| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$7,270.12 |
$11,726 |
5.0× |
| Acute gi blood loss imaging (78278) |
$956.04 |
$1,542 |
2.3× |
| Angio adrenal bilat select (75733) |
$2,507.28 |
$4,044 |
0.8× |
| Angio adrenal unilat select (75731) |
$2,009.42 |
$3,241 |
0.6× |
| Angio extremity unilateral (75710) |
$2,429.78 |
$3,919 |
0.7× |
| Angio pulmonary unilateral (75741) |
$2,512.24 |
$4,052 |
0.8× |
| Angiogram extremity bilateral (75716) |
$2,496.12 |
$4,026 |
0.8× |
| Angiogram pelvic (75736) |
$8,841.20 |
$14,260 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$2,310.12 |
$3,726 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,816.16 |
$7,768 |
1.5× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,817.90 |
$4,545 |
0.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,628.74 |
$2,627 |
0.5× |
| Ankle 2 views (73600) |
$492.90 |
$795 |
5.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,295.24 |
$3,702 |
0.7× |
| Arthrography knee lt (73580) |
$845.68 |
$1,364 |
2.3× |
| Arthrography wrist lt (73115) |
$1,063.92 |
$1,716 |
2.9× |
| Barium enema (74270) |
$1,486.76 |
$2,398 |
8.1× |
| Basic dosimetry (77300) |
$886.60 |
$1,430 |
6.3× |
| Bilat selctv renal venogram (75833) |
$5,313.40 |
$8,570 |
1.6× |
| Bone age studies (77072) |
$452.60 |
$730 |
4.1× |
| Bone imaging limited area (78300) |
$2,077.62 |
$3,351 |
5.0× |
| Bone survey complete (77075) |
$596.44 |
$962 |
5.5× |
| Bowel imaging (78290) |
$2,517.82 |
$4,061 |
6.0× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$2,212.78 |
$3,569 |
5.7× |
| Brain image w/flow 4 + views (78606) |
$1,644.24 |
$2,652 |
2.9× |
| Card MRI w/stress img & dye (75563) |
$2,095.60 |
$3,380 |
2.6× |
| Cardiac MRI w/stress img (75559) |
$2,406.22 |
$3,881 |
4.2× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,995.78 |
$3,219 |
5.5× |
| Cardiac shunt detection (78428) |
$324.88 |
$524 |
0.8× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$1,232.56 |
$1,988 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$365.80 |
$590 |
2.0× |
| Cisternogram (78630) |
$1,156.92 |
$1,866 |
2.0× |
| Clavicle complete (73000) |
$496.62 |
$801 |
5.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,308.94 |
$5,337 |
18.1× |
| Continuing medical physics consltj pr wk (77336) |
$847.54 |
$1,367 |
6.0× |
| Contrast exam abdominl aorta (75625) |
$2,582.30 |
$4,165 |
0.8× |
| Contrast exam thoracic aorta (75605) |
$3,940.10 |
$6,355 |
0.7× |
| Corpora cavernosography (74445) |
$94.24 |
$152 |
0.9× |
| Csf shunt evaluation (78645) |
$1,051.52 |
$1,696 |
1.9× |
| CT - st neck w&wo contr (70492) |
$1,979.04 |
$3,192 |
10.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,113.02 |
$5,021 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,918.28 |
$3,094 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,594.64 |
$2,572 |
8.7× |
| CT abdomen w/contrast (74160) |
$1,454.52 |
$2,346 |
7.9× |
| CT abdomen w/o contrast (74150) |
$1,027.34 |
$1,657 |
9.4× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$3,268.64 |
$5,272 |
9.0× |
| CT angio abdom w/o & w/dye (74175) |
$1,674.62 |
$2,701 |
9.1× |
| CT angio abdominal arteries (75635) |
$2,158.22 |
$3,481 |
11.8× |
| CT angio hrt w/3d image (75574) |
$1,108.56 |
$1,788 |
3.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$1,812.88 |
$2,924 |
9.9× |
| CT cervical spine w/contrast (72126) |
$1,600.84 |
$2,582 |
4.4× |
| CT cervical spine w/o contrast (72125) |
$1,272.24 |
$2,052 |
11.7× |
| CT chest w/contrast (71260) |
$1,516.52 |
$2,446 |
8.3× |
| CT extremity upper w & w/o contrast (73202) |
$1,622.54 |
$2,617 |
8.9× |
| CT head/brain with contrast (70460) |
$1,269.76 |
$2,048 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,530.16 |
