| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,479.50 |
$5,510 |
1.5× |
| Abdomen 2 views (74019) |
$252.90 |
$562 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,727.10 |
$3,838 |
3.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$2,358.45 |
$5,241 |
1.5× |
| Angio Adrenal Bilat Select (75733) |
$6,595.20 |
$14,656 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$5,556.60 |
$12,348 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$5,276.70 |
$11,726 |
1.4× |
| Angiography internal mammary rs&i (75756) |
$6,539.40 |
$14,532 |
1.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$11,162.70 |
$24,806 |
1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,732.45 |
$14,961 |
1.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,595.20 |
$14,656 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$11,162.70 |
$24,806 |
1.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$10,495.80 |
$23,324 |
1.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,177.70 |
$11,506 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,245.20 |
$11,656 |
1.4× |
| Ankle 2 views (73600) |
$214.65 |
$477 |
2.1× |
| Aortogram thoracic (75605) |
$11,162.70 |
$24,806 |
1.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,595.20 |
$14,656 |
1.7× |
| Aortography abdominal serialography rs&i (75625) |
$5,276.70 |
$11,726 |
1.4× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$6,595.20 |
$14,656 |
1.7× |
| Artery X-Rays Adrenal Gland (75731) |
$5,487.75 |
$12,195 |
1.5× |
| Basic dosimetry (77300) |
$443.25 |
$985 |
2.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$692.10 |
$1,538 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$774 |
$1,720 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$890.55 |
$1,979 |
1.9× |
| Bone age studies (77072) |
$190.80 |
$424 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,233 |
$2,740 |
2.6× |
| Bone Marrow Imaging Limited Area (78102) |
$692.10 |
$1,538 |
1.4× |
| Bone survey complete (77075) |
$512.10 |
$1,138 |
4.1× |
| Bone survey infant (77076) |
$190.80 |
$424 |
1.5× |
| Bowel imaging (78290) |
$1,660.50 |
$3,690 |
3.5× |
| Brachytx isodose complex (77318) |
$864.90 |
$1,922 |
1.9× |
| Brachytx isodose intermed (77317) |
$638.10 |
$1,418 |
1.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$528.30 |
$1,174 |
1.2× |
| Brain imaging < 4 static views (78600) |
$692.10 |
$1,538 |
1.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$692.10 |
$1,538 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$897.30 |
$1,994 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,640.60 |
$5,868 |
1.5× |
| Brain Imaging Vascular Flow Only (78610) |
$897.30 |
$1,994 |
1.4× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$897.30 |
$1,994 |
1.4× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$692.10 |
$1,538 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,154.70 |
$2,566 |
2.4× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,121.40 |
$2,492 |
1.7× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$4,792.50 |
$10,650 |
5.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,973.05 |
$8,829 |
9.5× |
| Cardiac shunt detection (78428) |
$906.30 |
$2,014 |
1.9× |
| Cardiovasc nucl exam unlisted (78499) |
$692.10 |
$1,538 |
1.4× |
| Cephalogram, orthodontic Non-Facility (70350) |
$186.30 |
$414 |
1.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$854.55 |
$1,899 |
1.3× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$897.30 |
$1,994 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$216.45 |
$481 |
2.1× |
| Chest 1 view (71045) |
$186.30 |
$414 |
1.8× |
| Chest xray 3 views (71047) |
$309.60 |
$688 |
3.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$412.20 |
$916 |
2.0× |
| Cineradiography/videoradiography (76120) |
$70.65 |
$157 |
0.6× |
| Clavicle complete (73000) |
$193.50 |
$430 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$198 |
$440 |
1.6× |
| Continuing medical physics consltj pr wk (77336) |
$266.40 |
$592 |
1.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$401.40 |
$892 |
1.9× |
| Corpora cavernosography (74445) |
$426.60 |
$948 |
3.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,027.25 |
$4,505 |
4.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,064.70 |
$2,366 |
3.7× |
