| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,235.40 |
$9,244 |
2.2× |
| Abdomen 2 views (74019) |
$380.80 |
$1,088 |
3.5× |
| Acute gi blood loss imaging (78278) |
$863.10 |
$2,466 |
2.1× |
| Angio Adrenal Bilat Select (75733) |
$2,758.70 |
$7,882 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$4,682.30 |
$13,378 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$3,513.65 |
$10,039 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$1,576.75 |
$4,505 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,090.05 |
$14,543 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,956.70 |
$14,162 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,672.55 |
$10,493 |
1.1× |
| Angiography Spinal Selective Rs&I (75705) |
$7,020.65 |
$20,059 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,234.60 |
$14,956 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,226.40 |
$3,504 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,430.70 |
$9,802 |
1.0× |
| Ankle 2 views (73600) |
$120.05 |
$343 |
1.3× |
| Aortogram thoracic (75605) |
$5,103.35 |
$14,581 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,499.20 |
$15,712 |
1.7× |
| Aortography abdominal serialography rs&i (75625) |
$4,522 |
$12,920 |
1.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,773 |
$10,780 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$2,015.65 |
$5,759 |
0.6× |
| Arthrogram ankle (73615) |
$687.05 |
$1,963 |
1.9× |
| Arthrogram elbow (73085) |
$1,297.45 |
$3,707 |
3.6× |
| Arthrogram hip (73525) |
$896.35 |
$2,561 |
2.5× |
| Arthrogram knee (73580) |
$700.35 |
$2,001 |
1.9× |
| Arthrogram shoulder (73040) |
$1,508.50 |
$4,310 |
4.1× |
| Arthrogram wrist (73115) |
$373.80 |
$1,068 |
1.0× |
| Basic dosimetry (77300) |
$308 |
$880 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$829.85 |
$2,371 |
2.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$798.35 |
$2,281 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,243.55 |
$3,553 |
3.0× |
| Bone age studies (77072) |
$154.35 |
$441 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,405.25 |
$4,015 |
3.4× |
| Bone survey complete (77075) |
$339.15 |
$969 |
3.1× |
| Bone survey infant (77076) |
$237.65 |
$679 |
2.2× |
| Bowel imaging (78290) |
$1,152.20 |
$3,292 |
2.8× |
| Brachytx isodose complex (77318) |
$926.80 |
$2,648 |
2.4× |
| Brachytx isodose intermed (77317) |
$855.40 |
$2,444 |
2.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$499.80 |
$1,428 |
1.3× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$460.60 |
$1,316 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,630.20 |
$10,372 |
2.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,311.80 |
$3,748 |
3.1× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,177.40 |
$3,364 |
1.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,017.45 |
$2,907 |
2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$795.20 |
$2,272 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$278.25 |
$795 |
3.1× |
| Chest 1 view (71045) |
$252.35 |
$721 |
2.8× |
| Chest xray 3 views (71047) |
$256.90 |
$734 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$579.25 |
$1,655 |
3.2× |
| Clavicle complete (73000) |
$199.50 |
$570 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$413 |
$1,180 |
3.8× |
| Continuing medical physics consltj pr wk (77336) |
$285.25 |
$815 |
2.0× |
| Corpora cavernosography (74445) |
$135.45 |
$387 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,938.50 |
$14,110 |
13.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,149 |
$6,140 |
8.6× |
| CT abdomen w contrast (74160) |
$1,349.95 |
$3,857 |
7.4× |
| CT abdomen w wo contrast (74170) |
$2,450 |
$7,000 |
13.4× |
| CT abdomen w/o contrast (74150) |
$1,145.90 |
$3,274 |
10.5× |
| CT angio hrt w/3d image (75574) |
$1,268.05 |
$3,623 |
3.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,955.05 |
$8,443 |
16.1× |
| CT angiography upper extremity lt (73206) |
$3,116.75 |
$8,905 |
17.0× |
| CT c-spine w/contrast (72126) |
$1,643.95 |
$4,697 |
4.5× |
| CT c-spine w/o contrast (72125) |
$1,537.55 |
$4,393 |
14.1× |
| CT cervical spine w&w/o contrast (72127) |
$3,180.80 |
$9,088 |
17.4× |
| CT chest w contrast (71260) |
$880.60 |
$2,516 |
4.8× |
| CT chest w/wo contrast (71270) |
$914.20 |
$2,612 |
5.0× |
| CT colonography screening (74263) |
$622.30 |
$1,778 |
2.5× |
| CT colonography w/o cntrst (74261) |
$711.90 |
$2,034 |
6.5× |
| CT head/brain with contrast (70460) |
$1,607.90 |
$4,594 |
8.8× |
| CT head/brain without and with contrast (70470) |
$2,009 |
$5,740 |
11.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,084.30 |
$3,098 |
3.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$341.60 |
$976 |
3.8× |
| CT hrt w/3d image congen (75573) |
