| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$7,078.89 |
$10,112.70 |
4.9× |
| Acute gi blood loss imaging (78278) |
$1,850.14 |
$2,643.06 |
4.4× |
| Angio adrenal bilat select (75733) |
$6,571.59 |
$9,387.99 |
2.0× |
| Angio adrenal unilat select (75731) |
$5,257.27 |
$7,510.38 |
1.6× |
| Angio extremity unilateral (75710) |
$5,467.55 |
$7,810.78 |
1.7× |
| Angio pulmonary unilateral (75741) |
$4,621.40 |
$6,602 |
1.4× |
| Angiogram extremity bilateral (75716) |
$6,834.44 |
$9,763.48 |
2.1× |
| Angiogram pelvic (75736) |
$6,531.08 |
$9,330.12 |
1.1× |
| Angiography internal mammary rs&i (75756) |
$2,782.37 |
$3,974.82 |
0.8× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,075.43 |
$8,679.18 |
1.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$6,792.31 |
$9,703.30 |
1.2× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,841 |
$2,630 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,991.03 |
$4,272.90 |
0.9× |
| Ankle 2 views (73600) |
$501.20 |
$716 |
5.5× |
| Arthrography knee lt (73580) |
$1,187.62 |
$1,696.60 |
3.3× |
| Barium enema (74270) |
$981.87 |
$1,402.67 |
5.4× |
| Basic dosimetry (77300) |
$607.03 |
$867.18 |
4.3× |
| Bilat selctv renal venogram (75833) |
$6,627.60 |
$9,468 |
2.0× |
| Bone age studies (77072) |
$564.90 |
$807 |
5.2× |
| Bone imaging limited area (78300) |
$1,538.55 |
$2,197.93 |
3.7× |
| Bone marrow imaging whole body (78104) |
$1,523.47 |
$2,176.38 |
3.6× |
| Bone survey complete (77075) |
$1,556.80 |
$2,224 |
14.3× |
| Bowel imaging (78290) |
$1,405.09 |
$2,007.27 |
3.4× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$2,219.44 |
$3,170.63 |
5.7× |
| Brain image w/flow 4 + views (78606) |
$2,202.44 |
$3,146.34 |
3.9× |
| Card MRI w/stress img & dye (75563) |
$474.08 |
$677.25 |
0.6× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$592.90 |
$847 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$737.91 |
$1,054.16 |
4.0× |
| Cisternogram (78630) |
$2,202.44 |
$3,146.34 |
3.9× |
| Clavicle complete (73000) |
$655.20 |
$936 |
7.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,640.40 |
$3,772 |
14.4× |
| Continuing medical physics consltj pr wk (77336) |
$717.17 |
$1,024.53 |
5.1× |
| Contrast exam abdominl aorta (75625) |
$5,877.61 |
$8,396.59 |
1.8× |
| Contrast exam thoracic aorta (75605) |
$5,467.55 |
$7,810.78 |
0.9× |
| Csf shunt evaluation (78645) |
$1,402.02 |
$2,002.88 |
2.5× |
| CT - st neck w&wo contr (70492) |
$4,409.30 |
$6,299 |
24.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,506.85 |
$7,866.93 |
15.1× |
| CT abdomen and pelvis without contrast (74176) |
$3,924.24 |
$5,606.06 |
15.7× |
| CT abdomen w wo contrast (74170) |
$3,568.23 |
$5,097.47 |
19.5× |
| CT abdomen w/contrast (74160) |
$2,879.94 |
$4,114.20 |
15.7× |
| CT abdomen w/o contrast (74150) |
$2,365.36 |
$3,379.08 |
21.7× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$5,009.63 |
$7,156.62 |
13.8× |
| CT angio abdom w/o & w/dye (74175) |
$3,246.05 |
$4,637.21 |
17.7× |
| CT angio abdominal arteries (75635) |
$3,246.05 |
$4,637.21 |
17.7× |
| CT angio hrt w/3d image (75574) |
$289.32 |
$413.32 |
0.8× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,019.58 |
$4,313.68 |
16.5× |
| CT cervical spine w/contrast (72126) |
$3,071.60 |
$4,388 |
8.4× |
| CT cervical spine w/o contrast (72125) |
$2,552.20 |
$3,646 |
23.4× |
| CT chest w/contrast (71260) |
$3,195.82 |
$4,565.45 |
17.4× |
| CT colonography diag w cont (74262) |
$1,512.43 |
$2,160.62 |