$2,468 |
8.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$772.52 |
$1,246 |
2.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$61.38 |
$99 |
0.7× |
| CT hrt w/3d image congen (75573) |
$978.36 |
$1,578 |
2.7× |
| CT limited/localized follow up study (76380) |
$433.38 |
$699 |
4.8× |
| CT lower ext w/wo contrast (73702) |
$1,699.42 |
$2,741 |
9.3× |
| CT lower extremity w contrast (73701) |
$1,174.28 |
$1,894 |
6.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$982.70 |
$1,585 |
9.0× |
| CT lumbar spine w/contrast (72132) |
$1,319.98 |
$2,129 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,127.16 |
$1,818 |
10.3× |
| CT lumbar spine w/o then w/ con (72133) |
$1,715.54 |
$2,767 |
9.4× |
| CT maxillofacial area w/o contrast (70486) |
$1,383.22 |
$2,231 |
12.7× |
| CT maxillofacial w/contrast (70487) |
$1,540.70 |
$2,485 |
8.4× |
| CT maxillofacial w/o then w/ con (70488) |
$1,650.44 |
$2,662 |
9.0× |
| CT orbit sella ear w/o con (70480) |
$1,200.32 |
$1,936 |
11.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$3,911.58 |
$6,309 |
21.4× |
| CT pelvis w & w/o contrast (72194) |
$1,726.70 |
$2,785 |
9.4× |
| CT pelvis w/o contrast (72192) |
$1,179.24 |
$1,902 |
10.8× |
| CT soft tissue neck w/contrast (70491) |
$1,605.18 |
$2,589 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,182.96 |
$1,908 |
10.8× |
| CT spine cervical w/wo contrast (72127) |
$2,412.42 |
$3,891 |
13.2× |
| CT thoracic spine w/contrast (72129) |
$1,430.96 |
$2,308 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$1,174.90 |
$1,895 |
10.8× |
| CT thoracic spine w/o then w/ con (72130) |
$1,585.34 |
$2,557 |
8.7× |
| CT thorax lung cancer scr c- (71271) |
$728.50 |
$1,175 |
6.7× |
| CT thorax w/o contrast (71250) |
$1,245.58 |
$2,009 |
11.4× |
| CT thorax w/o then w/ contrast (71270) |
$1,763.28 |
$2,844 |
9.6× |
| CT upper extremity w/dye (73201) |
$1,246.82 |
$2,011 |
3.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,148.86 |
$1,853 |
10.5× |
| CTA chest w/wo contrast (71275) |
$1,983.38 |
$3,199 |
10.8× |
| CTA head w contrast (70496) |
$2,126.60 |
$3,430 |
11.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,784.36 |
$2,878 |
9.7× |
| Cta Neck (70498) |
$2,093.12 |
$3,376 |
11.4× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$1,703.76 |
$2,748 |
9.3× |
| Dilation ureters/urethra rs&i (74485) |
$1,373.30 |
$2,215 |
0.6× |
| Diskography lumbar (72295) |
$2,903.46 |
$4,683 |
1.4× |
| Doppler echo fetal spectral display complete (76827) |
$897.14 |
$1,447 |
8.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$606.98 |
$979 |
5.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$968.44 |
$1,562 |
3.9× |
| Esophogram (74220) |
$841.34 |
$1,357 |
4.6× |
| Fetal biophysical profile non-stress testing (76818) |
$1,641.14 |
$2,647 |
15.0× |
| Fetal biophysical profile w/o nst (76819) |
$1,175.52 |
$1,896 |
10.8× |
| Fetal echo complete (76825) |
$2,277.88 |
$3,674 |
4.0× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,194.74 |
$1,927 |
4.8× |
| Functional MRI brain by phys/psych (70555) |
$1,709.96 |
$2,758 |
6.9× |
| Functional MRI brain by tech (70554) |
$1,652.30 |
$2,665 |
6.6× |
| Gastric emptying study (78264) |
$2,486.20 |
$4,010 |
6.0× |
| Gastroesophageal reflux study (78262) |
$1,636.18 |
$2,639 |
3.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,723.10 |
$6,005 |
5.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$5,549.62 |
$8,951 |
7.6× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$6,917.96 |
$11,158 |
9.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,729.86 |
$4,403 |
0.8× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$3,905.38 |
$6,299 |
1.2× |
| Hepatobil syst image w/drug (78227) |
