| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,039.75 |
$8,039.75 |
5.6× |
| Abdomen 2 views (74019) |
$780.75 |
$780.75 |
7.2× |
| Acute gi blood loss imaging (78278) |
$4,392 |
$4,392 |
10.5× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$3,740.75 |
$3,740.75 |
2.8× |
| Angiography extremity bilateral rs&i (75716) |
$6,390.75 |
$6,390.75 |
1.9× |
| Angiography extremity unilateral rs&i (75710) |
$6,396.25 |
$6,396.25 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$12,765.75 |
$12,765.75 |
3.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,940.75 |
$6,940.75 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,504 |
$6,504 |
2.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,176.75 |
$6,176.75 |
1.9× |
| Angiography Spinal Selective Rs&I (75705) |
$22,008.75 |
$22,008.75 |
3.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,176.75 |
$6,176.75 |
1.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,493 |
$1,493 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$15,303.75 |
$15,303.75 |
4.6× |
| Ankle 2 views (73600) |
$522.50 |
$522.50 |
5.7× |
| Aortogram thoracic (75605) |
$6,227.12 |
$6,227.12 |
1.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$11,710.50 |
$11,710.50 |
3.6× |
| Aortography abdominal serialography rs&i (75625) |
$11,445.50 |
$11,445.50 |
3.5× |
| Arthrogram ankle (73615) |
$1,405.25 |
$1,405.25 |
3.9× |
| Arthrogram elbow (73085) |
$1,405.25 |
$1,405.25 |
3.9× |
| Arthrogram hip (73525) |
$1,405.25 |
$1,405.25 |
3.9× |
| Arthrogram knee (73580) |
$1,699.75 |
$1,699.75 |
4.7× |
| Arthrogram shoulder (73040) |
$1,741.50 |
$1,741.50 |
4.8× |
| Arthrogram wrist (73115) |
$1,405.25 |
$1,405.25 |
3.9× |
| Basic dosimetry (77300) |
$1,344.50 |
$1,344.50 |
9.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$5,057 |
$5,057 |
12.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$7,000.25 |
$7,000.25 |
16.8× |
| Bone &/joint imaging whole body (78306) |
$12,626.50 |
$12,626.50 |
30.2× |
| Bone age studies (77072) |
$482.50 |
$482.50 |
4.4× |
| Bone Imaging 3 Phase (78315) |
$12,452.75 |
$12,452.75 |
29.8× |
| Bone survey complete (77075) |
$6,248 |
$6,248 |
57.2× |
| Bone survey infant (77076) |
$3,696.75 |
$3,696.75 |
33.9× |
| Bowel imaging (78290) |
$7,525.25 |
$7,525.25 |
18.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$8,756.25 |
$8,756.25 |
15.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$19,629 |
$19,629 |
13.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$6,290.75 |
$6,290.75 |
15.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$6,942 |
$6,942 |
12.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$7,096 |
$7,096 |
12.5× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$3,602 |
$3,602 |
6.4× |
| Cervical spine 2 or 3 views (72040) |
$2,951.75 |
$2,951.75 |
32.5× |
| Chest 1 view (71045) |
$408.75 |
$408.75 |
4.5× |
| Chest xray 3 views (71047) |
$408.75 |
$408.75 |
4.5× |
| Cholecystography, oral contrast Non-Facility (74290) |
$4,775 |
$4,775 |
26.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$2,861.50 |
$2,861.50 |
15.6× |
| Cisternography Positive Contrast Rs&I (70015) |
$12,419.75 |
$12,419.75 |
15.2× |
| Clavicle complete (73000) |
$2,847.50 |
$2,847.50 |
31.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,272.25 |
$1,272.25 |
11.7× |
| Continuing medical physics consltj pr wk (77336) |
$606.50 |
$606.50 |
4.3× |
| Corpora cavernosography (74445) |
$7,452.50 |
$7,452.50 |
