| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$17,283.75 |
$23,045 |
12.0× |
| Acute gi blood loss imaging (78278) |
$2,905.50 |
$3,874 |
7.0× |
| Angio extremity unilateral (75710) |
$6,768 |
$9,024 |
2.1× |
| Angio pulmonary unilateral (75741) |
$6,565.88 |
$8,754.50 |
2.0× |
| Angiogram extremity bilateral (75716) |
$7,833 |
$10,444 |
2.4× |
| Angiogram pelvic (75736) |
$11,148.75 |
$14,865 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$8,565.75 |
$11,421 |
2.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$11,949.75 |
$15,933 |
3.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$10,479 |
$13,972 |
1.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,645.25 |
$3,527 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$7,672.88 |
$10,230.50 |
2.3× |
| Ankle 2 views (73600) |
$1,929 |
$2,572 |
21.2× |
| Arthrography knee lt (73580) |
$2,778 |
$3,704 |
7.6× |
| Arthrography wrist lt (73115) |
$2,195.25 |
$2,927 |
6.0× |
| Barium enema (74270) |
$2,913.75 |
$3,885 |
15.9× |
| Basic dosimetry (77300) |
$2,840.25 |
$3,787 |
20.2× |
| Bilat selctv renal venogram (75833) |
$12,032.25 |
$16,043 |
3.6× |
| Bone age studies (77072) |
$1,371.75 |
$1,829 |
12.6× |
| Bone imaging limited area (78300) |
$3,594 |
$4,792 |
8.6× |
| Bone marrow imaging whole body (78104) |
$2,367.75 |
$3,157 |
5.7× |
| Bone survey complete (77075) |
$2,471.25 |
$3,295 |
22.6× |
| Bowel imaging (78290) |
$5,185.88 |
$6,914.50 |
12.4× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$4,275.75 |
$5,701 |
10.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$1,755 |
$2,340 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,159.50 |
$1,546 |
6.3× |
| Cisternogram (78630) |
$1,065.75 |
$1,421 |
1.9× |
| Clavicle complete (73000) |
$1,887.75 |
$2,517 |
20.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$7,469.25 |
$9,959 |
40.8× |
| Continuing medical physics consltj pr wk (77336) |
$1,471.50 |
$1,962 |
10.5× |
| Contrast exam abdominl aorta (75625) |
$7,701.75 |
$10,269 |
2.3× |
| Contrast exam thoracic aorta (75605) |
$10,330.50 |
$13,774 |
1.8× |
| CT - st neck w&wo contr (70492) |
$9,950.25 |
$13,267 |
54.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$12,247.50 |
$16,330 |
33.6× |
| CT abdomen and pelvis without contrast (74176) |
$12,780 |
$17,040 |
51.3× |
| CT abdomen w wo contrast (74170) |
$9,311.25 |
$12,415 |
50.8× |
| CT abdomen w/contrast (74160) |
$8,283.75 |
$11,045 |
45.2× |
| CT abdomen w/o contrast (74150) |
$5,940.75 |
$7,921 |
54.4× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$11,544.75 |
$15,393 |
31.7× |
| CT angio abdom w/o & w/dye (74175) |
$12,843.75 |
$17,125 |
70.1× |
| CT angio abdominal arteries (75635) |
$10,683 |
$14,244 |
58.3× |
| CT angio hrt w/3d image (75574) |
$10,522.50 |
$14,030 |
28.9× |
| CT angiograph pelv w/o&w/dye (72191) |
$10,498.12 |
$13,997.50 |
57.3× |
| CT cervical spine w/contrast (72126) |
$5,041.50 |
$6,722 |
13.8× |
| CT cervical spine w/o contrast (72125) |
$5,784 |
$7,712 |
53.0× |
| CT chest w/contrast (71260) |
$10,278.75 |
$13,705 |
56.1× |
| CT extremity upper w & w/o contrast (73202) |
$8,419.12 |
$11,225.50 |
46.0× |
| CT head/brain with contrast (70460) |
$4,579.50 |
$6,106 |
25.0× |
| CT head/brain without and with contrast (70470) |
$4,669.50 |
$6,226 |
25.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$657 |
$876 |
7.2× |
| CT hrt w/3d image congen (75573) |
$2,725.50 |
$3,634 |
7.5× |
| CT limited/localized follow up study (76380) |
$1,693.50 |
$2,258 |
18.6× |
| CT lower ext w/wo contrast (73702) |
$7,723.50 |