| CT abdomen w contrast (74160) |
$1,484.10 |
$3,298 |
7.1× |
| CT abdomen w wo contrast (74170) |
$1,538.55 |
$3,419 |
7.3× |
| CT abdomen w/o contrast (74150) |
$909.90 |
$2,022 |
7.3× |
| CT angio hrt w/3d image (75574) |
$2,010.15 |
$4,467 |
4.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,086.65 |
$4,637 |
9.9× |
| CT angiography upper extremity lt (73206) |
$2,990.70 |
$6,646 |
14.2× |
| CT c-spine w/contrast (72126) |
$2,175.30 |
$4,834 |
5.2× |
| CT c-spine w/o contrast (72125) |
$1,246.05 |
$2,769 |
9.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$118.35 |
$263 |
0.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,585.70 |
$5,746 |
12.3× |
| CT chest w contrast (71260) |
$1,282.50 |
$2,850 |
6.1× |
| CT chest w/wo contrast (71270) |
$2,216.70 |
$4,926 |
10.5× |
| CT colonography screening (74263) |
$6,571.35 |
$14,603 |
23.0× |
| CT colonography w/dye (74262) |
$4,542.75 |
$10,095 |
21.6× |
| CT colonography w/o cntrst (74261) |
$1,478.25 |
$3,285 |
11.8× |
| CT head/brain with contrast (70460) |
$1,123.65 |
$2,497 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,257.30 |
$2,794 |
6.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$401.40 |
$892 |
1.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$138.60 |
$308 |
1.3× |
| CT hrt w/3d image congen (75573) |
$401.40 |
$892 |
1.0× |
| CT iac w contrast (70481) |
$1,524.15 |
$3,387 |
7.3× |
| CT limited/localized follow up study (76380) |
$458.10 |
$1,018 |
4.4× |
| CT lower ext w/o (73700) |
$1,251.90 |
$2,782 |
10.0× |
| CT lower extremity w wo contrast (73702) |
$2,726.10 |
$6,058 |
13.0× |
| CT lower extremity w/contrast material (73701) |
$1,255.05 |
$2,789 |
6.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,605.05 |
$5,789 |
12.4× |
| CT lumbar spine w/contrast (72132) |
$1,858.50 |
$4,130 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$957.15 |
$2,127 |
7.6× |
| CT maxillofacial w contrast (70487) |
$1,213.20 |
$2,696 |
5.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,739.60 |
$6,088 |
13.0× |
| CT maxillofacial wo contrast (70486) |
$1,083.15 |
$2,407 |
8.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,947.05 |
$6,549 |
14.0× |
| CT orbits w/o contrast (70480) |
$1,140.75 |
$2,535 |
9.1× |
| CT pelvis w/o contrast (72192) |
$1,149.75 |
$2,555 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$2,628.90 |
$5,842 |
12.5× |
| CT scan of arm combo (73202) |
$2,729.70 |
$6,066 |
13.0× |
| CT soft tissue neck w contrast (70491) |
$1,282.05 |
$2,849 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,315.80 |
$2,924 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$972.45 |
$2,161 |
7.8× |
| CT thoracic spine w/contrast (72129) |
$1,359.45 |
$3,021 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$958.50 |
$2,130 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$2,612.25 |
$5,805 |
12.4× |
| CT thorax w/o contrast (71250) |
$996.75 |
$2,215 |
8.0× |
| CT unlisted procedure (76497) |
$507.60 |
$1,128 |
4.9× |
| CT upper ext wo (73200) |
$939.60 |
$2,088 |
7.5× |
| CT upper extremity with contrast (73201) |
$1,390.50 |
$3,090 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,906.20 |
$4,236 |
9.1× |
| Cta Abdomen (74175) |
$1,302.75 |
$2,895 |
6.2× |
| CTA abdomen pelvis (74174) |
$1,838.70 |
$4,086 |
4.4× |
| CTA chest (71275) |
$1,715.40 |
$3,812 |
8.2× |
| Cta Head (70496) |
$1,377 |
$3,060 |
6.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$235.35 |
$523 |
0.6× |
| Cta Neck (70498) |
$1,280.70 |
$2,846 |
6.1× |
| Cta Pelvis (72191) |
$2,185.65 |
$4,857 |
10.4× |
| Cystography minimum 3 views rs&i (74430) |
$655.65 |
$1,457 |
1.6× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$520.65 |
$1,157 |
1.8× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$897.30 |
$1,994 |
1.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$222.30 |
$494 |
1.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$303.30 |
$674 |
2.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$481.50 |
$1,070 |
3.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$311.40 |
$692 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$140.40 |
$312 |
1.3× |
| Echo exam of eye (76529) |
$385.65 |
$857 |
3.7× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$652.95 |
$1,451 |
2.3× |
