| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,806.17 |
$6,806.17 |
4.9× |
| Acute gi blood loss imaging (78278) |
$4,116.06 |
$4,116.06 |
10.2× |
| Angiography internal mammary rs&i (75756) |
$5,615.55 |
$5,615.55 |
1.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,083.32 |
$6,083.32 |
1.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$17,602.46 |
$17,602.46 |
3.1× |
| Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Age Under 21 (75733) |
$5,010.57 |
$5,010.57 |
1.6× |
| Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Age Under 21 (75731) |
$5,010.57 |
$5,010.57 |
1.6× |
| Angiography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75716) |
$5,377.44 |
$5,377.44 |
1.7× |
| Angiography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75710) |
$4,771.97 |
$4,771.97 |
1.5× |
| Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Age Under 21 (75736) |
$20,607.36 |
$20,607.36 |
3.7× |
| Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Age Under 21 (75741) |
$5,010.57 |
$5,010.57 |
1.6× |
| Angiography, spinal, selective, radiological supervision and interpretation Age Under 21 (75705) |
$20,607.36 |
$20,607.36 |
3.7× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$2,959.43 |
$2,959.43 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,231.70 |
$6,231.70 |
2.0× |
| Ankle 2 views (73600) |
$836.42 |
$836.42 |
9.6× |
| Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision… (75630) |
$4,891.27 |
$4,891.27 |
1.5× |
| Aortography, abdominal, by serialography, radiological supervision and interpretation Age Under 21 (75625) |
$6,173.70 |
$6,173.70 |
1.9× |
| Aortography, thoracic, by serialography, radiological supervision and interpretation Age Under 21 (75605) |
$20,607.36 |
$20,607.36 |
3.7× |
| Basic radiation dosimetry calculation (77300) |
$759.37 |
$759.37 |
5.6× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$3,220.54 |
$3,220.54 |
5.9× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,649.24 |
$1,649.24 |
4.1× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$2,792.59 |
$2,792.59 |
5.1× |
| Brain imaging, positron emission tomography (PET); metabolic evaluation Age Under 21 (78608) |
$18,377.91 |
$18,377.91 |
12.8× |
| Card MRI w/stress img & dye (75563) |
$6,077 |
$6,077 |
7.7× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$6,437.26 |
$6,437.26 |
11.8× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$3,332.96 |
$3,332.96 |
6.1× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$8,220.62 |
$8,220.62 |
20.5× |
| Cardiac MRI morphology & function w/o contrast (75557) |
$3,634.45 |
$3,634.45 |
15.2× |
| Cardiac MRI w/stress img (75559) |
$5,287.51 |
$5,287.51 |
9.6× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$7,224.18 |
$7,224.18 |
20.6× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$3,916.77 |
$3,916.77 |
7.2× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$1,559.52 |
$1,559.52 |
8.9× |
| Cineradiography/videoradiography (76120) |
$2,790.22 |
$2,790.22 |
26.6× |
| Clavicle complete (73000) |
$922.64 |
$922.64 |
10.6× |
| Complex dynamic pharyngeal and speech evaluation by cine or video recording Age Under 21 (70371) |
$1,476.52 |
$1,476.52 |
6.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$3,656.46 |
$3,656.46 |
10.4× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$5,849.82 |
$5,849.82 |
33.2× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,980.59 |
$3,980.59 |
22.6× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$6,259.81 |
$6,259.81 |
35.5× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,026.82 |
$2,026.82 |
11.5× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$9,159.80 |
$9,159.80 |
52.0× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$6,259.81 |
$6,259.81 |
35.5× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,126.75 |
$2,126.75 |
12.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$6,026.62 |
$6,026.62 |
34.2× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$3,596.24 |
$3,596.24 |
34.2× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$4,832.58 |
$4,832.58 |
27.4× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$6,043.28 |
$6,043.28 |
34.3× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$4,159.95 |
$4,159.95 |
23.6× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$3,999.82 |
