| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,828 |
$7,656 |
2.8× |
| Abdomen 2 views (74019) |
$284.50 |
$569 |
2.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,056.50 |
$2,113 |
2.6× |
| Angiography extremity bilateral rs&i (75716) |
$4,148 |
$8,296 |
1.3× |
| Angiography extremity unilateral rs&i (75710) |
$3,870 |
$7,740 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$2,580 |
$5,160 |
0.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,155 |
$14,310 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,840 |
$9,680 |
1.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$8,009.50 |
$16,019 |
1.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,000 |
$8,000 |
1.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,518 |
$3,036 |
0.5× |
| Aortogram thoracic (75605) |
$4,148 |
$8,296 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,290 |
$8,580 |
1.4× |
| Aortography abdominal serialography rs&i (75625) |
$4,290 |
$8,580 |
1.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,580 |
$5,160 |
0.8× |
| Arthrogram elbow (73085) |
$546.50 |
$1,093 |
1.6× |
| Arthrogram hip (73525) |
$546.50 |
$1,093 |
1.6× |
| Arthrogram shoulder (73040) |
$546.50 |
$1,093 |
1.6× |
| Arthrogram wrist (73115) |
$546.50 |
$1,093 |
1.6× |
| Arthrography knee lt (73580) |
$546.50 |
$1,093 |
1.6× |
| Basic radiation dosimetry calculation (77300) |
$206.50 |
$413 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,192.50 |
$2,385 |
3.0× |
| Bone age studies (77072) |
$238.50 |
$477 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,369 |
$2,738 |
3.4× |
| Bone survey complete (77075) |
$511 |
$1,022 |
4.9× |
| Brachytx isodose complex (77318) |
$780 |
$1,560 |
2.1× |
| Brachytx isodose intermed (77317) |
$780 |
$1,560 |
2.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$474 |
$948 |
1.3× |
| Brain image w/flow 4 + views (78606) |
$928 |
$1,856 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,262 |
$10,524 |
3.7× |
| Brain Imaging Vascular Flow Only (78610) |
$928 |
$1,856 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$321 |
$642 |
3.7× |
| Chest 1 view (71045) |
$165.50 |
$331 |
1.9× |
| Chest 3 views (71047) |
$270.50 |
$541 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$306 |
$612 |
1.7× |
| 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× |
| 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 hrt w/3d image (75574) |
$1,976.50 |
$3,953 |
5.6× |
| CT angiography upper extremity lt (73206) |
$2,084.50 |
$4,169 |
11.8× |
| CT c-spine w/o contrast (72125) |
$1,975.50 |
$3,951 |
18.8× |
| CT cervical spine w&w/o contrast (72127) |
$2,084.50 |
$4,169 |
11.8× |
| CT cervical spine with contrast (72126) |
$1,975.50 |
$3,951 |
5.6× |
| CT chest w/wo contrast (71270) |
$2,084.50 |
$4,169 |
11.8× |
| CT chest with contrast (71260) |
$1,976.50 |
$3,953 |
11.2× |
| 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 lower ext w/o (73700) |
$1,470.50 |
$2,941 |
14.0× |
| CT lower extremity w wo contrast (73702) |
$2,084.50 |
$4,169 |
11.8× |
| CT lower extremity with contrast (73701) |
$1,975.50 |
$3,951 |
11.2× |
| CT lumbar spine w & w/o contrast (72133) |
$2,084.50 |
$4,169 |
11.8× |
| CT lumbar spine w/o contrast (72131) |
$1,975.50 |
$3,951 |
18.8× |
| CT lumbar spine with contrast (72132) |
$1,975.50 |
$3,951 |
5.6× |
| CT maxillofacial w contrast (70487) |
$1,975.50 |
$3,951 |
11.2× |
| CT maxillofacial w/o contrast (70486) |
$1,415.50 |
$2,831 |
13.5× |
| CT maxillofacial w/wo contrast (70488) |
$2,084.50 |
$4,169 |
11.8× |
| CT neck soft tissue w contrast (70491) |
$1,762 |
$3,524 |
10.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (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 soft tissue neck w/o & w/contrast material (70492) |
$1,859.50 |
$3,719 |
10.6× |
| 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 contrast (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 extremity w/o & w/contrast material (73202) |
$2,084.50 |
$4,169 |
11.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,470.50 |
$2,941 |
14.0× |
| 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 abdomen pelvis (74174) |
$2,084.50 |
$4,169 |
5.9× |
| CTA chest (71275) |
$2,084.50 |
$4,169 |
11.8× |
| Cta Head (70496) |
$1,859.50 |
$3,719 |
