| 3-D radiotherapy plan dose-volume histograms (77295) |
$8,195.40 |
$13,659 |
5.9× |
| Abdomen 1 View (74018) |
$159 |
$265 |
1.8× |
| Abdomen 2 views (74019) |
$208.20 |
$347 |
2.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$657 |
$1,095 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,184.80 |
$5,308 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,006 |
$5,010 |
1.0× |
| Ankle 2 views (73600) |
$148.20 |
$247 |
1.7× |
| Aortography thoracic serialography rs&i (75605) |
$5,200.20 |
$8,667 |
0.9× |
| Artery X-Rays Abdomen (75726) |
$5,200.20 |
$8,667 |
0.9× |
| Artery X-Rays Pelvis (75736) |
$5,200.20 |
$8,667 |
0.9× |
| Artery X-Rays Spine (75705) |
$5,200.20 |
$8,667 |
0.9× |
| Basic radiation dosimetry calculation (77300) |
$995.40 |
$1,659 |
7.4× |
| Bone age studies (77072) |
$192 |
$320 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,174.80 |
$1,958 |
2.9× |
| Bone Imaging Limited Area (78300) |
$480.60 |
$801 |
1.2× |
| Bone Imaging Whole Body (78306) |
$1,138.20 |
$1,897 |
2.8× |
| Bone marrow imaging limited area (78102) |
$604.80 |
$1,008 |
1.5× |
| Bone survey infant (77076) |
$197.40 |
$329 |
1.9× |
| Brachytx isodose complex (77318) |
$1,881.60 |
$3,136 |
5.0× |
| Brachytx isodose intermed (77317) |
$1,392.60 |
$2,321 |
3.7× |
| Brachytx Isodose Plan Simple (77316) |
$1,052.40 |
$1,754 |
2.8× |
| Brain Image W/Flow < 4 Views (78601) |
$582.60 |
$971 |
1.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$732.60 |
$1,221 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$511.20 |
$852 |
5.9× |
| Cerebrospinal Fluid Scan (78630) |
$666.60 |
$1,111 |
1.2× |
| Chest 1 view (71045) |
$261 |
$435 |
3.0× |
| Chest 2 views (71046) |
$274.20 |
$457 |
3.1× |
| Chest 3 views (71047) |
$288 |
$480 |
3.3× |
| Chest 4 or more views (71048) |
$302.40 |
$504 |
2.9× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$212.40 |
$354 |
2.0× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$175.80 |
$293 |
1.7× |
| Clavicle complete (73000) |
$151.20 |
$252 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,148.40 |
$1,914 |
11.0× |
| Continuing medical physics consltj pr wk (77336) |
$966.60 |
$1,611 |
7.2× |
| Contrast Exam Abdominl Aorta (75625) |
$3,006 |
$5,010 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$410.40 |
$684 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,981.40 |
$4,969 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,744.20 |
$2,907 |
7.3× |
| CT abdomen w contrast (74160) |
$885.60 |
$1,476 |
5.0× |
| CT abdomen w wo contrast (74170) |
$1,063.20 |
$1,772 |
6.1× |
| CT abdomen w/o contrast (74150) |
$811.80 |
$1,353 |
7.8× |
| CT Angio Abdomen and Pelvis (74174) |
$3,279.60 |
$5,466 |
9.4× |
| CT Angio Chest (71275) |
$1,071 |
$1,785 |
6.1× |
| CT Angio Head (70496) |
$1,341 |
$2,235 |
7.6× |
| CT angio hrt w/3d image (75574) |
$726.60 |
$1,211 |
2.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,419.60 |
$2,366 |
8.1× |
| CT Angio Neck (70498) |
$1,069.80 |
$1,783 |
6.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,174.80 |
$1,958 |
6.7× |
| CT cervical spine w/ contrast (72126) |
$1,029.60 |
$1,716 |
2.9× |
| CT cervical spine w/o contrast (72125) |
$907.20 |
$1,512 |
8.7× |
| CT chest w contrast (71260) |
$925.80 |
$1,543 |
5.3× |
| CT chest w/wo contrast (71270) |
$973.80 |
$1,623 |
5.5× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$618 |
$1,030 |
5.9× |
| CT head/brain with contrast (70460) |
$1,023 |
$1,705 |
5.8× |
| CT head/brain without and with contrast (70470) |
$1,219.20 |
$2,032 |
6.9× |
| CT iac w contrast (70481) |
$881.40 |
$1,469 |
5.0× |
| CT lower ext w/o (73700) |
$905.40 |
$1,509 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$1,048.80 |
$1,748 |
6.0× |
| CT lumbar spine w contrast (72132) |
$912 |
$1,520 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$691.20 |
$1,152 |
6.6× |
| CT maxillofacial w contrast (70487) |
$915.60 |
$1,526 |
5.2× |
| CT maxillofacial wo contrast (70486) |
$792.60 |
$1,321 |
7.6× |