68.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$29,550.50 |
$29,550.50 |
81.1× |
| CT abdomen and pelvis without contrast (74176) |
$29,550.50 |
$29,550.50 |
118.6× |
| CT abdomen w contrast (74160) |
$20,430.75 |
$20,430.75 |
111.5× |
| CT abdomen w wo contrast (74170) |
$23,643 |
$23,643 |
129.1× |
| CT abdomen w/o contrast (74150) |
$19,878.50 |
$19,878.50 |
182.1× |
| CT angio hrt w/3d image (75574) |
$17,724.50 |
$17,724.50 |
48.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$18,386 |
$18,386 |
100.4× |
| CT angiography upper extremity lt (73206) |
$18,386 |
$18,386 |
100.4× |
| CT c-spine w/contrast (72126) |
$14,431.75 |
$14,431.75 |
39.6× |
| CT c-spine w/o contrast (72125) |
$13,879.50 |
$13,879.50 |
127.1× |
| CT cervical spine w&w/o contrast (72127) |
$17,790 |
$17,790 |
97.1× |
| CT chest w contrast (71260) |
$19,844.25 |
$19,844.25 |
108.3× |
| CT chest w/wo contrast (71270) |
$23,459.25 |
$23,459.25 |
128.1× |
| CT head/brain with contrast (70460) |
$20,208.75 |
$20,208.75 |
110.3× |
| CT head/brain without and with contrast (70470) |
$26,169 |
$26,169 |
142.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$22,156.50 |
$22,156.50 |
60.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,272.25 |
$1,272.25 |
14.0× |
| CT hrt w/3d image congen (75573) |
$17,724.50 |
$17,724.50 |
48.7× |
| CT iac w contrast (70481) |
$12,708 |
$12,708 |
69.4× |
| CT limited/localized follow up study (76380) |
$3,618.25 |
$3,618.25 |
39.8× |
| CT lower ext w/o (73700) |
$15,282.25 |
$15,282.25 |
140.0× |
| CT lower extremity w wo contrast (73702) |
$18,463.50 |
$18,463.50 |
100.8× |
| CT lower extremity w/contrast material (73701) |
$15,833.25 |
$15,833.25 |
86.4× |
| CT lumbar spine w & w/o contrast (72133) |
$17,790 |
$17,790 |
97.1× |
| CT lumbar spine w/contrast (72132) |
$14,431.75 |
$14,431.75 |
39.6× |
| CT lumbar spine w/o contrast (72131) |
$13,879.50 |
$13,879.50 |
127.1× |
| CT maxillofacial w contrast (70487) |
$12,708 |
$12,708 |
69.4× |
| CT maxillofacial w/wo contrast (70488) |
$16,459.50 |
$16,459.50 |
89.9× |
| CT maxillofacial wo contrast (70486) |
$12,152.50 |
$12,152.50 |
111.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$16,459.50 |
$16,459.50 |
89.9× |
| CT orbits w/o contrast (70480) |
$12,152.50 |
$12,152.50 |
111.3× |
| CT pelvis w/o contrast (72192) |
$19,201.25 |
$19,201.25 |
175.9× |
| CT pelvis w/wo contrast (72194) |
$21,978 |
$21,978 |
120.0× |
| CT scan of arm combo (73202) |
$18,463.50 |
$18,463.50 |
100.8× |
| CT soft tissue neck w contrast (70491) |
$12,708 |
$12,708 |
69.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$16,459.50 |
$16,459.50 |
89.9× |
| CT soft tissue neck w/o contrast (70490) |
$12,152.50 |
$12,152.50 |
111.3× |
| CT thoracic spine w/contrast (72129) |
$14,431.75 |
$14,431.75 |
78.8× |
| CT thoracic spine w/o contrast (72128) |
$13,879.50 |
$13,879.50 |
127.1× |
| CT thoracic spine w/wo contrast (72130) |
$17,790 |
$17,790 |
97.1× |
| CT thorax w/o contrast (71250) |
$19,290.75 |
$19,290.75 |
176.7× |
| CT upper ext wo (73200) |
$15,282.25 |
$15,282.25 |
140.0× |
| CT upper extremity with contrast (73201) |
$15,833.25 |
$15,833.25 |
43.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$18,386 |
$18,386 |
100.4× |
| Cta Abdomen (74175) |
$18,386 |
$18,386 |
100.4× |
| CTA abdomen pelvis (74174) |
$29,550.50 |
$29,550.50 |
81.1× |
| CTA chest (71275) |
$18,386 |
$18,386 |
100.4× |
| Cta Head (70496) |
$9,152.25 |
$9,152.25 |
50.0× |
| Cta Neck (70498) |
$16,806.75 |
