| 3-D radiotherapy plan dose-volume histograms (77295) |
$280 |
$5,050 |
0.2× |
| Abdomen 2 views (74019) |
$80 |
$312.50 |
0.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$432 |
$1,054 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$232 |
$1,801 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$213 |
$1,056 |
0.1× |
| Ankle 2 views (73600) |
$80 |
$360.50 |
0.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$189 |
$507 |
0.5× |
| Arthrogram elbow (73085) |
$136 |
$632 |
0.4× |
| Arthrogram hip (73525) |
$189 |
$918.50 |
0.5× |
| Arthrogram shoulder (73040) |
$190 |
$1,223 |
0.5× |
| Arthrogram wrist (73115) |
$189 |
$561 |
0.5× |
| Arthrography knee lt (73580) |
$166 |
$1,260 |
0.5× |
| Basic radiation dosimetry calculation (77300) |
$37 |
$311 |
0.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$282 |
$1,443 |
0.7× |
| Bone &/joint imaging whole body (78306) |
$366 |
$1,443 |
0.9× |
| Bone age studies (77072) |
$80 |
$227 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$429 |
$1,740 |
1.1× |
| Bone survey complete (77075) |
$80 |
$515 |
0.8× |
| Brain image w/flow 4 + views (78606) |
$406 |
$760 |
0.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$253 |
$630 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,035 |
$3,035 |
2.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$402 |
$655 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$80 |
$316 |
0.9× |
| Chest 1 view (71045) |
$80 |
$488 |
0.9× |
| Chest 3 views (71047) |
$80 |
$355 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$80 |
$236 |
0.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$228 |
$647 |
0.3× |
| Clavicle complete (73000) |
$80 |
$404 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$250 |
$1,591 |
2.4× |
| Continuing medical physics consltj pr wk (77336) |
$98 |
$425 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$250 |
$2,845.50 |
0.7× |
| CT abdomen and pelvis without contrast (74176) |
$250 |
$1,844 |
1.0× |
| CT abdomen w contrast (74160) |
$300 |
$2,574 |
1.7× |
| CT abdomen w wo contrast (74170) |
$350 |
$2,790 |
2.0× |
| CT abdomen w/o contrast (74150) |
$250 |
$1,900 |
2.4× |
| CT angiography upper extremity lt (73206) |
$350 |
$3,282 |
2.0× |
| CT c-spine w/o contrast (72125) |
$250 |
$1,573 |
2.4× |
| CT cervical spine w&w/o contrast (72127) |
$350 |
$2,849 |
2.0× |
| CT cervical spine with contrast (72126) |
$300 |
$2,191 |
0.9× |
| CT chest w/wo contrast (71270) |
$350 |
$2,585 |
2.0× |
| CT chest with contrast (71260) |
$300 |
$2,276 |
1.7× |
| CT head/brain with contrast (70460) |
$300 |
$1,651 |
1.7× |
| CT head/brain without and with contrast (70470) |
$350 |
$1,912 |
2.0× |
| CT iac w contrast (70481) |
$300 |
$2,011 |
1.7× |
| CT limited/localized follow up study (76380) |
$188 |
$245 |
2.2× |
| CT lower ext w/o (73700) |
$250 |
$1,287 |
2.4× |
| CT lower extremity w wo contrast (73702) |
$350 |
$2,275 |
2.0× |
| CT lower extremity with contrast (73701) |
$300 |
$1,965 |
1.7× |
| CT lumbar spine w & w/o contrast (72133) |
$350 |
$3,400 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$250 |
$1,752 |
2.4× |
| CT lumbar spine with contrast (72132) |
$300 |
$2,440 |
0.9× |
| CT maxillofacial w contrast (70487) |
$300 |
$2,068 |
1.7× |
| CT maxillofacial w/o contrast (70486) |
$250 |
$1,967 |
2.4× |
| CT maxillofacial w/wo contrast (70488) |
$350 |
$2,469 |
2.0× |
| CT neck soft tissue w contrast (70491) |
$300 |
$1,879 |
1.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$350 |
$2,800 |
2.0× |
| CT orbits w/o contrast (70480) |
$250 |
$1,443 |
2.4× |
| CT pelvis w & w/o contrast (72194) |
$350 |
$2,081 |
2.0× |
| CT pelvis w/o contrast (72192) |
$250 |
$1,831 |
2.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$140 |
$362 |
1.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$350 |
$2,143 |
2.0× |
| CT soft tissue neck w/o contrast (70490) |
$250 |
$1,348 |
2.4× |
| CT thoracic spine w/contrast (72129) |
$300 |
$2,226 |
1.7× |
| CT thoracic spine w/o contrast (72128) |
$250 |
$1,598 |
2.4× |
| CT thoracic spine w/wo contrast (72130) |
$350 |
$3,093 |
2.0× |
| CT thorax w/o contrast (71250) |
$250 |
$1,591 |
2.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$350 |
$3,028.50 |
2.0× |
| CT upper extremity w/o contrast rt (73200) |
$250 |
$1,878 |
2.4× |
