| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$12,191.72 |
$12,191.72 |
8.4× |
| Acute gi blood loss imaging (78278) |
$4,119.30 |
$4,119.30 |
9.9× |
| Angio extremity unilateral (75710) |
$12,073.60 |
$12,073.60 |
3.7× |
| Angio pulmonary unilateral (75741) |
$17,011.40 |
$17,011.40 |
5.2× |
| Angiogram extremity bilateral (75716) |
$10,592.05 |
$10,592.05 |
3.2× |
| Angiogram pelvic (75736) |
$18,182.95 |
$18,182.95 |
3.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$28,241.70 |
$28,241.70 |
8.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$16,348.70 |
$16,348.70 |
2.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,037.45 |
$1,037.45 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$19,033.10 |
$19,033.10 |
5.8× |
| Ankle 2 views (73600) |
$1,810.75 |
$1,810.75 |
19.9× |
| Arthrography knee lt (73580) |
$4,837.95 |
$4,837.95 |
13.3× |
| Arthrography wrist lt (73115) |
$4,279.55 |
$4,279.55 |
11.7× |
| Barium enema (74270) |
$5,350.35 |
$5,350.35 |
29.2× |
| Bone age studies (77072) |
$2,663.80 |
$2,663.80 |
24.4× |
| Bone imaging limited area (78300) |
$5,756.40 |
$5,756.40 |
13.8× |
| Bone survey complete (77075) |
$5,634.05 |
$5,634.05 |
51.6× |
| Bowel imaging (78290) |
$6,711.45 |
$6,711.45 |
16.1× |
| Brain image w/flow 4 + views (78606) |
$5,673.15 |
$5,673.15 |
10.0× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$5,673.15 |
$5,673.15 |
13.6× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$16,596.85 |
$16,596.85 |
39.8× |
| Cerebrospinal fluid leakage (78650) |
$4,593.45 |
$4,593.45 |
3.4× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$3,675.20 |
$3,675.20 |
20.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$3,777.52 |
$3,777.52 |
20.6× |
| Cisternogram (78630) |
$4,001.35 |
$4,001.35 |
7.1× |
| Clavicle complete (73000) |
$2,082.02 |
$2,082.02 |
22.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$2,862.25 |
$2,862.25 |
31.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$13,384 |
$13,384 |
73.1× |
| Contrast exam abdominl aorta (75625) |
$13,233.85 |
$13,233.85 |
4.0× |
| Contrast exam thoracic aorta (75605) |
$14,684.35 |
$14,684.35 |
2.5× |
| CT - st neck w&wo contr (70492) |
$10,449 |
$10,449 |
57.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$30,237 |
$30,237 |
83.0× |
| CT abdomen and pelvis without contrast (74176) |
$26,724 |
$26,724 |
107.3× |
| CT abdomen w wo contrast (74170) |
$15,872 |
$15,872 |
86.7× |
| CT abdomen w/contrast (74160) |
$15,007 |
$15,007 |
81.9× |
| CT abdomen w/o contrast (74150) |
$14,097.52 |
$14,097.52 |
129.1× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$39,086.20 |
$39,086.20 |
107.3× |
| CT angio abdom w/o & w/dye (74175) |
$20,244.10 |
$20,244.10 |
110.5× |
| CT angio abdominal arteries (75635) |
$25,259 |
$25,259 |
137.9× |
| CT angio hrt w/3d image (75574) |
$16,866.40 |
$16,866.40 |
46.3× |
| CT angiograph pelv w/o&w/dye (72191) |
$18,840.30 |
$18,840.30 |
102.9× |
| CT cervical spine w/contrast (72126) |
$14,755.50 |
$14,755.50 |
40.5× |
| CT cervical spine w/o contrast (72125) |
$13,790 |
$13,790 |
126.3× |
| CT chest w/contrast (71260) |
$14,707 |
$14,707 |
80.3× |
| CT extremity upper w & w/o contrast (73202) |
$16,120 |
$16,120 |
88.0× |
| CT head/brain with contrast (70460) |
$11,122 |
$11,122 |
60.7× |
| CT head/brain without and with contrast (70470) |
$13,425 |
$13,425 |
73.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$16,089.70 |