$2,472.56 |
$3,988 |
4.4× |
| Hepatobiliary system imaging (78226) |
$2,081.96 |
$3,358 |
5.0× |
| Humerus min 2 views (73060) |
$539.40 |
$870 |
5.9× |
| Hysterosalpingography (74740) |
$1,427.86 |
$2,303 |
5.7× |
| Imrt planning (77301) |
$9,383.70 |
$15,135 |
6.5× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$4,257.54 |
$6,867 |
5.9× |
| Intracavitary radiation source applic complex (77763) |
$1,683.92 |
$2,716 |
2.3× |
| Intracavitary radiation source applic intermed (77762) |
$721.68 |
$1,164 |
1.3× |
| Intracavitary radiation source applic simple (77761) |
$629.30 |
$1,015 |
1.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,634.94 |
$2,637 |
4.2× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,240.62 |
$2,001 |
3.2× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,367.72 |
$2,206 |
3.5× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$553.66 |
$893 |
1.4× |
| Ivp (74400) |
$1,009.36 |
$1,628 |
5.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,397.48 |
$2,254 |
2.5× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,410.56 |
$3,888 |
4.3× |
| Liver & spleen; static only (78215) |
$1,654.16 |
$2,668 |
4.0× |
| Liver imaging w/vascular flow (78202) |
$1,070.12 |
$1,726 |
1.9× |
| Lung perfusion differential (78597) |
$971.54 |
$1,567 |
2.3× |
| Lung ventilat&perfus imaging (78582) |
$1,434.06 |
$2,313 |
2.5× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$936.20 |
$1,510 |
0.6× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$2,919.58 |
$4,709 |
0.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,443.42 |
$3,941 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,036.76 |
$4,898 |
8.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,610.82 |
$4,211 |
7.2× |
| Med physic dos eval rad exps (76145) |
$1,228.22 |
$1,981 |
3.2× |
| Mlc device(s) for imrt (77338) |
$3,253.76 |
$5,248 |
8.3× |
| Mr safety determination physician/other qhp (76016) |
$82.46 |
$133 |
0.9× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$173.60 |
$280 |
2.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$23.56 |
$38 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$114.08 |
$184 |
1.1× |
| Mr safety med physics xm customization plng&mntr (76017) |
$272.18 |
$439 |
1.1× |
| MRA head w & w/o contrast (70546) |
$2,207.82 |
$3,561 |
6.1× |
| MRA head w/contrast (70545) |
$1,825.90 |
$2,945 |
5.0× |
| MRA head w/o contrast (70544) |
$1,696.94 |
$2,737 |
6.8× |
| MRA neck w/contrast (70548) |
$1,656.02 |
$2,671 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,502.26 |
$2,423 |
6.0× |
| MRA neck w/wo contrast (70549) |
$2,112.34 |
$3,407 |
5.8× |
| MRI abdomen w/contrast (74182) |
$2,408.70 |
$3,885 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,561.84 |
$4,132 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$2,059.02 |
$3,321 |
8.3× |
| MRI any jnt lwr ext with con lt (73722) |
$2,530.84 |
$4,082 |
3.1× |
| MRI breast without contrast bilateral (77047) |
$1,999.50 |
$3,225 |
8.0× |
| MRI breast without contrast material unilateral (77046) |
$1,569.22 |
$2,531 |
6.3× |
| MRI cardiac w/o contrast (75557) |
$2,209.06 |
$3,563 |
8.9× |
| MRI cervical spine w/o contrast (72141) |
$1,929.44 |
$3,112 |
7.7× |
| MRI cervical spine with contrast (72142) |
$2,216.50 |
$3,575 |
6.1× |
| MRI chest w & w/o contrast (71552) |
$2,316.32 |
$3,736 |
6.4× |
| MRI chest w/contrast (71551) |
$1,832.10 |
$2,955 |
2.2× |
| MRI chest w/o contrast (71550) |
$1,789.94 |
$2,887 |
7.2× |
| MRI fetal sngl/1st gestation (74712) |
$2,082.58 |
$3,359 |
8.4× |
| MRI joint upper ext w/contrast (73222) |
$1,922.62 |
$3,101 |
2.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,931.36 |
$4,728 |
8.0× |
| MRI joint upr extrem w/o dye (73221) |
