| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,579 |
$6,579 |
4.7× |
| Acute gi blood loss imaging (78278) |
$2,505 |
$2,505 |
6.1× |
| Ankle 2 views (73600) |
$377 |
$377 |
4.2× |
| Basic radiation dosimetry calculation (77300) |
$546 |
$546 |
4.0× |
| Clavicle complete (73000) |
$454 |
$454 |
5.1× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$5,009 |
$5,009 |
14.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,525 |
$2,525 |
14.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$3,769 |
$3,769 |
21.0× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$3,011 |
$3,011 |
16.8× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$5,508 |
$5,508 |
30.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,775 |
$2,775 |
15.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$3,582 |
$3,582 |
20.0× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,827 |
$2,827 |
15.8× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$4,310 |
$4,310 |
24.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$2,289 |
$2,289 |
21.4× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$4,707 |
$4,707 |
26.3× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$2,582 |
$2,582 |
14.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$3,046 |
$3,046 |
17.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$2,371 |
$2,371 |
22.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$3,918 |
$3,918 |
21.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$3,803 |
$3,803 |
35.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$5,692 |
$5,692 |
31.8× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$3,605 |
$3,605 |
20.1× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$3,471 |
$3,471 |
19.4× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$2,330 |
$2,330 |
13.0× |
| Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose… (77336) |
$769 |
$769 |
5.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,996 |
$4,996 |
14.0× |
| CT abdomen and pelvis without contrast (74176) |
$4,441 |
$4,441 |
18.2× |
| CT abdomen w & w/o contrast (74170) |
$3,009 |
$3,009 |
16.8× |
| CT abdomen w/contrast (74160) |
$2,564 |
$2,564 |
14.3× |
| CT abdomen w/o contrast (74150) |
$2,176 |
$2,176 |
20.4× |
| CT cervical spine w/contrast (72126) |
$3,770 |
$3,770 |
10.6× |
| CT cervical spine w/o contrast (72125) |
$2,822 |
$2,822 |
26.4× |
| CT chest w/contrast (71260) |
$2,052 |
$2,052 |
11.5× |
| CT extremity upper w & w/o contrast (73202) |
$2,394 |
$2,394 |
13.4× |
| CT extremity upper w/o contrast (73200) |
$1,935 |
$1,935 |
18.1× |
| CT head/brain with contrast (70460) |
$1,941 |
$1,941 |
10.8× |
| CT head/brain without and with contrast (70470) |
$2,829 |
$2,829 |
15.8× |
| CT l-spine w/contrast (72132) |
$2,375 |
$2,375 |
6.7× |
| CT lower extremity w/dye (73701) |
$3,368 |
$3,368 |
18.8× |
| CT lumbar spine w/o contrast (72131) |
$2,352 |
$2,352 |
22.0× |
| CT maxillofacial w/wo contrast (70488) |
$3,629 |
$3,629 |
20.3× |
| CT neck w/contrast (70491) |
$3,010 |
$3,010 |
16.8× |
| CT neck w/o contrast (70490) |
$3,078 |
$3,078 |
28.8× |
| CT pelvis w & w/o contrast (72194) |
$2,374 |
$2,374 |
13.2× |
| CT pelvis w/o contrast (72192) |
$1,872 |
$1,872 |
17.5× |
| CT thoracic spine w/contrast (72129) |
$3,036 |
$3,036 |
16.9× |
| CT thoracic spine w/o contrast (72128) |
$2,730 |
$2,730 |
25.6× |
| CT thorax lung cancer scr c- (71271) |
$522 |
$522 |
4.9× |
| CT thorax w/o contrast (71250) |
$1,693 |
$1,693 |
15.9× |
| CT upper extremity w/dye (73201) |
$2,192 |
$2,192 |
6.1× |
| CTA head w contrast (70496) |
$1,639 |
$1,639 |
9.1× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$554 |
$554 |
1.6× |
| Diskography lumbar s&i (72295) |
