| Abdomen 2 views (74019) |
$96.64 |
$302 |
0.8× |
| Acute gi blood loss imaging (78278) |
$710.08 |
$2,219 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$884.16 |
$2,763 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$1,046.40 |
$3,270 |
0.3× |
| Angiography internal mammary rs&i (75756) |
$1,221.12 |
$3,816 |
0.3× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,253.44 |
$7,042 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,221.12 |
$3,816 |
0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,260 |
$7,062.50 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$3,688 |
$11,525 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,688 |
$14,650 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,791.04 |
$5,597 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,221.12 |
$3,816 |
0.3× |
| Ankle 2 views (73600) |
$85.92 |
$268.50 |
0.8× |
| Aortogram thoracic (75605) |
$5,126.40 |
$16,020 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$828.96 |
$2,590.50 |
0.2× |
| Aortography abdominal serialography rs&i (75625) |
$1,374.40 |
$4,295 |
0.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,356.80 |
$4,240 |
0.4× |
| Arthrogram ankle (73615) |
$220.80 |
$690 |
0.5× |
| Arthrogram hip (73525) |
$530.08 |
$1,656.50 |
1.3× |
| Arthrogram knee (73580) |
$311.20 |
$972.50 |
0.8× |
| Arthrogram shoulder (73040) |
$481.28 |
$1,504 |
1.2× |
| Arthrogram wrist (73115) |
$265.28 |
$829 |
0.6× |
| Basic dosimetry (77300) |
$197.12 |
$616 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$515.20 |
$1,610 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$496.32 |
$1,551 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$587.20 |
$1,835 |
1.2× |
| Bone age studies (77072) |
$124.16 |
$388 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$612.80 |
$1,915 |
1.3× |
| Bone survey complete (77075) |
$238.88 |
$746.50 |
1.9× |
| Bowel imaging (78290) |
$742.40 |
$2,320 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$430.08 |
$1,344 |
0.7× |
| Brain Imaging Vascular Flow Only (78610) |
$321.28 |
$1,004 |
0.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$701.76 |
$2,193 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$102.56 |
$320.50 |
1.0× |
| Chest 1 view (71045) |
$88.32 |
$276 |
0.9× |
| Chest xray 3 views (71047) |
$131.36 |
$410.50 |
1.3× |
| Cholecystography, oral contrast Non-Facility (74290) |
$190.08 |
$594 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$333.76 |
$1,043 |
1.6× |
| Clavicle complete (73000) |
$95.20 |
$297.50 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$456 |
$1,425 |
3.7× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$94.72 |
$296 |
0.9× |
| Continuing medical physics consltj pr wk (77336) |
$431.36 |
$1,348 |
2.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$233.92 |
$731 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,458.24 |
$4,557 |
3.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,109.12 |
$3,466 |
3.9× |
| CT abdomen w contrast (74160) |
$733.76 |
$2,293 |
3.5× |
| CT abdomen w wo contrast (74170) |
$838.72 |
$2,621 |
4.0× |
| CT abdomen w/o contrast (74150) |
$609.92 |
$1,906 |
4.9× |
| CT angio hrt w/3d image (75574) |
$343.68 |
$1,074 |
0.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$998.40 |
$3,120 |
4.8× |
| CT angiography upper extremity lt (73206) |
$786.88 |
$2,459 |
3.8× |
| CT c-spine w/contrast (72126) |
$725.76 |
$2,268 |
1.8× |
| CT c-spine w/o contrast (72125) |
$621.76 |
$1,943 |
5.0× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$408.96 |
$1,278 |
2.0× |
| CT cervical spine w&w/o contrast (72127) |
$901.76 |
$2,818 |
4.4× |
| CT chest w contrast (71260) |
$744 |
$2,325 |
3.6× |
| CT chest w/wo contrast (71270) |
$852.80 |
$2,665 |
4.1× |
| CT head/brain with contrast (70460) |
$600.96 |
$1,878 |
2.9× |
| CT head/brain without and with contrast (70470) |
$738.56 |
$2,308 |
3.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$343.68 |
$1,074 |
0.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$61.76 |
$193 |
0.6× |
| CT iac w contrast (70481) |
$738.56 |
$2,308 |
3.6× |
| CT limited/localized follow up study (76380) |
$303.68 |
$949 |
3.0× |
| CT lower ext w/o (73700) |
$606.72 |
$1,896 |
4.9× |
| CT lower extremity w wo contrast (73702) |
$835.20 |
$2,610 |
4.0× |
| CT lower extremity w/contrast material (73701) |
$932.80 |
$2,915 |
4.5× |
| CT lumbar spine w & w/o contrast (72133) |
$448.80 |
$1,402.50 |
2.2× |
| CT lumbar spine w/contrast (72132) |
$758.08 |
$2,369 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$718.08 |
$2,244 |
5.8× |
| CT maxillofacial w contrast (70487) |
$671.36 |
$2,098 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$991.68 |
