| 3-D radiotherapy plan dose-volume histograms (77295) |
$4,363.50 |
$4,363.50 |
3.0× |
| Abdomen 2 views (74019) |
$319.50 |
$319.50 |
2.9× |
| Acute gi blood loss imaging (78278) |
$1,044 |
$1,044 |
2.5× |
| Ankle 2 views (73600) |
$308 |
$308 |
3.4× |
| Arthrogram elbow (73085) |
$1,635 |
$1,635 |
4.4× |
| Arthrogram hip (73525) |
$1,605.50 |
$1,605.50 |
4.4× |
| Arthrogram knee (73580) |
$1,635 |
$1,635 |
4.4× |
| Arthrogram shoulder (73040) |
$1,631.50 |
$1,631.50 |
4.4× |
| Arthrogram wrist (73115) |
$1,862 |
$1,862 |
5.1× |
| Basic dosimetry (77300) |
$442.50 |
$442.50 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,011.50 |
$1,011.50 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,039.50 |
$1,039.50 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$1,044 |
$1,044 |
2.5× |
| Bone age studies (77072) |
$266 |
$266 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,067 |
$1,067 |
2.5× |
| Bone survey complete (77075) |
$600.50 |
$600.50 |
5.4× |
| Bone survey infant (77076) |
$295 |
$295 |
2.7× |
| Bowel imaging (78290) |
$999.50 |
$999.50 |
2.4× |
| Brachytx isodose complex (77318) |
$1,384 |
$1,384 |
3.5× |
| Brachytx isodose intermed (77317) |
$1,124.50 |
$1,124.50 |
2.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$784.50 |
$784.50 |
2.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$949.50 |
$949.50 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$928.50 |
$928.50 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$316 |
$316 |
3.4× |
| Chest 1 view (71045) |
$265 |
$265 |
2.9× |
| Chest xray 3 views (71047) |
$322.50 |
$322.50 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$362.50 |
$362.50 |
2.0× |
| Clavicle complete (73000) |
$308 |
$308 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$317 |
$317 |
2.9× |
| Continuing medical physics consltj pr wk (77336) |
$208 |
$208 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,104.50 |
$2,104.50 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,446.50 |
$1,446.50 |
5.7× |
| CT abdomen w contrast (74160) |
$1,996 |
$1,996 |
10.8× |
| CT abdomen w wo contrast (74170) |
$2,240 |
$2,240 |
12.1× |
| CT abdomen w/o contrast (74150) |
$1,364 |
$1,364 |
12.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$4,154 |
$4,154 |
22.4× |
| CT angiography upper extremity lt (73206) |
$3,383 |
$3,383 |
18.3× |
| CT c-spine w/contrast (72126) |
$1,919 |
$1,919 |
5.2× |
| CT c-spine w/o contrast (72125) |
$1,337.50 |
$1,337.50 |
12.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,219.50 |
$2,219.50 |
12.0× |
| CT chest w contrast (71260) |
$1,981.50 |
$1,981.50 |
10.7× |
| CT chest w/wo contrast (71270) |
$2,217.50 |
$2,217.50 |
12.0× |
| CT head/brain with contrast (70460) |
$1,976 |
$1,976 |
10.7× |
| CT head/brain without and with contrast (70470) |
$2,220.50 |
$2,220.50 |
12.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,498.50 |
$1,498.50 |
16.3× |
| CT iac w contrast (70481) |
$1,975.50 |
$1,975.50 |
10.7× |
| CT limited/localized follow up study (76380) |
$801 |
$801 |
8.7× |
| CT lower ext w/o (73700) |
$1,485.50 |
$1,485.50 |
13.5× |
| CT lower extremity w wo contrast (73702) |
$2,212 |
$2,212 |
11.9× |
| CT lower extremity w/contrast material (73701) |
$340 |
$340 |
1.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,219.50 |
$2,219.50 |
12.0× |
| CT lumbar spine w/contrast (72132) |
$1,988.50 |
$1,988.50 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$1,337.50 |
$1,337.50 |
12.1× |
| CT maxillofacial w contrast (70487) |
$1,938 |
$1,938 |
10.5× |
| CT maxillofacial w/wo contrast (70488) |
$2,220.50 |
$2,220.50 |
12.0× |
| CT maxillofacial wo contrast (70486) |
$1,322 |
$1,322 |
12.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$697.50 |
$697.50 |
3.8× |
| CT orbits w/o contrast (70480) |
$1,377 |
$1,377 |
12.5× |
| CT pelvis w/o contrast (72192) |
$1,350 |
$1,350 |
12.2× |
| CT pelvis w/wo contrast (72194) |
$2,213 |
$2,213 |
12.0× |
| CT scan of arm combo (73202) |