$1,543 |
$1,543 |
0.8× |
| Doppler fetal mid cerebral artery (76821) |
$421 |
$421 |
3.9× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$547 |
$547 |
5.1× |
| Dxa bone density/peripheral (77081) |
$314 |
$314 |
3.5× |
| Fetal biophys profile w/o nst (76819) |
$731 |
$731 |
6.8× |
| Fetal biophysical profile non-stress testing (76818) |
$987 |
$987 |
9.2× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$692 |
$692 |
2.8× |
| Gated heart planar single (78472) |
$2,260 |
$2,260 |
5.5× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$2,168 |
$2,168 |
3.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,730 |
$1,730 |
4.2× |
| Ht muscle image spect sing (78451) |
$1,900 |
$1,900 |
1.4× |
| Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial… (77301) |
$8,554 |
$8,554 |
6.0× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$4,874 |
$4,874 |
6.8× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$1,951 |
$1,951 |
4.8× |
| Isodose brachytherapy complex 10+ sources (77318) |
$2,358 |
$2,358 |
6.2× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$1,078 |
$1,078 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,135 |
$1,135 |
2.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,011 |
$1,011 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$2,268 |
$2,268 |
4.1× |
| Lung perfusion imaging (78580) |
$989 |
$989 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,270 |
$3,270 |
9.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$2,686 |
$2,686 |
7.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$2,195 |
$2,195 |
9.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,096 |
$3,096 |
8.7× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$3,582 |
$3,582 |
14.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,770 |
$3,770 |
10.6× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$4,236 |
$4,236 |
11.9× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$4,485 |
$4,485 |
12.6× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$3,747 |
$3,747 |
10.5× |
| Mandible min 4v (70110) |
$626 |
$626 |
5.9× |
| MRA head w/o contrast (70544) |
$3,582 |
$3,582 |
14.7× |
| MRA neck w/o contrast (70547) |
$3,582 |
$3,582 |
14.7× |
| MRI abdomen w/o contrast (74181) |
$2,518 |
$2,518 |
10.3× |
| MRI abdomen w/wo contrast (74183) |
$3,407 |
$3,407 |
9.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,892 |
$2,892 |
3.6× |
| MRI breast c- bilateral (77047) |
$3,666 |
$3,666 |
15.0× |
| MRI breast without contrast material unilateral (77046) |
$2,107 |
$2,107 |
8.6× |
| MRI c-spine w&w/o cont (72156) |
$3,577 |
$3,577 |
10.0× |
| MRI cervical spine w/contrast (72142) |
$3,626 |
$3,626 |
10.2× |
| MRI chest w/o contrast (71550) |
$3,886 |
$3,886 |
15.9× |
| MRI chest w/wo contrast (71552) |
$5,227 |
$5,227 |
14.7× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,656 |
$3,656 |
10.3× |
| MRI joint upr extrem w/dye (73222) |
$2,934 |
$2,934 |
3.7× |
| MRI joint upr extrem w/o dye (73221) |
$2,540 |
$2,540 |
10.4× |
| MRI lumbar spine w/contrast (72149) |
$3,250 |
$3,250 |
9.1× |
| MRI lumbar spine w/wo contrast (72158) |
$3,547 |
$3,547 |
10.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,998 |
$3,998 |
11.2× |
| MRI pelvis w & w/o contrast (72197) |
$4,839 |
$4,839 |
13.6× |
| MRI pelvis w/o contrast (72195) |
$3,527 |
$3,527 |
14.5× |
| MRI spine cervical w/o contrast (72141) |
$3,116 |
$3,116 |
12.8× |
| MRI t-spine w&w/o cont (72157) |
$3,487 |
$3,487 |
9.8× |
| MRI thoracic spine w/contrast (72147) |
$3,729 |
$3,729 |
10.5× |
| MRI thoracic spine w/o contrst (72146) |
$3,036 |
$3,036 |
12.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,694 |
$2,694 |
11.1× |
| Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per… (77338) |
$275 |
$275 |
0.7× |
| Myocardial spect multiple studies (78452) |
$3,306 |
$3,306 |
2.5× |
| Nm bone 3 phase (78315) |
$1,999 |
$1,999 |
4.9× |
| Nm bone imaging whole body (78306) |
$1,936 |
$1,936 |
4.7× |
| Nm gastric emptying (78264) |
$1,693 |
$1,693 |
4.1× |
| Nm lymph system (78195) |
$1,875 |
$1,875 |
3.4× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$1,257 |
$1,257 |
3.1× |
| Ob us limited fetus(s) (76815) |
$530 |
$530 |
5.0× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$469 |
$469 |
4.4× |
| Panoramic X-ray of jaws (70355) |
$406 |
$406 |
4.6× |
| Parathyroid planar imaging (78070) |
$1,609 |
$1,609 |
3.9× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,900 |
$1,900 |
4.7× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,654 |
$7,654 |
5.2× |
| PET imaging for CT attenuation whole body (78816) |
$7,825 |
$7,825 |
5.4× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,412 |
$1,412 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$564 |
$564 |
6.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$559 |
$559 |
5.2× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$645 |
$645 |
6.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$266 |
$266 |
3.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$289 |
$289 |
3.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$553 |
$553 |
5.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$439 |
$439 |
4.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$718 |
$718 |
6.7× |
| Radex spine cervical 2 or 3 views (72040) |
$439 |
$439 |
4.9× |
| Radex spine cervical 4 or 5 views (72050) |
$780 |
$780 |
7.3× |
| Radex spine cervical 6 or more views (72052) |
$1,041 |
$1,041 |
9.7× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$587 |
$587 |
6.6× |
| Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)… (77372) |
$23,569 |
$23,569 |
3.1× |
| Radiation tx delivery lvl 3 (77412) |
$624 |
$624 |
1.1× |
| Radiologic exam abdomen 3+ views (74021) |
$387 |
$387 |
3.6× |
| Radiologic exam chest 3 views (71047) |
$456 |
$456 |
5.1× |
| Radiologic exam chest 4+ views (71048) |
$447 |
$447 |
4.2× |
| Radiologic exam colon double contrast study (74280) |
$1,034 |
$1,034 |
5.8× |
| Radiologic exam colon single contrast study (74270) |
$751 |
$751 |
4.2× |
| Radiologic exam esophagus double contrast study (74221) |
$642 |
$642 |
3.6× |
| Radiologic exam esophagus single contrast study (74220) |
$642 |
$642 |
3.6× |
| Radiologic exam small int single contrast study (74250) |
$756 |
$756 |
4.2× |
| Radiologic exam swallow function contrast study (74230) |
$500 |
$500 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,347 |
$1,347 |
7.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,135 |
$1,135 |
6.3× |
| Radiologic examination femur 1 view (73551) |
$334 |
$334 |
3.8× |
| Radiologic examination femur minimum 2 views (73552) |
$365 |
$365 |
4.1× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$245 |
$245 |
2.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$346 |
$346 |
3.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$520 |
$520 |
4.9× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$314 |
$314 |
3.5× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$405 |
$405 |
4.6× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$547 |
$547 |
6.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$346 |
$346 |
3.9× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$313 |
$313 |
3.5× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$375 |
$375 |
4.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$426 |
$426 |
4.0× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$508 |
$508 |