| CT upper extremity with contrast (73201) |
$300 |
$2,624.50 |
0.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$250 |
$1,801 |
1.4× |
| Cta Abdomen (74175) |
$350 |
$1,997 |
2.0× |
| CTA abdomen pelvis (74174) |
$350 |
$3,027 |
1.0× |
| CTA chest (71275) |
$350 |
$1,774 |
2.0× |
| Cta Head (70496) |
$300 |
$1,473 |
1.7× |
| CTA lwr ext w&w/o contrast (73706) |
$350 |
$3,166.50 |
2.0× |
| Cta Neck (70498) |
$350 |
$1,355 |
2.0× |
| Cta Pelvis (72191) |
$350 |
$1,650 |
2.0× |
| Cystography minimum 3 views rs&i (74430) |
$59 |
$552 |
0.2× |
| Diskogram cervical (72285) |
$206 |
$1,231 |
0.1× |
| Diskography lumbar (72295) |
$174 |
$1,262 |
0.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$200 |
$562 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$56 |
$388 |
0.5× |
| Echo exam of fetal heart (76825) |
$200 |
$562 |
0.4× |
| Echoencephalography real time imaging (76506) |
$200 |
$453 |
1.9× |
| Esophagus (74220) |
$80 |
$511 |
0.5× |
| Fetal biophysical profile non-stress testing (76818) |
$200 |
$643 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$200 |
$457 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$63 |
$420 |
0.3× |
| Foot 2 views (73620) |
$80 |
$351 |
0.9× |
| Forearm 2 views (73090) |
$80 |
$366 |
0.9× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$80 |
$149 |
0.3× |
| Gated Heart Planar Single (78472) |
$294 |
$1,369 |
0.7× |
| Hand 2 views (73120) |
$80 |
$334 |
0.8× |
| Hand 3 views (73130) |
$80 |
$370 |
0.9× |
| Heart Infarct Image (78466) |
$225 |
$1,153 |
0.6× |
| Humerus Min 2 Views Left (73060) |
$80 |
$400 |
0.9× |
| Hysterosalpingogram (74740) |
$128 |
$583 |
0.5× |
| Interstitial radiation source applic complex (77778) |
$1,330 |
$2,905 |
1.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,132 |
$1,642 |
1.6× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$797 |
$1,642 |
1.4× |
| Kidney funcj study non-img radioisotopic study (78725) |
$141 |
$290 |
0.4× |
| Kidney imaging morphology (78700) |
$217 |
$1,004 |
0.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$296 |
$1,370 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$245 |
$1,297 |
0.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$462 |
$1,180 |
0.8× |
| Knee 3 views (73562) |
$80 |
$409.50 |
0.9× |
| Liver & spleen imaging static only (78215) |
$252 |
$1,245 |
0.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$187 |
$1,245 |
0.5× |
| Liver imaging w/vascular flow (78202) |
$271 |
$1,245 |
0.5× |
| Lymphoscintigraphy (78195) |
$441 |
$1,161 |
0.8× |
| Mammary ductogram or galactogram multiple (77054) |
$97 |
$553 |
0.4× |
| Mammary ductogram or galactogram single (77053) |
$75 |
$409 |
0.3× |
| Meckels Diverticulum (78290) |
$411 |
$945 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$514 |
$1,359 |
1.4× |
| MRA head w & w/o contrast (70546) |
$500 |
$3,146 |
1.4× |
| MRA head w/o contrast (70544) |
$400 |
$1,888 |
1.7× |
| MRA head with contrast (70545) |
$500 |
$2,094 |
1.4× |
| MRA neck w contrast (70548) |
$500 |
$2,631 |
1.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$500 |
$2,637 |
1.4× |
| MRA neck w/o contrast (70547) |
$400 |
$1,807 |
1.7× |
| MRI abdomen w contrast (74182) |
$500 |
$2,816 |
1.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$500 |
$3,240 |
1.4× |
| MRI abdomen w/o contrast (74181) |
$400 |
$2,479 |
1.7× |
| MRI any jnt lwr ext with con lt (73722) |
$500 |
$2,559 |
0.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$500 |
$2,281.50 |
0.6× |
| MRI bone marrow blood supply (77084) |
$444 |
$924 |
1.9× |
| MRI c-spine with contrast (72142) |
$500 |
$2,565 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$400 |
$2,232 |
1.7× |
| MRI chest w/o & w/contrast material (71552) |
$500 |
$3,059 |
1.4× |
| MRI chest w/o contrast (71550) |
$400 |
$2,449 |
1.7× |
| MRI chest with contrast (71551) |
$500 |
$2,425 |
0.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$500 |
$3,229.50 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$500 |
$2,105 |
1.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$400 |
$3,416 |
1.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$400 |
$1,874 |
1.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$500 |
$2,343 |
1.4× |
| MRI orbit/face/neck w/contrast (70542) |
$500 |
$2,811 |
1.4× |