$16,806.75 |
91.8× |
| Cta Pelvis (72191) |
$18,386 |
$18,386 |
100.4× |
| Cystography minimum 3 views rs&i (74430) |
$6,034.75 |
$6,034.75 |
16.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$6,464 |
$6,464 |
3.0× |
| Diskography lumbar (72295) |
$3,129.50 |
$3,129.50 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,149.50 |
$1,149.50 |
10.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$1,083.50 |
$1,083.50 |
11.9× |
| Esophagus (74220) |
$4,640 |
$4,640 |
25.3× |
| Facial bones min 3 views (70150) |
$3,050.25 |
$3,050.25 |
27.9× |
| Fetal biophysical profile non-stress testing (76818) |
$3,351.25 |
$3,351.25 |
30.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,262.25 |
$1,262.25 |
11.6× |
| Fluoroscopy up to 1 hr (76000) |
$3,437.25 |
$3,437.25 |
13.8× |
| Foot 2 views (73620) |
$1,644.75 |
$1,644.75 |
18.1× |
| Forearm 2 views (73090) |
$2,709.75 |
$2,709.75 |
29.8× |
| Hand 2 views (73120) |
$1,950 |
$1,950 |
17.9× |
| Heart first pass single,planar (78481) |
$3,303.25 |
$3,303.25 |
5.8× |
| Heart Infarct Image (78466) |
$4,407.75 |
$4,407.75 |
10.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$11,453.50 |
$11,453.50 |
20.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$12,026.25 |
$12,026.25 |
28.8× |
| Hysterosalpingogram (74740) |
$5,404 |
$5,404 |
21.7× |
| Intracavitary Radiation Source Applic Simple (77761) |
$2,154.50 |
$2,154.50 |
3.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$11,956.50 |
$11,956.50 |
21.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$16,782.75 |
$16,782.75 |
29.6× |
| Knee 3 views (73562) |
$3,251 |
$3,251 |
35.8× |
| Liver & spleen imaging static only (78215) |
$10,485.25 |
$10,485.25 |
25.1× |
| Lung perf&ventilat diferentl (78598) |
$21,637 |
$21,637 |
38.2× |
| Lung perfusion differential (78597) |
$9,681.75 |
$9,681.75 |
23.2× |
| Lung ventilation imaging (78579) |
$11,475 |
$11,475 |
27.5× |
| Lymphoscintigraphy (78195) |
$5,907 |
$5,907 |
10.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$17,750.50 |
$17,750.50 |
21.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$15,433.75 |
$15,433.75 |
42.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$16,018.25 |
$16,018.25 |
44.0× |
| Mammary ductogram or galactogram multiple (77054) |
$3,183.50 |
$3,183.50 |
12.8× |
| Mammary ductogram or galactogram single (77053) |
$1,303.25 |
$1,303.25 |
5.2× |
| MRA head w & w/o contrast (70546) |
$13,887.75 |
$13,887.75 |
38.1× |
| MRA head w/o contrast (70544) |
$11,576 |
$11,576 |
46.5× |
| MRA head with contrast (70545) |
$13,116 |
$13,116 |
36.0× |
| MRA neck w contrast (70548) |
$13,116 |
$13,116 |
36.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$13,887.75 |
$13,887.75 |
38.1× |
| MRA neck w/o contrast (70547) |
$11,576 |
$11,576 |
46.5× |
| MRI abdomen w contrast (74182) |
$11,576 |
$11,576 |
31.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$11,611.25 |
$11,611.25 |
31.9× |
| MRI abdomen w/o contrast (74181) |
$9,826.75 |
$9,826.75 |
39.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$17,750.50 |
$17,750.50 |
21.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$18,523 |
$18,523 |
50.8× |
| MRI bone marrow blood supply (77084) |
$16,813 |
$16,813 |
67.5× |
| MRI c-spine with contrast (72142) |
$18,925.75 |
$18,925.75 |
51.9× |
| MRI cervical spine w/o contrast (72141) |
$6,223.25 |
$6,223.25 |
25.0× |
| MRI chest w/o & w/contrast material (71552) |
$10,802.75 |
$10,802.75 |
29.7× |
| MRI chest w/o contrast (71550) |
