| 3-Dimensional radiotherapy plan including dose-volume histograms (77295) |
$1,343 |
$3,875 |
0.9× |
| Acute gi blood loss imaging (78278) |
$401 |
$866 |
1.0× |
| Angio extremity unilateral (75710) |
$3,044 |
$4,509 |
0.9× |
| Angio pulmonary unilateral (75741) |
$3,044 |
$3,482 |
0.9× |
| Angiogram extremity bilateral (75716) |
$3,044 |
$4,741 |
0.9× |
| Angiogram pelvic (75736) |
$5,071 |
$6,940 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,044 |
$4,298 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,071 |
$8,138 |
0.9× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$3,044 |
$4,166 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,044 |
$6,940 |
0.9× |
| Ankle 2 views (73600) |
$86 |
$412 |
0.9× |
| Barium enema (74270) |
$190 |
$684 |
1.0× |
| Basic dosimetry (77300) |
$135 |
$383 |
1.0× |
| Bilat selctv renal venogram (75833) |
$3,044 |
$4,739 |
0.9× |
| Bone age studies (77072) |
$116 |
$399 |
1.1× |
| Bone survey complete (77075) |
$116 |
$266 |
1.1× |
| Bowel imaging (78290) |
$401 |
$837 |
1.0× |
| Brachytx isodose pln cplx w/dosimetry cal (77318) |
$360 |
$1,235 |
0.9× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$520 |
$1,320 |
0.9× |
| Brain image w/flow 4 + views (78606) |
$520 |
$3,389 |
0.9× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$392 |
$3,843 |
1.1× |
| Cardiac shunt detection (78428) |
$401 |
$617 |
1.0× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$190 |
$426 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$190 |
$753 |
1.0× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$761 |
$1,192 |
0.9× |
| Clavicle complete (73000) |
$86 |
$385 |
0.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$190 |
$2,262 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$135 |
$336 |
1.0× |
| Contrast exam abdominl aorta (75625) |
$3,044 |
$3,957 |
0.9× |
| Contrast exam thoracic aorta (75605) |
$5,071 |
$6,218 |
0.9× |
| Csf shunt evaluation (78645) |
$520 |
$1,693 |
0.9× |
| CT - st neck w&wo contr (70492) |
$190 |
$2,233.50 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$392 |
$6,785 |
1.1× |
| CT abdomen and pelvis without contrast (74176) |
$245 |
$3,962.50 |
1.0× |
| CT abdomen w wo contrast (74170) |
$190 |
$3,099 |
1.0× |
| CT abdomen w/contrast (74160) |
$190 |
$2,435 |
1.0× |
| CT abdomen w/o contrast (74150) |
$116 |
$2,326 |
1.1× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$392 |
$3,890.50 |
1.1× |
| CT angio abdom w/o & w/dye (74175) |
$190 |
$3,837 |
1.0× |
| CT angio abdominal arteries (75635) |
$190 |
$2,385.50 |
1.0× |
| CT angio hrt w/3d image (75574) |
$190 |
$2,011.50 |
0.5× |
| CT angiograph pelv w/o&w/dye (72191) |
$190 |
$3,921 |
1.0× |
| CT cervical spine w/contrast (72126) |
$392 |
$2,167 |
1.1× |
| CT cervical spine w/o contrast (72125) |
$116 |
$2,097.50 |
1.1× |
| CT chest w/contrast (71260) |
$190 |
$2,297 |
1.0× |
| CT extremity upper w & w/o contrast (73202) |
$190 |
$2,059 |
1.0× |
| CT head/brain with contrast (70460) |
$190 |
$1,619 |
1.0× |
| CT head/brain without and with contrast (70470) |
$190 |
$2,433 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$190 |
$1,573.50 |
0.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$86 |
$598 |
0.9× |
| CT hrt w/3d image congen (75573) |
$190 |
$2,183 |
0.5× |
| CT limited/localized follow up study (76380) |
$86 |
$850 |
0.9× |
| CT lower ext w/wo contrast (73702) |
$190 |
$2,092 |
1.0× |
| CT lower extremity w contrast (73701) |
$190 |
$1,947.50 |
1.0× |
| CT lower extremity w/o contrast unilateral (73700) |
