| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,110 |
$7,300 |
3.7× |
| Abdomen 2 views (74019) |
$143.50 |
$205 |
1.4× |
| Acute gi blood loss imaging (78278) |
$1,064 |
$1,520 |
2.7× |
| Angio Adrenal Bilat Select (75733) |
$3,626 |
$5,180 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,626 |
$5,180 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$3,152.80 |
$4,504 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$2,419.90 |
$3,457 |
0.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,851.40 |
$5,502 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,626 |
$5,180 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,152.80 |
$4,504 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$3,848.60 |
$5,498 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,851.40 |
$5,502 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,442.70 |
$2,061 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,419.90 |
$3,457 |
0.8× |
| Ankle 2 views (73600) |
$113.40 |
$162 |
1.3× |
| Aortogram thoracic (75605) |
$3,743.60 |
$5,348 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,152.80 |
$4,504 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,152.80 |
$4,504 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,152.80 |
$4,504 |
1.0× |
| Arthrogram ankle (73615) |
$478.10 |
$683 |
1.4× |
| Arthrogram elbow (73085) |
$550.20 |
$786 |
1.6× |
| Arthrogram hip (73525) |
$550.20 |
$786 |
1.6× |
| Arthrogram knee (73580) |
$605.50 |
$865 |
1.7× |
| Arthrogram shoulder (73040) |
$550.20 |
$786 |
1.6× |
| Arthrogram wrist (73115) |
$550.20 |
$786 |
1.6× |
| Basic dosimetry (77300) |
$285.60 |
$408 |
2.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$653.10 |
$933 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$799.40 |
$1,142 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$1,143.80 |
$1,634 |
2.9× |
| Bone age studies (77072) |
$171.50 |
$245 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$1,040.90 |
$1,487 |
2.6× |
| Bone Marrow Imaging Limited Area (78102) |
$457.10 |
$653 |
1.1× |
| Bone survey complete (77075) |
$364 |
$520 |
3.5× |
| Bone survey infant (77076) |
$238.70 |
$341 |
2.3× |
| Bowel imaging (78290) |
$664.30 |
$949 |
1.7× |
| Brachytx isodose complex (77318) |
$903.70 |
$1,291 |
2.4× |
| Brachytx isodose intermed (77317) |
$666.40 |
$952 |
1.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$511 |
$730 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$717.50 |
$1,025 |
1.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$828.80 |
$1,184 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$9,961.70 |
$14,231 |
6.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,202.60 |
$1,718 |
3.0× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$3,579.10 |
$5,113 |
4.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,996.70 |
$4,281 |
8.6× |
| Cardiac shunt detection (78428) |
$707.70 |
$1,011 |
1.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$605.50 |
$865 |
1.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$501.90 |
$717 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$140.70 |
$201 |
1.6× |
| Chest 1 view (71045) |
$107.10 |
$153 |
1.2× |
| Chest xray 3 views (71047) |
$183.40 |
$262 |
2.1× |
| Cholecystography, oral contrast Non-Facility (74290) |
$485.80 |
$694 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$303.10 |
$433 |
1.7× |
| Cineradiography/videoradiography (76120) |
$244.30 |
$349 |
2.3× |
| Clavicle complete (73000) |
$121.80 |
$174 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$674.80 |
$964 |
6.4× |
| Continuing medical physics consltj pr wk (77336) |
$546.70 |
$781 |
4.1× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$237.30 |
$339 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,401.30 |
$4,859 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,527 |
$3,610 |
10.6× |
| CT abdomen w contrast (74160) |
$1,360.10 |
$1,943 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,688.40 |
$2,412 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,254.40 |
$1,792 |
12.0× |
| CT angio hrt w/3d image (75574) |
$1,862 |
$2,660 |
5.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,722.70 |
$2,461 |
9.8× |
| CT angiography upper extremity lt (73206) |
$1,722.70 |
$2,461 |
9.8× |
| CT c-spine w/contrast (72126) |
$1,360.10 |
$1,943 |
3.9× |
| CT c-spine w/o contrast (72125) |
$1,254.40 |
$1,792 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,688.40 |
$2,412 |
9.6× |
| CT chest w contrast (71260) |
$1,360.10 |
$1,943 |
7.7× |
| CT chest w/wo contrast (71270) |
$1,688.40 |
$2,412 |
9.6× |
| CT colonography w/dye (74262) |
$595.70 |
$851 |
3.4× |
| CT head/brain with contrast (70460) |