$8,522.75 |
$8,522.75 |
34.2× |
| MRI chest with contrast (71551) |
$10,033.25 |
$10,033.25 |
12.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$16,972.25 |
$16,972.25 |
46.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$17,738 |
$17,738 |
48.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$15,433.75 |
$15,433.75 |
61.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$11,621.50 |
$11,621.50 |
46.6× |
| MRI orbit face neck w contrast (70542) |
$13,116 |
$13,116 |
36.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$13,887.75 |
$13,887.75 |
38.1× |
| MRI pelvis w/contrast (72196) |
$18,472.25 |
$18,472.25 |
50.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$17,750.50 |
$17,750.50 |
48.7× |
| MRI pelvis w/o contrast (72195) |
$14,822.88 |
$14,822.88 |
59.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$20,782.50 |
$20,782.50 |
57.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$17,581.75 |
$17,581.75 |
48.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$20,835.75 |
$20,835.75 |
57.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$17,137.50 |
$17,137.50 |
47.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$21,800.25 |
$21,800.25 |
59.8× |
| MRI temporomandibular joint (70336) |
$17,642.50 |
$17,642.50 |
70.8× |
| MRI thoracic spine w/o contrast (72146) |
$6,129.50 |
$6,129.50 |
24.6× |
| MRI up ext w/o contrast (73218) |
$13,887.75 |
$13,887.75 |
55.7× |
| MRI upper ext joint w/o contrast (73221) |
$15,929.25 |
$15,929.25 |
63.9× |
| MRI, joint upper extrem combo (73223) |
$18,523 |
$18,523 |
50.8× |
| Myelogram Cervical (72240) |
$9,614.50 |
$9,614.50 |
11.7× |
| Myelogram Lumbar (72265) |
$15,659.50 |
$15,659.50 |
19.1× |
| Myelogram thoracic (72255) |
$15,659.50 |
$15,659.50 |
19.1× |
| Myelography 2 or more regions (72270) |
$16,348.75 |
$16,348.75 |
20.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$15,447.75 |
$15,447.75 |
11.4× |
| Myocardial Spect Multiple Studies (78452) |
$19,654 |
$19,654 |
14.5× |
| Myocardial spect single study at rest or stress (78451) |
$10,305.75 |
$10,305.75 |
7.6× |
| Neck soft tissue (70360) |
$2,483.50 |
$2,483.50 |
27.3× |
| Nm cardiac blood pool multiple (78473) |
$7,475.75 |
$7,475.75 |
17.9× |
| Nm cisternogram (78630) |
$2,854 |
$2,854 |
5.0× |
| Nm csf leak detection (78650) |
$8,693.25 |
$8,693.25 |
6.4× |
| Nm gastric emptying study (78264) |
$2,961.75 |
$2,961.75 |
7.1× |
| Nm peritoneal-venous shunt patency (78291) |
$6,691.25 |
$6,691.25 |
16.0× |
| Nonvascular shunt X-ray (75809) |
$819 |
$819 |
7.5× |
| Nuclear Rx Oral Admin (79005) |
$11,496 |
$11,496 |
47.2× |
| Orthopantogram (70355) |
$2,198.25 |
$2,198.25 |
24.2× |
| Osseous survey limited (77074) |
$6,248 |
$6,248 |
57.2× |
| Parathyroid Planar Imaging (78070) |
$5,955 |
$5,955 |
14.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,456.50 |
$2,456.50 |
5.9× |
| Pelvis 1 or 2 views (72170) |
$3,024.50 |
$3,024.50 |
27.7× |
| Peritoneogram after injection (74190) |
$6,056.25 |
$6,056.25 |
10.6× |
| PET image w/CT, skull-thigh (78815) |
$18,902 |
$18,902 |
12.7× |
| PET imaging CT for attenuation limited area (78814) |
$18,175 |
$18,175 |
12.2× |
| PET imaging for CT attenuation whole body (78816) |
$19,629 |
$19,629 |
13.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$10,731 |
$10,731 |
3.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$10,167.50 |
$10,167.50 |
24.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$21,637 |
