| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,855.60 |
$5,508 |
2.3× |
| Abdomen 2 views (74019) |
$246.40 |
$352 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,229.20 |
$1,756 |
2.6× |
| Angio Adrenal Bilat Select (75733) |
$8,608.60 |
$12,298 |
2.3× |
| Angiography extremity bilateral rs&i (75716) |
$9,146.38 |
$13,066.25 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$5,420.10 |
$7,743 |
1.4× |
| Angiography internal mammary rs&i (75756) |
$6,632.50 |
$9,475 |
1.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,319 |
$6,170 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$9,146.38 |
$13,066.25 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$7,630 |
$10,900 |
2.0× |
| Angiography Spinal Selective Rs&I (75705) |
$16,100 |
$23,000 |
2.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,341.50 |
$13,345 |
1.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,755.20 |
$3,936 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,109.70 |
$5,871 |
1.1× |
| Ankle 2 views (73600) |
$291.38 |
$416.25 |
2.8× |
| Aortogram thoracic (75605) |
$10,398.50 |
$14,855 |
1.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$7,317.10 |
$10,453 |
1.9× |
| Aortography abdominal serialography rs&i (75625) |
$7,317.10 |
$10,453 |
1.9× |
| Artery X-Rays Adrenal Gland (75731) |
$8,199.10 |
$11,713 |
2.2× |
| Arthrogram ankle (73615) |
$1,323.70 |
$1,891 |
3.2× |
| Arthrogram elbow (73085) |
$1,557.50 |
$2,225 |
3.7× |
| Arthrogram hip (73525) |
$1,323.70 |
$1,891 |
3.2× |
| Arthrogram knee (73580) |
$1,323.70 |
$1,891 |
3.2× |
| Arthrogram shoulder (73040) |
$1,023.40 |
$1,462 |
2.4× |
| Arthrogram wrist (73115) |
$1,248.10 |
$1,783 |
3.0× |
| Basic dosimetry (77300) |
$655.20 |
$936 |
4.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,425.20 |
$2,036 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$985.42 |
$1,407.75 |
2.1× |
| Bone age studies (77072) |
$293.30 |
$419 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,463 |
$2,090 |
3.1× |
| Bone survey complete (77075) |
$429.10 |
$613 |
3.4× |
| Bone survey infant (77076) |
$478.80 |
$684 |
3.8× |
| Bowel imaging (78290) |
$1,229.20 |
$1,756 |
2.6× |
| Brachytx isodose complex (77318) |
$1,071.70 |
$1,531 |
2.4× |
| Brachytx isodose intermed (77317) |
$1,131.90 |
$1,617 |
2.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$861 |
$1,230 |
1.9× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,381.80 |
$1,974 |
2.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,174.20 |
$3,106 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,585.40 |
$5,122 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,483.30 |
$2,119 |
3.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,908.90 |
$2,727 |
4.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,696.80 |
$2,424 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$282.80 |
$404 |
2.7× |
| Chest 1 view (71045) |
$212.10 |
$303 |
2.0× |
| Chest xray 3 views (71047) |
$128.80 |
$184 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$582.40 |
$832 |
2.8× |
| Cineradiography/videoradiography (76120) |
$498.40 |
$712 |
4.0× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,901.20 |
$2,716 |
2.0× |
| Clavicle complete (73000) |
$349.65 |
$499.50 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$288.40 |
$412 |
2.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$286.30 |
$409 |
2.7× |
| Continuing medical physics consltj pr wk (77336) |
$479.50 |
$685 |
3.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$429.10 |
$613 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,132.95 |
$1,618.50 |
2.7× |
| CT abdomen and pelvis without contrast (74176) |
$702.45 |
$1,003.50 |
2.5× |
| CT abdomen w contrast (74160) |
$1,025.50 |
$1,465 |
4.9× |
| CT abdomen w wo contrast (74170) |
$1,085.70 |
$1,551 |
5.2× |
| CT abdomen w/o contrast (74150) |
$367.50 |
$525 |
2.9× |
| CT angio hrt w/3d image (75574) |
$497.70 |
$711 |
1.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,130.50 |
$1,615 |
5.4× |
| CT angiography upper extremity lt (73206) |
$847.88 |
$1,211.25 |
4.0× |
| CT c-spine w/contrast (72126) |
$1,355.90 |
$1,937 |
3.2× |
| CT c-spine w/o contrast (72125) |
$367.50 |
$525 |
2.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,085.70 |
$1,551 |
5.2× |
| CT chest w contrast (71260) |
$769.12 |
$1,098.75 |