$1,752.12 |
$2,826 |
7.0× |
| Mri Lower Extremity W/O Dye (73718) |
$1,770.72 |
$2,856 |
7.1× |
| MRI lumbar spine with contrast (72149) |
$2,143.96 |
$3,458 |
5.9× |
| MRI lumbar w/wo contrast (72158) |
$2,808.60 |
$4,530 |
7.7× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,490.54 |
$4,017 |
6.8× |
| MRI orbit/face/neck w/contrast (70542) |
$2,276.64 |
$3,672 |
6.2× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,938.12 |
$3,126 |
7.8× |
| MRI pelvis w/ contrast (72196) |
$1,895.96 |
$3,058 |
5.2× |
| MRI pelvis w/o contrast (72195) |
$1,574.80 |
$2,540 |
6.3× |
| MRI pelvis w/wo contrast (72197) |
$2,782.56 |
$4,488 |
7.6× |
| MRI spectroscopy (76390) |
$1,582.86 |
$2,553 |
17.4× |
| MRI spine cervical wo/w contrast (72156) |
$2,463.26 |
$3,973 |
6.8× |
| MRI spine thoracic w/contrast (72147) |
$2,860.06 |
$4,613 |
7.9× |
| MRI thoracic spine w wo contrast (72157) |
$2,587.26 |
$4,173 |
7.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,969.12 |
$3,176 |
7.9× |
| MRI tmj (70336) |
$1,688.88 |
$2,724 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,656.64 |
$2,672 |
6.6× |
| Mri Upper Extremity W/Dye (73219) |
$1,801.10 |
$2,905 |
4.9× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,285.32 |
$3,686 |
6.3× |
| Myelogram Cpa (70010) |
$317.44 |
$512 |
0.9× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$1,988.34 |
$3,207 |
1.5× |
| Myocardial perfusion planar multiple studies (78454) |
$3,061.56 |
$4,938 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$3,300.26 |
$5,323 |
2.4× |
| Nm bone 3 phase (78315) |
$3,146.50 |
$5,075 |
7.5× |
| Nm bone imaging whole body (78306) |
$2,683.98 |
$4,329 |
6.4× |
| Nm heart perfusion spect stress rest (78452) |
$4,024.42 |
$6,491 |
3.0× |
| Nm kidney function (78725) |
$1,558.68 |
$2,514 |
3.7× |
| Nm lymph system (78195) |
$2,496.12 |
$4,026 |
4.4× |
| Nm thyroid imaging only (78013) |
$1,060.20 |
$1,710 |
2.5× |
| Nose to rectum for fb child (76010) |
$137.02 |
$221 |
1.5× |
| Nuclear rx IV admin (79101) |
$1,723.60 |
$2,780 |
7.1× |
| Ob us < 14 wks single fetus (76801) |
$376.34 |
$607 |
3.4× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$310.62 |
$501 |
2.8× |
| Oral radiopharm rx (79005) |
$1,659.12 |
$2,676 |
6.8× |
| Orthopantogram (70355) |
$155.62 |
$251 |
1.7× |
| Parathyrd planar w/spect&CT (78072) |
$2,646.78 |
$4,269 |
4.7× |
| Parathyroid imaging (78070) |
$1,900.30 |
$3,065 |
4.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,165.04 |
$3,492 |
5.2× |
| Peritoneal-venous shunt patency test (78291) |
$1,181.10 |
$1,905 |
2.8× |
| Peritoneogram rs&i (74190) |
$731.60 |
$1,180 |
1.3× |
| PET brain metabolic eval (78608) |
$3,698.30 |
$5,965 |
2.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$5,542.18 |
$8,939 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$3,226.48 |
$5,204 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$6,483.34 |
$10,457 |
4.3× |
| PET imaging limited area chest head/neck (78811) |
$2,090.02 |
$3,371 |
1.5× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$4,933.34 |
$7,957 |
3.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,394.44 |
$3,862 |
0.7× |
| Pulmonary perfusion imaging particulate (78580) |
$1,094.30 |
$1,765 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$798.56 |
$1,288 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$579.08 |
$934 |
6.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$675.18 |
$1,089 |
6.2× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$1,127.78 |
$1,819 |
10.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$1,274.10 |
$2,055 |
11.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$246.14 |
$397 |
2.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$265.98 |
