| 3-D radiotherapy plan dose-volume histograms (77295) |
$640.22 |
$3,123 |
0.4× |
| Abdomen 2 views (74019) |
$505.53 |
$2,466 |
4.4× |
| Acute gi blood loss imaging (78278) |
$772.85 |
$3,770 |
1.8× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$662.15 |
$3,230 |
0.5× |
| Angio Adrenal Bilat Select (75733) |
$1,399.95 |
$6,829 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$2,966.35 |
$14,470 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,551.02 |
$12,444 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$648.62 |
$3,164 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,892.36 |
$9,231 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,689.82 |
$8,243 |
0.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,664.50 |
$8,119.50 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,233.89 |
$10,897 |
0.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,774.48 |
$8,656 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$635.30 |
$3,099 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$743.54 |
$3,627 |
0.2× |
| Ankle 2 views (73600) |
$387.46 |
$1,890 |
4.1× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,261.57 |
$6,154 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,415.92 |
$16,663 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$2,777.14 |
$13,547 |
0.8× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,468.83 |
$7,165 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$1,261.57 |
$6,154 |
0.4× |
| Arthrogram hip (73525) |
$734.21 |
$3,581.50 |
1.9× |
| Arthrogram knee (73580) |
$417.58 |
$2,037 |
1.1× |
| Arthrogram shoulder (73040) |
$454.69 |
$2,218 |
1.2× |
| Arthrogram wrist (73115) |
$583.74 |
$2,847.50 |
1.5× |
| Basic dosimetry (77300) |
$101.89 |
$497 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$725.70 |
$3,540 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,022.13 |
$4,986 |
2.3× |
| Bone age studies (77072) |
$143.50 |
$700 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,400.36 |
$6,831 |
3.2× |
| Bone survey complete (77075) |
$483.80 |
$2,360 |
4.2× |
| Bone survey infant (77076) |
$525.83 |
$2,565 |
4.6× |
| Bowel imaging (78290) |
$560.06 |
$2,732 |
1.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$418 |
$2,039 |
0.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$850.75 |
$4,150 |
1.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$375.77 |
$1,833 |
0.6× |
| Cervical spine 2 or 3 views (72040) |
$374.95 |
$1,829 |
3.9× |
| Chest 1 view (71045) |
$219.25 |
$1,069.50 |
2.3× |
| Chest xray 3 views (71047) |
$483.19 |
$2,357 |
5.1× |
| Cholecystography, oral contrast Non-Facility (74290) |
$261.38 |
$1,275 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$499.59 |
$2,437 |
2.6× |
| Clavicle complete (73000) |
$323.18 |
$1,576.50 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$79.95 |
$390 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$101.89 |
$497 |
0.7× |
| Corpora cavernosography (74445) |
$1,072.36 |
$5,231 |
9.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,330.83 |
$21,126 |
11.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,452.83 |
$11,965 |
9.4× |
| CT abdomen w contrast (74160) |
$1,828.40 |
$8,919 |
9.5× |
| CT abdomen w wo contrast (74170) |
$2,473.74 |
$12,067 |
12.9× |
| CT abdomen w/o contrast (74150) |
$989.54 |
$4,827 |
8.7× |
| CT angio hrt w/3d image (75574) |
$3,102.68 |
$15,135 |
8.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,770.48 |
$8,636.50 |
9.2× |
| CT angiography upper extremity lt (73206) |
$821.03 |
$4,005 |
4.3× |
| CT c-spine w/contrast (72126) |
$2,760.74 |
$13,467 |
7.2× |
| CT c-spine w/o contrast (72125) |
$1,579.53 |
$7,705 |
13.8× |
| CT chest w contrast (71260) |
$1,996.09 |
$9,737 |
10.4× |
| CT chest w/wo contrast (71270) |
$2,235.53 |
$10,905 |
11.7× |
| CT head/brain with contrast (70460) |
$1,911.01 |
$9,322 |
10.0× |
| CT head/brain without and with contrast (70470) |
$2,252.34 |
$10,987 |
11.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,102.68 |
$15,135 |
8.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$2,637.33 |
$12,865 |
27.7× |
| CT hrt w/3d image congen (75573) |
$3,102.68 |
$15,135 |
8.1× |
| CT iac w contrast (70481) |
$1,296.01 |
$6,322 |
6.8× |
| CT limited/localized follow up study (76380) |
$80.57 |
$393 |
0.8× |
| CT lower ext w/o (73700) |
$1,758.60 |
$8,578.50 |
15.4× |
| CT lower extremity w wo contrast (73702) |
$2,715.33 |
$13,245.50 |
14.2× |