5.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$427 |
$427 |
4.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$614 |
$614 |
5.7× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$399 |
$399 |
3.7× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$383 |
$383 |
3.6× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$1,307 |
$1,307 |
3.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$402 |
$402 |
4.5× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$970 |
$970 |
9.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$474 |
$474 |
5.3× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$470 |
$470 |
4.4× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$476 |
$476 |
4.5× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$471 |
$471 |
4.4× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$679 |
$679 |
6.4× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$549 |
$549 |
5.1× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$353 |
$353 |
4.0× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$441 |
$441 |
5.0× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$346 |
$346 |
3.9× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$341 |
$341 |
3.8× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$489 |
$489 |
4.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$257 |
$257 |
2.9× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$304 |
$304 |
3.4× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$341 |
$341 |
3.2× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$2,838 |
$2,838 |
5.1× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,634 |
$1,634 |
6.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$916 |
$916 |
3.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,033 |
$2,033 |
5.0× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$3,773 |
$3,773 |
6.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,397 |
$2,397 |
4.3× |
| Rp loclzj tum spect 2 areas (78831) |
$3,163 |
$3,163 |
2.4× |
| Scapula complete (73010) |
$433 |
$433 |
4.1× |
| Screening digital breast tomosynthesis bi (77063) |
$27 |
$27 |
— |
| Simulation intermediate (77285) |
$1,830 |
$1,830 |
4.8× |
| Special dosimetry (77331) |
$334 |
$334 |
2.4× |
| Special physics consult (77370) |
$864 |
$864 |
6.3× |
| Special treatment procedure (77470) |
$3,100 |
$3,100 |
5.5× |
| Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance,… (77373) |
$7,117 |
$7,117 |
3.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,558 |
$2,558 |
6.7× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$764 |
$764 |
4.3× |
| Thyroid imaging with vascular flow (78013) |
$1,069 |
$1,069 |
2.6× |
| Thyroid met imaging body (78018) |
$2,246 |
$2,246 |
4.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,343 |
$1,343 |
3.3× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,343 |
$1,343 |
3.3× |
| Tr simulation simple (77280) |
$1,289 |
$1,289 |
9.4× |
| Treatment device complex (77334) |
$1,335 |
$1,335 |
3.5× |
| Treatment device simple (77332) |
$447 |
$447 |
3.3× |
| Ultrasound breast limited (76642) |
$490 |
$490 |
5.5× |
| Ultrasound, abdomen limited (76705) |
$689 |
$689 |
6.5× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$545 |
$545 |
5.1× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$1,053 |
$1,053 |
9.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$1,124 |
$1,124 |
4.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$854 |
$854 |
8.0× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$819 |
$819 |
7.7× |
| Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Age Under 21 (76873) |
$856 |
$856 |
8.0× |
| Umbilical-artery Doppler (OB) (76820) |
$504 |
$504 |
4.7× |
