&i (74430) |
$894.40 |
$2,236 |
2.3× |
| Diskography lumbar (72295) |
$2,967.20 |
$7,418 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$531.60 |
$1,329 |
4.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$378 |
$945 |
4.0× |
| Esophagus (74220) |
$798.40 |
$1,996 |
4.2× |
| Facial bones min 3 views (70150) |
$1,206.80 |
$3,017 |
10.6× |
| Fetal biophysical profile non-stress testing (76818) |
$873.60 |
$2,184 |
7.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$743.20 |
$1,858 |
6.5× |
| Fluoroscopy up to 1 hr (76000) |
$1,078.60 |
$2,696.50 |
4.1× |
| Foot 2 views (73620) |
$665.60 |
$1,664 |
7.0× |
| Forearm 2 views (73090) |
$662.40 |
$1,656 |
7.0× |
| Hand 2 views (73120) |
$570 |
$1,425 |
5.0× |
| Heart first pass single,planar (78481) |
$1,792 |
$4,480 |
3.0× |
| Heart Infarct Image (78466) |
$1,549.60 |
$3,874 |
3.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,749.60 |
$9,374 |
1.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,040 |
$7,600 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,294.80 |
$8,237 |
5.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,966.20 |
$7,415.50 |
6.8× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$2,119.20 |
$5,298 |
3.5× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$2,119.20 |
$5,298 |
3.5× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$2,119.20 |
$5,298 |
3.5× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$2,119.20 |
$5,298 |
2.8× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$1,765.60 |
$4,414 |
4.2× |
| Hysterosalpingogram (74740) |
$1,643.80 |
$4,109.50 |
6.3× |
| Image fusion (77399) |
$2,309.60 |
$5,774 |
15.7× |
| Interstitial radiation source applic complex (77778) |
$2,119.20 |
$5,298 |
2.8× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,119.20 |
$5,298 |
2.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,119.20 |
$5,298 |
3.5× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,765.60 |
$4,414 |
2.9× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,743.80 |
$4,359.50 |
4.0× |
| Kidney imaging morphology (78700) |
$2,550 |
$6,375 |
5.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,938.40 |
$7,346 |
5.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$4,497.20 |
$11,243 |
7.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$4,437.20 |
$11,093 |
7.5× |
| Knee 3 views (73562) |
$823.60 |
$2,059 |
8.7× |
| Liver & spleen imaging static only (78215) |
$2,101.60 |
$5,254 |
4.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,546 |
$6,365 |
5.8× |
| Liver imaging static only (78201) |
$2,090.80 |
$5,227 |
3.5× |
| Liver imaging w/vascular flow (78202) |
$1,971.60 |
$4,929 |
3.3× |
| Lung perf&ventilat diferentl (78598) |
$2,873.60 |
$7,184 |
4.8× |
| Lung perfusion differential (78597) |
$1,846.80 |
$4,617 |
4.2× |
| Lung ventilation imaging (78579) |
$1,846.80 |
$4,617 |
4.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,858.40 |
$12,146 |
1.4× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,192 |
$10,480 |
1.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$4,781.80 |
$11,954.50 |
2.8× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$5,849.20 |
$14,623 |
8.5× |
| Lymphoscintigraphy (78195) |
$7,145.40 |
$17,863.50 |
12.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$4,998.40 |
$12,496 |
5.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$4,998.40 |
$12,496 |
13.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$6,033.60 |
$15,084 |
15.8× |
| Mammary ductogram or galactogram multiple (77054) |
$1,592.40 |
$3,981 |
6.1× |
| Mammary ductogram or galactogram single (77053) |
$843.20 |
$2,108 |
3.2× |
| MRA head w & w/o contrast (70546) |
$5,312.40 |
$13,281 |
13.9× |
| MRA head w/o contrast (70544) |
$3,268 |
$8,170 |
12.5× |
| MRA head with contrast (70545) |
$4,304.40 |
$10,761 |
11.3× |
| MRA neck w contrast (70548) |
$2,548 |
$6,370 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,862.80 |
$12,157 |
12.8× |
| MRA neck w/o contrast (70547) |
$2,316.60 |
$5,791.50 |
8.9× |
| MRI abdomen w contrast (74182) |
$3,475.40 |
$8,688.50 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,604.80 |
