| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,341.76 |
$9,059.65 |
4.0× |
| Abdomen 2 views (74019) |
$361.28 |
$516.12 |
3.0× |
| Acute gi blood loss imaging (78278) |
$1,533.17 |
$2,190.24 |
3.3× |
| Angio Adrenal Bilat Select (75733) |
$3,553.33 |
$5,076.19 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$6,895.64 |
$9,850.91 |
1.9× |
| Angiography extremity unilateral rs&i (75710) |
$6,770.83 |
$9,672.62 |
1.9× |
| Angiography internal mammary rs&i (75756) |
$2,450.42 |
$3,500.60 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,064.24 |
$8,663.20 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$7,726.93 |
$11,038.47 |
2.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,342.79 |
$7,632.56 |
1.5× |
| Angiography Spinal Selective Rs&I (75705) |
$6,579.66 |
$9,399.52 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,167.94 |
$13,097.05 |
1.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,444.47 |
$3,492.10 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,340.65 |
$3,343.78 |
0.6× |
| Ankle 2 views (73600) |
$346.14 |
$494.49 |
3.4× |
| Aortogram thoracic (75605) |
$5,570.66 |
$7,958.08 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$6,779.39 |
$9,684.84 |
1.9× |
| Aortography abdominal serialography rs&i (75625) |
$6,412.03 |
$9,160.04 |
1.8× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$4,892.40 |
$6,989.14 |
1.3× |
| Artery X-Rays Adrenal Gland (75731) |
$3,360.34 |
$4,800.48 |
0.9× |
| Arthrogram ankle (73615) |
$1,341.74 |
$1,916.78 |
3.3× |
| Arthrogram elbow (73085) |
$991.23 |
$1,416.04 |
2.5× |
| Arthrogram hip (73525) |
$1,322.23 |
$1,888.90 |
3.3× |
| Arthrogram knee (73580) |
$1,303.64 |
$1,862.34 |
3.2× |
| Arthrogram shoulder (73040) |
$1,245.79 |
$1,779.70 |
3.1× |
| Arthrogram wrist (73115) |
$1,379.24 |
$1,970.34 |
3.4× |
| Basic dosimetry (77300) |
$462.13 |
$660.19 |
3.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,316.22 |
$1,880.32 |
2.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,350.45 |
$1,929.21 |
2.9× |
| Bone &/joint imaging whole body (78306) |
$1,472.51 |
$2,103.58 |
3.2× |
| Bone age studies (77072) |
$358.18 |
$511.68 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$1,686.57 |
$2,409.39 |
3.6× |
| Bone Marrow Imaging Limited Area (78102) |
$1,034.49 |
$1,477.84 |
2.2× |
| Bone survey complete (77075) |
$522.61 |
$746.58 |
4.3× |
| Bone survey infant (77076) |
$248.98 |
$355.68 |
2.1× |
| Bowel imaging (78290) |
$1,235.58 |
$1,765.11 |
2.7× |
| Brachytx isodose complex (77318) |
$1,776.13 |
$2,537.33 |
4.1× |
| Brachytx isodose intermed (77317) |
$1,383.05 |
$1,975.79 |
3.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$997.52 |
$1,425.03 |
2.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$4,680.70 |
$6,686.72 |
7.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,457.82 |
$7,796.88 |
3.3× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$871.18 |
$1,244.55 |
1.4× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,810.76 |
$2,586.80 |
3.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,787.97 |
$2,554.24 |
3.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$3,085.26 |
$4,407.52 |
3.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,316.77 |
$3,309.67 |
5.7× |
| Cardiac shunt detection (78428) |
$746.57 |
$1,066.53 |
1.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,587.77 |
$2,268.24 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$379.45 |
$542.07 |
3.8× |
| Chest 1 view (71045) |
$368.26 |
$526.09 |
3.7× |
| Chest xray 3 views (71047) |
$621.96 |
$888.52 |
6.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$376.94 |
$538.49 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$768 |
$1,097.14 |
3.8× |
| Cineradiography/videoradiography (76120) |
$529.98 |
$757.12 |
4.4× |
| Cisternography Positive Contrast Rs&I (70015) |
$1,719.14 |
$2,455.91 |
1.9× |
| Clavicle complete (73000) |
$349.86 |
$499.80 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$245.04 |
$350.06 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$666.12 |
$951.60 |
4.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$482.66 |
$689.52 |
2.4× |
| Corpora cavernosography (74445) |
$646.57 |
$923.67 |
5.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,765.74 |
$3,951.06 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,896.01 |
$2,708.58 |
6.9× |
| CT abdomen w contrast (74160) |
