| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,505.50 |
$8,674 |
4.0× |
| Abdomen 2 views (74019) |
$276.75 |
$369 |
2.2× |
| Acute gi blood loss imaging (78278) |
$1,213.50 |
$1,618 |
2.6× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$3,396 |
$4,528 |
2.2× |
| Angio Adrenal Bilat Select (75733) |
$8,295 |
$11,060 |
2.2× |
| Angiography extremity bilateral rs&i (75716) |
$8,301 |
$11,068 |
2.2× |
| Angiography extremity unilateral rs&i (75710) |
$8,301 |
$11,068 |
2.2× |
| Angiography internal mammary rs&i (75756) |
$8,295 |
$11,060 |
2.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$14,317.50 |
$19,090 |
2.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,295 |
$11,060 |
2.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,295 |
$11,060 |
2.2× |
| Angiography Spinal Selective Rs&I (75705) |
$14,313 |
$19,084 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,317.50 |
$19,090 |
2.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$8,301 |
$11,068 |
2.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$8,301 |
$11,068 |
2.2× |
| Ankle 2 views (73600) |
$232.50 |
$310 |
2.3× |
| Aortogram thoracic (75605) |
$14,313 |
$19,084 |
2.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$8,301 |
$11,068 |
2.2× |
| Aortography abdominal serialography rs&i (75625) |
$8,301 |
$11,068 |
2.2× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$8,295 |
$11,060 |
2.2× |
| Artery X-Rays Adrenal Gland (75731) |
$8,295 |
$11,060 |
2.2× |
| Arthrogram ankle (73615) |
$1,024.50 |
$1,366 |
2.5× |
| Arthrogram elbow (73085) |
$1,024.50 |
$1,366 |
2.5× |
| Arthrogram hip (73525) |
$1,026 |
$1,368 |
2.5× |
| Arthrogram knee (73580) |
$1,024.50 |
$1,366 |
2.5× |
| Arthrogram shoulder (73040) |
$1,026 |
$1,368 |
2.5× |
| Arthrogram wrist (73115) |
$1,024.50 |
$1,366 |
2.5× |
| Basic dosimetry (77300) |
$649.50 |
$866 |
4.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$997.50 |
$1,330 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$997.50 |
$1,330 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$1,056 |
$1,408 |
2.2× |
| Bone age studies (77072) |
$298.50 |
$398 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,056 |
$1,408 |
2.2× |
| Bone Marrow Imaging Limited Area (78102) |
$997.50 |
$1,330 |
2.1× |
| Bone survey complete (77075) |
$708 |
$944 |
5.7× |
| Bone survey infant (77076) |
$305.25 |
$407 |
2.5× |
| Bowel imaging (78290) |
$997.50 |
$1,330 |
2.1× |
| Brachytx isodose complex (77318) |
$1,197 |
$1,596 |
2.7× |
| Brachytx isodose intermed (77317) |
$1,031.25 |
$1,375 |
2.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,031.25 |
$1,375 |
2.3× |
| Brain imaging < 4 static views (78600) |
$997.50 |
$1,330 |
2.1× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$997.50 |
$1,330 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,335 |
$1,780 |
2.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,278 |
$5,704 |
2.5× |
| Brain Imaging Vascular Flow Only (78610) |
$1,335 |
$1,780 |
2.1× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,335 |
$1,780 |
2.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$997.50 |
$1,330 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$997.50 |
$1,330 |
2.1× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,335 |
$1,780 |
2.1× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,100 |
$2,800 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,400 |
$3,200 |
5.8× |
| Cardiac shunt detection (78428) |
$997.50 |
$1,330 |
2.1× |
| Cephalogram, orthodontic Non-Facility (70350) |
$240 |
$320 |
2.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,335 |
$1,780 |
2.1× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$1,335 |
$1,780 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$306 |
$408 |
3.0× |
| Chest 1 view (71045) |
$246.75 |
$329 |
2.4× |
| Chest xray 3 views (71047) |
$283.50 |
$378 |
2.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$504 |
$672 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$483 |
$644 |
2.3× |
| Cineradiography/videoradiography (76120) |
$327.75 |
$437 |
2.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,064.75 |
$2,753 |
2.2× |
| Clavicle complete (73000) |
$264.75 |
$353 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$652.50 |
$870 |
5.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$345 |
$460 |
3.4× |
| Continuing medical physics consltj pr wk (77336) |
$727.50 |
$970 |
4.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$504 |
$672 |
2.4× |
| Corpora cavernosography (74445) |