| MRI pelvis w contrast (72196) |
$500 |
$2,432 |
1.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$500 |
$2,479 |
1.4× |
| MRI pelvis w/o contrast (72195) |
$400 |
$2,018 |
1.7× |
| MRI scan of arm joint before and after contrast (73223) |
$500 |
$3,435.50 |
1.4× |
| MRI scan of leg joint before and after contrast (73723) |
$500 |
$4,022 |
1.4× |
| MRI spectroscopy (76390) |
$1,680 |
$1,680 |
19.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$500 |
$3,101 |
1.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$500 |
$2,627 |
1.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$500 |
$2,962 |
1.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$500 |
$2,049 |
1.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$500 |
$2,679 |
1.4× |
| MRI thoracic spine w/o contrast (72146) |
$400 |
$2,013 |
1.7× |
| MRI tmj (70336) |
$400 |
$1,821 |
1.7× |
| MRI upper ext joint w/o contrast (73221) |
$400 |
$2,983.50 |
1.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$500 |
$3,174.50 |
1.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$400 |
$3,215.50 |
1.7× |
| Myelogram Cervical (72240) |
$159 |
$1,395 |
0.2× |
| Myelogram Lumbar (72265) |
$157 |
$1,226 |
0.2× |
| Myelogram thoracic (72255) |
$148 |
$1,192 |
0.2× |
| Myelography 2 or more regions (72270) |
$191 |
$1,328 |
0.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,957 |
$1,957 |
1.5× |
| Neck soft tissue (70360) |
$80 |
$281 |
0.9× |
| Nm adrenal scan (78075) |
$546 |
$578 |
0.4× |
| Nm bone marrow wb (78104) |
$313 |
$788 |
0.8× |
| Nm cisternogram (78630) |
$416 |
$790 |
0.8× |
| Nm gastric emptying study (78264) |
$409 |
$1,054 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$307 |
$898 |
0.8× |
| Nm peritoneal-venous shunt patency (78291) |
$329 |
$679 |
0.8× |
| Nm red cell sequestration (78140) |
$156 |
$419 |
0.4× |
| Nm whole blood volume (78122) |
$143 |
$601 |
0.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,554 |
$5,169 |
1.1× |
| Nuclear medicine of heart pumping function (78473) |
$378 |
$1,984 |
0.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$3,667 |
$3,667 |
2.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$287 |
$1,136 |
0.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$263 |
$1,319 |
0.7× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$237 |
$306 |
0.4× |
| Nuclear Rx Oral Admin (79005) |
$190 |
$1,456 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$200 |
$453 |
1.9× |
| Orthopantogram (70355) |
$80 |
$208 |
0.9× |
| Osseous survey infant (77076) |
$80 |
$305 |
0.8× |
| Osseous survey limited (77074) |
$80 |
$396 |
0.8× |
| Parathyroid imaging (78070) |
$369 |
$1,010 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$80 |
$217 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$4,716 |
$4,716 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$4,222 |
$4,222 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$5,248 |
$5,248 |
3.7× |
| PET imaging limited area chest head/neck (78811) |
$3,142 |
$3,142 |
2.4× |
| PET whole body (78813) |
$4,191 |
$4,191 |
2.9× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$137 |
$645 |
0.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$500 |
$3,769 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$296 |
$1,004 |
0.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$84 |
$518 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$80 |
$320 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$80 |
$502 |
0.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$80 |
$693 |
0.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$80 |
$338 |
0.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$80 |
$656 |
0.8× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$1,036 |
$11,098 |
0.1× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$624 |
$509 |
1.1× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$116 |
$366 |
1.1× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$436 |
$431 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$48 |
$400 |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$80 |
$261 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$80 |
$161 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$80 |
$322 |
0.9× |
| Radiologic exam colon single contrast study (74270) |
$80 |
$788 |