8.3× |
| CT colonography w/o cntrst (74261) |
$1,458.48 |
$2,083.54 |
13.4× |
| CT extremity upper w & w/o contrast (73202) |
$5,000.10 |
$7,143 |
27.3× |
| CT head/brain with contrast (70460) |
$2,456.30 |
$3,509 |
13.4× |
| CT head/brain without and with contrast (70470) |
$3,071.60 |
$4,388 |
16.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$154.20 |
$220.29 |
0.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$67.38 |
$96.26 |
0.7× |
| CT hrt w/3d image congen (75573) |
$289.32 |
$413.32 |
0.8× |
| CT limited/localized follow up study (76380) |
$1,310.36 |
$1,871.94 |
14.4× |
| CT lower ext w/wo contrast (73702) |
$5,375.11 |
$7,678.73 |
29.3× |
| CT lower extremity w contrast (73701) |
$3,315.98 |
$4,737.12 |
18.1× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,979.62 |
$4,256.60 |
27.3× |
| CT lumbar spine w/contrast (72132) |
$2,972.85 |
$4,246.93 |
8.2× |
| CT lumbar spine w/o contrast (72131) |
$2,470.40 |
$3,529.15 |
22.6× |
| CT lumbar spine w/o then w/ con (72133) |
$3,460.71 |
$4,943.87 |
18.9× |
| CT maxillofacial area w/o contrast (70486) |
$2,193.10 |
$3,133 |
20.1× |
| CT maxillofacial w/contrast (70487) |
$2,640.40 |
$3,772 |
14.4× |
| CT maxillofacial w/o then w/ con (70488) |
$4,102 |
$5,860 |
22.4× |
| CT orbit sella ear w/o con (70480) |
$2,193.10 |
$3,133 |
20.1× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$3,815.70 |
$5,451 |
20.8× |
| CT pelvis w & w/o contrast (72194) |
$3,087.70 |
$4,411 |
16.9× |
| CT pelvis w/o contrast (72192) |
$3,068.98 |
$4,384.26 |
28.1× |
| CT soft tissue neck w/contrast (70491) |
$2,640.40 |
$3,772 |
14.4× |
| CT soft tissue neck w/o contrast (70490) |
$2,193.10 |
$3,133 |
20.1× |
| CT spine cervical w/wo contrast (72127) |
$3,325.70 |
$4,751 |
18.2× |
| CT thoracic spine w/contrast (72129) |
$3,970.16 |
$5,671.65 |
21.7× |
| CT thoracic spine w/o contrast (72128) |
$3,299.16 |
$4,713.08 |
30.2× |
| CT thoracic spine w/o then w/ con (72130) |
$4,299.22 |
$6,141.75 |
23.5× |
| CT thorax lung cancer scr c- (71271) |
$288.54 |
$412.20 |
2.6× |
| CT thorax w/o contrast (71250) |
$2,485.73 |
$3,551.04 |
22.8× |
| CT thorax w/o then w/ contrast (71270) |
$3,219.90 |
$4,599.86 |
17.6× |
| CT upper extremity w/dye (73201) |
$2,483 |
$3,547.15 |
6.8× |
| CT upper extremity w/o contrast rt (73200) |
$2,075.49 |
$2,964.98 |
19.0× |
| CTA chest w/wo contrast (71275) |
$4,335 |
$6,192.86 |
23.7× |
| CTA head w contrast (70496) |
$3,353.70 |
$4,791 |
18.3× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$3,019.58 |
$4,313.68 |
16.5× |
| Cta Neck (70498) |
$3,119.90 |
$4,457 |
17.0× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$3,019.58 |
$4,313.68 |
16.5× |
| Dilation ureters/urethra rs&i (74485) |
$811.20 |
$1,158.86 |
0.4× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$3,368.76 |
$4,812.52 |
1.7× |
| Diskography lumbar (72295) |
$4,371.50 |
$6,245 |
2.1× |
| Esophogram (74220) |
$811.95 |
$1,159.93 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$1,019.90 |
$1,457 |
9.3× |
| Fetal biophysical profile w/o nst (76819) |
$577.12 |
$824.45 |
5.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$922.05 |
$1,317.21 |
3.7× |
| Full mouth X-ray of teeth (70320) |
$251.30 |
$359 |
1.0× |
| Gastric emptying study (78264) |
$2,133.80 |
$3,048.29 |
5.1× |
| Gated heart planar single (78472) |
$1,889.58 |
$2,699.40 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$3,281.14 |
$4,687.34 |
4.5× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$6,119.71 |
