| 3-D radiotherapy plan dose-volume histograms (77295) |
$7,718.25 |
$10,291 |
5.3× |
| Abdomen 2 views (74019) |
$1,437 |
$1,916 |
13.2× |
| Acute gi blood loss imaging (78278) |
$2,040.75 |
$2,721 |
4.9× |
| Angio Adrenal Bilat Select (75733) |
$6,915.75 |
$9,221 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$16,417.50 |
$21,890 |
5.0× |
| Angiography extremity unilateral rs&i (75710) |
$13,521.75 |
$18,029 |
4.1× |
| Angiography internal mammary rs&i (75756) |
$3,166.50 |
$4,222 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,074.25 |
$4,099 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,020.50 |
$10,694 |
2.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,295.75 |
$11,061 |
2.5× |
| Angiography Spinal Selective Rs&I (75705) |
$12,958.50 |
$17,278 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,745 |
$7,660 |
1.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,751.12 |
$5,001.50 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,221 |
$5,628 |
1.3× |
| Ankle 2 views (73600) |
$566.25 |
$755 |
6.2× |
| Aortogram thoracic (75605) |
$8,838.38 |
$11,784.50 |
1.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$17,811.75 |
$23,749 |
5.4× |
| Aortography abdominal serialography rs&i (75625) |
$15,205.12 |
$20,273.50 |
4.6× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$8,779.12 |
$11,705.50 |
2.7× |
| Artery X-Rays Adrenal Gland (75731) |
$4,362.75 |
$5,817 |
1.3× |
| Arthrogram ankle (73615) |
$935.25 |
$1,247 |
2.6× |
| Arthrogram elbow (73085) |
$848.25 |
$1,131 |
2.3× |
| Arthrogram hip (73525) |
$1,830 |
$2,440 |
5.0× |
| Arthrogram knee (73580) |
$1,090.50 |
$1,454 |
3.0× |
| Arthrogram shoulder (73040) |
$2,424.75 |
$3,233 |
6.7× |
| Arthrogram wrist (73115) |
$1,029 |
$1,372 |
2.8× |
| Basic dosimetry (77300) |
$921.75 |
$1,229 |
6.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,431.75 |
$1,909 |
3.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,153.50 |
$1,538 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$4,398 |
$5,864 |
10.5× |
| Bone age studies (77072) |
$525.75 |
$701 |
4.8× |
| Bone Imaging 3 Phase (78315) |
$6,125.25 |
$8,167 |
14.7× |
| Bone Marrow Imaging Limited Area (78102) |
$645.75 |
$861 |
1.5× |
| Bone survey complete (77075) |
$1,467 |
$1,956 |
13.4× |
| Bone survey infant (77076) |
$561.75 |
$749 |
5.1× |
| Bowel imaging (78290) |
$991.50 |
$1,322 |
2.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$780.75 |
$1,041 |
1.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,987.25 |
$3,983 |
5.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,970 |
$7,960 |
4.0× |
| Brain Imaging Vascular Flow Only (78610) |
$708 |
$944 |
1.2× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$2,798.25 |
$3,731 |
4.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$3,396.75 |
$4,529 |
8.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$2,476.50 |
$3,302 |
4.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,079.25 |
$1,439 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$1,176 |
$1,568 |
12.9× |
| Chest 1 view (71045) |
$613.50 |
$818 |
6.8× |
| Chest xray 3 views (71047) |
$337.50 |
$450 |
3.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,242 |
$1,656 |
6.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$442.50 |
$590 |
0.5× |
| Clavicle complete (73000) |
$645 |
$860 |
7.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$4,261.88 |
$5,682.50 |
39.0× |
| Continuing medical physics consltj pr wk (77336) |
$901.50 |
$1,202 |
6.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$381.75 |
$509 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$11,562 |
$15,416 |
31.7× |
| CT abdomen and pelvis without contrast (74176) |
$9,735.38 |
$12,980.50 |
39.1× |
| CT abdomen w contrast (74160) |
$5,048.25 |
$6,731 |
27.6× |
| CT abdomen w wo contrast (74170) |
$4,359 |
$5,812 |
23.8× |
| CT abdomen w/o contrast (74150) |
$3,810 |
$5,080 |
34.9× |
| CT angio hrt w/3d image (75574) |
$5,227.50 |
$6,970 |