$3,999.82 |
38.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$4,462.31 |
$4,462.31 |
25.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$4,147.15 |
$4,147.15 |
39.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$4,576.33 |
$4,576.33 |
26.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$5,532.09 |
$5,532.09 |
31.4× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$5,410.38 |
$5,410.38 |
30.7× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$6,927.29 |
$6,927.29 |
39.3× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$1,225.28 |
$1,225.28 |
9.1× |
| Csf shunt evaluation (78645) |
$2,577.97 |
$2,577.97 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$12,691.28 |
$12,691.28 |
36.2× |
| CT abdomen and pelvis without contrast (74176) |
$9,136.03 |
$9,136.03 |
38.1× |
| CT abdomen w & w/o contrast (74170) |
$6,421.22 |
$6,421.22 |
36.4× |
| CT abdomen w/contrast (74160) |
$5,356.56 |
$5,356.56 |
30.4× |
| CT abdomen w/o contrast (74150) |
$4,888.94 |
$4,888.94 |
46.6× |
| CT angio hrt w/3d image (75574) |
$1,314.48 |
$1,314.48 |
3.8× |
| CT cervical spine w/contrast (72126) |
$5,496.23 |
$5,496.23 |
15.7× |
| CT cervical spine w/o contrast (72125) |
$4,883.82 |
$4,883.82 |
46.5× |
| CT chest w/contrast (71260) |
$5,209.24 |
$5,209.24 |
29.6× |
| CT extremity upper w & w/o contrast (73202) |
$3,578.30 |
$3,578.30 |
20.3× |
| CT extremity upper w/o contrast (73200) |
$3,616.76 |
$3,616.76 |
34.4× |
| CT head/brain with contrast (70460) |
$4,595.57 |
$4,595.57 |
26.1× |
| CT head/brain without and with contrast (70470) |
$5,888.27 |
$5,888.27 |
33.4× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,693.70 |
$1,693.70 |
4.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,693.70 |
$1,693.70 |
4.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$285.71 |
$285.71 |
3.3× |
| CT l-spine w/contrast (72132) |
$5,593.59 |
$5,593.59 |
16.0× |
| CT limited/localized follow up study (76380) |
$2,081.92 |
$2,081.92 |
23.8× |
| CT lower extremity w/dye (73701) |
$3,938.32 |
$3,938.32 |
22.4× |
| CT lumbar spine w/o contrast (72131) |
$5,123.40 |
$5,123.40 |
48.8× |
| CT maxillofacial w/wo contrast (70488) |
$5,433.44 |
$5,433.44 |
30.8× |
| CT neck w/contrast (70491) |
$5,096.48 |
$5,096.48 |
28.9× |
| CT neck w/o contrast (70490) |
$4,671.15 |
$4,671.15 |
44.5× |
| CT pelvis w & w/o contrast (72194) |
$6,272.62 |
$6,272.62 |
35.6× |
| CT pelvis w/o contrast (72192) |
$4,248.36 |
$4,248.36 |
40.5× |
| CT thoracic spine w/contrast (72129) |
$4,883.82 |
$4,883.82 |
27.7× |
| CT thoracic spine w/o contrast (72128) |
$5,888.27 |
$5,888.27 |
56.1× |
| CT thorax lung cancer scr c- (71271) |
$619.86 |
$619.86 |
5.9× |
| CT thorax w/o contrast (71250) |
$4,259.90 |
$4,259.90 |
40.6× |
| CT upper extremity w/dye (73201) |
$3,970.34 |
$3,970.34 |
11.3× |
| CTA head w contrast (70496) |
$9,431.32 |
$9,431.32 |
53.5× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$1,795.77 |
$1,795.77 |
5.1× |
| Dilation ureters/urethra rs&i (74485) |
$8,637.23 |
$8,637.23 |
4.1× |
| Discography, cervical or thoracic, radiological supervision and interpretation Age Under 21 (72285) |
$13,746.76 |
$13,746.76 |
7.0× |
| Diskography lumbar s&i (72295) |
$9,378.66 |
$9,378.66 |
4.8× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Age Under 21 (76827) |
$489.27 |
$489.27 |
4.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$489.27 |
$489.27 |
4.7× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$1,160.47 |
$1,160.47 |
11.0× |
| Dxa bone density study axial skeleton (77085) |
$731.08 |
$731.08 |
7.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76825) |
$3,859.29 |
$3,859.29 |
7.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$2,543.48 |
$2,543.48 |
10.6× |
| Fetal biophys profile w/o nst (76819) |
$825.26 |
$825.26 |
7.9× |
| Fetal biophysical profile non-stress testing (76818) |
$1,558.53 |
$1,558.53 |
14.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,390.32 |
$1,390.32 |
5.8× |
| Full mouth X-ray of teeth (70320) |
$909.87 |
$909.87 |
3.8× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$2,401.68 |
$2,401.68 |
4.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$1,811.47 |
$1,811.47 |
4.5× |
| Gastroesophageal reflux study (78262) |
$2,553.68 |
$2,553.68 |
6.4× |
| Gated heart planar single (78472) |
$4,960.46 |