3.7× |
| CT chest w/wo contrast (71270) |
$1,085.70 |
$1,551 |
5.2× |
| CT head/brain with contrast (70460) |
$1,025.50 |
$1,465 |
4.9× |
| CT head/brain without and with contrast (70470) |
$814.28 |
$1,163.25 |
3.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$756 |
$1,080 |
1.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$261.80 |
$374 |
2.5× |
| CT hrt w/3d image congen (75573) |
$769.12 |
$1,098.75 |
1.8× |
| CT iac w contrast (70481) |
$1,025.50 |
$1,465 |
4.9× |
| CT limited/localized follow up study (76380) |
$294 |
$420 |
2.8× |
| CT lower ext w/o (73700) |
$612.50 |
$875 |
4.9× |
| CT lower extremity w wo contrast (73702) |
$1,085.70 |
$1,551 |
5.2× |
| CT lower extremity w/contrast material (73701) |
$1,281.88 |
$1,831.25 |
6.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,085.70 |
$1,551 |
5.2× |
| CT lumbar spine w/contrast (72132) |
$1,640.80 |
$2,344 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$367.50 |
$525 |
2.9× |
| CT maxillofacial w contrast (70487) |
$1,025.50 |
$1,465 |
4.9× |
| CT maxillofacial w/wo contrast (70488) |
$926.80 |
$1,324 |
4.4× |
| CT maxillofacial wo contrast (70486) |
$367.50 |
$525 |
2.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,085.70 |
$1,551 |
5.2× |
| CT orbits w/o contrast (70480) |
$490 |
$700 |
3.9× |
| CT pelvis w/o contrast (72192) |
$490 |
$700 |
3.9× |
| CT pelvis w/wo contrast (72194) |
$922.60 |
$1,318 |
4.4× |
| CT scan of arm combo (73202) |
$1,085.70 |
$1,551 |
5.2× |
| CT soft tissue neck w contrast (70491) |
$769.12 |
$1,098.75 |
3.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$814.28 |
$1,163.25 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$490 |
$700 |
3.9× |
| CT thoracic spine w/contrast (72129) |
$1,204.70 |
$1,721 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$367.50 |
$525 |
2.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,085.70 |
$1,551 |
5.2× |
| CT thorax w/o contrast (71250) |
$367.50 |
$525 |
2.9× |
| CT upper ext wo (73200) |
$490 |
$700 |
3.9× |
| CT upper extremity with contrast (73201) |
$1,694.88 |
$2,421.25 |
4.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$769.12 |
$1,098.75 |
3.7× |
| Cta Abdomen (74175) |
$1,130.50 |
$1,615 |
5.4× |
| CTA abdomen pelvis (74174) |
$755.30 |
$1,079 |
1.8× |
| CTA chest (71275) |
$847.88 |
$1,211.25 |
4.0× |
| Cta Head (70496) |
$847.88 |
$1,211.25 |
4.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,261 |
$3,230 |
5.4× |
| Cta Neck (70498) |
$847.88 |
$1,211.25 |
4.0× |
| Cta Pelvis (72191) |
$1,130.50 |
$1,615 |
5.4× |
| Cystography minimum 3 views rs&i (74430) |
$985.60 |
$1,408 |
2.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,781.30 |
$8,259 |
2.3× |
| Diskogram cervical (72285) |
$8,786.40 |
$12,552 |
3.8× |
| Diskography lumbar (72295) |
$8,786.40 |
$12,552 |
3.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$395.50 |
$565 |
3.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$882 |
$1,260 |
7.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$361.90 |
$517 |
2.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$361.90 |
$517 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$235.90 |
$337 |
2.3× |
| Dxa bone density study axial skeleton (77085) |
$415.80 |
$594 |
3.3× |
| Echo exam of eye (76529) |
$387.10 |
$553 |
3.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$896.70 |
$1,281 |
3.1× |
| Esophageal motility (78258) |
$1,229.20 |
$1,756 |
2.6× |
| Esophagus (74220) |
$679.70 |
$971 |
3.2× |
| Facial bones min 3 views (70150) |
$395.50 |
$565 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$521.50 |
$745 |
4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$423.50 |
$605 |
3.4× |
| Fetal Echo (76825) |
$1,673.88 |
$2,391.25 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$466.90 |
$667 |
1.6× |
| Foot 2 views (73620) |
$291.38 |
$416.25 |
2.8× |
| Forearm 2 views (73090) |
$174.82 |
$249.75 |
1.7× |
| Functional MRI brain by phys/psych (70555) |
$1,141.70 |
$1,631 |
4.0× |
| Functional MRI brain by tech (70554) |
$1,141.70 |
$1,631 |
4.0× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$710.50 |
$1,015 |
2.5× |
| Hand 2 views (73120) |
$431.38 |
$616.25 |
3.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,142 |
$3,060 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,258.90 |