$1,118.60 |
$1,598 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,397.20 |
$1,996 |
7.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,017.80 |
$1,454 |
2.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$102.20 |
$146 |
1.2× |
| CT hrt w/3d image congen (75573) |
$1,229.20 |
$1,756 |
3.5× |
| CT iac w contrast (70481) |
$1,118.60 |
$1,598 |
6.4× |
| CT limited/localized follow up study (76380) |
$863.80 |
$1,234 |
9.9× |
| CT lower ext w/o (73700) |
$911.40 |
$1,302 |
8.7× |
| CT lower extremity w wo contrast (73702) |
$1,362.20 |
$1,946 |
7.7× |
| CT lower extremity w/contrast material (73701) |
$1,090.60 |
$1,558 |
6.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,688.40 |
$2,412 |
9.6× |
| CT lumbar spine w/contrast (72132) |
$1,360.10 |
$1,943 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$1,254.40 |
$1,792 |
12.0× |
| CT maxillofacial w contrast (70487) |
$1,118.60 |
$1,598 |
6.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,397.20 |
$1,996 |
7.9× |
| CT maxillofacial wo contrast (70486) |
$938 |
$1,340 |
8.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,397.20 |
$1,996 |
7.9× |
| CT orbits w/o contrast (70480) |
$938 |
$1,340 |
8.9× |
| CT pelvis w/o contrast (72192) |
$1,254.40 |
$1,792 |
12.0× |
| CT pelvis w/wo contrast (72194) |
$1,688.40 |
$2,412 |
9.6× |
| CT scan of arm combo (73202) |
$1,362.20 |
$1,946 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$1,118.60 |
$1,598 |
6.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,397.20 |
$1,996 |
7.9× |
| CT soft tissue neck w/o contrast (70490) |
$938 |
$1,340 |
8.9× |
| CT thoracic spine w/contrast (72129) |
$1,360.10 |
$1,943 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,254.40 |
$1,792 |
12.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,688.40 |
$2,412 |
9.6× |
| CT thorax w/o contrast (71250) |
$1,254.40 |
$1,792 |
12.0× |
| CT upper ext wo (73200) |
$911.40 |
$1,302 |
8.7× |
| CT upper extremity with contrast (73201) |
$1,253.70 |
$1,791 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,908.90 |
$2,727 |
10.8× |
| Cta Abdomen (74175) |
$2,101.40 |
$3,002 |
11.9× |
| CTA abdomen pelvis (74174) |
$2,867.20 |
$4,096 |
8.2× |
| CTA chest (71275) |
$1,971.90 |
$2,817 |
11.2× |
| Cta Head (70496) |
$2,199.40 |
$3,142 |
12.5× |
| Cta Neck (70498) |
$2,199.40 |
$3,142 |
12.5× |
| Cta Pelvis (72191) |
$2,101.40 |
$3,002 |
11.9× |
| Cystography minimum 3 views rs&i (74430) |
$429.10 |
$613 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,213.80 |
$1,734 |
0.6× |
| Diskogram cervical (72285) |
$1,904.70 |
$2,721 |
1.0× |
| Diskography lumbar (72295) |
$1,904.70 |
$2,721 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$254.80 |
$364 |
2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$391.30 |
$559 |
3.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$350.70 |
$501 |
3.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$744.80 |
$1,064 |
7.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$330.40 |
$472 |
3.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$195.30 |
$279 |
0.8× |
| Esophagus (74220) |
$272.30 |
$389 |
1.5× |
| Facial bones min 3 views (70150) |
$183.40 |
$262 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$408.10 |
$583 |
3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$359.80 |
$514 |
3.4× |
| Fetal Echo (76825) |
$460.60 |
$658 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$465.50 |
$665 |
1.9× |
| Foot 2 views (73620) |
$112.70 |
$161 |
1.3× |
| Forearm 2 views (73090) |
$121.80 |
$174 |
1.4× |
| Functional MRI brain by phys/psych (70555) |
$2,719.50 |
$3,885 |
11.4× |
| Functional MRI brain by tech (70554) |
$2,719.50 |
$3,885 |
11.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,539.30 |
$2,199 |
3.8× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$318.50 |
$455 |
1.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,841 |
$2,630 |
3.4× |
| Hand 2 views (73120) |
$113.40 |
$162 |
1.1× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,114.40 |
$1,592 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,701.70 |
$2,431 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,685.20 |
$3,836 |
3.8× |
| Heart first pass single,planar (78481) |
$805.70 |
$1,151 |
1.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,608.20 |
$3,726 |
0.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,608.20 |
$3,726 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,252.60 |
$3,218 |
4.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,149.40 |
$1,642 |
2.9× |
| Hysterosalpingogram (74740) |
$568.40 |
$812 |
2.4× |
| Interstitial radiation source applic complex (77778) |
$909.30 |
$1,299 |
1.3× |