| CT lower extremity w/contrast material (73701) |
$2,194.74 |
$10,706 |
11.4× |
| CT lumbar spine w & w/o contrast (72133) |
$3,111.70 |
$15,179 |
16.2× |
| CT lumbar spine w/contrast (72132) |
$2,779.80 |
$13,560 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$1,382.93 |
$6,746 |
12.1× |
| CT maxillofacial w contrast (70487) |
$1,917.57 |
$9,354 |
10.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,111.50 |
$10,300 |
11.0× |
| CT maxillofacial wo contrast (70486) |
$1,584.65 |
$7,730 |
13.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,412.66 |
$6,891 |
7.4× |
| CT orbits w/o contrast (70480) |
$1,101.47 |
$5,373 |
9.6× |
| CT pelvis w/o contrast (72192) |
$957.15 |
$4,669 |
8.4× |
| CT pelvis w/wo contrast (72194) |
$2,051.03 |
$10,005 |
10.7× |
| CT scan of arm combo (73202) |
$2,948.21 |
$14,381.50 |
15.4× |
| CT soft tissue neck w contrast (70491) |
$1,985.02 |
$9,683 |
10.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,342.33 |
$11,426 |
12.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,627.70 |
$7,940 |
14.2× |
| CT thoracic spine w/contrast (72129) |
$2,900.34 |
$14,148 |
15.1× |
| CT thoracic spine w/o contrast (72128) |
$1,443 |
$7,039 |
12.6× |
| CT thorax w/o contrast (71250) |
$997.94 |
$4,868 |
8.7× |
| CT upper ext wo (73200) |
$1,894.72 |
$9,242.50 |
16.6× |
| CT upper extremity with contrast (73201) |
$2,326.76 |
$11,350 |
6.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$671.17 |
$3,274 |
3.5× |
| Cta Abdomen (74175) |
$1,076.87 |
$5,253 |
5.6× |
| CTA abdomen pelvis (74174) |
$1,363.25 |
$6,650 |
3.6× |
| CTA chest (71275) |
$2,481.12 |
$12,103 |
12.9× |
| Cta Head (70496) |
$2,347.05 |
$11,449 |
12.2× |
| Cta Neck (70498) |
$2,250.49 |
$10,978 |
11.7× |
| Cta Pelvis (72191) |
$953.87 |
$4,653 |
5.0× |
| Cystography minimum 3 views rs&i (74430) |
$520.50 |
$2,539 |
1.4× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$835.99 |
$4,078 |
0.4× |
| Diskogram cervical (72285) |
$983.39 |
$4,797 |
0.5× |
| Diskography lumbar (72295) |
$983.39 |
$4,797 |
0.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$53.51 |
$261 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$56.58 |
$276 |
0.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$218.74 |
$1,067 |
0.8× |
| Esophagus (74220) |
$520.70 |
$2,540 |
2.7× |
| Facial bones min 3 views (70150) |
$290.69 |
$1,418 |
2.5× |
| Fetal Echo (76825) |
$369.41 |
$1,802 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$130.79 |
$638 |
0.5× |
| Foot 2 views (73620) |
$376.48 |
$1,836.50 |
4.0× |
| Forearm 2 views (73090) |
$376.90 |
$1,838.50 |
4.0× |
| Hand 2 views (73120) |
$319.60 |
$1,559 |
2.8× |
| Heart first pass single,planar (78481) |
$666.05 |
$3,249 |
1.1× |
| Heart Infarct Image (78466) |
$392.78 |
$1,916 |
0.9× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,096.54 |
$10,227 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,052.26 |
$10,011 |
3.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,497.94 |
$7,307 |
3.4× |
| Hysterosalpingogram (74740) |
$219.35 |
$1,070 |
0.8× |
| Knee 3 views (73562) |
$423.74 |
$2,067 |
4.5× |
| Liver & spleen imaging static only (78215) |
$467.20 |
$2,279 |
1.1× |
| Lung perf&ventilat diferentl (78598) |
$521.73 |
$2,545 |
0.9× |
| Lung perfusion differential (78597) |
$273.06 |
$1,332 |
0.6× |
| Lung ventilation imaging (78579) |
$638.78 |
$3,116 |
1.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,083.02 |
$5,283 |
0.3× |
| Lymphoscintigraphy (78195) |
$2,973.53 |
$14,505 |
5.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,297.53 |
$16,085.50 |
3.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$294.18 |
$1,435 |
0.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,943.71 |
$9,481.50 |
5.1× |
| Mammary ductogram or galactogram multiple (77054) |
$327.59 |
$1,598 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$21.53 |
$105 |
0.7× |
| MRA head w & w/o contrast (70546) |
$2,264.64 |
$11,047 |
5.9× |
| MRA head w/o contrast (70544) |
$1,340.09 |
$6,537 |
5.1× |
| MRA head with contrast (70545) |
$1,996.70 |
$9,740 |
5.2× |
| MRA neck w contrast (70548) |
$1,990.96 |
$9,712 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,258.08 |
$11,015 |
5.9× |
| MRA neck w/o contrast (70547) |
$1,336.19 |
$6,518 |
5.1× |
| MRI abdomen w contrast (74182) |
$2,199.24 |
$10,728 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,494.44 |
$12,168 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$1,476 |
$7,200 |
