| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,336.63 |
$2,673.25 |
1.0× |
| Abdomen 2 views (74019) |
$193.88 |
$387.75 |
1.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$342.88 |
$685.75 |
0.9× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,034.50 |
$4,069 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,072.13 |
$4,144.25 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,631 |
$5,262 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,337.75 |
$4,675.50 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,571.50 |
$7,143 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,072.13 |
$4,144.25 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,631 |
$5,262 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$5,471 |
$10,942 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,471 |
$10,942 |
1.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,072.13 |
$4,144.25 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,072.13 |
$4,144.25 |
0.7× |
| Ankle 2 views (73600) |
$138.38 |
$276.75 |
1.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$255 |
$510 |
0.7× |
| Aortogram thoracic (75605) |
$3,286 |
$6,572 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,072.13 |
$4,144.25 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,072.13 |
$4,144.25 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,072.13 |
$4,144.25 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,034.50 |
$4,069 |
0.6× |
| Arthrogram elbow (73085) |
$245 |
$490 |
0.7× |
| Arthrogram hip (73525) |
$309 |
$618 |
0.9× |
| Arthrogram shoulder (73040) |
$457.50 |
$915 |
1.3× |
| Arthrogram wrist (73115) |
$309 |
$618 |
0.9× |
| Arthrography knee lt (73580) |
$412.50 |
$825 |
1.2× |
| Basic radiation dosimetry calculation (77300) |
$113.88 |
$227.75 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$505.13 |
$1,010.25 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$1,004 |
$2,008 |
2.5× |
| Bone age studies (77072) |
$122.13 |
$244.25 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$582.63 |
$1,165.25 |
1.5× |
| Bone Marrow Imaging Limited Area (78102) |
$533.25 |
$1,066.50 |
1.3× |
| Bone survey complete (77075) |
$232.25 |
$464.50 |
2.2× |
| Brain image w/flow 4 + views (78606) |
$572.63 |
$1,145.25 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,230.75 |
$2,461.50 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,797.88 |
$3,595.75 |
5.2× |
| Cervical spine 2 or 3 views (72040) |
$199.88 |
$399.75 |
2.3× |
| Chest 1 view (71045) |
$139.50 |
$279 |
1.6× |
| Chest 3 views (71047) |
$176.88 |
$353.75 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$289.50 |
$579 |
1.7× |
| Clavicle complete (73000) |
$129.88 |
$259.75 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,170 |
$2,340 |
11.2× |
| Continuing medical physics consltj pr wk (77336) |
$305 |
$610 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,015.56 |
$6,031.12 |
8.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,184.13 |
$4,368.25 |
9.2× |
| CT abdomen w contrast (74160) |
$1,236.44 |
$2,472.88 |
7.1× |
| CT abdomen w wo contrast (74170) |
$1,563.56 |
$3,127.12 |
8.9× |
| CT abdomen w/o contrast (74150) |
$1,172.32 |
$2,344.62 |
11.2× |
| CT angio hrt w/3d image (75574) |
$1,630.25 |
$3,260.50 |
4.7× |
| CT angiography upper extremity lt (73206) |
$1,647.88 |
$3,295.75 |
9.4× |
| CT c-spine w/o contrast (72125) |
$1,252.38 |
$2,504.75 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,388.88 |
$2,777.75 |
7.9× |
| CT cervical spine with contrast (72126) |
$1,365.63 |
$2,731.25 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,591.63 |
$3,183.25 |
9.1× |
| CT chest with contrast (71260) |
$1,299.63 |
$2,599.25 |
7.4× |
| CT head/brain with contrast (70460) |
$1,036.63 |
$2,073.25 |
5.9× |
| CT head/brain without and with contrast (70470) |
$1,273.13 |
$2,546.25 |
7.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$674.25 |
$1,348.50 |
1.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$188.38 |
$376.75 |
2.2× |
| CT iac w contrast (70481) |
$1,133.88 |
$2,267.75 |
6.5× |
| CT limited/localized follow up study (76380) |
$266.88 |
$533.75 |
3.1× |
| CT lower ext w/o (73700) |
$1,047.88 |
$2,095.75 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$1,228.75 |
$2,457.50 |
7.0× |
| CT lower extremity with contrast (73701) |
$1,115.38 |
$2,230.75 |
6.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,322.50 |
$2,645 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$1,251.75 |
$2,503.50 |