$3,099 |
4.8× |
| CT maxillofacial wo contrast (70486) |
$440.80 |
$1,377.50 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$884.16 |
$2,763 |
4.3× |
| CT orbits w/o contrast (70480) |
$629.12 |
$1,966 |
5.1× |
| CT pelvis w/o contrast (72192) |
$533.76 |
$1,668 |
4.3× |
| CT pelvis w/wo contrast (72194) |
$795.20 |
$2,485 |
3.8× |
| CT scan of arm combo (73202) |
$794.88 |
$2,484 |
3.8× |
| CT soft tissue neck w contrast (70491) |
$731.84 |
$2,287 |
3.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$823.36 |
$2,573 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$688.32 |
$2,151 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$728.32 |
$2,276 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$669.12 |
$2,091 |
5.4× |
| CT thoracic spine w/wo contrast (72130) |
$818.88 |
$2,559 |
4.0× |
| CT thorax w/o contrast (71250) |
$578.56 |
$1,808 |
4.7× |
| CT upper ext wo (73200) |
$449.92 |
$1,406 |
3.6× |
| CT upper extremity with contrast (73201) |
$717.44 |
$2,242 |
1.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$884.16 |
$2,763 |
4.3× |
| Cta Abdomen (74175) |
$829.44 |
$2,592 |
4.0× |
| CTA abdomen pelvis (74174) |
$937.92 |
$2,931 |
2.3× |
| CTA chest (71275) |
$737.28 |
$2,304 |
3.6× |
| Cta Head (70496) |
$930.88 |
$2,909 |
4.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$930.88 |
$2,909 |
2.3× |
| Cta Neck (70498) |
$780.80 |
$2,440 |
3.8× |
| Cta Pelvis (72191) |
$885.12 |
$2,766 |
4.3× |
| Cystography minimum 3 views rs&i (74430) |
$267.52 |
$836 |
0.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$784.64 |
$2,452 |
0.3× |
| Diskogram cervical (72285) |
$759.68 |
$2,374 |
0.3× |
| Diskography lumbar (72295) |
$1,168.32 |
$3,651 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$138.24 |
$432 |
1.1× |
| Esophagus (74220) |
$182.08 |
$569 |
0.9× |
| Facial bones min 3 views (70150) |
$203.52 |
$636 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$178.24 |
$557 |
1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$50.88 |
$159 |
0.4× |
| Fluoroscopy up to 1 hr (76000) |
$184 |
$575 |
0.7× |
| Foot 2 views (73620) |
$101.44 |
$317 |
1.0× |
| Forearm 2 views (73090) |
$113.60 |
$355 |
1.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$176.32 |
$551 |
0.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$306.24 |
$957 |
0.5× |
| Hand 2 views (73120) |
$110.08 |
$344 |
0.9× |
| Heart first pass single,planar (78481) |
$367.04 |
$1,147 |
0.6× |
| Heart Infarct Image (78466) |
$430.08 |
$1,344 |
0.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,377.60 |
$4,305 |
0.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,227.84 |
$3,837 |
0.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$373.76 |
$1,168 |
0.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$373.76 |
$1,168 |
0.8× |
| Hysterosalpingogram (74740) |
$260.80 |
$815 |
0.9× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$389.76 |
$1,218 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$745.60 |
$2,330 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$791.36 |
$2,473 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$836.80 |
$2,615 |
1.3× |
| Knee 3 views (73562) |
$139.20 |
$435 |
1.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$481.92 |
$1,506 |
1.0× |
| Liver imaging static only (78201) |
$814.40 |
$2,545 |
1.3× |
| Liver imaging w/vascular flow (78202) |
$729.28 |
$2,279 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$321.92 |
$1,006 |
0.5× |
| Lung perfusion differential (78597) |
$218.56 |
$683 |
0.5× |
| Lung ventilation imaging (78579) |
$220.48 |
$689 |
0.5× |
| Lymphoscintigraphy (78195) |
$463.36 |
$1,448 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,102.08 |
$3,444 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$934.40 |
$2,920 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,412.80 |
$4,415 |
3.4× |
| Mammary ductogram or galactogram multiple (77054) |
$201.60 |
$630 |
0.7× |
| Mammary ductogram or galactogram single (77053) |
$134.72 |
$421 |
0.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$310.40 |
$970 |
0.7× |
| MRA head w & w/o contrast (70546) |
$1,232.64 |
$3,852 |
3.0× |
| MRA head w/o contrast (70544) |
$809.28 |
$2,529 |
2.9× |
| MRA head with contrast (70545) |
$1,101.44 |
$3,442 |
2.7× |
| MRA neck w contrast (70548) |
$1,093.12 |
$3,416 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,150.08 |
$3,594 |
2.8× |
| MRA neck w/o contrast (70547) |
$829.76 |
$2,593 |
2.9× |
| MRI abdomen w contrast (74182) |
$913.92 |
$2,856 |
2.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,145.60 |
$3,580 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$802.24 |
$2,507 |