$10,298 |
42.2× |
| CT lower extremity w contrast (73701) |
$7,215.75 |
$9,621 |
39.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$9,623.25 |
$12,831 |
88.1× |
| CT lumbar spine w/contrast (72132) |
$5,831.25 |
$7,775 |
16.0× |
| CT lumbar spine w/o contrast (72131) |
$6,210 |
$8,280 |
56.9× |
| CT lumbar spine w/o then w/ con (72133) |
$5,007 |
$6,676 |
27.3× |
| CT maxillofacial area w/o contrast (70486) |
$8,750.25 |
$11,667 |
80.2× |
| CT maxillofacial w/contrast (70487) |
$9,458.25 |
$12,611 |
51.6× |
| CT maxillofacial w/o then w/ con (70488) |
$8,771.25 |
$11,695 |
47.9× |
| CT orbit sella ear w/o con (70480) |
$8,712.75 |
$11,617 |
79.8× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$8,771.25 |
$11,695 |
47.9× |
| CT pelvis w & w/o contrast (72194) |
$8,345.25 |
$11,127 |
45.6× |
| CT pelvis w/o contrast (72192) |
$8,426.25 |
$11,235 |
77.2× |
| CT soft tissue neck w/contrast (70491) |
$12,218.25 |
$16,291 |
66.7× |
| CT soft tissue neck w/o contrast (70490) |
$10,156.50 |
$13,542 |
93.0× |
| CT spine cervical w/wo contrast (72127) |
$5,007.75 |
$6,677 |
27.3× |
| CT thoracic spine w/contrast (72129) |
$5,307.75 |
$7,077 |
29.0× |
| CT thoracic spine w/o contrast (72128) |
$6,177.75 |
$8,237 |
56.6× |
| CT thoracic spine w/o then w/ con (72130) |
$3,872.25 |
$5,163 |
21.1× |
| CT thorax lung cancer scr c- (71271) |
$1,720.50 |
$2,294 |
15.8× |
| CT thorax w/o contrast (71250) |
$6,675.75 |
$8,901 |
61.2× |
| CT thorax w/o then w/ contrast (71270) |
$6,810 |
$9,080 |
37.2× |
| CT upper extremity w/dye (73201) |
$11,394 |
$15,192 |
31.3× |
| CT upper extremity w/o contrast rt (73200) |
$7,937.25 |
$10,583 |
72.7× |
| CTA chest w/wo contrast (71275) |
$12,969 |
$17,292 |
70.8× |
| CTA head w contrast (70496) |
$12,363.75 |
$16,485 |
67.5× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$11,285.25 |
$15,047 |
61.6× |
| Cta Neck (70498) |
$12,363.75 |
$16,485 |
67.5× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$11,577.38 |
$15,436.50 |
63.2× |
| Dilation ureters/urethra rs&i (74485) |
$2,900.25 |
$3,867 |
1.3× |
| Diskography lumbar (72295) |
$7,012.50 |
$9,350 |
3.4× |
| Esophogram (74220) |
$2,432.25 |
$3,243 |
13.3× |
| Fetal biophysical profile non-stress testing (76818) |
$1,161.75 |
$1,549 |
10.6× |
| Fetal biophysical profile w/o nst (76819) |
$1,300.50 |
$1,734 |
11.9× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,429.12 |
$1,905.50 |
5.7× |
| Gastric emptying study (78264) |
$3,564.75 |
$4,753 |
8.5× |
| Gated heart planar single (78472) |
$4,377 |
$5,836 |
10.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,807 |
$9,076 |
9.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,698.25 |
$4,931 |
1.1× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$11,884.50 |
$15,846 |
3.6× |
| Hepatobil syst image w/drug (78227) |
$5,248.50 |
$6,998 |
9.3× |
| Hepatobiliary system imaging (78226) |
$4,645.50 |
$6,194 |
11.1× |
| Humerus min 2 views (73060) |
$2,178.75 |
$2,905 |
24.0× |
| Hysterosalpingography (74740) |
$3,120.38 |
$4,160.50 |
12.5× |
| Imrt planning (77301) |
$7,365.75 |
$9,821 |
5.1× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$2,134.50 |
$2,846 |
5.1× |
| Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425) |
$6,486 |
$8,648 |
0.8× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$8,185.50 |
$10,914 |
1.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$3,657 |
$4,876 |
9.4× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$2,492.25 |
$3,323 |
6.4× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$7,068.75 |
