| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,828 |
$7,656 |
2.8× |
| Abdomen 1 View (74018) |
$228.50 |
$457 |
2.6× |
| Abdomen 2 views (74019) |
$284.50 |
$569 |
2.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,056.50 |
$2,113 |
2.6× |
| Adrenal Cortex & Medulla Img (78075) |
$1,979.50 |
$3,959 |
1.5× |
| Angio internal mammary (75756) |
$2,580 |
$5,160 |
0.8× |
| Angio pulmonary bilat (75743) |
$4,840 |
$9,680 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$4,148 |
$8,296 |
1.3× |
| Angiography extremity unilateral rs&i (75710) |
$3,870 |
$7,740 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,518 |
$3,036 |
0.5× |
| Aortography thoracic serialography rs&i (75605) |
$4,148 |
$8,296 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,580 |
$5,160 |
0.8× |
| Artery X-Rays Abdomen (75726) |
$8,009.50 |
$16,019 |
1.4× |
| Artery X-Rays Pelvis (75736) |
$7,155 |
$14,310 |
1.3× |
| Arthrogram ankle (73615) |
$546.50 |
$1,093 |
1.6× |
| Arthrogram hip (73525) |
$546.50 |
$1,093 |
1.6× |
| Arthrogram Wrist (73115) |
$546.50 |
$1,093 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$206.50 |
$413 |
1.5× |
| Bone age studies (77072) |
$238.50 |
$477 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,369 |
$2,738 |
3.4× |
| Bone Imaging Whole Body (78306) |
$1,192.50 |
$2,385 |
3.0× |
| Bone survey infant (77076) |
$299.50 |
$599 |
2.9× |
| Brachytx isodose complex (77318) |
$780 |
$1,560 |
2.1× |
| Brachytx isodose intermed (77317) |
$780 |
$1,560 |
2.1× |
| Brachytx Isodose Plan Simple (77316) |
$474 |
$948 |
1.3× |
| Brain Flow Imaging Only (78610) |
$928 |
$1,856 |
1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$928 |
$1,856 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,262 |
$10,524 |
3.7× |
| Cardiovasc nucl exam unlisted (78499) |
$1,177.50 |
$2,355 |
2.9× |
| Cerebrospinal Fluid Scan (78630) |
$928 |
$1,856 |
1.7× |
| Chest 1 view (71045) |
$165.50 |
$331 |
1.9× |
| Chest 2 views (71046) |
$245.50 |
$491 |
2.8× |
| Chest 3 views (71047) |
$270.50 |
$541 |
3.1× |
| Chest 4 or more views (71048) |
$295.50 |
$591 |
2.8× |
| Cholecystography Oral Contrast (74290) |
$361.50 |
$723 |
2.1× |
| Clavicle complete (73000) |
$292 |
$584 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$113 |
$226 |
1.1× |
| Continuing medical physics consltj pr wk (77336) |
$405 |
$810 |
3.0× |
| Contrast Exam Abdominl Aorta (75625) |
$4,290 |
$8,580 |
1.4× |
| Contrast X-Ray Bladder (74430) |
$414.50 |
$829 |
1.2× |
| Contrast X-Ray Of Elbow (73085) |
$546.50 |
$1,093 |
1.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$546.50 |
$1,093 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,624.50 |
$5,249 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,358.50 |
$4,717 |
9.8× |
| CT abdomen w contrast (74160) |
$2,161 |
$4,322 |
12.3× |
| CT abdomen w wo contrast (74170) |
$2,036 |
$4,072 |
11.6× |
| CT abdomen w/o contrast (74150) |
$1,769.50 |
$3,539 |
16.8× |
| CT Angio Abdomen and Pelvis (74174) |
$2,084.50 |
$4,169 |
5.9× |
| CT Angio Chest (71275) |
$2,084.50 |
$4,169 |
11.8× |
| CT Angio Head (70496) |
$1,859.50 |
$3,719 |
10.6× |
| CT angio hrt w/3d image (75574) |
$1,976.50 |
$3,953 |
5.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,084.50 |
$4,169 |
11.8× |
| CT Angio Neck (70498) |
$1,859.50 |
$3,719 |
10.6× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,084.50 |
$4,169 |
11.8× |
| CT cervical spine w/ contrast (72126) |
$1,975.50 |
$3,951 |
5.6× |
| CT cervical spine w/o contrast (72125) |
$1,975.50 |
$3,951 |
18.8× |
| CT cervical spine w/wo cont (72127) |
$2,084.50 |
$4,169 |
11.8× |
| CT chest w contrast (71260) |
$1,976.50 |
$3,953 |
11.2× |
| CT chest w/wo contrast (71270) |
$2,084.50 |
$4,169 |
11.8× |
| CT head/brain with contrast (70460) |
$1,739.50 |
$3,479 |
9.9× |
| CT head/brain without and with contrast (70470) |
$1,819.50 |
$3,639 |
10.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,976.50 |
$3,953 |
5.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$190 |