| Esophageal motility (78258) |
$1,149.30 |
$2,554 |
2.4× |
| Esophagus (74220) |
$470.70 |
$1,046 |
2.2× |
| Facial bones min 3 views (70150) |
$325.80 |
$724 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$612 |
$1,360 |
4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$445.05 |
$989 |
3.6× |
| Fetal Echo (76825) |
$1,093.50 |
$2,430 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$420.75 |
$935 |
1.5× |
| Foot 2 views (73620) |
$233.55 |
$519 |
2.2× |
| Forearm 2 views (73090) |
$233.55 |
$519 |
2.2× |
| Functional MRI brain by phys/psych (70555) |
$1,030.95 |
$2,291 |
3.6× |
| Functional MRI brain by tech (70554) |
$715.50 |
$1,590 |
2.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$990 |
$2,200 |
2.1× |
| Gastric mucosa imaging (78261) |
$692.10 |
$1,538 |
1.4× |
| Gastrointestinal protein loss Facility (78282) |
$692.10 |
$1,538 |
1.4× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$993.60 |
$2,208 |
1.5× |
| Hand 2 views (73120) |
$238.95 |
$531 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,278.90 |
$2,842 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,674.80 |
$5,944 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,551.40 |
$7,892 |
4.3× |
| Heart first pass single,planar (78481) |
$897.30 |
$1,994 |
1.4× |
| Heart Infarct Image (78466) |
$692.10 |
$1,538 |
1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,732.45 |
$14,961 |
1.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,595.20 |
$14,656 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,532.70 |
$3,406 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$897.75 |
$1,995 |
1.9× |
| Hysterosalpingogram (74740) |
$688.50 |
$1,530 |
2.4× |
| Image fusion (77399) |
$237.60 |
$528 |
1.5× |
| Interstitial radiation source applic complex (77778) |
$6,230.25 |
$13,845 |
7.5× |
| Intracavitary Radiation Source Applic Complex (77763) |
$5,209.65 |
$11,577 |
6.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$3,947.40 |
$8,772 |
6.0× |
| Intracavitary Radiation Source Applic Simple (77761) |
$2,978.10 |
$6,618 |
4.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$231.75 |
$515 |
1.8× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$692.10 |
$1,538 |
1.4× |
| Kidney imaging morphology (78700) |
$692.10 |
$1,538 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$897.30 |
$1,994 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$897.30 |
$1,994 |
1.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$897.30 |
$1,994 |
1.4× |
| Knee 3 views (73562) |
$317.25 |
$705 |
3.0× |
| Liver & spleen imaging static only (78215) |
$954.90 |
$2,122 |
2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$955.80 |
$2,124 |
2.0× |
| Liver imaging static only (78201) |
$1,632.15 |
$3,627 |
2.5× |
| Liver imaging w/vascular flow (78202) |
$1,632.15 |
$3,627 |
2.5× |
| Lung perf&ventilat diferentl (78598) |
$1,474.20 |
$3,276 |
2.3× |
| Lung perfusion differential (78597) |
$692.10 |
$1,538 |
1.4× |
| Lung ventilation imaging (78579) |
$852.75 |
$1,895 |
1.8× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$4,908.60 |
$10,908 |
1.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$4,050.90 |
$9,002 |
1.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,986.20 |
$6,636 |
1.6× |
| Lymphoscintigraphy (78195) |
$1,264.50 |
$2,810 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,250.45 |
$5,001 |
2.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,415.15 |
$5,367 |
5.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,838.15 |
$6,307 |
6.8× |
| Magnetic Resonance Elastography (76391) |
$729 |
$1,620 |
2.5× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$258.75 |
$575 |
2.5× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$423.45 |
$941 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$2,017.35 |
$4,483 |
4.5× |
| Mr safety determination physician/other qhp (76016) |
$87.30 |
$194 |
0.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$24.30 |
$54 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$90.90 |
$202 |
0.8× |
| Mr safety implt pos&/immoblj (76019) |
$58.95 |
$131 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$238.95 |
$531 |
0.8× |
| MRA head w & w/o contrast (70546) |
$2,457 |
$5,460 |
5.9× |
| MRA head w/o contrast (70544) |
$2,003.40 |
$4,452 |
7.0× |