$21,637 |
38.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,279.25 |
$1,279.25 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$3,134.50 |
$3,134.50 |
34.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$2,737.50 |
$2,737.50 |
30.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$3,562 |
$3,562 |
39.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$485.75 |
$485.75 |
5.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$802.25 |
$802.25 |
7.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$1,531.25 |
$1,531.25 |
14.0× |
| Radex fingr minimum 2 views (73140) |
$2,423.25 |
$2,423.25 |
26.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$3,105 |
$3,105 |
34.2× |
| Radex Hand Minimum 3 Views (73130) |
$2,898.25 |
$2,898.25 |
31.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$485.75 |
$485.75 |
5.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$802.25 |
$802.25 |
7.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$802.25 |
$802.25 |
7.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,531.25 |
$1,531.25 |
14.0× |
| Radex Humerus Minimum 2 Views (73060) |
$2,946 |
$2,946 |
32.4× |
| Radex Kne 1/2 Views (73560) |
$3,251 |
$3,251 |
35.8× |
| Radex Kne Compl 4/More Views (73564) |
$3,300.25 |
$3,300.25 |
30.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$2,982.75 |
$2,982.75 |
27.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$3,050.25 |
$3,050.25 |
33.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$3,251 |
$3,251 |
35.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$1,935.25 |
$1,935.25 |
21.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$1,760.25 |
$1,760.25 |
19.4× |
| Radex Toe Minimum 2 Views (73660) |
$2,361 |
$2,361 |
26.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$737.75 |
$737.75 |
6.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$2,798.25 |
$2,798.25 |
30.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,531.25 |
$1,531.25 |
14.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$408.75 |
$408.75 |
4.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$780.75 |
$780.75 |
7.2× |
| Radiologic exam chest 2 views (71046) |
$408.75 |
$408.75 |
4.5× |
| Radiologic exam colon single contrast study (74270) |
$6,430.75 |
$6,430.75 |
35.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$3,619 |
$3,619 |
19.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$3,843.25 |
$3,843.25 |
21.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$4,952.50 |
$4,952.50 |
27.0× |
| Radiologic examination femur 1 view (73551) |
$485.75 |
$485.75 |
5.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$2,067 |
$2,067 |
22.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$2,861.50 |
$2,861.50 |
31.5× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$3,648 |
$3,648 |
6.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$3,106.50 |
$3,106.50 |
28.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$1,657.25 |
$1,657.25 |
15.2× |
| Radiological examination surgical specimen (76098) |
$1,548.25 |
$1,548.25 |
2.7× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$7,574.25 |
$7,574.25 |
31.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$8,414 |
$8,414 |
34.5× |
| Ribs bilateral 3 views (71110) |
$4,694.75 |
$4,694.75 |
43.0× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$8,116.75 |
$8,116.75 |
19.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$7,672.50 |
$7,672.50 |
18.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$15,897.75 |