| CT neck tissue combo (70492) |
$972.60 |
$1,621 |
5.5× |
| CT orbits w/o contrast (70480) |
$723.60 |
$1,206 |
6.9× |
| CT pelvis w/o contrast (72192) |
$705 |
$1,175 |
6.7× |
| CT scan of leg combo (73702) |
$1,290.60 |
$2,151 |
7.3× |
| CT scans face/jaw combo (70488) |
$1,144.80 |
$1,908 |
6.5× |
| CT soft tissue neck w contrast (70491) |
$857.40 |
$1,429 |
4.9× |
| CT soft tissue neck w/o contrast (70490) |
$757.80 |
$1,263 |
7.2× |
| CT thoracic spine w contrast (72129) |
$923.40 |
$1,539 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$754.80 |
$1,258 |
7.2× |
| CT thoracic spine w/wo cont (72130) |
$1,423.20 |
$2,372 |
8.1× |
| CT thorax w/o contrast (71250) |
$708.60 |
$1,181 |
6.8× |
| CT upper ext wo (73200) |
$701.40 |
$1,169 |
6.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,068 |
$1,780 |
6.1× |
| CT upper extremity with contrast (73201) |
$912.60 |
$1,521 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,112.40 |
$1,854 |
6.3× |
| Cta Abdomen (74175) |
$1,169.40 |
$1,949 |
6.7× |
| CTA pelvis (72191) |
$1,643.40 |
$2,739 |
9.4× |
| Dxa Bone Density Axial (77080) |
$229.20 |
$382 |
2.2× |
| Dxa bone density study (77085) |
$261 |
$435 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$130.20 |
$217 |
1.5× |
| Echo Guide For Artery Repair (76936) |
$454.20 |
$757 |
2.1× |
| Echograp Trans R Pros Study (76873) |
$334.80 |
$558 |
3.2× |
| Esophagram (74220) |
$252 |
$420 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$299.40 |
$499 |
1.3× |
| Foot 2 views (73620) |
$155.40 |
$259 |
1.8× |
| Forearm 2 views (73090) |
$162 |
$270 |
1.9× |
| Gastric emptying imaging study (78264) |
$778.80 |
$1,298 |
1.9× |
| Gated Heart Planar Single (78472) |
$1,266 |
$2,110 |
3.2× |
| Hand 2 views (73120) |
$174 |
$290 |
1.7× |
| Hepatobil Syst Image W/Drug (78227) |
$880.20 |
$1,467 |
1.6× |
| Hepatobiliary System Imaging (78226) |
$760.20 |
$1,267 |
1.9× |
| Ht Muscle Image Spect Sing (78451) |
$1,500 |
$2,500 |
1.2× |
| Hysterosalpingogram (74740) |
$525.60 |
$876 |
2.2× |
| Interstitial radiation source applic complex (77778) |
$2,752.80 |
$4,588 |
3.9× |
| Intracavitary Radiation Source Applic Complex (77763) |
$1,519.20 |
$2,532 |
2.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$1,191.60 |
$1,986 |
2.2× |
| Intracavitary radiation source applic simple (77761) |
$1,023 |
$1,705 |
1.8× |
| Joint Survey Single View (77077) |
$151.20 |
$252 |
1.4× |
| K Flow/Funct Image Multiple (78709) |
$1,167.60 |
$1,946 |
2.1× |
| K Flow/Funct Image W/Drug (78708) |
$1,060.20 |
$1,767 |
1.9× |
| K Flow/Funct Image W/O Drug (78707) |
$853.80 |
$1,423 |
1.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$462 |
$770 |
1.2× |
| Knee 3 Views (73562) |
$184.20 |
$307 |
2.1× |
| Lung Perf&Ventilat Diferentl (78598) |
$945.60 |
$1,576 |
1.7× |
| Lung perfusion differential (78597) |
$724.20 |
$1,207 |
1.8× |
| Lung Ventilat&Perfus Imaging (78582) |
$756.60 |
$1,261 |
1.4× |
| Lung Ventilation Imaging (78579) |
$462 |
$770 |
1.2× |
| Lymph System Imaging (78195) |
$650.40 |
$1,084 |
1.2× |
| Magnetic Image Jaw Joint (70336) |
$1,287 |
$2,145 |
5.4× |
| Mammary ductogram or galactogram multiple (77054) |
$305.40 |
$509 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$277.80 |
$463 |
1.2× |
| Meckels Divert Exam (78290) |
$655.80 |
$1,093 |
1.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$7,182 |
$11,970 |
19.2× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,646.60 |
$4,411 |
7.6× |
| MRA head w/o contrast (70544) |
$1,758 |
$2,930 |
7.4× |
| MRA head with contrast (70545) |
$1,887 |
$3,145 |
5.4× |
| MRA neck w contrast (70548) |
$2,139.60 |
$3,566 |
6.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,452.20 |
$4,087 |
7.0× |
| MRA neck w/o contrast (70547) |
$989.40 |
$1,649 |
4.1× |
| MRI abdomen w contrast (74182) |
$1,725 |
$2,875 |
4.9× |
| MRI abdomen w/o contrast (74181) |
$1,442.40 |
$2,404 |
6.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,748.40 |
$2,914 |
2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,090.40 |