$1,013.55 |
$1,447.93 |
5.0× |
| CT abdomen w wo contrast (74170) |
$1,714.20 |
$2,448.85 |
8.4× |
| CT abdomen w/o contrast (74150) |
$1,285.65 |
$1,836.64 |
10.6× |
| CT angio hrt w/3d image (75574) |
$1,893 |
$2,704.29 |
4.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,116.75 |
$4,452.50 |
15.3× |
| CT angiography upper extremity lt (73206) |
$2,067.52 |
$2,953.60 |
10.2× |
| CT c-spine w/contrast (72126) |
$1,374.11 |
$1,963.01 |
3.4× |
| CT c-spine w/o contrast (72125) |
$1,455.41 |
$2,079.16 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,706.66 |
$2,438.08 |
8.4× |
| CT chest w contrast (71260) |
$1,911.71 |
$2,731.02 |
9.4× |
| CT chest w/wo contrast (71270) |
$2,335.96 |
$3,337.09 |
11.5× |
| CT colonography screening (74263) |
$1,305.30 |
$1,864.72 |
4.7× |
| CT colonography w/dye (74262) |
$1,305.82 |
$1,865.46 |
6.4× |
| CT colonography w/o cntrst (74261) |
$1,157.52 |
$1,653.60 |
9.6× |
| CT head/brain with contrast (70460) |
$1,307.68 |
$1,868.11 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,417.37 |
$2,024.82 |
7.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$938.60 |
$1,340.86 |
2.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$132.48 |
$189.26 |
1.3× |
| CT hrt w/3d image congen (75573) |
$1,624.75 |
$2,321.07 |
4.0× |
| CT iac w contrast (70481) |
$1,059.40 |
$1,513.43 |
5.2× |
| CT limited/localized follow up study (76380) |
$507.79 |
$725.41 |
5.0× |
| CT lower ext w/o (73700) |
$1,517.61 |
$2,168.01 |
12.5× |
| CT lower extremity w wo contrast (73702) |
$1,853.12 |
$2,647.31 |
9.1× |
| CT lower extremity w/contrast material (73701) |
$1,457.94 |
$2,082.76 |
7.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,830.14 |
$2,614.48 |
9.0× |
| CT lumbar spine w/contrast (72132) |
$1,483.78 |
$2,119.68 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,556.79 |
$2,223.99 |
12.9× |
| CT maxillofacial w contrast (70487) |
$2,206.11 |
$3,151.58 |
10.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,740.16 |
$3,914.51 |
13.5× |
| CT maxillofacial wo contrast (70486) |
$1,217.62 |
$1,739.46 |
10.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,168.07 |
$1,668.67 |
5.8× |
| CT orbits w/o contrast (70480) |
$1,116 |
$1,594.29 |
9.2× |
| CT pelvis w/o contrast (72192) |
$1,334.88 |
$1,906.97 |
11.0× |
| CT pelvis w/wo contrast (72194) |
$2,690.90 |
$3,844.15 |
13.2× |
| CT scan of arm combo (73202) |
$1,532.31 |
$2,189.02 |
7.5× |
| CT soft tissue neck w contrast (70491) |
$1,293.79 |
$1,848.27 |
6.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,585.14 |
$2,264.49 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,311.13 |
$1,873.04 |
10.8× |
| CT thoracic spine w/contrast (72129) |
$1,288.22 |
$1,840.32 |
6.3× |
| CT thoracic spine w/o contrast (72128) |
$1,350.09 |
$1,928.70 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,586.54 |
$2,266.49 |
7.8× |
| CT thorax w/o contrast (71250) |
$1,118.10 |
$1,597.28 |
9.2× |
| CT unlisted procedure (76497) |
$339.52 |
$485.03 |
3.4× |
| CT upper ext wo (73200) |
$1,226.86 |
$1,752.66 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,163.76 |
$1,662.50 |
2.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,450.61 |
$3,500.87 |
12.1× |
| Cta Abdomen (74175) |
$2,595.50 |
$3,707.86 |
12.8× |
| CTA abdomen pelvis (74174) |
$3,302.21 |
$4,717.44 |
8.2× |
| CTA chest (71275) |
$2,027.27 |
$2,896.10 |
10.0× |
| Cta Head (70496) |
$2,447.94 |
$3,497.05 |
12.1× |
| Cta Neck (70498) |
$2,344.58 |
$3,349.40 |
11.5× |
| Cta Pelvis (72191) |
$1,880.50 |
$2,686.43 |
9.3× |
| Cystography minimum 3 views rs&i (74430) |
$818.02 |
$1,168.60 |
2.0× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$1,082.14 |
$1,545.91 |
3.9× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$3,232.73 |
$4,618.19 |
1.3× |
| Diskogram cervical (72285) |
$1,820 |
$2,600 |
0.8× |
| Diskography lumbar (72295) |
$2,883.07 |
$4,118.67 |
1.3× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$195.29 |
$278.99 |
1.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$415.69 |
$593.84 |
3.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$388.02 |
$554.32 |
3.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$419.64 |
$599.48 |
3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$118.43 |
$169.18 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$289.70 |
$413.86 |