$296.25 |
$395 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,472.50 |
$4,630 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,400 |
$3,200 |
8.5× |
| CT abdomen w contrast (74160) |
$1,965 |
$2,620 |
9.5× |
| CT abdomen w wo contrast (74170) |
$2,182.50 |
$2,910 |
10.5× |
| CT abdomen w/o contrast (74150) |
$1,747.50 |
$2,330 |
14.1× |
| CT angio hrt w/3d image (75574) |
$1,965 |
$2,620 |
4.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,380 |
$1,840 |
6.7× |
| CT angiography upper extremity lt (73206) |
$1,380 |
$1,840 |
6.7× |
| CT c-spine w/contrast (72126) |
$1,822.50 |
$2,430 |
4.4× |
| CT c-spine w/o contrast (72125) |
$1,530 |
$2,040 |
12.4× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$750.75 |
$1,001 |
3.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,980 |
$2,640 |
9.6× |
| CT chest w contrast (71260) |
$1,747.50 |
$2,330 |
8.4× |
| CT chest w/wo contrast (71270) |
$1,965 |
$2,620 |
9.5× |
| CT colonography screening (74263) |
$2,617.50 |
$3,490 |
9.3× |
| CT colonography w/dye (74262) |
$1,492.50 |
$1,990 |
7.2× |
| CT colonography w/o cntrst (74261) |
$1,162.50 |
$1,550 |
9.4× |
| CT head/brain with contrast (70460) |
$1,530 |
$2,040 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,747.50 |
$2,330 |
8.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,095 |
$1,460 |
2.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$292.50 |
$390 |
2.8× |
| CT hrt w/3d image congen (75573) |
$1,237.50 |
$1,650 |
3.0× |
| CT iac w contrast (70481) |
$1,597.50 |
$2,130 |
7.7× |
| CT limited/localized follow up study (76380) |
$435 |
$580 |
4.2× |
| CT lower ext w/o (73700) |
$1,380 |
$1,840 |
11.2× |
| CT lower extremity w wo contrast (73702) |
$2,107.50 |
$2,810 |
10.2× |
| CT lower extremity w/contrast material (73701) |
$1,822.50 |
$2,430 |
8.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,182.50 |
$2,910 |
10.5× |
| CT lumbar spine w/contrast (72132) |
$1,890 |
$2,520 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,597.50 |
$2,130 |
12.9× |
| CT maxillofacial w contrast (70487) |
$1,597.50 |
$2,130 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,672.50 |
$2,230 |
8.1× |
| CT maxillofacial wo contrast (70486) |
$1,335 |
$1,780 |
10.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,747.50 |
$2,330 |
8.4× |
| CT orbits w/o contrast (70480) |
$1,455 |
$1,940 |
11.8× |
| CT pelvis w/o contrast (72192) |
$1,485 |
$1,980 |
12.0× |
| CT pelvis w/wo contrast (72194) |
$1,747.50 |
$2,330 |
8.4× |
| CT scan of arm combo (73202) |
$1,777.50 |
$2,370 |
8.6× |
| CT soft tissue neck w contrast (70491) |
$1,747.50 |
$2,330 |
8.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,965 |
$2,620 |
9.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,552.50 |
$2,070 |
12.6× |
| CT thoracic spine w/contrast (72129) |
$1,627.50 |
$2,170 |
7.9× |
| CT thoracic spine w/o contrast (72128) |
$1,312.50 |
$1,750 |
10.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,747.50 |
$2,330 |
8.4× |
| CT thorax w/o contrast (71250) |
$1,552.50 |
$2,070 |
12.6× |
| CT unlisted procedure (76497) |
$367.50 |
$490 |
3.6× |
| CT upper ext wo (73200) |
$1,380 |
$1,840 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,597.50 |
$2,130 |
3.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,890 |
$2,520 |
9.1× |
| Cta Abdomen (74175) |
$2,272.50 |
$3,030 |
11.0× |
| CTA abdomen pelvis (74174) |
$3,427.50 |
$4,570 |
8.3× |
| CTA chest (71275) |
$1,912.50 |
$2,550 |
9.2× |
| Cta Head (70496) |
$2,040 |
$2,720 |
9.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,062 |
$1,416 |
2.6× |
| Cta Neck (70498) |
$1,965 |
$2,620 |
9.5× |
| Cta Pelvis (72191) |
$1,530 |
$2,040 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$1,026 |
$1,368 |
2.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$652.50 |
$870 |
2.3× |
| Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without… (78414) |
$1,335 |
$1,780 |
2.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$5,172.75 |
$6,897 |
2.1× |
| Diskogram cervical (72285) |
$5,006.25 |
$6,675 |
2.2× |
| Diskography lumbar (72295) |
$5,006.25 |
$6,675 |
2.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$305.25 |
$407 |
2.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$404.25 |
$539 |
3.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$305.25 |
$407 |
2.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$320.25 |
$427 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$232.50 |
$310 |
2.3× |
| Dxa bone density study axial skeleton (77085) |