2.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$965.12 |
$3,016 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,135.04 |
$3,547 |
2.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,037.76 |
$3,243 |
3.7× |
| MRI breast wo contrast unilateral (77046) |
$657.92 |
$2,056 |
2.3× |
| MRI c-spine with contrast (72142) |
$814.08 |
$2,544 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$660 |
$2,062.50 |
2.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,040 |
$3,250 |
2.5× |
| MRI chest w/o contrast (71550) |
$927.36 |
$2,898 |
3.3× |
| MRI chest with contrast (71551) |
$961.60 |
$3,005 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$946.88 |
$2,959 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,396 |
$4,362.50 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,114.40 |
$3,482.50 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$686.56 |
$2,145.50 |
2.4× |
| MRI orbit face neck w contrast (70542) |
$896 |
$2,800 |
2.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,127.04 |
$3,522 |
2.7× |
| MRI pelvis w/contrast (72196) |
$869.12 |
$2,716 |
2.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,132.16 |
$3,538 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$832.64 |
$2,602 |
3.0× |
| MRI spectroscopy (76390) |
$657.92 |
$2,056 |
6.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,135.36 |
$3,548 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$846.08 |
$2,644 |
2.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,125.12 |
$3,516 |
2.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$928 |
$2,900 |
2.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,122.56 |
$3,508 |
2.7× |
| MRI temporomandibular joint (70336) |
$700.80 |
$2,190 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$843.52 |
$2,636 |
3.0× |
| MRI up ext w/o contrast (73218) |
$773.12 |
$2,416 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$921.28 |
$2,879 |
3.3× |
| MRI, joint upper extrem combo (73223) |
$1,148.48 |
$3,589 |
2.8× |
| Myocardial infarct spect (78469) |
$514.88 |
$1,609 |
0.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,400.32 |
$4,376 |
0.9× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,697.60 |
$5,305 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,995.20 |
$6,235 |
1.3× |
| Myocardial spect single study at rest or stress (78451) |
$1,731.20 |
$5,410 |
1.1× |
| N-invas est c ffr sw aly CTA (75580) |
$811.52 |
$2,536 |
0.8× |
| Neck soft tissue (70360) |
$135.68 |
$424 |
1.3× |
| Nm adrenal scan (78075) |
$729.28 |
$2,279 |
0.5× |
| Nm cardiac blood pool multiple (78473) |
$725.76 |
$2,268 |
1.5× |
| Nm cisternogram (78630) |
$648.64 |
$2,027 |
1.0× |
| Nm gastric emptying study (78264) |
$576.64 |
$1,802 |
1.2× |
| Nm kidney scan w/flow (78701) |
$412.16 |
$1,288 |
0.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$247.68 |
$774 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,225.28 |
$3,829 |
0.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$412.16 |
$1,288 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$573.12 |
$1,791 |
2.1× |
| Ob us nuchal meas 1 gest (76813) |
$38.72 |
$121 |
0.3× |
| Orthopantogram (70355) |
$135.68 |
$424 |
1.3× |
| Osseous survey limited (77074) |
$310.72 |
$971 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$496.32 |
$1,551 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$84.64 |
$264.50 |
0.7× |
| PET image w/CT, skull-thigh (78815) |
$1,417.60 |
$4,430 |
0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,227.84 |
$3,837 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,791.04 |
$5,597 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$450.56 |
$1,408 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$401.92 |
$1,256 |
0.6× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$879.36 |
$2,748 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$315.52 |
$986 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$100.48 |
$314 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$85.92 |
$268.50 |
0.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$138.08 |
$431.50 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$67.84 |
$212 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$139.52 |
$436 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$214.72 |
$671 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$99.68 |
$311.50 |
1.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$138.08 |
$431.50 |
1.3× |
| Radex Hand Minimum 3 Views (73130) |
$140.48 |
$439 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$86.08 |
$269 |
0.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$169.60 |
$530 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$92 |
$287.50 |
