| 3-D radiotherapy plan dose-volume histograms (77295) |
$15,779.15 |
$15,779.15 |
10.7× |
| Acute gi blood loss imaging (78278) |
$2,925.82 |
$2,925.82 |
6.9× |
| Angiography internal mammary rs&i (75756) |
$4,776.17 |
$4,776.17 |
1.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$11,434.24 |
$11,434.24 |
3.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,679.81 |
$9,679.81 |
1.6× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$14,146.17 |
$14,146.17 |
4.2× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$7,073.10 |
$7,073.10 |
2.1× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$12,175.63 |
$12,175.63 |
3.6× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$6,471.49 |
$6,471.49 |
1.9× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$7,704.23 |
$7,704.23 |
1.3× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$5,774.66 |
$5,774.66 |
1.7× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$10,192.43 |
$10,192.43 |
1.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$5,065.33 |
$5,065.33 |
1.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,699.11 |
$3,699.11 |
1.1× |
| Ankle 2 views (73600) |
$301.22 |
$301.22 |
3.2× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$10,935.52 |
$10,935.52 |
3.2× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$7,884.68 |
$7,884.68 |
2.3× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$7,824.58 |
$7,824.58 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$2,075.38 |
$2,075.38 |
14.5× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,398.90 |
$1,398.90 |
3.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$2,631.01 |
$2,631.01 |
4.5× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$11,934.11 |
$11,934.11 |
7.8× |
| Card MRI w/stress img & dye (75563) |
$3,970.81 |
$3,970.81 |
4.7× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$5,284.98 |
$5,284.98 |
12.4× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$2,164.14 |
$2,164.14 |
8.5× |
| Cardiac MRI w/stress img (75559) |
$2,596.97 |
$2,596.97 |
4.5× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$3,309.01 |
$3,309.01 |
8.9× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$620.88 |
$620.88 |
3.3× |
| Cineradiography/videoradiography (76120) |
$2,715.30 |
$2,715.30 |
24.4× |
| Clavicle complete (73000) |
$301.22 |
$301.22 |
3.2× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$2,106.93 |
$2,106.93 |
8.3× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including… (74262) |
$1,395.26 |
$1,395.26 |
7.5× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$937.68 |
$937.68 |
8.4× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$937.68 |
$937.68 |
3.7× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$8,596.34 |
$8,596.34 |
23.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$4,537 |
$4,537 |
24.3× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$5,122.52 |
$5,122.52 |
27.4× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$4,716.52 |
$4,716.52 |
25.2× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$6,437.58 |
$6,437.58 |
34.4× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$4,472.96 |
$4,472.96 |
23.9× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$4,702.42 |
$4,702.42 |
25.1× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$3,301.52 |
$3,301.52 |
17.6× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$3,561.02 |
$3,561.02 |
19.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,901.96 |
$2,901.96 |
26.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$5,107.68 |
$5,107.68 |
27.3× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$3,770 |
$3,770 |
20.2× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$3,589.24 |
$3,589.24 |
19.2× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,742.18 |
$2,742.18 |
24.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,220.12 |
$3,220.12 |
