| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,050.25 |
$10,100.50 |
3.8× |
| Abdomen 2 views (74019) |
$425.50 |
$851 |
4.2× |
| Acute gi blood loss imaging (78278) |
$1,231.50 |
$2,463 |
3.2× |
| Angiography extremity bilateral rs&i (75716) |
$5,581.25 |
$11,162.50 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$5,917 |
$11,834 |
2.0× |
| Angiography internal mammary rs&i (75756) |
$5,783.50 |
$11,567 |
1.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,039.50 |
$10,079 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,149 |
$10,298 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,146.50 |
$10,293 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$5,417 |
$10,834 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,665 |
$19,330 |
1.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,870 |
$5,740 |
0.9× |
| Ankle 2 views (73600) |
$196 |
$392 |
2.3× |
| Aortogram thoracic (75605) |
$5,039.50 |
$10,079 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,517.50 |
$11,035 |
1.8× |
| Aortography abdominal serialography rs&i (75625) |
$5,372.75 |
$10,745.50 |
1.8× |
| Arthrogram elbow (73085) |
$1,331.50 |
$2,663 |
4.0× |
| Arthrogram hip (73525) |
$1,331 |
$2,662 |
4.0× |
| Arthrogram knee (73580) |
$921 |
$1,842 |
2.8× |
| Arthrogram shoulder (73040) |
$1,331 |
$2,662 |
4.0× |
| Arthrogram wrist (73115) |
$667.50 |
$1,335 |
2.0× |
| Basic dosimetry (77300) |
$368 |
$736 |
2.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,175 |
$2,350 |
3.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,231.50 |
$2,463 |
3.2× |
| Bone &/joint imaging whole body (78306) |
$1,175 |
$2,350 |
3.1× |
| Bone age studies (77072) |
$328 |
$656 |
3.3× |
| Bone Imaging 3 Phase (78315) |
$1,175 |
$2,350 |
3.1× |
| Bone survey complete (77075) |
$570.25 |
$1,140.50 |
5.7× |
| Bone survey infant (77076) |
$327 |
$654 |
3.3× |
| Bowel imaging (78290) |
$1,231.50 |
$2,463 |
3.2× |
| Brachytx isodose complex (77318) |
$742 |
$1,484 |
2.1× |
| Brachytx isodose intermed (77317) |
$742 |
$1,484 |
2.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$742 |
$1,484 |
2.1× |
| Brain imaging < 4 static views (78600) |
$821 |
$1,642 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,732 |
$7,464 |
7.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,517.50 |
$11,035 |
4.0× |
| Brain Imaging Vascular Flow Only (78610) |
$2,027.50 |
$4,055 |
3.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,390.25 |
$2,780.50 |
3.6× |
| Cephalogram, orthodontic Non-Facility (70350) |
$117 |
$234 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$616.50 |
$1,233 |
7.4× |
| Chest 1 view (71045) |
$406 |
$812 |
4.9× |
| Chest xray 3 views (71047) |
$386.50 |
$773 |
4.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$359 |
$718 |
2.1× |
| Clavicle complete (73000) |
$213.50 |
$427 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$154 |
$308 |
1.5× |
| Continuing medical physics consltj pr wk (77336) |
$303.50 |
$607 |
2.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$259.50 |
$519 |
1.5× |
| Corpora cavernosography (74445) |
$155 |
$310 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,462 |
$4,924 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,602.50 |
$3,205 |
7.0× |
| CT abdomen w contrast (74160) |
$1,849.50 |
$3,699 |
11.0× |
| CT abdomen w wo contrast (74170) |
$1,849.50 |
$3,699 |
11.0× |
| CT abdomen w/o contrast (74150) |
$894.50 |
$1,789 |
8.9× |
| CT angio hrt w/3d image (75574) |
$2,459 |
$4,918 |
7.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,237.75 |
$2,475.50 |
7.4× |
| CT angiography upper extremity lt (73206) |
$1,917.50 |
$3,835 |
11.4× |
| CT c-spine w/contrast (72126) |
$2,462 |
$4,924 |
7.4× |
| CT c-spine w/o contrast (72125) |
$948 |
$1,896 |
9.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,849.50 |
$3,699 |
11.0× |
| CT chest w contrast (71260) |
$2,031.50 |
$4,063 |
12.1× |
| CT chest w/wo contrast (71270) |
$2,462 |
$4,924 |
14.6× |
| CT head/brain with contrast (70460) |
$1,849.50 |
$3,699 |
11.0× |
| CT head/brain without and with contrast (70470) |
$1,916.50 |
$3,833 |
11.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$582 |
$1,164 |
1.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT hrt w/3d image congen (75573) |
$1,400 |
$2,800 |
4.2× |
| CT iac w contrast (70481) |
$1,849.50 |
$3,699 |