0.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$174.72 |
$546 |
1.4× |
| Radex Humerus Minimum 2 Views (73060) |
$113.60 |
$355 |
1.1× |
| Radex Kne 1/2 Views (73560) |
$113.92 |
$356 |
1.1× |
| Radex Kne Compl 4/More Views (73564) |
$183.68 |
$574 |
1.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$169.60 |
$530 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$118.72 |
$371 |
1.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$160.48 |
$501.50 |
1.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$138.08 |
$431.50 |
1.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$135.68 |
$424 |
1.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$150.08 |
$469 |
1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$271.36 |
$848 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$99.36 |
$310.50 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$92.32 |
$288.50 |
0.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$140.80 |
$440 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$266.24 |
$832 |
2.2× |
| Radiation treatment delivery level 3 (77412) |
$431.36 |
$1,348 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$77.92 |
$243.50 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$104.32 |
$326 |
0.8× |
| Radiologic exam chest 2 views (71046) |
$107.20 |
$335 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$393.60 |
$1,230 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$229.44 |
$717 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$227.20 |
$710 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$225.92 |
$706 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$130.88 |
$409 |
1.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$135.68 |
$424 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$106.88 |
$334 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$169.60 |
$530 |
1.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$135.68 |
$424 |
1.3× |
| Radiological examination surgical specimen (76098) |
$273.28 |
$854 |
0.4× |
| Radiopharm Dacryocystography (78660) |
$503.36 |
$1,573 |
1.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$481.92 |
$1,506 |
1.7× |
| Ribs bilateral 3 views (71110) |
$142.24 |
$444.50 |
1.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$347.84 |
$1,087 |
0.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$745.60 |
$2,330 |
1.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$770.88 |
$2,409 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$745.60 |
$2,330 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,441.60 |
$4,505 |
2.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,017.60 |
$3,180 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,441.60 |
$4,505 |
0.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,272 |
$3,975 |
0.8× |
| Sacroiliac Joints < 3 Views (72200) |
$88.32 |
$276 |
0.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$191.04 |
$597 |
0.7× |
| Salivary gland imaging (78230) |
$298.56 |
$933 |
0.6× |
| Scapula (73010) |
$164.32 |
$513.50 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$28.80 |
$90 |
1.2× |
| Shoulder 1 view (73020) |
$111.52 |
$348.50 |
1.1× |
| Sialogram (70390) |
$203.52 |
$636 |
0.7× |
| Small bowel series (74250) |
$264.32 |
$826 |
1.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$464.96 |
$1,453 |
1.1× |
| Special Physics Consult (77370) |
$131.84 |
$412 |
0.8× |
| Special treatment procedure (77470) |
$504.64 |
$1,577 |
0.8× |
| Spine thoracic 3 views (72072) |
$123.20 |
$385 |
1.0× |
| Splenoportograpy rs&i (75810) |
$1,791.04 |
$5,597 |
0.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$373.12 |
$1,166 |
0.8× |
| Testicular Imaging With Vascular Flow (78761) |
$503.36 |
$1,573 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$754.24 |
$2,357 |
1.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$455.68 |
$1,424 |
2.9× |
| Thoracolumbar 2 views (72080) |
$116.16 |
$363 |
1.1× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$475.84 |
$1,487 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$640.96 |
$2,003 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$273.28 |
$854 |
0.6× |
| Thyroid uptake measurement (78012) |
$273.28 |
$854 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$310.40 |
$970 |
0.7× |
| Tmj unilateral (70328) |
$135.68 |
$424 |
1.3× |
| Tomogram (76100) |
$171.20 |
$535 |
1.4× |
| Treatment device complex (77334) |
$468.16 |
$1,463 |
1.1× |
| Ultrasound breast complete (76641) |
$200 |
$625 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$212.80 |
$665 |
1.7× |
| Umbilical-artery Doppler (OB) (76820) |
$55.68 |
$174 |
0.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$34.88 |