14.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$4,413.75 |
$5,885 |
24.1× |
| CT angiography upper extremity lt (73206) |
$2,782.50 |
$3,710 |
15.2× |
| CT c-spine w/contrast (72126) |
$6,099.38 |
$8,132.50 |
16.7× |
| CT c-spine w/o contrast (72125) |
$3,161.25 |
$4,215 |
29.0× |
| CT cervical spine w&w/o contrast (72127) |
$4,255.50 |
$5,674 |
23.2× |
| CT chest w contrast (71260) |
$3,933 |
$5,244 |
21.5× |
| CT chest w/wo contrast (71270) |
$6,459.75 |
$8,613 |
35.3× |
| CT colonography w/dye (74262) |
$3,963 |
$5,284 |
21.6× |
| CT colonography w/o cntrst (74261) |
$3,963 |
$5,284 |
36.3× |
| CT head/brain with contrast (70460) |
$6,150.38 |
$8,200.50 |
33.6× |
| CT head/brain without and with contrast (70470) |
$4,939.50 |
$6,586 |
27.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,963 |
$5,284 |
10.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$5,598 |
$7,464 |
61.6× |
| CT hrt w/3d image congen (75573) |
$3,963 |
$5,284 |
10.9× |
| CT iac w contrast (70481) |
$2,823.75 |
$3,765 |
15.4× |
| CT limited/localized follow up study (76380) |
$1,189.50 |
$1,586 |
13.1× |
| CT lower ext w/o (73700) |
$3,655.50 |
$4,874 |
33.5× |
| CT lower extremity w wo contrast (73702) |
$7,503.38 |
$10,004.50 |
41.0× |
| CT lower extremity w/contrast material (73701) |
$4,663.88 |
$6,218.50 |
25.5× |
| CT lumbar spine w & w/o contrast (72133) |
$6,761.25 |
$9,015 |
36.9× |
| CT lumbar spine w/contrast (72132) |
$6,219.75 |
$8,293 |
17.1× |
| CT lumbar spine w/o contrast (72131) |
$3,506.25 |
$4,675 |
32.1× |
| CT maxillofacial w contrast (70487) |
$2,946 |
$3,928 |
16.1× |
| CT maxillofacial w/wo contrast (70488) |
$5,787.75 |
$7,717 |
31.6× |
| CT maxillofacial wo contrast (70486) |
$3,864 |
$5,152 |
35.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$5,157 |
$6,876 |
28.2× |
| CT orbits w/o contrast (70480) |
$3,929.25 |
$5,239 |
36.0× |
| CT pelvis w/o contrast (72192) |
$4,221.75 |
$5,629 |
38.7× |
| CT pelvis w/wo contrast (72194) |
$7,014.75 |
$9,353 |
38.3× |
| CT scan of arm combo (73202) |
$5,220.75 |
$6,961 |
28.5× |
| CT soft tissue neck w contrast (70491) |
$3,432.75 |
$4,577 |
18.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$5,481 |
$7,308 |
29.9× |
| CT soft tissue neck w/o contrast (70490) |
$2,905.50 |
$3,874 |
26.6× |
| CT thoracic spine w/contrast (72129) |
$4,924.88 |
$6,566.50 |
26.9× |
| CT thoracic spine w/o contrast (72128) |
$3,161.25 |
$4,215 |
29.0× |
| CT thoracic spine w/wo contrast (72130) |
$6,651.75 |
$8,869 |
36.3× |
| CT thorax w/o contrast (71250) |
$5,490 |
$7,320 |
50.3× |
| CT upper ext wo (73200) |
$3,280.50 |
$4,374 |
30.0× |
| CT upper extremity with contrast (73201) |
$3,813 |
$5,084 |
10.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,804.12 |
$6,405.50 |
26.2× |
| Cta Abdomen (74175) |
$6,308.25 |
$8,411 |
34.4× |
| CTA abdomen pelvis (74174) |
$12,619.50 |
$16,826 |
34.6× |
| CTA chest (71275) |
$3,101.25 |
$4,135 |
16.9× |
| Cta Head (70496) |
$6,536.25 |
$8,715 |
35.7× |
| Cta Neck (70498) |
$5,033.62 |
$6,711.50 |
27.5× |
| Cta Pelvis (72191) |
$3,090.75 |
$4,121 |
16.9× |
| Cystography minimum 3 views rs&i (74430) |
$1,527.75 |
$2,037 |
4.2× |
| Diskography lumbar (72295) |
$15,862.50 |
$21,150 |
7.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$1,694.25 |
$2,259 |
15.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$855 |
$1,140 |
7.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,187.25 |
$1,583 |
10.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$297.75 |
$397 |
3.3× |
| Esophagus (74220) |
$1,325.25 |
$1,767 |
7.2× |
| Facial bones min 3 views (70150) |
$1,140 |
$1,520 |
10.4× |
| Fetal biophysical profile non-stress testing (76818) |
$1,037.62 |
$1,383.50 |
9.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,285.12 |
$1,713.50 |
11.8× |
| Fetal Echo (76825) |
$4,274.25 |
$5,699 |
7.5× |
| Fluoroscopy up to 1 hr (76000) |
$1,758.75 |
$2,345 |
7.1× |
| Foot 2 views (73620) |
$638.25 |
$851 |
7.0× |
| Forearm 2 views (73090) |
$1,059 |
$1,412 |
11.7× |
| Hand 2 views (73120) |