| Urethrocystography retrograde rs&i (74450) |
$952 |
$952 |
3.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$1,025 |
$1,025 |
5.7× |
| Urography antegrade rs&i (74425) |
$1,038 |
$1,038 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; Age Under 21 (74410) |
$1,148 |
$1,148 |
6.4× |
| Us abdominal aorta real time screen study aaa (76706) |
$876 |
$876 |
8.2× |
| Us breast uni real time with image complete (76641) |
$540 |
$540 |
5.1× |
| Us chest (76604) |
$522 |
$522 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$733 |
$733 |
6.9× |
| Us elastography organ (76981) |
$689 |
$689 |
6.5× |
| Us exam, pelvic, limited (76857) |
$654 |
$654 |
6.1× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$742 |
$742 |
8.3× |
| US OB Follow-Up/Repeat (76816) |
$611 |
$611 |
5.7× |
| Us ob transvaginal (76817) |
$844 |
$844 |
7.9× |
| Us retroperitoneal complete (76770) |
$946 |
$946 |
8.9× |
| Us retroperitoneal ltd (76775) |
$622 |
$622 |
5.8× |
| Us scrotum (76870) |
$697 |
$697 |
6.5× |
| Us soft tissue head/neck (76536) |
$802 |
$802 |
7.5× |
| Us spinal canal (76800) |
$720 |
$720 |
6.7× |
| Us transrectal (76872) |
$713 |
$713 |
6.7× |
| Us unlstd proc (76999) |
$471 |
$471 |
5.3× |
| Use 1st target lesion (76982) |
$358 |
$358 |
3.4× |
| Venogram sinus/jugular (75860) |
$3,554 |
$3,554 |
1.1× |
| X-ray exam hips bi 3-4 views (73522) |
$355 |
$355 |
3.3× |
| X-ray exam of finger(s) (73140) |
$303 |
$303 |
3.4× |
| X-ray exam of knee 1 or 2 (73560) |
$325 |
$325 |
3.7× |
| X-ray exam ribs bil 3 views (71110) |
$590 |
$590 |
5.5× |
| X-ray exam ribs uni 2 views (71100) |
$337 |
$337 |
3.8× |
| X-ray heel (73650) |
$302 |
$302 |
3.4× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$416 |
$416 |
3.9× |
| X-ray retrograde pyelogram (74420) |
$1,010 |
$1,010 |
2.8× |
| Xr abdomen 1 view (74018) |
$317 |
$317 |
3.6× |
| Xr abdomen 2 views (74019) |
$412 |
$412 |
3.9× |
| Xr arthrogram hip (73525) |
$793 |
$793 |
2.2× |
| Xr arthrogram knee (73580) |
$1,140 |
$1,140 |
3.2× |
| Xr arthrogram wrist (73115) |
$969 |
$969 |
2.7× |
| Xr bone age studies (77072) |
$289 |
$289 |
2.7× |
| Xr bone length study (77073) |
$442 |
$442 |
4.1× |
| Xr bone survey infant (77076) |
$432 |
$432 |
4.0× |
| Xr chest 1 view (71045) |
$251 |
$251 |
2.8× |
| Xr chest 2 views (71046) |
$345 |
$345 |
3.9× |
| Xr eye foreign body (70030) |
$314 |
$314 |
3.5× |
| Xr facial bones 3+ views (70150) |
$550 |
$550 |
5.1× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$390 |
$390 |
4.4× |
| Xr forearm 2 views (73090) |
$346 |
$346 |
3.9× |
| Xr hand 2v (73120) |
$329 |
$329 |
3.1× |
| Xr hysterosalpingogram (74740) |
$1,028 |
$1,028 |
4.2× |
| Xr myelogram l-spine (72265) |
$2,101 |
$2,101 |
2.6× |
| Xr myelogram t-spine (72255) |
$611 |
$611 |
0.8× |
| Xr neck soft tissue (70360) |
$348 |
$348 |
3.9× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$407 |
$407 |
4.6× |
| Xr osseous survey complete (77075) |
$798 |
$798 |
7.5× |
| Xr pelvis 1-2 views (72170) |
$432 |
$432 |
4.0× |
| Xr pelvis min 3 view (72190) |
$545 |
$545 |
5.1× |
| Xr sacrum/coccyx 2+ views (72220) |
$353 |
$353 |
4.0× |
| Xr shoulder 1 view (73020) |
$267 |
$267 |
3.0× |
| Xr sinuses 3+ views (70220) |
$538 |
$538 |
6.1× |
| Xr skull min 4 view (70260) |
$791 |
$791 |
7.4× |
| Xr spine 1 view (72020) |
$351 |
$351 |
3.9× |
| Xr spine thoracic 3v (72072) |
$617 |
$617 |
5.8× |
| Xr sternum 2+ views (71120) |
$617 |
$617 |
6.9× |
| Xr surgical specimen (76098) |
$620 |
$620 |
1.1× |
| Xr t-spine 2 views (72070) |
$496 |
$496 |
4.6× |
| Xr tibia/fibula 2 views (73590) |
$374 |
$374 |
4.2× |
| Xr tmj bilateral (70330) |
$394 |
$394 |
4.4× |
| Xr wrist 2 views (73100) |
$313 |
$313 |
3.5× |