| 3-D radiotherapy plan dose-volume histograms (77295) |
$5,227.80 |
$17,426 |
3.9× |
| Abdomen 2 views (74019) |
$641.40 |
$2,138 |
6.3× |
| Acute gi blood loss imaging (78278) |
$1,277.70 |
$4,259 |
3.3× |
| Angiography extremity bilateral rs&i (75716) |
$4,625.10 |
$15,417 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,625.10 |
$15,417 |
1.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,413.80 |
$8,046 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,103.80 |
$10,346 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,103.80 |
$10,346 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,103 |
$27,010 |
1.5× |
| Ankle 2 views (73600) |
$429.90 |
$1,433 |
5.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,625.10 |
$15,417 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$4,625.10 |
$15,417 |
1.5× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,098.30 |
$3,661 |
0.4× |
| Arthrogram hip (73525) |
$609.90 |
$2,033 |
1.8× |
| Arthrogram shoulder (73040) |
$1,808.40 |
$6,028 |
5.3× |
| Arthrogram wrist (73115) |
$609.90 |
$2,033 |
1.8× |
| Basic dosimetry (77300) |
$875.70 |
$2,919 |
6.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,561.50 |
$5,205 |
4.0× |
| Bone &/joint imaging whole body (78306) |
$1,561.50 |
$5,205 |
4.0× |
| Bone age studies (77072) |
$238.50 |
$795 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,872.60 |
$6,242 |
4.8× |
| Bone survey complete (77075) |
$706.80 |
$2,356 |
6.9× |
| Bowel imaging (78290) |
$603.30 |
$2,011 |
1.5× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$408.30 |
$1,361 |
1.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$172.50 |
$575 |
0.3× |
| Cervical spine 2 or 3 views (72040) |
$495.60 |
$1,652 |
5.8× |
| Chest 1 view (71045) |
$351.60 |
$1,172 |
4.1× |
| Chest xray 3 views (71047) |
$266.70 |
$889 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$771.30 |
$2,571 |
4.5× |
| Clavicle complete (73000) |
$453.90 |
$1,513 |
5.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,899 |
$6,330 |
18.6× |
| Continuing medical physics consltj pr wk (77336) |
$1,116 |
$3,720 |
8.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,098.90 |
$13,663 |
12.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,698.50 |
$8,995 |
11.6× |
| CT abdomen w contrast (74160) |
$4,084.20 |
$13,614 |
23.9× |
| CT abdomen w wo contrast (74170) |
$4,433.10 |
$14,777 |
25.9× |
| CT abdomen w/o contrast (74150) |
$3,010.50 |
$10,035 |
29.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,479.60 |
$4,932 |
8.6× |
| CT angiography upper extremity lt (73206) |
$1,479.60 |
$4,932 |
8.6× |
| CT c-spine w/contrast (72126) |
$3,352.80 |
$11,176 |
9.8× |
| CT c-spine w/o contrast (72125) |
$2,617.80 |
$8,726 |
25.7× |
| CT cervical spine w&w/o contrast (72127) |
$3,352.80 |
$11,176 |
19.6× |
| CT chest w contrast (71260) |
$4,011.30 |
$13,371 |
23.4× |
| CT chest w/wo contrast (71270) |
$3,960.60 |
$13,202 |
23.1× |
| CT head/brain with contrast (70460) |
$3,471.60 |
$11,572 |
20.3× |
| CT head/brain without and with contrast (70470) |
$4,264.80 |
$14,216 |
24.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,301 |
$1,301 |
15.3× |
| CT iac w contrast (70481) |
$489 |
$1,630 |
2.9× |
| CT limited/localized follow up study (76380) |
$1,046.10 |
$3,487 |
12.3× |
| CT lower ext w/o (73700) |
$2,373.60 |
$7,912 |
23.3× |
| CT lower extremity w wo contrast (73702) |
$4,014.90 |
$13,383 |
23.5× |
| CT lower extremity w/contrast material (73701) |
$3,680.40 |
$12,268 |
21.5× |
| CT lumbar spine w & w/o contrast (72133) |
$3,352.80 |
$11,176 |
19.6× |
| CT lumbar spine w/contrast (72132) |
$3,352.80 |
$11,176 |
9.8× |
| CT lumbar spine w/o contrast (72131) |
$3,150.60 |
$10,502 |
30.9× |
| CT maxillofacial w contrast (70487) |
$1,690.50 |
$5,635 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$3,889.20 |
$12,964 |
22.7× |