10.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$647.50 |
$1,295 |
1.8× |
| CTA lwr ext w&w/o contrast (73706) |
$2,084.50 |
$4,169 |
11.8× |
| Cta Neck (70498) |
$1,859.50 |
$3,719 |
10.6× |
| Cta Pelvis (72191) |
$2,084.50 |
$4,169 |
11.8× |
| Cystography minimum 3 views rs&i (74430) |
$414.50 |
$829 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$229 |
$458 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$111.50 |
$223 |
1.3× |
| Echoencephalography real time imaging (76506) |
$287.50 |
$575 |
2.7× |
| Esophagus (74220) |
$254.50 |
$509 |
1.4× |
| Fetal biophysical profile non-stress testing (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× |
| Forearm 2 views (73090) |
$255.50 |
$511 |
2.9× |
| Gated Heart Planar Single (78472) |
$1,156.50 |
$2,313 |
2.9× |
| Hand 3 views (73130) |
$255.50 |
$511 |
2.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$991.50 |
$1,983 |
1.4× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$991.50 |
$1,983 |
1.4× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$338 |
$676 |
0.9× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$338 |
$676 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,332 |
$2,664 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,006.50 |
$2,013 |
2.5× |
| Ht muscle image spect sing (78451) |
$2,036.50 |
$4,073 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$255.50 |
$511 |
2.9× |
| Hysterosalpingogram (74740) |
$512 |
$1,024 |
2.1× |
| Interstitial radiation source applic complex (77778) |
$2,298.50 |
$4,597 |
3.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$234.50 |
$469 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$700.50 |
$1,401 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$752 |
$1,504 |
1.4× |
| 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 Ventilation Imaging (78579) |
$514 |
$1,028 |
1.3× |
| Lymphoscintigraphy (78195) |
$673.50 |
$1,347 |
1.2× |
| Meckels Diverticulum (78290) |
$888.50 |
$1,777 |
2.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$560.50 |
$1,121 |
1.5× |
| MRA head w & w/o contrast (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 & w/contrast material (74183) |
$2,164.50 |
$4,329 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,580.50 |
$3,161 |
6.6× |
| MRI any jnt lwr ext with con lt (73722) |
$1,834 |
$3,668 |
2.3× |
| 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 w/o contrast unilat (77046) |
$1,248 |
$2,496 |
5.2× |
| MRI c-spine with contrast (72142) |
$1,834 |
$3,668 |
5.2× |
| MRI cervical spine w/o contrast (72141) |
$1,580.50 |
$3,161 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,344 |
$4,688 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,741 |
$3,482 |
7.3× |
| MRI chest with contrast (71551) |
$1,980 |
$3,960 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,834 |
$3,668 |
5.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,834 |
$3,668 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,580.50 |
$3,161 |
6.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,960 |
$3,920 |
8.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,684 |
$5,368 |
7.7× |
| MRI orbit/face/neck w/contrast (70542) |
$2,274 |
$4,548 |
6.5× |
| MRI pelvis w contrast (72196) |
$1,834 |
$3,668 |
5.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,164.50 |
$4,329 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$1,580.50 |
$3,161 |
6.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,164.50 |
$4,329 |
6.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,164.50 |
$4,329 |
6.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,164.50 |
$4,329 |
6.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,834 |
$3,668 |
5.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,164.50 |
$4,329 |
6.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,834 |
$3,668 |
5.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,164.50 |
$4,329 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,580.50 |
$3,161 |
6.6× |
| MRI tmj (70336) |
$1,580.50 |
$3,161 |
6.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,580.50 |
$3,161 |
6.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,164.50 |
$4,329 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,580.50 |
$3,161 |
6.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,594 |
$5,188 |
