| 3-D radiotherapy plan dose-volume histograms (77295) |
$620.60 |
$620.60 |
0.5× |
| Abdomen 2 views (74019) |
$600.60 |
$600.60 |
6.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,145.40 |
$1,145.40 |
3.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,370.75 |
$3,370.75 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,629.05 |
$3,629.05 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$7,424.10 |
$7,424.10 |
2.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,532.20 |
$6,532.20 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,365.10 |
$3,365.10 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$6,532.20 |
$6,532.20 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,532.20 |
$6,532.20 |
1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,643.50 |
$2,643.50 |
0.9× |
| Ankle 2 views (73600) |
$547.50 |
$547.50 |
6.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$919.70 |
$919.70 |
2.9× |
| Aortogram thoracic (75605) |
$6,532.20 |
$6,532.20 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,373.20 |
$3,373.20 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,353.35 |
$3,353.35 |
1.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$6,532.20 |
$6,532.20 |
2.2× |
| Arthrogram elbow (73085) |
$905.55 |
$905.55 |
2.8× |
| Arthrogram hip (73525) |
$710.20 |
$710.20 |
2.2× |
| Arthrogram shoulder (73040) |
$1,255.30 |
$1,255.30 |
3.9× |
| Arthrogram wrist (73115) |
$813.90 |
$813.90 |
2.5× |
| Arthrography knee lt (73580) |
$1,070.20 |
$1,070.20 |
3.3× |
| Basic radiation dosimetry calculation (77300) |
$91.60 |
$91.60 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,480.70 |
$1,480.70 |
4.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,744.90 |
$1,744.90 |
4.7× |
| Bone &/joint imaging whole body (78306) |
$2,696.20 |
$2,696.20 |
7.3× |
| Bone age studies (77072) |
$547.50 |
$547.50 |
5.7× |
| Bone Imaging 3 Phase (78315) |
$819.90 |
$819.90 |
2.2× |
| Bone survey complete (77075) |
$1,801.90 |
$1,801.90 |
18.7× |
| Brachytx isodose complex (77318) |
$486.70 |
$486.70 |
1.4× |
| Brachytx isodose intermed (77317) |
$303.50 |
$303.50 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$287.40 |
$287.40 |
0.8× |
| Brain image w/flow 4 + views (78606) |
$1,704.10 |
$1,704.10 |
3.4× |
| Brain imaging < 4 static views (78600) |
$852.60 |
$852.60 |
2.3× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,027.70 |
$1,027.70 |
2.8× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,578.20 |
$1,578.20 |
3.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$7,094.10 |
$7,094.10 |
5.4× |
| Brain Imaging Vascular Flow Only (78610) |
$572 |
$572 |
1.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,387 |
$2,387 |
6.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$980.60 |
$980.60 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$651.40 |
$651.40 |
8.1× |
| Chest 1 view (71045) |
$370.90 |
$370.90 |
4.6× |
| Chest 3 views (71047) |
$686 |
$686 |
8.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$950.10 |
$950.10 |
5.9× |
| Clavicle complete (73000) |
$582.20 |
$582.20 |
7.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$407.90 |
$407.90 |
4.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$728.50 |
$728.50 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,253.20 |
$3,253.20 |
10.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,776.65 |
$1,776.65 |
8.1× |
| CT abdomen w contrast (74160) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT abdomen w wo contrast (74170) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT abdomen w/o contrast (74150) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT angio hrt w/3d image (75574) |
$895.60 |
$895.60 |
2.8× |
| CT angiography upper extremity lt (73206) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT c-spine w/o contrast (72125) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT cervical spine w&w/o contrast (72127) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT cervical spine with contrast (72126) |
$2,702.50 |
$2,702.50 |
8.4× |
| CT chest w/wo contrast (71270) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT chest with contrast (71260) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT colonography w/dye (74262) |
$2,535.60 |
$2,535.60 |
15.7× |
| CT colonography w/o cntrst (74261) |
$2,535.60 |
$2,535.60 |
26.4× |
| CT head/brain with contrast (70460) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT head/brain without and with contrast (70470) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$895.60 |