17.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$3,123.54 |
$3,123.54 |
28.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$3,786.07 |
$3,786.07 |
20.2× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$4,397.28 |
$4,397.28 |
23.5× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$4,264.96 |
$4,264.96 |
22.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$4,326.78 |
$4,326.78 |
23.1× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$2,531.29 |
$2,531.29 |
17.7× |
| Corpora cavernosography, radiological supervision and interpretation Age Under 21 (74445) |
$663.16 |
$663.16 |
5.9× |
| Csf shunt evaluation (78645) |
$2,262.11 |
$2,262.11 |
3.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$8,286.86 |
$8,286.86 |
22.3× |
| CT abdomen and pelvis without contrast (74176) |
$5,654.75 |
$5,654.75 |
22.2× |
| CT abdomen w & w/o contrast (74170) |
$4,636.54 |
$4,636.54 |
24.8× |
| CT abdomen w/contrast (74160) |
$4,073.86 |
$4,073.86 |
21.8× |
| CT abdomen w/o contrast (74150) |
$3,219.10 |
$3,219.10 |
28.9× |
| CT angio hrt w/3d image (75574) |
$1,472.76 |
$1,472.76 |
4.0× |
| CT cervical spine w/contrast (72126) |
$3,436.15 |
$3,436.15 |
9.2× |
| CT cervical spine w/o contrast (72125) |
$3,030.08 |
$3,030.08 |
27.2× |
| CT chest w/contrast (71260) |
$4,219.93 |
$4,219.93 |
22.6× |
| CT extremity upper w & w/o contrast (73202) |
$4,367.76 |
$4,367.76 |
23.3× |
| CT extremity upper w/o contrast (73200) |
$3,098.81 |
$3,098.81 |
27.8× |
| CT head/brain with contrast (70460) |
$3,499.97 |
$3,499.97 |
18.7× |
| CT head/brain without and with contrast (70470) |
$4,133.84 |
$4,133.84 |
22.1× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$3,218.74 |
$3,218.74 |
8.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,013.59 |
$3,013.59 |
8.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$3,009.70 |
$3,009.70 |
32.4× |
| CT l-spine w/contrast (72132) |
$3,711.87 |
$3,711.87 |
10.0× |
| CT limited/localized follow up study (76380) |
$1,971.22 |
$1,971.22 |
21.2× |
| CT lower extremity w/dye (73701) |
$4,331.66 |
$4,331.66 |
23.2× |
| CT lumbar spine w/o contrast (72131) |
$3,334.05 |
$3,334.05 |
29.9× |
| CT maxillofacial w/wo contrast (70488) |
$4,264.11 |
$4,264.11 |
22.8× |
| CT neck w/contrast (70491) |
$3,897.22 |
$3,897.22 |
20.8× |
| CT neck w/o contrast (70490) |
$3,013.53 |
$3,013.53 |
27.0× |
| CT pelvis w & w/o contrast (72194) |
$4,212.02 |
$4,212.02 |
22.5× |
| CT pelvis w/o contrast (72192) |
$2,931.36 |
$2,931.36 |
26.3× |
| CT thoracic spine w/contrast (72129) |
$3,635.94 |
$3,635.94 |
19.4× |
| CT thoracic spine w/o contrast (72128) |
$3,402.14 |
$3,402.14 |
30.5× |
| CT thorax lung cancer scr c- (71271) |
$934.98 |
$934.98 |
8.4× |
| CT thorax w/o contrast (71250) |
$3,120.47 |
$3,120.47 |
28.0× |
| CT upper extremity w/dye (73201) |
$3,672.78 |
$3,672.78 |
9.9× |
| CTA head w contrast (70496) |
$4,253.38 |
$4,253.38 |
22.7× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$2,074.88 |
$2,074.88 |
5.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Age Under 21 (70170) |
$1,058.76 |
$1,058.76 |
4.2× |
| Dilation ureters/urethra rs&i (74485) |
$3,019.83 |
$3,019.83 |
1.4× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$7,308.79 |
$7,308.79 |
3.5× |
| Diskography lumbar s&i (72295) |
$7,308.79 |
$7,308.79 |
3.5× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$2,403.83 |
$2,403.83 |
21.6× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$1,842.92 |
$1,842.92 |
16.5× |
| Doppler fetal mid cerebral artery (76821) |
$841.28 |
$841.28 |
7.5× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$1,085.90 |
$1,085.90 |
9.7× |
| Dxa bone density study axial skeleton (77085) |
$1,528.69 |
$1,528.69 |
13.7× |
| Dxa bone density/peripheral (77081) |
$1,283.97 |
$1,283.97 |
13.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$5,448.65 |
$5,448.65 |
9.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$2,403.83 |