$2,213 |
$2,213 |
12.0× |
| CT soft tissue neck w contrast (70491) |
$1,997 |
$1,997 |
10.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,236 |
$2,236 |
12.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,377 |
$1,377 |
12.5× |
| CT thoracic spine w/contrast (72129) |
$1,988.50 |
$1,988.50 |
10.7× |
| CT thoracic spine w/o contrast (72128) |
$1,337.50 |
$1,337.50 |
12.1× |
| CT thoracic spine w/wo contrast (72130) |
$2,219.50 |
$2,219.50 |
12.0× |
| CT thorax w/o contrast (71250) |
$1,348.50 |
$1,348.50 |
12.2× |
| CT upper ext wo (73200) |
$1,337.50 |
$1,337.50 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,980 |
$1,980 |
5.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,427 |
$2,427 |
13.1× |
| Cta Abdomen (74175) |
$2,343.50 |
$2,343.50 |
12.7× |
| CTA abdomen pelvis (74174) |
$2,398 |
$2,398 |
6.5× |
| CTA chest (71275) |
$2,343.50 |
$2,343.50 |
12.7× |
| Cta Head (70496) |
$2,331 |
$2,331 |
12.6× |
| Cta Neck (70498) |
$2,333.50 |
$2,333.50 |
12.6× |
| Cta Pelvis (72191) |
$2,341.50 |
$2,341.50 |
12.6× |
| Cystography minimum 3 views rs&i (74430) |
$304 |
$304 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$439.50 |
$439.50 |
4.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$62 |
$62 |
0.7× |
| Esophagus (74220) |
$397 |
$397 |
2.1× |
| Facial bones min 3 views (70150) |
$321.50 |
$321.50 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$373 |
$373 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$708.50 |
$708.50 |
6.4× |
| Fluoroscopy up to 1 hr (76000) |
$418 |
$418 |
1.7× |
| Foot 2 views (73620) |
$304 |
$304 |
3.3× |
| Forearm 2 views (73090) |
$359 |
$359 |
3.9× |
| Hand 2 views (73120) |
$308 |
$308 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,126.50 |
$1,126.50 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,103.50 |
$1,103.50 |
2.6× |
| Hysterosalpingogram (74740) |
$837 |
$837 |
3.3× |
| Interstitial radiation source applic complex (77778) |
$6,304 |
$6,304 |
8.6× |
| Intracavitary Radiation Source Applic Complex (77763) |
$3,672 |
$3,672 |
5.0× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$3,906 |
$3,906 |
6.7× |
| Intracavitary Radiation Source Applic Simple (77761) |
$1,882 |
$1,882 |
3.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$156 |
$156 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,382.50 |
$1,382.50 |
2.4× |
| Knee 3 views (73562) |
$338.50 |
$338.50 |
3.7× |
| Lung perfusion differential (78597) |
$946 |
$946 |
2.2× |
| Lymphoscintigraphy (78195) |
$1,139.50 |
$1,139.50 |
2.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,809 |
$2,809 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,766 |
$2,766 |
7.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,452.50 |
$3,452.50 |
9.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$334 |
$334 |
3.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$760.50 |
$760.50 |
1.9× |
| MRA head w & w/o contrast (70546) |
$3,353 |
$3,353 |
9.1× |
| MRA head w/o contrast (70544) |
$2,331 |
$2,331 |
9.3× |
| MRA head with contrast (70545) |
$2,740.50 |
$2,740.50 |
7.4× |
| MRA neck w contrast (70548) |
$2,787 |
$2,787 |
7.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,401.50 |
$3,401.50 |
9.2× |
| MRA neck w/o contrast (70547) |
$2,332.50 |
$2,332.50 |
9.3× |
| MRI abdomen w contrast (74182) |
$3,391 |
$3,391 |
9.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,459 |
$3,459 |
9.4× |
| MRI abdomen w/o contrast (74181) |
$2,368.50 |
$2,368.50 |
9.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,809 |
$2,809 |
3.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,452.50 |
$3,452.50 |
9.4× |
| MRI breast w/o contrast bilateral (77047) |
$3,988 |
$3,988 |
15.8× |
| MRI breast wo contrast unilateral (77046) |
$4,012 |
$4,012 |
15.9× |
| MRI c-spine with contrast (72142) |
$2,831 |
$2,831 |
7.7× |
| MRI cervical spine w/o contrast (72141) |
$2,373.50 |
$2,373.50 |
9.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,467.50 |