$895.60 |
2.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$300 |
$300 |
3.7× |
| CT hrt w/3d image congen (75573) |
$895.60 |
$895.60 |
2.8× |
| CT iac w contrast (70481) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT limited/localized follow up study (76380) |
$868.90 |
$868.90 |
10.9× |
| CT lower ext w/o (73700) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT lower extremity w wo contrast (73702) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT lower extremity with contrast (73701) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT lumbar spine w & w/o contrast (72133) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT lumbar spine w/o contrast (72131) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT lumbar spine with contrast (72132) |
$2,702.50 |
$2,702.50 |
8.4× |
| CT maxillofacial w contrast (70487) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT maxillofacial w/o contrast (70486) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT maxillofacial w/wo contrast (70488) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT neck soft tissue w contrast (70491) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT orbits w/o contrast (70480) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT pelvis w & w/o contrast (72194) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT pelvis w/o contrast (72192) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$1,830.30 |
$1,830.30 |
22.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT soft tissue neck w/o contrast (70490) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT thoracic spine w/contrast (72129) |
$2,702.50 |
$2,702.50 |
16.8× |
| CT thoracic spine w/o contrast (72128) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT thoracic spine w/wo contrast (72130) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT thorax w/o contrast (71250) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT unlisted procedure (76497) |
$572.50 |
$572.50 |
7.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$3,253.20 |
$3,253.20 |
20.2× |
| CT upper extremity w/o contrast rt (73200) |
$2,702.50 |
$2,702.50 |
28.1× |
| CT upper extremity with contrast (73201) |
$2,702.50 |
$2,702.50 |
8.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$6,605.20 |
$6,605.20 |
40.9× |
| Cta Abdomen (74175) |
$3,253.20 |
$3,253.20 |
20.2× |
| CTA abdomen pelvis (74174) |
$3,135.85 |
$3,135.85 |
9.8× |
| CTA chest (71275) |
$3,253.20 |
$3,253.20 |
20.2× |
| Cta Head (70496) |
$3,253.20 |
$3,253.20 |
20.2× |
| CTA lwr ext w&w/o contrast (73706) |
$3,253.20 |
$3,253.20 |
20.2× |
| Cta Neck (70498) |
$3,253.20 |
$3,253.20 |
20.2× |
| Cta Pelvis (72191) |
$3,253.20 |
$3,253.20 |
20.2× |
| Cystography minimum 3 views rs&i (74430) |
$1,051.50 |
$1,051.50 |
3.3× |
| Diskogram cervical (72285) |
$3,350.80 |
$3,350.80 |
1.9× |
| Diskography lumbar (72295) |
$3,420.85 |
$3,420.85 |
1.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$319.50 |
$319.50 |
3.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$258.20 |
$258.20 |
2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$125.75 |
$125.75 |
1.6× |
| Echoencephalography real time imaging (76506) |
$1,767.30 |
$1,767.30 |
18.4× |
| Esophagus (74220) |
$527.40 |
$527.40 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$286.30 |
$286.30 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$287.70 |
$287.70 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$359.40 |
$359.40 |
1.6× |
| Foot 2 views (73620) |
$547.50 |
$547.50 |
6.8× |
| Forearm 2 views (73090) |
$535.60 |
$535.60 |
6.7× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$445.90 |
$445.90 |
2.0× |
| Gated Heart Planar Single (78472) |
$1,271.20 |
$1,271.20 |
3.5× |
| Hand 2 views (73120) |
$547.50 |
$547.50 |
5.7× |
| Hand 3 views (73130) |
$608.80 |
$608.80 |
7.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$6,532.20 |
$6,532.20 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,214.50 |
$2,214.50 |
4.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,214.50 |
$2,214.50 |
6.0× |
| Ht muscle image spect sing (78451) |
$2,842.30 |
$2,842.30 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$478.90 |
$478.90 |
6.0× |
| Hysterosalpingogram (74740) |
$930 |
$930 |
4.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$523.10 |
$523.10 |
5.4× |
| Kidney funcj study non-img radioisotopic study (78725) |