$2,403.83 |
9.4× |
| Fetal biophys profile w/o nst (76819) |
$1,162.90 |
$1,162.90 |
10.4× |
| Fetal biophysical profile non-stress testing (76818) |
$1,352.18 |
$1,352.18 |
12.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,705.74 |
$1,705.74 |
6.7× |
| Gated heart planar single (78472) |
$4,404.16 |
$4,404.16 |
10.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$6,540.37 |
$6,540.37 |
8.8× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$12,737.63 |
$12,737.63 |
17.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$17,991.37 |
$17,991.37 |
24.2× |
| Heart infarct image (78466) |
$2,652.20 |
$2,652.20 |
6.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,721.53 |
$6,721.53 |
2.0× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$8,065.83 |
$8,065.83 |
2.4× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$4,788.24 |
$4,788.24 |
8.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$4,442.42 |
$4,442.42 |
10.4× |
| Ht muscle image spect sing (78451) |
$9,800.46 |
$9,800.46 |
7.1× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$1,041.94 |
$1,041.94 |
2.4× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$26,572.32 |
$26,572.32 |
18.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$19,681.98 |
$19,681.98 |
26.5× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$2,676.23 |
$2,676.23 |
6.3× |
| Intracavitary radiation source application - complex (77763) |
$10,712.75 |
$10,712.75 |
14.4× |
| Intracavitary radiation source application - intermediate (77762) |
$9,641.48 |
$9,641.48 |
16.4× |
| Intracavitary radiation source application - simple (77761) |
$8,034.57 |
$8,034.57 |
13.6× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session (77424) |
$12,438.79 |
$12,438.79 |
1.6× |
| Isodose brachytherapy complex 10+ sources (77318) |
$10,067.49 |
$10,067.49 |
25.2× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$7,805.98 |
$7,805.98 |
19.5× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$7,213.84 |
$7,213.84 |
18.1× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$11,127.57 |
$11,127.57 |
27.9× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$9,986.14 |
$9,986.14 |
25.0× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$1,828.21 |
$1,828.21 |
4.3× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$2,602.41 |
$2,602.41 |
6.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$7,347.98 |
$7,347.98 |
12.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$4,975.20 |
$4,975.20 |
8.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$6,314.68 |
$6,314.68 |
10.9× |
| Leveen/shunt patency exam (78291) |
$1,855.80 |
$1,855.80 |
4.4× |
| Liver and spleen imaging (78215) |
$2,591.51 |
$2,591.51 |
6.1× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$2,591.51 |
$2,591.51 |
6.1× |
| Liver imaging (78201) |
$2,660.71 |
$2,660.71 |
4.6× |
| Liver imaging with flow (78202) |
$2,660.71 |
$2,660.71 |
4.6× |
| Lung perf&ventilat diferentl (78598) |
$3,879.26 |
$3,879.26 |
6.7× |
| Lung perfusion imaging (78580) |
$3,047.50 |
$3,047.50 |
7.1× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$4,684.33 |
$4,684.33 |
1.4× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$3,055.72 |
$3,055.72 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,307.05 |
$4,307.05 |
11.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$3,758.32 |
$3,758.32 |
10.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$3,109.48 |
$3,109.48 |
12.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,494.64 |
$4,494.64 |
12.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$3,662.04 |
$3,662.04 |
9.8× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$6,107.69 |
$6,107.69 |
24.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$3,587.52 |
$3,587.52 |
9.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,376.14 |
$4,376.14 |
11.8× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$3,323.12 |