| CT maxillofacial wo contrast (70486) |
$2,276.40 |
$7,588 |
22.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,287.10 |
$10,957 |
19.2× |
| CT orbits w/o contrast (70480) |
$2,032.80 |
$6,776 |
19.9× |
| CT pelvis w/o contrast (72192) |
$2,671.20 |
$8,904 |
26.2× |
| CT pelvis w/wo contrast (72194) |
$3,764.40 |
$12,548 |
22.0× |
| CT scan of arm combo (73202) |
$3,258.90 |
$10,863 |
19.0× |
| CT soft tissue neck w contrast (70491) |
$3,889.20 |
$12,964 |
22.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,112.30 |
$7,041 |
12.3× |
| CT soft tissue neck w/o contrast (70490) |
$3,889.20 |
$12,964 |
38.1× |
| CT thoracic spine w/contrast (72129) |
$2,722.20 |
$9,074 |
15.9× |
| CT thoracic spine w/o contrast (72128) |
$2,671.20 |
$8,904 |
26.2× |
| CT thoracic spine w/wo contrast (72130) |
$595.50 |
$1,985 |
3.5× |
| CT thorax w/o contrast (71250) |
$2,265 |
$7,550 |
22.2× |
| CT upper ext wo (73200) |
$2,120.40 |
$7,068 |
20.8× |
| CT upper extremity with contrast (73201) |
$2,987.40 |
$9,958 |
8.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$961.50 |
$3,205 |
5.6× |
| Cta Abdomen (74175) |
$883.20 |
$2,944 |
5.2× |
| CTA abdomen pelvis (74174) |
$2,740.20 |
$9,134 |
8.1× |
| CTA chest (71275) |
$2,783.40 |
$9,278 |
16.3× |
| Cta Head (70496) |
$1,479.60 |
$4,932 |
8.6× |
| Cta Neck (70498) |
$1,479.60 |
$4,932 |
8.6× |
| Cta Pelvis (72191) |
$1,479.60 |
$4,932 |
8.6× |
| Cystography minimum 3 views rs&i (74430) |
$519.30 |
$1,731 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$177.60 |
$592 |
1.7× |
| Esophagus (74220) |
$970.20 |
$3,234 |
5.7× |
| Facial bones min 3 views (70150) |
$649.50 |
$2,165 |
6.4× |
| Fetal biophysical profile non-stress testing (76818) |
$111.60 |
$372 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$275.40 |
$918 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$799.20 |
$2,664 |
3.4× |
| Foot 2 views (73620) |
$429.90 |
$1,433 |
5.1× |
| Forearm 2 views (73090) |
$453.90 |
$1,513 |
5.3× |
| Hand 2 views (73120) |
$379.80 |
$1,266 |
3.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$899.70 |
$2,999 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,734.30 |
$5,781 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,734.30 |
$5,781 |
4.4× |
| Hysterosalpingogram (74740) |
$756.60 |
$2,522 |
3.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,530.60 |
$5,102 |
2.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,530.60 |
$5,102 |
2.9× |
| Knee 3 views (73562) |
$707.10 |
$2,357 |
8.3× |
| Lung perfusion differential (78597) |
$379.50 |
$1,265 |
1.0× |
| Lymphoscintigraphy (78195) |
$1,277.70 |
$4,259 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$5,258.70 |
$17,529 |
6.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,723.20 |
$15,744 |
13.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$765 |
$2,550 |
2.1× |
| Mr safety determination physician/other qhp (76016) |
$83.10 |
$277 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$23.10 |
$77 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$86.70 |
$289 |
0.9× |
| Mr safety implt pos&/immoblj (76019) |
$56.10 |
$187 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$228.30 |
$761 |
1.0× |
| MRA head w/o contrast (70544) |
$2,452.50 |
$8,175 |
10.5× |
| MRA neck w contrast (70548) |
$376.50 |
$1,255 |
1.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$451.20 |
$1,504 |
1.3× |
| MRA neck w/o contrast (70547) |
$2,452.50 |
$8,175 |
10.5× |
| MRI abdomen w contrast (74182) |
$2,479.20 |
$8,264 |
7.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,689.60 |
$5,632 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$2,326.80 |
$7,756 |
10.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$6,052.80 |
$20,176 |
7.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$6,580.80 |
$21,936 |
19.3× |
| MRI c-spine with contrast (72142) |
$778.50 |
$2,595 |
2.3× |
