| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$3,695.60 |
$9,239 |
2.6× |
| Acute gi blood loss imaging (78278) |
$1,239.40 |
$3,098.50 |
3.0× |
| Angio adrenal bilat select (75733) |
$3,157.60 |
$7,894 |
1.0× |
| Angio adrenal unilat select (75731) |
$2,555.20 |
$6,388 |
0.8× |
| Angio extremity unilateral (75710) |
$3,801.60 |
$9,504 |
1.2× |
| Angio pulmonary unilateral (75741) |
$3,184 |
$7,960 |
1.0× |
| Angiogram extremity bilateral (75716) |
$6,979.20 |
$17,448 |
2.1× |
Angiogram pelvic (75736)
unusually low: confirm this is the full procedure |
$2,182 |
$5,455 |
0.4× |
| Angiography internal mammary rs&i (75756) |
$3,189.20 |
$7,973 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,314.60 |
$5,786.50 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,553.60 |
$11,384 |
0.8× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$846.40 |
$2,116 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,810.80 |
$4,527 |
0.5× |
| Ankle 2 views (73600) |
$439.60 |
$1,099 |
4.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,578.40 |
$11,446 |
1.4× |
| Arthrography knee lt (73580) |
$848 |
$2,120 |
2.3× |
| Arthrography wrist lt (73115) |
$610.80 |
$1,527 |
1.7× |
| Barium enema (74270) |
$1,014.60 |
$2,536.50 |
5.5× |
| Basic dosimetry (77300) |
$451.20 |
$1,128 |
3.2× |
| Bilat selctv renal venogram (75833) |
$8,456 |
$21,140 |
2.6× |
| Bone age studies (77072) |
$177.80 |
$444.50 |
1.6× |
| Bone imaging limited area (78300) |
$1,564.80 |
$3,912 |
3.7× |
| Bone marrow imaging whole body (78104) |
$948.80 |
$2,372 |
2.3× |
| Bone survey complete (77075) |
$878.80 |
$2,197 |
8.0× |
| Bowel imaging (78290) |
$789.20 |
$1,973 |
1.9× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$1,199.20 |
$2,998 |
3.1× |
| Brain image w/flow 4 + views (78606) |
$1,560.40 |
$3,901 |
2.8× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$2,289.20 |
$5,723 |
4.0× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$2,200.80 |
$5,502 |
3.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$2,022.40 |
$5,056 |
4.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,539.20 |
$3,848 |
4.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$634.80 |
$1,587 |
3.5× |
| Cisternogram (78630) |
$1,946 |
$4,865 |
3.4× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$632.60 |
$1,581.50 |
0.8× |
| Clavicle complete (73000) |
$376 |
$940 |
4.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$4,796 |
$11,990 |
26.2× |
| Continuing medical physics consltj pr wk (77336) |
$294 |
$735 |
2.1× |
| Contrast exam abdominl aorta (75625) |
$3,421.60 |
$8,554 |
1.0× |
| Contrast exam thoracic aorta (75605) |
$3,397.60 |
$8,494 |
0.6× |
| Csf shunt evaluation (78645) |
$1,816.40 |
$4,541 |
3.2× |
| CT - st neck w&wo contr (70492) |
$3,558.40 |
$8,896 |
19.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$10,603.60 |
$26,509 |
29.1× |
| CT abdomen and pelvis without contrast (74176) |
$9,739.20 |
$24,348 |
39.1× |
| CT abdomen w wo contrast (74170) |
$5,674 |
$14,185 |
31.0× |
| CT abdomen w/contrast (74160) |
$5,428.40 |
$13,571 |
29.6× |
| CT abdomen w/o contrast (74150) |
$5,109.60 |
$12,774 |
46.8× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$8,622.80 |
$21,557 |
23.7× |
| CT angio abdom w/o & w/dye (74175) |
$4,989 |
$12,472.50 |
27.2× |
| CT angio abdominal arteries (75635) |
$3,265.40 |
$8,163.50 |
17.8× |
| CT angio hrt w/3d image (75574) |
$1,373.60 |
$3,434 |
3.8× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,794.40 |
$9,486 |
20.7× |
| CT cervical spine w/contrast (72126) |
$3,068 |
$7,670 |
8.4× |
| CT cervical spine w/o contrast (72125) |
$2,677.60 |
$6,694 |
24.5× |
| CT chest w/contrast (71260) |
$2,873.20 |