$16,089.70 |
44.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$16,089.70 |
$16,089.70 |
177.0× |
| CT hrt w/3d image congen (75573) |
$16,089.70 |
$16,089.70 |
44.2× |
| CT limited/localized follow up study (76380) |
$902.85 |
$902.85 |
9.9× |
| CT lower ext w/wo contrast (73702) |
$16,097 |
$16,097 |
87.9× |
| CT lower extremity w contrast (73701) |
$15,242 |
$15,242 |
83.2× |
| CT lower extremity w/o contrast unilateral (73700) |
$14,289.62 |
$14,289.62 |
130.9× |
| CT lumbar spine w/contrast (72132) |
$14,795.90 |
$14,795.90 |
40.6× |
| CT lumbar spine w/o contrast (72131) |
$13,793 |
$13,793 |
126.3× |
| CT lumbar spine w/o then w/ con (72133) |
$15,625.52 |
$15,625.52 |
85.3× |
| CT maxillofacial area w/o contrast (70486) |
$12,118 |
$12,118 |
111.0× |
| CT maxillofacial w/contrast (70487) |
$12,954 |
$12,954 |
70.7× |
| CT maxillofacial w/o then w/ con (70488) |
$13,721 |
$13,721 |
74.9× |
| CT orbit sella ear w/o con (70480) |
$12,511 |
$12,511 |
114.6× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$14,135 |
$14,135 |
77.2× |
| CT pelvis w & w/o contrast (72194) |
$14,427 |
$14,427 |
78.8× |
| CT pelvis w/o contrast (72192) |
$12,745 |
$12,745 |
116.7× |
| CT soft tissue neck w/contrast (70491) |
$9,897 |
$9,897 |
54.0× |
| CT soft tissue neck w/o contrast (70490) |
$9,253 |
$9,253 |
84.8× |
| CT spine cervical w/wo contrast (72127) |
$13,676 |
$13,676 |
74.7× |
| CT thoracic spine w/contrast (72129) |
$14,755.50 |
$14,755.50 |
80.6× |
| CT thoracic spine w/o contrast (72128) |
$13,792 |
$13,792 |
126.3× |
| CT thoracic spine w/o then w/ con (72130) |
$15,670.75 |
$15,670.75 |
85.6× |
| CT thorax lung cancer scr c- (71271) |
$13,732.85 |
$13,732.85 |
125.8× |
| CT thorax w/o contrast (71250) |
$13,755 |
$13,755 |
126.0× |
| CT thorax w/o then w/ contrast (71270) |
$15,563 |
$15,563 |
85.0× |
| CT upper extremity w/dye (73201) |
$15,320.75 |
$15,320.75 |
42.1× |
| CT upper extremity w/o contrast rt (73200) |
$14,266.50 |
$14,266.50 |
130.7× |
| CTA chest w/wo contrast (71275) |
$18,878 |
$18,878 |
103.1× |
| CTA head w contrast (70496) |
$17,689 |
$17,689 |
96.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$20,532.35 |
$20,532.35 |
112.1× |
| Cta Neck (70498) |
$14,508 |
$14,508 |
79.2× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$19,771.85 |
$19,771.85 |
107.9× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$4,475.85 |
$4,475.85 |
2.2× |
| Diskography lumbar (72295) |
$4,475.85 |
$4,475.85 |
2.2× |
| Doppler echo fetal spectral display complete (76827) |
$447.30 |
$447.30 |
4.1× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$447.30 |
$447.30 |
4.1× |
| Doppler fetal mid cerebral artery (76821) |
$447.30 |
$447.30 |
4.1× |
| Dxa bone density study axial skeleton (77085) |
$3,029 |
$3,029 |
27.7× |
| Esophogram (74220) |
$2,494.92 |
$2,494.92 |
13.6× |
| Fetal biophysical profile non-stress testing (76818) |
$7,944.45 |
$7,944.45 |
72.8× |
| Fetal biophysical profile w/o nst (76819) |
$447.30 |
$447.30 |
4.1× |
| Fetal echo complete (76825) |
$1,922.25 |
$1,922.25 |
3.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$593.75 |
$593.75 |
2.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$8,336.25 |
$8,336.25 |
14.7× |
| Gastric emptying study (78264) |
$8,336.25 |
$8,336.25 |
20.0× |
| Gated heart planar single (78472) |
$12,772.90 |
$12,772.90 |
30.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$10,392.10 |