5.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,533.70 |
$12,359.50 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,899.52 |
$14,144 |
7.6× |
| MRI breast w/o contrast bilateral (77047) |
$886.01 |
$4,322 |
3.4× |
| MRI breast wo contrast unilateral (77046) |
$767.52 |
$3,744 |
2.9× |
| MRI c-spine with contrast (72142) |
$2,712.15 |
$13,230 |
7.1× |
| MRI cardiac w/o contrast (75557) |
$231.86 |
$1,131 |
0.9× |
| MRI cervical spine w/o contrast (72141) |
$2,054.72 |
$10,023 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,489.33 |
$7,265 |
3.9× |
| MRI chest w/o contrast (71550) |
$878.63 |
$4,286 |
3.4× |
| MRI chest with contrast (71551) |
$1,310.57 |
$6,393 |
1.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,410.80 |
$11,760 |
6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,783.20 |
$8,698.50 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$923.94 |
$4,507 |
3.5× |
| MRI orbit face neck w contrast (70542) |
$1,378.22 |
$6,723 |
3.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,566.20 |
$7,640 |
4.1× |
| MRI pelvis w/contrast (72196) |
$1,912.86 |
$9,331 |
5.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,173.62 |
$10,603 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,282.48 |
$6,256 |
4.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,493 |
$17,039 |
9.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,920.84 |
$14,248 |
7.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,313.01 |
$16,161 |
8.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,939.51 |
$9,461 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,203.96 |
$10,751 |
5.8× |
| MRI temporomandibular joint (70336) |
$734.52 |
$3,583 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,300.32 |
$6,343 |
5.0× |
| MRI up ext w/o contrast (73218) |
$1,153.34 |
$5,626 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,246.29 |
$10,957.50 |
8.6× |
| MRI, joint upper extrem combo (73223) |
$3,773.64 |
$18,408 |
9.9× |
| Myelogram Cervical (72240) |
$317.34 |
$1,548 |
0.4× |
| Myelogram Lumbar (72265) |
$412.46 |
$2,012 |
0.5× |
| Myelogram thoracic (72255) |
$317.34 |
$1,548 |
0.4× |
| Myelography 2 or more regions (72270) |
$317.34 |
$1,548 |
0.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$997.12 |
$4,864 |
0.7× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$1,453.45 |
$7,090 |
0.6× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$931.73 |
$4,545 |
0.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$1,453.45 |
$7,090 |
0.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,363.84 |
$21,287 |
3.1× |
| Myocardial Spect Multiple Studies (78452) |
$4,363.84 |
$21,287 |
3.1× |
| Myocardial spect single study at rest or stress (78451) |
$3,621.94 |
$17,668 |
2.6× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$931.73 |
$4,545 |
0.6× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$1,453.45 |
$7,090 |
0.9× |
| N-invas est c ffr sw aly CTA (75580) |
$502.05 |
$2,449 |
0.5× |
| Neck soft tissue (70360) |
$335.18 |
$1,635 |
3.5× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$260.56 |
$1,271 |
0.6× |
| Nm adrenal scan (78075) |
$1,202.94 |
$5,868 |
0.9× |
| Nm cisternogram (78630) |
$657.44 |
$3,207 |
1.1× |
| Nm gastric emptying study (78264) |
$806.47 |
$3,934 |
1.8× |
| Nm kidney scan w/flow (78701) |
$330.46 |
$1,612 |
0.8× |
| Nuclear Rx Oral Admin (79005) |
$1,194.95 |
$5,829 |
4.7× |
| Ob us nuchal meas 1 gest (76813) |
$142.27 |
$694 |
1.2× |
| Osseous survey limited (77074) |
$352.19 |
$1,718 |
3.1× |
| Parathyroid Planar Imaging (78070) |
$863.87 |
$4,214 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$282.29 |
$1,377 |
2.5× |
| Peritoneogram after injection (74190) |
$1,028.49 |
$5,017 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$1,404.25 |
$6,850 |
0.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,146.77 |
$5,594 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,327.79 |
$6,477 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$824.51 |
$4,022 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,161.33 |
$5,665 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$407.34 |
$1,987 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$452.54 |
$2,207.50 |
4.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$308.22 |
$1,503.50 |
3.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$486.78 |
$2,374.50 |
5.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$68.88 |
$336 |
0.6× |
