| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,544 |
$5,088 |
1.9× |
| Abdomen 2 views (74019) |
$222.75 |
$445.50 |
2.2× |
| Acute gi blood loss imaging (78278) |
$660.50 |
$1,321 |
1.7× |
| Angio Adrenal Bilat Select (75733) |
$3,312 |
$6,624 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$2,731.75 |
$5,463.50 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,346.50 |
$4,693 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$662 |
$1,324 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,787.25 |
$3,574.50 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,104.50 |
$6,209 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,731 |
$7,462 |
1.2× |
| Angiography Spinal Selective Rs&I (75705) |
$5,876 |
$11,752 |
1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,246.50 |
$6,493 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,500.50 |
$3,001 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,737.50 |
$7,475 |
1.2× |
| Ankle 2 views (73600) |
$191 |
$382 |
2.3× |
| Aortogram thoracic (75605) |
$2,763 |
$5,526 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,408.25 |
$4,816.50 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,421.25 |
$4,842.50 |
0.8× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,312 |
$6,624 |
1.1× |
| Artery X-Rays Adrenal Gland (75731) |
$3,428 |
$6,856 |
1.1× |
| Arthrogram hip (73525) |
$665 |
$1,330 |
2.0× |
| Arthrogram knee (73580) |
$1,305.50 |
$2,611 |
3.9× |
| Arthrogram shoulder (73040) |
$502 |
$1,004 |
1.5× |
| Arthrogram wrist (73115) |
$543 |
$1,086 |
1.6× |
| Basic dosimetry (77300) |
$508.25 |
$1,016.50 |
3.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$788 |
$1,576 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$911.50 |
$1,823 |
2.4× |
| Bone age studies (77072) |
$176.50 |
$353 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$783.25 |
$1,566.50 |
2.0× |
| Bone Marrow Imaging Limited Area (78102) |
$709.25 |
$1,418.50 |
1.8× |
| Bone survey complete (77075) |
$304 |
$608 |
3.0× |
| Bone survey infant (77076) |
$285.50 |
$571 |
2.8× |
| Bowel imaging (78290) |
$665 |
$1,330 |
1.7× |
| Brachytx isodose complex (77318) |
$745 |
$1,490 |
2.1× |
| Brachytx isodose intermed (77317) |
$739.50 |
$1,479 |
2.0× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$286 |
$572 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,740.50 |
$3,481 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,842 |
$7,684 |
2.8× |
| Brain Imaging Vascular Flow Only (78610) |
$687.50 |
$1,375 |
1.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$953 |
$1,906 |
2.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,480 |
$2,960 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,480 |
$2,960 |
4.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$785 |
$1,570 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$176.50 |
$353 |
2.1× |
| Chest 1 view (71045) |
$158.50 |
$317 |
1.9× |
| Chest xray 3 views (71047) |
$161 |
$322 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$421.25 |
$842.50 |
2.5× |
| Clavicle complete (73000) |
$273 |
$546 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| Continuing medical physics consltj pr wk (77336) |
$343 |
$686 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,757.75 |
$3,515.50 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,056.50 |
$2,113 |
4.6× |
| CT abdomen w contrast (74160) |
$1,576.50 |
$3,153 |
9.3× |
| CT abdomen w wo contrast (74170) |
$1,757.75 |
$3,515.50 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,019.50 |
$2,039 |
10.1× |
| CT angio hrt w/3d image (75574) |
$1,253.75 |
$2,507.50 |
3.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,844.50 |
$3,689 |
10.9× |
| CT angiography upper extremity lt (73206) |
$1,844.50 |
$3,689 |
10.9× |
| CT c-spine w/contrast (72126) |
$1,576.50 |
$3,153 |
4.7× |
| CT c-spine w/o contrast (72125) |
$1,019.50 |
$2,039 |
10.1× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,753.50 |
$3,507 |
10.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,398.75 |
$2,797.50 |
8.2× |
| CT chest w contrast (71260) |
$1,633.50 |
$3,267 |
9.6× |
| CT chest w/wo contrast (71270) |