$3,467.50 |
9.4× |
| MRI chest w/o contrast (71550) |
$2,371 |
$2,371 |
9.4× |
| MRI chest with contrast (71551) |
$2,822.50 |
$2,822.50 |
3.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,452.50 |
$3,452.50 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,353 |
$2,353 |
9.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,352 |
$2,352 |
9.3× |
| MRI orbit face neck w contrast (70542) |
$2,808.50 |
$2,808.50 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,451.50 |
$3,451.50 |
9.4× |
| MRI pelvis w/contrast (72196) |
$2,823 |
$2,823 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,459 |
$3,459 |
9.4× |
| MRI pelvis w/o contrast (72195) |
$2,371 |
$2,371 |
9.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,474 |
$3,474 |
9.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,831 |
$2,831 |
7.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,474 |
$3,474 |
9.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,831 |
$2,831 |
7.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,485 |
$3,485 |
9.5× |
| MRI temporomandibular joint (70336) |
$2,372.50 |
$2,372.50 |
9.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,373.50 |
$2,373.50 |
9.4× |
| MRI up ext w/o contrast (73218) |
$2,354 |
$2,354 |
9.3× |
| MRI upper ext joint w/o contrast (73221) |
$4,311 |
$4,311 |
17.1× |
| MRI, joint upper extrem combo (73223) |
$3,453.50 |
$3,453.50 |
9.4× |
| Myelogram Cervical (72240) |
$1,527.50 |
$1,527.50 |
1.8× |
| Myelogram Lumbar (72265) |
$1,498.50 |
$1,498.50 |
1.8× |
| Myelogram thoracic (72255) |
$1,520 |
$1,520 |
1.8× |
| Myelography 2 or more regions (72270) |
$1,576 |
$1,576 |
1.9× |
| Myocardial infarct spect (78469) |
$2,105.50 |
$2,105.50 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,672.50 |
$2,672.50 |
2.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,638 |
$2,638 |
1.9× |
| Neck soft tissue (70360) |
$309.50 |
$309.50 |
3.4× |
| Nm gastric emptying study (78264) |
$1,015 |
$1,015 |
2.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$7,641.50 |
$7,641.50 |
5.2× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$17 |
$17 |
0.6× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$365 |
$365 |
3.3× |
| Osseous survey limited (77074) |
$471.50 |
$471.50 |
4.3× |
| Parathyroid Planar Imaging (78070) |
$771 |
$771 |
1.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$998.50 |
$998.50 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$297.50 |
$297.50 |
2.7× |
| PET image w/CT, skull-thigh (78815) |
$3,521 |
$3,521 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$3,523.50 |
$3,523.50 |
2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$4,763 |
$4,763 |
11.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$894.50 |
$894.50 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$910.50 |
$910.50 |
1.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$335 |
$335 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$306.50 |
$306.50 |
3.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$335 |
$335 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$321.50 |
$321.50 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$375 |
$375 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$299.50 |
$299.50 |
3.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$332.50 |
$332.50 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$335 |
$335 |
3.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$283.50 |
$283.50 |
3.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$448.50 |
$448.50 |
4.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$590 |
$590 |
5.3× |
| Radex Humerus Minimum 2 Views (73060) |
$308 |
$308 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$308 |
$308 |
3.4× |
| Radex Kne Compl 4/More Views (73564) |
$374 |
$374 |
3.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$343 |
$343 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$283.50 |
$283.50 |