$494.25 |
$659 |
4.5× |
| Heart first pass single,planar (78481) |
$1,644.75 |
$2,193 |
2.9× |
| Heart Infarct Image (78466) |
$829.50 |
$1,106 |
2.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,012.50 |
$5,350 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,905.25 |
$5,207 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,123.75 |
$4,165 |
5.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,473.25 |
$4,631 |
8.3× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$674.25 |
$899 |
1.2× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$1,011 |
$1,348 |
1.8× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$337.50 |
$450 |
0.6× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$1,250.25 |
$1,667 |
1.7× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$954 |
$1,272 |
2.4× |
| Hysterosalpingogram (74740) |
$2,019.75 |
$2,693 |
8.1× |
| Image fusion (77399) |
$1,187.25 |
$1,583 |
8.5× |
| Interstitial radiation source applic complex (77778) |
$8,474.25 |
$11,299 |
11.7× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,052 |
$2,736 |
2.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,945.50 |
$2,594 |
3.4× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,523.62 |
$2,031.50 |
2.6× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$46,524 |
$62,032 |
6.0× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$493.50 |
$658 |
1.2× |
| Kidney imaging morphology (78700) |
$2,187.75 |
$2,917 |
5.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,802.75 |
$3,737 |
4.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,415 |
$3,220 |
4.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,571 |
$3,428 |
4.5× |
| Knee 3 views (73562) |
$1,240.50 |
$1,654 |
13.6× |
| Liver & spleen imaging static only (78215) |
$2,152.50 |
$2,870 |
5.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,095 |
$1,460 |
2.6× |
| Liver imaging static only (78201) |
$1,080 |
$1,440 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$1,140 |
$1,520 |
2.0× |
| Lung perf&ventilat diferentl (78598) |
$2,210.25 |
$2,947 |
3.9× |
| Lung perfusion differential (78597) |
$2,210.25 |
$2,947 |
5.3× |
| Lung ventilation imaging (78579) |
$819.75 |
$1,093 |
2.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,302.38 |
$5,736.50 |
1.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$2,045.25 |
$2,727 |
0.6× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,590 |
$2,120 |
1.0× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,817.25 |
$2,423 |
2.8× |
| Lymphoscintigraphy (78195) |
$3,928.88 |
$5,238.50 |
6.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,305.25 |
$4,407 |
4.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$4,470 |
$5,960 |
12.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$5,845.50 |
$7,794 |
16.0× |
| Mammary ductogram or galactogram multiple (77054) |
$1,186.50 |
$1,582 |
4.8× |
| Mammary ductogram or galactogram single (77053) |
$932.25 |
$1,243 |
3.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,485.75 |
$1,981 |
3.8× |
| MRA head w & w/o contrast (70546) |
$8,073 |
$10,764 |
22.2× |
| MRA head w/o contrast (70544) |
$4,725 |
$6,300 |
19.0× |
| MRA head with contrast (70545) |
$4,092 |
$5,456 |
11.2× |
| MRA neck w contrast (70548) |
$6,276.75 |
$8,369 |
17.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$7,539.38 |
$10,052.50 |
20.7× |
| MRA neck w/o contrast (70547) |
$4,581.75 |
$6,109 |
18.4× |
| MRI abdomen w contrast (74182) |
$6,046.12 |
$8,061.50 |
16.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$6,144.38 |
$8,192.50 |
16.9× |
| MRI abdomen w/o contrast (74181) |
$5,871 |
$7,828 |
23.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,602 |
$6,136 |
5.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,949.75 |
$7,933 |
16.3× |
| MRI bone marrow blood supply (77084) |
$3,839.25 |
$5,119 |
15.4× |
| MRI breast w/o contrast bilateral (77047) |
$4,099.50 |
$5,466 |
16.5× |
| MRI breast wo contrast unilateral (77046) |
$1,963.50 |
$2,618 |
7.9× |