$931 |
$2,660 |
2.6× |
| CT iac w contrast (70481) |
$2,174.55 |
$6,213 |
11.9× |
| CT limited/localized follow up study (76380) |
$341.60 |
$976 |
3.8× |
| CT lower ext w/o (73700) |
$1,058.75 |
$3,025 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$2,282.35 |
$6,521 |
12.5× |
| CT lower extremity w/contrast material (73701) |
$1,224.30 |
$3,498 |
6.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,249.15 |
$3,569 |
6.8× |
| CT lumbar spine w/contrast (72132) |
$627.55 |
$1,793 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$621.60 |
$1,776 |
5.7× |
| CT maxillofacial w contrast (70487) |
$1,662.50 |
$4,750 |
9.1× |
| CT maxillofacial w/wo contrast (70488) |
$3,676.05 |
$10,503 |
20.1× |
| CT maxillofacial wo contrast (70486) |
$1,502.90 |
$4,294 |
13.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$4,043.55 |
$11,553 |
22.1× |
| CT orbits w/o contrast (70480) |
$1,870.05 |
$5,343 |
17.1× |
| CT pelvis w/o contrast (72192) |
$1,003.45 |
$2,867 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$2,488.50 |
$7,110 |
13.6× |
| CT scan of arm combo (73202) |
$1,753.15 |
$5,009 |
9.6× |
| CT soft tissue neck w contrast (70491) |
$1,229.20 |
$3,512 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,157.75 |
$6,165 |
11.8× |
| CT soft tissue neck w/o contrast (70490) |
$990.50 |
$2,830 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$1,048.25 |
$2,995 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$900.55 |
$2,573 |
8.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,949.50 |
$5,570 |
10.6× |
| CT thorax w/o contrast (71250) |
$845.25 |
$2,415 |
7.7× |
| CT upper ext wo (73200) |
$811.65 |
$2,319 |
7.4× |
| CT upper extremity with contrast (73201) |
$940.45 |
$2,687 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,321.15 |
$9,489 |
18.1× |
| Cta Abdomen (74175) |
$2,230.55 |
$6,373 |
12.2× |
| CTA abdomen pelvis (74174) |
$3,818.50 |
$10,910 |
10.5× |
| CTA chest (71275) |
$2,399.25 |
$6,855 |
13.1× |
| Cta Head (70496) |
$2,314.90 |
$6,614 |
12.6× |
| Cta Neck (70498) |
$2,915.85 |
$8,331 |
15.9× |
| Cta Pelvis (72191) |
$1,588.65 |
$4,539 |
8.7× |
| Cystography minimum 3 views rs&i (74430) |
$386.75 |
$1,105 |
1.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$694.40 |
$1,984 |
0.3× |
| Diskogram cervical (72285) |
$1,137.15 |
$3,249 |
0.6× |
| Diskography lumbar (72295) |
$720.30 |
$2,058 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$239.05 |
$683 |
2.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$438.90 |
$1,254 |
4.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$611.80 |
$1,748 |
5.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$240.45 |
$687 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$192.85 |
$551 |
2.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$787.15 |
$2,249 |
3.2× |
| Esophageal motility (78258) |
$553.70 |
$1,582 |
1.3× |
| Esophagus (74220) |
$413 |
$1,180 |
2.3× |
| Facial bones min 3 views (70150) |
$319.55 |
$913 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$433.30 |
$1,238 |
4.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$361.55 |
$1,033 |
3.3× |
| Fetal Echo (76825) |
$873.60 |
$2,496 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$739.55 |
$2,113 |
3.0× |
| Foot 2 views (73620) |
$119.70 |
$342 |
1.3× |
| Forearm 2 views (73090) |
$221.90 |
$634 |
2.4× |
| Functional MRI brain by tech (70554) |
$1,037.40 |
$2,964 |
4.2× |
| Hand 2 views (73120) |
$222.95 |
$637 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,249.75 |
$9,285 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,963.75 |
$11,325 |
5.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,566.80 |
$13,048 |
6.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,686.20 |
$10,532 |
1.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,663.10 |
$10,466 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,223.95 |
$3,497 |
2.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$1,709.40 |
$4,884 |
3.0× |
| Hysterosalpingogram (74740) |
$1,001.35 |
$2,861 |
4.0× |
| Interstitial radiation source applic complex (77778) |
$3,622.50 |
$10,350 |
5.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$899.85 |
$2,571 |
1.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$477.75 |
$1,365 |
0.8× |
| Intracavitary Radiation Source Applic Simple (77761) |
$309.40 |
$884 |
0.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$102.55 |
$293 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,233.40 |
$3,524 |
2.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,351.70 |
$3,862 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,591.75 |
$7,405 |
4.6× |
| Knee 3 views (73562) |
$249.55 |
$713 |
2.7× |
| Liver & spleen imaging static only (78215) |
$792.40 |