$296.25 |
$395 |
2.4× |
| Echo exam of eye (76529) |
$255.75 |
$341 |
2.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$700.50 |
$934 |
2.5× |
| Esophageal motility (78258) |
$997.50 |
$1,330 |
2.1× |
| Esophagus (74220) |
$458.25 |
$611 |
2.2× |
| Facial bones min 3 views (70150) |
$298.50 |
$398 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$382.50 |
$510 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$479.25 |
$639 |
3.9× |
| Fetal Echo (76825) |
$1,462.50 |
$1,950 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$654.75 |
$873 |
2.3× |
| Foot 2 views (73620) |
$255.75 |
$341 |
2.5× |
| Forearm 2 views (73090) |
$248.25 |
$331 |
2.4× |
| Functional MRI brain by phys/psych (70555) |
$2,677.50 |
$3,570 |
9.5× |
| Functional MRI brain by tech (70554) |
$1,890 |
$2,520 |
6.7× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,014 |
$1,352 |
2.1× |
| Gastric mucosa imaging (78261) |
$997.50 |
$1,330 |
2.1× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$740.25 |
$987 |
2.6× |
| Gastrointestinal protein loss Facility (78282) |
$997.50 |
$1,330 |
2.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,438.50 |
$1,918 |
2.2× |
| Hand 2 views (73120) |
$334.50 |
$446 |
2.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,070.75 |
$2,761 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,070.75 |
$2,761 |
2.5× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,460.50 |
$4,614 |
4.2× |
| Heart first pass single,planar (78481) |
$1,335 |
$1,780 |
2.1× |
| Heart Infarct Image (78466) |
$997.50 |
$1,330 |
2.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$8,295 |
$11,060 |
2.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,295 |
$11,060 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,335 |
$1,780 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,056 |
$1,408 |
2.2× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$1,641.75 |
$2,189 |
2.5× |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
$2,051.25 |
$2,735 |
3.1× |
| Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators Non-Facility (77615) |
$3,210.75 |
$4,281 |
4.9× |
| Hyperthermia generated by intracavitary probe(s) Non-Facility (77620) |
$1,822.50 |
$2,430 |
2.8× |
| Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) Non-Facility (77605) |
$2,538.75 |
$3,385 |
3.1× |
| Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) Non-Facility (77600) |
$1,392.75 |
$1,857 |
3.1× |
| Hysterosalpingogram (74740) |
$654.75 |
$873 |
2.3× |
| Interstitial radiation source applic complex (77778) |
$2,504.25 |
$3,339 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,168.25 |
$2,891 |
2.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,641.75 |
$2,189 |
2.5× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,641.75 |
$2,189 |
2.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$296.25 |
$395 |
2.4× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$997.50 |
$1,330 |
2.1× |
| Kidney imaging morphology (78700) |
$997.50 |
$1,330 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,386 |
$1,848 |
2.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,386 |
$1,848 |
2.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,335 |
$1,780 |
2.1× |
| Knee 3 views (73562) |
$342.75 |
$457 |
3.3× |
| Liver & spleen imaging static only (78215) |
$997.50 |
$1,330 |
2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$997.50 |
$1,330 |
2.1× |
| Liver imaging static only (78201) |
$1,386 |
$1,848 |
2.2× |
| Liver imaging w/vascular flow (78202) |
$1,600.50 |
$2,134 |
2.5× |
| Lung perf&ventilat diferentl (78598) |
$1,335 |
$1,780 |
2.1× |
| Lung perfusion differential (78597) |
$997.50 |
$1,330 |
2.1× |
| Lung ventilation imaging (78579) |
$997.50 |
$1,330 |
2.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$8,295 |
$11,060 |
2.2× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$8,295 |
$11,060 |
2.2× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$4,141.50 |
$5,522 |
2.2× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,571.25 |
$2,095 |
2.1× |
| Lymphoscintigraphy (78195) |
$1,335 |
$1,780 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,257.50 |
$3,010 |
2.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$5,670 |
$7,560 |
27.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$5,317.50 |
$7,090 |
8.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$5,430 |
$7,240 |
26.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,732.50 |
$2,310 |
4.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,257.50 |