$1,757.75 |
$3,515.50 |
10.4× |
| CT colonography screening (74263) |
$1,004 |
$2,008 |
4.4× |
| CT colonography w/dye (74262) |
$291.50 |
$583 |
1.7× |
| CT colonography w/o cntrst (74261) |
$721.50 |
$1,443 |
7.1× |
| CT head/brain with contrast (70460) |
$1,576.50 |
$3,153 |
9.3× |
| CT head/brain without and with contrast (70470) |
$1,642 |
$3,284 |
9.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,156.50 |
$2,313 |
3.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT hrt w/3d image congen (75573) |
$1,075.75 |
$2,151.50 |
3.2× |
| CT iac w contrast (70481) |
$1,576.50 |
$3,153 |
9.3× |
| CT limited/localized follow up study (76380) |
$207 |
$414 |
2.5× |
| CT lower ext w/o (73700) |
$1,056.50 |
$2,113 |
10.4× |
| CT lower extremity w wo contrast (73702) |
$1,694 |
$3,388 |
10.0× |
| CT lower extremity w/contrast material (73701) |
$1,633.50 |
$3,267 |
9.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,042.50 |
$2,085 |
6.1× |
| CT lumbar spine w/contrast (72132) |
$1,576.50 |
$3,153 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,019.50 |
$2,039 |
10.1× |
| CT maxillofacial w contrast (70487) |
$1,576.50 |
$3,153 |
9.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,670 |
$3,340 |
9.8× |
| CT maxillofacial wo contrast (70486) |
$1,019.50 |
$2,039 |
10.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,757.75 |
$3,515.50 |
10.4× |
| CT orbits w/o contrast (70480) |
$1,019.50 |
$2,039 |
10.1× |
| CT pelvis w/o contrast (72192) |
$1,056.50 |
$2,113 |
10.4× |
| CT pelvis w/wo contrast (72194) |
$1,347 |
$2,694 |
7.9× |
| CT scan of arm combo (73202) |
$1,821.50 |
$3,643 |
10.7× |
| CT soft tissue neck w contrast (70491) |
$1,576.50 |
$3,153 |
9.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,757.75 |
$3,515.50 |
10.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,019.50 |
$2,039 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,576.50 |
$3,153 |
9.3× |
| CT thoracic spine w/o contrast (72128) |
$1,019.50 |
$2,039 |
10.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,040.50 |
$2,081 |
6.1× |
| CT thorax w/o contrast (71250) |
$1,056.50 |
$2,113 |
10.4× |
| CT upper ext wo (73200) |
$1,056.50 |
$2,113 |
10.4× |
| CT upper extremity with contrast (73201) |
$1,633.50 |
$3,267 |
4.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,122 |
$2,244 |
6.6× |
| Cta Abdomen (74175) |
$1,780 |
$3,560 |
10.5× |
| CTA abdomen pelvis (74174) |
$2,069.50 |
$4,139 |
6.1× |
| CTA chest (71275) |
$1,780 |
$3,560 |
10.5× |
| Cta Head (70496) |
$1,780 |
$3,560 |
10.5× |
| Cta Neck (70498) |
$1,780 |
$3,560 |
10.5× |
| Cta Pelvis (72191) |
$1,780 |
$3,560 |
10.5× |
| Cystography minimum 3 views rs&i (74430) |
$868.50 |
$1,737 |
2.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$546 |
$1,092 |
2.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,772 |
$3,544 |
0.9× |
| Diskogram cervical (72285) |
$2,139.50 |
$4,279 |
1.1× |
| Diskography lumbar (72295) |
$713 |
$1,426 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$454.50 |
$909 |
4.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$803.75 |
$1,607.50 |
7.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$176.50 |
$353 |
1.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$311.50 |
$623 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$197 |
$394 |
2.3× |
| Dxa bone density study axial skeleton (77085) |
$415 |
$830 |
4.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$565.50 |
$1,131 |
2.5× |
| Esophagus (74220) |
$427 |
$854 |
2.5× |
| Facial bones min 3 views (70150) |
$196 |
$392 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$293 |
$586 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$163.50 |
$327 |
1.6× |
| Fetal Echo (76825) |
$821.75 |
$1,643.50 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$576.25 |
$1,152.50 |
2.5× |
| Foot 2 views (73620) |
$191 |
$382 |
2.3× |
| Forearm 2 views (73090) |
$192 |
$384 |
2.3× |
| Functional MRI brain by phys/psych (70555) |
$1,603 |
$3,206 |
6.9× |
| Functional MRI brain by tech (70554) |
$809.50 |
$1,619 |
3.5× |
| Hand 2 views (73120) |
$285.50 |
$571 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,854.25 |