$3,323.12 |
8.9× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$4,692.75 |
$4,692.75 |
12.6× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$4,238.84 |
$4,238.84 |
11.4× |
| Magnetic resonance elastography (76391) |
$666.78 |
$666.78 |
2.6× |
| Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part… (70554) |
$6,456.42 |
$6,456.42 |
25.4× |
| Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire… (70555) |
$7,846 |
$7,846 |
30.8× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$1,879.35 |
$1,879.35 |
7.4× |
| Mammary ductogram single (77053) |
$1,566.12 |
$1,566.12 |
6.2× |
| Mandible min 4v (70110) |
$443.39 |
$443.39 |
4.0× |
| Mr safety determination physician/other qhp (76016) |
$442.94 |
$442.94 |
4.8× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$294.99 |
$294.99 |
4.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$123.68 |
$123.68 |
4.0× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$464.32 |
$464.32 |
4.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$1,220.54 |
$1,220.54 |
4.8× |
| MRA head w/o contrast (70544) |
$3,164.34 |
$3,164.34 |
12.4× |
| MRA neck w/ contrast (70548) |
$3,714.46 |
$3,714.46 |
10.0× |
| MRA neck w/o contrast (70547) |
$3,184.90 |
$3,184.90 |
12.5× |
| MRI abdomen w/contrast (74182) |
$3,682.86 |
$3,682.86 |
9.9× |
| MRI abdomen w/o contrast (74181) |
$3,250.24 |
$3,250.24 |
12.8× |
| MRI abdomen w/wo contrast (74183) |
$4,179.56 |
$4,179.56 |
11.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,526.84 |
$3,526.84 |
4.2× |
| MRI breast c- bilateral (77047) |
$3,379.02 |
$3,379.02 |
13.3× |
| MRI breast without contrast material unilateral (77046) |
$2,544.79 |
$2,544.79 |
10.0× |
| MRI c-spine w&w/o cont (72156) |
$4,223.48 |
$4,223.48 |
11.4× |
| MRI cervical spine w/contrast (72142) |
$3,729.40 |
$3,729.40 |
10.0× |
| MRI chest w/contrast (71551) |
$3,513.60 |
$3,513.60 |
4.2× |
| MRI chest w/o contrast (71550) |
$2,834.28 |
$2,834.28 |
11.1× |
| MRI chest w/wo contrast (71552) |
$4,421.24 |
$4,421.24 |
11.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,279.40 |
$4,279.40 |
11.5× |
| MRI joint upr extrem w/dye (73222) |
$3,760.42 |
$3,760.42 |
4.5× |
| MRI joint upr extrem w/o dye (73221) |
$3,149.50 |
$3,149.50 |
12.4× |
| MRI lumbar spine w/contrast (72149) |
$4,031.04 |
$4,031.04 |
10.8× |
| MRI lumbar spine w/wo contrast (72158) |
$4,640.70 |
$4,640.70 |
12.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,578.10 |
$4,578.10 |
12.3× |
| MRI pelvis w & w/o contrast (72197) |
$4,162.80 |
$4,162.80 |
11.2× |
| MRI pelvis w/contrast (72196) |
$3,081.55 |
$3,081.55 |
8.3× |
| MRI pelvis w/o contrast (72195) |
$2,064.72 |
$2,064.72 |
8.1× |
| MRI spectroscopy (76390) |
$4,321.42 |
$4,321.42 |
46.6× |
| MRI spine cervical w/o contrast (72141) |
$3,356.28 |
$3,356.28 |
13.2× |
| MRI t-spine w&w/o cont (72157) |
$4,389.87 |
$4,389.87 |
11.8× |
| MRI thoracic spine w/contrast (72147) |
$3,630.16 |
$3,630.16 |
9.8× |
| MRI thoracic spine w/o contrst (72146) |
$3,210.27 |
$3,210.27 |
12.6× |
| MRI tmj (70336) |
$1,015.43 |
$1,015.43 |
4.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,097.11 |
$3,097.11 |
12.2× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$29,991.75 |
$29,991.75 |
75.1× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$3,635.65 |
$3,635.65 |
4.3× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$7,643.28 |
$7,643.28 |
5.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$9,554.09 |
$9,554.09 |
6.3× |
| Myocardial spect multiple studies (78452) |
$11,895.86 |
$11,895.86 |
8.6× |
| Myocrd img PET 2rtracer CT (78433) |
$10,387.30 |
$10,387.30 |
4.4× |
| Myocrd img PET metab eval single study (78459) |
$7,300.52 |
$7,300.52 |
5.3× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$9,915.72 |
$9,915.72 |
6.5× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$8,882.43 |
$8,882.43 |
