| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,437 |
$8,874 |
3.3× |
| Abdomen 2 views (74019) |
$229.50 |
$459 |
2.3× |
| Acute gi blood loss imaging (78278) |
$1,045 |
$2,090 |
2.7× |
| Angio Adrenal Bilat Select (75733) |
$2,870 |
$5,740 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,129.50 |
$6,259 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,762.50 |
$7,525 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$2,870 |
$5,740 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,039.50 |
$10,079 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,870 |
$5,740 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,878 |
$7,756 |
1.3× |
| Angiography Spinal Selective Rs&I (75705) |
$5,039.50 |
$10,079 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,792.50 |
$13,585 |
1.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,870 |
$5,740 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,870 |
$5,740 |
0.9× |
| Ankle 2 views (73600) |
$166.50 |
$333 |
2.0× |
| Aortogram thoracic (75605) |
$5,039.50 |
$10,079 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,006 |
$4,012 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$3,129.50 |
$6,259 |
1.0× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$2,870 |
$5,740 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,870 |
$5,740 |
0.9× |
| Arthrogram ankle (73615) |
$942 |
$1,884 |
2.8× |
| Arthrogram hip (73525) |
$532 |
$1,064 |
1.6× |
| Arthrogram knee (73580) |
$2,894 |
$5,788 |
8.6× |
| Arthrogram shoulder (73040) |
$1,002.50 |
$2,005 |
3.0× |
| Arthrogram wrist (73115) |
$1,077 |
$2,154 |
3.2× |
| Basic dosimetry (77300) |
$343.25 |
$686.50 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$718 |
$1,436 |
1.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,054.50 |
$2,109 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,138.50 |
$2,277 |
2.9× |
| Bone age studies (77072) |
$209.50 |
$419 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,138.50 |
$2,277 |
2.9× |
| Bone Marrow Imaging Limited Area (78102) |
$677 |
$1,354 |
1.8× |
| Bone survey complete (77075) |
$359.50 |
$719 |
3.6× |
| Bone survey infant (77076) |
$216 |
$432 |
2.1× |
| Bowel imaging (78290) |
$873 |
$1,746 |
2.3× |
| Brachytx isodose complex (77318) |
$1,292.50 |
$2,585 |
3.6× |
| Brachytx isodose intermed (77317) |
$907.50 |
$1,815 |
2.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$619 |
$1,238 |
1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,113.50 |
$2,227 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,541.50 |
$3,083 |
1.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$978.50 |
$1,957 |
1.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,238.50 |
$2,477 |
3.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$948.50 |
$1,897 |
2.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$988.50 |
$1,977 |
1.9× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$729.50 |
$1,459 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$193.50 |
$387 |
2.3× |
| Chest 1 view (71045) |
$100.50 |
$201 |
1.2× |
| Chest xray 3 views (71047) |
$143.50 |
$287 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$303 |
$606 |
1.8× |
| Clavicle complete (73000) |
$167.50 |
$335 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| Continuing medical physics consltj pr wk (77336) |
$468.50 |
$937 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,415.50 |
$2,831 |
4.2× |
| CT abdomen and pelvis without contrast (74176) |
$849 |
$1,698 |
3.7× |
| CT abdomen w contrast (74160) |
$1,097 |
$2,194 |
6.5× |
| CT abdomen w wo contrast (74170) |
$1,235.50 |
$2,471 |
7.3× |
| CT abdomen w/o contrast (74150) |
$560 |
$1,120 |
5.5× |
| CT angio hrt w/3d image (75574) |
$881.50 |
$1,763 |
2.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,271 |
$2,542 |
7.5× |
| CT angiography upper extremity lt (73206) |
$1,354 |
$2,708 |
8.0× |
| CT c-spine w/contrast (72126) |
$1,085.50 |
$2,171 |
3.2× |
| CT c-spine w/o contrast (72125) |
$560 |
$1,120 |
5.5× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,259.50 |
$2,519 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,085.50 |
$2,171 |
6.4× |
| CT chest w contrast (71260) |
$1,099 |
$2,198 |
6.5× |
| CT chest w/wo contrast (71270) |
$1,235.50 |
$2,471 |
7.3× |
| CT head/brain with contrast (70460) |
$1,179.50 |
$2,359 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,235.50 |
$2,471 |
7.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$936.25 |
$1,872.50 |
2.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT hrt w/3d image congen (75573) |
$1,754 |
$3,508 |
5.2× |
| CT iac w contrast (70481) |
$1,097 |
$2,194 |
6.5× |
| CT limited/localized follow up study (76380) |
$374.50 |
$749 |
4.4× |
| CT lower ext w/o (73700) |
$560 |
$1,120 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$1,085.50 |
$2,171 |
6.4× |
| CT lower extremity w/contrast material (73701) |
$1,097 |
$2,194 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,085.50 |
$2,171 |
6.4× |
| CT lumbar spine w/contrast (72132) |
$1,085.50 |
$2,171 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$560 |
$1,120 |
5.5× |