$4,960.46 |
12.4× |
| Heart infarct image (78466) |
$3,511.81 |
$3,511.81 |
8.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,529.40 |
$6,529.40 |
2.1× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Age Under… (75889) |
$5,730.48 |
$5,730.48 |
1.8× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$4,354.95 |
$4,354.95 |
8.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,347.01 |
$3,347.01 |
8.3× |
| Ht muscle image spect sing (78451) |
$6,016.95 |
$6,016.95 |
4.6× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$5,611 |
$5,611 |
4.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$7,265.06 |
$7,265.06 |
10.4× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$3,681.71 |
$3,681.71 |
9.2× |
| Isodose brachytherapy complex 10+ sources (77318) |
$3,879.70 |
$3,879.70 |
10.3× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$2,061.51 |
$2,061.51 |
5.5× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$759.37 |
$759.37 |
2.0× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$759.37 |
$759.37 |
2.0× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$759.37 |
$759.37 |
2.0× |
| Kidney function study, non-imaging radioisotopic study Age Under 21 (78725) |
$2,942.05 |
$2,942.05 |
7.3× |
| Kidney imaging morphol - nm kidney cortex (78700) |
$2,569.01 |
$2,569.01 |
6.4× |
| Kidney imaging morphology; with vascular flow Age Under 21 (78701) |
$3,265.26 |
$3,265.26 |
8.1× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$6,986.57 |
$6,986.57 |
12.8× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,516.91 |
$3,516.91 |
6.4× |
| Leveen/shunt patency exam (78291) |
$1,305.59 |
$1,305.59 |
3.3× |
| Liver and spleen imaging (78215) |
$3,403.23 |
$3,403.23 |
8.5× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$3,476.04 |
$3,476.04 |
8.7× |
| Liver imaging (78201) |
$2,309.69 |
$2,309.69 |
4.2× |
| Liver imaging with flow (78202) |
$2,995.69 |
$2,995.69 |
5.5× |
| Lung perf&ventilat diferentl (78598) |
$5,430.59 |
$5,430.59 |
10.0× |
| Lung perfusion imaging (78580) |
$5,518.74 |
$5,518.74 |
13.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Age Under 21 (75801) |
$1,985.72 |
$1,985.72 |
3.2× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Age Under 21 (75807) |
$6,780.81 |
$6,780.81 |
2.1× |
| Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Age Under 21 (75805) |
$4,598.75 |
$4,598.75 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$7,473.29 |
$7,473.29 |
21.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$5,947.97 |
$5,947.97 |
17.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$5,413.98 |
$5,413.98 |
22.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$7,266.35 |
$7,266.35 |
20.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$8,235.95 |
$8,235.95 |
23.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$6,457.70 |
$6,457.70 |
26.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$6,858.82 |
$6,858.82 |
19.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$7,473.29 |
$7,473.29 |
21.3× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$5,115.05 |
$5,115.05 |
14.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$6,188.13 |
$6,188.13 |
17.7× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$5,259.41 |
$5,259.41 |
15.0× |
| Magnetic resonance elastography (76391) |
$1,379.69 |
$1,379.69 |
5.8× |
| Mandible min 4v (70110) |
$1,037.56 |
$1,037.56 |
9.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$105 |
$105 |
1.1× |
| MRA head w/o contrast (70544) |
$4,084.13 |
$4,084.13 |
17.0× |
| MRA neck w/ contrast (70548) |
$5,062.68 |
$5,062.68 |
14.4× |
| MRA neck w/o contrast (70547) |
$3,674.04 |
$3,674.04 |
15.3× |
| MRI abdomen w/contrast (74182) |
$7,224.18 |
$7,224.18 |
20.6× |
| MRI abdomen w/o contrast (74181) |
$6,541.99 |
$6,541.99 |
27.3× |
| MRI abdomen w/wo contrast (74183) |
$8,373.93 |
$8,373.93 |
23.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$6,016.95 |
$6,016.95 |
7.6× |
| MRI breast c- bilateral (77047) |
$7,478.40 |
$7,478.40 |
31.2× |
| MRI breast without contrast material unilateral (77046) |
$4,986.02 |
$4,986.02 |
20.8× |
| MRI c-spine w&w/o cont (72156) |
$8,587.26 |
$8,587.26 |
24.5× |
| MRI cervical spine w/contrast (72142) |
$7,326.39 |
$7,326.39 |
20.9× |
| MRI chest w/contrast (71551) |
$8,439.06 |
$8,439.06 |
10.7× |
