| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,952.80 |
$4,882 |
1.3× |
| Abdomen 2 views (74019) |
$282.80 |
$707 |
2.4× |
| Acute gi blood loss imaging (78278) |
$521.20 |
$1,303 |
1.2× |
| Angio Adrenal Bilat Select (75733) |
$2,892 |
$7,230 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,679.20 |
$6,698 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,350 |
$5,875 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,247.20 |
$3,118 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,486.80 |
$6,217 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,070.40 |
$7,676 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,886 |
$7,215 |
0.8× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,632.80 |
$6,582 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,074.80 |
$2,687 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,320.40 |
$3,301 |
0.4× |
| Ankle 2 views (73600) |
$253.20 |
$633 |
2.6× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,207.20 |
$5,518 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,375.20 |
$8,438 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$2,733.60 |
$6,834 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,438.40 |
$6,096 |
0.7× |
| Arthrogram elbow (73085) |
$522.80 |
$1,307 |
1.3× |
| Arthrogram hip (73525) |
$516.40 |
$1,291 |
1.3× |
| Arthrogram knee (73580) |
$516.40 |
$1,291 |
1.3× |
| Arthrogram shoulder (73040) |
$548 |
$1,370 |
1.4× |
| Arthrogram wrist (73115) |
$522.80 |
$1,307 |
1.3× |
| Basic dosimetry (77300) |
$208 |
$520 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$621.60 |
$1,554 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$750.80 |
$1,877 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$807.20 |
$2,018 |
1.8× |
| Bone age studies (77072) |
$138.40 |
$346 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$936.40 |
$2,341 |
2.1× |
| Bone Marrow Imaging Limited Area (78102) |
$478.80 |
$1,197 |
1.1× |
| Bone survey complete (77075) |
$197.60 |
$494 |
1.7× |
| Bone survey infant (77076) |
$138.40 |
$346 |
1.2× |
| Bowel imaging (78290) |
$521.20 |
$1,303 |
1.2× |
| Brachytx isodose intermed (77317) |
$592.40 |
$1,481 |
1.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$822.80 |
$2,057 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,880.40 |
$4,701 |
1.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$478.80 |
$1,197 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,112 |
$2,780 |
2.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$656.40 |
$1,641 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$460.80 |
$1,152 |
4.8× |
| Chest 1 view (71045) |
$141.20 |
$353 |
1.5× |
| Chest xray 3 views (71047) |
$278.40 |
$696 |
2.9× |
| Cholecystography, oral contrast Non-Facility (74290) |
$240.80 |
$602 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$260.80 |
$652 |
1.3× |
| Clavicle complete (73000) |
$225.20 |
$563 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$628 |
$1,570 |
5.4× |
| Continuing medical physics consltj pr wk (77336) |
$250.40 |
$626 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,725.20 |
$6,813 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,543.20 |
$3,858 |
5.8× |
| CT abdomen w contrast (74160) |
$1,667.60 |
$4,169 |
8.5× |
| CT abdomen w wo contrast (74170) |
$1,901.20 |
$4,753 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,084 |
$2,710 |
9.3× |
| CT angio hrt w/3d image (75574) |
$304.40 |
$761 |
0.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,648 |
$4,120 |
8.4× |
| CT angiography upper extremity lt (73206) |
$742 |
$1,855 |
3.8× |
| CT c-spine w/contrast (72126) |
$1,677.20 |
$4,193 |
4.3× |
| CT c-spine w/o contrast (72125) |
$1,148.80 |
$2,872 |
9.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,450.40 |
$3,626 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,746 |
$4,365 |
8.9× |
| CT chest w contrast (71260) |
$1,064.40 |
$2,661 |
5.4× |
| CT chest w/wo contrast (71270) |
$1,277.20 |
$3,193 |
6.5× |
| CT head/brain with contrast (70460) |
$1,472.80 |
$3,682 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,723.60 |
$4,309 |
8.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$304.40 |
$761 |
0.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$102.80 |
$257 |
1.1× |
| CT iac w contrast (70481) |
$738.80 |
$1,847 |
3.8× |
| CT lower ext w/o (73700) |
$1,109.60 |
$2,774 |
9.5× |
| CT lower extremity w wo contrast (73702) |
$1,786.40 |
$4,466 |
9.1× |
| CT lower extremity w/contrast material (73701) |
$1,575.60 |
$3,939 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,035.20 |
$5,088 |
10.4× |
| CT lumbar spine w/contrast (72132) |
$1,723.20 |
$4,308 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$1,356.80 |
$3,392 |
11.6× |
| CT maxillofacial w contrast (70487) |
$1,060.80 |
$2,652 |
5.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,299.20 |
$3,248 |
6.6× |
| CT maxillofacial wo contrast (70486) |
