| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$10,073 |
$10,073 |
7.0× |
| Acute gi blood loss imaging (78278) |
$2,269 |
$2,269 |
5.4× |
| Angio adrenal bilat select (75733) |
$11,978 |
$11,978 |
3.6× |
| Angio adrenal unilat select (75731) |
$11,978 |
$11,978 |
3.6× |
| Angio extremity unilateral (75710) |
$8,269 |
$8,269 |
2.5× |
| Angio pulmonary unilateral (75741) |
$11,978 |
$11,978 |
3.6× |
| Angiogram extremity bilateral (75716) |
$11,575 |
$11,575 |
3.5× |
| Angiogram pelvic (75736) |
$7,188 |
$7,188 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$5,877 |
$5,877 |
1.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$11,978 |
$11,978 |
3.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,489 |
$14,489 |
2.5× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$622 |
$622 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$5,877 |
$5,877 |
1.8× |
| Ankle 2 views (73600) |
$500 |
$500 |
5.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$11,885 |
$11,885 |
3.6× |
| Arthrography knee lt (73580) |
$1,480 |
$1,480 |
4.1× |
| Arthrography wrist lt (73115) |
$1,469 |
$1,469 |
4.0× |
| Barium enema (74270) |
$1,015 |
$1,015 |
5.5× |
| Basic dosimetry (77300) |
$1,030 |
$1,030 |
7.3× |
| Bilat selctv renal venogram (75833) |
$6,601 |
$6,601 |
2.0× |
| Bone age studies (77072) |
$485 |
$485 |
4.4× |
| Bone survey complete (77075) |
$1,512 |
$1,512 |
13.8× |
| Bowel imaging (78290) |
$2,482 |
$2,482 |
5.9× |
| Brain image w/flow 4 + views (78606) |
$2,142 |
$2,142 |
3.8× |
| Card MRI w/stress img & dye (75563) |
$6,087 |
$6,087 |
7.4× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$3,255 |
$3,255 |
7.8× |
| Cardiac MRI w/stress img (75559) |
$4,464 |
$4,464 |
7.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$5,275 |
$5,275 |
14.5× |
| Cardiac shunt detection (78428) |
$1,883 |
$1,883 |
4.5× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Age Under 21 (78635) |
$2,784 |
$2,784 |
4.9× |
| Cerebrospinal fluid leakage (78650) |
$3,255 |
$3,255 |
2.4× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$536 |
$536 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,039 |
$1,039 |
5.7× |
| Cisternogram (78630) |
$3,555 |
$3,555 |
6.3× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$4,453 |
$4,453 |
5.4× |
| Clavicle complete (73000) |
$379 |
$379 |
4.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$4,787 |
$4,787 |
26.1× |
| Contrast exam abdominl aorta (75625) |
$9,630 |
$9,630 |
2.9× |
| Contrast exam thoracic aorta (75605) |
$11,978 |
$11,978 |
2.1× |
| Csf shunt evaluation (78645) |
$2,054 |
$2,054 |
3.6× |
| CT - st neck w&wo contr (70492) |
$4,588 |
$4,588 |
25.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,968 |
$3,968 |
10.9× |
| CT abdomen and pelvis without contrast (74176) |
$3,053 |
$3,053 |
12.3× |
| CT abdomen w wo contrast (74170) |
$4,572 |
$4,572 |
25.0× |
| CT abdomen w/contrast (74160) |
$3,870 |
$3,870 |
21.1× |
| CT abdomen w/o contrast (74150) |
$3,518 |
$3,518 |
32.2× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$3,886 |
$3,886 |
10.7× |
| CT angio abdom w/o & w/dye (74175) |
$5,180 |
$5,180 |
28.3× |
| CT angio abdominal arteries (75635) |
$7,148 |
$7,148 |
39.0× |
| CT angio hrt w/3d image (75574) |
$5,614 |
$5,614 |
15.4× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,861 |
$3,861 |
21.1× |
| CT cervical spine w/contrast (72126) |
$5,229 |
$5,229 |
14.4× |
| CT cervical spine w/o contrast (72125) |
$4,754 |
$4,754 |
43.5× |
| CT chest w/contrast (71260) |
$3,323 |
$3,323 |
18.1× |
| CT extremity upper w & w/o contrast (73202) |
$3,683 |
$3,683 |
20.1× |
| CT head/brain with contrast (70460) |