$3,708.50 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,921.50 |
$3,843 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$1,854.25 |
$3,708.50 |
2.8× |
| Heart Infarct Image (78466) |
$959.50 |
$1,919 |
2.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,163.50 |
$4,327 |
0.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,965 |
$3,930 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,503.50 |
$3,007 |
2.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,503.50 |
$3,007 |
3.9× |
| Hysterosalpingogram (74740) |
$307.50 |
$615 |
1.3× |
| Interstitial radiation source applic complex (77778) |
$568 |
$1,136 |
0.8× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,207 |
$2,414 |
1.8× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,207 |
$2,414 |
2.3× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,207 |
$2,414 |
2.3× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$16,544.25 |
$33,088.50 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$889.25 |
$1,778.50 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$894.25 |
$1,788.50 |
1.7× |
| Knee 3 views (73562) |
$273 |
$546 |
3.2× |
| Liver & spleen imaging static only (78215) |
$608.50 |
$1,217 |
1.6× |
| Liver imaging static only (78201) |
$699 |
$1,398 |
1.3× |
| Liver imaging w/vascular flow (78202) |
$693.50 |
$1,387 |
1.3× |
| Lung perfusion differential (78597) |
$1,036 |
$2,072 |
2.7× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$6,131.50 |
$12,263 |
2.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,428 |
$6,856 |
1.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,894 |
$5,788 |
1.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,641 |
$3,282 |
2.7× |
| Lymphoscintigraphy (78195) |
$691 |
$1,382 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,729.50 |
$3,459 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,233.50 |
$2,467 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,011.50 |
$4,023 |
6.0× |
| Mammary ductogram or galactogram multiple (77054) |
$790.50 |
$1,581 |
3.4× |
| Mammary ductogram or galactogram single (77053) |
$216 |
$432 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,455.25 |
$4,910.50 |
6.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$123.50 |
$247 |
1.3× |
| Mr safety implt pos&/immoblj (76019) |
$80.50 |
$161 |
1.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$325 |
$650 |
1.4× |
| MRA head w & w/o contrast (70546) |
$2,380.25 |
$4,760.50 |
7.1× |
| MRA head w/o contrast (70544) |
$885 |
$1,770 |
3.8× |
| MRA head with contrast (70545) |
$1,571 |
$3,142 |
4.7× |
| MRA neck w contrast (70548) |
$1,698.50 |
$3,397 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,731.25 |
$3,462.50 |
5.1× |
| MRA neck w/o contrast (70547) |
$1,536.25 |
$3,072.50 |
6.7× |
| MRI abdomen w contrast (74182) |
$840.50 |
$1,681 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,944 |
$3,888 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$899.75 |
$1,799.50 |
3.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,124 |
$2,248 |
1.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,882.50 |
$3,765 |
5.6× |
| MRI bone marrow blood supply (77084) |
$983.50 |
$1,967 |
4.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,566 |
$3,132 |
6.8× |
| MRI breast wo contrast unilateral (77046) |
$1,466 |
$2,932 |
6.4× |
| MRI c-spine with contrast (72142) |
$1,864.50 |
$3,729 |
5.5× |
| MRI cardiac w/o cont stress (75559) |
$1,284.50 |
$2,569 |
2.4× |
| MRI cardiac w/o contrast (75557) |
$912 |
$1,824 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$863 |
$1,726 |
3.7× |
| MRI chest w/o & w/contrast material (71552) |
$2,255.75 |
$4,511.50 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,588.50 |
$3,177 |
6.9× |
| MRI chest with contrast (71551) |
$1,276.50 |
$2,553 |
1.7× |
| MRI fetal sngl/1st gestation (74712) |
$869.50 |
$1,739 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,353.50 |
$2,707 |
4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,893 |
$5,786 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,600.25 |
$3,200.50 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$938.25 |
$1,876.50 |
