| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,580.08 |
$7,046.28 |
2.8× |
| Abdomen 2 views (74019) |
$484.63 |
$745.58 |
3.9× |
| Acute gi blood loss imaging (78278) |
$1,899.89 |
$2,922.90 |
4.0× |
| Angio Adrenal Bilat Select (75733) |
$8,032.15 |
$12,357.15 |
2.2× |
| Angiography extremity bilateral rs&i (75716) |
$6,537.23 |
$10,057.27 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$6,589.65 |
$10,137.93 |
1.8× |
| Angiography internal mammary rs&i (75756) |
$9,370.28 |
$14,415.81 |
2.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$8,473.96 |
$13,036.86 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$8,712.50 |
$13,403.84 |
2.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$8,299.56 |
$12,768.56 |
2.2× |
| Angiography Spinal Selective Rs&I (75705) |
$9,223.06 |
$14,189.32 |
1.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,473.96 |
$13,036.86 |
1.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,267.08 |
$8,103.20 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$9,370.28 |
$14,415.81 |
2.5× |
| Ankle 2 views (73600) |
$342.19 |
$526.45 |
3.3× |
| Aortogram thoracic (75605) |
$8,588.61 |
$13,213.24 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,114.60 |
$7,868.61 |
1.4× |
| Aortography abdominal serialography rs&i (75625) |
$5,114.60 |
$7,868.61 |
1.4× |
| Artery X-Rays Adrenal Gland (75731) |
$6,364.88 |
$9,792.12 |
1.7× |
| Arthrogram ankle (73615) |
$896.86 |
$1,379.78 |
2.2× |
| Arthrogram elbow (73085) |
$1,645.29 |
$2,531.21 |
4.0× |
| Arthrogram hip (73525) |
$1,144.55 |
$1,760.84 |
2.8× |
| Arthrogram knee (73580) |
$1,595.94 |
$2,455.29 |
3.9× |
| Arthrogram shoulder (73040) |
$1,136.17 |
$1,747.96 |
2.8× |
| Arthrogram wrist (73115) |
$1,879.87 |
$2,892.10 |
4.6× |
| Basic dosimetry (77300) |
$835.71 |
$1,285.71 |
5.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,570.71 |
$2,416.48 |
3.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,570.71 |
$2,416.48 |
3.3× |
| Bone &/joint imaging whole body (78306) |
$1,570.71 |
$2,416.48 |
3.3× |
| Bone age studies (77072) |
$248.92 |
$382.95 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$1,876.13 |
$2,886.35 |
4.0× |
| Bone Marrow Imaging Limited Area (78102) |
$1,192.06 |
$1,833.94 |
2.5× |
| Bone survey complete (77075) |
$459.13 |
$706.35 |
3.7× |
| Bone survey infant (77076) |
$392.63 |
$604.05 |
3.2× |
| Bowel imaging (78290) |
$1,889.08 |
$2,906.28 |
4.0× |
| Brachytx isodose complex (77318) |
$2,321.53 |
$3,571.58 |
5.2× |
| Brachytx isodose intermed (77317) |
$1,949.45 |
$2,999.16 |
4.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$1,715.06 |
$2,638.56 |
3.9× |
| Brain imaging < 4 static views (78600) |
$1,283.34 |
$1,974.37 |
2.7× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,283.34 |
$1,974.37 |
2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,377.93 |
$3,658.36 |
3.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,838.18 |
$8,981.82 |
3.5× |
| Brain Imaging Vascular Flow Only (78610) |
$1,653.76 |
$2,544.24 |
2.6× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,102.51 |
$1,696.17 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,784.87 |
$2,745.96 |
3.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,809.11 |
$2,783.24 |
2.0× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,350.43 |
$3,616.04 |
5.7× |
| Cardiac shunt detection (78428) |
$1,564.69 |
$2,407.21 |
3.3× |
| Cardiovasc nucl exam unlisted (78499) |
$1,283.34 |
$1,974.37 |
2.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,878.28 |
$2,889.66 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$341.74 |
$525.75 |
3.3× |
| Chest 1 view (71045) |
$442.83 |
$681.28 |
4.3× |
| Chest xray 3 views (71047) |
$509.33 |
$783.59 |
5.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$772.81 |
$1,188.94 |
3.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,644.58 |
$2,530.13 |
1.8× |
| Clavicle complete (73000) |
$438.28 |
$674.28 |
4.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,525.91 |
$2,347.55 |
12.4× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$848.66 |
$1,305.63 |
8.3× |
| Continuing medical physics consltj pr wk (77336) |
$592.62 |
$911.72 |
3.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$479.63 |
$737.89 |
2.3× |