$4,081 |
$4,081 |
22.3× |
| CT head/brain without and with contrast (70470) |
$4,823 |
$4,823 |
26.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,756 |
$1,756 |
4.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,597 |
$1,597 |
17.6× |
| CT hrt w/3d image congen (75573) |
$2,078 |
$2,078 |
5.7× |
| CT limited/localized follow up study (76380) |
$1,896 |
$1,896 |
20.9× |
| CT lower ext w/wo contrast (73702) |
$3,771 |
$3,771 |
20.6× |
| CT lower extremity w contrast (73701) |
$3,192 |
$3,192 |
17.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,900 |
$2,900 |
26.6× |
| CT lumbar spine w/contrast (72132) |
$4,923 |
$4,923 |
13.5× |
| CT lumbar spine w/o contrast (72131) |
$4,475 |
$4,475 |
41.0× |
| CT lumbar spine w/o then w/ con (72133) |
$5,817 |
$5,817 |
31.8× |
| CT maxillofacial area w/o contrast (70486) |
$3,825 |
$3,825 |
35.0× |
| CT maxillofacial w/contrast (70487) |
$4,210 |
$4,210 |
23.0× |
| CT maxillofacial w/o then w/ con (70488) |
$4,976 |
$4,976 |
27.2× |
| CT orbit sella ear w/o con (70480) |
$4,353 |
$4,353 |
39.9× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$5,660 |
$5,660 |
30.9× |
| CT pelvis w & w/o contrast (72194) |
$4,758 |
$4,758 |
26.0× |
| CT pelvis w/o contrast (72192) |
$3,658 |
$3,658 |
33.5× |
| CT soft tissue neck w/contrast (70491) |
$3,880 |
$3,880 |
21.2× |
| CT soft tissue neck w/o contrast (70490) |
$3,529 |
$3,529 |
32.3× |
| CT spine cervical w/wo contrast (72127) |
$6,180 |
$6,180 |
33.7× |
| CT thoracic spine w/contrast (72129) |
$4,804 |
$4,804 |
26.2× |
| CT thoracic spine w/o contrast (72128) |
$4,367 |
$4,367 |
40.0× |
| CT thoracic spine w/o then w/ con (72130) |
$5,677 |
$5,677 |
31.0× |
| CT thorax w/o contrast (71250) |
$3,021 |
$3,021 |
27.7× |
| CT thorax w/o then w/ contrast (71270) |
$3,928 |
$3,928 |
21.4× |
| CT upper extremity w/dye (73201) |
$3,116 |
$3,116 |
8.6× |
| CT upper extremity w/o contrast rt (73200) |
$2,834 |
$2,834 |
26.0× |
| CTA chest w/wo contrast (71275) |
$4,474 |
$4,474 |
24.4× |
| CTA head w contrast (70496) |
$6,187 |
$6,187 |
33.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,412 |
$1,412 |
3.9× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$4,334 |
$4,334 |
23.7× |
| Cta Neck (70498) |
$7,484 |
$7,484 |
40.9× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$4,334 |
$4,334 |
23.7× |
| Dilation ureters/urethra rs&i (74485) |
$6,459 |
$6,459 |
3.0× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$5,383 |
$5,383 |
2.6× |
| Diskography lumbar (72295) |
$4,733 |
$4,733 |
2.3× |
| Doppler echo fetal spectral display complete (76827) |
$1,391 |
$1,391 |
12.7× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$1,263 |
$1,263 |
11.6× |
| Echo exam of eye (76529) |
$1,715 |
$1,715 |
18.9× |
| Echo exam of eye (76516) |
$1,391 |
$1,391 |
12.7× |
| Echo exam of eye thickness (76514) |
$1,391 |
$1,391 |
46.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,643 |
$1,643 |
6.6× |
| Esophageal motility (78258) |
$2,142 |
$2,142 |
5.1× |
| Esophogram (74220) |
$981 |
$981 |
5.4× |
| Fetal echo complete (76825) |
$1,898 |
$1,898 |
3.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$840 |
$840 |
3.4× |
| Functional MRI brain by phys/psych (70555) |
$4,058 |
$4,058 |
16.3× |
| Functional MRI brain by tech (70554) |
$963 |
$963 |
3.9× |
| Gastric emptying study (78264) |
$2,535 |
$2,535 |
6.1× |
| Gastric mucosa imaging (78261) |
$1,489 |
$1,489 |
3.6× |
| Gastroesophageal reflux study (78262) |
$2,357 |
$2,357 |
5.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$11,978 |
$11,978 |
3.6× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$6,349 |
$6,349 |
1.9× |