2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$805.22 |
$1,150.31 |
2.9× |
| Esophageal motility (78258) |
$600.82 |
$858.31 |
1.3× |
| Esophagus (74220) |
$493.32 |
$704.75 |
2.4× |
| Facial bones min 3 views (70150) |
$348.10 |
$497.28 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$707.76 |
$1,011.09 |
5.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$495.16 |
$707.37 |
4.1× |
| Fetal Echo (76825) |
$1,277.29 |
$1,824.70 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$756.85 |
$1,081.21 |
2.7× |
| Foot 2 views (73620) |
$356.26 |
$508.95 |
3.5× |
| Forearm 2 views (73090) |
$411.54 |
$587.91 |
4.1× |
| Functional MRI brain by phys/psych (70555) |
$2,002 |
$2,860 |
7.2× |
| Functional MRI brain by tech (70554) |
$2,516.32 |
$3,594.73 |
9.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,490.14 |
$2,128.77 |
3.2× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$522.39 |
$746.27 |
1.9× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,644.77 |
$2,349.67 |
2.6× |
| Hand 2 views (73120) |
$511.52 |
$730.74 |
4.2× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,472.29 |
$3,531.84 |
3.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$4,239.29 |
$6,056.13 |
5.3× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$6,586.43 |
$9,409.19 |
8.2× |
| Heart first pass single,planar (78481) |
$940.84 |
$1,344.05 |
1.5× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,977.23 |
$7,110.33 |
1.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,912.31 |
$7,017.58 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,354.51 |
$1,935.02 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,233.96 |
$1,762.80 |
2.7× |
| High energy neutron radj tx dlvr 1/> isocenter (77423) |
$2,031.75 |
$2,902.50 |
3.2× |
| Hysterosalpingogram (74740) |
$818.94 |
$1,169.91 |
3.0× |
| Image fusion (77399) |
$695.02 |
$992.88 |
4.5× |
| Interstitial radiation source applic complex (77778) |
$4,401.49 |
$6,287.84 |
5.5× |
| Intraop radiaj tx deliver electrons sngl tx sess (77425) |
$6,886.11 |
$9,837.30 |
0.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$316.68 |
$452.40 |
2.6× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,241.07 |
$1,772.96 |
2.7× |
| Kidney imaging morphology (78700) |
$864.14 |
$1,234.48 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,076.26 |
$1,537.52 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,302.36 |
$1,860.51 |
2.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,754.73 |
$2,506.76 |
2.8× |
| Knee 3 views (73562) |
$355.14 |
$507.35 |
3.5× |
| Liver & spleen imaging static only (78215) |
$1,101.93 |
$1,574.18 |
2.4× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,382.21 |
$1,974.59 |
3.0× |
| Liver imaging static only (78201) |
$1,982.67 |
$2,832.38 |
3.2× |
| Liver imaging w/vascular flow (78202) |
$2,358.68 |
$3,369.55 |
3.8× |
| Lung perf&ventilat diferentl (78598) |
$1,844.75 |
$2,635.36 |
2.9× |
| Lung perfusion differential (78597) |
$1,414.50 |
$2,020.72 |
3.1× |
| Lung ventilation imaging (78579) |
$1,211.64 |
$1,730.91 |
2.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$2,346.04 |
$3,351.48 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,130.88 |
$1,615.54 |
0.3× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,585.09 |
$2,264.41 |
0.9× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,291.40 |
$1,844.86 |
1.8× |
| Lymphoscintigraphy (78195) |
$1,613.85 |
$2,305.50 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,501.92 |
$3,574.16 |
2.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$1,302.69 |
$1,860.98 |
6.4× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$1,157.74 |
$1,653.91 |
1.8× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$2,689.11 |
$3,841.58 |
13.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,995.04 |
$2,850.05 |
4.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,403.74 |
$3,433.92 |
5.9× |
| Magnetic Resonance Elastography (76391) |
$831.10 |
$1,187.28 |
3.0× |
| Mammary ductogram or galactogram multiple (77054) |
$623.74 |
$891.05 |
2.3× |
| Mammary ductogram or galactogram single (77053) |
$474.39 |
$677.70 |
1.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$174.38 |
$249.12 |
1.7× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$487.50 |
$696.43 |
1.1× |
| Mlc imrt design & construction per imrt plan (77338) |
$5,614.09 |
$8,020.13 |
12.9× |