| Corpora cavernosography (74445) |
$632 |
$972.30 |
5.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,331.51 |
$8,202.33 |
12.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,768.81 |
$4,259.70 |
9.8× |
| CT abdomen w contrast (74160) |
$2,542.44 |
$3,911.44 |
12.3× |
| CT abdomen w wo contrast (74170) |
$3,361.01 |
$5,170.78 |
16.2× |
| CT abdomen w/o contrast (74150) |
$1,804.53 |
$2,776.20 |
14.6× |
| CT angio hrt w/3d image (75574) |
$1,604.96 |
$2,469.17 |
3.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,623.80 |
$5,575.08 |
17.5× |
| CT angiography upper extremity lt (73206) |
$1,753.93 |
$2,698.35 |
8.5× |
| CT c-spine w/contrast (72126) |
$2,319.64 |
$3,568.67 |
5.6× |
| CT c-spine w/o contrast (72125) |
$1,711.90 |
$2,633.69 |
13.9× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$760.21 |
$1,169.55 |
3.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,355.28 |
$3,623.51 |
11.4× |
| CT chest w contrast (71260) |
$2,606.10 |
$4,009.38 |
12.6× |
| CT chest w/wo contrast (71270) |
$3,173.68 |
$4,882.58 |
15.3× |
| CT colonography screening (74263) |
$1,332.74 |
$2,050.37 |
4.7× |
| CT colonography w/dye (74262) |
$2,515.55 |
$3,870.07 |
12.1× |
| CT colonography w/o cntrst (74261) |
$1,913.45 |
$2,943.77 |
15.5× |
| CT head/brain with contrast (70460) |
$2,186.28 |
$3,363.50 |
10.6× |
| CT head/brain without and with contrast (70470) |
$2,621.44 |
$4,032.98 |
12.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,768.77 |
$2,721.18 |
4.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$438.29 |
$674.29 |
4.3× |
| CT hrt w/3d image congen (75573) |
$1,604.96 |
$2,469.17 |
3.9× |
| CT iac w contrast (70481) |
$2,186.28 |
$3,363.50 |
10.6× |
| CT limited/localized follow up study (76380) |
$1,200.71 |
$1,847.25 |
11.7× |
| CT lower ext w/o (73700) |
$1,435.92 |
$2,209.10 |
11.6× |
| CT lower extremity w wo contrast (73702) |
$2,793.71 |
$4,298.01 |
13.5× |
| CT lower extremity w/contrast material (73701) |
$1,782.16 |
$2,741.79 |
8.6× |
| CT lumbar spine w & w/o contrast (72133) |
$2,409.74 |
$3,707.29 |
11.6× |
| CT lumbar spine w/contrast (72132) |
$2,391.10 |
$3,678.62 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$1,787.55 |
$2,750.07 |
14.5× |
| CT maxillofacial w contrast (70487) |
$2,054.45 |
$3,160.69 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,551.72 |
$3,925.73 |
12.3× |
| CT maxillofacial wo contrast (70486) |
$1,698.74 |
$2,613.44 |
13.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,258 |
$3,473.85 |
10.9× |
| CT orbits w/o contrast (70480) |
$1,767.06 |
$2,718.56 |
14.3× |
| CT pelvis w/o contrast (72192) |
$1,565.04 |
$2,407.76 |
12.7× |
| CT pelvis w/wo contrast (72194) |
$2,430.92 |
$3,739.87 |
11.7× |
| CT scan of arm combo (73202) |
$2,120.07 |
$3,261.65 |
10.2× |
| CT soft tissue neck w contrast (70491) |
$1,869.63 |
$2,876.35 |
9.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,310.83 |
$3,555.12 |
11.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,593.87 |
$2,452.10 |
12.9× |
| CT thoracic spine w/contrast (72129) |
$1,883.79 |
$2,898.14 |
9.1× |
| CT thoracic spine w/o contrast (72128) |
$1,645.09 |
$2,530.91 |
13.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,491.95 |
$3,833.77 |
12.0× |
| CT thorax w/o contrast (71250) |
$2,060.95 |
$3,170.69 |
16.7× |
| CT unlisted procedure (76497) |
$2,281.63 |
$3,510.20 |
22.2× |
| CT upper ext wo (73200) |
$1,882.94 |
$2,896.83 |
15.2× |
| CT upper extremity with contrast (73201) |
$2,053.53 |
$3,159.28 |
5.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,606.10 |
$4,009.38 |
12.6× |
| Cta Abdomen (74175) |
$2,736.62 |
$4,210.19 |
13.2× |
| CTA abdomen pelvis (74174) |
$4,175.89 |
$6,424.44 |
10.1× |
| CTA chest (71275) |
$2,736.62 |
$4,210.19 |
13.2× |
| Cta Head (70496) |
$2,483.72 |
$3,821.10 |
12.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,967.43 |
$7,642.20 |
12.1× |
| Cta Neck (70498) |
$2,483.72 |
$3,821.10 |
12.0× |
| Cta Pelvis (72191) |
$2,333.66 |
$3,590.25 |
11.3× |
| Cystography minimum 3 views rs&i (74430) |
$917.40 |
$1,411.39 |
2.2× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$548.20 |
$843.39 |
1.9× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$4,136.11 |
$6,363.25 |
1.7× |
| Diskogram cervical (72285) |
$6,859.20 |