2.0× |
| Neck soft tissue (70360) |
$243 |
$486 |
2.8× |
| Nm adrenal scan (78075) |
$1,979.50 |
$3,959 |
1.5× |
| Nm cisternogram (78630) |
$928 |
$1,856 |
1.7× |
| Nm gastric emptying study (78264) |
$611.50 |
$1,223 |
1.5× |
| Nm gastroesophageal reflux study (78262) |
$582 |
$1,164 |
1.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,865.50 |
$3,731 |
1.3× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$5,262 |
$10,524 |
3.7× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$5,262 |
$10,524 |
3.7× |
| Nuclear Rx Oral Admin (79005) |
$448 |
$896 |
1.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$409 |
$818 |
3.9× |
| Osseous survey infant (77076) |
$299.50 |
$599 |
2.9× |
| Parathyroid 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, skull-thigh (78815) |
$4,243.50 |
$8,487 |
3.0× |
| PET imaging for CT attenuation whole body (78816) |
$4,243.50 |
$8,487 |
3.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,164.50 |
$4,329 |
6.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$602.50 |
$1,205 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$659.50 |
$1,319 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$512 |
$1,024 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$700.50 |
$1,401 |
6.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$260 |
$520 |
2.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,000 |
$12,000 |
0.8× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$1,041.25 |
$2,082.50 |
1.9× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$702 |
$1,404 |
6.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$581 |
$1,162 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$260 |
$520 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$228.50 |
$457 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$309.50 |
$619 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$245.50 |
$491 |
2.8× |
| 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 upr gi trc double contrast study (74246) |
$254.50 |
$509 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$254.50 |
$509 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$289.50 |
$579 |
3.3× |
| Radiological examination surgical specimen (76098) |
$512 |
$1,024 |
0.9× |
| Ribs bilateral 3 views (71110) |
$322.50 |
$645 |
3.1× |
| 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 spect 1 area single day imaging (78803) |
$2,192.50 |
$4,385 |
4.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$444 |
$888 |
1.9× |
| Rp Therapy Intravenous Administration (79101) |
$443.50 |
$887 |
1.9× |
| Scanogram (77073) |
$305 |
$610 |
2.9× |
| Scapula complete (73010) |
$271.50 |
$543 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$39.50 |
$79 |
1.7× |
| Simulation intermediate (77285) |
$560.50 |
$1,121 |
1.5× |
| Small bowel series (74250) |
$254.50 |
$509 |
1.4× |
| Spec medical radj physics consltj (77370) |
$1,203.50 |
$2,407 |
8.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$785.50 |
$1,571 |
2.1× |
| Special dosimetry (77331) |
$206.50 |
$413 |
1.5× |
| Special treatment procedure (77470) |
$997 |
$1,994 |
1.8× |
| Spine thoracic 3 views (72072) |
$415.50 |
$831 |
4.0× |
| Stereotactic body radiation delivery (77373) |
$3,169 |
$6,338 |
1.8× |
| 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 simple (77280) |
$423 |
$846 |
3.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,087 |
$2,174 |
2.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$667 |
$1,334 |
1.7× |
| Thyroid uptake measurement (78012) |
$315 |
$630 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$687.50 |
$1,375 |
1.7× |
| Tmj unilateral (70328) |
$232 |
$464 |
2.7× |
| Treatment device intermediate (77333) |
$384.50 |
$769 |
2.8× |
| Treatment devices simple (77332) |
$384.50 |
$769 |
2.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,550.50 |
$3,101 |
2.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$633 |
$1,266 |
1.6× |
| Tx devices design & construction complex (77334) |
$384.50 |
$769 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$77.50 |
$155 |
0.7× |
| Umbilical-artery Doppler (OB) (76820) |
$157.50 |
$315 |
1.5× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$1,177.50 |
$2,355 |
2.9× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$168 |
$336 |
1.6× |