$7,183 |
15.7× |
| CT extremity upper w & w/o contrast (73202) |
$2,261.20 |
$5,653 |
12.3× |
| CT head/brain with contrast (70460) |
$4,573 |
$11,432.50 |
25.0× |
| CT head/brain without and with contrast (70470) |
$4,704.40 |
$11,761 |
25.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,373.60 |
$3,434 |
3.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$181.80 |
$454.50 |
2.0× |
| CT limited/localized follow up study (76380) |
$1,629 |
$4,072.50 |
17.9× |
| CT lower ext w/wo contrast (73702) |
$2,236.80 |
$5,592 |
12.2× |
| CT lower extremity w contrast (73701) |
$2,381 |
$5,952.50 |
13.0× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,069.80 |
$5,174.50 |
19.0× |
| CT lumbar spine w/contrast (72132) |
$3,646.40 |
$9,116 |
10.0× |
| CT lumbar spine w/o contrast (72131) |
$3,318 |
$8,295 |
30.4× |
| CT lumbar spine w/o then w/ con (72133) |
$3,928.40 |
$9,821 |
21.4× |
| CT maxillofacial area w/o contrast (70486) |
$2,680.40 |
$6,701 |
24.6× |
| CT maxillofacial w/contrast (70487) |
$3,373.20 |
$8,433 |
18.4× |
| CT maxillofacial w/o then w/ con (70488) |
$3,503.20 |
$8,758 |
19.1× |
| CT orbit sella ear w/o con (70480) |
$4,460.60 |
$11,151.50 |
40.9× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$4,965.80 |
$12,414.50 |
27.1× |
| CT pelvis w & w/o contrast (72194) |
$5,213.20 |
$13,033 |
28.5× |
| CT pelvis w/o contrast (72192) |
$4,718.40 |
$11,796 |
43.2× |
| CT soft tissue neck w/contrast (70491) |
$3,189.20 |
$7,973 |
17.4× |
| CT soft tissue neck w/o contrast (70490) |
$2,892 |
$7,230 |
26.5× |
| CT spine cervical w/wo contrast (72127) |
$4,356.40 |
$10,891 |
23.8× |
| CT thoracic spine w/contrast (72129) |
$2,583.80 |
$6,459.50 |
14.1× |
| CT thoracic spine w/o contrast (72128) |
$2,474.40 |
$6,186 |
22.7× |
| CT thoracic spine w/o then w/ con (72130) |
$2,248.80 |
$5,622 |
12.3× |
| CT thorax lung cancer scr c- (71271) |
$88.40 |
$221 |
0.8× |
| CT thorax w/o contrast (71250) |
$2,539 |
$6,347.50 |
23.3× |
| CT thorax w/o then w/ contrast (71270) |
$2,905.20 |
$7,263 |
15.9× |
| CT upper extremity w/dye (73201) |
$2,134 |
$5,335 |
5.9× |
| CT upper extremity w/o contrast rt (73200) |
$2,217.40 |
$5,543.50 |
20.3× |
| CTA chest w/wo contrast (71275) |
$3,597 |
$8,992.50 |
19.6× |
| CTA head w contrast (70496) |
$3,859.60 |
$9,649 |
21.1× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$3,485.60 |
$8,714 |
19.0× |
| Cta Neck (70498) |
$3,446.40 |
$8,616 |
18.8× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,186.60 |
$5,466.50 |
11.9× |
| Diskography lumbar (72295) |
$1,160 |
$2,900 |
0.6× |
| Doppler fetal mid cerebral artery (76821) |
$424 |
$1,060 |
3.9× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$821.60 |
$2,054 |
3.3× |
| Esophogram (74220) |
$1,136.80 |
$2,842 |
6.2× |
| Fetal biophysical profile non-stress testing (76818) |
$669.60 |
$1,674 |
6.1× |
| Fetal biophysical profile w/o nst (76819) |
$520.60 |
$1,301.50 |
4.8× |
| Fetal echo complete (76825) |
$1,397.20 |
$3,493 |
2.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$826.40 |
$2,066 |
3.3× |
| Gastric emptying study (78264) |
$1,748 |
$4,370 |
4.2× |
| Gated heart planar single (78472) |
$2,374.80 |
$5,937 |
5.7× |
| Heart infarct image (78466) |
$1,833.60 |
$4,584 |
4.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,397.20 |
$8,493 |
1.0× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$3,096.80 |
$7,742 |
0.9× |
| Hepatobil syst image w/drug (78227) |
$1,718.40 |
$4,296 |
3.0× |
| Hepatobiliary system imaging (78226) |
$1,752 |
$4,380 |
4.2× |
| Humerus min 2 views (73060) |
$483.20 |
$1,208 |
5.3× |
| Hysterosalpingography (74740) |
$1,129.60 |
$2,824 |
4.5× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$2,356.40 |