$3,010 |
5.5× |
| Magnetic Resonance Elastography (76391) |
$840 |
$1,120 |
3.0× |
| Mammary ductogram or galactogram multiple (77054) |
$652.50 |
$870 |
2.3× |
| Mammary ductogram or galactogram single (77053) |
$652.50 |
$870 |
2.3× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$240 |
$320 |
2.3× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$3,008.25 |
$4,011 |
6.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,945.50 |
$2,594 |
4.4× |
| MRA head w & w/o contrast (70546) |
$2,910 |
$3,880 |
7.1× |
| MRA head w/o contrast (70544) |
$2,092.50 |
$2,790 |
7.4× |
| MRA head with contrast (70545) |
$2,617.50 |
$3,490 |
6.4× |
| MRA neck w contrast (70548) |
$2,040 |
$2,720 |
4.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,257.50 |
$3,010 |
5.5× |
| MRA neck w/o contrast (70547) |
$2,040 |
$2,720 |
7.2× |
| MRI abdomen w contrast (74182) |
$1,972.50 |
$2,630 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,872.50 |
$3,830 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$2,107.50 |
$2,810 |
7.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,107.50 |
$2,810 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,400 |
$3,200 |
5.8× |
| MRI bone marrow blood supply (77084) |
$1,230 |
$1,640 |
4.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,312.50 |
$1,750 |
4.7× |
| MRI breast wo contrast unilateral (77046) |
$870 |
$1,160 |
3.1× |
| MRI c-spine with contrast (72142) |
$2,040 |
$2,720 |
4.9× |
| MRI cardiac w/o cont stress (75559) |
$1,597.50 |
$2,130 |
2.5× |
| MRI cardiac w/o contrast (75557) |
$1,312.50 |
$1,750 |
4.7× |
| MRI cervical spine w/o contrast (72141) |
$1,635 |
$2,180 |
5.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,182.50 |
$2,910 |
5.3× |
| MRI chest w/o contrast (71550) |
$1,822.50 |
$2,430 |
6.5× |
| MRI chest with contrast (71551) |
$2,062.50 |
$2,750 |
2.2× |
| MRI fetal sngl/1st gestation (74712) |
$1,152 |
$1,536 |
4.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,965 |
$2,620 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,730 |
$3,640 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,672.50 |
$2,230 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,380 |
$1,840 |
4.9× |
| MRI orbit face neck w contrast (70542) |
$1,732.50 |
$2,310 |
4.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,812.50 |
$3,750 |
6.8× |
| MRI pelvis w/contrast (72196) |
$2,100 |
$2,800 |
5.1× |
| MRI pelvis w/o contrast (72195) |
$2,040 |
$2,720 |
7.2× |
| MRI spectroscopy (76390) |
$1,597.50 |
$2,130 |
15.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,182.50 |
$2,910 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,965 |
$2,620 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,610 |
$3,480 |
6.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,257.50 |
$3,010 |
5.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,325 |
$3,100 |
5.6× |
| MRI temporomandibular joint (70336) |
$1,620 |
$2,160 |
5.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,965 |
$2,620 |
7.0× |
| MRI up ext w/o contrast (73218) |
$1,597.50 |
$2,130 |
5.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,407.50 |
$3,210 |
8.5× |
| MRI, joint upper extrem combo (73223) |
$2,692.50 |
$3,590 |
6.5× |
| Myelogram Cervical (72240) |
$2,064.75 |
$2,753 |
2.2× |
| Myelogram Lumbar (72265) |
$2,066.25 |
$2,755 |
2.2× |
| Myelogram thoracic (72255) |
$2,064.75 |
$2,753 |
2.2× |
| Myelography 2 or more regions (72270) |
$2,064.75 |
$2,753 |
2.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,811.50 |
$5,082 |
2.5× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,335 |
$1,780 |
2.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$5,598 |
$7,464 |
2.2× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,278 |
$5,704 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$4,278 |
$5,704 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$7,895.25 |
$10,527 |
3.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,278 |
$5,704 |
2.5× |
| Myocardial infarct spect (78469) |
$1,335 |
$1,780 |
2.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,396 |
$4,528 |
2.2× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,396 |
$4,528 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,311.25 |
$4,415 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$3,278.25 |
$4,371 |
2.1× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$4,278 |
$5,704 |
2.5× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$5,313 |
$7,084 |
3.0× |
| Neck soft tissue (70360) |