| MRI cervical spine w/o contrast (72141) |
$6,642.90 |
$22,143 |
28.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,183.50 |
$3,945 |
3.5× |
| MRI chest w/o contrast (71550) |
$5,652.60 |
$18,842 |
24.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$8,023.80 |
$26,746 |
23.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,976.10 |
$16,587 |
21.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$5,007.60 |
$16,692 |
21.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,007.60 |
$16,692 |
14.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,279.30 |
$20,931 |
18.4× |
| MRI pelvis w/o contrast (72195) |
$3,948.30 |
$13,161 |
17.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$7,422.60 |
$24,742 |
21.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$778.50 |
$2,595 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$8,307 |
$27,690 |
24.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$926.10 |
$3,087 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$880.20 |
$2,934 |
2.6× |
| MRI temporomandibular joint (70336) |
$1,470.30 |
$4,901 |
6.3× |
| MRI thoracic spine w/o contrast (72146) |
$4,998 |
$16,660 |
21.5× |
| MRI up ext w/o contrast (73218) |
$4,241.70 |
$14,139 |
18.2× |
| MRI upper ext joint w/o contrast (73221) |
$5,133.60 |
$17,112 |
22.1× |
| MRI, joint upper extrem combo (73223) |
$5,405.70 |
$18,019 |
15.9× |
| Myocardial Spect Multiple Studies (78452) |
$5,667 |
$18,890 |
4.5× |
| Myocardial spect single study at rest or stress (78451) |
$1,200.30 |
$4,001 |
1.0× |
| Neck soft tissue (70360) |
$429.90 |
$1,433 |
5.1× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$390 |
$1,300 |
1.0× |
| Nm cisternogram (78630) |
$1,530.60 |
$5,102 |
2.9× |
| Nm gastric emptying study (78264) |
$1,277.70 |
$4,259 |
3.3× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,749.80 |
$19,166 |
4.3× |
| Osseous survey limited (77074) |
$396.30 |
$1,321 |
3.9× |
| Parathyroid Planar Imaging (78070) |
$1,277.70 |
$4,259 |
3.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$430.50 |
$1,435 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$453.90 |
$1,513 |
4.5× |
| Peritoneogram after injection (74190) |
$212.70 |
$709 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$4,293.90 |
$14,313 |
3.1× |
| PET imaging CT for attenuation limited area (78814) |
$2,073.30 |
$6,911 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,390.10 |
$7,967 |
1.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,288.50 |
$4,295 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,277.70 |
$4,259 |
3.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,417.50 |
$4,725 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$570.90 |
$1,903 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$484.20 |
$1,614 |
5.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$387.90 |
$1,293 |
4.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$453.90 |
$1,513 |
5.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$198.60 |
$662 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$138.60 |
$462 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$425.40 |
$1,418 |
5.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$484.20 |
$1,614 |
5.7× |
| Radex Hand Minimum 3 Views (73130) |
$556.80 |
$1,856 |
6.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$506.40 |
$1,688 |
6.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$266.10 |
$887 |
2.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$645.90 |
$2,153 |
6.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$372 |
$1,240 |
3.6× |
| Radex Humerus Minimum 2 Views (73060) |
$519.30 |
$1,731 |
6.1× |
| Radex Kne 1/2 Views (73560) |
$321.60 |
$1,072 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$788.40 |
$2,628 |
7.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$738.60 |
$2,462 |
7.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$606.90 |