$8,742.44 |
8.4× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$3,501.22 |
$5,001.74 |
4.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,991.03 |
$4,272.90 |
0.9× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$5,257.27 |
$7,510.38 |
1.6× |
| Hepatobil syst image w/drug (78227) |
$1,961.41 |
$2,802.02 |
3.5× |
| Hepatobiliary system imaging (78226) |
$1,961.41 |
$2,802.02 |
4.7× |
| Humerus min 2 views (73060) |
$518.70 |
$741 |
5.7× |
| Image fusion (77399) |
$520.60 |
$743.72 |
3.7× |
| Imrt planning (77301) |
$6,588.18 |
$9,411.68 |
4.6× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$5,587.04 |
$7,981.49 |
7.7× |
| Intracavitary radiation source applic complex (77763) |
$3,454.15 |
$4,934.50 |
4.7× |
| Intracavitary radiation source applic intermed (77762) |
$2,415.57 |
$3,450.81 |
4.2× |
| Intracavitary radiation source applic simple (77761) |
$2,023.62 |
$2,890.89 |
3.5× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$1,329.56 |
$1,899.37 |
3.4× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$1,046.65 |
$1,495.21 |
2.7× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$3,357.83 |
$4,796.90 |
8.6× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$1,037.74 |
$1,482.48 |
2.7× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$2,168.67 |
$3,098.10 |
3.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,770.79 |
$2,529.70 |
3.1× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,881.92 |
$2,688.46 |
3.3× |
| Liver & spleen; w vasc flow (78216) |
$2,129.34 |
$3,041.92 |
5.1× |
| Lung perf&ventilat diferentl (78598) |
$2,173.39 |
$3,104.84 |
3.8× |
| Lung ventilat&perfus imaging (78582) |
$1,745.54 |
$2,493.63 |
3.1× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,187.67 |
$1,696.67 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,187.67 |
$1,696.67 |
1.8× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$1,187.67 |
$1,696.67 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$1,187.67 |
$1,696.67 |
0.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,417.50 |
$2,025 |
3.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,417.50 |
$2,025 |
3.9× |
| Mammary ductogram multiple ducts (77054) |
$988.11 |
$1,411.59 |
4.0× |
| Mammary ductogram single (77053) |
$744.45 |
$1,063.50 |
3.0× |
| Mlc device(s) for imrt (77338) |
$3,027.54 |
$4,325.05 |
7.7× |
| MRA head w & w/o contrast (70546) |
$1,284.50 |
$1,835 |
3.5× |
| MRA head w/contrast (70545) |
$611.10 |
$873 |
1.7× |
| MRA head w/o contrast (70544) |
$611.10 |
$873 |
2.5× |
| MRA neck w/contrast (70548) |
$611.10 |
$873 |
1.7× |
| MRA neck w/o contrast (70547) |
$611.10 |
$873 |
2.5× |
| MRA neck w/wo contrast (70549) |
$1,284.50 |
$1,835 |
3.5× |
| MRI abdomen w/contrast (74182) |
$738.50 |
$1,055 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,431.50 |
$2,045 |
3.9× |
| MRI abdomen w/o contrast (74181) |
$686.70 |
$981 |
2.8× |
| MRI any jnt lwr ext with con lt (73722) |
$3,072.61 |
$4,389.44 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$592.90 |
$847 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$592.90 |
$847 |
2.4× |
| MRI cervical spine with contrast (72142) |
$734.30 |
$1,049 |
2.0× |
| MRI chest w & w/o contrast (71552) |
$1,189.25 |
$1,698.93 |
3.3× |
| MRI chest w/contrast (71551) |
$590.56 |
$843.66 |
0.7× |
| MRI chest w/o contrast (71550) |
$549.32 |
$784.75 |
2.2× |
| MRI joint upper ext w/contrast (73222) |
$580.63 |
$829.47 |