$240 |
$320 |
2.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$1,506.75 |
$2,009 |
3.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,005.75 |
$1,341 |
2.1× |
| Nm adrenal scan (78075) |
$3,236.25 |
$4,315 |
2.1× |
| Nm bone marrow multi (78103) |
$997.50 |
$1,330 |
2.1× |
| Nm bone marrow wb (78104) |
$997.50 |
$1,330 |
2.1× |
| Nm cardiac blood pool multiple (78473) |
$997.50 |
$1,330 |
2.1× |
| Nm cisternogram (78630) |
$1,335 |
$1,780 |
2.1× |
| Nm csf leak detection (78650) |
$3,396 |
$4,528 |
2.2× |
| Nm gastric emptying study (78264) |
$1,056 |
$1,408 |
2.2× |
| Nm gastroesophageal reflux study (78262) |
$997.50 |
$1,330 |
2.1× |
| Nm kidney scan w/flow (78701) |
$997.50 |
$1,330 |
2.1× |
| Nm peritoneal-venous shunt patency (78291) |
$997.50 |
$1,330 |
2.1× |
| Nm red cell sequestration (78140) |
$997.50 |
$1,330 |
2.1× |
| Noncardiac Vascular Flow Imaging (78445) |
$997.50 |
$1,330 |
2.1× |
| Nonvascular shunt X-ray (75809) |
$296.25 |
$395 |
2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$6,261 |
$8,348 |
3.8× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,893.75 |
$2,525 |
4.0× |
| Nuclear Rx Oral Admin (79005) |
$581.25 |
$775 |
2.1× |
| Ob us nuchal meas 1 gest (76813) |
$501.75 |
$669 |
4.1× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$305.25 |
$407 |
2.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$305.25 |
$407 |
2.5× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$307.50 |
$410 |
2.5× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$334.50 |
$446 |
2.1× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$85.50 |
$114 |
2.5× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$324 |
$432 |
2.6× |
| Orthopantogram (70355) |
$240 |
$320 |
2.3× |
| Osseous survey limited (77074) |
$296.25 |
$395 |
2.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,335 |
$1,780 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$997.50 |
$1,330 |
2.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$997.50 |
$1,330 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$276.75 |
$369 |
2.2× |
| Perineogram (74775) |
$652.50 |
$870 |
2.3× |
| Peritoneogram after injection (74190) |
$1,400.25 |
$1,867 |
2.2× |
| PET image w/CT, skull-thigh (78815) |
$3,890.25 |
$5,187 |
2.3× |
| PET imaging CT for attenuation limited area (78814) |
$4,278 |
$5,704 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$4,371.75 |
$5,829 |
2.6× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$3,811.50 |
$5,082 |
2.5× |
| PET whole body (78813) |
$4,278 |
$5,704 |
2.5× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$3,396 |
$4,528 |
2.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$3,396 |
$4,528 |
2.2× |
| Platelet survival study Non-Facility (78191) |
$997.50 |
$1,330 |
2.1× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$4,278 |
$5,704 |
2.5× |
| Proton trmt simple w/comp (77522) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery complex (77525) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery intermediate (77523) |
$3,799.50 |
$5,066 |
2.6× |
| Proton tx delivery simple w/o compensation (77520) |
$2,715.75 |
$3,621 |
4.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$8,295 |
$11,060 |
2.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$8,295 |
$11,060 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$997.50 |
$1,330 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,386 |
$1,848 |
2.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$3,984 |
$5,312 |
3.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,404 |
$1,872 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$284.25 |
$379 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.50 |
$310 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$277.50 |
$370 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$240 |
$320 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$616.50 |
$822 |
5.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$473.25 |
$631 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$232.50 |
$310 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$298.50 |
$398 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$338.25 |
$451 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$240 |
$320 |
2.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$314.25 |
$419 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$421.50 |
$562 |
3.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$645.75 |
$861 |
5.2× |
| Radex Humerus Minimum 2 Views (73060) |