$116 |
$1,787.50 |
1.1× |
| CT lumbar spine w/contrast (72132) |
$392 |
$2,149 |
1.1× |
| CT lumbar spine w/o contrast (72131) |
$116 |
$2,064.50 |
1.1× |
| CT lumbar spine w/o then w/ con (72133) |
$190 |
$2,769 |
1.0× |
| CT maxillofacial area w/o contrast (70486) |
$116 |
$2,061.50 |
1.1× |
| CT maxillofacial w/contrast (70487) |
$190 |
$2,420 |
1.0× |
| CT maxillofacial w/o then w/ con (70488) |
$190 |
$2,713 |
1.0× |
| CT orbit sella ear w/o con (70480) |
$116 |
$1,582 |
1.1× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$190 |
$2,372 |
1.0× |
| CT pelvis w & w/o contrast (72194) |
$190 |
$2,749 |
1.0× |
| CT pelvis w/o contrast (72192) |
$116 |
$2,028.50 |
1.1× |
| CT soft tissue neck w/contrast (70491) |
$190 |
$2,124 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$116 |
$1,951 |
1.1× |
| CT spine cervical w/wo contrast (72127) |
$190 |
$2,665 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$190 |
$2,068 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$116 |
$2,057.50 |
1.1× |
| CT thoracic spine w/o then w/ con (72130) |
$190 |
$2,364 |
1.0× |
| CT thorax lung cancer scr c- (71271) |
$116 |
$2,033 |
1.1× |
| CT thorax w/o contrast (71250) |
$116 |
$2,033 |
1.1× |
| CT thorax w/o then w/ contrast (71270) |
$190 |
$2,678 |
1.0× |
| CT upper extremity w/dye (73201) |
$392 |
$2,048.50 |
1.1× |
| CT upper extremity w/o contrast rt (73200) |
$116 |
$1,793.50 |
1.1× |
| CTA chest w/wo contrast (71275) |
$190 |
$3,728.50 |
1.0× |
| CTA head w contrast (70496) |
$190 |
$3,290 |
1.0× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$190 |
$2,640.50 |
1.0× |
| Cta Neck (70498) |
$190 |
$3,290 |
1.0× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$190 |
$3,953 |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$116 |
$715 |
1.1× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$116 |
$697 |
1.1× |
| Doppler fetal mid cerebral artery (76821) |
$116 |
$704 |
1.1× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$245 |
$580 |
1.0× |
| Esophogram (74220) |
$190 |
$492 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$116 |
$1,065 |
1.1× |
| Fetal biophysical profile w/o nst (76819) |
$116 |
$809 |
1.1× |
| Fetal echo complete (76825) |
$514 |
$1,251 |
0.9× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$245 |
$1,123 |
1.0× |
| Functional MRI brain by phys/psych (70555) |
$245 |
$334 |
1.0× |
| Gastric emptying study (78264) |
$401 |
$1,751 |
1.0× |
| Gated heart planar single (78472) |
$401 |
$1,240 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$754 |
$1,867 |
1.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$754 |
$951 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,044 |
$4,166 |
0.9× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$3,044 |
$6,315 |
0.9× |
| Hepatobil syst image w/drug (78227) |
$520 |
$591 |
0.9× |
| Hepatobiliary system imaging (78226) |
$401 |
$2,292 |
1.0× |
| Humerus min 2 views (73060) |
$86 |
$611 |
0.9× |
| Hysterosalpingography (74740) |
$245 |
$722 |
1.0× |
| Imrt planning (77301) |
$1,343 |
$2,070 |
0.9× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$754 |
$4,054 |
1.0× |
| Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424) |
$8,270 |
$10,861 |
1.1× |
| Isodose brachytherapy intermed 5 to 10 sources (77317) |
$360 |
$1,011 |
0.9× |
| Isodose brachytherapy plan simple 1 to 4 source (77316) |
$360 |
$686 |
0.9× |
| Isodose teletherapy plan complex multi tx w/cal (77307) |
$360 |
$532 |
0.9× |
| Isodose teletherapy plan simple 1 or 2 port w/cal (77306) |