| Radex fingr minimum 2 views (73140) |
$257.69 |
$1,257 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$427.74 |
$2,086.50 |
4.5× |
| Radex Hand Minimum 3 Views (73130) |
$376.90 |
$1,838.50 |
4.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$268.35 |
$1,309 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$99.02 |
$483 |
0.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$504.92 |
$2,463 |
4.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$581.59 |
$2,837 |
5.1× |
| Radex Humerus Minimum 2 Views (73060) |
$287.41 |
$1,402 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$351.48 |
$1,714.50 |
3.7× |
| Radex Kne Compl 4/More Views (73564) |
$488.31 |
$2,382 |
4.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$399.55 |
$1,949 |
3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$246 |
$1,200 |
2.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$424.35 |
$2,070 |
4.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$181.63 |
$886 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$425.99 |
$2,078 |
3.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$304.84 |
$1,487 |
3.2× |
| Radex Toe Minimum 2 Views (73660) |
$277.98 |
$1,356 |
2.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$438.91 |
$2,141 |
4.6× |
| Radiation treatment delivery level 1 (77402) |
$51.66 |
$252 |
0.5× |
| Radiation treatment delivery level 3 (77412) |
$99.84 |
$487 |
0.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$322.06 |
$1,571 |
3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$505.53 |
$2,466 |
4.4× |
| Radiologic exam chest 2 views (71046) |
$257.68 |
$1,257 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$629.76 |
$3,072 |
3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$541.82 |
$2,643 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$477.04 |
$2,327 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$522.55 |
$2,549 |
5.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$383.35 |
$1,870 |
4.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$242.93 |
$1,185 |
0.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$285.57 |
$1,393 |
2.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$137.56 |
$671 |
1.2× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$137.56 |
$671 |
1.4× |
| Radiological examination surgical specimen (76098) |
$381.30 |
$1,860 |
0.6× |
| Renal Cyst Study (74470) |
$291.31 |
$1,421 |
0.5× |
| Ribs bilateral 3 views (71110) |
$372.90 |
$1,819 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,095.93 |
$5,346 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,830.24 |
$8,928 |
3.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,041.20 |
$5,079 |
1.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,095.93 |
$5,346 |
1.8× |
| Rp therapy intra-arterial particulate admn (79445) |
$203.16 |
$991 |
0.8× |
| Rp Therapy Intravenous Administration (79101) |
$295 |
$1,439 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$365.72 |
$1,784 |
3.2× |
| Scapula (73010) |
$418.92 |
$2,043.50 |
3.7× |
| Sella turcica (70240) |
$117.47 |
$573 |
1.2× |
| Shoulder 1 view (73020) |
$329.34 |
$1,606.50 |
3.5× |
| Sialogram (70390) |
$336.41 |
$1,641 |
1.3× |
| Small bowel series (74250) |
$391.96 |
$1,912 |
2.0× |
| Special dosimetry (77331) |
$101.89 |
$497 |
0.7× |
| Special treatment procedure (77470) |
$268.35 |
$1,309 |
0.4× |
| Spine thoracic 3 views (72072) |
$438.50 |
$2,139 |
3.8× |
| Superior sagittal sinus venogram (75870) |
$406.93 |
$1,985 |
0.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$78.11 |
$381 |
0.2× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$389.71 |
$1,901 |
1.5× |
| Testicular Imaging With Vascular Flow (78761) |
$602.29 |
$2,938 |
1.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$256.25 |
$1,250 |
0.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$182.04 |
$888 |
1.2× |
| Thoracolumbar 2 views (72080) |
$280.65 |
$1,369 |
3.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$878.63 |
$4,286 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$614.59 |
$2,998 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$740.46 |
$3,612 |
1.7× |
| Tomogram (76100) |
$271.83 |
$1,326 |
2.4× |
| Treatment device complex (77334) |
$190.86 |
$931 |
0.5× |
| Ultrasound breast complete (76641) |
$160.62 |
$783.50 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$101.48 |
$495 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$713.81 |
$3,482 |
6.2× |