0.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$80 |
$740 |
0.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$80 |
$629 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$80 |
$338.50 |
0.9× |
| Radiological examination surgical specimen (76098) |
$61 |
$215 |
0.1× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$169 |
$495 |
0.7× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$138 |
$450 |
0.3× |
| Ribs bilateral 3 views (71110) |
$80 |
$680 |
0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$339 |
$1,377 |
0.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$382 |
$1,377 |
0.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$474 |
$1,377 |
0.9× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$225 |
$1,783 |
1.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$495 |
$495 |
2.1× |
| Rp Therapy Intravenous Administration (79101) |
$205 |
$633 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$80 |
$298 |
0.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$166 |
$436 |
0.7× |
| Scanogram (77073) |
$80 |
$329 |
0.8× |
| Scapula complete (73010) |
$80 |
$380 |
0.8× |
| Sella turcica (70240) |
$80 |
$126 |
0.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$121 |
$431 |
1.2× |
| Sialogram (70390) |
$156 |
$357 |
0.7× |
| Simulation intermediate (77285) |
$417 |
$1,296 |
1.1× |
| Small bowel series (74250) |
$80 |
$654 |
0.5× |
| Spec medical radj physics consltj (77370) |
$159 |
$2,580 |
1.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$49 |
$849 |
0.1× |
| Special dosimetry (77331) |
$21 |
$295 |
0.2× |
| Special treatment procedure (77470) |
$156 |
$2,580 |
0.3× |
| Spine thoracic 3 views (72072) |
$80 |
$393 |
0.8× |
| Stereotactic body radiation delivery (77373) |
$1,082 |
$5,937 |
0.6× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$189 |
$314 |
1.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$148 |
$655 |
0.4× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$82 |
$340 |
0.2× |
| Testicular Imaging With Vascular Flow (78761) |
$269 |
$974 |
0.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$397 |
$1,320 |
1.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$252 |
$530 |
1.9× |
| Thoracolumbar 2 views (72080) |
$80 |
$240.50 |
0.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$389 |
$1,169 |
0.7× |
| Tmj unilateral (70328) |
$80 |
$433 |
0.9× |
| Tomogram (76100) |
$80 |
$725 |
0.8× |
| Treatment device intermediate (77333) |
$106 |
$916 |
0.8× |
| Treatment devices simple (77332) |
$17 |
$887 |
0.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$791 |
$2,565 |
1.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$327 |
$1,142 |
0.8× |
| Tx devices design & construction complex (77334) |
$71 |
$944 |
0.2× |
| Ultrasound, abdomen limited (76705) |
$200 |
$648 |
1.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$31 |
$31 |
0.4× |
| Unlisted fluoroscopic procedure (76496) |
$324 |
$324 |
3.7× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$2,452 |
$2,452 |
23.9× |
| Unlisted Ultrasound Procedure (76999) |
$109 |
$109 |
1.2× |
| Upper Extremity Infant (73092) |
$80 |
$333 |
0.8× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$312 |
$551 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$511 |
$511 |
2.1× |
| Urethrocystography voiding (74455) |
$149 |
$650 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$187 |
$890 |
1.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$214 |
$884 |
1.2× |
| Us chest (76604) |
$200 |
$254 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$200 |
$574 |
1.9× |
| Us guided compression repair (76936) |
$376 |
$172 |
1.7× |
| Us infant hips dynamic (76885) |
$200 |
$575 |
2.3× |
| Us kidney transplant (76776) |
$200 |
$358 |
1.9× |
| Us ob transvaginal (76817) |
$132 |
$426 |
1.3× |
| Us pelvic non ob complete (76856) |
$200 |
$708 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$200 |
$432 |
1.9× |
| Us pregnancy ltd (76815) |
$200 |
$416 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$200 |
$412 |
1.9× |
| Us retroperitoneal complete (76770) |
$200 |
$407 |
1.9× |
| Us retroperitoneal limited (76775) |
$200 |
$407 |
1.9× |
| Us scrotum and contents (76870) |
$200 |
$574 |
1.9× |
| Us soft tissue head/neck (76536) |
$200 |
$593 |
1.9× |
| Us spinal canal and contents (76800) |
$200 |
$604 |