12.0× |
| CT lumbar spine with contrast (72132) |
$1,397.50 |
$2,795 |
4.0× |
| CT maxillofacial w contrast (70487) |
$863.63 |
$1,727.25 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$974.88 |
$1,949.75 |
9.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,003 |
$2,006 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$1,265.25 |
$2,530.50 |
7.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,133.88 |
$2,267.75 |
6.5× |
| CT orbits w/o contrast (70480) |
$1,011.25 |
$2,022.50 |
9.7× |
| CT pelvis w & w/o contrast (72194) |
$1,359.13 |
$2,718.25 |
7.8× |
| CT pelvis w/o contrast (72192) |
$1,108 |
$2,216 |
10.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,242.25 |
$2,484.50 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$972.63 |
$1,945.25 |
9.3× |
| CT thoracic spine w/contrast (72129) |
$1,355.13 |
$2,710.25 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,207.88 |
$2,415.75 |
11.6× |
| CT thorax w/o contrast (71250) |
$1,169.75 |
$2,339.50 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,228.75 |
$2,457.50 |
7.0× |
| CT upper extremity w/o contrast rt (73200) |
$990 |
$1,980 |
9.5× |
| CT upper extremity with contrast (73201) |
$1,107.75 |
$2,215.50 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,089.50 |
$4,179 |
11.9× |
| Cta Abdomen (74175) |
$2,004.38 |
$4,008.75 |
11.5× |
| CTA abdomen pelvis (74174) |
$3,603.50 |
$7,207 |
10.4× |
| CTA chest (71275) |
$1,585.50 |
$3,171 |
9.1× |
| Cta Head (70496) |
$1,858.50 |
$3,717 |
10.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$356.50 |
$713 |
1.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,668.13 |
$3,336.25 |
9.5× |
| Cta Neck (70498) |
$1,632.25 |
$3,264.50 |
9.3× |
| Cta Pelvis (72191) |
$1,608.63 |
$3,217.25 |
9.2× |
| Cystography minimum 3 views rs&i (74430) |
$265.88 |
$531.75 |
0.8× |
| Diskogram cervical (72285) |
$3,424.25 |
$6,848.50 |
1.8× |
| Diskography lumbar (72295) |
$3,424.25 |
$6,848.50 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$281 |
$562 |
2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$171.25 |
$342.50 |
2.0× |
| Echoencephalography real time imaging (76506) |
$371.50 |
$743 |
3.6× |
| Esophageal motility (78258) |
$452.38 |
$904.75 |
1.1× |
| Esophagus (74220) |
$265.88 |
$531.75 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$359.63 |
$719.25 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$369.75 |
$739.50 |
1.6× |
| Foot 2 views (73620) |
$137.25 |
$274.50 |
1.6× |
| Forearm 2 views (73090) |
$107.38 |
$214.75 |
1.2× |
| Gated Heart Planar Single (78472) |
$796.75 |
$1,593.50 |
2.0× |
| Hand 2 views (73120) |
$146.75 |
$293.50 |
1.4× |
| Hand 3 views (73130) |
$154.50 |
$309 |
1.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,072.13 |
$4,144.25 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$917 |
$1,834 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$867.50 |
$1,735 |
2.2× |
| Ht muscle image spect sing (78451) |
$1,292.25 |
$2,584.50 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$127.13 |
$254.25 |
1.5× |
| Hysterosalpingogram (74740) |
$346.13 |
$692.25 |
1.5× |
| Image fusion (77399) |
$93.13 |
$186.25 |
0.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$121.38 |
$242.75 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$693.38 |
$1,386.75 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,083.75 |
$2,167.50 |
2.0× |
| Knee 3 views (73562) |
$153.50 |
$307 |
1.8× |
| Liver & spleen imaging static only (78215) |
$682.75 |
$1,365.50 |
1.7× |
| Liver imaging static only (78201) |
$797.88 |
$1,595.75 |
1.5× |
| Lung Ventilation Imaging (78579) |
$397.88 |
$795.75 |
1.0× |
| Lymphoscintigraphy (78195) |
$931.50 |
$1,863 |
1.7× |
| Mammary ductogram or galactogram multiple (77054) |
$346.13 |
$692.25 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$346.13 |
$692.25 |
1.5× |
| Meckels Diverticulum (78290) |
$349.13 |
$698.25 |
0.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$567.88 |
$1,135.75 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$26.50 |
$53 |
0.9× |
| MRA head w/o contrast (70544) |
$1,459.63 |
$2,919.25 |
6.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,012.50 |
$2,025 |
2.9× |
| MRA neck w/o contrast (70547) |
$1,009.75 |
$2,019.50 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,730.50 |
$3,461 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,396.50 |
$2,793 |
5.9× |
| MRI any jnt lwr ext with con lt (73722) |
$946.25 |
$1,892.50 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$990.63 |