| Intracavitary Radiation Source Applic Complex (77763) |
$793.10 |
$1,133 |
1.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$637.70 |
$911 |
1.2× |
| Intracavitary Radiation Source Applic Simple (77761) |
$445.90 |
$637 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$953.40 |
$1,362 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$975.80 |
$1,394 |
1.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$833 |
$1,190 |
1.5× |
| Knee 3 views (73562) |
$132.30 |
$189 |
1.5× |
| Liver & spleen imaging static only (78215) |
$642.60 |
$918 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$614.60 |
$878 |
1.5× |
| Liver imaging static only (78201) |
$536.20 |
$766 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$572.60 |
$818 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$1,658.30 |
$2,369 |
3.0× |
| Lung perfusion differential (78597) |
$1,323 |
$1,890 |
3.3× |
| Lung ventilation imaging (78579) |
$955.50 |
$1,365 |
2.4× |
| Lymphoscintigraphy (78195) |
$888.30 |
$1,269 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,729.30 |
$3,899 |
3.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,364.60 |
$3,378 |
6.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,227.70 |
$4,611 |
9.2× |
| Magnetic Resonance Elastography (76391) |
$738.50 |
$1,055 |
3.1× |
| Mammary ductogram or galactogram multiple (77054) |
$638.40 |
$912 |
2.7× |
| Mammary ductogram or galactogram single (77053) |
$458.50 |
$655 |
1.9× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$262.50 |
$375 |
3.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,313.90 |
$1,877 |
3.5× |
| MRA head w & w/o contrast (70546) |
$3,920 |
$5,600 |
11.2× |
| MRA head w/o contrast (70544) |
$2,012.50 |
$2,875 |
8.4× |
| MRA head with contrast (70545) |
$2,209.20 |
$3,156 |
6.3× |
| MRA neck w contrast (70548) |
$2,209.20 |
$3,156 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,920 |
$5,600 |
11.2× |
| MRA neck w/o contrast (70547) |
$2,012.50 |
$2,875 |
8.4× |
| MRI abdomen w contrast (74182) |
$2,380 |
$3,400 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,404.40 |
$6,292 |
12.6× |
| MRI abdomen w/o contrast (74181) |
$2,046.80 |
$2,924 |
8.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,729.30 |
$3,899 |
3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,392.50 |
$6,275 |
12.5× |
| MRI bone marrow blood supply (77084) |
$4,263.70 |
$6,091 |
17.8× |
| MRI breast w/o contrast bilateral (77047) |
$4,329.50 |
$6,185 |
18.1× |
| MRI breast wo contrast unilateral (77046) |
$3,239.60 |
$4,628 |
13.5× |
| MRI c-spine with contrast (72142) |
$2,475.90 |
$3,537 |
7.1× |
| MRI cardiac w/o cont stress (75559) |
$3,047.80 |
$4,354 |
5.6× |
| MRI cardiac w/o contrast (75557) |
$2,111.20 |
$3,016 |
8.8× |
| MRI cervical spine w/o contrast (72141) |
$2,046.80 |
$2,924 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$4,368 |
$6,240 |
12.5× |
| MRI chest w/o contrast (71550) |
$2,046.80 |
$2,924 |
8.6× |
| MRI chest with contrast (71551) |
$2,650.20 |
$3,786 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,351.30 |
$3,359 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,227.70 |
$4,611 |
9.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,036.30 |
$2,909 |
8.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,046.80 |
$2,924 |
8.6× |
| MRI orbit face neck w contrast (70542) |
$2,407.30 |
$3,439 |
6.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,379.90 |
$6,257 |
12.5× |
| MRI pelvis w/contrast (72196) |
$2,305.10 |
$3,293 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,393.20 |
$6,276 |
12.6× |
| MRI pelvis w/o contrast (72195) |
$2,036.30 |
$2,909 |
8.5× |
| MRI spectroscopy (76390) |
$2,138.50 |
$3,055 |
24.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,581.50 |
$6,545 |
13.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,475.90 |
$3,537 |
7.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,581.50 |
$6,545 |
13.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,473.80 |
$3,534 |
7.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,581.50 |
$6,545 |
13.1× |
| MRI temporomandibular joint (70336) |
$2,046.80 |
$2,924 |
8.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,289 |
$3,270 |
9.6× |
| MRI up ext w/o contrast (73218) |
$2,036.30 |
$2,909 |
8.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,046.80 |
$2,924 |
8.6× |
| MRI, joint upper extrem combo (73223) |
$4,392.50 |
$6,275 |
12.5× |
| Myelogram Cervical (72240) |
$862.40 |
$1,232 |
1.1× |
| Myelogram Lumbar (72265) |
$738.50 |
$1,055 |
0.9× |
| Myelogram thoracic (72255) |
$785.40 |
$1,122 |
1.0× |
| Myelography 2 or more regions (72270) |
$1,110.20 |
$1,586 |
1.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,283.80 |