$380 |
2.2× |
| CT iac w contrast (70481) |
$1,975.50 |
$3,951 |
11.2× |
| CT l-spine w&w/o contrast (72133) |
$2,084.50 |
$4,169 |
11.8× |
| CT lower ext w/o (73700) |
$1,470.50 |
$2,941 |
14.0× |
| CT lower extremity w/contrast material (73701) |
$1,975.50 |
$3,951 |
11.2× |
| CT lumbar spine w contrast (72132) |
$1,975.50 |
$3,951 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$1,975.50 |
$3,951 |
18.8× |
| CT maxillofacial w contrast (70487) |
$1,975.50 |
$3,951 |
11.2× |
| CT maxillofacial wo contrast (70486) |
$1,415.50 |
$2,831 |
13.5× |
| CT neck tissue combo (70492) |
$1,859.50 |
$3,719 |
10.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,230.50 |
$2,461 |
7.0× |
| CT orbits w/o contrast (70480) |
$1,415.50 |
$2,831 |
13.5× |
| CT pelvis w&w/o contrast (72194) |
$1,874.50 |
$3,749 |
10.6× |
| CT pelvis w/o contrast (72192) |
$1,785 |
$3,570 |
17.0× |
| CT scan of leg combo (73702) |
$2,084.50 |
$4,169 |
11.8× |
| CT scans face/jaw combo (70488) |
$2,084.50 |
$4,169 |
11.8× |
| CT soft tissue neck w contrast (70491) |
$1,762 |
$3,524 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,697.50 |
$3,395 |
16.2× |
| CT thoracic spine w contrast (72129) |
$1,975.50 |
$3,951 |
11.2× |
| CT thoracic spine w/o contrast (72128) |
$1,975.50 |
$3,951 |
18.8× |
| CT thoracic spine w/wo cont (72130) |
$2,084.50 |
$4,169 |
11.8× |
| CT thorax w/o contrast (71250) |
$1,846 |
$3,692 |
17.6× |
| CT unlisted procedure (76497) |
$113.19 |
$226.38 |
1.3× |
| CT upper ext wo (73200) |
$1,470.50 |
$2,941 |
14.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,084.50 |
$4,169 |
11.8× |
| CT upper extremity with contrast (73201) |
$1,975.50 |
$3,951 |
5.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,084.50 |
$4,169 |
11.8× |
| Cta Abdomen (74175) |
$2,084.50 |
$4,169 |
11.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$647.50 |
$1,295 |
1.8× |
| CTA pelvis (72191) |
$2,084.50 |
$4,169 |
11.8× |
| Dxa Bone Density Axial (77080) |
$229 |
$458 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$111.50 |
$223 |
1.3× |
| Esophagram (74220) |
$254.50 |
$509 |
1.4× |
| Fetal Biophys Profile W/Nst (76818) |
$224.50 |
$449 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$312.50 |
$625 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$360 |
$720 |
1.5× |
| Follow-Up Angiography (75898) |
$4,000 |
$8,000 |
1.3× |
| Forearm 2 views (73090) |
$255.50 |
$511 |
2.9× |
| Gastric emptying imaging study (78264) |
$611.50 |
$1,223 |
1.5× |
| Gastroesophageal Reflux Exam (78262) |
$582 |
$1,164 |
1.4× |
| Gated Heart Planar Single (78472) |
$1,156.50 |
$2,313 |
2.9× |
| Hdr Rdncl Ntrstl/Icav Brchtx (77771) |
$991.50 |
$1,983 |
1.4× |
| Hdr Rdncl Ntrstl/Icav Brchtx 1 Channel (77770) |
$991.50 |
$1,983 |
1.4× |
| Heart Image (Pet) Multiple (78492) |
$5,262 |
$10,524 |
3.7× |
| Hepatobil Syst Image W/Drug (78227) |
$1,332 |
$2,664 |
2.4× |
| Hepatobiliary System Imaging (78226) |
$1,006.50 |
$2,013 |
2.5× |
| Ht Muscle Image Spect Sing (78451) |
$2,036.50 |
$4,073 |
1.6× |
| Hysterosalpingogram (74740) |
$512 |
$1,024 |
2.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$540.50 |
$1,081 |
6.2× |
| Interstitial radiation source applic complex (77778) |
$2,298.50 |
$4,597 |
3.3× |
| Joint Survey Single View (77077) |
$234.50 |
$469 |
2.2× |
| K Flow/Funct Image W/Drug (78708) |
$752 |
$1,504 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$700.50 |
$1,401 |
1.3× |
| Liver & Spleen Imaging Static Only (78215) |
$803 |
$1,606 |
2.0× |
| Liver imaging static only (78201) |
$821.50 |
$1,643 |
1.5× |
| Liver imaging w/vascular flow (78202) |
$821.50 |
$1,643 |
1.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$659.50 |
$1,319 |
1.2× |
| Lung Ventilation Imaging (78579) |
$514 |
$1,028 |
1.3× |
| Lymph System Imaging (78195) |
$673.50 |
$1,347 |
1.2× |
| Magnetic Image Jaw Joint (70336) |
$1,580.50 |
$3,161 |
6.6× |
| Meckels Divert Exam (78290) |
$888.50 |