0.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,417.50 |
$2,025 |
3.9× |
| MRI joint upr extrem w/o dye (73221) |
$686.70 |
$981 |
2.8× |
| Mri Lower Extremity W/O Dye (73718) |
$686.70 |
$981 |
2.8× |
| MRI lumbar spine with contrast (72149) |
$828.10 |
$1,183 |
2.3× |
| MRI lumbar w/wo contrast (72158) |
$1,082.20 |
$1,546 |
3.0× |
| MRI lwr ext w/o jnts with con rt (73719) |
$725.90 |
$1,037 |
2.0× |
| MRI orbit/face/neck w/contrast (70542) |
$580.63 |
$829.47 |
1.6× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,417.50 |
$2,025 |
3.9× |
| MRI orbit/face/neck w/o contrast (70540) |
$592.90 |
$847 |
2.4× |
| MRI pelvis w/ contrast (72196) |
$590.56 |
$843.66 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$686.70 |
$981 |
2.8× |
| MRI pelvis w/wo contrast (72197) |
$1,431.50 |
$2,045 |
3.9× |
| MRI spectroscopy (76390) |
$474.08 |
$677.25 |
5.2× |
| MRI spine cervical wo/w contrast (72156) |
$1,082.20 |
$1,546 |
3.0× |
| MRI spine thoracic w/contrast (72147) |
$828.10 |
$1,183 |
2.3× |
| MRI thoracic spine w wo contrast (72157) |
$1,082.20 |
$1,546 |
3.0× |
| MRI thoracic spine w/o contrast (72146) |
$686.70 |
$981 |
2.8× |
| MRI tmj (70336) |
$413.88 |
$591.25 |
1.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$686.70 |
$981 |
2.8× |
| Mri Upper Extremity W/Dye (73219) |
$580.63 |
$829.47 |
1.6× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$1,417.50 |
$2,025 |
3.9× |
| Myelogram thoracic (72255) |
$1,002.72 |
$1,432.46 |
1.2× |
| Myelography 2 or more regions (72270) |
$2,867.70 |
$4,096.71 |
3.5× |
| Myelography lumbosacral (72265) |
$1,032.88 |
$1,475.55 |
1.3× |
| Myocardial spect single study at rest or stress (78451) |
$3,172.35 |
$4,531.93 |
2.3× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,440.64 |
$3,486.63 |
2.7× |
| Nm bone 3 phase (78315) |
$2,603.73 |
$3,719.62 |
6.2× |
| Nm bone imaging whole body (78306) |
$2,332.67 |
$3,332.38 |
5.6× |
| Nm bone marrow scan limited (78102) |
$1,277.35 |
$1,824.78 |
3.1× |
| Nm bone marrow scan multiple (78103) |
$1,550.58 |
$2,215.12 |
3.7× |
| Nm heart perfusion spect stress rest (78452) |
$4,784.97 |
$6,835.67 |
3.5× |
| Nm liver image static only (78201) |
$1,218.70 |
$1,741 |
2.1× |
| Nm lymph system (78195) |
$1,860.80 |
$2,658.29 |
3.3× |
| Nm thyroid imaging only (78013) |
$968.48 |
$1,383.55 |
2.3× |
| Nose to rectum for fb child (76010) |
$459.57 |
$656.53 |
5.1× |
| Nuclear rx IV admin (79101) |
$1,760.07 |
$2,514.39 |
7.2× |
| Ob us < 14 wks single fetus (76801) |
$875.70 |
$1,251 |
8.0× |
| Oral radiopharm rx (79005) |
$1,540.71 |
$2,201.01 |
6.3× |
| Orthopantogram (70355) |
$590.80 |
$844 |
6.5× |
| Parathyroid imaging (78070) |
$1,889.47 |
$2,699.24 |
4.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,783.85 |
$5,405.50 |
9.1× |
| Peritoneal-venous shunt patency test (78291) |
$1,394.72 |
$1,992.46 |
3.3× |
| Pulmonary perfusion imaging particulate (78580) |
$1,601.45 |
$2,287.79 |
3.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,055.60 |
$1,508 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$711.20 |
$1,016 |
6.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$424.20 |
$606 |
4.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$573.30 |
$819 |
6.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$1,066.10 |
$1,523 |
9.8× |
| Radex spine cervical 2 or 3 views (72040) |
$623 |
$890 |
6.9× |
| Radex spine cervical 4 or 5 views (72050) |
$830.20 |
$1,186 |
7.6× |