$9,012 |
9.5× |
| MRI abdomen w/o contrast (74181) |
$4,144 |
$10,360 |
15.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$5,198 |
$12,995 |
6.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,832 |
$14,580 |
15.3× |
| MRI bone marrow blood supply (77084) |
$2,681.20 |
$6,703 |
10.3× |
| MRI breast wo contrast unilateral (77046) |
$1,087.20 |
$2,718 |
4.2× |
| MRI c-spine with contrast (72142) |
$4,319.20 |
$10,798 |
11.3× |
| MRI cervical spine w/o contrast (72141) |
$3,951.20 |
$9,878 |
15.1× |
| MRI chest w/o & w/contrast material (71552) |
$7,206.80 |
$18,017 |
18.9× |
| MRI chest w/o contrast (71550) |
$4,142.80 |
$10,357 |
15.9× |
| MRI chest with contrast (71551) |
$5,212.40 |
$13,031 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$5,998 |
$14,995 |
15.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,584.80 |
$11,462 |
12.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$5,501.60 |
$13,754 |
21.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,762.40 |
$9,406 |
14.4× |
| MRI orbit face neck w contrast (70542) |
$3,828.40 |
$9,571 |
10.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,421.60 |
$8,554 |
9.0× |
| MRI pelvis w/contrast (72196) |
$4,039.80 |
$10,099.50 |
10.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,212.20 |
$10,530.50 |
11.0× |
| MRI pelvis w/o contrast (72195) |
$3,652.20 |
$9,130.50 |
14.0× |
| MRI spectroscopy (76390) |
$5,231.20 |
$13,078 |
55.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$6,828 |
$17,070 |
17.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,948.60 |
$12,371.50 |
13.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,628.80 |
$14,072 |
14.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$5,101.60 |
$12,754 |
13.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,504 |
$13,760 |
14.4× |
| MRI temporomandibular joint (70336) |
$3,920 |
$9,800 |
15.0× |
| MRI thoracic spine w/o contrast (72146) |
$3,204.40 |
$8,011 |
12.3× |
| MRI up ext w/o contrast (73218) |
$5,501.60 |
$13,754 |
21.1× |
| MRI upper ext joint w/o contrast (73221) |
$4,828 |
$12,070 |
18.5× |
| MRI, joint upper extrem combo (73223) |
$5,832.80 |
$14,582 |
15.3× |
| Myelogram Cervical (72240) |
$3,113.20 |
$7,783 |
3.6× |
| Myelogram Lumbar (72265) |
$2,618 |
$6,545 |
3.1× |
| Myelogram thoracic (72255) |
$2,047.20 |
$5,118 |
2.4× |
| Myelography 2 or more regions (72270) |
$3,718 |
$9,295 |
4.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,698.40 |
$14,246 |
4.0× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,539.20 |
$3,848 |
2.6× |
| Myocardial infarct spect (78469) |
$3,696 |
$9,240 |
6.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,905.20 |
$7,263 |
2.1× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,594 |
$11,485 |
3.2× |
| Myocardial Spect Multiple Studies (78452) |
$10,845.60 |
$27,114 |
7.7× |
| Myocardial spect single study at rest or stress (78451) |
$4,160.80 |
$10,402 |
2.9× |
| Neck soft tissue (70360) |
$526.80 |
$1,317 |
5.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,633.40 |
$4,083.50 |
3.9× |
| Nm adrenal scan (78075) |
$3,389.60 |
$8,474 |
2.4× |
| Nm bone marrow wb (78104) |
$3,389.60 |
$8,474 |
7.8× |
| Nm cardiac blood pool multiple (78473) |
$2,388.80 |
$5,972 |
5.5× |
| Nm cisternogram (78630) |
$2,888.80 |
$7,222 |
4.9× |
| Nm csf leak detection (78650) |
$3,219.20 |
$8,048 |
2.3× |
| Nm gastric emptying study (78264) |
$3,198.40 |
$7,996 |
7.3× |
| Nm gastroesophageal reflux study (78262) |
$1,846.80 |
$4,617 |
4.2× |
| Nm kidney scan w/flow (78701) |
$2,926.80 |
$7,317 |
6.7× |
| Nm peritoneal-venous shunt patency (78291) |
$1,679.20 |
$4,198 |
3.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,719.60 |
$4,299 |
3.9× |
| Nonvascular shunt X-ray (75809) |
$788 |
$1,970 |
6.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$2,754 |
$6,885 |
6.3× |
| Nuclear Rx Oral Admin (79005) |
$8,801.60 |
$22,004 |
34.5× |
| Orthopantogram (70355) |
$574.40 |
$1,436 |
6.0× |
| Osseous survey limited (77074) |
$744.80 |
$1,862 |
6.5× |
| Parathyrd planar w/spect&CT (78072) |
$762.40 |
$1,906 |
1.3× |