$9,425 |
18.1× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$2,769.75 |
$3,693 |
7.1× |
| Ivp (74400) |
$3,139.50 |
$4,186 |
17.1× |
| Ivp w tomography (74415) |
$3,343.50 |
$4,458 |
18.3× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$4,243.50 |
$5,658 |
7.5× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$3,521.25 |
$4,695 |
6.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,393.75 |
$4,525 |
6.0× |
| Liver & spleen; static only (78215) |
$3,609.75 |
$4,813 |
8.6× |
| Liver & spleen; w vasc flow (78216) |
$4,266 |
$5,688 |
10.2× |
| Lung perfusion differential (78597) |
$2,781.75 |
$3,709 |
6.7× |
| Lung ventilat&perfus imaging (78582) |
$4,267.50 |
$5,690 |
7.5× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$4,411.50 |
$5,882 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$9,616.50 |
$12,822 |
26.4× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$9,616.50 |
$12,822 |
26.4× |
| Mammary ductogram single (77053) |
$2,824.50 |
$3,766 |
11.3× |
| Mlc device(s) for imrt (77338) |
$2,610 |
$3,480 |
6.7× |
| Mr safety determination physician/other qhp (76016) |
$360 |
$480 |
4.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$243 |
$324 |
3.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$99.75 |
$133 |
3.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$375 |
$500 |
3.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$987.75 |
$1,317 |
4.0× |
| MRA head w & w/o contrast (70546) |
$9,917.25 |
$13,223 |
27.2× |
| MRA head w/contrast (70545) |
$9,169.12 |
$12,225.50 |
25.2× |
| MRA head w/o contrast (70544) |
$10,928.25 |
$14,571 |
43.9× |
| MRA neck w/contrast (70548) |
$9,270.75 |
$12,361 |
25.4× |
| MRA neck w/o contrast (70547) |
$10,928.25 |
$14,571 |
43.9× |
| MRA neck w/wo contrast (70549) |
$9,917.25 |
$13,223 |
27.2× |
| MRI abdomen w/contrast (74182) |
$10,085.25 |
$13,447 |
27.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$13,590.75 |
$18,121 |
37.3× |
| MRI abdomen w/o contrast (74181) |
$8,789.25 |
$11,719 |
35.3× |
| MRI any jnt lwr ext with con lt (73722) |
$8,808.75 |
$11,745 |
10.8× |
| MRI breast without contrast bilateral (77047) |
$13,632 |
$18,176 |
54.7× |
| MRI cervical spine w/o contrast (72141) |
$15,358.50 |
$20,478 |
61.6× |
| MRI cervical spine with contrast (72142) |
$12,172.50 |
$16,230 |
33.4× |
| MRI chest w & w/o contrast (71552) |
$11,165.25 |
$14,887 |
30.6× |
| MRI chest w/contrast (71551) |
$10,421.25 |
$13,895 |
12.7× |
| MRI chest w/o contrast (71550) |
$8,637 |
$11,516 |
34.7× |
| MRI joint upper ext w/contrast (73222) |
$8,155.50 |
$10,874 |
10.0× |
| MRI joint upr extr w/o&w/dye (73223) |
$8,883 |
$11,844 |
24.4× |
| MRI joint upr extrem w/o dye (73221) |
$8,457.75 |
$11,277 |
33.9× |
| Mri Lower Extremity W/O Dye (73718) |
$8,749.50 |
$11,666 |
35.1× |
| MRI lumbar spine with contrast (72149) |
$5,865.75 |
$7,821 |
16.1× |
| MRI lumbar w/wo contrast (72158) |
$11,577.75 |
$15,437 |
31.8× |
| MRI lwr ext w/o jnts with con rt (73719) |
$8,155.50 |
$10,874 |
22.4× |
| MRI orbit/face/neck w/contrast (70542) |
$8,711.25 |
$11,615 |
23.9× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$10,013.25 |
$13,351 |
27.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$6,861.75 |
$9,149 |
27.5× |
| MRI pelvis w/ contrast (72196) |
$10,085.25 |
$13,447 |
27.7× |
| MRI pelvis w/o contrast (72195) |
$8,789.25 |
$11,719 |
35.3× |
| MRI pelvis w/wo contrast (72197) |
$13,590.75 |
$18,121 |
37.3× |
| MRI spine cervical wo/w contrast (72156) |
$9,458.25 |
$12,611 |
26.0× |
| MRI spine thoracic w/contrast (72147) |