3.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$320 |
$320 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$338.50 |
$338.50 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$283.50 |
$283.50 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$316 |
$316 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$317.50 |
$317.50 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$298 |
$298 |
3.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$450 |
$450 |
4.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$335 |
$335 |
3.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,684 |
$1,684 |
15.3× |
| Radiation Delivery Stereotactic Cranial Cobalt (77371) |
$76,101 |
$76,101 |
9.8× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$12,801 |
$12,801 |
1.6× |
| Radiation treatment delivery level 1 (77402) |
$812 |
$812 |
7.5× |
| Radiation treatment delivery level 2 (77407) |
$1,158 |
$1,158 |
2.8× |
| Radiation treatment delivery level 3 (77412) |
$1,262 |
$1,262 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$177 |
$177 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$324.50 |
$324.50 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$290.50 |
$290.50 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$411 |
$411 |
2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$962 |
$962 |
5.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,595.50 |
$1,595.50 |
8.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,778 |
$1,778 |
9.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$306.50 |
$306.50 |
3.3× |
| Radiological examination surgical specimen (76098) |
$777.50 |
$777.50 |
1.3× |
| Ribs bilateral 3 views (71110) |
$326 |
$326 |
3.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,029.50 |
$3,029.50 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,902 |
$1,902 |
3.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,939.50 |
$1,939.50 |
3.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,072.50 |
$2,072.50 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$282.50 |
$282.50 |
2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$946 |
$946 |
3.8× |
| Scapula (73010) |
$313 |
$313 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$180 |
$180 |
7.7× |
| Shoulder 1 view (73020) |
$304 |
$304 |
3.3× |
| Simulation intermediate (77285) |
$1,130.50 |
$1,130.50 |
2.9× |
| Small bowel series (74250) |
$377 |
$377 |
2.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,062.50 |
$1,062.50 |
2.7× |
| Special dosimetry (77331) |
$569.50 |
$569.50 |
4.0× |
| Special Physics Consult (77370) |
$639.50 |
$639.50 |
4.5× |
| Special treatment procedure (77470) |
$1,775 |
$1,775 |
3.0× |
| Spine thoracic 3 views (72072) |
$312.50 |
$312.50 |
2.8× |
| Stereotactic Body Radiation Delivery (77373) |
$6,314 |
$6,314 |
3.3× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$476 |
$476 |
4.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,435.50 |
$1,435.50 |
3.6× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$651 |
$651 |
1.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,504.50 |
$1,504.50 |
3.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$880 |
$880 |
6.2× |
| Thoracolumbar 2 views (72080) |
$290 |
$290 |
3.2× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,189 |
$1,189 |
2.8× |
| Thyroid imaging w/blood flow (78013) |
$553.50 |
$553.50 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$898.50 |
$898.50 |
2.1× |
| Tmj unilateral (70328) |
$239.50 |
$239.50 |
2.6× |
| Treatment device complex (77334) |
$1,029 |
$1,029 |
2.6× |
| Treatment device intermediate (77333) |
$607 |
$607 |
4.3× |
| Treatment devices simple (77332) |
$458 |
$458 |
3.2× |
| Ultrasound breast complete (76641) |
$728 |
$728 |
6.6× |
| Ultrasound Exam Aaa Screen (76706) |
$353 |
$353 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$681.50 |
$681.50 |
6.2× |
| Umbilical-artery Doppler (OB) (76820) |
$344.50 |
$344.50 |
3.1× |
| Urethrocystogram voiding (74455) |