$2,023 |
7.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$1,178.10 |
$3,927 |
11.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$596.70 |
$1,989 |
7.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$264.60 |
$882 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$499.80 |
$1,666 |
4.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$801 |
$2,670 |
9.4× |
| Radex Toe Minimum 2 Views (73660) |
$338.40 |
$1,128 |
4.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$402 |
$1,340 |
3.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$562.50 |
$1,875 |
6.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$14,815.50 |
$49,385 |
2.1× |
| Radiation treatment delivery level 2 (77407) |
$2,273.70 |
$7,579 |
6.0× |
| Radiation treatment delivery level 3 (77412) |
$2,273.70 |
$7,579 |
4.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$453.90 |
$1,513 |
5.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$582.90 |
$1,943 |
5.7× |
| Radiologic exam chest 2 views (71046) |
$806.40 |
$2,688 |
9.5× |
| Radiologic exam colon single contrast study (74270) |
$1,299.30 |
$4,331 |
7.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$187.80 |
$626 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,186.80 |
$3,956 |
6.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,098.90 |
$3,663 |
6.4× |
| Radiologic examination femur 1 view (73551) |
$320.10 |
$1,067 |
3.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$464.10 |
$1,547 |
5.5× |
| Radiological examination surgical specimen (76098) |
$255.60 |
$852 |
0.5× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$273.60 |
$912 |
0.7× |
| Ribs bilateral 3 views (71110) |
$239.10 |
$797 |
2.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,277.70 |
$4,259 |
3.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$250.50 |
$835 |
0.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,631.10 |
$5,437 |
3.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,530.60 |
$5,102 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,639.30 |
$12,131 |
6.9× |
| Sacroiliac Joints < 3 Views (72200) |
$276.90 |
$923 |
2.7× |
| Scapula (73010) |
$453.90 |
$1,513 |
4.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$96.30 |
$321 |
4.1× |
| Shoulder 1 view (73020) |
$453.90 |
$1,513 |
5.3× |
| Simulation intermediate (77285) |
$345.90 |
$1,153 |
0.9× |
| Small bowel series (74250) |
$868.50 |
$2,895 |
5.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$3,033.60 |
$10,112 |
8.3× |
| Special dosimetry (77331) |
$319.80 |
$1,066 |
2.4× |
| Special Physics Consult (77370) |
$1,421.70 |
$4,739 |
10.8× |
| Special treatment procedure (77470) |
$4,164.60 |
$13,882 |
7.7× |
| Spine thoracic 3 views (72072) |
$603.90 |
$2,013 |
5.9× |
| Stereotactic Body Radiation Delivery (77373) |
$2,886.30 |
$9,621 |
1.7× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,303.80 |
$4,346 |
3.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$349.20 |
$1,164 |
1.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,436.30 |
$8,121 |
6.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$526.20 |
$1,754 |
4.0× |
| Thoracolumbar 2 views (72080) |
$47.70 |
$159 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,277.70 |
$4,259 |
3.3× |
| Tmj unilateral (70328) |
$90.60 |
$302 |
1.1× |
| Treatment device complex (77334) |
$1,254.90 |
$4,183 |
3.4× |
| Treatment device intermediate (77333) |
$144.90 |
$483 |
1.1× |
| Treatment devices simple (77332) |
$370.80 |
$1,236 |
2.8× |
| Ultrasound breast complete (76641) |
$1,089.60 |
$3,632 |
10.7× |
| Ultrasound Exam Aaa Screen (76706) |
$377.70 |
$1,259 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$924 |
$3,080 |
9.1× |
| Umbilical-artery Doppler (OB) (76820) |
$268.20 |
$894 |
2.6× |
| Unlisted fluoroscopic procedure (76496) |
$392.40 |
$1,308 |
4.6× |
| Unlisted magnetic resonance procedure (76498) |