9.7× |
| Nm bone 3 phase (78315) |
$5,650.46 |
$5,650.46 |
13.3× |
| Nm bone imaging whole body (78306) |
$4,728.76 |
$4,728.76 |
11.1× |
| Nm bone marrow ltd (78102) |
$920.73 |
$920.73 |
2.2× |
| Nm csf cisternogram (78630) |
$5,433.40 |
$5,433.40 |
9.4× |
| Nm csf leak detection (78650) |
$3,228.22 |
$3,228.22 |
2.3× |
| Nm gastric emptying (78264) |
$3,729.61 |
$3,729.61 |
8.7× |
| Nm lung ventilation imaging (78579) |
$3,660.50 |
$3,660.50 |
8.6× |
| Nm lymph system (78195) |
$3,833.65 |
$3,833.65 |
6.6× |
| Nm myocard infarct spect (78469) |
$3,158.05 |
$3,158.05 |
5.5× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$939.15 |
$939.15 |
2.2× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$3,446.38 |
$3,446.38 |
8.1× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$4,568.46 |
$4,568.46 |
10.7× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$412.67 |
$412.67 |
1.0× |
| Ob us limited fetus(s) (76815) |
$1,017.76 |
$1,017.76 |
9.1× |
| Ob us nuchal meas 1 gest (76813) |
$1,137.95 |
$1,137.95 |
10.2× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$3,525.59 |
$3,525.59 |
31.6× |
| Panoramic X-ray of jaws (70355) |
$808.94 |
$808.94 |
8.7× |
| Parathyrd planar w/spect&CT (78072) |
$8,216.02 |
$8,216.02 |
14.2× |
| Parathyroid planar imaging (78070) |
$4,117.69 |
$4,117.69 |
9.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$6,280.11 |
$6,280.11 |
14.7× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$7,793.14 |
$7,793.14 |
2.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$11,426.02 |
$11,426.02 |
7.5× |
| PET imaging CT for attenuation limited area (78814) |
$10,907.30 |
$10,907.30 |
7.2× |
| PET imaging for CT attenuation whole body (78816) |
$11,972.65 |
$11,972.65 |
7.9× |
| PET imaging whole body (78813) |
$8,277.07 |
$8,277.07 |
5.4× |
| Plasma volume multiple (78111) |
$2,767.56 |
$2,767.56 |
2.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$8,062.39 |
$8,062.39 |
5.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,255.37 |
$3,255.37 |
1.0× |
| Pulmonary ventilation & perfusion imaging (78582) |
$5,549.56 |
$5,549.56 |
9.6× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$3,879.26 |
$3,879.26 |
9.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,277.39 |
$2,277.39 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$521.52 |
$521.52 |
5.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$634.29 |
$634.29 |
5.7× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$718.86 |
$718.86 |
6.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$831.62 |
$831.62 |
7.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$301.22 |
$301.22 |
3.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$301.22 |
$301.22 |
3.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$333.17 |
$333.17 |
3.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$301.22 |
$301.22 |
2.7× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$428.54 |
$428.54 |
3.8× |
| Radex spine cervical 2 or 3 views (72040) |
$301.22 |
$301.22 |
3.2× |
| Radex spine cervical 4 or 5 views (72050) |
$301.22 |
$301.22 |
2.7× |
| Radex spine cervical 6 or more views (72052) |
$359.77 |
$359.77 |
3.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$301.22 |
$301.22 |
3.2× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$19,147.12 |
$19,147.12 |
2.4× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$35,628.60 |
$35,628.60 |
4.5× |
| Radiation tx delivery lvl 1 (77402) |
$1,304.06 |
$1,304.06 |
12.0× |
| Radiation tx delivery lvl 2 (77407) |
$2,197 |
$2,197 |
5.3× |
| Radiation tx delivery lvl 3 (77412) |
$3,040.63 |
$3,040.63 |
5.2× |
| Radiologic exam abdomen 3+ views (74021) |
$286.85 |
$286.85 |
2.6× |
| Radiologic exam chest 3 views (71047) |
$264.97 |
$264.97 |
2.9× |
| Radiologic exam chest 4+ views (71048) |
$264.97 |
$264.97 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$1,678.13 |
$1,678.13 |