| Ureteral reflux study (78740) |
$560.06 |
$2,732 |
1.3× |
| Urethrocystogram voiding (74455) |
$415.54 |
$2,027 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$415.54 |
$2,027 |
1.6× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,286.38 |
$6,275 |
6.7× |
| Us breast unilateral limited (76642) |
$160.62 |
$783.50 |
1.7× |
| Us chest (76604) |
$213.82 |
$1,043 |
1.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$228.17 |
$1,113 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$486.47 |
$2,373 |
4.3× |
| Us encephalogram (76506) |
$217.92 |
$1,063 |
1.9× |
| Us infant hips w manipulation (76885) |
$261.99 |
$1,278 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$150.88 |
$736 |
1.3× |
| Us ob detailed single fetus (76811) |
$198.24 |
$967 |
0.8× |
| Us ob limited (76815) |
$676.91 |
$3,302 |
5.9× |
| Us ob transvaginal (76817) |
$777.98 |
$3,795 |
6.8× |
| Us pelvic non ob complete (76856) |
$799.09 |
$3,898 |
7.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$413.08 |
$2,015 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$917.99 |
$4,478 |
8.0× |
| Us retroperitoneal complete (76770) |
$735.34 |
$3,587 |
6.4× |
| Us retroperitoneal limited (76775) |
$375.15 |
$1,830 |
3.3× |
| Us scrotum and contents (76870) |
$728.57 |
$3,554 |
6.4× |
| Us soft tissue head/neck (76536) |
$679.17 |
$3,313 |
5.9× |
| Us spinal canal and contents (76800) |
$144.94 |
$707 |
1.3× |
| Us transrectal (76872) |
$245.80 |
$1,199 |
2.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$281.47 |
$1,373 |
2.5× |
| Venogram adrenal unilat (75840) |
$1,301.96 |
$6,351 |
0.4× |
| Venogram extremity bilateral (75822) |
$972.11 |
$4,742 |
0.6× |
| Venogram Extremity Unilateral (75820) |
$826.36 |
$4,031 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,797.03 |
$8,766 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$575.03 |
$2,805 |
0.3× |
| Venography Renal Bilateral (75833) |
$1,301.96 |
$6,351 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,301.96 |
$6,351 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$585.48 |
$2,856 |
0.2× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$648.62 |
$3,164 |
0.9× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,261.57 |
$6,154 |
0.2× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$468.84 |
$2,287 |
0.8× |
| Wrist 2 views (73100) |
$365.21 |
$1,781.50 |
3.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$608.65 |
$2,969 |
5.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$185.53 |
$905 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$881.71 |
$4,301 |
4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$415.33 |
$2,026 |
4.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$319.60 |
$1,559 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$504.92 |
$2,463 |
4.4× |
| X-ray exam of femur 2/> (73552) |
$552.17 |
$2,693.50 |
5.8× |
| X-ray eye for foreign body (70030) |
$194.55 |
$949 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$209.10 |
$1,020 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$1,054.32 |
$5,143 |
5.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$209.31 |
$1,021 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$659.28 |
$3,216 |
5.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$283.52 |
$1,383 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$527.06 |
$2,571 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$362.03 |
$1,766 |
3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$470.68 |
$2,296 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$420.05 |
$2,049 |
3.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$362.03 |
$1,766 |
3.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$226.94 |
$1,107 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$406.93 |
$1,985 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$322.88 |
$1,575 |
2.8× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,587.32 |
$7,743 |
8.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$268.35 |
$1,309 |
2.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$412.26 |
$2,011 |
4.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$335.18 |
$1,635 |
3.5× |
| Xr bone length studies (77073) |
$207.87 |
$1,014 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$506.15 |
$2,469 |
4.4× |
| Xr c-spine 6 or more views (72052) |
$633.66 |
$3,091 |
5.5× |
| Xr chest 4+ views (71048) |
$499.18 |
$2,435 |
4.4× |
| Xr urogram antegrade (74425) |
$527.06 |
$2,571 |
1.4× |