$10,552.61 |
3.0× |
| Diskography lumbar (72295) |
$7,961.01 |
$12,247.70 |
3.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$434.58 |
$668.58 |
3.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$434.58 |
$668.58 |
3.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$296.14 |
$455.60 |
2.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$248.92 |
$382.95 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$183.99 |
$283.06 |
1.8× |
| Dxa bone density study axial skeleton (77085) |
$217.85 |
$335.16 |
1.8× |
| Esophageal motility (78258) |
$1,217.62 |
$1,873.26 |
2.6× |
| Esophagus (74220) |
$479.63 |
$737.89 |
2.3× |
| Facial bones min 3 views (70150) |
$475.35 |
$731.30 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$566.65 |
$871.77 |
4.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$566.65 |
$871.77 |
4.6× |
| Fetal Echo (76825) |
$2,910.51 |
$4,477.70 |
4.5× |
| Fluoroscopy up to 1 hr (76000) |
$777.01 |
$1,195.40 |
2.8× |
| Foot 2 views (73620) |
$501.54 |
$771.60 |
4.9× |
| Forearm 2 views (73090) |
$473.29 |
$728.14 |
4.6× |
| Functional MRI brain by phys/psych (70555) |
$1,813.01 |
$2,789.24 |
6.4× |
| Functional MRI brain by tech (70554) |
$1,813.01 |
$2,789.24 |
6.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,698.31 |
$2,612.78 |
3.6× |
| Gastric mucosa imaging (78261) |
$1,283.34 |
$1,974.37 |
2.7× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$2,253.36 |
$3,466.71 |
3.5× |
| Hand 2 views (73120) |
$389.79 |
$599.67 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,406.34 |
$5,240.53 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$3,406.34 |
$5,240.53 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,406.34 |
$5,240.53 |
4.1× |
| Heart first pass single,planar (78481) |
$1,564.69 |
$2,407.21 |
2.4× |
| Heart Infarct Image (78466) |
$1,283.34 |
$1,974.37 |
2.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,114.60 |
$7,868.61 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,114.60 |
$7,868.61 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,560.46 |
$3,939.17 |
4.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,865.33 |
$2,869.74 |
3.9× |
| Hysterosalpingogram (74740) |
$1,284.48 |
$1,976.12 |
4.6× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$28,365.10 |
$43,638.62 |
3.3× |
| Intraop radiaj tx deliver xray single tx session (77424) |
$28,365.10 |
$43,638.62 |
3.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$248.92 |
$382.95 |
2.0× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$855.56 |
$1,316.24 |
1.8× |
| Kidney imaging morphology (78700) |
$1,647.69 |
$2,534.91 |
3.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,821.72 |
$2,802.64 |
2.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,938.46 |
$2,982.25 |
3.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,914.69 |
$2,945.67 |
3.0× |
| Knee 3 views (73562) |
$807.56 |
$1,242.40 |
7.9× |
| Liver & spleen imaging static only (78215) |
$1,707.24 |
$2,626.52 |
3.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,863.35 |
$2,866.69 |
3.9× |
| Liver imaging static only (78201) |
$4,463.18 |
$6,866.43 |
7.0× |
| Liver imaging w/vascular flow (78202) |
$4,463.18 |
$6,866.43 |
7.0× |
| Lung perf&ventilat diferentl (78598) |
$2,459.87 |
$3,784.42 |
3.8× |
| Lung perfusion differential (78597) |
$1,055.69 |
$1,624.14 |
2.2× |
| Lung ventilation imaging (78579) |
$1,027.65 |
$1,581 |
2.2× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$6,925.87 |
$10,655.18 |
1.9× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$5,405.60 |
$8,316.30 |
1.4× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$2,799.32 |
$4,306.65 |
1.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,200.50 |
$1,846.92 |
1.6× |
| Lymphoscintigraphy (78195) |
$1,886.92 |
$2,902.95 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,953.58 |
$3,005.50 |
2.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,710.42 |
$4,169.87 |
6.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,253.91 |
$3,467.56 |
5.5× |
| Magnetic Resonance Elastography (76391) |
$1,722.67 |
$2,650.26 |
6.1× |
| Mammary ductogram or galactogram multiple (77054) |
$615.32 |
$946.65 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$615.32 |
$946.65 |