$15,897.75 |
28.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$5,146.50 |
$5,146.50 |
9.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$8,090.75 |
$8,090.75 |
14.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$7,008.50 |
$7,008.50 |
5.2× |
| Rp Therapy Intravenous Administration (79101) |
$8,414 |
$8,414 |
34.5× |
| Sacroiliac Joints < 3 Views (72200) |
$542.75 |
$542.75 |
5.0× |
| Salivary gland imaging (78230) |
$2,968.25 |
$2,968.25 |
7.1× |
| Scapula (73010) |
$2,821.50 |
$2,821.50 |
25.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$299.75 |
$299.75 |
12.8× |
| Sella turcica (70240) |
$1,438.50 |
$1,438.50 |
15.8× |
| Shoulder 1 view (73020) |
$1,363.25 |
$1,363.25 |
15.0× |
| Sialogram (70390) |
$1,138 |
$1,138 |
4.6× |
| Small bowel series (74250) |
$5,292.25 |
$5,292.25 |
28.9× |
| Special Physics Consult (77370) |
$606.50 |
$606.50 |
4.3× |
| Spine thoracic 3 views (72072) |
$3,196.25 |
$3,196.25 |
29.3× |
| Splenoportograpy rs&i (75810) |
$6,176.75 |
$6,176.75 |
1.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$5,910.50 |
$5,910.50 |
23.7× |
| Testicular Imaging With Vascular Flow (78761) |
$8,962.50 |
$8,962.50 |
21.5× |
| Thoracolumbar 2 views (72080) |
$2,951.75 |
$2,951.75 |
32.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$12,697 |
$12,697 |
22.4× |
| Thyroid imaging w/blood flow (78013) |
$1,147.50 |
$1,147.50 |
2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,778.25 |
$1,778.25 |
4.3× |
| Tmj unilateral (70328) |
$1,760.25 |
$1,760.25 |
19.4× |
| Tomogram (76100) |
$2,929.50 |
$2,929.50 |
26.8× |
| Treatment device complex (77334) |
$2,010.75 |
$2,010.75 |
5.1× |
| Ultrasound breast complete (76641) |
$3,691 |
$3,691 |
33.8× |
| Ultrasound Exam Aaa Screen (76706) |
$777 |
$777 |
7.1× |
| Ultrasound, abdomen limited (76705) |
$2,045.50 |
$2,045.50 |
18.7× |
| Unlisted magnetic resonance procedure (76498) |
$18,797.50 |
$18,797.50 |
206.8× |
| Ureteral reflux study (78740) |
$3,458.75 |
$3,458.75 |
8.3× |
| Urethrocystogram voiding (74455) |
$5,758.50 |
$5,758.50 |
23.1× |
| Urethrocystography retrograde rs&i (74450) |
$7,890.75 |
$7,890.75 |
31.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$6,208 |
$6,208 |
33.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$8,638.75 |
$8,638.75 |
47.2× |
| Us breast unilateral limited (76642) |
$3,691 |
$3,691 |
40.6× |
| Us chest (76604) |
$1,052.25 |
$1,052.25 |
9.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$5,631.75 |
$5,631.75 |
25.0× |
| Us compl joint r-t w/image documentation (76881) |
$1,816 |
$1,816 |
16.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$1,709.25 |
$1,709.25 |
15.7× |
| Us ob limited (76815) |
$2,121.50 |
$2,121.50 |
19.4× |
| Us ob transvaginal (76817) |
$4,570.75 |
$4,570.75 |
41.9× |
| Us pelvic non ob complete (76856) |
$5,101.75 |
$5,101.75 |
46.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$2,130.25 |
$2,130.25 |
19.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$2,992.50 |
$2,992.50 |
27.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$1,557 |
$1,557 |
14.3× |
| Us retroperitoneal complete (76770) |
$2,992.50 |
$2,992.50 |
27.4× |
| Us retroperitoneal limited (76775) |
$1,709.25 |
$1,709.25 |
15.7× |
| Us scrotum and contents (76870) |
$4,707.75 |
$4,707.75 |
43.1× |
| Us soft tissue head/neck (76536) |
$4,434 |
$4,434 |
40.6× |
| Us spinal canal and contents (76800) |
$4,862 |
$4,862 |
44.5× |
| Us transrectal (76872) |
$3,269.75 |