$10,392.10 |
3.2× |
| Hepatobil syst image w/drug (78227) |
$10,517.10 |
$10,517.10 |
18.5× |
| Hepatobiliary system imaging (78226) |
$10,517.10 |
$10,517.10 |
25.2× |
| Humerus min 2 views (73060) |
$2,443.25 |
$2,443.25 |
26.9× |
| Hysterosalpingography (74740) |
$1,878.60 |
$1,878.60 |
7.5× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$2,830.30 |
$2,830.30 |
6.8× |
| Ivp (74400) |
$8,120.85 |
$8,120.85 |
44.3× |
| Ivp w tomography (74415) |
$6,380 |
$6,380 |
34.8× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$16,596.85 |
$16,596.85 |
29.3× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$13,587.25 |
$13,587.25 |
24.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$12,772.90 |
$12,772.90 |
22.5× |
| Kidney w vascular flow (78701) |
$9,098.10 |
$9,098.10 |
21.8× |
| Liver & spleen; static only (78215) |
$10,638.75 |
$10,638.75 |
25.5× |
| Liver imaging w/vascular flow (78202) |
$5,058.25 |
$5,058.25 |
8.9× |
| Lung perf&ventilat diferentl (78598) |
$2,471.35 |
$2,471.35 |
4.4× |
| Lung perfusion differential (78597) |
$2,471.35 |
$2,471.35 |
5.9× |
| Lung ventilat&perfus imaging (78582) |
$8,662.05 |
$8,662.05 |
15.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$12,406.95 |
$12,406.95 |
34.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$11,028.60 |
$11,028.60 |
30.3× |
| Mammary ductogram single (77053) |
$782.15 |
$782.15 |
3.1× |
| MRA head w/o contrast (70544) |
$8,632.50 |
$8,632.50 |
34.6× |
| MRA neck w/o contrast (70547) |
$8,632.50 |
$8,632.50 |
34.6× |
| MRA neck w/wo contrast (70549) |
$13,656.30 |
$13,656.30 |
37.5× |
| MRI abdomen w/contrast (74182) |
$8,877.15 |
$8,877.15 |
24.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$9,226.05 |
$9,226.05 |
25.3× |
| MRI abdomen w/o contrast (74181) |
$7,352 |
$7,352 |
29.5× |
| MRI any jnt lwr ext with con lt (73722) |
$10,568.20 |
$10,568.20 |
12.9× |
| MRI bone marrow (77084) |
$9,565.70 |
$9,565.70 |
38.4× |
| MRI breast without contrast bilateral (77047) |
$2,102.10 |
$2,102.10 |
8.4× |
| MRI cervical spine w/o contrast (72141) |
$12,937.10 |
$12,937.10 |
51.9× |
| MRI cervical spine with contrast (72142) |
$13,597.35 |
$13,597.35 |
37.3× |
| MRI chest w & w/o contrast (71552) |
$15,689.50 |
$15,689.50 |
43.1× |
| MRI chest w/o contrast (71550) |
$6,412.95 |
$6,412.95 |
25.7× |
| MRI fetal sngl/1st gestation (74712) |
$1,518.55 |
$1,518.55 |
6.1× |
| MRI joint upper ext w/contrast (73222) |
$11,028.60 |
$11,028.60 |
13.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$25,529.75 |
$25,529.75 |
70.1× |
| MRI joint upr extrem w/o dye (73221) |
$8,909.40 |
$8,909.40 |
35.8× |
| Mri Lower Extremity W/O Dye (73718) |
$9,546.40 |
$9,546.40 |
38.3× |
| MRI lumbar spine with contrast (72149) |
$13,597.35 |
$13,597.35 |
37.3× |
| MRI lumbar w/wo contrast (72158) |
$14,476.45 |
$14,476.45 |
39.7× |
| MRI lwr ext w/o jnts with con rt (73719) |
$9,787.70 |
$9,787.70 |
26.9× |
| MRI orbit/face/neck w/contrast (70542) |
$13,656.30 |
$13,656.30 |
37.5× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$9,508.20 |
$9,508.20 |
26.1× |
| MRI orbit/face/neck w/o contrast (70540) |
$13,222.95 |
$13,222.95 |
53.1× |
| MRI pelvis w/ contrast (72196) |
$13,971.45 |
$13,971.45 |
38.3× |
| MRI pelvis w/o contrast (72195) |
$7,313.45 |
$7,313.45 |
29.4× |
| MRI pelvis w/wo contrast (72197) |
$9,758.85 |
$9,758.85 |
26.8× |
| MRI spine cervical wo/w contrast (72156) |
$14,476.45 |