2.2× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$183.99 |
$283.06 |
1.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$1,751.18 |
$2,694.13 |
4.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$118.10 |
$181.69 |
3.5× |
| MRA head w & w/o contrast (70546) |
$2,667.95 |
$4,104.54 |
6.5× |
| MRA head w/o contrast (70544) |
$1,564.10 |
$2,406.30 |
5.5× |
| MRA head with contrast (70545) |
$2,425.98 |
$3,732.28 |
5.9× |
| MRA neck w contrast (70548) |
$1,991 |
$3,063.07 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,667.95 |
$4,104.54 |
6.5× |
| MRA neck w/o contrast (70547) |
$1,564.10 |
$2,406.30 |
5.5× |
| MRI abdomen w contrast (74182) |
$2,850.08 |
$4,384.74 |
6.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,845 |
$5,915.39 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$2,218.66 |
$3,413.33 |
7.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,116.87 |
$3,256.72 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,786.93 |
$4,287.58 |
6.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,722.67 |
$2,650.26 |
6.1× |
| MRI breast wo contrast unilateral (77046) |
$1,722.67 |
$2,650.26 |
6.1× |
| MRI c-spine with contrast (72142) |
$2,434.13 |
$3,744.81 |
5.9× |
| MRI cardiac w/o cont stress (75559) |
$1,244.24 |
$1,914.21 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$1,203.53 |
$1,851.58 |
4.3× |
| MRI cervical spine w/o contrast (72141) |
$1,768.73 |
$2,721.13 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,463.79 |
$5,328.90 |
8.4× |
| MRI chest w/o contrast (71550) |
$2,096.63 |
$3,225.59 |
7.4× |
| MRI chest with contrast (71551) |
$2,710.42 |
$4,169.87 |
2.9× |
| MRI fetal sngl/1st gestation (74712) |
$1,072.51 |
$1,650.01 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,100.16 |
$3,231.02 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,309.64 |
$3,553.29 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,970.52 |
$3,031.57 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,400.68 |
$3,693.36 |
8.5× |
| MRI orbit face neck w contrast (70542) |
$2,496.44 |
$3,840.68 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,915.68 |
$4,485.66 |
7.1× |
| MRI pelvis w/contrast (72196) |
$2,483.62 |
$3,820.96 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,288.73 |
$5,059.59 |
8.0× |
| MRI pelvis w/o contrast (72195) |
$1,782.33 |
$2,742.04 |
6.3× |
| MRI spectroscopy (76390) |
$2,253.81 |
$3,467.40 |
21.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,994.20 |
$4,606.46 |
7.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,213.85 |
$3,405.93 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,052.11 |
$4,695.56 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,208.38 |
$3,397.50 |
5.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,965.49 |
$4,562.29 |
7.2× |
| MRI temporomandibular joint (70336) |
$2,119.72 |
$3,261.10 |
7.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,776.94 |
$2,733.76 |
6.3× |
| MRI up ext w/o contrast (73218) |
$1,970.64 |
$3,031.75 |
7.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,841.65 |
$2,833.30 |
6.5× |
| MRI, joint upper extrem combo (73223) |
$2,481.04 |
$3,816.99 |
6.0× |
| Myelogram Cervical (72240) |
$2,447.32 |
$3,765.11 |
2.6× |
| Myelogram Lumbar (72265) |
$2,179.54 |
$3,353.14 |
2.4× |
| Myelogram thoracic (72255) |
$2,179.54 |
$3,353.14 |
2.4× |
| Myelography 2 or more regions (72270) |
$3,168.95 |
$4,875.30 |
3.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$6,662.05 |
$10,249.31 |
4.4× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$9,986.72 |
$15,364.19 |
3.8× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$5,239.36 |
$8,060.55 |
3.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$5,838.18 |
$8,981.82 |
3.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$8,171.29 |
$12,571.22 |
3.1× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$5,838.18 |
$8,981.82 |
3.5× |
| Myocardial infarct spect (78469) |
$2,975.46 |
$4,577.63 |
4.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,110.68 |
$6,324.13 |
2.7× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$5,561.50 |
$8,556.15 |
3.6× |
| Myocardial Spect Multiple Studies (78452) |
$5,561.50 |
$8,556.15 |
3.6× |
| Myocardial spect single study at rest or stress (78451) |
$3,924.20 |
$6,037.23 |