| CT maxillofacial w contrast (70487) |
$1,097 |
$2,194 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,328.50 |
$2,657 |
7.8× |
| CT maxillofacial wo contrast (70486) |
$560 |
$1,120 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,235.50 |
$2,471 |
7.3× |
| CT orbits w/o contrast (70480) |
$560 |
$1,120 |
5.5× |
| CT pelvis w/o contrast (72192) |
$839.50 |
$1,679 |
8.3× |
| CT pelvis w/wo contrast (72194) |
$1,328.50 |
$2,657 |
7.8× |
| CT scan of arm combo (73202) |
$1,167 |
$2,334 |
6.9× |
| CT soft tissue neck w contrast (70491) |
$1,097 |
$2,194 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,235.50 |
$2,471 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$560 |
$1,120 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$1,085.50 |
$2,171 |
6.4× |
| CT thoracic spine w/o contrast (72128) |
$560 |
$1,120 |
5.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,085.50 |
$2,171 |
6.4× |
| CT thorax w/o contrast (71250) |
$559.75 |
$1,119.50 |
5.5× |
| CT unlisted procedure (76497) |
$414 |
$828 |
4.9× |
| CT upper ext wo (73200) |
$560 |
$1,120 |
5.5× |
| CT upper extremity with contrast (73201) |
$1,097 |
$2,194 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,198 |
$2,396 |
7.1× |
| Cta Abdomen (74175) |
$1,259.50 |
$2,519 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,716 |
$3,432 |
5.1× |
| CTA chest (71275) |
$1,259.50 |
$2,519 |
7.4× |
| Cta Head (70496) |
$1,259.50 |
$2,519 |
7.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,259.50 |
$2,519 |
3.7× |
| Cta Neck (70498) |
$1,099 |
$2,198 |
6.5× |
| Cta Pelvis (72191) |
$1,259.50 |
$2,519 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$487.50 |
$975 |
1.4× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$460 |
$920 |
2.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,891.50 |
$3,783 |
0.9× |
| Diskogram cervical (72285) |
$3,343.50 |
$6,687 |
1.8× |
| Diskography lumbar (72295) |
$3,610.50 |
$7,221 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$338 |
$676 |
3.3× |
| Esophagus (74220) |
$360 |
$720 |
2.1× |
| Facial bones min 3 views (70150) |
$241.50 |
$483 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$214.50 |
$429 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$477.50 |
$955 |
4.7× |
| Fluoroscopy up to 1 hr (76000) |
$446.50 |
$893 |
1.9× |
| Foot 2 views (73620) |
$160.50 |
$321 |
1.9× |
| Forearm 2 views (73090) |
$160.75 |
$321.50 |
1.9× |
| Hand 2 views (73120) |
$229.50 |
$459 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,718.50 |
$3,437 |
2.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,893.50 |
$7,787 |
5.8× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$4,331 |
$8,662 |
6.4× |
| Heart Infarct Image (78466) |
$754.50 |
$1,509 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,047 |
$2,094 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,047 |
$2,094 |
2.7× |
| Hysterosalpingogram (74740) |
$880 |
$1,760 |
3.8× |
| Interstitial radiation source applic complex (77778) |
$4,807 |
$9,614 |
7.1× |
| Kidney imaging morphology (78700) |
$873 |
$1,746 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,287.50 |
$2,575 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,287.50 |
$2,575 |
2.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,375 |
$4,750 |
4.5× |
| Knee 3 views (73562) |
$188 |
$376 |
2.2× |
| Liver & spleen imaging static only (78215) |
$794 |
$1,588 |
2.1× |
| Lung perf&ventilat diferentl (78598) |
$1,134 |
$2,268 |
2.2× |
| Lymphoscintigraphy (78195) |
$907.50 |
$1,815 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,886 |
$3,772 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,886 |
$3,772 |
5.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,626 |
$3,252 |
4.8× |
| Mammary ductogram or galactogram multiple (77054) |
$345.50 |
$691 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$567.50 |
$1,135 |
2.5× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$117 |
$234 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,490 |
$4,980 |
6.9× |
| 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) |
$2,455.50 |
$4,911 |
7.3× |
| MRA head w/o contrast (70544) |
$1,467.50 |
$2,935 |
6.4× |
| MRA head with contrast (70545) |
$2,005 |
$4,010 |
5.9× |
| MRA neck w contrast (70548) |
$2,005 |
$4,010 |
5.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,974 |
$3,948 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,467.50 |
$2,935 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,886 |
$3,772 |
5.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,974 |
$3,948 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,381 |
$2,762 |
6.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,886 |
$3,772 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,974 |
$3,948 |
5.8× |
| MRI bone marrow blood supply (77084) |
$1,232.50 |
$2,465 |
5.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,035 |
$2,070 |
4.5× |
| MRI breast wo contrast unilateral (77046) |
$1,035 |
$2,070 |
4.5× |
| MRI c-spine with contrast (72142) |
$2,042.50 |
$4,085 |
6.1× |
| MRI cardiac w/o contrast (75557) |
$358 |
$716 |
1.6× |