| Radex spine cervical 6 or more views (72052) |
$1,281.70 |
$1,831 |
11.7× |
| Radiation delivery stereotactic cranial linear (77372) |
$20,558.78 |
$29,369.69 |
2.7× |
| Radiation tx delivery lvl 1 (77402) |
$653.27 |
$933.24 |
6.1× |
| Radiation tx delivery lvl 2 (77407) |
$607.03 |
$867.18 |
1.5× |
| Radiation tx delivery lvl 3 (77412) |
$985.71 |
$1,408.16 |
1.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$564.35 |
$806.22 |
5.2× |
| Radiologic exam phrnx&/crv esoph contrast study (74210) |
$718.60 |
$1,026.57 |
3.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$933.68 |
$1,333.83 |
5.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$864.98 |
$1,235.68 |
4.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$543.90 |
$777 |
6.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$707.66 |
$1,010.95 |
6.5× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$186.96 |
$267.09 |
0.8× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$1,674.58 |
$2,392.26 |
6.9× |
| Renal cyst study (74470) |
$939.40 |
$1,411.36 |
1.6× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,382.82 |
$1,975.46 |
3.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,150.74 |
$3,072.48 |
5.2× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,775.22 |
$5,393.17 |
6.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,337.17 |
$3,338.82 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,154.33 |
$3,077.61 |
3.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,108.48 |
$3,012.12 |
1.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$581 |
$830 |
2.4× |
| Saline infused sonohysterogram (76831) |
$941.93 |
$1,345.61 |
3.8× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$314.40 |
$449.15 |
13.4× |
Selective spinal angiogram (75705)
unusually low: confirm this is the full procedure |
$2,169.87 |
$3,099.82 |
0.4× |
| Shoulder arthrogram (73040) |
$1,236.17 |
$1,765.96 |
3.4× |
| Simulation complex (77290) |
$2,169.24 |
$3,098.92 |
5.5× |
| Simulation intermediate (77285) |
$1,515.99 |
$2,165.70 |
3.9× |
| Simulation simple (77280) |
$1,105.75 |
$1,579.64 |
7.9× |
| Small bowel series (74250) |
$922.40 |
$1,317.71 |
5.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,404.39 |
$2,006.27 |
3.6× |
| Special dosimetry (77331) |
$734.38 |
$1,049.12 |
5.2× |
| Special physics consult (77370) |
$1,146.18 |
$1,637.40 |
8.2× |
| Special treatment procedure (77470) |
$2,413.65 |
$3,448.07 |
4.2× |
| Speech evaluation complex (70371) |
$935.90 |
$1,337 |
3.8× |
| Stereotactic body radiation delivery (77373) |
$10,262.96 |
$14,661.37 |
5.5× |
| Superior sagittal sinus venogram (75870) |
$2,233.20 |
$3,190.29 |
0.7× |
| Testicular imaging w/flow (78761) |
$1,653.05 |
$2,361.50 |
4.0× |
| Therapeutic enema barium or air (74283) |
$505.27 |
$721.81 |
2.8× |
| Thyroid met imaging body (78018) |
$2,369.96 |
$3,385.65 |
4.2× |
| Thyroid uptake single/multiple quant measurement (78012) |
$726.51 |
$1,037.87 |
1.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,385.20 |
$1,978.86 |
3.3× |
| Treatment device intermediate (77333) |
$958.74 |
$1,369.63 |
6.8× |
| Treatment devices complex (77334) |
$1,803.49 |
$2,576.42 |
4.6× |
| Treatment devices simple (77332) |
$623.01 |
$890.02 |
4.4× |
| Ultrasound breast limited (76642) |
$310.80 |
$444 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$938.70 |
$1,341 |
8.6× |
| Umbilical-artery Doppler (OB) (76820) |
$564.19 |
$805.99 |
5.2× |
| Unlisted CT procedure (76497) |