$8,749.50 |
$11,666 |
24.0× |
| MRI thoracic spine w wo contrast (72157) |
$13,725 |
$18,300 |
37.7× |
| MRI thoracic spine w/o contrast (72146) |
$8,800.50 |
$11,734 |
35.3× |
| MRI tmj (70336) |
$8,236.50 |
$10,982 |
33.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$6,781.50 |
$9,042 |
27.2× |
| Mri Upper Extremity W/Dye (73219) |
$8,155.50 |
$10,874 |
22.4× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$9,270.75 |
$12,361 |
25.4× |
| Myelogram thoracic (72255) |
$4,342.88 |
$5,790.50 |
5.3× |
| Myelography 2 or more regions (72270) |
$5,085.38 |
$6,780.50 |
6.2× |
| Myelography lumbosacral (72265) |
$6,022.88 |
$8,030.50 |
7.4× |
| Myocardial spect single study at rest or stress (78451) |
$6,882.75 |
$9,177 |
5.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$4,926 |
$6,568 |
5.5× |
| Nm bone 3 phase (78315) |
$4,813.50 |
$6,418 |
11.5× |
| Nm bone imaging whole body (78306) |
$4,479 |
$5,972 |
10.7× |
| Nm heart perfusion spect stress rest (78452) |
$13,211.25 |
$17,615 |
9.8× |
| Nm liver image static only (78201) |
$4,342.50 |
$5,790 |
7.7× |
| Nm lymph system (78195) |
$4,350 |
$5,800 |
7.7× |
| Nm thyroid imaging only (78013) |
$2,598 |
$3,464 |
6.2× |
| Ob us < 14 wks single fetus (76801) |
$2,796 |
$3,728 |
25.6× |
| Oral radiopharm rx (79005) |
$3,972 |
$5,296 |
16.3× |
| Orthopantogram (70355) |
$1,266 |
$1,688 |
13.9× |
| Parathyroid imaging (78070) |
$5,228.25 |
$6,971 |
12.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$9,973.50 |
$13,298 |
23.9× |
| Peritoneogram rs&i (74190) |
$3,432 |
$4,576 |
6.0× |
| PET brain metabolic eval (78608) |
$17,917.50 |
$23,890 |
12.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$17,917.50 |
$23,890 |
12.0× |
| PET imaging CT for attenuation limited area (78814) |
$16,744.50 |
$22,326 |
11.2× |
| PET imaging for CT attenuation whole body (78816) |
$15,504.75 |
$20,673 |
10.4× |
| PET imaging limited area chest head/neck (78811) |
$14,890.50 |
$19,854 |
11.0× |
| PET imaging whole body (78813) |
$14,890.50 |
$19,854 |
10.0× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$16,590 |
$22,120 |
11.1× |
| Pulmonary perfusion imaging particulate (78580) |
$1,269.75 |
$1,693 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$4,042.50 |
$5,390 |
7.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$741 |
$988 |
8.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,018.50 |
$1,358 |
9.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$1,189.50 |
$1,586 |
10.9× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$1,102.50 |
$1,470 |
10.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$1,356 |
$1,808 |
14.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$2,209.50 |
$2,946 |
24.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$1,953.75 |
$2,605 |
17.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$2,091 |
$2,788 |
19.2× |
| Radex spine cervical 2 or 3 views (72040) |
$2,018.25 |
$2,691 |
22.2× |
| Radex spine cervical 4 or 5 views (72050) |
$2,365.50 |
$3,154 |
21.7× |
| Radex spine cervical 6 or more views (72052) |
$2,482.50 |
$3,310 |
22.7× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$483.75 |
$645 |
5.3× |
| Radiation delivery stereotactic cranial linear (77372) |
$36,267 |
$48,356 |
4.7× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77371) |
$73,029 |
$97,372 |
9.5× |
| Radiation tx delivery lvl 1 (77402) |
$1,152.75 |
$1,537 |
10.8× |
| Radiation tx delivery lvl 2 (77407) |
$1,467.75 |
$1,957 |
3.6× |
| Radiation tx delivery lvl 3 (77412) |
$3,573.75 |
$4,765 |