2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$5,239.36 |
$8,060.55 |
3.1× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$9,986.72 |
$15,364.19 |
5.6× |
| N-invas est c ffr sw aly CTA (75580) |
$4,253.77 |
$6,544.26 |
4.2× |
| Neck soft tissue (70360) |
$540.04 |
$830.83 |
5.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$814.88 |
$1,253.66 |
1.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,283.34 |
$1,974.37 |
2.7× |
| Nm adrenal scan (78075) |
$5,009.63 |
$7,707.12 |
3.3× |
| Nm bone marrow multi (78103) |
$1,192.06 |
$1,833.94 |
2.5× |
| Nm bone marrow wb (78104) |
$1,315.30 |
$2,023.54 |
2.8× |
| Nm cisternogram (78630) |
$2,441.46 |
$3,756.09 |
3.8× |
| Nm csf leak detection (78650) |
$2,975.46 |
$4,577.63 |
1.9× |
| Nm gastric emptying study (78264) |
$1,627.21 |
$2,503.40 |
3.4× |
| Nm gastroesophageal reflux study (78262) |
$2,339.10 |
$3,598.61 |
5.0× |
| Nm kidney scan w/flow (78701) |
$1,746.71 |
$2,687.25 |
3.7× |
| Nm peritoneal-venous shunt patency (78291) |
$1,217.62 |
$1,873.26 |
2.6× |
| Nm red cell sequestration (78140) |
$2,004.28 |
$3,083.51 |
4.2× |
| Noncardiac Vascular Flow Imaging (78445) |
$936.34 |
$1,440.53 |
2.0× |
| Nonvascular shunt X-ray (75809) |
$365.64 |
$562.53 |
3.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$9,437.23 |
$14,518.82 |
5.8× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,018.69 |
$1,567.21 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$1,515.72 |
$2,331.87 |
5.5× |
| Ob us nuchal meas 1 gest (76813) |
$272.32 |
$418.95 |
2.2× |
| Osseous survey limited (77074) |
$433.69 |
$667.22 |
3.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,695.25 |
$2,608.08 |
2.6× |
| Parathyroid Planar Imaging (78070) |
$1,653.70 |
$2,544.15 |
3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,752.37 |
$2,695.96 |
3.7× |
| Pelvis 1 or 2 views (72170) |
$335.60 |
$516.31 |
2.7× |
| Peritoneogram after injection (74190) |
$1,214.75 |
$1,868.84 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$5,840.75 |
$8,985.77 |
3.5× |
| PET imaging CT for attenuation limited area (78814) |
$5,840.75 |
$8,985.77 |
3.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,840.75 |
$8,985.77 |
3.5× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$1,678.60 |
$2,582.46 |
1.1× |
| PET whole body (78813) |
$3,329.20 |
$5,121.85 |
2.0× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$2,975.46 |
$4,577.63 |
1.9× |
| Platelet survival study Non-Facility (78191) |
$855.56 |
$1,316.24 |
1.8× |
| Proton trmt simple w/comp (77522) |
$5,018.77 |
$7,721.18 |
3.4× |
| Proton tx delivery complex (77525) |
$5,038.72 |
$7,751.87 |
3.4× |
| Proton tx delivery intermediate (77523) |
$5,028.74 |
$7,736.52 |
3.4× |
| Proton tx delivery simple w/o compensation (77520) |
$2,504.39 |
$3,852.91 |
3.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,559.67 |
$8,553.34 |
1.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$5,698.65 |
$8,767.16 |
1.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,284.60 |
$1,976.31 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,787.64 |
$2,750.22 |
2.8× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$4,253.77 |
$6,544.26 |
3.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,182.75 |
$1,819.61 |
1.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$420.32 |
$646.65 |
4.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$459.03 |
$706.20 |
4.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$756.13 |
$1,163.28 |
7.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$183.99 |
$283.06 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$256.59 |
$394.75 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$493.14 |
$758.68 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$487.77 |
$750.42 |
4.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$565.35 |
$869.77 |
5.5× |
| Radex Hand Minimum 3 Views (73130) |
$467.43 |
$719.13 |
4.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$181.27 |
$278.88 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$300.22 |
$461.87 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$300.22 |
$461.87 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$572.34 |
$880.53 |
4.6× |
| Radex Humerus Minimum 2 Views (73060) |
$306.16 |