| MRA head with contrast (70545) |
$2,344.95 |
$5,211 |
5.6× |
| MRA neck w contrast (70548) |
$3,357.90 |
$7,462 |
8.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,035.15 |
$8,967 |
9.7× |
| MRA neck w/o contrast (70547) |
$2,362.05 |
$5,249 |
8.3× |
| MRI abdomen w contrast (74182) |
$2,415.15 |
$5,367 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,756.25 |
$6,125 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,729.35 |
$3,843 |
6.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,707.10 |
$8,238 |
3.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,099.95 |
$9,111 |
9.8× |
| MRI bone marrow blood supply (77084) |
$2,172.60 |
$4,828 |
7.6× |
| MRI breast w/o contrast bilateral (77047) |
$557.55 |
$1,239 |
1.9× |
| MRI breast wo contrast unilateral (77046) |
$535.50 |
$1,190 |
1.9× |
| MRI c-spine with contrast (72142) |
$3,258 |
$7,240 |
7.8× |
| MRI cardiac w/o cont stress (75559) |
$4,190.40 |
$9,312 |
6.4× |
| MRI cardiac w/o contrast (75557) |
$1,696.95 |
$3,771 |
5.9× |
| MRI cervical spine w/o contrast (72141) |
$1,827.45 |
$4,061 |
6.4× |
| MRI chest w/o & w/contrast material (71552) |
$5,106.60 |
$11,348 |
12.2× |
| MRI chest w/o contrast (71550) |
$3,948.75 |
$8,775 |
13.8× |
| MRI chest with contrast (71551) |
$4,417.20 |
$9,816 |
4.7× |
| MRI fetal sngl/1st gestation (74712) |
$2,394.45 |
$5,321 |
8.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,437.65 |
$5,417 |
5.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,580.98 |
$5,735.50 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,159.55 |
$4,799 |
7.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,512.80 |
$5,584 |
8.8× |
| MRI orbit face neck w contrast (70542) |
$2,554.20 |
$5,676 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,713.95 |
$6,031 |
6.5× |
| MRI pelvis w/contrast (72196) |
$2,741.85 |
$6,093 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,750.40 |
$6,112 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$2,050.20 |
$4,556 |
7.2× |
| MRI spectroscopy (76390) |
$2,185.65 |
$4,857 |
21.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,669.40 |
$5,932 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,944.70 |
$8,766 |
9.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,637.90 |
$5,862 |
6.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,600.90 |
$8,002 |
8.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,938.85 |
$8,753 |
9.4× |
| MRI temporomandibular joint (70336) |
$3,002.40 |
$6,672 |
10.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,832.85 |
$4,073 |
6.4× |
| MRI up ext w/o contrast (73218) |
$2,185.65 |
$4,857 |
7.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,984.95 |
$4,411 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$4,129.20 |
$9,176 |
9.9× |
| Musculoskeletal Nuclear Exam (78399) |
$692.10 |
$1,538 |
1.4× |
| Myelogram Cervical (72240) |
$1,627.65 |
$3,617 |
1.7× |
| Myelogram Lumbar (72265) |
$1,627.65 |
$3,617 |
1.7× |
| Myelogram thoracic (72255) |
$1,627.65 |
$3,617 |
1.7× |
| Myelography 2 or more regions (72270) |
$1,627.65 |
$3,617 |
1.7× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,942.10 |
$6,538 |
1.9× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$897.30 |
$1,994 |
1.4× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$4,276.80 |
$9,504 |
1.6× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$2,640.60 |
$5,868 |
1.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$2,640.60 |
$5,868 |
1.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,298.40 |
$9,552 |
1.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$2,640.60 |
$5,868 |
1.5× |
| Myocardial infarct spect (78469) |
$1,653.75 |
$3,675 |
2.5× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,365.20 |
$5,256 |
1.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,365.20 |
$5,256 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,454.30 |
$5,454 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,365.20 |
$5,256 |
1.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$2,640.60 |
$5,868 |
1.5× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$4,189.50 |
$9,310 |
2.3× |
| N-invas est c ffr sw aly CTA (75580) |
$1,578.15 |
$3,507 |
1.5× |
| Neck soft tissue (70360) |
$186.30 |
$414 |
1.8× |
| Nm adrenal scan (78075) |