$884 |
$2,210 |
7.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$807.60 |
$2,019 |
4.1× |
| CT orbits w/o contrast (70480) |
$626 |
$1,565 |
5.4× |
| CT pelvis w/o contrast (72192) |
$705.20 |
$1,763 |
6.1× |
| CT pelvis w/wo contrast (72194) |
$1,500 |
$3,750 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$486.40 |
$1,216 |
2.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$588.40 |
$1,471 |
3.0× |
| CT soft tissue neck w/o contrast (70490) |
$403.60 |
$1,009 |
3.5× |
| CT thoracic spine w/contrast (72129) |
$1,518.80 |
$3,797 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$1,196 |
$2,990 |
10.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,806 |
$4,515 |
9.2× |
| CT thorax w/o contrast (71250) |
$883.60 |
$2,209 |
7.6× |
| CT upper ext wo (73200) |
$1,212.40 |
$3,031 |
10.4× |
| CT upper extremity with contrast (73201) |
$1,345.60 |
$3,364 |
3.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$836.80 |
$2,092 |
4.3× |
| Cta Abdomen (74175) |
$1,118 |
$2,795 |
5.7× |
| CTA abdomen pelvis (74174) |
$1,415.60 |
$3,539 |
3.6× |
| CTA chest (71275) |
$976 |
$2,440 |
5.0× |
| Cta Head (70496) |
$863.60 |
$2,159 |
4.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,247.60 |
$5,619 |
5.8× |
| Cta Neck (70498) |
$1,384 |
$3,460 |
7.1× |
| Cta Pelvis (72191) |
$976.80 |
$2,442 |
5.0× |
| Cystography minimum 3 views rs&i (74430) |
$467.60 |
$1,169 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,250.40 |
$8,126 |
1.4× |
| Diskogram cervical (72285) |
$3,660.40 |
$9,151 |
1.7× |
| Diskography lumbar (72295) |
$3,660.40 |
$9,151 |
1.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$259.20 |
$648 |
2.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$159.60 |
$399 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$196 |
$490 |
1.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$117.60 |
$294 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$196 |
$490 |
1.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$306.40 |
$766 |
1.2× |
| Esophagus (74220) |
$384 |
$960 |
2.0× |
| Facial bones min 3 views (70150) |
$299.60 |
$749 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$426.40 |
$1,066 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$311.20 |
$778 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$346.40 |
$866 |
1.3× |
| Foot 2 views (73620) |
$209.20 |
$523 |
2.2× |
| Forearm 2 views (73090) |
$229.20 |
$573 |
2.4× |
| Functional MRI brain by tech (70554) |
$1,110.40 |
$2,776 |
4.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$594.40 |
$1,486 |
1.3× |
| Hand 2 views (73120) |
$222.40 |
$556 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$900 |
$2,250 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$900 |
$2,250 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$918 |
$2,295 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$840 |
$2,100 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$613.20 |
$1,533 |
1.4× |
| Hysterosalpingogram (74740) |
$344.40 |
$861 |
1.3× |
| Kidney imaging morphology (78700) |
$710.80 |
$1,777 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$954.80 |
$2,387 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$718 |
$1,795 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,522 |
$3,805 |
2.5× |
| Knee 3 views (73562) |
$401.60 |
$1,004 |
4.1× |
| Liver & spleen imaging static only (78215) |
$478.80 |
$1,197 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$478.80 |
$1,197 |
1.1× |
| Liver imaging static only (78201) |
$1,466.80 |
$3,667 |
2.4× |
| Liver imaging w/vascular flow (78202) |
$1,466.80 |
$3,667 |
2.4× |
| Lung perf&ventilat diferentl (78598) |
$621.60 |
$1,554 |
1.0× |
| Lung perfusion differential (78597) |
$478.80 |
$1,197 |
1.1× |
| Lung ventilation imaging (78579) |
$478.40 |
$1,196 |
1.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$5,453.20 |
$13,633 |
1.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,635.20 |
$9,088 |
1.0× |
| Lymphoscintigraphy (78195) |
$833.20 |
$2,083 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,505.20 |
$3,763 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,366.40 |
$5,916 |
6.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,366.40 |
$5,916 |
6.1× |
| Mammary ductogram or galactogram single (77053) |
$435.20 |
$1,088 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,223.20 |
$3,058 |
2.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$66 |
$165 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,358.80 |
$5,897 |
6.1× |
| MRA head w/o contrast (70544) |
$1,268.40 |
$3,171 |
4.8× |
| MRA head with contrast (70545) |
$1,306.40 |
$3,266 |
3.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,559.20 |
$3,898 |
4.0× |
| MRA neck w/o contrast (70547) |
$842 |
$2,105 |
3.2× |
| MRI abdomen w contrast (74182) |
$1,469.20 |
$3,673 |
3.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,469.20 |