$14,476.45 |
39.7× |
| MRI spine thoracic w/contrast (72147) |
$13,597.35 |
$13,597.35 |
37.3× |
| MRI thoracic spine w wo contrast (72157) |
$14,476.45 |
$14,476.45 |
39.7× |
| MRI thoracic spine w/o contrast (72146) |
$12,937.10 |
$12,937.10 |
51.9× |
| MRI tmj (70336) |
$7,758.75 |
$7,758.75 |
31.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$8,879.10 |
$8,879.10 |
35.6× |
| Mri Upper Extremity W/Dye (73219) |
$8,597.22 |
$8,597.22 |
23.6× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$10,114.35 |
$10,114.35 |
27.8× |
| Myelogram thoracic (72255) |
$12,768.30 |
$12,768.30 |
15.6× |
| Myelography 2 or more regions (72270) |
$14,439.15 |
$14,439.15 |
17.6× |
| Myelography lumbosacral (72265) |
$13,002.90 |
$13,002.90 |
15.9× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$23,433.95 |
$23,433.95 |
15.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$23,433.95 |
$23,433.95 |
15.7× |
| Myocardial spect single study at rest or stress (78451) |
$10,582.10 |
$10,582.10 |
7.8× |
| Myocrd img PET metab eval single study (78459) |
$23,433.95 |
$23,433.95 |
17.3× |
| Nm adrenal imaging (78075) |
$11,098.95 |
$11,098.95 |
8.2× |
| Nm bone 3 phase (78315) |
$14,509.95 |
$14,509.95 |
34.8× |
| Nm bone imaging whole body (78306) |
$13,030.05 |
$13,030.05 |
31.2× |
| Nm bone marrow scan limited (78102) |
$2,132.05 |
$2,132.05 |
5.1× |
| Nm heart perfusion spect stress rest (78452) |
$12,115.35 |
$12,115.35 |
9.0× |
| Nm kidney imaging morphology (78700) |
$9,271.15 |
$9,271.15 |
22.2× |
| Nm liver image static only (78201) |
$2,771.50 |
$2,771.50 |
4.9× |
| Nm lymph system (78195) |
$4,935.45 |
$4,935.45 |
8.7× |
| Nm thyroid imaging only (78013) |
$5,084.20 |
$5,084.20 |
12.2× |
| Nose to rectum for fb child (76010) |
$1,433.45 |
$1,433.45 |
15.8× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$3,714.05 |
$3,714.05 |
8.9× |
| Nuclear medicine study to assess blood clot in vein using radiolabeled peptide (78456) |
$14,509.95 |
$14,509.95 |
10.7× |
| Nuclear rx IV admin (79101) |
$31,031.90 |
$31,031.90 |
127.4× |
| Ob us < 14 wks single fetus (76801) |
$5,788.60 |
$5,788.60 |
53.0× |
| Ob us nuchal meas 1 gest (76813) |
$447.30 |
$447.30 |
4.1× |
| Oral radiopharm rx (79005) |
$17,179.40 |
$17,179.40 |
70.5× |
| Orthopantogram (70355) |
$1,458.65 |
$1,458.65 |
16.1× |
| Parathyroid imaging (78070) |
$3,870.95 |
$3,870.95 |
9.3× |
| PET brain metabolic eval (78608) |
$23,433.95 |
$23,433.95 |
15.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$23,433.95 |
$23,433.95 |
15.7× |
| PET imaging CT for attenuation limited area (78814) |
$23,433.95 |
$23,433.95 |
15.7× |
| PET imaging for CT attenuation whole body (78816) |
$23,433.95 |
$23,433.95 |
15.7× |
| PET imaging limited area chest head/neck (78811) |
$23,433.95 |
$23,433.95 |
17.3× |
| PET imaging whole body (78813) |
$23,433.95 |
$23,433.95 |
15.7× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$23,433.95 |
$23,433.95 |
15.7× |
| Pulmonary perfusion imaging particulate (78580) |
$7,446.60 |
$7,446.60 |
17.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,801.48 |
$1,801.48 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$328.15 |
$328.15 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$2,731 |
$2,731 |
25.0× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$4,485.75 |
$4,485.75 |
41.1× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$4,485.75 |
$4,485.75 |