$232.50 |
$310 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$250.50 |
$334 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$380.25 |
$507 |
3.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$298.50 |
$398 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$240 |
$320 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$312.75 |
$417 |
2.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$270.75 |
$361 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$240 |
$320 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$298.50 |
$398 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$240 |
$320 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$232.50 |
$310 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$298.50 |
$398 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$319.50 |
$426 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$491.25 |
$655 |
4.0× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$22,077 |
$29,436 |
2.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,077 |
$29,436 |
2.5× |
| Radiation treatment delivery level 1 (77402) |
$556.50 |
$742 |
4.6× |
| Radiation treatment delivery level 2 (77407) |
$755.25 |
$1,007 |
1.7× |
| Radiation treatment delivery level 3 (77412) |
$1,072.50 |
$1,430 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$232.50 |
$310 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$312.75 |
$417 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$285 |
$380 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$509.25 |
$679 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$458.25 |
$611 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$458.25 |
$611 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$509.25 |
$679 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$240 |
$320 |
2.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$240 |
$320 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$242.25 |
$323 |
2.4× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$1,400.25 |
$1,867 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$296.25 |
$395 |
2.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$296.25 |
$395 |
2.4× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$652.50 |
$870 |
2.3× |
| Radiologic examination, teeth; partial examination, less than full mouth Non-Facility (70310) |
$652.50 |
$870 |
2.3× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$240 |
$320 |
2.3× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$267 |
$356 |
2.6× |
| Radiological examination surgical specimen (76098) |
$1,374.75 |
$1,833 |
2.1× |
| Radiopharm Dacryocystography (78660) |
$997.50 |
$1,330 |
2.1× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration Facility (79300) |
$581.25 |
$775 |
2.1× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$581.25 |
$775 |
2.1× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$581.25 |
$775 |
2.1× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$581.25 |
$775 |
2.1× |
| Red cell survival study Non-Facility (78130) |
$997.50 |
$1,330 |
2.1× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$1,335 |
$1,780 |
2.1× |
| Red cell volume determination (separate procedure); single sampling Non-Facility (78120) |
$997.50 |
$1,330 |
2.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$1,068.75 |
$1,425 |
2.3× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$755.25 |
$1,007 |
1.7× |
| Renal Cyst Study (74470) |
$1,400.25 |
$1,867 |
2.2× |
| Ribs bilateral 3 views (71110) |
$400.50 |
$534 |
3.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$997.50 |
$1,330 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$997.50 |
$1,330 |
2.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,396 |
$4,528 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,396 |
$4,528 |
5.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,311.25 |
$4,415 |
5.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,396 |
$4,528 |
2.2× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,812.25 |
$5,083 |
2.3× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,396 |
$4,528 |
2.2× |
| Rp therapy intra-arterial particulate admn (79445) |
$581.25 |
$775 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$581.25 |
$775 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$298.50 |
$398 |
2.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$690 |
$920 |
2.4× |
| Salivary gland function study (78232) |
$997.50 |
$1,330 |
2.1× |
| Salivary gland imaging (78230) |
$997.50 |
$1,330 |