$429 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$600.16 |
$968 |
5.5× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$967.20 |
$1,560 |
8.9× |
| Radex spine cervical 2 or 3 views (72040) |
$753.30 |
$1,215 |
8.3× |
| Radex spine cervical 4 or 5 views (72050) |
$881.02 |
$1,421 |
8.1× |
| Radex spine cervical 6 or more views (72052) |
$967.82 |
$1,561 |
8.9× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$325.50 |
$525 |
3.6× |
| Radiation delivery stereotactic cranial linear (77372) |
$17,745.02 |
$28,621 |
2.3× |
| Radiation tx delivery lvl 1 (77402) |
$347.82 |
$561 |
3.3× |
| Radiation tx delivery lvl 2 (77407) |
$644.18 |
$1,039 |
1.6× |
| Radiation tx delivery lvl 3 (77412) |
$1,290.84 |
$2,082 |
2.2× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$703.70 |
$1,135 |
6.4× |
| Radiologic exam esophagus double contrast study (74221) |
$932.48 |
$1,504 |
5.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,473.12 |
$2,376 |
8.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,200.32 |
$1,936 |
6.6× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$254.82 |
$411 |
2.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$410.44 |
$662 |
4.5× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$955.42 |
$1,541 |
8.8× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$283.96 |
$458 |
2.6× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$846.92 |
$1,366 |
7.8× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$1,674.62 |
$2,701 |
4.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$946.74 |
$1,527 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,286.50 |
$2,075 |
3.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,481.36 |
$7,228 |
7.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,760.18 |
$2,839 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,913.94 |
$3,087 |
3.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,150.84 |
$5,082 |
2.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$833.28 |
$1,344 |
3.4× |
| Saline infused sonohysterogram (76831) |
$742.76 |
$1,198 |
3.0× |
| Selective spinal angiogram (75705) |
$3,503 |
$5,650 |
0.6× |
| Shoulder arthrogram (73040) |
$1,567.98 |
$2,529 |
4.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$528.86 |
$853 |
4.8× |
| Simulation complex (77290) |
$3,663.58 |
$5,909 |
9.4× |
| Simulation intermediate (77285) |
$1,975.94 |
$3,187 |
5.1× |
| Simulation simple (77280) |
$1,876.12 |
$3,026 |
13.4× |
| Small bowel series (74250) |
$539.40 |
$870 |
2.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,901.54 |
$3,067 |
4.9× |
| Special dosimetry (77331) |
$347.82 |
$561 |
2.5× |
| Special physics consult (77370) |
$941.78 |
$1,519 |
6.7× |
| Special treatment procedure (77470) |
$3,520.36 |
$5,678 |
6.1× |
| Splenoportography (75810) |
$1,642.38 |
$2,649 |
0.5× |
| Stereotactic body radiation delivery (77373) |
$5,268.76 |
$8,498 |
2.8× |
| Superior sagittal sinus venogram (75870) |
$1,628.74 |
$2,627 |
0.5× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$192.20 |
$310 |
1.8× |
| Testicular imaging w/flow (78761) |
$1,310.68 |
$2,114 |
3.1× |
| Therapeutic enema barium or air (74283) |
$1,497.30 |
$2,415 |
8.2× |
| Thyroid met imaging body (78018) |
$2,715.60 |
$4,380 |
4.8× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,964.78 |
$3,169 |
4.7× |
| Treatment device intermediate (77333) |
$1,073.84 |
$1,732 |
7.7× |
| Treatment devices complex (77334) |
$1,868.06 |
$3,013 |
4.8× |
| Treatment devices simple (77332) |
$898.38 |
$1,449 |
6.4× |
| Ultrasound breast limited (76642) |
$576.60 |
$930 |
6.3× |
| Ultrasound, abdomen limited (76705) |
$1,126.54 |
$1,817 |
10.3× |
| Unlisted diagnostic radiographic procedure (76499) |