$1,236.50 |
$1,236.50 |
4.9× |
| Urethrocystography retrograde rs&i (74450) |
$428 |
$428 |
1.7× |
| Us breast unilateral limited (76642) |
$587 |
$587 |
6.4× |
| Us chest (76604) |
$469.50 |
$469.50 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$780 |
$780 |
7.1× |
| Us encephalogram (76506) |
$479.50 |
$479.50 |
4.3× |
| Us hips infant static (76886) |
$1,735 |
$1,735 |
18.9× |
| Us infant hips w manipulation (76885) |
$494.50 |
$494.50 |
5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$526.50 |
$526.50 |
4.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$227.50 |
$227.50 |
2.1× |
| Us ob detailed single fetus (76811) |
$1,118.50 |
$1,118.50 |
4.4× |
| Us ob limited (76815) |
$194 |
$194 |
1.8× |
| Us ob transvaginal (76817) |
$496 |
$496 |
4.5× |
| Us pelvic non ob complete (76856) |
$696.50 |
$696.50 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$145 |
$145 |
1.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$293 |
$293 |
2.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$510 |
$510 |
4.6× |
| Us retroperitoneal complete (76770) |
$795 |
$795 |
7.2× |
| Us retroperitoneal limited (76775) |
$681 |
$681 |
6.2× |
| Us scrotum and contents (76870) |
$689.50 |
$689.50 |
6.2× |
| Us soft tissue head/neck (76536) |
$678.50 |
$678.50 |
6.1× |
| Us spinal canal and contents (76800) |
$771 |
$771 |
7.0× |
| Us transrectal (76872) |
$693 |
$693 |
6.3× |
| Us, eye b-scan (76512) |
$687 |
$687 |
6.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$706 |
$706 |
6.4× |
| Venogram Extremity Unilateral (75820) |
$350 |
$350 |
0.2× |
| Wrist 2 views (73100) |
$308 |
$308 |
3.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$453 |
$453 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$357 |
$357 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$442.50 |
$442.50 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$308 |
$308 |
3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$308 |
$308 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$559.50 |
$559.50 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$310.50 |
$310.50 |
3.4× |
| X-ray eye for foreign body (70030) |
$311.50 |
$311.50 |
3.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$289 |
$289 |
3.1× |
| X-ray IV pyelogram (ivp) (74400) |
$288.50 |
$288.50 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$308 |
$308 |
3.4× |
| X-ray leg, infant (73592) |
$306.50 |
$306.50 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$316 |
$316 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$516 |
$516 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$309.50 |
$309.50 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$349 |
$349 |
3.2× |
| X-ray retrograde pyelogram (74420) |
$191 |
$191 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$294 |
$294 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$297.50 |
$297.50 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$375.50 |
$375.50 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$316 |
$316 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$283.50 |
$283.50 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$315 |
$315 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$448.50 |
$448.50 |
4.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$309.50 |
$309.50 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$278.50 |
$278.50 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$339.50 |
$339.50 |
3.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$284 |
$284 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$289 |
$289 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$365 |
$365 |
3.3× |
| Xr bone length studies (77073) |
$299 |
$299 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$512 |
$512 |
4.6× |
| Xr c-spine 6 or more views (72052) |
$515 |
$515 |
4.7× |
| Xr chest 4+ views (71048) |
$351 |
$351 |
3.2× |
| Xr urogram antegrade (74425) |
$676.50 |
$676.50 |
1.8× |