2.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$997.50 |
$1,330 |
2.1× |
| Scapula (73010) |
$298.50 |
$398 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$123 |
$164 |
5.3× |
| Sella turcica (70240) |
$240 |
$320 |
2.3× |
| Shoulder 1 view (73020) |
$240 |
$320 |
2.3× |
| Sialogram (70390) |
$652.50 |
$870 |
2.3× |
| Simulation intermediate (77285) |
$1,397.25 |
$1,863 |
3.2× |
| Small bowel series (74250) |
$509.25 |
$679 |
2.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,031.25 |
$1,375 |
2.3× |
| Special dosimetry (77331) |
$384 |
$512 |
2.4× |
| Special Physics Consult (77370) |
$483.75 |
$645 |
3.0× |
| Special treatment procedure (77470) |
$1,641.75 |
$2,189 |
2.5× |
| Speech evaluation complex (70371) |
$652.50 |
$870 |
2.3× |
| Spine thoracic 3 views (72072) |
$364.50 |
$486 |
3.0× |
| Spleen imaging only (78185) |
$997.50 |
$1,330 |
2.1× |
| Splenoportograpy rs&i (75810) |
$8,295 |
$11,060 |
2.2× |
| Stereotactic Body Radiation Delivery (77373) |
$6,561 |
$8,748 |
3.1× |
| Superior sagittal sinus venogram (75870) |
$8,295 |
$11,060 |
2.2× |
| Surf radj ther orthvlt dlvr>150-500 kv per fxj (77438) |
$324 |
$432 |
2.7× |
| Surf radj ther supfc dlvr<=150 kv per fraction (77437) |
$324 |
$432 |
2.7× |
| Surf radj ther supfc/orthvlt treatment planning (77436) |
$117 |
$156 |
2.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$372.75 |
$497 |
3.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,031.25 |
$1,375 |
2.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,031.25 |
$1,375 |
2.3× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$652.50 |
$870 |
2.3× |
| Testicular Imaging With Vascular Flow (78761) |
$997.50 |
$1,330 |
2.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,620 |
$2,160 |
3.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$983.25 |
$1,311 |
6.2× |
| Thoracolumbar 2 views (72080) |
$249.75 |
$333 |
2.4× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$997.50 |
$1,330 |
2.1× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$997.50 |
$1,330 |
2.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,335 |
$1,780 |
2.1× |
| Thyroid imaging w/blood flow (78013) |
$997.50 |
$1,330 |
2.1× |
| Thyroid uptake measurement (78012) |
$997.50 |
$1,330 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$997.50 |
$1,330 |
2.1× |
| Tmj unilateral (70328) |
$240 |
$320 |
2.3× |
| Tomogram (76100) |
$296.25 |
$395 |
2.4× |
| Treatment device complex (77334) |
$1,743 |
$2,324 |
3.9× |
| Treatment device intermediate (77333) |
$384 |
$512 |
2.4× |
| Treatment devices simple (77332) |
$597.75 |
$797 |
3.8× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
$336 |
$448 |
2.7× |
| Ultrasound breast complete (76641) |
$840 |
$1,120 |
6.8× |
| Ultrasound elastography first target lesion (76982) |
$338.25 |
$451 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$292.50 |
$390 |
2.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$1,012.50 |
$1,350 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$600 |
$800 |
4.9× |
| Umbilical-artery Doppler (OB) (76820) |
$327 |
$436 |
2.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$87 |
$116 |
0.8× |
| Unlisted fluoroscopic procedure (76496) |
$272.25 |
$363 |
2.6× |
| Unlisted magnetic resonance procedure (76498) |
$435 |
$580 |
4.2× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$24.75 |
$33 |
2.2× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$208.50 |
$278 |
2.2× |
| Ureteral reflux study (78740) |
$997.50 |
$1,330 |
2.1× |
| Urethrocystogram voiding (74455) |
$654.75 |
$873 |
2.3× |
| Urethrocystography retrograde rs&i (74450) |
$654.75 |
$873 |
2.3× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$504 |
$672 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$564.75 |
$753 |
2.7× |
| Us breast unilateral limited (76642) |
$435 |
$580 |
4.2× |
| Us chest (76604) |
$405 |
$540 |
3.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$830.25 |
$1,107 |
3.3× |
| Us compl joint r-t w/image documentation (76881) |
$342.75 |
$457 |
2.8× |
| Us elastography parenchyma (76981) |
$363.75 |
$485 |
2.9× |
| Us encephalogram (76506) |
$502.50 |
$670 |
4.1× |
| Us hips infant static (76886) |
$357.75 |
$477 |
3.5× |
| Us infant hips w manipulation (76885) |
$571.50 |
$762 |
5.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$300 |
$400 |
2.4× |
| Us ob detailed single fetus (76811) |
$748.50 |
$998 |
2.7× |
| Us ob limited (76815) |
$305.25 |
$407 |
2.5× |
| Us ob transvaginal (76817) |
$532.50 |
$710 |
4.3× |