11.0× |
| CT limited/localized follow up study (76380) |
$199.75 |
$399.50 |
2.4× |
| CT lower ext w/o (73700) |
$927 |
$1,854 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,849.50 |
$3,699 |
11.0× |
| CT lower extremity w/contrast material (73701) |
$1,916.50 |
$3,833 |
11.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,849.50 |
$3,699 |
11.0× |
| CT lumbar spine w/contrast (72132) |
$2,462 |
$4,924 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$894.50 |
$1,789 |
8.9× |
| CT maxillofacial w contrast (70487) |
$1,849.50 |
$3,699 |
11.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,849.50 |
$3,699 |
11.0× |
| CT maxillofacial wo contrast (70486) |
$894.50 |
$1,789 |
8.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,849.50 |
$3,699 |
11.0× |
| CT orbits w/o contrast (70480) |
$927 |
$1,854 |
9.2× |
| CT pelvis w/o contrast (72192) |
$927 |
$1,854 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$1,849.50 |
$3,699 |
11.0× |
| CT scan of arm combo (73202) |
$1,849.50 |
$3,699 |
11.0× |
| CT soft tissue neck w contrast (70491) |
$1,849.50 |
$3,699 |
11.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,849.50 |
$3,699 |
11.0× |
| CT soft tissue neck w/o contrast (70490) |
$894.50 |
$1,789 |
8.9× |
| CT thoracic spine w/contrast (72129) |
$1,849.50 |
$3,699 |
11.0× |
| CT thoracic spine w/o contrast (72128) |
$894.50 |
$1,789 |
8.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,849.50 |
$3,699 |
11.0× |
| CT thorax w/o contrast (71250) |
$954.75 |
$1,909.50 |
9.5× |
| CT upper ext wo (73200) |
$894.50 |
$1,789 |
8.9× |
| CT upper extremity with contrast (73201) |
$2,462 |
$4,924 |
7.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,849.50 |
$3,699 |
11.0× |
| Cta Abdomen (74175) |
$1,849.50 |
$3,699 |
11.0× |
| CTA abdomen pelvis (74174) |
$2,462 |
$4,924 |
7.4× |
| CTA chest (71275) |
$1,849.50 |
$3,699 |
11.0× |
| Cta Head (70496) |
$1,849.50 |
$3,699 |
11.0× |
| Cta Neck (70498) |
$2,293 |
$4,586 |
13.6× |
| Cta Pelvis (72191) |
$2,293 |
$4,586 |
13.6× |
| Cystography minimum 3 views rs&i (74430) |
$707.25 |
$1,414.50 |
2.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$4,937.50 |
$9,875 |
2.5× |
| Diskogram cervical (72285) |
$2,126 |
$4,252 |
1.1× |
| Diskography lumbar (72295) |
$2,126 |
$4,252 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$183.50 |
$367 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$395.50 |
$791 |
3.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$136.50 |
$273 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$277 |
$554 |
2.8× |
| Esophagus (74220) |
$540.75 |
$1,081.50 |
3.2× |
| Facial bones min 3 views (70150) |
$329.50 |
$659 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$535 |
$1,070 |
5.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$442.50 |
$885 |
4.4× |
| Fluoroscopy up to 1 hr (76000) |
$579.50 |
$1,159 |
2.5× |
| Foot 2 views (73620) |
$195.25 |
$390.50 |
2.3× |
| Forearm 2 views (73090) |
$213.50 |
$427 |
2.6× |
| Hand 2 views (73120) |
$213.50 |
$427 |
2.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,047 |
$2,094 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,047 |
$2,094 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,047 |
$2,094 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,352 |
$2,704 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,416.50 |
$2,833 |
3.7× |
| Hysterosalpingogram (74740) |
$707.75 |
$1,415.50 |
3.1× |
| Interstitial radiation source applic complex (77778) |
$1,047.50 |
$2,095 |
1.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$11,366 |
$22,732 |
1.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$159 |
$318 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,586 |
$3,172 |
3.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,514.25 |
$3,028.50 |
2.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,586 |
$3,172 |
3.0× |
| Knee 3 views (73562) |
$314 |
$628 |
3.8× |
| Liver & spleen imaging static only (78215) |
$1,416.50 |
$2,833 |
3.7× |
| Liver imaging static only (78201) |
$2,825 |
$5,650 |
5.4× |
| Lung perf&ventilat diferentl (78598) |
$1,639 |
$3,278 |
3.1× |
| Lung perfusion differential (78597) |
$1,164 |
$2,328 |
3.0× |
| Lung ventilation imaging (78579) |
$1,164 |
$2,328 |
3.0× |
| Lymphoscintigraphy (78195) |
$700 |
$1,400 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,335.50 |