$2,365.20 |
$5,256 |
1.5× |
| Nm bone marrow multi (78103) |
$825.75 |
$1,835 |
1.7× |
| Nm bone marrow wb (78104) |
$1,201.05 |
$2,669 |
2.5× |
| Nm cardiac blood pool multiple (78473) |
$1,162.80 |
$2,584 |
2.4× |
| Nm cisternogram (78630) |
$897.30 |
$1,994 |
1.4× |
| Nm csf leak detection (78650) |
$2,343.15 |
$5,207 |
1.5× |
| Nm gastric emptying study (78264) |
$985.05 |
$2,189 |
2.1× |
| Nm gastroesophageal reflux study (78262) |
$692.10 |
$1,538 |
1.4× |
| Nm kidney scan w/flow (78701) |
$820.35 |
$1,823 |
1.7× |
| Nm peritoneal-venous shunt patency (78291) |
$1,257.30 |
$2,794 |
2.6× |
| Nm red cell sequestration (78140) |
$692.10 |
$1,538 |
1.4× |
| Noncardiac Vascular Flow Imaging (78445) |
$855.90 |
$1,902 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$879.75 |
$1,955 |
7.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,780.70 |
$12,846 |
3.5× |
| Nuclear medicine study of endocrine organs (78099) |
$696.60 |
$1,548 |
1.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,674 |
$3,720 |
3.5× |
| Nuclear Rx Oral Admin (79005) |
$1,055.70 |
$2,346 |
3.8× |
| Ob us nuchal meas 1 gest (76813) |
$617.40 |
$1,372 |
4.9× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$376.65 |
$837 |
3.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$545.40 |
$1,212 |
4.4× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$453.60 |
$1,008 |
3.6× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$855.90 |
$1,902 |
5.4× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$123.75 |
$275 |
3.6× |
| Orthopantogram (70355) |
$185.85 |
$413 |
1.8× |
| Osseous survey limited (77074) |
$341.55 |
$759 |
2.7× |
| Parathyrd planar w/spect&CT (78072) |
$1,458 |
$3,240 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$746.55 |
$1,659 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,229.40 |
$2,732 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$230.40 |
$512 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$2,796.30 |
$6,214 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$2,640.60 |
$5,868 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$3,207.60 |
$7,128 |
1.9× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,365.20 |
$5,256 |
1.5× |
| PET whole body (78813) |
$2,640.60 |
$5,868 |
1.5× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$2,325.60 |
$5,168 |
1.5× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$2,325.60 |
$5,168 |
1.5× |
| Platelet survival study Non-Facility (78191) |
$692.10 |
$1,538 |
1.4× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$2,640.60 |
$5,868 |
1.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$6,595.20 |
$14,656 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$5,245.20 |
$11,656 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$759.60 |
$1,688 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$930.15 |
$2,067 |
1.4× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$627.30 |
$1,394 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$896.40 |
$1,992 |
1.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$226.35 |
$503 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$235.80 |
$524 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$282.15 |
$627 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$186.30 |
$414 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$238.95 |
$531 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$255.15 |
$567 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$187.65 |
$417 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$263.25 |
$585 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$242.10 |
$538 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$186.30 |
$414 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$238.95 |
$531 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$101.48 |
$225.50 |
0.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$347.85 |
$773 |
2.8× |
| Radex Humerus Minimum 2 Views (73060) |
$253.35 |
$563 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$263.70 |
$586 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$367.20 |
$816 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$244.80 |
$544 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$275.40 |
$612 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$277.65 |