| Parathyroid Planar Imaging (78070) |
$1,034.40 |
$2,586 |
2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$762.40 |
$1,906 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$569.20 |
$1,423 |
5.0× |
| Perineogram (74775) |
$2,617.60 |
$6,544 |
10.0× |
| Peritoneogram after injection (74190) |
$2,726.40 |
$6,816 |
4.6× |
| Proton tx delivery complex (77525) |
$2,647.20 |
$6,618 |
1.9× |
| Proton tx delivery simple w/o compensation (77520) |
$2,167.40 |
$5,418.50 |
3.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,054.80 |
$10,137 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,466.80 |
$8,667 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,610.60 |
$4,026.50 |
3.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$4,726.40 |
$11,816 |
8.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,872.40 |
$4,681 |
3.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$750.40 |
$1,876 |
7.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$605.20 |
$1,513 |
6.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$682 |
$1,705 |
7.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$540.20 |
$1,350.50 |
4.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$787.20 |
$1,968 |
6.9× |
| Radex fingr minimum 2 views (73140) |
$564.40 |
$1,411 |
5.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$663.20 |
$1,658 |
7.0× |
| Radex Hand Minimum 3 Views (73130) |
$662.40 |
$1,656 |
7.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$848 |
$2,120 |
8.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$630 |
$1,575 |
5.5× |
| Radex Humerus Minimum 2 Views (73060) |
$628 |
$1,570 |
6.6× |
| Radex Kne 1/2 Views (73560) |
$608.40 |
$1,521 |
6.4× |
| Radex Kne Compl 4/More Views (73564) |
$867.20 |
$2,168 |
7.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$938.40 |
$2,346 |
8.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$535 |
$1,337.50 |
5.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$1,120.40 |
$2,801 |
9.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$693.60 |
$1,734 |
7.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$495.20 |
$1,238 |
5.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$634.40 |
$1,586 |
5.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$1,077.40 |
$2,693.50 |
11.3× |
| Radex Toe Minimum 2 Views (73660) |
$550.80 |
$1,377 |
5.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$708 |
$1,770 |
6.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$733.20 |
$1,833 |
7.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$2,726.80 |
$6,817 |
23.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$437.20 |
$1,093 |
4.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$612 |
$1,530 |
5.4× |
| Radiologic exam chest 2 views (71046) |
$724.40 |
$1,811 |
7.6× |
| Radiologic exam colon single contrast study (74270) |
$1,231.80 |
$3,079.50 |
6.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$773.80 |
$1,934.50 |
4.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$997.40 |
$2,493.50 |
5.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,331.40 |
$3,328.50 |
6.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$678.80 |
$1,697 |
7.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$1,090 |
$2,725 |
9.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$526.40 |
$1,316 |
4.6× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$1,221.20 |
$3,053 |
4.7× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$904.40 |
$2,261 |
3.5× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$468 |
$1,170 |
4.9× |
| Radiological examination surgical specimen (76098) |
$1,127.60 |
$2,819 |
1.9× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$4,618.80 |
$11,547 |
18.1× |
| Renal Cyst Study (74470) |
$1,452 |
$3,630 |
2.4× |
| Ribs bilateral 3 views (71110) |
$823.40 |
$2,058.50 |
7.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$3,837.20 |
$9,593 |
8.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,201.20 |
$8,003 |
7.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$7,752.40 |
$19,381 |
13.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,950.40 |