4.1× |
| MRI orbit face neck w contrast (70542) |
$1,474.50 |
$2,949 |
4.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,871.75 |
$3,743.50 |
5.5× |
| MRI pelvis w/contrast (72196) |
$1,286.75 |
$2,573.50 |
3.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,938.75 |
$3,877.50 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,407.50 |
$2,815 |
6.1× |
| MRI spectroscopy (76390) |
$1,064 |
$2,128 |
12.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,984.25 |
$3,968.50 |
5.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,542.25 |
$3,084.50 |
4.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,022.75 |
$4,045.50 |
6.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,133 |
$2,266 |
3.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,022.75 |
$4,045.50 |
6.0× |
| MRI temporomandibular joint (70336) |
$912 |
$1,824 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,012.75 |
$2,025.50 |
4.4× |
| MRI up ext w/o contrast (73218) |
$857 |
$1,714 |
3.7× |
| MRI upper ext joint w/o contrast (73221) |
$931 |
$1,862 |
4.0× |
| MRI, joint upper extrem combo (73223) |
$1,969.75 |
$3,939.50 |
5.8× |
| Myelogram Cervical (72240) |
$2,585.50 |
$5,171 |
3.4× |
| Myelogram Lumbar (72265) |
$2,585.50 |
$5,171 |
3.4× |
| Myelogram thoracic (72255) |
$2,585.50 |
$5,171 |
3.4× |
| Myelography 2 or more regions (72270) |
$2,585.50 |
$5,171 |
3.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,981 |
$7,962 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$5,070 |
$10,140 |
2.4× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,138.50 |
$6,277 |
2.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,893 |
$9,786 |
2.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$3,981 |
$7,962 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,099.50 |
$4,199 |
1.7× |
| Myocardial spect single study at rest or stress (78451) |
$2,099 |
$4,198 |
1.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,252 |
$6,504 |
2.4× |
| N-invas est c ffr sw aly CTA (75580) |
$2,073 |
$4,146 |
2.5× |
| Neck soft tissue (70360) |
$222.75 |
$445.50 |
2.6× |
| Nm adrenal scan (78075) |
$1,156.50 |
$2,313 |
0.9× |
| Nm cardiac blood pool multiple (78473) |
$1,209 |
$2,418 |
3.1× |
| Nm cisternogram (78630) |
$844.50 |
$1,689 |
1.6× |
| Nm csf leak detection (78650) |
$1,707 |
$3,414 |
1.4× |
| Nm gastric emptying study (78264) |
$749.50 |
$1,499 |
1.9× |
| Nm gastroesophageal reflux study (78262) |
$684.50 |
$1,369 |
1.8× |
| Nm kidney scan w/flow (78701) |
$889.25 |
$1,778.50 |
2.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$553.75 |
$1,107.50 |
1.4× |
| Nonvascular shunt X-ray (75809) |
$360.50 |
$721 |
3.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,042 |
$6,084 |
2.3× |
| Nuclear Rx Oral Admin (79005) |
$794.50 |
$1,589 |
3.5× |
| Ob us nuchal meas 1 gest (76813) |
$282.50 |
$565 |
2.8× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$134.50 |
$269 |
1.3× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$247.50 |
$495 |
2.4× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$393.25 |
$786.50 |
3.9× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$57.75 |
$115.50 |
2.1× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$300 |
$600 |
3.0× |
| Orthopantogram (70355) |
$124.50 |
$249 |
1.5× |
| Parathyrd planar w/spect&CT (78072) |
$2,274 |
$4,548 |
4.3× |
| Parathyroid Planar Imaging (78070) |
$511.50 |
$1,023 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$191 |
$382 |
1.9× |
| Perineogram (74775) |
$545.50 |
$1,091 |
2.4× |
| Peritoneogram after injection (74190) |
$285.50 |
$571 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$3,842 |
$7,684 |
2.8× |
| PET imaging CT for attenuation limited area (78814) |
$3,842 |
$7,684 |
2.8× |
| PET imaging for CT attenuation whole body (78816) |
$3,842 |
$7,684 |
2.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,832.50 |
$5,665 |
2.3× |
| PET whole body (78813) |
$3,785.50 |
$7,571 |
2.7× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,818 |
$7,636 |
2.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,428 |
$6,856 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,550.75 |