1.9× |
| Us transrectal (76872) |
$171 |
$898 |
1.6× |
| Us transrectal prostate volume (76873) |
$255 |
$237 |
2.4× |
| Us xtr non-vasc lmtd (76882) |
$200 |
$392.50 |
1.9× |
| Venogram extremity bilateral (75822) |
$190 |
$598 |
0.1× |
| Venography caval superior serialography rs&i (75827) |
$169 |
$1,053 |
0.1× |
| Venography extremity unilateral rs&i (75820) |
$153 |
$384 |
0.1× |
| Wrist 2 views (73100) |
$80 |
$343 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$80 |
$480 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$80 |
$493 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$80 |
$386.50 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$80 |
$965 |
0.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$80 |
$310 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$80 |
$374 |
0.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$80 |
$605 |
0.8× |
| X-ray exam hip uni 1 view (73501) |
$80 |
$235 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$80 |
$328 |
0.9× |
| X-ray exam hip uni 4/> views (73503) |
$80 |
$379 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$80 |
$796 |
0.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$80 |
$899 |
0.8× |
| X-ray exam of femur 1 (73551) |
$80 |
$193 |
0.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$80 |
$559 |
0.5× |
| X-ray eye for foreign body (70030) |
$46 |
$175 |
0.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$52 |
$444 |
0.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$80 |
$333 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$80 |
$397.50 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$80 |
$256 |
0.9× |
| X-ray IV pyelogram+drip infusn (74410) |
$204 |
$799 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$80 |
$321 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$80 |
$355.50 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$80 |
$321 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$80 |
$295 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$80 |
$429 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$80 |
$620 |
0.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$80 |
$529 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$32 |
$339 |
0.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$80 |
$175 |
0.9× |
| X-ray of voice box or throat (70370) |
$80 |
$252 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$38 |
$390 |
0.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$80 |
$307 |
0.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$115 |
$738 |
0.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$80 |
$306 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$80 |
$402 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$80 |
$765 |
0.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$80 |
$328 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$80 |
$310 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$80 |
$412 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$30 |
$292 |
0.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$80 |
$218 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$34 |
$524 |
0.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$80 |
$353 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$80 |
$248 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$80 |
$304 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$80 |
$253 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$80 |
$390 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$80 |
$288 |
0.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$80 |
$245 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$80 |
$398.50 |
0.9× |
| Xr arthrogram ankle (73615) |
$188 |
$632 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$80 |
$543 |
0.8× |
| Xr chest 4+ views (71048) |
$80 |
$482 |
0.8× |
| Xr Cholecystography Oral Contrast (74290) |
$80 |
$239 |
0.5× |
| Xr finger(s) 2+ views (73140) |
$80 |
$241 |
0.9× |
| Xr optic foramina (70190) |
$80 |
$152 |
0.9× |
| Xr shoulder 1 view (73020) |
$80 |
$363 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$80 |
$443 |
0.8× |
| Xr tibia/fibula 2 views (73590) |
$80 |
$402.50 |
0.9× |
| Xr tmj bilateral (70330) |
$80 |
$639 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$80 |
$334 |
0.9× |