$360 |
$471 |
0.9× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$520 |
$1,202 |
0.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$520 |
$1,251 |
0.9× |
| Liver & spleen; static only (78215) |
$401 |
$1,664 |
1.0× |
| Lung perfusion differential (78597) |
$401 |
$2,334 |
1.0× |
| Lung ventilat&perfus imaging (78582) |
$520 |
$1,941 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$392 |
$2,950 |
1.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$392 |
$2,623 |
1.1× |
| Mlc device(s) for imrt (77338) |
$360 |
$1,277 |
0.9× |
| MRA head w & w/o contrast (70546) |
$392 |
$2,867 |
1.1× |
| MRA head w/contrast (70545) |
$392 |
$2,650 |
1.1× |
| MRA head w/o contrast (70544) |
$245 |
$2,631 |
1.0× |
| MRA neck w/o contrast (70547) |
$245 |
$2,076 |
1.0× |
| MRA neck w/wo contrast (70549) |
$392 |
$2,490 |
1.1× |
| MRI abdomen w/contrast (74182) |
$392 |
$3,118 |
1.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$392 |
$3,626 |
1.1× |
| MRI abdomen w/o contrast (74181) |
$245 |
$2,503 |
1.0× |
| MRI any jnt lwr ext with con lt (73722) |
$761 |
$2,371 |
0.9× |
| MRI breast without contrast bilateral (77047) |
$245 |
$3,390 |
1.0× |
| MRI cardiac w/o contrast (75557) |
$245 |
$2,662 |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$245 |
$2,584 |
1.0× |
| MRI cervical spine with contrast (72142) |
$392 |
$3,190 |
1.1× |
| MRI chest w & w/o contrast (71552) |
$392 |
$3,204.50 |
1.1× |
| MRI chest w/o contrast (71550) |
$245 |
$2,377 |
1.0× |
| MRI fetal sngl/1st gestation (74712) |
$245 |
$329 |
1.0× |
| MRI joint upper ext w/contrast (73222) |
$761 |
$2,899 |
0.9× |
| MRI joint upr extr w/o&w/dye (73223) |
$392 |
$2,969 |
1.1× |
| MRI joint upr extrem w/o dye (73221) |
$245 |
$2,774 |
1.0× |
| Mri Lower Extremity W/O Dye (73718) |
$245 |
$2,168 |
1.0× |
| MRI lumbar spine with contrast (72149) |
$392 |
$3,150 |
1.1× |
| MRI lumbar w/wo contrast (72158) |
$392 |
$3,428 |
1.1× |
| MRI lwr ext w/o jnts with con rt (73719) |
$392 |
$2,258 |
1.1× |
| MRI orbit/face/neck w/contrast (70542) |
$392 |
$2,677 |
1.1× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$392 |
$2,811 |
1.1× |
| MRI orbit/face/neck w/o contrast (70540) |
$245 |
$2,389 |
1.0× |
| MRI pelvis w/ contrast (72196) |
$392 |
$2,587 |
1.1× |
| MRI pelvis w/o contrast (72195) |
$245 |
$1,920 |
1.0× |
| MRI pelvis w/wo contrast (72197) |
$392 |
$3,146 |
1.1× |
| MRI spectroscopy (76390) |
$86 |
$125 |
0.9× |
| MRI spine cervical wo/w contrast (72156) |
$392 |
$3,714 |
1.1× |
| MRI spine thoracic w/contrast (72147) |
$392 |
$3,150 |
1.1× |
| MRI thoracic spine w wo contrast (72157) |
$392 |
$3,859 |
1.1× |
| MRI thoracic spine w/o contrast (72146) |
$245 |
$2,797 |
1.0× |
| MRI tmj (70336) |
$245 |
$1,813 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$245 |
$2,032 |
1.0× |
| Mri Upper Extremity W/Dye (73219) |
$392 |
$2,419 |
1.1× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$392 |
$2,535 |
1.1× |
| Myelogram thoracic (72255) |
$761 |
$1,644 |
0.9× |
| Myelography 2 or more regions (72270) |
$761 |
$1,701 |
0.9× |
| Myelography lumbosacral (72265) |
$761 |
$1,216 |
0.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,390 |
$2,570 |
1.0× |
| Myocrd img PET metab eval single study (78459) |
$1,390 |
$2,290 |
1.0× |
| Nm adrenal imaging (78075) |
$1,390 |
$1,961 |
1.0× |
| Nm bone 3 phase (78315) |
$401 |
$2,099 |
1.0× |
| Nm bone imaging whole body (78306) |
$401 |
$1,560 |
1.0× |
| Nm heart perfusion spect stress rest (78452) |
$1,390 |
$4,263 |
1.0× |
| Nm lymph system (78195) |