$5,891 |
3.2× |
| Intracavitary radiation source applic simple (77761) |
$1,364.80 |
$3,412 |
2.4× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,142.40 |
$2,856 |
2.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,016.80 |
$2,542 |
2.6× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,016.80 |
$2,542 |
2.6× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$455.60 |
$1,139 |
1.2× |
| Ivp (74400) |
$1,160 |
$2,900 |
6.3× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,082.40 |
$2,706 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,499.60 |
$3,749 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,803.20 |
$4,508 |
3.2× |
| Kidney w vascular flow (78701) |
$1,188.20 |
$2,970.50 |
2.8× |
| Liver & spleen; static only (78215) |
$1,597.20 |
$3,993 |
3.8× |
| Liver & spleen; w vasc flow (78216) |
$1,510.80 |
$3,777 |
3.6× |
| Liver imaging w/vascular flow (78202) |
$981.20 |
$2,453 |
1.7× |
| Lung perf&ventilat diferentl (78598) |
$1,677.20 |
$4,193 |
3.0× |
| Lung perfusion differential (78597) |
$1,677.20 |
$4,193 |
4.0× |
| Lung ventilat&perfus imaging (78582) |
$2,026.80 |
$5,067 |
3.6× |
| Lung ventilation imaging (78579) |
$1,930.80 |
$4,827 |
4.6× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$2,999.60 |
$7,499 |
1.8× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$2,999.60 |
$7,499 |
4.6× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$2,999.60 |
$7,499 |
0.9× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,999.60 |
$7,499 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,121.20 |
$10,303 |
11.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,121.20 |
$10,303 |
11.3× |
| Mammary ductogram multiple ducts (77054) |
$410 |
$1,025 |
1.6× |
| Mammary ductogram single (77053) |
$379.20 |
$948 |
1.5× |
| MRA head w & w/o contrast (70546) |
$5,035.20 |
$12,588 |
13.8× |
| MRA head w/contrast (70545) |
$4,750 |
$11,875 |
13.0× |
| MRA head w/o contrast (70544) |
$3,747.20 |
$9,368 |
15.0× |
| MRA neck w/contrast (70548) |
$4,037.60 |
$10,094 |
11.1× |
| MRA neck w/o contrast (70547) |
$3,181.20 |
$7,953 |
12.8× |
| MRA neck w/wo contrast (70549) |
$4,120 |
$10,300 |
11.3× |
| MRI abdomen w/contrast (74182) |
$3,978.40 |
$9,946 |
10.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,250.60 |
$10,626.50 |
11.7× |
| MRI abdomen w/o contrast (74181) |
$3,072.40 |
$7,681 |
12.3× |
| MRI any jnt lwr ext with con lt (73722) |
$3,722.40 |
$9,306 |
4.5× |
| MRI bone marrow (77084) |
$3,818.40 |
$9,546 |
15.3× |
| MRI breast without contrast bilateral (77047) |
$4,674 |
$11,685 |
18.8× |
| MRI breast without contrast material unilateral (77046) |
$3,117.60 |
$7,794 |
12.5× |
| MRI cardiac w/o contrast (75557) |
$919.60 |
$2,299 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$3,880.80 |
$9,702 |
15.6× |
| MRI cervical spine with contrast (72142) |
$4,100 |
$10,250 |
11.3× |
| MRI chest w & w/o contrast (71552) |
$2,624.40 |
$6,561 |
7.2× |
| MRI chest w/contrast (71551) |
$2,199.80 |
$5,499.50 |
2.7× |
| MRI chest w/o contrast (71550) |
$1,591.60 |
$3,979 |
6.4× |
| MRI joint upper ext w/contrast (73222) |
$4,307.60 |
$10,769 |
5.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$4,691.20 |
$11,728 |
12.9× |
| MRI joint upr extrem w/o dye (73221) |
$3,502.40 |
$8,756 |
14.1× |
| Mri Lower Extremity W/O Dye (73718) |
$2,982.80 |
$7,457 |
12.0× |
| MRI lumbar spine with contrast (72149) |
$7,032.20 |
$17,580.50 |
19.3× |
| MRI lumbar w/wo contrast (72158) |
$7,519.60 |
$18,799 |
20.6× |
| MRI lwr ext w/o jnts with con rt (73719) |
$3,722.40 |
$9,306 |
10.2× |
| MRI orbit/face/neck w/contrast (70542) |
$4,850.40 |
$12,126 |