$4,671 |
3.1× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$247.50 |
$495 |
1.5× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$742.50 |
$1,485 |
1.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,091.50 |
$6,183 |
9.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,090.50 |
$6,181 |
9.2× |
| Mammary ductogram or galactogram multiple (77054) |
$468 |
$936 |
2.0× |
| Mammary ductogram or galactogram single (77053) |
$468 |
$936 |
2.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,989.25 |
$5,978.50 |
8.3× |
| Mr safety determination physician/other qhp (76016) |
$292.50 |
$585 |
3.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$30 |
$60 |
1.1× |
| Mr safety implt pos&/immoblj (76019) |
$72.50 |
$145 |
1.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$111.50 |
$223 |
0.5× |
| MRA head w & w/o contrast (70546) |
$3,063.50 |
$6,127 |
9.2× |
| MRA head w/o contrast (70544) |
$1,795 |
$3,590 |
7.8× |
| MRA head with contrast (70545) |
$3,062 |
$6,124 |
9.1× |
| MRA neck w contrast (70548) |
$2,956 |
$5,912 |
8.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,955.50 |
$5,911 |
8.8× |
| MRA neck w/o contrast (70547) |
$1,860 |
$3,720 |
8.1× |
| MRI abdomen w contrast (74182) |
$2,984.50 |
$5,969 |
8.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,982.50 |
$5,965 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$1,812.75 |
$3,625.50 |
7.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,284.75 |
$6,569.50 |
4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,806.50 |
$3,613 |
5.4× |
| MRI bone marrow blood supply (77084) |
$1,672.50 |
$3,345 |
7.3× |
| MRI breast w/o contrast bilateral (77047) |
$2,583.50 |
$5,167 |
11.3× |
| MRI c-spine with contrast (72142) |
$3,063 |
$6,126 |
9.2× |
| MRI cervical spine w/o contrast (72141) |
$1,795.50 |
$3,591 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,980.75 |
$5,961.50 |
8.9× |
| MRI chest w/o contrast (71550) |
$1,812 |
$3,624 |
7.9× |
| MRI chest with contrast (71551) |
$3,092.50 |
$6,185 |
4.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,672.50 |
$3,345 |
5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,091 |
$6,182 |
9.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,812 |
$3,624 |
7.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,860.50 |
$3,721 |
8.1× |
| MRI orbit face neck w contrast (70542) |
$3,063 |
$6,126 |
9.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,955 |
$5,910 |
8.8× |
| MRI pelvis w/contrast (72196) |
$3,092.50 |
$6,185 |
9.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,983 |
$5,966 |
8.9× |
| MRI pelvis w/o contrast (72195) |
$1,812 |
$3,624 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,955 |
$5,910 |
8.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,091.50 |
$6,183 |
9.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,983.50 |
$5,967 |
8.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,091.50 |
$6,183 |
9.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,983.50 |
$5,967 |
8.9× |
| MRI temporomandibular joint (70336) |
$1,813.75 |
$3,627.50 |
7.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,812 |
$3,624 |
7.9× |
| MRI up ext w/o contrast (73218) |
$1,877.50 |
$3,755 |
8.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,877.50 |
$3,755 |
8.2× |
| MRI, joint upper extrem combo (73223) |
$3,092 |
$6,184 |
9.2× |
| Myelogram Cervical (72240) |
$1,609 |
$3,218 |
2.1× |
| Myelogram Lumbar (72265) |
$1,609 |
$3,218 |
2.1× |
| Myelogram thoracic (72255) |
$761.50 |
$1,523 |
1.0× |
| Myelography 2 or more regions (72270) |
$1,609 |
$3,218 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$2,284 |
$4,568 |
1.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,980.50 |
$7,961 |
2.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,385.50 |
$8,771 |
3.5× |
| Myocardial Spect Multiple Studies (78452) |
$4,186 |
$8,372 |
3.4× |
| Myocardial spect single study at rest or stress (78451) |
$2,696 |
$5,392 |
2.2× |
| N-invas est c ffr sw aly CTA (75580) |
$3,236 |
$6,472 |
3.9× |
| Neck soft tissue (70360) |
$218.50 |
$437 |
2.6× |
| Nm csf leak detection (78650) |
$2,824.50 |
$5,649 |
2.3× |
| Nm gastric emptying study (78264) |
$1,175.50 |
$2,351 |
3.1× |
| Nm gastroesophageal reflux study (78262) |
$1,231.50 |
$2,463 |
3.2× |
| Nm kidney scan w/flow (78701) |
$1,586.50 |