$520 |
$1,791 |
0.9× |
| Nm thyroid imaging only (78013) |
$401 |
$762 |
1.0× |
| Nose to rectum for fb child (76010) |
$86 |
$192 |
0.9× |
| Ob us < 14 wks single fetus (76801) |
$116 |
$327 |
1.1× |
| Ob us nuchal meas 1 gest (76813) |
$116 |
$231 |
1.1× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$116 |
$158 |
1.1× |
| Oral radiopharm rx (79005) |
$269 |
$1,937 |
1.1× |
| Orthopantogram (70355) |
$86 |
$411 |
0.9× |
| Parathyroid imaging (78070) |
$401 |
$801 |
1.0× |
| PET brain metabolic eval (78608) |
$1,574 |
$5,165 |
1.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$1,574 |
$3,436 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,574 |
$3,665 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,044 |
$4,739 |
0.9× |
| Pulmonary perfusion imaging particulate (78580) |
$401 |
$1,124 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$514 |
$923 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$86 |
$726 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$116 |
$180 |
1.1× |
| Radex hip unilateral with pelvis 1 view (73501) |
$86 |
$259.50 |
0.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$86 |
$468 |
0.9× |
| Radex spine cervical 2 or 3 views (72040) |
$86 |
$618.50 |
0.9× |
| Radex spine cervical 4 or 5 views (72050) |
$116 |
$650.50 |
1.1× |
| Radex spine cervical 6 or more views (72052) |
$116 |
$779.50 |
1.1× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$86 |
$141.50 |
0.9× |
| Radiation delivery stereotactic cranial linear (77372) |
$8,270 |
$11,030 |
1.1× |
| Radiation tx delivery lvl 1 (77402) |
$127 |
$162 |
1.2× |
| Radiation tx delivery lvl 2 (77407) |
$257 |
$352 |
0.6× |
| Radiation tx delivery lvl 3 (77412) |
$257 |
$396 |
0.4× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$116 |
$604 |
1.1× |
| Radiologic exam esophagus double contrast study (74221) |
$190 |
$593 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$190 |
$1,127 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$190 |
$1,032 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$86 |
$966.50 |
0.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$116 |
$515.50 |
1.1× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$116 |
$777 |
1.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,390 |
$1,895 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,390 |
$2,743 |
1.0× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$1,574 |
$2,165 |
1.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,390 |
$1,908 |
1.0× |
| Saline infused sonohysterogram (76831) |
$245 |
$581 |
1.0× |
| Salivary gland funct study (78232) |
$401 |
$433 |
1.0× |
| Screening digital breast tomosynthesis; bilateral (77063) |
— |
$128 |
— |
| Selective spinal angiogram (75705) |
$5,071 |
$8,171 |
0.9× |
| Shoulder arthrogram (73040) |
$392 |
$1,014 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$116 |
$485 |
1.1× |
| Simulation complex (77290) |
$360 |
$1,433 |
0.9× |
| Simulation simple (77280) |
$135 |
$520 |
1.0× |
| Small bowel series (74250) |
$190 |
$983 |
1.0× |
| Special dosimetry (77331) |
$135 |
$621 |
1.0× |
| Special physics consult (77370) |
$135 |
$167 |
1.0× |
| Special treatment procedure (77470) |
$577 |
$2,144 |
1.0× |
| Stereotactic body radiation delivery (77373) |
$1,844 |
$2,445 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$3,044 |
$4,166 |
0.9× |
| Therapeutic enema barium or air (74283) |
$190 |
$368 |
1.0× |
| Thyroid met imaging body (78018) |
$520 |
$2,310 |
0.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$401 |