$265.36 |
$428 |
2.9× |
| Unlisted fluoroscopic procedure (76496) |
$605.12 |
$976 |
6.7× |
| Unlisted magnetic resonance procedure (76498) |
$1,128.71 |
$1,820.50 |
12.4× |
| Ureteral reflux study (78740) |
$623.72 |
$1,006 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$1,153.20 |
$1,860 |
4.6× |
| Urethrocystography voiding (74455) |
$1,256.12 |
$2,026 |
5.0× |
| Urography antegrade (74425) |
$748.96 |
$1,208 |
2.1× |
| Urography retrograde w/wo kub (74420) |
$1,517.76 |
$2,448 |
4.2× |
| Us abdominal aorta real time screen study aaa (76706) |
$393.08 |
$634 |
3.6× |
| Us breast uni real time with image complete (76641) |
$853.74 |
$1,377 |
7.8× |
| Us chest (76604) |
$478.02 |
$771 |
4.4× |
| Us compl joint r-t w/image documentation (76881) |
$938.68 |
$1,514 |
8.6× |
| Us encephalogram (76506) |
$1,001.92 |
$1,616 |
9.2× |
| Us gi endoscopic (76975) |
$411.68 |
$664 |
1.7× |
| Us guided compression repair (76936) |
$714.86 |
$1,153 |
3.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$881.02 |
$1,421 |
9.7× |
| Us kidney transplanted (76776) |
$435.86 |
$703 |
4.0× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$726.02 |
$1,171 |
6.7× |
| Us ob followup per fetus (76816) |
$514.60 |
$830 |
4.7× |
| Us ob limited 1 or more fetuses (76815) |
$673.32 |
$1,086 |
6.2× |
| Us obstetric transvaginal (76817) |
$1,009.98 |
$1,629 |
9.3× |
| Us pelvic limited or f/u non-ob (76857) |
$529.48 |
$854 |
4.9× |
| Us pelvis complete (76856) |
$1,362.76 |
$2,198 |
12.5× |
| Us retroperitoneal complete (76770) |
$1,261.70 |
$2,035 |
11.6× |
| Us retroperitoneal limited (76775) |
$510.88 |
$824 |
4.7× |
| Us scrotum (76870) |
$1,158.78 |
$1,869 |
10.6× |
| Us soft tissue head/neck (76536) |
$1,176.14 |
$1,897 |
10.8× |
| Us spinal canal (76800) |
$664.64 |
$1,072 |
6.1× |
| Us transrectal (76872) |
$1,232.56 |
$1,988 |
11.3× |
| Us transrectal prostate volume (76873) |
$389.36 |
$628 |
3.6× |
| Us unlstd proc (76999) |
$532.58 |
$859 |
5.9× |
| Vein X-ray liver w/hemodynam (75885) |
$3,442.24 |
$5,552 |
1.0× |
| Venogram extremity bilateral (75822) |
$2,092.50 |
$3,375 |
1.3× |
| Venogram ivc w serialography (75825) |
$2,051.58 |
$3,309 |
0.6× |
| Venogram svc w serialography (75827) |
$2,174.96 |
$3,508 |
1.3× |
| Venography ext unilateral (75820) |
$1,932.54 |
$3,117 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,688.38 |
$5,949 |
1.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,628.74 |
$2,627 |
0.5× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$788.02 |
$1,271 |
1.2× |
| Venous sampling by catheter (75893) |
$4,351.78 |
$7,019 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$396.18 |
$639 |
4.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$620.62 |
$1,001 |
6.8× |
| X-ray aorta leg arteries (75630) |
$3,474.48 |
$5,604 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,639.28 |
$2,644 |
8.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$615.66 |
$993 |
6.8× |
| X-ray exam hips bi 3-4 views (73522) |
$783.06 |
$1,263 |
7.2× |
| X-ray exam of finger(s) (73140) |
$469.96 |
$758 |
5.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,505.98 |
$2,429 |
8.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$513.98 |
$829 |
5.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$490.42 |
$791 |
5.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$602.64 |
$972 |
6.6× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$517.70 |
$835 |
4.7× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$634.26 |
$1,023 |
7.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$455.70 |
$735 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$533.20 |
$860 |
5.9× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$684.48 |