| MRI c-spine with contrast (72142) |
$6,616.50 |
$8,822 |
18.2× |
| MRI cervical spine w/o contrast (72141) |
$4,932.75 |
$6,577 |
19.8× |
| MRI chest w/o & w/contrast material (71552) |
$7,326.75 |
$9,769 |
20.1× |
| MRI chest w/o contrast (71550) |
$4,938 |
$6,584 |
19.8× |
| MRI chest with contrast (71551) |
$5,046.75 |
$6,729 |
6.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,584.75 |
$6,113 |
12.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$6,319.50 |
$8,426 |
17.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,784.25 |
$6,379 |
19.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$4,221 |
$5,628 |
16.9× |
| MRI orbit face neck w contrast (70542) |
$3,271.88 |
$4,362.50 |
9.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$8,808.75 |
$11,745 |
24.2× |
| MRI pelvis w/contrast (72196) |
$4,181.25 |
$5,575 |
11.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$5,477.25 |
$7,303 |
15.0× |
| MRI pelvis w/o contrast (72195) |
$4,904.25 |
$6,539 |
19.7× |
| MRI spectroscopy (76390) |
$3,733.12 |
$4,977.50 |
41.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$9,515.25 |
$12,687 |
26.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$5,223 |
$6,964 |
14.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$6,468 |
$8,624 |
17.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$6,616.50 |
$8,822 |
18.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$6,884.62 |
$9,179.50 |
18.9× |
| MRI temporomandibular joint (70336) |
$4,287 |
$5,716 |
17.2× |
| MRI thoracic spine w/o contrast (72146) |
$4,899.75 |
$6,533 |
19.7× |
| MRI up ext w/o contrast (73218) |
$5,949.75 |
$7,933 |
23.9× |
| MRI upper ext joint w/o contrast (73221) |
$3,795.75 |
$5,061 |
15.2× |
| MRI, joint upper extrem combo (73223) |
$6,608.62 |
$8,811.50 |
18.1× |
| Myelogram Cervical (72240) |
$2,229.75 |
$2,973 |
2.7× |
| Myelogram Lumbar (72265) |
$2,229.75 |
$2,973 |
2.7× |
| Myelogram thoracic (72255) |
$2,229.75 |
$2,973 |
2.7× |
| Myelography 2 or more regions (72270) |
$3,029.25 |
$4,039 |
3.7× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$864.75 |
$1,153 |
1.5× |
| Myocardial infarct spect (78469) |
$1,644.75 |
$2,193 |
2.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$5,971.50 |
$7,962 |
4.4× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$5,971.50 |
$7,962 |
4.4× |
| Myocardial Spect Multiple Studies (78452) |
$8,389.50 |
$11,186 |
6.2× |
| Myocardial spect single study at rest or stress (78451) |
$609.75 |
$813 |
0.5× |
| Neck soft tissue (70360) |
$687.75 |
$917 |
7.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$529.50 |
$706 |
1.3× |
| Nm adrenal scan (78075) |
$1,709.25 |
$2,279 |
1.3× |
| Nm bone marrow wb (78104) |
$1,625.25 |
$2,167 |
3.9× |
| Nm cardiac blood pool multiple (78473) |
$3,350.25 |
$4,467 |
8.0× |
| Nm cisternogram (78630) |
$2,730 |
$3,640 |
4.8× |
| Nm csf leak detection (78650) |
$1,767 |
$2,356 |
1.3× |
| Nm gastric emptying study (78264) |
$3,304.50 |
$4,406 |
7.9× |
| Nm gastroesophageal reflux study (78262) |
$1,337.25 |
$1,783 |
3.2× |
| Nm kidney scan w/flow (78701) |
$1,752 |
$2,336 |
4.2× |
| Nm peritoneal-venous shunt patency (78291) |
$962.25 |
$1,283 |
2.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$411.75 |
$549 |
1.0× |
| Nonvascular shunt X-ray (75809) |
$1,034.25 |
$1,379 |
9.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,581.50 |
$7,442 |
3.9× |
| Nuclear Rx Oral Admin (79005) |
$3,396.75 |
$4,529 |
13.9× |
| Orthopantogram (70355) |
$223.50 |
$298 |
2.5× |
| Osseous survey limited (77074) |
$429 |
$572 |
3.9× |
| Parathyroid Planar Imaging (78070) |
$2,320.50 |
$3,094 |
5.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,443 |
$1,924 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$1,077 |
$1,436 |
9.9× |
| Perineogram (74775) |
$492 |
$656 |
2.0× |
| Peritoneogram after injection (74190) |
$3,571.50 |
$4,762 |
6.3× |
| PET image w/CT, skull-thigh (78815) |
$5,970 |
$7,960 |
4.0× |
| PET imaging CT for attenuation limited area (78814) |