$1,834 |
1.0× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,283.80 |
$1,834 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,267.90 |
$6,097 |
3.3× |
| Myocardial spect single study at rest or stress (78451) |
$2,151.80 |
$3,074 |
1.7× |
| N-invas est c ffr sw aly CTA (75580) |
$866.60 |
$1,238 |
1.0× |
| Neck soft tissue (70360) |
$96.60 |
$138 |
1.1× |
| Nm adrenal scan (78075) |
$1,285.90 |
$1,837 |
1.0× |
| Nm bone marrow multi (78103) |
$560.70 |
$801 |
1.4× |
| Nm bone marrow wb (78104) |
$741.30 |
$1,059 |
1.8× |
| Nm cisternogram (78630) |
$954.80 |
$1,364 |
1.8× |
| Nm csf leak detection (78650) |
$809.90 |
$1,157 |
0.6× |
| Nm gastric emptying study (78264) |
$898.80 |
$1,284 |
2.2× |
| Nm gastroesophageal reflux study (78262) |
$753.20 |
$1,076 |
1.9× |
| Nm peritoneal-venous shunt patency (78291) |
$653.80 |
$934 |
1.6× |
| Noncardiac Vascular Flow Imaging (78445) |
$354.20 |
$506 |
0.9× |
| Nonvascular shunt X-ray (75809) |
$413.70 |
$591 |
3.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,769.10 |
$6,813 |
3.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$716.80 |
$1,024 |
1.8× |
| Nuclear Rx Oral Admin (79005) |
$597.80 |
$854 |
2.6× |
| Ob us nuchal meas 1 gest (76813) |
$371.70 |
$531 |
3.5× |
| Osseous survey limited (77074) |
$255.50 |
$365 |
2.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,373.40 |
$1,962 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$510.30 |
$729 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,373.40 |
$1,962 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$121.80 |
$174 |
1.2× |
| Peritoneogram after injection (74190) |
$394.10 |
$563 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$8,995.70 |
$12,851 |
6.3× |
| PET imaging CT for attenuation limited area (78814) |
$8,864.80 |
$12,664 |
6.2× |
| PET imaging for CT attenuation whole body (78816) |
$8,995.70 |
$12,851 |
6.3× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$8,864.80 |
$12,664 |
6.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,634.80 |
$3,764 |
0.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,669.80 |
$3,814 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$749.70 |
$1,071 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,726.20 |
$2,466 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$436.10 |
$623 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$123.20 |
$176 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$111.30 |
$159 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$132.30 |
$189 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$126 |
$180 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$227.50 |
$325 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$250.60 |
$358 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$96.60 |
$138 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$123.20 |
$176 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$123.20 |
$176 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$111.30 |
$159 |
1.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$185.50 |
$265 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$157.50 |
$225 |
1.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$224 |
$320 |
2.1× |
| Radex Humerus Minimum 2 Views (73060) |
$132.30 |
$189 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$121.80 |
$174 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$143.50 |
$205 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$143.50 |
$205 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$121.80 |
$174 |
1.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$157.50 |
$225 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$132.30 |
$189 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$143.50 |
$205 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$206.50 |
$295 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$194.60 |
$278 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$96.60 |
$138 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$113.40 |
$162 |
1.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$123.20 |
$176 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$290.50 |
$415 |
2.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$24,177.30 |
$34,539 |
3.3× |
| Radiation treatment delivery level 1 (77402) |
$391.30 |
$559 |
3.8× |
| Radiation treatment delivery level 2 (77407) |
$398.30 |
$569 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$512.40 |
$732 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$121.80 |
$174 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$171.50 |
$245 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$159.60 |