$2,264 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,320.20 |
$3,772 |
3.2× |
| Lung perf&ventilat diferentl (78598) |
$529.55 |
$1,513 |
0.9× |
| Lung ventilation imaging (78579) |
$906.85 |
$2,591 |
2.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$710.15 |
$2,029 |
0.2× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$603.05 |
$1,723 |
0.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,404.20 |
$4,012 |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$697.20 |
$1,992 |
1.1× |
| Lymphoscintigraphy (78195) |
$1,167.60 |
$3,336 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,179.85 |
$3,371 |
1.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,489.25 |
$4,255 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,991.50 |
$5,690 |
5.5× |
| Magnetic Resonance Elastography (76391) |
$692.65 |
$1,979 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$148.75 |
$425 |
0.6× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$46.20 |
$132 |
0.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,079.75 |
$3,085 |
2.8× |
| Mr safety determination physician/other qhp (76016) |
$77.35 |
$221 |
0.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$21.70 |
$62 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$80.50 |
$230 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$52.15 |
$149 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$211.75 |
$605 |
0.8× |
| MRA head w & w/o contrast (70546) |
$1,766.80 |
$5,048 |
4.8× |
| MRA head w/o contrast (70544) |
$1,221.85 |
$3,491 |
4.9× |
| MRA head with contrast (70545) |
$1,298.85 |
$3,711 |
3.6× |
| MRA neck w contrast (70548) |
$1,297.45 |
$3,707 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,766.80 |
$5,048 |
4.8× |
| MRA neck w/o contrast (70547) |
$1,221.85 |
$3,491 |
4.9× |
| MRI abdomen w contrast (74182) |
$996.80 |
$2,848 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,509.90 |
$4,314 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$904.40 |
$2,584 |
3.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$736.75 |
$2,105 |
0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,194.50 |
$6,270 |
6.0× |
| MRI bone marrow blood supply (77084) |
$611.10 |
$1,746 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,122.10 |
$3,206 |
4.5× |
| MRI breast wo contrast unilateral (77046) |
$863.45 |
$2,467 |
3.5× |
| MRI c-spine with contrast (72142) |
$1,412.95 |
$4,037 |
3.9× |
| MRI cardiac w/o cont stress (75559) |
$1,020.60 |
$2,916 |
1.8× |
| MRI cardiac w/o contrast (75557) |
$861 |
$2,460 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$1,177.75 |
$3,365 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,305.50 |
$3,730 |
3.6× |
| MRI chest w/o contrast (71550) |
$1,035.30 |
$2,958 |
4.2× |
| MRI chest with contrast (71551) |
$1,100.05 |
$3,143 |
1.3× |
| MRI fetal sngl/1st gestation (74712) |
$976.85 |
$2,791 |
3.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,596 |
$4,560 |
4.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,995.70 |
$5,702 |
5.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,457.40 |
$4,164 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,283.45 |
$3,667 |
5.2× |
| MRI orbit face neck w contrast (70542) |
$1,438.85 |
$4,111 |
3.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,716.70 |
$7,762 |
7.5× |
| MRI pelvis w/contrast (72196) |
$1,451.80 |
$4,148 |
4.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,687.35 |
$4,821 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,332.10 |
$3,806 |
5.3× |
| MRI spectroscopy (76390) |
$816.90 |
$2,334 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,460.50 |
$7,030 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,422.75 |
$4,065 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,508.45 |
$7,167 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,373.40 |
$3,924 |
3.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,390.50 |
$6,830 |
6.6× |
| MRI temporomandibular joint (70336) |
$631.40 |
$1,804 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,492.40 |
$4,264 |
6.0× |
| MRI up ext w/o contrast (73218) |
$1,416.80 |
$4,048 |
5.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,008 |
$2,880 |
4.0× |
| MRI, joint upper extrem combo (73223) |
$1,391.60 |
$3,976 |
3.8× |
| Myelogram Cervical (72240) |
$2,592.80 |
$7,408 |
3.2× |
| Myelogram Lumbar (72265) |
$2,586.85 |
$7,391 |
3.2× |
| Myelogram thoracic (72255) |
$2,376.50 |
$6,790 |
2.9× |
| Myelography 2 or more regions (72270) |
$4,283.65 |
$12,239 |
5.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,064.70 |
$3,042 |
0.8× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,627.50 |
$4,650 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,733.10 |