| MRI cervical spine w/o contrast (72141) |
$1,467.50 |
$2,935 |
6.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,974 |
$3,948 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,381 |
$2,762 |
6.0× |
| MRI chest with contrast (71551) |
$1,886 |
$3,772 |
2.5× |
| MRI fetal sngl/1st gestation (74712) |
$366.50 |
$733 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,886 |
$3,772 |
5.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,309.50 |
$4,619 |
6.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,381 |
$2,762 |
6.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,467.50 |
$2,935 |
6.4× |
| MRI orbit face neck w contrast (70542) |
$2,005 |
$4,010 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,455.50 |
$4,911 |
7.3× |
| MRI pelvis w/contrast (72196) |
$1,886 |
$3,772 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,974 |
$3,948 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$1,381 |
$2,762 |
6.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,005 |
$4,010 |
5.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,886 |
$3,772 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,886 |
$3,772 |
5.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,886 |
$3,772 |
5.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,886 |
$3,772 |
5.6× |
| MRI temporomandibular joint (70336) |
$1,381 |
$2,762 |
6.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,381 |
$2,762 |
6.0× |
| MRI up ext w/o contrast (73218) |
$1,381 |
$2,762 |
6.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,381 |
$2,762 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$2,309.50 |
$4,619 |
6.8× |
| Myelogram Cervical (72240) |
$1,394.50 |
$2,789 |
1.8× |
| Myelogram Lumbar (72265) |
$1,216 |
$2,432 |
1.6× |
| Myelogram thoracic (72255) |
$1,305.50 |
$2,611 |
1.7× |
| Myelography 2 or more regions (72270) |
$1,847 |
$3,694 |
2.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,366.50 |
$8,733 |
3.5× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,054.50 |
$2,109 |
2.0× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$4,840.50 |
$9,681 |
2.3× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,104.50 |
$6,209 |
2.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,840.50 |
$9,681 |
2.3× |
| Myocardial infarct spect (78469) |
$1,507 |
$3,014 |
2.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,688.50 |
$5,377 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,812 |
$5,624 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$2,688.50 |
$5,377 |
2.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,104.50 |
$6,209 |
2.2× |
| N-invas est c ffr sw aly CTA (75580) |
$2,073 |
$4,146 |
2.5× |
| Neck soft tissue (70360) |
$100.50 |
$201 |
1.2× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$739.50 |
$1,479 |
2.0× |
| Nm cisternogram (78630) |
$1,447 |
$2,894 |
2.8× |
| Nm csf leak detection (78650) |
$2,137 |
$4,274 |
1.7× |
| Nm gastric emptying study (78264) |
$1,138.50 |
$2,277 |
2.9× |
| Nm gastroesophageal reflux study (78262) |
$1,102 |
$2,204 |
2.8× |
| Nm peritoneal-venous shunt patency (78291) |
$692.50 |
$1,385 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,437 |
$8,874 |
3.3× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,153 |
$2,306 |
3.0× |
| Nuclear Rx Oral Admin (79005) |
$1,292.50 |
$2,585 |
5.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$493 |
$986 |
4.9× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$51 |
$102 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$1,134 |
$2,268 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$787 |
$1,574 |
2.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,651.50 |
$3,303 |
4.3× |
| Pelvis 1 or 2 views (72170) |
$149.50 |
$299 |
1.5× |
| Perineogram (74775) |
$537 |
$1,074 |
2.3× |
| Peritoneogram after injection (74190) |
$1,114.50 |
$2,229 |
2.1× |
| PET image w/CT, skull-thigh (78815) |
$4,320.50 |
$8,641 |
3.1× |
| PET imaging CT for attenuation limited area (78814) |
$4,366.50 |
$8,733 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$4,102 |
$8,204 |
3.0× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,448.50 |
$4,897 |
2.0× |
| PET whole body (78813) |
$2,772.50 |
$5,545 |
2.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$2,772.50 |
$5,545 |
2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$988.50 |
$1,977 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,134 |
$2,268 |
2.2× |
| 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) |
$685 |
$1,370 |
1.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$168.50 |
$337 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$160.50 |
$321 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$179 |
$358 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$138.50 |
$277 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$258 |
$516 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$160.50 |
$321 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$168.50 |
$337 |
2.0× |
| Radex Hand Minimum 3 Views (73130) |
$198.50 |
$397 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$244.50 |
$489 |
2.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$231 |