$1,385.20 |
$1,385.20 |
3.8× |
| Kidney imaging morphology (78700) |
$1,493.30 |
$1,493.30 |
4.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,149.60 |
$2,149.60 |
4.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,703.75 |
$1,703.75 |
3.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,856.80 |
$2,856.80 |
5.7× |
| Knee 3 views (73562) |
$529.10 |
$529.10 |
6.6× |
| Liver & spleen imaging static only (78215) |
$1,529.30 |
$1,529.30 |
4.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,202.50 |
$2,202.50 |
6.0× |
| Liver imaging static only (78201) |
$1,139.10 |
$1,139.10 |
2.3× |
| Liver imaging w/vascular flow (78202) |
$1,454.40 |
$1,454.40 |
2.9× |
| Lung perf&ventilat diferentl (78598) |
$3,677.20 |
$3,677.20 |
7.4× |
| Lung perfusion differential (78597) |
$1,533.90 |
$1,533.90 |
4.2× |
| Lung Ventilation Imaging (78579) |
$1,535.60 |
$1,535.60 |
4.2× |
| Lymphoscintigraphy (78195) |
$674.35 |
$674.35 |
1.4× |
| Mammary ductogram or galactogram multiple (77054) |
$744.70 |
$744.70 |
3.4× |
| Mammary ductogram or galactogram single (77053) |
$795.90 |
$795.90 |
3.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$81.95 |
$81.95 |
1.0× |
| Meckels Diverticulum (78290) |
$1,584.40 |
$1,584.40 |
4.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$643.50 |
$643.50 |
1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$62.50 |
$62.50 |
2.3× |
| MRA head w & w/o contrast (70546) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRA head w/o contrast (70544) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRA head with contrast (70545) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRA neck w contrast (70548) |
$4,269.60 |
$4,269.60 |
13.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRA neck w/o contrast (70547) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI abdomen w contrast (74182) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI abdomen w/o contrast (74181) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI any jnt lwr ext with con lt (73722) |
$3,917 |
$3,917 |
5.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,917 |
$3,917 |
5.4× |
| MRI breast w/o contrast bilateral (77047) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI breast w/o contrast unilat (77046) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI c-spine with contrast (72142) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI cervical spine w/o contrast (72141) |
$2,642.30 |
$2,642.30 |
12.0× |
| MRI chest w/o & w/contrast material (71552) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI chest w/o contrast (71550) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI chest with contrast (71551) |
$4,269.60 |
$4,269.60 |
5.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,917 |
$3,917 |
12.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,917 |
$3,917 |
12.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,917 |
$3,917 |
17.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,917 |
$3,917 |
17.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI orbit/face/neck w/contrast (70542) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI pelvis w contrast (72196) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI pelvis w/o contrast (72195) |
$4,269.60 |
$4,269.60 |
19.5× |
| MRI scan of arm joint before and after contrast (73223) |
$4,550.10 |
$4,550.10 |
14.2× |
| MRI scan of leg joint before and after contrast (73723) |
$4,550.10 |
$4,550.10 |
14.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,269.60 |
$4,269.60 |
13.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,657.70 |
$5,657.70 |
17.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,642.30 |
$2,642.30 |
12.0× |
| MRI tmj (70336) |
$1,163.20 |
$1,163.20 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$3,917 |
$3,917 |
17.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,550.10 |
$4,550.10 |
14.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,917 |
$3,917 |
17.9× |
| Myelogram Lumbar (72265) |
$6,411.40 |
$6,411.40 |
8.9× |
| Myelogram thoracic (72255) |
$6,818.60 |
$6,818.60 |
9.5× |
| Myelography 2 or more regions (72270) |
$7,198.80 |
$7,198.80 |
10.0× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$7,094.10 |
$7,094.10 |
6.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,097.65 |
$3,097.65 |
2.6× |
| Neck soft tissue (70360) |
$498.80 |
$498.80 |
6.2× |
| Nm adrenal scan (78075) |
$1,407.40 |
$1,407.40 |
1.2× |