$3,673 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$793.20 |
$1,983 |
3.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,818.80 |
$4,547 |
2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,333.20 |
$5,833 |
6.0× |
| MRI bone marrow blood supply (77084) |
$1,042 |
$2,605 |
3.9× |
| MRI breast w/o contrast bilateral (77047) |
$292.40 |
$731 |
1.1× |
| MRI breast wo contrast unilateral (77046) |
$292.40 |
$731 |
1.1× |
| MRI c-spine with contrast (72142) |
$1,798.40 |
$4,496 |
4.6× |
| MRI cardiac w/o contrast (75557) |
$966.80 |
$2,417 |
3.6× |
| MRI cervical spine w/o contrast (72141) |
$1,634.80 |
$4,087 |
6.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,645.20 |
$4,113 |
4.2× |
| MRI chest w/o contrast (71550) |
$888.40 |
$2,221 |
3.3× |
| MRI chest with contrast (71551) |
$1,645.20 |
$4,113 |
1.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,638.80 |
$4,097 |
4.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,596 |
$3,990 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,425.20 |
$3,563 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$573.60 |
$1,434 |
2.2× |
| MRI orbit face neck w contrast (70542) |
$1,062.40 |
$2,656 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,062.40 |
$2,656 |
2.7× |
| MRI pelvis w/contrast (72196) |
$1,190.80 |
$2,977 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,452 |
$3,630 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$1,074.40 |
$2,686 |
4.0× |
| MRI spectroscopy (76390) |
$753.20 |
$1,883 |
7.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,272.40 |
$5,681 |
5.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,605.20 |
$4,013 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,791.60 |
$4,479 |
4.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,666.80 |
$4,167 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,076 |
$5,190 |
5.3× |
| MRI temporomandibular joint (70336) |
$349.20 |
$873 |
1.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,515.20 |
$3,788 |
5.7× |
| MRI up ext w/o contrast (73218) |
$1,272.40 |
$3,181 |
4.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,254.40 |
$3,136 |
4.7× |
| MRI, joint upper extrem combo (73223) |
$1,794 |
$4,485 |
4.6× |
| Myelogram thoracic (72255) |
$825.20 |
$2,063 |
0.9× |
| Myocardial infarct spect (78469) |
$1,466.80 |
$3,667 |
2.4× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,970.40 |
$4,926 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,782.80 |
$6,957 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,907.60 |
$4,769 |
1.3× |
| Neck soft tissue (70360) |
$192.80 |
$482 |
2.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$478.80 |
$1,197 |
1.1× |
| Nm bone marrow multi (78103) |
$478.80 |
$1,197 |
1.1× |
| Nm cisternogram (78630) |
$656.40 |
$1,641 |
1.1× |
| Nm csf leak detection (78650) |
$1,658.80 |
$4,147 |
1.1× |
| Nm gastric emptying study (78264) |
$534.40 |
$1,336 |
1.2× |
| Nm kidney scan w/flow (78701) |
$919.20 |
$2,298 |
2.1× |
| Nonvascular shunt X-ray (75809) |
$287.60 |
$719 |
2.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,093.60 |
$7,734 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$466 |
$1,165 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$165.20 |
$413 |
1.4× |
| Osseous survey limited (77074) |
$209.60 |
$524 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$858 |
$2,145 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$478.80 |
$1,197 |
1.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$738 |
$1,845 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$271.60 |
$679 |
2.3× |
| PET image w/CT, skull-thigh (78815) |
$3,246.80 |
$8,117 |
2.0× |
| PET imaging CT for attenuation limited area (78814) |
$2,922 |
$7,305 |
1.8× |
| PET imaging for CT attenuation whole body (78816) |
$3,311.60 |
$8,279 |
2.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$554 |
$1,385 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$839.60 |
$2,099 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$613.60 |
$1,534 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$342.40 |
$856 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$182.80 |
$457 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$346 |
$865 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$136.80 |
$342 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$159.20 |
$398 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$297.60 |
$744 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$232.80 |
$582 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$303.20 |
$758 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$313.20 |
$783 |
3.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$118 |
$295 |
1.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$159.20 |
$398 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$167.20 |
$418 |
1.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$234.40 |
$586 |
2.0× |