9.0× |
| Radiologic exam colon single contrast study (74270) |
$1,536.82 |
$1,536.82 |
8.2× |
| Radiologic exam esophagus double contrast study (74221) |
$1,179.24 |
$1,179.24 |
6.3× |
| Radiologic exam esophagus single contrast study (74220) |
$1,032.29 |
$1,032.29 |
5.5× |
| Radiologic exam small int single contrast study (74250) |
$1,099.80 |
$1,099.80 |
5.9× |
| Radiologic exam swallow function contrast study (74230) |
$1,158.03 |
$1,158.03 |
6.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,203.20 |
$1,203.20 |
6.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,094.60 |
$1,094.60 |
5.9× |
| Radiologic examination femur 1 view (73551) |
$259.29 |
$259.29 |
2.8× |
| Radiologic examination femur minimum 2 views (73552) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$429.05 |
$429.05 |
4.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$429.05 |
$429.05 |
4.6× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$329.37 |
$329.37 |
3.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$828.06 |
$828.06 |
7.4× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$2,782.86 |
$2,782.86 |
4.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$648.39 |
$648.39 |
5.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$577.91 |
$577.91 |
5.2× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,730.05 |
$1,730.05 |
4.6× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$1,706.75 |
$1,706.75 |
15.3× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$658.46 |
$658.46 |
7.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$577.91 |
$577.91 |
5.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$577.91 |
$577.91 |
5.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$577.91 |
$577.91 |
5.2× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$301.22 |
$301.22 |
2.7× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$429.05 |
$429.05 |
4.6× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$301.22 |
$301.22 |
3.2× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$301.22 |
$301.22 |
2.7× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$6,528.98 |
$6,528.98 |
11.3× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$2,484.12 |
$2,484.12 |
10.0× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$4,596.77 |
$4,596.77 |
18.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$2,793.28 |
$2,793.28 |
11.2× |
| Red cell mass multiple (78121) |
$983.57 |
$983.57 |
1.7× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$12,773.31 |
$12,773.31 |
31.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$16,541.98 |
$16,541.98 |
40.2× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$2,502.25 |
$2,502.25 |
9.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$4,014.43 |
$4,014.43 |
9.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$4,411.47 |
$4,411.47 |
10.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$6,087.83 |
$6,087.83 |
10.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,808.50 |
$4,808.50 |
8.3× |
| Rp loclzj tum spect w/CT 1 (78830) |
$8,734.71 |
$8,734.71 |
6.3× |
| Rp loclzj tum spect w/CT 2 (78832) |
$12,528.57 |
$12,528.57 |
8.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$2,654.40 |
$2,654.40 |
10.7× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$1,418.40 |
$1,418.40 |
5.6× |
| Scapula complete (73010) |
$301.22 |
$301.22 |
2.7× |
| Screening digital breast tomosynthesis bi (77063) |
$46.28 |
$46.28 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$869.61 |
$869.61 |
7.8× |
| Simulation intermediate (77285) |
$4,169.83 |
$4,169.83 |
10.4× |
| Special dosimetry (77331) |
$3,113.59 |
$3,113.59 |
21.7× |
| Special physics consult (77370) |
$3,809.10 |
$3,809.10 |
26.6× |
| Special teletherapy port plan (77321) |
$5,771.28 |
$5,771.28 |
14.5× |
| Special treatment procedure (77470) |
$16,973.22 |
$16,973.22 |
28.8× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$10,271.08 |