| MRI chest w/o contrast (71550) |
$5,290.08 |
$5,290.08 |
22.1× |
| MRI chest w/wo contrast (71552) |
$7,548.66 |
$7,548.66 |
21.5× |
| MRI fetal sngl/1st gestation (74712) |
$1,262.14 |
$1,262.14 |
5.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$7,473.29 |
$7,473.29 |
21.3× |
| MRI joint upr extrem w/dye (73222) |
$5,840.67 |
$5,840.67 |
7.4× |
| MRI joint upr extrem w/o dye (73221) |
$5,835.56 |
$5,835.56 |
24.3× |
| MRI lumbar spine w/contrast (72149) |
$7,603.60 |
$7,603.60 |
21.7× |
| MRI lumbar spine w/wo contrast (72158) |
$8,740.56 |
$8,740.56 |
24.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$6,934.19 |
$6,934.19 |
19.8× |
| MRI pelvis w & w/o contrast (72197) |
$7,224.18 |
$7,224.18 |
20.6× |
| MRI pelvis w/contrast (72196) |
$6,692.75 |
$6,692.75 |
19.1× |
| MRI pelvis w/o contrast (72195) |
$5,233.86 |
$5,233.86 |
21.8× |
| MRI spectroscopy (76390) |
$5,465.08 |
$5,465.08 |
62.5× |
| MRI spine cervical w/o contrast (72141) |
$6,305.67 |
$6,305.67 |
26.3× |
| MRI t-spine w&w/o cont (72157) |
$8,652.42 |
$8,652.42 |
24.7× |
| MRI thoracic spine w/contrast (72147) |
$7,146.26 |
$7,146.26 |
20.4× |
| MRI thoracic spine w/o contrst (72146) |
$7,070.90 |
$7,070.90 |
29.5× |
| MRI tmj (70336) |
$7,159.04 |
$7,159.04 |
29.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$5,259.41 |
$5,259.41 |
21.9× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$1,696.54 |
$1,696.54 |
4.5× |
| Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),… (72270) |
$4,795.88 |
$4,795.88 |
6.1× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78432) |
$21,509.03 |
$21,509.03 |
14.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$21,509.03 |
$21,509.03 |
15.0× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$23,259.18 |
$23,259.18 |
16.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78430) |
$26,221.67 |
$26,221.67 |
18.3× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78453) |
$6,016.95 |
$6,016.95 |
4.6× |
| Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first… (78454) |
$6,016.95 |
$6,016.95 |
4.6× |
| Myocardial spect multiple studies (78452) |
$8,197.63 |
$8,197.63 |
6.3× |
| Myocrd img PET 2rtracer CT (78433) |
$28,057.42 |
$28,057.42 |
12.7× |
| Myocrd img PET metab eval single study (78459) |
$21,509.03 |
$21,509.03 |
16.5× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$26,221.67 |
$26,221.67 |
18.3× |
| Myocrd img PET rst&strs CT (78431) |
$32,368.92 |
$32,368.92 |
14.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$3,986.24 |
$3,986.24 |
4.6× |
| Nm adrenal imaging (78075) |
$6,986.57 |
$6,986.57 |
5.4× |
| Nm bone 3 phase (78315) |
$6,665.91 |
$6,665.91 |
16.6× |
| Nm bone imaging whole body (78306) |
$4,841.67 |
$4,841.67 |
12.1× |
| Nm bone marrow ltd (78102) |
$2,299.48 |
$2,299.48 |
5.7× |
| Nm bone marrow multi (78103) |
$2,250.93 |
$2,250.93 |
5.6× |
| Nm bone marrow wb (78104) |
$4,193.99 |
$4,193.99 |
10.4× |
| Nm csf cisternogram (78630) |
$4,526.13 |
$4,526.13 |
8.3× |
| Nm csf leak detection (78650) |
$4,239.97 |
$4,239.97 |
3.3× |
| Nm gastric emptying (78264) |
$5,518.74 |
$5,518.74 |
13.7× |
| Nm lung ventilation imaging (78579) |
$6,052.71 |
$6,052.71 |
15.1× |
| Nm lymph system (78195) |
$4,190.16 |
$4,190.16 |
7.7× |
| Nm myocard infarct spect (78469) |
$4,102.01 |
$4,102.01 |
7.5× |
| Nm salivary gland (78230) |
$3,111.96 |
$3,111.96 |
7.7× |
| Non-cardiac vascular flow imaging (ie, angiography, venography) Age Under 21 (78445) |
$1,217.43 |
$1,217.43 |
3.0× |
| Nuclear medicine study for detecting heart shunt (78428) |
$904.46 |
$904.46 |
2.3× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$3,640.82 |
$3,640.82 |
9.1× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$3,934.65 |
$3,934.65 |
9.8× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$2,139.80 |
$2,139.80 |
3.9× |
| Nuclear medicine study of brain, less than 4 static views (78600) |
$2,005.65 |
$2,005.65 |
5.0× |
| Nuclear medicine study of heart muscle following heart attack with measurement of internal blood volume ejected with… (78468) |
$2,081.04 |
$2,081.04 |
3.8× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$4,960.46 |
$4,960.46 |
12.4× |
| Nuclear medicine study of red blood cell survival (78130) |
$4,434.15 |
$4,434.15 |
11.0× |
| Nuclear medicine study of salivary gland function (78232) |