$5,970 |
$7,960 |
4.0× |
| PET imaging for CT attenuation whole body (78816) |
$5,970 |
$7,960 |
4.0× |
| Proton tx delivery complex (77525) |
$1,097.25 |
$1,463 |
0.8× |
| Proton tx delivery simple w/o compensation (77520) |
$672 |
$896 |
1.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,644 |
$6,192 |
1.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,644 |
$6,192 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,543.12 |
$2,057.50 |
3.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$3,942.75 |
$5,257 |
7.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,029.50 |
$2,706 |
3.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$1,188 |
$1,584 |
13.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$786.75 |
$1,049 |
8.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$1,214.25 |
$1,619 |
13.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$439.50 |
$586 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$948.38 |
$1,264.50 |
10.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$1,161 |
$1,548 |
12.8× |
| Radex Hand Minimum 3 Views (73130) |
$1,090.50 |
$1,454 |
12.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$585.75 |
$781 |
6.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$989.25 |
$1,319 |
9.1× |
| Radex Humerus Minimum 2 Views (73060) |
$1,065.75 |
$1,421 |
11.7× |
| Radex Kne 1/2 Views (73560) |
$589.88 |
$786.50 |
6.5× |
| Radex Kne Compl 4/More Views (73564) |
$1,570.50 |
$2,094 |
14.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$855.75 |
$1,141 |
7.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$531 |
$708 |
5.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$326.62 |
$435.50 |
3.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$717.75 |
$957 |
7.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$348 |
$464 |
3.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$620.25 |
$827 |
5.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$729.38 |
$972.50 |
8.0× |
| Radex Toe Minimum 2 Views (73660) |
$516 |
$688 |
5.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$537.75 |
$717 |
4.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$1,133.25 |
$1,511 |
12.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$365.25 |
$487 |
3.3× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$17,656.50 |
$23,542 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$963 |
$1,284 |
10.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$957.75 |
$1,277 |
8.8× |
| Radiologic exam chest 2 views (71046) |
$1,142.25 |
$1,523 |
12.6× |
| Radiologic exam colon single contrast study (74270) |
$1,569 |
$2,092 |
8.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,440.75 |
$1,921 |
7.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,572.75 |
$2,097 |
8.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,426.50 |
$1,902 |
7.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$1,073.25 |
$1,431 |
11.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$818.25 |
$1,091 |
7.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$241.50 |
$322 |
2.2× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$307.50 |
$410 |
1.2× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$162 |
$216 |
0.7× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$469.50 |
$626 |
5.2× |
| Radiological examination surgical specimen (76098) |
$1,291.88 |
$1,722.50 |
2.3× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$829.50 |
$1,106 |
3.4× |
| Renal Cyst Study (74470) |
$4,257.75 |
$5,677 |
7.5× |
| Ribs bilateral 3 views (71110) |
$868.50 |
$1,158 |
8.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$2,155.50 |
$2,874 |
5.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,687 |
$4,916 |
8.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,839.75 |
$6,453 |
8.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,792 |
$5,056 |
6.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,614.50 |
$3,486 |
4.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,271.25 |
$1,695 |