$10,271.08 |
5.4× |
| Surface application of low dose rate radionuclide source (77789) |
$3,770.77 |
$3,770.77 |
34.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$5,810.65 |
$5,810.65 |
14.5× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$935.42 |
$935.42 |
5.0× |
| Thyroid imaging with vascular flow (78013) |
$2,001.65 |
$2,001.65 |
4.7× |
| Thyroid met imaging body (78018) |
$5,662.10 |
$5,662.10 |
9.8× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,075.86 |
$1,075.86 |
2.5× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$3,707.65 |
$3,707.65 |
8.7× |
| Tr simulation simple (77280) |
$2,958.81 |
$2,958.81 |
20.6× |
| Treatment device complex (77334) |
$3,732.30 |
$3,732.30 |
9.3× |
| Treatment device intermediate (77333) |
$2,946.06 |
$2,946.06 |
20.6× |
| Treatment device simple (77332) |
$2,287.74 |
$2,287.74 |
16.0× |
| Ultrasound breast limited (76642) |
$1,178.02 |
$1,178.02 |
12.7× |
| Ultrasound, abdomen limited (76705) |
$1,073.86 |
$1,073.86 |
9.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$1,140.07 |
$1,140.07 |
10.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$1,178.02 |
$1,178.02 |
10.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$1,017.76 |
$1,017.76 |
4.0× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$1,017.76 |
$1,017.76 |
9.1× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$1,137.95 |
$1,137.95 |
10.2× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$1,842.92 |
$1,842.92 |
16.5× |
| Umbilical-artery Doppler (OB) (76820) |
$995.26 |
$995.26 |
8.9× |
| Unlisted fluoroscopic procedure (76496) |
$1,846.05 |
$1,846.05 |
19.9× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$4,973.03 |
$4,973.03 |
53.6× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$487.67 |
$487.67 |
44.1× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$1,220.88 |
$1,220.88 |
12.9× |
| Ureteral reflux study (78740) |
$2,219.56 |
$2,219.56 |
5.2× |
| Urethrocystography retrograde rs&i (74450) |
$2,406.42 |
$2,406.42 |
9.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$603.57 |
$603.57 |
3.2× |
| Urography antegrade rs&i (74425) |
$2,818.38 |
$2,818.38 |
7.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$1,017.76 |
$1,017.76 |
9.1× |
| Us breast uni real time with image complete (76641) |
$1,248.13 |
$1,248.13 |
11.2× |
| Us chest (76604) |
$504.47 |
$504.47 |
4.5× |
| Us compl joint r-t w/image documentation (76881) |
$1,435.24 |
$1,435.24 |
12.9× |
| Us elastography organ (76981) |
$387.41 |
$387.41 |
3.5× |
| Us encephalogram (76506) |
$1,017.76 |
$1,017.76 |
9.1× |
| Us exam, pelvic, limited (76857) |
$1,073.86 |
$1,073.86 |
9.6× |
| Us guided compression repair (76936) |
$2,113.79 |
$2,113.79 |
9.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$697.24 |
$697.24 |
7.5× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$961.51 |
$961.51 |
10.4× |
| US OB Follow-Up/Repeat (76816) |
$1,017.76 |
$1,017.76 |
9.1× |
| Us ob transvaginal (76817) |
$1,017.76 |
$1,017.76 |
9.1× |
| Us retroperitoneal complete (76770) |
$1,401.80 |
$1,401.80 |
12.6× |
| Us retroperitoneal ltd (76775) |
$1,164.73 |
$1,164.73 |
10.4× |
| Us scrotum (76870) |
$1,137.95 |
$1,137.95 |
10.2× |
| Us soft tissue head/neck (76536) |
$1,017.76 |
$1,017.76 |
9.1× |
| Us spinal canal (76800) |
$697.24 |
$697.24 |
6.3× |
| Us transrectal (76872) |
$1,017.76 |
$1,017.76 |
9.1× |
| Venogram sinus/jugular (75860) |
$31,959.13 |
$31,959.13 |
9.5× |
| Venography adrenal unilateral selective rs&i (75840) |
$10,370.63 |
$10,370.63 |
3.1× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$99 |
$99 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$8,013.49 |
$8,013.49 |
2.4× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$6,392.07 |
$6,392.07 |
1.9× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$6,378.63 |
$6,378.63 |
3.8× |