13.3× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$5,284.80 |
$13,212 |
14.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$3,560 |
$8,900 |
14.3× |
| MRI pelvis w/ contrast (72196) |
$3,842 |
$9,605 |
10.5× |
| MRI pelvis w/o contrast (72195) |
$2,812.80 |
$7,032 |
11.3× |
| MRI pelvis w/wo contrast (72197) |
$3,985.20 |
$9,963 |
10.9× |
| MRI spectroscopy (76390) |
$4,706 |
$11,765 |
51.8× |
| MRI spine cervical wo/w contrast (72156) |
$5,002.60 |
$12,506.50 |
13.7× |
| MRI spine thoracic w/contrast (72147) |
$5,866 |
$14,665 |
16.1× |
| MRI thoracic spine w wo contrast (72157) |
$5,626.40 |
$14,066 |
15.4× |
| MRI thoracic spine w/o contrast (72146) |
$4,314.40 |
$10,786 |
17.3× |
| MRI tmj (70336) |
$2,886 |
$7,215 |
11.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,615.20 |
$9,038 |
14.5× |
| Mri Upper Extremity W/Dye (73219) |
$4,989.60 |
$12,474 |
13.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$4,307.60 |
$10,769 |
11.8× |
| Myelogram thoracic (72255) |
$1,683.20 |
$4,208 |
2.1× |
| Myelography 2 or more regions (72270) |
$1,838 |
$4,595 |
2.2× |
| Myelography lumbosacral (72265) |
$1,572.40 |
$3,931 |
1.9× |
| Myocardial perfusion planar multiple studies (78454) |
$3,553.20 |
$8,883 |
2.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,205.60 |
$5,514 |
1.6× |
| Myocrd img PET metab eval single study (78459) |
$5,564 |
$13,910 |
4.1× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$9,877.20 |
$24,693 |
11.0× |
| Nm adrenal imaging (78075) |
$2,176.40 |
$5,441 |
1.6× |
| Nm bone 3 phase (78315) |
$2,568.80 |
$6,422 |
6.2× |
| Nm bone imaging whole body (78306) |
$2,238.40 |
$5,596 |
5.4× |
| Nm bone marrow scan limited (78102) |
$948.80 |
$2,372 |
2.3× |
| Nm bone multi (78305) |
$1,464.80 |
$3,662 |
3.5× |
| Nm heart perfusion spect stress rest (78452) |
$4,024.40 |
$10,061 |
3.0× |
| Nm liver image static only (78201) |
$1,693.20 |
$4,233 |
3.0× |
| Nm lymph system (78195) |
$2,168.80 |
$5,422 |
3.8× |
| Nm myocard infarct spect (78469) |
$1,050 |
$2,625 |
1.9× |
| Nm thyroid imaging only (78013) |
$872.80 |
$2,182 |
2.1× |
| Nose to rectum for fb child (76010) |
$169.60 |
$424 |
1.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,327.20 |
$3,318 |
3.2× |
| Nuclear rx IV admin (79101) |
$994 |
$2,485 |
4.1× |
| Ob us < 14 wks single fetus (76801) |
$721.60 |
$1,804 |
6.6× |
| Oral radiopharm rx (79005) |
$1,095.60 |
$2,739 |
4.5× |
| Parathyroid imaging (78070) |
$2,082 |
$5,205 |
5.0× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,191.60 |
$5,479 |
5.2× |
| Peritoneal-venous shunt patency test (78291) |
$1,650.80 |
$4,127 |
4.0× |
| PET brain metabolic eval (78608) |
$1,624 |
$4,060 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$9,738 |
$24,345 |
3.0× |
| Pulmonary perfusion imaging particulate (78580) |
$1,674.20 |
$4,185.50 |
4.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,164.80 |
$2,912 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$514 |
$1,285 |
4.7× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$520.40 |
$1,301 |
4.8× |
| Radex hip unilateral with pelvis 1 view (73501) |
$922.80 |
$2,307 |
10.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$794.40 |
$1,986 |
8.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$337.20 |
$843 |
3.1× |
| Radex spine cervical 2 or 3 views (72040) |
$726.40 |
$1,816 |
8.0× |
| Radex spine cervical 4 or 5 views (72050) |
$906 |
$2,265 |
8.3× |
| Radex spine cervical 6 or more views (72052) |
$961.20 |
$2,403 |
8.8× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$554.40 |
$1,386 |
6.1× |
| Radiation tx delivery lvl 1 (77402) |
$562.40 |
$1,406 |
5.3× |
| Radiation tx delivery lvl 2 (77407) |
$622.80 |
$1,557 |
1.5× |