| Hepatobil syst image w/drug (78227) |
$2,092 |
$2,092 |
3.7× |
| Hepatobiliary system imaging (78226) |
$1,623 |
$1,623 |
3.9× |
| Humerus min 2 views (73060) |
$462 |
$462 |
5.1× |
| Ivp (74400) |
$856 |
$856 |
4.7× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$3,511 |
$3,511 |
6.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$2,909 |
$2,909 |
5.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,169 |
$3,169 |
5.6× |
| Kidney w vascular flow (78701) |
$2,826 |
$2,826 |
6.8× |
| Liver & spleen; static only (78215) |
$1,798 |
$1,798 |
4.3× |
| Liver & spleen; w vasc flow (78216) |
$1,970 |
$1,970 |
4.7× |
| Liver imaging w/vascular flow (78202) |
$1,798 |
$1,798 |
3.2× |
| Lung perfusion differential (78597) |
$1,623 |
$1,623 |
3.9× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$2,511 |
$2,511 |
1.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$2,511 |
$2,511 |
3.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$2,511 |
$2,511 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$2,511 |
$2,511 |
0.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$5,106 |
$5,106 |
14.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$6,475 |
$6,475 |
17.8× |
| Mr safety determination physician/other qhp (76016) |
$359 |
$359 |
4.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$235 |
$235 |
3.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$100 |
$100 |
3.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$364 |
$364 |
3.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$986 |
$986 |
4.0× |
| MRA head w & w/o contrast (70546) |
$4,926 |
$4,926 |
13.5× |
| MRA head w/contrast (70545) |
$3,749 |
$3,749 |
10.3× |
| MRA head w/o contrast (70544) |
$3,789 |
$3,789 |
15.2× |
| MRA neck w/contrast (70548) |
$3,753 |
$3,753 |
10.3× |
| MRA neck w/o contrast (70547) |
$3,547 |
$3,547 |
14.2× |
| MRA neck w/wo contrast (70549) |
$4,613 |
$4,613 |
12.7× |
| MRI abdomen w/contrast (74182) |
$4,458 |
$4,458 |
12.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,270 |
$5,270 |
14.5× |
| MRI abdomen w/o contrast (74181) |
$3,796 |
$3,796 |
15.2× |
| MRI any jnt lwr ext with con lt (73722) |
$4,322 |
$4,322 |
5.3× |
| MRI bone marrow (77084) |
$4,174 |
$4,174 |
16.8× |
| MRI breast without contrast material unilateral (77046) |
$1,059 |
$1,059 |
4.3× |
| MRI cardiac w/o contrast (75557) |
$4,058 |
$4,058 |
16.3× |
| MRI cervical spine w/o contrast (72141) |
$4,408 |
$4,408 |
17.7× |
| MRI cervical spine with contrast (72142) |
$4,849 |
$4,849 |
13.3× |
| MRI chest w & w/o contrast (71552) |
$5,275 |
$5,275 |
14.5× |
| MRI chest w/contrast (71551) |
$4,398 |
$4,398 |
5.4× |
| MRI chest w/o contrast (71550) |
$4,058 |
$4,058 |
16.3× |
| MRI elastography (76391) |
$1,059 |
$1,059 |
4.3× |
| MRI fetal sngl/1st gestation (74712) |
$4,058 |
$4,058 |
16.3× |
| MRI joint upper ext w/contrast (73222) |
$4,269 |
$4,269 |
5.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$5,045 |
$5,045 |
13.8× |
| MRI joint upr extrem w/o dye (73221) |
$3,880 |
$3,880 |
15.6× |
| Mri Lower Extremity W/O Dye (73718) |
$4,981 |
$4,981 |
20.0× |
| MRI lumbar spine with contrast (72149) |
$5,629 |
$5,629 |
15.5× |
| MRI lumbar w/wo contrast (72158) |
$5,870 |
$5,870 |
16.1× |
| MRI lwr ext w/o jnts with con rt (73719) |
$5,422 |
$5,422 |
14.9× |
| MRI orbit/face/neck w/contrast (70542) |
$4,770 |
$4,770 |
13.1× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$5,637 |
$5,637 |
15.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$4,174 |
$4,174 |
16.8× |
| MRI pelvis w/ contrast (72196) |
$4,776 |
$4,776 |
13.1× |
| MRI pelvis w/o contrast (72195) |
$4,297 |
$4,297 |
17.2× |