| Nm cisternogram (78630) |
$1,435.90 |
$1,435.90 |
2.9× |
| Nm gastric emptying study (78264) |
$2,777.80 |
$2,777.80 |
7.6× |
| Nm gastroesophageal reflux study (78262) |
$1,454.40 |
$1,454.40 |
4.0× |
| Nm peritoneal-venous shunt patency (78291) |
$1,058 |
$1,058 |
2.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,157.60 |
$1,157.60 |
0.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,765.30 |
$1,765.30 |
4.8× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$1,365 |
$1,365 |
2.7× |
| Nuclear Rx Oral Admin (79005) |
$667.80 |
$667.80 |
3.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$342.95 |
$342.95 |
3.6× |
| Osseous survey infant (77076) |
$482 |
$482 |
5.0× |
| Osseous survey limited (77074) |
$939.80 |
$939.80 |
9.8× |
| Parathyrd planar w/wo subtrj (78071) |
$747.80 |
$747.80 |
2.0× |
| Parathyroid imaging (78070) |
$1,407.40 |
$1,407.40 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$588.50 |
$588.50 |
6.1× |
| PET image w/CT, skull-thigh (78815) |
$7,094.10 |
$7,094.10 |
5.4× |
| PET imaging for CT attenuation whole body (78816) |
$10,058.30 |
$10,058.30 |
7.6× |
| PET whole body (78813) |
$7,094.10 |
$7,094.10 |
5.4× |
| Pr csf ventriculography (78635) |
$1,151.50 |
$1,151.50 |
2.3× |
| Pr heart first pass single,planar (78481) |
$2,437.50 |
$2,437.50 |
4.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,550.10 |
$4,550.10 |
14.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,005.10 |
$1,005.10 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,694.30 |
$2,694.30 |
5.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$888.10 |
$888.10 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$154.40 |
$154.40 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,087.90 |
$1,087.90 |
11.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$1,019.40 |
$1,019.40 |
10.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$832.40 |
$832.40 |
8.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$819.90 |
$819.90 |
8.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$447.70 |
$447.70 |
5.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$564 |
$564 |
7.0× |
| Radiologic exam colon single contrast study (74270) |
$1,340.40 |
$1,340.40 |
8.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$675.40 |
$675.40 |
4.2× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$350.60 |
$350.60 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,409.60 |
$1,409.60 |
8.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,378.60 |
$1,378.60 |
8.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$616.90 |
$616.90 |
7.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$503.10 |
$503.10 |
6.3× |
| Radiological examination surgical specimen (76098) |
$736.50 |
$736.50 |
1.5× |
| Review by radiologist of adrenal gland vein image (75840) |
$6,532.20 |
$6,532.20 |
2.2× |
| Ribs bilateral 3 views (71110) |
$517.50 |
$517.50 |
5.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,250.90 |
$1,250.90 |
3.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,757.40 |
$3,757.40 |
7.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,816.20 |
$2,816.20 |
5.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$877.10 |
$877.10 |
4.1× |
| Rp Therapy Intravenous Administration (79101) |
$877.10 |
$877.10 |
4.1× |
| Sacroiliac Joints < 3 Views (72200) |
$519.10 |
$519.10 |
5.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,092.55 |
$1,092.55 |
5.0× |
| Salivary gland imaging (78230) |
$994 |
$994 |
2.7× |
| Scanogram (77073) |
$894.40 |
$894.40 |
9.3× |
| Scapula complete (73010) |
$608.80 |
$608.80 |
6.3× |
| Screening digital breast tomosynthesis (77063) |
$85.60 |
$85.60 |
3.7× |
| Sella turcica (70240) |
$445.90 |
$445.90 |
5.6× |
| Sialogram (70390) |
$582.20 |
$582.20 |
2.7× |
| Simulation intermediate (77285) |
$158.10 |
$158.10 |
0.5× |
| Small bowel series (74250) |
$1,175.80 |
$1,175.80 |
7.3× |
| Special dosimetry (77331) |
$127.20 |
$127.20 |
1.0× |
| Special treatment procedure (77470) |
$295.50 |
$295.50 |
0.6× |
| Spine thoracic 3 views (72072) |
$927.60 |
$927.60 |
9.6× |
| Spleen imaging only (78185) |
$1,202.10 |
$1,202.10 |
3.3× |
| Splenoportograpy rs&i (75810) |
$805.80 |
$805.80 |
0.3× |
| Superior sagittal sinus venogram (75870) |
$6,532.20 |
$6,532.20 |
2.2× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$421.40 |
$421.40 |
1.2× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$377.90 |
$377.90 |