$2,401.68 |
$2,401.68 |
6.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,992.88 |
$1,992.88 |
5.0× |
| Ob us limited fetus(s) (76815) |
$1,089.69 |
$1,089.69 |
10.4× |
| Optic foramina (70190) |
$2,164.49 |
$2,164.49 |
24.8× |
| Panoramic X-ray of jaws (70355) |
$257 |
$257 |
2.9× |
| Parathyrd planar w/spect&CT (78072) |
$3,276.75 |
$3,276.75 |
6.0× |
| Parathyroid planar imaging (78070) |
$3,993.41 |
$3,993.41 |
9.9× |
| Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Age… (75885) |
$5,644.29 |
$5,644.29 |
1.8× |
| Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Age Under 21 (74775) |
$1,556.33 |
$1,556.33 |
6.5× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$28,057.42 |
$28,057.42 |
19.5× |
| PET imaging CT for attenuation limited area (78814) |
$26,221.67 |
$26,221.67 |
18.3× |
| PET imaging for CT attenuation whole body (78816) |
$28,057.42 |
$28,057.42 |
19.5× |
| PET imaging whole body (78813) |
$28,057.42 |
$28,057.42 |
19.5× |
| Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) Age Under 21 (78811) |
$27,139.54 |
$27,139.54 |
20.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$28,057.42 |
$28,057.42 |
19.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$6,383.33 |
$6,383.33 |
2.0× |
| Pulmonary ventilation & perfusion imaging (78582) |
$6,052.71 |
$6,052.71 |
11.1× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$5,430.59 |
$5,430.59 |
13.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,627.37 |
$1,627.37 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$437.38 |
$437.38 |
5.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$724.69 |
$724.69 |
6.9× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$2,783.84 |
$2,783.84 |
26.5× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$2,809.37 |
$2,809.37 |
26.8× |
| Radex hip unilateral with pelvis 1 view (73501) |
$727.88 |
$727.88 |
8.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$1,053.51 |
$1,053.51 |
12.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$1,170.04 |
$1,170.04 |
11.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$727.88 |
$727.88 |
6.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$1,170.04 |
$1,170.04 |
11.1× |
| Radex spine cervical 2 or 3 views (72040) |
$983.29 |
$983.29 |
11.2× |
| Radex spine cervical 4 or 5 views (72050) |
$1,629.76 |
$1,629.76 |
15.5× |
| Radex spine cervical 6 or more views (72052) |
$1,703.18 |
$1,703.18 |
16.2× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$1,971.35 |
$1,971.35 |
22.6× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$43,799 |
$43,799 |
5.9× |
| Radiation tx delivery lvl 1 (77402) |
$525.40 |
$525.40 |
5.1× |
| Radiation tx delivery lvl 2 (77407) |
$525.40 |
$525.40 |
1.4× |
| Radiation tx delivery lvl 3 (77412) |
$1,013.39 |
$1,013.39 |
1.8× |
| Radiologic exam abdomen 3+ views (74021) |
$1,363.19 |
$1,363.19 |
13.0× |
| Radiologic exam chest 3 views (71047) |
$1,328.06 |
$1,328.06 |
15.2× |
| Radiologic exam chest 4+ views (71048) |
$2,001.69 |
$2,001.69 |
19.1× |
| Radiologic exam colon double contrast study (74280) |
$1,297.74 |
$1,297.74 |
7.4× |
| Radiologic exam colon single contrast study (74270) |
$2,282.61 |
$2,282.61 |
13.0× |
| Radiologic exam esophagus double contrast study (74221) |
$1,307.31 |
$1,307.31 |
7.4× |
| Radiologic exam esophagus single contrast study (74220) |
$1,573.89 |
$1,573.89 |
8.9× |
| Radiologic exam small int single contrast study (74250) |
$2,068.71 |
$2,068.71 |
11.7× |
| Radiologic exam swallow function contrast study (74230) |
$2,261.87 |
$2,261.87 |
12.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$2,304.97 |
$2,304.97 |
13.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$2,121.39 |
$2,121.39 |
12.0× |
| Radiologic examination femur 1 view (73551) |
$437.38 |
$437.38 |
5.0× |
| Radiologic examination femur minimum 2 views (73552) |
$1,018.40 |
$1,018.40 |
11.6× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$1,015.20 |
$1,015.20 |
11.6× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$964.13 |
$964.13 |
11.0× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$905.07 |
$905.07 |
10.4× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$1,021.59 |
$1,021.59 |
11.7× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$1,059.90 |
$1,059.90 |
12.1× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$964.13 |