6.2× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$1,005.75 |
$1,341 |
9.2× |
| Radiologic exam esophagus double contrast study (74221) |
$2,432.25 |
$3,243 |
13.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$3,865.50 |
$5,154 |
21.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$4,614 |
$6,152 |
25.2× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$1,356 |
$1,808 |
14.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$1,783.50 |
$2,378 |
19.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,617 |
$2,156 |
14.8× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$609.75 |
$813 |
5.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$1,533 |
$2,044 |
14.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$572.25 |
$763 |
5.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,543.25 |
$3,391 |
6.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,926.25 |
$5,235 |
9.4× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$4,425.75 |
$5,901 |
7.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,264 |
$4,352 |
5.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,669.50 |
$6,226 |
8.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$2,761.50 |
$3,682 |
11.3× |
| Saline infused sonohysterogram (76831) |
$1,835.25 |
$2,447 |
7.4× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$528.75 |
$705 |
22.6× |
| Selective spinal angiogram (75705) |
$9,603 |
$12,804 |
1.7× |
| Shoulder arthrogram (73040) |
$4,641.75 |
$6,189 |
12.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,441.50 |
$1,922 |
13.2× |
| Simulation complex (77290) |
$3,558 |
$4,744 |
9.1× |
| Simulation intermediate (77285) |
$3,198 |
$4,264 |
8.2× |
| Simulation simple (77280) |
$2,175 |
$2,900 |
15.5× |
| Small bowel series (74250) |
$3,763.50 |
$5,018 |
20.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$2,658 |
$3,544 |
6.8× |
| Special dosimetry (77331) |
$2,847 |
$3,796 |
20.3× |
| Special physics consult (77370) |
$1,471.50 |
$1,962 |
10.5× |
| Special treatment procedure (77470) |
$2,431.50 |
$3,242 |
4.2× |
| Stereotactic body radiation delivery (77373) |
$18,864.75 |
$25,153 |
10.1× |
| Testicular imaging w/flow (78761) |
$2,723.25 |
$3,631 |
6.5× |
| Thyroid met imaging body (78018) |
$6,363.75 |
$8,485 |
11.2× |
| Thyroid uptake single/multiple quant measurement (78012) |
$2,536.50 |
$3,382 |
6.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$5,772 |
$7,696 |
13.8× |
| Treatment device intermediate (77333) |
$1,560.75 |
$2,081 |
11.1× |
| Treatment devices complex (77334) |
$3,450 |
$4,600 |
8.8× |
| Treatment devices simple (77332) |
$1,350.75 |
$1,801 |
9.6× |
| Ultrasound breast limited (76642) |
$1,174.12 |
$1,565.50 |
12.9× |
| Ultrasound, abdomen limited (76705) |
$3,048 |
$4,064 |
27.9× |
| Umbilical-artery Doppler (OB) (76820) |
$1,188.75 |
$1,585 |
10.9× |
| Unlisted diagnostic radiographic procedure (76499) |
$696.75 |
$929 |
7.7× |
| Unlisted magnetic resonance procedure (76498) |
$6,567 |
$8,756 |
72.3× |
| Urethrocystography retrograde rs&i (74450) |
$2,541 |
$3,388 |
10.2× |
| Urethrocystography voiding (74455) |
$2,541 |
$3,388 |
10.2× |
| Urography antegrade (74425) |
$3,258 |
$4,344 |
8.9× |
| Urography retrograde w/wo kub (74420) |
$3,641.25 |
$4,855 |
10.0× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$3,357 |
$4,476 |
18.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$806.25 |
$1,075 |
7.4× |
| Us breast uni real time with image complete (76641) |
$1,698.75 |
$2,265 |
15.6× |
| Us chest (76604) |
$1,486.50 |
$1,982 |
13.6× |
| Us compl joint r-t w/image documentation (76881) |