$3,227 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,520 |
$3,600 |
3.0× |
| Heart Infarct Image (78466) |
$2,624.30 |
$3,749 |
5.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,487.82 |
$7,839.75 |
1.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,608.60 |
$12,298 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,465.10 |
$2,093 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,313.90 |
$1,877 |
2.7× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$2,412.90 |
$3,447 |
3.6× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$2,412.90 |
$3,447 |
3.6× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$2,412.90 |
$3,447 |
3.6× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$3,153.50 |
$4,505 |
3.8× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$1,074.50 |
$1,535 |
2.3× |
| Hysterosalpingogram (74740) |
$531.82 |
$759.75 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$2,773.40 |
$3,962 |
3.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,153.50 |
$4,505 |
3.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,399.60 |
$3,428 |
3.6× |
| Intracavitary Radiation Source Applic Simple (77761) |
$2,412.90 |
$3,447 |
3.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$331.10 |
$473 |
2.6× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,114.40 |
$1,592 |
2.3× |
| Kidney imaging morphology (78700) |
$1,327.20 |
$1,896 |
2.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,347.50 |
$1,925 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,397.90 |
$1,997 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,913.10 |
$2,733 |
2.9× |
| Knee 3 views (73562) |
$349.65 |
$499.50 |
3.4× |
| Liver & spleen imaging static only (78215) |
$1,229.20 |
$1,756 |
2.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,676.50 |
$2,395 |
3.5× |
| Liver imaging static only (78201) |
$2,118.90 |
$3,027 |
3.3× |
| Liver imaging w/vascular flow (78202) |
$3,189.20 |
$4,556 |
4.9× |
| Lung perf&ventilat diferentl (78598) |
$1,464.40 |
$2,092 |
2.3× |
| Lung perfusion differential (78597) |
$1,348.20 |
$1,926 |
2.8× |
| Lung ventilation imaging (78579) |
$1,229.20 |
$1,756 |
2.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,782.80 |
$5,404 |
1.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,428.30 |
$3,469 |
0.6× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,428.30 |
$3,469 |
1.3× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,254.40 |
$1,792 |
1.7× |
| Lymphoscintigraphy (78195) |
$1,465.10 |
$2,093 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,719.20 |
$2,456 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,719.20 |
$2,456 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,908.90 |
$2,727 |
4.6× |
| Magnetic Resonance Elastography (76391) |
$217.70 |
$311 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$860.30 |
$1,229 |
3.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$270.20 |
$386 |
2.6× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$1,684.90 |
$2,407 |
3.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,211.70 |
$1,731 |
2.7× |
| MRA head w & w/o contrast (70546) |
$1,908.90 |
$2,727 |
4.6× |
| MRA head w/o contrast (70544) |
$1,141.70 |
$1,631 |
4.0× |
| MRA head with contrast (70545) |
$1,651.30 |
$2,359 |
3.9× |
| MRA neck w contrast (70548) |
$1,651.30 |
$2,359 |
3.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,908.90 |
$2,727 |
4.6× |
| MRA neck w/o contrast (70547) |
$1,141.70 |
$1,631 |
4.0× |
| MRI abdomen w contrast (74182) |
$1,461.60 |
$2,088 |
3.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,908.90 |
$2,727 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,141.70 |
$1,631 |
4.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,289.40 |
$1,842 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,149 |
$3,070 |
5.1× |
| MRI breast w/o contrast bilateral (77047) |
$1,151.50 |
$1,645 |
4.0× |
| MRI breast wo contrast unilateral (77046) |
$1,151.50 |
$1,645 |
4.0× |
| MRI c-spine with contrast (72142) |
$1,719.20 |
$2,456 |
4.1× |
| MRI cardiac w/o contrast (75557) |
$1,141.70 |
$1,631 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$856.28 |
$1,223.25 |
3.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,908.90 |
$2,727 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,141.70 |
$1,631 |
4.0× |
| MRI chest with contrast (71551) |
$1,461.60 |
$2,088 |