$1,104 |
7.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$762.60 |
$1,230 |
7.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$587.14 |
$947 |
6.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$668.98 |
$1,079 |
6.1× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$293.26 |
$473 |
2.7× |
| X-ray perineogram (74775) |
$650.38 |
$1,049 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$561.72 |
$906 |
6.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$879.16 |
$1,418 |
8.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$683.86 |
$1,103 |
6.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$597.06 |
$963 |
5.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$562.34 |
$907 |
6.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$734.70 |
$1,185 |
8.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,026.72 |
$1,656 |
9.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$661.54 |
$1,067 |
6.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$542.50 |
$875 |
6.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$437.10 |
$705 |
4.8× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$627.44 |
$1,012 |
6.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$796.08 |
$1,284 |
8.8× |
| Xr abdomen 1 view (74018) |
$460.66 |
$743 |
5.1× |
| Xr abdomen 2 views (74019) |
$623.72 |
$1,006 |
5.7× |
| Xr abdomen 3 views (74021) |
$636.74 |
$1,027 |
5.8× |
| Xr arthrogram ankle (73615) |
$619.38 |
$999 |
1.7× |
| Xr arthrogram elbow (73085) |
$633.64 |
$1,022 |
1.7× |
| Xr arthrogram hip (73525) |
$950.46 |
$1,533 |
2.6× |
| Xr bone density axial (77080) |
$983.32 |
$1,586 |
9.0× |
| Xr bone length study (77073) |
$647.90 |
$1,045 |
5.9× |
| Xr bone survey infant (77076) |
$920.08 |
$1,484 |
8.4× |
| Xr bone survey limited (77074) |
$530.10 |
$855 |
4.9× |
| Xr chest 1 view (71045) |
$184.76 |
$298 |
2.0× |
| Xr chest 2 views (71046) |
$511.50 |
$825 |
5.6× |
| Xr cystogram 3+ views (74430) |
$627.44 |
$1,012 |
1.7× |
| Xr eye foreign body (70030) |
$316.20 |
$510 |
3.5× |
| Xr facial bones 3 views (70150) |
$748.34 |
$1,207 |
6.9× |
| Xr lower extremity 2 views infant (73592) |
$538.78 |
$869 |
5.9× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$660.30 |
$1,065 |
6.0× |
| Xr mandible 4 views (70110) |
$761.36 |
$1,228 |
7.0× |
| Xr nasal bones (70160) |
$548.08 |
$884 |
6.0× |
| Xr pelvis 3 views (72190) |
$804.14 |
$1,297 |
7.4× |
| Xr spine 1 view (72020) |
$551.80 |
$890 |
6.1× |
| Xr sternum 2 views (71120) |
$566.06 |
$913 |
6.2× |
| Xr stress view joint (77071) |
$82.46 |
$133 |
0.9× |
| Xr surgical specimen (76098) |
$1,034.16 |
$1,668 |
1.8× |
| Xr upper extremity 2 views infant (73092) |
$620.62 |
$1,001 |
5.7× |
| Xray elbow 2 views (73070) |
$474.30 |
$765 |
5.2× |
| Xray forearm 2 views (73090) |
$560.48 |
$904 |
6.2× |
| Xray knee 1 or 2 views rt (73560) |
$596.44 |
$962 |
6.6× |
| Xray neck soft tissue (70360) |
$472.44 |
$762 |
5.2× |
| Xray optic foramina (70190) |
$571.64 |
$922 |
6.3× |
| Xray orbits complete min 4 views (70200) |
$894.04 |
$1,442 |
8.2× |
| Xray pelvis 1 or 2 views (72170) |
$274.66 |
$443 |
2.5× |
| Xray ribs bilateral 3 views (71110) |
$823.98 |
$1,329 |
7.5× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$670.22 |
$1,081 |
6.1× |
| Xray scapula complete (73010) |
$575.36 |
$928 |
5.3× |
| Xray shoulder 1 view (73020) |
$229.40 |
$370 |
2.5× |
| Xray spine thoracic 2 views (72070) |
$430.28 |
$694 |
3.9× |
| Xray spine thoracic 3 views (72072) |
$535.06 |
$863 |
4.9× |
| Xray tibia-fibula 2 views bil (73590) |
$614.42 |
$991 |
6.8× |
| Xray tmj open - closed unilat (70328) |
$389.36 |
$628 |
4.3× |
| Xray tmj's bilateral open-clsc (70330) |
$654.72 |
$1,056 |
7.2× |