$3,269.75 |
30.0× |
| Us transrectal prostate volume (76873) |
$4,707.75 |
$4,707.75 |
43.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$4,403 |
$4,403 |
40.3× |
| Venogram adrenal unilat (75840) |
$9,018.50 |
$9,018.50 |
2.7× |
| Venogram extremity bilateral (75822) |
$1,299.25 |
$1,299.25 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$857 |
$857 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$6,286.50 |
$6,286.50 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$6,176.75 |
$6,176.75 |
3.8× |
| Venography Renal Bilateral (75833) |
$17,340.50 |
$17,340.50 |
5.3× |
| Venography renal unilateral selective rs&i (75831) |
$6,176.75 |
$6,176.75 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$6,176.75 |
$6,176.75 |
1.9× |
| Venous sampling by catheter (75893) |
$5,815 |
$5,815 |
1.0× |
| Wrist 2 views (73100) |
$522.50 |
$522.50 |
5.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$4,140.75 |
$4,140.75 |
37.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$2,849.25 |
$2,849.25 |
31.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$7,731.75 |
$7,731.75 |
42.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$1,847.25 |
$1,847.25 |
20.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$485.75 |
$485.75 |
5.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$802.25 |
$802.25 |
7.3× |
| X-ray exam of femur 2/> (73552) |
$485.75 |
$485.75 |
5.3× |
| X-ray eye for foreign body (70030) |
$1,023.50 |
$1,023.50 |
11.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$2,880 |
$2,880 |
31.7× |
| X-ray IV pyelogram (ivp) (74400) |
$7,527.25 |
$7,527.25 |
41.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$1,644.75 |
$1,644.75 |
18.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$3,302.25 |
$3,302.25 |
36.3× |
| X-ray leg, infant (73592) |
$522.50 |
$522.50 |
5.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$2,951.75 |
$2,951.75 |
27.0× |
| X-ray nose-rectum child f.b. (76010) |
$3,094.25 |
$3,094.25 |
34.0× |
| X-ray optic foramen (70190) |
$1,956 |
$1,956 |
21.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$4,020.50 |
$4,020.50 |
36.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$3,633.50 |
$3,633.50 |
40.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$4,694.75 |
$4,694.75 |
43.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$5,215.25 |
$5,215.25 |
47.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$1,079.75 |
$1,079.75 |
9.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$3,262.50 |
$3,262.50 |
35.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$3,930 |
$3,930 |
43.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$4,837.25 |
$4,837.25 |
44.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$3,058.75 |
$3,058.75 |
28.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$2,234.75 |
$2,234.75 |
12.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$2,538.25 |
$2,538.25 |
27.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$2,161.50 |
$2,161.50 |
23.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$3,235.25 |
$3,235.25 |
35.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$2,951.75 |
$2,951.75 |
27.0× |
| Xr bone length studies (77073) |
$959.25 |
$959.25 |
8.8× |
| Xr c-spine 4 or 5 views (72050) |
$4,157.50 |
$4,157.50 |
38.1× |
| Xr c-spine 6 or more views (72052) |
$4,998 |
$4,998 |
45.8× |
| Xr chest 4+ views (71048) |
$780.75 |
$780.75 |
7.2× |
| Xr urogram antegrade (74425) |
$953.75 |
$953.75 |
2.6× |