| Mr safety determination physician/other qhp (76016) |
$1,860.28 |
$2,657.54 |
18.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$89.33 |
$127.62 |
2.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$95.44 |
$136.35 |
0.9× |
| Mr safety implt pos&/immoblj (76019) |
$90.62 |
$129.45 |
1.3× |
| Mr safety med physics xm customization plng&mntr (76017) |
$604.80 |
$864 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,256.42 |
$3,223.46 |
5.6× |
| MRA head w/o contrast (70544) |
$1,685.03 |
$2,407.18 |
6.1× |
| MRA head with contrast (70545) |
$1,488.91 |
$2,127.01 |
3.7× |
| MRA neck w contrast (70548) |
$1,608.81 |
$2,298.30 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,411.78 |
$3,445.40 |
6.0× |
| MRA neck w/o contrast (70547) |
$1,820 |
$2,600 |
6.6× |
| MRI abdomen w contrast (74182) |
$3,040.56 |
$4,343.66 |
7.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,233.68 |
$4,619.54 |
8.0× |
| MRI abdomen w/o contrast (74181) |
$2,193.96 |
$3,134.23 |
7.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,262.67 |
$3,232.38 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,108.02 |
$4,440.03 |
7.7× |
| MRI bone marrow blood supply (77084) |
$1,402.13 |
$2,003.04 |
5.1× |
| MRI breast w/o contrast bilateral (77047) |
$2,687.05 |
$3,838.64 |
9.7× |
| MRI breast wo contrast unilateral (77046) |
$2,594.76 |
$3,706.80 |
9.4× |
| MRI c-spine with contrast (72142) |
$2,212.60 |
$3,160.85 |
5.5× |
| MRI cardiac w/o cont stress (75559) |
$1,272.35 |
$1,817.64 |
2.0× |
| MRI cardiac w/o contrast (75557) |
$1,397.82 |
$1,996.89 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$2,158.42 |
$3,083.45 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,691.23 |
$2,416.04 |
4.2× |
| MRI chest w/o contrast (71550) |
$1,672.22 |
$2,388.88 |
6.1× |
| MRI chest with contrast (71551) |
$1,345.32 |
$1,921.89 |
1.5× |
| MRI fetal sngl/1st gestation (74712) |
$1,028.01 |
$1,468.58 |
3.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,750.96 |
$3,929.95 |
6.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,167.78 |
$4,525.39 |
7.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,729.24 |
$3,898.91 |
9.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,258.26 |
$3,226.08 |
8.2× |
| MRI orbit face neck w contrast (70542) |
$1,972.15 |
$2,817.36 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,441.28 |
$3,487.54 |
6.0× |
| MRI pelvis w/contrast (72196) |
$1,592.32 |
$2,274.74 |
3.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,001.85 |
$2,859.78 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,648.92 |
$2,355.60 |
6.0× |
| MRI spectroscopy (76390) |
$1,624.75 |
$2,321.07 |
16.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,478.21 |
$3,540.30 |
6.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,306.27 |
$3,294.67 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,630.37 |
$3,757.67 |
6.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,375.60 |
$3,393.71 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,690.06 |
$3,842.95 |
6.7× |
| MRI temporomandibular joint (70336) |
$2,011.25 |
$2,873.21 |
7.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,040.86 |
$2,915.52 |
7.4× |
| MRI up ext w/o contrast (73218) |
$2,490.67 |
$3,558.10 |
9.0× |
| MRI upper ext joint w/o contrast (73221) |
$2,726.62 |
$3,895.18 |
9.9× |
| MRI, joint upper extrem combo (73223) |
$2,942.58 |
$4,203.69 |
7.3× |
| Myelogram Cervical (72240) |
$2,061.65 |
$2,945.21 |
2.3× |
| Myelogram Lumbar (72265) |
$1,549.91 |
$2,214.16 |
1.7× |
| Myelogram thoracic (72255) |
$1,393.41 |
$1,990.58 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,663.48 |
$2,376.40 |
1.8× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$4,361.66 |
$6,230.95 |
2.9× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$2,924.43 |
$4,177.76 |
1.1× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$4,419.69 |
$6,313.84 |
2.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$1,912.39 |
$2,731.99 |
1.2× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$4,169.80 |
$5,956.85 |
1.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$4,386.89 |
$6,266.99 |
2.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,163.93 |
$3,091.33 |
1.4× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$4,049.86 |
$5,785.52 |
2.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,691.55 |