1.6× |
| MRI fetal sngl/1st gestation (74712) |
$1,049.30 |
$1,499 |
3.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,651.30 |
$2,359 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,908.90 |
$2,727 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,141.70 |
$1,631 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,141.70 |
$1,631 |
4.0× |
| MRI orbit face neck w contrast (70542) |
$1,719.20 |
$2,456 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,908.90 |
$2,727 |
4.6× |
| MRI pelvis w/contrast (72196) |
$1,403.50 |
$2,005 |
3.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,759.80 |
$2,514 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,026.20 |
$1,466 |
3.6× |
| MRI spectroscopy (76390) |
$1,628.20 |
$2,326 |
15.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,908.90 |
$2,727 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,719.20 |
$2,456 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,908.90 |
$2,727 |
4.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,719.20 |
$2,456 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,908.90 |
$2,727 |
4.6× |
| MRI temporomandibular joint (70336) |
$1,141.70 |
$1,631 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$856.28 |
$1,223.25 |
3.0× |
| MRI up ext w/o contrast (73218) |
$1,141.70 |
$1,631 |
4.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,427.12 |
$2,038.75 |
5.0× |
| MRI, joint upper extrem combo (73223) |
$1,908.90 |
$2,727 |
4.6× |
| Myelogram Cervical (72240) |
$1,969.10 |
$2,813 |
2.1× |
| Myelogram Lumbar (72265) |
$1,969.10 |
$2,813 |
2.1× |
| Myelogram thoracic (72255) |
$1,969.10 |
$2,813 |
2.1× |
| Myelography 2 or more regions (72270) |
$1,969.10 |
$2,813 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,295.20 |
$6,136 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$6,580 |
$9,400 |
3.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,467.40 |
$6,382 |
2.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,467.40 |
$6,382 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,848.12 |
$4,068.75 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,848.12 |
$4,068.75 |
1.8× |
| N-invas est c ffr sw aly CTA (75580) |
$2,396.10 |
$3,423 |
2.3× |
| Neck soft tissue (70360) |
$233.10 |
$333 |
2.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,074.50 |
$1,535 |
2.3× |
| Nm bone marrow multi (78103) |
$798.70 |
$1,141 |
1.7× |
| Nm bone marrow wb (78104) |
$1,229.20 |
$1,756 |
2.6× |
| Nm cardiac blood pool multiple (78473) |
$1,773.80 |
$2,534 |
3.7× |
| Nm cisternogram (78630) |
$1,696.80 |
$2,424 |
2.6× |
| Nm csf leak detection (78650) |
$2,577.40 |
$3,682 |
1.7× |
| Nm gastric emptying study (78264) |
$1,313.90 |
$1,877 |
2.7× |
| Nm gastroesophageal reflux study (78262) |
$1,229.20 |
$1,756 |
2.6× |
| Nm peritoneal-venous shunt patency (78291) |
$1,229.20 |
$1,756 |
2.6× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,155.70 |
$1,651 |
2.4× |
| Nonvascular shunt X-ray (75809) |
$484.40 |
$692 |
3.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,194.70 |
$7,421 |
3.1× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,229.20 |
$1,756 |
2.6× |
| Nuclear Rx Oral Admin (79005) |
$836.50 |
$1,195 |
3.0× |
| Ob us nuchal meas 1 gest (76813) |
$363.82 |
$519.75 |
2.9× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$277.20 |
$396 |
2.2× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$227.50 |
$325 |
1.8× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$508.38 |
$726.25 |
4.1× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$112 |
$160 |
3.2× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$420 |
$600 |
3.4× |
| Orthopantogram (70355) |
$197.40 |
$282 |
1.9× |
| Osseous survey limited (77074) |
$429.10 |
$613 |
3.4× |
| Parathyrd planar w/spect&CT (78072) |
$2,068.50 |
$2,955 |
3.2× |
| Parathyroid Planar Imaging (78070) |
$945 |
$1,350 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,997.80 |
$2,854 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$219.98 |
$314.25 |
1.8× |
| Perineogram (74775) |
$819.70 |
$1,171 |
2.9× |
| Peritoneogram after injection (74190) |
$1,997.80 |
$2,854 |
3.1× |
| PET image w/CT, skull-thigh (78815) |
$5,280.80 |
$7,544 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$5,280.80 |
$7,544 |
3.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$7,317.10 |