$9,876 |
6.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,563.20 |
$6,408 |
4.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$4,032 |
$10,080 |
15.8× |
| Rp Therapy Intravenous Administration (79101) |
$4,274.80 |
$10,687 |
16.8× |
| Sacroiliac Joints < 3 Views (72200) |
$506 |
$1,265 |
4.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,842.80 |
$4,607 |
7.1× |
| Salivary gland imaging (78230) |
$1,318.40 |
$3,296 |
3.0× |
| Scapula (73010) |
$755.20 |
$1,888 |
6.6× |
| Sella turcica (70240) |
$810 |
$2,025 |
8.5× |
| Shoulder 1 view (73020) |
$462.40 |
$1,156 |
4.9× |
| Sialogram (70390) |
$904.40 |
$2,261 |
3.5× |
| Simulation intermediate (77285) |
$2,119.20 |
$5,298 |
5.2× |
| Small bowel series (74250) |
$986.40 |
$2,466 |
5.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$2,119.20 |
$5,298 |
5.2× |
| Special dosimetry (77331) |
$2,119.20 |
$5,298 |
14.4× |
| Special Physics Consult (77370) |
$1,765.60 |
$4,414 |
12.0× |
| Special treatment procedure (77470) |
$2,119.20 |
$5,298 |
3.5× |
| Speech evaluation complex (70371) |
$1,277.20 |
$3,193 |
4.9× |
| Spine thoracic 3 views (72072) |
$885.20 |
$2,213 |
7.7× |
| Splenoportograpy rs&i (75810) |
$3,810 |
$9,525 |
1.1× |
| Superior sagittal sinus venogram (75870) |
$3,041.60 |
$7,604 |
0.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$1,765.60 |
$4,414 |
15.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,119.20 |
$5,298 |
5.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$2,119.20 |
$5,298 |
5.2× |
| Testicular Imaging With Vascular Flow (78761) |
$2,139.60 |
$5,349 |
4.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,119.20 |
$5,298 |
5.2× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,765.60 |
$4,414 |
12.0× |
| Thoracolumbar 2 views (72080) |
$701.60 |
$1,754 |
7.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,975.20 |
$7,438 |
5.0× |
| Thyroid imaging w/blood flow (78013) |
$1,153.20 |
$2,883 |
2.6× |
| Thyroid uptake measurement (78012) |
$615.60 |
$1,539 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,077.40 |
$2,693.50 |
2.5× |
| Tmj unilateral (70328) |
$778.80 |
$1,947 |
8.2× |
| Tomogram (76100) |
$1,210 |
$3,025 |
10.6× |
| Treatment device complex (77334) |
$2,119.20 |
$5,298 |
5.2× |
| Treatment device intermediate (77333) |
$2,119.20 |
$5,298 |
14.4× |
| Treatment devices simple (77332) |
$1,765.60 |
$4,414 |
12.0× |
| Ultrasound breast complete (76641) |
$1,401.60 |
$3,504 |
12.3× |
| Ultrasound, abdomen limited (76705) |
$1,641 |
$4,102.50 |
14.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$118.80 |
$297 |
1.2× |
| Unlisted fluoroscopic procedure (76496) |
$395.60 |
$989 |
4.2× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$1,868.40 |
$4,671 |
4.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$2,309.60 |
$5,774 |
20.7× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$2,309.60 |
$5,774 |
15.7× |
| Unlisted ultrasound procedure (76999) |
$684.40 |
$1,711 |
7.2× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$2,576.40 |
$6,441 |
232.9× |
| Ureteral reflux study (78740) |
$2,550 |
$6,375 |
5.8× |
| Urethrocystogram voiding (74455) |
$1,240.40 |
$3,101 |
4.8× |
| Urethrocystography retrograde rs&i (74450) |
$788.20 |
$1,970.50 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,005.20 |
$2,513 |
5.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,625.40 |
$4,063.50 |
8.5× |
| Us breast unilateral limited (76642) |
$729.60 |
$1,824 |
7.7× |
| Us chest (76604) |
$813.80 |
$2,034.50 |
7.1× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$2,172.80 |
$5,432 |
9.2× |
| Us compl joint r-t w/image documentation (76881) |
$1,063.60 |
$2,659 |
9.3× |
| Us encephalogram (76506) |
$995.40 |
$2,488.50 |
8.7× |
| Us hips infant static (76886) |
$1,024.40 |
$2,561 |
10.8× |
| Us infant hips w manipulation (76885) |
$1,331.20 |
$3,328 |
14.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$842.80 |
$2,107 |
7.4× |
| Us ob detailed single fetus (76811) |
$2,160 |
$5,400 |
8.3× |
| Us ob limited (76815) |
$1,199.20 |
$2,998 |
10.5× |
| Us ob transvaginal (76817) |
$1,710 |
$4,275 |
15.0× |