$3,484 |
6.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,138 |
$5,230 |
4.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,132.80 |
$1,888 |
4.7× |
| MRI cervical spine w contrast (72142) |
$1,696.80 |
$2,828 |
4.9× |
| MRI cervical spine w/o cont (72141) |
$1,380.60 |
$2,301 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,578.60 |
$2,631 |
6.6× |
| MRI chest with contrast (71551) |
$1,732.20 |
$2,887 |
2.2× |
| MRI chest wo w contrast (71552) |
$2,149.20 |
$3,582 |
6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,471.20 |
$2,452 |
4.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,170 |
$1,950 |
4.9× |
| MRI lumbar spine w contrast (72149) |
$1,470 |
$2,450 |
4.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,907.40 |
$3,179 |
5.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,254 |
$2,090 |
5.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,895.40 |
$3,159 |
5.4× |
| MRI pelvis w contrast (72196) |
$1,552.20 |
$2,587 |
4.4× |
| MRI pelvis w/o & w contrast (72197) |
$1,928.40 |
$3,214 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$1,446 |
$2,410 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,152.60 |
$1,921 |
4.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,296 |
$2,160 |
5.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,672.80 |
$2,788 |
4.8× |
| MRI, abdomen, combo (74183) |
$1,960.80 |
$3,268 |
5.6× |
| MRI, dorsal spine combo (72157) |
$1,909.80 |
$3,183 |
5.5× |
| MRI, dorsal spine contrast (72147) |
$1,636.20 |
$2,727 |
4.7× |
| MRI, joint upper extrem (73221) |
$1,266 |
$2,110 |
5.3× |
| MRI, joint upper extrem combo (73223) |
$3,790.80 |
$6,318 |
10.8× |
| MRI, lumbar spine combo (72158) |
$1,668.60 |
$2,781 |
4.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,061 |
$3,435 |
1.6× |
| Neck soft tissue (70360) |
$142.20 |
$237 |
1.6× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$535.20 |
$892 |
1.4× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$604.80 |
$1,008 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$12,150 |
$20,250 |
8.8× |
| Nuclear Rx Oral Admin (79005) |
$670.80 |
$1,118 |
2.9× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$737.40 |
$1,229 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$169.80 |
$283 |
1.6× |
| Peritoneogram Rs&I (74190) |
$630 |
$1,050 |
1.2× |
| PET image w/CT, full body (78816) |
$4,395.60 |
$7,326 |
3.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,396.60 |
$5,661 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$601.80 |
$1,003 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$289.20 |
$482 |
2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$750 |
$1,250 |
1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$166.20 |
$277 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$134.40 |
$224 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$179.40 |
$299 |
2.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$327.60 |
$546 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$141 |
$235 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$172.80 |
$288 |
2.0× |
| Radex Hand Minimum 3 Views (73130) |
$177.60 |
$296 |
2.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$182.40 |
$304 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$200.40 |
$334 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$256.80 |
$428 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$199.20 |
$332 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$118.80 |
$198 |
1.4× |
| Radex Spine 1 View Specify Level (72020) |
$157.20 |
$262 |
1.8× |
| Radex Sternum Minimum 2 Views (71120) |
$199.20 |
$332 |
2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$238.20 |
$397 |
2.7× |
| Radex Toe Minimum 2 Views (73660) |
$156 |
$260 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$194.40 |
$324 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$171 |
$285 |
2.0× |
| Radiation treatment delivery level 1 (77402) |
$2,296.20 |
$3,827 |
22.5× |