$1,847.33 |
$2,639.04 |
20.3× |
| Unlisted fluoroscopic procedure (76496) |
$530.78 |
$758.26 |
5.8× |
| Unlisted miscellaneous procedure, diagnostic nuclear medicine UNSCHEDULED (78999) |
$1,320.98 |
$1,887.12 |
3.2× |
| Urethrocystography retrograde rs&i (74450) |
$878.76 |
$1,255.37 |
3.5× |
| Urethrocystography voiding (74455) |
$866.02 |
$1,237.17 |
3.5× |
| Urography antegrade (74425) |
$913.92 |
$1,305.60 |
2.5× |
| Urography retrograde w/wo kub (74420) |
$1,055.02 |
$1,507.17 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; Other Diagnostic Radiology FS (74410) |
$878.76 |
$1,255.37 |
4.8× |
| Us breast uni real time with image complete (76641) |
$310.80 |
$444 |
2.8× |
| Us chest (76604) |
$687.40 |
$982 |
6.3× |
| Us compl joint r-t w/image documentation (76881) |
$1,017.06 |
$1,452.95 |
9.3× |
| Us encephalogram (76506) |
$890.40 |
$1,272 |
8.2× |
| Us guided compression repair (76936) |
$1,463.82 |
$2,091.17 |
6.5× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$626.50 |
$895 |
6.9× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$626.50 |
$895 |
6.9× |
| Us kidney transplanted (76776) |
$695.10 |
$993 |
6.4× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$682.50 |
$975 |
6.3× |
| Us ob detailed single fetus (76811) |
$1,062.60 |
$1,518 |
4.3× |
| Us ob limited 1 or more fetuses (76815) |
$634.90 |
$907 |
5.8× |
| Us obstetric transvaginal (76817) |
$912.80 |
$1,304 |
8.4× |
| Us pelvic limited or f/u non-ob (76857) |
$492.80 |
$704 |
4.5× |
| Us pelvis complete (76856) |
$1,045.10 |
$1,493 |
9.6× |
| Us retroperitoneal limited (76775) |
$987 |
$1,410 |
9.0× |
| Us scrotum (76870) |
$1,084.30 |
$1,549 |
9.9× |
| Us soft tissue head/neck (76536) |
$854.70 |
$1,221 |
7.8× |
| Us spinal canal (76800) |
$622.30 |
$889 |
5.7× |
| Us transrectal (76872) |
$6,176.41 |
$8,823.44 |
56.6× |
| Us transrectal prostate volume (76873) |
$537.46 |
$767.80 |
4.9× |
| Vein X-ray liver w/hemodynam (75885) |
$4,231.89 |
$6,045.56 |
1.3× |
| Venogram extremity bilateral (75822) |
$2,344.93 |
$3,349.90 |
1.4× |
| Venogram ivc w serialography (75825) |
$4,928.06 |
$7,040.09 |
1.5× |
| Venogram svc w serialography (75827) |
$2,954.92 |
$4,221.32 |
1.8× |
| Venography adrenal unilateral selective rs&i (75840) |
$5,651.56 |
$8,073.66 |
1.7× |
| Venography ext unilateral (75820) |
$2,099.22 |
$2,998.88 |
1.3× |
| Venography renal unilateral selective rs&i (75831) |
$4,418.40 |
$6,312 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,220.70 |
$4,601 |
1.0× |
| Venous sampling by catheter (75893) |
$3,531.74 |
$5,045.34 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$509.13 |
$727.33 |
5.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$560 |
$800 |
6.2× |
| X-ray aorta leg arteries (75630) |
$6,087.90 |
$8,697 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,494.68 |
$2,135.25 |
8.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$614.60 |
$878 |
6.8× |
| X-ray exam of finger(s) (73140) |
$544.60 |
$778 |
6.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$789.15 |
$1,127.36 |
4.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$527.10 |
$753 |
5.8× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$607.60 |
$868 |
6.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$531.30 |
$759 |
5.8× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$544.60 |
$778 |
5.0× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$585.20 |
$836 |
6.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$451.50 |