| Us pelvic non ob complete (76856) |
$600 |
$800 |
4.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$435 |
$580 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$467.25 |
$623 |
3.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$507 |
$676 |
4.1× |
| Us retroperitoneal complete (76770) |
$630 |
$840 |
5.1× |
| Us retroperitoneal limited (76775) |
$480 |
$640 |
3.9× |
| Us scrotum and contents (76870) |
$457.50 |
$610 |
3.7× |
| Us soft tissue head/neck (76536) |
$585 |
$780 |
4.7× |
| Us spinal canal and contents (76800) |
$720 |
$960 |
5.8× |
| Us transrectal (76872) |
$501.75 |
$669 |
4.1× |
| Us transrectal prostate volume (76873) |
$588.75 |
$785 |
4.8× |
| Us, eye b-scan (76512) |
$305.25 |
$407 |
2.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$412.50 |
$550 |
3.3× |
| Vasogram (74440) |
$652.50 |
$870 |
2.3× |
| Venogram adrenal unilat (75840) |
$8,301 |
$11,068 |
2.2× |
| Venogram extremity bilateral (75822) |
$4,141.50 |
$5,522 |
2.2× |
| Venogram Extremity Unilateral (75820) |
$4,146.75 |
$5,529 |
2.2× |
| Venography caval inferior serialography rs&i (75825) |
$8,301 |
$11,068 |
2.2× |
| Venography caval superior serialography rs&i (75827) |
$4,141.50 |
$5,522 |
2.2× |
| Venography Orbital Rs&I (75880) |
$1,612.50 |
$2,150 |
2.2× |
| Venography Renal Bilateral (75833) |
$8,295 |
$11,060 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$8,295 |
$11,060 |
2.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$8,301 |
$11,068 |
2.2× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$1,612.50 |
$2,150 |
2.2× |
| Venous sampling by catheter (75893) |
$14,313 |
$19,084 |
2.2× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$1,600.50 |
$2,134 |
2.5× |
| Vertebral fracture assessment via dxa (77086) |
$240 |
$320 |
2.3× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,335 |
$1,780 |
2.1× |
| Wrist 2 views (73100) |
$240 |
$320 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$534 |
$712 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$240 |
$320 |
2.3× |
| X-ray b.e. reductn intuss (74283) |
$735.75 |
$981 |
3.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$663.75 |
$885 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$232.50 |
$310 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$359.25 |
$479 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$633.75 |
$845 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$330 |
$440 |
3.2× |
| X-ray eye for foreign body (70030) |
$240 |
$320 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$240 |
$320 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$525 |
$700 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240 |
$320 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$240 |
$320 |
2.3× |
| X-ray leg, infant (73592) |
$240 |
$320 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$325.50 |
$434 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$318 |
$424 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$240 |
$320 |
2.3× |
| X-ray optic foramen (70190) |
$240 |
$320 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$298.50 |
$398 |
2.4× |
| X-ray retrograde pyelogram (74420) |
$1,026 |
$1,368 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$298.50 |
$398 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$299.25 |
$399 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$473.25 |
$631 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$296.25 |
$395 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$268.50 |
$358 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$240 |
$320 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$298.50 |
$398 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$298.50 |
$398 |
2.4× |
| X-Ray Small Bowel Enteroclysis (74251) |
$877.50 |
$1,170 |
4.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$240 |
$320 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$240 |
$320 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$240 |
$320 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$282 |
$376 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$296.25 |
$395 |
2.4× |
| Xr bone length studies (77073) |
$276.75 |
$369 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$372.75 |
$497 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$356.25 |
$475 |
2.9× |
| Xr chest 4+ views (71048) |
$296.25 |
$395 |
2.4× |
| Xr myelogram posterior fossa (70010) |
$1,024.50 |
$1,366 |
2.5× |
| Xr urogram antegrade (74425) |
$1,026 |
$1,368 |
2.5× |