$471.02 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$287.90 |
$442.93 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$648.78 |
$998.12 |
5.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$451.39 |
$694.45 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$263.78 |
$405.81 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$372.13 |
$572.50 |
3.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$478.46 |
$736.10 |
4.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$209.79 |
$322.76 |
2.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$583 |
$896.92 |
4.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$227.30 |
$349.69 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$359.89 |
$553.68 |
3.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$291.48 |
$448.42 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$478.55 |
$736.23 |
4.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$493.14 |
$758.68 |
4.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$31,128.17 |
$47,889.49 |
3.6× |
| Radiation treatment delivery level 1 (77402) |
$293.80 |
$452 |
2.4× |
| Radiation treatment delivery level 2 (77407) |
$1,110.62 |
$1,708.65 |
2.4× |
| Radiation treatment delivery level 3 (77412) |
$1,591.06 |
$2,447.78 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$412.02 |
$633.87 |
4.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$421.40 |
$648.31 |
3.4× |
| Radiologic exam chest 2 views (71046) |
$442.83 |
$681.28 |
4.3× |
| Radiologic exam colon single contrast study (74270) |
$790.11 |
$1,215.55 |
3.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$435.26 |
$669.63 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$721.49 |
$1,109.99 |
3.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$969.20 |
$1,491.08 |
4.7× |
| Radiologic examination femur 1 view (73551) |
$181.27 |
$278.88 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$315.26 |
$485.02 |
3.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$328.88 |
$505.98 |
2.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$328.88 |
$505.98 |
2.7× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$510.13 |
$784.81 |
1.8× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$408.82 |
$628.95 |
4.0× |
| Radiological examination surgical specimen (76098) |
$1,325.47 |
$2,039.18 |
2.1× |
| Radiopharm Dacryocystography (78660) |
$934.30 |
$1,437.39 |
2.0× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$3,045.39 |
$4,685.22 |
11.0× |
| Red cell survival study Non-Facility (78130) |
$2,004.28 |
$3,083.51 |
4.2× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$2,004.28 |
$3,083.51 |
3.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$655.36 |
$1,008.24 |
1.4× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$655.36 |
$1,008.24 |
1.4× |
| Renal Cyst Study (74470) |
$1,182.75 |
$1,819.61 |
1.8× |
| Ribs bilateral 3 views (71110) |
$351.92 |
$541.41 |
2.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,305.24 |
$2,008.06 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,824.75 |
$4,345.77 |
6.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,316.37 |
$6,640.57 |
6.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,975.46 |
$4,577.63 |
4.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,931.76 |
$7,587.33 |
7.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,618.65 |
$7,105.62 |
3.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,239.36 |
$8,060.55 |
3.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,618.65 |
$7,105.62 |
3.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$1,306.14 |
$2,009.44 |
4.7× |
| Rp Therapy Intravenous Administration (79101) |
$1,078.04 |
$1,658.53 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$248.92 |
$382.95 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,034.70 |
$1,591.85 |
3.7× |
| Salivary gland function study (78232) |
$1,164.27 |
$1,791.18 |
2.5× |
| Salivary gland imaging (78230) |
$1,283.34 |
$1,974.37 |
2.7× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$992.14 |
$1,526.37 |
2.1× |
| Scapula (73010) |
$527.78 |
$811.96 |
4.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$145.39 |
$223.68 |
6.2× |
| Shoulder 1 view (73020) |
$426.92 |
$656.80 |
4.2× |
| Sialogram (70390) |
$980.23 |