$1,777 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$560.50 |
$1,121 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,915 |
$3,830 |
5.5× |
| MRA head w/o contrast (70544) |
$1,306.50 |
$2,613 |
5.5× |
| MRA head with contrast (70545) |
$1,611 |
$3,222 |
4.6× |
| MRA neck w contrast (70548) |
$1,611 |
$3,222 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,915 |
$3,830 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,306.50 |
$2,613 |
5.5× |
| MRI abdomen w contrast (74182) |
$1,758 |
$3,516 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,580.50 |
$3,161 |
6.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,834 |
$3,668 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,164.50 |
$4,329 |
6.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,834 |
$3,668 |
2.3× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,497.50 |
$2,995 |
6.2× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,248 |
$2,496 |
5.2× |
| MRI cervical spine w contrast (72142) |
$1,834 |
$3,668 |
5.2× |
| MRI cervical spine w/o cont (72141) |
$1,580.50 |
$3,161 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,741 |
$3,482 |
7.3× |
| MRI chest with contrast (71551) |
$1,980 |
$3,960 |
2.5× |
| MRI chest wo w contrast (71552) |
$2,344 |
$4,688 |
6.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,834 |
$3,668 |
5.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,164.50 |
$4,329 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,580.50 |
$3,161 |
6.6× |
| MRI lumbar spine w contrast (72149) |
$1,834 |
$3,668 |
5.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,164.50 |
$4,329 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,960 |
$3,920 |
8.2× |
| MRI orbit face neck w contrast (70542) |
$2,274 |
$4,548 |
6.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,684 |
$5,368 |
7.7× |
| MRI pelvis w contrast (72196) |
$1,834 |
$3,668 |
5.2× |
| MRI pelvis w/o & w contrast (72197) |
$2,164.50 |
$4,329 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$1,580.50 |
$3,161 |
6.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,580.50 |
$3,161 |
6.6× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,834 |
$3,668 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,580.50 |
$3,161 |
6.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,164.50 |
$4,329 |
6.2× |
| MRI, abdomen, combo (74183) |
$2,164.50 |
$4,329 |
6.2× |
| MRI, dorsal spine combo (72157) |
$2,164.50 |
$4,329 |
6.2× |
| MRI, dorsal spine contrast (72147) |
$1,834 |
$3,668 |
5.2× |
| MRI, joint upper extrem (73221) |
$1,580.50 |
$3,161 |
6.6× |
| MRI, joint upper extrem combo (73223) |
$2,164.50 |
$4,329 |
6.2× |
| MRI, lumbar spine combo (72158) |
$2,164.50 |
$4,329 |
6.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,594 |
$5,188 |
2.0× |
| Neck soft tissue (70360) |
$243 |
$486 |
2.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,865.50 |
$3,731 |
1.3× |
| Nuclear Rx Intra-Arterial (79445) |
$444 |
$888 |
1.9× |
| Nuclear Rx Oral Admin (79005) |
$448 |
$896 |
1.9× |
| Parathyroid Planar Imaging (78070) |
$701 |
$1,402 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$255.50 |
$511 |
2.4× |
| Peritoneogram Rs&I (74190) |
$859.50 |
$1,719 |
1.6× |
| PET image w/CT, full body (78816) |
$4,243.50 |
$8,487 |
3.0× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,243.50 |
$8,487 |
3.0× |
| Pet Myocardial Sngl Study (78491) |
$5,262 |
$10,524 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$602.50 |
$1,205 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$228.50 |
$457 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$512 |
$1,024 |
0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$255.50 |
$511 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$261.50 |
$523 |
3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$360 |
$720 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$202 |
$404 |
2.3× |
| Radex foot complete minimum 3 views (73630) |
$255.50 |
$511 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$255.50 |