$1,981.25 |
1.3× |
| MRI breast w/o contrast bilateral (77047) |
$751.88 |
$1,503.75 |
3.2× |
| MRI breast w/o contrast unilat (77046) |
$729.88 |
$1,459.75 |
3.1× |
| MRI c-spine with contrast (72142) |
$910.25 |
$1,820.50 |
2.6× |
| MRI cardiac w/o contrast (75557) |
$1,350.13 |
$2,700.25 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,494 |
$2,988 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,474.25 |
$2,948.50 |
4.2× |
| MRI chest w/o contrast (71550) |
$973.63 |
$1,947.25 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$973.63 |
$1,947.25 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,150.13 |
$2,300.25 |
4.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,091.13 |
$4,182.25 |
6.0× |
| MRI pelvis w contrast (72196) |
$1,618.13 |
$3,236.25 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,679.88 |
$3,359.75 |
4.8× |
| MRI pelvis w/o contrast (72195) |
$1,370.38 |
$2,740.75 |
5.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,336 |
$2,672 |
3.8× |
| MRI scan of leg joint before and after contrast (73723) |
$1,505.13 |
$3,010.25 |
4.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,218.13 |
$4,436.25 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,265.25 |
$2,530.50 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,397.38 |
$4,794.75 |
6.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,242.25 |
$4,484.50 |
6.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,516.38 |
$3,032.75 |
6.4× |
| MRI tmj (70336) |
$1,349 |
$2,698 |
5.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,463 |
$2,926 |
6.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,797.88 |
$3,595.75 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,319 |
$2,638 |
5.5× |
| Myelogram Lumbar (72265) |
$1,101.50 |
$2,203 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,408 |
$2,816 |
1.1× |
| Neck soft tissue (70360) |
$163 |
$326 |
1.9× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$298.50 |
$597 |
0.8× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$288.38 |
$576.75 |
0.7× |
| Nm cisternogram (78630) |
$487.25 |
$974.50 |
0.9× |
| Nm gastric emptying study (78264) |
$1,029.88 |
$2,059.75 |
2.6× |
| Nm gastroesophageal reflux study (78262) |
$451.25 |
$902.50 |
1.1× |
| Nm peritoneal-venous shunt patency (78291) |
$276.25 |
$552.50 |
0.7× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$996.75 |
$1,993.50 |
0.7× |
| Nuclear Rx Oral Admin (79005) |
$308 |
$616 |
1.3× |
| Osseous survey infant (77076) |
$224.75 |
$449.50 |
2.2× |
| Parathyrd planar w/wo subtrj (78071) |
$858 |
$1,716 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$151.75 |
$303.50 |
1.5× |
| PET image w/CT, skull-thigh (78815) |
$3,012.32 |
$6,024.62 |
2.1× |
| PET imaging CT for attenuation limited area (78814) |
$2,868.63 |
$5,737.25 |
2.0× |
| PET imaging for CT attenuation whole body (78816) |
$3,155.38 |
$6,310.75 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,877.75 |
$3,755.50 |
5.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,072.13 |
$4,144.25 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$387.25 |
$774.50 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$930.50 |
$1,861 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$359.44 |
$718.88 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$172 |
$344 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$186.13 |
$372.25 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$179.88 |
$359.75 |
1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$222.63 |
$445.25 |
2.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$5,544 |
$11,088 |
0.8× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$465.25 |
$930.50 |
0.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$352.88 |
$705.75 |
3.5× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$409.13 |
$818.25 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$200.13 |
$400.25 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$193.38 |
$386.75 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$282.13 |
$564.25 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$176.88 |
$353.75 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$421.13 |
$842.25 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$277.13 |
$554.25 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$418.94 |
$837.88 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$515.88 |
$1,031.75 |
2.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$157.50 |
$315 |
1.8× |