$1,508.04 |
3.5× |
| Simulation intermediate (77285) |
$2,337.67 |
$3,596.42 |
5.3× |
| Small bowel series (74250) |
$670.21 |
$1,031.09 |
3.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,162.59 |
$1,788.60 |
2.6× |
| Special dosimetry (77331) |
$355.93 |
$547.58 |
2.2× |
| Special Physics Consult (77370) |
$966.86 |
$1,487.48 |
6.1× |
| Special treatment procedure (77470) |
$1,258.20 |
$1,935.69 |
1.9× |
| Spine thoracic 3 views (72072) |
$248.92 |
$382.95 |
2.0× |
| Spleen imaging only (78185) |
$1,192.06 |
$1,833.94 |
2.5× |
| Splenoportograpy rs&i (75810) |
$10,535.45 |
$16,208.38 |
2.8× |
| Stereotactic Body Radiation Delivery (77373) |
$23,495.06 |
$36,146.25 |
11.1× |
| Superior sagittal sinus venogram (75870) |
$5,405.60 |
$8,316.30 |
1.4× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$678.56 |
$1,043.94 |
5.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$4,850.63 |
$7,462.50 |
11.0× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$4,479.35 |
$6,891.31 |
10.1× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,213.42 |
$1,866.80 |
4.3× |
| Testicular Imaging With Vascular Flow (78761) |
$1,647.69 |
$2,534.91 |
3.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,663.60 |
$4,097.84 |
6.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$410.87 |
$632.11 |
2.6× |
| Thoracolumbar 2 views (72080) |
$205.54 |
$316.21 |
2.0× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,121.43 |
$1,725.27 |
2.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,776.91 |
$2,733.71 |
2.8× |
| Thyroid imaging w/blood flow (78013) |
$1,242.98 |
$1,912.27 |
2.6× |
| Thyroid uptake measurement (78012) |
$855.56 |
$1,316.24 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,373.09 |
$2,112.45 |
2.9× |
| Tmj unilateral (70328) |
$183.99 |
$283.06 |
1.8× |
| Treatment device complex (77334) |
$1,781.08 |
$2,740.13 |
4.0× |
| Treatment device intermediate (77333) |
$1,014.05 |
$1,560.08 |
6.4× |
| Treatment devices simple (77332) |
$980.69 |
$1,508.76 |
6.2× |
| Ultrasound breast complete (76641) |
$914.78 |
$1,407.35 |
7.4× |
| Ultrasound elastography first target lesion (76982) |
$1,046.32 |
$1,609.73 |
8.5× |
| Ultrasound Exam Aaa Screen (76706) |
$644.56 |
$991.63 |
5.2× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$704.51 |
$1,083.86 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$623.20 |
$958.77 |
5.0× |
| Umbilical-artery Doppler (OB) (76820) |
$296.14 |
$455.60 |
2.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$161.03 |
$247.74 |
1.6× |
| Unlisted fluoroscopic procedure (76496) |
$216.37 |
$332.88 |
2.1× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$1,307.48 |
$2,011.50 |
2.8× |
| Unlisted magnetic resonance procedure (76498) |
$2,299.89 |
$3,538.29 |
22.4× |
| Unlisted ultrasound procedure (76999) |
$201.29 |
$309.68 |
2.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$169.83 |
$261.28 |
15.4× |
| Ureteral reflux study (78740) |
$1,627.49 |
$2,503.83 |
3.4× |
| Urethrocystogram voiding (74455) |
$853.34 |
$1,312.83 |
3.0× |
| Urethrocystography retrograde rs&i (74450) |
$853.34 |
$1,312.83 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$578.82 |
$890.49 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$596.21 |
$917.25 |
2.9× |
| Us breast unilateral limited (76642) |
$914.78 |
$1,407.35 |
8.9× |
| Us chest (76604) |
$533.90 |
$821.38 |
4.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$526.45 |
$809.93 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$610.75 |
$939.62 |
4.9× |
| Us elastography parenchyma (76981) |
$1,046.32 |
$1,609.73 |
8.5× |
| Us encephalogram (76506) |
$1,031.93 |
$1,587.58 |
8.4× |
| Us hips infant static (76886) |
$485.76 |
$747.32 |
4.7× |
| Us infant hips w manipulation (76885) |
$772.08 |
$1,187.82 |
7.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$358.31 |
$551.24 |
2.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$284.86 |
$438.24 |
2.3× |
| Us ob detailed single fetus (76811) |
$1,064.80 |
$1,638.16 |
3.8× |
| Us ob limited (76815) |
$490.82 |
$755.10 |
4.0× |
| Us ob transvaginal (76817) |
$831.56 |
$1,279.32 |
6.7× |
| Us pelvic non ob complete (76856) |
$782.26 |
$1,203.47 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$332.61 |