| Radex Humerus Minimum 2 Views (73060) |
$210 |
$525 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$329.20 |
$823 |
3.4× |
| Radex Kne Compl 4/More Views (73564) |
$437.60 |
$1,094 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$276.40 |
$691 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$267.20 |
$668 |
2.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$228 |
$570 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$428.80 |
$1,072 |
4.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$117.20 |
$293 |
1.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$560.40 |
$1,401 |
4.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$220.40 |
$551 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$250 |
$625 |
2.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$146.40 |
$366 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$342.80 |
$857 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$297.60 |
$744 |
2.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$9,874 |
$24,685 |
1.2× |
| Radiation treatment delivery level 1 (77402) |
$279.60 |
$699 |
2.5× |
| Radiation treatment delivery level 2 (77407) |
$736 |
$1,840 |
1.7× |
| Radiation treatment delivery level 3 (77412) |
$971.20 |
$2,428 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$147.20 |
$368 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$282.80 |
$707 |
2.4× |
| Radiologic exam chest 2 views (71046) |
$217.60 |
$544 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$371.20 |
$928 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$360.80 |
$902 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$550.40 |
$1,376 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$118 |
$295 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$264.40 |
$661 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$202.80 |
$507 |
1.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$138.40 |
$346 |
1.2× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$418.40 |
$1,046 |
1.6× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$516.40 |
$1,291 |
1.9× |
| Radiological examination surgical specimen (76098) |
$705.60 |
$1,764 |
1.2× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$664 |
$1,660 |
2.6× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$430.80 |
$1,077 |
1.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$430.80 |
$1,077 |
1.0× |
| Ribs bilateral 3 views (71110) |
$428 |
$1,070 |
3.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$802 |
$2,005 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,924.80 |
$4,812 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,924.80 |
$4,812 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,162.80 |
$2,907 |
1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,706.40 |
$6,766 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,004.80 |
$5,012 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$338.40 |
$846 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$347.20 |
$868 |
3.0× |
| Scapula (73010) |
$235.20 |
$588 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$49.60 |
$124 |
2.1× |
| Sella turcica (70240) |
$102.80 |
$257 |
1.1× |
| Shoulder 1 view (73020) |
$197.20 |
$493 |
2.0× |
| Simulation intermediate (77285) |
$683.20 |
$1,708 |
1.6× |
| Small bowel series (74250) |
$231.20 |
$578 |
1.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$494.40 |
$1,236 |
1.2× |
| Special dosimetry (77331) |
$185.20 |
$463 |
1.2× |
| Special Physics Consult (77370) |
$240.40 |
$601 |
1.6× |
| Special treatment procedure (77470) |
$1,063.20 |
$2,658 |
1.7× |
| Spine thoracic 3 views (72072) |
$402.40 |
$1,006 |
3.5× |
| Spleen imaging only (78185) |
$478.80 |
$1,197 |
1.1× |
| Stereotactic Body Radiation Delivery (77373) |
$2,202.40 |
$5,506 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$494.40 |
$1,236 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$494.40 |
$1,236 |
1.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$402 |
$1,005 |
1.5× |
| Testicular Imaging With Vascular Flow (78761) |
$518.40 |
$1,296 |
1.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$683.20 |
$1,708 |
1.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$334.80 |
$837 |
2.2× |
| Thoracolumbar 2 views (72080) |
$263.60 |
$659 |
2.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$621.60 |
$1,554 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$478.80 |
$1,197 |
1.1× |
| Thyroid uptake measurement (78012) |
$478.80 |
$1,197 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$478.80 |
$1,197 |
1.1× |
| Tomogram (76100) |
$284 |
$710 |
2.4× |
| Treatment device complex (77334) |
$433.20 |
$1,083 |
1.0× |
| Treatment device intermediate (77333) |
$229.60 |
$574 |
1.5× |
| Treatment devices simple (77332) |
$229.60 |
$574 |
1.5× |
| Ultrasound breast complete (76641) |
$310.80 |
$777 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$228.80 |