$964.13 |
11.0× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$999.23 |
$999.23 |
11.4× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$1,123.75 |
$1,123.75 |
12.9× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$1,585.86 |
$1,585.86 |
15.1× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$1,045.55 |
$1,045.55 |
12.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$683.19 |
$683.19 |
6.5× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$871.54 |
$871.54 |
10.0× |
| Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and… (74470) |
$2,057.53 |
$2,057.53 |
3.7× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$1,773.43 |
$1,773.43 |
16.9× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$1,045.55 |
$1,045.55 |
10.0× |
| Radiologic examination, salivary gland for calculus Age Under 21 (70380) |
$2,020.82 |
$2,020.82 |
23.1× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$2,351.24 |
$2,351.24 |
6.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$1,115.75 |
$1,115.75 |
12.8× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$2,440.64 |
$2,440.64 |
23.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$855.58 |
$855.58 |
9.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$973.71 |
$973.71 |
9.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$1,383.94 |
$1,383.94 |
13.2× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$3,869.27 |
$3,869.27 |
36.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$5,583.64 |
$5,583.64 |
53.2× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$1,597.83 |
$1,597.83 |
15.2× |
| Radiologic examination, teeth; single view Age Under 21 (70300) |
$477.27 |
$477.27 |
5.5× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$980.08 |
$980.08 |
11.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$1,031.17 |
$1,031.17 |
11.8× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$973.71 |
$973.71 |
11.1× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$826.84 |
$826.84 |
9.5× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$1,395.11 |
$1,395.11 |
13.3× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$983.29 |
$983.29 |
11.2× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$756.62 |
$756.62 |
8.7× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$1,205.16 |
$1,205.16 |
11.5× |
| Radiopharmaceutical dacryocystography Age Under 21 (78660) |
$1,355.41 |
$1,355.41 |
3.4× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$8,132.48 |
$8,132.48 |
14.9× |
| Radiopharmaceutical therapy, by intravenous administration Age Under 21 (79101) |
$2,747.86 |
$2,747.86 |
11.7× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$2,747.86 |
$2,747.86 |
11.7× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion (79403) |
$7,036.39 |
$7,036.39 |
30.0× |
| Red cell mass multiple (78121) |
$6,522.84 |
$6,522.84 |
12.0× |
| Red cell volume determination (separate procedure); single sampling Age Under 21 (78120) |
$3,926.99 |
$3,926.99 |
9.8× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$2,071.91 |
$2,071.91 |
8.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$3,849.06 |
$3,849.06 |
9.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$4,480.15 |
$4,480.15 |
11.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$8,315.15 |
$8,315.15 |
15.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$5,051.19 |
$5,051.19 |
9.3× |
| Rp loclzj tum spect 2 areas (78831) |
$7,667.47 |
$7,667.47 |
5.9× |
| Rp loclzj tum spect w/CT 1 (78830) |
$7,312.33 |
$7,312.33 |
5.6× |
| Rp loclzj tum spect w/CT 2 (78832) |
$8,295.99 |
$8,295.99 |
5.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,317.09 |
$1,317.09 |
5.6× |
| Scapula complete (73010) |
$986.49 |
$986.49 |
9.4× |
| Screening digital breast tomosynthesis bi (77063) |
$195.45 |
$195.45 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,302.53 |
$1,302.53 |
12.4× |
| Simulation intermediate (77285) |
$2,061.51 |
$2,061.51 |
5.5× |
| Special dosimetry (77331) |
$759.37 |
$759.37 |
5.6× |
| Special physics consult (77370) |
$1,791.46 |
$1,791.46 |
13.3× |
| Special teletherapy port plan (77321) |
$2,061.51 |
$2,061.51 |
5.5× |
| Special treatment procedure (77470) |
$4,434.52 |
$4,434.52 |
8.0× |
| Spleen imaging only, with or without vascular flow Age Under 21 (78185) |