| Radiological examination surgical specimen (76098) |
$335 |
$670 |
0.6× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,034.50 |
$4,069 |
0.6× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,595.63 |
$7,191.25 |
1.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,373.13 |
$2,746.25 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,716.50 |
$3,433 |
1.3× |
| Rp Therapy Intravenous Administration (79101) |
$503.50 |
$1,007 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$157.50 |
$315 |
1.5× |
| Scanogram (77073) |
$205.44 |
$410.88 |
2.0× |
| Scapula complete (73010) |
$161.38 |
$322.75 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$50.63 |
$101.25 |
2.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$173.75 |
$347.50 |
1.7× |
| Sialogram (70390) |
$346.13 |
$692.25 |
1.5× |
| Simulation intermediate (77285) |
$322.63 |
$645.25 |
0.9× |
| Small bowel series (74250) |
$300.75 |
$601.50 |
1.7× |
| Spec medical radj physics consltj (77370) |
$134.63 |
$269.25 |
1.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$323.13 |
$646.25 |
0.9× |
| Special dosimetry (77331) |
$131.63 |
$263.25 |
1.0× |
| Special treatment procedure (77470) |
$558.50 |
$1,117 |
1.0× |
| Spine thoracic 3 views (72072) |
$188.38 |
$376.75 |
1.8× |
| Spleen imaging only (78185) |
$380 |
$760 |
1.0× |
| Stereotactic body radiation delivery (77373) |
$1,991.13 |
$3,982.25 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$674.25 |
$1,348.50 |
1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$449.50 |
$899 |
1.2× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$300.13 |
$600.25 |
1.3× |
| Ther rad simulaj-aided field setting complex (77290) |
$391.75 |
$783.50 |
1.0× |
| Ther rad simulaj-aided field setting simple (77280) |
$188.88 |
$377.75 |
1.4× |
| Thoracolumbar 2 views (72080) |
$111.38 |
$222.75 |
1.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$817.63 |
$1,635.25 |
1.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$442.88 |
$885.75 |
1.1× |
| Thyroid uptake measurement (78012) |
$459 |
$918 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$709.13 |
$1,418.25 |
1.8× |
| Treatment device intermediate (77333) |
$323.50 |
$647 |
2.4× |
| Treatment devices simple (77332) |
$222 |
$444 |
1.7× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,221.50 |
$2,443 |
2.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,104.63 |
$2,209.25 |
2.8× |
| Tx devices design & construction complex (77334) |
$447.63 |
$895.25 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$308 |
$616 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$126.50 |
$253 |
1.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$61.38 |
$122.75 |
0.7× |
| Unlisted magnetic resonance procedure (76498) |
$2,398.50 |
$4,797 |
27.6× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$250.75 |
$501.50 |
0.6× |
| Unlisted Ultrasound Procedure (76999) |
$335 |
$670 |
3.9× |
| Upper Extremity Infant (73092) |
$126.50 |
$253 |
1.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$304.63 |
$609.25 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$261.88 |
$523.75 |
1.1× |
| Urethrocystography voiding (74455) |
$300.75 |
$601.50 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$387.25 |
$774.50 |
2.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$451.25 |
$902.50 |
2.6× |
| Us abdl aorta screen aaa (76706) |
$299 |
$598 |
2.9× |
| Us breast unilateral complete (76641) |
$259.38 |
$518.75 |
2.5× |
| Us breast unilateral limited (76642) |
$168.63 |
$337.25 |
1.9× |
| Us chest (76604) |
$442.25 |
$884.50 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$238.88 |
$477.75 |
2.3× |
| Us guided compression repair (76936) |
$338.88 |
$677.75 |
1.6× |
| Us infant hips dynamic (76885) |
$411.88 |
$823.75 |
4.7× |
| Us kidney transplant (76776) |
$467.50 |
$935 |
4.5× |
| Us ob transvaginal (76817) |
$280.38 |
$560.75 |
2.7× |
| Us pelvic non ob complete (76856) |
$347.88 |
$695.75 |
3.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$114.63 |
$229.25 |
1.1× |
| Us pregnancy ltd (76815) |
$132.75 |
$265.50 |
1.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$331 |
$662 |
3.2× |
| Us retroperitoneal complete (76770) |
$397.25 |
$794.50 |
3.8× |
| Us retroperitoneal limited (76775) |
$411.38 |
$822.75 |
3.9× |
| Us scrotum and contents (76870) |
$326.50 |
$653 |
3.1× |
| Us soft tissue head/neck (76536) |
$302.38 |
$604.75 |
2.9× |
| Us spinal canal and contents (76800) |
$432.63 |
$865.25 |
4.2× |
| Us transrectal (76872) |