$3,845.07 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,511.79 |
$3,588.27 |
1.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,625.49 |
$5,179.27 |
2.2× |
| Myocrd Img Pet Prfuj W/Metab Dual Radiotracer (78432) |
$2,840.84 |
$4,058.35 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$4,647.33 |
$6,639.04 |
4.7× |
| Neck soft tissue (70360) |
$282.46 |
$403.52 |
2.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$693.06 |
$990.08 |
1.5× |
| Nm adrenal scan (78075) |
$1,971.04 |
$2,815.77 |
1.3× |
| Nm bone marrow wb (78104) |
$1,317.84 |
$1,882.63 |
2.8× |
| Nm cardiac blood pool multiple (78473) |
$1,606.93 |
$2,295.61 |
3.5× |
| Nm cisternogram (78630) |
$1,807.85 |
$2,582.64 |
2.9× |
| Nm csf leak detection (78650) |
$1,085.41 |
$1,550.58 |
0.7× |
| Nm gastric emptying study (78264) |
$1,712.91 |
$2,447.02 |
3.7× |
| Nm gastroesophageal reflux study (78262) |
$1,181.22 |
$1,687.45 |
2.6× |
| Nm peritoneal-venous shunt patency (78291) |
$740.64 |
$1,058.06 |
1.6× |
| Nm red cell sequestration (78140) |
$1,059.35 |
$1,513.36 |
2.3× |
| Noncardiac Vascular Flow Imaging (78445) |
$732.52 |
$1,046.45 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$526.34 |
$751.92 |
4.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,847.11 |
$11,210.16 |
4.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,121.25 |
$1,601.79 |
2.4× |
| Nuclear Rx Oral Admin (79005) |
$1,339.23 |
$1,913.19 |
5.0× |
| Ob us nuchal meas 1 gest (76813) |
$444.08 |
$634.40 |
3.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$288.29 |
$411.84 |
2.4× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$324.76 |
$463.94 |
2.7× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$496.17 |
$708.81 |
4.1× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$58.54 |
$83.63 |
1.7× |
| Osseous survey limited (77074) |
$427.81 |
$611.16 |
3.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,562.04 |
$2,231.49 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$1,247.50 |
$1,782.14 |
2.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,247.55 |
$1,782.22 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$388.16 |
$554.51 |
3.2× |
| Perineogram (74775) |
$609.70 |
$871 |
2.2× |
| Peritoneogram after injection (74190) |
$1,064.34 |
$1,520.48 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$5,223.95 |
$7,462.78 |
3.2× |
| PET imaging CT for attenuation limited area (78814) |
$5,192.10 |
$7,417.28 |
3.1× |
| PET imaging for CT attenuation whole body (78816) |
$4,513.05 |
$6,447.22 |
2.7× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$3,835.41 |
$5,479.16 |
2.6× |
| PET whole body (78813) |
$2,675.02 |
$3,821.46 |
1.6× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$3,172.02 |
$4,531.45 |
2.1× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$1,666.87 |
$2,381.24 |
1.0× |
| Proton tx delivery complex (77525) |
$8,824.03 |
$12,605.76 |
6.1× |
| Proton tx delivery intermediate (77523) |
$3,968.57 |
$5,669.38 |
2.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,138.34 |
$4,483.34 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,582.22 |
$3,688.88 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,192.29 |
$1,703.27 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,103.19 |
$3,004.56 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,200.98 |
$1,715.69 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$348.76 |
$498.24 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$270.38 |
$386.27 |
2.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$332.37 |
$474.81 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$196.78 |
$281.12 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$267.25 |
$381.78 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$313.96 |
$448.52 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$413.85 |
$591.22 |
4.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$386.04 |
$551.48 |
3.8× |
| Radex Hand Minimum 3 Views (73130) |
$454.68 |
$649.54 |
4.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$321.52 |
$459.32 |
3.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$456.81 |
$652.59 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$366.44 |
$523.48 |
3.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$412.29 |
$588.99 |
3.4× |
| Radex Humerus Minimum 2 Views (73060) |
$345.98 |
$494.25 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$403.44 |