$1,061.25 |
$1,415 |
9.7× |
| Us elastography parenchyma (76981) |
$669.75 |
$893 |
6.1× |
| Us encephalogram (76506) |
$1,188.75 |
$1,585 |
10.9× |
| Us guided compression repair (76936) |
$290.25 |
$387 |
1.3× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,614.75 |
$2,153 |
17.8× |
| Us kidney transplanted (76776) |
$2,277 |
$3,036 |
20.9× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$1,140.75 |
$1,521 |
10.4× |
| Us ob detailed single fetus (76811) |
$2,307 |
$3,076 |
9.3× |
| Us ob followup per fetus (76816) |
$1,755 |
$2,340 |
16.1× |
| Us ob limited 1 or more fetuses (76815) |
$1,552.50 |
$2,070 |
14.2× |
| Us obstetric transvaginal (76817) |
$3,606.75 |
$4,809 |
33.0× |
| Us pelvic limited or f/u non-ob (76857) |
$957.75 |
$1,277 |
8.8× |
| Us pelvis complete (76856) |
$2,948.25 |
$3,931 |
27.0× |
| Us retroperitoneal complete (76770) |
$3,488.25 |
$4,651 |
32.0× |
| Us retroperitoneal limited (76775) |
$2,760 |
$3,680 |
25.3× |
| Us scrotum (76870) |
$3,090 |
$4,120 |
28.3× |
| Us soft tissue head/neck (76536) |
$3,440.25 |
$4,587 |
31.5× |
| Us spinal canal (76800) |
$1,059.75 |
$1,413 |
9.7× |
| Us transrectal prostate volume (76873) |
$1,518 |
$2,024 |
13.9× |
| Us unlstd proc (76999) |
$648 |
$864 |
7.1× |
| Vein X-ray liver w/hemodynam (75885) |
$11,460 |
$15,280 |
3.5× |
| Venogram extremity bilateral (75822) |
$7,698.75 |
$10,265 |
4.7× |
| Venogram ivc w serialography (75825) |
$11,914.50 |
$15,886 |
3.6× |
| Venogram svc w serialography (75827) |
$7,275.75 |
$9,701 |
4.4× |
| Venography ext unilateral (75820) |
$7,698.75 |
$10,265 |
4.7× |
| Venography renal unilateral selective rs&i (75831) |
$10,527 |
$14,036 |
3.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$7,645.50 |
$10,194 |
2.3× |
| Venous sampling by catheter (75893) |
$7,146.75 |
$9,529 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$1,731 |
$2,308 |
19.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$2,018.25 |
$2,691 |
22.2× |
| X-ray aorta leg arteries (75630) |
$9,026.25 |
$12,035 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$3,246.75 |
$4,329 |
17.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$1,961.25 |
$2,615 |
21.6× |
| X-ray exam hips bi 3-4 views (73522) |
$927 |
$1,236 |
8.5× |
| X-ray exam of finger(s) (73140) |
$973.50 |
$1,298 |
10.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$3,100.50 |
$4,134 |
16.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$1,470.75 |
$1,961 |
16.2× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$1,455 |
$1,940 |
16.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$1,953 |
$2,604 |
21.5× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$1,542.75 |
$2,057 |
14.1× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$2,037.75 |
$2,717 |
22.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$1,478.25 |
$1,971 |
16.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$1,098.75 |
$1,465 |
12.1× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$2,671.50 |
$3,562 |
29.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$2,442 |
$3,256 |
22.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$813.75 |
$1,085 |
9.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$2,216.25 |
$2,955 |
20.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$2,383.50 |
$3,178 |
21.8× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$831.38 |
$1,108.50 |
7.6× |
| X-ray perineogram (74775) |
$3,584.25 |
$4,779 |
14.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$960.75 |
$1,281 |