$3,173 |
4.1× |
| Nm peritoneal-venous shunt patency (78291) |
$944 |
$1,888 |
2.5× |
| Nonvascular shunt X-ray (75809) |
$203 |
$406 |
2.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,627.50 |
$5,255 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$973 |
$1,946 |
4.3× |
| Ob us nuchal meas 1 gest (76813) |
$304 |
$608 |
3.0× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$453.50 |
$907 |
4.5× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$338.50 |
$677 |
3.4× |
| Orthopantogram (70355) |
$143.50 |
$287 |
1.7× |
| Osseous survey limited (77074) |
$254.50 |
$509 |
2.5× |
| Parathyrd planar w/spect&CT (78072) |
$770.25 |
$1,540.50 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$821.50 |
$1,643 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$259.50 |
$519 |
2.6× |
| Perineogram (74775) |
$545.50 |
$1,091 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$3,738 |
$7,476 |
2.7× |
| PET imaging CT for attenuation limited area (78814) |
$3,647.50 |
$7,295 |
2.7× |
| PET imaging for CT attenuation whole body (78816) |
$3,960.50 |
$7,921 |
2.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,199.50 |
$2,399 |
1.0× |
| PET whole body (78813) |
$1,490.50 |
$2,981 |
1.1× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,980.50 |
$7,961 |
2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,164 |
$2,328 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,564.50 |
$3,129 |
3.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,069.50 |
$2,139 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,332 |
$2,664 |
2.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$218 |
$436 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$213.50 |
$427 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$226.50 |
$453 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$273.50 |
$547 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$549 |
$1,098 |
5.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$214.25 |
$428.50 |
2.1× |
| Radex fingr minimum 2 views (73140) |
$213.50 |
$427 |
2.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$218 |
$436 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$218 |
$436 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$212 |
$424 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$238.50 |
$477 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$240 |
$480 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$192 |
$384 |
1.9× |
| Radex Humerus Minimum 2 Views (73060) |
$196 |
$392 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$199.50 |
$399 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$565.50 |
$1,131 |
5.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$327.50 |
$655 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$218 |
$436 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$327.50 |
$655 |
3.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$289.50 |
$579 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$215.50 |
$431 |
2.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$637.50 |
$1,275 |
6.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$275 |
$550 |
3.3× |
| Radex Toe Minimum 2 Views (73660) |
$201 |
$402 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$678 |
$1,356 |
6.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$213.50 |
$427 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$222.25 |
$444.50 |
2.2× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$11,366 |
$22,732 |
1.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$11,365.50 |
$22,731 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$936.50 |
$1,873 |
9.6× |
| Radiation treatment delivery level 2 (77407) |
$1,198.50 |
$2,397 |
3.2× |
| Radiation treatment delivery level 3 (77412) |
$1,318.50 |
$2,637 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$425.50 |
$851 |
5.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$425.50 |
$851 |
4.2× |
| Radiologic exam chest 2 views (71046) |
$391.75 |
$783.50 |
4.7× |
| Radiologic exam colon single contrast study (74270) |
$540.75 |
$1,081.50 |
3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,552.75 |
$3,105.50 |
9.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$455.50 |
$911 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$317.75 |
$635.50 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$412.50 |