$462 |
2.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$229.50 |
$459 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$225.50 |
$451 |
2.2× |
| Radex Humerus Minimum 2 Views (73060) |
$179 |
$358 |
2.1× |
| Radex Kne 1/2 Views (73560) |
$184.75 |
$369.50 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$241 |
$482 |
2.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$235 |
$470 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$161 |
$322 |
1.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$220.75 |
$441.50 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$179 |
$358 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$200 |
$400 |
2.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$359 |
$718 |
3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$224.50 |
$449 |
2.7× |
| Radex Toe Minimum 2 Views (73660) |
$160.50 |
$321 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$146 |
$292 |
1.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$168.50 |
$337 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$263 |
$526 |
2.6× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$8,973.50 |
$17,947 |
1.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,175.50 |
$14,351 |
1.0× |
| Radiation treatment delivery level 1 (77402) |
$989 |
$1,978 |
10.0× |
| Radiation treatment delivery level 2 (77407) |
$1,572.50 |
$3,145 |
4.2× |
| Radiation treatment delivery level 3 (77412) |
$1,747 |
$3,494 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$168.50 |
$337 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$224 |
$448 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$188.50 |
$377 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$445.50 |
$891 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$354 |
$708 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$454 |
$908 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$435.25 |
$870.50 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$194 |
$388 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$164.50 |
$329 |
2.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$283 |
$566 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$283 |
$566 |
2.8× |
| Radiological examination surgical specimen (76098) |
$773.50 |
$1,547 |
1.5× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$1,292.50 |
$2,585 |
5.7× |
| Renal Cyst Study (74470) |
$678.50 |
$1,357 |
1.3× |
| Ribs bilateral 3 views (71110) |
$329 |
$658 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$812.50 |
$1,625 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,237.50 |
$2,475 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,681.50 |
$5,363 |
5.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,136 |
$4,272 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,774.75 |
$5,549.50 |
5.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,681.50 |
$5,363 |
2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,104.50 |
$6,209 |
2.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,736 |
$5,472 |
2.2× |
| Rp Therapy Intravenous Administration (79101) |
$952.50 |
$1,905 |
4.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$365 |
$730 |
1.6× |
| Scapula (73010) |
$205.50 |
$411 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$60.50 |
$121 |
2.6× |
| Sella turcica (70240) |
$130.50 |
$261 |
1.6× |
| Shoulder 1 view (73020) |
$220.50 |
$441 |
2.6× |
| Sialogram (70390) |
$698 |
$1,396 |
3.0× |
| Simulation intermediate (77285) |
$1,456 |
$2,912 |
4.0× |
| Small bowel series (74250) |
$400.50 |
$801 |
2.4× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$978.50 |
$1,957 |
2.7× |
| Special dosimetry (77331) |
$414 |
$828 |
3.2× |
| Special Physics Consult (77370) |
$336 |
$672 |
2.6× |
| Special treatment procedure (77470) |
$1,688.50 |
$3,377 |
3.2× |
| Spine thoracic 3 views (72072) |
$234.50 |
$469 |
2.3× |
| Splenoportograpy rs&i (75810) |
$2,870 |
$5,740 |
0.9× |
| Stereotactic Body Radiation Delivery (77373) |
$2,077.50 |
$4,155 |
1.2× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$130.50 |
$261 |
1.3× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$130.50 |
$261 |
1.3× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$47.50 |
$95 |
1.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$973.50 |
$1,947 |
2.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$484 |
$968 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$918.50 |
$1,837 |
2.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,578 |
$3,156 |
4.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$580 |
$1,160 |
4.5× |
| Thoracolumbar 2 views (72080) |
$173.50 |
$347 |
2.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,560.50 |
$3,121 |
3.0× |
| Thyroid imaging w/blood flow (78013) |
$546 |
$1,092 |
1.4× |
| Thyroid uptake measurement (78012) |
$406 |
$812 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$763.50 |
$1,527 |
2.0× |
| Tmj unilateral (70328) |
$220.50 |
$441 |
2.6× |
| Tomogram (76100) |
$385 |
$770 |
3.8× |
| Treatment device complex (77334) |
$787.50 |
$1,575 |
2.2× |
| Treatment device intermediate (77333) |
$665.50 |