$228 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$391.30 |
$559 |
2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$345.10 |
$493 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$381.50 |
$545 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$337.40 |
$482 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$111.30 |
$159 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$121.80 |
$174 |
1.4× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$169.40 |
$242 |
0.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$183.40 |
$262 |
1.7× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$172.20 |
$246 |
0.7× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$121.10 |
$173 |
0.5× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$320.60 |
$458 |
3.7× |
| Radiological examination surgical specimen (76098) |
$130.20 |
$186 |
0.2× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$716.80 |
$1,024 |
3.1× |
| Renal Cyst Study (74470) |
$571.20 |
$816 |
1.0× |
| Ribs bilateral 3 views (71110) |
$183.40 |
$262 |
1.7× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$718.20 |
$1,026 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$801.50 |
$1,145 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,118.90 |
$3,027 |
3.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,047.90 |
$1,497 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,429.40 |
$2,042 |
2.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,026.50 |
$2,895 |
1.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,026.50 |
$2,895 |
1.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,367.10 |
$1,953 |
1.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$644 |
$920 |
2.8× |
| Rp Therapy Intravenous Administration (79101) |
$1,169 |
$1,670 |
5.0× |
| Sacroiliac Joints < 3 Views (72200) |
$121.80 |
$174 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$469 |
$670 |
2.0× |
| Salivary gland imaging (78230) |
$443.80 |
$634 |
1.1× |
| Scapula (73010) |
$121.80 |
$174 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$88.55 |
$126.50 |
3.8× |
| Shoulder 1 view (73020) |
$111.30 |
$159 |
1.3× |
| Sialogram (70390) |
$359.10 |
$513 |
1.5× |
| Simulation intermediate (77285) |
$987 |
$1,410 |
2.6× |
| Small bowel series (74250) |
$337.40 |
$482 |
1.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$849.80 |
$1,214 |
2.3× |
| Special dosimetry (77331) |
$114.80 |
$164 |
0.9× |
| Special Physics Consult (77370) |
$723.80 |
$1,034 |
5.4× |
| Special treatment procedure (77470) |
$2,040.50 |
$2,915 |
3.7× |
| Spine thoracic 3 views (72072) |
$171.50 |
$245 |
1.6× |
| Splenoportograpy rs&i (75810) |
$2,307.20 |
$3,296 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$15,017.80 |
$21,454 |
8.4× |
| Superior sagittal sinus venogram (75870) |
$2,277.80 |
$3,254 |
0.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$693 |
$990 |
1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$427 |
$610 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$606.90 |
$867 |
1.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,251.60 |
$1,788 |
3.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$637.70 |
$911 |
4.7× |
| Thoracolumbar 2 views (72080) |
$157.50 |
$225 |
1.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,184.40 |
$1,692 |
2.2× |
| Thyroid imaging w/blood flow (78013) |
$411.60 |
$588 |
1.0× |
| Thyroid uptake measurement (78012) |
$352.80 |
$504 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$786.10 |
$1,123 |
2.0× |
| Tmj unilateral (70328) |
$106.40 |
$152 |
1.2× |
| Treatment device complex (77334) |
$685.30 |
$979 |
1.8× |
| Ultrasound breast complete (76641) |
$357.70 |
$511 |
3.4× |
| Ultrasound elastography first target lesion (76982) |
$345.10 |
$493 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$399 |
$570 |
3.8× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$238 |
$340 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$435.40 |
$622 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$350.70 |
$501 |
3.3× |
| Unlisted fluoroscopic procedure (76496) |
$327.60 |
$468 |
3.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$922.95 |
$1,318.50 |
9.0× |
| Unlisted ultrasound procedure (76999) |
$349.30 |
$499 |
4.0× |
| Ureteral reflux study (78740) |
$403.90 |
$577 |
1.0× |
| Urethrocystogram voiding (74455) |
$429.10 |
$613 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$429.10 |
$613 |
1.8× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$373.80 |
$534 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$424.90 |
$607 |
2.4× |
| Us breast unilateral limited (76642) |
$275.80 |
$394 |
3.2× |
| Us chest (76604) |
$282.80 |
$404 |
2.7× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$638.40 |