$825 |
4.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$128 |
$256 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$213.50 |
$427 |
2.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$339.50 |
$679 |
3.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$234.50 |
$469 |
2.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$117 |
$234 |
1.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$557 |
$1,114 |
6.7× |
| Radiological examination surgical specimen (76098) |
$1,168.25 |
$2,336.50 |
2.2× |
| Renal Cyst Study (74470) |
$1,087 |
$2,174 |
2.1× |
| Ribs bilateral 3 views (71110) |
$329.50 |
$659 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,455.50 |
$2,911 |
3.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,277 |
$2,554 |
3.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,399.50 |
$8,799 |
8.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,824 |
$5,648 |
5.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,384.25 |
$4,768.50 |
4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,967 |
$5,934 |
2.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,363.50 |
$6,727 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,184 |
$2,368 |
1.0× |
| Rp Therapy Intravenous Administration (79101) |
$1,939.50 |
$3,879 |
8.7× |
| Sacroiliac Joints < 3 Views (72200) |
$265 |
$530 |
2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$797 |
$1,594 |
3.5× |
| Scapula (73010) |
$220.50 |
$441 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$723.75 |
$1,447.50 |
31.0× |
| Sella turcica (70240) |
$191 |
$382 |
2.3× |
| Shoulder 1 view (73020) |
$189 |
$378 |
2.3× |
| Sialogram (70390) |
$704.50 |
$1,409 |
3.1× |
| Simulation intermediate (77285) |
$742 |
$1,484 |
2.1× |
| Small bowel series (74250) |
$387.75 |
$775.50 |
2.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$716 |
$1,432 |
2.0× |
| Special dosimetry (77331) |
$368 |
$736 |
2.9× |
| Special Physics Consult (77370) |
$418.50 |
$837 |
3.2× |
| Special treatment procedure (77470) |
$1,157 |
$2,314 |
2.2× |
| Spine thoracic 3 views (72072) |
$329.50 |
$659 |
3.3× |
| Splenoportograpy rs&i (75810) |
$2,870 |
$5,740 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$3,900.50 |
$7,801 |
2.3× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$117.50 |
$235 |
1.2× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$117.50 |
$235 |
1.2× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$43 |
$86 |
1.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$716 |
$1,432 |
2.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$741.50 |
$1,483 |
2.1× |
| Testicular Imaging With Vascular Flow (78761) |
$1,586 |
$3,172 |
4.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,010.25 |
$2,020.50 |
2.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$605.50 |
$1,211 |
4.7× |
| Thoracolumbar 2 views (72080) |
$201 |
$402 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,388.75 |
$2,777.50 |
2.7× |
| Thyroid imaging w/blood flow (78013) |
$821 |
$1,642 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,041.75 |
$2,083.50 |
2.7× |
| Tmj unilateral (70328) |
$117 |
$234 |
1.4× |
| Treatment device complex (77334) |
$1,124 |
$2,248 |
3.1× |
| Treatment device intermediate (77333) |
$506 |
$1,012 |
3.9× |
| Treatment devices simple (77332) |
$321.75 |
$643.50 |
2.5× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
$161 |
$322 |
1.6× |
| Ultrasound breast complete (76641) |
$475.25 |
$950.50 |
4.7× |
| Ultrasound Exam Aaa Screen (76706) |
$325.75 |
$651.50 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$711.50 |
$1,423 |
7.1× |
| Umbilical-artery Doppler (OB) (76820) |
$234 |
$468 |
2.3× |
| Unlisted fluoroscopic procedure (76496) |
$649.50 |
$1,299 |
7.8× |
| Urethrocystogram voiding (74455) |
$707.75 |
$1,415.50 |
3.1× |
| Urethrocystography retrograde rs&i (74450) |
$561.75 |
$1,123.50 |
2.5× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$599 |
$1,198 |
3.6× |
| Us breast unilateral limited (76642) |
$607 |
$1,214 |
7.3× |
| Us chest (76604) |
$475 |
$950 |
4.7× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$526.50 |
$1,053 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$472.25 |
$944.50 |
4.7× |
| Us elastography parenchyma (76981) |
$98.25 |
$196.50 |
1.0× |
| Us encephalogram (76506) |
$699 |
$1,398 |
7.0× |
| Us hips infant static (76886) |