$617 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$256.05 |
$569 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$263.70 |
$586 |
2.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$250.20 |
$556 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$401.85 |
$893 |
3.9× |
| Radex Toe Minimum 2 Views (73660) |
$191.25 |
$425 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$238.95 |
$531 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$292.95 |
$651 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$260.10 |
$578 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$13,771.35 |
$30,603 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$350.10 |
$778 |
2.9× |
| Radiation treatment delivery level 2 (77407) |
$464.40 |
$1,032 |
1.0× |
| Radiation treatment delivery level 3 (77412) |
$664.65 |
$1,477 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$186.30 |
$414 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$332.10 |
$738 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$247.95 |
$551 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$811.35 |
$1,803 |
3.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$401.40 |
$892 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$597.60 |
$1,328 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$416.70 |
$926 |
2.0× |
| Radiologic examination femur 1 view (73551) |
$186.30 |
$414 |
1.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$341.55 |
$759 |
3.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$228.60 |
$508 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$475.20 |
$1,056 |
3.8× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$503.10 |
$1,118 |
1.8× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$472.50 |
$1,050 |
1.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$185.85 |
$413 |
1.8× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$736.20 |
$1,636 |
7.1× |
| Radiological examination surgical specimen (76098) |
$735.75 |
$1,635 |
1.1× |
| Radiopharm Dacryocystography (78660) |
$692.10 |
$1,538 |
1.4× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,278.45 |
$2,841 |
4.6× |
| Red cell survival study Non-Facility (78130) |
$692.10 |
$1,538 |
1.4× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$897.30 |
$1,994 |
1.4× |
| Red cell volume determination (separate procedure); single sampling Non-Facility (78120) |
$692.10 |
$1,538 |
1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,850.85 |
$4,113 |
4.0× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$636.75 |
$1,415 |
1.4× |
| Ribs bilateral 3 views (71110) |
$335.25 |
$745 |
2.7× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$931.05 |
$2,069 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$931.50 |
$2,070 |
1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,739.15 |
$6,087 |
4.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,356.65 |
$5,237 |
3.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,764.45 |
$3,921 |
2.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,365.20 |
$5,256 |
1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,640.60 |
$5,868 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,298.15 |
$5,107 |
1.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$959.85 |
$2,133 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$895.50 |
$1,990 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$238.95 |
$531 |
1.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$641.25 |
$1,425 |
2.2× |
| Salivary gland function study (78232) |
$692.10 |
$1,538 |
1.4× |
| Salivary gland imaging (78230) |
$692.10 |
$1,538 |
1.4× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$692.10 |
$1,538 |
1.4× |
| Scapula (73010) |
$221.85 |
$493 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$84.15 |
$187 |
3.6× |
| Shoulder 1 view (73020) |
$186.30 |
$414 |
1.8× |
| Sialogram (70390) |
$845.10 |
$1,878 |
3.0× |
| Simulation intermediate (77285) |
$1,390.50 |
$3,090 |
3.1× |
| Small bowel series (74250) |
$898.20 |
$1,996 |
4.3× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$638.10 |
$1,418 |
1.4× |
| Special dosimetry (77331) |
$301.05 |
$669 |
1.9× |
| Special Physics Consult (77370) |
$640.35 |
$1,423 |
4.0× |
| Special treatment procedure (77470) |
$1,062 |
$2,360 |