$576.34 |
4.0× |
| Radex Kne Compl 4/More Views (73564) |
$389.80 |
$556.84 |
3.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$238.43 |
$340.61 |
2.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$289.38 |
$413.40 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$409.98 |
$585.69 |
3.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$241.68 |
$345.25 |
2.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$288.29 |
$411.84 |
2.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$353.08 |
$504.40 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$289.93 |
$414.19 |
2.9× |
| Radex Toe Minimum 2 Views (73660) |
$362.72 |
$518.16 |
3.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$245.91 |
$351.30 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$416.28 |
$594.68 |
4.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$377.51 |
$539.30 |
3.1× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$75,161.07 |
$107,372.96 |
8.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$22,872.30 |
$32,674.72 |
2.7× |
| Radiation treatment delivery level 1 (77402) |
$503.85 |
$719.79 |
4.3× |
| Radiation treatment delivery level 2 (77407) |
$586.24 |
$837.49 |
1.3× |
| Radiation treatment delivery level 3 (77412) |
$937.20 |
$1,338.85 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$296.58 |
$423.68 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$420.58 |
$600.83 |
3.5× |
| Radiologic exam chest 2 views (71046) |
$491.02 |
$701.45 |
4.9× |
| Radiologic exam colon single contrast study (74270) |
$696.48 |
$994.97 |
3.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$689.96 |
$985.65 |
3.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$717.54 |
$1,025.06 |
3.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$671.93 |
$959.90 |
3.3× |
| Radiologic examination femur 1 view (73551) |
$343.54 |
$490.76 |
3.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$141.05 |
$201.50 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$412.70 |
$589.58 |
4.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$505.84 |
$722.62 |
4.2× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$325.78 |
$465.40 |
2.7× |
| Radiological examination surgical specimen (76098) |
$856.54 |
$1,223.63 |
1.4× |
| Radiopharm Dacryocystography (78660) |
$644.71 |
$921.02 |
1.4× |
| Radiopharmaceutical therapy, by intra-articular administration Non-Facility (79440) |
$1,259.96 |
$1,799.95 |
4.7× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$1,259.96 |
$1,799.95 |
4.7× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$565.33 |
$807.62 |
2.1× |
| Red cell survival study Non-Facility (78130) |
$820.29 |
$1,171.84 |
1.8× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$2,831.79 |
$4,045.42 |
4.5× |
| Renal Cyst Study (74470) |
$750.23 |
$1,071.76 |
1.2× |
| Ribs bilateral 3 views (71110) |
$387.82 |
$554.03 |
3.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,150.97 |
$1,644.24 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,256.09 |
$1,794.41 |
2.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,644.86 |
$6,635.51 |
7.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,387.93 |
$1,982.76 |
2.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,514.11 |
$5,020.16 |
5.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$5,867.27 |
$8,381.81 |
3.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$7,755.88 |
$11,079.83 |
4.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,600.46 |
$6,572.09 |
3.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$719.26 |
$1,027.52 |
2.7× |
| Rp Therapy Intravenous Administration (79101) |
$889.76 |
$1,271.09 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$279.55 |
$399.36 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$645.28 |
$921.83 |
2.3× |
| Salivary gland function study (78232) |
$895.53 |
$1,279.33 |
1.9× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$590.99 |
$844.27 |
1.3× |
| Scapula (73010) |
$427.70 |
$611 |
3.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$72.61 |
$103.73 |
3.1× |
| Sella turcica (70240) |
$154.44 |
$220.63 |
1.5× |
| Shoulder 1 view (73020) |
$289.92 |
$414.18 |
2.9× |
| Sialogram (70390) |
$566.48 |
$809.25 |
2.1× |
| Simulation intermediate (77285) |
$1,474.85 |
$2,106.93 |
3.4× |
| Small bowel series (74250) |
$625.06 |