$912 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$482.30 |
$689 |
4.6× |
| Us elastography parenchyma (76981) |
$367.50 |
$525 |
3.5× |
| Us encephalogram (76506) |
$306.60 |
$438 |
2.9× |
| Us hips infant static (76886) |
$293.30 |
$419 |
3.4× |
| Us infant hips w manipulation (76885) |
$354.20 |
$506 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$380.80 |
$544 |
3.6× |
| Us ob detailed single fetus (76811) |
$751.10 |
$1,073 |
3.1× |
| Us ob limited (76815) |
$306.60 |
$438 |
2.9× |
| Us ob transvaginal (76817) |
$408.10 |
$583 |
3.9× |
| Us pelvic non ob complete (76856) |
$408.10 |
$583 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$260.40 |
$372 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$258.30 |
$369 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$240.10 |
$343 |
2.3× |
| Us retroperitoneal complete (76770) |
$607.60 |
$868 |
5.8× |
| Us retroperitoneal limited (76775) |
$424.90 |
$607 |
4.1× |
| Us scrotum and contents (76870) |
$367.50 |
$525 |
3.5× |
| Us soft tissue head/neck (76536) |
$306.60 |
$438 |
2.9× |
| Us spinal canal and contents (76800) |
$306.60 |
$438 |
2.9× |
| Us transrectal (76872) |
$366.80 |
$524 |
3.5× |
| Us transrectal prostate volume (76873) |
$373.10 |
$533 |
3.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$438.20 |
$626 |
4.2× |
| Venogram extremity bilateral (75822) |
$1,122.10 |
$1,603 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,790.90 |
$3,987 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$2,783.20 |
$3,976 |
1.8× |
| Venography Renal Bilateral (75833) |
$2,426.90 |
$3,467 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$2,790.90 |
$3,987 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,783.20 |
$3,976 |
0.9× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,419.90 |
$3,457 |
3.8× |
| Venous sampling by catheter (75893) |
$3,749.20 |
$5,356 |
0.7× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$499.80 |
$714 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$330.40 |
$472 |
3.8× |
| Wrist 2 views (73100) |
$113.40 |
$162 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$171.50 |
$245 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$157.50 |
$225 |
1.8× |
| X-ray b.e. reductn intuss (74283) |
$465.50 |
$665 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$519.40 |
$742 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$121.80 |
$174 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$149.10 |
$213 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$190.40 |
$272 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$137.20 |
$196 |
1.6× |
| X-ray eye for foreign body (70030) |
$177.80 |
$254 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$143.50 |
$205 |
1.6× |
| X-ray IV pyelogram (ivp) (74400) |
$429.10 |
$613 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$121.80 |
$174 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$113.40 |
$162 |
1.3× |
| X-ray leg, infant (73592) |
$171.50 |
$245 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$157.50 |
$225 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$272.30 |
$389 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$189.70 |
$271 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$183.40 |
$262 |
1.7× |
| X-ray retrograde pyelogram (74420) |
$605.50 |
$865 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$132.30 |
$189 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$157.50 |
$225 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$206.50 |
$295 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$143.50 |
$205 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$132.30 |
$189 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$183.40 |
$262 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$206.50 |
$295 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$143.50 |
$205 |
1.4× |
| X-Ray Small Bowel Enteroclysis (74251) |
$331.80 |
$474 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$96.60 |
$138 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$163.10 |
$233 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$149.80 |
$214 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$149.80 |
$214 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$210.70 |
$301 |
2.0× |
| Xr bone length studies (77073) |
$183.40 |
$262 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$206.50 |
$295 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$261.80 |
$374 |
2.5× |
| Xr chest 4+ views (71048) |
$209.30 |
$299 |
2.0× |
| Xr myelogram posterior fossa (70010) |
$869.40 |
$1,242 |
2.5× |
| Xr urogram antegrade (74425) |
$625.80 |
$894 |
1.8× |