$3,101.50 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$543.75 |
$1,087.50 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,655 |
$3,310 |
3.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,188 |
$2,376 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,211 |
$2,422 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$355 |
$710 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$191 |
$382 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$191 |
$382 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$191 |
$382 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$194 |
$388 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$204.50 |
$409 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$191 |
$382 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$273 |
$546 |
3.2× |
| Radex Hand Minimum 3 Views (73130) |
$191 |
$382 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$191 |
$382 |
2.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$213.50 |
$427 |
2.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$184.25 |
$368.50 |
1.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$194 |
$388 |
1.9× |
| Radex Humerus Minimum 2 Views (73060) |
$192 |
$384 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$191 |
$382 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$281 |
$562 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$208 |
$416 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$184.25 |
$368.50 |
2.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$199.75 |
$399.50 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$277.50 |
$555 |
3.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$184.25 |
$368.50 |
2.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$290 |
$580 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$184.25 |
$368.50 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$184.25 |
$368.50 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$234.50 |
$469 |
2.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$191 |
$382 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$213.75 |
$427.50 |
2.1× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$19,643 |
$39,286 |
2.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$7,515.50 |
$15,031 |
1.1× |
| Radiation treatment delivery level 1 (77402) |
$989 |
$1,978 |
10.0× |
| Radiation treatment delivery level 2 (77407) |
$1,268.50 |
$2,537 |
3.4× |
| Radiation treatment delivery level 3 (77412) |
$1,623.50 |
$3,247 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$222.75 |
$445.50 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$374.25 |
$748.50 |
3.7× |
| Radiologic exam chest 2 views (71046) |
$158.50 |
$317 |
1.9× |
| Radiologic exam colon single contrast study (74270) |
$427 |
$854 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$408.50 |
$817 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$416.50 |
$833 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$416.50 |
$833 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$226.50 |
$453 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$273 |
$546 |
3.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$321 |
$642 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$191 |
$382 |
1.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$234.50 |
$469 |
2.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$557.50 |
$1,115 |
6.6× |
| Radiological examination surgical specimen (76098) |
$303.50 |
$607 |
0.6× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$936.50 |
$1,873 |
4.1× |
| Red cell volume determination (separate procedure); single sampling Non-Facility (78120) |
$1,198.50 |
$2,397 |
3.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$919.50 |
$1,839 |
2.5× |
| Renal Cyst Study (74470) |
$1,313 |
$2,626 |
2.5× |
| Ribs bilateral 3 views (71110) |
$202.50 |
$405 |
2.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,000 |
$2,000 |
2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$914.50 |
$1,829 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,809 |
$5,618 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,359 |
$2,718 |