| Venography, epidural, radiological supervision and interpretation Age Under 21 (75872) |
$2,849.52 |
$2,849.52 |
4.3× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$6,153.68 |
$6,153.68 |
3.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$3,055.72 |
$3,055.72 |
1.8× |
| Venography, orbital, radiological supervision and interpretation Age Under 21 (75880) |
$2,849.52 |
$2,849.52 |
4.3× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$4,488.22 |
$4,488.22 |
1.3× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$7,462.18 |
$7,462.18 |
1.3× |
| Vertebral fracture assessment via dxa (77086) |
$177.91 |
$177.91 |
1.9× |
| X-ray exam hips bi 3-4 views (73522) |
$364.45 |
$364.45 |
3.3× |
| X-ray exam of finger(s) (73140) |
$301.22 |
$301.22 |
3.2× |
| X-ray exam of knee 1 or 2 (73560) |
$301.22 |
$301.22 |
3.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,893.65 |
$1,893.65 |
10.1× |
| X-ray exam ribs bil 3 views (71110) |
$577.91 |
$577.91 |
5.2× |
| X-ray exam ribs uni 2 views (71100) |
$301.22 |
$301.22 |
3.2× |
| X-ray heel (73650) |
$301.22 |
$301.22 |
3.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$770.54 |
$770.54 |
6.9× |
| X-ray retrograde pyelogram (74420) |
$1,268.62 |
$1,268.62 |
3.4× |
| Xr abdomen 1 view (74018) |
$286.85 |
$286.85 |
3.1× |
| Xr abdomen 2 views (74019) |
$286.85 |
$286.85 |
2.6× |
| Xr arthrogram ankle (73615) |
$3,895.09 |
$3,895.09 |
10.5× |
| Xr arthrogram elbow (73085) |
$1,891.78 |
$1,891.78 |
5.1× |
| Xr arthrogram hip (73525) |
$1,350.64 |
$1,350.64 |
3.6× |
| Xr arthrogram knee (73580) |
$1,720.79 |
$1,720.79 |
4.6× |
| Xr arthrogram wrist (73115) |
$1,989.03 |
$1,989.03 |
5.3× |
| Xr bone age studies (77072) |
$301.22 |
$301.22 |
2.7× |
| Xr bone length study (77073) |
$296.62 |
$296.62 |
2.7× |
| Xr bone survey infant (77076) |
$912.24 |
$912.24 |
8.2× |
| Xr bone survey ltd (77074) |
$572.28 |
$572.28 |
5.1× |
| Xr chest 1 view (71045) |
$264.97 |
$264.97 |
2.9× |
| Xr chest 2 views (71046) |
$264.97 |
$264.97 |
2.9× |
| Xr eye foreign body (70030) |
$301.22 |
$301.22 |
3.2× |
| Xr facial bones 3+ views (70150) |
$301.22 |
$301.22 |
2.7× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$301.22 |
$301.22 |
3.2× |
| Xr forearm 2 views (73090) |
$301.22 |
$301.22 |
3.2× |
| Xr hand 2v (73120) |
$301.22 |
$301.22 |
2.7× |
| Xr hysterosalpingogram (74740) |
$2,084.80 |
$2,084.80 |
8.2× |
| Xr myelogram c-spine (72240) |
$3,197.17 |
$3,197.17 |
3.8× |
| Xr myelogram l-spine (72265) |
$3,137.10 |
$3,137.10 |
3.8× |
| Xr myelogram t-spine (72255) |
$2,460.06 |
$2,460.06 |
2.9× |
| Xr neck soft tissue (70360) |
$301.22 |
$301.22 |
3.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$301.22 |
$301.22 |
3.2× |
| Xr osseous survey complete (77075) |
$559.98 |
$559.98 |
5.0× |
| Xr pelvis 1-2 views (72170) |
$301.22 |
$301.22 |
2.7× |
| Xr pelvis min 3 view (72190) |
$577.91 |
$577.91 |
5.2× |
| Xr peritoneogram (74190) |
$3,472.30 |
$3,472.30 |
6.0× |
| Xr sacrum/coccyx 2+ views (72220) |
$301.22 |
$301.22 |
3.2× |
| Xr sella turcica (70240) |
$429.05 |
$429.05 |
4.6× |
| Xr shoulder 1 view (73020) |
$301.22 |
$301.22 |
3.2× |
| Xr sinuses 3+ views (70220) |
$301.22 |
$301.22 |
3.2× |
| Xr skull min 4 view (70260) |
$301.22 |
$301.22 |
2.7× |
| Xr spine 1 view (72020) |
$301.22 |
$301.22 |
3.2× |
| Xr spine thoracic 3v (72072) |
$577.91 |
$577.91 |
5.2× |
| Xr sternum 2+ views (71120) |
$301.22 |
$301.22 |
3.2× |
| Xr stress view joint (77071) |
$531.88 |
$531.88 |
5.7× |
| Xr surgical specimen (76098) |
$894.18 |
$894.18 |
1.5× |
| Xr t-spine 2 views (72070) |
$301.22 |
$301.22 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$301.22 |
$301.22 |
3.2× |
| Xr tmj bilateral (70330) |
$545.90 |
$545.90 |
5.9× |
| Xr tmj unilateral (70328) |
$900.04 |
$900.04 |
9.7× |
| Xr venogram renal bilat (75833) |
$16,026.96 |
$16,026.96 |
4.8× |
| Xr wrist 2 views (73100) |
$301.22 |
$301.22 |
3.2× |