$389.70 |
$1,299 |
4.6× |
| Unlisted ultrasound procedure (76999) |
$206.10 |
$687 |
2.4× |
| Us breast unilateral limited (76642) |
$1,089.60 |
$3,632 |
12.8× |
| Us chest (76604) |
$387.90 |
$1,293 |
3.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$320.40 |
$1,068 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$348.60 |
$1,162 |
3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$174.30 |
$581 |
1.7× |
| Us ob limited (76815) |
$963 |
$3,210 |
9.4× |
| Us ob transvaginal (76817) |
$1,838.10 |
$6,127 |
18.0× |
| Us pelvic non ob complete (76856) |
$1,297.50 |
$4,325 |
12.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$649.50 |
$2,165 |
6.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$460.80 |
$1,536 |
4.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$958.20 |
$3,194 |
9.4× |
| Us retroperitoneal complete (76770) |
$1,150.50 |
$3,835 |
11.3× |
| Us retroperitoneal limited (76775) |
$425.40 |
$1,418 |
4.2× |
| Us scrotum and contents (76870) |
$920.70 |
$3,069 |
9.0× |
| Us soft tissue head/neck (76536) |
$817.50 |
$2,725 |
8.0× |
| Us spinal canal and contents (76800) |
$488.40 |
$1,628 |
4.8× |
| Venogram extremity bilateral (75822) |
$1,326.60 |
$4,422 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,485.30 |
$4,951 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$1,942.50 |
$6,475 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,550.10 |
$5,167 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,337.60 |
$7,792 |
0.8× |
| Wrist 2 views (73100) |
$516.30 |
$1,721 |
6.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$823.20 |
$2,744 |
8.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$313.20 |
$1,044 |
3.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,893.30 |
$6,311 |
11.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$408.30 |
$1,361 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$568.80 |
$1,896 |
6.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$603.60 |
$2,012 |
5.9× |
| X-ray exam of femur 2/> (73552) |
$582.90 |
$1,943 |
6.9× |
| X-ray eye for foreign body (70030) |
$529.50 |
$1,765 |
6.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$723 |
$2,410 |
8.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$83.40 |
$278 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$402 |
$1,340 |
4.7× |
| X-ray leg, infant (73592) |
$359.40 |
$1,198 |
4.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$512.10 |
$1,707 |
5.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$353.10 |
$1,177 |
3.5× |
| X-ray nose-rectum child f.b. (76010) |
$453.90 |
$1,513 |
5.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$741.90 |
$2,473 |
7.3× |
| X-ray retrograde pyelogram (74420) |
$788.40 |
$2,628 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$468 |
$1,560 |
5.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$556.80 |
$1,856 |
5.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$851.40 |
$2,838 |
8.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$696.90 |
$2,323 |
6.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$453.90 |
$1,513 |
5.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$669 |
$2,230 |
7.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$738.60 |
$2,462 |
7.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$488.40 |
$1,628 |
4.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$367.20 |
$1,224 |
4.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$382.50 |
$1,275 |
4.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$686.10 |
$2,287 |
8.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$481.50 |
$1,605 |
4.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$52.20 |
$174 |
0.5× |
| Xr c-spine 4 or 5 views (72050) |
$795.60 |
$2,652 |
7.8× |
| Xr c-spine 6 or more views (72052) |
$800.70 |
$2,669 |
7.9× |
| Xr chest 4+ views (71048) |
$888.90 |
$2,963 |
8.7× |