| Unlisted Ultrasound Procedure (76999) |
$113.50 |
$227 |
1.3× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$700.50 |
$1,401 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$414.50 |
$829 |
1.7× |
| Urethrocystography voiding (74455) |
$414.50 |
$829 |
1.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$498.50 |
$997 |
2.8× |
| Us abdl aorta screen aaa (76706) |
$297.50 |
$595 |
2.8× |
| Us breast unilateral complete (76641) |
$227.50 |
$455 |
2.2× |
| Us breast unilateral limited (76642) |
$227.50 |
$455 |
2.6× |
| Us chest (76604) |
$216.50 |
$433 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$540.50 |
$1,081 |
5.1× |
| Us infant hips dynamic (76885) |
$540.50 |
$1,081 |
6.2× |
| Us ob detailed single fetus (76811) |
$392.50 |
$785 |
1.6× |
| Us ob transvaginal (76817) |
$536.50 |
$1,073 |
5.1× |
| Us pelvic non ob complete (76856) |
$614 |
$1,228 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$199.50 |
$399 |
1.9× |
| Us pregnancy ltd (76815) |
$253.50 |
$507 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$473 |
$946 |
4.5× |
| 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 soft tissue head/neck (76536) |
$473 |
$946 |
4.5× |
| Us spinal canal and contents (76800) |
$278 |
$556 |
2.6× |
| Us xtr non-vasc lmtd (76882) |
$187.50 |
$375 |
1.8× |
| Venogram extremity bilateral (75822) |
$837.50 |
$1,675 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$4,462.50 |
$8,925 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$2,200 |
$4,400 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$880.50 |
$1,761 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$228.50 |
$457 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.50 |
$401 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$255.50 |
$511 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$254.50 |
$509 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.50 |
$511 |
2.9× |
| 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 of femur 1 (73551) |
$144.50 |
$289 |
1.7× |
| X-ray eye for foreign body (70030) |
$151 |
$302 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$360 |
$720 |
3.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$273.50 |
$547 |
3.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$255.50 |
$511 |
2.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$261.50 |
$523 |
3.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$255.50 |
$511 |
2.4× |
| 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 Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$437.50 |
$875 |
4.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$290 |
$580 |
2.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$204 |
$408 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$261.50 |
$523 |
2.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$518 |
$1,036 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$322.50 |
$645 |
3.7× |
| 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 Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$297 |
$594 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$364.50 |
$729 |
4.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$211 |
$422 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$415.50 |
$831 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$333 |
$666 |
3.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$271.50 |
$543 |
3.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$222.50 |
$445 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$260 |
$520 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$433.50 |
$867 |
4.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$200.50 |
$401 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$255.50 |
$511 |
2.9× |
| Xr arthrogram ankle (73615) |
$546.50 |
$1,093 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$437.50 |
$875 |
4.2× |
| Xr chest 4+ views (71048) |
$295.50 |
$591 |
2.8× |
| Xr Cholecystography Oral Contrast (74290) |
$361.50 |
$723 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$202 |
$404 |
2.3× |
| Xr spine cervical 4 or 5 views (72050) |
$372.50 |
$745 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$281.50 |
$563 |
3.2× |
| Xr tmj bilateral (70330) |
$307 |
$614 |
3.5× |
| Xray knee 1 or 2 views rt (73560) |
$255.50 |
$511 |
2.9× |