1.6× |
| Spine thoracic 3 views (72072) |
$238.95 |
$531 |
1.9× |
| Spleen imaging only (78185) |
$692.10 |
$1,538 |
1.4× |
| Splenoportograpy rs&i (75810) |
$5,541.75 |
$12,315 |
1.5× |
| Stereotactic Body Radiation Delivery (77373) |
$6,891.30 |
$15,314 |
3.2× |
| Superior sagittal sinus venogram (75870) |
$4,950.45 |
$11,001 |
1.3× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$68.85 |
$153 |
0.6× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$68.85 |
$153 |
0.6× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$25.20 |
$56 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$850.50 |
$1,890 |
7.0× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$154.80 |
$344 |
1.5× |
| Tbs technical calculation only (77091) |
$154.80 |
$344 |
1.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$748.80 |
$1,664 |
1.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$614.25 |
$1,365 |
1.4× |
| Testicular Imaging With Vascular Flow (78761) |
$692.10 |
$1,538 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,511.10 |
$3,358 |
3.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$624.60 |
$1,388 |
3.9× |
| Thoracolumbar 2 views (72080) |
$320.40 |
$712 |
3.1× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$692.10 |
$1,538 |
1.4× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$692.10 |
$1,538 |
1.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,152 |
$2,560 |
1.8× |
| Thyroid imaging w/blood flow (78013) |
$823.05 |
$1,829 |
1.7× |
| Thyroid uptake measurement (78012) |
$692.10 |
$1,538 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$833.40 |
$1,852 |
1.7× |
| Tmj unilateral (70328) |
$256.05 |
$569 |
2.5× |
| Treatment device complex (77334) |
$944.10 |
$2,098 |
2.1× |
| Treatment device intermediate (77333) |
$455.85 |
$1,013 |
2.8× |
| Treatment devices simple (77332) |
$445.05 |
$989 |
2.8× |
| Ultrasound breast complete (76641) |
$287.10 |
$638 |
2.3× |
| Ultrasound elastography first target lesion (76982) |
$190.80 |
$424 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$190.80 |
$424 |
1.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$321.30 |
$714 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$436.50 |
$970 |
3.5× |
| Umbilical-artery Doppler (OB) (76820) |
$202.50 |
$450 |
1.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$186.30 |
$414 |
1.8× |
| Unlisted fluoroscopic procedure (76496) |
$58.95 |
$131 |
0.6× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$692.10 |
$1,538 |
1.4× |
| Unlisted genitourinary px dx nuclear medicine (78799) |
$692.10 |
$1,538 |
1.4× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$692.10 |
$1,538 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$1,543.95 |
$3,431 |
14.8× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$692.10 |
$1,538 |
1.4× |
| Unlisted ns dx nm (78699) |
$692.10 |
$1,538 |
1.4× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$2,248.20 |
$4,996 |
18.4× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$237.60 |
$528 |
1.5× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$696.60 |
$1,548 |
1.5× |
| Unlisted ultrasound procedure (76999) |
$818.10 |
$1,818 |
7.8× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$153.90 |
$342 |
13.9× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$247.95 |
$551 |
2.6× |
| Ureteral reflux study (78740) |
$1,159.65 |
$2,577 |
2.4× |
| Urethrocystogram voiding (74455) |
$599.40 |
$1,332 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$520.65 |
$1,157 |
1.8× |
| Us breast unilateral limited (76642) |
$258.30 |
$574 |
2.5× |
| Us chest (76604) |
$306.90 |
$682 |
2.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$499.05 |
$1,109 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$370.35 |
$823 |
3.0× |
| Us elastography parenchyma (76981) |
$190.80 |
$424 |
1.5× |
| Us encephalogram (76506) |
$619.20 |
$1,376 |
4.9× |
| Us hips infant static (76886) |
$153 |
$340 |
1.5× |
| Us infant hips w manipulation (76885) |
$746.55 |
$1,659 |
7.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$222.75 |
$495 |
1.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$153.90 |
$342 |
1.2× |
| Us ob detailed single fetus (76811) |
$765.90 |
$1,702 |
2.7× |
| Us ob limited (76815) |
$350.55 |
$779 |
2.8× |
| Us ob transvaginal (76817) |