$511 |
2.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$260 |
$520 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$204 |
$408 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$322.50 |
$645 |
3.7× |
| Radex shoulder complete minimum 2 views (73030) |
$297 |
$594 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$211 |
$422 |
2.4× |
| Radex Spine 1 View Specify Level (72020) |
$271.50 |
$543 |
3.1× |
| Radex Sternum Minimum 2 Views (71120) |
$260 |
$520 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$307 |
$614 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$200.50 |
$401 |
2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$255.50 |
$511 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,000 |
$12,000 |
0.8× |
Radiation treatment delivery level 1 (77402)
range across 2 matching MRF lines |
$154–$1,250 |
$308–$2,500 |
varies |
| Radiation treatment delivery level 2 (77407) |
$581 |
$1,162 |
1.5× |
Radiation treatment delivery level 3 (77412)
range across 2 matching MRF lines |
$832.50–$1,250 |
$1,665–$2,500 |
varies |
| Radiolog exam mandible compl minimum 4 views (70110) |
$260 |
$520 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$309.50 |
$619 |
2.9× |
| Radiologic exam colon double contrast study (74280) |
$254.50 |
$509 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$254.50 |
$509 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$254.50 |
$509 |
1.4× |
| Radiologic exam knee complete 4/more views (73564) |
$255.50 |
$511 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$254.50 |
$509 |
1.4× |
| Radiologic exam swallow function contrast study (74230) |
$306 |
$612 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$254.50 |
$509 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$144.50 |
$289 |
1.7× |
| Radiologic examination femur minimum 2 views (73552) |
$289.50 |
$579 |
3.3× |
| Radiologic examination knee 1/2 views (73560) |
$255.50 |
$511 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$281.50 |
$563 |
3.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$338 |
$676 |
0.9× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$338 |
$676 |
0.9× |
| Ribs bilateral 3 views (71110) |
$322.50 |
$645 |
3.1× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$633 |
$1,266 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,550.50 |
$3,101 |
3.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,550.50 |
$3,101 |
2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,192.50 |
$4,385 |
4.0× |
| Rp Therapy Intravenous Administration (79101) |
$443.50 |
$887 |
1.9× |
| Scapula (73010) |
$271.50 |
$543 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$39.50 |
$79 |
1.7× |
| Shoulder Arthrography (73040) |
$546.50 |
$1,093 |
1.6× |
| Skull less than 4 views (70250) |
$333 |
$666 |
3.2× |
| Special dosimetry (77331) |
$206.50 |
$413 |
1.5× |
| Special Physics Consult (77370) |
$1,203.50 |
$2,407 |
8.9× |
| Special teletherapy port plan (77321) |
$785.50 |
$1,571 |
2.1× |
| Special treatment procedure (77470) |
$997 |
$1,994 |
1.8× |
| Stereotactic Body Radiation Delivery (77373) |
$3,169 |
$6,338 |
1.8× |
| Sternoclavicular joints (71130) |
$222.50 |
$445 |
2.5× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$343.75 |
$687.50 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$281 |
$562 |
0.7× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$560.50 |
$1,121 |
1.5× |
| Ther Rad Simulaj-Aided Field Setting Intermed (77285) |
$560.50 |
$1,121 |
1.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$423 |
$846 |
3.1× |
| Thoracic spine 3 views (72072) |
$415.50 |
$831 |
4.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$667 |
$1,334 |
1.7× |
| Thyroid Met Imaging Body (78018) |
$1,087 |
$2,174 |
2.0× |
| Thyroid Uptake Measurement (78012) |
$315 |
$630 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$687.50 |
$1,375 |
1.7× |
| Tx Devices Design & Construction Complex (77334) |
$384.50 |
$769 |
1.0× |