$892.94 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,245.61 |
$1,779.44 |
2.9× |
| Special dosimetry (77331) |
$461.26 |
$658.94 |
3.0× |
| Special Physics Consult (77370) |
$864.63 |
$1,235.18 |
5.6× |
| Special treatment procedure (77470) |
$2,646.35 |
$3,780.50 |
4.1× |
| Speech evaluation complex (70371) |
$680.62 |
$972.32 |
2.5× |
| Spine thoracic 3 views (72072) |
$334.39 |
$477.70 |
2.8× |
| Splenoportograpy rs&i (75810) |
$2,604.20 |
$3,720.29 |
0.7× |
| Stereotactic Body Radiation Delivery (77373) |
$8,794.87 |
$12,564.10 |
4.2× |
| Superior sagittal sinus venogram (75870) |
$2,774.41 |
$3,963.44 |
0.8× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$222.11 |
$317.30 |
2.2× |
| Tbs technical calculation only (77091) |
$169.04 |
$241.49 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$2,305.84 |
$3,294.06 |
5.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$1,277.64 |
$1,825.20 |
2.9× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$651.62 |
$930.89 |
2.4× |
| Testicular Imaging With Vascular Flow (78761) |
$919.25 |
$1,313.21 |
2.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,611.30 |
$2,301.86 |
3.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$932.35 |
$1,331.93 |
6.0× |
| Thoracolumbar 2 views (72080) |
$255.96 |
$365.66 |
2.5× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,025.16 |
$1,464.51 |
2.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,458.60 |
$2,083.71 |
2.3× |
| Thyroid imaging w/blood flow (78013) |
$908.54 |
$1,297.92 |
2.0× |
| Thyroid uptake measurement (78012) |
$575.69 |
$822.41 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,078.17 |
$1,540.24 |
2.3× |
| Tmj unilateral (70328) |
$240.60 |
$343.72 |
2.4× |
| Tomogram (76100) |
$436.02 |
$622.89 |
3.6× |
| Treatment device complex (77334) |
$1,723.12 |
$2,461.60 |
4.0× |
| Treatment device intermediate (77333) |
$1,136.51 |
$1,623.58 |
7.3× |
| Treatment devices simple (77332) |
$760.98 |
$1,087.12 |
4.9× |
| Ultrasound breast complete (76641) |
$505.68 |
$722.39 |
4.2× |
| Ultrasound elastography first target lesion (76982) |
$148.33 |
$211.90 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$450.63 |
$643.76 |
3.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$647.92 |
$925.60 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$601.30 |
$859 |
5.0× |
| Umbilical-artery Doppler (OB) (76820) |
$367.64 |
$525.20 |
3.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$539.50 |
$770.72 |
5.4× |
| Unlisted fluoroscopic procedure (76496) |
$2,136.83 |
$3,052.62 |
21.2× |
| Unlisted magnetic resonance procedure (76498) |
$1,435.74 |
$2,051.06 |
14.2× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$356.48 |
$509.26 |
0.8× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$251.62 |
$359.45 |
2.1× |
| Unlisted procedure, therapeutic radiology clinical treatment planning 2nd-5th Sessions (77299) |
$364.34 |
$520.49 |
2.3× |
| Unlisted ultrasound procedure (76999) |
$256.98 |
$367.12 |
2.6× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$202.02 |
$288.60 |
18.3× |
| Urea breath test, C-14 (isotopic); analysis Facility (78268) |
$245.86 |
$351.23 |
2.6× |
| Ureteral reflux study (78740) |
$800.82 |
$1,144.03 |
1.7× |
| Urethrocystogram voiding (74455) |
$908.31 |
$1,297.59 |
3.3× |
| Urethrocystography retrograde rs&i (74450) |
$833.20 |
$1,190.29 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$183.09 |
$261.56 |
0.9× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,079.11 |
$1,541.59 |
5.3× |
| Us breast unilateral limited (76642) |
$517.15 |
$738.78 |
5.1× |
| Us chest (76604) |
$505.96 |
$722.80 |
4.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$988.62 |
$1,412.32 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$439.22 |
$627.45 |
3.6× |
| Us elastography parenchyma (76981) |
$422.48 |
$603.54 |
3.5× |
| Us encephalogram (76506) |
$478 |
$682.85 |
3.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$395.80 |
$565.43 |
3.3× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$851.69 |
$1,216.70 |
7.0× |
| Us ob detailed single fetus (76811) |
$757.12 |
$1,081.60 |
2.7× |
| Us ob limited (76815) |
$403.16 |
$575.95 |
3.3× |
| Us ob transvaginal (76817) |
$683.59 |
$976.56 |
5.6× |
| Us pelvic non ob complete (76856) |
$534.18 |
$763.11 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$474.81 |
$678.30 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$679.59 |