$1,829.35 |
$1,829.35 |
4.6× |
| Splenoportography, radiological supervision and interpretation Age Under 21 (75810) |
$5,010.57 |
$5,010.57 |
1.6× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$12,709.97 |
$12,709.97 |
7.1× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Age Under 21 (70332) |
$2,001.69 |
$2,001.69 |
8.4× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$2,768.30 |
$2,768.30 |
6.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,061.51 |
$2,061.51 |
5.5× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$1,578.68 |
$1,578.68 |
9.0× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Age Under 21 (78015) |
$2,818.14 |
$2,818.14 |
7.0× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Age Under 21 (78016) |
$807.37 |
$807.37 |
2.0× |
| Thyroid imaging with vascular flow (78013) |
$2,475.77 |
$2,475.77 |
6.2× |
| Thyroid met imaging body (78018) |
$4,366.45 |
$4,366.45 |
8.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,193.17 |
$1,193.17 |
3.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$2,602.24 |
$2,602.24 |
6.5× |
| Tr simulation simple (77280) |
$759.37 |
$759.37 |
5.6× |
| Treatment device complex (77334) |
$1,413.12 |
$1,413.12 |
3.8× |
| Treatment device intermediate (77333) |
$1,370.33 |
$1,370.33 |
10.1× |
| Treatment device simple (77332) |
$1,319.53 |
$1,319.53 |
9.8× |
| Ultrasound breast limited (76642) |
$549.32 |
$549.32 |
6.3× |
| Ultrasound, abdomen limited (76705) |
$1,849.81 |
$1,849.81 |
17.6× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$499.50 |
$499.50 |
4.8× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$2,005.65 |
$2,005.65 |
19.1× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$3,247.38 |
$3,247.38 |
13.5× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$1,753.99 |
$1,753.99 |
16.7× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$2,436.16 |
$2,436.16 |
23.2× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$1,742.49 |
$1,742.49 |
16.6× |
| Unlisted CT procedure (76497) |
$1,749.43 |
$1,749.43 |
20.0× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$2,369.72 |
$2,369.72 |
27.1× |
| Ureteral reflux study (78740) |
$2,930.56 |
$2,930.56 |
7.3× |
| Urethrocystography retrograde rs&i (74450) |
$1,861.20 |
$1,861.20 |
7.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$2,282.61 |
$2,282.61 |
13.0× |
| Urography antegrade rs&i (74425) |
$844.42 |
$844.42 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$4,284.29 |
$4,284.29 |
24.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Age Under 21 (74415) |
$2,426.28 |
$2,426.28 |
13.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$643.86 |
$643.86 |
6.1× |
| Us breast uni real time with image complete (76641) |
$1,267.27 |
$1,267.27 |
12.1× |
| Us chest (76604) |
$1,541.93 |
$1,541.93 |
14.7× |
| Us compl joint r-t w/image documentation (76881) |
$1,502.32 |
$1,502.32 |
14.3× |
| Us elastography organ (76981) |
$673.23 |
$673.23 |
6.4× |
| Us encephalogram (76506) |
$2,234.33 |
$2,234.33 |
21.3× |
| Us exam, pelvic, limited (76857) |
$1,849.81 |
$1,849.81 |
17.6× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$530.15 |
$530.15 |
6.1× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$530.15 |
$530.15 |
6.1× |
| US OB Follow-Up/Repeat (76816) |
$1,179.12 |
$1,179.12 |
11.2× |
| Us ob transvaginal (76817) |
$530.15 |
$530.15 |
5.0× |
| Us retroperitoneal complete (76770) |
$1,918.77 |
$1,918.77 |
18.3× |
| Us retroperitoneal ltd (76775) |
$1,598.13 |
$1,598.13 |
15.2× |
| Us scrotum (76870) |
$1,810.21 |
$1,810.21 |
17.2× |
| Us soft tissue head/neck (76536) |
$1,539.37 |
$1,539.37 |
14.7× |
| Us spinal canal (76800) |
$1,936.67 |
$1,936.67 |
18.4× |
| Us transrectal (76872) |
$1,854.91 |
$1,854.91 |
17.7× |
| Us trgt dyn mbubb 1st les (76978) |
$1,207.22 |
$1,207.22 |
3.4× |
| Us unlstd proc (76999) |
$527.60 |
$527.60 |
6.0× |
| Use 1st target lesion (76982) |
$673.23 |
$673.23 |
6.4× |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Age Under 21 (74440) |
$1,452.56 |
$1,452.56 |
6.1× |
| Venogram sinus/jugular (75860) |
$5,010.57 |
$5,010.57 |
1.6× |
| Venography adrenal unilateral selective rs&i (75840) |
$6,277.98 |
$6,277.98 |
2.0× |
| Venography deep dorsal vein penis radiolgicl supervision interpretation (76499) |
$410.22 |
$410.22 |
4.7× |