| MRI pelvis w/wo contrast (72197) |
$5,788 |
$5,788 |
15.9× |
| MRI spectroscopy (76390) |
$4,174 |
$4,174 |
45.9× |
| MRI spine cervical wo/w contrast (72156) |
$5,732 |
$5,732 |
15.7× |
| MRI spine thoracic w/contrast (72147) |
$4,612 |
$4,612 |
12.7× |
| MRI thoracic spine w wo contrast (72157) |
$5,451 |
$5,451 |
15.0× |
| MRI thoracic spine w/o contrast (72146) |
$4,191 |
$4,191 |
16.8× |
| MRI tmj (70336) |
$4,174 |
$4,174 |
16.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$5,037 |
$5,037 |
20.2× |
| Mri Upper Extremity W/Dye (73219) |
$5,423 |
$5,423 |
14.9× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$6,547 |
$6,547 |
18.0× |
| Myelogram thoracic (72255) |
$2,379 |
$2,379 |
2.9× |
| Myelography 2 or more regions (72270) |
$2,379 |
$2,379 |
2.9× |
| Myelography lumbosacral (72265) |
$2,379 |
$2,379 |
2.9× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$6,504 |
$6,504 |
4.8× |
| Myocardial perfusion planar multiple studies (78454) |
$6,504 |
$6,504 |
4.8× |
| Myocardial spect single study at rest or stress (78451) |
$6,164 |
$6,164 |
4.6× |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
$6,626 |
$6,626 |
4.4× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$6,626 |
$6,626 |
4.4× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$10,334 |
$10,334 |
4.5× |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
$11,481 |
$11,481 |
5.0× |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
$11,481 |
$11,481 |
7.2× |
| Nm bone 3 phase (78315) |
$2,998 |
$2,998 |
7.2× |
| Nm bone imaging whole body (78306) |
$2,826 |
$2,826 |
6.8× |
| Nm bone marrow scan multiple (78103) |
$2,398 |
$2,398 |
5.7× |
| Nm bone multi (78305) |
$3,169 |
$3,169 |
7.6× |
| Nm heart perfusion spect stress rest (78452) |
$6,504 |
$6,504 |
4.8× |
| Nm kidney function (78725) |
$2,280 |
$2,280 |
5.5× |
| Nm kidney imaging morphology (78700) |
$2,568 |
$2,568 |
6.2× |
| Nm liver image static only (78201) |
$1,626 |
$1,626 |
2.9× |
| Nm lymph system (78195) |
$2,909 |
$2,909 |
5.1× |
| Nm thyroid imaging only (78013) |
$1,690 |
$1,690 |
4.0× |
| Nose to rectum for fb child (76010) |
$504 |
$504 |
5.5× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$3,424 |
$3,424 |
6.0× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Age Under 21 (76519) |
$1,531 |
$1,531 |
14.0× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$1,501 |
$1,501 |
13.7× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$1,391 |
$1,391 |
12.7× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter Age Under… (76510) |
$1,569 |
$1,569 |
11.3× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$1,531 |
$1,531 |
14.0× |
| Oral radiopharm rx (79005) |
$1,418 |
$1,418 |
5.8× |
| Orthopantogram (70355) |
$279 |
$279 |
3.1× |
| Parathyroid imaging (78070) |
$2,226 |
$2,226 |
5.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,691 |
$1,691 |
4.1× |
| Peritoneal-venous shunt patency test (78291) |
$2,054 |
$2,054 |
4.9× |
| Peritoneogram rs&i (74190) |
$1,515 |
$1,515 |
2.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,324 |
$7,324 |
4.9× |
| PET imaging CT for attenuation limited area (78814) |
$6,813 |
$6,813 |
4.6× |
| PET imaging for CT attenuation whole body (78816) |
$6,646 |
$6,646 |
4.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,395 |
$4,395 |
1.3× |
| Pulmonary perfusion imaging particulate (78580) |
$2,054 |
$2,054 |
4.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,177 |
$1,177 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$372 |
$372 |
4.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$481 |
$481 |
4.4× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$920 |
$920 |