$572 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$363.20 |
$908 |
3.1× |
| Umbilical-artery Doppler (OB) (76820) |
$181.60 |
$454 |
1.6× |
| Unlisted fluoroscopic procedure (76496) |
$220 |
$550 |
2.3× |
| Unlisted ultrasound procedure (76999) |
$136 |
$340 |
1.4× |
| Ureteral reflux study (78740) |
$518.40 |
$1,296 |
1.2× |
| Urethrocystogram voiding (74455) |
$335.60 |
$839 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$353.20 |
$883 |
1.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,296 |
$3,240 |
6.6× |
| Us breast unilateral limited (76642) |
$254.80 |
$637 |
2.6× |
| Us chest (76604) |
$164.40 |
$411 |
1.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$335.60 |
$839 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$325.60 |
$814 |
2.8× |
| Us elastography parenchyma (76981) |
$362.80 |
$907 |
3.1× |
| Us encephalogram (76506) |
$170 |
$425 |
1.5× |
| Us infant hips w manipulation (76885) |
$219.60 |
$549 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$279.20 |
$698 |
2.4× |
| Us ob detailed single fetus (76811) |
$292.40 |
$731 |
1.1× |
| Us ob limited (76815) |
$278.40 |
$696 |
2.4× |
| Us ob transvaginal (76817) |
$314.80 |
$787 |
2.7× |
| Us pelvic non ob complete (76856) |
$474.80 |
$1,187 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$474.80 |
$1,187 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$351.60 |
$879 |
3.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$376 |
$940 |
3.2× |
| Us retroperitoneal complete (76770) |
$459.20 |
$1,148 |
3.9× |
| Us retroperitoneal limited (76775) |
$234 |
$585 |
2.0× |
| Us scrotum and contents (76870) |
$474.80 |
$1,187 |
4.1× |
| Us soft tissue head/neck (76536) |
$346.40 |
$866 |
3.0× |
| Us spinal canal and contents (76800) |
$147.20 |
$368 |
1.3× |
| Us transrectal (76872) |
$299.60 |
$749 |
2.6× |
| Us transrectal prostate volume (76873) |
$536.40 |
$1,341 |
4.6× |
| Us, eye b-scan (76512) |
$159.20 |
$398 |
1.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$168.80 |
$422 |
1.4× |
| Venogram extremity bilateral (75822) |
$832.40 |
$2,081 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$711.60 |
$1,779 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,748.80 |
$6,872 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$2,071.20 |
$5,178 |
1.2× |
| Venography Renal Bilateral (75833) |
$5,152.80 |
$12,882 |
1.5× |
| Venography renal unilateral selective rs&i (75831) |
$3,092 |
$7,730 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$102.80 |
$257 |
1.1× |
| Wrist 2 views (73100) |
$174.80 |
$437 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$282.80 |
$707 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$161.20 |
$403 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$519.60 |
$1,299 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$197.20 |
$493 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$137.20 |
$343 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$167.20 |
$418 |
1.4× |
| X-ray exam of femur 2/> (73552) |
$129.60 |
$324 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$215.60 |
$539 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$1,059.20 |
$2,648 |
5.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240.40 |
$601 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$381.60 |
$954 |
3.9× |
| X-ray leg, infant (73592) |
$104.40 |
$261 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$483.20 |
$1,208 |
4.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$850.40 |
$2,126 |
7.3× |
| X-ray nose-rectum child f.b. (76010) |
$202.80 |
$507 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$138.40 |
$346 |
1.2× |
| X-ray retrograde pyelogram (74420) |
$537.60 |
$1,344 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$286.80 |
$717 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$415.60 |
$1,039 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$390.80 |
$977 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$222.40 |
$556 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$364.40 |
$911 |
3.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$217.20 |
$543 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$368.40 |
$921 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$294.80 |
$737 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$118.40 |
$296 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$250.40 |
$626 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$205.20 |
$513 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$394.40 |
$986 |
3.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$453.60 |
$1,134 |
3.9× |
| Xr bone length studies (77073) |
$244.40 |
$611 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$626.80 |
$1,567 |
5.4× |
| Xr c-spine 6 or more views (72052) |
$774 |
$1,935 |
6.6× |
| Xr chest 4+ views (71048) |
$298 |
$745 |
2.6× |
| Xr urogram antegrade (74425) |
$537.60 |
$1,344 |
1.4× |