$109 |
0.3× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$27.52 |
$86 |
2.5× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$88.32 |
$276 |
0.9× |
| Urethrocystogram voiding (74455) |
$327.04 |
$1,022 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$301.12 |
$941 |
1.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$431.36 |
$1,348 |
2.1× |
| Us breast unilateral limited (76642) |
$175.20 |
$547.50 |
1.7× |
| Us chest (76604) |
$232 |
$725 |
1.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$375.68 |
$1,174 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$203.52 |
$636 |
1.6× |
| Us elastography parenchyma (76981) |
$31.68 |
$99 |
0.3× |
| Us encephalogram (76506) |
$255.36 |
$798 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$175.20 |
$547.50 |
1.4× |
| Us ob detailed single fetus (76811) |
$171.52 |
$536 |
0.6× |
| Us ob limited (76815) |
$50.88 |
$159 |
0.4× |
| Us ob transvaginal (76817) |
$52.48 |
$164 |
0.4× |
| Us pelvic non ob complete (76856) |
$54.40 |
$170 |
0.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$186.24 |
$582 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$52.16 |
$163 |
0.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$128.96 |
$403 |
1.0× |
| Us retroperitoneal complete (76770) |
$239.68 |
$749 |
1.9× |
| Us retroperitoneal limited (76775) |
$213.12 |
$666 |
1.7× |
| Us scrotum and contents (76870) |
$200 |
$625 |
1.6× |
| Us soft tissue head/neck (76536) |
$122.88 |
$384 |
1.0× |
| Us transrectal (76872) |
$29.28 |
$91.50 |
0.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$189.12 |
$591 |
1.5× |
| Venogram extremity bilateral (75822) |
$593.60 |
$1,855 |
0.3× |
| Venogram Extremity Unilateral (75820) |
$1,075.68 |
$3,361.50 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$1,428.48 |
$4,464 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$616.96 |
$1,928 |
0.3× |
| Venography Renal Bilateral (75833) |
$1,746.88 |
$5,459 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,227.84 |
$3,837 |
0.3× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,117.12 |
$6,616 |
0.3× |
| Wrist 2 views (73100) |
$111.04 |
$347 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$168.80 |
$527.50 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$118.72 |
$371 |
1.2× |
| X-ray b.e. reductn intuss (74283) |
$380.16 |
$1,188 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$368 |
$1,150 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$73.60 |
$230 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$117.44 |
$367 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$106.08 |
$331.50 |
0.9× |
| X-ray exam of femur 2/> (73552) |
$138.24 |
$432 |
1.3× |
| X-ray eye for foreign body (70030) |
$135.68 |
$424 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$135.68 |
$424 |
1.3× |
| X-ray IV pyelogram (ivp) (74400) |
$326.72 |
$1,021 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$88 |
$275 |
0.9× |
| X-ray leg, infant (73592) |
$92.32 |
$288.50 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$116.16 |
$363 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$190.72 |
$596 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$101.76 |
$318 |
1.0× |
| X-ray optic foramen (70190) |
$169.60 |
$530 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$203.52 |
$636 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$180 |
$562.50 |
0.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$101.12 |
$316 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$111.36 |
$348 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$156.32 |
$488.50 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$126.88 |
$396.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$116.16 |
$363 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$145.76 |
$455.50 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$213.28 |
$666.50 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$203.52 |
$636 |
1.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$444.48 |
$1,389 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$84.80 |
$265 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$139.04 |
$434.50 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$102.24 |
$319.50 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$116.16 |
$363 |
0.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$79.04 |
$247 |
0.6× |
| Xr bone length studies (77073) |
$287.04 |
$897 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$145.28 |
$454 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$170.08 |
$531.50 |
1.4× |
| Xr chest 4+ views (71048) |
$144.32 |
$451 |
1.2× |
| Xr myelogram posterior fossa (70010) |
$407.04 |
$1,272 |
1.0× |