5.2× |
| Rp Therapy Intravenous Administration (79101) |
$881.25 |
$1,175 |
3.6× |
| Sacroiliac Joints < 3 Views (72200) |
$216 |
$288 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,293.75 |
$1,725 |
5.2× |
| Salivary gland imaging (78230) |
$689.25 |
$919 |
1.7× |
| Scapula (73010) |
$402.75 |
$537 |
3.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$123.75 |
$165 |
5.3× |
| Sella turcica (70240) |
$407.25 |
$543 |
4.5× |
| Shoulder 1 view (73020) |
$585 |
$780 |
6.4× |
| Sialogram (70390) |
$580.50 |
$774 |
2.3× |
| Simulation intermediate (77285) |
$1,393.50 |
$1,858 |
3.6× |
| Small bowel series (74250) |
$1,497.75 |
$1,997 |
8.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,445.25 |
$1,927 |
3.7× |
| Special dosimetry (77331) |
$1,203.75 |
$1,605 |
8.6× |
| Special Physics Consult (77370) |
$928.88 |
$1,238.50 |
6.6× |
| Special treatment procedure (77470) |
$2,471.62 |
$3,295.50 |
4.3× |
| Speech evaluation complex (70371) |
$627.75 |
$837 |
2.5× |
| Spine thoracic 3 views (72072) |
$1,428.75 |
$1,905 |
13.1× |
| Splenoportograpy rs&i (75810) |
$4,644 |
$6,192 |
1.4× |
| Stereotactic Body Radiation Delivery (77373) |
$3,866.25 |
$5,155 |
2.1× |
| Superior sagittal sinus venogram (75870) |
$3,175.12 |
$4,233.50 |
1.0× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$927 |
$1,236 |
8.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,884 |
$2,512 |
4.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$740.25 |
$987 |
1.9× |
| Testicular Imaging With Vascular Flow (78761) |
$844.50 |
$1,126 |
2.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,194.12 |
$2,925.50 |
5.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$858 |
$1,144 |
6.1× |
| Thoracolumbar 2 views (72080) |
$794.25 |
$1,059 |
8.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,103.75 |
$2,805 |
3.7× |
| Thyroid imaging w/blood flow (78013) |
$1,157.25 |
$1,543 |
2.8× |
| Thyroid uptake measurement (78012) |
$306 |
$408 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,750.88 |
$2,334.50 |
4.2× |
| Tmj unilateral (70328) |
$180 |
$240 |
2.0× |
| Tomogram (76100) |
$1,186.50 |
$1,582 |
10.9× |
| Treatment device complex (77334) |
$2,204.62 |
$2,939.50 |
5.6× |
| Treatment device intermediate (77333) |
$1,468.50 |
$1,958 |
10.5× |
| Treatment devices simple (77332) |
$894 |
$1,192 |
6.4× |
| Ultrasound breast complete (76641) |
$1,352.25 |
$1,803 |
12.4× |
| Ultrasound Exam Aaa Screen (76706) |
$634.50 |
$846 |
5.8× |
| Ultrasound, abdomen limited (76705) |
$1,877.25 |
$2,503 |
17.2× |
| Umbilical-artery Doppler (OB) (76820) |
$1,104.75 |
$1,473 |
10.1× |
| Unlisted magnetic resonance procedure (76498) |
$2,286 |
$3,048 |
25.2× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$674.25 |
$899 |
6.3× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$1,683.75 |
$2,245 |
12.0× |
| Ureteral reflux study (78740) |
$891 |
$1,188 |
2.1× |
| Urethrocystogram voiding (74455) |
$1,644 |
$2,192 |
6.6× |
| Urethrocystography retrograde rs&i (74450) |
$1,527.75 |
$2,037 |
6.1× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,128.38 |
$1,504.50 |
6.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,064.25 |
$1,419 |
5.8× |
| Us breast unilateral limited (76642) |
$1,234.50 |
$1,646 |
13.6× |
| Us chest (76604) |
$709.88 |
$946.50 |
6.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$2,874 |
$3,832 |
12.7× |
| Us compl joint r-t w/image documentation (76881) |
$937.50 |
$1,250 |
8.6× |
| Us encephalogram (76506) |
$786.38 |
$1,048.50 |
7.2× |
| Us hips infant static (76886) |
$459 |
$612 |
5.1× |
| Us infant hips w manipulation (76885) |
$949.50 |
$1,266 |
10.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$605.25 |
$807 |
5.5× |
| Us ob detailed single fetus (76811) |
$1,269.75 |
$1,693 |
5.1× |
| Us ob limited (76815) |
$932.25 |
$1,243 |
8.5× |
| Us ob transvaginal (76817) |
$1,289.25 |
$1,719 |
11.8× |
| Us pelvic non ob complete (76856) |
$1,983 |
$2,644 |
18.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$1,162.50 |