$645 |
5.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$529.20 |
$756 |
5.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$722.40 |
$1,032 |
6.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$670.60 |
$958 |
7.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$733.60 |
$1,048 |
6.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,110.20 |
$1,586 |
10.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$581.21 |
$830.30 |
6.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,185.80 |
$1,694 |
10.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$671.30 |
$959 |
6.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$574.70 |
$821 |
6.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$680.40 |
$972 |
7.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$976.50 |
$1,395 |
10.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$791.70 |
$1,131 |
7.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$639.10 |
$913 |
5.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$423.50 |
$605 |
4.7× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$491.40 |
$702 |
5.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$568.40 |
$812 |
6.3× |
| Xr abdomen 1 view (74018) |
$422.77 |
$603.96 |
4.7× |
| Xr abdomen 2 views (74019) |
$598.01 |
$854.30 |
5.5× |
| Xr abdomen 3 views (74021) |
$696.63 |
$995.18 |
6.4× |
| Xr arthrogram elbow (73085) |
$872.35 |
$1,246.22 |
2.4× |
| Xr arthrogram hip (73525) |
$973.22 |
$1,390.32 |
2.7× |
| Xr bone length study (77073) |
$567.70 |
$811 |
5.2× |
| Xr bone survey infant (77076) |
$1,005.90 |
$1,437 |
9.2× |
| Xr bone survey limited (77074) |
$664.95 |
$949.93 |
6.1× |
| Xr chest 1 view (71045) |
$460.41 |
$657.73 |
5.1× |
| Xr chest 2 views (71046) |
$564.07 |
$805.81 |
6.2× |
| Xr chest 3 views (71047) |
$597.18 |
$853.12 |
6.6× |
| Xr cystogram 3+ views (74430) |
$878.76 |
$1,255.37 |
2.4× |
| Xr facial bones 3 views (70150) |
$983.50 |
$1,405 |
9.0× |
| Xr lower extremity 2 views infant (73592) |
$426.30 |
$609 |
4.7× |
| Xr mandible 4 views (70110) |
$665.23 |
$950.33 |
6.1× |
| Xr myelogram c-spine (72240) |
$1,247.11 |
$1,781.58 |
1.5× |
| Xr nasal bones (70160) |
$716.10 |
$1,023 |
7.9× |
| Xr pelvis 3 views (72190) |
$765.80 |
$1,094 |
7.0× |
| Xr sialogram (70390) |
$800.48 |
$1,143.55 |
3.2× |
| Xr spine 1 view (72020) |
$388.50 |
$555 |
4.3× |
| Xr sternum 2 views (71120) |
$564.20 |
$806 |
6.2× |
| Xr surgical specimen (76098) |
$863.34 |
$1,233.35 |
1.5× |
| Xr upper extremity 2 views infant (73092) |
$426.30 |
$609 |
3.9× |
| Xray elbow 2 views (73070) |
$470.40 |
$672 |
5.2× |
| Xray forearm 2 views (73090) |
$505.40 |
$722 |
5.6× |
| Xray knee 1 or 2 views rt (73560) |
$587.30 |
$839 |
6.5× |
| Xray neck soft tissue (70360) |
$467.86 |
$668.37 |
5.1× |
| Xray orbits complete min 4 views (70200) |
$821.10 |
$1,173 |
7.5× |
| Xray pelvis 1 or 2 views (72170) |
$527.80 |
$754 |
4.8× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$661.50 |
$945 |
6.1× |
| Xray scapula complete (73010) |
$573.30 |
$819 |
5.3× |
| Xray shoulder 1 view (73020) |
$582.40 |
$832 |
6.4× |
| Xray sinuses paranasal <3 views (70210) |
$499.13 |
$713.04 |
5.5× |
| Xray spine thoracic 2 views (72070) |
$588.70 |
$841 |
5.4× |
| Xray spine thoracic 3 views (72072) |
$712.60 |
$1,018 |
6.5× |
| Xray tibia-fibula 2 views bil (73590) |
$555.80 |
$794 |
6.1× |
| Xray tmj open - closed unilat (70328) |
$434.70 |
$621 |
4.8× |