| Radiation tx delivery lvl 3 (77412) |
$661.20 |
$1,653 |
1.1× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$938.40 |
$2,346 |
8.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,305.60 |
$3,264 |
7.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,241.20 |
$3,103 |
6.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$468.80 |
$1,172 |
5.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$800 |
$2,000 |
7.3× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$571.20 |
$1,428 |
5.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$202.40 |
$506 |
1.9× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$488 |
$1,220 |
5.4× |
| Renal cyst study (74470) |
$1,540 |
$3,850 |
2.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,594.80 |
$6,487 |
6.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$933.20 |
$2,333 |
2.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,407.60 |
$6,019 |
4.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,340.40 |
$5,851 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,975.20 |
$4,938 |
3.5× |
| Rp therapy intra-arterial particulate admn (79445) |
$2,847.60 |
$7,119 |
11.7× |
| Saline infused sonohysterogram (76831) |
$592 |
$1,480 |
2.4× |
| Salivary gland imaging (78230) |
$2,112.80 |
$5,282 |
5.1× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$293.60 |
$734 |
12.6× |
| Selective spinal angiogram (75705) |
$5,617.20 |
$14,043 |
1.0× |
| Shoulder arthrogram (73040) |
$1,245.60 |
$3,114 |
3.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$203.20 |
$508 |
1.9× |
| Simulation complex (77290) |
$947.20 |
$2,368 |
2.4× |
| Simulation intermediate (77285) |
$956.40 |
$2,391 |
2.4× |
| Simulation simple (77280) |
$413.20 |
$1,033 |
2.9× |
| Small bowel series (74250) |
$1,451.60 |
$3,629 |
7.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,016.80 |
$2,542 |
2.6× |
| Special dosimetry (77331) |
$455.60 |
$1,139 |
3.2× |
| Special physics consult (77370) |
$674 |
$1,685 |
4.8× |
| Special treatment procedure (77470) |
$1,240 |
$3,100 |
2.1× |
| Speech evaluation complex (70371) |
$1,773.20 |
$4,433 |
7.1× |
| Splenoportography (75810) |
$10,186 |
$25,465 |
3.1× |
| Superior sagittal sinus venogram (75870) |
$3,162 |
$7,905 |
1.0× |
| Testicular imaging w/flow (78761) |
$1,327.20 |
$3,318 |
3.2× |
| Thyroid met imaging body (78018) |
$832.40 |
$2,081 |
1.5× |
| Thyroid uptake single/multiple quant measurement (78012) |
$890.60 |
$2,226.50 |
2.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,332.40 |
$3,331 |
3.2× |
| Treatment device intermediate (77333) |
$640.40 |
$1,601 |
4.6× |
| Treatment devices complex (77334) |
$640.40 |
$1,601 |
1.6× |
| Treatment devices simple (77332) |
$640.40 |
$1,601 |
4.6× |
| Ultrasound breast limited (76642) |
$528 |
$1,320 |
5.8× |
| Ultrasound, abdomen limited (76705) |
$1,511.60 |
$3,779 |
13.8× |
| Ultrasound, elastography; first target lesion (76982) |
$274.40 |
$686 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$421.20 |
$1,053 |
3.9× |
| Unlisted CT procedure (76497) |
$610.80 |
$1,527 |
6.7× |
| Unlisted diagnostic radiographic procedure (76499) |
$121.20 |
$303 |
1.3× |
| Unlisted magnetic resonance procedure (76498) |
$3,841.60 |
$9,604 |
42.3× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine UNSCHEDULED (78999) |
$1,194.80 |
$2,987 |
2.9× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$1,166.80 |
$2,917 |
105.5× |
| Ureteral reflux study (78740) |
$1,327.20 |
$3,318 |
3.2× |
| Urethrocystography retrograde rs&i (74450) |
$588.20 |
$1,470.50 |
2.4× |
| Urethrocystography voiding (74455) |
$971.20 |
$2,428 |
3.9× |
| Urography antegrade (74425) |
$1,038.80 |
$2,597 |
2.9× |
| Urography retrograde w/wo kub (74420) |