$970.84 |
5.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$443.49 |
$633.56 |
3.7× |
| Us retroperitoneal complete (76770) |
$645.21 |
$921.73 |
5.3× |
| Us retroperitoneal limited (76775) |
$514.36 |
$734.80 |
4.2× |
| Us scrotum and contents (76870) |
$703.98 |
$1,005.68 |
5.8× |
| Us soft tissue head/neck (76536) |
$679.22 |
$970.32 |
5.6× |
| Us spinal canal and contents (76800) |
$330.88 |
$472.68 |
2.7× |
| Us transrectal (76872) |
$276.23 |
$394.61 |
2.3× |
| Us transrectal prostate volume (76873) |
$697.38 |
$996.25 |
5.8× |
| Us, eye b-scan (76512) |
$323.96 |
$462.80 |
2.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$640.54 |
$915.06 |
5.3× |
| Venogram adrenal unilat (75840) |
$4,829.93 |
$6,899.90 |
1.3× |
| Venogram extremity bilateral (75822) |
$2,169.43 |
$3,099.18 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$2,138.14 |
$3,054.48 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$4,497.58 |
$6,425.12 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$2,540.72 |
$3,629.60 |
1.4× |
| Venography Orbital Rs&I (75880) |
$1,453.33 |
$2,076.18 |
2.0× |
| Venography Renal Bilateral (75833) |
$5,231.82 |
$7,474.03 |
1.4× |
| Venography renal unilateral selective rs&i (75831) |
$4,746.16 |
$6,780.23 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,373.10 |
$4,818.72 |
0.9× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$3,302.21 |
$4,717.44 |
4.5× |
| Venous sampling by catheter (75893) |
$6,467.55 |
$9,239.36 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$196.56 |
$280.80 |
2.0× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$1,952.54 |
$2,789.34 |
3.1× |
| Wrist 2 views (73100) |
$453.65 |
$648.08 |
4.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$498.20 |
$711.72 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$288.29 |
$411.84 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,083.68 |
$1,548.12 |
5.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$404.55 |
$577.94 |
4.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$367.02 |
$524.31 |
3.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$353.89 |
$505.56 |
2.9× |
| X-ray exam of femur 2/> (73552) |
$312.50 |
$446.42 |
3.1× |
| X-ray eye for foreign body (70030) |
$434.98 |
$621.40 |
4.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$302.85 |
$432.64 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$1,151.72 |
$1,645.31 |
5.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$298.32 |
$426.17 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$151.91 |
$217.01 |
1.5× |
| X-ray leg, infant (73592) |
$249.52 |
$356.46 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$355.94 |
$508.48 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$591.61 |
$845.16 |
4.9× |
| X-ray nose-rectum child f.b. (76010) |
$289.68 |
$413.83 |
2.9× |
| X-ray optic foramen (70190) |
$235.10 |
$335.85 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$304.68 |
$435.25 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$1,340.98 |
$1,915.68 |
3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$242.89 |
$346.99 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$204.10 |
$291.57 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$357.26 |
$510.37 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$236.20 |
$337.43 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$251.37 |
$359.10 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$245.07 |
$350.10 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$292.29 |
$417.56 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$330.22 |
$471.74 |
2.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,305.86 |
$1,865.52 |
6.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$255.77 |
$365.38 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$294.84 |
$421.20 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$279.55 |
$399.36 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$359.91 |
$514.16 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$384.10 |
$548.71 |
3.2× |
| Xr bone length studies (77073) |
$351.55 |
$502.21 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$387.43 |
$553.47 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$467.20 |
$667.43 |
3.9× |
| Xr chest 4+ views (71048) |
$646.51 |
$923.58 |
5.3× |
| Xr urogram antegrade (74425) |
$780.42 |
$1,114.88 |
1.9× |