$446.40 |
$992 |
3.6× |
| Us pelvic non ob complete (76856) |
$483.30 |
$1,074 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$317.25 |
$705 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$412.65 |
$917 |
3.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$499.05 |
$1,109 |
4.0× |
| Us retroperitoneal complete (76770) |
$525.60 |
$1,168 |
4.2× |
| Us retroperitoneal limited (76775) |
$445.95 |
$991 |
3.6× |
| Us scrotum and contents (76870) |
$464.40 |
$1,032 |
3.7× |
| Us soft tissue head/neck (76536) |
$456.75 |
$1,015 |
3.6× |
| Us spinal canal and contents (76800) |
$662.40 |
$1,472 |
5.3× |
| Us transrectal (76872) |
$534.15 |
$1,187 |
4.3× |
| Us transrectal prostate volume (76873) |
$846.45 |
$1,881 |
6.8× |
| Us, eye b-scan (76512) |
$486 |
$1,080 |
3.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$605.25 |
$1,345 |
4.8× |
| Venogram extremity bilateral (75822) |
$3,136.05 |
$6,969 |
1.7× |
| Venogram Extremity Unilateral (75820) |
$2,599.65 |
$5,777 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$6,595.20 |
$14,656 |
1.7× |
| Venography caval superior serialography rs&i (75827) |
$2,712.60 |
$6,028 |
1.4× |
| Venography Orbital Rs&I (75880) |
$1,282.05 |
$2,849 |
1.7× |
| Venography Renal Bilateral (75833) |
$6,732.45 |
$14,961 |
1.8× |
| Venography renal unilateral selective rs&i (75831) |
$6,595.20 |
$14,656 |
1.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$6,539.40 |
$14,532 |
1.7× |
| Venous sampling by catheter (75893) |
$11,162.70 |
$24,806 |
1.7× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$1,632.15 |
$3,627 |
2.5× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$897.30 |
$1,994 |
1.4× |
| Wrist 2 views (73100) |
$261.90 |
$582 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$71.10 |
$158 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$246.15 |
$547 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$1,660.05 |
$3,689 |
7.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,802.25 |
$4,005 |
8.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$238.50 |
$530 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$186.30 |
$414 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$221.85 |
$493 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$186.30 |
$414 |
1.8× |
| X-ray eye for foreign body (70030) |
$239.85 |
$533 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$251.10 |
$558 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$221.85 |
$493 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$266.40 |
$592 |
2.6× |
| X-ray leg, infant (73592) |
$278.10 |
$618 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$245.25 |
$545 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$528.30 |
$1,174 |
4.2× |
| X-ray nose-rectum child f.b. (76010) |
$186.30 |
$414 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$363.15 |
$807 |
2.9× |
| X-ray retrograde pyelogram (74420) |
$655.65 |
$1,457 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$186.30 |
$414 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$326.25 |
$725 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$364.95 |
$811 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$238.95 |
$531 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$215.10 |
$478 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$322.20 |
$716 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$388.35 |
$863 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$309.60 |
$688 |
2.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$3,310.20 |
$7,356 |
15.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$186.30 |
$414 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$303.75 |
$675 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$259.20 |
$576 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$238.95 |
$531 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$239.85 |
$533 |
1.9× |
| Xr bone length studies (77073) |
$194.40 |
$432 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$389.70 |
$866 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$553.05 |
$1,229 |
4.4× |
| Xr chest 4+ views (71048) |
$388.35 |
$863 |
3.1× |
| Xr myelogram posterior fossa (70010) |
$819.90 |
$1,822 |
2.0× |
| Xr urogram antegrade (74425) |
$819.90 |
$1,822 |
2.0× |