$511.70 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$541.48 |
$833.05 |
4.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$370.18 |
$569.50 |
3.0× |
| Us retroperitoneal complete (76770) |
$677.50 |
$1,042.31 |
5.5× |
| Us retroperitoneal limited (76775) |
$644.56 |
$991.63 |
5.2× |
| Us scrotum and contents (76870) |
$395.47 |
$608.42 |
3.2× |
| Us soft tissue head/neck (76536) |
$623.16 |
$958.70 |
5.0× |
| Us spinal canal and contents (76800) |
$507.34 |
$780.53 |
4.1× |
| Us transrectal (76872) |
$679.71 |
$1,045.70 |
5.5× |
| Us transrectal prostate volume (76873) |
$272.32 |
$418.95 |
2.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$839.10 |
$1,290.93 |
6.8× |
| Venogram adrenal unilat (75840) |
$7,820.53 |
$12,031.59 |
2.1× |
| Venogram extremity bilateral (75822) |
$2,697.30 |
$4,149.69 |
1.5× |
| Venogram Extremity Unilateral (75820) |
$2,875.07 |
$4,423.19 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$5,114.60 |
$7,868.61 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$3,902.70 |
$6,004.15 |
2.1× |
| Venography Orbital Rs&I (75880) |
$6,925.87 |
$10,655.18 |
9.3× |
| Venography Renal Bilateral (75833) |
$7,126.77 |
$10,964.26 |
1.9× |
| Venography renal unilateral selective rs&i (75831) |
$6,302.92 |
$9,696.80 |
1.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$6,518.45 |
$10,028.39 |
1.7× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$7,113.27 |
$10,943.49 |
9.6× |
| Venous sampling by catheter (75893) |
$8,473.96 |
$13,036.86 |
1.3× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$2,975.46 |
$4,577.63 |
4.6× |
| Wrist 2 views (73100) |
$451.35 |
$694.39 |
4.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$673.44 |
$1,036.06 |
5.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$299.78 |
$461.18 |
2.9× |
| X-ray b.e. reductn intuss (74283) |
$587.89 |
$904.44 |
2.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,149.73 |
$1,768.81 |
5.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$382.25 |
$588.08 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$181.27 |
$278.88 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$300.22 |
$461.87 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$453.11 |
$697.10 |
4.4× |
| X-ray eye for foreign body (70030) |
$184.67 |
$284.11 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$162.90 |
$250.61 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$243.56 |
$374.70 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$294.44 |
$452.99 |
2.9× |
| X-ray leg, infant (73592) |
$209.50 |
$322.32 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$400.96 |
$616.86 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$624.12 |
$960.19 |
5.1× |
| X-ray nose-rectum child f.b. (76010) |
$580.26 |
$892.70 |
5.6× |
| X-ray optic foramen (70190) |
$204.43 |
$314.51 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$488.72 |
$751.88 |
4.0× |
| X-ray retrograde pyelogram (74420) |
$917.40 |
$1,411.39 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$189.98 |
$292.27 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$339.86 |
$522.86 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$617.72 |
$950.34 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$435.10 |
$669.38 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$205.54 |
$316.21 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$302.30 |
$465.08 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$340.25 |
$523.46 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$438.60 |
$674.77 |
3.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$701.72 |
$1,079.57 |
3.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$293.14 |
$450.98 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$263.03 |
$404.66 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$200.11 |
$307.86 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$248.92 |
$382.95 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$248.92 |
$382.95 |
2.0× |
| Xr bone length studies (77073) |
$459.71 |
$707.25 |
3.7× |
| Xr c-spine 4 or 5 views (72050) |
$732.12 |
$1,126.34 |
5.9× |
| Xr c-spine 6 or more views (72052) |
$898.20 |
$1,381.84 |
7.3× |
| Xr chest 4+ views (71048) |
$546.33 |
$840.50 |
4.4× |
| Xr urogram antegrade (74425) |
$1,007.64 |
$1,550.22 |
2.4× |