8.4× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$920 |
$920 |
8.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$290 |
$290 |
3.2× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$290 |
$290 |
3.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$481 |
$481 |
4.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$481 |
$481 |
4.4× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$920 |
$920 |
8.4× |
| Radex spine cervical 2 or 3 views (72040) |
$586 |
$586 |
6.4× |
| Radex spine cervical 4 or 5 views (72050) |
$645 |
$645 |
5.9× |
| Radex spine cervical 6 or more views (72052) |
$781 |
$781 |
7.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$485 |
$485 |
5.3× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$861 |
$861 |
7.9× |
| Radiologic exam esophagus double contrast study (74221) |
$820 |
$820 |
4.5× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$1,175 |
$1,175 |
6.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,034 |
$1,034 |
5.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$529 |
$529 |
2.9× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$290 |
$290 |
3.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$290 |
$290 |
3.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,206 |
$1,206 |
11.0× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$496 |
$496 |
4.5× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$621 |
$621 |
5.7× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$478 |
$478 |
5.3× |
| Renal cyst study (74470) |
$1,175 |
$1,175 |
2.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$3,595 |
$3,595 |
8.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$5,643 |
$5,643 |
10.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,568 |
$2,568 |
4.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$5,841 |
$5,841 |
4.3× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$6,626 |
$6,626 |
4.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$5,841 |
$5,841 |
4.3× |
| Salivary gland funct study (78232) |
$2,872 |
$2,872 |
6.9× |
| Selective spinal angiogram (75705) |
$11,978 |
$11,978 |
2.1× |
| Shoulder arthrogram (73040) |
$1,365 |
$1,365 |
3.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,242 |
$1,242 |
11.4× |
| Simulation complex (77290) |
$2,183 |
$2,183 |
5.6× |
| Simulation simple (77280) |
$1,175 |
$1,175 |
8.4× |
| Small bowel series (74250) |
$885 |
$885 |
4.8× |
| Speech evaluation complex (70371) |
$1,014 |
$1,014 |
4.1× |
| Spleen imaging only (78185) |
$1,671 |
$1,671 |
4.0× |
| Splenoportography (75810) |
$6,601 |
$6,601 |
2.0× |
| Superior sagittal sinus venogram (75870) |
$4,395 |
$4,395 |
1.3× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$1,168 |
$1,168 |
4.7× |
| Testicular imaging w/flow (78761) |
$1,712 |
$1,712 |
4.1× |
| Therapeutic enema barium or air (74283) |
$1,060 |
$1,060 |
5.8× |
| Thyroid met imaging body (78018) |
$1,933 |
$1,933 |
3.4× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,690 |
$1,690 |
4.0× |
| Ultrasound breast limited (76642) |
$555 |
$555 |
6.1× |
| Ultrasound, abdomen limited (76705) |
$832 |
$832 |
7.6× |
| Ultrasound, elastography; first target lesion (76982) |
$553 |
$553 |
5.1× |
| Unlisted diagnostic radiographic procedure (76499) |
$359 |
$359 |
4.0× |
| Unlisted magnetic resonance procedure (76498) |
$4,793 |
$4,793 |
52.7× |
| Ureteral reflux study (78740) |
$2,054 |
$2,054 |
4.9× |
| Urethrocystography retrograde rs&i (74450) |
$1,293 |
$1,293 |
5.2× |
| Urethrocystography voiding (74455) |
$1,566 |
$1,566 |
6.3× |
| Urography antegrade (74425) |
$1,023 |
$1,023 |
2.8× |
| Urography retrograde w/wo kub (74420) |
$1,023 |