$1,331 |
5.1× |
| Treatment devices simple (77332) |
$715.50 |
$1,431 |
5.5× |
| Ultrasound breast complete (76641) |
$291 |
$582 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$438 |
$876 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$288 |
$576 |
2.8× |
| Ureteral reflux study (78740) |
$609 |
$1,218 |
1.6× |
| Urethrocystogram voiding (74455) |
$649.50 |
$1,299 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$547.25 |
$1,094.50 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$670 |
$1,340 |
3.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$715 |
$1,430 |
4.2× |
| Us breast unilateral limited (76642) |
$262 |
$524 |
3.1× |
| Us chest (76604) |
$382.50 |
$765 |
3.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$365.50 |
$731 |
1.7× |
| Us compl joint r-t w/image documentation (76881) |
$310.50 |
$621 |
3.1× |
| Us encephalogram (76506) |
$395.50 |
$791 |
3.9× |
| Us infant hips w manipulation (76885) |
$224.50 |
$449 |
2.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$219.50 |
$439 |
2.2× |
| Us ob limited (76815) |
$395.50 |
$791 |
3.9× |
| Us ob transvaginal (76817) |
$461 |
$922 |
4.6× |
| Us pelvic non ob complete (76856) |
$381.50 |
$763 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$294.25 |
$588.50 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$331 |
$662 |
3.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$251 |
$502 |
2.5× |
| Us retroperitoneal complete (76770) |
$455.50 |
$911 |
4.5× |
| Us retroperitoneal limited (76775) |
$329 |
$658 |
3.3× |
| Us scrotum and contents (76870) |
$356.50 |
$713 |
3.5× |
| Us soft tissue head/neck (76536) |
$349 |
$698 |
3.5× |
| Us transrectal (76872) |
$479.50 |
$959 |
4.7× |
| Us transrectal prostate volume (76873) |
$369.50 |
$739 |
3.7× |
| Us, eye b-scan (76512) |
$204.50 |
$409 |
2.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$470.50 |
$941 |
4.7× |
| Venogram adrenal unilat (75840) |
$2,870 |
$5,740 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,802.50 |
$3,605 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$1,802.50 |
$3,605 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$3,762.50 |
$7,525 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$3,492 |
$6,984 |
2.3× |
| Venography Renal Bilateral (75833) |
$3,621.50 |
$7,243 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$2,870 |
$5,740 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,698 |
$3,396 |
0.6× |
| Venous sampling by catheter (75893) |
$5,039.50 |
$10,079 |
0.9× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$762.50 |
$1,525 |
1.5× |
| Vertebral fracture assessment via dxa (77086) |
$172 |
$344 |
2.0× |
| Wrist 2 views (73100) |
$159.50 |
$319 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$329 |
$658 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$209 |
$418 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$603 |
$1,206 |
3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$169.50 |
$339 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$160.50 |
$321 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$230 |
$460 |
2.3× |
| X-ray exam of femur 2/> (73552) |
$160.50 |
$321 |
1.9× |
| X-ray eye for foreign body (70030) |
$160.50 |
$321 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$193.50 |
$387 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$877.50 |
$1,755 |
5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$208.50 |
$417 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$316.50 |
$633 |
3.8× |
| X-ray leg, infant (73592) |
$146 |
$292 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$203.50 |
$407 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$338 |
$676 |
3.3× |
| X-ray optic foramen (70190) |
$193.50 |
$387 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$241.50 |
$483 |
2.4× |
| X-ray retrograde pyelogram (74420) |
$838 |
$1,676 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$220.50 |
$441 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$219 |
$438 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$285 |
$570 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$200 |
$400 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$179 |
$358 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$224.50 |
$449 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$274.50 |
$549 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$167.50 |
$335 |
1.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$499.50 |
$999 |
2.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$134 |
$268 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$216 |
$432 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$210 |
$420 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$229.50 |
$459 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$293.50 |
$587 |
2.9× |
| Xr bone length studies (77073) |
$235 |
$470 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$274.50 |
$549 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$321 |
$642 |
3.2× |
| Xr chest 4+ views (71048) |
$232.50 |
$465 |
2.3× |
| Xr urogram antegrade (74425) |
$1,141.50 |
$2,283 |
3.4× |