$10,666 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,664.20 |
$7,612 |
2.0× |
| Neck soft tissue (70360) |
$449.40 |
$1,284 |
4.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$654.85 |
$1,871 |
1.6× |
| Nm cardiac blood pool multiple (78473) |
$1,478.40 |
$4,224 |
3.5× |
| Nm cisternogram (78630) |
$576.10 |
$1,646 |
1.0× |
| Nm csf leak detection (78650) |
$343 |
$980 |
0.3× |
| Nm gastric emptying study (78264) |
$1,104.95 |
$3,157 |
2.6× |
| Nm peritoneal-venous shunt patency (78291) |
$995.40 |
$2,844 |
2.4× |
| Nonvascular shunt X-ray (75809) |
$458.50 |
$1,310 |
4.2× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,437.30 |
$12,678 |
3.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$188.30 |
$538 |
0.5× |
| Nuclear Rx Oral Admin (79005) |
$2,253.30 |
$6,438 |
9.2× |
| Ob us nuchal meas 1 gest (76813) |
$270.20 |
$772 |
2.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$84 |
$240 |
0.8× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$122.50 |
$350 |
1.1× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$73.85 |
$211 |
2.4× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$84 |
$240 |
0.8× |
| Orthopantogram (70355) |
$157.15 |
$449 |
1.7× |
| Osseous survey limited (77074) |
$317.45 |
$907 |
2.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,341.55 |
$3,833 |
2.4× |
| Parathyroid Planar Imaging (78070) |
$1,010.45 |
$2,887 |
2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,043.70 |
$2,982 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$206.15 |
$589 |
1.9× |
| Peritoneogram after injection (74190) |
$567.70 |
$1,622 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$3,703.70 |
$10,582 |
2.5× |
| PET imaging CT for attenuation limited area (78814) |
$3,218.95 |
$9,197 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$3,779.65 |
$10,799 |
2.5× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,319.15 |
$3,769 |
1.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$2,497.25 |
$7,135 |
1.7× |
| Proton trmt simple w/comp (77522) |
$5,476.45 |
$15,647 |
4.2× |
| Proton tx delivery complex (77525) |
$3,929.45 |
$11,227 |
3.0× |
| Proton tx delivery intermediate (77523) |
$3,901.45 |
$11,147 |
3.0× |
| Proton tx delivery simple w/o compensation (77520) |
$2,028.95 |
$5,797 |
3.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,869.90 |
$13,914 |
1.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,141.60 |
$8,976 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$906.85 |
$2,591 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,812.30 |
$5,178 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$679.35 |
$1,941 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$238.70 |
$682 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$201.60 |
$576 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$301.35 |
$861 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$47.60 |
$136 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$78.75 |
$225 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$149.45 |
$427 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$169.40 |
$484 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$239.40 |
$684 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$267.75 |
$765 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$47.60 |
$136 |
0.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$149.45 |
$427 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$289.80 |
$828 |
2.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$834.75 |
$2,385 |
7.6× |
| Radex Humerus Minimum 2 Views (73060) |
$230.65 |
$659 |
2.5× |
| Radex Kne 1/2 Views (73560) |
$225.05 |
$643 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$275.10 |
$786 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$462 |
$1,320 |
4.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$205.10 |
$586 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$470.05 |
$1,343 |
4.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$241.85 |
$691 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$165.90 |
$474 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$383.60 |
$1,096 |
3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$194.95 |
$557 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$163.10 |
$466 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$142.10 |
$406 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$267.75 |
$765 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,758.50 |
$39,310 |
1.8× |
| Radiation treatment delivery level 1 (77402) |
$464.45 |
$1,327 |
4.4× |
| Radiation treatment delivery level 2 (77407) |
$527.45 |
$1,507 |
1.3× |
| Radiation treatment delivery level 3 (77412) |
$624.40 |
$1,784 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$309.75 |