41.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$2,104.75 |
$2,104.75 |
23.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$2,443.25 |
$2,443.25 |
26.9× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$2,905.40 |
$2,905.40 |
26.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$2,216.95 |
$2,216.95 |
20.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$2,286.95 |
$2,286.95 |
20.9× |
| Radex spine cervical 2 or 3 views (72040) |
$2,773.98 |
$2,773.98 |
30.5× |
| Radex spine cervical 4 or 5 views (72050) |
$3,517.08 |
$3,517.08 |
32.2× |
| Radex spine cervical 6 or more views (72052) |
$3,011.10 |
$3,011.10 |
27.6× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$2,505.15 |
$2,505.15 |
22.9× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$4,755.60 |
$4,755.60 |
26.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$3,840.55 |
$3,840.55 |
21.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$3,475.22 |
$3,475.22 |
19.0× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$2,457.05 |
$2,457.05 |
27.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$2,383.08 |
$2,383.08 |
26.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$3,045.38 |
$3,045.38 |
27.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$3,211.25 |
$3,211.25 |
7.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$10,895.45 |
$10,895.45 |
26.1× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$17,818.50 |
$17,818.50 |
31.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$13,030.05 |
$13,030.05 |
23.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,597.90 |
$4,597.90 |
8.1× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$766.55 |
$766.55 |
32.8× |
| Shoulder arthrogram (73040) |
$4,705.70 |
$4,705.70 |
12.9× |
| Small bowel series (74250) |
$4,561.30 |
$4,561.30 |
24.9× |
| Testicular imaging w/flow (78761) |
$6,505.50 |
$6,505.50 |
15.6× |
| Thyroid met imaging body (78018) |
$15,224.85 |
$15,224.85 |
26.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$5,084.20 |
$5,084.20 |
12.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$5,084.20 |
$5,084.20 |
12.2× |
| Ultrasound breast limited (76642) |
$3,062.75 |
$3,062.75 |
33.7× |
| Ultrasound, abdomen limited (76705) |
$4,046 |
$4,046 |
37.1× |
| Umbilical-artery Doppler (OB) (76820) |
$447.30 |
$447.30 |
4.1× |
| Unlisted diagnostic radiographic procedure (76499) |
$3,738.55 |
$3,738.55 |
41.1× |
| Ureteral reflux study (78740) |
$6,517.95 |
$6,517.95 |
15.6× |
| Urethrocystography retrograde rs&i (74450) |
$3,342.10 |
$3,342.10 |
13.4× |
| Urethrocystography voiding (74455) |
$3,342.10 |
$3,342.10 |
13.4× |
| Urography antegrade (74425) |
$2,139.45 |
$2,139.45 |
5.9× |
| Urography retrograde w/wo kub (74420) |
$3,979.05 |
$3,979.05 |
10.9× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$4,825.85 |
$4,825.85 |
26.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$3,062.75 |
$3,062.75 |
28.1× |
| Us breast uni real time with image complete (76641) |
$3,062.75 |
$3,062.75 |
28.1× |
| Us chest (76604) |
$3,823.35 |
$3,823.35 |
35.0× |
| Us compl joint r-t w/image documentation (76881) |
$3,477.45 |
$3,477.45 |
31.9× |
| Us encephalogram (76506) |
$3,964.55 |
$3,964.55 |
36.3× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$3,348.50 |
$3,348.50 |
36.8× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$2,602.65 |
$2,602.65 |
23.8× |
| Us ob detailed single fetus (76811) |
$5,319.50 |