$1,023 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$1,023 |
$1,023 |
5.6× |
| Us abdominal aorta real time screen study aaa (76706) |
$935 |
$935 |
8.6× |
| Us breast uni real time with image complete (76641) |
$555 |
$555 |
5.1× |
| Us chest (76604) |
$1,160 |
$1,160 |
10.6× |
| Us compl joint r-t w/image documentation (76881) |
$1,344 |
$1,344 |
12.3× |
| Us elastography parenchyma (76981) |
$553 |
$553 |
5.1× |
| Us encephalogram (76506) |
$1,113 |
$1,113 |
10.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$2,030 |
$2,030 |
22.3× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$1,844 |
$1,844 |
20.3× |
| Us kidney transplanted (76776) |
$1,887 |
$1,887 |
17.3× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$1,223 |
$1,223 |
11.2× |
| Us ob limited 1 or more fetuses (76815) |
$1,041 |
$1,041 |
9.5× |
| Us pelvic limited or f/u non-ob (76857) |
$1,391 |
$1,391 |
12.7× |
| Us pelvis complete (76856) |
$1,531 |
$1,531 |
14.0× |
| Us retroperitoneal complete (76770) |
$1,997 |
$1,997 |
18.3× |
| Us retroperitoneal limited (76775) |
$1,816 |
$1,816 |
16.6× |
| Us scrotum (76870) |
$1,653 |
$1,653 |
15.1× |
| Us soft tissue head/neck (76536) |
$1,160 |
$1,160 |
10.6× |
| Us spinal canal (76800) |
$1,316 |
$1,316 |
12.1× |
| Us transrectal (76872) |
$741 |
$741 |
6.8× |
| Us trgt dyn mbubb 1st les (76978) |
$926 |
$926 |
2.5× |
| Vascular flow imaging (78445) |
$2,909 |
$2,909 |
7.0× |
| Vasography, vesiculography, or epididymography, radiological supervision and interpretation Other Diagnostic Radiology… (74440) |
$1,175 |
$1,175 |
4.7× |
| Vein X-ray liver w/hemodynam (75885) |
$11,978 |
$11,978 |
3.6× |
| Venogram epidural (75872) |
$4,395 |
$4,395 |
6.7× |
| Venogram extremity bilateral (75822) |
$2,085 |
$2,085 |
1.3× |
| Venogram ivc w serialography (75825) |
$6,551 |
$6,551 |
2.0× |
| Venogram svc w serialography (75827) |
$4,361 |
$4,361 |
2.7× |
| Venography adrenal unilateral selective rs&i (75840) |
$11,978 |
$11,978 |
3.6× |
| Venography ext unilateral (75820) |
$2,069 |
$2,069 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$6,550 |
$6,550 |
2.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,395 |
$4,395 |
1.3× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$4,395 |
$4,395 |
6.7× |
| Venous sampling by catheter (75893) |
$11,978 |
$11,978 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$462 |
$462 |
5.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$605 |
$605 |
6.7× |
| X-ray aorta leg arteries (75630) |
$8,522 |
$8,522 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,091 |
$1,091 |
6.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$672 |
$672 |
7.4× |
| X-ray exam hips bi 3-4 views (73522) |
$481 |
$481 |
4.4× |
| X-ray exam of finger(s) (73140) |
$485 |
$485 |
5.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$820 |
$820 |
4.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$462 |
$462 |
5.1× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$500 |
$500 |
5.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$605 |
$605 |
6.7× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$586 |
$586 |
5.4× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$672 |
$672 |
7.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$485 |
$485 |
5.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$472 |
$472 |
5.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$586 |
$586 |
6.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$586 |
$586 |
5.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$512 |
$512 |
5.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$485 |
$485 |
4.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$621 |