| Us pelvic non ob complete (76856) |
$1,587 |
$3,967.50 |
13.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$913.60 |
$2,284 |
8.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,287.20 |
$3,218 |
11.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$1,006 |
$2,515 |
8.8× |
| Us retroperitoneal complete (76770) |
$1,559.20 |
$3,898 |
13.6× |
| Us retroperitoneal limited (76775) |
$1,455.60 |
$3,639 |
12.7× |
| Us scrotum and contents (76870) |
$1,280.60 |
$3,201.50 |
11.2× |
| Us soft tissue head/neck (76536) |
$1,077.60 |
$2,694 |
9.4× |
| Us spinal canal and contents (76800) |
$1,028.20 |
$2,570.50 |
9.0× |
| Us transrectal (76872) |
$1,572.40 |
$3,931 |
13.8× |
| Us, eye b-scan (76512) |
$771.20 |
$1,928 |
6.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,975.20 |
$4,938 |
17.3× |
| Venogram adrenal unilat (75840) |
$3,387.20 |
$8,468 |
1.0× |
| Venogram extremity bilateral (75822) |
$3,245.40 |
$8,113.50 |
1.9× |
| Venogram Extremity Unilateral (75820) |
$1,710.60 |
$4,276.50 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$6,490.40 |
$16,226 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$2,970.40 |
$7,426 |
1.7× |
| Venography Renal Bilateral (75833) |
$2,763 |
$6,907.50 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$3,173.20 |
$7,933 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,371.40 |
$10,928.50 |
1.3× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,471.20 |
$6,178 |
0.4× |
| Wrist 2 views (73100) |
$676.40 |
$1,691 |
7.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$995 |
$2,487.50 |
8.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$428 |
$1,070 |
4.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,039.40 |
$2,598.50 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$594.80 |
$1,487 |
6.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$720.80 |
$1,802 |
7.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$855.20 |
$2,138 |
7.5× |
| X-ray exam of femur 2/> (73552) |
$748.80 |
$1,872 |
7.9× |
| X-ray eye for foreign body (70030) |
$660.80 |
$1,652 |
6.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$600 |
$1,500 |
6.3× |
| X-ray IV pyelogram (ivp) (74400) |
$1,496 |
$3,740 |
7.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$689.20 |
$1,723 |
7.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$433.60 |
$1,084 |
4.6× |
| X-ray leg, infant (73592) |
$527.60 |
$1,319 |
5.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$774.80 |
$1,937 |
6.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,994 |
$4,985 |
17.4× |
| X-ray nose-rectum child f.b. (76010) |
$2,009.60 |
$5,024 |
21.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$872.40 |
$2,181 |
7.6× |
| X-ray retrograde pyelogram (74420) |
$1,703.40 |
$4,258.50 |
4.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$843.60 |
$2,109 |
8.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$749.20 |
$1,873 |
6.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,248.80 |
$3,122 |
10.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$519.20 |
$1,298 |
4.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$826.80 |
$2,067 |
8.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$821.60 |
$2,054 |
8.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,171.60 |
$2,929 |
10.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$729.60 |
$1,824 |
6.4× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,305.60 |
$3,264 |
6.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$606 |
$1,515 |
6.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$407 |
$1,017.50 |
4.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$593.40 |
$1,483.50 |
6.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$838.40 |
$2,096 |
7.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$1,117.60 |
$2,794 |
9.8× |
| Xr bone length studies (77073) |
$958.40 |
$2,396 |
8.4× |
| Xr c-spine 4 or 5 views (72050) |
$991.60 |
$2,479 |
8.7× |
| Xr c-spine 6 or more views (72052) |
$894 |
$2,235 |
7.8× |
| Xr chest 4+ views (71048) |
$854 |
$2,135 |
7.5× |
| Xr urogram antegrade (74425) |
$2,094.40 |
$5,236 |
5.5× |