| Radiation treatment delivery level 2 (77407) |
$3,547.80 |
$5,913 |
9.2× |
| Radiation treatment delivery level 3 (77412) |
$3,961.80 |
$6,603 |
7.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$322.20 |
$537 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$250.20 |
$417 |
2.4× |
| Radiologic exam colon double contrast study (74280) |
$609.60 |
$1,016 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$424.20 |
$707 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$354.60 |
$591 |
2.0× |
| Radiologic exam knee complete 4/more views (73564) |
$233.40 |
$389 |
2.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$203.40 |
$339 |
1.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$293.40 |
$489 |
1.7× |
| Radiologic exam swallow function contrast study (74230) |
$305.40 |
$509 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$439.20 |
$732 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$101.40 |
$169 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$125.40 |
$209 |
1.4× |
| Radiologic examination knee 1/2 views (73560) |
$157.20 |
$262 |
1.8× |
| Radiologic Examination Osseous Survey Limited (77074) |
$267.60 |
$446 |
2.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$208.80 |
$348 |
2.4× |
| Ribs bilateral 3 views (71110) |
$258 |
$430 |
2.5× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$862.80 |
$1,438 |
2.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,989 |
$3,315 |
3.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,500 |
$2,500 |
2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,362 |
$2,270 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,283 |
$3,805 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,622.60 |
$4,371 |
1.8× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,692 |
$2,820 |
1.3× |
| Rp Therapy Intravenous Administration (79101) |
$696.60 |
$1,161 |
3.0× |
| Scapula (73010) |
$192.60 |
$321 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30 |
$50 |
1.3× |
| Shoulder 1 view (73020) |
$101.40 |
$169 |
1.2× |
| Sialogram (70390) |
$374.40 |
$624 |
1.6× |
| Skull less than 4 views (70250) |
$172.20 |
$287 |
1.6× |
| Special dosimetry (77331) |
$239.40 |
$399 |
1.8× |
| Special Physics Consult (77370) |
$1,416 |
$2,360 |
10.5× |
| Special teletherapy port plan (77321) |
$724.20 |
$1,207 |
1.9× |
| Special treatment procedure (77470) |
$2,168.40 |
$3,614 |
3.9× |
| Speech evaluation, complex (70371) |
$277.80 |
$463 |
1.2× |
| Stereotactic Body Radiation Delivery (77373) |
$21,266.40 |
$35,444 |
11.9× |
| Sternoclavicular joints (71130) |
$254.40 |
$424 |
2.9× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$304.80 |
$508 |
3.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,769.40 |
$2,949 |
4.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$827.40 |
$1,379 |
2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$3,106.20 |
$5,177 |
8.3× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$2,163.60 |
$3,606 |
5.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,290.60 |
$2,151 |
9.6× |
| Thoracic spine 2 views (72070) |
$180.60 |
$301 |
1.7× |
| Thoracic spine 3 views (72072) |
$274.80 |
$458 |
2.6× |
| Thoracolumbar 2 views (72080) |
$190.80 |
$318 |
2.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$475.80 |
$793 |
1.2× |
| Thyroid Met Imaging Body (78018) |
$1,016.40 |
$1,694 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$579.60 |
$966 |
1.4× |
| Tx Devices Design & Construction Complex (77334) |
$1,853.40 |
$3,089 |
4.9× |
| Tx devices design & construction intermediate (77333) |
$625.20 |
$1,042 |
4.6× |
| Tx devices design & construction simple (77332) |
$429.60 |
$716 |
3.2× |
Ultrasound Breast Limited (76642)
range across 6 matching MRF lines |
$438–$876 |
$730–$1,460 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$186 |
$310 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$447.60 |
$746 |
4.3× |
| Upper gi w/o kub (74240) |
$384.60 |
$641 |
2.2× |
| Urethrocystogram voiding (74455) |
$411 |
$685 |
1.7× |