$10,453 |
1.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,619.75 |
$3,742.50 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,045.10 |
$1,493 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,554.70 |
$2,221 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$929.60 |
$1,328 |
1.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$233.10 |
$333 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$291.38 |
$416.25 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$291.38 |
$416.25 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$75.60 |
$108 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$459.20 |
$656 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$180.60 |
$258 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$174.82 |
$249.75 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$349.65 |
$499.50 |
3.4× |
| Radex Hand Minimum 3 Views (73130) |
$174.82 |
$249.75 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$264.60 |
$378 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$401.10 |
$573 |
3.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$452.38 |
$646.25 |
3.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$578.38 |
$826.25 |
4.6× |
| Radex Humerus Minimum 2 Views (73060) |
$291.38 |
$416.25 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$233.10 |
$333 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$350.70 |
$501 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$296.10 |
$423 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$230.30 |
$329 |
2.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$233.80 |
$334 |
1.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$233.10 |
$333 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$233.10 |
$333 |
2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$291.38 |
$416.25 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$169.58 |
$242.25 |
1.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$345.80 |
$494 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$233.10 |
$333 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$532 |
$760 |
4.2× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$52,813.60 |
$75,448 |
6.0× |
| Radiation treatment delivery level 1 (77402) |
$722.75 |
$1,032.50 |
5.9× |
| Radiation treatment delivery level 2 (77407) |
$1,239.35 |
$1,770.50 |
2.7× |
| Radiation treatment delivery level 3 (77412) |
$1,442 |
$2,060 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$282.80 |
$404 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$271.42 |
$387.75 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$224 |
$320 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$609.70 |
$871 |
2.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$507.50 |
$725 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$482.30 |
$689 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$609.70 |
$871 |
2.9× |
| Radiologic examination femur 1 view (73551) |
$330.75 |
$472.50 |
3.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$303.10 |
$433 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$174.82 |
$249.75 |
1.7× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$438.20 |
$626 |
0.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$233.80 |
$334 |
1.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$233.10 |
$333 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$224 |
$320 |
2.1× |
| Radiological examination surgical specimen (76098) |
$695.80 |
$994 |
1.1× |
| Radiopharm Dacryocystography (78660) |
$945 |
$1,350 |
2.0× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,124.90 |
$1,607 |
4.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$1,135.40 |
$1,622 |
4.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$2,142 |
$3,060 |
4.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$2,142 |
$3,060 |
4.6× |
| Renal Cyst Study (74470) |
$2,350.60 |
$3,358 |
3.6× |
| Ribs bilateral 3 views (71110) |
$415.10 |
$593 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,342.60 |
$1,918 |
2.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$5,040 |
$7,200 |
7.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,991.10 |
$4,273 |
4.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,490.08 |
$3,557.25 |
3.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,199.80 |