$885 |
3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$527.10 |
$1,506 |
4.8× |
| Radiologic exam chest 2 views (71046) |
$256.20 |
$732 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$894.60 |
$2,556 |
4.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$169.05 |
$483 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$910.70 |
$2,602 |
5.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$831.42 |
$2,375.50 |
4.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$239.75 |
$685 |
2.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$206.85 |
$591 |
1.9× |
| Radiological examination surgical specimen (76098) |
$128.10 |
$366 |
0.2× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$529.55 |
$1,513 |
0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,310 |
$6,600 |
5.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$1,848.70 |
$5,282 |
4.6× |
| Renal Cyst Study (74470) |
$1,605.10 |
$4,586 |
2.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,010.80 |
$2,888 |
2.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$666.40 |
$1,904 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,626.10 |
$4,646 |
2.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,316.35 |
$3,761 |
2.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,453.55 |
$4,153 |
2.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,335.60 |
$3,816 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,514.45 |
$4,327 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,335.60 |
$3,816 |
1.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,087.80 |
$3,108 |
4.5× |
| Rp Therapy Intravenous Administration (79101) |
$561.92 |
$1,605.50 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$576.80 |
$1,648 |
2.3× |
| Scapula (73010) |
$241.85 |
$691 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$55.65 |
$159 |
2.4× |
| Shoulder 1 view (73020) |
$47.25 |
$135 |
0.5× |
| Sialogram (70390) |
$314.30 |
$898 |
1.3× |
| Simulation intermediate (77285) |
$872.90 |
$2,494 |
2.2× |
| Small bowel series (74250) |
$553.70 |
$1,582 |
3.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$628.60 |
$1,796 |
1.6× |
| Special dosimetry (77331) |
$895.65 |
$2,559 |
6.4× |
| Special Physics Consult (77370) |
$640.15 |
$1,829 |
4.6× |
| Special treatment procedure (77470) |
$1,544.20 |
$4,412 |
2.7× |
| Speech evaluation complex (70371) |
$640.50 |
$1,830 |
2.6× |
| Spine thoracic 3 views (72072) |
$304.15 |
$869 |
2.8× |
| Splenoportograpy rs&i (75810) |
$2,525.60 |
$7,216 |
0.8× |
| Stereotactic Body Radiation Delivery (77373) |
$13,758.50 |
$39,310 |
7.4× |
| Superior sagittal sinus venogram (75870) |
$2,786 |
$7,960 |
0.8× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$163.45 |
$467 |
1.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$846.30 |
$2,418 |
2.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$409.50 |
$1,170 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,177.40 |
$3,364 |
3.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$579.60 |
$1,656 |
4.1× |
| Thoracolumbar 2 views (72080) |
$303.80 |
$868 |
3.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,361.50 |
$3,890 |
2.4× |
| Thyroid uptake measurement (78012) |
$786.45 |
$2,247 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$835.45 |
$2,387 |
2.0× |
| Tomogram (76100) |
$1,229.90 |
$3,514 |
11.3× |
| Treatment device complex (77334) |
$787.50 |
$2,250 |
2.0× |
| Treatment device intermediate (77333) |
$497.70 |
$1,422 |
3.5× |
| Treatment devices simple (77332) |
$404.95 |
$1,157 |
2.9× |
| Ultrasound breast complete (76641) |
$440.30 |
$1,258 |
4.0× |
| Ultrasound elastography first target lesion (76982) |
$233.45 |
$667 |
2.1× |
| Ultrasound Exam Aaa Screen (76706) |
$155.75 |
$445 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$537.60 |
$1,536 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$611.80 |
$1,748 |
5.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$4,859.75 |
$13,885 |
53.5× |
| Unlisted fluoroscopic procedure (76496) |
$690.55 |
$1,973 |
7.6× |
| Unlisted magnetic resonance procedure (76498) |
$1,597.05 |
$4,563 |
17.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$2,802.10 |
$8,006 |
26.3× |
| Unlisted ultrasound procedure (76999) |
$269.50 |
$770 |
3.0× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$179.20 |
$512 |
1.9× |
| Ureteral reflux study (78740) |
$390.95 |
$1,117 |
0.9× |
| Urethrocystogram voiding (74455) |
$641.55 |
$1,833 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$630.70 |
$1,802 |
2.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,572.55 |
$4,493 |
8.6× |
| Us breast unilateral limited (76642) |
$316.40 |
$904 |
3.5× |
| Us chest (76604) |
$331.45 |
$947 |