10.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$2,453.25 |
$3,271 |
22.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$1,082.25 |
$1,443 |
9.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$1,051.50 |
$1,402 |
9.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,347 |
$1,796 |
14.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$1,929 |
$2,572 |
21.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,940.25 |
$2,587 |
21.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$2,432.25 |
$3,243 |
22.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$1,327.50 |
$1,770 |
12.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$581.25 |
$775 |
6.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$675.75 |
$901 |
7.4× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$1,073.25 |
$1,431 |
11.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$2,369.25 |
$3,159 |
26.1× |
| Xr abdomen 1 view (74018) |
$706.50 |
$942 |
7.8× |
| Xr abdomen 2 views (74019) |
$1,017.38 |
$1,356.50 |
9.3× |
| Xr abdomen 3 views (74021) |
$1,020.75 |
$1,361 |
9.4× |
| Xr arthrogram ankle (73615) |
$2,759.25 |
$3,679 |
7.6× |
| Xr arthrogram elbow (73085) |
$1,872 |
$2,496 |
5.1× |
| Xr arthrogram hip (73525) |
$5,412.75 |
$7,217 |
14.9× |
| Xr bone density appendicular (77081) |
$623.25 |
$831 |
6.9× |
| Xr bone density axial (77080) |
$2,324.25 |
$3,099 |
21.3× |
| Xr bone length study (77073) |
$597 |
$796 |
5.5× |
| Xr bone survey limited (77074) |
$2,142 |
$2,856 |
19.6× |
| Xr chest 1 view (71045) |
$836.62 |
$1,115.50 |
9.2× |
| Xr chest 2 views (71046) |
$1,036.12 |
$1,381.50 |
11.4× |
| Xr chest 3 views (71047) |
$720 |
$960 |
7.9× |
| Xr cystogram 3+ views (74430) |
$1,858.50 |
$2,478 |
5.1× |
| Xr eye foreign body (70030) |
$533.25 |
$711 |
5.9× |
| Xr facial bones 3 views (70150) |
$1,673.25 |
$2,231 |
15.3× |
| Xr lower extremity 2 views infant (73592) |
$592.50 |
$790 |
6.5× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$2,478.75 |
$3,305 |
22.7× |
| Xr mandible 4 views (70110) |
$1,048.50 |
$1,398 |
9.6× |
| Xr myelogram c-spine (72240) |
$6,619.50 |
$8,826 |
8.1× |
| Xr nasal bones (70160) |
$1,227.75 |
$1,637 |
13.5× |
| Xr pelvis 3 views (72190) |
$1,770.75 |
$2,361 |
16.2× |
| Xr spine 1 view (72020) |
$1,053 |
$1,404 |
11.6× |
| Xr sternum 2 views (71120) |
$1,048.50 |
$1,398 |
11.5× |
| Xr surgical specimen (76098) |
$2,361 |
$3,148 |
4.1× |
| Xr upper extremity 2 views infant (73092) |
$576 |
$768 |
5.3× |
| Xray elbow 2 views (73070) |
$1,605 |
$2,140 |
17.7× |
| Xray forearm 2 views (73090) |
$1,246.50 |
$1,662 |
13.7× |
| Xray knee 1 or 2 views rt (73560) |
$1,369.50 |
$1,826 |
15.1× |
| Xray neck soft tissue (70360) |
$2,061.75 |
$2,749 |
22.7× |
| Xray optic foramina (70190) |
$885 |
$1,180 |
9.7× |
| Xray orbits complete min 4 views (70200) |
$1,673.25 |
$2,231 |
15.3× |
| Xray pelvis 1 or 2 views (72170) |
$1,856.25 |
$2,475 |
17.0× |
| Xray ribs bilateral 3 views (71110) |
$960.75 |
$1,281 |
8.8× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$1,961.25 |
$2,615 |
18.0× |
| Xray scapula complete (73010) |
$1,146 |
$1,528 |
10.5× |
| Xray shoulder 1 view (73020) |
$1,354.50 |
$1,806 |
14.9× |
| Xray sinuses paranasal <3 views (70210) |
$784.50 |
$1,046 |
8.6× |
| Xray spine thoracic 2 views (72070) |
$966.75 |
$1,289 |
8.9× |
| Xray spine thoracic 3 views (72072) |
$1,194 |
$1,592 |
10.9× |
| Xray tibia-fibula 2 views bil (73590) |
$1,818 |
$2,424 |
20.0× |
| Xray tmj open - closed unilat (70328) |
$528.75 |
$705 |
5.8× |
| Xray tmj's bilateral open-clsc (70330) |
$1,056 |
$1,408 |
11.6× |