$509 |
1.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$401 |
$1,085 |
1.0× |
| Treatment devices complex (77334) |
$360 |
$614 |
0.9× |
| Treatment devices simple (77332) |
$135 |
$222 |
1.0× |
| Ultrasound breast limited (76642) |
$86 |
$303 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$116 |
$769.50 |
1.1× |
| Umbilical-artery Doppler (OB) (76820) |
$116 |
$704 |
1.1× |
| Urethrocystography retrograde rs&i (74450) |
$245 |
$955 |
1.0× |
| Urethrocystography voiding (74455) |
$245 |
$1,343 |
1.0× |
| Urography antegrade (74425) |
$392 |
$758 |
1.1× |
| Urography retrograde w/wo kub (74420) |
$392 |
$632 |
1.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$116 |
$190.50 |
1.1× |
| Us breast uni real time with image complete (76641) |
$116 |
$319.50 |
1.1× |
| Us chest (76604) |
$116 |
$201 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$116 |
$154 |
1.1× |
| Us elastography parenchyma (76981) |
$116 |
$276 |
1.1× |
| Us encephalogram (76506) |
$116 |
$936 |
1.1× |
| Us gi endoscopic (76975) |
$245 |
$358 |
1.0× |
| Us guided compression repair (76936) |
$281 |
$726 |
1.2× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$86 |
$846 |
0.9× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$86 |
$558 |
0.9× |
| Us kidney transplanted (76776) |
$116 |
$423 |
1.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$116 |
$207 |
1.1× |
| Us ob detailed single fetus (76811) |
$245 |
$572 |
1.0× |
| Us ob followup per fetus (76816) |
$116 |
$524 |
1.1× |
| Us ob limited 1 or more fetuses (76815) |
$116 |
$524 |
1.1× |
| Us obstetric transvaginal (76817) |
$116 |
$866 |
1.1× |
| Us pelvic limited or f/u non-ob (76857) |
$116 |
$479 |
1.1× |
| Us pelvis complete (76856) |
$116 |
$685 |
1.1× |
| Us retroperitoneal complete (76770) |
$116 |
$791 |
1.1× |
| Us retroperitoneal limited (76775) |
$116 |
$611 |
1.1× |
| Us scrotum (76870) |
$116 |
$576 |
1.1× |
| Us soft tissue head/neck (76536) |
$116 |
$580.50 |
1.1× |
| Us spinal canal (76800) |
$116 |
$409 |
1.1× |
| Us transrectal (76872) |
$116 |
$583 |
1.1× |
| Us trgt dyn mbubb 1st les (76978) |
$190 |
$292 |
0.5× |
| Vein X-ray liver w/hemodynam (75885) |
$3,044 |
$5,407 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,495 |
$2,046 |
0.9× |
| Venogram ivc w serialography (75825) |
$3,044 |
$4,408 |
0.9× |
| Venogram svc w serialography (75827) |
$1,495 |
$3,215 |
0.9× |
| Venography ext unilateral (75820) |
$1,495 |
$2,046 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$3,044 |
$4,739 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,044 |
$4,166 |
0.9× |
| Venous sampling by catheter (75893) |
$5,071 |
$6,940 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$192 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$86 |
$818.50 |
0.9× |
| X-ray aorta leg arteries (75630) |
$3,044 |
$4,166 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$190 |
$735 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$86 |
$504 |
0.9× |
| X-ray exam hips bi 3-4 views (73522) |
$116 |
$613 |
1.1× |
| X-ray exam of finger(s) (73140) |
$86 |
$372 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$86 |
$265 |
0.9× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$86 |
$601 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$86 |
$651 |
0.9× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$116 |
$309 |
1.1× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$86 |
$758 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$86 |