3.0× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,365.35 |
$3,901 |
6.1× |
| Us compl joint r-t w/image documentation (76881) |
$468.30 |
$1,338 |
4.3× |
| Us elastography parenchyma (76981) |
$233.45 |
$667 |
2.1× |
| Us encephalogram (76506) |
$292.60 |
$836 |
2.7× |
| Us hips infant static (76886) |
$484.40 |
$1,384 |
5.3× |
| Us infant hips w manipulation (76885) |
$550.55 |
$1,573 |
6.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$383.60 |
$1,096 |
3.5× |
| Us ob detailed single fetus (76811) |
$239.40 |
$684 |
1.0× |
| Us ob limited (76815) |
$376.25 |
$1,075 |
3.4× |
| Us ob transvaginal (76817) |
$299.60 |
$856 |
2.7× |
| Us pelvic non ob complete (76856) |
$462.35 |
$1,321 |
4.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$381.85 |
$1,091 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$172.90 |
$494 |
1.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$376.25 |
$1,075 |
3.4× |
| Us retroperitoneal complete (76770) |
$504 |
$1,440 |
4.6× |
| Us retroperitoneal limited (76775) |
$522.90 |
$1,494 |
4.8× |
| Us scrotum and contents (76870) |
$452.20 |
$1,292 |
4.1× |
| Us soft tissue head/neck (76536) |
$446.95 |
$1,277 |
4.1× |
| Us spinal canal and contents (76800) |
$337.40 |
$964 |
3.1× |
| Us transrectal (76872) |
$682.15 |
$1,949 |
6.2× |
| Us transrectal prostate volume (76873) |
$263.20 |
$752 |
2.4× |
| Us, eye b-scan (76512) |
$226.10 |
$646 |
2.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$392.70 |
$1,122 |
3.6× |
| Venogram adrenal unilat (75840) |
$2,094.05 |
$5,983 |
0.6× |
| Venogram extremity bilateral (75822) |
$2,492 |
$7,120 |
1.5× |
| Venogram Extremity Unilateral (75820) |
$2,249.45 |
$6,427 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$3,262 |
$9,320 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$3,278.45 |
$9,367 |
2.0× |
| Venography Orbital Rs&I (75880) |
$789.60 |
$2,256 |
1.2× |
| Venography Renal Bilateral (75833) |
$2,392.25 |
$6,835 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,324 |
$6,640 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,806 |
$5,160 |
0.5× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$1,596.70 |
$4,562 |
2.4× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,222.15 |
$6,349 |
0.4× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$183.05 |
$523 |
0.3× |
| Wrist 2 views (73100) |
$135.10 |
$386 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$682.50 |
$1,950 |
6.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$277.90 |
$794 |
3.1× |
| X-ray b.e. reductn intuss (74283) |
$638.75 |
$1,825 |
3.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$932.40 |
$2,664 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$150.85 |
$431 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$82.60 |
$236 |
0.9× |
| X-ray exam of femur 2/> (73552) |
$257.60 |
$736 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$161 |
$460 |
1.8× |
| X-ray IV pyelogram (ivp) (74400) |
$1,140.65 |
$3,259 |
6.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$232.75 |
$665 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$328.30 |
$938 |
3.6× |
| X-ray leg, infant (73592) |
$155.05 |
$443 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$247.45 |
$707 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$557.20 |
$1,592 |
5.1× |
| X-ray nose-rectum child f.b. (76010) |
$179.20 |
$512 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$275.80 |
$788 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$651.35 |
$1,861 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$218.75 |
$625 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$290.50 |
$830 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$343 |
$980 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$150.15 |
$429 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$234.50 |
$670 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$331.45 |
$947 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$414.05 |
$1,183 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$206.50 |
$590 |
1.9× |
| X-Ray Small Bowel Enteroclysis (74251) |
$937.65 |
$2,679 |
5.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$175 |
$500 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$137.55 |
$393 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$137.55 |
$393 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$267.75 |
$765 |
2.5× |
| Xr bone length studies (77073) |
$114.45 |
$327 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$301.70 |
$862 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$390.60 |
$1,116 |
3.6× |
| Xr chest 4+ views (71048) |
$294 |
$840 |
2.7× |
| Xr myelogram posterior fossa (70010) |
$1,558.55 |
$4,453 |
4.3× |
| Xr urogram antegrade (74425) |
$950.25 |
$2,715 |
2.6× |