1.1× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$815.90 |
$815.90 |
3.7× |
| Testicular Imaging With Vascular Flow (78761) |
$1,535.60 |
$1,535.60 |
4.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$226.80 |
$226.80 |
0.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$104.30 |
$104.30 |
0.8× |
| Thoracolumbar 2 views (72080) |
$805.80 |
$805.80 |
10.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,027.70 |
$2,027.70 |
4.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,134 |
$1,134 |
3.1× |
| Thyroid uptake measurement (78012) |
$687.70 |
$687.70 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,574.10 |
$1,574.10 |
4.3× |
| Tmj unilateral (70328) |
$379 |
$379 |
4.7× |
| Tomogram (76100) |
$1,244.60 |
$1,244.60 |
12.9× |
| Treatment device intermediate (77333) |
$105.40 |
$105.40 |
0.9× |
| Treatment devices simple (77332) |
$64.20 |
$64.20 |
0.5× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$3,831.30 |
$3,831.30 |
7.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$517.50 |
$517.50 |
1.4× |
| Tx devices design & construction complex (77334) |
$160.30 |
$160.30 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$193.60 |
$193.60 |
2.0× |
| Umbilical-artery Doppler (OB) (76820) |
$265.55 |
$265.55 |
2.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$828.20 |
$828.20 |
10.3× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$1,230.90 |
$1,230.90 |
3.3× |
| Unlisted Ultrasound Procedure (76999) |
$314.50 |
$314.50 |
3.9× |
| Upper Extremity Infant (73092) |
$348.20 |
$348.20 |
3.6× |
| Urethrocystography retrograde rs&i (74450) |
$970.60 |
$970.60 |
4.4× |
| Urethrocystography voiding (74455) |
$970.60 |
$970.60 |
4.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,277.20 |
$1,277.20 |
7.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$2,009.20 |
$2,009.20 |
12.5× |
| Us abdl aorta screen aaa (76706) |
$406.30 |
$406.30 |
4.2× |
| Us breast unilateral complete (76641) |
$913.40 |
$913.40 |
9.5× |
| Us breast unilateral limited (76642) |
$609.10 |
$609.10 |
7.6× |
| Us chest (76604) |
$923.75 |
$923.75 |
9.6× |
| Us compl joint r-t w/image documentation (76881) |
$998.15 |
$998.15 |
10.4× |
| Us elastography parenchyma (76981) |
$398.70 |
$398.70 |
4.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$246.30 |
$246.30 |
2.6× |
| Us guided compression repair (76936) |
$1,562.20 |
$1,562.20 |
7.9× |
| Us infant hips dynamic (76885) |
$2,013.30 |
$2,013.30 |
25.2× |
| Us infant hips limited static (76886) |
$220 |
$220 |
2.7× |
| Us kidney transplant (76776) |
$1,767.30 |
$1,767.30 |
18.4× |
| Us ob detailed single fetus (76811) |
$343.50 |
$343.50 |
1.6× |
| Us ob transvaginal (76817) |
$394.55 |
$394.55 |
4.1× |
| Us pelvic non ob complete (76856) |
$343.50 |
$343.50 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$922.05 |
$922.05 |
9.6× |
| Us pregnancy ltd (76815) |
$402.60 |
$402.60 |
4.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$292 |
$292 |
3.0× |
| Us retroperitoneal complete (76770) |
$924.05 |
$924.05 |
9.6× |
| Us retroperitoneal limited (76775) |
$183.20 |
$183.20 |
1.9× |
| Us scrotum and contents (76870) |
$1,767.30 |
$1,767.30 |
18.4× |
| Us soft tissue head/neck (76536) |
$1,767.30 |
$1,767.30 |
18.4× |
| Us spinal canal and contents (76800) |
$1,801.90 |
$1,801.90 |
18.7× |
| Us transrectal (76872) |
$1,891.10 |
$1,891.10 |
19.7× |
| Us transrectal prostate volume (76873) |
$1,891.10 |
$1,891.10 |
19.7× |
| Us xtr non-vasc lmtd (76882) |
$1,088.20 |
$1,088.20 |
11.3× |
| Vascular flow imaging (78445) |
$260 |
$260 |
0.7× |
| Vasogram (74440) |
$716.30 |
$716.30 |
3.3× |
| Venogram extremity bilateral (75822) |
$2,643.50 |
$2,643.50 |
1.8× |
| Venography caval inferior serialography rs&i (75825) |
$6,532.20 |
$6,532.20 |
2.2× |
| Venography caval superior serialography rs&i (75827) |
$1,391.30 |
$1,391.30 |
1.0× |
| Venography epidural rs&i (75872) |
$2,643.50 |
$2,643.50 |
4.6× |
| Venography extremity unilateral rs&i (75820) |
$1,451.75 |
$1,451.75 |
1.0× |
| Venography Renal Bilateral (75833) |
$6,532.20 |
$6,532.20 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$6,532.20 |
$6,532.20 |
2.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$209.70 |
$209.70 |
0.1× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$6,532.20 |
$6,532.20 |
1.3× |
| Wrist 2 views (73100) |
$547.50 |
$547.50 |
6.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,175.80 |
$1,175.80 |
12.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$651.40 |