$303.50 |
$607 |
3.6× |
| Us infant hips w manipulation (76885) |
$367 |
$734 |
4.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$439.75 |
$879.50 |
4.4× |
| Us ob detailed single fetus (76811) |
$749 |
$1,498 |
3.3× |
| Us ob limited (76815) |
$304 |
$608 |
3.0× |
| Us ob transvaginal (76817) |
$475 |
$950 |
4.7× |
| Us pelvic non ob complete (76856) |
$686.50 |
$1,373 |
6.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$475 |
$950 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$550 |
$1,100 |
5.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$450.75 |
$901.50 |
4.5× |
| Us retroperitoneal complete (76770) |
$550 |
$1,100 |
5.5× |
| Us retroperitoneal limited (76775) |
$391.75 |
$783.50 |
3.9× |
| Us scrotum and contents (76870) |
$458.25 |
$916.50 |
4.6× |
| Us soft tissue head/neck (76536) |
$532.50 |
$1,065 |
5.3× |
| Us spinal canal and contents (76800) |
$506 |
$1,012 |
5.0× |
| Us transrectal (76872) |
$253.75 |
$507.50 |
2.5× |
| Us transrectal prostate volume (76873) |
$350.50 |
$701 |
3.5× |
| Us, eye b-scan (76512) |
$314.50 |
$629 |
3.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$470.50 |
$941 |
4.7× |
| Venogram extremity bilateral (75822) |
$2,741.25 |
$5,482.50 |
1.8× |
| Venogram Extremity Unilateral (75820) |
$2,383.25 |
$4,766.50 |
1.6× |
| Venography caval inferior serialography rs&i (75825) |
$2,870 |
$5,740 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$2,741.25 |
$5,482.50 |
1.8× |
| Venography renal unilateral selective rs&i (75831) |
$3,157 |
$6,314 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,870 |
$5,740 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$352.50 |
$705 |
4.2× |
| Wrist 2 views (73100) |
$189 |
$378 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$272 |
$544 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$204.50 |
$409 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$433.50 |
$867 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$733 |
$1,466 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$201 |
$402 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$348.50 |
$697 |
4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$224.75 |
$449.50 |
2.2× |
| X-ray exam of femur 2/> (73552) |
$208.50 |
$417 |
2.5× |
| X-ray eye for foreign body (70030) |
$410.50 |
$821 |
4.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$268.25 |
$536.50 |
3.2× |
| X-ray IV pyelogram (ivp) (74400) |
$395.75 |
$791.50 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$339.50 |
$679 |
4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$201 |
$402 |
2.4× |
| X-ray leg, infant (73592) |
$394 |
$788 |
4.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$620.50 |
$1,241 |
6.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$329.50 |
$659 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$359 |
$718 |
4.3× |
| X-ray optic foramen (70190) |
$234.50 |
$469 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$327.50 |
$655 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$1,331.50 |
$2,663 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$238.25 |
$476.50 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$384.50 |
$769 |
3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$335.25 |
$670.50 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$438.50 |
$877 |
4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$204.50 |
$409 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$336.75 |
$673.50 |
4.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$345.50 |
$691 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$620.50 |
$1,241 |
6.2× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,014.50 |
$2,029 |
6.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$160.50 |
$321 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$269 |
$538 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$220 |
$440 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$329.50 |
$659 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$329.50 |
$659 |
3.3× |
| Xr bone length studies (77073) |
$245.50 |
$491 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$345.50 |
$691 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$643 |
$1,286 |
6.4× |
| Xr chest 4+ views (71048) |
$373 |
$746 |
3.7× |
| Xr urogram antegrade (74425) |
$1,332 |
$2,664 |
4.0× |