| Venography renal unilateral selective rs&i (75831) |
$5,010.57 |
$5,010.57 |
1.6× |
| Venography, caval, inferior, with serialography, radiological supervision and interpretation Age Under 21 (75825) |
$5,641.09 |
$5,641.09 |
1.8× |
| Venography, caval, superior, with serialography, radiological supervision and interpretation Age Under 21 (75827) |
$5,125.51 |
$5,125.51 |
3.2× |
| Venography, epidural, radiological supervision and interpretation Age Under 21 (75872) |
$5,010.57 |
$5,010.57 |
8.0× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$5,873.11 |
$5,873.11 |
3.7× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$4,405.12 |
$4,405.12 |
2.8× |
| Venography, superior sagittal sinus, radiological supervision and interpretation Age Under 21 (75870) |
$2,249.09 |
$2,249.09 |
0.7× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$20,607.36 |
$20,607.36 |
3.7× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$4,538.91 |
$4,538.91 |
8.3× |
| X-ray exam hips bi 3-4 views (73522) |
$1,053.51 |
$1,053.51 |
10.0× |
| X-ray exam of finger(s) (73140) |
$672.02 |
$672.02 |
7.7× |
| X-ray exam of knee 1 or 2 (73560) |
$836.42 |
$836.42 |
9.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$5,845.40 |
$5,845.40 |
33.2× |
| X-ray exam ribs bil 3 views (71110) |
$1,189.20 |
$1,189.20 |
11.3× |
| X-ray exam ribs uni 2 views (71100) |
$826.84 |
$826.84 |
9.5× |
| X-ray heel (73650) |
$785.33 |
$785.33 |
9.0× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$1,256.23 |
$1,256.23 |
12.0× |
| X-ray retrograde pyelogram (74420) |
$2,946.66 |
$2,946.66 |
8.4× |
| Xr abdomen 1 view (74018) |
$772.58 |
$772.58 |
8.8× |
| Xr abdomen 2 views (74019) |
$1,275.38 |
$1,275.38 |
12.1× |
| Xr arthrogram ankle (73615) |
$2,405.53 |
$2,405.53 |
6.9× |
| Xr arthrogram elbow (73085) |
$1,345.63 |
$1,345.63 |
3.8× |
| Xr arthrogram hip (73525) |
$1,227.50 |
$1,227.50 |
3.5× |
| Xr arthrogram knee (73580) |
$999.23 |
$999.23 |
2.9× |
| Xr arthrogram wrist (73115) |
$1,792.56 |
$1,792.56 |
5.1× |
| Xr bone age studies (77072) |
$922.64 |
$922.64 |
8.8× |
| Xr bone length study (77073) |
$1,356.80 |
$1,356.80 |
12.9× |
| Xr bone survey infant (77076) |
$1,441.40 |
$1,441.40 |
13.7× |
| Xr bone survey ltd (77074) |
$3,288.23 |
$3,288.23 |
31.3× |
| Xr chest 1 view (71045) |
$753.42 |
$753.42 |
8.6× |
| Xr chest 2 views (71046) |
$967.31 |
$967.31 |
11.1× |
| Xr eye foreign body (70030) |
$1,027.97 |
$1,027.97 |
11.8× |
| Xr facial bones 3+ views (70150) |
$1,075.86 |
$1,075.86 |
10.2× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$951.34 |
$951.34 |
10.9× |
| Xr forearm 2 views (73090) |
$935.40 |
$935.40 |
10.7× |
| Xr hand 2v (73120) |
$897.09 |
$897.09 |
8.5× |
| Xr hysterosalpingogram (74740) |
$1,798.97 |
$1,798.97 |
7.5× |
| Xr myelogram c-spine (72240) |
$4,806.27 |
$4,806.27 |
6.1× |
| Xr myelogram l-spine (72265) |
$4,439.12 |
$4,439.12 |
5.6× |
| Xr myelogram t-spine (72255) |
$3,497.36 |
$3,497.36 |
4.4× |
| Xr neck soft tissue (70360) |
$775.76 |
$775.76 |
8.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$980.08 |
$980.08 |
11.2× |
| Xr osseous survey complete (77075) |
$3,288.23 |
$3,288.23 |
31.3× |
| Xr pelvis 1-2 views (72170) |
$747.04 |
$747.04 |
7.1× |
| Xr pelvis min 3 view (72190) |
$2,451.81 |
$2,451.81 |
23.3× |
| Xr peritoneogram (74190) |
$2,470.98 |
$2,470.98 |
4.5× |
| Xr sacrum/coccyx 2+ views (72220) |
$877.92 |
$877.92 |
10.0× |
| Xr sella turcica (70240) |
$1,814.93 |
$1,814.93 |
20.8× |
| Xr shoulder 1 view (73020) |
$747.04 |
$747.04 |
8.5× |
| Xr sialogram (70390) |
$1,792.56 |
$1,792.56 |
7.5× |
| Xr sinuses 3+ views (70220) |
$1,556.33 |
$1,556.33 |
17.8× |
| Xr skull min 4 view (70260) |
$1,818.10 |
$1,818.10 |
17.3× |
| Xr spine 1 view (72020) |
$691.97 |
$691.97 |
7.9× |
| Xr spine thoracic 3v (72072) |
$1,422.26 |
$1,422.26 |
13.5× |
| Xr sternum 2+ views (71120) |
$1,010.42 |
$1,010.42 |
11.6× |
| Xr surgical specimen (76098) |
$936.99 |
$936.99 |
1.7× |
| Xr t-spine 2 views (72070) |
$1,248.25 |
$1,248.25 |
11.9× |
| Xr tibia/fibula 2 views (73590) |
$964.13 |
$964.13 |
11.0× |
| Xr tmj bilateral (70330) |
$1,181.22 |
$1,181.22 |
13.5× |
| Xr tmj unilateral (70328) |
$1,181.22 |
$1,181.22 |
13.5× |
| Xr venogram renal bilat (75833) |
$5,010.57 |
$5,010.57 |
1.6× |
| Xr wrist 2 views (73100) |
$715.12 |
$715.12 |
8.2× |