$156 |
$312 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$312 |
$624 |
3.0× |
| Venogram extremity bilateral (75822) |
$1,775 |
$3,550 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$2,072.13 |
$4,144.25 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,531.63 |
$3,063.25 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,249.50 |
$2,499 |
0.8× |
| Venography Renal Bilateral (75833) |
$2,072.13 |
$4,144.25 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,034.50 |
$4,069 |
0.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,072.13 |
$4,144.25 |
0.7× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,571.50 |
$7,143 |
0.6× |
| Wrist 2 views (73100) |
$127.13 |
$254.25 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$286.63 |
$573.25 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$172 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$150.75 |
$301.50 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$478.75 |
$957.50 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$131.63 |
$263.25 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$146.25 |
$292.50 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$194.63 |
$389.25 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$156 |
$312 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$179.88 |
$359.75 |
2.1× |
| X-ray exam hip uni 4/> views (73503) |
$188.38 |
$376.75 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$185.50 |
$371 |
1.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$194.63 |
$389.25 |
1.9× |
| X-ray exam of femur 1 (73551) |
$140.50 |
$281 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$211.88 |
$423.75 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$154 |
$308 |
1.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$147.88 |
$295.75 |
1.7× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,340.50 |
$4,681 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$140.50 |
$281 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$152.38 |
$304.75 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$231 |
$462 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$70.25 |
$140.50 |
0.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$183 |
$366 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$176 |
$352 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$270.38 |
$540.75 |
2.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$176.50 |
$353 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$140 |
$280 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$179.38 |
$358.75 |
2.1× |
| X-ray of voice box or throat (70370) |
$169.75 |
$339.50 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$198.38 |
$396.75 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$160.75 |
$321.50 |
1.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$385 |
$770 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$212.50 |
$425 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$188.88 |
$377.75 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$240 |
$480 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$154.50 |
$309 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$196.13 |
$392.25 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$214.13 |
$428.25 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$188.38 |
$376.75 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$228.75 |
$457.50 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$182.63 |
$365.25 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$126.50 |
$253 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$149.50 |
$299 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$160.75 |
$321.50 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$188.38 |
$376.75 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$238.88 |
$477.75 |
2.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$110.88 |
$221.75 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$135.50 |
$271 |
1.6× |
| Xr arthrogram ankle (73615) |
$245 |
$490 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$233.75 |
$467.50 |
2.2× |
| Xr chest 4+ views (71048) |
$176.88 |
$353.75 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$93.38 |
$186.75 |
1.1× |
| Xr shoulder 1 view (73020) |
$136.63 |
$273.25 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$282.63 |
$565.25 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$130.76 |
$261.50 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$153.50 |
$307 |
1.8× |