$1,209.80 |
$3,024.50 |
3.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$355.60 |
$889 |
3.3× |
| Us breast uni real time with image complete (76641) |
$896.60 |
$2,241.50 |
8.2× |
| Us chest (76604) |
$786.80 |
$1,967 |
7.2× |
| Us compl joint r-t w/image documentation (76881) |
$861.20 |
$2,153 |
7.9× |
| Us elastography parenchyma (76981) |
$260.80 |
$652 |
2.4× |
| Us encephalogram (76506) |
$556.40 |
$1,391 |
5.1× |
| Us guided compression repair (76936) |
$1,077.20 |
$2,693 |
4.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$639.20 |
$1,598 |
7.0× |
| Us kidney transplanted (76776) |
$1,623.20 |
$4,058 |
14.9× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$605.60 |
$1,514 |
5.5× |
| Us ob detailed single fetus (76811) |
$900 |
$2,250 |
3.6× |
| Us ob followup per fetus (76816) |
$482.40 |
$1,206 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$453.60 |
$1,134 |
4.2× |
| Us obstetric transvaginal (76817) |
$471.40 |
$1,178.50 |
4.3× |
| Us pelvic limited or f/u non-ob (76857) |
$732.80 |
$1,832 |
6.7× |
| Us pelvis complete (76856) |
$715.20 |
$1,788 |
6.6× |
| Us retroperitoneal complete (76770) |
$1,133 |
$2,832.50 |
10.4× |
| Us retroperitoneal limited (76775) |
$949.20 |
$2,373 |
8.7× |
| Us scrotum (76870) |
$876.60 |
$2,191.50 |
8.0× |
| Us soft tissue head/neck (76536) |
$819.60 |
$2,049 |
7.5× |
| Us spinal canal (76800) |
$464.80 |
$1,162 |
4.3× |
| Us transrectal (76872) |
$644 |
$1,610 |
5.9× |
| Us unlstd proc (76999) |
$724.40 |
$1,811 |
8.0× |
| Vein X-ray liver w/hemodynam (75885) |
$11,028 |
$27,570 |
3.3× |
| Venogram extremity bilateral (75822) |
$1,777.60 |
$4,444 |
1.1× |
| Venogram ivc w serialography (75825) |
$2,700.40 |
$6,751 |
0.8× |
| Venogram svc w serialography (75827) |
$2,810.40 |
$7,026 |
1.7× |
| Venography adrenal unilateral selective rs&i (75840) |
$7,500.40 |
$18,751 |
2.3× |
| Venography ext unilateral (75820) |
$984 |
$2,460 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$6,678 |
$16,695 |
2.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,895.20 |
$7,238 |
0.9× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,455.60 |
$3,639 |
0.3× |
| Vertebral fracture assessment via dxa (77086) |
$192 |
$480 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$336.80 |
$842 |
3.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$504.80 |
$1,262 |
5.6× |
| X-ray aorta leg arteries (75630) |
$4,464.20 |
$11,160.50 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,265.60 |
$3,164 |
6.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$514 |
$1,285 |
5.7× |
| X-ray exam hips bi 3-4 views (73522) |
$1,919.60 |
$4,799 |
17.6× |
| X-ray exam of finger(s) (73140) |
$426.80 |
$1,067 |
4.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$2,329.20 |
$5,823 |
12.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$710 |
$1,775 |
7.8× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$544.40 |
$1,361 |
6.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$676.40 |
$1,691 |
7.4× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$369.20 |
$923 |
3.4× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$456.80 |
$1,142 |
5.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$467.20 |
$1,168 |
5.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$473.20 |
$1,183 |
5.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$462.40 |
$1,156 |
5.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$587.60 |
$1,469 |
5.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$488.40 |
$1,221 |
5.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$785.20 |
$1,963 |
7.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$784.80 |
$1,962 |