$651.40 |
8.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$716.30 |
$716.30 |
9.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,698.50 |
$1,698.50 |
10.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$588.50 |
$588.50 |
7.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$645.30 |
$645.30 |
8.1× |
| X-ray exam hip uni 1 view (73501) |
$292.50 |
$292.50 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$414.40 |
$414.40 |
5.2× |
| X-ray exam hip uni 4/> views (73503) |
$307.30 |
$307.30 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$426.70 |
$426.70 |
4.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$477.70 |
$477.70 |
5.0× |
| X-ray exam of femur 1 (73551) |
$154.40 |
$154.40 |
1.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$2,301.90 |
$2,301.90 |
14.3× |
| X-ray eye for foreign body (70030) |
$523.10 |
$523.10 |
6.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$783.50 |
$783.50 |
8.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$476.50 |
$476.50 |
6.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$588.50 |
$588.50 |
7.4× |
| X-ray head for orthodontia (70350) |
$140.10 |
$140.10 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$547.50 |
$547.50 |
6.8× |
| X-ray IV pyelogram+drip infusn (74410) |
$1,555.80 |
$1,555.80 |
9.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$720.40 |
$720.40 |
9.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$628.45 |
$628.45 |
6.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$382.40 |
$382.40 |
4.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$230.45 |
$230.45 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$795.90 |
$795.90 |
8.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,086.40 |
$1,086.40 |
11.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$744.70 |
$744.70 |
7.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$529.30 |
$529.30 |
6.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$556 |
$556 |
6.9× |
| X-ray of voice box or throat (70370) |
$523.20 |
$523.20 |
6.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$744.70 |
$744.70 |
7.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$618.60 |
$618.60 |
6.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,277.20 |
$1,277.20 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$456.30 |
$456.30 |
5.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$795.90 |
$795.90 |
8.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$732.60 |
$732.60 |
7.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$612.40 |
$612.40 |
6.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$612.40 |
$612.40 |
7.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$347.80 |
$347.80 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$807.80 |
$807.80 |
10.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$570 |
$570 |
7.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$767.10 |
$767.10 |
8.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$651.40 |
$651.40 |
6.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$572 |
$572 |
7.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$547.50 |
$547.50 |
6.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$399.95 |
$399.95 |
5.0× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$273.40 |
$273.40 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$873.20 |
$873.20 |
9.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$614.20 |
$614.20 |
6.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$259.70 |
$259.70 |
3.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$608.80 |
$608.80 |
7.6× |
| Xr arthrogram ankle (73615) |
$679.80 |
$679.80 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$1,019.40 |
$1,019.40 |
10.6× |
| Xr chest 4+ views (71048) |
$783.50 |
$783.50 |
8.1× |
| Xr Cholecystography Oral Contrast (74290) |
$655.20 |
$655.20 |
4.1× |
| Xr finger(s) 2+ views (73140) |
$259.70 |
$259.70 |
3.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$622.70 |
$622.70 |
6.5× |
| Xr myelogram posterior fossa (70010) |
$1,464.60 |
$1,464.60 |
4.6× |
| Xr optic foramina (70190) |
$667.80 |
$667.80 |
8.3× |
| Xr shoulder 1 view (73020) |
$421.40 |
$421.40 |
5.3× |
| Xr spine cervical 4 or 5 views (72050) |
$907.40 |
$907.40 |
9.4× |
| Xr tibia/fibula 2 views (73590) |
$600.60 |
$600.60 |
7.5× |
| Xr tmj bilateral (70330) |
$564 |
$564 |
7.0× |
| Xray knee 1 or 2 views rt (73560) |
$377.10 |
$377.10 |
4.7× |