$345 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86 |
$576.50 |
0.9× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$86 |
$700.50 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$116 |
$652 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86 |
$352 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$116 |
$603 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$116 |
$505 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$86 |
$533 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$116 |
$732 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$116 |
$412 |
1.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$116 |
$213 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$510.50 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$86 |
$888.50 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$612 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$116 |
$922 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$116 |
$489.50 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$86 |
$203 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$86 |
$568.50 |
0.9× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$86 |
$373 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$86 |
$847 |
0.9× |
| Xr abdomen 1 view (74018) |
$86 |
$411 |
0.9× |
| Xr abdomen 2 views (74019) |
$116 |
$488 |
1.1× |
| Xr arthrogram hip (73525) |
$392 |
$474 |
1.1× |
| Xr bone density appendicular (77081) |
$86 |
$306 |
0.9× |
| Xr bone density axial (77080) |
$116 |
$298 |
1.1× |
| Xr bone length study (77073) |
$116 |
$417 |
1.1× |
| Xr bone survey infant (77076) |
$116 |
$173 |
1.1× |
| Xr bone survey limited (77074) |
$116 |
$173 |
1.1× |
| Xr chest 1 view (71045) |
$86 |
$409 |
0.9× |
| Xr chest 2 views (71046) |
$86 |
$556 |
0.9× |
| Xr chest 3 views (71047) |
$86 |
$550 |
0.9× |
| Xr cystogram 3+ views (74430) |
$392 |
$944 |
1.1× |
| Xr eye foreign body (70030) |
$86 |
$144 |
0.9× |
| Xr facial bones 3 views (70150) |
$116 |
$406 |
1.1× |
| Xr lower extremity 2 views infant (73592) |
$86 |
$564 |
0.9× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$116 |
$385 |
1.1× |
| Xr mandible 4 views (70110) |
$116 |
$666 |
1.1× |
| Xr myelogram c-spine (72240) |
$761 |
$1,644 |
0.9× |
| Xr nasal bones (70160) |
$86 |
$330 |
0.9× |
| Xr pelvis 3 views (72190) |
$116 |
$687 |
1.1× |
| Xr spine 1 view (72020) |
$86 |
$290 |
0.9× |
| Xr sternum 2 views (71120) |
$86 |
$494.50 |
0.9× |
| Xr surgical specimen (76098) |
$514 |
$591 |
0.9× |
| Xr upper extremity 2 views infant (73092) |
$116 |
$573 |
1.1× |
| Xray elbow 2 views (73070) |
$86 |
$575 |
0.9× |
| Xray forearm 2 views (73090) |
$86 |
$881.50 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$86 |
$683.50 |
0.9× |
| Xray neck soft tissue (70360) |
$86 |
$424.50 |
0.9× |
| Xray orbits complete min 4 views (70200) |
$116 |
$460.50 |
1.1× |
| Xray pelvis 1 or 2 views (72170) |
$116 |
$490.50 |
1.1× |
| Xray ribs bilateral 3 views (71110) |
$116 |
$647.50 |
1.1× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$116 |
$587 |
1.1× |
| Xray scapula complete (73010) |
$116 |
$364 |
1.1× |
| Xray shoulder 1 view (73020) |
$86 |
$243 |
0.9× |
| Xray sinuses paranasal <3 views (70210) |
$86 |
$334.50 |
0.9× |
| Xray spine thoracic 2 views (72070) |
$116 |
$585 |
1.1× |
| Xray spine thoracic 3 views (72072) |
$116 |
$792.50 |
1.1× |
| Xray tibia-fibula 2 views bil (73590) |
$86 |
$933.50 |
0.9× |
| Xray tmj open - closed unilat (70328) |
$86 |
$254.50 |
0.9× |
| Xray tmj's bilateral open-clsc (70330) |
$86 |
$430 |
0.9× |