| Urethrocystography retrograde (74450) |
$384.60 |
$641 |
1.6× |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
$454.20–$908.40 |
$757–$1,514 |
varies |
| Us chest (76604) |
$341.40 |
$569 |
3.3× |
| Us complete joint (76881) |
$212.40 |
$354 |
2.0× |
| Us exam, pelvic, limited (76857) |
$273.60 |
$456 |
2.6× |
| Us kidney transplant (76776) |
$412.20 |
$687 |
3.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$156.60 |
$261 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$237.60 |
$396 |
2.3× |
| Us ob transvaginal (76817) |
$296.40 |
$494 |
2.8× |
| Us pelvic non ob complete (76856) |
$614.40 |
$1,024 |
5.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$474 |
$790 |
4.5× |
| Us retroperitoneal complete (76770) |
$525.60 |
$876 |
5.0× |
| Us retroperitoneal limited (76775) |
$395.40 |
$659 |
3.8× |
| Us scrotum and contents (76870) |
$820.20 |
$1,367 |
7.8× |
| Us thyroid (76536) |
$411 |
$685 |
3.9× |
| Us transrectal (76872) |
$440.40 |
$734 |
4.2× |
| Vein X-Ray Chest (75827) |
$1,471.20 |
$2,452 |
0.9× |
| Venogram Sinus/Jugular (75860) |
$3,006 |
$5,010 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,006 |
$5,010 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,471.20 |
$2,452 |
0.9× |
| Venography Renal Bilateral (75833) |
$3,427.20 |
$5,712 |
1.1× |
| Venography Renal Unilateral (75831) |
$3,006 |
$5,010 |
1.0× |
| Wrist 2 views (73100) |
$127.20 |
$212 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$194.40 |
$324 |
2.2× |
| X-ray antegrade pyelogram tube (74425) |
$440.40 |
$734 |
1.3× |
| X-Ray Aorta Leg Arteries (75630) |
$3,262.20 |
$5,437 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$191.40 |
$319 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$139.20 |
$232 |
1.6× |
| X-Ray Exam Breast Specimen (76098) |
$630 |
$1,050 |
1.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$181.80 |
$303 |
2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$192 |
$320 |
1.8× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$259.80 |
$433 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$90.60 |
$151 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$115.20 |
$192 |
1.3× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$207.60 |
$346 |
2.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$197.40 |
$329 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$219 |
$365 |
2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$260.40 |
$434 |
2.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$414 |
$690 |
4.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$236.40 |
$394 |
2.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$369.60 |
$616 |
3.5× |
X-Ray Exam Unilat Ribs/Chest (71101)
range across 2 matching MRF lines |
$159–$211.80 |
$265–$353 |
varies |
| X-ray humerus (73060) |
$168 |
$280 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$169.80 |
$283 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$178.80 |
$298 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$184.80 |
$308 |
1.8× |
| X-ray nose-rectum child f.b. (76010) |
$183.60 |
$306 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$313.20 |
$522 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$161.40 |
$269 |
1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$123 |
$205 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$163.20 |
$272 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$320.40 |
$534 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$305.40 |
$509 |
2.9× |
| X-ray thoracic spine 4 vw (72074) |
$313.20 |
$522 |
3.0× |
| X-Ray Tmj Unilat (70328) |
$127.80 |
$213 |
1.5× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$510 |
$850 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$129 |
$215 |
1.2× |
| X-Rays Bone Survey Complete (77075) |
$301.20 |
$502 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$350.40 |
$584 |
3.3× |
| Xr facial bones less than 3 views (70140) |
$115.80 |
$193 |
1.3× |
| Xr orbits complete 4 views (70200) |
$339.60 |
$566 |
3.2× |