2.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,809 |
$5,618 |
5.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,659 |
$5,318 |
2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,252 |
$6,504 |
2.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,765.50 |
$5,531 |
2.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$766.75 |
$1,533.50 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$640.75 |
$1,281.50 |
2.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$307.50 |
$615 |
1.3× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$684.50 |
$1,369 |
1.8× |
| Scapula (73010) |
$218 |
$436 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$54.75 |
$109.50 |
2.3× |
| Sella turcica (70240) |
$191 |
$382 |
2.3× |
| Shoulder 1 view (73020) |
$191 |
$382 |
2.3× |
| Sialogram (70390) |
$1,176 |
$2,352 |
5.1× |
| Simulation intermediate (77285) |
$745 |
$1,490 |
2.1× |
| Small bowel series (74250) |
$427 |
$854 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$719 |
$1,438 |
2.0× |
| Special dosimetry (77331) |
$355.50 |
$711 |
2.7× |
| Special Physics Consult (77370) |
$343 |
$686 |
2.6× |
| Special treatment procedure (77470) |
$1,275.25 |
$2,550.50 |
2.4× |
| Speech evaluation complex (70371) |
$471.50 |
$943 |
2.0× |
| Spine thoracic 3 views (72072) |
$191 |
$382 |
1.9× |
| Splenoportograpy rs&i (75810) |
$3,427.50 |
$6,855 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$2,528.50 |
$5,057 |
1.5× |
| Superior sagittal sinus venogram (75870) |
$3,364 |
$6,728 |
1.1× |
| 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) |
$719 |
$1,438 |
2.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$276 |
$552 |
0.8× |
| Testicular Imaging With Vascular Flow (78761) |
$921.50 |
$1,843 |
2.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$745 |
$1,490 |
2.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$276 |
$552 |
2.1× |
| Thoracolumbar 2 views (72080) |
$198.25 |
$396.50 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,006.75 |
$2,013.50 |
1.9× |
| Thyroid imaging w/blood flow (78013) |
$432.75 |
$865.50 |
1.1× |
| Thyroid uptake measurement (78012) |
$511.50 |
$1,023 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$606.50 |
$1,213 |
1.6× |
| Treatment device complex (77334) |
$548.50 |
$1,097 |
1.5× |
| Treatment device intermediate (77333) |
$529.25 |
$1,058.50 |
4.1× |
| Treatment devices simple (77332) |
$529.25 |
$1,058.50 |
4.1× |
| Ultrasound breast complete (76641) |
$236.25 |
$472.50 |
2.3× |
| Ultrasound Exam Aaa Screen (76706) |
$443.50 |
$887 |
4.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$500 |
$1,000 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$437.50 |
$875 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$214.75 |
$429.50 |
2.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$236.50 |
$473 |
2.8× |
| Unlisted fluoroscopic procedure (76496) |
$123.50 |
$247 |
1.5× |
| Unlisted magnetic resonance procedure (76498) |
$1,868.50 |
$3,737 |
22.2× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$289 |
$578 |
0.7× |
| Unlisted ultrasound procedure (76999) |
$304 |
$608 |
3.6× |
| Ureteral reflux study (78740) |
$921.50 |
$1,843 |
2.4× |
| Urethrocystogram voiding (74455) |
$769 |
$1,538 |
3.3× |
| Urethrocystography retrograde rs&i (74450) |
$868.50 |
$1,737 |
3.8× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$900 |
$1,800 |
5.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$900 |
$1,800 |
5.3× |
| Us breast unilateral limited (76642) |
$304 |
$608 |
3.6× |
| Us chest (76604) |
$291.75 |
$583.50 |
2.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$2,550 |
$5,100 |
12.2× |
| Us compl joint r-t w/image documentation (76881) |
$329 |
$658 |
3.3× |
| Us elastography parenchyma (76981) |
$233.50 |
$467 |
2.3× |
| Us encephalogram (76506) |
$301 |
$602 |
3.0× |
| Us hips infant static (76886) |
$304 |
$608 |
3.6× |
| Us infant hips w manipulation (76885) |
$293.25 |
$586.50 |
3.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$297.75 |
$595.50 |
2.9× |
| Us ob detailed single fetus (76811) |
$696.50 |
$1,393 |
3.0× |
| Us ob limited (76815) |
$302.50 |
$605 |
3.0× |
| Us ob transvaginal (76817) |