$5,319.50 |
21.3× |
| Us ob followup per fetus (76816) |
$447.30 |
$447.30 |
4.1× |
| Us ob limited 1 or more fetuses (76815) |
$1,992.80 |
$1,992.80 |
18.3× |
| Us obstetric transvaginal (76817) |
$4,282.02 |
$4,282.02 |
39.2× |
| Us pelvic limited or f/u non-ob (76857) |
$1,868 |
$1,868 |
17.1× |
| Us pelvis complete (76856) |
$4,844.10 |
$4,844.10 |
44.4× |
| Us retroperitoneal complete (76770) |
$3,901.80 |
$3,901.80 |
35.7× |
| Us scrotum (76870) |
$4,726 |
$4,726 |
43.3× |
| Us soft tissue head/neck (76536) |
$3,305.28 |
$3,305.28 |
30.3× |
| Us spinal canal (76800) |
$3,067.25 |
$3,067.25 |
28.1× |
| Us transrectal (76872) |
$5,491.35 |
$5,491.35 |
50.3× |
| Us unlstd proc (76999) |
$867.15 |
$867.15 |
9.5× |
| Venogram extremity bilateral (75822) |
$6,120.20 |
$6,120.20 |
3.7× |
| Venogram ivc w serialography (75825) |
$12,840 |
$12,840 |
3.9× |
| Venogram svc w serialography (75827) |
$5,734.55 |
$5,734.55 |
3.5× |
| Venography ext unilateral (75820) |
$7,602.45 |
$7,602.45 |
4.6× |
| Venography renal unilateral selective rs&i (75831) |
$12,840 |
$12,840 |
3.9× |
| Venous sampling by catheter (75893) |
$18,107.50 |
$18,107.50 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$1,918.85 |
$1,918.85 |
21.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$2,234.50 |
$2,234.50 |
24.6× |
| X-ray aorta leg arteries (75630) |
$15,949.85 |
$15,949.85 |
4.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$4,937.60 |
$4,937.60 |
27.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$1,917.20 |
$1,917.20 |
21.1× |
| X-ray exam hips bi 3-4 views (73522) |
$2,286.95 |
$2,286.95 |
20.9× |
| X-ray exam of finger(s) (73140) |
$1,948.90 |
$1,948.90 |
21.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,218.50 |
$1,218.50 |
6.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$2,701.85 |
$2,701.85 |
29.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$1,732.50 |
$1,732.50 |
19.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$2,192.95 |
$2,192.95 |
24.1× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$1,793.65 |
$1,793.65 |
16.4× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$2,457.05 |
$2,457.05 |
27.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$1,880.45 |
$1,880.45 |
20.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$1,122.35 |
$1,122.35 |
12.3× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$1,972.55 |
$1,972.55 |
21.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$2,425.05 |
$2,425.05 |
22.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$1,693.65 |
$1,693.65 |
18.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$2,773.98 |
$2,773.98 |
25.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$3,660.22 |
$3,660.22 |
33.5× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$1,888.80 |
$1,888.80 |
17.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$2,478.92 |
$2,478.92 |
27.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$4,079.40 |
$4,079.40 |
37.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$1,956.45 |
$1,956.45 |
17.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$2,276.70 |
$2,276.70 |
20.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$2,627.85 |
$2,627.85 |
28.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$2,673.05 |
$2,673.05 |
29.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$2,794.95 |
$2,794.95 |
30.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$3,284.30 |