$621 |
5.7× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$570 |
$570 |
5.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$485 |
$485 |
5.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$580 |
$580 |
5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$548 |
$548 |
5.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$462 |
$462 |
4.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$462 |
$462 |
5.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$485 |
$485 |
5.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$570 |
$570 |
6.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$645 |
$645 |
5.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$504 |
$504 |
4.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$496 |
$496 |
5.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$500 |
$500 |
5.5× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$485 |
$485 |
5.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$733 |
$733 |
8.1× |
| Xr abdomen 1 view (74018) |
$623 |
$623 |
6.9× |
| Xr abdomen 2 views (74019) |
$726 |
$726 |
6.7× |
| Xr abdomen 3 views (74021) |
$726 |
$726 |
6.7× |
| Xr arthrogram ankle (73615) |
$1,480 |
$1,480 |
4.1× |
| Xr arthrogram elbow (73085) |
$1,469 |
$1,469 |
4.0× |
| Xr arthrogram hip (73525) |
$1,480 |
$1,480 |
4.1× |
| Xr bone density axial (77080) |
$915 |
$915 |
8.4× |
| Xr bone length study (77073) |
$655 |
$655 |
6.0× |
| Xr bone survey infant (77076) |
$840 |
$840 |
7.7× |
| Xr bone survey limited (77074) |
$1,170 |
$1,170 |
10.7× |
| Xr chest 1 view (71045) |
$623 |
$623 |
6.9× |
| Xr chest 2 views (71046) |
$797 |
$797 |
8.8× |
| Xr chest 3 views (71047) |
$829 |
$829 |
9.1× |
| Xr cystogram 3+ views (74430) |
$760 |
$760 |
2.1× |
| Xr eye foreign body (70030) |
$280 |
$280 |
3.1× |
| Xr facial bones 3 views (70150) |
$512 |
$512 |
4.7× |
| Xr joint survey 1 view (77077) |
$504 |
$504 |
4.6× |
| Xr lower extremity 2 views infant (73592) |
$379 |
$379 |
4.2× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$593 |
$593 |
5.4× |
| Xr mandible 4 views (70110) |
$561 |
$561 |
5.1× |
| Xr myelogram c-spine (72240) |
$2,379 |
$2,379 |
2.9× |
| Xr nasal bones (70160) |
$472 |
$472 |
5.2× |
| Xr pelvis 3 views (72190) |
$570 |
$570 |
5.2× |
| Xr sella turcica (70240) |
$310 |
$310 |
3.4× |
| Xr sialogram (70390) |
$1,526 |
$1,526 |
6.1× |
| Xr spine 1 view (72020) |
$470 |
$470 |
5.2× |
| Xr sternum 2 views (71120) |
$485 |
$485 |
5.3× |
| Xr stress view joint (77071) |
$336 |
$336 |
3.7× |
| Xr surgical specimen (76098) |
$1,635 |
$1,635 |
2.9× |
| Xr upper extremity 2 views infant (73092) |
$621 |
$621 |
5.7× |
| Xray elbow 2 views (73070) |
$485 |
$485 |
5.3× |
| Xray forearm 2 views (73090) |
$485 |
$485 |
5.3× |
| Xray knee 1 or 2 views rt (73560) |
$485 |
$485 |
5.3× |
| Xray neck soft tissue (70360) |
$445 |
$445 |
4.9× |
| Xray optic foramina (70190) |
$386 |
$386 |
4.2× |
| Xray orbits complete min 4 views (70200) |
$613 |
$613 |
5.6× |
| Xray pelvis 1 or 2 views (72170) |
$485 |
$485 |
4.4× |
| Xray ribs bilateral 3 views (71110) |
$536 |
$536 |
4.9× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$536 |
$536 |
4.9× |
| Xray scapula complete (73010) |
$428 |
$428 |
3.9× |
| Xray shoulder 1 view (73020) |
$484 |
$484 |
5.3× |
| Xray sinuses paranasal <3 views (70210) |
$462 |
$462 |
5.1× |
| Xray spine thoracic 2 views (72070) |
$485 |
$485 |
4.4× |
| Xray spine thoracic 3 views (72072) |
$561 |
$561 |
5.1× |
| Xray tibia-fibula 2 views bil (73590) |
$485 |
$485 |
5.3× |
| Xray tmj open - closed unilat (70328) |
$478 |
$478 |
5.3× |
| Xray tmj's bilateral open-clsc (70330) |
$672 |
$672 |
7.4× |