$281.25 |
$562.50 |
2.8× |
| Us pelvic non ob complete (76856) |
$454 |
$908 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$301 |
$602 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$454 |
$908 |
4.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$434.50 |
$869 |
4.3× |
| Us retroperitoneal complete (76770) |
$470.50 |
$941 |
4.7× |
| Us retroperitoneal limited (76775) |
$469 |
$938 |
4.6× |
| Us scrotum and contents (76870) |
$454 |
$908 |
4.5× |
| Us soft tissue head/neck (76536) |
$384 |
$768 |
3.8× |
| Us spinal canal and contents (76800) |
$464.75 |
$929.50 |
4.6× |
| Us transrectal (76872) |
$470.50 |
$941 |
4.7× |
| Us transrectal prostate volume (76873) |
$300.50 |
$601 |
3.0× |
| Us, eye b-scan (76512) |
$311 |
$622 |
3.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$454 |
$908 |
4.5× |
| Venogram adrenal unilat (75840) |
$3,428 |
$6,856 |
1.1× |
| Venogram extremity bilateral (75822) |
$1,442.50 |
$2,885 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,178 |
$2,356 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,168.50 |
$4,337 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,718.25 |
$3,436.50 |
1.1× |
| Venography Orbital Rs&I (75880) |
$2,329 |
$4,658 |
3.8× |
| Venography Renal Bilateral (75833) |
$3,308.25 |
$6,616.50 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$2,483.50 |
$4,967 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,656 |
$5,312 |
0.9× |
| Venous sampling by catheter (75893) |
$4,573 |
$9,146 |
0.8× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$574 |
$1,148 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$364.50 |
$729 |
4.3× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,198.50 |
$2,397 |
2.3× |
| Wrist 2 views (73100) |
$191 |
$382 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$374.25 |
$748.50 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.50 |
$401 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$433.75 |
$867.50 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$585.25 |
$1,170.50 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$191 |
$382 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$199 |
$398 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$202.75 |
$405.50 |
2.0× |
| X-ray exam of femur 2/> (73552) |
$281 |
$562 |
3.3× |
| X-ray eye for foreign body (70030) |
$330 |
$660 |
3.9× |
| X-ray IV pyelogram (ivp) (74400) |
$900 |
$1,800 |
5.3× |
| X-ray leg, infant (73592) |
$406.50 |
$813 |
4.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$210.50 |
$421 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$364.25 |
$728.50 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$283 |
$566 |
3.4× |
| X-ray optic foramen (70190) |
$234.50 |
$469 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$203.50 |
$407 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$868.50 |
$1,737 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$191 |
$382 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$201.75 |
$403.50 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$309.75 |
$619.50 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$195 |
$390 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$181.50 |
$363 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$186 |
$372 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$309.75 |
$619.50 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$275.50 |
$551 |
2.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$726 |
$1,452 |
4.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$191 |
$382 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$184.25 |
$368.50 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$191 |
$382 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$214.50 |
$429 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$318.75 |
$637.50 |
3.2× |
| Xr bone length studies (77073) |
$225.25 |
$450.50 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$275.50 |
$551 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$309.75 |
$619.50 |
3.1× |
| Xr chest 4+ views (71048) |
$174 |
$348 |
1.7× |
| Xr urogram antegrade (74425) |
$448 |
$896 |
1.3× |