7.2× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$326.80 |
$817 |
3.0× |
| X-ray perineogram (74775) |
$919.60 |
$2,299 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$619.60 |
$1,549 |
6.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$756.40 |
$1,891 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$428.80 |
$1,072 |
3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$196.40 |
$491 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$492.20 |
$1,230.50 |
5.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$543.20 |
$1,358 |
6.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$711.60 |
$1,779 |
7.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$652.40 |
$1,631 |
6.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$536 |
$1,340 |
4.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$269.20 |
$673 |
3.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$426.80 |
$1,067 |
4.7× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$437.60 |
$1,094 |
4.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$597.20 |
$1,493 |
6.6× |
| Xr abdomen 1 view (74018) |
$481.80 |
$1,204.50 |
5.3× |
| Xr abdomen 2 views (74019) |
$708 |
$1,770 |
6.5× |
| Xr abdomen 3 views (74021) |
$653 |
$1,632.50 |
6.0× |
| Xr arthrogram ankle (73615) |
$848 |
$2,120 |
2.3× |
| Xr arthrogram hip (73525) |
$1,225.20 |
$3,063 |
3.4× |
| Xr bone density axial (77080) |
$347.60 |
$869 |
3.2× |
| Xr bone length study (77073) |
$164.40 |
$411 |
1.5× |
| Xr bone survey infant (77076) |
$472.40 |
$1,181 |
4.3× |
| Xr bone survey limited (77074) |
$638 |
$1,595 |
5.8× |
| Xr chest 1 view (71045) |
$493.60 |
$1,234 |
5.4× |
| Xr chest 2 views (71046) |
$703.20 |
$1,758 |
7.7× |
| Xr chest 3 views (71047) |
$891.60 |
$2,229 |
9.8× |
| Xr cystogram 3+ views (74430) |
$626.20 |
$1,565.50 |
1.7× |
| Xr eye foreign body (70030) |
$271.20 |
$678 |
3.0× |
| Xr facial bones 3 views (70150) |
$795.20 |
$1,988 |
7.3× |
| Xr lower extremity 2 views infant (73592) |
$228.40 |
$571 |
2.5× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$784.80 |
$1,962 |
7.2× |
| Xr mandible 4 views (70110) |
$805.60 |
$2,014 |
7.4× |
| Xr myelogram c-spine (72240) |
$1,516.40 |
$3,791 |
1.9× |
| Xr nasal bones (70160) |
$670.80 |
$1,677 |
7.4× |
| Xr pelvis 3 views (72190) |
$564.40 |
$1,411 |
5.2× |
| Xr sella turcica (70240) |
$671.60 |
$1,679 |
7.4× |
| Xr sialogram (70390) |
$1,122.40 |
$2,806 |
4.5× |
| Xr spine 1 view (72020) |
$623.20 |
$1,558 |
6.9× |
| Xr sternum 2 views (71120) |
$525.40 |
$1,313.50 |
5.8× |
| Xr surgical specimen (76098) |
$608.80 |
$1,522 |
1.1× |
| Xr upper extremity 2 views infant (73092) |
$228.40 |
$571 |
2.1× |
| Xray elbow 2 views (73070) |
$403.60 |
$1,009 |
4.4× |
| Xray forearm 2 views (73090) |
$467.20 |
$1,168 |
5.1× |
| Xray knee 1 or 2 views rt (73560) |
$405.60 |
$1,014 |
4.5× |
| Xray neck soft tissue (70360) |
$449 |
$1,122.50 |
4.9× |
| Xray orbits complete min 4 views (70200) |
$694.60 |
$1,736.50 |
6.4× |
| Xray pelvis 1 or 2 views (72170) |
$452.80 |
$1,132 |
4.1× |
| Xray ribs bilateral 3 views (71110) |
$772 |
$1,930 |
7.1× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$698.80 |
$1,747 |
6.4× |
| Xray scapula complete (73010) |
$475.20 |
$1,188 |
4.4× |
| Xray shoulder 1 view (73020) |
$377.20 |
$943 |
4.2× |
| Xray sinuses paranasal <3 views (70210) |
$252 |
$630 |
2.8× |
| Xray spine thoracic 2 views (72070) |
$688.40 |
$1,721 |
6.3× |
| Xray spine thoracic 3 views (72072) |
$838.40 |
$2,096 |
7.7× |
| Xray tibia-fibula 2 views bil (73590) |
$488.40 |
$1,221 |
5.4× |
| Xray tmj open - closed unilat (70328) |
$412.60 |
$1,031.50 |
4.5× |
| Xray tmj's bilateral open-clsc (70330) |
$553.80 |
$1,384.50 |
6.1× |