$1,714 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,514.80 |
$2,164 |
0.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,320.10 |
$4,743 |
2.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$661.50 |
$945 |
2.4× |
| Rp Therapy Intravenous Administration (79101) |
$814.10 |
$1,163 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$268.10 |
$383 |
2.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$579.60 |
$828 |
2.0× |
| Scapula (73010) |
$233.10 |
$333 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$74.55 |
$106.50 |
3.2× |
| Sella turcica (70240) |
$233.10 |
$333 |
2.2× |
| Shoulder 1 view (73020) |
$264.60 |
$378 |
2.5× |
| Simulation intermediate (77285) |
$1,131.90 |
$1,617 |
2.5× |
| Small bowel series (74250) |
$453.60 |
$648 |
2.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$961.80 |
$1,374 |
2.1× |
| Special dosimetry (77331) |
$427 |
$610 |
2.7× |
| Special Physics Consult (77370) |
$2,679.60 |
$3,828 |
16.6× |
| Special treatment procedure (77470) |
$1,536.50 |
$2,195 |
2.3× |
| Speech evaluation complex (70371) |
$570.50 |
$815 |
2.0× |
| Spine thoracic 3 views (72072) |
$385.70 |
$551 |
3.1× |
| Spleen imaging only (78185) |
$1,229.20 |
$1,756 |
2.6× |
| Stereotactic Body Radiation Delivery (77373) |
$6,119.40 |
$8,742 |
2.9× |
| Superior sagittal sinus venogram (75870) |
$2,826.25 |
$4,037.50 |
0.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$263.20 |
$376 |
2.2× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$1,180.20 |
$1,686 |
26.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$1,637.30 |
$2,339 |
13.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$824.60 |
$1,178 |
1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$537.60 |
$768 |
1.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$900.20 |
$1,286 |
3.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,526 |
$2,180 |
3.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$525 |
$750 |
3.3× |
| Thoracolumbar 2 views (72080) |
$233.10 |
$333 |
2.2× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$1,229.20 |
$1,756 |
2.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,348.20 |
$1,926 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$1,087.80 |
$1,554 |
2.3× |
| Thyroid uptake measurement (78012) |
$899.50 |
$1,285 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,185.10 |
$1,693 |
2.5× |
| Tmj unilateral (70328) |
$311.50 |
$445 |
3.0× |
| Tomogram (76100) |
$429.10 |
$613 |
3.4× |
| Treatment device complex (77334) |
$1,487.50 |
$2,125 |
3.3× |
| Treatment device intermediate (77333) |
$529.90 |
$757 |
3.3× |
| Treatment devices simple (77332) |
$529.90 |
$757 |
3.3× |
| Ultrasound breast complete (76641) |
$283.50 |
$405 |
2.3× |
| Ultrasound Exam Aaa Screen (76706) |
$298.20 |
$426 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$408.80 |
$584 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$271.42 |
$387.75 |
2.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$233.10 |
$333 |
2.2× |
| Unlisted fluoroscopic procedure (76496) |
$308 |
$440 |
3.0× |
| Unlisted magnetic resonance procedure (76498) |
$683.90 |
$977 |
6.6× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$1,120 |
$1,600 |
7.0× |
| Unlisted ultrasound procedure (76999) |
$352.80 |
$504 |
3.4× |
| Ureteral reflux study (78740) |
$1,327.20 |
$1,896 |
2.8× |
| Urethrocystogram voiding (74455) |
$636.30 |
$909 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$543.20 |
$776 |
1.9× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$819.70 |
$1,171 |
3.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$819.70 |
$1,171 |
3.9× |
| Us breast unilateral limited (76642) |
$281.40 |
$402 |
2.7× |
| Us chest (76604) |
$398.30 |
$569 |
3.2× |
| Us compl joint r-t w/image documentation (76881) |
$425.60 |
$608 |
3.4× |
| Us elastography parenchyma (76981) |
$361.90 |
$517 |
2.9× |
| Us encephalogram (76506) |
$428.40 |
$612 |
3.4× |
| Us hips infant static (76886) |
$315 |
$450 |
3.0× |
| Us infant hips w manipulation (76885) |
$357.88 |
$511.25 |
3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$234.50 |
$335 |
1.9× |
| Us ob detailed single fetus (76811) |
$870.10 |
$1,243 |
3.0× |
| Us ob limited (76815) |
$408.80 |
$584 |
3.3× |
| Us ob transvaginal (76817) |
$428.40 |
$612 |
3.4× |
| Us pelvic non ob complete (76856) |
$452.90 |