| Tx devices design & construction intermediate (77333) |
$384.50 |
$769 |
2.8× |
| Tx devices design & construction simple (77332) |
$384.50 |
$769 |
2.8× |
| Ultrasound Breast Limited (76642) |
$227.50 |
$455 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$297.50 |
$595 |
2.8× |
Ultrasound, abdomen limited (76705)
range across 3 matching MRF lines |
$25–$156.50 |
$50–$313 |
varies |
| Umbilical-artery Doppler (OB) (76820) |
$157.50 |
$315 |
1.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$168 |
$336 |
1.6× |
| Unlisted us procedure (76999) |
$113.50 |
$227 |
1.3× |
| Upper gi w/o kub (74240) |
$254.50 |
$509 |
1.4× |
| Ureteral Reflux Study (78740) |
$700.50 |
$1,401 |
1.7× |
| Urethrocystogram voiding (74455) |
$414.50 |
$829 |
1.7× |
| Urethrocystography retrograde (74450) |
$414.50 |
$829 |
1.7× |
| Us breast unilateral complete (76641) |
$227.50 |
$455 |
2.2× |
| Us chest (76604) |
$216.50 |
$433 |
2.1× |
| Us complete joint (76881) |
$540.50 |
$1,081 |
5.1× |
| Us exam, pelvic, limited (76857) |
$199.50 |
$399 |
1.9× |
| Us head (76506) |
$287.50 |
$575 |
2.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$187.50 |
$375 |
1.8× |
| Us ob detailed single fetus (76811) |
$392.50 |
$785 |
1.6× |
| Us ob limited 1 or more fetuses (76815) |
$253.50 |
$507 |
2.4× |
| Us ob transvaginal (76817) |
$536.50 |
$1,073 |
5.1× |
| Us pelvic non ob complete (76856) |
$614 |
$1,228 |
5.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$473 |
$946 |
4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$409 |
$818 |
3.9× |
| Us retroperitoneal complete (76770) |
$656.50 |
$1,313 |
6.3× |
| Us retroperitoneal limited (76775) |
$369 |
$738 |
3.5× |
| Us scrotum and contents (76870) |
$449 |
$898 |
4.3× |
| Us spinal canal and contents (76800) |
$278 |
$556 |
2.6× |
| Us thyroid (76536) |
$473 |
$946 |
4.5× |
| Vein X-Ray Chest (75827) |
$2,200 |
$4,400 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$4,462.50 |
$8,925 |
1.4× |
| Venography extremity bilateral rs&i (75822) |
$837.50 |
$1,675 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$880.50 |
$1,761 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.50 |
$401 |
2.3× |
| X-Ray Aorta Leg Arteries (75630) |
$4,290 |
$8,580 |
1.4× |
| X-Ray Bend Only L-S Spine (72120) |
$290 |
$580 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.50 |
$511 |
2.9× |
| X-Ray Exam Breast Specimen (76098) |
$512 |
$1,024 |
0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$700.50 |
$1,401 |
6.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$177.50 |
$355 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$194 |
$388 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$372 |
$744 |
3.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$437.50 |
$875 |
4.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$321 |
$642 |
3.7× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$437.50 |
$875 |
4.2× |
| X-ray eye for foreign body (70030) |
$151 |
$302 |
1.7× |
| X-ray humerus (73060) |
$255.50 |
$511 |
2.9× |
| X-ray IV pyelogram (ivp) (74400) |
$498.50 |
$997 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$255.50 |
$511 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$290 |
$580 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$230.50 |
$461 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$299.50 |
$599 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$364.50 |
$729 |
4.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$415.50 |
$831 |
4.0× |
| X-ray thoracic spine 4 vw (72074) |
$433.50 |
$867 |
4.1× |
| X-Ray Tmj Unilat (70328) |
$232 |
$464 |
2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$518 |
$1,036 |
1.5× |
| X-Rays Bone Length Studies (77073) |
$305 |
$610 |
2.9× |
| X-Rays Bone Survey Complete (77075) |
$511 |
$1,022 |
4.9× |
| Xr c-spine 4 or 5 views (72050) |
$372.50 |
$745 |
3.5× |
| Xr facial bones less than 3 views (70140) |
$273.50 |
$547 |
3.1× |
| Xr orbits complete 4 views (70200) |
$261.50 |
$523 |
2.5× |