$3,284.30 |
30.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$2,442.88 |
$2,442.88 |
22.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$1,986.72 |
$1,986.72 |
21.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$1,566.70 |
$1,566.70 |
17.2× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$2,078.55 |
$2,078.55 |
22.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$1,732.50 |
$1,732.50 |
19.1× |
| Xr abdomen 1 view (74018) |
$1,248.70 |
$1,248.70 |
13.7× |
| Xr abdomen 2 views (74019) |
$2,080.80 |
$2,080.80 |
19.1× |
| Xr abdomen 3 views (74021) |
$2,273.10 |
$2,273.10 |
20.8× |
| Xr arthrogram ankle (73615) |
$4,220.52 |
$4,220.52 |
11.6× |
| Xr arthrogram elbow (73085) |
$6,027.35 |
$6,027.35 |
16.5× |
| Xr arthrogram hip (73525) |
$5,109.75 |
$5,109.75 |
14.0× |
| Xr bone density axial (77080) |
$1,956.45 |
$1,956.45 |
17.9× |
| Xr bone length study (77073) |
$880.25 |
$880.25 |
8.1× |
| Xr bone survey infant (77076) |
$2,232.82 |
$2,232.82 |
20.5× |
| Xr bone survey limited (77074) |
$867.50 |
$867.50 |
7.9× |
| Xr chest 1 view (71045) |
$1,248.70 |
$1,248.70 |
13.7× |
| Xr chest 2 views (71046) |
$2,080.80 |
$2,080.80 |
22.9× |
| Xr chest 3 views (71047) |
$2,273.10 |
$2,273.10 |
25.0× |
| Xr cystogram 3+ views (74430) |
$4,043.12 |
$4,043.12 |
11.1× |
| Xr eye foreign body (70030) |
$1,324.15 |
$1,324.15 |
14.6× |
| Xr facial bones 3 views (70150) |
$3,635.32 |
$3,635.32 |
33.3× |
| Xr lower extremity 2 views infant (73592) |
$1,781.60 |
$1,781.60 |
19.6× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$3,221.15 |
$3,221.15 |
29.5× |
| Xr mandible 4 views (70110) |
$1,365.25 |
$1,365.25 |
12.5× |
| Xr myelogram c-spine (72240) |
$13,002.90 |
$13,002.90 |
15.9× |
| Xr nasal bones (70160) |
$2,190.75 |
$2,190.75 |
24.1× |
| Xr pelvis 3 views (72190) |
$2,905.40 |
$2,905.40 |
26.6× |
| Xr sella turcica (70240) |
$2,106.98 |
$2,106.98 |
23.2× |
| Xr sialogram (70390) |
$1,678.25 |
$1,678.25 |
6.7× |
| Xr spine 1 view (72020) |
$1,143.68 |
$1,143.68 |
12.6× |
| Xr sternum 2 views (71120) |
$2,158.88 |
$2,158.88 |
23.8× |
| Xr surgical specimen (76098) |
$1,528.45 |
$1,528.45 |
2.7× |
| Xr upper extremity 2 views infant (73092) |
$1,006.30 |
$1,006.30 |
9.2× |
| Xray elbow 2 views (73070) |
$1,732.50 |
$1,732.50 |
19.1× |
| Xray forearm 2 views (73090) |
$2,158.40 |
$2,158.40 |
23.8× |
| Xray internal auditory meati compl (70134) |
$1,704.45 |
$1,704.45 |
3.0× |
| Xray knee 1 or 2 views rt (73560) |
$1,693.65 |
$1,693.65 |
18.6× |
| Xray neck soft tissue (70360) |
$2,287.68 |
$2,287.68 |
25.2× |
| Xray optic foramina (70190) |
$2,078.60 |
$2,078.60 |
22.9× |
| Xray orbits complete min 4 views (70200) |
$2,683.45 |
$2,683.45 |
24.6× |
| Xray pelvis 1 or 2 views (72170) |
$3,028.02 |
$3,028.02 |
27.7× |
| Xray ribs bilateral 3 views (71110) |
$2,916.22 |
$2,916.22 |
26.7× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$3,055.95 |
$3,055.95 |
28.0× |
| Xray scapula complete (73010) |
$2,691 |
$2,691 |
24.6× |
| Xray shoulder 1 view (73020) |
$1,214.50 |
$1,214.50 |
13.4× |
| Xray sinuses paranasal <3 views (70210) |
$924.55 |
$924.55 |
10.2× |
| Xray spine thoracic 2 views (72070) |
$1,734.70 |
$1,734.70 |
15.9× |
| Xray spine thoracic 3 views (72072) |
$2,627.85 |
$2,627.85 |
24.1× |
| Xray tibia-fibula 2 views bil (73590) |
$2,411.20 |
$2,411.20 |
26.5× |
| Xray tmj's bilateral open-clsc (70330) |
$3,622.20 |
$3,622.20 |
39.9× |