$647 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$361.90 |
$517 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$466.90 |
$667 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$507.50 |
$725 |
4.1× |
| Us retroperitoneal complete (76770) |
$404.25 |
$577.50 |
3.2× |
| Us retroperitoneal limited (76775) |
$391.30 |
$559 |
3.1× |
| Us scrotum and contents (76870) |
$433.30 |
$619 |
3.5× |
| Us soft tissue head/neck (76536) |
$431.90 |
$617 |
3.4× |
| Us spinal canal and contents (76800) |
$282.45 |
$403.50 |
2.3× |
| Us transrectal (76872) |
$452.20 |
$646 |
3.6× |
| Us transrectal prostate volume (76873) |
$484.40 |
$692 |
3.9× |
| Us, eye b-scan (76512) |
$588 |
$840 |
4.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$452.20 |
$646 |
3.6× |
| Vasogram (74440) |
$819.70 |
$1,171 |
2.9× |
| Venogram adrenal unilat (75840) |
$8,608.60 |
$12,298 |
2.3× |
| Venogram extremity bilateral (75822) |
$2,410.10 |
$3,443 |
1.3× |
| Venogram Extremity Unilateral (75820) |
$2,577.40 |
$3,682 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$7,317.10 |
$10,453 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$4,109.70 |
$5,871 |
2.2× |
| Venography Orbital Rs&I (75880) |
$4,109.70 |
$5,871 |
5.5× |
| Venography Renal Bilateral (75833) |
$10,760.75 |
$15,372.50 |
2.8× |
| Venography renal unilateral selective rs&i (75831) |
$7,317.10 |
$10,453 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,290.62 |
$11,843.75 |
2.2× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$4,109.70 |
$5,871 |
5.5× |
| Venous sampling by catheter (75893) |
$10,398.50 |
$14,855 |
1.6× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$2,202.90 |
$3,147 |
3.4× |
| Vertebral fracture assessment via dxa (77086) |
$233.10 |
$333 |
2.2× |
| Wrist 2 views (73100) |
$233.10 |
$333 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$429.10 |
$613 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$291.38 |
$416.25 |
2.8× |
| X-ray b.e. reductn intuss (74283) |
$530.60 |
$758 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$772.80 |
$1,104 |
3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$291.38 |
$416.25 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$94.50 |
$135 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$157.50 |
$225 |
1.3× |
| X-ray exam of femur 2/> (73552) |
$94.50 |
$135 |
0.9× |
| X-ray eye for foreign body (70030) |
$291.38 |
$416.25 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$233.10 |
$333 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$819.70 |
$1,171 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$233.10 |
$333 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$353.50 |
$505 |
3.4× |
| X-ray leg, infant (73592) |
$291.38 |
$416.25 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$361.90 |
$517 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$429.10 |
$613 |
3.4× |
| X-ray nose-rectum child f.b. (76010) |
$233.80 |
$334 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$214.72 |
$306.75 |
1.7× |
| X-ray retrograde pyelogram (74420) |
$1,199.10 |
$1,713 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$311.50 |
$445 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$296.10 |
$423 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$536.38 |
$766.25 |
4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$361.90 |
$517 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$233.10 |
$333 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$233.10 |
$333 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$429.10 |
$613 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$361.90 |
$517 |
2.9× |
| X-Ray Small Bowel Enteroclysis (74251) |
$527.10 |
$753 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$219.10 |
$313 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$233.10 |
$333 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$233.10 |
$333 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$336 |
$480 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$390.60 |
$558 |
3.1× |
| Xr bone length studies (77073) |
$286.30 |
$409 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$429.10 |
$613 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$429.10 |
$613 |
3.4× |
| Xr chest 4+ views (71048) |
$246.40 |
$352 |
2.0× |
| Xr urogram antegrade (74425) |
$872.90 |
$1,247 |
2.1× |