$1,550 |
10.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,075.50 |
$1,434 |
9.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$533.25 |
$711 |
4.9× |
| Us retroperitoneal complete (76770) |
$1,626.75 |
$2,169 |
14.9× |
| Us retroperitoneal limited (76775) |
$767.25 |
$1,023 |
7.0× |
| Us scrotum and contents (76870) |
$1,177.50 |
$1,570 |
10.8× |
| Us soft tissue head/neck (76536) |
$1,284 |
$1,712 |
11.8× |
| Us spinal canal and contents (76800) |
$592.50 |
$790 |
5.4× |
| Us transrectal (76872) |
$770.62 |
$1,027.50 |
7.1× |
| Us transrectal prostate volume (76873) |
$906.75 |
$1,209 |
8.3× |
| Us, eye b-scan (76512) |
$487.50 |
$650 |
4.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$898.50 |
$1,198 |
8.2× |
| Venogram adrenal unilat (75840) |
$4,221 |
$5,628 |
1.3× |
| Venogram extremity bilateral (75822) |
$3,571.50 |
$4,762 |
2.2× |
| Venogram Extremity Unilateral (75820) |
$1,234.50 |
$1,646 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$12,861.38 |
$17,148.50 |
3.9× |
| Venography caval superior serialography rs&i (75827) |
$4,891.12 |
$6,521.50 |
3.0× |
| Venography Renal Bilateral (75833) |
$6,484.88 |
$8,646.50 |
2.0× |
| Venography renal unilateral selective rs&i (75831) |
$4,221 |
$5,628 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,589.75 |
$11,453 |
2.6× |
| Venous sampling by catheter (75893) |
$4,221 |
$5,628 |
0.7× |
| Wrist 2 views (73100) |
$391.50 |
$522 |
4.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,259.25 |
$1,679 |
11.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$432.75 |
$577 |
4.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,038.50 |
$2,718 |
11.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$438.75 |
$585 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$1,192.50 |
$1,590 |
13.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$2,190.75 |
$2,921 |
20.1× |
| X-ray exam of femur 2/> (73552) |
$1,137 |
$1,516 |
12.5× |
| X-ray eye for foreign body (70030) |
$293.25 |
$391 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$363 |
$484 |
4.0× |
| X-ray IV pyelogram (ivp) (74400) |
$1,554 |
$2,072 |
8.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$286.88 |
$382.50 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$189.75 |
$253 |
2.1× |
| X-ray leg, infant (73592) |
$526.50 |
$702 |
5.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,437 |
$1,916 |
13.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,701.38 |
$2,268.50 |
15.6× |
| X-ray nose-rectum child f.b. (76010) |
$519 |
$692 |
5.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$731.25 |
$975 |
6.7× |
| X-ray retrograde pyelogram (74420) |
$1,344.75 |
$1,793 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$477 |
$636 |
5.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$1,110 |
$1,480 |
10.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,034.25 |
$1,379 |
9.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$616.88 |
$822.50 |
5.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,284.75 |
$1,713 |
14.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,420.50 |
$1,894 |
15.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,291.12 |
$1,721.50 |
11.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$2,834.25 |
$3,779 |
26.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$560.25 |
$747 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$666 |
$888 |
7.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$399 |
$532 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$624.75 |
$833 |
6.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$1,362.75 |
$1,817 |
12.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$1,236.75 |
$1,649 |
11.3× |
| Xr bone length studies (77073) |
$540 |
$720 |
4.9× |
| Xr c-spine 4 or 5 views (72050) |
$2,340 |
$3,120 |
21.4× |
| Xr c-spine 6 or more views (72052) |
$1,551 |
$2,068 |
14.2× |
| Xr chest 4+ views (71048) |
$780 |
$1,040 |
7.1× |
| Xr urogram antegrade (74425) |
$1,166.25 |
$1,555 |
3.2× |